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Traumatic Brain Injury
Services, treatments and outcomes

Edited by

M.A. Chamberlain
Charterhouse Professor of Rehabilitation Medicine
Rheumatology and Rehabilitation Research Unit
Leeds University, UK

V. Neumann
Consultant, Chapel Allerton Hospital, Leeds, UK and
Senior Lecturer in Rehabilitation Medicine
Rheumatology and Rehabilitation Research Unit
Leeds University, UK

A. Tennant
Charterhouse Principal Research Fellow
Rheumatology and Rehabilitation Research Unit
Leeds University, UK

Springer-Science+Business Media, B.V.

Page 142

130 Evaluation of memory rehabilitation

groups. By group comparison one can thus eliminate the retest gains
from the total gain made by the trained patients. Another often made
suggestion to reduce retest effects is to use parallel versions of tests. Our
experience with parallel versions (we actually used parallel versions for
most of our tasks) is that they also show retest effects [30]. Possible
explanations are, for example, the subject's growing familiarity with
the testing situation and the test requirements, a decreased level of
tension or the gradual development of an approach to tackling the task
at hand.

Hawthorne effects (performing better as a result of receiving attention,
for example, from a therapist) were controlled for by the group of
pseudotreatment patients. These patients received the same amount
of attention from a therapist and spent the same amount of time
on memory games and exercises as the strategy group, but learned no
strategies other than attention, time and simple repetition, the drill and
practice method.

Finally, we think it is of the greatest importance to control for
individual differences as well, especially in an heterogeneous popu-
lation such as CHI patients and even more so in small group studies.
We accounted for interindividual variability (besides by random
group assignment) in a statistical, covariance-like way. A regression
equation was used to determine the effects of the training methods while
controlling statistically for interindividual differences in baseline perfor-
mance. So, the post-treatment score was predicted from: (1) the baseline
level of that score (PRE), (2) a dummy variable representing the strategy
condition and (3) a dummy variable representing the pseudotraining

On all measures, the baseline level was expected to be the best
predictor of the later scores, but the question was whether the strategy
and pseudotraining dummies could significantly contribute to the
regression equation. In the following results, any significant change
in proportion of variance explained by these dummies will be called

Table 10.3 Mean subjective ratings for the training (10-point scale ranging
from 1 =lowest possible to 10 =highest possible)

Satisfaction with the training
Personal fit of the training
Applicability in daily life
Recommendability to other patients

Strategy training
mean (range)




mean (range)



Page 143

Capacity Coping Insight




I I I 6


pre post pre post pre post




/ •

pre post

Results 131

__...._strategy training

_ _.__pseudo training

Figure 10.2 Subjective judgements of strategy training and pseudotraining.
Mean subjective ratings before and after the training of the trained CHI groups
(10-point scale, ranging from 1 = lowest possible to 10 =highest possible).


The main results of our evaluation study, then, are as follows:

• Subjective judgements: To put it mildly, the subjective data are not
clearly in favour of the strategy training. The control patients were
as highly satisfied with the treatment and the results of training as
the strategy patients (Table 10.3 and Figure 10.2).

Also, with respect to other subjective data (Memory Questionnaire), there
were no specific effects of strategy training. Even the no-treatment group
reported less and less memory complaints in the course of the study.
And these results are true for judgements of patients and relatives alike
(Figure 10.3).

• Control Sum Scores: The mean scores for the three groups are
depicted in Figure 10.4 and the results of the regression analyses are
summarized in Table 10.4. After baseline level had been accounted for,
no single effect of strategy training was found on the reaction time
tasks, and the one significant contribution (post-2, movement time) to
the regression equation of the pseudotraining cannot be conceived of
as convincing evidence of rehabilitation effects.

• Control Memory Sum Score: Regression analyses showed that
neither strategy training nor pseudotraining could add significantly
to the equation once baseline level was accounted for, either at
follow-up, post-2, or post-1 (Table 10.5 and Figure 10.5).

Page 283

272 Index

Rey complex 220
Role-playing 180-1, 199
Royal College of Physicians xi

Report 66
Rural community service 51-65, 260

Satiation 164-5

Barthel Index 213-14, 218, 228, 234,

Communication Performance scale

Disability Rating Scale 255
General Health Questionnaire 80, 81
Glasgow Coma Scale 6, 26, 69, 229
Glasgow Outcome Scale 6, 26, 27,

69, 229, 231, 245, 248
Neurobehavioural Rating Scale 220
Newcastle Incidence Assessment

scale 45
Nottingham Health Profile 70, 228
Physical Independence Handicap

scale 227
Rehabilitation Need and Status

scale 27
Uniform Data Set 250
Westmead PfA scale 247
see also Outcome measures

SCI, see spinal cord injury
Seating 3, 39, 227

clinic 47
Service organisation 3-11, 12

district 37
home-based, see Home-based service
national service, see National service
peripatetic 260, 262
planning and development 8-10,

20-2, 25-34
regional service, see Regional service
response framework 9-10
rural service, see Rural community

urban, see Urban community service

bio-engineering 39
costs 82
patient access 10
prosthetic 40, 46
specialist 39-40

Sexual relationships 173, 174--5
Shaping, behaviour rehabilitation 161

attentional 143

communication, see Communication

functional, see Functional skills

professional 105
Slow information processing 141-52,

case studies 149-51
Meichenbaum procedure 143
strategy training

aims 141-2
attentional skills 143
behavioural approach 146, 149-51
cognitive approach 145, 146,

error awareness 144
evaluation 146--7
examples 147-50
patient selection criteria 146
strategic level 143
strategy acceptance 144, 145
strategy application and

maintenance 145-6
theoretical model 142-6
Tune Pressure Management 145,

Social groups 186
Social integration 31-2, 93, 226
Social isolation 80-1, 97
Spasticity 47, 108, 109, 110

outcome measures 208
Special Needs Coordinator 77
Speech therapy 64

clinic 47
Spinal cord injury (SCI) 214
Splinting, joints 110

key workers 41-2, 43-4, 71
postacute rehabilitation centre 90
regional unit 40-4

Stimulation groups 183
Strategy training, see Slow

information processing
Stress 33, 114
Stroke rehabilitation 10, 38, 261

Centre for Rehabilitation of Brain
Injury 88, 89-98
CHI study 125-38
Leeds short-term 228-31
National Traumatic Brain Injury

Research study 52
North Western RHA 15-22

Page 284

Nuffield Provincial Hospitals Trust
Royal Hospital and Home 197-202

Subarachnoid haemorrhage 52
Swallowing problems Ill

acute phase service provision 9
after-care 27
characteristic problems 104
children 39
consequences 26, 30, 47, 115-16
domains 26
impairment factors 6
incidence 14-15, 45, 53
National Traumatic Brain Injury

Research Study 52
neuroanotomical effects 194
outcome conditions 26, 47, 97, 260
patient trust 30
psychodynamic aspects 29-30
stages 25
see also Head injury

coordination 30
community rehabilitation 60-1
Placement Assessment and

Counselling 62
primary health care 60
roving· approach 38
Young Adult 67, 76, 77

Tel Aviv, University 26

memory 127--8, 129-30, 256
psychological 91
Short Test of Mental Status 71
trail making 245

Therapy 30-1, 62
art 61-2
behaviour 54
groups, see Group therapy
multi-discipline 30-1
occupational, see Occupational

physiotherapy, see Physiotherapy
structured 7

Time pressure management (TPM)
145, 146-50

Tokens 156, 157-8
Tomography, computer 26
Trail making test 245
Training 34, 115

cognitive 91-2, 93

emotional 93
ICIDH staff 232
memory 127

Index 273

physical medicine and
rehabilitation 31

schemes 62
slow information processing, see

Slow information processing,
strategy training

vocational 32
see also Education

Transportation 84-5
Traumatic brain injury, see Head

injury; TBI
Trust building 30

Unconsciousness 52
Unemployment 62

see also Employment
Uniform Data Set 250
Urban community service 9-10,

66-83, 259, 262
case histories 74-8, 81
costs 82
evaluation 78-81
maximum involvement 76-7
minimum involvement 74--5
moderate involvement 75-6
neurosurgery focus 68, 69
occupational therapy 67-82

assessments 71-5, 76
costs 82

'packages of care' 79
patient assessment 70-2
research 78-81
resources 81-2
results evaluation 79-81

USA 8, 12, 89
rehabilitation centres 88

Validity 209
Vocational assessments 115
Vocational rehabilitation 27
Vocational Rehabilitation Centre 32
Vocational training 32

Work, see Employment
Work groups, see Group therapy
Working for Patients 225

Young Adult Team 67, 76, 77
Young Disabled Unit 67
Younger patients 51, 52

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