Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.
To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Sentence repetition is part of the assessment tasks used to better characterise aphasic patients’ oral production. Moreover, impaired sentence and phrase repetition is a core feature of the logopenic variant of primary progressive aphasia. The aim of this study is to present the TEFREP (TEst Français de RÉpétition de Phrases), a French sentence repetition task that manipulates psycholinguistic variables known to affect the performance of aphasic patients. The final version of the TEFREP consists of 24 sentences in which length, semantic reversibility and type of sentence have been manipulated. The task shows good psychometric properties (validity and reliability). Norms according to age and education level have been developed from a sample of 80 healthy adults and older adults. In conclusion, the TEFREP fulfills the current need for a reliable assessment tool of sentence repetition in Canadian French-speaking populations and contributes to the differential diagnosis of language impairment.
In 2005 Elliott et al. published a paper entitled ‘Effect of posture on levels of arousal and awareness in vegetative and minimally conscious patients: a preliminary investigation’. Twelve patients, of whom 5 were in the vegetative state (VS) and 7 in the minimally conscious state (MCS), were assessed with the Wessex Head Injury Matrix (WHIM) when supine and when upright on a tilt table. The present study replicated and extended these findings by including a third position, sitting, in addition to supine and standing. We assessed 16 patients (8 in the VS and 8 in the MCS) with mixed aetiologies and compared the observed behaviours in three different positions (supine, sitting and standing) using the WHIM. Most patients (75%) showed more behaviours when in the upright position, compared to lying down (p < .003). Our findings are similar to those seen in the study reported by Elliott et al. With regard to sitting, 62.5% of patients were more responsive when assessed sitting in a wheelchair (p < .05) than in a supine position, and almost 69% were more responsive if assessed in an upright position compared to sitting. This was particularly true for patients in the MCS, where 87.5% did better if assessed on a tilt table or standing frame compared to sitting, suggesting that positional changes can have an effect on the level of arousal and awareness among patients in the VS and MCS.
Background: The extent to which care home residents with severe dementia show awareness is influenced by the extent to which the environment provides opportunities for engagement and by the way in which care staff interact with them. We aimed to establish whether training care staff to observe and identify signs of awareness in residents with severe dementia resulted in improved quality of life for residents.
Methods: In this pilot cluster randomized trial, care staff in four homes (n = 32) received training and supervision and carried out structured observations of residents using the AwareCare measure (n = 32) over an eight-week period, while staff in four control homes (n = 33) had no training with regard to their residents (n = 33) and no contact with the research team. The primary outcome was resident quality of life. Secondary outcomes were resident well-being, behavior and cognition, staff attitudes and well-being, and care practices in the home.
Results: Following intervention, residents in the intervention group had significantly better quality of life as rated by family members than those in the control group, but care staff ratings of quality of life did not differ. There were no other significant between-group differences. Staff participating in the intervention identified benefits in terms of their understanding of residents’ needs.
Conclusions: Staff were able to use the observational measure effectively and relatives of residents in the intervention homes perceived an improvement in their quality of life.
Literature published a decade ago reflected a pessimistic view of the market-oriented reforms that Latin America carried out in the 1980s and 1990s, and many politicians have attacked these reforms openly. Indeed, the atmosphere is so negative that it would be reasonable to assume that many of the reforms have been reversed. This paper will take a new look at the situation ten years later. Our argument is that the reforms have generally not been reversed. The reversal that has occurred has been with respect to privatisation in a few countries; negative public opinion is also concentrated on privatisation; and the reforms helped to enable Latin America to take advantage of favourable conditions leading to high growth in the 2004–8 boom period and a relatively strong performance during the 2008–9 crisis. While much remains to be done to raise growth and improve distribution, objective information about the reforms is needed when policies for the future are made.
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.
The possibility of increasing the burning rate of solid rocket propellants by adding nanoparticles of aluminum into the propellant formulation has already been well-known for many years. This paper deals with micron- and nanoparticles embedded in gun propellants. The objective is to increase the gun performance. The burning behavior of solid propellants based on ultra-fine aluminum powder was investigated in a high pressure range which is reached in a gun tube. The burning rate of such a propellant is much higher (nearly two orders of magnitude) than for the similar propellant with the micron-sized aluminum. This paper presents a review of burning experiments with propellants based on the nano- and micron-sized particles of aluminum. The burning behavior of NENA solid propellants based on nano-scale aluminum was studied as a function of the portion of aluminum in the mixture. The burning of these propellants follows Vieille's burning law. The burning rate increases by augmenting the aluminum portion in the propellant. Theoretical models are reviewed in order to understand these experimental burning results. An advanced propellant coated with appropriate nanoparticles is presented in the conclusion. With this propellant and a special ignition by microwaves it should be possible to ignite solid propellants by using high loading densities (> 1.2 g/cm3).
Clinical experience and anecdotal written accounts suggest that school-age children with high-functioning autism spectrum disorders (ASD) have difficulties which can be described as ‘executive dysfunction’. Problems with organisation, planning and task completion impede academic achievement and cause disruption in daily routine. The authors review research of executive function in this population and conclude that clinicians will find little in the scientific literature to guide them in neuropsychological assessment and remediation. They describe their study of 23 clinic-referred children (18 boys, 5 girls; mean age of 9) illustrating the challenges facing clinicians who would measure executive function. Tests of executive function (including the NEPSY and the BADS-C) were administered. Parent and Teacher questionnaires (DEX-C, BRIEF and VABS) were completed. Scores on tests of executive function and other areas of cognition were found to be in the average or above average range. In contrast, responses on both teacher and parent questionnaires indicated significant executive dysfunction. Parents' responses on the BRIEF and on the DEX-C were not correlated with teacher responses on the BRIEF. The authors consider the importance of a “halo effect” on questionnaire responses and challenge the notion that questionnaire measures have more ecological validity than laboratory measures. Suggestions for future research include observation, interviews and graded modification of the testing environment.
Not enough attention is given to identifying individual neuropsychological deficits of children with ASD in the clinical setting with the aim of remediation despite being recommended by the National Autism Plan for Children (2003).
Studies have shown that various antioxidants are decreased in different age-related degenerative diseases and thus, oxidative stress would have a central role in the pathogenesis of many disorders that involve neuronal degeneration, including Alzheimer's disease (AD). The present study aimed to assess the nutritional status of Se in AD patients and to compare with control subjects with normal cognitive function. The case–control study was carried out on a group of elderly with AD (n 28) and compared with a control group (n 29), both aged between 60 and 89 years. Se intake was evaluated by using a 3-d dietary food record. Se was evaluated in plasma, erythrocytes and nails by using the method of hydride generation atomic absorption spectroscopy. Deficient Se intake was largely observed in the AD group. AD patients showed significantly lower Se levels in plasma, erythrocytes and nails (32·59 μg/l, 43·74 μg/l and 0·302 μg/g) when compared with the control group (50·99 μg/l, 79·16 μg/l and 0·400 μg/g). The results allowed us to suggest that AD has an important relation with Se deficiency.
Although memory deficits are typically the earliest and most profound symptoms of Alzheimer’s disease (AD) and mild cognitive impairment (MCI), there is increasing recognition of subtle executive dysfunctions in these patients. The purpose of the present study was to determine the sensitivity of the Behavioral Assessment of the Dysexecutive Syndrome (BADS), and to detect early specific signs of the dysexecutive syndrome in the transition from normal cognition to dementia. The BADS was administered to 50 MCI subjects, 50 mild AD patients, and 50 normal controls. Statistically significant differences were found among the three groups with the AD patients performing most poorly, and the MCI subjects performing between controls and AD patients. The Rule Shift Cards and the Action Program subtests were the most highly discriminative between MCI and controls; the Zoo Map and Modified Six Elements between MCI and AD; and the Action Program, Zoo Map, and Modified Six Elements between AD and controls. These results demonstrate that the BADS is clinically useful in discriminating between normal cognition and progressive neurodegenerative conditions. Furthermore, these data confirm the presence of a dysexecutive syndrome even in mildly impaired elderly subjects. (JINS, 2009, 15, 751–757.)
Over the past 25 years or so there have been a number of major changes in neuropsychological rehabilitation. First it is now much more of a partnership than it was in the 1970s and 80s. Then doctors, therapists and psychologists decided what patients should and could hope to achieve from rehabilitation programmes. Now we discuss with families and patients what they hope to get from rehabilitation and we try to accommodate to this at least in part. Second, rehabilitation has moved well beyond the drills and exercise approach. We no longer find it acceptable to sit people in front of a computer or workbook in the belief that such exercises will result in improved cognitive and, more importantly, social functioning. Third, rehabilitation staff now follow a goal setting approach when planning rehabilitation programmes. Clients, families and staff negotiate appropriate goals and determine how these are to be achieved. Fourth, there is increasing recognition that the cognitive, emotional, social and behavioural consequences of brain injury are interlinked and all should be addressed in the rehabilitation process. Fifth, technology is playing a larger part than ever before in helping people with cognitive deficits compensate for their problems. Sixth, it is now more widely accepted that no one model, theory or framework is sufficient to deal with the many and complex difficulties faced by people with neuropsychological impairments following an injury or insult to the brain.
The Understanding Brain Injury (UBI) Group, it could be argued, is the most important group of the programme at the Oliver Zangwill Centre (OZC) for Neuropsychological Rehabilitation. It is, perhaps, the main way of helping clients understand what has happened to them, how they have been affected by their brain injuries and what kind of recovery to expect. This information forms the basis of increasing awareness and self-esteem, and significantly contributes to the process of developing both a ‘shared understanding’ and a safe ‘therapeutic milieu’ as described in Chapter 4. Although the consequences of brain injury (e.g. memory, attention and emotional problems) are covered in more detail in other groups, without the knowledge and acceptance that we try to instil in the UBI Group, the other groups are thought to be less likely to succeed.
Central to the philosophy of the Centre is giving clients, where possible, the opportunity to develop good awareness of their strengths and weaknesses, and learn to self-advocate. Brain injury can be a bewildering experience, particularly in the context of cognitive impairments that make it more difficult to notice, understand or respond to problems. For the vast majority of clients, knowledge of brain injury and its consequences is limited to the client's own prior experience of it. One of the aims of the UBI Group is to normalize the consequences of brain injury; the educational, seminar-style format is used to describe how the brain works and how it may be affected by injury.
The Oliver Zangwill Centre (OZC) for Neuropsychological Rehabilitation opened in 1996 and was modelled on the American holistic programmes developed by Yehuda Ben-Yishay and George Prigatano. It was named after Oliver Louis Zangwill, Professor of Psychology at Cambridge University between 1954 and 1984. He was also a pioneer of brain injury rehabilitation in Great Britain during the Second World War when he worked in Edinburgh with brain injured soldiers. The Centre follows many of the principles laid down by Ben-Yishay (1978), Prigatano et al. (1986) and Christensen and Teasdale (1995), and is also significantly influenced by the critical ‘scientist practitioner’ model of clinical psychology adopted in the United Kingdom.
A holistic approach to brain injury rehabilitation ‘… consists of well-integrated interventions that exceed in scope, as well as in kind, those highly specific and circumscribed interventions which are usually subsumed under the term “cognitive remediation”’ (Ben-Yishay and Prigatano, 1990; p. 40). The holistic approach recognizes that it does not make sense to separate the cognitive, emotional and social consequences of brain injury as how we feel and think affects how we behave. Ben-Yishay's (1978) model follows a hierarchy of stages through which the patient or client should work in rehabilitation. These stages are engagement, awareness, mastery, control, acceptance and identity. Individual and group sessions are provided to enable patients to work through these stages.
The origins of the OZC go back to 1993 when one of us (BAW) spent several weeks at Prigatano's unit in Phoenix Arizona.
In Chapter 1 we presented a model of rehabilitation that highlights the range of theories that may be drawn upon to support the identification and development of interventions for the many consequences of brain injury or illness. The case presented here highlights in practice how cognitive neuropsychological intervention (as defined by Coltheart (2005)) can be integrated into neuropsychological rehabilitation, with a specific emphasis on communication and numeracy. The importance of learning method is also raised both in terms of learning specific skills or information as well as functional generalization.
We describe our work with Lorna as a further example of our interdisciplinary approach, in which team members worked in an integrated way with the client towards shared functional goals. Significantly, Lorna's level of communication was initially considered a potential barrier to her ability to benefit from the groups and participate fully in the therapeutic milieu process. Subsequently these concerns appeared largely unfounded.
Once again a formulation-based approach provided a means of integrating assessment results, developing a collaborative understanding regarding the client's needs and building a basis upon which to address these across the team. The case highlights specific and successful interventions for naming and numeracy difficulties, as well as development of compensatory strategies, together applied to increase participation in meaningful activities as part of the integrated rehabilitation programme.
History of injury
Lorna suffered a brain injury in May 1999 whilst living and working abroad.