Treating Patients with Frontal Neurocognitive Deficits After SAH and Stroke.

Five frontal systems circuits connect with the basal ganglia and other structures to control and regulate thinking and behavior. Subarachnoid hemorrhage and stroke following anterior circulation aneurysms typically disrupt these circuits, sometimes markedly affecting a patient's function. This article reviews the primary pathways and associated brain functions. The principles of cognitively and behaviorally rehabilitating these functions are also discussed by creating external structure and building on what the brain is still capable of doing.

Discriminating high fall risk on an inpatient rehabilitation unit.

The objective of this study was to identify on admission the most discriminating fall predictors for patients to an inpatient rehabilitation unit. Medical information from 34 patients who fell over a consecutive 7-month period and 102 controls (1:3 ratio) matched for diagnosis, age, and gender was analyzed to identify a set of best predictors. Admission mobility and problem solving FIM scores accounted for 17% of variance in whether a fall occurred during the admission. After statistically deriving optimal cutoff thresholds for decision making, high fall risk was retroactively assigned to patients. Logistic regression revealed increased odds of having fallen by 5.1 times for poorer mobility and 2.4 times for poorer problem solving. The practical benefits of the evidence-based risk assessment were discussed.

Visual deficit interventions in adult stroke and brain injury: a systematic review.

Visual deficits after cerebral injury are common. The variability in the types of injury sustained as well as their impact on function in the environment have produced multiple approaches at corrective intervention. To assess the effectiveness of these vision interventions, an extensive literature search was completed. The analysis of this review revealed some success with visual neglect disorders, but not enough evidence to comment definitively on interventions for hemianopsia, quadrantonopsia, diplopia, or convergence insufficiency. A lack of follow-up also limited efforts to assess the durability of documented gains. Additional research is necessary to clarify, quantify, and measure treatment outcomes for acquired visual dysfunction as well as to link laboratory testing to improvement in actual functioning for individuals in their environment.

Client-centered occupational therapy using constraint-induced therapy.

Constraint-induced therapy (CIT) is a rehabilitation intervention designed to promote increased use of a weak or paralyzed arm, most commonly in patients who sustained a stroke. CIT involves constraining the unaffected arm in a sling or mitt, forcing the use of the weaker or paralyzed arm in daily activities. The aim of this study was to determine whether immobilizing the uninvolved arm of persons who experienced a stroke while participating in meaningful activities of daily living would increase their satisfaction and performance in life roles. Nine clients participated in a pilot study consisting of 2 weeks of individualized occupation-based CIT. This pilot study combined therapy in the clinic with therapy in the individual's home environment and incorporated meaningful daily activities chosen by the client into treatment. Results revealed a significant change in reported satisfaction and performance postintervention; however, a decline in satisfaction at follow-up despite continued motor improvement. Even though voluntary movements demonstrated improvement, participants were not satisfied with their performance in functional goal-related activities in their natural environment. Motor improvement can be repeated; however, at follow-up, participants were not satisfied with the improvement in meaningful activities that they identified. This may have to do with participants wanting or expecting their affected upper extremity to function better despite the deficits. It is also possible that participants expected their function to improve at the rate that it did during treatment. Further investigation using meaningful activity is needed to identify integration of the affected upper extremity into individuals' own environments and determine how it affects overall life roles and satisfaction over time.

Effects of demographic and health variables on Rasch scaled cognitive scores.

OBJECTIVES: To determine whether demographic and health variables interact to predict cognitive scores in Asset and Health Dynamics of the Oldest-Old (AHEAD), a representative survey of older Americans, as a test of the developmental discontinuity hypothesis. METHODS: Rasch modeling procedures were used to rescale cognitive measures into interval scores, equating scales across measures, making it possible to compare predictor effects directly. Rasch scaling also reduces the likelihood of obtaining spurious interactions. Tasks included combined immediate and delayed recall, the Telephone Interview for Cognitive Status (TICS), Series 7, and an overall cognitive score. RESULTS: Demographic variables most strongly predicted performance on all scores, with health variables having smaller effects. Age interacted with both demographic and health variables, but patterns of effects varied. DISCUSSION: Demographic variables have strong effects on cognition. The developmental discontinuity hypothesis that health variables have stronger effects than demographic ones on cognition in older adults was not supported.

Memory Functioning Questionnaire: concurrent validity with memory performance and self-reported memory failures.

Concurrent validity of factor scores from the Memory Functioning Questionnaire (MFQ; Gilewski, Zelinski, & Schaie, in press) with memory performance was investigated in 2 studies. Study 1 involved 198 adults aged 55-85; Study 2, 89 adults aged 50-87. After effects of depression, education, and health were partialed out, MFQ scores predicted performance on laboratory memory tests in Study 1 and performance on clinical memory tests and diaries of memory failures over 2 weeks in Study 2. Additional variance in predicting performance and failures recorded in diaries is accounted for by MFQ scores after partialing out subjects' responses to a yes-no question about whether they have memory problems. Results suggest that the MFQ has moderate concurrent validity with memory measures and is preferable to responses to a single question about memory self-perception in assessing memory complaints in normal adults.