Lars Evald

Background: Aphasia affects both the individuals and their families, impacting communication, social connectedness, roles and mental health. The focus in neurorehabilitation often remains on the individual, yet research suggests that addressing the family as a system would be beneficial. It remains unknown to what extent this is translated into clinical practice. Aims: To explore professionals’ perspectives on communication support and training addressing the needs of families living with aphasia across disciplines, positions and stages of neurorehabilitation in Denmark. Methods & Procedures: An online survey with 21 items was developed and distributed via clinical networks and social media. The survey focused on characteristics of current services, perceived needs, barriers and facilitators related to communication support and training. Descriptive statistics and qualitative content analysis were applied. Outcomes & Results: A total of 285 professionals from different professions and positions completed the survey. The majority of respondents reported that their institution provided communication support and training for individuals living with aphasia and/or their relatives, but often inadequately and several unmet needs were highlighted. The need for a more systematic, flexible, tailored and outreached approach to communication training to address the multi‐faceted and evolving needs of families living with aphasia was highlighted. Conclusions & Implications: The results highlight the importance of supporting and training professionals in addressing the needs of families living with aphasia throughout the course of rehabilitation and life with aphasia. This highlights the necessity of developing and providing more flexible and tailored interventions directed at these families in order to achieve genuine and sustainable changes. WHAT THIS PAPER ADDS: What is already known on the subject Aphasia impacts both the individual and their families, whose rehabilitation needs are complex and evolving over time. Family‐focused interventions such as communication partner training (CPT) are recognised as beneficial yet remain inconsistently implemented and rarely embedded in routine clinical services. What this paper adds to existing knowledge This study provides insight into professionals’ experiences with CPT and informational support. It reveals that while such services are often offered, they are rarely sufficient in term of timing, content and consistency. It identifies barriers to implementation, including organisational fragmentation, lack of structured training and limited interdisciplinary coordination. What are the potential or actual clinical implications of this work? The findings emphasise the importance of recognising the family as a unit of care in aphasia rehabilitation. To meet complex and evolving needs, rehabilitation should be tailored, repeated, outreached and flexible. Sustainable implementation of CPT requires organisational commitment and interdisciplinary collaboration, ensuring that support is both accessible and responsive.

Objectives: To determine the prevalence of visual deficits among inpatients with acquired brain injury, to examine the agreement between objective screenings and patient-reported visual deficits, and to investigate patient characteristics associated with visual deficits. Methods: This cross-sectional study included data on screened and patient-reported visual deficits in patients with acquired brain injury admitted for inpatient rehabilitation. The screenings were conducted by occupational therapists. Visual acuity and visual field were assessed in 2014–2023, and complemented by assessment of ocular motility and patient-reported deficits in 2021–2023. Predictive values were calculated for the agreement between screening results and patient-reported symptoms. Logistic regression models were applied to investigate the association between clinical characteristics and visual deficits. Results: 2814 patients were screened, 65% were men, the median age was 64 years, and the most common diagnosis was stroke (66%). In screened patients 32% had reduced visual acuity, 18% had ocular motility deficits, and 15% had visual field deficits. Of 975 patients providing self-reports, 38% reported vision problems. A total of 28% of patients who did not report visual deficits, had visual deficits in the objective screening. Lower functional level was associated with greater odds of having any visual deficits. Traumatic and anoxic brain injuries were associated with lower odds of visual field deficits compared with stroke. Conclusions: The high proportion of patients with visual deficits underlines that these are common consequences following acquired brain injury. Objective screening and patient-reported deficits offer overlapping yet distinct insights into visual deficits. Knowledge of clinical characteristics associated with visual deficits may help recognize high-risk subgroups.

This psychometric study aimed to evaluate the psychometric properties of the Dysexecutive Questionnaire (DEX) following a cardiac event, and to examine the relationship between self- and informant-ratings. Approximately 7 months post-cardiac event, 196 participants and their informants (N = 179) completed the DEX. Reliability was assessed by confirmatory factor analysis and internal consistency estimates. Construct validity was evaluated using two performance-based neuropsychological tests, the Colour-Word Interference Test and the Trail Making Test (TMT), along with the Hospital Anxiety and Depression Scale (HADS). A one-factor model showed acceptable fit for the self-assessed DEX (RMSEA = 0.062) with excellent internal consistency (ω > 0.90). Slight positive associations were found between the DEX and the performance-based executive function measures, while strong positive associations emerged between the self-assessed DEX and the HADS. Overall, self-assessed and informant-reported scores did not differ significantly (self-assessed DEX median = 11, Q₁-Q₃ = 5.75-20; informant-reported DEX median = 11, Q₁-Q₃ = 4-19, p = 0.924). However, participants with severe executive dysfunction (TMT-B z-scores ≤-2) rated their own symptoms as less severe than informants (p = .001), indicating impaired self-awareness in a subgroup of participants. In conclusion, the DEX provides a useful perspective into general executive dysfunction in daily life but should be complemented with performance-based measures.Trial registration: ClinicalTrials.gov identifier: NCT03543371.

Objective: To describe cognitive impairment in out-of-hospital cardiac arrest (OHCA) survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA.Participants and Methods: This was a prospective case control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. We administered an extensive neuropsychological assessment at approximately 7 months post-cardiac event, including a neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes. Z-scores of individual tests were converted to neuropsychological composite scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions). Between-group differences on the neuropsychological composite scores were investigated with linear regression. Associations between anxiety, depression, fatigue, insomnia, hypertension, diabetes, and the neuropsychological composite scores among OHCA survivors were calculated with Spearman’s rho.Results: Of 184 eligible OHCA survivors, 108 were included (mean age = 62, 88% male), with 92 MI controls enrolled (mean age = 64, 89% male). Amongst OHCA survivors, 29% performed z <-1 indicating at least borderline-mild impairment in >2 cognitive domains, and 14% performed z <-2 exhibiting major impairment in >1 cognitive domain. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = -0.37, 95% confidence intervals [-0.61, -0.12]), verbal (MD = -0.34 [-0.62, -0.07]), and visual/constructive functions (MD = -0.26 [-0.47, -0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, processing speed (MD = -0.41 [-0.74, -0.09]) and executive functions (MD = -0.69 [-1.13, -0.24]) were also worse following OHCA. Depressive symptoms were associated with worse executive functions (rs = -0.37, p p = 0.01) post-OHCA. Anxiety symptoms (rs = -0.21, p = 0.01) and general fatigue (rs = -0.24, p = 0.01) were associated with worse executive functions. Diabetes was associated with worse processing speed (rs = -0.20, p = 0.03), visual/constructive (rs = -0.29, p p = 0.02), while hypertension and insomnia were not significantly associated with neuropsychological test performance.Conclusions: Cognitive impairment is generally mild following OHCA, but most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed worse than MI controls. We suggest that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue.

It has been suggested that performance validity tests (PVTs) assess the credibility of a patient’s objective test performance, symptom validity tests (SVTs) assess the credibility of a patient’s su...

Background: Delayed brain development, brain injury, and neurodevelopmental disabilities are commonly observed in infants operated for complex congenital heart defect. Our previous findings of poorer neurodevelopmental outcomes in individuals operated for simple congenital heart defects calls for further etiological clarification. Hence, we examined the microstructural tissue composition in cerebral cortex and subcortical structures in comparison to healthy controls and whether differences were associated with neurodevelopmental outcomes. Methods and Results: Adults (n=62) who underwent surgical closure of an atrial septal defect (n=33) or a ventricular septal defect (n=29) in childhood and a group of healthy, matched controls (n=38) were enrolled. Brain diffusional kurtosis imaging and neuropsychological assessment were performed. Cortical and subcortical tissue microstructure were assessed using mean kurtosis tensor and mean diffusivity and compared between groups and tested for associations with neuropsychological outcomes. Alterations in microstructural tissue composition were found in the parietal, temporal, and occipital lobes in the congenital heart defects, with distinct mean kurtosis tensor cluster‐specific changes in the right visual cortex (pericalcarine gyrus, P =0.002; occipital part of fusiform and lingual gyri, P =0.019). Altered microstructural tissue composition in the subcortical structures was uncovered in atrial septal defects but not in ventricular septal defects. Associations were found between altered cerebral microstructure and social recognition and executive function. Conclusions: Children operated for simple congenital heart defects demonstrated altered microstructural tissue composition in the cerebral cortex and subcortical structures during adulthood when compared with healthy peers. Alterations in cerebral microstructural tissue composition were associated with poorer neuropsychological performance. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03871881.

Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person’s needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.