Assessment of executive functions in children and adolescents with acquired brain injury (ABI) using a novel complex multi-tasking computerised task: The Jansari assessment of Executive Functions for Children (JEF-C©)

ABSTRACT

Objectives: The Jansari assessment of Executive Functions for Children (JEF-C^©) is a new non-immersive computerised assessment of executive functions. The objectives of the study were to test the feasibility and validity of JEF-C^© in children and adolescents with acquired brain injury (ABI).

Methods: Twenty-nine patients with ABI aged 10–18 years and 30 age-and gender-matched controls were tested. Participants performed JEF-C^©, Wechsler Abbreviated Scale of Intelligence (WASI) and the Behavioural Assessment of the Dysexecutive Syndrome for Children (BADS-C), while parents completed the Behaviour Rating Inventory of Executive Function (BRIEF) questionnaire.

Results: The JEF-C^© task proved feasible in patients with ABI. The internal consistency was medium (Cronbach’s alpha?=?0.62 and significant intercorrelations between individual JEF-C^© constructs). Patients performed significantly worse than controls on most of the JEF-C^© subscales and total score, with 41.4% of participants with ABI classified as having severe executive dysfunction. No significant correlations were found between JEF-C^© total score, the BRIEF indices, and the BADS-C. Significant correlations were found between JEF-C^© and demographic characteristics of the sample and intellectual ability, but not with severity/medical variables.

Conclusion: JEF-C^© is a playful complex task that appears to be a sensitive and ecologically valid assessment tool, especially for relatively high-functioning individuals.     

Is there a relationship between executive functions and academic success in children with neurofibromatosis type 1?

The present study aimed to compare the executive function (EF) of children with neurofibromatosis type 1 (NF1) to those of typically developing children and to investigate whether those abilities could predict the child's academic success in terms of academic skills and enablers. Twenty-nine children with NF1 and 27 age-and-gender-matched controls (aged 8–16 years) were examined with two tests to measure EF in an ecologically valid manner: the Behavioural Assessment of the Dysexecutive Syndrome in Children (BADS-C) and the parent questionnaire for the Behavior Rating Inventory of Executive Function (BRIEF). In order to evaluate academic success we used the Academic Competence Evaluation Scales (ACES). The performance of the NF1 group was significantly lower on the Water and Key search subtest of the BADS-C and on four scales of the BRIEF: initiate; working memory; plan/organise and organisation of materials. Significant correlations and predictive models via regression analysis were generated for: BADS-C, BRIEF and ACES scores. Based on these findings, children with NF1 have executive dysfunction that partially accounts for their difficulties in academic achievements.     

Evaluation of Wound Healing Following Surgical Extractions Using the IPR Scale

ObjectiveTo monitor wound healing following surgical extraction of wisdom teeth using the novel Inflammatory Proliferative Remodeling (IPR) Scale.MethodsA prospective study design was used. Participants included 94 otherwise healthy adult patients undergoing surgical extraction of a wisdom tooth at a tertiary medical centre from June 2018 to June 2019. The IPR Scale was completed by two resident surgeons in oral and maxillofacial surgery at three time points after the procedure, corresponding to the three phases of wound healing. Mean subscale and total scores were calculated. Patients graded their preoperative anxiety, intraoperative pain, and pain during follow-up on a 10 cm visual analog scale, and the findings were correlated with the IPR Scale scores.ResultsMean IPR total score (range 0–16) was excellent (14.43 ± 1.45). Mean scores by healing phase were as follows: inflammatory 6.35 ± 1.34 (range 0–8); proliferation, 4.56 ± 0.8 (range 0–5); remodeling, 2.83 ± 0.51 (range 0–3). There was a positive correlation between mean preoperative anxiety level (5.9 ± 3.6) and intraoperative pain perception (2.4 ± 2.4; P = 0.65) and a negative correlation between mean preoperative anxiety level and IPR Scale scores for each healing phase. Two cases were complicated by abscesses which resolved with treatment.ConclusionThe IPR Scale is a promising tool for the effective evaluation of the wound healing process following wisdom tooth extractions. Relaxation methods and behavioural adaptation might help to lower patient anxiety and thereby improve oral wound healing.     

Cognitive and emotional empathy in typical and impaired readers and its relationship to reading competence

Studies indicate a strong relationship between empathy and language skills, but the relationship between reading and empathy remains elusive, although a shared neural substrate (the temporoparietal junction; TPJ) has been implicated in both reading and empathy. Motivated by these observations, the purpose of the current study was to examine empathic skills in a large spectrum of reading abilities, including typical readers and individuals with dyslexia, and their relationship to reading competence. We administered the Intrapersonal Reactivity Index (IRI) test, which differentiates between two subscales of empathy (cognitive and emotional empathy), to a group of participants with dyslexia and typical readers. Results indicate that the general reading score (average z scores of all reading tests) was significantly positively correlated with empathic scores. In addition, tests of specific reading abilities—decoding, reading fluency, and reading-related measures of phonological awareness—were significantly positively correlated with empathic scores. Finally, participants with dyslexia who showed low reading abilities had significantly lower scores in total empathy and cognitive empathy, as measured by the IRI test, than did typical participants with high reading abilities. Taken together, these results indicate a strong association between reading-related skills and empathic abilities and may point to involvement of the TPJ in both empathy and reading.     

The handwriting performance of children with NF1

The objective of this study was to analyze the process and product of handwriting among children with Neurofibromatosis Type 1 (NF1) in comparison to those of Typically Developing (TD) children. Children with NF1 are at risk for some cognitive deficits, a wide range of deficits in perceptual skills and, motor and visual-motor integration skills which may interfere with handwriting competency, which is an essential ingredient for success at school. Participants were 30 NF1 children and 30 age and gender matched TD children, between the ages 8 and 16.08. The handwriting performance of children with NF1 was evaluated with the Beery–Buktenica Developmental Test of Visual-Motor Integration (VMI), for copying text and free style writing tasks, using: (1) Computerized Penmanship Evaluation Tool (ComPET) to assess mechanical aspects of the writing process. (2) The Hebrew Handwriting Evaluation (HHE) to examine product legibility. (3) The Six-Trait Writing Model to judge the quality of the written product. Significant differences between the NF1 children and the control group were found in the process and product measures. Significant correlations were found between the VMI, the ComPET, the HHE and the Six-Trait Writing Model variables for both groups. We suggest a possible relationship between executive dysfunction and poor performance in handwriting.     

Dissociation between the procedural learning of letter names and motor sequences in developmental dyslexia

Motor sequence learning has been studied extensively in Developmental dyslexia (DD). The purpose of the present research was to examine procedural learning of letter names and motor sequences in individuals with DD and control groups. Both groups completed the Serial Search Task which enabled the assessment of learning of letter names and motor sequences independently of each other. Control participants learned both the letter names as well as the motor sequence. In contrast, individuals with DD were impaired in learning of the letter names sequence and showed a reliable transfer of the motor sequence. Previous studies proved that motor sequence learning is impaired in DD. The present study demonstrated that this deficit is more pronounced when the task to be learned involves linguistic units. This result implies that the procedural learning system of language is more deficient than the motor procedural learning system in individuals with DD. The dissociation between motor and letter names sequence learning in those with DD also implies that the systems underlying these two tasks are separable.     

Perceived feasibility of an occupation-based telerehabilitation intervention for older adults with chronic health conditions in Israel

AimsOur study explored the perceived feasibility of using a home-based telerehabilitation service for older adults with chronic health conditions in Israel.MethodThis mixed-methods study included two focus groups of registered occupational therapists (n = 10) working in rehabilitation wards in Israel. Participants completed an open-ended questionnaire and Likert scale items so that data could be gathered on their perspectives regarding using an in-home telerehabilitation service for older adults after discharge from rehabilitation units. Thematic analysis with an a priori coding approach was applied to the data.ResultsPerceived advantages included transfer to the natural environment and the overcoming of geographical distance. Caregiver support and patient motivation were recognized as enabling factors. Perceived barriers included lack of hands-on contact and the concern that safety could be impeded by technological challenges and the patients’ cognitive status.ConclusionsFindings from this study can potentially contribute to facilitating the implementation of a home-based telerehabilitation service as a practical alternative for elderly patients after discharge from rehabilitation units in Israel.     

Suitability of the art therapy room and changes in outcome measures in the education system

This study examined the relationship between art therapists’ perceptions of their art therapy room in schools, and related outcome measures for 55 students. We posited that there would be a positive correlation between art therapists’ satisfaction and their perception of the suitability of the rooms in which they provide therapy, and their clients’ outcome measures. Thirty-six therapists completed a questionnaire about their perceptions of their therapy room. Students completed questionnaires on self-perception and loneliness, and their parents and homeroom teachers reported on behavioural problems before and after therapy. There were no correlations between the art therapists’ perceptions of the room and the outcome measures. However, there were correlations between improvement in outcome measures as reported by parents and teachers and single items; e.g. the location of the room, the suitability of its equipment, and perceiving the material and furnishings as positive.

Plain-language summary

• The art therapy room provides a framework for therapeutic work and is designed to meet the needs of the theoretical approach and personality of the therapist, the characteristics of the client population, and the institution in which the therapy takes place. The therapy room has a crucial impact on the initial relationship between the therapist and the client and is perceived as an environment that acts as both container and containment during the therapeutic process. Although the physical conditions of the therapy room are likely to play a role in the success of therapy, scant research has explored this issue, in particular in the school setting. The current study examined the relationship between art therapists' perceptions of their art therapy room in schools, and related outcome measures for 55 1st to 7th graders. We expected a positive correlation between art therapists' satisfaction and their perception of the suitability of their therapy rooms and their clients' outcome measures. We asked 36 therapists to complete a questionnaire on the physical conditions of their therapy room. Their student clients completed questionnaires on self-perception and loneliness, and their parents and homeroom teachers reported on behavioural problems before and after therapy. No main correlations were found between the art therapists' perceptions of the room and the outcome measures. However, there were correlations between improvement in outcome measures as reported by parents and teachers and single items, including the location of the room, the suitability of its equipment, and perceiving the material and furnishings as positive.

     

Intracranial electrode implantation produces regional neuroinflammation and memory deficits in rats

Deep brain stimulation (DBS) is an established treatment for advanced Parkinson's disease (PD). The procedure entails intracranial implantation of an electrode in a specific brain structure followed by chronic stimulation. Although the beneficial effects of DBS on motor symptoms in PD are well known, it is often accompanied by cognitive impairments, the origin of which is not fully understood. To explore the possible contribution of the surgical procedure itself, we studied the effect of electrode implantation in the subthalamic nucleus (STN) on regional neuroinflammation and memory function in rats implanted bilaterally with stainless steel electrodes. Age-matched sham and intact rats were used as controls. Brains were removed 1 or 8 weeks post-implantation and processed for in vitro autoradiography with [³H]PK11195, an established marker of microglial activation. Memory function was assessed by the novel object recognition test (ORT) before surgery and 2 and 8 weeks after surgery. Electrode implantation produced region-dependent changes in ligand binding density in the implanted brains at 1 as well as 8 weeks post-implantation. Cortical regions showed more intense and widespread neuroinflammation than striatal or thalamic structures. Furthermore, implanted animals showed deficits in ORT performance 2 and 8 weeks post-implantation. Thus, electrode implantation resulted in a widespread and persistent neuroinflammation and sustained memory impairment. These results suggest that the insertion and continued presence of electrodes in the brain, even without stimulation, may lead to inflammation-mediated cognitive deficits in susceptible individuals, as observed in patients treated with DBS.