Strategic sequence planning and prospective memory impairments in frontally lesioned head trauma patients performing activities of daily living

The aim of this research was to study strategic sequence planning and prospective memory in activities of daily living (ADL) in 10 patients with frontal lobe lesions after a mild to moderate closed head injury (CHI). The lesions were documented radiologically. The CHI patients were compared to 12 normal controls with a neuropsychological test battery and a realistic simulation of complex multitask ADL (planning and preparing a meal). Though the CHI patients were significantly slow on one test and subject to interference on an attention test, they manifested no basic executive or memory deficit on the paper-pencil tests. However, the CHI patients manifested marked anomalies in the organization of behavior in the meal preparation task. While small sequences of actions were easily produced, large action sets could not be correctly executed. An outstanding difficulty in strategic planning and prospective memory, particularly time-based more than event-based, appears to be an important underpinning of the impairment of ADL observed in the CHI patients with frontal lobe lesions.     

Personality assessment in neuropsychology: the nonspecificity of MMPI-2 neurocorrection methods

Three established methods of neurocorrection claim to improve Minnesota Multiphasic Personality Inventory (MMPI)/MMPI-2 validity with closed-head injury (CHI) patients. These methods (which suggest removing "neurological" items from scoring) were employed here comparing 35 CHI patients with 35 psychiatric patients with elevated profiles. The 14-item correction changed 2-point codes for 41% of CHI and 31% of psychiatric profiles, the 30-item system changed 77% of CHI and 71% of psychiatric profiles, whereas the 37-item system changed 80% of CHI and 71% of psychiatric profiles. There were no significant differences between the two groups in number of profiles changed or number of neurocorrective items endorsed. Using each of the three correction systems, the following percentage of profiles remained elevated: 99%, 87%, and 89%, respectively.     

Sensitivity and specificity of MMPI-2 neurologic correction factors: receiver operating characteristic analysis

A number of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) items have been hypothesized to reflect neurologic symptomatology, rather than psychopathology, among closed-head-injury (CHI) patients. Some investigators have proposed a correction factor interpretive approach, which involves the deletion of such items from the MMPI-2 profile, as a method of reducing the probability of artificial clinical scale elevations due to the symptoms of CHI. The present study employed receiver operating characteristic (ROC) analysis to evaluate the sensitivity and specificity of three correction factors. All three factors demonstrated strong sensitivity when discriminating CHI patients from normal individuals but demonstrated poor specificity when discriminating CHI patients from psychiatric patients. These findings suggest that caution should be applied in using MMPI-2 neurologic correction factors, particularly with patients who might have comorbid psychiatric conditions.     

Impaired skill learning in patients with severe closed-head injury as demonstrated by the serial reaction time (SRT) task

A group of 20 patients who sustained closed-head injury (CHI) and a matched control group of 20 individuals were tested on the serial reaction time (SRT) task. Three different sequence-learning measures were generated from the task: two implicit and one explicit. The two implicit sequence-learning measures include: (1) the learning rate on the first five blocks of the repeated sequence, assumed to reflect primarily general reaction time learning, and (2) the difference between the fifth block of the repeated sequence and the sixth block, a random sequence that reflects implicit sequence-specific learning. In addition, an explicit measure of sequence learning was generated. The results indicate that the CHI group was impaired on the explicit measure of sequence learning. The groups did not differ on general reaction time learning, one of the implicit measures of sequence learning. However, the control group was superior to the CHI group in learning the specific sequence repeated in the SRT task. This pattern of results is unique to the CHI group, corresponding with neither that of amnesic patients nor with that of patients with dysfunction of the basal ganglia (i.e., Parkinson's diseases).     

Assessment of visual-spatial deficits in patients with Parkinson's disease and closed head injuries using virtual environments.

Cognitive spatial deficits have been reliably reported in patients with Closed Head Injury (CHI), though in patients with Parkinson's disease (PD) the phenomenon is disputed. CHI and non-demented PD patients were tested using a Judgement of Line Orientation Test, and two spatial tests using virtual environments (VEs). Performance on the Line Orientation and one VE test was worse in the CHI group than controls, but PD patients showed no apparent spatial deficits. However, performance on the second VE test (virtual tray of objects task) did reveal a deficit, both CHI and PD groups being significantly impaired. The data illustrate that particular spatial deficits can be differentiated using appropriate VE-based tasks, and that non-demented PD patients show a paradigm-specific visual-spatial impairment.     

Understanding text after severe closed-head injury: assessing inferences and memory operations with a think-aloud procedure

A think-aloud method was used to examine the content of information available to working memory during narrative comprehension in a CHI population. Twenty severe CHI participants (>1 year post-injury) and 20 controls talked aloud after they read each sentence of story narratives. Trabasso and Magliano's (1996a) verbal protocol analysis was then used to code for the production of inferential and non-inferential clauses and the memory operations that supported inferential clause production. We found that CHI and control groups produced a comparable number of clauses, that inferences dominated narrative comprehension, and that both groups produced more explanatory inferences than predictive or associative inferences. Despite these qualitative similarities, the CHI group demonstrated poorer comprehension, generated proportionately fewer inferences, relied less on retrieval as a memory source for explanatory inferences, and produced more non-inferential clauses and associative inferences.     

Divided attention years after severe closed head injury: the effect of dependencies between the subtasks

Lesions of white matter which connects distant brain areas are characteristic for closed head injury (CHI). It was predicted that this impairs divided attention only if dependent subtasks are used which require communication between corresponding brain processes. Fourteen chronic severe CHI patients (mean age 42 years) and 14 healthy controls, matched on age, gender, and education, participated in an experiment on divided attention. A typical left hemisphere task and a typical right hemisphere task must be simultaneously performed in a condition where they are completely independent and in conditions with dependencies between the tasks. Only in the dependent conditions the CHI group showed poor divided attention performance.     

The use of virtual environments for survey spatial ability evaluation in topographical disorientation

Due to their interactivity and to the sense of presence they afford, virtual environments constitute an interesting opportunity to study spatial cognition. In accordance with this perspective, we aimed to introduce a spatial test in virtual simulation in order to investigate the survey spatial ability in patients with topographical disorientation. To do this, we used the "planning in advance task" in a virtual environment that constitutes an effective procedure to experimentally evaluate survey maps. With this procedure we present the single case of a woman, with a right medial temporal lobe lesion, who shows a selective impairment in the acquisition of new spatial relationships. The patient's performance in "planning in advance task" was compared with that of a control group made up of 40 female subjects matched for age and education. Results show how the patient revealed a significantly lower spatial performance when compared to the control group, demonstrating an inability to solve survey-type spatial tasks in complex virtual environments.     

Understanding of literal truth, ironic criticism, and deceptive praise following childhood head injury.

Children with closed head injury (CHI) have semantic-pragmatic language problems that include difficulty in understanding and producing both literal and nonliteral statements. For example, they are relatively insensitive to some of the social messages in nonstandard communication as well as to words that code distinctions among mental states. This suggests that they may have difficulty with comprehension tasks involving first- and second-order intentionality, such as those involved in understanding irony and deception. We studied how 6- to 15-year-old children, typically developing or with CHI, interpret scenarios involving literal truth, ironic criticism, and deceptive praise. Children with severe CHI had overall poorer mastery of the task. Even mild CHI impaired the ability to understand the intentionality underlying deceptive praise. CHI, especially biologically significant CHI, appears to place children at risk for failure to understand language as externalized thought.     

Rehabilitation of executive deficits in closed head injury and anterior communicating artery aneurysm patients

This paper reports a study that was aimed to rehabilitate executive functions in closed head injury (CHI) and anterior communicating artery (ACoA) aneurysm patients. The groups tested comprised 10 CHI patients, 9 ACoA aneurysm patients and 19 controls. We employed a dual-task paradigm that is known to tap the ability to co-ordinate two actions. The treatment consisted of five experimental sessions, in which the dual-task paradigm was used. In the CHI study, the dual-task cost was measured before the treatment (assessment), immediately after the treatment (retest), and 3 months after the treatment (follow-up). In the ACoA aneurysm study, the dual-task cost was also assessed 12 months after the treatment. A significant reduction of the dual-task cost from assessment to retest was found. This reduction remained stable in the follow-up sessions. The results are discussed with reference to the absence of spontaneous recovery of this specific executive function and to the possibility that the beneficial effect of the treatment generalises to other executive functions and/or daily living activities. Received: 31 March 1999 / Accepted: 23 July 1999     

A neuropsychological assessment of dual-task costs in closed-head injury patients using Cohen’s effect size estimation method

A test of whether patients suffering from a severe closed-head injury (CHI) were affected by disproportionate dual-task costs compared to those of healthy control participants was carried out through a direct comparison of CHI effects on dual-task (psychological refractory period, or PRP) performance and on single-task performance. In the dual-task condition of the present experiment, independent choice-responses were required to two sequential stimuli presented at a variable stimulus onset asynchrony (SOA). A significant delay of the reaction time (RT) to the second stimulus was reported by both CHI patients and controls at short (SOA) compared to long SOA, i.e., a PRP effect. The PRP effect was more pronounced for CHI patients than controls. In the single-task condition, a single choice-response was required to a stimulus presented in isolation. The RT produced by CHI patients in the single-task paradigm was longer than the RT produced by controls. CHI effects on dual-task performance and on single-task performance were compared following (1) their transformation into Cohen’s ds, and (2) the application of a correction algorithm taking into account the different reliability of single-task and dual-task measures. The analysis of Cohen’s ds revealed that CHI effects on performance were, if anything, smaller in the dual-task condition than in the single-task condition. The results imply that CHI patient’s slower responding in single- and dual-task performance reflects a single common cause—slowing of the central processing.     

Construct Validity of Concepts of Attention in Healthy Controls and Patients with CHI

The present study aimed to examine the construct validity of three aspects of attention, namely focused, divided, and supervisory control of attention. Factor-analytic techniques were applied to scores of healthy subjects on a series of neuropsychological tests tapping these aspects of attention. The two components found did not match the hypothesized aspects and were labeled as Memory-driven Action and Stimulus-driven Reaction. The second question was whether the same components could be found in a group of patients with CHI. The pattern of attentional functions found in healthy subjects had changed qualitatively in patients with CHI. A possible explanation for this result in terms of a shift from automatic to controlled processing is discussed.     

Attentional deficits in head-injured children: An information processing analysis

Attentional problems of closed head-injured (CHI) children were examined using an information processing (IP) approach. Based on Sternberg's (1969) additive factor method (AFM), the study examined attentional processes in terms of four stages and their corresponding task variables. A visual-spatial choice reaction-time task was undertaken with two groups of CHI children (severe and mild to moderate) and corresponding matched control groups. Results indicated that for this task both the CHI and the normal children exhibited a similar mode of linear, sequential information processing. It was found that the severe group was impaired not only in terms of slowed motor execution but also in terms of response selection. This group showed no impairment on the feature extraction, stimulus identification, and motor adjustment stages of processing. No evidence of impairment on any of the stages was found for the mild group. The utility of the AFM and implications of these findings are discussed with reference to CHI children and to neuropsychological assessment and rehabilitation.     

Speed of processing within semantic memory following severe closed head injury.

This study investigated the effects of severe closed head injury (CHI) on the speed of information processing within semantic categories. The question of whether subjects were able to benefit from priming was also investigated. Survivors of severe CHI who were less than 1 year postinjury and survivors who were greater than 1 year postinjury were compared with neurologically normal matched controls utilizing a category judgement task. The results demonstrated slower processing within semantic memory for both groups of CHI patients compared to normal controls. Furthermore, individuals with CHI were able to benefit from priming to the same relative degree as control subjects. Overall, the results suggested semantic organization remains intact after severe CHI, but accessing semantic information is slowed.     

Dyadische Planungsintervention nach Prostatektomie

Background

Prostate cancer is one of the most prevalent forms of cancer in men. One treatment for localized prostate cancer is radical prostatectomy. Patients and partners have to deal with stressors associated with the diagnosis, the surgery and its consequences (e.g. incontinence). Dyadic planning prepares for the coping process with illness consequences in order to enhance self-regulation and reduce anxiety. Dyadic planning means generating plans together with a partner specifying when, where and how the target person wants to initiate a health behavior.

Patients and methods

In this longitudinal randomized controlled trial (RCT) 112 prostatectomy patients and their spouses were invited to participate in a dyadic planning intervention. Participants were randomly allocated to a dyadic pelvic floor exercise (pfe) planning group or one of three control groups (i.e., individual pfe planning, dyadic or individual nutrition planning). Patients and partners received questionnaires at baseline, 2 weeks and 6 months after surgery.

Results

Patients in the dyadic pfe planning group reported higher dyadic pfe planning 2 weeks after surgery than patients in the nutrition planning groups. No such differential effects were found in partners. Additionally, there were no group differences in patient reports on anxiety 6 months after surgery, whereas partners in the dyadic pfe planning group reported lower anxiety levels compared to partners in the individual pfe planning group. Self-reported pfe planning did not, however, mediate the effects of the intervention on partners?? anxiety.

Conclusion

Economical dyadic planning interventions may not only support change of health-relevant behaviour in target persons but also emotional adjustment of their partners.     

Attributions of behavior in the pediatric mild closed head injury (CHI) population

Forty-one children between the ages of 6 and 11 years with a history of a mild closed head injury and 23 age-, gender-, and IQ-matched typically developing control children participated. All of the children in the CHI sample were referred for a magnetic resonance imaging (MRI) scan at 3 months post-injury and children in the CHI sample were further divided into MRI-Negative (n=31) and MRI-Positive (n=10) conditions according to the MRI results. Parents and teachers completed behavioral checklists at three points, including just prior to the MRI and 6 months post-injury. Prior to the MRI (Time 2), in both samples of children with a CHI, parents reported an increase in externalizing symptoms after the CHI. At 6 months post-injury (Time 3: post-MRI), parents of children in the MRI-Positive group did not report any significant changes in their child's externalizing behaviors when compared with pre-MRI, yet parents of children in the MRI-Negative group reported a further increase in externalizing behaviors. Parent attributions also changed as a function of group membership; whereas no changes were noted in the other two groups, parents of children in the MRI-Negative sample ascribed more controllability at Time 3 when compared with Time 2.     

Social cognition after head injury: sarcasm and theory of mind

Closed head injury (CHI) is associated with communication difficulties in everyday social interactions. Previous work has reported impaired comprehension of sarcasm, using sarcastic remarks where the intended meaning is the opposite of the sincere or literal meaning. Participants with CHI in the present study were assessed using two types of sarcastic items, those with a directly opposite meaning and those with an indirect, non-literal but not directly opposite meaning. The CHI group was differentially poorer at comprehending sarcastic versus sincere remarks, although type of sarcastic materials did not influence performance. Errors involved not only literal interpretations, but also incorrect non-literal interpretations. Theory of mind (mentalising) was also assessed by comparing comprehension of human actions with control physical events. The CHI group was selectively impaired on the mentalising component of this task, and mentalising scores correlated with sarcasm comprehension. The implications of the findings for our understanding of impaired sarcastic comprehension after acquired brain injury are discussed.     

Discourse after Closed Head Injury in Young Children

This study examined narrative discourse in 23 children, ages 6 to 8 years, who sustained a severe closed head injury (CHI) at least 1 year prior to assessment. Narratives were analyzed at multiple levels using language and information structure measures. Results revealed significant discourse impairments in the CHI group on all measures of information structure, whereas differences in the linguistic domain failed to reach significance. In addition, effects of age at injury and lateralization of lesion on discourse were considered. Although no significant differences were found according to age at injury, a consistent pattern of generally poorer discourse scores was found for the early injured group (<5 years). With regard to lesion focus, the group findings were unimpressive. However, preliminary examination of individual CHI cases with relatively large lateralized lesions suggested that the late injured children may show the language–brain patterns reported in brain-injured adults, whereas early injured children may not.     

Automatic and effortful processing after severe closed head injury

To investigate the automatic versus effortful distinction following severe closed head injury (CHI), we administered free recall and frequency of occurrence tasks to patients and controls. In Experiment 1 we found that both free recall (an effortful task) and judgment of relative frequency of occurrence (an automatic task) were impaired in 15 CHI patients as compared to 14 controls. In Experiment 2 we corroborated this finding and showed that absolute estimates of frequency were also impaired in new samples of 16 patients and 16 controls. We infer that cognitive tasks which normal individuals can perform without practice, feedback, or instructions may demand more effortful strategies following severe CHI.     

Oral and written discourse in adolescents with closed head injury

Analysis of oral and written discourse suggested differing cognitive demands for modes of expression. Verbal samples were provided by 8 adolescents with closed head injury (CHI) and 8 controls. A generation task using a picture stimulus was the basis for discourse. Eight measures [productivity, efficiency, semantic ties (lexical, incomplete, elliptical), maze use, coherence (global, local)] were utilized. A covariate model consisting of group membership (CHI vs control), executive functioning and working memory helps to explain variance in the discourse skills of adolescents with CHI.