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    A new test of semantic association for use in awake craniotomy : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2023) Chapman, Jo
    This project aimed to develop and validate a new test of non-verbal semantic association to replace the Pyramids and Palm Tree Test (PPTT) in mapping the Inferior Fronto-Occipital Fasciculus (IFOF) during awake craniotomy surgery. Research and clinical experience identified a range of problems with the PPTT, especially in its performance across cultures, and no other existing semantic test met all requirements for effective use in IFOF mapping. A new test was developed based on theoretical and clinical understandings of semantic association, using a novel item format. The final test metrics were an improvement upon the PPTT on all preselected measures of item quality. A total of 707 healthy adult participants were then recruited to complete the new test via an online survey. A final pool of 58 items were selected, all of which performed consistently as intended. Analyses of subgroup performance found there were no clinically significant gender, culture, age, or education effects on scores. These results again suggested the new test improved upon existing tests and achieved its initial design objectives. Validation then proceeded to clinical groups, but recruitment challenges meant too few participants were recruited to permit any analyses. While its validity could not be determined with this study’s data, the test and its general population norms will be available for further research and then clinical use if indicated.
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    Paced serial addition : an investigation into the nature of the cognitive processes involved in PASAT performance : thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1995) Stewart, Mark
    The Paced Auditory Serial Addition Test (PASAT) of Gronwall and Sampson (1974) is a neuropsychological test of attention used in both research and clinical settings (Lezak,1983). However, a review of the literature revealed that the cognitive processes and attentional factors underlying PASAT performance are not well understood. Two experiments were conducted with the aim of providing further empirical and theoretical insights into PASAT performance. In Experiment 1, 16 subjects (8 male and 8 female) performed auditory and visual versions of a shortened paced serial addition task. It was found that PASAT performance in the visual stimulus modality was superior, but that, as indexed by accuracy and error scores, the pattern of performance as a function of the rate of stimulus presentation (1.2, 1.6, 2.0, and 2.4 s) was similar. These results are consistent with the idea that the nature of the cognitive processing involved is independent of stimulus modality. The design of Experiment 2 was the same as the first, except that divided field stimulus presentation was used in an attempt to test two opposing theories of attention. The results were not consistent with the hypothesis. The findings of both experiments were discussed in terms of the possible role of attention deficits in PASAT performance. An interesting finding was that the superior performance of male subjects in Experiment 1 was reversed in Experiment 2. This differential effect for divided field stimulus presentation as a function of gender may be partly accounted for by differing degrees of cerebral lateralisation for males and females.
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    An analysis of performance on the Rey auditory-verbal learning test after traumatic brain injury, and its association with reported everyday memory performance : a thesis presented in partial fulfillment of the requirements for a degree of Master of Arts in Psychology at Massey University
    (Massey University, 2002) McGill, Roslyn A
    The current study was conducted in two parts. Study 1 examined the Rey Auditory-Verbal Learning Test (AVLT) performance of 353 individuals who had been referred to an outpatient psychology clinic having sustained a traumatic brain injury (TBI). Individuals were divided into subgroups based on their patterns of performance on the AVLT. Individuals with low trial 1 scores were divided into three groups based on their subsequent AVLT performance. Individuals with low delayed-recall scores were divided into four groups based on their performance on preceding AVLT trials. For the TBI group as a whole, significant correlations were found between AVLT scores and age, education, and general intelligence (as measured by verbal IQ). Study 2 investigated relative ratings of everyday memory performance on the Patient Competency Rating Scale). This data was available for 82 of the individuals in the initial sample. The relationship between reported everyday memory performance and test performance on the AVLT was examined for this group. No significant correlations were found between these two variables. Low correlations were found between patient and relative ratings on the PCRS. Individuals were divided in four groups based on their everyday memory and test performance. Individuals with low everyday memory performance were found to have a similar type and number of difficulties, regardless of their AVLT performance. The results of this study highlight the varied performance of individuals after TBI, both on memory tests such as the AVLT and reported everyday memory performance. The AVLT should not be used to predict the level of difficulty in daily life as the correlations are not significant.
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    Performance and effectiveness of strategy use on the Rey auditory verbal learning test after traumatic brain injury and in a control population : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in psychology at Massey University
    (Massey University, 1994) Grimmer, Bradley T
    Clinical assessment of memory is important for the diagnostic understanding, management and rehabilitation of individuals with significant brain dysfunction. The present study investigated ways in which disorganised thinking or impaired information processing contribute to memory problems in survivors of traumatic brain injury (TBI). Memory performance on the Rey Auditory-Verbal Learning Test was assessed for 141 TBI patients and 59 controls and the relative effectiveness of different strategies was evaluated. Results showed a significant main effect between group scores with controls demonstrating progressively superior performance across trials. The range of learning strategies observed across both groups were condensed into three sub-categories. Subjects who employed no strategies at all performed less well than those who used passive strategies, who in turn performed less well than subjects who adopted active strategies. This latter group obtained the highest memory scores in their respective TBI or control groups. However, a temporal effect was evident in that unlike controls who maintained their best performance from initial trials to delayed recall, TBI subjects showed a marked decline in long term memory recall. Taken together, these findings suggest that the ability to initiate, maintain and transfer learning strategies depends on intact meta-cognitive processes such as executive functioning and metamemory, whereby the individual actively employs effective learning strategies. This is an effortful and elaborative process that demands vigilance and planning. When such functions are compromised, as commonly occurs in TBI patients, subsequent learning abilities may be progressively constrained. Where some residual learning ability is indicated, retraining programmes should focus on the development of self-monitoring and other metacognitive skills before instruction in mnemonic techniques.
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    The patient competency rating scale as a measure of everyday functioning before and after traumatic brain injury : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 1996) Murphy, Latesha J
    Impaired self awareness is a common outcome of traumatic brain injury (TBI) and is usually measured by comparing self and informant ratings of everyday functioning. The Patient Competency Rating Scale (PCRS; Prigatano et al. 1990), has often been used for this purpose. The present study compared the before and after PCRS ratings of 53 sets of TBI patients and their informants. These groups were also compared to 130 sets of self and informant ratings for a non-head injured control group. Comparison of self and informant ratings for before and after revealed that TBI subjects were very aware of their post injury difficulties. A comparison of the self ratings of TBI (before injury) and control subjects suggested that the TBI group performed better than the control group, which acknowledged some difficulty with controlling emotion. Informants generally rated TBI subjects (before injury) and control subjects as more competent than the subjects rated themselves. A comparison of informant and self ratings (after injury) demonstrated that subjects with severe head injuries underestimated their difficulties, whilst subjects in the mild and moderate groups tended to be aware of their difficulties or overestimated them. This finding suggests that degree of awareness is dependent on the severity of injury.
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    Neuropsychological assessment of refugee survivors of war and torture : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University
    (Massey University, 2013) Veliu, Bahrie
    This thesis presents the results of psychological and neuropsychological assessment of a group of refugees with PTSD and a group of refugees with co-morbid TBI and PTSD. The study was designed to evaluate the outcome related to co-morbid TBI+PTSD, compared to the outcome of PTSD alone. In addition, this study also evaluated the methodological barriers in neuropsychological assessment of refugees. Eighteen refugees diagnosed with PTSD and depression participated in the study. Seven of them reported head injuries that had led to loss of consciousness, and were assigned to the TBI+PTSD group with the remaining eleven in the PTSD only group. Results indicated that neuropsychological assessment of refugees is challenging due to linguistic and cross-cultural barriers. Despite the adjustment of assessment according to suggestions from the literature, most refugees had difficulty doing the assessment, and for a small number assessment with the measures used in this study proved impossible. Nonparametric tests and boxplots were used to evaluate the differences between the TBI+PTSD group and the PTSD Only group in terms of psychological symptoms, self-reported functioning, and neuropsychological outcome. While no significant result was detected, possibly due to small sample size and high variability within the sample, the box plots revealed a number of tendencies that were consistent with the study's hypotheses.
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    Neuropsychological assessment of cognitive functioning in individuals with expressive disabilities in addition to traumatic brain injuries : a dissertation presented in partial fulfilment of the requirements of the degree of Doctor of Philosophy in Psychology at Massey University
    (Massey University, 2000) Babbage, Duncan Ross
    This research programme focussed on individuals who have severe physical and sensory disabilities that interfere with standard neuropsychological assessment. Current assessment guidelines when working with people who have such disabilities were examined, which revealed that while various suggestions have been made, much work is required to empirically evaluate the most appropriate procedures for conducting such assessments. The current research was an attempt to further examine these issues. The first study, a retrospective review of a cohort of individuals referred for neuropsychological assessment after traumatic brain injury, was conducted to determine the focus population for the research. Based on this review, the research was limited to individuals who (in addition to traumatic brain injuries) had severe expressive disabilities. That meant they were unable to speak, write, draw, or manipulate test materials-the common modalities for making responses in neuropsychological assessment of cognitive functioning. This review also examined the types of adaptations to standard measures that were required in order to assess such individuals. The research questions related to whether a comprehensive assessment across the domains of cognitive functioning could be undertaken with people in this group. Therefore, comprehensive cognitive assessment had to be defined. The next study therefore examined the issue of what constitutes a comprehensive neuropsychological assessment of cognitive functioning, by evaluating the domains into which researchers divided cognition in their journal articles. All articles published in four neuropsychology journals over a 12-month period were reviewed. Based on this information, a formulation of the domains of cognitive functioning was developed. In the third study was a survey of neuropsychological practitioners, in which a case vignette of an individual which severe expressive disabilities was presented. Respondents were asked to discuss the assessment strategies they would use in such a case. In addition, the survey examined whether clinicians divided the assessment of cognitive functioning into the same domains identified in the earlier journal review. The case vignette discussions provided suggestions regarding assessment strategies for people with expressive disabilities. The survey provided support for the earlier formulation of the domains of cognitive functioning developed from the research review. This formulation was used, therefore, in selecting the domains to be assessed in the final clinical phase of the research. Based on these studies, a group of measures was selected and adapted that would be suitable for the assessment of cognitive functioning in individuals with expressive disabilities. These measures covered a broad range of cognitive domains allowing for as comprehensive an assessment as possible, while not requiring an examinee to speak, write, draw, or manipulate test materials. Rather, an examinee was required only to select from multiple-choice answers by pointing, or in some cases to spell out answers on an alphabet board. These measures were administered to three groups of participants: individuals with expressive disabilities in addition to traumatic brain injuries, individuals with traumatic brain injury alone, and a healthy normative group. To examine the psychometric properties of these measures, a group of comparison measures, administered in their standard formats, was also included in the protocol. These tests were selected to measure the same constructs as the adapted measures, and were used to provide a benchmark against which performance on the new measures could be evaluated. As these comparison measures were administered in standard format, they could only be administered to the non-disabled participants. To evaluate further the adapted measures, some participants were seen for follow-up assessments two to four weeks after their initial assessments, and the adapted measures were re-administered. Internal consistency and test-retest reliability of the measures were investigated, and concurrent, construct and discriminant validity were also examined. The measures in this protocol were generally found to be reliable and valid neuropsychological assessment instruments and the results provided support for the types of adaptations trialed in this research. The performances of individuals with expressive disabilities were examined closely, which indicated that people with these disabilities were able to manage the task requirements of the adapted tests and that the tests were generally of appropriate difficulty. Qualitative aspects of conducting assessments with people with expressive disabilities were also discussed. Based on the performance of individuals in the normative group, preliminary norms were presented as both standard scores and percentile scores. These data were presented so that clinicians using the adapted measures described in this research could compare examinees to a reference group. However, the adaptations could not be considered fully standardised measures and the limitations of both the tests and the norms were discussed. The final section reviewed the aims that were outlined at the beginning of this research programme. Each of the 20 objectives of the research were met. The research provided clinically relevant information about working with people with severe expressive disabilities, was conducted in an ethical manner, which considered carefully the specific needs of participants, particularly those with severe disabilities, and did so in a manner that maintained scientific rigour and objectivity.
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    Brief cognitive screening instruments and the clinical utility of three screens in a New Zealand clinical geriatric setting : a thesis presented in partial fulfilment of the requirements for the degree of Doctorate in Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2012) Strauss, Heide-Marie
    Cognitive impairment (CI) is a serious concern for an aging global population, and its impact is not only felt within the family unit but also society at large. The current thesis involved two studies – an online survey about the use and role of screening instruments in New Zealand, and an evaluation of the clinical utility of three screens used in a clinical geriatric setting. The survey found that the Mini Mental Status Examination (MMSE) was the most frequently used screen, followed by the Clock Drawing Test (CDT), Addenbrooke‘s Cognitive Examination-Revised (ACE-R), Verbal Fluency (FAS), Three Word Recall (3WR), and Trail-making Test (TMT). The opinions of the survey respondents confirmed international publications suggesting that the MMSE does not fulfil the requirements of current assessment and/or screening practices. The survey further suggested that the ACE-R showed promise as an appropriate alternative to the MMSE due to its continuity from the MMSE, and because it appears to meet clinician requirements for brief screening instruments. The second study evaluated the clinical utility of the ACE-R, MMSE and the Modified Mini Mental State (3MS) within a larger assessment approach. It found that all three screens successfully differentiated between milder forms of CI and dementia; however, predictive ability for milder CI could not be determined. The ACE-R outperformed both the 3MS and MMSE in terms of predictive ability for dementia, with the 3MS showing marginally higher predictive ability than the MMSE. The study suggested that the 3MS‘s incremental validity did not justify its inclusion in a routine assessment process. Optimal sensitivity and specificity ratios – providing the best balance between sensitivity and specificity – were obtained with different cut-off scores than those recommended by the screens‘ original publications. This may have been due to the screens‘ authors seeking ratios that favoured sensitivity at the cost of specificity. However, in the data set from a clinical geriatric setting, used for this current study, the focus was on limiting both false-negatives and false-positives. While the MMSE showed adequate sensitivity and specificity, its known cultural and socio-economic bias makes it inappropriate for widespread use. The predictive ability (and incremental validity) of the ACE-R, coupled with the fact that it is cost-effective, relatively brief and covers all the recommended cognitive domains suggest that it is a suitable substitute for the MMSE in clinical geriatric service settings. Further research is however required to assess any potential biases inherent in the ACE-R. It is recommended that all initial assessments with CI patients include a mood screen due to their high comorbidity and the increased scope of treatment options available when a mood component underlies cognitive complaints.