Purpose: Older adults have an increased likelihood of requiring rehabilitative care due to cognitive and physical risk factors. Research has found a link between executive functioning performance and functional outcomes; however, there is a dearth of research on the assessment of judgement ability. In the current pilot study, we investigated the clinical utility of the Test of Practical Judgment (TOP-J) in an older adult rehabilitation sample.

Methods: Inpatients of mixed diagnoses (n = 25, mean age = 72.60) completed the TOP-J and Functional Independence Measure (FIM). We assessed TOP-J performance in the entire sample and in those with intact vs. impaired global cognition (on the Mini-Mental State Examination; MMSE). Correlational analyses were conducted between the TOP-J, MMSE and relevant FIM items.

Results: TOP-J performance fell between the means typically observed in individuals with mild cognitive impairment and mild Alzheimer's disease. Participants with intact global cognition obtained significantly higher TOP-J scores than those with impaired global cognition. Moderate to strong positive correlations emerged between TOP-J, MMSE and FIM items of problem solving, comprehension and memory.

Conclusions: Results provide support for the clinical utility and validity of the TOP-J among older adults in the rehabilitation setting. Administering the TOP-J may help identify patients at risk for future injury and facilitate role transitions.

This paper deals with research which makes links between developmental problems such as language-learning disorders, attentional disorders, and behaviour disturbance on the one hand, and risk for misuse of alcohol and other drugs (AOD) in adolescence on the other. Poor academic performance is frequently cited as a risk for adolescent AOD misuse, however few workers have critically examined the role of linguistically-based academic sub-skills (e.g., oral and written language competence; strong social skills) which normally contribute to academic success, and hence operate as protective factors with respect to risk for AOD misuse. Studies which specifically address language skills and their association with risk for AOD misuse are reviewed, as are investigations which deal with patterns of comorbidity which are typically evident in clinical populations. Particular emphasis is placed on comorbidities between language-learning difficulties on the one hand, and behavioural or attentional disorders, on the other. It is argued that more explicitly investigating and intervening at the level of core language/social skill competencies might serve to strengthen protective factors in vulnerable groups. It is also noted that comorbid problems need to be considered as important covariates in studies of language disordered children and adolescents, rather than being treated as exclusionary criteria.

The cognitive symptoms that characterise the Wernicke-Korsakoff's syndrome include anterograde amnesia, confabulation, temporal–spatial disorientation, severe apathy, poor awareness of one's own mental state and changes in executive functions. Such deficits may persist even after the clinical profile stabilises. There are no studies that report an intervention after the acute phase, possibly due to the complexity of these cases. This study provides a descriptive analysis of neuropsychological rehabilitation concomitant to the neurological and psychiatric treatment of a woman who presented the symptoms described by Korsakoff. The intervention focused on reducing the impact caused by the cognitive and behavioural sequelae in the patient's daily life. It described a 25-week neuropsychological program, providing education and compensatory strategies for the patient, and also orientation and support from 2 professional caregivers and family members. Quantitative and qualitative measures were used to evaluate the effect of the intervention on memory efficacy, emotional state and social participation. Both caregivers reported a decrease in the frequency of memory lapses after treatment. Positive changes were also seen in self-care, activities at home, decision-making and participation in social activities. It is concluded that this case achieved results through the collaboration between members of an interdisciplinary team and caregivers providing daily support.

During the process of community integration, individuals with acquired brain injury may experience difficulties in all areas of occupational performance including self-care, home management, community access, leisure, social activities and vocational pursuits. Community based rehabilitation services provide opportunities to minimise such difficulties by working with clients as they engage in meaningful real-life context-based occupations. The therapeutic use of occupation is at the core of occupational therapy practice. We reflect on the nature and principles of occupation and highlight particular benefits for facilitating community integration after brain injury. This is illustrated using the example of executive dysfunction. Several challenges for the occupational therapy profession arise from the shift in focus from hospital to community based rehabilitation, and the need for further research on community integration after brain injury from an occupational perspective is recognised.

The aims were to investigate the general and specific effects of mild traumatic brain injury (mTBI), and if people with orthopaedic injuries who had sustained their injuries through exposure to acceleration/deceleration force could have sustained a brain injury. The Rapid Screen of Concussion and Digit Symbol Substitution Test were given to patients with mTBI (89 male, 23 female), and patients with orthopaedic injuries that did (27 male, 5 female) or did not (27 male, 15 female) involve deceleration forces within 24 hours of injury. A group of uninjured people (31 male, 12 female) were also tested. Compared to all other groups, patients with mTBI recalled fewer words and correctly answered fewer orientation questions. Patients with either mTBI or deceleration orthopaedic injuries showed slower speed of information processing than patients with nondeceleration orthopaedic injuries or participants without injury. Nondeceleration patients and uninjured participants did not differ. These results suggest that there are both general injury effects and specific mTBI effects on efficiency of cognitive functioning. The results also highlight the probability that patients with a diagnosis of orthopaedic injury who were exposed to acceleration/deceleration forces may have suffered a mild brain injury as well.

Aim: To investigate the characteristics of Australian organisations providing case management to individuals who have acquired brain injury, and to determine the methods of case management service delivery including professional development and evaluation of outcomes.

Method: An anonymous 23-item web-based survey was used. Respondents were case managers who deliver services to adults and/or children with brain injuries. A snowball sampling method was used to recruit respondents from around Australia.

Findings: Fifty-one case managers completed the survey. Respondents were from a wide range of professions, the largest group being occupational therapy. The majority of respondents were based in metropolitan areas, were employed within the public health system and were based in the community. Respondents reported that the main determinant for clients receiving case management was the severity of the brain injury followed by complex family needs. Variations in practice and a lack of consistency in outcome measurement, goal setting and professional development were noted.

Discussion: This study provides an overview of characteristics of case management practices for people with acquired brain injury (ABI). Identifying roles and responsibilities of case managers is the first step to developing future research designs, which determine the effectiveness of case management.

Objectives: To summarise available evidence for responsiveness of six key assessments used with patients with disorders of consciousness: Coma Recovery Scale – Revised (CRS-R), Disorders Of Consciousness Scale (DOCS), Sensory Modality Assessment and Rehabilitation Technique (SMART), Sensory Stimulation Assessment Measure (SSAM), Wessex Head Injury Matrix (WHIM), and the Western Neuro Sensory Stimulation Profile (WNSSP).

Method: A literature search of five electronic databases was conducted using a systematic search strategy. Relevant literature was evaluated and pertinent information extracted.

Results: Database searches using key terms initially yielded 132 articles. Following review for inclusion identified 24 articles. No studies were specifically designed to investigate responsiveness of any of the measures and therefore responsiveness data were either based on statistical significance of change post-treatment or descriptive analysis of change scores. The majority of studies identified used the CRS-R (n = 11), WHIM (n = 5) and WNSSP (n = 6) and have established responsiveness to change. There is some preliminary evidence for the responsiveness of the other measures, based on very few available studies: DOCS (n = 2), SMART (n = 1) or SSAM (n = 1).

Conclusion: Future studies should seek to include responsiveness analysis, particularly in relation to the DOCS, SMART and SSAM.

Clinical care guidelines exist internationally recommending the appropriate standards of care for adults following brain injury. These guidelines recommend a care pathway including acute, inpatient and outpatient rehabilitation and community-based care. However, if and how these guidelines are implemented is largely unknown. The aim of this study was to explore the recollected continuum of care experienced by 202 adults with moderate to severe traumatic brain injury (TBI) in Victoria, Australia. The experiences of participants in this study were investigated using a mixed methods research approach (surveys and in-depth interviews). The results indicated that only 20% of participants in this study recollected receiving care in line with recommendations made in clinical care guidelines. Reasons they identified for their problematic access to services included: a lack of information about the services available, the absence of an advocate and services being restricted by limited funding. The findings of this study indicate that while guidelines provide recommendations regarding standards of care and can serve as a benchmark to improve the quality of services, they do not ensure the equitable delivery of services. Clinicians using these guidelines need to be aware of the factors that restrict clients’ access to services and take these into account when planning the delivery of services.

Irritability is not uncommon after traumatic brain injury (TBI). Unfortunately, no instruments are available to directly measure this clinical feature. This study thus aimed to develop a specific scale to evaluate the irritability for patients with TBI. A total of 144 participants, which include 80 healthy participants and 64 patients suffering from TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale (NTUIS). Our results showed the NTUIS has good reliability. The factor analysis further revealed 2 different components: annoyance, and verbal aggression. Moreover, both self-reported and family-reported irritability postinjury were significantly higher than the irritability reported by the healthy participants. Indeed patients with TBI have significant problems with irritability after injuries, and thus a more specific assessment tool to carefully evaluate patients' irritability should be used.

Background: Neuropsychological deficits occur in over half of the stroke survivors and are associated with the reduced functioning and a decline in quality of life. However, the trajectory of recovery and predictors of neuropsychological outcomes over the first year post stroke are poorly understood.

Method: Neuropsychological performance, assessed using the CNS-Vital signs, was examined at 1 month, 6 months and 12 months after ischaemic stroke (IS) in a sample drawn from a population-based study (N = 198).

Results: While mean scores across neuropsychological domains at each time-point fell in the average range, one in five individuals produced very low-range scores for verbal memory, attention and psychomotor speed. Significant improvements were seen for executive functioning, psychomotor speed and cognitive flexibility within 6 months post stroke, but no gains were noted from 6 to 12 months. Stroke-related neurological deficits and depression at baseline significantly contributed to the prediction of neuropsychological function at 12 month follow-up.

Conclusions: In a significant minority of IS survivors, focal deficits are evident in psychomotor speed, verbal memory, executive functions and attention. Significant improvements in these domains were only evident in the first 6 months post stroke. Initial stroke-related neurological deficits and concurrent depression may be the best predictors of later cognitive functioning.

A stroke can have implications for all areas of a person's life. In research on adaptation to stroke, finding meaning is associated with better adaptation. This study focuses on one of the driving principles behind meaning-making processes: global meaning. The aim of this study was to explore whether global meaning (i.e., fundamental beliefs and life goals concerning core values, relationships, worldview, identity and inner posture) is associated with processes and outcomes of rehabilitation, as experienced by people with stroke. In-depth, semi-structured interviews were conducted, and analysed using qualitative research methods. Aspects of global meaning were associated with the following elements of process and outcome of rehabilitation: motivation, handling stress and emotions, physical functioning and acceptance. The influence was mostly positive. If rehabilitation professionals took global meaning into account, respondents tended to associate this with better or faster recovery.

Objective: Submissions on recovery of post-stroke motor performance vary, especially in relation to increasing time after stroke. This study examined the trajectory of motor performance over the first 12 months after stroke.

Methods: Consecutive first-incidence stroke survivors (N = 83) were recruited within 1 month of onset from a tertiary health institution in Nigeria. Simplified Fugl Meyer scale (S-FM) was used to assess motor performance at monthly intervals. Changes in overall motor performance, and differences between the affected upper and lower extremities, were examined using Friedman's ANOVA and paired t-tests, respectively.

Results: Significant improvement in motor performance was observed across 12 months (p < .001), with the proportion of stroke survivors with severe impairment at onset (53.3%) decreasing to 20% by 12 months. Lower extremity motor performance scores were significantly higher than for the upper extremity from 1 to 12 months (p <.01 at 3, 4, 5, 6 and 12 months; and p < .05 at the remaining months).

Conclusions: The potential for long-term improvement in motor performance after stroke was observed, suggesting that this can be harnessed by long-term rehabilitation efforts. The comparatively poorer outcome in the upper extremity indicates the need for extra rehabilitation strategies to enhance upper-extremity motor recovery in the first year of stroke.

This paper investigates the premise that long-term engagement in performance-focussed sports training may lead to significantly enhanced clinical outcomes for people with neurological impairments (NI). The minimum volume of moderate-intensity activity recommended for good health is 450 MET.minutes/week, although evidence from the general population indicates that outcomes may be enhanced by completing up to five times this volume (2250 MET.minutes/week) at vigorous (rather than moderate) intensity. Most studies evaluating physical activity interventions for people with NI deliver low volumes (<450 MET.minutes/week), which may explain why evidence for some clinical outcomes is weak. Athletes (with or without NI) who aim to achieve high-level sports performance undertake an increasingly large volume of vigorous intensity physical activity over several seasons. Evidence that people with NI may enhance clinical outcomes through performance-focussed sports training includes: evidence from studies investigating the benefits of high-intensity and/or high volume clinical exercise; scientific evidence from elite/high-level athletes; and anecdotal evidence from Paralympic athlete testimonials. Additionally, sports participants with NI may also accrue an important array of psychosocial benefits, including higher rates of employment, and higher satisfaction with life and social integration. Rigorous, prospective, longitudinal clinical monitoring of people with NI undertaking performance-focussed sports training are required to evaluate its clinical utility.

Objective: To investigate the relationship between physical fitness and work integration following stroke. Design: Single-group study, measurement of physical fitness pre and post physical training, measurement of employment status in a follow-up assessment 2 to 36 months after rehabilitation. Setting: Interdisciplinary outpatient rehabilitation program. Participants: 58 stroke survivors (62% male, mean age at program start 46.7 years, mean time since stroke 1.1 years) who were consecutively referred to the program. Intervention: 1½ hours of intensive training of cardiorespiratory fitness and muscle strength 1–3 times weekly as part of the 3-month program. Measures: Physical fitness was measured with a modified Harvard Step Test, the Åstrand Cycling Test, and walking/running speed. The type of participants' employment as well as the amount of working hours was registered. Results: Good physical fitness as measured by the Harvard Step test, but not the Åstrand Cycling Test and walking/running speed, was related to return to competitive, full-time employment. Test results from training tended to predict work reintegration better than test results from training start. Improvement of physical fitness as measured by the Harvard Step Test was also related to follow-up employment. Conclusions: The results imply a relationship between physical fitness and work integration following stroke and should be confirmed with a randomised controlled study design.

Background and aims: As many as 50–60% of patients with traumatic brain injury (TBI) admitted to rehabilitation facilities may have olfactory impairment (OI). These incidence estimates are derived from studies conducted internationally and there is no comparable data available in the Australian context. The primary aim of this study was to identify the incidence of OI following TBI in a consecutive sample of adults admitted to the Epworth Hospital Brain Injury Rehabilitation Program in Victoria, Australia. A secondary aim was to investigate whether age, duration of posttraumatic amnesia (PTA) and presence of facial fractures made a significant contribution to the prediction of severity of OI.

Method: The sample comprised 134 adults (mean age 39.09 years, SD 18.36), the majority of whom had sustained moderate to severe injury (PTA mean 21.57 days, SD 18.78). OI was measured using the Pocket Smell Test (PST) and the University of Pennsylvania Smell Identification Test (UPSIT).

Results: Seventy-three participants (54.48%) demonstrated OI on the PST whereas 89 (66.42%) demonstrated OI on the UPSIT. Age, PTA duration, and presence of facial fractures predicted 10.3% of the variance in severity of OI.

Conclusion: A substantial proportion of adults admitted for rehabilitation following TBI has OI. Accurate assessment and appropriate management of post-traumatic OI must be incorporated into rehabilitation programs.

This article reviews literature in aphasia rehabilitation in the English-speaking world. Although attempts have been made to incorporate literature from other continents, the major bias is toward North America. Four themes are emphasised. They are (1) advances in neuroscience that have already realised influences in language rehabilitation and some that have potential influence for the near future; (2) effects on language rehabilitation that have resulted from the worldwide acknowledgment and acceptance of the International Classification of Functioning, Disability, and Health (ICF); (3) the growing emergence of psychosocial concerns in the management of aphasia; and (4) present and future applications of technology to aphasia rehabilitation. For the sake of manageability, the review is largely limited to the rehabilitation literature of the decade from 1998, and to published or in-press work that is programmatic in the sense that it represents more than a single publication.

The posterior fossa region of the brain is a frequent site for tumour development in children, with over half of all childhood tumours occurring at this site. The principal brain structure implicated at this site is the cerebellum. Children treated for posterior fossa tumours can have a wide range of neurological and psychosocial problems. This paper describes the literature to date that addresses the neuropsychological impact of tumour and treatment in children with posterior fossa tumours. This paper reviews the literature on the causes of morbidity in this group. It discusses the recent research on the role of the cerebellum in outcomes and the studies that identify variables that interact with radiation effects.