Effectiveness and feasibility of Socratic feedback to increase awareness of deficits in patients with acquired brain injury: Four single-case experimental design (SCED) studies.

OBJECTIVE: To investigate the effectiveness and feasibility of a Socratic feedback programme to improve awareness of deficits in patients with acquired brain injury (ABI). SETTING: Rehabilitation centre. PARTICIPANTS: Four patients with ABI with awareness problems. DESIGN: A series of single-case experimental design studies with random intervention starting points (A-B + maintenance design). MAIN MEASURES: Rate of trainer-feedback and self-control behaviour on everyday tasks, patient competency rating scale (PCRS), self-regulating skills interview (SRSI), hospital anxiety and depression scale. RESULTS: All patients needed less trainer feedback, the change was significant in 3 out of 4. One patient increased in overt self-corrective behaviour. SRSI performance increased in all patients (medium to strong effect size), and PCRS performance increased in two patients (medium and strong effect size). Mood and anxiety levels were elevated in one patient at the beginning of the training and decreased to normal levels at the end of the training. The feasibility of the programme was scored 9 out of 10. CONCLUSIONS: The Socratic feedback method is a promising intervention for improving awareness of deficits in patients with ABI. Controlled studies with larger populations are needed to draw more solid conclusions about the effect of this method.

Detection of MCI in the clinic: evaluation of the sensitivity and specificity of a computerised test battery, the Hopkins Verbal Learning Test and the MMSE.

INTRODUCTION: the sensitive detection of mild cognitive impairment (MCI) in older adults is an important problem that requires objective assessment. We evaluated whether the computerised cognitive test battery, CogState, was as sensitive to MCI as two well-validated 'paper-and-pencil' tests, the Hopkins Verbal Learning Test (HVLT) and the Mini-Mental Status Examination (MMSE). METHODS: these tests were administered with a subjective memory questionnaire and an 'Activities of Daily Living' scale to 21 individuals with MCI and 98 cognitively healthy controls matched for sex, education and IQ levels. The sensitivity and specificity of the tests and their discrimination between groups were determined. RESULTS: the HVLT had a maximum discrimination between controls and MCI cases of 90%, compared with 86% for CogState and 65% for the MMSE. Only CogState showed correlations with subjective memory complaints (SMC) and activities of daily living for the whole cohort when controlled for age, sex and years of education. Logistic regression analyses showed that diagnosis (control:MCI) was predicted by HVLT and a CogState ratio score. Age was a significant predictor of HVLT performance, while age and SMC predicted CogState performance. The computerised test battery was well tolerated by older adults, but presentation speed was a limiting factor for some participants. CONCLUSIONS: overall, we conclude that the HVLT has better sensitivity for the detection of MCI in older adults than the CogState, but that CogState may enable the identification of cognitive deficits above and beyond impairments in memory.