Evaluation of attention training after aquired brain injury : an occupational perspective

AIM: The aim of this thesis was to evaluate the effects of two different approaches of attention training, Attention Process Training (APT) and Activity-based Attention Training (ABAT) after ABI, on level of activity and participation. To be able to assess the effect of attention training on work performance, the aim of the first study in this thesis was to develop and validate a structured attention-demanding work task to be used as a task application for the Assessment of Work Performance (AWP). The second study in this thesis aimed to evaluate the effects of APT and ABAT in the sub-acute phase after ABI, on daily activity, work performance and perceived work ability. METHOD: Study I was a methodological pre-study developing and validating a simulated work task, the Attention-demanding Registration Task (AdRT). 65 individuals with attention deficits due to ABI and 47 healthy individuals performed the task and the performance was analysed using the statistical method the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC). In Study II, 51 participants with stroke or traumatic brain injury (TBI) 4-12 month-post injury were randomized to 20 hours of attention training with APT or ABAT. Effect in daily activity, work performance and perceived work ability was evaluated pre- and post-intervention as well as after three months. RESULTS: The Structured Work Task application AdRT showed high sensitivity and specificity in differentiating between individuals with attention deficits due to ABI and healthy individuals when comparing performance of the work task. Therefore, in the following randomized controlled trial, the AdRT was used together with the AWP to evaluate the effect of attention training after ABI on actual work performance. Attention training after ABI resulted in significant improvements on measures of daily activity with strong effect sizes in both intervention groups. Furthermore, assessment with AWP showed that process skills in the group receiving APT continued to improve to the three-month follow-up. Thereto the WAI showed a moderate work ability at the follow-up for the APT group whereas the ABAT group maintained a poor work ability. CONCLUSIONS: To assess work performance, the use of the Structured Work Task application AdRT, linked with the AWP, proved to be sensitive to attention deficits. Both approaches of attention training resulted in significantly improved performance in daily activity. Training with APT may have an additional positive effect on work performance and perceived work ability

Neuropsychological function in individuals with morbid obesity: A cross-sectional study

Background:Previous research has shown cognitive dysfunction to be present in a significant number ofindividuals with obesity. The objective of this study was to assess the neuropsychological profile of morbidlyobese patients referred to weight-loss treatment.Methods:An extensive battery of neuropsychological tests with well-known normative data covering variouscognitive domains was administered to 96 patients. The test results were transformed to z-scores for comparisonswith normative data. As a means of determining level of cognitive impairmentwithinthe group, deficit scores wereapplied. Group comparisons on the different cognitive domains were conducted between patients with depressivesymptoms and patients reporting no such symptoms.Results:As illustrated in mean z-scores, the patients demonstrated lower performance compared to normative dataon visual memory (mean -.26, CI -.43 to -.09,p= .003), speed of information processing (mean -.22, CI -.34 to -.09,p= .001), executive functions (mean -.28, CI -.40 to -.16,p< .001), and attention/vigilance (mean -.25, CI -.37 to -.13,p< .001). Their performance was good on verbal fluency (mean .24, CI .04 to .44,p= .016) and verbal memory(mean .55, CI .38 to .72,p< .001). No significant performance differences were observed in the cognitive domainsof visuospatial ability, motor function, and working memory. The deficit scores, however, revealed working memoryand motor function to be significantly impaired within the group as well. Patients with depressive symptoms differed from patients without such symptoms on visual memory (mean .43, CI .07 to .80,p= .021).Conclusions:Some characteristic cognitive weaknesses and strengths were evident at the group level, althoughpronounced variation was observed. Deficits in executive functions, information processing, and attention shouldbe taken into consideration in clinical practice.publishedVersio

Neuropsychological function in individuals with morbid obesity: A cross-sectional study

Background:Previous research has shown cognitive dysfunction to be present in a significant number ofindividuals with obesity. The objective of this study was to assess the neuropsychological profile of morbidlyobese patients referred to weight-loss treatment.Methods:An extensive battery of neuropsychological tests with well-known normative data covering variouscognitive domains was administered to 96 patients. The test results were transformed to z-scores for comparisonswith normative data. As a means of determining level of cognitive impairmentwithinthe group, deficit scores wereapplied. Group comparisons on the different cognitive domains were conducted between patients with depressivesymptoms and patients reporting no such symptoms.Results:As illustrated in mean z-scores, the patients demonstrated lower performance compared to normative dataon visual memory (mean -.26, CI -.43 to -.09,p= .003), speed of information processing (mean -.22, CI -.34 to -.09,p= .001), executive functions (mean -.28, CI -.40 to -.16,p< .001), and attention/vigilance (mean -.25, CI -.37 to -.13,p< .001). Their performance was good on verbal fluency (mean .24, CI .04 to .44,p= .016) and verbal memory(mean .55, CI .38 to .72,p< .001). No significant performance differences were observed in the cognitive domainsof visuospatial ability, motor function, and working memory. The deficit scores, however, revealed working memoryand motor function to be significantly impaired within the group as well. Patients with depressive symptoms differed from patients without such symptoms on visual memory (mean .43, CI .07 to .80,p= .021).Conclusions:Some characteristic cognitive weaknesses and strengths were evident at the group level, althoughpronounced variation was observed. Deficits in executive functions, information processing, and attention shouldbe taken into consideration in clinical practice

Neuropsychological function in individuals with morbid obesity: A cross-sectional study

Background:Previous research has shown cognitive dysfunction to be present in a significant number ofindividuals with obesity. The objective of this study was to assess the neuropsychological profile of morbidlyobese patients referred to weight-loss treatment.Methods:An extensive battery of neuropsychological tests with well-known normative data covering variouscognitive domains was administered to 96 patients. The test results were transformed to z-scores for comparisonswith normative data. As a means of determining level of cognitive impairmentwithinthe group, deficit scores wereapplied. Group comparisons on the different cognitive domains were conducted between patients with depressivesymptoms and patients reporting no such symptoms.Results:As illustrated in mean z-scores, the patients demonstrated lower performance compared to normative dataon visual memory (mean -.26, CI -.43 to -.09,p= .003), speed of information processing (mean -.22, CI -.34 to -.09,p= .001), executive functions (mean -.28, CI -.40 to -.16,p< .001), and attention/vigilance (mean -.25, CI -.37 to -.13,p< .001). Their performance was good on verbal fluency (mean .24, CI .04 to .44,p= .016) and verbal memory(mean .55, CI .38 to .72,p< .001). No significant performance differences were observed in the cognitive domainsof visuospatial ability, motor function, and working memory. The deficit scores, however, revealed working memoryand motor function to be significantly impaired within the group as well. Patients with depressive symptoms differed from patients without such symptoms on visual memory (mean .43, CI .07 to .80,p= .021).Conclusions:Some characteristic cognitive weaknesses and strengths were evident at the group level, althoughpronounced variation was observed. Deficits in executive functions, information processing, and attention shouldbe taken into consideration in clinical practice

Visual-Constructional Ability in Individuals with Severe Obesity: Rey Complex Figure Test Accuracy and the Q-Score

The aims of this study were to investigate visual-construction and organizational strategy among individuals with severe obesity, as measured by the Rey Complex Figure Test (RCFT), and to examine the validity of the Q-score as a measure for the quality of performance on the RCFT. Ninety-six non-demented morbidly obese (MO) patients and 100 healthy controls (HC) completed the RCFT. Their performance was calculated by applying the standard scoring criteria. The quality of the copying process was evaluated per the directions of the Q-score scoring system. Results revealed that the MO did not perform significantly lower than the HC on Copy accuracy (mean difference −0.302, CI −1.374 to 0.769, p = 0.579). In contrast, the groups did statistically differ from each other, with MO performing poorer than the HC on the Q-score (mean −1.784, CI −3.237 to −0.331, p = 0.016) and the Unit points (mean −1.409, CI −2.291 to −0.528, p = 0.002), but not on the Order points score (mean −0.351, CI −0.994 to 0.293, p = 0.284). Differences on the Unit score and the Q-score were slightly reduced when adjusting for gender, age, and education. This study presents evidence supporting the presence of inefficiency in visuospatial constructional ability among MO patients. We believe we have found an indication that the Q-score captures a wider range of cognitive processes that are not described by traditional scoring methods. Rather than considering accuracy and placement of the different elements only, the Q-score focuses more on how the subject has approached the task

Visual-Constructional Ability in Individuals with Severe Obesity: Rey Complex Figure Test Accuracy and the Q-Score

The aims of this study were to investigate visual-construction and organizational strategy among individuals with severe obesity, as measured by the Rey Complex Figure Test (RCFT), and to examine the validity of the Q-score as a measure for the quality of performance on the RCFT. Ninety-six non-demented morbidly obese (MO) patients and 100 healthy controls (HC) completed the RCFT. Their performance was calculated by applying the standard scoring criteria. The quality of the copying process was evaluated per the directions of the Q-score scoring system. Results revealed that the MO did not perform significantly lower than the HC on Copy accuracy (mean difference −0.302, CI −1.374 to 0.769, p = 0.579). In contrast, the groups did statistically differ from each other, with MO performing poorer than the HC on the Q-score (mean −1.784, CI −3.237 to −0.331, p = 0.016) and the Unit points (mean −1.409, CI −2.291 to −0.528, p = 0.002), but not on the Order points score (mean −0.351, CI −0.994 to 0.293, p = 0.284). Differences on the Unit score and the Q-score were slightly reduced when adjusting for gender, age, and education. This study presents evidence supporting the presence of inefficiency in visuospatial constructional ability among MO patients. We believe we have found an indication that the Q-score captures a wider range of cognitive processes that are not described by traditional scoring methods. Rather than considering accuracy and placement of the different elements only, the Q-score focuses more on how the subject has approached the task