Outcome of rehabilitation for neurobehavioural disorders

<p>BACKGROUND: The evidence base on neurobehavioural disorders and their rehabilitation has been growing for four decades. Over that time understanding of the need for effective interventions for a range of handicaps in personal, interpersonal and employment spheres has developed. There is a continuing need to demonstrate whether interventions, are effective and cost-sensitive. Moreover, in pursuing effectiveness, clinicians need to be able to predict which individuals are likely to benefit from a programme and here, clinical experience needs to be informed by research evidence.</p> <p>OBJECTIVE: To review the outcome of rehabilitation for neurobehavioural disorders.</p> <p>METHODS: This review initially considers the background to neurobehavioural rehabilitation and discusses methodological issues. It reviews the evidence for neurobehavioural interventions for severe head injury with emphasis on holistic models of care, behavioural treatments, interventions in non-specialist settings and for emotion perception and self-awareness.</p> <p>RESULTS: In general, there is a need for further high quality studies with longer follow-ups and evidence for generalisation in the community. However, there is a growing consensus that intensive holistic rehabilitation programmes can improve community reintegration and self-efficacy. For behaviour disturbance the evidence base largely comprises studies with weaker (single group or single case) designs. Overall studies here provide limited evidence in support of behavioural approaches for externalised behaviour such as aggression. Further RCT or group comparison studies are needed. In terms of negative behaviours such as apathy, there are few studies on head injury and conclusions cannot be made with confidence. Self awareness is a key issue associated with good outcome in general and research to date supports use of interventions that focus in on-task behaviour and education. The correct perception of emotions in others is a precursor to successful social interaction, and here there is very little evidence although early studies are encouraging.</p> <p>CONCLUSION: There is mounting evidence to support the effectiveness of non-pharmacological interventions for neurobehavioural disorders. Successful outcomes are often associated with intensive and prolonged interventions involving multidisciplinary working.</p&gt

Social behavior following traumatic brain injury and its association with emotion recognition, understanding of intentions, and cognitive flexibility

Although the adverse consequences of changes in social behavior following traumatic brain injury (TBI) are well documented, relatively little is known about possible underlying neuropsychological deficits. Following a model originally developed for social behavior deficits in schizophrenia, we investigated whether impairments in emotion recognition, understanding of other people's intentions ("theory of mind"), and cognitive flexibility soon after first TBI or 1 year later were associated with self and proxy ratings of behavior following TBI. Each of the three functions was assessed with two separate tests, and ratings of behavior were collected on three questionnaires. Patients with TBI (n = 33) were impaired in emotion recognition, "theory of mind," and cognitive flexibility compared with matched orthopedic controls (n = 34). Proxy ratings showed increases in behavioral problems 1 year following injury in the TBI group but not in the control group. However, test performance was not associated with questionnaire data. Severity of the impairments in emotion recognition, understanding intention, and flexibility were unrelated to the severity of behavioral problems following TBI. These findings failed to confirm the used model for social behavior deficits and may cast doubt on the alleged link between deficits in emotion recognition or theory of mind and social functioning

Social perception and executive function following stroke

Components of social perception include the ability to recognise and interpret both verbal and non-verbal emotional cues, such as vocal tone and facial expression. Functional brain imaging studies have shown that the frontal cortex of the brain is more active during tasks involving social and emotional perception (Baron-Cohen et ah, 1994). Individuals with frontal lobe lesions have been shown to have acquired difficulties in emotional and social functioning similar to those in which social functioning deficits are frequently observed, such as people with autism (Baron-Cohen, 1985). Difficulties in emotional perception has also been found in individuals who have sustained a brain injury (Cicone et ah, 1980). Additionally, acquired social perception deficits have been observed in stroke patients (Happe et ah, 1999). Executive functioning is also seen as being mediated by the frontal cortex (Dela Salla et ah, 1998). The aim of this present study was to investigate executive function and social perception in post-stroke individuals.The hypotheses were that stroke patients would show a reduced ability in social perception compared to matched controls and that executive functioning would be positively associated with social perception. Twenty-two individuals who had experienced a stroke were assessed on tasks of executive function and compared to a control group on tasks of emotional perception and social awareness.The results were analysed within and between groups and are discussed with reference to theories linking executive function and social perception with the frontal cortex. The findings of this present study indicated no significant differences in the recognition of emotion between individuals who have sustained lesions to the brain following stroke and age-matched controls. Also, no significant differences were found on tasks of social perception relative to controls. However, there is some evidence to suggest that the control group may have performed at an unexpectedly low level. Significant and positive associations were observed between executive function and both emotion recognition tasks and tasks of social perception. Methodological issues and conclusions are discussed

Multicultural Face Recognition Memory And Own-Race-Bias Among Adults With Acquired Brain Injury

Own-race bias (ORB) is a well-documented phenomenon that may influence face memory, such that face memory is improved when the observed target matches the observer’s racial background. However, the clinical measures widely used in neuropsychological evaluations lack racial diversity that may disenfranchise and disadvantage minority patients. Further, these existing measures have been criticized for having inconsistent visual contrast and facial content, as well as too much variability of non-facial information which may confound its acceptability as a measure of face memory specifically. To address these limitations, standardized, multicultural images with validated facial expressions (Beaupré et al., 2000) were used to create the Multicultural Facial Recognition Test (MCFR) to evaluate face recognition memory and ORB in a clinically relevant sample of persons with acquired brain injuries. Method: One-hundred fifteen adults (63 Black, 52 White) with history of acquired brain injury participated. The participants ranged in age from 18 to 79 and were on average 12 years post injury. Participants completed a battery of cognitive tests, including the MCFR, the criterion Warrington Recognition Memory Test (RMT-F), and a post-test survey to provide consumer feedback on the MCFR. Results: Internal consistency reliability of the MCFR was low, but the MCFR showed evidence of convergent validity as expected by theory. The MCFR correlated with the RMT-F and a measure of visual memory. However, the patterns of correlations among the MCFR and the cognitive measures differed significantly for Black and White participants. Additionally, evidence for ORB was present; however, this finding was only significant among Black participants. Although both racial groups performed best on the RMT-F, both groups also endorsed preferring the MCFR over the RMT-F. Conclusions: The findings support evidence of ORB, but also suggest that ORB may be differently experienced by ABI patients of different racial groups. These findings highlight the need to include multicultural stimuli in the development of valid tests of face memory, as well as, the necessity to include multicultural participants in clinical research, as findings from the dominant culture may not generalized to minority populations. Further evaluation of the psychometric properties of the MCFR should be pursued

Neurobiological mechanisms associated with facial affect recognition deficits after traumatic brain injury

The neurobiological mechanisms that underlie facial affect recognition deficits after traumatic brain injury (TBI) have not yet been identified. Using functional magnetic resonance imaging (fMRI), study aims were to 1) determine if there are differences in brain activation during facial affect processing in people with TBI who have facial affect recognition impairments (TBI-I) relative to people with TBI and healthy controls who do not have facial affect recognition impairments (TBI-N and HC, respectively); and 2) identify relationships between neural activity and facial affect recognition performance. A facial affect recognition screening task performed outside the scanner was used to determine group classification; TBI patients who performed greater than one standard deviation below normal performance scores were classified as TBI-I, while TBI patients with normal scores were classified as TBI-N. An fMRI facial recognition paradigm was then performed within the 3T environment. Results from 35 participants are reported (TBI-I = 11, TBI-N = 12, and HC = 12). For the fMRI task, TBI-I and TBI-N groups scored significantly lower than the HC group. Blood oxygenation level-dependent (BOLD) signals for facial affect recognition compared to a baseline condition of viewing a scrambled face, revealed lower neural activation in the right fusiform gyrus (FG) in the TBI-I group than the HC group. Right fusiform gyrus activity correlated with accuracy on the facial affect recognition tasks (both within and outside the scanner). Decreased FG activity suggests facial affect recognition deficits after TBI may be the result of impaired holistic face processing. Future directions and clinical implications are discussed

Pragmatic disorders and their social impact

Pragmatic disorders in children and adults have been the focus of clinical investigations for approximately 40 years. In that time, clinicians and researchers have established a diverse range of pragmatic phenomena that are disrupted in these disorders. Pragmatic deficits include problems with the use and understanding of speech acts, the processing of non-literal language, failure to adhere to Gricean maxims in conversation and discourse deficits. These deficits are found in several clinical populations including individuals with autistic spectrum disorders, schizophrenia, traumatic brain injury and right-hemisphere damage. However, what is less often investigated is the social impact of pragmatic disorders on the children and adults who are affected by them. In this paper, I examine what is known about pragmatic disorders in these clinical groups. I then consider the wider social consequences of these disorders, where consequences are broadly construed to include factors that act as indicators of social adjustment