This paper outlines some of the issues that arise when neuropsychologists, usually white, are faced with carrying out neuropsychological assessments on indigenous people. Whilst the focus is on the New Zealand situation and the assessment of Maori, it is suggested that some of the issues and possibly some of the solutions will provide a useful starting point for other countries, including Australia, where indigenous people have been colonised and as a result are over-represented in many of the negative statistics. New Zealand is in a transition stage where the number of indigenous clinical psychologists and neuropsychologists is growing but is still very small. Even when there are enough Maori neuropsychologists to serve the needs of Maori clients, there will still be situations when Maori prefer to be seen by a white neuropsychologist, or when a white neuropsychologist is the only professional available with the appropriate expertise related to the assessment of a particular disorder. It is therefore our professional responsibility to develop knowledge and skills that will assist us to carry out culturally-fair assessments which can lead to a better outcome for the client, and at the very least can reduce the harm done by an insensitive and invalid assessment.

Psychosocial adjustment problems following traumatic brain injury (TBI) frequently present a major barrier for rehabilitation. The ability to cope has been linked with psychological well-being following stressful and traumatic events, but has been poorly examined in the area of TBI. In terms of conceptualisation, most coping research has adopted the Lazarus and Folkman (1984) dichotomy of coping, namely problem-focused and emotion-focused. Despite the popularity of this theory, recent conceptualisations of coping have suggested that other dimensions are equally important and require investigation in the TBI area. However, measurement of coping continues to provide a major barrier for research in this area, particularly given the potential difficulties associated with self-report data in people with TBI. The current study used a contextually sensitive assessment technique to test current conceptualisations of coping in the TBI population. Specifically, the study examined coping strategies and styles in response to four stressful video-based scenarios. Rather than using a self-report questionnaire to assess predetermined coping strategies, participants spontaneously provided their own coping strategies, which were then coded into distinct coping strategies. The strategies were categorised into four groups according to their focus (emotion or problem) and approach (active or passive). Both the number and type of coping strategies differed across situations, providing support for the use of a contextually sensitive measurement technique. Further, the theoretically expected pattern of relationships was found between coping types and outcomes. However, these relationships differed across situations and over time, confirming suggestions that coping efficacy may differ depending on the demands of the situation and that chronic situations such as TBI may have an impact on coping style over time.

This study investigated cognitive flexibility as indexed by the Written and Oral Trail Making Test (TMT) in sixteen persons with dementia and 60 normal elderly. Written and Oral TMT performances were significantly correlated with each other and with other tests of cognitive flexibility providing an index of the convergent construct validity of these tests. Part B of the Written TMT was influenced by psychomotor ability although this was diminished by the use of a ratio score B/A rather than simply Part B performance. The Oral test was not related to visual or motor skills, providing evidence for its divergent validity. Both parts of the Written and Oral TMT were found to be sensitive to cognitive decline in dementia. Performance on both Oral and Written TMT was also influenced by age, gender, education and intellectual ability. Previous norms (e.g., MOANS) for the Written TMT which are based on relatively educated elderly, tended to provide deflated scores for the community group tested here. Some additional, preliminary normative data for both tests were compiled which take into account the influences of each of these variables.

Traumatic brain injury (TBI) impacts upon people's sexuality with 50% to 60% of persons reporting some level of disruption post-injury. However, only small proportions of patients/family members report that rehabilitation health professionals made inquiries about whether they had any sexual concerns. Rehabilitation programs have a responsibility to meet the challenge of addressing this important area of human functioning. An agency framework is described that provides a non-threatening, structured way for services to conceptualise, introduce or upgrade sexuality services in a manner that can be maintained over the long term. The framework contains an underlying philosophy of sexuality, five proposed modalities of service provision and detail of the underlying organisational structures that are required to provide sexuality services with consistency and effectiveness over the long term. Finally, organisational strategies that can be employed to implement the framework are discussed as well as suggestions about the sequencing of such strategies. By using the framework, rehabilitation services can put sexuality back onto their treatment agenda, as they seek to restore patients/clients with TBI to the “highest level of adaptation attainable” (World Health Organisation, 1996, p. 1) in all areas of their lives.

We report on the development of a new assessment tool to monitor recovery after severe traumatic brain injury (TBI). Although a number of scales exist to identify such recovery, most are limited if one is interested in monitoring small changes or in setting goals for rehabilitation. This is due to the fact that items are too broad, they may cross more than one dimension (e.g. cognition and motor functioning) and there is a danger that recording of responses may be too subjective. The Wessex Head Injury Matrix (WHIM) was developed to avoid these problems. We observed 88 people with severe TBI. These were consecutive admissions to two hospitals. Mean coma duration was 14 days and mean duration of post traumatic amnesia (PTA) was 56 days. Of 145 behaviours observed, we selected 62 and each behaviour was compared to every other behaviour to determine a likely order of recovery. The resulting WHIM is an observational tool to assess and monitor cognitive recovery after severe head injury. It can be used with patients who are in coma, just out of coma or who are minimally conscious. Two case examples are provided.

Successful communication is integral to quality health care and successful nursing practice. Ten people who had been in hospital in the 12 months prior to the study and who had no functional speech at that time were interviewed about their communication experiences with nurses. Overall, these individuals experienced difficulties, some of which appeared to be related to a lack of augmentative and alternative communication (AAC) resources and a lack of knowledge of AAC among nurses. In addition, the participants noted that nurses did not always have the time or the skills to communicate effectively with them. The participants suggested strategies to improve communication interactions between patients with no or limited functional speech and nurses. These strategies include pre-admission briefing and training nurses about effective strategies for communicating with patients who are unable to speak, including the use of augmentative and alternative communication systems.

This study investigated the effect of severe traumatic brain injury (TBI) on prospective memory. It also sought to identify the relative contributions of executive functioning and retrospective memory to prospective memory. Thirteen patients with severe TBI and 13 matched control subjects were assessed on two novel, yet ecologically valid, experimental measures of prospective memory and standard tests of neuropsychological functioning. Participants with TBI performed significantly worse than did controls on neuropsychological tests and a time-based prospective memory task, indicating that TBI affected not only retrospective but also prospective memory functioning. Multiple regression analyses identified relationships between executive functioning and time-based prospective memory and between retrospective memory and event-based prospective memory. Implications of these findings for the assessment and rehabilitation of memory impairment in individuals with TBI are discussed.

Over the past two decades there has been an increasing number of patients surviving severe traumatic brain injury and entering rehabilitation facilities at an earlier phase in their recovery. These patients often present in a minimally conscious state and are difficult to objectively assess. As a result, a number of batteries have been developed targeting this population. The Western Neuro Sensory Stimulation Profile (WNSSP) was used in the present study to identify patterns in recovery of cognitive-sensory modalities. The WNSSP records of 25 patients in a minimally conscious state were examined and profiles of recovery over four test occasions of a subset of 12 patients were examined in detail. Results demonstrated that within this highly heterogeneous group, Object Manipulation was an early emerging skill, and trends to significance were also observed in Auditory Response, Visual Tracking and Olfactory Response. A case study is presented to illustrate how the WNSSP results can be utilised to direct individualised treatment planning.

On addressing our first meeting in 1976, I speculated on whether the study of the brain and behaviour which had flowered in the preceding decade would continue to develop and assist us in treating brain impaired individuals. Not only did this happen but our Society (Australian Society for the Study of Brain Impairment) founded two years later has gone from one good thing to another. My reservation in accepting the invitation to speak at this 23rd Annual Brain Impairment Conference was a concern about preaching to the converted. My life-time role has been that of missionary, both at home and abroad and, like teachers of all faiths, I have no reservations about repeating what are to me fundamental truths. I will try to keep to the theme of the emergence of ideas rather than an autobiography, but some chronology will help set the background.

Individuals aged over 80 years represent the fastest growing segment of the population. It is becoming increasingly important to investigate the effect of age on cognitive functions such as language, in order to document “normal” and “abnormal” functioning. A task commonly used to test naming ability in clinical practice is the Boston Naming Test (BNT). Although norms exist for this age group, they may have limited applications because of small sample sizes on which they were derived. In addition, this test uses stimulus items that have been shown to be culturally specific. This study presents normative data for the BNT for two levels of education and two age bands based on a randomly selected Australian sample of older adults between the age of 81 and 94 years. Frequencies of the most common error types made in this group of nondemented individuals are also reported.

The frontal lobes, if damaged, may lead to a host of divergent abnormalities, depending on the extent, site, depth, and laterality of the damage. Because of the extensive connections which exist between the frontal lobes and the other systems of the brain, damage to a more remote system may cause frontal system disorder through disconnection. The Hand Movement Test (HMT, Kaufman & Kaufman, 1983) is thought to be sensitive to damage affecting these systems, although the test was developed for use with children rather than adults. This paper examines the effects of three diverse neuropsychological disorders, where damage to the frontal lobes or to their interconnections has been implicated, on hand movement sequencing performance in adults. The three groups studied included patients diagnosed with alcohol-related brain damage (n = 57), patients diagnosed with mild traumatic brain injury (n = 21), and patients diagnosed with age-related dementia (n = 30). HMT performance was significantly poorer in all three clinical groups relative to controls, supporting the addition of this brief, paediatric test in neuropsychological evaluations assessing these disorders.