A new tool for assessing longitudinal change in awareness deficits following traumatic brain injury

"A thesis submitted for fulfilment of the requirements for the degree of Combined Doctor of Philosophy / Masters in Clinical Neuropsychology, Department of Cognitive Science, Faculty of Human Sciences, Macquarie University""October 2012"Includes bibliographical references.Chapter 1. General introduction: Awareness deficits following traumatic brain injury -- Chapter 2. The insight interview: introducing a new tool for measuring deficits in awareness after traumatic brain injury -- Chapter 3. Relaibility and validity of the "insight interview" -- Chapter 4. Neuropsychological correlates of awareness deficits following traumatic brain injury -- Chapter 5. A longitudinal study of awareness deficits -- Chapter 6. Summary and conclusions."Awareness deficits are frequently observed in patients following a traumatic brain injury (TBI) and have been identified as one of the main factors in determining patients' functional and vocational outcomes. However, there is still relatively little known about the nature of awareness deficits in the early stages (< three months post-injury) following TBI, and even less is understood about the temporal profile of recovering awareness in people following TBI. This thesis investigates the longitudinal progression of awareness deficits and the neuropsychological factors which associate with the disorder and potentially predicts its persistence. Chapter 1 provides a general introduction by reviewing the current theoretical models with respect to causes as well as the nature and structure of different awareness deficits, and briefly discusses treatment approaches. Chapter 2 furthers the literature review with respect to measurement of awareness deficits and describes the development of a new tool, "The Insight Interview", designed to measure deficits across different domains of awareness (i.e., awareness of change, severity of impairments, current functional consequences and future functional consequences) over time and using both discrepancy "difference score" methods and interviewer-based ratings. Patients were found to demonstrate awareness deficits across all domains assessed, with the exception of the domain of awareness of current functional consequences. Chapter 3 examines the validity and reliability of the Insight Interview, both of which were found to be acceptable. Chapter 4 reports a study of the neuropsychological variables that may be predictive of awareness deficits in both the early stages (< three months post-injury) and 12 months later. The neuropsychological variables of memory, executive functioning and emotion recognition were all found to be associated with awareness deficits, however, patterns differed depending on both the domain of awareness being assessed and the time at which awareness was measured". -- Abstract.Mode of access: World Wide Web.1 online resource (vii, 293 pages) illustrations (some coloured

Masked onset priming effect for high-frequency words : further support for the speech-planning account

Two experiments investigated whether priming due to a match in just the onset between a masked prime and target is found with high-frequency target words. Forster and Davis (1991, Exp. 5) reported that the masked onset priming effect was absent for high-frequency words and used the finding to argue that the effect has its locus in the grapheme-phoneme mapping process that operates serially within the nonlexical route. Experiment 1 used primes that were unrelated to targets and found a masked onset priming effect of equal size for high-frequency and low-frequency target words. Experiment 2 used form-related primes as used by Forster and Davis, and again found that the effect of onset mismatch was not dependent on target word frequency. These results are interpreted in terms of an alternative view that the masked onset priming effect has its origin in the process of preparing a speech response.13 page(s

The Insight Interview: a new tool for measuring deficits in awareness after traumatic brain injury

Objective: Awareness deficits are common after traumatic brain injury (TBI); however, relatively little is known of awareness deficits in the early stages post-injury. This study outlines the development of a new tool, 'The Insight Interview', designed to measure awareness across different domains (awareness of change, severity of deficits, current and future functional consequences) from 3 months post-TBI.Methods: Forty-three patients with at least a severe TBI, their nominated family member and treating clinician were all administered different versions of the Insight Interview during the patient's inpatient stay. Awareness was measured; (1) by calculating a discrepancy score between the patient's and their family informant's and/or clinician's ratings of the patient's abilities and (2) using interviewer-based ratings of the patients' responses to interview questions.Results: Awareness differed depending upon the domain being assessed, with patients demonstrating greatest awareness in the current functional consequences domain. Evidence for a distinction between awareness of current and future functional consequences of impairments was also seen. Discrepancy scores and interviewer-based ratings showed good concordance. Adequate reliability and validity was demonstrated.Conclusion: The Insight Interview is a useful and valid tool for measuring awareness in the acute stages following TBI and highlights that awareness depends on domain assessed

Elaborative encoding through self-generation enhances outcomes with errorless learning: findings from the Skypekids memory study

Errorless learning has demonstrated efficacy in the treatment of memory impairment in adults and older adults with acquired brain injury. In the same population, use of elaborative encoding through supported self-generation in errorless paradigms has been shown to further enhance memory performance. However, the evidence base relevant to application of both standard and self-generation forms of errorless learning in children is far weaker. We address this limitation in the present study to examine recall performance in children with brain injury (n = 16) who were taught novel age-appropriate science and social science facts through the medium of Skype. All participants were taught these facts under conditions of standard errorless learning, errorless learning with self-generation, and trial-and-error learning after which memory was tested at 5-minute, 30-minute, 1-hour and 24-hour delays. Analysis revealed no main effect of time, with participants retaining most information acquired over the 24-hour testing period, but a significant effect of condition. Notably, self-generation proved more effective than both standard errorless and trial-and-error learning. Further analysis of the data revealed that severity of attentional impairment was less detrimental to recall performance under errorless conditions. This study extends the literature to provide further evidence of the value of errorless learning methods in children with ABI and the first demonstration of the effectiveness of self-generation when delivered via the Internet

The relationship between awareness deficits to executive functions and memory

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