Those after traumatic brain injury (TBI) who suffer mental health problems, by which I mean problems that a psychiatrist might understand as falling within their remit, suffer a double whammy. Not only do they suffer the stigma of the disabled, but even within this group they may be stigmatised. It has often been my experience that while families will allow for their injured loved one to be under the care of rehabilitation services, including a psychologist, they baulk at the possibility that their loved one may need psychiatric care. This comes to a head when it comes to detaining a patient, in England and Wales, under the Mental Health Act; this may be vigorously resisted by family because of what they infer this says about their loved one's sanity.

People with brain impairments are less active than the general population and consequently have an increased risk of chronic disease. To increase activity requires interventions that are theory driven and evidence based. Here, we describe the adapted physical activity program (APAP), a physical activity promotion program with demonstrated efficacy in community dwelling adults with brain impairments. Distinguishing features of the APAP include the following: delivery in the participants home/or community environment and the utilisation of the principals of community-based rehabilitation; the assessment of each of the domains of the International Classification of Functioning, Disability and Health (ICF) (i.e., health conditions, impairments, activity limitations, participation restrictions and personal and environmental characteristics) to determine how they will impact physical activity adoption and maintenance; the incorporation of theory-based physical activity adoption and maintenance strategies; the utilisation of lifestyle physical activity programs (including client-centred selection of activities) and/or structured exercise programs (requiring principles of exercise prescription). It is anticipated that this program description will permit researchers and/or practitioners to implement the program, replicate its evaluation and/or translate the program into multi-professional rehabilitation settings.

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.

Objectives and Background: In patients with medically refractory seizures 20–30% do not have epilepsy, and the majority are diagnosed with psychogenic non-epileptic seizures (PNES). Almost one-third of this group has a prolonged episode that is termed as PNES status epilepticus (PNES-SE). The aim of this study was to describe the characteristics of patients with (1) PNES-SE only and (2) PNES-SE with concurrent epileptic seizures.

Methods: We screened retrospectively all patients who underwent video-electroencephalogram (video-EEG) long-term monitoring at our institution between 1996 and 2009. Patients with PNES were identified by typical clinical features with no ictal EEG changes. Patients with continuous episodes for at least 30 min that led to intubation were identified as PNES-SE. They were divided into two groups: group 1, pure PNES-SE and group 2, PNES-SE with concurrent epilepsy. Group characteristics were defined with respect to demographic, clinical, electroencephalographic, neuroimaging and psychiatric variables.

Results: PNES were recorded in 88/916 patients (10%) of whom 6 (7%) were treated intensively due to misdiagnosis of status epilepticus (SE), with two having coexistent epileptic seizures. All patients had concurrent psychiatric disorder(s), diagnosed by a psychiatrist. Duration of time until correct diagnosis was lengthy in all cases, and particularly for patients with PNES-SE with coexisting epileptic seizures (more than 10 years).

Conclusion: To avoid iatrogenic complications and to treat the underlying psychiatric conditions, early diagnosis of PNES is necessary. Understanding the clinical characteristics of PNES-SE leads to early diagnoses, which may avoid iatrogenesis and economic burden.

Objective: To develop a tool for assessing intentions to continue or change activities for recovery following mild traumatic brain injury (mTBI) and determine if they are dependent on injury context or activity type. Method: Adult volunteers with no (or no recent) history of mTBI were randomly allocated to one of two vignette conditions, each with a different injury context. The vignette described an mTBI due to a motor vehicle accident (MVA, n = 76) or sport (SPORT, n = 89). Volunteers reported their rest or activity plans for 39 behaviours comprising three behaviour types (cognitive, physical, and restful). Results: Compared to a cut-score representing no change, on average there was a significant (p <= .001) planned decrease in physical and cognitive behaviours (MVAphysicalt(53) = 7.373; SPORTphysicalt(41) = 9.281; MVAcognitivet(41) = 9.367; SPORTcognitivet(51) = −3.521) and a significant planned increase in restful behaviours, such as sleep (MVArestfult(72) = 10.006; SPORTrestfult(86) = 9.566). An overall within-group effect for behaviour-type was not identified and there was no effect of condition (MVA vs. SPORT). Conclusion: The acute rest and activity plans for a simulated mTBI are behaviour specific and not dependent on context. An expectation for blanket-rest was not was observed but rest was planned for specific behaviours. This tool could be used to guide discussions with mTBI patients about their recovery so that their plans align with advice, and it could aid further research into the relation between intended and actual rest and activity and the effect on eventual outcomes.

The prevalence and determinates of depression in 67 older adults were assessed at 1 year post-stroke. The sample had an average age of 74 years (SD = 7, range = 60–87 years) at the time of their stroke and 52% were female. The relative contribution of demographic (gender, age), medical (history of previous stroke, hemispheric location of stroke), two measures of functional independence (Barthel Activities of Daily Living (ADL) Index and Nottingham Extended ADL Index) and aspects of cognitive functioning (IQ, attention, verbal memory and verbal fluency) to depression (Geriatric Depression Scale) was investigated. Results indicated that 51% of patients had impairment in activities of daily living, and 33% reported clinically significant levels of depression. Prevalence of cognitive impairment ranged from 28% on a measure of basic cognitive functioning through to 87% on a measure of complex attention. The results from a hierarchical multiple regression analysis showed that the combination of variables explained 40% of the variance in depression scores. In addition, the two individual variables of history of previous stroke and functional independence made significant unique contributions to the variance in depression scores. These results demonstrate the wide variety of factors involved and provide support for a biopsychosocial model of post-stroke depression.

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.

An experiment is reported in which young and older adults performed a visual orienting task and a cue discrimination task. In the visual orienting task symbolic cues (letters) provided predictive information concerning the likely location of a target stimulus. Two letters, drawn from a pool of four ‘valid’ and four ‘invalid’ letters, were presented bilaterally, at either central or peripheral locations. In the cue discrimination task participants were presented with the same bilateral letter stimuli, and indicated whether these represented a valid letter on the right with an invalid letter on the left, or vice versa. In the visual orienting task young adults shifted attention appropriately in response to the letter cues, but older adults failed to do this. Older participants also performed more poorly on the cue discrimination task. However, even older participants who performed as well as young participants on the cue discrimination task failed to orient in response to the letter cues. Results are discussed in terms of effects of ageing on the ability to forge functionally effective links between different task components in the course of learning how to perform new perceptuomotor skills.

This paper is a personal exploration of one woman's lived experience with aphasia, verbal dyspraxia and accent change following cryptogenic ischaemic stroke. I share insights into my experiences, especially of an emotional and cultural nature, after growing up multilingual in Europe and then living with communication changes in a predominantly English-speaking country (Australia) and following return to Europe. My formal reflections commenced 15 years after the stroke and, following my previous studies in the medical field, multimodal visual arts and philosophy, were initiated in the context of postgraduate study emphasising a multimodal arts-based, collaborative, experiential approach to reconstructing understandings of experiences, values and meanings. Central features of this personal narrative include emergent, iterative enquiry and learning: emergent, in that the enquiry was open-ended, allowing for an element of surprise and the opportunity to pursue unanticipated directions; iterative, in that it involved knowingly experiencing and conversing about what had been discovered in order to engage with the process of continuous meaning-making. Following the enquiry, fellow students provided intersubjective responses to issues that touched personal reflection on their part. In particular, I highlight one fellow student's intersubjective responses that touched me in return by providing especially pertinent understanding and images.

Contemporary psychological literature as well as the preceding papers (Mateer & Sohlberg, 2003; Wilson, 2003; Ylvisaker, 2003) emphasise the individual patient's personal ecological context as a crucial factor in the delivery of cognitive rehabilitation services. Testing and assessment procedures in neuropsychology have been enjoined to take increasing notice of the patient's historical, cultural and social background in providing services (American Psychological Association, 2003). Similarly, the design and delivery of treatment services must take into account how and where patients are living their lives post-injury. This has the benefit of moving cognitive rehabilitation from an emphasis on the more obvious or face-valid concerns about sterile “cognitive” models to individual ways of facilitating learning and information transfer improvement in the real world. In this way of approaching the problem, the patient's cultural and demographic context as well as their emotional adaptations are not confounding variables but critical design variables. The challenge now in delivering these paradigms of care is to show that they are appropriate and effective in some place in healthcare delivery systems, whether traditional or alternative. Questions of effectiveness of cognitive rehabilitation treatments and cost should be balanced in an equation relating to the probability of objective and demonstrable patient enhancement in living. Goals set and achieved must have consensual value that cannot be captured by traditional cost-benefit analysis in preventive or curative healthcare economic methodology. Cognitive rehabilitation as a family of interventions has little to no chance of being evaluated as efficacious using traditional treatment designs, using traditional neuropsychological measures as dependent variables, and involving research designs with crossover, sham or placebo conditions.

Dual task performance in children with Tourette Syndrome (TS) was studied. The participants were children with TS (N = 48, 40 male, 8 female), Attention Deficit Hyperactivity Disorder (ADHD; mixed types N = 44, 34 male, 10 female) and unaffected controls (N = 48, 34 male, 14 female). Eleven of the TS participants had no comorbidities (TS only) and they were compared to matched groups of participants with TS plus comorbidities (TS+), ADHD, and controls. Each participant was administered screening measures of behaviour, intelligence and verbal ability, as well as specific tests of dual task performance. Children with TS-only correctly recalled fewer digit span forward trials, and identified fewer spaceship pairs than controls under single task conditions in the SkySearch subtest of the Test of Everyday Attention for Children. However, the TS-only and control groups showed better counting performance while simultaneously searching for targets, than the TS+ and ADHD groups. Taken together, these results suggest that some previously reported cognitive deficits in children with TS are due to comorbidities, rather than to the syndrome itself.