Background: Neuropsychological deficits occur in over half of the stroke survivors and are associated with the reduced functioning and a decline in quality of life. However, the trajectory of recovery and predictors of neuropsychological outcomes over the first year post stroke are poorly understood.

Method: Neuropsychological performance, assessed using the CNS-Vital signs, was examined at 1 month, 6 months and 12 months after ischaemic stroke (IS) in a sample drawn from a population-based study (N = 198).

Results: While mean scores across neuropsychological domains at each time-point fell in the average range, one in five individuals produced very low-range scores for verbal memory, attention and psychomotor speed. Significant improvements were seen for executive functioning, psychomotor speed and cognitive flexibility within 6 months post stroke, but no gains were noted from 6 to 12 months. Stroke-related neurological deficits and depression at baseline significantly contributed to the prediction of neuropsychological function at 12 month follow-up.

Conclusions: In a significant minority of IS survivors, focal deficits are evident in psychomotor speed, verbal memory, executive functions and attention. Significant improvements in these domains were only evident in the first 6 months post stroke. Initial stroke-related neurological deficits and concurrent depression may be the best predictors of later cognitive functioning.

The importance of physical activity to promote health is not new. However, the importance of physical activity in people with neurological conditions is increasingly being recognised. With many of the consequences of neurological conditions including difficulties with mobility, balance and strength; it stands to reason that optimising physical activity levels can result in many physical benefits. Physical activity can have many other flow-on effects with benefits seen in reduced mortality, and enhanced community participation and quality of life (Gordon et al., 2004). We are yet to understand the full extent to which physical activity contributes to rehabilitation outcomes; however, there is a growing body of research highlighting that the intensity of activity within rehabilitation environments is often inadequate for therapeutic gains (Kuys, Brauer, & Ada, 2006; McClanachan, Gesch, Wuthapanich, Fleming, & Kuys, 2013; Polese, Scianni, Kuys, Ada, & Teixeira-Salmela, 2014). It is not surprising therefore, that levels of physical activity continue to be poor following reintegration into the community (Morris, MacGillivray, & McFarlane, 2014). It is important that, as health care professionals, we support and encourage physical activity in all our clients. To that end, this special issue of Brain Impairment is devoted to raising the issue of physical activity in people with neurological conditions, and addressing questions such as: Why is physical activity important? How do we measure it? How do we enhance it, and what are the benefits of increased activity? This special issue brings together experts from around the world investigating and promoting physical activity across the continuum of care in various neurological populations including stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease.

Introduction: Studies on script processing have shown inconsistent relations between deficits in script action generation and frontal lobe pathology. Therefore, we investigated which difficulties in script action generation are linked to anterior lesions. Moreover, we explored whether verbal script generation can be predicted by specific executive processes.

Methods: Fifty-two patients with acquired brain injury (mean age: 44.23 years, 30 male/22 female) were included, of whom 30 had anterior and 22 had posterior lesions. Several indices of the Everyday Description Task were investigated: relevant central actions (RCAs); relevant trivial actions (RTAs); relevant and irrelevant intrusions (RI & IRI); sequencing (SEs) and perseverative (PEs) errors. Additionally, five z-composite scores representing planning, response generation, working memory, inhibition and shifting were calculated. Correlations and multiple linear regression analyses were computed.

Results: Anteriorly lesioned patients produced significantly less RCAs and more PEs and SEs compared to posteriorly damaged patients. No differences were found with RTAs, RI and IRI. RCAs were predicted by planning, response generation and working memory, RI by response generation and working memory, IRI by inhibition, PEs and SEs by response generation and shifting. None of these executive processes predicted RTAs.

Conclusions: Difficulties in RCAs, PEs and SEs are sensitive indicators of anterior brain damage and script generation demands various executive abilities.

The aim of this paper was to review the limited, but growing, literature on prospective memory (PM) following stroke using a scoping study methodology. Multiple databases were systematically searched and yielded 11 studies that were classified as observational (n = 7) or intervention studies (n = 4) and reviewed for quality. PM impairment after stroke was more commonly identified using behavioural measures compared to self-report measures. There were mixed findings regarding the extent and nature of PM impairment poststroke; however, more studies reported impairment for time-based PM, compared to both event- and activity-based PM. Studies examining rehabilitative techniques for PM resulted in mixed findings and were limited as most were case studies of poor methodological quality. Overall previous research in this area was limited as most studies were often underpowered due to small sample sizes, or used single-item measures which may not be robust enough to reliably measure PM impairment. Additionally, the methods used to measure PM were varied and many studies did not control for retrospective memory impairment, which could impact the results, as PM has both a retrospective (remembering both the action and when it needs to be completed) and prospective component (remembering to perform the action when appropriate). In conclusion, PM impairment is apparent poststroke, specifically for time-based PM. However, more research is needed to determine why PM impairment occurs, and how it can be improved.

The role of physical activity (PA) after stroke is increasingly recognised as important for function, fitness and wellbeing. Current evidence shows that targeted PA after stroke improves cardiovascular fitness, walking ability and muscle strength and may ameliorate depression and improve quality of life. Secondary stroke prevention and management of cardiovascular risk factors are further health benefits. Despite increasing emphasis on organised exercise classes for stroke, PA levels remain low and effects of organised exercise interventions are not maintained once programmes have finished. Barriers to PA after stroke are complex and innovative approaches to maintaining and promoting long-term engagement in activity are required. This commentary proposes that using the International Classification of Disability and Functioning (ICF) to guide thinking about PA after stroke may help us develop and apply comprehensive solutions that increase PA levels. This approach considers stroke survivors’ PA engagement in terms of Body – the physical impairments imposed by stroke; Person – the role of identity, and psychological factors on PA; and Environment – the physical and social environments that influence PA engagement. The commentary discusses how innovative solutions addressing these issues may enable stroke survivors to be better supported to lead active lifestyles.

Background and aims: The Quality of Life Inventory (QOLI, Frisch, 1994) manual states that in most cases QOLI total scores are invalid when two or more of the 16-domain scores are missing. The current study aimed to investigate this guideline.

Methods: Two samples were utilised consisting of 259 community-dwelling adults and 144 adults surveyed 12 months following traumatic brain injury (TBI). First, the domains of the QOLI were regressed against Quality of Life Index (QLI) total scores. Second, a series of Receiver Operator Curve analyses systematically investigated the sensitivity of QOLI scores in detecting depression, as identified by the HADS and DASS.

Results: The final model predicting QLI scores comprised seven of the 16-QOLI domains, R2 = .57, and accounted for equivalent variance to the full 16-domain model, R2 = .59. With as few as seven domains, the sensitivity of QOLI scores in identifying participants with depression was very good and equivalent to the complete 16-QOLI domain total score (>76%). Similar results were observed when these analyses were replicated within the sample with TBI.

Conclusions: These findings showed the QOLI was more robust to missing domain scores than the current validity guidelines stated in the scale's manual suggest. Future research could determine the core domains of the QOLI in a range of samples including adolescents and specific clinical groups.

The ultimate goal of upper-limb rehabilitation after stroke is to promote real-world use, that is, use of the paretic upper-limb in everyday activities outside the clinic or laboratory. Although real-world use can be collected through self-report questionnaires, an objective indicator is preferred. Accelerometers are a promising tool. The current paper aims to explore the feasibility of accelerometers to measure upper-limb use after stroke and discuss the translation of this measurement tool into clinical practice. Accelerometers are non-invasive, wearable sensors that measure movement in arbitrary units called activity counts. Research to date indicates that activity counts are a reliable and valid index of upper-limb use. While most accelerometers are unable to distinguish between the type and quality of movements performed, recent advancements have used accelerometry data to produce clinically meaningful information for clinicians, patients, family and care givers. Despite this, widespread uptake in research and clinical environments remains limited. If uptake was enhanced, we could build a deeper understanding of how people with stroke use their arm in real-world environments. In order to facilitate greater uptake, however, there is a need for greater consistency in protocol development, accelerometer application and data interpretation.

Background: Falls and fall-related injuries rank among the most common complications after stroke, and are characterised by high rates of morbidity and mortality. This study examined the proportion, and the socio-demographic and clinical characteristics of those who fell among stroke survivors attending physiotherapy facilities in selected hospitals in Nigeria.

Methods: Socio-demographic, clinical and falls data were obtained using a researcher-designed questionnaire while the modified Rankin scale (mRS) was used to assess functional ability of the participants. Descriptive statistics of frequencies, percentages, mean and standard deviation were used to summarise all data. Pearson's Chi square statistic was used to identify significant socio-demographic and clinical characteristics of those who fell.

Results: One hundred stroke survivors participated in the study with a majority of males (67%). Mean ± SD age of the stroke survivors was 55.97 ± 9.56 years (range = 33–85 years). Thirty-three (33%) stroke survivors fell within the 3 months prior to the study and a significant proportion were older (p < .001) and had more diminished functional ability (p < .001).

Conclusion: A considerable proportion of the stroke survivors fell, especially those in the older age-group and those with diminished functional ability. These findings suggest that improving functional ability after stroke may prevent falls while older stroke survivors would also require intensive falls prevention strategies to reduce their susceptibility to falls post stroke. Longitudinal studies on the incidence and frequency of falls among stroke survivors in Nigeria, and clinical trials on appropriate falls prevention strategies are however urgently required.

This study examined subjective and objective cognitive functioning in 26 female breast cancer survivors (BCS) who received chemotherapy treatment that finished .5 to 5 years prior to testing and compared their results to 25 demographically matched women with no history of cancer. Participants were assessed on prospective memory (PM) tasks; neuropsychological tests of processing speed, attentional flexibility with greater cognitive load, executive function, and verbal memory; self-report measures of cognitive dysfunction and PM failures; and distress. The BCS group showed significantly slower speed of processing and reduced attentional flexibility, and reported significantly more cognitive complaints and PM failures than the control group on five of six self-report measures. The groups did not differ on other PM or neuropsychological measures or on a measure of distress. Subjective cognition correlated with some neuropsychological tests and with a virtual reality PM task. Objective cognitive impairments were associated with reduced quality of life in the BCS group. The results provide some evidence of both self-reported impairment and objective cognitive dysfunction following chemotherapy treatment.

Stroke is a leading cause of disability worldwide, with approximately one third of people left with permanent deficits impacting on their function. This may contribute to a physically inactive lifestyle and further associated health issues. Current research suggests that people after stroke are not meeting the recommended levels of physical activity, and are less active than people with other chronic illnesses. Thus, it is important to understand how to support people after stroke to uptake and maintain physical activity. Wearable sensors and mobile health (mHealth) technologies are a potential platform to measure and promote physical activity. Some of these technologies may incorporate behaviour change techniques such as real-time feedback. Although wearable activity trackers and smartphone technology are widely available, the feasibility and applicability of these technologies for people after stroke is unclear. This article reviews the devices available for assessment of physical activity in stroke and discusses the potential for advances in technology to promote physical activity in this population.

Purpose: To determine validity, reliability and feasibility of accelerometers (ActivPAL™, Sensewear Pro2 Armband) and portable global positioning systems (GPS) (Garmin Forerunner 405CX) for community ambulation measurement after stroke.

Methods: Fifteen community-dwelling stroke survivors attended two sessions; completing a 6-minute walk, treadmill walking, and 200-m outdoor circuit. Feasibility was determined by wearing devices over four days. Measures collected included step count, time spent walking, distance, energy expenditure and location. Intra-class correlation coefficients (ICC), Bland–Altman plots and absolute percentage of error (APE) were used to determine validity and reliability.

Results: ActivPAL™ had excellent validity and reliability for most measures (ICC: 0.821–0.999, APE: 0%–11.1%), except for good-excellent findings at speeds < 0.42 m/s (ICC: 0.659–0.894, APE: 1.6%–11.1%). Sensewear had missing values for 23% of recordings and high error for all measures. GPS demonstrated excellent validity and reliability for time spent walking and step count (ICC: 0.805–0.999, APE: 0.9%–10%), and 100% accuracy for location. However, it was not valid or reliable for distance (ICC = −0.139, APE = 23.8%). All devices appeared feasible for community ambulation measurement with assistance for setup and data analysis.

Conclusions: ActivPAL™ and Garmin GPS appear valid, reliable and feasible tools for community ambulation measurement after stroke, except for distance. Sensewear demonstrated poor validity and reliability when worn on the paretic arm.

Increasing research evidence suggests that basal ganglia are an important part of frontal-subcortical circuit which is involved not only in motor control but also in affective, cognitive and executive functions. In this article, we describe the ability of facial emotion recognition and cognitive functioning in a patient with left basal ganglia and insula damage. The patient's ability to recognise facial emotional expressions was intact in spite of unilateral injury of the left insula and basal ganglia. He showed preserved intellectual function in general, but experienced difficulties on subsets of the executive functions: set-shifting and ability to activate or generate cognitive strategies, commonly found in patients with caudate lesions. This case contributes to evidence that striatal structures are important for executive functions.

Previous studies investigating long-term outcomes in children following vitamin B12 deficiency during infancy have been limited to IQ or clinical observation. This paper seeks to describe comprehensive neuropsychological profiles in a case series of school-aged children who were treated for infantile vitamin B12 deficiency. This was a retrospective case series of seven children who were treated for vitamin B12 deficiency during infancy and aged 5 to 16 years at the time of testing. While most children had age-expected intellectual performance, the distribution of the sample was skewed to the lower end of the normal range. Furthermore, children were found to have impairments in a number of neuropsychological domains, most common were attention and memory, followed by executive function. These results suggest that while neurological symptoms quickly resolve following treatment, these effects on early brain development may disrupt brain maturation and have the potential to impact on later development.

Objective: The aims of the study were to: (1) test the reliability, validity, and responsiveness of our originally developed desire to void scale (DVS); and (2) investigate the time course of the DV after stroke during the post-acute phase.

Methods: DVS was tested by having two independent raters assess the scale and calculating the weighted kappa. To evaluate its concurrent validity, Pearson's correlation coefficients between DVS and the bladder management item of the Functional Independence Measure (FIM) were calculated. A prospective analysis of the time course of the DVS and its relationships with age, sex, stroke type, paretic side, and the FIM score in 103 patients hospitalised in a rehabilitation ward was then performed. To quantify its responsiveness, standardised response means during the recovering phase of stroke were obtained. To predict discharge DVS scores from demographic characteristics and admission status, multiple regression analysis was performed.

Results: The DVS had satisfactory inter- and intra-rater reliabilities. The standardised response means for DVS from admission to discharge was .58. The discharge DVS improved significantly when compared with the admission DVS. Stroke type, admission DVS, and cognition scores of the FIM were independent predictors of discharge DVS.

Reduced cardiorespiratory fitness or cardiorespiratory deconditioning is a secondary physical impairment commonly reported to affect people after traumatic brain injury (TBI), both in the short- and long-term. Eleven studies have measured peak oxygen uptake ${\rm ({\dot V}O}_{{\rm 2peak}} )$ to evaluate fitness in this population. The mean (SD) ${\rm \dot VO}_{{\rm 2peak}}$ from these studies was 27.2 (6.7) mL.kg−1·min−1, which is markedly below the average fitness level of age-matched healthy individuals. The aetiology of cardiorespiratory deconditioning has not been well evaluated among people with TBI; however, studies on prolonged bed rest and studies on the acute consequences of TBI inform our current understanding. The primary aim of this paper is to present a model to describe the physiological factors contributing to the development of cardiorespiratory deconditioning among people with severe TBI. We propose that both central and peripheral factors contribute to reduced fitness, and that these changes occur because of both the initial brain damage and trauma sustained and the prolonged and initially extreme physical inactivity that is commonly experienced after this type of injury. Reduced fitness can significantly affect the ability to return to pre-injury activities. Given that reintegration into the community is a key goal of rehabilitation among people with TBI, interventions that can prevent or reverse reduced fitness need to be implemented.

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.

The literature about the care givers of patients with Disorders of Consciousness (DOCs) has highlighted the impact on both mental and physical dimensions of quality of life. This study aimed to: (1) describe emotional burden, quality of life, and coping styles in care givers of hospitalized patients with DOCs, compared to Italian normative data; (2) explore the relationships between these variables and their associations with socio-demographic features; and (3) describe their changes over time.

Fifteen care givers of patients with DOCs, mostly middle-aged women, were assessed using the Family Strain Questionnaire, the SF-36 Health Survey, and the Coping Orientation to Problems Experienced – Nuova Versione Italiana. Eleven subjects were also assessed after 6 and 12 months. Data were analysed through descriptive statistics, correlations, and nonparametric tests of group differences.

Compared to the Italian normative data, our sample showed a worse outcome in mental health, social functioning, global mental component, and emotional role functioning. Furthermore, subjects with high emotional burden had more thoughts of death compared to subjects with low emotional burden. Follow-up analyses revealed no variables changed over time.

These results highlight the need for psychological interventions and support, since care givers represent an important part of an all-embracing support and care network for patients with DOCs.

Background: The spousal care givers of people with Parkinson's (PwP) have unique, first-hand information that is invaluable in the effective management of Parkinson's disease (PD). However, there is a dearth of research that specifically focuses on health professionals’ experiences of engagement with the spousal care givers of PwP.

Methods: Interpretative phenomenological analysis (IPA) was used to describe and identify the meaning that health professionals working with PD (HPPs) gave to their engagement experiences with spousal care givers of PwP. Semi-structured interviews with a purposive sample of 12 HPPs were digitally recorded, transcribed verbatim and analysed for emerging themes.

Results: Two major themes emerged from the interviews with HPPs: (i) the Philosophy of Care (PoC) is an Intrinsic Element in the Engagement Experience; and (ii) HPPs Expressed a Deep Appreciation of Partners’ Support of the PwP. HPPs experienced significant tensions and challenges in their engagements with the partners of PwP, as a result of the interaction between their lived reality and their PoC. They also appreciated greatly the caregiving provided by the partners. The insights gained have the potential to ease or resolve problematic tensions within the engagement process.

Brain cancer is a complex and distressing illness with a typically poor prospect for survival. Worldwide, approximately 256,000 people (1800 in Australia) are diagnosed each year (Ferlay, Soerjomataram & Ervik, 2013). Cancer of the brain poses a double threat – to one's survival and sense of self. Most people with primary brain tumour develop serious neuro-cognitive symptoms (e.g., seizures, memory loss) and experience poor mental health and quality of life, which places enormous burden on family care givers. Not surprisingly, high rates of psychological distress have been reported by people with brain tumour and their family care givers. Psychological distress can persist beyond primary treatment, and often increases in the long-term phase of illness due to the perceived threat and experience of recurrence and functional decline. Over the last decade, there have been many advances in the psychosocial management of people with brain tumour. This paper provides an overview of the functional, psychological and social consequences of brain tumour, summarises some leading developments in psychological assessment and management, and outlines future directions in intervention research.

Objectives: (1) Evaluate the features of purpose-built apartment living on access, environmental control, and home and community mobility of people living with neurotrauma and (2) Examine tenant perceptions of those features.

Research design: Observational case series pilot study. Setting: Three apartments within a residential development in Melbourne, Australia. Participants: Three males (aged 30–55 years) with traumatic brain and/or spinal cord injury living in the three separate apartments.

Method and procedures: Measures: Two-published measures of user experience of built and technology environments, coupled with customised interdisciplinary post-occupancy evaluation (POE) methods and GPS-enabled mobility tracking. Analysis: Measures completed per manual guidelines and data reported descriptively. Customised measured drawings produced to represent tenants’ physical access and mobility. GPS community mobility data plotted on Google Earth.

Results: Built design features which enabled access and mobility included linear paths of travel, well-located furnishings, and joinery design that allowed approach from either side using a wheelchair. Personal home furnishing choices posed barriers to physical access. Home automation technologies positively influenced participants’ sense of control and independence, but posed learning challenges. Close proximity of housing to accessible public transport and services enabled community travel options.

Conclusion: Findings from this pilot study indicate the combination of housing location, design and technologies used, together with availability of local community services, provides an acceptable level of environmental control, access, mobility and tenant experience. Further research is required to determine validity of the novel measures used, and deliver rigorous research design to evaluate those features most important in achieving optimal outcomes.