The effect of importance level, delay, and rate of forgetting on prose recall in multiple sclerosis.

Memory deficits are frequently seen in patients with multiple sclerosis (MS). The focus of this study was to examine semantic encoding and the rate of forgetting in MS patients. The prose passages of the Wechsler Memory Scale Logical Memory subtest were used to examine MS patients' semantic sensitivity to the idea units of a story. The stories were divided into high, medium, and low idea units, reflecting their overall importance to the meaning of the story. MS patients recalled fewer idea units than controls, but both groups favored the main ideas relative to the nonessential details at both the immediate and delayed recall of the passages. Likewise, MS patients forgot information at a much faster rate than controls. Implications of this faster forgetting rate in MS patients are discussed from an applied setting.

Contribution of functional ratings to prediction of longterm employment outcome after traumatic brain injury.

The present study investigated the contribution of functional ratings to prediction of employment outcome after traumatic brain injury (TBI). Previous studies have suggested that functional ratings obtained at a significant time post-injury can supplement neurologic, pre-injury, neuropsychologic, and other post-injury variables in predicting long-term employment outcome. Functional ratings studied were patients' needs for physical, cognitive, and behavioural supervision. This investigation also addressed the issue of predicting long-term outcome for the select group of TBI patients who receive post-acute brain injury rehabilitation. Subjects were 76 patients with TBI. The mean age (25th, 50th, and 75th percentiles) was 32 (22, 28, 39) years and mean premorbid education level was 13 (12, 12, 14) years. Predictors studied were severity of injury, premorbid education level, pre-injury substance use, and needs for physical, cognitive and behavioural supervision at discharge from post-acute rehabilitation. Supervision needs ratings were obtained an average of 9.6 (4.2, 5.9, 11.2) months post-injury. Productivity status was assessed an average of 22.5 (12.6, 20.7, 30.5) months post-injury and 12.9 (4.9, 12.4, 16.6) months post-discharge from treatment. Spearman correlation coefficients revealed that premorbid educational level, pre-injury substance use, and needs for physical and behavioural supervision were related to long-term functional outcome (p < 0.05). However, multiple logistic regression analysis revealed that only level of pre-injury substance use was predictive of long-term productivity outcome once adjusted for the effects of the other predictors. Patients with no history of pre-injury substance use were more than eight times as likely to be employed at follow-up as those with a history of pre-injury substance abuse (p < 0.01).

Impaired awareness and employment outcome after traumatic brain injury.

Inaccurate self-awareness is a common finding after traumatic brain injury. Such impaired awareness has been hypothesized to limit patients' eventual functional outcomes by decreasing motivation for treatment and resulting in selection of inappropriate long-term goals. Previous investigations of the association between impaired awareness and employment outcome have produced inconsistent results. The present article reviews these studies and presents the results of our new investigation of this issue. In addition, we studied the comparability of two methods of measuring impaired awareness. Results provided strong support for a positive relationship between accurate self-awareness and favorable employment outcome at follow-up.

Prediction of employment outcome one to three years following traumatic brain injury (TBI).

The current study investigated the relationship between age, education (EDUC), pre-injury productivity (PIP), Glasgow Coma Scale score, and a functional rating score at admittance and discharge from rehabilitation (Disability Rating Scale [DRS]) to employment status at one to three years following traumatic brain injury. EDUC, admit DRS, discharge DRS, and PIP all correlated significantly with follow-up employment status, 0.29, -0.32, -0.36, and 0.25 respectively. All possible combinations were then evaluated by Mallow's Cp statistic. The best fitting model was then used in a discriminant function analysis. The discriminant function correctly classified 84% of the employed subjects, 66% of the unemployed, and 75% across both groups. The current results compare favourably with those obtained in previous studies.

The Awareness Questionnaire: factor structure and internal consistency.

Patients with traumatic brain injuries often show impaired awareness of their impairments. This impaired awareness can decrease motivation for treatment and limit eventual functional outcome. The importance of this phenomenon has led to the development of multiple techniques and scales for measuring impaired awareness. The present paper briefly reviews the various methods of operationalizing impaired awareness and describes a new scale (the Awareness Questionnaire) designed to incorporate all these methods. Findings of previous studies supporting the validity of the Awareness Questionnaire are presented. The present investigation examined the factor structure and internal consistency of the Awareness Questionnaire with samples of 126 traumatic brain injury survivors and 75 family members/significant others. Principal components factor analysis with varimax rotation indicated three factors: cognitive, behavioural/affective, and motor/sensory. Investigation of internal consistency (Cronbach Coefficient Alpha) in both the patient and family sample yielded satisfactory results. These findings are supportive of continued use and investigation of the Awareness Questionnaire.

Assessment and treatment of impaired awareness after brain injury: implications for community re-integration.

Impaired self-awareness of deficits is a common finding in patients who have suffered traumatic brain injury. Impaired awareness can limit motivation for treatment and contribute to poor outcome. Consequently, it is important for brain injury rehabilitation professionals to understand this phenomenon and utilize treatment approaches that may improve patient awareness. The present article reviews the existing literature on measurement of impaired awareness, characteristics of impaired awareness, the relationship of impaired awareness to functional outcome, possible treatment approaches for impaired awareness and empirical investigations of interventions to improve awareness. The treatment strategies we use to address impaired awareness in our community re-integration program for brain injury survivors are described in detail. These approaches include: establishment of the therapeutic alliance, family interventions, peer feedback, education, roleplaying, videotape feedback, real world experiences, therapeutic milieu and psychotherapy.

Efficacy of postacute brain injury rehabilitation for patients with primary malignant brain tumors.

BACKGROUND: Patients with primary malignant brain tumors (PMBT) often have neurobehavioral deficits due to the tumor, subsequent surgery, and therapies that interfere with their ability to live independently or work. Previous studies have shown that such patients generally have a progressive decline in functioning from diagnosis to death. Consequently, PMBT patients have not been considered good candidates for rehabilitation services. The current study is a preliminary, retrospective investigation of the effectiveness of postacute brain injury rehabilitation methods, originally developed for traumatic brain injury survivors, in a sample of patients with PMBT. METHODS: The subjects were 13 patients with a history of surgical resection of PMBT and subsequent radiation and chemotherapy. There were 8 males and 5 females with a mean age of 34.3 +/- 10.0 years and a mean educational level of 15.1 +/- 1.7 years. Mean time from tumor diagnosis to the commencement of rehabilitation was 75.4 +/- 87.9 months. All patients had cognitive deficits documented with neuropsychologic tests. Patients received an average of 2.6 +/- 1.9 months of postacute brain injury rehabilitation. RESULTS: Six patients had increased independence during the time from the start of rehabilitation to discharge, six were unchanged, and one patient had decreased independence. Eight patients had increased productivity during the same time period, four were unchanged, and one had decreased productivity. Treatment gains were maintained at follow-up 8.0 +/- 7.6 months after discharge. CONCLUSIONS: The results of the current study offer preliminary support for the effectiveness of postacute brain injury rehabilitation in the management of PMBT patients. Although additional investigation is needed, such treatment appears to be an attractive, relatively low cost option for these patients.

Failure of posttrial administration of vasopressin analogue (DDAVP) to influence memory in healthy, young, male volunteers.

The effects of intranasal treatment with DDAVP on healthy, male volunteers was assessed. Subjects were asked to learn prose passages and then were given either 60 micrograms of DDAVP or saline in a double-blind procedure. Subjects were then asked to recall the passages after a 24-h delay. Treatment had no effect on recall of passages. This suggests that treatment with vasopressin affects acquisition rather than consolidation of newly learned information.

Vasopressin analogue (DDAVP) facilitates recall of narrative prose.

The effects of treatment with 1-desamino-D-arginine vasopressin (DDAVP) on memory in healthy adult human subjects were investigated. Each subject (males only) received 60 micrograms of DDAVP intranasally and then heard six narrative passages of prose presented at differing rates of presentation. Proportion of recall was measured at high, medium, and low levels of importance of idea units within the passage. The results indicated that treatment with DDAVP facilitated recall for both high and medium importance idea units. There was no interaction between treatment and either rate of presentation or level of verbal ability. These findings provide further evidence for the modest facilitation provided by acute administration of DDAVP on human memory.