The aims of this project were (1) to investigate two forms of event perception: perception of movement and perception of sudden appearance, (2) to develop event perception procedures which could be applied to testing clinical populations, and (3) to relate event perception to abnormalities shown by neuroimaging. In addition issues relevant to each of the particular clinical populations involved were addressed.
Event perception tasks used stimuli consisting of a background of randomly selected dots of light. In one task a dot was added to the display (appearance), in the other a dot started to move (movement onset). Four laboratory experiments were conducted examining the ability to detect and locate these events under varying conditions in healthy controls. Results indicated that neuronal coding strategies were different for appearances and movement onset.
Laboratory tasks were adapted for clinical application and administered to groups of patients with different neurological conditions. Five studies were conducted to assess sensitivity and specificity of the Event Perception tasks in clinical settings. The groups studied were chronic solvent abusers, detoxified alcoholics, patients suffering from optic neuritis, and patients with traumatic brain injury. Event Perception tasks were found to be differentially sensitive to neurological conditions and showed dissociations and double dissociations both within and between neurological conditions. Relationships with Magnetic Resonance Imaging (MRI) and Single Photon Emission Computed Tomography (SPECT) were investigated in patients with head injury. Patterns of brain damage differed significantly for patients with impaired performance on the movement task.
It is concluded that Event Perception tasks are of value in the assessment of neurological patients: They allow assessment of functions which are not usually evaluated in neuropsychological examinations, facilitate detection of subtle deficits and deficits which may present at an early stage, and offer greater specificity and
sensitivity than many traditional neuropsychological test procedures. Event Perception tasks are easy to administer and do not suffer from training effects on repeated administration to the same degree as many traditional measures. It is also argued that tests with a theoretical basis are better suited to clinical research in neuropsychology than many traditional tasks because they potentially allow a more precise explanation and assessment of the abnormal processes under investigation.
Records of coma and post-traumatic amnesia (PTA) were collected for a group of 38 patients with closed head injury. The results confirmed earlier studies indicating that patients may have short or negligible coma but report prolonged PTA. Comparison of eight patients with prolonged PTA (> 7 days) and short coma (< 6 hours) with the rest of the group on MRI in the acute stage showed that these patients had significantly more extensive hemispheric damage. In the group as a whole both coma and PTA were related to the number of areas in central brain structures in which lesions were detected, but only PTA was significantly related to the number of hemispheric areas in which lesions were found. It is concluded that although both coma and PTA are related to brain damage they reflect disparate patterns of lesions. Assessment of PTA can thus provide additional information concerning severity of injury.
On-site pulmonary rehabilitation (PR) programmes are currently scarce due to the COVID-19 pandemic. Existing programmes faced major routine changes to ensure safety and continuity of care with unknown impacts on patients. Thus, we explored the impact of such changes in people with chronic respiratory diseases going through PR during the pandemic. A qualitative study was conducted. Semi-structured interviews were audio-recorded and transcribed per verbatim. A preliminary deductive thematic analysis was performed. 17 patients (7 ILD, 8 COPD and, 2 asthma; 9 males; 63±10 years) were interviewed and 5 themes were identified. Implemented infection prevention and control measures and a closer healthcare professional (HCP)-patient interaction were identified as important factors that contributed to patients’ perception of a safe environment. Reduced social interaction with peers and increased HCP workload and stress were recognised as having a negative impact. PR was perceived as essential, to break social isolation and relieve stress induced by the pandemic, and for patients to feel fitter, more capable, and confident (Fig.1). On-site PR is valued by patients and was perceived safe and beneficial during the pandemic. Careful reflection about maintaining PR programmes closed is recommended. Future studies should also explore the impact of these changes on PR effectiveness and seek perspectives of other stakeholders, such as HCPs.
Two subgroups of patients were identified from 48 patients with traumatic head injury who had MRI during the acute stage: (a) those with severe diffuse injury--six patients with lesions in both the corpus callosum and the brain stem; (b) those with severe focal injury--16 patients with extensive frontotemporal lesions. Most patients with diffuse injury were in a coma on admission to hospital, whereas most patients with focal injury were out of coma. Duration of post-traumatic amnesia was prolonged in both groups. Patients were followed up at six months after injury, when a battery of neuropsychological tests was given. Patients with both diffuse and focal patterns of injury were impaired by comparison with controls on a range of measures, including tests of memory and attention. The findings contrast with the view that diffuse injury is of much greater importance than focal injury in determining outcome after head injury.
A battery of psychometric tests was administered to 85 patients with epilepsy, of whom 26 were untreated, 40 received carbamazepine monotherapy and 19 took carbamazepine with another anticonvulsant. Carbamazepine alone had little effect on performance, but carbamazepine polypharmacy produced significant impairment. Increasing concentrations of carbamazepine (four tests) and its active metabolite, carbamazepine 10,11 epoxide (seven tests), correlated with decreasing performance in the monotherapy patients.
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