The phenomenology of agency and intention in the face of paralysis and insentience

Studies of perception have focussed on sensation, though more recently the perception of action has, once more, become the subject of investigation. These studies have looked at acute experimental situations. The present paper discusses the subjective experience of those with either clinical syndromes of loss of movement or sensation (spinal cord injury, sensory neuronopathy syndrome or motor stroke), or with experimental paralysis or sensory loss. The differing phenomenology of these is explored and their effects on intention and agency discussed. It is shown that sensory loss can have effects on the focussing of motor command and that for some a sense of agency can return despite paralysis.

Gender Differences in Cognitive and Emotional Adjustment to Traumatic Brain Injury

This study examined gender differences in cognitive and emotional status after traumatic brain injury (TBI) among 262 men and 140 women with TBI referred for neuropsychological evaluations. In this cross-sectional study, cognition was measured in terms of both absolute level of functioning (i.e., raw/standard scores) and estimated decline from premorbid levels expressed as z-deficit scores in the following domains: intelligence [Wechsler Adult Intelligence Scale—Revised (WAIS-R)], memory and attention [Wechsler Memory Scale—Revised (WMS-R)], processing speed (Trails A), and cognitive flexibility (Trails B). Emotional functioning was measured in terms of depression (Beck Depression Inventory) and general emotional distress (Brief Symptom Inventory). Kruskal–Wallis nonparametric one-way ANOVAs indicated that women and men differed significantly on 2 of 8 raw/standard cognitive scores [men demonstrated lower WMS-R General Memory (p < .05) and Trails B scores (p < .0001) and 4 of 8 relative decline scores [women demonstrated more estimated change in VIQ (Verbal IQ) [p < .0001], FSIQ (Full Scale IQ) [p < .01], and Attention (p < .01)]; men demonstrated greater estimated z-decline scores on Trails B (p < .01)]. Women reported significantly higher levels of depression (p < .01), but men endorsed significantly greater general psychological distress (p < .05). Research and assessment recommendations are suggested.     

Mild Head Injury in Children and Adolescents

Although mild head injury is the most prevalent type of head injury in children and adolescents, only a relatively small number of studies on this kind of head injury have been reported. This article summarizes a review of studies examining cognitive, academic, and psychosocial outcomes in children who sustained mild head injuries. Despite earlier claims of mild head injury being a "silent epidemic," the studies, which were published from 1970 to 1998, provide no compelling evidence to support this view.     

Metamemory following childhood brain injury: A consequence of executive impairment

In this study, we investigated the influence of children’s level of executive functioning on two types of metamemory knowledge following a traumatic brain injury (TBI). For this purpose, 22 children (aged 7 to 14 years) who had sustained a moderate to severe TBI and 44 typically developing children were recruited. The children with TBI were divided into two groups according to the severity of their executive impairment. Injury severity was determined by the Glasgow Coma Scale (GCS) score on admission or by the duration of unconsciousness. All children were then tested on both their knowledge of general memory functioning and their level of memory self-awareness, respectively assessed using the total number of correct responses on an adapted version of a metamemory interview and a self-other discrepancy score on a questionnaire evaluating everyday memory abilities. Data analyses revealed that participants with TBI who suffered impaired executive functions demonstrated less general metamemory knowledge, and underestimated the frequency of their memory problems, compared with children with TBI who had preserved executive functions and with control participants. Considering the well-established effect of metamemory knowledge on people’s spontaneous implementation of strategies, the interest and the importance of these findings on both theoretical and clinical grounds are discussed.     

When Self-Blame Is Rational and Appropriate: The Limited Utility of Socratic Questioning in the Context of Moral Injury: Commentary on Wachen et al. (2016)

In this commentary, we argue that a generally sound therapeutic technique—Socratic questioning—is ill-suited to address a common variant of combat-related emotional and psychological distress. Specifically, moral injury is a term used to describe a syndrome of shame, self-handicapping, anger, and demoralization that occurs when deeply held beliefs and expectations about moral and ethical conduct are transgressed. Importantly, moral injury can and often does result from instances of intentional perpetration. We contend that challenging the accuracy of self-blame in such cases is conceptually problematic and potentially harmful. Such an approach is based on a questionable premise—i.e., that self-blame and resulting guilt are inherently illogical or inaccurate. Though this is often the case, it is not invariably so. We briefly describe an alternate approach—Adaptive Disclosure—that allows for accurate and legitimate self-blame when warranted but also promotes the possibilities of self-forgiveness, compassion, and moral reparation.     

The effect of burn injury on adolescents autobiographical memory

Autobiographical memory recall was investigated in two female adolescent groups; one group who had experienced a burn injury and a matched control group. The Burn group was not currently depressed or anxious, but scored significantly higher on the intrusion subscale of the impact of event scale compared to controls. Two autobiographical memory tasks, the autobiographical memory cueing task and the Children's Autobiographical Memory Inventory (CAMI), were used. For the cueing task, the Burn group was significantly slower to recall specific memories. This group also recalled significantly fewer specific memories and significantly more extended overgeneral memories. For the CAMI, the burns group produced significantly lower semantic and episodic recall. The Burn group also produced significant correlations between sub-scales of the impact of event scale and selected measures on the autobiographical memory tasks. Higher intrusion scores were associated with less detailed episodic recall. Higher avoidance scores were associated with longer latencies to recall memories to negative cue words and fewer specific memories to all cue words. These results are discussed from the perspective that the Burn group experienced intrusive thoughts which interfered with normal autobiographical functioning.     

Group Intervention Studies in the Cognitive Rehabilitation of Individuals with Traumatic Brain Injury: Challenges Faced by Researchers

There are many factors to consider in designing and interpreting group studies. These include both analytic considerations, such as the selection of valid and reliable outcome measures, and subjective considerations, such as the selection of outcomes that are perceived to be important to participants and researchers. In this paper, we review key issues to consider in the design of group studies in neurorehabilitation, using problem-solving studies in traumatic brain injury as an example.     

Early Versus Late Onset of Spinal Cord Injury Among the Elderly

The objective of this study is to compare elderly individuals with late (60 years old) versus early (<60 years old) onset spinal cord injury (SCI) across quality of life (QOL) domains for which cross-sectional design was used. The outcome measures selected were secondary medical complications (e.g., pneumonia, autonomic dysreflexia, number of days hospitalized), Functional Independence Measure (FIM), Satisfaction With Life Scale (SWLS), and the Craig Handicap Assessment and Reporting Technique (CHART). Analyses between groups showed that individuals with SCI onset 60 years of age or older were significantly older, had a greater proportion of incomplete lesions, were more likely to have SCI resulting from medical complication, and were less likely to be working. After controlling for differences in demographic and lesion characteristics, the majority of QOL domains were similar between groups. However, overall self-reported handicap (CHART-total score) was significantly greater among elderly with late onset SCI, particularly in the areas of physical independence and social integration. Differences in QOL between elderly with late versus early onset SCI were most prominent in the area of physical independence and social integration. The importance of appropriate statistical control, theoretical implications, and future directions are discussed.     

Effects of behaviour change interventions on physical activity in people with spinal cord injury: A systematic review and meta-analysis

ObjectivesThis review investigated the effectiveness of behaviour-change interventions to improve physical activity (PA) participation in individuals with a spinal cord injury. Additionally, the review sought to analyse the change in PA behaviour that might be expected by utilising behaviour change in PA interventions and what specific intervention characteristics, application of behaviour change theories, and behaviour change techniques are most efficacious.MethodsThe protocol was prospectively registered on PROSPERO: CRD42021252744, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed in this review. Eight databases were comprehensively searched using a well-defined strategy developed in collaboration with an academic liaison librarian. Randomised, non-randomised controlled, and non-controlled studies were included in this review; however, controlled and non-controlled studies were analysed separately. Studies were included if participants were older than 16 years and had an SCI of any cause, level or severity, regardless of the time since injury. The behaviour change technique taxonomy version 1 was used to code the intervention characteristics for behaviour modification. The combined effects across studies were pooled in a meta-analysis, and the risk of bias was assessed using the Cochrane Risk of Bias 2 tool.ResultsThe search retrieved 10,155 titles and abstracts. After duplicate removal and screening against the eligibility criteria, 23 studies were included. The overall effect estimate of the change in PA participation in the controlled trials post-intervention was medium (d = 0.50, 95% CI = 0.31–0.70) in favour of behaviour-targeted interventions. The mean difference in PA volume between pre- and post-intervention was an increase of 22 minutes per week (95% CI = 5.96–38.90). Interventions that provided practical support (d = 0.81, 95% CI = 0.46–1.16), which were individualised (d = 0.62, 95% CI = 0.34–0.90) and that utilised monitoring (d = 0.59, 95% CI = 0.34–0.83) had a greater effect on change to PA than those that were group-based and did not utilise those specific techniques.ConclusionsInterventions that target behaviour change to increase PA in people with SCI appear effective. Utilising behaviour change frameworks and specific behaviour change techniques augments PA uptake and levels, and interventions aimed at improving PA in people with SCI should incorporate a behaviour modification component. More research is needed on the isolated effect of intervention structure parameters and specific behaviour change techniques.