Time perception impairment following thalamic stroke: a case study

Impaired time perception is considered to be a relatively unusual and poorly understood consequence of brain injury. This paper presents a case study of altered time perception in JB, a 50-year-old woman who in 2011 had a small thalamic stroke affecting the right anteromedian region. We report on her subjective experience and present results from studies of retrospective timing (i.e., estimating how much time has passed and the clock time) and prospective timing (i.e., producing and reproducing intervals). The results showed that relative to neurologically healthy and brain-injured controls, JB had impaired retrospective timing and impaired prospective time reproduction. However, her prospective time production did not differ significantly from either of the control groups. We interpret this to mean that JB’s essential timing functions are intact, and that rather, her time perception impairment stems from a problem in anterograde memory for time intervals. Further, we argue that unlike other cognitive domains, time perception alteration is neither anticipated nor evaluated in most patients, yet these impairments can have a remarkably serious impact on daily life. We encourage further investigation of this topic

Selection and visualisation of outcome measures for complex post-acute acquired brain injury rehabilitation interventions.

BACKGROUND: Outcome measurement challenges rehabilitation services to select tools that promote stakeholder engagement in measuring complex interventions. OBJECTIVES: To examine the suitability of outcome measures for complex post-acute acquired brain injury (ABI) rehabilitation interventions, report outcomes of a holistic, neuropsychological ABI rehabilitation program and propose a simple way of visualizing complex outcomes. METHODS: Patient/carer reported outcome measures (PROMS), experience measures (PREMS) and staff-rated measures were collected for consecutive admissions over 1 year to an 18-week holistic, neuropsychological rehabilitation programme at baseline, 18 weeks and 3- and 6-month follow-up. RESULTS: Engagement with outcome measurement was poorest for carers and at follow-up for all stakeholders. Dependence, abilities, adjustment, unmet needs, symptomatology including executive dysfunction, and self-reassurance showed improvements at 18 weeks. Adjustment, social participation, perceived health, symptomatology including dysexecutive difficulties, and anxiety were worse at baseline for those who did not complete rehabilitation, than those who did. A radar plot facilitated outcome visualization. CONCLUSIONS: Engagement with outcome measurement was best when time and support were provided. Supplementing patient- with staff-rated and attendance measures may explain missing data and help quantify healthcare needs. The MPAI4, EBIQ and DEX-R appeared suitable measures to evaluate outcomes and distinguish those completing and not completing neuropsychological rehabilitation.National Institute for Health Researc

A randomized controlled trial of assisted intention monitoring for the rehabilitation of executive impairments following acquired brain injury

Background. Acquired brain injury (ABI) can impair executive function, impeding planning and attainment of intentions. Research shows promise for some goal-management rehabilitation interventions. However, evidence that alerts assist monitoring and completion of day-to-day intentions is limited. Objective. To examine the efficacy of brief goal-directed rehabilitation paired with periodic SMS text messages designed to enhance executive monitoring of intentions (assisted intention monitoring [AIM]). Methods. A randomized, double-blind, controlled trial was conducted. Following a baseline phase, 74 people with ABI and executive problems were randomized to receive AIM or control (information and games) for 3 weeks (phase 1) before crossing over to either AIM or no intervention (phase 2). The primary outcome was change in composite score of proportion of daily intentions achieved. A total of 59 people (71% male; 46% traumatic brain injury) completed all study phases. Results. Per protocol crossover analysis found a significant benefit of AIM for all intentions [F(1, 56) = 4.28; P = .04; f = 0.28; 3.7% mean difference; 95% CI = 0.1%-7.4%] and all intentions excluding a proxy prospective memory task [F(1, 55) = 4.79; P = .033; f = 0.28, medium effect size; 3% mean difference; 95% CI = 0.3%-5.6%] in the absence of significant changes on tests of executive functioning. Intention-to-treat analyses, comparing AIM against control at the end of phase 1 revealed no statistically significant differences in the attainment of intentions. Conclusion. Combining brief executive rehabilitation with alerts may be effective for some in improving achievement of daily intentions, but further evaluation of clinical effectiveness and mechanisms is required

Hospitality and tourism VET in schools: Teachers - the missing ingredient

Students undertaking vocational education and training (VET) in school comprise a rapidly growing component of Australia's VET system, with numbers reaching in excess of 100,000 by the Year 2000, representing around 8% of Australia's vocational students (ANTA, 2002). The inclusion of VET in schools has meant changes to curricula, structures, industry partnerships-and changes in the specialisations of teachers. Finding suitably qualified teachers for classroom delivery of VET has become a pressing issue. The University of Queensland explored the need for a teacher education program for hospitality and tourism teachers, conducting an analysis of the demand for specialist VET teachers, a focus group involving key stakeholders to explore issues surrounding the provision of these teachers, and identified appropriate pathways for their education. This paper reports on the context and background of VET in schools, recommendations of the focus group and the development of a program by the university

Characterising neuropsychological rehabilitation service users for service design

Purpose – Needs of people following acquired brain injury vary over their life-course presenting challenges for community services, especially for those with “hidden” neuropsychological needs. Characterisation of subtypes of rehabilitation service user may help improve service design towards optimal targeting of resources. This paper aims to characterise a neuropsychologically complex group of service users. Design/methodology/approach – Preliminary data from 35 participants accepted for a holistic neuropsychological rehabilitation day programme were subject to cluster analysis using self-ratings of mood, executive function and brain injury symptomatology. Findings – Analysis identified three clusters significantly differentiated in terms of symptom severity (Cluster 1 least and Cluster 2 most severe), self-esteem (Clusters 2 and 3 low self-esteem) and mood (Cluster 2 more anxious and depressed). The three clusters were then compared on characteristics including age at injury, type of injury, chronicity of problems, presence of pre-injury problems and completion of rehabilitation. Cluster 2 were significantly younger at time of injury, and all had head injury. Research limitations/implications – Results suggest different subgroups of neuropsychological rehabilitation service user, highlighting the importance of early identification and provision of rehabilitation to prevent deterioration, especially for those injured when young. Implications for design of, and research into, community rehabilitation service design for those with “hidden disability” are considered. Originality/value – The paper findings suggests that innovative conceptual frameworks for understanding potentially complex longer term outcomes are required to enable development of tools for triaging and efficient allocation of community service resources

The importance of culture in holistic neuropsychological rehabilitation: suggestions for improving cultural competence.

This chapter describes the major issues to be considered during neuropsychological rehabilitation after brain injury in a multicultural context and to make suggestions regarding how to create culture-centred services. It discusses few domains of neuropsychological rehabilitation that we think especially interact with cultural issues: the creation of a therapeutic milieu; assessment for rehabilitation; the case formulation, or the shared understanding of the needs and competencies of the clients; and the development of a coherent post-injury identity. Rehabilitation is defined as the development of therapeutic relationships that enable the person to actively increase participation in different environments by improving his/her abilities, skills and strategies. The holistic model of brain injury rehabilitation is one of the most established models in neuropsychology. Ben-Yishay and Diller presented the major conceptual framework of this model and further outlined the personal and professional requirements of the team that contribute to the success of holistic programmes

The importance of culture in holistic neuropsychological rehabilitation:Suggestions for improving cultural competence.

This chapter describes the major issues to be considered during neuropsychological rehabilitation after brain injury in a multicultural context and to make suggestions regarding how to create culture-centred services. It discusses few domains of neuropsychological rehabilitation that we think especially interact with cultural issues: the creation of a therapeutic milieu; assessment for rehabilitation; the case formulation, or the shared understanding of the needs and competencies of the clients; and the development of a coherent post-injury identity. Rehabilitation is defined as the development of therapeutic relationships that enable the person to actively increase participation in different environments by improving his/her abilities, skills and strategies. The holistic model of brain injury rehabilitation is one of the most established models in neuropsychology. Ben-Yishay and Diller presented the major conceptual framework of this model and further outlined the personal and professional requirements of the team that contribute to the success of holistic programmes

The importance of culture in holistic neuropsychological rehabilitation: suggestions for improving cultural competence.

This chapter describes the major issues to be considered during neuropsychological rehabilitation after brain injury in a multicultural context and to make suggestions regarding how to create culture-centred services. It discusses few domains of neuropsychological rehabilitation that we think especially interact with cultural issues: the creation of a therapeutic milieu; assessment for rehabilitation; the case formulation, or the shared understanding of the needs and competencies of the clients; and the development of a coherent post-injury identity. Rehabilitation is defined as the development of therapeutic relationships that enable the person to actively increase participation in different environments by improving his/her abilities, skills and strategies. The holistic model of brain injury rehabilitation is one of the most established models in neuropsychology. Ben-Yishay and Diller presented the major conceptual framework of this model and further outlined the personal and professional requirements of the team that contribute to the success of holistic programmes

Donor immunization with pneumococcal conjugate vaccine and early protective antibody responses following allogeneic hematopoietic cell transplantation

Patients undergoing hematopoietic cell transplantation (HCT) are at increased risk for infections with Streptococcus pneumoniae and have long-lasting, impaired antibody responses to pneumococcal polysaccharide vaccines. We examined whether donor immunization with a heptavalent pneumococcal conjugate vaccine (PCV7) would elicit protective antibody responses to additional doses of vaccine administered early after transplantation. Ninety-six patients scheduled to receive an allogeneic hematopoietic cell transplant were randomized with their donors to receive either a dose of PCV7 vaccine or no vaccine before transplantation. All patients received PCV7 at 3 months, 6 months, and 12 months following transplantation, and serotype-specific antibody concentrations were determined after each dose. Following HCT, geometric mean antibody concentrations of patients in the immunized donor group were significantly higher for 5 of the 7 vaccine serotypes after one dose (P \u3c.05) and for 4 of the 7 serotypes after 2 doses of vaccine (P \u3c.03). Sixty-seven percent of patients in the immunized donor group had presumed protective IgG concentrations more than or equal to 0.50 microg/mL to all 7 serotypes following the first dose of vaccine compared to 36% in the unimmunized donor group (P =.05). After the third dose of vaccine, both groups had more than 60% of patients with concentrations at least 0.50 microg/mL to all vaccine serotypes. Donor immunization enhances early antibody responses of patients undergoing HCT to pneumococcal conjugate vaccine. A 3-dose schedule of PCV7 vaccine at 3, 6, and 12 months is immunogenic in these patients regardless of donor immunization

Large-Scale Comparative Sequence Analysis of the Human and Murine Bruton’s Tyrosine Kinase Loci Reveals Conserved Regulatory Domains

Large-scale genomic DNA sequencing of orthologous and paralogous loci in different species should contribute to a basic understanding of the evolution of both the protein-coding regions and noncoding regulatory elements. We compared 93 kb of human sequence to 89 kb of mouse sequence in the Bruton’s tyrosine kinase (BTK) region. In addition to showing the conservation of both position and orientation of the five functionally unrelated genes in the region (BTK, α- d -galactosidase A, L44L, FTP-3, and FCI-12), the comparison revealed conservation of clusters of noncoding sequence flanking the first exon of each gene. Furthermore, in the sequence comparison at the BTK locus, the conservation of clusters of noncoding sequence extends throughout the locus; the noncoding sequence is more highly conserved in the BTK locus in comparison to the flanking loci. This suggests a correlation with the complex developmental regulation of expression of btk. To determine whether a highly conserved 3.5-kb segment flanking the first exon of BTK contains transcriptional regulatory signals, we tested various portions of the segment for promoter and expression activity in several appropriate cell lines. The results demonstrate the contribution of the conserved region flanking the first exon to the cell lineage-specific expression pattern of btk. These data show the usefulness of large scale sequence comparisons to focus investigation on regions of noncoding sequence that play essential roles in complex gene regulation. [The sequence data described in this paper have been submitted to GenBank under accession nos. U78027 and U58105 .