Brain Game Video

 

 

Thanks for taking the time to view our video. How did you get on?

Interpreting Your Results

The video is based on a real Cognitive test called The Stroop Test. This is named after J. R. Stroop, who first published the effect in 1935. Within our version a larger range of colours are used and it is presented in a different format via the video.

The test is normally used to assess the Executive functions, which are a range of complex abilities, such as multi-tasking, planning, impulse control, flexible thinking and organisation. The area of the brain commonly linked to executive functions is the Frontal Lobes.

In the case of this test, the key skills are inhibition, attention and processing speed. During trial three, when you are asked to read the colour of the word, this is measuring your ability to inhibit that learned response of reading the actual word.

Next Steps

If you enjoyed the video please share it with your friends and see how they get on.

If you would like to learn more about Alba Psychology and how we apply the testing of cognitive function in practice, please click on our information video below:

 

Effort testing – Worth the effort? (Part 1 of 3)

Every neuropsychological assessment should include a test of effort?

Dr Fraser Morrison, Clinical Director, Alba Psychology

Part one

The purpose of a neuropsychological assessment is to assess the level of cognitive functioning in an individual, ordinarily within the context of identifying a neuropsychological deficit. A neuropsychological assessment can comprise of a number of assessment methods including clinical judgement, feedback from significant others and cognitive testing (Hebben & Milberg, 2002). The assessment process is used with the assumption that it will improve the understanding of an individual’s neuropsychological functioning and offer an explanation for the observed deficit and behavioural presentation of brain dysfunction (British Psychological Society, 2009).

 

Within the context of a Personal Injury Claim, neuropsychological assessments are used ordinarily in cases that involve brain injury, possibly as a result of an incident such as Road Traffic Accident. Other cases involving potential negligence such as medical procedures or industrial accidents that have led to cognitive impairment can also necessitate the use of a neuropsychological assessment.

 

As is the case with any assessment, it is crucial that the process is based on valid and relevant pieces of information. In the context of cognitive testing a basic assumption of testing principles is that an individual will attempt to perform at their best level, or with maximum effort. If they do not then it would categorise an assessment as an inaccurate measure of cognitive abilities. In the case of cognitive testing, one assumes that test scores will reflect test performance, which in turn offers an accurate reflection of neuropsychological domains of functioning. If, for whatever reason, performance in cognitive testing is deemed to be an inaccurate reflection of actual neuropsychological functioning then the assessment process is worthless. Thus the accuracy of test performance must be examined to ensure this is reflective of actual neuropsychological functioning.

 

In order to determine whether neuropsychological test results are valid there must be evidence that clinical presentation during testing in consistent with an individual’s history. It is equally important that the observed pattern of results fit with a model of disease or neuropsychological disorder (Lezak et al., 2004). In examples where this is not the case it offers evidence that an individual may be performing at a level below their optimum performance and implies that the assessment process and test results have questionable validity.

 

Part two to follow next week……….

Coping with Panic Attacks – 1 of 2

Symptoms of anxiety are common following major life event such as a brain injury. This can sometimes result in a panic attack. The following methods can be used to help.

 

COPING WITH A PANIC ATTACK

 

During a panic attack you are extremely likely to breathe very fast and/or deeply.  This will have the effect of reducing the amount of carbon dioxide you have in your lungs which  in turn will create a lot of unpleasant body sensations which are likely to make you more afraid.  A vicious circle of fear leading to over breathing which leads to unpleasant body sensations (tingling, headaches, racing heart, flushes, nausea, chest pain, etc.) which cause more fear which leads again to over breathing,, gets established.  To stop this very nasty process you have to raise the carbon dioxide amount in your lungs.  You can do this in two ways:

 

A)   If you have a paper bag handy hold it tight over your nose and mouth so that no air can get into your lungs from outside the bag and breathe the air in the bag for several minutes until you calm down.

 

B)   If a bag is not handy or it would be embarrassing to use one (say in a supermarket) then you should change your breathing so you breathe in less air in a given period of time.  You can probably do this most easily by slowing down your breathing in small steps.  Attempt to breathe in smoothly and slowly and to let your breathe out just as slowly.  As you slow your breathing down you are bound to increase the depth of each breath.  However, try to avoid a very big increase in depth because that would undo the good work you have done by slowing down.  The ideal you are aiming for is SMOOTH, SLOW, REGULAR and fairly shallow breathing.  If you have managed to slow down for a few seconds but feel out of breath* and a stronger urge to take a quick gulp,  DON’T.  Resist it by swallowing a couple of times, that should get rid of the urge;  if it doesn’t then go ahead, take a gulp BUT once you’ve let the air in HOLD IT in for about 5 seconds and then let it out SLOWLY.  If you can hold a gulp for a few seconds you prevent it from lowering the carbon dioxide level.

 

To sum up, breathe in and out as slowly and evenly as you can and avoid any big increase in depth as you do so.

TO HELP YOURSELF SLOW DOWN YOUR BREATHING YOU COULD:

 

Count to yourself while breathing.  To start off with you might say “one thousand” to your self while breathing in and “two thousand” while breathing out so your breathing would be:

 

IN                     OUT                        IN

 

“one thousand”     “two thousand”      “one thousand”    etc.

 

and soon you might be able to say more to yourself while breathing in and out and so take longer to do it.

 

For example,

 

IN                                                 OUT

 

“one thousand, two                       “three thousand,  four

thousand”                                     thousand”

 

 

*  The feeling of being out of breath that people sometimes get when anxious is paradoxically often caused by breathing too much air.  Taking in less air for a little while will often make it go away.  We don’t know why some people become breathless after over breathing but it is a well established fact that they do.

Improving Social Skills in Brain Injury

Following brain injury it can be common to find it difficult to interact with others socially. Here are some tips to making those situations easier

You can learn how to start a conversation and converse with anybody, anytime.

 

1. In order to make interesting conversation, you must be interesting to others. Keeping yourself informed on current events, staying involved in activities, and keeping a mental list of good topics of discussion are excellent ways to break the ice. And a great tool to help you learn how to start a conversation with almost anybody.

 

2. Instead of focusing on how uncomfortable you feel, prepare yourself by thinking of the issues that interest you most and what you would like to discuss about a particular subject.

A little preparation will go a long way in enabling you to easily converse with others. Don’t be afraid to ask questions.

In general, people like to talk about themselves and will respond favourably when asked simple, friendly questions. Learning how to start a conversation is not quite as difficult if you prepare in advance.

 

3. Make an effort to be a good listener when starting a conversation. After you make the initial effort, listen closely to the other person’s response.

Often you’ll find an invitation to continue the conversation if you listen carefully and respond accordingly. Balance is the key in any conversation.

Alternate between talking and listening to what the other person is saying and make additional comments as appropriate.

Learning how to start a conversation is really just using good manners and showing a genuine interest in others.

 

4. Even if you find it extremely difficult, always greet those you encounter with a smile and look them directly in the eye.

It may be hard at first, but self-confidence is a learned skill and by acting confidently, you will gain new self-confidence.

Soon enough you will notice that it is not as hard to maintain eye contact and carry on a conversation. Act confidently and you will eventually become confident.

Developing self-confidence is an important part of learning how to start a conversation.

5. Try to remember small details about co-workers and acquaintances. Asking about a weekend plan or a relative is an excellent way to start a conversation and show genuine interest in those around you.

If you are interesting, attentive, and act with confidence you will appear to be the kind of person people like to have as a friend.

By practicing these new skills until they become second nature, you will increase your own self-esteem and learn how to start a conversation easily.

Learning how to start a conversation is really just a process of practicing your social skills until they become a habit.

Repetition and determination are the most important factors in building your level of confidence and conversing effortlessly in any situation.

 

 

If you need to improve your conversational skills, here are a few tips that can help you enhance your conversational skills and boost your image.

 

1. Always say what you think, not what you think others want you to say. Especially in a professional setting, learning to express your views and ideas in a positive, non-threatening manner will invite reactions and responses.

Effective leaders always say what they are thinking and express their ideas freely. Having the courage to speak your mind as well as listening openly to the views and ideas of others is a sure way to earn the respect and admiration of all those you encounter.

 

2. Listen carefully to what others are saying. People often interpret things said by others in a way that clouds their ability to hear what people are intending to say.

By giving your full attention to the speaker, you can hear what they intend for you to hear instead of what you want to hear.

The art of conversation includes the ability to listen to others as well as the ability to speak effectively.

 

3. Always assume that a speaker is saying exactly what they mean to say. Even if it seems unclear, try to find meaning and coherence to the words they are saying and give them the respect of hearing what they want you to hear.

In any conversation, the ability to give respect is just as important as receiving it. The art of conversation is a give and take between parties, not one speaker and one listener.

 

4. Any conversation can be broken down into three parts.

The first part is small talk. Small talk is dictated by social rules and includes polite greetings, inquiries about the well-being of others, etc.

Stage two is the end of the small talk and moving on to the purpose of the conversation such as business, the sharing of opinions and personal views.

Without the ability to express yourself efficiently, the conversation can easily slip back into small talk, lessening the chances of accomplishing the initial goal of the conversation.

The third part of a conversation is where the various ideas and views expressed can be merged into a satisfying end for all parties involved in the conversation.

The art of conversation is a learned skill that is common among successful, energetic people. If you are unable to effectively express yourself in any situation, you will likely find that you do not attract the attention and command the respect that is bestowed upon some others.

People who talk freely and easily with others usually find more professional and personal fulfilment than those who are introverted and silent.

If you want to improve your professional and social standing, learn to communicate efficiently and in a positive manner.

You will notice a dramatic difference in the way other people perceive you if you demonstrate self-confidence and project a friendly, informed image.

 

 

CHALLENGES TO UPSETTING THOUGHTS USING CBT IN BRAIN INJURY

When adjusting to a head injury it can be common to experience low mood or depression. An effective way to manage this is using principles of Cognitive Behavioural Therapy to “challenge thoughts”.

 

  • What is the evidence ?

            What evidence do I have to support my thoughts ?

What evidence do I have against them ?

 

  • What alternative views are there ?

How would someone else view this situation ?

How would I have viewed this situation in the past ?

 

  • What is the effect of thinking the way I do ?

Does it help me, or hinder me from getting what I want ?  How ?

 

  • What thinking error am I making ?

(a)   Am I thinking in all-or-nothing terms

ignoring the middle ground ?

 

            (b)   Am I catastrophizing

overestimating the chances of disaster ?

 

(c)   Am I personalizing

blaming myself for something which is not my fault ?

 

(d)   Am I focusing on the negative

looking on the dark side; ignoring my strengths ?

 

(e)   Am I jumping to conclusions

predicting the future and mind-reading ?

 

            (f)   Am I living by fixed rules

fretting about how things ought to be; overusing the words

                  should, must and can’t ?

 

  • What action can I take ?

What can I do to change my situation ?

Am I overlooking solutions to problems on the assumption they

won’t work ?

Managing Anger – Self Statements

Anger issues can be common following head injury. Have a look at the following statements that may help with this initially.

For further help please contact Alba Psychology.

ANGER MANAGEMENT  – COPING  SELF-STATEMENTS

Following brain injury it is common to experience difficulties with mood regulation or anger. A useful way of coping with these is the use of “self talk” or “self statements” which can be used to review your behaviour following a situation.

PREPARING FOR A PROVOCATION

This could be a rough situation, but I know how to deal with it.

I can work on a plan to handle this.

Easy does it.

Remember, stick to the issues and don’t take it personally.

There won’t be any need for an argument.

I know what to do.

IMPACT AND CONFRONTATION

As long as I keep my cool, I’m in control of the situation.

You don’t need to prove yourself.

Don’t make more of this than you have to.

There is no point in getting angry.

Think of what you have to do.

Look for the positives and don’t jump to conclusions.

COPING WITH AROUSAL

Muscles are getting tight, relax and slow things down.

Time to take a deep breath, let’s take the issue point by point.

My anger is a signal of what I need to do.

Time for problem solving.

He probably wants me to get angry, but I’m going to deal with this constructively.

SUBSEQUENT REFLECTION

A.  Conflict unresolved

Forget about the aggravation.

Thinking about it only makes me upset, try to shake it off.

Don’t let it interfere with your job.

Remember relaxation.

Don’t take it personally.

It’s probably not so serious.

B.  Conflict resolved

I handled that one pretty well.

That’s doing a good job.

I could have become more upset than it was worth.

My pride can get me into trouble, but I’m getting better at this all the time.

I actually got through that without getting angry.

Haskell & Co Solicitors

A prompt and efficient service, resulting in a positive outcome for our client (Haskell & Co Solicitors, Kent)

Cognitive Impairment, Substances and Ability to Drive

The current guidelines provided by the DVLA suggest you should not drive for a period of time if you have a neurological condition, such as brain injury, that impairs your cognitive function. This applies to cognitive impairment associated to substance use, however, how do substances impact on your cognitive function in terms of ability to drive? The evidence in this area is not clear however some useful guidance is provided by USA – National Highway Traffic Safety Administration, and is discussed below.

 Methadone

In individuals receiving 35-85 mg methadone daily, significant impairment was measured on attention, perception and learning tasks but there was no reaction time deficit. In individuals receiving a daily average of 63 mg methadone, significant impairment in distance perception, attention span and time perception was observed. No significant adverse effects were measured with addicts stabilized for at least 1 year on daily oral doses of methadone

Cannabis

The short term effects of marijuana use include problems with memory and learning, distorted perception, difficultly in thinking and problem-solving, and loss of coordination. Heavy users may have increased difficulty sustaining attention, shifting attention to meet the demands of changes in the environment, and in registering, processing and using information. In general, laboratory performance studies indicate that sensory functions are not highly impaired, but perceptual functions are significantly affected. The ability to concentrate and maintain attention are decreased during marijuana use, and impairment of hand-eye coordination is dose-related over a wide range of dosages.Impairment in retention time and tracking, subjective sleepiness, distortion of time and distance, vigilance, and loss of coordination in divided attention tasks have been reported. Note however, that subjects can often “pull themselves together” to concentrate on simple tasks for brief periods of time. Significant performance impairments are usually observed for at least 1-2 hours following marijuana use, and residual effects have been reported up to 24 hours.

 

Heroin

Performance Effects: Laboratory studies have shown that morphine may cause sedation and significant psychomotor impairment for up to 4 hours following a single dose in normal individuals. Early effects may include slowed reaction time, depressed consciousness, sleepiness, and poor performance on divided attention and psychomotor tasks. Late effects may include inattentiveness, slowed reaction time, greater error rate in tests, poor concentration, distractibility, fatigue, and poor performance in psychomotor tests. Subjective feelings of sedation, sluggishness, fatigue, intoxication, and body sway have also been reported. Significant tolerance may develop making effects less pronounced in long-term users for the same dose. In a laboratory setting, heroin produced subjective feelings of sedation for up to 5-6 hours and slowed reaction times up to 4 hours, in former narcotic addicts. Euphoria and elation could also play a role on perception of risks and alteration of behaviors.

Effects on Driving: The drug manufacturer states that morphine may impair the mental and/or physical abilities needed to perform potentially hazardous activities such as driving a car, and individuals must be cautioned accordingly. Driving ability in cancer individuals receiving long-term morphine analgesia (mean 209 mg daily) was considered not to be impaired by the sedative effects of morphine to an extent that accidents might occur. There were no significant differences between the morphine treated cancer individuals and a control group in vigilance, concentration, motor reactions, or divided attention. A small but significant slowing of reaction time was observed at 3 hours. In several driving under the influence case reports, where the subjects tested positive for morphine and/or 6-acetylmorphine, observations included slow driving, weaving, poor vehicle control, poor coordination, slow response to stimuli, delayed reactions, difficultly in following instructions, and falling asleep at the wheel.

Diazepam

Performance Effects: Laboratory studies have shown that single doses of diazepam (5-20 mg) are capable of causing significant performance decrements, with maximal effect occurring at approximately 2 hour post dose, and lasting up to at least 3-4 hours. Decreases in divided attention, increases in lane travel, slowed reaction time (auditory and visual), increased braking time, decreased eye-hand coordination, and impairment of tracking, vigilance, information retrieval, psychomotor and cognitive skills have been recorded. Lengthened reaction times have been observed up to 9.5 hours post dose. Lethargy and fatigue are common, and diazepam increases subjective perceptions of sedation. Such performance effects are likely to be exacerbated in the elderly. In drug users, diazepam has greater behavioral changes, including subjects’ rating of liking and decrements in psychomotor and cognitive performance. Reduced concentration, impaired speech patterns and content, and amnesia can also be produced, and diazepam may produce some effects that may last for days. Laboratory studies testing the effect of ethanol on subjects already using benzodiazepines demonstrate further increases in impairment of psychomotor and other driving skills, compared to either drug alone.

Effects on Driving: The drug manufacturer suggests individuals treated with diazepam be cautioned against engaging in hazardous occupations requiring complete mental alertness such as driving a motor vehicle. Simulator and driving studies have shown that diazepam produces significant driving impairment over multiple doses. Single doses of diazepam can increase lateral deviation of lane control, reduce reaction times, reduce ability to perform multiple tasks, decrease attention, adversely effect memory and cognition, and increase the effects of fatigue. Significant impairment is further increased when diazepam is combined with low concentrations of alcohol (0.05 g/100 mL). A number of epidemiological studies have been conducted to evaluate the risk of crashes associated with the use of diazepam and other benzodiazepines. These show a range of relative risk, but most demonstrate increases in risk compared to drug free drivers. These increases have been twice to several fold. The elderly may have an increased risk of a motor vehicle crash.

Amphetamine

Performance Effects: Laboratory studies have been limited to much lower doses than those used by methamphetamine abusers. Doses of 10-30 mg methamphetamine have shown to improve reaction time, relief fatigue, improve cognitive function testing, increase subjective feelings of alertness, increase time estimation, and increase euphoria. However, subjects were willing to make more high-risk choices. The majority of laboratory tests were administered 1 hour post dose. Expected performance effects following higher doses may include agitation, inability to focus attention on divided attention tasks, inattention, restlessness, motor excitation, increased reaction time, and time distortion, depressed reflexes, poor balance and coordination, and inability to follow directions.

Effects on Driving: The drug manufacturer states that individuals should be informed that methamphetamine and amphetamine may impair the ability to engage in potentially hazardous activities such as driving a motor vehicle. In epidemiology studies drive-off-the-road type accidents, high speed, failing to stop, diminished divided attention, inattentive driving, impatience, and high risk driving have been reported. Significant impairment of driving performance would also be expected during drug withdrawal. In a recent review of 101 driving under the influence cases, where methamphetamine was the only drug detected, blood concentrations ranged from <0.05-2.36 mg/L (mean 0.35 mg/L, median 0.23 mg/L). Driving and driver behaviors included speeding, lane travel, erratic driving, accidents, nervousness, rapid and non-stop speech, unintelligible speech, disorientation, agitation, staggering and awkward movements, irrational or violent behavior, and unconsciousness. Impairment was attributed to distraction, disorientation, motor excitation, hyperactive reflexes, general cognitive impairment, or withdrawal, fatigue and hypersomnolence.

Customer Service Survey 2014

Alba Psychology recently carried out a survey with all instructing solicitors over the past year. The results are very interesting and are described below.

Q1. How satisfied were you with the quality of the report Alba Psychology provided?

66% of respondents said they were “Very Satisfied”

16% of respondents said they were “Extremely Satisfied”

Q2. How satisfied were you with the turnaround time of the report?

53% of respondents said they were “Very Satisfied”

18% of respondents said they were “Extremely Satisfied”

Q3. How satisfied were you with the usefulness of the report provided?

68% of respondents said they were “Very Satisfied”

14% of respondents said they were “Extremely Satisfied”

Q4. How satisfied were you with the level of communication provided by Alba Psychology?

 75% of respondents said they were “Very Satisfied”

15% of respondents said they were “Extremely Satisfied”

Overall the results look extremely positive in terms of our performance over 2013 however we will endeavor to improve the performance of Alba Psychology in 2014.

Please do not hesitate to contact us if you have anything you wish to feedback about your experience with Alba Psychology.

Best wishes,

Fraser

Dr Fraser Morrison

Clinical Director, Alba Psychology

Anonymous Solicitor

The report received proved to be very useful, and helped lead to a £300,000 recovery by our clients. Very satisfied with the service provided, and in particular the helpful communication with Dr Morrison (Anonymous Solicitor, January 2014)