A longitudinal analysis of factors associated with post traumatic growth after acquired brain injury.

ABSTRACTPost-Traumatic Growth (PTG) is a form of positive psychological change that occurs for some individuals following traumatic experiences. High levels of PTG have been reported among survivors of acquired brain injury (ABI). Yet it remains unclear why some survivors of ABI develop PTG and others do not. The present study investigated early and late factors that are associated with long-term PTG in people with moderate to severe ABIs. Participants (n = 32, Mage = 50.59, SD = 12.28) completed self-report outcome measures at two time-points seven years apart (one-year and eight-years post-ABI). Outcome measures assessed emotional distress, coping, quality of life and ongoing symptoms of brain injury, as well as PTG at the later timepoint. Multiple regression analyses indicated that one-year post-ABI, fewer symptoms of depression, more symptoms of anxiety, and use of adaptive coping strategies accounted for a significant amount of variance in later PTG. At eight years post-ABI, fewer symptoms of depression, fewer ongoing symptoms of brain injury, better psychological quality of life and use of adaptive coping strategies explained a substantial amount of variance in PTG. For individuals with ABIs, PTG may be promoted by implementing long-term neuropsychological support which aims to facilitate use of adaptive coping strategies, supports psychological wellbeing and allows individuals to find meaning post-ABI.

Actions are characterized by 'canonical moments' in a sequence of movements.

Understanding what others are doing is an essential aspect of social cognition that depends on our ability to quickly recognize and categorize their actions. To effectively study action recognition we need to understand how actions are bounded, where they start and where they end. Here we borrow a conceptual approach - the notion of 'canonicality' - introduced by Palmer and colleagues in their study of object recognition and apply it to the study of action recognition. Using a set of 50 video clips sourced from stock photography sites, we show that many everyday actions - transitive and intransitive, social and non-social, communicative - are characterized by 'canonical moments' in a sequence of movements that are agreed by participants to 'best represent' a named action, as indicated in a forced choice (Exp 1, n = 142) and a free choice (Exp 2, n = 125) paradigm. In Exp 3 (n = 102) we confirm that canonical moments from action sequences are more readily named as depicting specific actions and, mirroring research in object recognition, that such canonical moments are privileged in memory (Exp 4, n = 95). We suggest that 'canonical moments', being those that convey maximal information about human actions, are integral to the representation of human action.1.

Mental rotation of hands and objects in ageing and Parkinson's disease: differentiating motor imagery and visuospatial ability.

Motor imagery supports motor learning and performance and has the potential to be a useful strategy for neurorehabilitation. However, motor imagery ability may be impacted by ageing and neurodegeneration, which could limit its therapeutic effectiveness. Motor imagery can be assessed implicitly using a hand laterality task (HLT), whereby laterality judgements are slower for stimuli corresponding to physically more difficult postures, as indicated by a "biomechanical constraint" effect. Performance is also found to differ between back and palm views of the hand, which may differentially recruit visual and sensorimotor processes. Older adults and individuals with Parkinson's disease (PD) have shown altered performance on the HLT; however, the effects of both ageing and PD on laterality judgements for the different hand views (back and palm) have not been directly examined. The present study compared healthy younger, healthy older, and PD groups on the HLT, an object-based mental rotation task, and an explicit motor imagery measure. The older and PD groups were slower than the younger group on the HLT, particularly when judging laterality from the back view, and exhibited increased biomechanical constraint effects for the palm. While response times were generally similar between older and PD groups, the PD group showed reduced accuracy for the back view. Letter rotation was slower and less accurate only in the PD group, while explicit motor imagery ratings did not differ significantly between groups. These results suggest that motor imagery may be slowed but relatively preserved in both typical ageing and neurodegeneration, while a PD-specific impairment in visuospatial processing may influence task performance. The findings have implications for the use of motor imagery in rehabilitation protocols.

Feelings first? Sex differences in affective and cognitive processes in emotion recognition.

The recognition of emotional expressions is important for social understanding and interaction, but findings on the relationship between emotion recognition, empathy, and theory of mind, as well as sex differences in these relationships, have been inconsistent. This may reflect the relative involvement of affective and cognitive processes at different stages of emotion recognition and in different experimental paradigms. In this study, images of faces were morphed from neutral to full expression of five basic emotions (anger, disgust, fear, happiness, and sadness), which participants were asked to identify as quickly and accurately as possible. Accuracy and response times from healthy males (n = 46) and females (n = 43) were analysed in relation to self-reported empathy (Empathy Quotient; EQ) and mentalising/theory of mind (Reading the Mind in the Eyes Test). Females were faster and more accurate than males in recognising dynamic emotions. Linear mixed-effects modelling showed that response times were inversely related to the emotional empathy subscale of the EQ, but this was accounted for by a female advantage on both measures. Accuracy was unrelated to EQ scores but was predicted independently by sex and Eyes Test scores. These findings suggest that rapid processing of dynamic emotional expressions is strongly influenced by sex, which may reflect the greater involvement of affective processes at earlier stages of emotion recognition.

Self-reported outcomes and patterns of service engagement after an acquired brain injury: a long-term follow-up study.

PRIMARY OBJECTIVE: To describe the clinical characteristics, self-reported outcomes in domains relating to activities of daily living and patterns of service engagement in the survivors of a moderate-to-severe acquired brain injury over seven years. RESEARCH DESIGN: A longitudinal research design was used. METHODS AND PROCEDURES: Thirty-two individuals who sustained a moderate-to-severe acquired brain injury completed a Sociodemographic and Support Questionnaire at one (t1) and seven years (t2) after completing a publicly funded inpatient neurorehabilitation program. MAIN OUTCOMES AND RESULTS: There were minimal changes in independent living, mobility, ability to maintain key relationships and in return to work in the interval between t1 and t2. Sixty-nine percent of participants engaged with two or more allied health professional services and 75% engaged with support services in the community over the seven years. CONCLUSIONS: There were minimal additional gains in outcomes relating to activities of daily-living and there was a high level of service need in the first decade postinjury. Young and middle-aged individuals who sustain an ABI may continue to live in the community for decades with some level of disability and may require ongoing access to services.

Holistic processing of faces and words predicts reading accuracy and speed in dyslexic readers.

We compared the performance of dyslexic and typical readers on two perceptual tasks, the Vanderbilt Holistic Face Processing Task and the Holistic Word Processing Task. Both yield a metric of holistic processing that captures the extent to which participants automatically attend to information that is spatially nearby but irrelevant to the task at hand. Our results show, for the first time, that holistic processing of faces is comparable in dyslexic and typical readers but that dyslexic readers show greater holistic processing of words. Remarkably, we show that these metrics predict the performance of dyslexic readers on a standardized reading task, with more holistic processing in both tasks associated with higher accuracy and speed. In contrast, a more holistic style on the words task predicts less accurate reading of both words and pseudowords for typical readers. We discuss how these findings may guide our conceptualization of the visual deficit in dyslexia.

Effects of a Brief E-Learning Resource on Sexual Attitudes and Beliefs of Healthcare Professionals Working in Prostate Cancer Care: A Pilot Study.

Sexual issues and treatment side effects are not routinely discussed with men receiving treatment for prostate cancer, and support to address these concerns is not consistent across settings. This study evaluates a brief e-learning resource designed to improve sexual wellbeing support and examine its effects on healthcare professionals' sexual attitudes and beliefs. Healthcare professionals (n = 44) completed an online questionnaire at baseline which included a modified 12-item sexual attitudes and beliefs survey (SABS). Follow-up questionnaires were completed immediately after the e-learning and at 4 weeks. Data were analysed using one-way, repeat measures ANOVAs to assess change in attitudes and beliefs over time. Significant improvements were observed at follow-up for a number of survey statements including 'knowledge and understanding', 'confidence in discussing sexual wellbeing' and the extent to which participants felt 'equipped with the language to initiate conversations'. The resource was seen as concise, relevant to practice and as providing useful information on potential side effects of treatment. In brief, e-learning has potential to address barriers to sexual wellbeing communication and promote delivery of support for prostate cancer survivors. Practical methods and resources should be included with these interventions to support implementation of learning and long-term changes in clinical behaviour.

Efficacy, Use, and Acceptability of a Web-Based Self-management Intervention Designed to Maximize Sexual Well-being in Men Living With Prostate Cancer: Single-Arm Experimental Study.

BACKGROUND: Sexual dysfunction is a frequent side effect associated with different prostate cancer treatment approaches. It can have a substantial impact on men and their partners and is associated with increased psychological morbidity. Despite this, sexual concerns are often not adequately addressed in routine practice. Evidence-based web-based interventions have the potential to provide ongoing information and sexual well-being support throughout all stages of care. OBJECTIVE: The aim of this study is to examine the efficacy of a web-based self-management intervention designed to maximize sexual well-being in men living with prostate cancer and explore user perspectives on usability and acceptability. METHODS: We used a single-arm study design, and participants were provided with access to the 5-step intervention for a period of 3 months. The intervention content was tailored based on responses to brief screening questions on treatment type, relationship status, and sexual orientation. Efficacy was assessed by using two-tailed, paired sample t tests for comparing the mean differences between pre- and postintervention measurements for exploring the participants' self-reported knowledge and understanding, sexual satisfaction, and comfort in discussing sexual issues. Usability and acceptability were determined based on the program use data and a postintervention survey for exploring perceived usefulness. RESULTS: A total of 109 participants were recruited for this study. Significant postintervention improvements at follow-up were observed in the total scores (out of 20) from the survey (mean 12.23/20 points, SD 2.46 vs mean 13.62/20, SD 2.31; t88=9.570; P=.001) as well as in individual item scores on the extent to which the participants agreed that they had sufficient information to manage the impact that prostate cancer had on their sex life (mean 2.31/4 points, SD 0.86 vs mean 2.57/4, SD 0.85; t88=3.660; P=.001) and had the potential to have a satisfying sex life following treatment (mean 2.38/4 points, SD 0.79 vs mean 3.17/4, SD 0.78; t88=7.643; P=.001). The median number of intervention sessions was 3 (range 1-11), and intervention sessions had a median duration of 22 minutes (range 8-77). Acceptable usability scores were reported, with the highest result observed for the question on the extent to which the intervention provided relevant information. CONCLUSIONS: This study provides evidence on the efficacy of a tailored web-based intervention for maximizing sexual well-being in men living with prostate cancer. The results indicate that the intervention may improve one's self-perceived knowledge and understanding of how to manage sexual issues and increase self-efficacy or the belief that a satisfactory sex life could be achieved following treatment. The findings will be used to refine the intervention content before testing as part of a larger longitudinal study for examining its effectiveness.

The Tablet-Based, Engagement, Assessment, Support, and Sign-Posting (EASSi) Tool for Facilitating and Structuring Sexual Well-Being Conversations in Routine Prostate Cancer Care: Mixed-Methods Study.

BACKGROUND: Long-term side-effects associated with different prostate cancer treatment approaches are common. Sexual challenges are the most frequently occurring issues and can result in increased psychological morbidity. It is recognized that barriers to communication can make initiating discussions around sexual concerns in routine practice difficult. Health care professionals need to routinely initiate conversations, effectively engage with patients, and assess needs in order to provide essential support. One proposed method that could support health care professionals to do this involves the use of prompts or structured frameworks to guide conversations. OBJECTIVE: This study aimed to assess feasibility, acceptability, and satisfaction with the tablet-based Engagement, Assessment, Support, and Sign-posting (EASSi) tool designed to facilitate and structure sexual well-being discussions in routine prostate cancer care. METHODS: Health care professionals (n=8) used the EASSi tool during 89 posttreatment appointments. Quantitative data were recorded based on program usage and surveys completed by health care professionals and patients. Qualitative data exploring perceptions on use of the tool were gathered using semistructured interviews with all health care professionals (n=8) and a sample of patients (n=10). RESULTS: Surveys were completed by health care professionals immediately following each appointment (n=89, 100%). Postal surveys were returned by 59 patients (66%). Health care professionals and patients reported that the tool helped facilitate discussions (81/89, 91% and 50/59, 85%, respectively) and that information provided was relevant (82/89, 92% and 50/59, 85%, respectively). The mean conversation duration was 6.01 minutes (SD 2.91). Qualitative synthesis identified the tool's ability to initiate and structure discussions, improve the "depth" of conversations, and normalize sexual concerns. CONCLUSIONS: The EASSi tool was appropriate and acceptable for use in practice and provided a flexible approach to facilitate routine brief conversations and deliver essential sexual well-being support. Further work will be conducted to evaluate the effectiveness of using the tablet-based tool in prostate cancer care settings.

Development of a conceptual framework to improve sexual wellbeing communication in routine prostate cancer care.

OBJECTIVE: To systematically develop a framework to improve sexual wellbeing communication in routine prostate cancer care. METHODS: The Theoretical Domains Framework was used to guide a multi-phase process used to identify components of the framework based on evidence reviews, semi-structured interviews and stakeholder workshops. 'Think-aloud' testing was used to explore usability, potential barriers and other factors relevant to implementation. RESULTS: A conceptual communication framework consisting of 'Engagement' (E), 'Assessment' (A), information and 'Support' (S) and 'Sign-posting' (Si) sections was developed. The framework emphasises routine engagement to normalise sexual concerns, brief, non-sensitive assessment, personalised advice based on treatment type and relationship status, and a mechanism for referral to additional support or self-management resources in the form of a patient and partner handout. Usability testing identified strategies to promote implementation. CONCLUSIONS: The proposed framework is appropriate for use in routine practice and appears to be acceptable to patients, partners and healthcare professionals. Its use may help address gaps in sexual wellbeing support for men and partners living with prostate cancer. Further work will be conducted evaluating an online engagement tool, modelled on the framework. PRACTICE IMPLICATIONS: The EASSi framework can facilitate and structure sexual wellbeing conversations and ensure fundamental but individualised support is provided routinely in prostate cancer care.

Healthcare professional perceived barriers and facilitators to discussing sexual wellbeing with patients after diagnosis of chronic illness: A mixed-methods evidence synthesis.

OBJECTIVES: To explore healthcare professional perceived barriers and facilitators to discussing sexual health and wellbeing with patients after diagnosis of chronic illness. METHODS: Five databases were searched and included data were synthesised using a meta-ethnographic approach. Confidence in findings was assessed using the GRADE-CERQual framework. Searches, extraction and quality assessment procedures were conducted independently by at least two authors. RESULTS: Concepts extracted from 30 included studies were used to develop a conceptual framework based on five overarching themes. These were [1] individual and societal attitudes to sex and sexual wellbeing [2], patient specific factors [3], organizational and professional factors [4], strategies to overcome barriers in practice and [5] perceived training needs. Healthcare professionals acknowledged the importance of discussing and providing support for sexual wellbeing needs, but recognized it is not routinely provided. CONCLUSIONS: While patient specific factors and organizational issues such as lack of time were frequently identified as barriers, intra-personal and social perceptions appear to have the strongest influence on healthcare professional perspectives. PRACTICE IMPLICATIONS: Brief education and tools to support healthcare professionals to have effective conversations with patients are required. These should address social barriers, normalise sexual issues, and support healthcare professionals to initiate discussions around sexual concerns.

Illuminating sex differences in mental rotation using pupillometry.

We use pupillometry to measure sex differences in mental rotation (MR) and to investigate the contentious claim that it is a unique spatial ability marked by male advantage in performance. Across two MR tasks - using Shepard-Metzler style cube figures and images of human hands - we measure reaction time (RT) and sensitivity, d', and supplement these behavioural data with a physiological metric of 'cognitive effort', pupil diameter. Differences in RT and in d' between the sexes are slight for the cubes task, while females are consistently faster than males on the hands task. In contrast, pupillometry reveals striking a sex difference, with males showing significantly lower pupil dilation during the cubes task, suggesting less cognitive effort for comparable behavioural performance. This difference is attenuated during the MR of hands, in line with recent findings that sex differences in spatial abilities dissipate when elements of social perspective taking are introduced. Taxonomy: Attention, Perception.

Holistic word processing in dyslexia.

People with dyslexia have difficulty learning to read and many lack fluent word recognition as adults. In a novel task that borrows elements of the 'word superiority' and 'word inversion' paradigms, we investigate whether holistic word recognition is impaired in dyslexia. In Experiment 1 students with dyslexia and controls judged the similarity of pairs of 6- and 7-letter words or pairs of words whose letters had been partially jumbled. The stimuli were presented in both upright and inverted form with orthographic regularity and orientation randomized from trial to trial. While both groups showed sensitivity to orthographic regularity, both word inversion and letter jumbling were more detrimental to skilled than dyslexic readers supporting the idea that the latter may read in a more analytic fashion. Experiment 2 employed the same task but using shorter, 4- and 5-letter words and a design where orthographic regularity and stimuli orientation was held constant within experimental blocks to encourage the use of either holistic or analytic processing. While there was no difference in reaction time between the dyslexic and control groups for inverted stimuli, the students with dyslexia were significantly slower than controls for upright stimuli. These findings suggest that holistic word recognition, which is largely based on the detection of orthographic regularity, is impaired in dyslexia.

Spatial orienting of attention to social cues is modulated by cue type and gender of viewer.

Across three experiments, we examined the efficacy of three cues from the human body-body orientation, head turning, and eye-gaze direction-to shift an observer's attention in space. Using a modified Posner cueing paradigm, we replicate the previous findings of gender differences in the gaze-cueing effect whereby female but not male participants responded significantly faster to validly cued than to invalidly cued targets. In contrast to the previous studies, we report a robust cueing effect for both male and female participants when head turning direction was used as the central cue, whereas oriented bodies proved ineffectual as cues to attention for both males and females. These results are discussed with reference to the time course of central cueing effects, gender differences in spatial attention, and current models of how cues from the human body are combined to judge another person's direction of attention.

Point Me in the Right Direction: Same and Cross Category Visual Aftereffects to Directional Cues.

Of the many hand gestures that we use in communication pointing is one of the most common and powerful in its role as a visual referent that directs joint attention. While numerous studies have examined the developmental trajectory of pointing production and comprehension, very little consideration has been given to adult visual perception of hand pointing gestures. Across two studies, we use a visual adaptation paradigm to explore the mechanisms underlying the perception of proto-declarative hand pointing. Twenty eight participants judged whether 3D modeled hands pointed, in depth, at or to the left or right of a target (test angles of 0°, 0.75° and 1.5° left and right) before and after adapting to either hands or arrows which pointed 10° to the right or left of the target. After adaptation, the perception of the pointing direction of the test hands shifted with respect to the adapted direction, revealing separate mechanisms for coding right and leftward pointing directions. While there were subtle yet significant differences in the strength of adaptation to hands and arrows, both cues gave rise to a similar pattern of aftereffects. The considerable cross category adaptation found when arrows were used as adapting stimuli and the asymmetry in aftereffects to left and right hands suggests that the adaptation aftereffects are likely driven by simple orientation cues, inherent in the morphological structure of the hand, and not dependent on the biological status of the hand pointing cue. This finding provides evidence in support of a common neural mechanism that processes these directional social cues, a mechanism that may be blind to the biological status of the stimulus category.

Heads First: Visual Aftereffects Reveal Hierarchical Integration of Cues to Social Attention.

Determining where another person is attending is an important skill for social interaction that relies on various visual cues, including the turning direction of the head and body. This study reports a novel high-level visual aftereffect that addresses the important question of how these sources of information are combined in gauging social attention. We show that adapting to images of heads turned 25° to the right or left produces a perceptual bias in judging the turning direction of subsequently presented bodies. In contrast, little to no change in the judgment of head orientation occurs after adapting to extremely oriented bodies. The unidirectional nature of the aftereffect suggests that cues from the human body signaling social attention are combined in a hierarchical fashion and is consistent with evidence from single-cell recording studies in nonhuman primates showing that information about head orientation can override information about body posture when both are visible.

Holistic processing of faces as measured by the Thatcher illusion is intact in autism spectrum disorders.

Impaired face perception in autism spectrum disorders is thought to reflect a perceptual style characterized by componential rather than configural processing of faces. This study investigated face processing in adolescents with autism spectrum disorders using the Thatcher illusion, a perceptual phenomenon exhibiting 'inversion effects' that characterize typical face processing. While previous studies used a limited range of face orientations, we measured perception of normality/grotesqueness of faces at seven orientations ranging from upright to inverted to allow for a detailed comparison of both reaction time and error by orientation profiles. We found that, like their typically developing peers, adolescents with autism spectrum disorders show strong inversion effects whereby reaction times were longer and error rates greater at inverted when compared to upright orientations. Additionally, the adolescents with autism spectrum disorders, like their peers in the typically developing group, show a marked nonlinearity in the error by orientation profile. Error is roughly constant out to 90° and then increases steeply, indicating a sudden shift from configural to local processing that reflects experience with faces in their typical orientations. These findings agree with recent reports that face perception is qualitatively similar in autistic and neurotypical groups.

Inversion effects in the perception of the moving human form: a comparison of adolescents with autism spectrum disorder and typically developing adolescents.

The "body inversion effect" refers to superior recognition of upright than inverted images of the human body and indicates typical configural processing. Previous research by Reed et al. using static images of the human body shows that people with autism fail to demonstrate this effect. Using a novel task in which adults, adolescents with autism, and typically developing adolescents judged whether walking stick figures-created from biological motion recordings and shown at seven orientations between 0° and 180°-were normal or distorted, this study shows clear effects of stimulus inversion. Reaction times and "inverse efficiency" increased with orientation for normal but not distorted walkers, and sensitivity declined with rotation from upright for all groups. Notably, the effect of stimulus inversion was equally detrimental to both groups of adolescents suggesting intact configural processing of the body in motion in autism spectrum disorder.

Shared or separate mechanisms for self-face and other-face processing? Evidence from adaptation.

Evidence that self-face recognition is dissociable from general face recognition has important implications both for models of social cognition and for our understanding of face recognition. In two studies, we examine how adaptation affects the perception of personally familiar faces, and we use a visual adaptation paradigm to investigate whether the neural mechanisms underlying the recognition of one's own and other faces are shared or separate. In Study 1 we show that the representation of personally familiar faces is rapidly updated by visual experience with unfamiliar faces, so that the perception of one's own face and a friend's face is altered by a brief period of adaptation to distorted unfamiliar faces. In Study 2, participants adapted to images of their own and a friend's face distorted in opposite directions; the contingent aftereffects we observe are indicative of separate neural populations, but we suggest that these reflect coding of facial identity rather than of the categories "self" and "other."

My hand or yours? Markedly different sensitivity to egocentric and allocentric views in the hand laterality task.

In the hand laterality task participants judge the handedness of visually presented stimuli--images of hands shown in a variety of postures and views--and indicate whether they perceive a right or left hand. The task engages kinaesthetic and sensorimotor processes and is considered a standard example of motor imagery. However, in this study we find that while motor imagery holds across egocentric views of the stimuli (where the hands are likely to be one's own), it does not appear to hold across allocentric views (where the hands are likely to be another person's). First, we find that psychophysical sensitivity, d', is clearly demarcated between egocentric and allocentric views, being high for the former and low for the latter. Secondly, using mixed effects methods to analyse the chronometric data, we find high positive correlation between response times across egocentric views, suggesting a common use of motor imagery across these views. Correlations are, however, considerably lower between egocentric and allocentric views, suggesting a switch from motor imagery across these perspectives. We relate these findings to research showing that the extrastriate body area discriminates egocentric ('self') and allocentric ('other') views of the human body and of body parts, including hands.