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This study was undertaken to introduce an innovative approach to cognitive rehabilitation intervention (Goal Management Training- GMT) delivery, through a web-based platform administered to adults with cerebrovascular disease (CVD) or suffering from CVD risk factors who presented with executive function impairments. The feasibility of this approach was investigated by developing a semi-quantitative-qualitative tool to measure therapist competence and group engagement adapted from the Cognitive Therapy adherence-to-protocol scale. Results from two raters analyzing random web-based GMT session recordings showed no compromise in any aspect measured. In addition, the efficacy of the intervention was established using neuropsychological and functional outcome measures, with significant results observed on the Goal Attainment Scale functional measure. To our knowledge, this study is the first of its kind to a) employ videoconferencing technology to overcome accessibility barrier to cognitive rehabilitation and b) develop an adherence to protocol tool to measure various aspects of GMT.

This study was undertaken to introduce an innovative approach to cognitive rehabilitation intervention (Goal Management Training- GMT) delivery, through a web-based platform administered to adults with cerebrovascular disease (CVD) or suffering from CVD risk factors who presented with executive function impairments. The feasibility of this approach was investigated by developing a semi-quantitative-qualitative tool to measure therapist competence and group engagement adapted from the Cognitive Therapy adherence-to-protocol scale. Results from two raters analyzing random web-based GMT session recordings showed no compromise in any aspect measured. In addition, the efficacy of the intervention was established using neuropsychological and functional outcome measures, with significant results observed on the Goal Attainment Scale functional measure. To our knowledge, this study is the first of its kind to a) employ videoconferencing technology to overcome accessibility barrier to cognitive rehabilitation and b) develop an adherence to protocol tool to measure various aspects of GMT.

Objectives: To evaluate the effectiveness of cognitive rehabilitation therapy with patients with schizophrenia within a forensic population. The intervention aimed to improve domains of cognitive functioning which have been found to be impaired as a result of schizophrenia. Forensic patients with schizophrenia have been found to have greater impairments in cognitive functioning relative to non-violent patients. Therefore interventions which target these deficits are important in rehabilitation interventions. Design: A within subject repeated design was used. A control measure was also implemented which involved patients being used as their own control. Method: 17 participants successfully completed the cognitive rehabilitation intervention. Initially 23 participants were recruited. Participants received approximately five hours of the computer-assisted cognitive remediation administered over seven weekly sessions. Outcome measures were cognitive assessments measuring executive functioning, attention, verbal learning and memory, perceptual organisation and visual memory. Outcome measures were administered pre-intervention, during treatment, post treatment and at three months follow up. A control assessment was also administered prior to the commencement of the intervention. Results: Post treatment measures on attention, perceptual organisation, visual memory and aspects of executive functioning were found to be significantly improved in comparison to pre intervention and control assessments. At 3 month follow up these improvements in cognitive functioning were found to be sustained. Conclusion: The pilot study indicated that cognitive rehabilitations are effective in improving cognitive functioning within forensic populations with schizophrenia. These results have the potential to improve functional outcomes and recovery, which could indirectly improve symptoms and risk of future violence. Further research is required in this area to provide additional evidence for this intervention to be available to forensic patients with schizophrenia.

Adults with mild to moderate acquired brain injury (ABI) often pursue post-secondary or professional education after their injuries in order to enter or re-enter the job market. An increasing number of these adults report problems with reading-to-learn. The problem is particularly concerning given the growing population of adult survivors of ABI. Combat-related brain trauma and sports concussions are two factors contributing to increases in traumatic brain injuries, while higher incidences of stroke in young adults and better rates of survival after brain tumors are contributing to increases in non-traumatic brain injuries. Despite the rising need, empirical evaluation of reading comprehension interventions for adults with ABI is scarce. This study used a within-subject design to evaluate whether adult college students with ABI with no more than moderate cognitive impairments benefited from using a multi-component reading comprehension strategy package to improve comprehension of expository text. The strategy package was based on empirical support from the cognitive rehabilitation literature that shows individuals with ABI benefit from metacognitive strategy training to improve function in other academic activities. Further empirical support was drawn from the special education literature that demonstrates other populations of struggling readers benefit from reading comprehension strategy use. In this study, participants read chapters from an introductory-level college Anthropology textbook in two different conditions: strategy and no-strategy. The results indicated that providing these readers with reading comprehension strategies was associated with better recall of correct information units in two free recall tasks: one elicited immediately after reading the chapter, and one elicited the following day. The strategy condition was also associated with better efficiency of recall in the delayed task and a more accurate ability to recognize statements from a sentence verification task designed to reflect the local and global coherence of the text. The findings support further research into using reading comprehension strategies as an intervention approach for the adult ABI population. Future research needs include identifying how to match particular reading comprehension strategies to individuals, examining whether reading comprehension performance improves further through the incorporation of systematic training, and evaluating texts from a range of disciplines and genres.

There is no research on the assessment or treatment of help-seeking behaviors for individuals with acquired brain injury (ABI). The current study evaluated the efficacy of a group treatment protocol, NICE (Noticing you have a problem, Identifying the information you need for help, Compensatory strategies, Evaluating progress), to train help-seeking for adults with ABI when lost. Theoretical and treatment components from two empirically validated interventions that target social problem solving and social competence were adapted to develop the NICE group treatment protocol. A single subject modified variant of a nonconcurrent and multiple probe multiple baseline across participant cohort design was used to examine sensitivity to treatment effects for seven persons with ABI. The overall findings suggest that the NICE group treatment has potential to improve help-seeking when wayfinding. This dissertation supports further investigation of the NICE group treatment to train help-seeking skills.

ABSTRACT The purpose of this qualitative inquiry was to describe parents’ experiences of the Brain Balance Program, as revealed in their online writing. This study provides a description of parents’ experiences in a way that highlights what participating in the program was like, asserts their judgements about this program, describes the impact of the program on the parent and child and describes the parents’ motives for doing the program and motives for writing about the experience. Six online documents were chosen that were information rich and showed a maximum variation of viewpoints. The sample of online documents were written by parents and retrieved from online sources in November, 2012. Basic Qualitative Descriptive research (Merriam, 2009) was used to design the study and qualitative content analysis was used to produce the findings. Content analysis is “a research method for the subjective interpretation of the content of text data through systematic classification process of coding and identifying themes or patterns” (Hsieh & Shannon, 2005, p. 1278). The findings provide a thick description of parents’ perspectives on their experience of helping their child through a multimodal program for neurobehavioral disorders. Limitations, implications and areas of future research pertaining to the study are discussed. This study can inform parents’ decision making around interventions and provides support for further research in biomedical and cognitive rehabilitative approaches for neurobehavioral disorders.

The primary aim of this study was to investigate source memory performance in individuals diagnosed with Parkinson's disease (PD). The secondary goal was to explore how memory was impacted when subjects were asked to generate responses during encoding. Fifty idiopathic PD patients and fifty healthy control subjects completed a task measuring item memory and source memory which also included a generation manipulation. Relative to controls, PD patients exhibited deficits in source memory but not item memory. Both groups demonstrated enhanced memory performance in the generative condition of the item memory task. The PD group displayed a marginally significant trend toward improvement in source memory when instructed to generate a response. These findings lend support to the notion of a selective pattern of source memory impairment in PD, highlighted by a dissociation between item and source memory performance. Generative tasks may be related to increased activation of key frontal regions that facilitate memory performance. These results could inform new perspectives for cognitive rehabilitation in PD, although further research is necessary.

The present study investigated the reliability and robustness of a new mnemonic strategy - self-imagination - in a group of memory-impaired individuals with neurological damage. Despite severe memory deficits, almost all of the participants demonstrated a self-imagination effect (SIE) for recognition memory in study 1. Moreover, the ability to benefit from self-imagination was not affected by the severity of the memory deficit. In study 3, more than half of the participants showed a SIE on a task of event-based prospective memory. The data from study 2 suggest the SIE is not attributable to semantic processing or emotional processing and indicate that self-imagination is distinct from other mnemonic strategies. Overall the findings from the present study implicate self-imagination as a new and effective mnemonic strategy. The data also indicate that when it comes to memory there is something special about processing information in relation to the self.

Doctor of Philosphy (PhD) / Agitation following traumatic brain injury (TBI) is characterised by a heightened state of activity with disorganised information processing that interferes with learning and achieving functional goals. This thesis outlines a series of studies across four research phases, investigating how occupational performance of adults with TBI is affected by agitated behaviour and information processing difficulties. Clinicians report the presence of agitation interferes with engagement in therapy and achievement of rehabilitation goals. Research Phase One used a retrospective chart review of 80 adults with severe TBI to identify a high incidence of agitated behaviour during inpatient TBI rehabilitation. Agitated behaviour was associated with lengthier rehabilitation admission, prolonged duration of post-traumatic amnesia (PTA), and poor cognitive functioning at discharge. The association between agitation and poor cognition persisted for at least two years after discharge, highlighting the significant impact of agitated behaviour on people’s ability to relearn cognitive skills for daily function. These initial research findings directed subsequent research phases, in which an information processing model was adopted to examine application of cognitive strategies during occupational performance. An emerging occupational therapy assessment, The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis, was selected as the primary method for evaluating how application of cognitive strategies during occupational performance is affected in agitated patients. Clinical utility of this measure was established in a case study of an adult demonstrating severely agitated behaviour during inpatient TBI rehabilitation, followed by examination of instrument reliability and validity with ten experienced occupational therapists and five adults with agitated behaviour following brain injury. The PRPP System of Task Analysis emerged as a valid and reliable method for determining strategy application deficits during occupational performance of adults with agitated behaviour, in acute stages of TBI rehabilitation. Consistent patterns of processing deficits were related to the Perceive and Recall Quadrants of the PRPP System. The assessment tool forms part of a dynamic, interactive assessment and intervention system. The PRPP System of Intervention was evaluated in the final research phase, using an experimental single case design with replication across eight adults. The effectiveness of PRPP Intervention was examined in comparison to conventional occupational therapy in an ABAB design. Efficacy of the PRPP Intervention was demonstrated, with patients applying significantly more information processing strategies to occupational performance tasks during PRPP Intervention than during conventional occupational therapy sessions. Agitated behaviour concurrently reduced over the period of the study. Relationships between information processing and agitated behaviour are hypothesised.