Children with frontal lobe damage often appear to demonstrate remarkable recovery with few apparent signs of impairment immediately after injury. Over time, however, many develop increasing deficits in self-regulation, attention, and executive function, as well as in other higher functions. Current literature suggests that, in particular, these children seem to experience worsening socio-behavioural problems. Some case studies (Grattan & Eslinger, 1992; Anderson et al., 1999) describe individuals with childhood frontal lesions who developed severe social problems, deficits in executive functions and who also had lower than expected levels of moral reasoning. In the present study, social-adaptive behaviour and maturity of moral reasoning were measured in 16 children with focal frontal lesions and in 12 age-matched controls. Children with frontal lobe lesions had poorer adaptive behaviour ratings and lower levels of moral maturity than controls. These results support previous research suggesting that children with frontal lobe lesions have reduced social understanding and typically experience ongoing sociobehavioural problems.

Objective: Review the literature to evaluate the evidence for effective treatment to mitigate substance misuse and substance use disorders (SUD) following traumatic brain injury (TBI).

Design: Systematic review.

Data source: Scopus.

Study eligibility criteria: A study was considered eligible for review if (a) the intended population specifically included persons with TBI; (b) the experimental intervention targeted misuse of alcohol, illegal drugs or prescription drugs; (c) the intervention was compared to the standard of care, control or another intervention; (d) the outcomes under study included substance use or misuse; and (e) the study design was a controlled trial.

Results: Six studies were identified that met the inclusion criteria. Three studies were conducted during the acute phase of recovery using brief interventions, while the remaining three were conducted with individuals in the post-acute phase (usually several years post-injury) using more intensive treatment. All studies were found to be vulnerable to bias due to methodological weaknesses.

Conclusions: While firm conclusions could not be drawn from the results of the studies, each study provided important information about the challenges to conducting SUD intervention trials with persons with TBI. The choices researchers will have to make to address these challenges are delineated.

Primary objective: Recent research studies attest to the presence of deficits in emotion perception following severe traumatic brain injury (TBI). Additionally, a growing number of studies report significant levels of alexithymia (disorder of emotional cognition) following TBI. This research aimed to examine the relation between the two, while assessing the influence of posttraumatic stress disorder (PTSD). Design: Cross-sectional study examining levels of alexithymia, emotion perception disorders and PTSD and their association, in 20 people with severe, chronic TBI and 20 adults without brain injuries. Methods: Participants were assessed on the Toronto Alexithymia — 20 Scale, the Posttraumatic Diagnostic Scale and on two emotion perception tasks: matching and labelling of photos depicting the 6 basic emotions. Results: The group with TBI were impaired relative to controls when matching facial expressions. Their performance on ‘fear’ was especially poor. Performance on labelling was similar in pattern, although failed to reach significance. There was no association between poor performance on fear, or other negative expressions, and either PTSD or alexithymia symptoms in the TBI group. Conclusions: Alexithymia, as assessed by the TAS-20, taps a constellation of difficulties that do not appear to include difficulties with emotion perception in people with traumatic brain injuries.

There is limited understanding of the effects of normal and abnormal aging on gist-based memory in relation to the massive evidence regarding detail-based memory. This void is striking given the widely accepted view that memory is rarely veridical, but most often abstracted. The present study examined the effects of healthy advanced aging and mild Alzheimer's disease (AD) on three distinct forms of gist. Two of these gist forms involved a passage: transformed gist (global generalised meaning of a passage) and main-idea gist (main points of a passage). The third gist form involved a word list: categorical gist (clustering of words according to semantic categories during list recall). These gist forms were assessed in immediate and delayed recall conditions. A total of 36 participants were included: 12 cognitively healthy young seniors (65–79 years), 12 cognitively healthy old seniors (80–95 years), and 12 young seniors with mild AD (65–79 years). The findings revealed that age and dementia did not equally affect all three forms of gist. Specifically, transformed gist was relatively maintained in the cognitively healthy senior groups as compared to the other two gist forms (main-idea gist and categorical gist), whereas all three gist forms were impaired in individuals with AD. The present study suggests that transformed gist operates differently than detail-based memory in the cognitively healthy senior groups. These findings have important theoretical implications in terms of informing existing models on the interrelationship between gist and detail-based memory and clinical implications in diagnosis of AD.

Objectives: (1) Examine the opportunities young people with acquired brain injury (ABI) have to make everyday choices after moving out of residential aged care (RAC) into community-based shared supported accommodation (SSA); (2) Compare everyday choice making of this group with a group of people with ABI living in RAC.

Research design: Mixed methods comparing two independent groups.

Method and procedures: Responses on eleven relevant items of the Resident Choice Scale (RCS) were compared between two groups; 45 people with ABI living in RAC and 20 people with ABI who had moved from RAC to live in SSA. In addition, the choice making experiences of the SSA group were investigated through semi-structured interviews with the individual and/or their family member. Interviews were recorded, transcribed and thematically analysed.

Results: Greater opportunities for everyday choice making were demonstrated on 10 out of the 11 RCS items for people living in SSA, compared to RAC. These included improved choice regarding meals, bedtime and leisure activities. Qualitative data also illustrated new choice opportunities afforded to the SSA group. Five key themes relating to choice were identified: rules and routines, communication, things to do, food and home-like environment.

Conclusions: Community-based, age-appropriate and small-scale supported accommodation provides people with ABI more opportunities for everyday choice making than RAC.

Primary objective: Social cognition underlies social skills and can be disrupted in numerous developmental and acquired brain disorders during childhood and adolescence. Despite this, there are few tools to assess social cognition clinically in this age group. This study examined adolescent performance on The Awareness of Social Inference Test (TASIT), a valid measure of social cognition in adults.

Design: Cross-sectional design examining performance on Parts 1, 2 and 3 of TASIT (and alternate forms) in Australian girls and boys with varying levels of English familiarity.

Methods: 665 schoolchildren from private and government schools were administered TASIT subtests. Of these, 464 students aged 13–15 were selected to provide normative data. Scores from a further 97 provided information about the effects of lack of English familiarity.

Results: The two Forms of TASIT were statistically equivalent for two of the three parts. Adolescents performed lower than adults, although the differences were not large. Some incremental effects were seen for chronological age. Gender effects were apparent on all subtests. Lack of English familiarity (i.e., English not spoken at home) reduced scores a further 6–13% relative to high English proficiency.

Conclusions: TASIT appears to be suitable for adolescents. Norms are best aggregated across ages in adolescence and stratified according to gender.

rimary Objectives: To examine the HADS structure in TBI, using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), and investigate the effects of TBI severity, Gender, and Age on factor scores. Methods and Procedures: HADS data from 186 TBI patients in a population study in Tasmania were subjected to EFA. HADS data from a second sample of 185 TBI participants in the same study underwent CFA. One-month follow-up data were used, allowing inclusion of severe TBI patients while still being early post-injury. Factor loadings were used to investigate the effects of demographic and clinical variables at 2 weeks post-injury. Results: While EFA suggested 2-factor (anxiety, depression) and 3-factor (anxiety, psychomotor, depression) structures provided adequate descriptions, CFA strongly supported the 3-factor model. Using this model, significant effects of TBI severity were noted on Psychomotor and Depression scores at 2 weeks post-injury. Males reported significantly fewer symptoms on all 3 factors, as did younger participants. Conclusions: CFA indicates that a 3-factor model provides the best fit for HADS data in TBI. One factor, Psychomotor, has been relatively neglected in the literature, and the current findings suggest its assessment and rehabilitation should receive more attention.

This article considers 10 of the most important developments in neuropsychological rehabilitation over the past 5 years. While several leaders in the field were contacted to discover what they considered to be the most important developments, the selection discussed here is the author's alone and is, therefore, a personal view. Included are: computational models; support for people with dementia; new assessment procedures; new treatment strategies for cognitive, emotional and psychosocial problems; new theoretical models to improve our understanding of the consequences of brain injury; and recognition of the need to find new ways to evaluate the efficacy of rehabilitation. The final section of the article considers possible future developments in rehabilitation, including stronger links with basic neuro-science; better use of imaging procedures; collaboration with pharmaceutical companies; better evaluation of our programs; and the need to educate researchers and practitioners as to the meaning of rehabilitation.

This study aimed to examine the associations among functional impairments, strain and depressive symptoms for caregivers of individuals with brain tumour and other cancers. Sixty-three caregivers (71% female) of individuals with brain tumour (n = 27) and other cancers (n = 36) were recruited from community services. Participants rated their level of depressive symptoms and strain and the functional impairments of the individual with cancer. Overall, approximately 25% of the total caregiver sample was in the clinical range for depressive symptoms. For caregivers of individuals with brain tumour, strain was significantly related to depressive symptoms (r = .57) and the individual's functional impairments (r = –.58); however, level of depressive symptoms was not significantly related to functional impairments (p > .05). For caregivers of individuals with other cancer, level of depressive symptoms was significantly correlated with strain (r = .50) and their relatives' degree of cognitive, interpersonal and emotional difficulties (r = –.36–.46), but not with activities of daily living (p > .05). In a multivariate analysis involving all the caregivers, strain predicted depressive symptoms (R2 = .32, p < .001) after controlling for gender and cancer type. In addition, strain was found to significantly mediate the effects of the interpersonal and emotional difficulties of individuals with cancer on caregiver depressive symptoms. Overall, these findings highlight the need to develop and evaluate strategies for alleviating the role strain associated with supporting individuals with cancer.

Recognition of facial affect has been studied extensively in adults with and without traumatic brain injury (TBI), mostly by asking examinees to match basic emotion words to isolated faces. This method may not capture affect labelling in everyday life when faces are in context and choices are open-ended. To examine effects of context and response format, we asked 148 undergraduate students to label emotions shown on faces either in isolation or in natural visual scenes. Responses were categorised as representing basic emotions, social emotions, cognitive state terms, or appraisals. We used students’ responses to create a scoring system that was applied prospectively to five men with TBI. In both groups, over 50% of responses were neither basic emotion words nor synonyms, and there was no significant difference in response types between faces alone vs. in scenes. Adults with TBI used labels not seen in students’ responses, talked more overall, and often gave multiple labels for one photo. Results suggest benefits of moving beyond forced-choice tests of faces in isolation to fully characterise affect recognition in adults with and without TBI.

Background: Application of salient cultural knowledge held by families following child and adolescent traumatic brain injury (TBI) has yet to be documented in the literature. While the importance of the family is a well-established determinant of enhanced outcomes in child and adolescent TBI, the emphasis to date has been on the leading role of professional knowledge. The role of whānau (extended family) is recognised as an essential aspect of hauora (wellbeing) for Māori, who are overrepresented in TBI populations. However, whānau knowledge systems as a potent resource for enhancing recovery outcomes have not previously been explored. This paper describes the development of an indigenous intervention, Te Waka Oranga.

Method: Rangahau Kaupapa Māori (Māori determined research methods) theory building was used to develop a TBI intervention for working with Māori. The intervention emerged from the findings and analysis of data from 18 wānanga (culturally determined fora) held on rural, remote and urban marae (traditional meeting houses).

Results: The intervention framework, called Te Waka Oranga, describes a process akin to teams of paddlers working together to move a waka (canoe, vessel) in a desired direction of recovery. This activity occurs within a Māori defined space, enabling both world views, that of the whānau and the clinical world, to work together. Whānau knowledge therefore has a vital role alongside clinical knowledge in maximising outcomes in mokopuna (infants, children, adolescents and young adults) with TBI.

Conclusion: Te Waka Oranga provides for the equal participation of two knowledge systems, that of whānau and of clinical staff in their work in the context of mokopuna TBI. This framework challenges the existing paradigm of the role of families in child and adolescent TBI rehabilitation by highlighting the essential role of cultural knowledge and practices held within culturally determined groups. Further research is needed to test the intervention.

Following a severe traumatic brain injury (TBI) there is a complex presentation of psychological symptoms which may impact on recovery. Validated treatments addressing these symptoms for this group of people are limited. This article reports on the protocol for a single-centre, two-armed, Phase II Randomised Control Trial (RCT) to address the adjustment process following a severe TBI. Participants will be recruited from Liverpool Brain Injury Rehabilitation Unit and randomly allocated to one of two groups, Acceptance and Commitment Therapy (ACT) or an active control (Befriending). The active treatment group utilises the six core processes of ACT with the intention of increasing participation and psychological flexibility and reducing psychological distress. A number of primary and secondary outcome measures, administered at assessment, post-treatment and 1-month follow-up, will be used to assess clinical outcomes. The publication of the protocol before the trial results are available addresses fidelity criterion (intervention design) for RCTs. This ensures transparency in the RCT and that it meets the guidelines according to the CONSORT statement. The protocol has also been registered on the Australian New Zealand Clinical Trials Registry ACTRN12610000851066.

Research on observer rating of memory in children is examined in relation to the potential to develop screening instruments to improve efficiency in memory assessment, to shed light on the area of everyday memory in children, and to develop observer rating to the point where it may substitute for objective assessment. Several scales including the Parent Memory Questionnaire, the Children's Memory Questionnaire, the Observer Memory Questionnaire — Parent Form and the Working Memory Rating Scale are reviewed. Only the Working Memory Rating Scale has been published. Some of the other scales have good internal consistency and test–retest reliability but none have proven to be effective screening instruments and none can yet be recommended for clinical application. Relationships with objective test results have been at best modest, an issue that requires more detailed analysis if such instruments are to become effective screeners or even substitutes for objective assessment. Further observer rating research will shed light on everyday memory in children including its relationship to objective assessment and its place in models of memory. It remains to be established whether observer ratings add unique information to memory assessment or whether they can become a reliable, cost-effective substitute for objective assessment.

Purpose: Use accelerometers to examine the physical activity behaviours of individuals following TBI undergoing inpatient rehabilitation.

Method: Twenty-one individuals with Traumatic brain injury (TBI) undergoing inpatient rehabilitation (9 females, 12 males; M age = 43.8 ± 14.7 years; M GCS = 9.1 ± 4.3; M time since injury = 40.8 ± 22.1 days; M length of stay (LOS) = 30 ± 14 days) wore accelerometers for an average of 8.4 ± 2.0 consecutive days (1440 minutes/day). Activity counts (AC) were collected at 1 minute epochs and descriptive statistics were calculated to assess intensity of activity and time spent being active and sedentary.

Results: During scheduled therapy, time individuals completed an average of 161.4 ± 65.5 AC/minute, which decreased to 114.5 ± 51.3 during non-therapy time and 22.2 ± 10 when sleeping. Using population level cut points, individuals were on average considered inactive during therapy, inactive or sedentary during non-therapy time, and only one participant spent >1 minute in moderate intensity activity. The mean length of active and sedentary bouts was 9 minutes.

Discussion: Findings indicate that the amount and intensity of activity completed is low amongst individuals completing inpatient rehabilitation after TBI, with the majority considered sedentary or inactive. While the sample is small, it is important to develop and implement safe and effective strategies to increase activity levels during rehabilitation.

Most people only recognise the value of olfactory function after it is lost. In the context of traumatic brain injury with its far-reaching physical, cognitive, behavioural and emotional sequelae, posttraumatic olfactory dysfunction is an additional consequence that many survivors have to face as they adjust to a changed life situation. The aim of this article is to provide an update on posttraumatic anosmia for clinicians working in the area of brain injury rehabilitation. Brief reviews of incidence studies and causal mechanisms of olfactory impairment after brain injury are provided. Consequences of anosmia in the domains of safety, eating, personal hygiene, leisure, work and relationships with associated adaptive strategies are described.

The International Classification of Functioning, Disability and Health (ICF) is a taxonomy that classifies health states and health conditions. It is a complex and detailed taxonomy, with 1,424 categories, covering body structures and functions, activities and participation, and environmental factors. The complexity and detail, however, can serve as a barrier in its everyday application. A number of strategies have been developed to facilitate use of the ICF in clinical and research practice, including the development of ‘core sets’. In this article, we present another method which will assist both the newcomer and those more familiar with the ICF. Along with a description of the ICF structure and contents, the article presents a graphical representation of ‘ICF trees’ as a vehicle to more readily grasp the detail of the ICF structure and contents and facilitate its use in the area of acquired brain impairment.

There is compelling evidence that traditional methods used to address the detrimental impacts of missing data are inadequate. Despite this, researchers have been slow to utilise newer statistical approaches known to be more effective. The aim of the current article is to offer a conceptual explanation of the rationale for using newer missing data techniques, with a focus on multiple imputation (MI). To illustrate the relative efficacy of deletion, single imputation and multiple imputation techniques in the clinical setting, 20 cases were selected randomly from a population study investigating the cognitive sequelae of traumatic brain injury (TBI), and 8 out of 20 cases had scores on one variable deleted to simulate a missing data set. Comparing the parameter estimates obtained by each technique to the known parameters of the complete data set revealed that MI outperformed deletion and single imputation approaches. It is therefore recommended that more sophisticated techniques such as MI should be considered in clinical research.