says. “I wanted to create an image, and I just thought well, a phoenix rising from the ashes will sum up my journey really, because I’ve come from a really dark place into a more hopeful place. And I wanted to have it full of colour, because the phoenix has so much life - it’s just had a bit of a difficult journey.” This vignette illustrates the point that the Centre is interested in a highly individualised outcome – here we gather that Nat has developed a new understanding of herself achieved in part through artwork, and the psychologically meaningful image of a phoenix – seems so pertinent to Nat. The OZC team is interested in standardised measures. As outlined in Wilson et al (2009), we consider it important to link the assessment and therapy to models to enable reviewing of our work in the context of peer reviewed research. One of the teams’ major strands of work has been in the measurement and rehabilitation of Executive Function problems. With inspiration from Donald Stuss’ concepts about the nature of frontal lobe functions (Stuss 2011), the Dysexecutive Function Questionnaire (DEX) from the Pearson published BADS test battery (Wilson, et al 1996) has been examined using Rasch techniques. Simblett and Bateman (2011) demonstrated the need to revise the original questionnaire, – A DEX-R scale – not yet published – was constructed to provide a symptom checklist that gives a balanced number of items for each of the putative frontal lobe symptom clusters. The scale has been subjected to validation assessment with stroke patients. Interestingly Brazilian visiting scholar Fabricia Loschiavo translated the DEX-R into Portuguese and used it to assess patients with Bipolar disorder in the psychiatric clinic in her home City of Minas Gerais. She found that the tool could detect differences between BiPolar-type 1 and type 2 patients – type 1 exhibiting greater difficulties in the functions related to orbitofrontal functions (metacognitive, social and self-regulation symptoms). These findings provided a foundation for further work examining the potential role of neuropsychological rehabilitation in this patient group (Loschiavo et al 2013). This is an exciting development from the point of view of the OZC team to find that the development work done with patients with acquired brain injury may have broader applicability. Sara Simblett recently completed her PhD at the Dept of Psychiatry University of Cambridge, on the subject of self-help and technology. She undertook clinical work with stroke patients living at home in Cambridgeshire, bringing forward the 10 BRAIN INJURY PROFESSIONAL
idea of computerised Cognitive Behavioural Therapy (see Simblett, Ring and Bateman, 2012). This approach is widely used to support self management of anxiety and depression in non-brain injured patients. Simblett has demonstrated in her thesis that some stroke patients could really benefit from this approach too, with reductions in anxiety and depression symptoms in a feasibility randomised controlled trial. Looking ahead, we see at OZC much potential for this type of approach. The team is working on developing a monitored self-assessment and self-help system that enables learning and revision of key topics (such as monitoring thoughts, goal setting, activity scheduling, and relaxation exercises). In summary, some of the recent work that has been happening at Oliver Zangwill Centre has included neuropsychological rehabilitation outcomes research, international collaborations and very early steps towards establishing a computerised self-help platform that may be of interest to patient groups in addition to those with acquired brain injury. The challenges to being able to deliver compassionate and comprehensive rehabilitation are great, so there is a great need to keep working on research in this field.
References
Ashworth, F., Gracey, F. & Gilbert, P. Compassion Focused Therapy After Traumatic Brain Injury: Theoretical Foundations and A Case Illustration. Brain Impairment. 2012; 12(2):138-149. Bateman (2014) Foreward to Cameron, M., and Marsh, S. (2014) Surviving is one thing, Living is Quite Another. The Ajahma Charitable Trust [http://www.publicserviceworks. com/] Bowen, C., Yeates, G and Palmer, S (2010) A Relational Approach to Rehabilitation: Thinking about Relationships after Brain Injury. Karnac Brain Injury Series. Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T. Evidence based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil 2011;92 519-30. Loschiavo, F. Q., Sediyama, C., Neves, F., Malloy-Diniz, L. F., & Bateman, A. (2013, June). Neuropsychological rehabilitation for bipolar disorder. Bipolar Disorders 15, 130-131 Prigatano, G. (1999) Principles of Neuropsychological Rehabilitation. Oxford University Press SK Simblett, A Bateman Dimensions of the Dysexecutive Questionnaire (DEX) examined using Rasch analysis Neuropsychological Rehabilitation 21 (1), 1-25 Simblett, S.K. Ring, H. and Bateman A (2011) Computerised cognitive behavioural therapy (cCBT): a possible treatment for mood disorders experienced by people with neurological conditions? Neuropsychological Rehabilitation 21(6)925-928 Stuss DT. 2011. Traumatic brain injury: relation to executive dysfunction and the frontal lobes. Current Opinion Neurology 24(6):584-9. Wilson, B.A, Gracey,F. Evans,J.J and Bateman,A.(2009) Neuropsychological Rehabilitation: Theory, Models, Therapy and Outcome. Cambridge University Press; Wilson, B.A, Winegardner, J., and Ashworth F. (2014) Life After Brain Injury: Survivors’ Stories. Psychology Press Wilson, B.A, Alderman, N., Burgess, P.W., Emslie, H., Evans, J.J. (1996) Behavioural Assessment of Dysexecutive Syndrome. Thames Valley Test Company (now published by Pearsons)
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