Apathy is common, its severity depending on diagnosis and localization of lesion. Apathy and depression in brain damaged patients share common features, but may be differentiated. The significant relationship between apathy and heart rate may provide a psychophysiological correlation of the disengagement, lack of interest and absence of emotional responsivity typically seen in apathy. The results have implications for the theoretical understanding of apathy and related negative symptoms, and for rehabilitation practice.
Fifty-four patients with traumatic brain injury (TBI) consecutively admitted to a rehabilitation hospital were examined 2 years post-injury. Social interaction and support, subjective complaints, and functional status were assessed. A large variability in social interaction and support patterns was found. Most patients had more interaction and received more support from family members than from friends and neighbours. Thirty-one patients (57.4%) reported that their social networks had markedly declined subsequent to injury. Relatively short duration of coma (< 1 week) and severe sequelae in terms of low functional status and poor emotional adjustment at follow-up, especially in terms of deficits in initiating behaviour, were found to be related to little interaction and support. The importance of both provider and patient initiative in order to establish and preserve a social support network is suggested, and clinical implications briefly discussed.
Within the last decade, various applications of two-way audio-visual telecommunication have been implemented in the Norwegian health care system to facilitate the delivery of medical services to patients located in rural areas away from the hospitals. This technology may also be useful to extend neuropsychological services to underserved areas and thereby reduce the patients' travel time and costs. In the current study, a total of 12 visual, verbal and performance tests were administered face-to-face and via videophones to 32 volunteer participants to examine the consistency and stability of test-scores when delivered via different formats. The obtained reliability coefficients ranged from .37 to .86 with a median value of .74. When testing for mean differences, the measures on verbal learning (WMS-Logical Memory I) and auditory attention (Seashore Rhythm Test) differed significantly due to administration format (t = 2.34, p = .024 and t = 2.37, p = .025, respectively). The findings imply that administration format does not appear to affect the reliability of measurement but neuropsychological test performance is significantly higher for the measures of attention and memory when delivered via videophone. Additional research on these cognitive domains is required, and if the observed differences due to testing format persist, separate normative data via telecommunication will be required before assessments are carried out. Also, since only normal participants were included in this study, the findings may have external validity for normal populations, but similar controlled trials with patients need to be completed before remote assessments can be implemented in regular clinical practice.
The need for developing team cooperation procedures when treating patients with traumatic brain injury (TBI) is stated. One approach in promoting team cooperation is to combine team development with a specific training programme. A memory training programme used in a subacute TBI rehabilitation unit is described. A combination of a team development procedure and memory training programme was performed in the unit. A questionnaire to assess team members' attitudes to team cooperation was administered before and after team development, and memory training procedures were implemented. The post-training questionnaire administration indicated a more positive perception among team members of how the team functioned. The efficacy of memory training showed variable results. The programme described may illustrate the advantages of combining a specific treatment programme with efforts to promote team development.
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