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Purpose: Many factors contribute to persisting post-concussion symptoms (PPCSs), necessitating multi-modal treatment. Quantitative investigations have shown the potential of interdisciplinary intervention to reduce the burden of PPCSs and facilitate return to activities. There are often varied responses to intervention, warranting further investigation of potential factors underlying treatment response. This study aimed to explore participant experiences of i-RECOveR, an interdisciplinary intervention for PPCSs and its impact on symptoms, daily function, and concussion beliefs. Materials and Method: Semi-structured interviews were conducted 1-month post-treatment via videoconferencing with 13 individuals (61% female) with mild traumatic brain injury (Mage=39.77 years, SD = 16.27) who participated in i-RECOveR. Interview transcripts were analysed thematically. Results: Three themes reflected participants' treatment journeys from concussion to life after treatment: (1) Dissatisfaction with Previous Consultations, reflected personal experiences prior to commencing treatment; (2) Perceived Active Ingredients of Intervention, reflected participant experiences of i-RECOveR; and (3) Impact of Interdisciplinary Intervention, reflected a range of positive changes after completing i-RECOveR. Conclusions: Findings highlight current gaps in the acute management of concussion and provide end-user insights into the facilitators and barriers of treatment engagement and response. Responses also highlight the potential positive impact of interdisciplinary treatments. Clinician perspectives should be explored in future research. IMPLICATIONS FOR REHABILITATION: Access to additional training in concussion care and referral pathways may help medical practitioners manage patients after concussion. Clinicians working with individuals with persisting post-concussion symptoms should develop an understanding of the individual's perceived control over their symptoms, and work with them toward increasing autonomy and control and recognition that symptoms are often multifactorial in nature. Persisting post-concussion symptom rehabilitation may be improved by taking an interdisciplinary approach that is integrated individualised, and is specialised for concussion. Telehealth and hybrid treatment models are well tolerated by individuals with persisting post-concussion symptoms and may facilitate treatment engagement, especially for individuals with mild traumatic brain injury who report disabling symptoms made worse by travelling to in-person treatments. [ABSTRACT FROM AUTHOR]

Competency-based assessment on placement ideally involves evaluation of a trainee performing clinical skills using fit-for-purpose tools that are simple for clinical supervisors to use and informative to the trainee. The current study examined the potential utility of a new tool, the Psychology Competency Evaluation Tool – Summative (PsyCET-S), designed to assess the attainment of professional competencies in clinical psychology trainees. Twelve experts tested the inter-rater reliability of the vignette ordering, before the tool was used to assess performance of clinical psychology trainees on placement by both supervisors and trainees. Ninety-nine placement reviews of 45 trainees at different stages of training were analysed. Strong inter-rater reliability in the rank ordering of vignettes within each domain indicated their ability to capture competence development. Supervisor and trainee ratings showed a gradual increase in competence from early to later stages of training in all domains, with performance plateauing for the final placement. Evidence of both the leniency bias and halo effect were evident, with supervisors appearing more lenient than the trainees themselves. The PsyCET-S encourages supervisors to evaluate the development of professional competencies in their trainees in a way that can optimise trainee learning and future practice as a Psychologist. What is already known about this topic: Board-approved supervisors of professional psychology trainees are required to "effectively monitor, assess and evaluate the competencies of a supervisee", yet simple and effective methods for how to do this are limited. Effective competency-based assessment can optimise students' learning and is essential to regulating the profession. Tools that measure the performance of clinical skills and their development over time are needed. What this topic adds: We present a new evaluation tool that describes expected student performance of professional competencies on placement at the beginning of clinical training through to entry-to-practice that is designed to capture both supervisor and trainee ratings. Data from 99 placement reviews indicate that the tool captures the progression of competency attainment over time from both the trainee and supervisor perspective. The tool provides trainees with meaningful feedback on their competency development while preserving the normative function of supervision. [ABSTRACT FROM AUTHOR]

During the early recovery period after traumatic brain injury (TBI), referred to as post-traumatic amnesia (PTA), approximately 44% of individuals may exhibit agitated behaviours. Agitation can impede recovery and poses a significant management challenge for healthcare services. As families provide significant support for their injured relatives during this time, this study aimed to explore the family's experience during PTA to better understand their role in agitation management. There were 20 qualitative semi-structured interviews conducted with 24 family members of patients exhibiting agitation during early TBI recovery (75% female, aged 30–71 years), predominantly parents (n = 12), spouses (n = 7) and children (n = 3). The interviews explored the family's experience of supporting their relative exhibiting agitation during PTA. The interviews were analyzed using reflexive thematic analysis, which revealed three key themes: family contributions to patient care, expectations of the health care service and supporting families to support patients. This study emphasized the significant role of families in managing agitation during early TBI recovery and highlighted that families who are well-informed and well-supported have the potential to minimize their relative's agitation during PTA, which may reduce the burden on healthcare staff and promote patient recovery. [ABSTRACT FROM AUTHOR]

Objective: Neuropsychological assessment (NP) feedback helps patients and caregivers understand assessment results to maximise their utility and impact in everyday life. Yet feedback practices are inconsistent and there are no evidence-based guidelines for how feedback should be most effectively delivered. The aim of our study was to develop a psychometrically sound feedback competency checklist, the Psychology Competency Assessment Tool – Feedback (PsyCET-F), for use in research, training, and clinical settings. Method: The Delphi method of expert consensus was used to establish checklist items that clearly described competencies important for NP feedback. To examine the inter-rater reliability of the checklist, two experienced neuropsychologists rated the competencies demonstrated by trainee neuropsychologists across four feedback sessions. Results: After two Delphi rounds, consensus was reached on the 20-item checklist. Consensus was defined as at least 80% agreement amongst the panel of 20 experts. Four item categories resulted from the Delphi: (a) Opening the Session; (b) Applying Specific Feedback Techniques; (c) Engagement, Collaboration, and Alliance; and (d) Structuring and Ending the Session. Inter-rater reliability was moderate (κW = 0.79, p <.001, 80.52% agreement) when using a simple coding system, coded as Beginner, Intermediate, Competent, and Skilful; and strong (κW = 0.82, p <.001) when competency level was coded using an 8-point, detailed coding method. Conclusions: The PsyCET-F is psychometrically sound and fit-for-purpose for measuring competencies in giving NP feedback. It can be used in the training of clinicians to develop effective feedback skills. International benchmarking and usability testing will be conducted in a future study. [ABSTRACT FROM AUTHOR]

Agitated behaviours pose a significant challenge during early recovery following traumatic brain injury (TBI). This study aimed to gain a deeper understanding of how clinicians worldwide manage post-TBI agitation. Understanding the factors that influence how clinicians manage agitation can help inform the use of consistent and effective management strategies for reducing agitation in TBI care. Using a qualitative design, semi-structured interviews were conducted with 33 clinicians (58% female, aged 23–71 years) from 16 countries who had experience working with agitated patients. The interviews explored the approaches used to manage agitation during early TBI recovery. Interviews were analysed using thematic analysis. The central theme of the interviews was the effective management of agitation, consisting of three sub-themes: managing the safety of staff and patients, reducing triggers for agitation, and implementing behavioural principles for managing agitation. Two overarching themes influenced the effective management of agitation: clinician-related factors and systemic factors. This study highlighted key approaches for effective agitation management during early TBI recovery, as described by clinicians working with these patients worldwide. There were similarities in the strategies described, although there were many challenges that impeded the consistent implementation of such strategies in TBI care settings. Effective management of agitation during early traumatic brain injury (TBI) recovery continues to pose a significant challenge for clinicians worldwide. Healthcare services may improve the management of agitation by involving the patient's family in care delivery and implementing low-cost less-restrictive non-pharmacological interventions to reduce reliance on pharmacological interventions. Proactively addressing and removing potential sources of agitation (patient-related and environmental) may help reduce the risk of agitation occurring. The use of simple behaviour management strategies may be effective for reducing agitation, but strategies need to be implemented consistently and the approach should be flexible and tailored to the patient. Clinicians should develop an understanding of a patient's premorbid behaviours and interests to best inform the management approach. Management of agitation may be improved by increasing clinicians' agency in responding to agitated behaviours, through the provision of information and resources, ongoing training and skill development, supervision and support. [ABSTRACT FROM AUTHOR]

Agitation is common during the post-traumatic amnesia (PTA) period after traumatic brain injury (TBI), although our knowledge of what causes or predicts agitation is limited. The current study aimed to examine the association of agitation in PTA with the concurrent impairments in orientation and memory while controlling for covariates of agitation. Participants were 125 patients in PTA following moderate to extremely severe TBI recruited from an inpatient brain injury rehabilitation service who were assessed throughout PTA on the Agitated Behavior Scale (ABS) and the Westmead PTA Scale (WPTAS). Agitation was observed in 42.4% of participants (ABS score > 21), with disinhibited behaviours (e.g., distractibility and impulsivity) most common. Multilevel modelling found daily ABS scores to be associated with daily scores on the WPTAS but in a non-linear pattern. Analysis of covariates found that shorter time post-admission, younger age, presence of infection and higher antipsychotic doses were associated with higher ABS scores. These results support a relationship between agitation and the concurrent cognitive impairment during PTA. While a causal link cannot yet be inferred, management strategies that can potentially interfere with cognition (e.g., sedating medications, environmental changes) should be used cautiously in case they exacerbate agitation. [ABSTRACT FROM AUTHOR]

It is uncertain whether therapy delivered during posttraumatic amnesia (PTA) following traumatic brain injury can be effective due to risk of agitation and poor learning capacity. This study used goal attainment scaling (GAS) to assess gains in activities of daily living (ADL) retraining during PTA. Occupational therapists' perspectives on goal setting and therapy delivery were also explored qualitatively. Forty-nine rehabilitation inpatients were provided with manualised ADL retraining following errorless and procedural learning principles during PTA. From 104 GAS goals, 90% were achieved at PTA emergence. GAS T-scores changed significantly (p < .001) from baseline (M = 26.94, SD = 4.90) to post-intervention (M = 61.44, SD = 11.45). Mean post-intervention T-scores correlated significantly (p < .001) with change in Functional Independence Measure scores. The four therapists reported that GAS was unfamiliar and time-consuming initially, although it aided goal-directed therapy and measurement of patient performance. Application of manualised skill retraining using errorless and procedural learning techniques was described as novel and challenging, but providing valuable structure. The intervention reportedly promoted therapeutic alliance, skill-building and meaningful time-use without elevating agitation, but fatigue impeded therapy. Overall, GAS captured positive individual change following ADL retraining during PTA and therapists indicated that the intervention and use of GAS was generally beneficial and feasible within clinical practice. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the effectiveness of individual cognitive behavioural therapy (CBT) for post-stroke fatigue and sleep disturbance compared to treatment as usual (TAU). In a parallel two-group pilot randomised controlled trial of 15 participants, nine were allocated to eight weekly sessions of adapted CBT and six continued usual care rehabilitation. The primary outcome was the Fatigue Severity Scale (FSS-7) at two and four months from baseline. Secondary outcomes included measures of sleep, mood and quality of life. Outcomes were assessed by a rater who was blind to group membership. At the four-month endpoint, the CBT group demonstrated significantly reduced fatigue relative to TAU (FSS-7 mean difference: 1.92, 95% CI: 0.24 to 3.60). Significant group differences also emerged for sleep quality and depression, favouring the CBT group. Insomnia and physical quality of life improved immediately post-therapy but were no longer superior to TAU at follow-up. Overall, CBT is a promising treatment for improving post-stroke fatigue, sleep quality and depression. Gains were maintained for two months after therapy cessation and represented large treatment effects. These findings highlight the feasibility of the intervention and warrant extension to a phase III clinical trial. [ABSTRACT FROM AUTHOR]

Purpose: To identify predictors of treatment response to cognitive behavior therapy (CBT) for sleep disturbance following acquired brain injury (ABI). Methods: Classification and regression tree (CART) analysis was conducted on individual patient data from two pilot randomized controlled trials (RCTs): one in traumatic brain injury (TBI), the other in stroke. The combined sample comprised 32 participants; 15 receiving CBT and 17 allocated to treatment as usual (TAU). The outcome was reliable improvement on the Pittsburgh Sleep Quality Index (PSQI). Results: Study group was a statistically significant predictor of outcome, with CBT participants more likely to achieve reliable improvements than TAU (OR = 4.88, p = 0.042). Study group (CBT vs. TAU) exhibited an area under the ROC curve (AUROC) of 69%. In separate CART analyzes, verbal memory (CVLT-II >45.5), age (<47.5) and baseline depression (HADS-D > 6) predicted positive outcomes in CBT recipients. Each of these variables added a small (∼5%) but not statistically significant amount to AUROC over study group. Conclusions: In this ABI sample, better memory, younger age, and higher baseline depression were associated with positive treatment response to CBT although individually these variables were not better than group alone in predicting outcomes. The present findings generate hypotheses for further investigation in future studies. Implications for rehabilitation: Cognitive behavior therapy improves sleep quality over treatment as usual in persons with acquired brain injury. Individuals who are younger in age with better memory and co-morbid symptoms of depression are more likely to respond to the treatment. These findings are based on a small sample and can be considered hypothesis generating for future clinical studies. [ABSTRACT FROM AUTHOR]

Primary objective:Increasing physical activity (PA) among people with severe traumatic brain injury (TBI) represents an important long-term rehabilitation goal. To design effective interventions to promote PA, the factors associated with PA engagement post-TBI need to be understood. Research design:A qualitative study design was employed to investigate the factors influencing PA engagement in people with severe TBI living in the community. Methods and Procedures:Face-to-face interviews were conducted with eight people with severe TBI three to five years post-injury. A constant comparative method of data collection and analysis was adopted. Main outcomes and results:Interviews were analysed using thematic analysis. Three themes were identified: continuance of self and PA (perception of self, stage of life, and PA normality), beliefs about PA (knowledge of PA and associated benefits), and purpose of PA engagement (reasons for being physically active). Lifelong PA habits and current life priorities impacted on PA engagement post-TBI and influenced whether TBI-associated impairments were considered as a barrier to PA. Conclusion:Among this group of people, PA engagement post-TBI was influenced by perceptions of lifelong PA habits and current life priorities. Interventions to increase PA need to address these perceptions and adapt PA to account for life priorities within the context of TBI-associated impairments. [ABSTRACT FROM AUTHOR]

Purpose: Smartphones have great potential as a convenient, multifunction tool to support cognition and independence following traumatic brain injury (TBI). However, there has been limited investigation of their helpful and less helpful aspects for people with TBI. We aimed to investigate patterns of smartphone use amongst individuals with TBI, identify potential barriers to use, and examine the relationships between smartphone use and daily functioning. Method: Twenty-nine participants with TBI and 33 non-injured participants completed the Smartphone Survey, and measures of subjective and objective cognitive functioning, mood, and community integration. Results: Smartphone use was equally common in both groups, and patterns of app use were similar. More participants with TBI than the comparison group listed using their smartphone as a memory aid as its main benefit. Difficulty in learning how to use the smartphone was identified by participants with TBI, however only 10% had been shown how to use it by a clinician. Those with poorer subjective cognitive function used memory/organisational apps more frequently; and higher communication app use with better social integration, in participants with TBI. Conclusions: These findings suggest that smartphones have potential in improving independence following TBI, but receiving support in using them is vital. [ABSTRACT FROM AUTHOR]

Primary objective: Family caregivers play an important role in managing challenging behaviours after TBI. The aims of this study were to understand how family caregivers of individuals with TBI perceive challenging behaviours and their impact on the TBI individual's community integration and family functioning. Research design: A qualitative research design was employed to capture the lived experience of family caregivers of individuals with TBI. Methods and procedures: Face-to-face interviews were conducted on six female family caregivers of individuals with severe TBI (sustained an average of 17 years earlier) and long-standing challenging behaviours. Main outcomes and results: The results revealed that family caregivers adopted a broader definition of challenging behaviour than that used by professionals and these behaviours impacted on the community integration of the individual with TBI, most notably leading to poor social relationships. Challenging behaviours were viewed as a key source of distress and burden for family caregivers and they used many different strategies to manage the behaviours. Conclusion: Greater understanding of challenging behaviours from the perspectives of family caregivers may help provide more effective support and interventions to improve quality-of-life for individuals with challenging behaviours after TBI and their families. [ABSTRACT FROM AUTHOR]

This study examined the relationship between the nature of feedback provided by close-others and self-awareness in individuals with traumatic brain injury (TBI). Using a cross-sectional design, 69 individuals with mild-to-severe TBI and their close-others completed the Awareness Questionnaire, Hospital Anxiety and Depression Scale, Trail Making Test–Part B and Feedback about Cognitive Difficulties Questionnaire, between 3 months and 20 years post-injury. Results showed cognitive and/or behavioural issues post-injury were identified in 97% of individuals with TBI and over 80% of these were provided with feedback by close-others at least sometimes after making errors. Close-others reported two main reasons for not providing feedback about problems: (1) not wanting to hurt the feelings of the injured individual and (2) pointing out errors would be detrimental to the injured individual's rehabilitation. Whilst nearly 60% of the individuals with TBI were reported to detect an error once they received feedback, they showed low levels of acceptance/acknowledgement in response to feedback. Analyses including injury-related and emotional variables failed to identify any mediated or moderated relations between frequency of feedback and self-awareness. The high rates of feedback by close-others but low acceptance/acknowledgement of that feedback by individuals with TBI suggests that clinicians may need to work in partnership with close-others to facilitate supportive relationships for effective delivery of feedback. [ABSTRACT FROM AUTHOR]

Objective: To examine self-awareness over the first year following traumatic brain injury (TBI) and the association of demographic, biological, cognitive, psychological and social-environmental factors with change in awareness. Research design: Using a longitudinal design the progression of awareness and association of demographic and biopsychosocial factors with its trajectory were analysed using random effects regression. Methods and procedures: Sixty individuals with mainly moderate-to-severe TBI completed assessments at 3, 6 and/or 12 months post-injury. Measures of awareness (Self-Awareness of Deficits Interview; SADI), demographic (age at time of injury and gender), injury severity (post-traumatic amnesia duration), cognitive (Trails Making Test-Part B), psychological (Hospital Anxiety and Depression Scale) and social-environmental (return to pre-injury activities) factors were administered. Main outcomes and results: Awareness improved over the first year post-injury. Analysis of SADI sub-scales revealed that females had greater awareness in terms of setting more realistic goals early in recovery compared to males. Models including demographic, biological, cognitive, psychological and social-environmental factors did not contribute significantly to prediction of awareness on the SADI above the influence of time. Conclusions: Time post-injury had the strongest influence on the development of awareness. This understanding may be important in determining the optimal timing of rehabilitative intervention. [ABSTRACT FROM AUTHOR]

Clinical neuropsychologists are increasingly involved in delivering psychological interventions to people with neurological conditions. This is a key competency for accredited Australian postgraduate neuropsychology courses; however it is not clear how effective courses are in preparing neuropsychologists to deliver interventions. The study aims were to (a) determine the frequency and confidence with which particular types of interventions are delivered by Australian neuropsychologists, (b) examine the availability of opportunities to deliver interventions on clinical placements, (c) identify barriers to delivering interventions in current workplaces; and (d) determine which factors influence the frequency and confidence with which neuropsychologists deliver interventions. An online survey was completed by 114 participants who had graduated from a postgraduate neuropsychology program. Results indicated that respondents delivered different intervention types with varying frequency. They reported limited opportunities to practice these interventions on placements. The majority wanted to be doing more interventions, with lack of time, resources, and adequate training being the major barriers. There were several significant relationships between the frequency and confidence with which respondents delivered interventions and the perceived quality of their postgraduate training. These results highlight the need to consider appropriate postgraduate training options in delivery of interventions, including increasing opportunities to practice interventions on placements. [ABSTRACT FROM AUTHOR]

The aim of the study was to describe the development and predictors of psychological adjustment during community-based traumatic brain injury (TBI) rehabilitation. Forty-two adolescent and adult individuals with TBI (mean age 32 years, 88% male, median post-traumatic amnesia 11 days) participated in a single-group, longitudinal design study. The main measures used were the Reactions to Impairment and Disability Inventory, Adjustment subscale; Sydney Psychosocial Reintegration Scale; Hospital Anxiety and Depression Scale; and Self-awareness of Deficits Interview. At rehabilitation start, individuals differed significantly from each other with respect to their level of psychological adjustment. Individual trajectories of psychological adjustment were highly variable. However, for the sample as a whole, psychological adjustment did not change during the course of rehabilitation (multilevel regression models;p> .05). Good psychological adjustment was related to low levels of emotional distress and a small discrepancy between current and aspired functional status. Poor functional status had a more minor impact on psychological adjustment in individuals with poor self-awareness than in individuals with high levels of self-awareness. The results confirm parts of theoretical models of psychological adjustment to acquired brain injury, especially the importance of goal refinement. However, the results need to be treated cautiously, given the limited sample size. [ABSTRACT FROM PUBLISHER]

Although cognitive-behavioural therapy (CBT) is the treatment of choice for anxiety, its delivery needs to be adapted for individuals with traumatic brain injury (TBI). It also requires clients' active engagement for maximum benefit. This study was a pilot randomised controlled trial involving an anxiety treatment programme adapted for people with TBI, based on CBT and motivational interviewing (MI). Twenty-seven participants with moderate/severe TBI (aged 21–73 years, 78% males) recruited from a brain injury rehabilitation hospital were randomly allocated to receive MI + CBT (n = 9), non-directive counselling (NDC) + CBT (n = 10) and treatment-as-usual (TAU) (n = 8). CBT and MI were manualised and delivered in 12 weekly individual sessions. Primary outcome was self-reported anxiety symptoms assessed at baseline, at the end of NDC/MI and immediately following CBT. Assessment was conducted by assessors blinded to group assignment. Intention-to-treat analyses showed that the two active treatment groups demonstrated significantly greater anxiety reduction than TAU. Participants receiving MI showed greater response to CBT, in terms of reduction in anxiety, stress and non-productive coping, compared to participants who received NDC. The results provided preliminary support for the adapted CBT programme, and the potential utility of MI as treatment prelude. Longer follow-up data are required to evaluate the maintenance of treatment effects. [ABSTRACT FROM PUBLISHER]

A brief preparatory programme, based on the principles of motivational interviewing (MI), was developed as a way of engaging clients with traumatic brain injury (TBI) and preparing them for a cognitive behaviour therapy (CBT) programme for anxiety. The MI + CBT programme was delivered to a male client in his early 40s with severe TBI at four months post-injury, using a single-subject design with repeated measures pre- and post-treatment. The client received three sessions of manualised MI, followed by nine sessions of CBT. The MI sessions focused on helping the client to develop more realistic goals and supporting his self-efficacy about his ability to cope with anxiety. Specific strategies were used to accommodate the client's cognitive limitations, such as the use of personally meaningful metaphors and role plays. Re-assessments were conducted at the end of MI, CBT and nine weeks post-treatment, using a semi-structured clinical interview and self-report measures of anxiety, mood and change expectancy. The client showed significant improvement in anxiety following treatment and a significant reduction in subjective units of distress (SUDS) between the MI and CBT phases. The results suggest the potential utility of MI in people with TBI, and the need to evaluate treatment protocols in a controlled trial. [ABSTRACT FROM PUBLISHER]

Levels of expressed emotion (EE) within the family, particularly criticism and emotional over-involvement, are associated with a patient's psychological outcome in a range of psychiatric and medical conditions. This study aimed to examine the relationship between levels of family EE and anxiety and depression in patients who have sustained a traumatic brain injury (TBI). A further aim was to examine whether family members' levels of psychological distress and attributions of patient symptom controllability, were related to their levels of patient-directed EE. Participants were 43 patients who had sustained a complicated mild to severe TBI three months to five years previously, and their nominated family members. Results indicated that family members' criticism and emotional over-involvement were associated with patients' levels of anxiety and depression. Moreover, family members' levels of anxiety and depression were associated with their levels of patient-directed criticism and emotional over-involvement, whilst their attributions of patient symptom control were not. These findings suggest that levels of EE within the family are associated with psychological adjustment following TBI. Consequently, interventions targeting EE in family members may help to reduce psychiatric difficulties following TBI. [ABSTRACT FROM PUBLISHER]

Purpose: In a pilot randomized controlled trial, we investigated the effectiveness of a 12-weekly anxiety treatment programme adapted for individuals with moderate-severe TBI, based on cognitive behaviour therapy (CBT) and Motivational Interviewing (MI). The current study explored the variables associated with treatment response and group differences in change expectancy and working alliance. Methods: Twenty-seven participants recruited from a brain injury rehabilitation hospital were randomly assigned to MI ++ CBT, non-directive counselling (NDC) ++ CBT and treatment-as-usual and assessors were blinded to treatment conditions. Correlation and multiple regression were used to examine the association between reduction in anxiety ratings and a number of clinical, injury and cognitive variables. Random effects regression was used to examine group difference in changes in working alliance and expectancy. Results: There was a trend suggesting that greater injury severity may be predictive of poorer response to CBT and injury severity was significantly related to memory functioning. Participants receiving MI pre-treatment showed a greater increase in change expectancy at the end of CBT and at follow-up, but not at the end of MI. Conclusions: There is a need to further investigate the effectiveness of treatment for individuals with different injury severity and to explore the relationship between change expectancy and treatment outcome. [ABSTRACT FROM AUTHOR]

Background: CBT is a potentially effective treatment for anxiety disorders following TBI; however, empirical evidence has mainly come from clients with mild TBI. This paper describes a CBT-based anxiety treatment programme adapted for clients with more severe injuries. Two case studies are provided to illustrate the implementation of the programme, as a step toward larger scale testing of the programme's feasibility. Methods and procedures: A manualised adapted CBT treatment manual was used to deliver CBT in a standardised manner to two clients, one with severe and one with moderate TBI. Outcome was evaluated using a single-subject design with repeated measures of anxiety, mood and coping style at pre- and post-CBT. Results: The two clients demonstrated positive treatment response on either a measure of anxiety or a continuous measure of distress. Although neither demonstrated a clinically significant change according to the primary outcome measure (Hospital Anxiety and Depression Scale), they showed significant change in at least one corroborated measure of anxiety. Conclusions: This study suggests the potential utility of the adapted CBT programme for clients with moderate-severe TBI. Limitations of the single case studies were discussed, while noting how they would be addressed in a follow-up randomised controlled trial. [ABSTRACT FROM AUTHOR]

The role of semantics in reading aloud remains controversial. To explore this issue, the current study examined the impact of semantic loss on reading-aloud performance in 7 patients with semantic dementia. The results revealed a heterogenous pattern of reading difficulties. Of the patients, 2 selectively made errors on inconsistent words (i.e., surface dyslexia), 4 had a generalized reading deficit with increased errors on consistent words, inconsistent words, and nonwords, while the remaining patient had relatively intact reading-aloud accuracy. All patients had longer reading latencies on real words than controls. The relationship between the reading and semantic deficits in the patients was examined at the item-specific level. This suggested that reading-aloud errors were related to the semantic impairment for inconsistent words but not consistent words. In contrast, semantic loss was related to longer latencies for both consistent and inconsistent words. These findings support models of reading that include a role for semantics in the reading-aloud process. [ABSTRACT FROM AUTHOR]

An influential theory of dyslexia is based on the premise that individuals with the disorder have impaired sensitivity to rapidly changing stimuli in the visual and auditory modalities, due to a dysfunction in the magnocellular channel of the visual system and its analogue in the auditory pathway. The deficit in the auditory system is thought to cause difficulties in the segmentation of speech and the formation of accurate phonological representations, leading to problems in making the grapheme–phoneme correspondences necessary for reading. In a sample of 13 adults with a history of severe reading difficulty and 18 controls, visual contrast thresholds were measured in response to an 8-Hz flickering Gaussian blob as well as a slowly modulated 8 cycles/deg Gaussian windowed grating. Auditory thresholds were measured in response to a 4-s burst of white noise, the 2nd or 3rd second of which was amplitude modulated at 100 Hz or 1 Hz. The adult reading difficulty group exhibited normal thresholds to rapidly changing stimuli in both modalities and to the slowly modulated visual stimulus, but some showed reduced sensitivity to the 1-Hz amplitude-modulated auditory stimulus. Sensitivity to amplitude modulation at slower rates has been shown to be important for segmentation of the speech stream and so may be implicated in the reading difficulty of the affected individuals. A magnocellular deficit cannot explain this impaired sensitivity, which may be the result of a reduced echoic memory span. [ABSTRACT FROM AUTHOR]