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Social participation (SP) is one of many objectives in the rehabilitation of patients with traumatic brain injury (TBI). Studies on predictors of SP specific to post-acute universally accessible specialized rehabilitation pathways following TBI are scarce. Our objectives were to: 1) characterize SP, as well as a set of pre-injury, injury-related, and post-injury variables in individuals participating in inpatient-outpatient or outpatient rehabilitation pathways within a universally accessible and organized trauma continuum of care; and 2) examine the ability of pre-injury, injury-related, and post-injury variables in predicting SP outcome after TBI according to rehabilitation path. Participants (

IntroductionStroke is a leading cause of morbidity and mortality worldwide, placing an immense burden on patients and the health system. Timely access to rehabilitation services can improve stroke survivors’ quality of life. The use of standardised outcome measures is endorsed for optimising patient rehabilitation outcomes and improving clinical decision-making. This project results from a provincially mandated recommendation to use the fourth version of the Mayo-Portland Adaptability Inventory (MPAI-4) to measure changes in social participation of stroke survivors and to maintain commitment to evidence-informed practices in stroke care. This protocol outlines the implementation process of the MPAI-4 for three rehabilitation centres. The objectives are to: (a) describe the context of MPAI-4 implementation; (b) determine clinical teams’ readiness for change; (c) identify barriers and enablers to implementing the MPAI-4 and match the implementation strategies; (d) evaluate the MPAI-4 implementation outcomes including the degree of integration of the MPAI-4 into clinical practice and (e) explore participants’ experiences using the MPAI-4.Methods and analysisWe will use a multiple case study design within an integrated knowledge translation (iKT) approach with active engagement from key informants. Each case is a rehabilitation centre implementing MPAI-4. We will collect data from clinicians and programme managers using mixed methods guided by several theoretical frameworks. Data sources include surveys, focus groups and patient charts. We will conduct descriptive, correlational and content analyses. Ultimately, we will analyse, integrate data from qualitative and quantitative components and report them within and across participating sites. Results will provide insights about iKT within stroke rehabilitation settings that could be applied to future research projects.Ethics and disseminationThe project received Institutional Review Board approval from the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal. We will disseminate results in peer-reviewed publications and at local, national and international scientific conferences.

ObjectiveTo validate the factor structure and establish internal consistency reliability of the French-Canadian version of the Mayo-Portland Adaptability Inventory (MPAI-4), using a Canadian sample of adults with traumatic brain injury (TBI) receiving post-acute rehabilitation services.DesignPsychometric analysis of prospectively collected French-Canadian MPAI-4 data.SettingInpatient and outpatient TBI rehabilitation programs.ParticipantsAdults (N = 1012) with a mild, moderate or severe TBI who received inpatient or outpatient rehabilitation interventions and for whom a first French-Canadian MPAI-4 measure was completed between 2016 and 2020.InterventionsNot applicable.Main Outcome MeasureFrench-Canadian MPAI-4 questionnaire.ResultsTo evaluate the factor structure of the French-Canadian MPAI-4, an exploratory factor analysis using a varimax rotation method was conducted on z-scores for all items. The final and best solution was a three-factor solution, which accounted for 48.68% of the variance. The internal consistency of the French-Canadian MPAI-4 was determined using Cronbach’s alpha and all three subscales showed good internal consistency (all .70 ≤ α ≤ .89). Reference norms for the TBI sample are provided in the form of T scores for subscales and total score, as well as descriptive raw data according to sex, age, TBI severity and rehabilitation setting.ConclusionsThe three factors extracted using data from the French-Canadian MPAI-4 are similar, but not entirely identical to the three subscales of the original MPAI-4. Overall, the French-Canadian MPAI-4 factor structure is validated. The questionnaire shows good psychometric properties and represents a suitable tool to measure functional evolution and social participation of TBI adults receiving rehabilitation services in a French-Canadian context. The provided reference norms will also help guide the clinical use of the MPAI-4 in French-Canadian TBI populations.

ObjectivesThis study evaluated the impact of a multimodal cognitive rehabilitation intervention, the Cognitive Enrichment Program (CEP), on executive functioning (EF) and resumption of daily activities following traumatic brain injury (TBI) in older individuals, in comparison to an active control group having received holistic rehabilitation as usual care.MethodsThe CEP’sexecutive function module included planning, problem solving, and goal management training, as well as strategies focusing on self-awareness. Effectiveness was evaluated by psychometric tests (Modified Six Elements Task-adapted – MSET-A, D-KEFSSorting testandStroop four-color version), while generalization was measured through self-reported questionnaires about daily functioning (Dysexecutive Functioning Questionnaire – DEX,Forsaken daily life activities). Measures were obtained before and after intervention, and six months later.ResultsANCOVA results showed significant group-by-time interactions onTackling the 6 subtasksandAvoiding rule-breakingmeasures of the MSET-A, with moderate effect sizes. Despite improvements in Sorting and Stroop scores, there were no group-by-time interaction on these measures. DEX generalization measure showed a significant reduction in patient/significant other difference on theExecutive Cognitionsubscale. There was a reduction in the number ofForsaken daily life activitiesin the experimental group compared to controls which was not significant immediately after CEP, but that was significant six months later.ConclusionsOur study shows that older adults with TBI can improve their executive functioning with a positive impact on everyday activities after receiving multimodal cognitive training compared to an active control group.

ObjectivesThis study aimed to evaluate the impact of a multimodal cognitive intervention, the Cognitive Enrichment Program (CEP), on episodic memory in traumatic brain injured (TBI) older adults, as compared to an active control group that received usual care in the form of holistic rehabilitation.MethodsThe CEP’s Memory module consisted in memory strategies to promote encoding. Effectiveness was evaluated by psychometric tests (Face-name association, Word list recall, Text memory), while generalization was measured through self-reported questionnaires about daily memory functioning (Self-Evaluation Memory Questionnaire) and psychological well-being (Psychological General Well-Being Index). Measures were obtained before and after intervention, and six months later.ResultsBoth groups showed improvement on most measures, but the experimental group showed greater statistically significant improvement. ANCOVA mixed model repeated measures analysis showed a strong group-by-time interaction for theFace-name associationtest, with a large effect size. A significant group-by-time interaction was obtained on three generalization self-report measures, including increased memorization of the content ofConversations, reducedSlips of attention, and increased memory ofPolitical & social Events, with moderate to large effect sizes. Clinically significant improvements were found forPsychological well-beingin the experimental group, where 50% of participants improved to the well-being category and remained stable six months later (9/17; 53%). Also, the number of experimental participants showing severe distress before CEP training (9) was reduced after intervention (5) and remained relatively stable at 6 months.ConclusionsThe CEP is a promising cognitive rehabilitation program that showed high satisfaction in participants and that can not only improve episodic memory in terms of psychometric scores, but also in daily life situations, as well as enhance psychological well-being in older individuals having sustained a TBI.

BackgroundIn wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity—typically linked to this mode of mobility—contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects.ObjectiveThis study’s overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton–assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device.MethodsA total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton–assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users’ satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures.ResultsThis study is currently underway with active recruitment in Montréal, Québec, Canada. Results are expected in the spring of 2021.ConclusionsThe results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton–assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury.Trial RegistrationClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752International Registered Report Identifier (IRRID)DERR1-10.2196/19251

BACKGROUND In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity—typically linked to this mode of mobility—contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. OBJECTIVE This study’s overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton–assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. METHODS A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton–assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users’ satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. RESULTS This study is currently underway with active recruitment in Montréal, Québec, Canada. Results are expected in the spring of 2021. CONCLUSIONS The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton–assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury. CLINICALTRIAL ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19251

Objectives This study evaluated the impact of a 12-week, 24-session multimodal group cognitive rehabilitation intervention, the Cognitive Enrichment Program (CEP), on executive functioning and resumption of daily activities after traumatic brain injury (TBI) in older individuals as compared with an active control group that received individual holistic rehabilitation as usual care. Methods In total, 37 patients with a TBI and aged 57 to 90 years were assigned to experimental (n = 23) and control (n = 14) groups in a semi-randomized, controlled, before–after intervention trial with follow-up at 6 months, with blinded outcome measurement. The CEP's executive function module included planning, problem solving, and goal management training as well as strategies focusing on self-awareness. Efficacy was evaluated by neuropsychological tests (Six Elements Task-Adapted [SET-A], D-KEFS Sorting test and Stroop four-color version); generalization was measured by self-reporting questionnaires about daily functioning (Dysexecutive Functioning Questionnaire, forsaken daily activities). Results ANCOVA results showed significant group-by-time interactions; the experimental group showed a statistically significant improvement on Tackling the 6 subtasks and Avoiding rule-breaking measures of the SET-A, with medium effect sizes. The generalization measure, the Dysexecutive Functioning Questionnaire, showed a significant reduction in experimental patient–significant other difference on the Executive cognition subscale. The number of forsaken daily activities was reduced in the experimental versus control group, which was not significant immediately after the CEP but was significant 6 months later. Conclusions Our study shows that older adults with TBI can improve their executive functioning, with a positive impact on everyday activities, after receiving multimodal cognitive training with the CEP. ClinicalTrials.gov Identifier: NCT04590911.

INTRODUCTION Clinicians need to understand the heterogeneity of sexual problems following traumatic brain injury (TBI) for their adequate identification and treatment. OBJECTIVE To systematically identify groups of individuals with TBI showing similar patterns of sexual functioning. METHODS Forty-two individuals with TBI with a mean age of 37.9 years (SD = 9.7) and an average of 3.3 years post-injury (SD = 4.3). We included four primary measures in the cluster analysis (sexual quality of life questionnaire, sexual desire inventory, generalized anxiety disorder scale, and the patient health questionnaire for depression) and two secondary measures for cluster validation (post-concussion symptom scale and dysexecutive questionnaire). RESULTS A hierarchical cluster analysis using the Ward method revealed the existence of two groups of individuals with TBI: a) with sexual problems who were older, showed lower levels of sexual quality of life and sexual desire, with significant symptoms of anxiety and depression, and b) without sexual problems who were younger, showed high levels of sexual quality of life and sexual desire, as well as low complaints of anxiety and depression. CONCLUSIONS Clinicians must be more proactive in assessing sexual concerns, mostly when emotional and cognitive difficulties are present in older individuals with TBI, regardless of gender, chronicity and injury severity.

Evidence-based neurorehabilitation must be informed by the values, expectations, and goals of individuals with acquired brain injury (ABI). The Client’s Intervention Priorities (CIP)© is a person-centered tool for defining rehabilitation priorities according to self-perceived functioning. The use of the CIP tool is encouraged to promote self-determination and optimal involvement of individuals with ABI in interdisciplinary neurorehabilitation. The objective of this study was to determine the reliability (internal consistency, temporal stability) and content validity (expert agreement) of the CIP tool. Thirty individuals with ABI (66.7% with traumatic brain injury, 33.3% with stroke) with a mean age of 44.8 (SD = 12.6) years were administered the CIP twice at a test-retest interval of 2.3 (SD = 0.7) weeks. An expert panel of 17 neurorehabilitation clinicians and researchers participated in the validation. The CIP tool showed excellent (total score α = .90) and good (CIP subscales α = .83-.87) internal consistencies, with excellent temporal stability (intraclass correlation coefficients = .78-.90). Experts agreed that the CIP items reflect the Disability Creation Process model (89.4% scored as having high to very high correspondence) and were comprehensibly stated (98% rated as clear to absolutely clear). The CIP is a valid and reliable self-assessment tool to assist professionals and their clients in developing and prioritizing rehabilitation goals.

Little is known about the long-term consequences of traumatic brain injury (TBI) regarding risky sexual behaviour. The objectives of the study were (1) to compare risky sexual behaviour in a sample of individuals with TBI having received interdisciplinary rehabilitation with that of healthy controls, and (2) to explore the relationships between risky sexual behaviour, executive functions, and mental health in individuals with TBI. The study group consisted of 42 individuals with TBI with a mean age of 37.9 years (SD = 9.7), 12.8 years of education (SD = 3.3), and 3.3 years post-injury (SD = 4.3). Healthy controls consisted of 47 participants, with a mean age of 37.6 years (SD = 10.7), and 13 years of education (SD = 3). Risky sexual behaviour was measured with the Sexual Risk Survey and executive function with the Dysexecutive Questionnaire. Mental health measures included the Generalised Anxiety Disorder Scale, and the Patient Health Questionnaire for depression. Compared to healthy controls, individuals with TBI reported more dysexecutive and mental health problems, without differences in risky sexual behaviour. In individuals with TBI, risky sexual behaviour was associated with behavioural, cognitive and emotional dysexecutive problems, but not with anxiety or depression. It was concluded that special attention should be given to individuals with TBI showing difficulties in executive functions given their association with risky sexual behaviour.

Sexual quality of life involves the impact of sexual dysfunction on general quality of life. Postconcussion symptoms are frequent after traumatic brain injury (TBI) but their relationship with sexual quality of life remains unexplored. The current study aimed to: (a) compare sexual quality of life in a sample of individuals with TBI and healthy controls; and (b) explore the relationship between sexual quality of life and postconcussion symptoms in individuals with TBI. Forty-one individuals with TBI and 41 healthy controls, comparable in age, gender, years of education, work and relationship status, and annual income. Sexual quality of life was assessed with the self-report Sexual Quality of Life Questionnaire, and postconcussion symptoms with the Post-concussion Symptom Scale. Compared to healthy controls, individuals with TBI showed significantly lower sexual quality of life. In individuals with TBI, diminished sexual quality of life was significantly associated with self-reported postconcussion symptoms; the affective factor of the Post-concussion Symptom Scale provided the most unique contribution to sexual quality of life. Affective postconcussion symptoms could partially explain the impact of TBI on sexual quality of life. Ongoing screening and treatment of postconcussion symptoms, in particular affective symptoms, may lead to a secondary remediation/prevention of sexual difficulties in individuals with TBI.

OBJECTIVE: To explore the experiences, attitudes, and needs related to service delivery regarding sexuality issues in individuals with traumatic brain injury (TBI). METHODS: Community-dwelling individuals with TBI having completed a post-acute TBI rehabilitation program. The TBI sample consisted of 16 men (42.1%) and 22 women (57.9%), with an average age of 38.9 years (SD = 9.9) and 12.8 years of education (SD = 2.8). They were on average 2.6 years post-injury (SD = 1.4). Glasgow coma scale at admission was on average 12.6 (SD = 3.5). Participants completed a questionnaire adapted to individuals with TBI addressing experiences, attitudes, and needs regarding sexuality and service delivery. RESULTS: Individuals with TBI reported a low frequency of specific discussions with their treating clinician(s) about sexual and reproductive health issues, as well as many unmet needs regarding sexuality. None of the participants considered discussion about these issues to be inappropriate. They reported more favourable attitudes towards discussing sexual health topics compared to actual service delivery with family physicians, general practitioners, psychologists, and other health care professionals (p’s < 0.05). CONCLUSIONS: Individuals with TBI desired more openness about discussing sexual concerns. Findings are discussed in terms of the clinical implications to meet the individuals’ needs regarding sexual concerns after TBI.

To date, very little is known about the normal development trajectory of visual texture segregation, or how it is affected by preterm birth. The goal of this study was to characterize the development of visual texture segregation using texture segregation visual evoked potentials (tsVEPs) in children born full-term and children born preterm without major neurological impairment. Forty-five full-term and 43 preterm children were tested at either 12, 24 or 36 months of age (corrected age for prematurity at 12 and 24 months old). VEPs were obtained using two lower-level stimuli defined by orientation (oriVEP) and two higher-level stimuli defined by texture (texVEP). TsVEP was obtained by dividing by two the subtraction of oriVEP from texVEP. Results show a clear maturation of the processes underlying visual texture segregation in the full-term group, with a significant N2 latency reduction between 12 and 36 months of age for all conditions. Significant N2 amplitude reduction was observed for oriVEP between 12 and 24 months, as well as for texVEP between 12 and 24 months, and 12 and 36 months. Comparison between full-term and preterm children indicated significantly lower N2 amplitude for the preterm group at 12 months for oriVEP and texVEP. These differences were no longer apparent at 24 months of age, suggesting that children born preterm catch up with their full-term counterparts somewhere between 12 and 24 months of age. Our results appear to reflect a maturational delay in preterm children in both lower-level and higher-level visual processing during, at least, early childhood.

To assess emotion recognition from dynamic facial, vocal and musical expressions in sub-groups of adults with traumatic brain injuries (TBI) of different severities and identify possible common underlying mechanisms across domains.Forty-one adults participated in this study: 10 with moderate-severe TBI, nine with complicated mild TBI, 11 with uncomplicated mild TBI and 11 healthy controls, who were administered experimental (emotional recognition, valence-arousal) and control tasks (emotional and structural discrimination) for each domain.Recognition of fearful faces was significantly impaired in moderate-severe and in complicated mild TBI sub-groups, as compared to those with uncomplicated mild TBI and controls. Effect sizes were medium-large. Participants with lower GCS scores performed more poorly when recognizing fearful dynamic facial expressions. Emotion recognition from auditory domains was preserved following TBI, irrespective of severity. All groups performed equally on control tasks, indicating no perceptual disorders. Although emotional recognition from vocal and musical expressions was preserved, no correlation was found across auditory domains.This preliminary study may contribute to improving comprehension of emotional recognition following TBI. Future studies of larger samples could usefully include measures of functional impacts of recognition deficits for fearful facial expressions. These could help refine interventions for emotional recognition following a brain injury.

The aim of this semilongitudinal study was to investigate the development of central visual pathways in children born preterm but without major neurologic impairments and to establish their cognitive and behavioral profile at school age. Ten children born preterm were assessed at 6 months and at school age, using visual evoked potentials at both time points and cognitive and behavioral tests at school age. We also tested 10 age-matched children born full-term. At 6 months’ corrected age, we found no significant differences between preterm and full-term groups for either amplitude or latency of N1 and P1 components. At school age, the preterm group manifested significantly higher N1 amplitudes and tended to show higher P1 amplitudes than the full-term group. We found no significant differences in cognitive and behavioral measures at school age. These results suggest that preterm birth affects visual pathways development, yet the children born preterm did not manifest cognitive problems.

Objective: Attentional problems are amongst the most commonly reported complaints following mild traumatic brain injury (mTBI), including difficulties orienting and disengaging attention, sustaining it over time, and dividing attentional resources across multiple simultaneous demands. The objective of this study was to track, using a single novel electrophysiological task, various components associated with the deployment of visuospatial selective attention. Methods: A paradigm was designed to evoke earlier visual evoked potentials (VEPs), as well as attention-related and visuocognitive ERPs. Data from 36 individuals with mTBI (19 subacute, 17 chronic) and 22 uninjured controls are presented. Postconcussion symptoms (PCS), anxiety (BAI), depression (BDI-II) and visual attention (TEA Map Search, DKEFS Trail Making Test) were also assessed. Results: Earlier VEPs (P1, N1), as well as processes related to visuospatial orientation (N2pc) and encoding in visual short-term memory (SPCN), appear comparable in mTBI and control participants. However, there appears to be a disruption in the spatiotemporal dynamics of attention (N2pc-Ptc, P2) in subacute mTBI, which recovers within six months. This is also reflected in altered neuropsychological performance (information processing speed, attentional shifting). Furthermore, orientation of attention (P3a) and working memory processes (P3b) are also affected and remain as such in the chronic post-mTBI period, in co-occurrence with persisting postconcussion symptomatology. Conclusions: This study adds original findings indicating that such a sensitive and rigorous ERP task implemented at diagnostic and follow-up levels could allow for the identification of subtle but complex brain activation and connectivity deficits that can occur following mTBI.

During child development, physiological changes occur in the auditory cortex, which are reflected by differences in the electrophysiological signals. This study aimed to examine the age-related changes of the Mismatch Negativity component (MMN) in response to speech and non-speech stimuli in a cross-sectional design. Results revealed distinct patterns of activation according to stimulus type and age. Age-related differences for tone discrimination occurred earlier in children's development than did the discriminative process for speech sounds. Therefore, networks involved in speech processing are still immature in late childhood and may be more vulnerable to physiological changes.

Brain injury can directly and indirectly affect important aspects related to sexuality and sexual function. In this critical review of the literature, traumatic brain injury (TBI) and sexuality are examined. A general review of the concept of sexuality and the neurological correlates of sexual function are proposed as a framework to understand the cognitive, behavioral and physical effects of TBI on sexuality and sexual function. Studies are then classified according to the participants enrolled and findings are presented from the professional's, the survivor's, the patient/partner's, and the non-injured spouse's perspectives. Results are discussed taking into account methodological limitations and knowledge gaps. Next, implications for sexual rehabilitation for individuals with TBI are discussed. Finally, suggestions for future research and their pertinence for improving rehabilitation outcomes are considered.

Over the last two decades, the hypothesis of a magnocellular deficit in dyslexia has raised considerable interest and controversy. Using an electrophysiological procedure (visual evoked potentials, VEP), we compared magnocellular and parvocellular contrast and spatial frequency-response functions between phonological dyslexics (n = 16) and a typical reading group (n = 12) matched for age and socioeconomic background. No significant differences were found between the two groups in the amplitude of the VEP components associated with either magnocellular or parvocellular responses. However, topographic analyses revealed a group difference in the distribution of amplitude in the right frontal and left temporal regions, which appeared to be underactivated in dyslexics. These results suggest a deficit in the higher-level cortical regions involved in phonological and/or linguistic processing, and calls into question the notion of a magnocellular involvement in dyslexia.

Cet article de synthese a pour objectif de faire etat des connaissances actuelles sur l’impact de la douleur chronique (DC) sur le fonctionnement cognitif/neuropsychologique, en portant une attention particuliere aux facteurs psychologiques concomitants. Une premiere section de l’article discute du fonctionnement neuropsychologique de patients presentant de la DC sans etiologie particuliere, tandis qu’une deuxieme section porte sur le fonctionnement neuropsychologique de patients souffrant de fibromyalgie. Les etudes existantes permettent d’identifier des deficits de l’attention, de la memoire et des fonctions executives dans les deux groupes. Les resultats suggerent que les deficits de l’attention sont particulierement associes a la douleur d’intensite elevee. Les symptomes d’anxiete et de depression, la propension a la catastrophisation et l’autoperception hypervigilante s’associent aux difficultes cognitives chez les douloureux chroniques, sans toutefois que leur presence soit necessaire pour qu’il y ait impact sur la cognition. Les recherches nous fournissent des preuves que l’association entre la douleur d’intensite elevee, certains facteurs psychologiques/emotifs et les troubles de la cognition identifies pourrait etre liee aux changements neuropathologiques qui s’operent chez les douloureux chroniques. Les implications pour l’evaluation neuropsychologique sont discutees.

Cet article présente la façon dont l’outil interdisciplinaire Priorités d’intervention du client (PIC) fait appel à la résilience et à l’autodétermination soutenant le client dans le choix de ses objectifs d’intervention. Le PIC a été développé en contexte de réadaptation pour des personnes ayant un traumatisme craniocérébral. Il s’agit toutefois d’un outil interdisciplinaire, non spécifique à une discipline, à une clientèle ou à un contexte clinique, qui permet à diverses clientèles de cibler leurs priorités d’intervention ainsi que leurs forces, favorisant ainsi l’actualisation de leurs capacités d’adaptation et de résilience., This article discusses how the interdisciplinary tool Client’s Intervention Priorities (CIP) enhances resiliency and self-determination supporting the client in the choice of his own goals of intervention. CIP has been developed in the context of rehabilitation for people with traumatic brain injury. It is however an interdisciplinary tool, it is not specific to any specialty, clientele or clinical context, which allows different clienteles to target priorities as well as their strengths, promoting their capacity of adaptation and resilience.

Introduction/Background Of major importance for the social participation of adults with traumatic brain injury (TBI) is the possibility to drive. Return to safe driving is usually addressed during rehabilitation, but we know little about driving abilities and behaviours in the years following TBI. The aim of this study was to evaluate if individuals with a TBI having passed a driving evaluation differed, in terms of self-reported driving behaviours and documented driving offences, from those who did not undergo a driving evaluation, and from normal controls. Material and method A total of 162 adults aged 18–60 years old participated in this study: 48 with mild/moderate/severe TBI whose license was suspended after injury and reinstated following a driving evaluation during outpatient rehabilitation (TBI-DE) and 24 with TBI who maintained their driving privileges without undergoing a driving evaluation (TBI-NE), recruited from 6 rehabilitation centers, 2–3 years after rehabilitation; 90 normal control participants paired for age, sex and geographical region, recruited from the general population. Self-reported driving abilities and habits, driving anger expression, driving sensation seeking, breach of rules of driving, and driving accidents and offences were measured during a telephone interview. Objective driving offences were obtained from the Quebec Automobile Insurance Board with participants’ consent. Results The TBI-DE group included significantly more individuals with moderate and severe TBI than the TBI-NE group, and reported significantly lower scores for verbal expression of anger and use of vehicle to express anger compared to controls. However, the TBI-DE group presented significantly more objective driving offences before their TBI and more demerit points after their TBI than the control group. Also, a significantly higher frequency of serious accidents was documented in the TBI-DE group compared to other groups. Conclusion Self-perceived risky driving behaviours may be underestimated by some individuals with TBI and should be specifically addressed during and after rehabilitation.

The goal of the present study was to assess the impact of mild traumatic brain injury (MTBI) on episodic memory performance in relation to attentional and executive control processes in young adults.A verbal memory paradigm manipulating attentional load (full attention or divided attention) and semantic congruency between pairs of category-target words during encoding was administrated to 13 individuals with MTBI and 12 normal control participants. Environmental supports during retrieval (free recall, cued recall and recognition modes) were also manipulated.Results show that recall performances of individuals with MTBI were similar to those of controls when words were encoded under full attention. In contrast, individuals with MTBI performed worse than control participants when encoding under divided attention, whatever the semantic link between pairs of words.By using a sensitive test, one was able to objectively measure subtle impairments in memory performance, suggesting a diminished availability of attentional resources after MTBI. Young adults' learning of verbal material under divided attention might be compromised by the reduction of cognitive resources following MTBI. These findings are also discussed in light of different factors that can influence cognitive performance.

Mild traumatic brain injury (mTBI) has subtle effects on several brain functions that can be difficult to assess and follow up. We investigated the impact of mTBI on the perception of sine-wave gratings defined by first- and second-order characteristics. Fifteen adults diagnosed with mTBI were assessed at 15 days, 3 months, and 12 months postinjury. Fifteen matched controls followed the same testing schedule. Reaction times (RTs) for flicker detection and motion direction discrimination were measured. Stimulus contrast of first- and second-order patterns was equated to control for visibility, and correct-response RT means, standard deviations (SDs), medians, and interquartile ranges (IQRs) were calculated. The level of symptoms was also evaluated to compare it to RT data. In general in mTBI, RTs were longer, and SDs as well as IQRs larger, than those of controls. In addition, mTBI participants' RTs to first-order stimuli were shorter than those to second-order stimuli, and SDs as well as IQRs larger for first- than for second-order stimuli in the motion condition. All these observations were made over the three sessions. The level of symptoms observed in mTBI was higher than that of control participants, and this difference did also persist up to 1 year after the brain injury, despite an improvement. The combination of RT measures with particular stimulus properties is a highly sensitive method for measuring mTBI-induced visuomotor anomalies and provides a fine probe of the underlying mechanisms when the brain is exposed to mild trauma.

Because nervous system development may be affected by prematurity, many prematurely born children present language or cognitive disorders at school age. The goal of this study is to investigate whether these impairments can be identified early in life using electrophysiological auditory event-related potentials (AERPs) and mismatch negativity (MMN). Brain responses to speech and non-speech stimuli were assessed in prematurely born children to identify early electrophysiological markers of language and cognitive impairments. Participants were 74 children (41 full-term, 33 preterm) aged 3, 12, and 36 months. Pre-attentional auditory responses (MMN and AERPs) were assessed using an oddball paradigm, with speech and non-speech stimuli presented in counterbalanced order between participants. Language and cognitive development were assessed using the Bayley Scale of Infant Development, Third Edition (BSID-III). Results show that preterms as young as 3 months old had delayed MMN response to speech stimuli compared to full-terms. A significant negative correlation was also found between MMN latency to speech sounds and the BSID-III expressive language subscale. However, no significant differences between full-terms and preterms were found for the MMN to non-speech stimuli, suggesting preserved pre-attentional auditory discrimination abilities in these children. Identification of early electrophysiological markers for delayed language development could facilitate timely interventions.

Objective. To explore differences according to sex in sociosexuality and infidelity in individuals with TBI and in healthy controls.Participants. Forty-two individuals with mild, moderate, and severe TBI having completed a postacute TBI rehabilitation program, at least six months after injury, and 47 healthy controls.Main Measures. Sociosexual Orientation Inventory-Revised (SOI-R) and Attitudes toward Infidelity Scale.Results. Overall, men score significantly higher than women in sociosexuality. However, there was a nonsignificant trend towards a reduction of sociosexuality levels in men with TBI. Infidelity levels were comparable in healthy controls and individuals with TBI. In individuals with TBI, less acceptance of infidelity was significantly associated with an unrestricted sociosexual orientation, but not in healthy controls.Conclusions. As documented in previous cross-cultural studies, men have higher levels of sociosexuality than women. However, men with TBI showed a tendency towards the reduction of sociosexuality. The possibility of a latent explanatory variable is suggested (e.g., post-TBI neuroendocrinological changes). TBI does not seem to have an impact on infidelity, but individuals with TBI who express less acceptance of infidelity also report a more promiscuous mating strategy regarding their behavior, attitudes, and desire. Theoretical implications are discussed in terms of evolutionary theories of human sexuality and neuropsychology.

Visual evoked potentials (VEPs) were recorded to textures segregated by gradients in orientation or motion. Recordings were obtained in traumatic brain-injured (TBI) subjects and in normal controls. We analyzed both the low-level VEPs (llVEPs) evoked by homogenous stimuli, as well as the components associated with texture segregation (tsVEP) obtained through an appropriate linear combination. Our results suggest that the tsVEP, presumably higher up in the visual processing chain than the llVEP, is sensitive to TBI and can reveal further information as to the nature of possible information processing deficits after TBI. It could also help quantify cortical damage that is not revealed with more standard clinical tools.

To date, very little is known about the normal development trajectory of visual texture segregation, or how it is affected by preterm birth. The goal of this study was to characterize the development of visual texture segregation using texture segregation visual evoked potentials (tsVEPs) in children born full-term and children born preterm without major neurological impairment. Forty-five full-term and 43 preterm children were tested at either 12, 24 or 36 months of age (corrected age for prematurity at 12 and 24 months old). VEPs were obtained using two lower-level stimuli defined by orientation (oriVEP) and two higher-level stimuli defined by texture (texVEP). TsVEP was obtained by dividing by two the subtraction of oriVEP from texVEP. Results show a clear maturation of the processes underlying visual texture segregation in the full-term group, with a significant N2 latency reduction between 12 and 36 months of age for all conditions. Significant N2 amplitude reduction was observed for oriVEP between 12 and 24 months, as well as for texVEP between 12 and 24 months, and 12 and 36 months. Comparison between full-term and preterm children indicated significantly lower N2 amplitude for the preterm group at 12 months for oriVEP and texVEP. These differences were no longer apparent at 24 months of age, suggesting that children born preterm catch up with their full-term counterparts somewhere between 12 and 24 months of age. Our results appear to reflect a maturational delay in preterm children in both lower-level and higher-level visual processing during, at least, early childhood.

PURPOSE With the use of the pattern reversal visual evoked potential and the motor reaction time, we sought to differentiate anisometropic amblyopia from strabismic amblyopia on the basis of the visual transmission time. METHODS Pattern reversal visual evoked potentials and motor reaction times were obtained in nine normal subjects, eight anisometropic and seven strabismic amblyopes. RESULTS Our results show that while the peak time of the pattern visual evoked potential in anisometropic amblyopia and strabismic amblyopia was significantly delayed, it could not distinguish the two types of amblyopia. In contrast, a significantly longer interocular increment in strabismics compared to anisometropes was found with the reaction time, but not with the pattern visual evoked potential. CONCLUSION Our findings thus show that it is possible to distinguish strabismic from anisometropic amblyopes using interocular differences in reaction time measurements. Our results bring support to the contention that the two types of amblyopia represent different neural abnormalities.

We report on a family where four of the eleven children presented with reduced visual acuities, a red-green deficit at the Farnsworth-Munsel FM 100-hue test, normal appearing fundi and unexpected electroretinographic findings. Light- (photopic) and dark- (scotopic) adapted electroretinograms (ERG) and oscillatory potentials (OPs) were obtained following an accepted standard protocol. The b-wave of their photopic ERG was significantly more attenuated than the a-wave due to the specific abolition of OP4, while the amplitudes of OP2 and OP3 were within the normal range, giving to the b-wave a truncated appearance reminiscent of that seen in congenital stationary night blindness (CSNB) with myopia. Interestingly in the latter condition, which is believed to result from an ON-retinal pathway anomaly, it is OP2 and OP3 which are specifically abolished while OP4 is of normal amplitude thus resulting in an OP response pattern which complements that seen with our patients. Also of interest is the fact that, in our patients, the amplitude of the dark-adapted OP2 was, on average, 240% larger than that measured in light-adaptation while, in normal, a non-significant 14% increase is noted; a finding which is in keeping with other studies reporting supernormal scotopic ERGs in some forms of cone dystrophies. Based on the photopic OP response pattern, our patients represent the electrophysiological complement of patients affected with CSNB. Interestingly their symptoms are also complementary, a finding which could support a functional discrimination between the photopic OPs.

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Individuals who have sustained a mild brain injury (e.g., mild traumatic brain injury or mild cerebrovascular stroke) are at risk to show persistent cognitive symptoms (attention and memory) after the acute postinjury phase. Although studies have shown that those patients perform normally on neuropsychological tests, cognitive symptoms remain present, and there is a need for more precise diagnostic tools. The aim of this study was to develop precise and sensitive markers for the diagnosis of post brain injury deficits in visual and attentional functions which could be easily translated in a clinical setting. Using electrophysiology, we have developed a task that allows the tracking of the processes involved in the deployment of visual spatial attention from early stages of visual treatment (N1, P1, N2, and P2) to higher levels of cognitive processing (no-go N2, P3a, P3b, N2pc, SPCN). This study presents a description of this protocol and its validation in 19 normal participants. Results indicated the statistically significant presence of all ERPs aimed to be elicited by this novel task. This task could allow clinicians to track the recovery of the mechanisms involved in the deployment of visual-attentional processing, contributing to better diagnosis and treatment management for persons who suffer a brain injury.