The aim of this scoping review was to examine the literature related to economic evaluations of neuropsychological rehabilitation in individuals with acquired brain injury (ABI). PsychINFO, Medline, ...EMBASE, Cochrane and CINHAL databases were searched in accordance with formal scoping review methodology. Studies were included if published between 1995 and 2019 with a study population of adults aged 18 years or more with any ABI aetiology and there was reported data on resource use, costs or comparative economic analyses as part of an outcome study for rehabilitation interventions. Case studies and trial protocols were excluded. Of 3575 records screened, 30 articles were identified as meeting the inclusion criteria. The majority of studies documented cost savings from provision of various models of multidisciplinary inpatient or outpatient rehabilitation. However, these benefits were estimated without a control group. Eight studies included a cost-effectiveness analysis, and in three, the intervention was reported to be cost-effective compared to the control, one of which saved $9,654 per treated patient. Overall, few eligible studies were identified. Those that included a cost-effectiveness analysis yielded mixed evidence for interventions to be considered cost-effective for ABI. Recommendations for how to incorporate cost-effectiveness analyses into intervention studies are discussed.
To determine the frequency, impact, and factors associated with self-reported neurobehavioural disability (NBD) in individuals with stroke. A secondary aim was to examine the course of self-reported ...NBD over time and associations with outcomes.
Eighty-seven participants admitted for inpatient rehabilitation post-stroke completed the St Andrew's-Swansea Neurobehavioural Outcome Scale. Demographic and stroke details and measures of functional disability, cognitive impairment, mood, and self-rated impact of NBD symptoms were completed. Twenty-seven participants and 19 close-others were reassessed three to six months following discharge.
Overall reporting of neurobehavioural problems was infrequent. The domains of interpersonal and cognitive difficulties were the most commonly identified but were still only reported occasionally. However, even mild NBD was significantly correlated with negative impact. Greater self-reported NBD was significantly correlated with greater functional dependence, anxiety, and depression during inpatient rehabilitation. Self-reports of NBD remained stable over time and, at follow-up, was significantly correlated with depressive symptoms both in participants with stroke and close-others.
In survivors of stroke, self-report of NBD is associated with poor outcomes in function, anxiety, and depression. These findings highlight the importance of routine and comprehensive assessment and intervention to manage NBD following stroke.
IMPLICATIONS FOR REHABILITATION
Despite relatively infrequent self-reporting, presence of NBD remained stable across a six month follow-up period following rehabilitation which highlights the potential persistent nature of these difficulties.
Even mild levels of self-reported NBD were associated with emotional distress in both stroke survivors and their significant others indicating a need for relevant interventions to support long-term outcomes.
Routine screening for the presence of NBD is recommended to facilitate early detection and intervention to optimise post-stroke recovery.
Introduction and Aims
Cognitive impairment is a common feature of individuals with substance‐use disorders. However, research tends to exclude highly complex clinical cases, limiting the ...generalisability of findings for ‘real‐world' populations. The objective of this study was to examine the complexities associated with addiction, substance use and cognitive impairment through the characterisation of client presentations to a newly established specialised addiction neuropsychology service.
Design and Methods
Retrospective case file audit. Neuropsychological assessment reports for consenting clients over a 4‐year period were de‐identified and reviewed. Cognitive domains assessed included attention, processing speed, working memory, intellectual functioning, memory and executive functioning.
Results
Of the 200 case files examined, the majority were male clients, with 11 years or lower of education and a history of daily substance use, with 30% continuing to use daily. Seventy‐one percent had a formal mental health diagnosis and 41% had reported a history of trauma. The most prevalent cognitive impairments were observed in complex attention (50%) and memory (40%). New diagnoses were conveyed in 25% of cases, comprising acquired brain injury (16%) and neurodevelopmental disabilities (9%).
Discussion and Conclusions
It is common for clients with substance use histories referred to an addiction neuropsychology service to present with complex histories including psychosocial difficulties, comorbid mental health and medical issues and cognitive impairment. As such, careful diagnostic formulations are required when multiple factors may contribute to cognitive deficits. This study highlights the importance of a state‐wide specialist addiction neuropsychology service in supporting diagnostic clarification and informing relevant treatment approaches.
In considering the cognitive harms of methamphetamine (MA) use, there is currently a limited appreciation of the profile of pre-existing, comorbid, or modifiable risk factors for cognitive impairment ...in individuals with MA-polydrug use who present to clinical services. This is in contrast to the well-recognized evidence in alcohol use groups. The aim of this study was to investigate the biopsychosocial and neuropsychological profiles of MA-polysubstance using individuals reporting cognitive impairment in comparison to an alcohol-using group.
A retrospective file audit was undertaken of individuals who presented for assessment to a specialist addiction neuropsychology service and reported either more than 1 year of heavy MA use as part of a polydrug use history (
= 40) or having only used alcohol (
= 27). Clinical histories including demographic, medical, mental health, substance use, and neuropsychological assessment results were extracted from medical records. Between group comparisons were conducted to explore differences in the MA-polydrug vs. the alcohol group.
Individuals in the MA-polydrug group were significantly younger, commenced substance use at an earlier age, were more likely to have an offending history, and experienced an overdose than those in the alcohol group. No differences in comorbid neurodevelopmental, psychiatric or acquired brain injury diagnoses were observed between groups. For neuropsychological functioning, significant group differences were observed in overall IQ, semantic verbal fluency, and psychomotor tracking, where individuals in the alcohol group performed significantly worse.
Neuropsychological profiles were largely equivalent between groups across cognitive domains, with minor differences in favor of the MA-polydrug group. Relative to the general population, cognitive functioning was reduced for both groups across a range of domains. High rates of comorbid mental health concerns were common across both groups, however, individuals in the MA-polydrug group presented with a higher risk of overall harm from substance use at a significantly younger age which is a unique concern for this group. These findings highlight the importance of considering the biopsychosocial factors, such as age of first use, emotional distress, indirect substance related harms including overdose and blood born virus infection that may be relevant to experiences of cognitive difficulty in MA-polydrug users.
Objective: Aboriginal and Torres Strait Islander populations are at a significantly higher risk of neurological and cognitive impairment from a range of aetiologies. In order to better identify and ...support Indigenous Australians with cognitive impairment, culturally appropriate screening, management and referral processes are critical. The primary aim of this study was to investigate the frequency of presentations and type of cognitive screening conducted with Indigenous Australians presenting to health services.
Methods: Hospital data for 30 Indigenous Australians presenting with neurological symptoms to Emergency Departments within a large metropolitan health service were compared with a group of 30 non-Indigenous, Australian-born, Englishspeaking, age-, gender- and diagnosis-matched individuals.
Results: Only two individuals, one from each group, received cognitive screening. This was likely related to a surprisingly large proportion of Indigenous Australians presenting to hospital with headache and migraine. Significantly more Indigenous Australians (36.7%) were consulted by a member of the multidisciplinary team compared to 10% of the non-Indigenous group. No differences in follow-up referrals were observed.
Conclusions: Results indicated a lack of cognitive screening practices being undertaken in both groups. It was encouraging to see Indigenous Australians receiving consultations from multidisciplinary team members at a higher rate, with a similar follow-up pathway being observed. This study further highlights the need for adoption of screening practices in primary health care settings and the development and use of culturally appropriate cognitive screening measures.
So what? This study investigates the cognitive screening practices of a metropolitan health service and highlights the need for culturally appropriate cognitive screening methods to be developed and implemented to facilitate the identification of cognitive impairment in Indigenous Australians presenting for treatment.
To examine self-rated, clinician-rated, and self-awareness of on-road driving performance in individuals with traumatic brain injury (TBI) deemed fit and unfit to resume driving and healthy controls, ...and to explore their associations with demographic, injury, cognitive, and mood variables.
Participants included 37 individuals with moderate to severe TBI, and 49 healthy age, sex, and education-matched controls from Australia and Canada. Participants completed an on-road assessment, the Brain Injury Driving Self-Awareness Measure (BIDSAM), and a comprehensive neuropsychological assessment.
Awareness scores on the BIDSAM were significantly different between groups, F(2, 83) = 28.44 (P < .001; η = 0.41), with post hoc tests indicating TBI participants who failed the on-road assessment had worse scores compared with those who passed and controls. Poor self-awareness was significantly correlated with reduced psychomotor speed (rs = -0.37; P < .01) and attentional switching (rs = 0.28; P < .01). Worse self-ratings of driving were associated with depression (rs = 0.42; P < .01) and anxiety (rs = 0.38; P < .01).
Individuals with TBI who failed an on-road assessment significantly overestimated their driving ability. Impaired cognitive function was associated with reduced self-awareness of driving. These findings suggest impaired awareness of driving may need to be addressed as part of driver rehabilitation programs.
Objective:
To investigate the feasibility and preliminary efficacy of a driving simulator intervention on driving outcomes following acquired brain injury.
Design:
Pilot randomised controlled trial.
...Setting:
Occupational therapy driver assessment and rehabilitation service.
Subjects:
Individuals post-acquired brain injury aiming to return to driving.
Intervention:
Eight sessions of simulated driver training over four weeks, in addition to usual care. Control: Usual care only.
Main measures:
Feasibility outcomes: Participant recruitment and retention; data completeness; therapy attendance and fidelity; adverse events. Performance outcomes: on-road driving performance; Simulator Sickness Questionnaire; Brain Injury Driving Self-Awareness Measure and Driving Comfort Scale – Daytime, assessed at baseline and five weeks post-randomisation.
Results:
Out of 523 individuals screened, 22 (4%) were recruited and randomised, with 20 completing their allocated group (n = 12 Simulator, n = 8 Usual Care). For those who completed training, session attendance was 100% with simulator sickness rated, on average, as mild. Six individuals (50%) in the Simulator group failed the on-road assessment, versus two (25%) in the Usual Care group (P = 0.373). On average, the Simulator group reported a positive change in confidence ratings (M = 5.77, SD = 13.96) compared to the Usual Care group, who reported a negative change (M = −6.97, SD = 8.47), P = 0.034. The Simulator group (M = 0.67, SD = 3.34) demonstrated no significant change in self-awareness relative to the Usual Care group (M = −0.83, SD = 1.83, P = 0.325).
Conclusions:
With adjustments to inclusion criteria and recruitment strategies, it may be feasible to deliver the intervention and conduct a larger trial. There is potential benefit of simulator training for improving driver confidence after acquired brain injury.
Effectiveness of interventions for violent behaviour may be undermined by the presence of neurocognitive impairment, which is known to be common among alcohol and other drug (AOD) users and violent ...offenders. The current study aimed to examine whether the cognitive functioning of individuals with AOD histories presenting to a specialist addiction neuropsychology service differed according to their offending history (i.e. non-offending, non-violent offending and violent offending), using a retrospective case file audit design. Data were extracted from 190 clients. Tests assessed a breadth of cognitive domains. Violent offenders demonstrated the lowest premorbid IQ out of the three groups, and a significantly higher proportion of violent offenders presented with impaired divided attention and impaired cognitive inhibition compared to non-violent offenders. Rates of impairment across groups were well beyond those expected within the general population. Delivery of both AOD and violence interventions should be adapted to accommodate individuals' cognitive difficulties.
Objective: To characterise on-road driving performance in individuals with traumatic brain injury who fail on-road driving assessment, compared with both those who pass assessment and healthy ...controls, and the injury and cognitive factors associated with driving performance.
Study design: Cross-sectional.
Methods: Forty eight participants with traumatic brain injury (Age M = 40.50 SD = 14.62, 77% male, post-traumatic amnesia days M = 28.74 SD =27.68) and 48 healthy matched controls completed a standardised on-road driving assessment in addition to cognitive measures.
Results: Individuals with traumatic brain injury who passed on-road driving assessment performed no differently from controls while individuals with traumatic brain injury who failed the assessment demonstrated significantly worse driving performance relative to controls across a range of driving manoeuvres and error types including observation of on-road environment, speed control, gap selection, lane position, following distance and basic car control. Longer time post-injury and reduced visual perception were both significantly correlated with reduced driving skills.
Conclusions: This exploratory study indicated that drivers with traumatic brain injury who failed on-road assessment demonstrated a heterogeneous pattern of impaired driving manoeuvres, characterised by skill deficits across both operational (e.g., basic car control and lane position) and tactical domains (e.g., following distance, gap selection, and observation) of driving. These preliminary findings can be used for implementation of future driving assessments and rehabilitation programs.
Implications for rehabilitation
Clinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries.
Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres.
Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury.
Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury.
Cognitive impairment is common in individuals presenting to alcohol and other drug (AOD) settings and the presence of biopsychosocial complexity and health inequities can complicate the experience of ...symptoms and access to treatment services. A challenge for neuropsychologists in these settings is to evaluate the likely individual contribution of these factors to cognition when providing an opinion regarding diagnoses such as acquired brain injury (ABI). This study therefore aimed to identify predictors of cognitive functioning in AOD clients attending for neuropsychological assessment.
Clinical data from 200 clients with AOD histories who attended for assessment between 2014 and 2018 were analysed and a series of multiple regressions were conducted to explore predictors of cognitive impairment including demographic, diagnostic, substance use, medication, and mental health variables.
Regression modelling identified age, gender, years of education, age of first use, days of abstinence, sedative load, emotional distress and diagnoses of ABI and developmental disorders as contributing to aspects of neuropsychological functioning. Significant models were obtained for verbal intellectual functioning (Adj R
= 0.19), nonverbal intellectual functioning (Adj R
= 0.10), information processing speed (Adj R
= 0.20), working memory (Adj R
= 0.05), verbal recall (Adj R
= 0.08), visual recall (Adj R
= 0.22), divided attention (Adj R
= 0.14), and cognitive inhibition (Adj R
= 0.07).
These findings highlight the importance of careful provision of diagnoses in clients with AOD histories who have high levels of unmet clinical needs. They demonstrate the interaction of premorbid and potentially modifiable comorbid factors such as emotional distress and prescription medication on cognition. Ensuring that modifiable risk factors for cognitive impairment are managed may reduce experiences of cognitive impairment and improve diagnostic clarity.
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