Parkinson's disease (PD) has long been associated with dementia. This has been found to correlate with participant age, age at onset of PD and severity of PD. In addition, a large corpus of research points to the fact that participants with, as well as without, dementia can be impaired in a variety of cognitive tasks. Among these, set-shifting and dual-tasking skills have received particular focus. Most studies report that a reduction in attentional resources can lead to problems with these tasks. However, none have been able to determine exactly which systems are involved in these skills and which neurological impairments underlie the observed cognitive deficits. The current study set out to investigate how performance on tasks requiring set-shifting and dual tasking related to each other, as well as overall measures of cognition gained across a variety of tasks. Fifteen participants with PD and 12 control participants underwent screening tests for dementia, as well as specific tests to assess attention, set-shifting and dual tasking. The results indicate that set-shifting ability correlated well with other measures of cognitive performance, whereas dualtasking skills did not. This could suggest that set-shifting and dual tasking are not necessarily controlled by the same process, or that a particular process is involved to different degrees. In addition, many participants showed individual performance variations and dissociations between tasks that were not necessarily evident from the statistical analysis. This indicates that it can be difficult to make assumptions on overall cognitive performance from specific tasks and vice versa. This observation has implications for clinical practice as well as research methodology.

Background: Falls and fall-related injuries rank among the most common complications after stroke, and are characterised by high rates of morbidity and mortality. This study examined the proportion, and the socio-demographic and clinical characteristics of those who fell among stroke survivors attending physiotherapy facilities in selected hospitals in Nigeria.

Methods: Socio-demographic, clinical and falls data were obtained using a researcher-designed questionnaire while the modified Rankin scale (mRS) was used to assess functional ability of the participants. Descriptive statistics of frequencies, percentages, mean and standard deviation were used to summarise all data. Pearson's Chi square statistic was used to identify significant socio-demographic and clinical characteristics of those who fell.

Results: One hundred stroke survivors participated in the study with a majority of males (67%). Mean ± SD age of the stroke survivors was 55.97 ± 9.56 years (range = 33–85 years). Thirty-three (33%) stroke survivors fell within the 3 months prior to the study and a significant proportion were older (p < .001) and had more diminished functional ability (p < .001).

Conclusion: A considerable proportion of the stroke survivors fell, especially those in the older age-group and those with diminished functional ability. These findings suggest that improving functional ability after stroke may prevent falls while older stroke survivors would also require intensive falls prevention strategies to reduce their susceptibility to falls post stroke. Longitudinal studies on the incidence and frequency of falls among stroke survivors in Nigeria, and clinical trials on appropriate falls prevention strategies are however urgently required.

Formal assessment of the impact of frontal-lobe impairment on social and interpersonal function has been somewhat neglected relative to interest in documenting executive impairment on nonsocial tasks. Despite this, experimental evidence is accruing that attests to the role of the orbitomedial frontal lobes, the amygdala and related structures in the appraisal and interpretation of socially relevant stimuli. In this address the evidence regarding the frontal lobes and social cognition, that is, social information processing is reviewed. At least 3 different constructs have been proposed that appear to be mediated by cerebral systems encompassing the orbitomedial frontal cortex: (1) social schema or social knowledge networks that guide judgments and behavioural responses, (2) emotional processing, including both the ability to recognise different affective states in others and the ability to experience affective (somatic) responses to emotionally important environmental stimuli, and (3) theory of mind – the ability to conceptualise what others are thinking and feeling. On the basis of this recent experimental work it is argued that a variety of assessment techniques are becoming available that are both practical and potentially sensitive to psychosocial changes after frontal lobe damage.

Background: The Skills To Enable People and CommunitieS (STEPS) Program is a new information, support and skills program that aims to develop sustainable networks of support for individuals with acquired brain injury (ABI) and their families in communities throughout Queensland, Australia. The program adopts a self-management approach and is delivered by trained peer and professional leaders. Aim: To explore the experiences of both peer and lay leaders in the delivery of the STEPS Skills Program and coordination of STEPS Network Groups. Method: A multiple qualitative case study design was utilised to explore the unique experiences of three trained STEPS Program Leaders. Data collection entailed in-depth semistructured interviews with participants and further incorporated routine STEPS Program Leader descriptive data. The data analysis involved a four-stage approach that included assembling the raw case data, constructing case records, producing case narratives and cross-case pattern analysis. Results: Case study narratives were produced to describe participant experiences with the STEPS Program. The cross-case pattern analysis revealed two dimensions of comparison. The first dimension describes the process by which participants became STEPS Program Leaders, while the second dimension reflects the growth outcomes experienced by participants through their involvement with the STEPS Program. Specific growth outcomes are described in relation to the following domains: ‘expansion of social roles and skills’, ‘appreciation of life’, ‘interpersonal relationships and communication’, ‘confidence, personal strength and accomplishment’ and ‘growth in self as a person’. The results are also described with respect to a model that depicts the process of growth through STEPS Program delivery. Conclusion: Posttraumatic growth of peer leaders after brain injury can be facilitated within a therapeutic intervention such as the STEPS Program.

There is growing recognition that people with disability have the right to be involved in making decisions that affect their lives. Decision-making support has emerged as one way to support people with cognitive disability to make decisions, however, there is a paucity of research that explores how disability support workers can be upskilled to provide decision-making support to this group. The aim of the research was to explore the impact of an evidence-based online training course on disability support workers of adults with cognitive disability. Changes in knowledge about decision-making support and confidence in providing decision-making support were explored, attitudes towards decision-making support, and facilitators and barriers. Participants completed an online training course and responded to a survey on three occasions: baseline, post-training, and at 2-month follow-up. Ninety-nine disability support workers across Australia participated in the online training and completed the baseline and post-training surveys. Thirty-six participants completed the training and all three surveys. The results revealed that there were statistically significant improvements in knowledge, confidence, and attitudes from baseline to post-training, which were maintained at 2-month follow-up. Barriers to decision-making support included service providers or other supporters, including the family of the person with cognitive disability, whilst a key enabler was knowing about the decision-making support principles. This research demonstrates that an evidence-based online training course about decision-making support can be effective in building capacity in disability support workers. There are, however, several barriers that must be addressed to facilitate the implementation of decision-making support.

Objective: To evaluate the olfactory and psychophysical performances in a 13-year-old boy with intellectual disability and severe hypoplasia of the corpus callosum and of the olfactory bulbs, compared to controls.

Methods: The Sniffin’ Sticks Identification Test was administered to the patient and to a patient control child with cognitive delay, with the same mental (5 years) and chronological age, but normal brain magnetic resonance image. Two typically developing control participants, aged 13 and 5, were also evaluated. Psychophysical tests were performed during the olfactory assessment by smart portable sensors.

Results: A significant decrease in olfactory function and a different psychophysical response to stimuli were observed in the patient compared to control participants, suggesting absence of ‘odorous stress’. A higher olfactory score but a similar psychophysical trend was found in the patient control with cognitive delay, while the two other control participants showed a selective increase of the anxiety state depending on the odour presented.

Conclusions: Olfactory dysfunction is reported in children with neurodevelopmental disabilities. Low-cost, portable devices to assess olfactory function are proposed for use with children with intellectual disability. Stress monitoring by unobtrusive platforms provides discriminant information in this subset, as compared to controls.

This study investigated the generalisability of the Rapid Screen of Concussion (RSC; a series of brief computerised tests) and the Digit Symbol Substitution Test (DSS; Wechsler, 1981) for discriminating between concussion (mTBI) and orthopaedic patient groups in two different centres, the Royal Brisbane Hospital, Brisbane (N = 177) and St. Vincent's Hospital, Sydney (N = 211). Group differences and interactions were assessed between test centre (Sydney or Brisbane) and injury type (mTBI or orthopaedic control) on a composite variable of the RSC and DSS subtests. Age, education and number of standard drinks of alcohol consumed were covaried for these analyses. While the mTBI patients obtained lower scores than orthopaedic patients, there were no significant differences between Brisbane and Sydney participants in performance on the RSC and DSS. There was no significant interaction between injury type and test centre. Similarities of correct classification rates of the RSC and DSS for Brisbane and Sydney were examined using a double cross-validation technique. When cross-validating from the Brisbane to Sydney sample it was revealed that sensitivity was 73% in Brisbane and 71% in Sydney, while specificity for the two samples was 76% and 67%, respectively. When cross-validating from the Sydney sample to the Brisbane sample sensitivity was 64% and 63%, respectively. Specificity was 81% in Sydney and 80% in Brisbane. These results indicated that correct classification rates were sufficiently similar between the cities and that the RSC and DSS could be generalised. When samples were combined, sensitivity was found to be 66% while specificity was 80%. The RSC and DSS are recommended as adjunct procedures to medical diagnoses of mTBI.

In the last 10 to 15 years there has been much development in the knowledge base that underpins clinical neurospychology. The aim of this article is to highlight new information about normal development in the intact brain and discuss the implications that this knowledge has had on paediatric brain injury. A personal perspective of the impact of this area of developing knowledge on clinical practice is illustrated using two recent clinical cases. A second article will discuss the impact on adult neuropsychology and will appear in a subsequent issue.

This year is a year of significant steps in the evolution of Brain Impairment. As outlined in the Editorial for Issue 16.1, a new team has been handed the baton from foundation editors Dr Jacinta Douglas and Dr Robyn Tate. The second major development occurring in 2015 is the move from hard copy to an exclusively on-line journal. From the beginning of this year, Brain Impairment will only be available on-line. This development reflects broader moves in academic publishing to an ever increasing footprint within the on-line universe. Many new journals have been launched as purely on-line publications. Established rehabilitation journals that pre-existed the on-line revolution are also joining the trend, adopting hybrid models, with a mix of hard copy and e-articles, all documented in the Issue Contents. Furthermore, most journals have now created e-archives of all past issues, increasing the ease of access for practitioners and scholars alike, and reducing even further, the need for hard copy.

In 1991 Dr Kevin Walsh, the founding President of ASSBI, presented an invited address entitled “Some gnomes worth knowing” in which he discussed examples of common errors and difficulties in neuropsychological test interpretation in the form of “gnomes” or aphorisms from prominent clinicians. His paper was aimed at demonstrating “the need for improvement in the education of all psychologists who are likely to be faced with essentially neuropsychological problems”. The current paper will examine the extent to which such improvement has occurred over the past eight years and will consider directions for the future. The major areas of concern outlined by Dr Walsh will be reviewed in terms of current clinical practice. Additional areas of controversy and concern which have emerged more recently, such as the assessment of mild head injury, the assessment of malingering and the impact of neurochemical changes in certain psychiatric conditions, will also be considered. The importance of considering the client in a more holistic manner, which takes into account a range of issues that may impact upon test scores, is emphasised. It is hoped that this presentation will assist in formulating more clearly the challenges facing all those involved in research, assessment and treatment of brain disorders as we approach a new millennium.