Cross-cultural adaptation and validation of the cooking task to the French-Canadian context: assessing the impact of executive function disorders through cooking activities.

BACKGROUND: Acquired brain injury (ABI) often leads to deficits in executive functioning (EF) which is responsible for severe and longstanding disabilities in activities of daily living. The "Cooking Task" (CT), an ecological test of EF involving multi-tasking, was developed in France and exhibits excellent psychometric properties but has not yet been adapted and validated for the French-Canadian context. OBJECTIVES: Conduct a cross-cultural adaptation and validation of the CT for the French-Canadian context. METHODS: The CT was translated and adapted by a committee of experts and was validated. RESULTS: Adaptation-changes were made to the language (e.g., cartable vs classeur), the materials (e.g., measuring cup vs scale), and the measuring units (e.g., ml/cups vs grams). Validation-Preliminary analyses were conducted on 24 participants with an ABI and 17 controls. Construct convergent validity: The French-Canadian-CT discriminates between ABI and control total score on the CT and on most error type categories. Construct known-group validity: French-Canadian-CT scores correlated with another measure of EF deficits (Dysexecutive Questionnaire and Six Elements Task). Inter-rater reliability score for the total error was high (ICC= .84) and results were similar to those obtained for the France-CT. CONTRIBUTIONS: This study will provide a new ecologically valid tool for clinicians in Canada.

Acquired brain injury often leads to deficits in executive functioning which is responsible for severe and longstanding disabilities in activities of daily living.Ecological assessments are used to evaluate the impact of executive function disorders on activities of daily living.The "Cooking Task" (CT), an ecological test of EF involving multi-tasking, exhibits excellent psychometric properties.The adaptation and validation of the Cooking Task in Canadian French will provide a new measurement tool for occupational therapists in Canada (French-speaking OT or French-speaking patient).

Effectiveness of a multidisciplinary rehabilitation program for persons with acquired brain injury and executive dysfunction.

PURPOSE: The purpose of this study is to explore the effects of a multidisciplinary acquired brain injury rehabilitation out-patient program (5 d/week for 7 weeks) on improvements to participants' activity and participation outcomes related to meal preparation and to determine whether gains are maintained at 3 and 6 months post program. METHODS: A single case experimental design with repeated measures pre- and post-intervention with 7 adult participants with ABI and executive dysfunction (4 females, mean age 38 ± 10.1 years) was used. RESULTS: A strong improvement effect between pre and post phases was found for number of errors on the Cooking Task for 6/7 participants; four participants showed significant improvement immediately after the program and at 3 and 6 months post. Six out of seven participants improved significantly on the Instrumental Activities of Daily Living Profile and four participants improved between the post and 6 month follow-up. Four out of seven participants showed significantly improved Life Habits scores pre- versus post-program. CONCLUSIONS: Significant improvements were observed in activity and participation outcomes related to preparing a meal in adults with ABI and executive dysfunction who participated in a 7-week multidisciplinary rehabilitation out-patient program. Treatment gains were maintained for the majority of participants at 3 and 6 months following the program. Implication of Rehabilitation A 7-week multidisciplinary rehabilitation out-patient program appears to improve activities and participation; the effects are sustainable after 6 months. A detailed description of the therapeutic interventions provided during the cooking activity should help clinicians better understand what specific functions are solicited or required during a particular activity. Knowledge from this study may help guide clinicians in their work within this complex area of rehabilitation.

Influence of prefrontal target region on the efficacy of repetitive transcranial magnetic stimulation in patients with medication-resistant depression: a [(18)F]-fluorodeoxyglucose PET and MRI study.

It is currently unknown whether the antidepressant effect of repetitive transcranial magnetic stimulation (rTMS) depends on specific characteristics of the stimulated frontal area, such as metabolic changes. We investigated the effect of high-frequency rTMS, administered over the most hypometabolic prefrontal area in depressed patients in a two-site, double-blind, randomized placebo-controlled add-on study. Forty-eight patients with medication-resistant major depression underwent magnetic resonance imaging and [(18)F]-fluorodeoxyglucose positron emission tomography (PET) in order to determine a target area for rTMS. After randomization to PET-guided (n = 16), standard (n = 18), or sham rTMS (n = 14) conditions, the patients received 10 sessions of 10-Hz rTMS (1600 pulses/session) at 90% motor threshold. Change from baseline in Montgomery-Asberg Depression Rating Scale (MADRS) scores did not differ between PET-guided, standard and sham groups at 2-wk end-point. Exploratory comparison of left PET-guided (n = 9), right PET-guided, standard, and sham rTMS revealed significant effects. The highest improvement in MADRS scores was observed with left PET-guided (60 + or - 31%), significantly superior to sham (30 + or - 37%, p = 0.01) and right-guided (31 + or - 33%, p = 0.02) stimulation. Comparison between left PET-guided and standard rTMS (49 + or - 28%) was not significant (p = 0.12). Comparison between stimulation over dorsolateral prefrontal cortex (BA 9-46), stimulation of other areas, and sham rTMS was statistically significant. Stimulation over BA 9-46 region (n = 15) was superior to sham rTMS (p = 0.02). The results do not support the general hypothesis of increased antidepressant effects of high-frequency rTMS with prefrontal hypometabolism-related PET guidance. Nonetheless, whether metabolism and anatomy characteristics of left frontal area underneath the coil might account for an increase or speeding up of rTMS effects needs further investigation.

Central nervous system involvement in hepatitis C virus cryoglobulinemia vasculitis: a multicenter case-control study using magnetic resonance imaging and neuropsychological tests.

OBJECTIVE: Involvement of the central nervous system (CNS) in patients with hepatitis C virus (HCV) mixed cryoglobulinemia (MC) is rare. The mechanism by which brain lesions are produced is unclear. We investigated these phenomena by clinical evaluation (neuropsychological tests) and cerebral magnetic resonance imaging (MRI) studies in patients with HCV-MC vasculitis. METHODS: This prospective study included 40 patients with MC vasculitis and chronic active HCV infection (HCV RNA+), 11 HCV controls without MC, and 36 healthy controls, matched for sex and age. A battery of 10 standardized neuropsychological tests was administered by one experienced neuropsychiatrist. All patients underwent cerebral MRI investigation. RESULTS: Twenty-four of the 27 (89%) evaluated patients with HCV-MC had a deficiency in one or more of the 10 cognitive domains examined. The most commonly involved domains were those of attention (70%), executive functions (44%), visual construction (37%), and visual spatial functions (33%). The number of impaired cognitive functions was significantly higher in patients with MC vasculitis than in HCV controls (2.18 +/- 1.84 vs 0.87 +/- 3.1; p < 0.05). MRI analysis showed that HCV-MC patients had a higher mean number of total (7.03 +/- 9.9 vs 0.90 +/- 1.81 and 2.03 +/- 3.1; p < 0.05) and periventricular (2.4 +/- 3.0 vs 0.38 +/- 0.5 and 0.8 +/- 1.4; p < 0.05) white matter high intensity signals than HCV controls and healthy controls, respectively. CONCLUSION: The high frequency of impaired cognitive function and the extent of MRI brain abnormalities in patients with HCV-associated mixed cryoglobulinemia vasculitis strongly suggest specific inflammatory involvement of the CNS.

Cerebral anoxia and disability.

OBJECTIVES: To describe the sequelae of cerebral anoxia following out-of-hospital cardiac arrest, to study the functional outcome and to seek a link between the acute stage and the disability. METHOD: A retrospective study was performed. The initial findings and the neurological and neuropsychological status are recorded of 12 patients admitted to the rehabilitation unit for after-effects of cerebral anoxia following out-of-hospital cardiac arrest. RESULTS: After clinical and neuropsychological assessment, all patients displayed cognitive impairment. Two groups of patients appeared: seven patients were severely disabled with a dysexecutive and behavioural frontal lobe syndrome and memory deficit; five out of the seven also presented an extra-pyramidal syndrome; the other five patients presented behavioural dysfunction related to frontal lobe disorder but were independent in daily life activities. No correlation was found between the acute stage data and the outcome. CONCLUSION: Neurological and neuropsychological impairment after cerebral anoxia may be severe but seems difficult to predict. A dysexecutive syndrome was noted in all 12 patients.