Lawson Falshaw - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)

Critical Review of the Literature: A Systematic Review of Assessments of Non-Linguistic Cognitive Functioning in Adults with Post-Stroke Fluent and Non-Fluent Aphasia.
Approximately one third of stroke survivors experience difficulties with understanding language (fluent aphasia), or producing language (non-fluent aphasia). Although copious research has been conducted assessing the language abilities of individuals with post-stroke aphasia, fewer studies have been conducted applying neuropsychological tests to assess the non-linguistic neuropsychological functioning of individuals with post-stroke aphasia. This review aimed to learn more about measures which may be used in neurorehabilitation to assess memory, executive functioning, attention, visuospatial skills, social cognition, and intellectual functioning of stroke survivors with fluent or non-fluent aphasia. The systematic review resulted in 17 quantitative papers published since 2013 involving the non-linguistic cognitive assessment of individuals with fluent or non-fluent aphasia after stroke across eight countries. The use of assessments by clinicians in multidisciplinary neurorehabilitation services has been considered. Findings have implications for how neurorehabilitation clinicians assess non-linguistic cognitive functioning in post-stroke aphasia.
Service Improvement Project: Improving the Rehabilitation of Individuals Admitted to the National Spinal Injuries Centre with Traumatic Brain Injury.
Study Design: Mixed methods service improvement project. Retrospective analysis of clinical documentation and qualitative focus group with clinicians.
Objectives: Although traumatic brain injury (TBI) and spinal cord injury (SCI) often cooccur, many barriers have been found to identifying TBI in SCI rehabilitation and adapting treatment accordingly. This study aimed to compare the number of TBIs detected at the UK National Spinal Injury Centre to figures found in previous research, and understand the barriers to adapting SCI rehabilitation in the presence of TBI.
Setting: United Kingdom inpatient spinal cord injury rehabilitation unit.
Methods: This mixed methods study assessed the documentation at each stage of 88 patients’ treatment where a TBI could be detected and used to inform rehabilitation, and subsequently, a focus group was conducted with staff to explore the barriers to detecting TBI and adapting SCI rehabilitation.
Results: Results suggested that data related to TBI were inconsistently recorded, the number of TBIs at the Centre was lower than previous research, and several barriers were interpreted from the focus group.
Conclusions: TBI in SCI populations may be an invisible unmet need. Several barriers may exist which prevent clinicians from detecting TBI in this population and adapting rehabilitation accordingly. Findings have implications for rehabilitation for individuals with TBI and SCI admitted to the service.
Theory-Driven Research Project: Exploring the Role of Social Cognition in Couples’ Relationship Satisfaction and Continuity After Acquired Brain Injury.
Although an acquired brain injury (ABI) may bring some couples closer together, for other couples, an ABI may pose challenges to their relationship. Recent research has suggested that social cognition is the strongest predictor of continuity in couples’ relationships after one partner experiences an ABI. The current study aimed to examine the role of social cognition in relationship satisfaction and continuity after ABI. Sixty-four participants who were in a relationship with someone who had experienced an ABI completed measures of their partner’s social cognition, their relationship satisfaction before and after injury, and a measure of relational continuity after ABI. It was found that the participants’ relationship satisfaction significantly decreased after injury, and that the average social cognition score for the group reporting a high change in relationship satisfaction was significantly poorer than the group reporting a low change in relationship satisfaction. Regression analysis suggested that overall social cognition could predict the continuity in relationships after injury, although no single content area on a measure of social cognition could predict relational continuity. Findings have implications for the impact of ABI on couples’ relationships and support to provide to couples following ABI.

Keywords: Spinal Injury
Traumatic Brain Injury
Neuropsychological assessment
Acquired Brain Injury
Social Cognition
Relationship satisfaction
Relational continuity
Stroke
Head Injury
Cognition
Aphasia
Advisor: King, N
Vohora, R
Cotter, I
Bonfield, B
Waterman, S