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Bray EA, Hogan C, Mitchell J, Geraghty T, Ownsworth T. Impact of Early Personal Resources on Long-Term Psychosocial Outcomes After Moderate-to-Severe Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil 2024:00001199-990000000-00157. [PMID: 38758101 DOI: 10.1097/htr.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To investigate the relationship between preinjury or early personal resources and long-term psychosocial outcomes following moderate-to-severe traumatic brain injury (TBI) and examine evidence for the stability of personal resources over time. METHODS The review protocol was registered with the International Register of Systematic Reviews (PROSPERO, Registration No. CRD4202341056). A search of PsycINFO, Cumulative Index to Allied Health Literature (CINAHL), MEDLINE, Scopus, and Web of Science was conducted from inception to February 23, 2023, for longitudinal studies involving adults with moderate-to-severe TBI that examined: (1) the relationship between preinjury or early personal resources (measured ≤6 months postinjury) and later psychosocial outcomes or (2) stability of personal resources over time with a minimum reassessment interval of 3 months. Two reviewers independently assessed eligibility and rated methodological quality of studies using a checklist informed by Strengthening the Reporting of Observational Studies in Epidemiology. RESULTS A narrative synthesis was conducted on 14 eligible articles summarizing 12 studies (N = 826). Nine studies examined the impact of preinjury or early personal resources on long-term psychosocial outcomes, most typically at 12 months postdischarge. Out of 9 studies 7 indicated that self-reported preinjury or early personal resources, including productive coping, higher self-esteem and resilience, and lower neuroticism, were associated with better psychosocial outcomes. Evidence from 7 studies examining the stability of personal resources over time was generally mixed, with personality changes (eg, neuroticism, conscientiousness, and extraversion) more evident from informant ratings than self-ratings. CONCLUSION Preinjury or early personal resources may influence later psychosocial outcomes after TBI. Further research is needed to investigate the stability of personal resources and factors mediating or moderating change across the adjustment trajectory.
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Affiliation(s)
- Emily Alice Bray
- The Hopkins Centre, Menzies Health Institute Queensland (Drs Bray, Hogan, and Mitchell, Dr Geraghty, and Dr Ownsworth), School of Applied Psychology (Dr Ownsworth) Griffith University, Brisbane, Queensland, Australia; and Division of Rehabilitation (Dr Geraghty), Metro South Health Hospital and Health Service, Brisbane, Queensland, Australia
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Sansonetti D, Fleming J, Patterson F, De Lacy L, Lannin NA. Factors associated with self-awareness impairment in an inpatient brain injury rehabilitation cohort. Brain Inj 2024:1-9. [PMID: 38634476 DOI: 10.1080/02699052.2024.2344096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Self-awareness impairment is common following acquired brain injury and can impact rehabilitation outcomes. Knowledge of factors associated with impaired self-awareness may assist with rehabilitation planning. OBJECTIVES To identify factors associated with self-awareness and determine predictors of self-awareness impairment for adults with traumatic brain injury (TBI) and stroke. DESIGN AND METHODS A retrospective cohort study of rehabilitation inpatients was conducted by medical record audit. Self-awareness was measured using the Self-awareness of Deficits Interview (SADI). Relationships between SADI scores and demographic and clinical variables were identified with non-parametric statistics. Predictors of SADI scores were identified using ordinal regression analyses for TBI and stroke groups. RESULTS Participants were 149 adults (18-70 years) with TBI (n = 110) and stroke (n = 39). For TBI, longer post-traumatic amnesia (PTA), lower functional cognition/communication, and behaviors of concern (BoC) were significantly associated with higher SADI scores (i.e. impaired self-awareness). For stroke, lower functional cognition/communication and motor scores were associated with higher SADI scores. Impaired self-awareness was predicted by PTA duration, acute length of stay and presence of BoC for the TBI group, and by functional cognition/communication for the stroke group. CONCLUSION Different factors were associated with impaired self-awareness for individuals with TBI and stroke during inpatient rehabilitation.
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Affiliation(s)
- Danielle Sansonetti
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Freyr Patterson
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Laura De Lacy
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia
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Sansonetti D, Fleming J, Patterson F, Lannin NA, Toglia J. Online awareness: a concept analysis and review of assessment approaches for adults with neurological conditions. Disabil Rehabil 2024:1-16. [PMID: 38596894 DOI: 10.1080/09638288.2024.2338876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE Self-awareness is a multifaceted phenomenon that comprises two main concepts: general awareness and online awareness. The latter is an emerging concept that requires further consensus on its definition. The aim of this paper is to define the key components of online awareness and identify approaches for measuring this concept for adults with neurological conditions. MATERIALS AND METHODS Concept analysis using Rodgers' evolutionary method was used to systematically review and summarise relevant literature. Papers were included if they provided a definition of online awareness or method for assessing online awareness for an adult neurological population. RESULTS Fifty-six papers were included in this review, with 21 online awareness assessment approaches identified. Online awareness was described to occur within the context of task performance, with the definition framework comprising four main aspects: 1/appraisal; 2/anticipation and prediction; 3/monitoring; and 4/self-evaluation. Self-regulation is a related concept that is considered to sit outside the conceptual boundaries of online awareness. CONCLUSIONS The findings of this analysis highlight the complexity of online awareness and its importance in rehabilitation. Psychometrically robust measures of online awareness that are inclusive of the essential elements of this concept are needed to advance practice in this area.
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Affiliation(s)
- Danielle Sansonetti
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Freyr Patterson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Natasha A Lannin
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
- Department of Neuroscience, Monash University, Clayton, Victoria, Australia
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy University, Dobbs Ferry, New York, USA
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McCabe C, Sica A, Doody N, Fortune DG. Self-awareness and quality of relationships after acquired brain injury: Systematic review without meta-analysis (SWiM). Neuropsychol Rehabil 2024; 34:335-361. [PMID: 36908086 DOI: 10.1080/09602011.2023.2186437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Relational aspects of self-awareness following Acquired Brain Injury (ABI) are increasingly being recognized. However, research underpinning the nature of the association between self-awareness and quality of relationships has yet to be synthesized. METHOD Searches, which were completed between February 2022 and February 2023, consisted of combining terms related to ABI, self-awareness, and quality of relationships. Data were analyzed using the Synthesis Without Meta-Analysis (SWiM) approach. RESULTS Associations between self-awareness and relationship quality across eight studies identified for this review differed in direction and significance. A more consistent pattern emerged, however, when studies assessing the quality of specific types of relationships i.e., spousal (N = 1) and therapeutic (N = 3), were compared to studies assessing the quality of a person's broader network of relationships (N = 4). In particular, good awareness was positively associated with the quality of specific relationships (r = 0.66) whereas it was negatively associated with the quality of a person's broader network of relationships (r = -0.35). CONCLUSION Results are discussed with consideration given to measures assessing the quality of specific relationships. In particular, such measures may tap into important patterns of interaction between two individuals, such as those related to attunement or communication, which may be valuable preconditions for improving awareness.
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Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Dublin, Ireland
| | - Niamh Doody
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Cameron KV, Ponsford JL, McKenzie DP, Stolwyk RJ. When stroke survivors' self-ratings are inconsistent with the ratings of others: a cohort study examining biopsychosocial factors associated with impaired self-awareness of functional abilities. BRAIN IMPAIR 2024; 25:IB23064. [PMID: 38566288 DOI: 10.1071/ib23064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024]
Abstract
Background Stroke survivors' self-ratings of functional abilities are often inconsistent with ratings assigned by others (e.g. clinicians), a phenomenon referred to as 'impaired self-awareness' (ISA). There is limited knowledge of the biopsychosocial contributors and consequences of post-stroke ISA measured across the rehabilitation journey. This multi-site cohort study explored biopsychosocial correlates of ISA during subacute rehabilitation (inpatient) and at 4 months post-discharge (community-dwelling). Methods Forty-five subacute stroke survivors participated (Age M (s.d.) = 71.5 (15.6), 56% female), and 38 were successfully followed-up. Self-assessments were compared to those of an independent rater (occupational therapist, close other) to calculate ISA at both time points. Survivors and raters completed additional cognitive, psychological and functional measures. Results Multivariate regression (multiple outcomes) identified associations between ISA during inpatient admission and poorer outcomes at follow-up, including poorer functional cognition, participation restriction, caregiver burden, and close other depression and anxiety. Regression models applied cross-sectionally, including one intended for correlated predictors, indicated associations between ISA during inpatient admission and younger age, male sex, poorer functional cognition, poorer rehabilitation engagement and less frequent use of non-productive coping (adjusted R 2 = 0.60). ISA at community follow-up was associated with poorer functional cognition and close other anxiety (adjusted R 2 = 0.66). Conclusions Associations between ISA and poorer outcomes across the rehabilitation journey highlight the clinical importance of ISA and the value of assessment and management approaches that consider the potential influence of numerous biological and psychosocial factors on ISA. Future studies should use larger sample sizes to confirm these results and determine the causal mechanisms of these relationships.
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Affiliation(s)
- Kate V Cameron
- School of Psychological Sciences, Monash University, Melbourne, Vic., Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Vic., Australia; and Monash-Epworth Rehabilitation Research Centre, Melbourne, Vic., Australia
| | - Dean P McKenzie
- Epworth HealthCare, Office for Research, Melbourne, Vic., Australia; and School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Monash University, Melbourne, Vic., Australia; and Monash-Epworth Rehabilitation Research Centre, Melbourne, Vic., Australia
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Dromer E, Arnould A, Barbot F, Azouvi P. Assessment of impaired self-awareness after moderate-to-severe traumatic brain injury: a comparison of assessment tools. Brain Inj 2024; 38:76-83. [PMID: 38247236 DOI: 10.1080/02699052.2024.2304875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To compare different assessment methods of impaired self-awareness (ISA). METHODS We included 37 patients with moderate-to-severe traumatic brain injury (TBI) at a subacute/chronic stage, and 33 healthy controls. ISA was assessed with three methods: discrepancy scores (comparison between patient and proxy ratings) on three scales (Patient Competency Rating Scale (PCRS), Awareness Questionnaire (AQ) and Dysexecutive Questionnaire (DEX)); clinician rating with the Self-Awareness of Deficits Interview (SADI); and the difference between prediction or estimation of performance and actual performance on two cognitive tasks. RESULTS Clinician-patient discrepancy scores appeared more sensitive than relative-patient discrepancy. The AQ was the most sensitive. The discrepancy scores were strongly correlated one with each other. Correlations with the SADI were weaker. Patients did not overestimate their performance on cognitive tasks, and the prediction did not significantly correlate with other measures of ISA. DISCUSSION/CONCLUSION Results support the multidimensional nature of ISA: discrepancy scores assess meta-cognitive knowledge (understanding that a function/skill is affected), while the SADI takes into account anticipatory awareness (ability to set realistic goals) and estimation of performance assesses anticipatory and situational awareness. Assessment of these different domains may provide a comprehensive overview of an individual's self-awareness.
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Affiliation(s)
- Emilie Dromer
- service de Médecine Physique et de Réadaptation, AP-HP, GH Paris Saclay, Hôpital Raymond Poincaré
- Equipe INSERM DevPsy, CESP, Université Paris-Saclay, UVSQ, Montigny le Bretonneux, France
| | - Annabelle Arnould
- service de Médecine Physique et de Réadaptation, AP-HP, GH Paris Saclay, Hôpital Raymond Poincaré
- Equipe INSERM DevPsy, CESP, Université Paris-Saclay, UVSQ, Montigny le Bretonneux, France
| | - Frédéric Barbot
- Centre d'Investigation Clinique, Inserm CIC 1429, AP-HP Hôpital Raymond Poincaré, Garches, France
| | - Philippe Azouvi
- service de Médecine Physique et de Réadaptation, AP-HP, GH Paris Saclay, Hôpital Raymond Poincaré
- Equipe INSERM DevPsy, CESP, Université Paris-Saclay, UVSQ, Montigny le Bretonneux, France
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Cheng WY, Klonoff PS, Perumparaichallai RK. Components of self-awareness affecting caregiver burden: a long-term follow-up study. Brain Inj 2024; 38:26-31. [PMID: 38258808 DOI: 10.1080/02699052.2024.2304883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Studies utilizing the discrepancy model of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) have commonly used the cognitive and physical domains to estimate self-awareness. This study included other aspects of self-awareness such as awareness of one's social and emotional status and daily functioning to explore their effects on caregiver burden for ABI survivors. METHODS We studied 64 patient-caregiver pairs up to 29 years post-discharge from a holistic, milieu-oriented outpatient neurorehabilitation program. Discrepancy scores between ABI survivors' and caregivers' reports on the MPAI-4 subscales (i.e. Abilities, Adjustment, and Participation) and Total Score were used to determine self-awareness. Caregiver burden was measured using the Zarit Burden Interview (ZBI). RESULTS Exploratory linear regression analyses revealed that caregiver burden derived from the ZBI was predicted by the discrepancy scores generated from the Abilities (p < 0.0001), Adjustment (p < 0.01), Participation subscales (p = 0.01), and Total Score (p < 0.001), respectively. Among the exploratory models generated, the Total Score model had the highest predictive value (R2 = .33) for caregiver burden. CONCLUSIONS Measures of self-awareness should be comprehensive by considering diverse components of self-awareness. Increasing ABI survivors' self-awareness in different domains has the potential to effectively alleviate caregiver burden.
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Affiliation(s)
- Wen-Yu Cheng
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Pamela S Klonoff
- The Center for Transitional Neuro-Rehabilitation, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Salazar-Frías D, Rodríguez-Bailón M, Ricchetti G, Navarro-Egido A, Funes MJ. The Cognitive Awareness Scale for Basic and Instrumental activities of daily living to measure self-awareness after acquired brain injury: preliminary evidence of its validity. Clin Neuropsychol 2023:1-23. [PMID: 37941388 DOI: 10.1080/13854046.2023.2278822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023]
Abstract
Objective: There is a crucial need for reliable tools to measure impaired self-awareness (ISA) in patients with acquired brain injury (ABI) across cognitive-functional domains. The aim of this study was to assess the psychometric properties of the Cog-Awareness ADL Scale, which is a novel self-proxy discrepancy method for measuring ISA in both basic and instrumental activities of daily living. Methods: This multicenter study included 54 patients (no-low ISA n = 33; severe ISA, n = 21) from four outpatient rehabilitation units in Málaga-Granada, Spain, and 51 healthy controls. The participants and proxy raters completed the Cog-Awareness ADL Scale and the Patient Competency Rating Scale (PCRS). Agreement between both scales was assessed using Spearman's correlations and the Bland-Altman plot. Group comparisons were made on measures of SA, cognitive abilities and demographic variables. Sensitivity and specificity were analysed by ROC curve analysis. Results: Convergent validity was supported by strong correlations with the PCRS and its subscales (rho's ranging from 0.51 to 0.80, p < 0.01 for all). The Bland-Altman plot confirmed measurement agreement (only 3.70% of the scores were outside the 95% limits). External validity was demonstrated by effectively discriminating between healthy controls and ABI patients with no-low and severe ISA on each discrepancy index while controlling for cognitive/demographic variables. The Cog-Awareness ADL Scale showed optimal diagnostic accuracy (AUC = 0.95, sensitivity = 0.90, specificity = 0.90). Conclusions: The Cog-Awareness ADL Scale proved to be a feasible, valid, and clinical tool to assess ISA across different cognitive-functional domains, in Spanish ABI-patients.
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Affiliation(s)
- Daniel Salazar-Frías
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - María Rodríguez-Bailón
- Physiotherapy (Occupational Therapy) Department, Health Science School, University of Málaga, Málaga, Spain
| | - Giorgia Ricchetti
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - Alba Navarro-Egido
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
| | - María Jesús Funes
- Mind, Brain and Behaviour Research Centre (CIMCYC), Experimental Psychology Department, School of Psychology, University of Granada, Granada, Spain
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McCabe C, Sica A, Fortune DG. Awareness through relationships in individuals undergoing rehabilitation following acquired brain injury. Neuropsychol Rehabil 2023:1-29. [PMID: 37903181 DOI: 10.1080/09602011.2023.2273578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023]
Abstract
AIM This cross-sectional study investigated the association between self-awareness and quality of therapeutic relationships following acquired brain injury (ABI) while controlling for the potential impact of cognitive problems. It also aimed to investigate attachment as a potential moderator. METHOD 83 adults with ABI were recruited alongside a key member of their community neurorehabilitation team. The Scale to Assess Therapeutic Relationships (STAR) was used to measure therapeutic relationship quality and attachment was measured using the Experiences in Close Relationships - Relationship Structure (ECR-RS) questionnaire. Awareness was measured using the Patient Competency Rating Scale (PCRS) and the Mayo-Portland Adaptability Inventory (MPAI-4) provided a measure of cognitive problems. The MPAI-4 also provided an additional measure of awareness. RESULTS A significant association between self-awareness and therapeutic relationships was found in some regression models such that higher-quality relationships were associated with better awareness, after controlling for the impact of cognitive problems. Neither childhood parental attachment nor participants' attachment towards their rehabilitation staff were moderators. CONCLUSION The observed associations between awareness in clients and therapeutic relationships with rehabilitation staff may have importance for rehabilitation in this context. Results highlight the value of continuing to prioritize the therapeutic relational environment in ABI rehabilitation and research.
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Affiliation(s)
- Corinne McCabe
- Department of Psychology, University of Limerick, Co Limerick, Ireland
| | - Andrea Sica
- Acquired Brain Injury Ireland, Co Dublin, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Co Limerick, Ireland
- HSE CHO 3 Mid West, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Kersey J, Baum CM, Hammel J, Terhorst L, McCue M, Skidmore ER. Cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury. PM R 2023; 15:176-183. [PMID: 34865309 DOI: 10.1002/pmrj.12743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/09/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Community participation is an important outcome of rehabilitation following traumatic brain injury. Yet, few measures assess inclusion and belonging (enfranchisement) as a dimension of community participation. The Enfranchisement scale of the Community Participation Indicators addresses this need. However, research on its psychometric properties is lacking. OBJECTIVE To examine cut points and sensitivity to change of the Enfranchisement scale of the Community Participation Indicators in adults with traumatic brain injury. DESIGN This was a repeated measures study with assessments administered twice (3 months apart). SETTING Assessments were administered either over the phone, virtually (Zoom), or in person at the participant's home. PARTICIPANTS A total of 44 participants from community settings who had either experienced a traumatic brain injury within the previous year or were receiving rehabilitation interventions were recruited. MAIN OUTCOME MEASURE The Enfranchisement scale has two subscales: the Control subscale (range: 13-65) and the Importance subscale (range: 14-70). On both subscales, lower scores indicate better enfranchisement. METHODS The software SAS PROC Logistic and the macro %ROCPlot were used to examine cut points at varying levels of sensitivity and specificity. The area under the receiver operating characteristics curve was calculated to determine overall classification accuracy. Minimum detectable change and minimal clinically important difference were also calculated. RESULTS For the Control subscale, a cut point of 44 (area under the curve = .75), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. For the Importance subscale, a cut point of 39 (area under the curve = .81), a minimum detectable change of 8, and a minimal clinically important difference of 5 were found. CONCLUSIONS The cut points resulted in good classification accuracy, providing support for their reliability. The results provided evidence that both subscales are sensitive to change in adults with brain injury.
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Affiliation(s)
- Jessica Kersey
- OTR/L, Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Carolyn M Baum
- OTR/L, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joy Hammel
- OTR/L, Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
| | - Michael McCue
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R Skidmore
- OTR/L, Department of Occupational Therapy, University of Pittsburgh, School of Health and Rehabilitation Science, Pittsburgh, Pennsylvania, USA
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Fogel Y. The Discrepancy between Actual Performance and Self-Awareness among Adolescents with Executive Function Deficits. CHILDREN 2022; 9:children9050684. [PMID: 35626861 PMCID: PMC9139761 DOI: 10.3390/children9050684] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022]
Abstract
Adolescents with executive function deficits (EFD) struggle to perform complex daily activities and have difficulty being self-aware of their performance. This study aimed to compare actual performance with self-awareness of performance among adolescents with EFD before and after a metacognitive intervention. The participants consisted of 41 adolescents aged 10 to 14 years, previously diagnosed with EFD. All performed the Children’s Cooking Task (CCT), and completed the Behavioral Rating Inventory Executive Function—Self-Report (BRIEF-SR) and the Self-Awareness of Performance Questionnaire. Significant positive differences were found in the time duration and the total number of errors from the CCT and three BRIEF-SR subscale scores before and after the intervention. No significant differences were found in self-awareness of performance. After a cognitive intervention, adolescents with EFD improved their performance of a learned skill, but their self-awareness of their performance remained unchanged. These results may imply that EFD inhibits self-awareness development, and that self-awareness may not depend on task performance, but, rather, is influenced by other external factors. The article reports the secondary analysis from the results of the Functional Individualized Therapy for Teenagers with Executive Deficits (FITTED) intervention on human participants.
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Affiliation(s)
- Yael Fogel
- Department of Occupational Therapy, Ariel University, Ariel 4077625, Israel
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Exploratory factor analysis of self-awareness for decision making on a right major of secondary students via the socialization of e-sport professionals. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1185-1198. [DOI: 10.1093/arclin/acac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
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Dromer E, Kheloufi L, Azouvi P. Impaired self-awareness after traumatic brain injury: a systematic review. Part 1: Assessment, clinical aspects and recovery. Ann Phys Rehabil Med 2021; 64:101468. [PMID: 33316433 DOI: 10.1016/j.rehab.2020.101468] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/04/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Impaired self-awareness (ISA) has frequently been found to be both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI). OBJECTIVES The present paper is the first of a two-part systematic review of ISA after traumatic brain injury (TBI), focusing on assessment methods, clinical aspects and recovery. METHODS Following the PRISMA guidelines, 95 articles meeting the inclusion criteria were included. RESULTS ISA occurs in 30% to 50% of patients with moderate to severe TBI, although it tends to improve with time. There is no one single gold-standard measure of ISA. Self-proxy discrepancy scores, with scales such as the Patient Competency Rating Scale or the Awareness Questionnaire, or a structured interview such as the Self Awareness of Deficits Interview, are the most frequently used assessment methods, with adequate psychometric properties. Scores on these different scales correlate only moderately with each other, which suggests that they may address different aspects of self-awareness. ISA mainly concerns cognitive and behavioral problems rather than physical or sensory impairments and may concern different areas of functioning, such as anticipatory, emergent or meta-cognitive awareness. CONCLUSION ISA is a complex and multifaceted issue that should be systematically assessed in rehabilitation settings using a range of relatively well-validated tools. The consequences and predictors of ISA after TBI will be addressed in a companion paper.
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Affiliation(s)
- Emilie Dromer
- AP-HP, GHU Paris-Saclay, Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, Inserm, CESP, UMR 1018, Team DevPsy, 94807, Villejuif, France
| | - Lyes Kheloufi
- AP-HP, GHU Paris-Saclay, Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, Inserm, CESP, UMR 1018, Team DevPsy, 94807, Villejuif, France
| | - Philippe Azouvi
- AP-HP, GHU Paris-Saclay, Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, Inserm, CESP, UMR 1018, Team DevPsy, 94807, Villejuif, France.
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15
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Hay CC, Pappadis MR, Sander AM, Weller SC, Wang W, Reistetter TA. Important-performance analysis to conceptualize goal priorities in community dwelling stroke survivors. Top Stroke Rehabil 2021; 29:310-320. [PMID: 34009101 PMCID: PMC8602464 DOI: 10.1080/10749357.2021.1928838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND It is important for clinicians to have a better understanding of stroke survivor's goals. Important performance analysis (IPA) is a tool that could be utilized to identify goal priorities in rehabilitation. OBJECTIVES To examine the utility of the IPA method to identify goal priorities in a diverse group of community dwelling stroke survivors. METHODS Thirty-eight stroke survivors completed private structured interviews and were asked to rate their perceived importance and performance of 37 goal areas. Important-performance analysis (IPA) was utilized to determine goal priorities for the overall sample. Different IPA methods used to identify goal priorities were compared. Goal priorities were also compared by age (dichotomized as <65 and ≥65 years) and sex (male or female). RESULTS The IPA method effectively separated the goals into the four quadrants, and distinguished which goals were a priority for the sample of stroke survivors. The five goals that were consistently identified as a focus area were: hand function, driving, balance, memory, and arm strength. Men rated mood control as more important than women (p = .046). The two goals rated as being more important for those older than 65 were home accessibility (p = .008) and skin health (p < .001). CONCLUSIONS Stroke survivors continue to have goals related to their stroke recovery in the years after their stroke. Both current performance as well as perceived importance should be considered during goal discussions with stroke survivors. IPA can help identify goal priorities in this population.
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Affiliation(s)
- Catherine Cooper Hay
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston (UTMB), Galveston, Texas, USA
| | - Monique R Pappadis
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston (UTMB), Galveston, Texas, USA.,Sealy Center on Aging, UTMB, Galveston, Texas, USA.,Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Angelle M Sander
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA.,H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas, USA
| | - Susan C Weller
- Sealy Center on Aging, UTMB, Galveston, Texas, USA.,Department of Preventive Medicine and Community Health and Department of Family Medicine, School of Medicine, UTMB, Galveston, Texas, USA
| | - Wanyi Wang
- School of Occupational Therapy, Texas Women's University, Houston, Texas, USA
| | - Timothy A Reistetter
- Sealy Center on Aging, UTMB, Galveston, Texas, USA.,Department of Occupational Therapy, School of Health Professions, UTMB, Galveston, Texas, USA
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16
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Wilkie L, Arroyo P, Conibeer H, Kemp AH, Fisher Z. The Impact of Psycho-Social Interventions on the Wellbeing of Individuals With Acquired Brain Injury During the COVID-19 Pandemic. Front Psychol 2021; 12:648286. [PMID: 33841287 PMCID: PMC8027334 DOI: 10.3389/fpsyg.2021.648286] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/23/2021] [Indexed: 01/07/2023] Open
Abstract
Individuals with Acquired Brain Injury (ABI) suffer chronic impairment across cognitive, physical and psycho-social domains, and the experience of anxiety, isolation and apathy has been amplified by the COVID-19 pandemic. A qualitative evaluation was conducted of 14 individuals with ABI who had participated in series of COVID adapted group-based intervention(s) that had been designed to improve wellbeing. Eight themes were identified: Facilitating Safety, Fostering Positive Emotion, Managing and Accepting Difficult Emotions, Promoting Meaning, Finding Purpose and Accomplishment, Facilitating Social Ties, (Re)Connecting to Nature, and Barriers to Efficacy. Findings are discussed with respects to recent theoretical developments in positive psychology and wellbeing science and support the use of online and outdoor interventions to enhance wellbeing in individuals living with ABI during the COVID-19 pandemic. This paper makes a unique contribution to second wave positive psychology (PP2.0) through the application of recent advances in wellbeing science to an ABI population during the COVID-19 pandemic. In doing so, this paper lays the foundation for new interventions that not only reduce impairment and distress, but also create opportunities for meaning and enhanced wellbeing in people living with chronic conditions and those individuals living with ABI in particular.
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Affiliation(s)
- Lowri Wilkie
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Pamela Arroyo
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Harley Conibeer
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Andrew Haddon Kemp
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
| | - Zoe Fisher
- Community Brain Injury Service, Morriston Hospital, Swansea, United Kingdom
- Health and Wellbeing Academy, College of Human and Health Sciences, Swansea University, Swansea, United Kingdom
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17
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Lloyd O, Ownsworth T, Fleming J, Jackson M, Zimmer-Gembeck M. Impaired Self-Awareness after Pediatric Traumatic Brain Injury: Protective Factor or Liability? J Neurotrauma 2021; 38:616-627. [PMID: 33107366 DOI: 10.1089/neu.2020.7191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Children and adolescents with traumatic brain injury (TBI) can experience impaired self-awareness, or difficulty in accurately perceiving their personal abilities. This study aimed to identify the neuro-developmental and socio-environmental factors associated with self-awareness impairment and determine how self-awareness is associated with psychosocial functioning. Parents and their children age 8-16 years with TBI (n = 107, 65.4% male, mean [M] age = 12.66 years, standard deviation [SD] = 2.6 years) were consecutively recruited from an outpatient clinic over a 4-year period. Children completed the Paediatric Awareness Questionnaire (PAQ) to report their functional abilities, and the Beck Youth Inventories to report their self-concept, and anxiety and depression symptoms. Parents completed the PAQ and measures of family functioning, parenting style, and children's emotional and behavioral problems. Self-awareness impairments were defined as more negative parent-child discrepancy scores on the PAQ. Younger age at injury, more severe injury, and more family dysfunction were significantly associated with poorer self-awareness. Poorer self-awareness was associated with worse parent-rated child adaptive functioning and emotional and behavioral problems. However, poorer self-awareness was also significantly associated with more positive self-concept and fewer symptoms of depression and anxiety as rated by children. Overall, impaired self-awareness seems to be both a liability and a benefit depending on the reporter (parent or child) and outcome of interest (adaptive function/behavior or self-concept/mood).
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Affiliation(s)
- Owen Lloyd
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia.,School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Megan Jackson
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia.,Queensland Paediatric Rehabilitation Service, The Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
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18
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Geurten M, Catale C, Gay P, Deplus S, Billieux J. Measuring Impulsivity in Children: Adaptation and Validation of a Short Version of the UPPS-P Impulsive Behaviors Scale in Children and Investigation of its Links With ADHD. J Atten Disord 2021; 25:105-114. [PMID: 29771172 DOI: 10.1177/1087054718775831] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Impulsivity is a multifaceted construct known to play a crucial role in the development and maintenance of a wide range of problematic behaviors and psychological disorders in children. Method: In this study, we adapted the short French adult version of the UPPS-P (urgency-premeditation-perseverance-sensation seeking-positive urgency) Impulsive Behaviors Scale for use with children (short UPPS-P-C) and tested its psychometric properties. Results: Confirmatory factor analyses conducted on a sample of 425 children (aged 8-14 years) supported the five-factor structure of the scale. Additional analyses emphasized the good internal and test-retest reliability of the short UPPS-P-C. Furthermore, our results also revealed that lack of premeditation, positive urgency, and negative urgency subscales were able to discriminate between children diagnosed with ADHD and their matched controls. Conclusion: These results suggest that the short UPPS-P-C may be considered as a promising time-saving tool to assess impulsivity traits in healthy children and in children with psychiatric disorders.
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Affiliation(s)
| | | | - Philippe Gay
- Haute École Pédagogique du Valais, St-Maurice, Switzerland
| | | | - Joël Billieux
- Catholic University of Louvain, Louvain-la-Neuve, Belgium.,University of Luxembourg, Esch-sur-Alzette, Luxembourg
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19
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McDonald S, Genova H. The effect of severe traumatic brain injury on social cognition, emotion regulation, and mood. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:235-260. [PMID: 34389120 DOI: 10.1016/b978-0-12-822290-4.00011-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This chapter provides a review of the emotional and psychosocial consequences of moderate to severe traumatic brain injury (TBI). Many of the disorders affecting socioemotional function arise from damage to frontotemporal systems, exacerbated by white matter injury. They include disorders of social cognition, such as the ability to recognize emotions in others, the ability to attribute mental states to others, and the ability to experience empathy. Patients with TBI also often have disorders of emotion regulation. Disorders of drive or apathy can manifest across cognitive, emotional, and behavioral domains. Likewise, disorders of control can lead to dysregulated emotions and behavior. Other disorders, such as loss of self-awareness, are also implicated in poor psychosocial recovery. Finally, this chapter overviews psychiatric disorders associated with TBI, especially anxiety and depression. For each kind of disorder, the nature of the disorder and its prevalence, as well as theoretical considerations and impact on every day functions, are reviewed.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
| | - Helen Genova
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, United States
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20
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Merchán-Baeza JA, Rodriguez-Bailon M, Ricchetti G, Navarro-Egido A, Funes MJ. Awareness of cognitive abilities in the execution of activities of daily living after acquired brain injury: an evaluation protocol. BMJ Open 2020; 10:e037542. [PMID: 33109646 PMCID: PMC7592290 DOI: 10.1136/bmjopen-2020-037542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION One of the main limitations that can be observed after acquired brain injury (ABI) is the alteration of the awareness of the deficits that can occur in the cognitive skills necessary for performing activities of daily living (ADL). According to the Dynamic Comprehensive Model of Awareness (DCMA), consciousness is composed of offline component, which contains the information stored about characteristics of the tasks and stable beliefs about one's own capabilities and online awareness, which is activated in the context of the performance of a specific task. The main objective of this project was to generate and validate a detailed cognitive assessment protocol within the context of ADL to evaluate the components of DCMA. METHODS AND ANALYSIS The proposed protocol consists of two ecological tools: The Cog-Awareness ADL Scale to measure offline component and the Awareness ADL-task: Basic and Instrumental ADL performance-based test to measure online awareness. The aim is to identify the presence of cognitive deficits and anosognosia in patients with ABI within the context of everyday life activities. These two measures will be administered to a group of patients with ABI. In addition, these participants will complete another series of classic tests on anosognosia and cognitive functions in order to find the convergent validity of the two tests proposed in this protocol. The external validity of the Cog-Awareness ADL Scale and the relationships between awareness components within the same ADL domain will be also analysed. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of Biomedical Research of Andalusia, on 13 January /2017 (Proceeding 1/2017). All participants are required to provide written informed consent. The findings from this will be disseminated via scientific publication. TRIAL REGISTRATION NUMBER NCT03712839.
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Affiliation(s)
- Jose Antonio Merchán-Baeza
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic (Barcelona), Spain
| | - Maria Rodriguez-Bailon
- Departament of Physiotherapy (Occupational Therapy), University of Malaga, Malaga, Spain
| | - Giorgia Ricchetti
- Departament of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain
| | - Alba Navarro-Egido
- Departament of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain
| | - María Jesús Funes
- Departament of Experimental Psychology; Mind, Brain and Behavior Research Center (CIMCYC-UGR), University of Granada, Granada, Spain
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21
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Villalobos D, Caperos JM, Bilbao Á, Bivona U, Formisano R, Pacios J. Self-Awareness Moderates the Association Between Executive Dysfunction and Functional Independence After Acquired Brain Injury. Arch Clin Neuropsychol 2020; 35:1059–1068. [PMID: 32743646 DOI: 10.1093/arclin/acaa048] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/15/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Impaired self-awareness (SA) is a common symptom after suffering acquired brain injury (ABI) which interferes with patient's rehabilitation and their functional independence. SA is associated with executive function and declarative memory, two cognitive functions that are related to participants' daily living functionality. Through this observational study, we aim to explore whether SA may play a moderator role in the relation between these two cognitive processes and functional independence. METHOD A sample of 69 participants with ABI completed a neuropsychological assessment focused on executive function and declarative memory which also included a measure of SA and functional independence. Two separated linear models were performed including functional independence, SA, and two neuropsychological factors (declarative memory and executive function) derived from a previous principal component analysis. RESULTS Moderation analysis show a significant interaction between SA and executive function, reflecting an association between lower executive functioning and poorer functional outcome, only in participants with low levels of SA. Notwithstanding, declarative memory do not show a significant interaction with SA, even though higher declarative memory scores were associated with better functional independence. CONCLUSIONS SA seems to play a moderator effect between executive function, but not declarative memory, and functional independence. Accordingly, participants with executive deficits and low levels of SA might benefit from receiving specific SA interventions in the first instance, which would in turn positively impact on their functional independence.
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Affiliation(s)
- Dolores Villalobos
- Department of Psychology, Faculty of Health Sciences, Camilo José Cela University, Villafranca del Castillo, Madrid, Spain
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Technical University of Madrid, Complutense University of Madrid, Madrid, Spain
- Department of Experimental Psychology, School of Psychology, Complutense University, Madrid, Spain
| | - José M Caperos
- Fundación San Juan de Dios, Madrid, Spain
- Departamento de Psicología, Universidad Pontificia Comillas, Madrid, Spain
| | - Álvaro Bilbao
- Centro de Referencia Estatal de Atención al Daño Cerebral (CEADAC), Madrid, Spain
| | - Umberto Bivona
- Istituto di Ricovero e Cura a Carattere Scientifico, Santa Lucia Foundation, Rome, Italy
| | - Rita Formisano
- Istituto di Ricovero e Cura a Carattere Scientifico, Santa Lucia Foundation, Rome, Italy
| | - Javier Pacios
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Technical University of Madrid, Complutense University of Madrid, Madrid, Spain
- Department of Experimental Psychology, School of Psychology, Complutense University, Madrid, Spain
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22
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Stubberud J, Løvstad M, Solbakk AK, Schanke AK, Tornås S. Emotional Regulation Following Acquired Brain Injury: Associations With Executive Functioning in Daily Life and Symptoms of Anxiety and Depression. Front Neurol 2020; 11:1011. [PMID: 33013668 PMCID: PMC7512052 DOI: 10.3389/fneur.2020.01011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: To examine whether a questionnaire measuring emotional regulation after acquired brain injury adds clinical information beyond what can be obtained with a comprehensive executive function questionnaire and an anxiety and depression measure. Method: Seventy adult persons (age 19–66 years, Mage = 43, SDage = 13) with acquired brain injury in the chronic phase and executive function complaints. All were recruited to participate in a randomized controlled trial (NCT02692352) evaluating the effects of cognitive rehabilitation. Traumatic brain injury was the dominant cause of injury (64%), and mean time since injury was 8 years. Emotional regulation was assessed with the Brain Injury Trust Regulation of Emotions Questionnaire (BREQ). Executive function was assessed with the Behavior Rating Inventory of Executive Function Adult Version (BRIEF-A). The Hopkins Symptom Checklist 25 (HCSL-25) was employed to measure anxiety and depression symptoms. Results: Overall, significant correlations were found between reports of emotional regulation (BREQ) and executive function in daily life (BRIEF-A). Furthermore, our analyses revealed a significant relationship between self-reported scores of emotional regulation (BREQ) and symptoms of anxiety and depression (HSCL-25). Conclusion: The significant associations between the BREQ and most of the other clinical measures indicate that, for patients with acquired brain injury, the BREQ does not add substantial information beyond what can be assessed with the BRIEF-A and the HSCL-25.
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Affiliation(s)
- Jan Stubberud
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Marianne Løvstad
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Anne-Kristin Solbakk
- Department of Psychology, University of Oslo, Oslo, Norway.,RITMO Centre for Interdisciplinary Studies in Rhythm, Time and Motion, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Olso, Norway.,Department of Neuropsychology, Helgeland Hospital, Mosjøen, Norway
| | - Anne-Kristine Schanke
- Department of Psychology, University of Oslo, Oslo, Norway.,Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - Sveinung Tornås
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
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23
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Chudoba LA, Schmitter-Edgecombe M. Insight into memory and functional abilities in individuals with amnestic mild cognitive impairment. J Clin Exp Neuropsychol 2020; 42:822-833. [PMID: 32957853 DOI: 10.1080/13803395.2020.1817338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Accurate insight into one's abilities facilitates engagement in rehabilitation and implementation of compensatory strategies. In this study, self-awareness, self-monitoring, and a new self-updating construct of insight were examined in amnestic mild cognitive impairment (aMCI). METHOD Individuals with aMCI and healthy older adults (HOAs) completed a list-learning task in a laboratory setting, and a naturalistic task of everyday functioning in a campus apartment along with other standardized neuropsychological tests. Participants made predictions about performance on the memory and functional tasks prior to task experience (self-awareness), immediately after task experience (self-monitoring), and after a delay (self-updating). RESULTS Individuals with aMCI performed more poorly than HOAs on the memory task and other neuropsychological tests but not the functional task. For both the memory and functional task, performance predictions and prediction accuracy measures revealed that the aMCI group exhibited intact self-awareness, self-monitoring, and self-updating. Prediction accuracy measures showed some association with an executive composite but not a memory composite. DISCUSSION Participants with aMCI demonstrated intact self-awareness, self-monitoring, and self-updating for a memory and functional task despite exhibiting poorer performance on neurocognitive tests compared to HOAs. These findings suggest that, even as memory in aMCI degrades, executive abilities may help sustain insight into difficulties, enabling adoption of cognitive strategies to support difficulties.
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Affiliation(s)
- Lisa A Chudoba
- Department of Psychology, Washington State University , Pullman, Washington, USA
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24
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Bivona U, Ciurli P, Ferri G, Fontanelli T, Lucatello S, Donvito T, Villalobos D, Cellupica L, Mungiello F, Lo Sterzo P, Ferraro A, Giandotti E, Lombardi G, Azicnuda E, Caltagirone C, Formisano R, Costa A. The Self-Awareness Multilevel Assessment Scale, a New Tool for the Assessment of Self-Awareness After Severe Acquired Brain Injury: Preliminary Findings. Front Psychol 2020; 11:1732. [PMID: 32793065 PMCID: PMC7393213 DOI: 10.3389/fpsyg.2020.01732] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022] Open
Abstract
Self-awareness (SA) is frequently impaired after severe acquired brain injury (sABI) and may lead to reduced subject's compliance to treatment, worse functional outcome, and high caregiver distress. Considering the multifaceted nature of SA, a specific and effective assessment is crucial to address treatment of impairment of SA (ISA). Many tools can currently assess ISA; however, they have some important limits. In the present study, we proposed the Self-Awareness Multilevel Assessment Scale (SAMAS), a new scale for assessment of SA at different levels (i.e., declarative, emergent, and anticipatory) across all domains of functioning. The SAMAS has been designed to be administered by the cognitive/behavioral therapist with the involvement of a patient's relative. Findings showed that the SAMAS allowed specifically assessing SA at a declarative level and on all possible functional domains. More interestingly, it seems also able to assess both emergent and anticipatory SA, thus overcoming some important limits of other current assessment methods. Our findings are consistent with a holistic perspective of the patient with sABI because thanks to the combined use of assessing tools, the SAMAS can provide an accurate diagnosis of ISA, thus better addressing the neurorehabilitation treatment and, accordingly, reducing the possible occurrence of its primary and secondary implications.
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Affiliation(s)
- Umberto Bivona
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Paola Ciurli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Giulia Ferri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Tiziana Fontanelli
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Susanna Lucatello
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Teresa Donvito
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Dolores Villalobos
- Department of Psychology, Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology (Technical University of Madrid and Complutense University of Madrid), Madrid, Spain
| | - Laura Cellupica
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Fabiana Mungiello
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Paola Lo Sterzo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Amalia Ferraro
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Eleonora Giandotti
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Giorgio Lombardi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Eva Azicnuda
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Carlo Caltagirone
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- Tor Vergata University, Rome, Italy
| | - Rita Formisano
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Alberto Costa
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- Università Telematica Niccolò Cusano, Rome, Italy
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25
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Prigatano GP, Sherer M. Impaired Self-Awareness and Denial During the Postacute Phases After Moderate to Severe Traumatic Brain Injury. Front Psychol 2020; 11:1569. [PMID: 32765359 PMCID: PMC7378811 DOI: 10.3389/fpsyg.2020.01569] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/11/2020] [Indexed: 12/02/2022] Open
Abstract
While a number of empirical studies have appeared on impaired self-awareness (ISA) after traumatic brain injury (TBI) over the last 20 years, the relative role of denial (as a psychological method of coping) has typically not been addressed in these studies. We propose that this failure has limited our understanding of how ISA and denial differentially affect efforts to rehabilitate persons with TBI. In this selective review paper, we summarize early findings in the field and integrate those findings with more recent observations (i.e., 1999–2019). We believe that this synthesis of information and expert clinical opinion will inform future research on ISA and denial as well as approaches to rehabilitation for persons with TBI.
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Affiliation(s)
- George P Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Mark Sherer
- TIRR Memorial Hermann, Houston, TX, United States
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26
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Matamala-Gomez M, Maisto M, Montana JI, Mavrodiev PA, Baglio F, Rossetto F, Mantovani F, Riva G, Realdon O. The Role of Engagement in Teleneurorehabilitation: A Systematic Review. Front Neurol 2020; 11:354. [PMID: 32435227 PMCID: PMC7218051 DOI: 10.3389/fneur.2020.00354] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/09/2020] [Indexed: 01/04/2023] Open
Abstract
The growing understanding of the importance of involving patients with neurological diseases in their healthcare routine either for at-home management of their chronic conditions or after the hospitalization period has opened the research for new rehabilitation strategies to enhance patient engagement in neurorehabilitation. In addition, the use of new digital technologies in the neurorehabilitation field enables the implementation of telerehabilitation systems such as virtual reality interventions, video games, web-based interventions, mobile applications, web-based or telephonic telecoach programs, in order to facilitate the relationship between clinicians and patients, and to motivate and activate patients to continue with the rehabilitation process at home. Here we present a systematic review that aims at reviewing the effectiveness of different engagement strategies and the different engagement assessments while using telerehabilitation systems in patients with neurological disorders. We used PICO's format to define the question of the review, and the systematic review protocol was designed following the Preferred Reported Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Bibliographical data was collected by using the following bibliographic databases: PubMed, EMBASE, Scopus, and Web of Science. Eighteen studies were included in this systematic review for full-text analyses. Overall, the reviewed studies using engagement strategies through telerehabilitation systems in patients with neurological disorders were mainly focused on patient self-management and self-awareness, patient motivation, and patient adherence subcomponents of engagement, that are involved in by the behavioral, cognitive, and emotional dimensions of engagement. Conclusion: The studies commented throughout this systematic review pave the way for the design of new telerehabilitation protocols, not only focusing on measuring quantitative or qualitative measures but measuring both of them through a mixed model intervention design (1). The future clinical studies with a mixed model design will provide more abundant data regarding the role of engagement in telerehabilitation, leading to a possibly greater understanding of its underlying components.
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Affiliation(s)
- Marta Matamala-Gomez
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Marta Maisto
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Jessica Isbely Montana
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | | | | | | | - Fabrizia Mantovani
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Olivia Realdon
- "Riccardo Massa" Department of Human Sciences for Education, University of Milano-Bicocca, Milan, Italy
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Fleming J, Tsi Hui Goh A, Lannin NA, Ownsworth T, Schmidt J. An exploratory study of verbal feedback on occupational performance for improving self‐awareness in people with traumatic brain injury. Aust Occup Ther J 2020; 67:142-152. [DOI: 10.1111/1440-1630.12632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/29/2019] [Accepted: 11/05/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Jennifer Fleming
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane Qld Australia
- School of Allied Health La Trobe University Melbourne Vic Australia
| | - Amelia Tsi Hui Goh
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane Qld Australia
| | - Natasha A. Lannin
- Department of Neurosciences Monash University Melbourne Vic Australia
- Occupational Therapy Department Alfred Health Melbourne Vic Australia
- Faculty of Medicine John Walsh Centre for Rehabilitation ResearchUniversity of Sydney Sydney NSW Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland Griffith University Brisbane Qld Australia
| | - Julia Schmidt
- School of Allied Health La Trobe University Melbourne Vic Australia
- Occupational Science and Occupational Therapy Department University of British Columbia Vancouver BC Canada
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Quiles C, Prouteau A, Verdoux H. Assessing metacognition during or after basic-level and high-level cognitive tasks? A comparative study in a non-clinical sample. Encephale 2020; 46:3-6. [PMID: 31227210 DOI: 10.1016/j.encep.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/25/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
This study explored in a non-clinical sample whether metacognitive awareness assessments measured during ("on line") and after ("end line") a neuropsychological task lead to comparable results in tests exploring basic-level or high-level cognitive functions. Short-term memory and working memory tests (forward and backward digit recall of the WAIS-III) were used to measure basic-level cognitive function. A social cognition test, the French adaptation of the Faces Test, was used to assess high-level cognitive function through recognition of facial emotions. For these two tests, we explored "on line" metacognitive awareness using a method based upon Koriat and Goldsmith's protocol. After each answer, participants were asked to rate their level of confidence in the correctness of their response. Persons had also to rate their confidence in their answer only once, at the end of the neuropsychological test, in order to explore "end line" metacognitive awareness. They were then asked "do you feel you have passed this test?" and had to rate their feeling of success on a 4-point Likert-type scale ("no", "rather not", "rather yes", "yes"). No association was found between "on line" and "end line" metacognitive awareness scores on memory tests. Poor "end line" metacognitive awareness was associated with lower "on line" metacognitive awareness score in the social cognition test. It might be of interest to assess both "on line" and "end line" metacognitive awareness in persons with schizophrenia to better take into accounts the multi-faceted structure of metacognition.
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Affiliation(s)
- C Quiles
- Université de Bordeaux, 33000 Bordeaux, France; INSERM, U1219, 33000 Bordeaux, France; Centre hospitalier Charles-Perrens, 33000 Bordeaux, France
| | - A Prouteau
- Université de Bordeaux, 33000 Bordeaux, France; Laboratoire de Psychologie Santé et Qualité de la vie EA 4139, 33000 Bordeaux, France
| | - H Verdoux
- Université de Bordeaux, 33000 Bordeaux, France; INSERM, U1219, 33000 Bordeaux, France; Centre hospitalier Charles-Perrens, 33000 Bordeaux, France.
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Masterson Y, Brady E, Miller A. Informational Practices of Postacute Brain Injury Patients During Personal Recovery: Qualitative Study. J Particip Med 2019; 11:e15174. [PMID: 33055067 PMCID: PMC7434071 DOI: 10.2196/15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The effects of brain injury, structural damage, or the physiological disruption of brain function last far beyond initial clinical treatment. Self-tracking and management technologies have the potential to help individuals experiencing brain injury in their personal recovery-helping them to function at their best despite ongoing symptoms of illness. However, current self-tracking technologies may be unsuited for measuring the interconnected, nonlinear ways in which brain injury manifests. OBJECTIVE This study aimed to investigate (1) the current informational practices and sensemaking processes used by postacute brain injury patients during personal recovery and (2) the potential role of quality-of-life instruments in improving patient awareness of brain injury recovery, advocacy, and involvement in care used outside the clinical context. Our objective was to explore the means of improving awareness through reflection that leads to compensatory strategies by anticipating or recognizing the occurrence of a problem caused by impairment. METHODS We conducted a qualitative study and used essentialist or realist thematic analysis to analyze the data collected through semistructured interviews and questionnaires, 2 weeks of structured data collection using brain injury-specific health-related quality of life instrument, quality of life after brain injury (QoLIBRI), and final interviews. RESULTS Informational practices of people with brain injury involve data collection, data synthesis, and obtaining and applying the insights to their lifestyles. Participants collected data through structured tools such as spreadsheets and wearable devices but switched to unstructured tools such as journals and blogs as changes in overall progress became more qualitative in nature. Although data collection helped participants summarize their progress better, the lack of conceptual understanding made it challenging to know what to monitor or communicate with clinicians. QoLIBRI served as an education tool in this scenario but was inadequate in facilitating reflection and sensemaking. CONCLUSIONS Individuals with postacute brain injury found the lack of conceptual understanding of recovery and tools for making sense of their health data as major impediments for tracking and being aware of their personal recovery. There is an urgent need for a better framework for recovery and a process model for choosing patient-generated health data tools that focus on the holistic nature of recovery and improve the understanding of brain injury for all stakeholders involved throughout recovery.
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Affiliation(s)
- Yamini Masterson
- Department of Human-Centered Computing, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Erin Brady
- Department of Human-Centered Computing, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Andrew Miller
- Department of Human-Centered Computing, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
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Sunderaraman P, Cosentino S, Lindgren K, James A, Schultheis M. Informant Report of Financial Capacity for Individuals With Chronic Acquired Brain Injury: An Assessment of Informant Accuracy. J Head Trauma Rehabil 2019; 33:E85-E94. [PMID: 29601341 PMCID: PMC6163092 DOI: 10.1097/htr.0000000000000382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Primarily, to investigate the association between informant report and objective performance on specific financial capacity (FC) tasks by adults with chronic, moderate to severe acquired brain injury, and to examine the nature of misestimates by the informants. DESIGN Cross-sectional design. SETTING A postacute, community-based rehabilitation center. PARTICIPANTS Data were obtained from 22 chronic acquired brain injury (CABI) adults, mean age of 46.6 years (SD = 8.67), mean years of education of 13.45 years (SD = 2.15), with moderate to severe acquired brain injury (86% had traumatic brain injury), with a mean postinjury period of 17.14 years (SD = 9.5). Whereas the CABI adults completed the Financial Competence Assessment Inventory interview-a combination of self-report and performance-based assessment, 22 informants completed a specifically designed parallel version of the interview. RESULTS Pearson correlations and 1-sample t tests based on the discrepancy scores between informant report and CABI group's performance were used. The CABI group's performance was not associated with its informant's perceptions. One-sample t tests revealed that informants both underestimated and overestimated CABI group's performance. CONCLUSIONS Results indicate lack of correspondence between self- and informant ratings. Further investigation revealed that misestimations by informants occurred in contrary directions with CABI adults' performance being inaccurately rated. These findings raise critical issues related to assuming that the informant report can be used as a "gold standard" for collecting functional data related to financial management, and the idea that obtaining objective data on financial tasks may represent a more valid method of assessing financial competency in adults with brain injury.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and the G. H. Sergievsky Center (Drs Sunderaraman and Cosentino) and Department of Neurology (Dr Cosentino), Columbia University Medical Center, New York City, New York; Bancroft Brain Injury Services, Cherry Hill, New Jersey (Dr Lindgren); and Psychology Department, Drexel University, Philadelphia, Pennsylvania (Ms James and Dr Schultheis)
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Bivona U, Costa A, Contrada M, Silvestro D, Azicnuda E, Aloisi M, Catania G, Ciurli P, Guariglia C, Caltagirone C, Formisano R, Prigatano GP. Depression, apathy and impaired self-awareness following severe traumatic brain injury: a preliminary investigation. Brain Inj 2019; 33:1245-1256. [PMID: 31304792 DOI: 10.1080/02699052.2019.1641225] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary Objective: The primary aim of this study was to determine the frequency of severe impaired self-awareness (ISA) in patients with severe traumatic brain injury (TBI) and the correlates of selected clinical, neuropsychiatric and cognitive variables. The secondary aim of the study was to assess depression and apathy on the basis of their level of self-awareness. Methods: Thirty patients with severe TBI and 30 demographically matched healthy control subjects (HCs) were compared on measures of ISA, depression, anxiety, alexithymia, neuropsychiatric symptoms and cognitive flexibility. Results: Twenty percent of the patients demonstrated severe ISA. Severe post-acute ISA was associated with more severe cognitive inflexibility, despite the absence of differences in TBI severity, as evidenced by a Glasgow Coma Scale (GCS) score lower than 9 in all cases in the acute phase. Patients with severe ISA showed lower levels of depression and anxiety but tended to show more apathy and to have greater difficulty describing their emotional state than patients with severe TBI who showed minimal or no disturbance in self-awareness. Conclusion: These findings support the general hypothesis that severe ISA following severe TBI is typically not associated with depression and anxiety, but rather with apathy and cognitive inflexibility.
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Affiliation(s)
- U Bivona
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - A Costa
- b Unicusano University , Rome , Italy
| | - M Contrada
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - D Silvestro
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - E Azicnuda
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - M Aloisi
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - G Catania
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - P Ciurli
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - C Guariglia
- a IRCCS, Santa Lucia Foundation , Rome , Italy.,c Sapienza University , Rome , Italy
| | - C Caltagirone
- a IRCCS, Santa Lucia Foundation , Rome , Italy.,d Tor Vergata University , Rome , Italy
| | - R Formisano
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - G P Prigatano
- e Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , AZ , USA
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Improving Self-awareness After Acquired Brain Injury Leads to Enhancements in Patients’ Daily Living Functionality. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To explore whether the improvement in self-awareness induced by a structured intervention programme in patients suffering a brain injury is associated with an enhancement in their functional outcomes.Method:This study uses a pre- and post-test control group design with a sample of 56 patients with acquired brain injury randomly assigned to an experimental and a control group. Pre- and post-intervention measurements were self-awareness (using a previously developed scale) and functional outcome (using the Lawton Instrumental Activities of Daily Living Scale).Results:Patients who received the intervention programme showed a greater improvement in their self-awareness level and functional outcome than patients in the control group. Additionally, the correlation analyses between improvements at both measures showed a relation between improvement in self-awareness and improvement in functional outcome, especially when the pre-treatment self-awareness level was considered.Conclusions:Implementing an intervention programme in self-awareness, in the context of a global rehabilitation process of patients with acquired brain injury, is useful for improving their self-awareness level and the functionality in their daily activities.
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Kersey J, Juengst SB, Skidmore E. Effect of Strategy Training on Self-Awareness of Deficits After Stroke. Am J Occup Ther 2019; 73:7303345020p1-7303345020p7. [PMID: 31120846 DOI: 10.5014/ajot.2019.031450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Self-awareness of deficits, or the ability to understand the effects of impairments on daily life, is often diminished after a stroke. Diminished self-awareness influences participation in rehabilitation and functional outcomes. OBJECTIVE To examine whether self-awareness of deficits changed over time after a stroke (N = 43) and whether metacognitive strategy training (n = 21) resulted in improved self-awareness compared with direct skill training (n = 22). DESIGN Secondary analysis of data collected from a randomized controlled trial. SETTING Inpatient stroke rehabilitation. PARTICIPANTS Adults with cognitive impairments after an acute stroke. INTERVENTION Metacognitive strategy training is an approach in which clients are guided through a process of self-assessment and develop solutions for barriers to task performance. This approach was compared with direct skill training, in which the therapist provides specific instructions for task completion, removing the client-initiated assessment and problem-solving components. OUTCOMES AND MEASURES Self-awareness measures included the Self-Regulation Skills Interview and Self-Awareness of Deficits Interview at baseline and 3 mo and 6 mo after the intervention. We used a one-way analysis of variance (ANOVA) to analyze change in self-awareness and a two-way ANOVA to examine differences between groups over time. RESULTS There was a statistically significant and potentially meaningful difference over time in the self-awareness domain of strategy behavior, F(2) = 3.35, p = .039, but there were no differences in improvements between the metacognitive strategy and direct skill training groups. Conclusions and Relevance Self-awareness warrants further investigation to determine whether it improves naturally over time or through both interventions after stroke. WHAT THIS ARTICLE ADDS Self-awareness of deficits, and the use of strategies in particular, may improve in the early stages of stroke recovery, but the optimal approach for intervention remains unclear.
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Affiliation(s)
- Jessica Kersey
- Jessica Kersey, MOT, OTR/L, is Occupational Therapist and Doctoral Student, Department of Occupational Therapy, School of Health and Rehabilitation Services, University of Pittsburgh, Pittsburgh, PA;
| | - Shannon B Juengst
- Shannon B. Juengst, PhD, CRC, is Assistant Professor, Department of Physical Medicine and Rehabilitation and Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas
| | - Elizabeth Skidmore
- Elizabeth Skidmore, PhD, OTR/L, is Professor and Chair, Department of Occupational Therapy, School of Health and Rehabilitation Services, University of Pittsburgh, Pittsburgh, PA
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A qualitative study of LoveYourBrain Yoga: a group-based yoga with psychoeducation intervention to facilitate community integration for people with traumatic brain injury and their caregivers. Disabil Rehabil 2019; 42:2482-2491. [PMID: 30741032 DOI: 10.1080/09638288.2018.1563638] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore participants' experiences in a group-based yoga with psychoeducation intervention designed to facilitate community integration for people with traumatic brain injury and their caregivers.Materials and methods: We conducted semi-structured interviews with 13 people with traumatic brain injury and three caregivers who had completed LoveYourBrain Yoga, a 6-session, manualized, group-based yoga intervention that incorporates breathing exercises, yoga, meditation, and psychoeducation. Interviews were analyzed using content analysis.Results: We identified seven themes: ease of participation, belonging, sustaining community connection, physical health, self-regulation, self-efficacy, and resilience. All participants valued the community-based yoga studio environment and multifaceted structure of the program. Participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. Participants reported ongoing use of tools (e.g., breathing exercises) to cope with negative emotions and stress. About half of participants sustained relationships built during LoveYourBrain Yoga and felt more capable of accessing other activities in their community.Conclusions: LoveYourBrain Yoga successfully promoted community integration for people with traumatic brain injury. It also facilitated diverse and meaningful physical, psychological, and social health benefits, which suggest that it may be an effective mode of community-based rehabilitation.Implications for rehabilitationTraumatic brain injury survivors often struggle to participate in their community, the ultimate goal of rehabilitationYoga is a holistic therapy with many benefits, yet is not accessible to the traumatic brain injury population at the community levelParticipants in a community-based yoga with psychoeducation intervention in six states experienced diverse and meaningful physical, psychological, and social health benefitsGroup-based yoga with psychoeducation may be an effective mode of community integration and community-based rehabilitation for traumatic brain injury survivors.
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Winkens I, Prinsen A, Meijerink A, Van Heugten C, Ponds R. Psychometric evaluation of the Self-Awareness in Daily Life-3 Scale (SADL-3) for the assessment of self-awareness after acquired brain injury. Brain Inj 2019; 33:598-609. [DOI: 10.1080/02699052.2019.1566969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ieke Winkens
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
| | | | | | - Caroline Van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rudolf Ponds
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Hurst FG, Ownsworth T, Beadle E, Shum DHK, Fleming J. Domain-specific deficits in self-awareness and relationship to psychosocial outcomes after severe traumatic brain injury. Disabil Rehabil 2018; 42:651-659. [DOI: 10.1080/09638288.2018.1504993] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Felicity G. Hurst
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Elizabeth Beadle
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - David H. K. Shum
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Neuropsychology and Applied Cognitive Neuroscience Laboratory CAS Key Laboratory of Mental Health, Institute of Psychology Chinese Academy of Sciences, Griffith University, Beijing, China
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia
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Levy S, Gansler D, Huey E, Wassermann E, Grafman J. Assessment of Patient Self-awareness and Related Neural Correlates in Frontotemporal Dementia and Corticobasal Syndrome. Arch Clin Neuropsychol 2018; 33:519-529. [PMID: 29088311 PMCID: PMC6116784 DOI: 10.1093/arclin/acx105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/20/2017] [Accepted: 10/10/2017] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE We compared two different methods of assessing self-awareness (clinician-rated vs. self- and caregiver report) in participants with neurodegenerative conditions. Additionally, we examined the contribution of memory dysfunction to assessment of self-awareness. METHOD Sixty-seven participants with various neurodegenerative disorders participated in this study. Data were collected on brain volume, neurocognitive function, demographic characteristics, and two measures of patient self-awareness, defined as (1) the discrepancy between patient and caregiver ratings of dysexecutive syndrome and (2) clinician-observed rating of patient insight. Penalized regression with best subset variable selection and 10-fold cross-validation was used to evaluate three neurocognitive frameworks: self-regulation, language, and perspective-taking, each predicting the results from the two methods of self-awareness measurement. RESULTS The self-regulation framework was more robustly predictive for both the clinician rating and discrepancy method than language or perspective-taking. Frameworks in which the clinician rating was the criterion were more robust than those with the discrepancy method as criterion. When a measure of memory functioning was added to the framework, there was no appreciable improvement in the prediction of self-awareness. CONCLUSIONS A self-regulation neurocognitive framework, consisting of regions of interest and neuropsychological test scores, was more effective in understanding patient self-awareness than perspective-taking or language frameworks. Compared to the discrepancy method, a clinician rating of self-awareness was more robustly associated with relevant clinical variables of regional brain volume and neuropsychological performance, suggesting it may be a useful measure to aid clinical diagnosis.
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Affiliation(s)
- Sarah Levy
- Department of Psychology, Suffolk University College of Arts and Sciences, Boston, MA, USA
| | - David Gansler
- Department of Psychology, Suffolk University College of Arts and Sciences, Boston, MA, USA
| | - Edward Huey
- Departments of Psychiatry and Neurology, Columbia University, NY, USA
| | - Eric Wassermann
- Department of Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jordan Grafman
- Department of Physical Medicine and Rehabilitation, Neurology; Shirley Ryan Ability Lab., Northwestern University, Chicago, IL, USA
- Department of Psychiatry, Feinberg School of Medicine and Department of Psychology, Northwestern University, Weinberg College of Arts and Sciences, Chicago, IL, USA
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Rothlind J, Dukarm P, Kraybill M. Assessment of Self-Awareness of Cognitive Function: Correlations of Self-Ratings with Actual Performance Ranks for Tests of Processing Speed, Memory and Executive Function in Non-Clinical Samples. Arch Clin Neuropsychol 2018; 32:316-327. [PMID: 28034850 DOI: 10.1093/arclin/acw109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/30/2016] [Indexed: 12/12/2022] Open
Abstract
Objective For individuals with neurologic disorders, self-awareness of cognitive impairment is associated with improved treatment course and clinical outcome. However, methods for assessment of levels of self-awareness are limited, and most require collateral information, which may not be readily available. Although distortions in self-awareness are most often associated with low cognitive ability, the frequently mixed pattern of cognitive strengths and deficits in individuals with neurologic disorders complicates assessment. The present study explores relationships between actual test performance and self-ratings, utilizing a brief probe administered during testing. The "common-metric" approach solicits self-appraisal ratings in percentile equivalents and capitalizes on available normative data for specific standardized neuropsychological tests to allow direct comparisons. Method A convenience sample of 199 adults recruited from community sources participated in this study, including healthy adults and neuropsychologically "at-risk" volunteers who were HIV positive and/or endorsing heavy current alcohol consumption. Immediately following completion of standardized neuropsychological tests, participants estimated their own percentile ranking. Results Across study groups, participant's estimates of their own percentile rank were modestly correlated with actual performance ranking. Highest correlations were obtained for tests of learning, memory and conceptual reasoning, and executive function, with smaller correlations for simple tests of motor and psychomotor speed. Conclusions The study reveals normal biases affecting the self-appraisal during standardized testing, and suggests that a common-metric approach for assessing self-appraisal may play a role in establishing clinical thresholds and identifying and quantifying reductions in insight in persons with neuropsychological deficits.
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Affiliation(s)
- Johannes Rothlind
- San Francisco VA Medical Center, Psychology Services, San Francisco, CA, USA
| | - Paul Dukarm
- Alaska Neuropsychological and Behavioral Health, LLC, Neuropsychology, Fairbanks, AK, USA
| | - Matthew Kraybill
- Ross University School of Medicine, Behavioral Science, Roseau, Dominica
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Zlotnik S, Toglia J. Measuring Adolescent Self-Awareness and Accuracy Using a Performance-Based Assessment and Parental Report. Front Public Health 2018; 6:15. [PMID: 29456993 PMCID: PMC5801478 DOI: 10.3389/fpubh.2018.00015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/16/2018] [Indexed: 11/25/2022] Open
Abstract
Aim The aim of this study was to assess awareness of performance and performance accuracy for a task that requires executive functions (EF), among healthy adolescents and to compare their performance to their parent’s ratings. Method Participants: 109 healthy adolescents (mean age 15.2 ± 1.86 years) completed the Weekly Calendar Planning Activity (WCPA). The discrepancy between self-estimated and actual performance was used to measure the level of awareness. The participants were divided into high and low accuracy groups according to the WCPA accuracy median score. The participants were also divided into high and low awareness groups. A comparison was conducted between groups using WCPA performance and parent ratings on the Behavior Rating Inventory of Executive Function (BRIEF). Results Higher awareness was associated with better EF performance. Participants with high accuracy scores were more likely to show high awareness of performance as compared to participants with low accuracy scores. The high accuracy group had better parental ratings of EF, higher efficiency, followed more rules, and were more aware of their WCPA performance. Conclusion Our results highlight the important contribution that self-awareness of performance may have on the individual’s function. Assessing the level of awareness and providing metacognitive training techniques for those adolescents who are less aware, could support their performance.
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Affiliation(s)
- Sharon Zlotnik
- Laboratory for Innovation in Rehabilitation Technology Israel Center for Research Excellence: LINKS - Learning in a NetworKed Society, Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, United States
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Juengst SB, Terhorst L, Dicianno BE, Niemeier JP, Wagner AK. Development and content validity of the behavioral assessment screening tool (BAST β). Disabil Rehabil 2018; 41:1200-1206. [PMID: 29303003 DOI: 10.1080/09638288.2017.1423403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Develop and establish the content validity of the Behavioral Assessment Screening Tool (BASTβ), a self-reported measure of behavioral and emotional symptoms after traumatic brain injury. METHODS This was an assessment development study, including two focus groups of individuals with traumatic brain injury (n = 11) and their family members (n = 10) and an expert panel evaluation of content validity by experts in traumatic brain injury rehabilitation (n = 7). We developed and assessed the Content Validity Index of the BASTβ. RESULTS The BASTβ initial items (n = 77) corresponded with an established conceptual model of behavioral dysregulation after traumatic brain injury. After expert panel evaluation and focus group feedback, the final BASTβ included 66 items (60 primary, 6 branching logic) rated on a three-level ordinal scale (Never, Sometimes, Always) with reference to the past two weeks, and an Environmental Context checklist including recent major life events (n = 23) and four open-ended questions about environmental factors. The BASTβ had a high Content Validity Index of 89.3%. CONCLUSION The BASTβ is a theoretically grounded, multidimensional self-reported assessment of behavioral dysregulation after traumatic brain injury, with good content validity. Future translation into mobile health modalities could improve effectiveness and efficiency of long-term symptom monitoring post-traumatic brain injury. Future work will establish and validate the factor structure, internal consistency reliabilities and other validities of the BAST. Implications for Rehabilitation Behavioral problems after traumatic brain injury is one of the strongest contributing factors to poor mood and community integration outcomes after injury. Behavior is complex and multidimensional, making it a challenge to measure and to monitor long term. The Behavioral Assessment Screening Tool (BAST) is a patient-oriented outcome assessment developed in collaboration with individuals with traumatic brain injury, their care partners, and experts in the field of traumatic brain injury rehabilitation to be relevant and accessible for adults with traumatic brain injuries. The BAST is a long-term monitoring and screening tool for community-dwelling adults with traumatic brain injuries, to improve identification and management of behavioral and emotional sequelae.
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Affiliation(s)
- Shannon B Juengst
- a Department of Physical Medicine and Rehabilitation , University of Texas Southwestern , Dallas , TX , USA.,b Department of Rehabilitation Counseling , University of Texas Southwestern , Dallas , TX , USA
| | - Lauren Terhorst
- c Department of Occupational Therapy , University of Pittsburgh , Pittsburgh , PA , USA.,d Clinical and Translational Science Institute , University of Pittsburgh , Pittsburgh , PA , USA
| | - Brad E Dicianno
- e Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA.,f Department of Rehabilitation Science and Technology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Janet P Niemeier
- g Department of Physical Medicine and Rehabilitation , Carolinas Medical Center , Charlotte , SC , USA
| | - Amy K Wagner
- f Department of Rehabilitation Science and Technology , University of Pittsburgh , Pittsburgh , PA , USA.,h Center for Neuroscience , University of Pittsburgh , Pittsburgh , PA , USA.,i Safar Center for Resuscitation , University of Pittsburgh , Pittsburgh , PA , USA
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Skidmore ER, Swafford M, Juengst SB, Terhorst L. Self-Awareness and Recovery of Independence With Strategy Training. Am J Occup Ther 2017; 72:7201345010p1-7201345010p5. [PMID: 29280726 DOI: 10.5014/ajot.2018.023556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Poor self-awareness co-occurs with cognitive impairments after stroke and may influence independence in daily activities. Strategy training promotes independence after stroke, but poor awareness may attenuate treatment response. We examined the degree to which awareness status affected changes in independence attributed to strategy training. METHOD We conducted a secondary analysis of 30 participants with cognitive impairments after acute stroke randomized to strategy training or attention control in addition to typical inpatient rehabilitation. We measured awareness with the Self-Awareness of Deficits Interview and independence with the FIM™. Data were analyzed using general linear models. RESULTS Poor awareness attenuated improvements in independence over time, F(3, 55) = 3.04, p = .038. Strategy training promoted greater improvements in independence over time relative to attention control, F(3, 55) = 5.93, p = .002. However, the interaction between awareness and intervention was not significant, F(1, 19) = 0.025, p = .877. CONCLUSION Awareness status may not affect the response to strategy training, indicating that strategy training may benefit people with poor awareness.
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Affiliation(s)
- Elizabeth R Skidmore
- Elizabeth R. Skidmore, PhD, OTR/L, is Professor and Chair, Department of Occupational Therapy and Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA;
| | - Melissa Swafford
- Melissa Swafford, MOT, OTR/L, is K. Leroy Irvis Fellow, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Shannon B Juengst
- Shannon B. Juengst, PhD, CRC, is Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas
| | - Lauren Terhorst
- Lauren Terhorst, PhD, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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Villalobos D, Bilbao Á, Espejo A, García-Pacios J. Efficacy of an intervention programme for rehabilitation of awareness of deficit after acquired brain injury: A pilot study. Brain Inj 2017; 32:158-166. [DOI: 10.1080/02699052.2017.1387931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dolores Villalobos
- Department of Psychology, Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology (Technical University of Madrid and Complutense University of Madrid), Madrid, Spain
| | - Álvaro Bilbao
- National Centre for Brain Injury Treatment (CEADAC), Madrid, Spain
| | - Alfonso Espejo
- Department of Psychology, Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
- National Centre for Brain Injury Treatment (CEADAC), Madrid, Spain
| | - Javier García-Pacios
- Department of Psychology, Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology (Technical University of Madrid and Complutense University of Madrid), Madrid, Spain
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Geytenbeek M, Fleming J, Doig E, Ownsworth T. The occurrence of early impaired self-awareness after traumatic brain injury and its relationship with emotional distress and psychosocial functioning. Brain Inj 2017; 31:1791-1798. [DOI: 10.1080/02699052.2017.1346297] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Megan Geytenbeek
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, The Princess Alexandra Hospital, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, The Princess Alexandra Hospital, Brisbane, Australia
| | - Emmah Doig
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia
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Chesnel C, Jourdan C, Bayen E, Ghout I, Darnoux E, Azerad S, Charanton J, Aegerter P, Pradat-Diehl P, Ruet A, Azouvi P, Vallat-Azouvi C. Self-awareness four years after severe traumatic brain injury: discordance between the patient’s and relative’s complaints. Results from the PariS-TBI study. Clin Rehabil 2017; 32:692-704. [DOI: 10.1177/0269215517734294] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To evaluate the patient’s awareness of his or her difficulties in the chronic phase of severe traumatic brain injury (TBI) and to determine the factors related to poor awareness. Design/Setting/Subjects: This study was part of a larger prospective inception cohort study of patients with severe TBI in the Parisian region (PariS-TBI study). Intervention/Main measures: Evaluation was carried out at four years and included the Brain Injury Complaint Questionnaire (BICoQ) completed by the patient and his or her relative as well as the evaluation of impairments, disability and quality of life. Results: A total of 90 patient-relative pairs were included. Lack of awareness was measured using the unawareness index that corresponded to the number of discordant results between the patient and relative in the direction of under evaluation of difficulties by the patient. The only significant relationship found with lack of awareness was the subjective burden perceived by the relative (Zarit Burden Inventory) ( r = 0.5; P < 0.00001). There was no significant relationship between lack of awareness and injury severity, pre-injury socio-demographic data, cognitive impairments, mood disorders, functional independence (Barthel index), global disability (Glasgow Outcome Scale), return to work at four years or quality of life (Quality Of Life after Brain Injury scale (QOLIBRI)). Conclusion: Lack of awareness four years post severe TBI was not related to the severity of the initial trauma, sociodemographic data, the severity of impairments, limitations of activity and participation, or the patient’s quality of life. However, poor awareness did significantly influence the weight of the burden perceived by the relative.
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Affiliation(s)
- Camille Chesnel
- Service de Médecine Physique et de Réadaptation, APHP – Hôpital Raymond Poincaré, Garches, France
| | - Claire Jourdan
- Service de Médecine Physique et de Réadaptation, APHP – Hôpital Raymond Poincaré, Garches, France
- HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France
| | - Eleonore Bayen
- Laboratoire d’Économie et de Gestion des Organisations de Santé (LEDa-LEGOS), Université Paris-Dauphine, Paris, France
- Université Pierre et Marie Curie, Paris, France
- Service de Médecine Physique et de Réadaptation, APHP – Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Idir Ghout
- Unité de Recherche Clinique (URC), APHP – Hôpital Ambroise Paré, Boulogne, France
| | - Emmanuelle Darnoux
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France
| | - Sylvie Azerad
- Unité de Recherche Clinique (URC), APHP – Hôpital Ambroise Paré, Boulogne, France
| | - James Charanton
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France
| | - Philippe Aegerter
- Unité de Recherche Clinique (URC), APHP – Hôpital Ambroise Paré, Boulogne, France
- UMR-S 1168, Université de Versailles Saint-Quentin, Versailles, France
| | - Pascale Pradat-Diehl
- Université Pierre et Marie Curie, Paris, France
- Service de Médecine Physique et de Réadaptation, APHP – Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Alexis Ruet
- Service de Médecine Physique et de Réadaptation, APHP – Hôpital Raymond Poincaré, Garches, France
| | - Philippe Azouvi
- Service de Médecine Physique et de Réadaptation, APHP – Hôpital Raymond Poincaré, Garches, France
- HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France
| | - Claire Vallat-Azouvi
- HANDIReSP EA 4047, Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France
- Antenne UEROS-SAMSAH92-UGECAM IDF, Hôpital Raymond Poincaré, Garches, France
- EA 2027: Laboratoire de Psychopathologie et Neuropsychologie, Université Paris 8, Saint-Denis, France
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Hellebrekers D, Winkens I, Kruiper S, Van Heugten C. Psychometric properties of the awareness questionnaire, patient competency rating scale and Dysexecutive Questionnaire in patients with acquired brain injury. Brain Inj 2017; 31:1469-1478. [PMID: 28980822 DOI: 10.1080/02699052.2017.1377350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Lack of self-awareness of impairments is common after acquired brain injury (ABI). We evaluated the psychometric properties of three commonly used instruments for measuring self-awareness: Awareness Questionnaire (AQ), Patient Competency Rating Scale (PCRS) and Dysexecutive questionnaire (DEX). METHOD We recruited 105 patients with ABI and their relatives. We determined feasibility, responsiveness, test- retest reliability, internal consistency, and construct validity of AQ, PCRS and DEX. RESULTS No floor or ceiling effects were present. Total scale scores showed sufficient responsiveness: effect sizes were moderate to large (.57-.85); test-retest reliability was sufficient for patient forms (.75- .88) but mixed for relative forms (.60-.66). Internal consistency was good (.80-.89). Construct validity results confirmed a three-factor structured AQ and a four-factor structured PCRS. A two-facture structure was found for DEX patient forms; a three-factor structure was found for relative forms. CONCLUSION Overall, the total scale scores of patient forms of all questionnaires demonstrated sufficient psychometric properties. Psychometric properties of subscales are questionable. We could not replicate the factor structures of AQ, PCRS and DEX: the items within subscales differed with previous findings. Additional research into the test-retest, inter-rater reliability and responsiveness of relative and clinician forms is required.
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Affiliation(s)
- Danique Hellebrekers
- a Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience , Maastricht University Medical Center , Maastricht , the Netherlands
| | - Ieke Winkens
- d Limburg Brain Injury Center , Maastricht University , Maastricht , the Netherlands
| | - Suzanne Kruiper
- c Rehabilitation Research Centre, Reade , Amsterdam , the Netherlands
| | - Caroline Van Heugten
- a Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience , Maastricht University Medical Center , Maastricht , the Netherlands.,b Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience , Maastricht University , Maastricht , the Netherlands.,c Rehabilitation Research Centre, Reade , Amsterdam , the Netherlands
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46
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Raskin SA, Shum DHK, Ellis J, Pereira A, Mills G. A comparison of laboratory, clinical, and self-report measures of prospective memory in healthy adults and individuals with brain injury. J Clin Exp Neuropsychol 2017; 40:423-436. [PMID: 28946819 DOI: 10.1080/13803395.2017.1371280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Individuals with traumatic brain injury (TBI) have demonstrated deficits in prospective memory (PM) functioning when compared to healthy adults. These deficits have been measured using laboratory measures, clinical measures, and self-report questionnaires. However, PM has been shown to involve multiple cognitive processes and have a variety of stages. Thus, it is not known whether these measures all assess the same aspects of PM. Thus, this study was designed to measure the convergent validity of the three types of PM measures in both healthy adults and individuals with TBI. We aimed to investigate the convergent validity of the three types of tasks in two ways. First, we sought to investigate whether the PM deficits experienced by people with TBI are consistent across tasks. Second, we sought to examine the relationship between the three types of tasks. Results demonstrated that while all three types of measures were sensitive to PM deficits in TBI, there were differences in the aspects/processes of PM being measured. Data from the laboratory measure suggested a specific difficulty with detecting the correct cue. Data from the clinical measure suggested that TBI has a greater effect on time-based cues than event-based cues and that the primary deficit is a prospective intention retrieval deficit rather than the retrospective memory component. In addition, those with TBI did not differ from healthy adults when the time delay was short enough, suggesting that PM is not universally impaired. Data from the self-report questionnaire suggested that those with TBI are more sensitive to difficulties with basic activities of daily living rather than instrumental activities on daily living. These results are discussed in terms of rehabilitation techniques that could focus first on cue detection and use basic activities of daily living as outcome measures.
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Affiliation(s)
- Sarah A Raskin
- a Department of Psychology and Neuroscience Program, Trinity College , Hartford , CT , USA
| | - David H K Shum
- b Menzies Health Institute Queensland and School of Applied Psychology, Griffith University , Brisbane, Gold Coast , QL , Australia.,c Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology , Chinese Academy of Sciences , Beijing , China
| | - Judi Ellis
- d Department of Psychology , University of Reading , Reading , UK
| | - Antonia Pereira
- e Department of Psychology , University of Chichester , Chichester , UK
| | - Ginger Mills
- f Department of Clinical Psychology , University of Hartford , Hartford , CT , USA
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Azouvi P, Arnould A, Dromer E, Vallat-Azouvi C. Neuropsychology of traumatic brain injury: An expert overview. Rev Neurol (Paris) 2017; 173:461-472. [PMID: 28847474 DOI: 10.1016/j.neurol.2017.07.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/13/2017] [Indexed: 01/12/2023]
Abstract
Traumatic brain injury (TBI) is a serious healthcare problem, and this report is a selective review of recent findings on the epidemiology, pathophysiology and neuropsychological impairments following TBI. Patients who survive moderate-to-severe TBI frequently suffer from a wide range of cognitive deficits and behavioral changes due to diffuse axonal injury. These deficits include slowed information-processing and impaired long-term memory, attention, working memory, executive function, social cognition and self-awareness. Mental fatigue is frequently also associated and can exacerbate the consequences of neuropsychological deficits. Personality and behavioral changes can include combinations of impulsivity and apathy. Even mild TBI raises specific problems: while most patients recover within a few weeks or months, a minority of patients may suffer from long-lasting symptoms (post-concussion syndrome). The pathophysiology of such persistent problems remains a subject of debate, but seems to be due to both injury-related and non-injury-related factors.
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Affiliation(s)
- P Azouvi
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France.
| | - A Arnould
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France
| | - E Dromer
- Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France
| | - C Vallat-Azouvi
- HANDIReSP EA 4047, université de Versailles Saint-Quentin, 78423 Montigny-Le-Bretonneux, France; Laboratoire de psychopathologie et neuropsychologie, EA 2027, université Paris-8-Saint-Denis, 2, rue de la Liberté, 93526 Saint-Denis, France; Antenne UEROS- UGECAMIDF, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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Harty S, Murphy PR, Robertson IH, O'Connell RG. Parsing the neural signatures of reduced error detection in older age. Neuroimage 2017; 161:43-55. [PMID: 28811254 DOI: 10.1016/j.neuroimage.2017.08.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/04/2017] [Accepted: 08/09/2017] [Indexed: 12/29/2022] Open
Abstract
Recent work has demonstrated that explicit error detection relies on a neural evidence accumulation process that can be traced in the human electroencephalogram (EEG). Here, we sought to establish the impact of natural aging on this process by recording EEG from young (18-35 years) and older adults (65-88 years) during the performance of a Go/No-Go paradigm in which participants were required to overtly signal their errors. Despite performing the task with equivalent accuracy, older adults reported substantially fewer errors, and the timing of their reports were both slower and more variable. These behavioral differences were linked to three key neurophysiological changes reflecting distinct parameters of the error detection decision process: a reduction in medial frontal delta/theta (2-7 Hz) activity, indicating diminished top-down input to the decision process; a slower rate of evidence accumulation as indexed by the rate of rise of a centro-parietal signal, known as the error positivity; and a higher motor execution threshold as indexed by lateralized beta-band (16-30 Hz) activity. Our data provide novel insight into how the natural aging process affects the neural underpinnings of error detection.
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Affiliation(s)
- Siobhán Harty
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland; Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, United Kingdom.
| | - Peter R Murphy
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland; Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ian H Robertson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | - Redmond G O'Connell
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland
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Honan CA, McDonald S, Tate R, Ownsworth T, Togher L, Fleming J, Anderson V, Morgan A, Catroppa C, Douglas J, Francis H, Wearne T, Sigmundsdottir L, Ponsford J. Outcome instruments in moderate-to-severe adult traumatic brain injury: recommendations for use in psychosocial research. Neuropsychol Rehabil 2017; 29:896-916. [DOI: 10.1080/09602011.2017.1339616] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Cynthia A. Honan
- Department of Psychology, School of Medicine, University of Tasmania, Newnham, Australia
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
| | - Skye McDonald
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Robyn Tate
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Studies, Sydney, Australia
| | - Tamara Ownsworth
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Leanne Togher
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Jennifer Fleming
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - Vicki Anderson
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Murdoch Childrens Research Institute, Psychological Sciences & Paediatrics, University of Melbourne, Melbourne, Australia
| | - Angela Morgan
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Murdoch Childrens Research Institute, Centre for Neuroscience of Speech, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Murdoch Childrens Research Institute, Psychological Sciences & Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jacinta Douglas
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Allied Health, Department of Community and Clinical Allied Health, LaTrobe University, Melbourne, Australia
| | - Heather Francis
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Department of Psychology, Faculty of Human Sciences, Macquarie University, Sydney, Australia
| | - Travis Wearne
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Linda Sigmundsdottir
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Studies, Sydney, Australia
| | - Jennie Ponsford
- Moving Ahead Centre for Research Excellence in Brain Recovery, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
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50
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Lloyd O, Ownsworth T, Fleming J, Zimmer-Gembeck MJ. Development and preliminary validation of the Paediatric Awareness Questionnaire for children and adolescents with traumatic brain injury. Child Neuropsychol 2017; 24:702-722. [DOI: 10.1080/09297049.2017.1332173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Owen Lloyd
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children’s Hospital, Children’s Health Queensland, Brisbane, Australia
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Melanie J. Zimmer-Gembeck
- School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Australia
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