This presentation discusses six patients with different problems, referred for rehabilitation, who challenged my views on how to apply neuropsychological principles to their treatment. We begin with Derek, who had sustained a traumatic brain injury from a gunshot wound. I was asked to reduce his weight, but he could not read or write because of the brain injury so I had to find another way to achieve the weight loss. This made me realize that neuropsychologists have to "think on their feet" and be flexible. The second patient is Kate, who developed brain stem encephalitis. Expected to die, and unable to speak, she convinced me that, however severe the injury, we should not give up and recovery can continue for many years. Kate, managed to speak intelligibly fourteen years after her illness! The next patient, Claire, a school nurse, had herpes simplex encephalitis which left her with prosopagnosia and extreme anxiety. Her story made me realize the personal consequences of prosopagnosia that is typically overlooked by most neuropsychologists. The fourth patient, Gary, was attacked by a gang while saving his father. He remained in a state of unconsciousness for 19 months and, thus, had a very poor prognosis. Nevertheless, he defied the predictions of all medical staff, woke up and did very well. The penultimate patient is Natasha, who, as far as we know is the only person in the world to have two syndromes, "Sheehans Syndrome" which is very rare in developed countries and "Sickle cell disease" which is not rare. As a result of the Sheehan's she developed Balint's Syndrome. Her case made me learn about Sheehan's Syndrome and accept that Natasha's main goal in life, was not what I expected it to be. The final patient is Paul, an opera singer, who was diagnosed with" Locked-in Syndrome" following a brain stem stroke. Not only was he a good communicator once a good system was found, but he felt he had a good quality of life by" living within his head". Although many of us feel that to be fully conscious but totally dependent on others, is a very cruel situation to be in, Paul did not feel this. All these patients taught me a great deal and I thank them for this.

Upon conclusion of this course, learners will be able to:

1. 1. Describe the main purposes of neuropsychological rehabilitation

2. 2. Discuss about six patients who challenged typical concepts about neuropsychological rehabilitation

3. 3. Gain some knowledge about Sheehan's syndrome

4. 4. Explain the three components of Balint's syndrome

5. 5. Summarize the difference between Locked-in syndrome and the minimally conscious state

6. 6. Recognize some of the anatomy associated with these syndromes

The quenching of cluster satellite galaxies is inextricably linked to the suppression of their cold interstellar medium (ISM) by environmental mechanisms. While the removal of neutral atomic hydrogen (H i) at large radii is well studied, how the environment impacts the remaining gas in the centres of galaxies, which are dominated by molecular gas, is less clear. Using new observations from the Virgo Environment traced in CO survey (VERTICO) and archival H i data, we study the H i and molecular gas within the optical discs of Virgo cluster galaxies on 1.2-kpc scales with spatially resolved scaling relations between stellar ($\Sigma_{\star}$), H i ($\Sigma_{\text{H}\,{\small\text{I}}}$), and molecular gas ($\Sigma_{\text{mol}}$) surface densities. Adopting H i deficiency as a measure of environmental impact, we find evidence that, in addition to removing the H i at large radii, the cluster processes also lower the average $\Sigma_{\text{H}\,{\small\text{I}}}$ of the remaining gas even in the central $1.2\,$kpc. The impact on molecular gas is comparatively weaker than on the H i, and we show that the lower $\Sigma_{\text{mol}}$ gas is removed first. In the most H i-deficient galaxies, however, we find evidence that environmental processes reduce the typical $\Sigma_{\text{mol}}$ of the remaining gas by nearly a factor of 3. We find no evidence for environment-driven elevation of $\Sigma_{\text{H}\,{\small\text{I}}}$ or $\Sigma_{\text{mol}}$ in H i-deficient galaxies. Using the ratio of $\Sigma_{\text{mol}}$-to-$\Sigma_{\text{H}\,{\small\text{I}}}$ in individual regions, we show that changes in the ISM physical conditions, estimated using the total gas surface density and midplane hydrostatic pressure, cannot explain the observed reduction in molecular gas content. Instead, we suggest that direct stripping of the molecular gas is required to explain our results.

OBJECTIVES/GOALS: To examine i) how longstanding (≥6 years) community-based participatory research (CBPR) partnerships nationwide implemented a validated questionnaire to measure success and its contributing factors and ii) how the CBPR partnerships utilized and applied a feedback mechanism, or reports of findings from the questionnaire and a facilitation guide METHODS/STUDY POPULATION: This mixed methods study builds upon a larger NIH-funded project entitled ’Measurement Approaches to Partnership Success (MAPS). MAPS developed and validated the 109-item MAPS questionnaire to measure success in longstanding (≥6 years) CBPR partnerships. In 2020, 55 CBPR partnerships nationwide completed the MAPS Questionnaire and, a year later, received the MAPS Feedback Mechanism, consisting of questionnaire findings and a facilitation guide on how to present the findings. In this follow-up study, we administered multi-method surveys to each partnership contact person in 2022 to examine their experience with and utility of the MAPS Questionnaire and the MAPS Feedback mechanism. We performed descriptive analysis of quantitative responses using SAS and thematic analysis of qualitative responses. RESULTS/ANTICIPATED RESULTS: Survey responses have been presently collected from 14 partnerships. Preliminary findings suggest that the most frequently reported benefits of completing the MAPS Questionnaire included stimulating partnership reflections and ease of completion. Many partnerships shared results of the MAPS Questionnaire by e-mail or during partnership meetings. Nearly half of the partnerships rated components of the MAPS feedback mechanism as useful. Over one-third of the partnerships reported that the COVID pandemic limited their capacity to engage with the MAPS Feedback Mechanism. Key qualitative suggestions included making the MAPS Questionnaire shorter, providing it in a different format, and offering additional facilitation to support the implementation of the MAPS Feedback Mechanism. DISCUSSION/SIGNIFICANCE: This study examines how CBPR partnerships utilize an evaluation instrument and apply results on success. Current findings suggest potential utility of the MAPS Questionnaire and Feedback Mechanism for ongoing evaluation. Reducing the questionnaire length and providing facilitation resources may enhance implementation across diverse settings.

Objective. The efficacy of individualized, community-based physical activity as an adjunctive smoking cessation treatment to enhance long-term smoking cessation rates was evaluated for the Lifestyle Enhancement Program (LEAP). Methods. The study was a two-arm, parallel-group, randomized controlled trial. All participants (n = 392) received cessation counseling and a nicotine patch and were randomized to physical activity (n = 199; YMCA membership and personalized exercise programming from a health coach) or an equal contact frequency wellness curriculum (n = 193). Physical activity treatment was individualized and flexible (with each participant selecting types of activities and intensity levels and being encouraged to exercise at the YMCA and at home, as well as to use “lifestyle” activity). The primary outcome (biochemically verified prolonged abstinence at 7-weeks (end of treatment) and 6- and 12-months postcessation) and secondary outcomes (7-day point prevalent tobacco abstinence (PPA), total minutes per week of leisure time physical activity and strength training) were assessed at baseline, 7 weeks, 6 months, and 12 months. Results. Prolonged abstinence in the physical activity and wellness groups was 19.6% and 25.4%, respectively, at 7-weeks, 15.1% and 16.6% at 6-months, and 14.1% and 17.1% at 12 months (all between-group P values >0.18). Similarly, PPA rates did not differ significantly between groups at any follow-up. Change from baseline leisure-time activity plus strength training increased significantly in the physical activity group at 7 weeks (P = 0.04). Across treatment groups, an increase in the number of minutes per week in strength training from baseline to 7 weeks predicted prolonged abstinence at 12 months (P ≤ 0.001). Further analyses revealed that social support, fewer years smoked, and less temptation to smoke were associated with prolonged abstinence over 12 months in both groups. Conclusions. Community-based physical activity programming, delivered as adjunctive treatment with behavioral/pharmacological cessation treatment, did not improve long-term quit rates compared to adjunctive wellness counseling plus behavioral/pharmacological cessation treatment. This trial is registered with https://beta.clinicaltrials.gov/study/NCT00403312, registration no. NCT00403312.

In 2005 Elliott et al. published a paper entitled ‘Effect of posture on levels of arousal and awareness in vegetative and minimally conscious patients: a preliminary investigation’. Twelve patients, of whom 5 were in the vegetative state (VS) and 7 in the minimally conscious state (MCS), were assessed with the Wessex Head Injury Matrix (WHIM) when supine and when upright on a tilt table. The present study replicated and extended these findings by including a third position, sitting, in addition to supine and standing. We assessed 16 patients (8 in the VS and 8 in the MCS) with mixed aetiologies and compared the observed behaviours in three different positions (supine, sitting and standing) using the WHIM. Most patients (75%) showed more behaviours when in the upright position, compared to lying down (p < .003). Our findings are similar to those seen in the study reported by Elliott et al. With regard to sitting, 62.5% of patients were more responsive when assessed sitting in a wheelchair (p < .05) than in a supine position, and almost 69% were more responsive if assessed in an upright position compared to sitting. This was particularly true for patients in the MCS, where 87.5% did better if assessed on a tilt table or standing frame compared to sitting, suggesting that positional changes can have an effect on the level of arousal and awareness among patients in the VS and MCS.

Background: The extent to which care home residents with severe dementia show awareness is influenced by the extent to which the environment provides opportunities for engagement and by the way in which care staff interact with them. We aimed to establish whether training care staff to observe and identify signs of awareness in residents with severe dementia resulted in improved quality of life for residents.

Methods: In this pilot cluster randomized trial, care staff in four homes (n = 32) received training and supervision and carried out structured observations of residents using the AwareCare measure (n = 32) over an eight-week period, while staff in four control homes (n = 33) had no training with regard to their residents (n = 33) and no contact with the research team. The primary outcome was resident quality of life. Secondary outcomes were resident well-being, behavior and cognition, staff attitudes and well-being, and care practices in the home.

Results: Following intervention, residents in the intervention group had significantly better quality of life as rated by family members than those in the control group, but care staff ratings of quality of life did not differ. There were no other significant between-group differences. Staff participating in the intervention identified benefits in terms of their understanding of residents’ needs.

Conclusions: Staff were able to use the observational measure effectively and relatives of residents in the intervention homes perceived an improvement in their quality of life.

The long-term outcome of persons with impaired consciousness after brain injury remains relatively unclear. The first 12 months post ictus are widely reported as the period of greatest change, with an estimated 20% of persons with traumatic brain injury recovering consciousness. However, beyond 12 months post traumatic and 6 months post-nontraumatic injury the chances of further recovery are thought to diminish significantly. The aim of this study was to investigate the behavioural and psychosocial outcome of 12 patients with impaired consciousness 2 years post ictus. At the time of recruitment five of these patients met the diagnostic criteria defining the vegetative state and seven of these patients met the diagnostic criteria defining the minimally conscious state. Patients were assessed using the Wessex Head Injury Matrix at recruitment and again at least 2 years after initial contact. Functional and psychosocial outcome were also explored. Most patients showed some improvements to their behavioural portfolio, but all were still very dependent physically and all required a high level of support in their activities of daily living. None of the patients had emerged from their original condition, despite exhibiting larger behavioural portfolios. The implications of these findings for the management of patients in low awareness states are discussed.

This article considers 10 of the most important developments in neuropsychological rehabilitation over the past 5 years. While several leaders in the field were contacted to discover what they considered to be the most important developments, the selection discussed here is the author's alone and is, therefore, a personal view. Included are: computational models; support for people with dementia; new assessment procedures; new treatment strategies for cognitive, emotional and psychosocial problems; new theoretical models to improve our understanding of the consequences of brain injury; and recognition of the need to find new ways to evaluate the efficacy of rehabilitation. The final section of the article considers possible future developments in rehabilitation, including stronger links with basic neuro-science; better use of imaging procedures; collaboration with pharmaceutical companies; better evaluation of our programs; and the need to educate researchers and practitioners as to the meaning of rehabilitation.

This article is concerned with patients in coma, the vegetative, or minimally conscious states. Studies addressing the issue of assessment and management of these patients are described. These include (a) the development of an assessment tool (Wessex Head Injury Matrix, WHIM); (b) use of the WHIM to assess the effects of posture on arousal, showing that some 75% of patients show more behaviours when assessed while they are in a standing frame than when supine; (c) a comparison of the WHIM with the Glasgow Coma Scale, demonstrating that the WHIM is more sensitive than the GCS for measuring the behavioural repertoire of people in states of reduced consciousness; (d) a discussion of situations when neuro-imaging techniques are required to assess residual functioning; and (e) the long term outcome of one of the first vegetative patients to be scanned with Positron Emission Tomography (PET). We conclude with a discussion about neuropsychology and patients in states of impaired consciousness.

Many studies of cognitive rehabilitation use neuropsychological tests to plan and evaluate treatment. This paper suggests that this is not a good rehabilitation procedure. The main purposes of rehabilitation are to achieve the maximum physical, psychological, social and vocational wellbeing of each individual and to enable people to return to their own, most appropriate environment. We do not engage in rehabilitation in order to help people achieve better scores on tests. This might be acceptable if there were a direct relationship between test scores and real life problems but there is not such a relationship. Although tests are useful in providing a picture of strengths and weaknesses, they are extremely limited in identifying everyday disabilities and handicaps. People can lead improved lives by compensating for or by-passing some of their cognitive problems yet remain unchanged on test scores. Conversely, they can improve on test scores yet remain severely handicapped in everyday life. One approach that is gaining ground in rehabilitation is goal planning. This allows patients/clients, their relatives and rehabilitation staff to negotiate appropriate and meaningful goals, determine how these should be achieved and measure success, or failure in real life situations. Goal planning both reduces the artificial distinction between rehabilitation practice and outcome measures, and allows the integration of theory and practice. The processes and procedures involved in goal planning are described and followed by an evaluative discussion.

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.

Literature published a decade ago reflected a pessimistic view of the market-oriented reforms that Latin America carried out in the 1980s and 1990s, and many politicians have attacked these reforms openly. Indeed, the atmosphere is so negative that it would be reasonable to assume that many of the reforms have been reversed. This paper will take a new look at the situation ten years later. Our argument is that the reforms have generally not been reversed. The reversal that has occurred has been with respect to privatisation in a few countries; negative public opinion is also concentrated on privatisation; and the reforms helped to enable Latin America to take advantage of favourable conditions leading to high growth in the 2004–8 boom period and a relatively strong performance during the 2008–9 crisis. While much remains to be done to raise growth and improve distribution, objective information about the reforms is needed when policies for the future are made.