Impaired self-awareness may affect clients' emotional status, engagement in rehabilitation and community reintegration following traumatic brain injury (TBI). The study aimed to investigate the relationship between self-awareness, emotional distress and community integration in adults with TBI during the transition from hospital to the community. Thirty-four rehabilitation clients with TBI were assessed in the week before and 2 months after discharge home. Measures of self-awareness and emotional functioning were administered predischarge and repeated at follow-up along with a measure of community integration. Nonparametric tests were used to compare levels of self-awareness and emotional distress pre- and postdischarge, their interrelationships and association with community integration. Self-awareness significantly increased following discharge, and a trend towards increased depression was found. There were no consistent relationships found between level of self-awareness, emotional functioning, and community integration. The development of self-awareness in the immediate postdischarge phase suggests this is an important time for clinical interventions targeting compensation strategies and adjustment to disability.

This study aimed to describe the recovery of impairments after severe traumatic brain injury (TBI) over a 3-year period. An inception cohort over 2 years was recruited from 11 brain injury rehabilitation units participating in a state-wide program. The 131 individuals with TBI were assessed at admission to the rehabilitation program, 18 months and 3 years post-trauma. This report described results from the Disability Rating Scale (DRS) and Mayo-Portland Adaptability Index (MPAI). Regression analyses, examining the influence of five acute injury variables on DRS and MPAI, revealed that posttraumatic amnesia (PTA) was a significant individual predictor. Data were thus analysed according to duration of PTA: 1 to 2 weeks (n = 19), 2 to 4 weeks (n = 44) and more than 4 weeks (n = 68). At program admission there was poorer overall level of functioning on the DRS in the longest PTA group, but no difference between the shorter PTA groups. Significant improvements occurred on the DRS for all PTA groups over the first 18 months posttrauma, with improvements continuing between 18 months and 3 years. At the 3-year follow-up, frequency data from the MPAI indicated that clinically significant impairments in mobility, hand function, communication and behaviour were uncommon in the shorter PTA groups, although 36% to 47% continued to experience cognitive impairments. Impairments were common in the longest PTA group in some areas, particularly cognition where two thirds or more continued to experience clinically significant impairments in attention, memory and novel problem-solving. These results confirm the predictive significance of PTA duration regarding longer-term level of recovery. They also highlight the limitation in classifying the ‘severe’ TBI category as an homogenous group: significant subgroup differences occurred on medical and functional variables at program admission, 18 months and 3 years posttrauma. These data further substantiate the persistence of neuropsychological impairments in the face of good physical recovery at all levels of severity within the severe TBI group.

Research into communication disorders has been undergoing a slow revolution over the past few decades with some fascinating advances and some exciting new directions ahead. The major change in emphasis that has emerged is an interest in assessing communication as this relates to real-life everyday type situations. In particular, three major thrusts can be identified. The first is the application of socially relevant linguistic theory to communication disorders. Thus, theorists such as Halliday have provided useful frameworks for identifying patterns in discourse. In turn, these have revealed the strengths and weakness of speakers with aphasia or other communication disorders (e.g., traumatic brain injuries) and also what their conversational partners do to help or hinder this process. The second is an examination of how cognitive processes, including memory, inferential reasoning and social cognition, contribute to communicative competence in people who have communication disorders but not aphasia, such as those with Alzheimer's disease, with traumatic brain injuries and with right hemisphere lesions. The third is the adoption of a more integrated approach, whereby verbal and nonverbal behaviours are examined in detail for their communicative meaning, for both the purposes of characterising communication breakdown and for developing an integrated treatment approach.

Individuals seeking compensation following traumatic brain injury (TBI) are often found to report a disproportionately high level of symptoms relative to objective indicators of impairment. Previous studies highlight that level of symptom reporting is also related to self-awareness, causal attribution, and emotional wellbeing. Therefore, the reasons for high symptom reporting in the context of compensation are generally unclear. This study aimed to identify whether self-awareness, causal attribution, and emotional wellbeing are significantly associated with level of symptom reporting after controlling for compensation status. A sample of 54 participants with TBI comprised two groups, namely, claimants (n = 27) and non-claimants (n = 27), who were similar in terms of demographic and neuro-cognitive variables. Participants completed the Symptom Expectancy Checklist, Hospital Anxiety Depression Scale, Awareness Questionnaire and a causal attribution scale. A series of independent t tests and Pearson's correlations identified that a higher level of symptom reporting was associated with the following: seeking compensation, less severe TBI, increased age, greater self-awareness, increased post-injury changes reported by relatives, a higher level of mood symptoms, and a tendency to blame other people. Multivariate analysis identified that after controlling for demographic, injury, and compensation status variables, level of mood symptoms and self-awareness were significantly associated with level of symptom reporting. The findings suggest that mood symptoms and heightened self-awareness are significantly related to high symptom reporting independent of compensation status, thus supporting the need for clinicians to interpret symptom reporting within a biopsychosocial context.

This article discusses the significance of conversation in current clinical practice with individuals with aphasia and their conversation partners. It explores the nature of everyday talk, and provides an overview of how studies to date have examined the conversations of individuals with aphasia and have provided some promising treatment avenues. It also proposes another framework, Speech Function Analysis, that may assist further in incorporating conversational principles into the therapy context. The framework provides a system network for examining speech functions in dialogue, while considering the effects of both lexical and syntactic limitations, and context. Examples of conversations between three individuals with aphasia and their partners are used to illustrate the analysis. The authors suggest that further knowledge of both aphasic speakers' and their partners' interactions as well as clinician–client interactions may increase our insights into this area, and make authentic and meaningful conversation more accessible in the clinical situation and beyond.

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.

This article presents preliminary findings on an investigation into the differences in communicative performance across varying speaking conditions, of an individual with a cognitive–linguistic impairment following traumatic brain injury (TBI). The article compares the communicative exchanges of an individual in a conversation with a therapist, a conversational dyad with a peer with TBI, and in a communication group task where they were interacting with other participants with TBI. The speaking conditions studied included an unstructured chat, the participant requesting information and the participant giving information. Results showed that the person with TBI responded to differences in communication partner and speaker role. He was best able to give information in the unstructured chat with the clinician and the information giving session in the group. Requesting was maximally facilitated in the information request condition with the clinician. Qualitatively, however, the most equal interactions occurred with the peer, with evidence of the person with TBI engaging in typical conversational strategies such as establishing common ground to facilitate topic development and co-constructing the discourse topics. These strategies did not occur in the clinician or group interactions, possibly due to power imbalance in the former and impaired cognitive–linguistic ability in the latter situation. Implications for clinical decision making regarding intervention strategies for patients with cognitive–communication deficits are discussed.

The majority of people with severe traumatic brain injury (TBI) experience long-term disability and are unable to return to their usual activities. Services that offer community social and leisure participation programs are likely to reduce the social burden associated with severe TBI. The aim of this study was to gain an understanding of the personal effects of becoming engaged in community leisure activities. It was hypothesised that adults with severe TBI who participated regularly in leisure activities over a 6-month period would show measurable positive change in the domains of community integration, social support, mental health and quality of life (QOL). Participants numbered 25 adults (mean age 36.95 years) who had been referred to community leisure programs participated in the study. All participants had sustained severe injuries (post-traumatic amnesia > 1 month). A repeated measures design over 6 months was used. Assessment involved a semistructured interview, global subjective QOL rating and administration of standardised measures: SF-12v2, Neurobehavioral Functioning Inventory, Instrumental-Expressive Social Support-Scale, and Community Integration Questionnaire. Adults who participated regularly over 6 months reported positive and statistically significant changes in social integration and mental health. These findings support the use of assisted community participation programs for adults with severe TBI.

Normative and reliability data for the Excluded Letter Fluency (ELF) Test are provided. A stratified random sample of 399 healthy young adults aged 18 to 34 years from Sydney, Australia, completed the ELF Test as well as a full-length WAIS-R, as part of a larger battery of tests. After a 1-year interval 99 of these individuals were retested on the same forms of the tests. The influence of age, sex and education was investigated on the ELF and only education was found to have a significant overall effect on the total scores. However, gender was found to have an effect on the error scores, with males making more rule-breaks than females. Tables are provided for converting ELF raw scores, corrected for years of education, to standard scores with 90% and 95% confidence intervals for both test and retest purposes. A table for calculating the base rate of errors, for males and for females, on the ELF is also provided.

In the context of evidence-based clinical practice (EBCP), the reliability of empirical data is largely determined by the methodological quality of research design. PsycBITE™ (Psychological Database of Brain Impairment Treatment Efficacy) is a web-based database listing all published, empirical reports on the effectiveness of nonpharmacological interventions for the psychological consequences of acquired brain impairment (ABI). The aim of this study was to survey the listings of PsycBITE™ and examine the methodological quality of the reports it contains. Reports listed in PsycBITE™ include systematic reviews (SRs), randomised controlled trials (RCTs), non-RCTs, case series (CSs) and single-subject designs (SSDs). They are indexed according to research design, neurological group, patient age group, target area and intervention type. The PEDro Scale is used to rate the methodological quality of RCTs, nonRCTs and CSs, with maximum obtainable methodological quality rating (MQR) of 10/10, 8/10 and 2/10 respectively. A search identified 1298 reports indexed in PsycBITE™. The largest proportion was SSDs (39%), followed by CSs (22%), RCTs (21%), non-RCTs (11%) and SRs (7%). The majority of reports was concerned with stroke (41%), traumatic brain injury (29%) and Alzheimer's and related dementias (22%). The most frequently investigated deficits were communication/language/speech disorders (24%); independent/self-care activities (19%); behaviour problems (17%); memory impairments (17%); anxiety, depression, stress, adjustment (15%). Approximately half of the RCTs, non-RCTs and CSs were rated for methodological quality. Mean MQR scores for RCTs, non-RCTs and CSs were 4.49, 2.85 and 1.15 respectively. While some PEDro criteria were met by a high proportion of RCTs and non-RCTs (≥ 70%), other criteria were only met by a small proportion of reports (as low as 1.6%). There was no significant difference in MQR scores between RCTs focusing on different neurological groups or target areas. Furthermore, there was no discernible improvement in MQR score for RCTs published over the last three decades. The methodological quality of studies investigating the efficacy of rehabilitation interventions in ABI has been consistently modest over several decades. This is largely attributable to poor adherence to fundamental tenets of research design, and requires urgent remediation. RCTs (and to a lesser extent, non-RCTs) are research methodologies which can potentially yield a high level of evidence, but only if they are adequately designed. PsycBITE™ has the facility to raise awareness of these issues and be instrumental in promoting EBCP in the field of ABI.

Right hemisphere damage (RHD) following unilateral stroke is often associated with impairment of pragmatic language, specifically, the ability to comprehend inferences that arise from language used in context. Three kinds of cognitive deficits have been proposed to explain the pragmatic deficits in RHD individuals, impaired Theory of Mind (TOM), weak central coherence (CC), and impaired executive function (EF). This study aims to evaluate the explanatory ability of these theories in relation to the comprehension of nonliteral (ironic) jokes versus literal lies. Twenty-one RHD patients and 21 age-matched controls were assessed on tasks tapping TOM, CC processing and general inference ability (EF) and the comprehension of irony. Second-order TOM and EF were found to play a significant role. However, neither construct, either in isolation or combined, completely explained the poor performance of RHD patients on this task compared to control participants.

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.

The term ‘cognitive-linguistic’ has been widely adopted in descriptions of a variety of communication disorders of neurogenic origin. Despite this, clear agreement on the meaning of the term has yet to be reached, with the result that it is used both inconsistently and misleadingly. This lack of terminological clarity also undermines the assessment of complex communicative function. In this article the terminology associated with complex communication disorders is discussed and a simple framework for conceptualising cognitive-linguistic function is outlined. On the basis of this it is proposed that some currently available assessments that purport to measure cognitive-linguistic skills in fact have less explanatory power than other assessments that are often not specifically targeted at communication. Further, it is suggested that the framework offers an ecologically valid basis for the systematic assessment of cognitive-linguistic function.

Attention is considered to be the foundation of most cognitive and neuropsychological processes and it is often the subject of study in the common childhood disorder, attention-deficit/hyperactivity disorder (ADHD). This article reviews studies on the attentional functioning of children with subtypes of ADHD and children with learning disabilities (LD). First, an overview of ADHD including current conceptualisation and cognitive theories of the disorder are outlined. Second, attention is described as a multidimensional construct consisting of a number of components. This model of attention will be used as a framework for reviewing studies in the ADHD literature. In particular, the following comparisons of children will be examined: (1) ADHD compared with non-disordered controls, (2) ADHD compared with LD, and (3) hyperactivity/impulsive forms of ADHD compared with inattentive ADHD. Finally, the implications of a multi-modal framework of attention will be discussed within the context of theory and treatment of ADHD.

In the previous issue of Brain Impairment, Ewing (2006) described developments in the knowledge base underpinning clinical neuropsychology and implications for paediatric brain injury. This article discusses new research regarding post-injury recovery in the adult brain and its implications for clinical practice.

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.

Most studies of conversational discourse in traumatic brain injury (TBI) have used summary measures averaged over time. These measures have yielded useful aggregate data but do not capture the temporal dynamics of interpersonal interactions. To fully characterise the conversational discourse of individuals with TBI, it may be useful to consider individuals and behaviours as systems changing over time. In this article, we review dynamic systems approaches that have been used to study conversational interactions, and present data to illustrate their potential utility in characterising the conversational discourse of individuals with TBI.