Education, training, and practice among nordic neuropsychologists. Results from a professional practices survey.

OBJECTIVE: To investigate sociodemographic characteristics, clinical and academic training, work setting and salary, clinical activities, and salary and job satisfaction among practicing neuropsychologists in four Nordic countries. METHODS: 890 neuropsychologists from Denmark, Finland, Norway, and Sweden participated in an internet-based survey between December 2013 and June 2015. RESULTS: Three-fourths (76%) of the participants were women, with a mean age of 47 years (range 24-79). In the total sample, 11% earned a PhD and 42% were approved as specialists in neuropsychology (equivalent to board certification in the U.S.). Approximately 72% worked full-time, and only 1% were unemployed. Of the participants, 66% worked in a hospital setting, and 93% had conducted neuropsychological assessments during the last year. Attention deficit hyperactivity disorder, learning disability, and intellectual disability were the most common conditions seen by neuropsychologists. A mean income of 53,277 Euros was found. Neuropsychologists expressed greater job satisfaction than income satisfaction. Significant differences were found between the Nordic countries. Finnish neuropsychologists were younger and worked more hours every week. Fewer Swedish neuropsychologists had obtained specialist approval and fewer worked full-time in neuropsychology positions. Danish and Norwegian neuropsychologists earned more money than their Nordic colleagues. CONCLUSION: This is the first professional practice survey of Nordic neuropsychologists to provide information about sociodemographic characteristics and work setting factors. Despite the well-established guidelines for academic and clinical education, there are relevant differences between the Nordic countries. The results of the study offer guidance for refining the development of organized and highly functioning neuropsychological specialty practices in Nordic countries.

The Clinical Diagnostic Utility of Electrophysiological Techniques in Assessment of Patients With Disorders of Consciousness Following Acquired Brain Injury: A Systematic Review.

OBJECTIVE: To investigate the diagnostic utility of electrophysiological recordings during active cognitive tasks in detecting residual cognitive capacities in patients with disorders of consciousness (DoC) after severe acquired brain injury. DESIGN: Systematic review of empirical research in MEDLINE, Embase, PsycINFO, and Cochrane from January 2002 to March 2016. MAIN MEASURES: Data extracted included sample size, type of electrophysiological technique and task design, rate of cognitive responders, false negatives and positives, and excluded subjects from the study analysis. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used for quality appraisal of the retrieved literature. RESULTS: Twenty-four studies examining electrophysiological signs of command-following in patients with DoC were identified. Sensitivity rates in healthy controls demonstrated variable accuracy across the studies, ranging from 71% to 100%. In patients with DoC, specificity and sensitivity rates varied in the included studies, ranging from 0% to 100%. Pronounced heterogeneity was found between studies regarding methodological approaches, task design, and procedures of analysis, rendering comparison between studies challenging. CONCLUSION: We are still far from establishing precise recommendations for standardized electrophysiological diagnostic procedures in DoC, but electrophysiological methods may add supplemental diagnostic information of covert cognition in some patients with DoC.

Identifying longitudinal trajectories of emotional distress symptoms 5 years after traumatic brain injury.

PRIMARY OBJECTIVE: To evaluate longitudinal trajectories of emotional distress symptoms after traumatic brain injury (TBI). RESEARCH DESIGN: Longitudinal study. METHODS AND PROCEDURES: Patients with mild-to-severe TBI, 118 patients participated at 3 months, 109 attended at 1-year and 89 attended the 5-year follow-up. Emotional distress was measured with the Impact of Event Scale-Revised. Patients were also assessed for coping style, anxiety, depression, substance abuse and trauma severity. MAIN OUTCOMES AND RESULTS: Based on growth mixture modelling, four trajectories of emotional distress symptoms were identified: 73.5% of patients were characterized by a pattern of resilience, 6.8% by a pattern of delayed distress, 14.6% by recovery and 5.1% by chronic distress. Relative to the resilience trajectory, avoidant-coping style and psychiatric problems were related to recovery and chronic trajectories. The delayed trajectory was similar to the resilience trajectory, except for elevated depressive and anxiety symptoms at 1- and 5-years. Demographics and injury-related variables were not significantly associated with emotional distress trajectories. CONCLUSIONS: Resilience was the most common trajectory following TBI. Patients characterized by recovery and chronic trajectories required attention and long-term clinical monitoring of their symptoms. Future research would benefit from longitudinal studies to analyse emotional distress symptoms and the strength of resilience over time.

Predicting the long-term impact of acquired severe injuries on functional health status: the role of optimism, emotional distress and pain.

STUDY DESIGN: Longitudinal. OBJECTIVE: To investigate the relative importance of personality traits, emotional distress and pain as predictors of functional health status in patients with spinal cord injury (SCI) or multiple traumas (MTs). SETTING: Sunnaas Rehabilitation Hospital, Norway. METHODS: Data were obtained from SCI and MT patients at admission (n=101) and at discharge (n=87) from rehabilitation, as well as 4 years post injury (n=75). The primary outcome measure was the sickness impact profile (SIP). Personality traits, that is, dispositional optimism and positive/negative affectivity, were measured using the Life Orientation Test-Revised and the Positive Affect and Negative Affect Schedule, respectively. RESULTS: Using hierarchical regression analysis, dispositional optimism and pain emerged as the most robust predictors of functional health status. Generally, these two variables accounted for a substantial part of the variance (that is, 20-40%) in the SIP scales. Significant correlations between pain and anxiety/depression were found in all phases of the study, and at follow-up depression level appeared as an independent predictor of functional health. CONCLUSION: The substantial predictive power, in terms of explained variance, of dispositional optimism, pain and depression/anxiety, indicates that these variables may be of practical-clinical importance in a rehabilitation setting. Specifically, patients characterized by low optimism, combined with presence of pain and depression/anxiety, may constitute a high-risk group for disability and reduced quality of life. On the other hand, high optimism should be regarded as a resilience characteristic, protecting the individual against long-term sequelae of severe physical injury.

Fatigue in polio survivors.

OBJECTIVES: Fatigue is commonly reported among polio survivors. The aims of the present study were to examine the incidence of perceived fatigue among a sample of Norwegian polio survivors, and to examine the association between the level of fatigue and sociodemographic and health variables. MATERIALS AND METHODS: A mailed questionnaire containing, among others, Fatigue Questionnaire, Fatigue Severity Scale, sociodemographic and health variables were sent to a representative group of 312 Norwegian polio survivors. 276 subjects (88%) answered the questionnaire. RESULTS: The incidence of fatigue among the polio survivors were considerably higher than in the normative data. Physical fatigue, more than mental fatigue, represented the major problems. Polio subjects who reported severe fatigue had significantly more other diseases and health problems than the normative group. CONCLUSIONS: The diagnosis and treatment of other or related physical conditions should be given higher priority in the management of persons with late effects of poliomyelitis, as these conditions probably can be the reasons for fatigue more than poliomyelitis sequelae alone.

[Severely injured patients after the initial phase--vegetative state or remaining cognitive functions?]. / Store hjerneskader etter akuttfasen--vegetativ fungering eller bevarte kognitive funksjoner?

BACKGROUND: We wanted to quantify improvements in the subacute rehabilitation phase in patients with severe brain injuries classified as vegetative or minimal brain consciousness. MATERIAL AND METHODS: Five patients were studied during a 12 months period using a method called Coma Recovery Scale (CRS) as described by Giacino et al. (1991). The parameters measured included visual and hearing functions, motor functioning, oromotor/verbal function, communication, and arousal. The observations of the patients and commandos given were standardised in a manual, and the responses achieved from the patients were recorded according to a scale for each parameter. RESULTS: This procedure for measuring closely the progress over time in these severely brain injured patients, was used for planning a realistic rehabilitation program. It was found to be very practical in communication with relatives of the patients and with the other therapists involved. INTERPRETATION: By decomposing the cognitive functions by this method using all the available possibilities for inputs, even minimal improvement in the cognitive functions mentioned could be uncovered and recorded.

Comprehensive driving assessment: neuropsychological testing and on-road evaluation of brain injured patients.

The study investigates the correspondence between neuropsychological test results and on-road driving performance among 55 patients with a CT-verified brain damage or documented neurological disorder (cerebrovascular accident: 43, traumatic brain injury: 5, multiple sclerosis: 4, other: 3). 5 patients showed unimpaired test profiles and passed the on-road evaluation. 18 patients showed severe neuropsychological deficits contrary to driving and were not recommended for on-road evaluation. Of the remaining 32 patients with some neuropsychological deficits, all 100% in the minor impaired group (n = 8) passed the driving evaluation, compared to 69% in the mildly impaired (n = 16) and 38% in the moderately impaired group (n = 8). Measures of reduced visuoconstructive ability, reaction time, visual attention, and awareness of cognitive impairments, were found to discriminate between groups. It is concluded that neuropsychological assessment of targeted functions provide an ecological valid prediction of driving skill after brain damage, but that on-road evaluation is needed as supplement in cases with ambiguous test findings.

[Automobile driving after a brain injury]. / Bilkjøring etter hjerneskade.

BACKGROUND: Little is known about driving fitness after brain damage. MATERIAL AND METHODS: The present study describes 62 brain injured patients, 36 with cerebral vascular accidents, 15 with traumatic brain injuries, and 11 with other neurological diseases, mean age 50 years, who after thorough assessment had been found fit enough for driving a car. 15 months later they were sent a questionnaire about their driving behaviour and skills. RESULTS: A higher number of traffic incidents were found after brain injury, but the difference was not significant. Patients with traumatic brain injury had a significantly higher number of traffic incidents post-injury than patients with stroke. A majority of those involved in incidents were young males with traumatic brain injury, who had deficits in cognitive executive functions. INTERPRETATION: Patients with traumatic brain injuries seem to need special attention when assessed for driving. Time to follow-up is too short for the results to be conclusive for the whole material of brain-injured patients. Further studies should be conducted.

The Norwegian Polio Study 1994 part II: early experiences of polio and later psychosocial well-being.

STUDY DESIGN: The Norwegian Polio Study 1994 was a nation-wide survey of the medical and psychosocial situation of polio survivors. METHOD: A questionnaire, consisting of 133 questions with sub-questions, was sent to a total of 2392 polio victims, most of them registered in 'The National Society of Polio Victims' in Norway. 1449 (61%) answered. OBJECTIVES: To investigate the relationship between early polio experiences, such as duration of hospitalization and perceived support, and later psychosocial well-being. RESULTS: Three hundred and ninety-one persons (27%) reported they had been psychologically harmed by the treatment received at the time they contracted polio (Harmed group), while 1053 persons (73%) did not (Non-Harmed group). Persons in the Harmed group were significantly younger at polio onset, were hospitalized for a longer period and had less parental visit and support. Today they use more medication, report more pain, general fatigue, sleep disturbance and concentration problems, more psychosocial distress, less satisfaction with life and less social support than persons in the Non-Harmed group. CONCLUSIONS: The results demonstrate that a subgroup of polio survivors has been vulnerable from childhood, with possible consequences for their physical, psychological and social wellbeing later in life. Recommendations for long-life treatment of children with similar diseases should include follow-up not only of their physical disabilities, but also on psychological and psychosocial needs.

[Assessment of cognitive suitability to drive after brain injury]. / Vurdering av kognitiv egnethet for bilkjøring etter hjerneskade.

There is an increasing interest in methods for assessing fitness to hold a driver's licence among patients with traumatic brain injury, cerebrovascular accidents and other central nervous system diseases which present cognitive impairments. This article describes a multimodal approach including medical, neuropsychological and open-road evaluations. We also present a study of 135 patients with cognitive deficits, 29 females and 106 males, mean age 48. Data from neuropsychological assessments are compared to scores on the Mini Mental State Examination and to results from the open-road tests. We recommend that patients with Mini Mental State scores > 20 are referred for further neuropsychological assessments, while patients with scores < 20 are usually unfit for driving. We regard the Mini Mental State Examination as unsuited for patients with aphasia. Our recommendation is that patients who present a complicated picture are referred to regional interdisciplinary centres.

Psychological distress, social support and coping behaviour among polio survivors: a 5-year perspective on 63 polio patients.

The aim of the study was to seek knowledge of psychological and psychosocial aspects of coping with late effects of polio. Sixty-three polio survivors, 43 women and 20 men (mean age 55.3 years) 3-5 years ago former inpatients at the Post-Polio Program at Sunnaas Rehabilitation Hospital, participated in the study. In addition to a semi-structured interview-guide, the Hospital Anxiety and Depression scale (HAD), the Sickness Impact Profile (SIP), Cope-Scale, Brief Type-A Questionnaire (BTAQ) and the Fatigue Severity Scale (FSS) were used. As a measure of physical status, we used working capacity defined as peak O2 (oxygen) uptake. Levels of working capacity did not correlate significantly with any psychological variables, and the subjects reporting improved psychological health over the last 3-5 years did not have higher levels of working capacity or less physical decrement. A significant correlation was found between self-reported fatigue. psychological variables and social support. Compared to previous studies, low psychological distress, normal type-A scores, high adjustment and problem-focused coping characterized the respondents, pointing to the importance of timing in psychosocial research of post-polio.

[Multiple sclerosis and prerequisites for driver's licence. A retrospective study of 33 patients with multiple sclerosis assessed at Sunnaas hospital]. / Multippel sklerose og egnethet for bilkjøring. Retrospektiv undersøkelse av 33 multippel sklerose-pasienter sertifikatvurdert ved Sunnaas sykehus.

There is increasing interest in assessing the prerequisites for a driver's licence among patients with traumatic brain injury, cerebrovascular accidents and other diseases of the central nervous system which cause cognitive impairments. In the present study, 33 patients with multiple sclerosis, 20 females and 13 males of mean age 43 years, were medically and neuropsychologically examined, and some were assessed in a practical driving test. In total, 19 patients were allowed to drive and 14 were refused. Regression analysis showed that, when deciding for or against driving, cognitive and emotional deficits were given more weight than duration of illness and degree of neurologic deficit. The authors discuss guidelines for assessing the prerequisites for a driver's licence among patients with multiple sclerosis, and indicators for when assessment is warranted.