rene an suzanne visual thinking strategies presentatie 27 september engelstalig versie maandag23
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The efficacy of VTS forpatients with executivefunction deficits afteracquired brain injuryRené ter Horst & Suzanne Kruiper
Executive functions
“The functions that regulate and control cognitive processes.”
Especially important when behavior is not automatic and routine, in new and complex situations (Shallice1988)
Executive function deficits: examples
impulsive
difficulty in grasping the whole picture
difficulty generating thoughts / ideas /solutions to problems
get caught in a thinking rut,
cannot easily shift frames of mind
In social communication:
not listening
jumping to conclusions
inappropriate comments
Critical Thinking
“the purposeful and reflective judgment about what to believe or what to do in response to observations, experience, verbal or written expressions, orarguments. It involves determining the meaning and significance of what is observed or expressed.”
Facione (2007)Dauer, Francis Watanabe
executive function deficits trouble with critical thinking
Fluid intelligence
“the capacity to think logically and solve problems in novel situations, independent of acquired knowledge. It is the ability to analyze novel problems, identify patterns and relationships that underlie these problems, and the extrapolation of these using logic”
Executive function deficits trouble with fluid intelligence
Rehabilitation of executive function deficits
protocol for disexecutive syndrome, Spikman (2010) Goal Management training Problem Solving training Algemene Plannings Aanpak
PCR (Policlinic Cognitive Rehabilitation)INR (Intensive Neuro Rehabilitation)
How?
The group‐setting: Different perspectives (shift between points of view) Discuss and compare different points of view Highlight agreement or contrasts Invite explanations Ongoing process of exploration and elaboration
Art as a medium to practice critical thinking
Accessible: no prior knowledge necessary No fixed meaning (therefore no wrong answers) Many layers of interpretation
Inclusion Criteria
No current cognitive rehabilitationExecutive function deficits (DEX > 27)Acquired brain injury, at least 1 year post onsetAge 18‐65Informed consent
Design
Group A T1 VTSTwice a weekfor 4 weeks
T2 no intervention T3
Group B no intervention VTSTwice a weekfor 4 weeks
Randomisation
Dysexecutive Questionnaire (DEX)
(Burgess et al., 1996)
Examples
Does or says embarrassing things when in the company of others.
Loses his/her temper at the slightest thing. Finds it hard to stop repeating saying or doing things once started.
Social Communication Skills Q.
Examples
Thinks of new topics to discuss and questions to ask Allows others to express themselves without interruptionsReads and responds to clues the other person givesSupports opinions with facts
ADI and MOI
Aesthetic Development Interview (ADI) (Housen, 1983) 2 paintings (3 parallel versions) No aid of facilitator or groupmembers
Material Object Interview (MOI) (Housen, 2002) 2 objects: generalisation to different context No aid of facilitator or groupmembers
Analysing the ADI and MOI
CADRE = Framework
- Context
- Association
- Divergent thinking
- Revision
- Explanation
Context
Examples Context“That looks like a Monet!”“I think it is an Italian painter out of Rembrandts time!”“A Greek nose from the Hellenistic era”
Association
Example Association
“Oh I love sunflowers, they are such cheerfull flowers. I always bought them for my grandmother. She diedseven years ago, her nose was always so red… etc.”
ADI
“….It seems like that is the edge of a bath, and on top there is something made of fabric….I do not knowwhether it is something she had wrapped aroundherself, or if it’s her clothes (divergent thinking) …No, I do not think it’s her clothes (revision), because if thiswas the case, she would’nt have put them aside socarelessly; you can see the fabric almost hanging in the water (explanation).”
Baseline characteristics
Group A
(n=7)
Group B
(n=6)
Age 46.14 (14.29) 46.83 (14.00)
Sex male: 4
female: 3
male: 5
female: 1
Time sinceonset (years)
6.89 (3.83) 9.53 (7.32)
Education 5.57 (0.98) 5.00 (1.27)
Baseline (cognitive screening)
Group A Group B
TMT‐A 50.57 (6.48) 42.50 (17.82)
TMT‐B / A 54.29 (7.80) 49.67 (7.39)
Stroop I 35.29 (9.96) 28.17 (13.57)
Stroop II 43.00 (9.61) 25.67 (12.77)*
Stroop III / II 57.14 (8.95) 49.17 (8.31)
RBMT immediate 47.71 (12.42) 32.83 (4.36)*
RBMT delayed 47.00 (12.56) 34.50 (6.78)
Results group A
T1 T2 T3
Picture Arrangement 9.43 (3.8) 11.57 (4.4) 12.83 (4.22)
Comprehension 13.00 (2.3) 14.71 (2.8) 15.67 (2.34)
DEX 37.67 (18.0) 32.14 (12.0) 27.67 (16.4)
SCSQ self 91.00 (9.90) 96.71 (10.3) 99.00 (14.38)
SCSQ proxy 97.00 (11.3) 99.50 (12.4) 100.50 (10.29)
RAPS % constraint q. 88.98 (7.3) 92.52 (8.4) 89.37 (9.4)
RAPS efficiency q.1 48.81 (10.2) 53.87 (23.8) 50.70 (13.6)
RAPS efficiency q.2 59.35 (11.2) 58.45 (9.5) 64.67 (13.8)
VTS
Results group A
T1 T2 T3
ADI Divergent th 2.00 (1.61) 4.21 (3.88) 4.42 (3.64)
MOI Divergent th 3.57 (2.88) 5.21 (4.11) 4.17 (2.44)
ADI Revision 0.79 (1.47) 1.36 (1.89) 0.92 (1.56)
MOI Revision 1.43 (2.73) 2.21 (1.63) 2.00 (2.12)
ADI Explanation 2.71 (2.63) 14.00 (8.36) 14.25 (11.07)
MOI Explanation 2.21 (2.06) 6.29 (3.97) 6.58 (5.32)
VTS
Results group B
T1 T2 T3
Picture Arrangement 7.67 (2.25) 9.33 (4.13) 10.67 (4.27)
Comprehension 9.50 (2.88) 9.83 (2.64) 10.83 (2.48)
DEX 35.50 (8.12) 28.17 (13.7) 28.33 (8.29)
SCSQ self 93.33 (7.17) 92.17 (11.27) 96.00 (5.44)
SCSQ proxy 93.67 (13.03) 93.33 (9.71) 96.00 (11.31)
RAPS % constraint q. 77.88 (21.35) 82.59 (18.01) 82.14 (12.82)
RAPS efficiency q.1 38.94 (18.33) 51.04 (24.21) 60.76 (30.97)
RAPS efficiency q.2 46.77 (14.7) 50.53 (15.9) 51.71 (18.6)
VTS
Results group B
T1 T2 T3
ADI Divergent th 0.50 (0.63) 0.58 (1.02) 1.42 (1.50)
ADI Explanation 2.25 (2.66) 3.17 (3.80) 5.42 (4.41)
ADI Revision 0.17 (0.26) 0.42 (0.49) 0.33 (0.41)
MOI Divergent th 2.25 (2.56) 2.08 (2.40) 1.17 (1.75)
MOI Explanation 0.58 (0.38) 1.58 (1.59) 1.00 (1.76)
MOI Revision 0.75 (0.99) 0.42 (0.49) 0.58 (0.80)
VTS
Evaluation: what have you learned?
observe in a different manner (more consciously, from a broader perspective) (n=8)
revise opinion more easily making it easier to choosebetween alternatives (n=5)
less inclined to jump to conclusions and respondpremature (agressively) (n= 5)
More inclined to listen to others (n= 4)
more awareness (n= 3)
Summary
Group A improved after VTS: ADI Explanation, MOI Explanation, WAIS‐III Comprehension
Group B did not improve on the tests after VTS: cognitive deficits?
Questionnaires (DEX, SCSQ) did not show improvement: better awareness / not all questions applicable
Future research
Effect of deficits in attention and memory on efficacyof VTS
MOI and ADI as outcome measures Goal Attainment Scaling in stead of questionnaires
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