Factors predicting rehabilitation outcomes after severe acquired brain injury in trauma, stroke and anoxia populations: A cohort study.

Severe acquired brain injury has long-term physical and cognitive effects. Identifying patient variables predictive of recovery in different brain injury populations would generate improved prognostic information and help rehabilitation teams set appropriate therapeutic goals. This cohort study of 447 NHS neurorehabilitation inpatients aimed to identify functional and cognitive predictors of recovery following severe acquired brain injury caused by trauma, stroke and anoxia. Motor and cognitive impairment ratings were collected at admission and discharge using the Functional Independence Measure and Functional Assessment Measure (FIM+FAM), and injury-related and demographic data were collated from medical records. Predictors of physical, cognitive and overall recovery were identified via hierarchical regression analyses. Several key findings emerged. Firstly, on-admission motor skills predicted functional and overall outcomes across groups. Secondly, on-admission social interaction skills predicted cognitive discharge outcomes in stroke and trauma, and overall outcomes for stroke, but did not predict anoxia outcomes. Thirdly, age predicted all forms of recovery for stroke only. Further group-specific factors were also identified as predicting motor and cognitive recovery, indicating that factors key to the rehabilitation trajectory may differ between populations. These variables should be considered in rehabilitation goal planning, although further research is required to explore their contributions to recovery.

The effects of acculturation on neuropsychological test performance: A systematic literature review.

Objectives: This systematic literature review collated a series of empirical works on the relationship between acculturation and performances on neuropsychological tests commonly used in clinical settings. Acculturation is theorized to influence test performance, but the integration between these two concepts is weak in the theoretical literature. The objective of this review was to synthesize quantitative studies of acculturative effects on neuropsychological test performance to extract common findings.Method: A systematic search strategy was conducted using four databases to find studies using a validated acculturative scale and neuropsychological test(s) that were routinely used in clinical practice. Studies that used statistical methods which accounted or controlled for potential confounding variables were included.Results: Twenty-one studies were included in the review and a majority covered American minority groups, but three studies were conducted outside the US. Scales of acculturation were mostly unidimensional, and most studies adopted a flexible approach to testing. Seven studies did not produce any significant results between acculturation and cognitive test performance.Conclusion: Considerable of heterogeneity among the studies limited efforts to synthesize the data. However, tests of verbal and visuospatial delayed memory were consistently robust against the effects of acculturation. Acculturation however, influenced a variety of verbal and non-verbal tests, but findings were dependent on sample characteristics. There were insufficient data to confirm the clinical utility of acculturation measurement alongside testing. Recommendations for future research were discussed.

A Factor Analysis of Functional Independence and Functional Assessment Measure Scores Among Focal and Diffuse Brain Injury Patients: The Importance of Bifactor Models.

OBJECTIVE: To explore the factor structure of the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM) among focal and diffuse acquired brain injury patients. DESIGN: Criterion standard. SETTING: A National Health Service acute acquired brain injury inpatient rehabilitation hospital. PARTICIPANTS: Referred sample of adults (N=447) admitted for inpatient treatment following an acquired brain injury significant enough to justify intensive inpatient neurorehabilitation INTERVENTION: Not applicable. OUTCOME MEASURE: Functional Independence Measure and Functional Assessment Measure. RESULTS: Exploratory factor analysis suggested a 2-factor structure to FIM+FAM scores, among both focal-proximate and diffuse-proximate acquired brain injury aetiologies. Confirmatory factor analysis suggested a 3-factor bifactor structure presented the best fit of the FIM+FAM score data across both aetiologies. However, across both analyses, a convergence was found towards a general factor, demonstrated by high correlations between factors in the exploratory factor analysis, and by a general factor explaining the majority of the variance in scores on confirmatory factor analysis. CONCLUSIONS: Our findings suggested that although factors describing specific functional domains can be derived from FIM+FAM item scores, there is a convergence towards a single factor describing overall functioning. This single factor informs the specific group factors (eg, motor, psychosocial, and communication function) after brain injury. Further research into the comparative value of the general and group factors as evaluative/prognostic measures is indicated.

Sexuality after stroke: an exploration of current professional approaches, barriers to providing support and future directions.

Purpose Sexual difficulties post-stroke are common, yet frequently neglected within rehabilitation. This study aimed to explore the process by which healthcare professionals approach and work with the topic of sexuality within stroke rehabilitation. Method Ten participants were recruited from 5 community and inpatient multi-disciplinary stroke rehabilitation teams. Semi-structured interviews were carried out and data were analysed using grounded theory methodology. Results The authors developed a theoretical model of how professionals engage with sexual concerns. Professionals' own personal level of comfort with the topic of sexuality interacted with a series of barriers to limit opportunities for engagement. These barriers included factors relating to the context and workplace environment of stroke rehabilitation, professionals' perceptions that they did not have adequate skills in this area and unhelpful attitudes towards stroke survivors and sexuality. Although the majority of participants rarely engaged with sexual issues, they adopted both direct and indirect strategies for engaging with their service users' sexual concerns. Concerns were usually addressed through the provision of information and supportive conversations. Conclusions The findings suggest that sexuality is not a legitimised topic within stroke rehabilitation, and current work practises limit professionals' abilities to address service-users' concerns. Implications for developing effective training and staff support are discussed. Implications for rehabilitation Professionals working within stroke rehabilitation rarely directly bring up sexuality with patients, but an indirect method of approaching the topic is more common. Addressing sexual concerns often does not require expertise. Training should show professionals how to use transferable knowledge to address sexual issues and also enhance communication skills. Sexuality should be incorporated within local stroke policy and procedures, to support professionals in addressing the concerns of their patients and motivate them to act.

Profound anterograde amnesia following routine anesthetic and dental procedure: a new classification of amnesia characterized by intermediate-to-late-stage consolidation failure?

Anterograde amnesia caused by bilateral hippocampal or diencephalon damage manifests in characteristic symptoms of preserved intellect and implicit learning, and short span of awareness with complete and rapid forgetting of episodic material. A new case, WO, 38-year-old male with anterograde amnesia, in the absence of structural brain changes or psychological explanation is presented, along with four comparison cases from the extant literature that share commonalities between them including preserved intellect, span of awareness greater than working memory, and complete forgetting within hours or days following successful learning, including notably for both explicit and implicit material. WO's amnesia onset coincided with anesthetic injection and root canal procedure, with extended vasovagal-like incident. The commonalities between the five cases presented may suggest a shared biological mechanism involving the breakdown of intermediate-to-late-stage consolidation that does not depend on the structural integrity of the hippocampi. Speculation on the mechanism of consolidation breakdown and diagnostic implications are discussed.

Relative contribution of attention and memory toward disorientation or post-traumatic amnesia in an acute brain injury sample.

PRIMARY OBJECTIVE: To examine the relative contribution of attention and memory to orientation/disorientation following moderate-to-severe brain injury. It was hypothesized that attention would be a comparable contributor to orientation, compared to memory; suggesting assessing attention has a role in understanding and estimating duration of post-traumatic amnesia. RESEARCH DESIGN: One hundred and five brain-injured inpatients were divided into three groups of high, moderate or low orientation. ANOVA was run on attention, memory and (as a control) language scores to examine group differences. Correlational analysis was run between orientation items and attention and memory indexes to examine the relative contribution of attention and memory on specific orientation item performance. Multiple regression examined the contribution of memory and attention to being oriented. METHODS AND POCEDURES: Patients' orientation, attention, memory and language were assessed during their inpatient rehabilitation. MAIN OUTCOMES AND RESULTS: Groups differed significantly and attention recovered more sharply between low and moderate orientation states compared to memory and language recovery. Memory contributed most to orientation, followed closely by attention, both surpassing language. Attention most related to temporal estimation, while memory most related to retrieval of well-consolidated memories. CONCLUSIONS: Attention contributes significantly to orientation, although to a slightly lesser degree than memory. Attention should be assessed routinely. The relative 'load' and contribution of attention to orientation and answering orientation-type questions is discussed.

Assessment of rape-supportive attitudes and beliefs in college men: development, reliability, and validity of the rape attitudes and beliefs scale.

Discussed is the development and psychometric analysis of a measure of rape-supportive attitudes and beliefs called the Rape Attitudes and Beliefs Scale (RABS), intended for the use with college men. Items were developed from a literature review of "rape myths" that were correlated to some measure of sexual aggression. An exploratory factor analysis using only male participants revealed five factors: a) justifications for sexual aggression based on women's behavior, b) belief that women should hold more responsibility for sexual assault, peer c) pressure/need for sexual status and misreading women's sexual intent, d) acceptance of the use of alcohol and coercive tactics to acquire sexual compliance, and e) dislike for the feminine and acceptance of traditional gender roles. Initial reliability and validity studies were favorable for the RABS, including evidence that these factors were positively related to measures of sexual aggression. Each factor demonstrated differential power to predict sexual aggression, with justifications being the most powerful. Implications for counseling and education are discussed.

Development of a global curriculum for professional psychology: implications of the Combined-Integrated model of doctoral training.

This article considers the development of a global training curriculum and qualification in professional psychology, with particular emphasis on the Combined-Integrated (C-I) model. The C-I model exposes professional psychology trainees to two or more of the practice areas (i.e., clinical, counseling, school/educational). The authors argue that the C-I approach is one that is well suited to the development of a global training curriculum due to its emphasis on broadly training psychologists as well as its respect for diversity and integration of various theoretical and professional orientations. A survey of training programs in 16 countries/regions on six continents found significant variation in training, minimal qualifications, and roles of the professional psychologist. The authors recommend that an international group of psychologists develop a regionally flexible, but common, training curriculum and qualification that would include a five- to six-year competency-based qualification. Ways in which the C-I training model may serve to integrate and globalize professional psychology are discussed.