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The problem of fitness to drive in patients with brain damage
Sense and non-sense in memory training B.G. Deelman,
M. Koning-Haanstra,
I. Berg (Groningen)
The effects of a specific type of cognitive rehabilitation of memory problems, strategy training, in comparison with pseudo-training and a no-treatment control condition are evaluated. The memory impaired subjects are traumatically brain injured patients. They are randomly assigned to one of the three conditions. In strategy training (about 18 one-hour individual sessions at the laboratory and daily homework) cognitive strategies are explained, demonstrated and exercized. The strategies are based upon the general principles of attention, time, spaced repetition, association, organization and connecting input and retrieval situation. In the pseudo-training, also in individual sessions various memory tasks are simply repeated at the lab
and as homework. In the no-treatment condition, the patients are tested according to the same time schedule as the trained groups: before and after two three-week periods of training and at follow-up four months after ending therapy. Results (Regression analysis of follow-up data with baseline level as covariate): - There is more improvement on objective memory tasks after strategy training than in both control conditions. - On the other hand, both trained groups subjectively report an improvement in memory functioning. - In none of the groups there is an improvement on other tests, such as reaction times.
The problem of f’i&ess to drive in patients with brain damage A.H. van Zomeren Increasing numbers of patients with brain lesions or diseases must be assessed for a judgment of their fitness to drive a car. Statistical studies have more or less outlined the size of this problem, but progress is slow in the search for valid assessment methods and techniques. Generally speaking, emphasis has too often been on instrumental shortcomings of patients, such as poor motor coordination or prolonged reaction times. At the same time, higher cognitive skills have been somewhat neglected, such as flexibility and ability to adapt driving style to lower-level impairments. However, integrity of higher cognitive levels
in many cases enables patients to compensate for shortcomings in the motor domain, speed of information processing etc. The problems of assessment of driving skills will be illustrated for three groups of neurologic patients: subjects with severe head injury, with cerebra-vascular accidents, and with Alzheimer’s disease. These groups differ in mean age and driving experience, while in addition the Alzheimer group stands out by the progressive character of the disease.
M.M.A. Derix The concept of subcortical dementia was introduced in 1974, based on findings in patients with progressive supranuclear palsy. The main characteristics were: forgetfulness, slowing of thought processes, impaired ability to manipulate acquired knowledge, and personality disturbances, in the absence of aphasia, apraxia and agnosia. From 1983 on, the number of neurological diseases with subcortical dementia has considerably expanded: extrapyramidal disorders, normal pressure hydrocephalus, Binswanger’s disease, the AIDS Dementia Complex and dementia in multiple sclerosis. There still remain controversies with regard to the distinction between cortical and subcortical dementia but on clinical and neurobehavioural examination there are marked differences, 178
especially in the early stages of these dementia syndromes. From own research and review of the literature, it is suggested that the neuropsychological de&its in patients with subcortical dementia can be understood as a decline in efficient proaxshg and ertcuding of new information and in WrWati%) o+d and new information, which becomes mainly manifest in complex situations requiring attention and effort. These disturbances, reminiscent of frontal lobe disorders, have been explained by deficits in timing and activation of intact cortical systems. However the neuropsychological deficits can be better described in terms of an information processing model of cognitive function.
M. Koning-Haanstra,
I. Berg (Groningen)
The effects of a specific type of cognitive rehabilitation of memory problems, strategy training, in comparison with pseudo-training and a no-treatment control condition are evaluated. The memory impaired subjects are traumatically brain injured patients. They are randomly assigned to one of the three conditions. In strategy training (about 18 one-hour individual sessions at the laboratory and daily homework) cognitive strategies are explained, demonstrated and exercized. The strategies are based upon the general principles of attention, time, spaced repetition, association, organization and connecting input and retrieval situation. In the pseudo-training, also in individual sessions various memory tasks are simply repeated at the lab
and as homework. In the no-treatment condition, the patients are tested according to the same time schedule as the trained groups: before and after two three-week periods of training and at follow-up four months after ending therapy. Results (Regression analysis of follow-up data with baseline level as covariate): - There is more improvement on objective memory tasks after strategy training than in both control conditions. - On the other hand, both trained groups subjectively report an improvement in memory functioning. - In none of the groups there is an improvement on other tests, such as reaction times.
The problem of f’i&ess to drive in patients with brain damage A.H. van Zomeren Increasing numbers of patients with brain lesions or diseases must be assessed for a judgment of their fitness to drive a car. Statistical studies have more or less outlined the size of this problem, but progress is slow in the search for valid assessment methods and techniques. Generally speaking, emphasis has too often been on instrumental shortcomings of patients, such as poor motor coordination or prolonged reaction times. At the same time, higher cognitive skills have been somewhat neglected, such as flexibility and ability to adapt driving style to lower-level impairments. However, integrity of higher cognitive levels
in many cases enables patients to compensate for shortcomings in the motor domain, speed of information processing etc. The problems of assessment of driving skills will be illustrated for three groups of neurologic patients: subjects with severe head injury, with cerebra-vascular accidents, and with Alzheimer’s disease. These groups differ in mean age and driving experience, while in addition the Alzheimer group stands out by the progressive character of the disease.
M.M.A. Derix The concept of subcortical dementia was introduced in 1974, based on findings in patients with progressive supranuclear palsy. The main characteristics were: forgetfulness, slowing of thought processes, impaired ability to manipulate acquired knowledge, and personality disturbances, in the absence of aphasia, apraxia and agnosia. From 1983 on, the number of neurological diseases with subcortical dementia has considerably expanded: extrapyramidal disorders, normal pressure hydrocephalus, Binswanger’s disease, the AIDS Dementia Complex and dementia in multiple sclerosis. There still remain controversies with regard to the distinction between cortical and subcortical dementia but on clinical and neurobehavioural examination there are marked differences, 178
especially in the early stages of these dementia syndromes. From own research and review of the literature, it is suggested that the neuropsychological de&its in patients with subcortical dementia can be understood as a decline in efficient proaxshg and ertcuding of new information and in WrWati%) o+d and new information, which becomes mainly manifest in complex situations requiring attention and effort. These disturbances, reminiscent of frontal lobe disorders, have been explained by deficits in timing and activation of intact cortical systems. However the neuropsychological deficits can be better described in terms of an information processing model of cognitive function.