Rethinking damaged cognition: an expert opinion on cognitive rehabilitation

Cognition is frequently damaged by acquired brain injury (ABI). Impaired thinking is both a symptom in its own right and also a barrier to recovery by impacting their insight and awareness and their engagement with rehabilitation. Here we consider the aims, mechanisms and contexts when the goal is to improve cognitive function in patients with ABI

The cost to see the Wizard: buy-ins and trade-offs in neurological rehabilitation

This scientific commentary refers to ‘A decision-neuroscientific intervention to improve cognitive recovery after stroke’ by Studer et al. (doi:10.1093/brain/awab128)

Aphasia Recovery: When, How and Who to Treat?

PURPOSE OF REVIEW: We now know that speech and language therapy (SALT) is effective in the rehabilitation of aphasia; however, there remains much individual variability in the response to interventions. So, what works for whom, when and how? RECENT FINDINGS: This review evaluates the current evidence for the efficacy of predominantly impairment-focused aphasia interventions with respect to optimal dose, intensity, timing and distribution or spacing of treatment. We conclude that sufficient dose of treatment is required to enable clinical gains and that e-therapies are a promising and practical way to achieve this goal. In addition, aphasia can be associated with other cognitive deficits and may lead to secondary effects such as low mood and social isolation. In order to personalise individual treatments to optimise recovery, we need to develop a greater understanding of the interactions between these factors

Advice-seeking during implementation: a network study of clinicians participating in a learning collaborative

Abstract Background Successful implementation depends on the transfer of knowledge and expertise among clinicians, which can occur when professionals seek advice from one another. This study examines advice-seeking patterns among mental health clinicians participating in learning collaboratives (a multi-component implementation and quality improvement strategy) to implement trauma-focused cognitive behavioral therapy (TF-CBT). We apply transactive memory system theory, which explains how professionals access and retrieve knowledge, to examine factors associated with the evolution of advice-seeking relationships during implementation. Our aim is to unpack learning collaboratives’ mechanisms by investigating how and why advice-seeking networks change, which may help us understand how implementation strategies can best target networks. Methods Using social network analysis and a pretest-post-test design, we examined patterns in general and treatment-specific advice-seeking among 146 participants (including five clinical experts) from 27 agencies participating in a regional scale-up of TF-CBT. Surveys were administered in-person at the first and last of three in-person learning sessions (10 months apart) that comprise a core component of learning collaboratives. Participants nominated up to five individuals from whom they seek general and treatment-specific advice. Exponential random graph models (ERGMs) tested the likelihood of maintaining or forming advice-seeking relationships based on indicators of expertise quality, accessibility, need, and prior advice-seeking relationships. Results Participants formed or maintained advice-seeking relationships with those who possess perceived expertise (e.g., learning collaborative faculty experts, supervisors, and those with greater field experience than themselves). Participants also tended to seek advice from those within the same organization and with similar disciplinary training, highlighting the importance of expertise accessibility. Prior relationships and network structural features were associated with advice-seeking, indicating that participants built on existing social ties. Advice-seeking did not vary based on participants’ role or experience. Conclusions Given the importance of accessible clinical expertise and ongoing supervision for delivering treatment with fidelity, learning collaboratives may support implementation by promoting clinicians’ awareness of and access to others’ expertise, especially those with substantial expertise to share (e.g., faculty experts and supervisors). Future controlled studies are needed to verify the effectiveness of learning collaboratives for building networks that connect clinicians and experts and for improving implementation

The Trail Making test: a study of its ability to predict falls in the acute neurological in-patient population

OBJECTIVE: To determine whether tests of cognitive function and patient-reported outcome measures of motor function can be used to create a machine learning-based predictive tool for falls. DESIGN: Prospective cohort study. SETTING: Tertiary neurological and neurosurgical center. SUBJECTS: In all, 337 in-patients receiving neurosurgical, neurological, or neurorehabilitation-based care. MAIN MEASURES: Binary (Y/N) for falling during the in-patient episode, the Trail Making Test (a measure of attention and executive function) and the Walk-12 (a patient-reported measure of physical function). RESULTS: The principal outcome was a fall during the in-patient stay ( n = 54). The Trail test was identified as the best predictor of falls. Moreover, addition of other variables, did not improve the prediction (Wilcoxon signed-rank P < 0.001). Classical linear statistical modeling methods were then compared with more recent machine learning based strategies, for example, random forests, neural networks, support vector machines. The random forest was the best modeling strategy when utilizing just the Trail Making Test data (Wilcoxon signed-rank P < 0.001) with 68% (± 7.7) sensitivity, and 90% (± 2.3) specificity. CONCLUSION: This study identifies a simple yet powerful machine learning (Random Forest) based predictive model for an in-patient neurological population, utilizing a single neuropsychological test of cognitive function, the Trail Making test

'An Apotheosis of Well-Being': Durkheim on austerity and double-dip recessions

This article is an attempt to contribute a view on the economic crisis from classical sociology, a voice often missing from the sociological response to the crisis. The work of Émile Durkheim provides a unique perspective here centred on morality and inequality produced in a historical context akin to our neoliberal times. It is argued there are four key points to take from Durkheim’s work. Firstly, that the initial credit crunch can be more fully understood with reference to the economic anomie which Durkheim sees as ‘chronic’ in a time of marketization. Secondly, that this creates an antagonistic relationship between a supposedly self-dependent rich and lazy poor. Thirdly, this conception of self-dependency and individual initiative makes any attempt to regulate the economy akin to sacrilege. Finally, the state is unwilling to intervene due to the emergence of ‘pseudo-democracies’. Therefore, Durkheim’s theory accounts for the initial crisis, austerity and double-dip recessions in a sociological framework. The article concludes by returning to the centrality of morality to the crisis for Durkheim and highlighting the omission of this in contemporary debates

Beyond capitalism and liberal democracy: on the relevance of GDH Cole’s sociological critique and alternative

This article argues for a return to the social thought of the often ignored early 20th-century English thinker GDH Cole. The authors contend that Cole combined a sociological critique of capitalism and liberal democracy with a well-developed alternative in his work on guild socialism bearing particular relevance to advanced capitalist societies. Both of these, with their focus on the limitations on ‘free communal service’ in associations and the inability of capitalism to yield emancipation in either production or consumption, are relevant to social theorists looking to understand, critique and contribute to the subversion of neoliberalism. Therefore, the authors suggest that Cole’s associational sociology, and the invitation it provides to think of formations beyond capitalism and liberal democracy, is a timely and valuable resource which should be returned to

More than one way to improve a CAT: Outcomes and reflections on two iterations of the Queen Square Intensive Comprehensive Aphasia Programme

Background The field of human expert performance teaches us that high quality, high-dose guided practice is required to make large gains in cognitively driven acts. The same also seems to be true for people with acquired brain injury, yet therapy services for people with aphasia (PWA) have traditionally not been designed with this in mind. Intensive Comprehensive Aphasia Programmes (ICAPs) are one way to address the chronic under-dosing of therapy that most PWA experience. Aims There are several ways to deliver an ICAP; here we describe two iterations of our Queen Square ICAP. There was a 20-month COVID-induced pause between the Year 1 (Y1) and Year 2 (Y2) ICAP groups. We analyse ICAP-induced changes in both groups of PWA on a series of key outcome measures that span the International Classification of Functioning, Disability and Health, covering language impairment and function as well as mood and social participation. Methods & Procedures Forty-six PWA took part in Y1 and 44 in Y2. The PWA were all in the chronic stage post stroke and varied in aphasia severity from mild to severe, with the Y2 group being more impaired than Y1. Quantitative data was collected before and after the ICAP. The Y2 therapy team provided independent reflections on their experiences of delivering an ICAP. Outcomes & Results ICAP-related changes in outcome measures (impairment, function and goal attainment) were generally comparable for the Y1 and Y2 groups, with both groups’ speech production abilities improving the most. Both groups made clinically and statistically significant gains on the main quality of life measure. Participation in the ICAP made a big difference to PWAs’ self-confidence ratings. Their mood ratings also improved significantly, although they were not, on average, in the depressed range at baseline (directly pre-ICAP). All improvements achieved in both groups were maintained at the 3-month follow-up, highlighting the lasting effects that ICAPs can provide. Conclusions Evidence continues to accrue that ICAPs are an efficient way of increasing the dose of expert coaching required for people with chronic aphasia to make clinically meaningful improvements in their communicative abilities and quality of life. The main challenge remaining is convincing health-care providers to invest in them

Networked but Commodified: The (Dis)Embeddedness of Digital Labour in the Gig Economy

This article investigates the (dis)embeddedness of digital labour within the remote gig economy. We use interview and survey data to highlight how platform workers in Southeast Asia and Sub-Saharan Africa are normatively disembedded from social protections through a process of commodification. Normative disembeddedness leaves workers exposed to the vagaries of the external labour market due to an absence of labour regulations and rights. It also endangers social reproduction by limiting access to healthcare and requiring workers to engage in significant unpaid ‘work-for-labour’. However, we show that these workers are also simultaneously embedded within interpersonal networks of trust, which enable the work to be completed despite the low-trust nature of the gig economy. In bringing together the concepts of normative and network embeddedness, we reconnect the two sides of Polanyi’s thinking and demonstrate the value of an integrated understanding of Polanyi’s approach to embeddedness for understanding contemporary economic transformations