Objective: To identify the systems available to sub-classify mild traumatic brain injury (TBI) and to determine their utility in predicting 1-year outcome.

Methods: A systematic review to identify mild-TBI sub-classification systems was conducted until March 2016. The identified systems were applied to a cohort of N = 290 adults who had experienced a mild-TBI, and who had been assessed for post-concussion symptoms 1-year post injury. ANOVAs and regression models were used to determine whether each sub-classification system could distinguish between outcomes and to explore their contribution to explaining variance in post-concussion symptoms 1-year post injury.

Results: Nineteen sub-classification systems for mild-TBI met the inclusion criteria for this review. The Saal (1991) classification system significantly differentiated the experience of post-concussion symptoms in our cohort 1-year post injury (F = 2.39, p = 0.05). However, the findings did not remain significant following correction for multiple comparisons and inclusion of socio-demographic and contextual factors in the regression model.

Conclusions: Current sub-classification systems fail to explain much of the variance in post-concussion symptoms 1 year following mild-TBI. Further research is needed to identify the factors (including socio-demographic and contextual factors) to determine, who may be at risk of developing persistent post-concussion symptoms.

We are pleased to bring you this special issue of Brain Impairment on quantitative data analysis, an area of increasing complexity and sophistication. In planning the special issue, our intention was to bring together a set of articles covering diverse and topical areas in the field, with the idea of having the volume serve as a ‘go-to’ resource. The special issue is aimed at researchers, clinicians engaged in research, and advanced students all of whom may have passing familiarity with a particular data analytic technique, but wish to know more about it and how to apply it. Accordingly, our aim is to equip the reader with concrete, hands-on information that can be applied in the day-to-day world of research. The authors of the articles comprising the special issue, each of whom is an expert in his/her field, were charged with the task of writing a practical guide and providing worked examples to illustrate the application of their selected technique/s. The papers in the special issue cover three domains: the single-case method, between-groups design, and psychometric aspects of instrument development.

Establishing a viable program of care and support for people with severe brain injury is challenging for professionals and family members. The aims of this grounded theory study were to explore how decisions about care were made following brain injury when an individual had received third party compensation, and factors or conditions that influenced care. The sample (n = 51) included 14 people with traumatic brain injury (mean age 36.5 years, range 19–56; mean time post-injury 9.9 years, range 2.5–37), and 37 ‘others’, who either provided or coordinated care (12 family members, 14 paid carers, 6 case managers, 4 directors of care agencies and 1 estate manager). Data were collected using single interviews with each participant. All 14 people with brain injury had received 24-hour support at the time of hospital discharge; at follow-up, only 8 received 24-hour support. Care decision-making and care maintenance occurred as an iterative process. Participants made decisions about the best living situation, configuration of carers and level of care, and then strived to maintain stable care. Care decision-making involved three key strategies (gathering information, appraising alternatives, and enacting a decision). Care maintenance also involved three key strategies (monitoring, managing conflict and supporting carers). Mutual risk tolerance and the presence of a case manager were necessary conditions for good care management, and enabled a person with brain injury to spend time alone, take low-level risks and experience autonomy. Professionals and family carers can use the findings of this study to actively increase risk taking and autonomy.

Impaired somatosensory processing could contribute to handgrip limitation following stroke. The aim of this study was to examine the association between somatosensory function measured by psychophysical tests and clinical measures of handgrip limitation poststroke. Forty-five people with stroke who could perform a pinch grip task were recruited from rehabilitation settings. Ability to discriminate surface friction, and to match object weight were quantified using psychophysical methods. Handgrip limitation was measured using items of the Motor Assessment Scale, Jebsen Taylor Hand Function Test and the Hand Function Survey. Impaired discrimination of surface friction was moderately to weakly associated with handgrip limitation (rs = .36 to .55). In contrast, an association between degree of impairment in matching weight and handgrip limitation poststroke was not observed (rs < .24). The findings suggest that processing of tactile cues arising between the object and skin when training handgrip ability may be beneficial for people with stroke.

The Australian community is ageing; over the next 40 years, our population over the age of 65 years will double to around 23%, and this considerable increase in older adults means an increasing number of people will be at risk of sustaining trauma through falls or road traffic accidents. In contrast to the increasingly well-documented outcome literature on younger adults, very few studies have focused on older adults. Instead of assuming that outcomes posttraumatic brain injury (post-TBI) will follow similar patterns as in younger samples, there are several reasons to investigate older age recovery separately, and these issues will be discussed by reviewing some of the primary characteristics of older adults who experience traumatic brain injury.

Skilled action is the end-product of learning processes that can improve several aspects of motor control such as strategic movement organisation, perceptual–motor associations, or muscle commands for basic components of sequentially evolving, complex movements. Experimental studies in healthy participants using functional imaging and transcranial magnetic stimulation have identified separable processes that form cortical motor representations and that assist this formation of representations. These processes capitalise on use-dependent plasticity and changes in cortical excitability before and after practice. In terms of neural circuits, motor learning manifests measurably via structures that support transient phenomena, such as attentive error monitoring, or through continued activation of brain structures that support control processes still adapting. Specifically, movement guidance engages the dorsal premotor and parietal cortex along the intraparietal sulcus in addition to the supplementary motor area and the anterior cerebellum. Movement conception based on explicit experience of the movement task involves the inferior premotor cortex. Evidence in patients recovering from brain lesions such as stroke, suggests that similar principles hold for neurorehabilitation as well. The challenging issue is to what degree altered motor strategies afford improvement in function through relearning and neural plasticity.

Many controversies remain with respect to how best to work with individuals who are challenged by cognitive impairments. Yet in the last decade, there has been substantial new research and a proliferation of literature, which has served to clarify major principles underlying cognitive interventions, and specified training procedures and teaching techniques that have demonstrated some effectiveness. Increasingly, it is possible to identify what techniques are likely to work for a particular individual, based on a number of variables including their cognitive profile, level of insight, and capacity for self-regulation. Education, the development of compensatory behaviours, the use of specialised instructional techniques and the inclusion of activities to improve self awareness and self-efficacy are but a few of the important components of most efforts at rehabilitation for cognitive impairments. Cognitive rehabilitation must be creative, eclectic, functionally oriented, and based in a partnership between clients, families/caregivers, and professionals.

This article reviews literature in aphasia rehabilitation in the English-speaking world. Although attempts have been made to incorporate literature from other continents, the major bias is toward North America. Four themes are emphasised. They are (1) advances in neuroscience that have already realised influences in language rehabilitation and some that have potential influence for the near future; (2) effects on language rehabilitation that have resulted from the worldwide acknowledgment and acceptance of the International Classification of Functioning, Disability, and Health (ICF); (3) the growing emergence of psychosocial concerns in the management of aphasia; and (4) present and future applications of technology to aphasia rehabilitation. For the sake of manageability, the review is largely limited to the rehabilitation literature of the decade from 1998, and to published or in-press work that is programmatic in the sense that it represents more than a single publication.

Many citizens misunderstand the actions of persons with brain injury, and these misunderstandings hamper rehabilitation. A specific misunderstanding is where people misattribute behaviours resulting from brain injury to the injured person's personality or life stage (e.g., adolescence). The present study examined if this pattern is explained by the Abnormal Conditions Focus model of attribution, which claims that attributions for behaviours reflect whether the behaviours are normal for the person (Consistency) and the culture (Consensus). Scenarios described an adolescent with brain injury performing four undesirable behaviours and then indicated whether the behaviour was normal or not normal for the person prior to injury and normal or not normal for that person's culture. For each of the four behaviours, students (n = 136) rated three attributions: brain injury, personality and adolescent norms. Participants attributed the behaviours more to brain injury and less to personality when the behaviours were not normal for that person than when they were normal for the person. They attributed the behaviours more to adolescence when the behaviours were normal for the person's culture than when they were not normal for the culture. Rehabilitation implications include assessing individuals' premorbid behaviour to enable citizens and less experienced professionals to make more accurate attributions for behaviours and target treatment more effectively.

Objectives: Neuropsychological assessment of memory disorders is an important prerequisite in the treatment of patients with alcohol-related cognitive disorders. Although many memory tests are available in clinical practice, a question remains regarding which test is most appropriate for this purpose. Our study's goal was to evaluate the discriminative power of indices of a standard memory test (the California Verbal Learning Test; CVLT) versus the subtests of an ecologically valid everyday memory test (the Rivermead Behavioural Memory Test; RBMT) in patients with alcohol-use disorder.

Method: The patients included 136 with Korsakoff's syndrome (KS), 73 alcoholics with cognitive impairment (CI) not fulfilling the criteria for KS, and 24 cognitively unimpaired alcoholics (ALC).

Results: KS patients performed significantly lower on all RBMT and CVLT variables than CI patients. ALC patients performed significantly better than CI patients on only one RBMT subtest, and had a significantly lower rate of forgetting and higher scores on free recall on CVLT. A combination of RBMT subtests and CVLT indices was able to discriminate KS patients from CI and ALC patients. The RBMT subtests could not significantly distinguish ALC from CI patients. Both rate of forgetting and a comparison between free and cued recall testing on the CVLT showed the largest between-group differences.

Conclusion: Although the RBMT provides information about everyday memory performance, the CVLT indices are better able to distinguish between uncomplicated alcoholics and those with cognitive impairment or KS.

Neuroscientific evidence indicates that human social functioning is supported by a distributed network of frontal and temporal brain regions that undergoes significant development during childhood and adolescence. Clinical studies of individuals with early brain insults (EBI) to frontotemporal regions suggest that such lesions may interfere with the maturation of sociocognitive skills and lead to increased sociobehavioural problems. However, little attention has focussed on the direct assessment of sociocognitive skills, such as moral reasoning, following focal EBI. In the present study, the performance of 15 patients with focal EBI (8–16 years) was compared to that of 15 demographically matched controls on basic neuropsychological measures (IQ and executive functions), sociocognitive tasks (moral reasoning, moral decision-making and empathy) and parent reports of sociobehavioural problems and social adaptive skills. Patients with focal EBI had significantly lower levels of moral reasoning maturity, moral decision-making, and empathy than their matched controls, but did not differ on more general measures of cognition. Their parents also reported increased sociobehavioural problems. These findings suggest that focal EBI to frontotemporal regions can result in reduced sociocognitive capacities, more specifically moral reasoning, and increased vulnerability to sociobehavioural problems.

The aim of this study was to develop and pilot a posttraumatic amnesia scale (PTA) scale for children aged between four and six years. The scale consists of seven orientation questions and five memory items modelled on the Westmead PTA Scale which assesses posttraumatic amnesia in children from eight years onwards and adults. The sample consisted of 45 four-year-olds, 82 five-year-olds and 49 six-year-old children from a variety of cultural and socioeconomic backgrounds. Children were recruited from hospitals, kindergartens and schools. Results were analysed across age groups using means and standard deviations. The orientation and memory items were analysed separately as well as in combination. Early analyses indicate that the majority of normal children in the four to 6 year age group can answer most of the orientation questions correctly and remember the memory stimuli from day to day. The results indicate that the Starship PTA Scale is suitable for young children aged 4 to 6 years. It is simple and quick to administer and utilises an operational definition of posttraumatic amnesia in terms of measuring continuous memory.

We report on the development of a new assessment tool to monitor recovery after severe traumatic brain injury (TBI). Although a number of scales exist to identify such recovery, most are limited if one is interested in monitoring small changes or in setting goals for rehabilitation. This is due to the fact that items are too broad, they may cross more than one dimension (e.g. cognition and motor functioning) and there is a danger that recording of responses may be too subjective. The Wessex Head Injury Matrix (WHIM) was developed to avoid these problems. We observed 88 people with severe TBI. These were consecutive admissions to two hospitals. Mean coma duration was 14 days and mean duration of post traumatic amnesia (PTA) was 56 days. Of 145 behaviours observed, we selected 62 and each behaviour was compared to every other behaviour to determine a likely order of recovery. The resulting WHIM is an observational tool to assess and monitor cognitive recovery after severe head injury. It can be used with patients who are in coma, just out of coma or who are minimally conscious. Two case examples are provided.