Occupational Therapist Practices Regarding Cognitive Deficits in Mild Acquired Brain Injury

This study examined occupational therapists’ current knowledge and practices in cognitive rehabilitation for adults with mild acquired brain injury (mABI). A survey was sent to 250 occupational therapists with questions that addressed assessment, treatment, and discharge planning for this population. Fifty-seven therapists (22.8%) returned the survey and met inclusion criteria. The Mini-Mental State Examination was the most well-known and used assessment overall and the Assessment of Motor and Process Skills and Executive Function Performance Test were the most well-known and used occupationally based assessments. Therapists cited availability of an assessment as the main reason for use and lack of knowledge about the assessment as the main reason for nonuse. The most common treatment was compensatory strategy training with quadraphonic and multicontext approaches used least. The modal reason for using certain strategies was their ability to lead to functional gains. The modal reason for not using certain strategies was a lack of knowledge. Over 75% of therapists responded that they discharge clients for further cognitive evaluation at least 50% of the time, mostly to outpatient therapy. There was only a slight difference in treatment between outpatient and inpatient therapists. This is problematic, particularly because outpatient therapists may have more time to treat using the multicontext approach, which increases transferability of skills between tasks. Occupational therapists need better occupationally based assessments to identify mild cognitive deficits with improved training on both new and existing assessments. Additionally, discharge planning practice patterns are adequate for this population

The table-top visual search ability test for children and young people: normative response time data from typically developing children

Five table-top tasks were developed to test the visual search ability of children and young people in a real-world context, and to assess the transfer of training related improvements in visual search on computerised tasks to real-world activities. Each task involved searching for a set of target objects among distracting objects on a table-top. Performance on the Table-top Visual Search Ability Test for Children (TVSAT-C) was measured as the time spent searching for targets divided by the number of targets found. 108 typically developing children (3-11 years old) and 8 children with vision impairment (7-12 years old) participated in the study. A significant correlation was found between log-transformed age and log-transformed performance (R^2=0.65, p=4×〖10〗^(-26)) in our normative sample, indicating a monomial power law relationship between age and performance with an exponent of -1.67, 95% "CI" [-1.90,-1.43]. We calculated age-dependent percentiles and receiver operating characteristic curve analysis indicated the 3rd percentile as the optimal cut-off for detecting a visual search deficit, giving a specificity of 97.2%, 95% "CI" [92.2%,99.1%] and sensitivity of 87.5%, 95% "CI" [52.9%,97.8%] for the test. Further studies are required to calculate measures of reliability and external validity, to confirm sensitivity for visual search deficits, and to investigate the most appropriate response modes for participants with conditions that affect manual dexterity. Additionally, more work is needed to assess construct validity where semantic knowledge is required that younger children may not have experience with. We have made the protocol and age-dependent normative data available for those interested in using the test in research or practice, and to illustrate the smooth developmental trajectory of visual search ability during childhood

ASSESSING COGNITIVE FUNCTIONS IN ARABIC AND ENGLISH SPEAKING POPULATIONS

The aims of this thesis are to assess cognitive functions in adult Arabic populations for clinical purposes, and to examine resulting cultural differences between Arabic and English speaking populations. In the first study, we translated, culturally adapted and validated an existing cognitive screening tool (Cognistat) for its use with Arabic adults with Acquired Brain Injury (ABI), and we examined the differences in cognitive performance between Arabic and English individuals. A total of 107 healthy Arabic speaking adults and 62 ABI patients (30 stroke and 32 traumatic brain injury; TBI) between 18-60 years were involved in the study. The results indicated that the translated/adapted tool is valid and reliable for its use with Arabic individuals with ABI. Cultural differences between Arabic and English individuals were found in orientation to time, memory, language (repetition and naming), construction, calculation and reasoning (similarities and judgment). In the second study we developed and validated a memory test – the Plymouth Saudi Memory Test (PSMT) – that assesses a wide range of memory domains in Arabic adults with ABI; cultural variations in memory functioning between both Arabic and English individuals were also investigated. A total of 80 healthy Arabic speaking adults and 61 ABI patients (30 stroke and 31 TBI) between 18-60 years were tested. The results demonstrated that the PSMT is a valid and reliable test for detecting memory deficits among Arabic adults with ABI, and the comparison between the Arabic and English individuals revealed variations in working memory, semantic memory, and prospective memory. As a follow-up of cultural differences uncovered in the first two studies, the third and final study investigated the effect of length of stay in the UK on unfamiliar faces recognition, as well as cultural differences in unfamiliar faces recognition between Arabic and British individuals. A face recognition task that involved both Arabic and English faces was designed, and 35 participants (19 Arabs and 16 English) between 18-49 were tested. Typically, Westerners show an external feature advantage when processing unfamiliar faces, while participants from Arabic countries show a greater reliance on internal features. Results showed that the expected internal feature advantage in Arabic participants is more likely to be found for those Arabic immigrants who spend more time back in their home country, suggesting that visual processing biases can be modified with exposure in adulthood. Altogether, these results provide the clinical and research community with new tools to evaluate cognitive skills in Arabic-speaking adults, and add to the body of evidence that some of these skills can be shaped by cultural experience. The findings of the cultural differences further our understanding of the potential variations in cognitive functions among people from different cultural backgrounds

Programme standards: medical and health sciences

This document, The Programme Standards: Medical and Health Sciences (the Programme Standards), contains benchmarked statements pertaining to the field of medical and health sciences. The complex multidisciplinary nature of medical and health science requires a sound, research-informed, scientific education. Graduates must acquire sufficient knowledge, understanding, skills and professionalism that underpin the education and training of health professionals. They should be aware of the current approaches used in health care and research. They are encouraged to integrate the knowledge of various key disciplines to further understand their respective fields. These objectives can be achieved by incorporating professional standards within the programme

Erfassung von leichten kognitiven und exekutiven Beeinträchtigungen bei Menschen mit erworbener Hirnverletzung : eine Auflistung umsetzbarer Assessments für die Ergotherapie auf einer Stroke Unit

Einleitung: In der Schweiz erleiden jährlich rund 60'000 Menschen eine Hirnverletzung oder -erkrankung. Daraus folgen häufig Beeinträchtigungen der kognitiven Funktionen. Leichte Einschränkungen sind mit den in der Praxis bekannten Assessments jedoch schwer zu erfassen. Dies wurde von den Ergotherapeuten im Inselspital Bern als Problem identifiziert. Fragestellung: Welche Assessments zur Erfassung von leichten kognitiven und exekutiven Beeinträchtigungen nach erworbener Hirnverletzung lassen sich in der Ergotherapie im Akutsetting des Inselspitals Bern umsetzen? Methode: Für die Beantwortung der Fragestellung wurde eine systematische Literaturrecherche in medizinischen Datenbanken durchgeführt. Anhand von Ein- und Ausschlusskriterien wurden fünf Hauptstudien inkludiert und anschliessend kritisch gewürdigt. Die Ergebnisse wurden zusammengefasst und in Bezug zum ICF gesetzt. Ergebnisse: Es wurden fünf standardisierte Assessments identifiziert, die den definierten Kriterien entsprechen. Folgende Assessments werden in der Arbeit vorgestellt: CTPA, E-TAM, NIHTB-CB, OPA und RBMT-3. Die Assessments erreichen grösstenteils gute Werte hinsichtlich Reliabilität und Validität. Die Praktikabilität unterscheidet sich jedoch deutlich bezüglich Kosten und Aufwand. Schlussfolgerung: Alle fünf Assessments entsprechen den Vorgaben des Inselspitals Bern. Jedes weist Stärken und Schwächen auf, welche kritisch bewertet wurden. Entsprechend formulierten die Verfasserinnen Empfehlungen für die Praxis

Neurocognitive screening following acquired brain injury: an adaptation of the Birmingham Cognitive Screen for Zimbabwe (Zim-BCoS)

Neuropsychology as a discipline has not taken root in low- and middle-income countries. Most neurocognitive tests used in these countries were developed and normed in high-income, mostly western countries. The psychometric robustness of these tests is often weak when they are used on low to middle-income clinical populations. The objectives of this study were to select, adapt and generate normative data for a suitable neurocognitive screen for use in Zimbabwe. To achieve these objectives, we divided the study into 4 phases. In Phase 1 of the study, we did a systematic review that identified 83 neurocognitive assessment instruments commonly used in low- and middle-income countries on patients who have suffered a stroke. From these instruments, we selected, adapted and normed the Birmingham Cognitive Screen (BCoS; Humphreys al., 2012) through phases 2 to 4 of this study. The screen offers a robust and sufficiently broad but shallow assessment tool for cognitive deficits across key cognitive domains commonly impaired following a stroke. In particular, in Phase 2 of the study, we evaluated the cross-cultural sensitivity of BCoS on healthy participants (N=105). We then performed surveys using the Delphi method on a panel of experts to culturally adapt BCoS for use in Zimbabwe (Zim-BCoS). We evaluated the inter-rater and test-retest reliability of the translated and validated Zim-BCoS and also compared its agreement with the original BCoS version to determine its robustness. In Phase 3, we evaluated the effects of demographic variables on performance on the cognitive domains assessed by Zim-BCoS. To do this, we performed multiple linear regression analyses to calculate regression-based norms using scores from a sample of healthy participants (N=412). From these analyses, participants' age, level of education and sex had significant effects, mainly on subtests in the language cognitive domain (Picture Naming, Sentence/Word Reading/Writing and Instruction Comprehension). In Phase 4 of the study, we performed neurocognitive assessments using Zim-BCoS (and other tests) to assess and determine the frequency of specific neurocognitive deficits in patients who had suffered a stroke and were attending two major hospitals in Harare, Zimbabwe's capital city (N=103). We also compared the performance of these patients to a matched control sample (N=103). To determine the psychometric stability of Zim-BCoS we determined its validity and reliability by comparing scores on its subtests to parallel neurocognitive tests that assess similar cognitive domains. We also assessed the predictive value of Zim-BCoS on patients' neuropsychiatric and functional outcomes. We evaluated the convergence and predictive validity as well as the inclusivity of Zim-BCoS to assess patients with aphasia. We used the Zim-BCoS test scores to establish prevalence rates of cognitive deficits and other post-stroke sequelae in the sample of patients with stroke. We also assessed the predictive value of ZimBCoS subtests on patients' neuropsychiatric and functional outcomes. All comparisons of ZimBCoS against standard cognitive tests and post-stroke sequelae measures had statistically significant convergence, predictive validity and inclusivity. In this study, we demonstrated the utility of Zim-BCoS for assessing cognitive impairment in patients who have suffered a stroke, particularly in resource poor contexts typical of low-income countries. We concluded that ZimBCoS is a robust neuropsychological screen suitable for research and clinical use in Zimbabwe. The screen has the potential to offer a cost effective and easy to use neurocognitive screen for patients with acquired neurological changes in low-income countries in Southern Africa

Proceedings of the 4th international conference on disability, virtual reality and associated technologies (ICDVRAT 2002)

The proceedings of the conferenc

Proceedings of the 5th international conference on disability, virtual reality and associated technologies (ICDVRAT 2004)

The proceedings of the conferenc