Inappropriate sexual behaviour (ISB) as a sequela of neurological impairment is
often overlooked in comparison to other challenging behaviours such as agitation
and aggression, yet the impact on patients and carers can be equally significant
and pervasive. Inconsistencies in terminology and lack of standardised measurements
tools for ISB limit the degree to which such behaviour can be objectively and consistently
identified, reported and managed within and between services. This paper proposes
a new ISB scale, the St Andrew’s Sexual Behaviour Assessment (SASBA) based
on the Overt Aggression scale – modified for Neurorehabilitation (OAS-MNR:
Alderman, Knight, and Morgan, 1997). The validity and reliability of the SASBA for
use with people who have both progressive neurological conditions and acquired brain
injury admitted to in – patient services is explored. This scale allows continuous
observations of four Categories of ISB, each of which has four levels of severity,
that were developed with reference to relevant literature (Johnson, Knight, and
Alderman, 2006). Statistical properties of the scale were obtained using written
descriptions and video enactments of ISB generated by clinicians. Results indicate
strong construct and content validity, and good inter-rater
The present single case study describes the rehabilitation of an acquired impairment
of multiplication fact retrieval. In addition to a conventional drill approach,
one set of problems was preceded by auditory cues while the other half was not.
After extensive repetition, non-specific improvements could be observed for all
trained problems (e.g., 3 x 7) as well as for their non-trained complementary problems
(e.g., 7 x 3). Beyond this general improvement, specific therapy effects were attributed
to an involvement of implicit memory systems and/or attentional processes during
training. Thus, the present results demonstrate that cues in the training of arithmetic
facts do not have to be visual to be effective.
A trail of a procedure for the assessments of social problem-solving skills (the
Social Problem-solving test; SPST), designed to assess 18 component skills distributed
across five domains of functioning, is reported. A group of 48 persons with traumatic
brain injury (TBI) observed seven videotaped scenarios involved a complex social
interaction between two people. They were first questioned about their interpretation
of the event, and how the actors should respond, and then asked to complete to role-play
in which they were required to implement a strategy to reach a specified goal. Their
performance on each of the components was compared with the results from 20 aged-matched
family controls. The TBI participants were most impaired in their ability to perform
in a socially skilled manner in the role-play and evaluate this performance, and
their orientation towards resolving the problem was characterised by greater anxiety
and evaluation of difficulty. The results support the usefulness of procedures designed
to identify the specific deficits in social problem solving of persons in post-acute
rehabilitation.
Mary E Braine is lecturer Practitioner, Greater Manchester Neuroscience Centre, Hope
Hospital Scott Lane, Salford M6 8HG
The area of management of challenging behaviour is under-researched and often inadequately
addressed in the holistic care of the neuroscience patient. This paper outlines
a framework by which to manage such patients, offering practical suggestions about
how to manage these patients to improve outcomes and quality of life. The proposed
framework emphasizes the importance of a comprehensive clinical assessment when
formulating a management plan of environmental and behavioural strategies, before
any pharmacological intervention should be considered. Continual assessment is crucial
to the framework, along with multidisciplinary working and appropriate staff training
and education.
A patient with amnesia was trained in route finding around a hospital rehabilitation
unit using a detailed computer-generated non-immersive 3D virtual environment based
on the real unit. Prior to the training, she was unable to perform 10 simple routes
around the real unit, all involving locations which she visited regularly. She was
tested at weekly intervals on these same 10 routes around the real unit during the
course of the study. Her first course of training involved practising two of the
10 routes in the virtual environment for 15 minutes each weekday. After three weeks'
training, she successfully performed these two routes in the real unit and she retained
her knowledge of these routes for the remainder of the study, despite not receiving
any further training on these routes. For her second course of training, two more
of the original 10 routes were chosen, one of which she practised in the virtual
environment and one in the real unit. Within two weeks, she had learned the route
practised in the virtual environment, but not the route practised in the real unit,
and she also retained her knowledge of this route. The results of this preliminary
study indicate that training in virtual environments may prove an effective method
of teaching new information to patients with severe memory impairments.
Andrewes, D. and Gielewski, E. (1999)
Neuropsychological Rehabilitation, 9 (1), 77-99.
Abstract:
A description is given of the assimilation back into the work-force of a 28-year-old
female law graduate with amnesia following herpes simplex encephalitis. This case
study describes the patient JR and the preparation and training required for her
eventual gainful employment as a part-time assistant librarian in the library of a
law firm. Her return to work was achieved despite the patient also suffering from
complex partial seizures and insulin-dependent diabetes. The difficulties encountered
in training are described with the importance of errorless learning and the breaking
down of tasks into procedural routines appropriate for nondeclarative memory. The
extensive use of environmental cues including a procedural folder led to habit learning
and unsupervised work in filing, checking in books on a computer, and shelving of
books. Apart from the therapeutic intervention, the project's success may be attributable
to preliminary diary training, relatively intact semantic memory for information
learned prior to the disease onset, the use of a familiar work environment, strong
family and rehabilitation support systems, and the personality characteristics of
the patient
Publisher: Psychology Press, part of the Taylor & Francis Group
Issue: Volume 9, Number 1 / February 1, 1999 Pages: 77 - 99
www.taylorandfrancis.metapress.com
Errorless Learning and the Acquisition of Word Processing skills.
Hunkin, N.M., Squires, E.J., Aldrich, F.K. and Parkin, A.J. (1998)
Neuropsychological Rehabilitation, 8 (4), 433-449
Publisher: Psychology Press, part of the Taylor & Francis Group
Issue: Volume 8, Number 4 / October 1, 1998 Pages: 433 - 449
Abstract:
Word processing and other computer-based tasks represent an important dimension
to rehabilitation because of the increasing prevalence of computers in both recreation
and employment. This study describes an investigation into the use of errorless
learning (EL) as a means of teaching basic word processing skills to a memory-impaired
individual. The protocol we used incorporated established EL methods together with
spaced repetition. The basic training was carried out using a simplified version
of a commercially available word processing package. The package was menu-driven
and therefore encouraged the use of recognition memory rather than explicit recall
of commands. The task of word processing was broken down into a hierarchy of subskills.
An incremental learning procedure was applied in which the subject was taught one
set of subskills and given plenty of practice, before the next set was introduced
in parallel. The participant was trained to follow a set procedure, for example,
to open and edit an existing file. When this procedure was well established, the
subject was given practice in carrying out the procedure without instructions. Thus
there was an opportunity to assess transfer skills. The participant, a man with
memory impairment following viral encephalitis, showed improvement on all exercises
and was able to use the skills acquired during training to perform the same tasks
without instructions.
www.taylorandfrancis.metapress.com
Enhancement of face recognition learning in patients with brain injury using three
cognitive training Procedures
Jane Powell, Susan Letson, Jules Davidoff, and Tim Valentine
Department of Psychology, Goldsmiths College, London UK
Richard Greenwood
Regional Neurological Rehabilitation Unit, Homerton Hospital, London, UK
Twenty patients with impairments of face recognition, in the context of a broader
pattern of cognitive deficits, were administered three new training procedures derived
from contemporary theories of face processing to enhance their learning of new faces:
semantic associations (being given additional verbal information about the to-be-learned
faces); caricaturing ( presentation of caricaturing versions of the faces during
training and veridical versions at recognition testing); and part recognition (focusing
patients on distinction features during the training phase). Using a within-subjects
design, each training procedure was applied to a different set of 10 previously
unfamiliar faces and entailed six presentations of each face. In a “simple
exposure” control procedure (SE), participants were given six presentations
of another set of faces using the same basic protocol but with no further elaboration.
Order of the four procedures was counterbalanced, and each condition was administered
on a different day. A control group of 12 patients with similar levels of face recognition
impairment were trained on all four sets of faces under SE conditions
NEUROPSYCHOLOGICAL REHABILITATION 2008, 18 (2), 182-203
Amnesia in acute herpetic and nonherpetic encephalitis
L. HOKKANEN, O. SALONEN AND J. LAUNES
Department of Neurology, University of Helsinki, Finland. hokkanen@launes.pp.fi
Abstract
OBJECTIVES: To evaluate how often global amnesia syndrome is encountered as a sequel
of herpes simplex virus type 1 encephalitis (HSVE) and in other types of acute encephalitides,
and to evaluate whether there are qualitative differences in amnesia caused by different
encephalitides.
SUBJECTS: Forty-five consecutive patients with encephalitis (mean age, 40.8 years)
studied prospectively within a 5-year period, 8 of whom had HSVE. There were 24
normal controls. MEASURES: Neuropsychological assessment and memory evaluation after
the acute stage of encephalitis, as well as at follow-up after 27.7 +/- 18.6 months.
RESULTS: Three patients (6%), including 1 with HSVE, had persistent anterograde
and retrograde memory defects, typical features of global amnesia. Twelve patients
had anterograde amnesia in the first assessment. No statistically significant differences
in the memory measures were found between the HSVE (n = 4) and the non-HSVE (n =
8) groups. Some patients had predominantly semantic difficulty, some had a "frontal-type"
memory disorder, and in some patients rapid forgetting was the prominent feature.
CONCLUSIONS: The frequency of amnesia can reliably be evaluated only in consecutive
series of patients. Previous literature, mainly case reports, may give the impression
that global amnesia is a common consequence of encephalitis. Our findings do not
support that view. Furthermore, there are clear differences in the quality of the
memory impairment between cases of acute encephalitides. Our findings suggest that
amnesia as a consequence of encephalitis, even HSVE, should not be considered a
uniform phenomenon.
Archives of Neurology Vol. 53 No. 10, October 1996
Cognitive rehabilitation of amnesia after virus encephalitis: A case report
Eliane Correa Miotto
Hospital das Clinicas, University of Sao Paulo, Sao Paulo,
Brazil
A number of memory rehabilitation techniques have targeted people with various degrees
of memory impairments. However, few studies have shown the contribution of preserved
non-declarative memory capacity and errorless learning in the treatment of amnesic
patients. The current case report describes the memory rehabilitation of a 44-year-old
man with amnesia following viral encephalitis. The patient’s procedural memory
capacity had an important role in the use of motor imagery strategy to remember
people’s names. It was further demonstrated that the applicants of a verbal
learning techniques was helpful in recalling new verbal information. These different
memory rehabilitation techniques are discussed in terms of alternative possibilities
in the rehabilitation of amnesic patients.
NEUROPSYCHOLOGICAL REHABILITATION 2007, 17 (4/5), 551-566
Neuropsychological and psychiatric profiles in acute encephalitis in adults
Stephen M. Pewter, W. Huw Williams, Catherine Haslam, and Janice M. Kay
Centre for Clinical Neuropsychology Research, University of Exeter School of Psychology,
Exeter UK
Acute encephalitis is an inflammation of brain tissue that can result form activity
in the central nervous system (CNS) of a number of viruses. Although the neurological
and psychiatric effects of encephalitis in the acute phase if the illness are well-known
(Caroff, Mann, Gliatto, Sullivan, & Campbell, 2001), lager scale studies of
the pattern of neuropsychological and psychiatric impairment following recovery
from the acute inflammatory phase are less apparent. This paper reports the results
of neuropsychological testing with a range of standardised cognitive measures in
a case series of long-term post acute participants. Psychiatric abnormality us examined
using the SCL-90-R self-report scale of distress (derogates 1983). We also examined
the role of emerging insight In the aetiology of depression in the population. Two
clusters of cognitive dysfunction were observed’ one group of primarily herpes
simplex cases showing a severe generalised deficit across a number of cognitive
domains and a second cluster showing a variety of more isolated disorders of executive
function. Abnormally high levels of distress were reported by participants, with
depression, obsessive- compulsive symptoms, interpersonal sensitivity and phonic
anxiety most significantly increased. Depression was found to be least severe in
those with most accurate insight into their problems. Examining the correlations
between cognitive and psychiatric test results demonstrates a relationship between
depression and interpersonal anxiety and specific cognitive measures. Obsessive-behaviour
and phobic anxiety, however, appear to exist independently of the assessed cognitive
deficits.
NEUROPSYCHOLOGICAL REHABILITATION 2007, 17 (4/5), 478-505
Neuropsychological sequelae of acute-onset sporadic viral encephalitis
Laura Hokkanen and Jyrki Launes, University of Helsinki, Helsinki, Finland
Acute encephalitis is an inflammation of the brain parenchyma. In the USA, by estimation,
20,000 cases occur every year. A variety of cognitive deficits may persist after
the acute stage, and they are often the sole cause of disability. Recent literature
demonstrates the heterogeneity of both mnestic disorders and the outcome following
encephalitis. Herpes simplex virus is the most commonly recognised single aetiology
of sporadic encephalitis and it may be the cause of the most severe symptoms. Antiviral
medication, however, seems to have improved the cognitive outcome when compared
to the historical, untreated cases. The cognitive sequelae following herpes simplex
virus encephalitis (HSVE) are best known and most commonly described, e.g., in textbooks,
but they do not represent the typical symptomatology of encephalitis in general.
Much less is unfortunately known about other types of encephalitis, those that account
perhaps up to 80% of all cases, where both mild and severe defects have been observed.
This article summarises the current knowledge.
NEUROPSYCHOLOGICAL REHABILITATION 2007, 17 (4/5), 450-477
Fatigue After Brain Injury
Cantor JB, Ashman T, Gordon W, Ginsberg A, Engmann C, Egan M, Spielman L, Dijkers
M, Flanagan S (2008) Fatigue after brain injury and its impact on participation
and quality of life.
The mechanisms of fatigue following traumatic brain injury are not fully understood
but to those working with the recovering traumatic brain injury (TBI) patient it
is a familiar problem. This piece of research involving 223 people with mild to
severe TBI living in the community measured fatigue, depression, pain and sleep
quality using standard measurement tools. Did depression, pain or disturbed sleep
account for fatigue after TBI? The results of this research go some way to demonstrating
that they do not.
There are several limitations to the study mainly related to demographic differences
between the TBI and control groups. However, it would appear that fatigue after
TBI is more common in women than in men but it is not related to other variables.
More research is needed into why women should be affected more than men. Is it due
to hormonal disturbances? Is it cultural in that women may feel more able to report
fatigue than men?
Fatigue is very debilitating and there is also a need for more research into how
best practice in helping the patient to cope with it.
Journal of Head Trauma Rehabilitation 23 (1): 41-45
A case study of the Cognitive and behavioural deficits of Temporal lobe damage in
herpes simplex encephalitis (1989)
Greer MK, Lyons-Crews M, Maudlin LB, Brown FR
Dis 19 (2) 317-326
Recall and recognition memory in amnesia: Patients with hippocampal, medial temporal,
temporal lobe or frontal pathology
Michael D. Kopelman, Peter Bright, Joseph Buckmana, Alex Fradera, Haruo Yoshimasu,
Clare Jacobson, Alan C.F. Colchester
Abstract
The relationship between recall and recognition memory impairments was examined
in memory-disordered patients with either hippocampal, medial temporal, more widespread
temporal lobe or frontal pathology. The Hirst [Hirst, W., Johnson, M. K., Phelps,
E. A., & Volpe, B. T. (1988). More on recognition and recall in amnesics. Journal
of Experimental Psychology: Learning, Memory, & Cognition, 14, 758–762]
technique for titrating exposure times was used to match recognition memory performance
as closely as possible before comparing recall memory scores. Data were available
from two different control groups given differing exposure times. Each of the patient
groups showed poorer recall memory performance than recognition scores, proportionate
to the difference seen in healthy participants. When patients’ scores were
converted to Zscores, there was no significant difference between mean Z-recall
and Z-recognition scores. When plotted on a scatterplot, the majority of the data-points
indicating disproportionately low recall memory scores came from healthy controls
or patients with pathology extending into the lateral temporal lobes, rather than
from patients with pathology confined to the medial temporal lobes. Patients with
atrophy extending into the parahippocampal gyrus (H+) performed worse than patients
with atrophy confined to the hippocampi (H−); but, when H− patients
were given a shorter exposure time (5 s) and compared with H+ at a longer exposure
(10 s), their performance was virtually identical and did not indicate any disproportionate
recall memory impairment in the H− group. Parahippocampal volumes on MRI
correlated significantly with both recall and recognition memory. The possibility
that findings were confounded by inter-stimulus artefacts was examined and rejected.
These findings argue against the view that hippocampal amnesia or memory disorders
in general are typically characterised by a disproportionate impairment in recall
memory. Disproportionate recall memory impairment has been observed in a number
of published cases, and the reason for the varying pattern obtained across hippocampal
patients requires further examination.
Full article
© 2006 Elsevier Ltd. All rights reserved.
Retrograde amnesia in patients with hippocampal, medial temporal, temporal lobe,
or frontal pathology
Peter Bright, Joseph Buckman, Alex Fradera,1 Haruo Yoshimasu, Alan C.F. Colchester
and Michael D. Kopelman
There is considerable controversy concerning the theoretical basis of retrograde
amnesia (R.A.). In the present paper, we compare medial temporal, medial plus lateral
temporal, and frontal lesion patients on a new autobiographical memory task and
measures of the more semantic aspects of memory (famous faces and news events).
Only those patients with damage extending beyond the medial temporal cortex into
the lateral temporal regions showed severe impairment on free recall remote memory
tasks, and this held for both the autobiographical and the more semantic memory
tests. However, on t-test analysis, the medial temporal group was impaired in retrieving
recent autobiographical memories. Within the medial temporal group, those patients
who had combined hippocampal and parahippocampal atrophy (H+) on quantified MRI
performed somewhat worse on the semantic tasks than those with atrophy confined
to the hippocampi (H−), but scores were very similar on autobiographical
episodic recall. Correlational analyses with regional MRI volumes showed that lateral
temporal volume was correlated significantly with performance on all three retrograde
amnesia tests. The findings are discussed in terms of consolidation, reconsolidation,
and multiple trace theory: We suggest that a widely distributed network of regions
underlies the retrieval of past memories, and that the extent of lateral temporal
damage appears to be critical to the emergence of a severe remote memory impairment.
Full article
Patients with hippocampal amnesia cannot imagine new experiences
Demis Hassabis *, Dharshan Kumaran *, Seralynne D. Vann , and Eleanor A. Maguire
*
*Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College
London, 12 Queen Square, London WC1N 3BG, United Kingdom; and School of Psychology,
Cardiff University, Tower Building, Park Place, Cardiff CF10 3AT, United Kingdom
Communicated by Endel Tulving, Rotman Research Institute of Baycrest Centre, North
York, ON, Canada, November 29, 2006 (received for review October 11, 2006)
Amnesic patients have a well established deficit in remembering their past experiences.
Surprisingly, however, the question as to whether such patients can imagine new
experiences has not been formally addressed to our knowledge. We tested whether
a group of amnesic patients with primary damage to the hippocampus bilaterally could
construct new imagined experiences in response to short verbal cues that outlined
a range of simple commonplace scenarios. Our results revealed that patients were
markedly impaired relative to matched control subjects at imagining new experiences.
Moreover, we identified a possible source for this deficit. The patients' imagined
experiences lacked spatial coherence, consisting instead of fragmented images in
the absence of a holistic representation of the environmental setting. The hippocampus,
therefore, may make a critical contribution to the creation of new experiences by
providing the spatial context into which the disparate elements of an experience
can be bound. Given how closely imagined experiences match episodic memories, the
absence of this function mediated by the hippocampus, may also fundamentally affect
the ability to vividly re-experience the past.
Author contributions: D.H. and E.A.M. designed research; D.H., D.K., S.D.V., and
E.A.M. performed research; D.H. and E.A.M. analyzed data; and D.H., D.K., and E.A.M.
wrote the paper.
www.pnas.org/cgi/content/abstract/0610561104v1