"Anxiety as a primary predictor of functional impairment after acquired brain injury: A brief report"Bertisch, Hilary C; Long, Coralynn; Langenbahn, Donna M; Rath, Joseph F; DILLER, LEONARD; Ashman, Teresa
GRANTS:R01-HD32943/HD/NICHD NIH HHS/United States
Objective: Cognitive and emotional symptoms are primary causes of long-term functional impairment after acquired brain injury (ABI). Although the occurrence of post-ABI emotional difficulties is well-documented, most investigators have focused on the impact of depression on functioning after ABI, with few examining the role of anxiety. Knowledge of the latter's impact is essential for optimal treatment planning in neurorehabilitation settings. The purpose of the present study is therefore to examine the predictive relationships between cognition, anxiety, and functional impairment in an ABI sample. Method: Multiple regression analyses were conducted with a sample of 54 outpatients with ABI. Predictors selected from an archival data set included standardized neuropsychological measures and Beck Anxiety Inventory scores. Dependent variables were caregiver ratings of functional impairments in the Affective/Behavioral, Cognitive, and Physical/Dependency domains. Results: Anxiety predicted a significant proportion of the variance in caregiver-assessed real-life affective/behavioral and cognitive functioning. In contrast, objective neuropsychological test scores did not contribute to the variance in functional impairment. Neither anxiety nor neuropsychological test scores significantly predicted impairment in everyday physical/dependency function. Conclusion: These findings support the role of anxiety in influencing functional outcome post-ABI and suggest the necessity of addressing symptoms of anxiety as an essential component of treatment in outpatient neurorehabilitation. (PsycINFO Database Record (c) 2013 APA, all rights reserved)..
"Group treatment in acquired brain injury rehabilitation"Bertisch, Hilary; Rath, Joseph F; Langenbahn, Donna M; Sherr, Rose Lynn; DILLER, LEONARD
The current article describes critical issues in adapting traditional group-treatment methods for working with individuals with reduced cognitive capacity secondary to acquired brain injury. Using the classification system based on functional ability developed at the NYU Rusk Institute of Rehabilitation Medicine (RIRM), we delineate the cognitive and interpersonal capabilities that differentiate group-participation capacity. An overview of the RIRM interventional process, including strategies of change (cognitive remediation versus psychosocial groups), is provided. Empirical support for the RIRM method of group assignment and treatment outcomes for our model is also referenced. .
"Clinical applications of problem-solving research in neuropsychological rehabilitation: Addressing the subjective experience of cognitive deficits in outpatients with acquired brain injury"Rath, Joseph F; Hradil, Amy L; Litke, David R; DILLER, LEONARD
GRANTS:R01 HD32943/HD/NICHD NIH HHS/United States
Objective: The goal of this paper is to illustrate how the lessons learned in over 20 years of randomized clinical trials have advanced cognitive rehabilitation beyond traditional approaches to problem solving by more explicitly integrating subjective self-appraisal factors in routine clinical practice. Results: The concept of problem orientation, as proposed by cognitive-behavioral psychologists, provides a much-needed framework for conceptualizing interventions to address the impact of subjective experience on cognitive functioning, within the context of cognitive remediation. By explicitly focusing on the beliefs, assumptions, and expectations that individuals with acquired brain injury have about their own cognitive functioning, the concept of problem orientation allows rehabilitation psychologists to add an element to interventions, not systematically addressed in standard approaches to cognitive remediation. Targeting objective deficits in cognitive remediation is necessary, but not sufficient: For optimal benefit, remedial interventions must address objective cognitive deficits and the patient's subjective experience of such deficits in tandem. Conclusion: Contemporary evidence-based treatment recommendations now typically include incorporating interventions to address motivational, attitudinal, and affective factors in cognitive remediation. Further research is needed to directly compare the effectiveness of cognitive rehabilitative interventions that systematically address subjective factors with those that do not. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
"When you can't keep the goal in mind"DILLER, LEONARD
Reviews the book, The rehabilitation of executive disorders: A guide to theory and practice edited by Michael Oddy & Andrew Worthington (2009). The book is divided into three sections: theory, rehabilitation, and professional issues. The theoretical section, in turn, is divided into three chapters. The second section, containing more than half of the chapters, is devoted to rehabilitation. Evans presents an overview of executive dysfunctions with clinical examples and approaches to rehabilitation. Various relevant aspects of difficulties in executive dysfunction are presented in separate chapters. These chapters provide introductions to special areas followed by the way executive dysfunctions provoke challenges in treatment. The third and final section discusses three key professional issues. The individual chapters are well written. The topics are covered in enough depth to satisfy the general reader in clinical neuropsychology or rehabilitation psychology. The reviewer notes that the book will be useful for clinical neuropsychologists and rehabilitation psychologists. .
"Short-term DTI predictors of cognitive dysfunction in mild traumatic brain injury"Miles, Laura; Grossman, Robert I; Johnson, Glyn; Babb, James S; DILLER, LEONARD; Inglese, Matilde
GRANTS:M01 RR00096/RR/NCRR NIH HHS/United States;R01 NS051623/NS/NINDS NIH HHS/United States;R01 NS39135/NS/NINDS NIH HHS/United States
PRIMARY OBJECTIVE: To explore whether baseline diffusion tensor imaging (DTI) metrics are predictive of cognitive functioning 6 months post-injury in patients with mild traumatic brain injury (MTBI). RESEARCH DESIGN: Seventeen patients with MTBI and 29 sex- and age-matched healthy controls were studied. METHODS AND PROCEDURES: Participants underwent an MRI protocol including DTI, at an average of 4.0 (range: 1-10) days post-injury. Mean diffusivity (MD) and fractional anisotropy (FA) were measured in the following white matter (WM) regions: centra semiovale, the genu and the splenium of the corpus callosum and the posterior limb of the internal capsule. Participants underwent neuropsychological (NP) testing at baseline and at 6-month follow-up. Least squares regression analysis was used to evaluate the association of MD and FA with each NP test score at baseline and follow-up. MAIN OUTCOMES AND RESULTS: Compared to controls, average MD was significantly higher (p = 0.02) and average FA significantly lower (p = 0.0001) in MTBI patients. At the follow-up, there was a trend toward a significant association between baseline MD and response speed (r = -0.53, p = 0.087) and a positive correlation between baseline FA and Prioritization form B (r = 0.72, p = 0.003). CONCLUSIONS: DTI may provide short-term non-invasive predictive markers of cognitive functioning in patients with MTBI.
"Clinical significance of dilated Virchow-Robin spaces in mild traumatic brain injury"Inglese, Matilde; Grossman, Robert I; DILLER, LEONARD; Babb, James S; Gonen, Oded; Silver, Jonathan M A; Rusinek, Henry
GRANTS:M01 RR 00096/RR/NCRR NIH HHS/United States;NS 39135/NS/NINDS NIH HHS/United States
PRIMARY OBJECTIVE: To investigate the relationship between the number of dilated Virchow-Robin spaces (VRS) and neurocognitive findings in patients with traumatic brain injury (TBI). RESEARCH DESIGN: Thirty-eight patients with TBI and 21 controls were studied. METHODS AND PROCEDURES: Fifteen patients underwent MRI within a mean interval of 5.4 (range 1-12) days from the brain injury and 23 after an average period of 5.5 (range 0.2-31) years. All subjects were examined with a battery of 13 neuropsychological tests (NP). MAIN OUTCOMES AND RESULTS: The average number of VRS was significantly higher in patients than in controls. There were no significant differences between patients and controls in terms of NP tests. The number of VRS showed a significant inverse correlation with processing speed and a positive correlation with visual perceptual of attention only in patients studied within a short delay of trauma. CONCLUSIONS: VRS are not directly associated to neurocognitive findings, suggesting that they may represent a result of the shear-strain injury.
"History of Rehabilitation for Traumatic Brain Injury"Boake, Corwin; DILLER, LEONARD
(from the chapter) While the occurrence of traumatic brain injury (TBI) in some ancient myths implies that TBI was recognized before recorded history (Courville, 1967), the resulting high fatality rate made rehabilitation generally impossible until the twentieth century. As shown by Gurdjian's (1973) compilation of statistics of brain wounds suffered in wars, most penetrating brain wounds before the 1900s were fatal. For example, during the U.S. Civil War, the fatality rate from penetrating brain wounds was about 70%. When advances in neurotrauma care during World War I led to improved survival, rehabilitation of TBI victims became a possibility. This chapter examines this history of rehabilitation for traumatic brain injury, focusing particularly on the time periods between World War I and the present.
"Pushing the frames of reference in traumatic brain injury rehabilitation"DILLER, LEONARD
Cognitive rehabilitation is an empirically based field driven by multiple sources of activities and knowledge bases. Drawing on frames of reference provided by rehabilitation, neuropsychology, and rehabilitation psychology, cognitive rehabilitation has evolved to a point where studies have been generated to qualify for consideration in tables of evidence. At the center of cognitive rehabilitation is the effort to teach people to overcome or adapt to limitations. While rehabilitation has traditionally been focused on activity, a recent trend in the literature is to incorporate the individuals experience into a frame of reference for rehabilitation. Emphasizing the experience of the person in the situation fits into cognitive rehabilitation and raises the bar for rehabilitation not only in viewing rehabilitation as an activity to relieve burdens but also in terms of how rehabilitants come to grips with limitations. Dealing with limitations is an important indicator of mental health.
"Hemiplegia"DILLER, LEONARD; Moroz, Alex
The focus of this chapter is hemiplegia, specifically addressing functional limitations, psychological problems, treatment, and vocational rehabilitation. Outcome prediction and future research are also highlighted. .
"The construct of problem solving in higher level neuropsychological assessment and rehabilitation"Rath, Joseph F; Langenbahn, Donna M; Simon, Dvorah; Sherr, Rose Lynn; Fletcher, Jason; DILLER, LEONARD
GRANTS:R01-HD32943/HD/NICHD NIH HHS/United States
Three inter-related studies examine the construct of problem solving as it relates to the assessment of deficits in higher level outpatients with traumatic brain injury (TBI). Sixty-one persons with TBI and 58 uninjured participants completed measures of problem solving and conceptually related constructs, which included neuropsychological tests, self-report inventories, and roleplayed scenarios. In Study I, TBI and control groups performed with no significant differences on measures of memory, reasoning, and executive function, but medium to large between-group differences were found on timed attention tasks. The largest between-group differences were found on psychosocial and problem-solving self-report inventories. In Study II, significant-other (SO) ratings of patient functioning were consistent with patient self-report, and for both self-report and SO ratings of patient problem solving, there was a theoretically meaningful pattern of correlations with timed attention tasks. In Study III, a combination of self-report inventories that accurately distinguished between participants with and without TBI, even when cognitive tests scores were in the normal range, was determined. The findings reflect intrinsic differences in measurement approaches to the construct of problem solving and suggest the importance of using a multidimensional approach to assessment.
"Development and exploratory analysis of the Neurorehabilitation Program Styles Survey"McCorkel, Beth A; Glueckauf, Robert L; Ecklund-Johnson, Eric P; Tomusk, Allison B; Trexler, Lance E; DILLER, LEONARD
OBJECTIVE: To develop a survey instrument that assesses implementation of key components of outpatient neurorehabilitation programs and test the capacity of this instrument to differentiate between rehabilitation approaches. DESIGN: The Neurorehabilitation Program Styles Survey (NPSS) was administered to 18 outpatient facilities: 10 specialized and 8 discipline-specific outpatient neurorehabilitation programs. Scores were compared between types of programs using independent samples t tests. RESULTS: The NPSS showed good reliability and contrasted groups validity, significantly differentiating between types of programs. CONCLUSIONS: The NPSS holds considerable promise as a tool for distinguishing among different types of brain injury programs, and for assessing the differential effectiveness of specialized versus discipline-specific outpatient brain rehabilitation programs. Future research on the NPSS will assess the stability of the instrument over time, its content validity, and capacity to differentiate the full continuum of neurorehabilitation programs.
"Social problem solving and community integration in postacute rehabilitation outpatients with traumatic brain injury"Rath, Joseph F; Hennessy, James J; DILLER, LEONARD
Objective: To enhance understanding of the role that social problem solving (SPS) plays in community integration following traumatic brain injury (TBI). Study Design: Regression analysis. Participants: Forty-five adults with TBI participating in higher level outpatient cognitive rehabilitation and 15 uninjured adults. Main Outcome Measures: Measures of community integration, problem-solving ability, and SPS self-appraisal and performance. Results: Individuals with TBI demonstrated poorer problem-solving as measured by both neuropsychological and SPS methods; however, the largest effect' size was observed for SPS self-appraisal. Only SPS self-appraisal predicted a significant proportion of the variance in community integration. Conclusions: It is important to assess brain-injured persons' confidence in their ability to cope with problems. A focus on objective test scores alone may lead to underdetection of disabling problem-solving deficits. (journal abstract).
"Group treatment of problem-solving deficits in outpatients with traumatic brain injury: A randomised outcome study"Rath, Joseph F; Simon, Dvorah; Langenbahn, Donna M; Sherr, Rose Lynn; DILLER, LEONARD
Sixty higher-level outpatients with traumatic brain injury (TBI), all at least 1 year post-injury, were randomly assigned to either conventional group neuropsychological rehabilitation or an innovative group treatment focused on the treatment logical of problem-solving deficits. Incorporating strategies for addressing underlying emotional self-regulation and logical thinking/reasoning deficits, the innovative treatment is unique in its attention to both motivational, attitudinal, and affective processes and problem-solving skills in persons with TBI. Participants in the innovative group improved in problem solving as assessed using a variety of measures, including (1) executive function, (2) problem-solving self-appraisal, (3) self-appraised emotional self-regulation and clear thinking, and (4) objective observer ratings of roleplayed scenarios. These improvements were maintained at follow-up. Baseline performance on timed attention tasks was related to improvement; individuals who processed the most slowly benefited the most. These participants did not show improvements on timed attention tasks, but did improve on problem-solving measures. Such findings are consistent with successful compensatory strategy use--the person may still have deficits and symptoms, but now has... (journal abstract).
"Problem solving group treatment for persons with acquired brain injury" [Meeting Abstract]Simon D; Sherr R; Langenbahn DM; Rath JF; DILLER L
"Traumatic brain injury: A hidden consequence for battered women"Jackson, H; Philp, E; Nuttall, RL; DILLER, L
The inability of substantial numbers of battered women to terminate or extricate themselves from violent relationships is of grave concern to clinical practitioners. Despite professional intervention, many victims of domestic violence return to the batterer and to repetitive battering, demonstrating that, for these women, traditional psychosocial interventions are ineffective. In a sample of 53 battered women, 92% reported having received blows to the head in the course of their battering; 40% reported loss of consciousness. Correlations between frequency of being hit in the head and severity of cognitive symptoms were significant, strongly suggesting that battered women should be routinely screened for traumatic brain injury and postconcussive syndrome. Development of treatment strategies to address the potentially damaging sequelae of head trauma in this population is essential.
"Cognitive rehabilitation during the industrialization of rehabilitation"DILLER, LEONARD
Discusses cognitive rehabilitation in an era of industrialized rehabilitation. The author discusses rehabilitation in terms of rights and privileges, costs and payments, and outcomes. The impact of industrialized rehabilitation on the stakeholders, recipients of rehabilitation services, providers, and 3rd-party payers, is also discussed. Ethical issues occurring in rehabilitation rounds include (1) risk taking in dependent people, (2) the availability of equal access to rehabilitation given the economics of rehabilitation, and (3) the most efficient use of therapy time, in light of decreased lengths of hospital stay. The author also describes the importance of provider-payer and provider-patient interactions. The author argues that the maxims of rehabilitation can be maintained in spite of the industrialization of rehabilitation and the economic threats that are shaking the entire system of health care..
"Poststroke rehabilitation practice guidelines"DILLER, LEONARD
This chapter briefly reviews facts about stroke as a condition then focuses on a discussion of poststroke rehabilitation guidelines, with a bias toward discussing those recommendations that are of greater interest to clinical neuropsychologists. Topics discussed include the following: stroke and its aftermath, cognitive deficits and rehabilitation, affective disturbances and rehabilitation, time and recovery, practice guidelines, recommendations for direct clinical practice, psychological examination in rehabilitation, treatment plans for cognitive deficits, and the management of depression..
"Measurement of problem-solving deficits in adults with acquired brain damage"Rath JF; Simon D; Langenbahn DM; Sherr RL; DILLER L
GRANTS:5R01HD32943/HD/NICHD NIH HHS/United States
OBJECTIVE: To compare the relative utility of conventional neuropsychological and social problem-solving approaches to measuring functional problem solving deficits in individuals with acquired brain damage (ABD). DESIGN: In Study I, scores for individuals with ABD were compared to scores for control and normative samples. In Study II, pre- and posttest scores were compared for individuals with ABD who completed a program of outpatient cognitive rehabilitation. PARTICIPANTS: In Study I, individuals with ABD were compared to healthy controls. In Study II, pre- and posttreatment assessments were obtained for 34 individuals with ABD. MAIN OUTCOME MEASURES: Two approaches were used, conventional neuropsychological (WAIS-R/II Comprehension subtest and Wisconsin Card Sorting Test) and social problem solving (Problem Solving Inventory and Rusk Problem Solving Role Play Test). RESULTS: In Study I, the ABD group demonstrated significant deficits on both social problem solving measures; however, neither conventional neuropsychological measure detected significant deficits in the ABD group, relative to control and normative groups. In Study II, significant treatment gains were demonstrated on both social problem-solving measures, however neither conventional neuropsychological measure was sensitive to improvements in functional problem-solving ability. CONCLUSIONS: In higher-level cognitive rehabilitation settings, the evaluation of functional problem-solving deficits in individuals with ABD can be facilitated by augmenting neuropsychological test data with results from social problem-solving measures.
"Dealing with rationalization and unawareness in the treatment of visual inattention"Weinberg, Joseph; DILLER, LEONARD
In this paper the authors present 2 case studies which may serve as useful paradigms for clinical interventions. They selected 2 patients with markedly restricted awareness of their failures or at least limited willingness to admit failure, to illustrate how resistant patients can be engaged in treatment..
"Psychological studies in stroke rehabilitation"DILLER, LEONARD; Simon, Dvorah
This chapter briefly discusses the significant developments in the field of neuropsychology, which increased our understanding of brain behavior relationships and the important developments in stroke rehabilitation in improving procedures and outcomes. However, the 2 lines of knowledge and experiences were not in communication with each other. This chapter examines some studies on this matter from a rehabilitation perspective..
"Cognitive remediation in traumatic brain injury: update and issues"Ben-Yishay Y; DILLER L
Cognitive Remediation (CR) is a relatively new treatment technique for alleviating residual cognitive deficits following traumatic brain injury. This is a promising yet still changing technique. The future of CR as a rational and systematic endeavor requires the incorporation of important new ideas that have been emerging in allied fields. For example, the emerging field of instructional psychology has contributed relevant concepts such as scaffolding, metacognition, and generalization. It is furthermore argued that the issues of awareness, self-concept, and self-efficacy are vital to the process of CR intervention, and an integrative (holistic) approach to the remedial endeavor is thus indicated.
"Response styles in perceptual retraining"DILLER L; Weinberg J
"Recovery from brain damage. Neuropsychological rehabilitation"DILLER L
"Stress, appraisal, and coping in mothers of disabled and nondisabled children"Miller, A C; Gordon, R M; Daniele, R J; DILLER, L
The cognitive-behavioral model of stress and coping provided the framework for this study of mothers of physically disabled children (n = 69) and mothers of nondisabled children (n = 63). The first aim was to test for differences between groups in responses to stressful parenting events. As hypothesized, mothers of disabled children reported higher levels of depressive symptomatology. Differences in psychological distress and health status approached significance. The second aim was to explore the mediating influences of coping strategies and cognitive appraisals. As predicted, emotion-focused coping was related to increased psychological distress in mothers of disabled children whereas problem-focused coping was associated with decreased distress. Both relationships were significant even after controlling for differences in type of parenting stressor. Hierarchical regressions showed that 58 and 25% of the variance in psychological distress was explained by the independent variables; however, the predictors were different for the two groups of mothers. Factors that may explain the differential effectiveness of coping and appraisal, and clinical implications of this study are discussed.
"Parameters of emotional processing in neuropsychiatric disorders: conceptual issues and a battery of tests"Borod JC; Welkowitz J; Alpert M; Brozgold AZ; Martin C; Peselow E; DILLER L
GRANTS:MH37592/MH/NIMH NIH HHS/United States;RR070604/RR/NCRR NIH HHS/United States
Components of emotional processing were examined in psychiatric and neurological populations: communication channel (face/voice), processing mode (expression/perception), and emotional valence (positive/negative). These were assessed with an experimental affect battery which was administered to schizophrenic, unipolar depressive, right-brain-damaged, Parkinson's disease, and normal control right-handed adults. For expression, subjects were taped while producing facial and vocal emotional expressions. Judges rated the expressions for accuracy and intensity. For perception, subjects were asked to identify and discriminate facial and vocal emotions. Using correlational techniques, relationships between facial and vocal channels and between expressive and perceptual modes were explored. The test battery has good psychometric properties and discriminates among diagnostic groups.
"Fostering the interdisciplinary team, fostering research in a society in transition"DILLER L
"A preliminary comparison of flat affect schizophrenics and brain-damaged patients on measures of affective processing"Borod JC; Alpert M; Brozgold A; Martin C; Welkowitz J; DILLER L; Peselow E; Angrist B; Lieberman A
GRANTS:MH 37592/MH/NIMH NIH HHS/United States
Flat affect is a major component of schizophrenia and is often also seen in neurological disorders. A preliminary set of comparisons were conducted to delineate neuropsychological mechanisms underlying flat affect in schizophrenia, and new measures are described for the assessment of affective deficits in clinical populations. Subjects were schizophrenic with flat affect (SZs), right brain-damaged (RBD), Parkinson's Disease (PDs), and normal control (NC) right-handed adults. Subjects were administered affective measures of expression and perception in both facial and vocal channels. For both perceptual and expressive tasks the SZs performed significantly less accurately than the NCs and the PDs but did not differ from the RBDs. This was the case for both face and voice. This finding lends support to the speculation that right hemisphere mechanisms, especially cortical ones, may be compromised among schizophrenics with flat affect.
"COGNITIVE REMEDIATION FOLLOWING TRAUMATIC BRAIN INJURY - RESPONSE"DILLER, L
"First year after stroke: tracking cognitive and affective deficits"Egelko S; Simon D; Riley E; Gordon W; Ruckdeschel-Hibbard M; DILLER L
A total of 58 cerebrovascular accident (CVA) rehabilitation inpatients with lateralized brain damage were assessed at two time points (T1 = admission to rehabilitation facility, about 7 weeks post-CVA, and T2 = 10 months post-CVA) in the following domains: hemispatial neglect, reaction time, depression, and affect comprehension. Performance was compared with 22 age-matched control subjects. Repeated measures ANOVAs were performed with patients subdivided into groups by laterality of lesion and visual field status (a strong predictor of psychometric performance, particularly in the hemispatial-neglect domain). During this initial year after stroke onset, significant improvements were observed in hemispatial neglect and affect comprehension in the two right-brain-damaged groups, but not the left-brain-damaged group. There was also a trend for improvement in observer rating of depression in all three groups. However, there was poor resolution of reaction time and self-reported depression in all three groups. These findings suggest that these latter domains should be targeted for more aggressive therapeutic intervention. An important component of such intervention, in addition to direct treatment of deficits, should be education of both patient and family as to the nature of deficits, expectations regarding resolution, and appropriate attributions of changed behavior after stroke.
"Relationship among CT scans, neurological exam, and neuropsychological test performance in right-brain-damaged stroke patients"Egelko S; Gordon WA; Hibbard MR; DILLER L; Lieberman A; Holliday R; Ragnarsson K; Shaver MS; Orazem J
GRANTS:10236-NINCDS/DS/DS NIH HHS/United States
Right-hemisphere stroke rehabilitation inpatients were assessed by: (1) CT scans; (2) neurological exam; and (3) cognitive and affective psychometric measures. Damage to temporal, parietal, and occipital regions was associated with visual-spatial impairments. Surprisingly, parietal damage was no more related than temporal and occipital damage to severity of visual inattention. While the neurologist's ratings of lability and depression were related to CT-scan measures, patients' self-report of depression was not so related. These findings support a less specific and probably greater interlobule organization of the right, as compared with left, hemisphere, and highlight the need for multifaceted affective assessment in such a brain-damaged group.
"Unilateral spatial neglect: Biases in contralateral search and fine spatial attention"Egelko S; Riley E; Simon D; DILLER L; Ezrachi O
Contralateral search and fine spatial attentional asymmetries, two aspects of hemispatial neglect, were examined in a total of 91 right brain damaged (RBD) and 40 non-aphasic left brain damaged (LBD) stroke rehabilitation inpatients. Fine spatial attentional asymmetries within a hemispace were found in both RBD and LBD patients on the LAVA figure-match test. This finding is in contrast to Gainotti's hypothesis that such problems in extracting contralateral visual information are uniquely characteristic of RBD patients. Furthermore, the study suggests that the gross search and fine attentional aspects of neglect are dissociable and may reflect different underlying mechanisms of hemispatial neglect.
"THE RELATIONSHIP AMONG PARAMETERS OF EMOTIONAL PROCESSING IN NEUROPSYCHIATRIC POPULATIONS" [Meeting Abstract]Borod, JC; Brozgold, AZ; Martin, C; Welkowitz, J; Peselow, E; DILLER, L; Lieberman, A; Alpert, M
"EXPLORATORY EYE-MOVEMENTS AND VISUAL HEMI-NEGLECT"JOHNSTON, CW; DILLER, L
"CLOSED HEAD-INJURY - PSYCHOLOGICAL, SOCIAL, AND FAMILY CONSEQUENCES - BROOKS,DN" [Book Review]DILLER, L
Reviews the book, Closed Head Injury: Psychological, Social, and Family Consequences edited by D. Neil Brooks (1984). Closed head injury (CHI) has risen to epidemic proportions in the United States. This book is a responsible, well-written review of the state of knowledge on the psychological, social, and family consequences of closed head injury. It fills a significant gap in knowledge and helps make the case for allocating resources to the study and management of an important emerging problem. Except for the chapter by Wood, it offers little coverage of methods of intervention for cognitive and psychosocial problems. The worker who is interested in how to assess will find useful information. The worker who is interested in how to treat and manage should look elsewhere.
"Perceptual remediation in patients with right brain damage: a comprehensive program"Gordon WA; Hibbard MR; Egelko S; DILLER L; Shaver MS; Lieberman A; Ragnarsson K
GRANTS:10236-NINCDS/DS/DS NIH HHS/United States
This study provided a comprehensive program to treat visual perceptual disturbances associated with right brain damage (RBD). Three types of previously evaluated perceptual remediation were integrated into a sequentially administered remediation program: basic visual scanning, somatosensory awareness and size estimation training, and complex visual perceptual organization. The purpose of the study was to evaluate the immediate (at rehabilitation discharge) and long-term (four months after discharge) effects of this treatment program on patients with RBD. The effects of treatment on ADL and mood state were also examined. Seventy-seven RBD stroke rehabilitation inpatients were studied--including 48 Experimental (E) and 29 Control (C). At rehabilitation discharge, the E group relative to the C group showed greater gains in all three types of perceptual functioning. Four months after discharge from rehabilitation, the C group continued to show gains in perceptual functioning while the E group had reached a plateau. Longitudinal decreases in levels of self-reported anxiety and hostility, but not depression, were noted only for the E group.
""PSYCHOLOGICAL AND BEHAVIORAL-ASPECTS OF PHYSICAL-DISABILITY - A MANUAL FOR HEALTH PRACTITIONERS - LINDEMANN,JE"" [Book Review]DILLER, L
"Review of Psychological and behavioral aspects of physical disability--A manual for health practitioners"DILLER, LEONARD
Reviews the book, Psychological and behavioral aspects of physical disability--A manual for health practitioners by James E. Lindemann (1981). According to the authors indication in the preface, this book is a guide for professionals who work with people with serious physically disabling conditions. It aims to provide information and 'how-to' suggestions for evaluation and treatment of physical disabilities. The book focuses on helping people make decisions, acquire skills, and seek experiences that permit them most fully to enjoy the competency and satisfaction of human existence. It is based on the emerging development in behavioral medicine and health psychology. .
"Treating perceptual organization deficits in nonneglecting RBD stroke patients"Weinberg J; Piasetsky E; DILLER L; Gordon W
GRANTS:NIH-NINCDS(10236-07)/DS/DS NIH HHS/United States
Thirty-five right brain-damaged (RBD) stroke patients, enrolled in active rehabilitation programs, participated in this study. Patients were selected on the basis of their evidenced deficits in performing complex visuo-cognitive tasks and the absence of overt evidence of unilateral visual-spatial neglect. Seventeen of the 35 patients were randomly chosen to receive a training program (lasting approximately 1 month) designed to establish a systematic strategy of organizing complex visual material. The remaining 18 patients were re-examined after 1 month, and served as controls. The design of the treatment program was based on the hypothesis that nonneglected RBD patients fail to appreciate and synthesize elements of complex visual material due to a breakdown in compensation for a persistent lateral bias in visual-spatial attention. Upon posttesting, it was found that those patients who received training exhibited significantly improved performance, as compared to controls, on a subgroup of visuo-cognitive tasks. These results are discussed in terms of: (1) offering indirect support for the argument that pathological asymmetries in attention play a significant role in the failure of RBD patients on many visuo-cognitive tasks; and, (2) offering a basis for extending the treatment of perceptual problems in RBD patients.
"Efficacy of psychosocial intervention with cancer patients"Gordon WA; Freidenbergs I; DILLER L; Hibbard M; Wolf C; Levine L; Lipkins R; Ezrachi O; Lucido D
GRANTS:N01-CN-5518/CN/NCI NIH HHS/United States
"Training sensory awareness and spatial organization in people with right brain damage"Weinberg J; DILLER L; Gordon WA; Gerstman LJ; Lieberman A; Lakin P; Hodges G; Ezrachi O
Building on a methodology to improve scanning and academic skill performance behavior in persons with acquired right brain damage due to stroke, this study presents 2 additional treatment methods: training in sensory awareness and spatial organization. The 53 patients studied were divided into two groups, experimental (N = 30) and control (N = 23). The experimental group received a treatment program incorporating the 2 new methods as well as a condensed version of the original program. The controls received standard rehabilitation. Both groups were retested after 1 month. Analyses revealed that the performance of those in the experimental group exceeded that of the controls, that those patients in the experimental group with severe impairments improved more than those with mild impairments, and that combined multiple-treatment produces greater generalization than the original single treatment program.
"Visual scanning training effect on reading-related tasks in acquired right brain damage"Weinberg J; DILLER L; Gordon WA; Gerstman LJ; Lieberman A; Lakin P; Hodges G; Ezrachi O
This study presents a method for analyzing and remediating the visual perceptual deficits often found in persons with acquired right brain injury due to stroke. A total of 57 patients were randomly assigned to experimental (N=25) or control (N=32) groups. All patients were administered the same test battery prior to assignment. Experimentals received the specific training program and the controls received standard rehabilitation. Both groups were retested after a period of one month. Analysis revealed the superior performance of the experimental group. The results suggest that the academic disorders found in right brain damage can be treated as secondary to a primary disturbance in visual scanning behavior.
"Relationship between initial competence and ability to profit from cues in brain-damaged individuals"Ben-Yishay Y; DILLER L; Gerstman L; Gordon W
"Behavioral correlates of the coronary profile"Gordon WA; Gertler MM; DILLER L; Leetma H; Gerstman LJ
"Performance of neurologically impaired preschool children with educational materials"Gordon R; White D; DILLER L
"Digit span in right and left hemiplegics"Weinberg J; DILLER L; Gerstman L; Schulman P
"Music as a facilitator for visual motor sequencing tasks in children with cerebral palsy"Berel, M; DILLER, L; Orgel, M
"The Treatment of Aphasia: A Film [Film Review]"Lumsdaine AA; DILLER L
Reviews the film, The Inner World of Aphasia. This type of film is close to the traditional professional lecture or literature, simply using the movie medium instead of the written or spoken word. There are a number of useful films in this vein, but they hardly get at the complex subjective feel of what it is like to be an aphasic. The film tells the story of a harassed, busy, and somewhat unsympathetic nurse who, in her haste, falls down a flight of stairs and winds up in a hospital with the full blown syndrome of disturbances associated with brain damage, including hemiplegia, hemianopsia, and aphasia.
""CEREBRAL PALSY - ITS INDIVIDUAL AND COMMUNITY PROBLEMS - CRUICKSHANK,WM"" [Book Review]DILLER, L
Reviews the book, Cerebral Palsy: Its Individual and Community Problems by William M. Cruickshank (Ed.). The authors major intent in this edition is similar to what it was in the original edition a decade ago: To bring together the points of view of the medical, psychological, therapeutic, social work and rehabilitation professions in order to bring about a better meeting of the minds among those concerned with cerebral palsy. Psychology, as expounded in this volume, has not kept pace with the needs of the population or the advances in adjacent fields, e.g., mental retardation or children with minimal brain damage. For a beginning psychology student, this book presents a fairly solid if uninspired introduction to a field..