OPSYRIS 2021

This year our group organised the OPSYRIS 2021 hybrid conference, on location at the University of East Anglia, thanks to the support of Dr Stephanie Rossit and the School of Psychology there.  OPSYRIS is the Organisation for Psychological Research in Stroke, a Special Interest Group under the World Federation of Neurorehabilitation and Prof Demeyere is the current chair of the Organisation.

We had a very full programme with brief poster blitz talks, longer research talks, a workshop on NHS ethics, 3 invited speakers and a keynote on the R4VAD study by Dr Fergus Doubal. This was our first experience of having 20 people in the room and a further 80 people online, a format that seemed to work really well allowing many people access to the content and some small group networking.  A really enjoyable day was had by all and we are very much looking forward to the next iteration

Congratulations to Dr Moore!

 

Margaret Moore successfully defended her PhD thesis, with the examiners commenting that she has made a major original contribution to the field, and that they recognised the originality in her work.

This superstar has already published six papers from her PhD in peer-reviewed journals, with 2 more under review.

Margaret is looking forward to a well earned break, and is planning to join Prof Mattingley’s lab in Brisbane at the University of Queensland for a postdoctoral fellowship. We look forward to continued collaborations, and to see where her journey takes her.

 

PS: there are more glorious graduation pictures on our insta gallery

OCS-Plus tool now published

We are delighted with the latest paper now out from our lab, which introduces the OCS-Plus, our brief tablet based cognitive screening tool developed to detect subtle changes in domain general cognitive function in memory and executive functioning. Here we present the tasks and provide normative data from 320 and validation and reliability data within this neurologically healthy normative sample. With this important initial step now complete, we are looking forward to further research the validity and usefulness of the OCS-Plus in clinical populations which present with more subtle cognitive deficits.

Demeyere N, Haupt M, Webb SS, Strobel L, Milosevich ET, Moore MJ, et al. Introducing the tablet-based Oxford Cognitive Screen-Plus (OCS-Plus) as an assessment tool for subtle cognitive impairments. Scientific Reports. 2021 Apr 12;11(1):8000.

New publication on mood and cognition – Neurology

This new paper, entitled Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke, was published today. Below is a summary of the paper for the general public.

 

After a stroke, many hidden or less visible consequences are often overlooked, these include changes in mood and thinking abilities. We know that stroke survivors are at an increased risk of suffering from depression and anxiety. We also know that many stroke survivors experience difficulties with cognition: how they process, react, and remember information, difficulties with language and numbers, with paying attention and perception and with planning complex tasks.

In this study, we investigated whether or not, at 6 months after stroke, impairments in specific types of cognition were associated with an increased risk of having more severe depression or anxiety symptoms. Using data from stroke participants recruited from 37 NHS sites across England, we found that impairment in a range of cognitive processes including visual processing, memory, language and number processing, and how well they complete complex tasks were all associated with more severe depressive symptoms but not with anxiety symptoms.

This work is important in highlighting that common struggles with a wide range of thinking processes due to the incurred stroke can affect a person’s recovery from stroke and have a negative impact on their quality of life. More work is needed to investigate how these associations between cognition and mood might change over time as patients recover from stroke. However, the results suggest that in addition to typical post-stroke rehabilitation which tends to focus on physical recovery, developing therapies to improve cognition has the potential to positively impact patient’s mood and with that their quality of life.

 

Reference:

Williams OA, Demeyere N. Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke. Neurology. 2021 Feb 15; Available from: https://n.neurology.org/content/early/2021/02/25/WNL.0000000000011748

Poem from John S

The below poem was sent to us by one of the participants in the ox-chronic study about his recent participation in the remote assessment. For context: Participants are sent a series of paper folders which are opened during the call, as well as an activity monitor to monitor sleep and overall activity over 7 days.

 

STROKE STUDY

 

A very large envelope came through my door

I pondered what this can be

Opening it up wondering what I would find

Wow it,s brain testing time just for me

 

This was followed up by a phone call

It was Grace on the other end

We fixed a time when she would be calling

I just hope my brain box won,t bend

 

Grace read a short story,

Later for me to recall

I must hold this story inside me

After all I don,t want to fall

 

Small hearts and big hearts were presented

I just had to circle the small

If I made a mess of this one

I must have been quite a fool

 

With circles and squares in a picture

I next had to join with a line

Not a straight one but zig zag all over

If I do this it all should be fine

 

They sent me a watch with no dial

To wear for seven long days

A watch you can,t see what the time is

This could start a new craze.

 

(Poem by John S, 92, stroke survivor)

Jacob Levenstein successfully defends DPhil

Wonderful news and many congratulations to Jacob Levenstein who has now successfully passed his PhD Viva. Even though it was on videocall in these times of COVID, Jacob kindly sent this wonderful Oxford SubFusc picture to share with you.

Jacob’s thesis was entitled. “Neurochemical and Structural Brain Imaging of Human Motor Control in Health and Post-Stroke” supervised by Profs Charlie Stagg and Nele Demeyere.  The viva examination was conducted with Prof Holly Bridge (internal examiner) and Prof Paul Mullins (Bangor University).

 

New paper presenting our digital Multiple Errands Test

Many stroke survivors have difficulties with complex thinking tasks following their stroke, with around 80% of survivors showing some form of this. Any problems in any or all of these complex abilities, such as planning, organisation, stopping actions or swapping actions can make it difficult to do many tasks of everyday life, affecting people’s independence and enjoyment of life. Tests that assess these complex mental abilities are typically quite abstract, involving connecting shapes, or finding patterns. These kind of tests also commonly miss those survivors who do well in a structured environment, like a lab or hospital, but have difficulties when having to organise their days or behaviour when distractions and interruptions are more common. The Oxford Digital Multiple Errands Test (OxMET) is a short to administer but powerful new test that uses a shopping scenario, more like the everyday real life complex situations, in an engaging and friendly way, without intimidating and abstract contexts.

This simple test is based around a common shopping scenario where an individual has 6 items to buy and 2 questions to answer. The trick is that there are rules to follow when completing the task that trips people up. Performance on this relatively simple task can reveal  a person’s ability to manage complex tasks. Further research will investigate whether this test done before a home-discharge can be helpful to understand how well people will cope independently once home, and what levels of support to put in place

 

paper reference:

Sam S. Webb, Anders Jespersen, Evangeline G. Chiu, Francesca Payne, Romina Basting, Mihaela D. Duta & Nele Demeyere (2021) The Oxford digital multiple errands test (OxMET): Validation of a simplified computer tablet based multiple errands test, Neuropsychological Rehabilitation, DOI: 10.1080/09602011.2020.1862679

 

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New paper out on Visual Perception Screening

Up to three quarters of people have visual perception problems after stroke. These problems can be difficulties with recognising objects, faces, shapes or with reading. Unfortunately, only 20% of these problems are discovered in routine clinical practice. This means many stroke survivors and their families do not get support in understanding and managing their visual perception problems. A first step to improving the diagnosis of visual perception problems after stroke is to better understand the current clinical practice and the challenges that clinicians face in making a diagnosis. We interviewed 25 clinicians involved in visual perception screening after stroke. We asked them how they currently screen for visual perceptual difficulties, what they find challenging, and what they would recommend to improve services. They told us visual perception was difficult to understand. For many it was unclear how it differed from sensory vision and visual inattention (or hemispatial neglect). They told us the biggest challenges were a lack of time and training. Many of the existing assessments were not suitable for stroke survivors with communication difficulties or with difficulties concentrating for more than 10 minutes. To improve services, they recommend:

1) More training and awareness

2) Quick and practical assessment tools

3) Good local relationships between orthoptists and occupational therapists

In a follow-up survey, we will ask a large number of clinicians from all over the UK if they agree with our conclusions. Next, we will use their advice to develop an instrument that meets their needs and hopefully improve diagnosis of visual perception difficulties after stroke.

 

Vancleef K, Colwell MJ, Hewitt O, Demeyere N. Current practice and challenges in screening for visual perception deficits after stroke: a qualitative study. Disability and Rehabilitation. 2020 Oct 5;0(0):1–10.

New paper on neglect dyslexia

Dissociating Word-Centred Neglect Dyslexia from Spatial Attention: A Case Study

 

Neglect dyslexia is a group of post-stroke reading impairments in which people have trouble reading letters on one side of individual words. For example, a patient with right neglect dyslexia might read the word PLANETS as “planet”, “plan”, or “planned”. These reading impairments are all thought to be caused by neglect, a condition in which people have trouble distributing attention equally across space. However, it is not yet clear whether this is an accurate explanation of all cases of neglect dyslexia.

 

In this experiment, we conducted a single case study of CD, a stroke survivor with right, word-centred neglect dyslexia. CD was found to exhibit right word-centred neglect dyslexia as well as left visuospatial neglect. If CD’s reading problems were caused by his neglect, this conjunction of neglect dyslexia and neglect in opposite lateralisations would not be expected. CD was consistently able to name all individual letters within words, but still committed neglect dyslexia errors when immediately reading the same words as a whole. This behavioural pattern would not be expected if CD’s reading problem was caused by a spatial attention problem.  Finally, factors which are known to modulate the severity of neglect had no effect on the severity of CD’s neglect dyslexia. These findings strongly suggest that CD’s neglect dyslexia cannot be accurately characterised as a neglect-related impairment.

 

These findings are important because they suggest that we may need to change the way we think about word-centred neglect dyslexia. Current therapies which aim to help people with word-centred neglect dyslexia try to improve neglect attentional biases. If not all cases of neglect dyslexia are not actually caused by these biases, new therapies are needed to help people with neglect dyslexia. However, before these new therapies can be designed, we need to get a better understanding of what causes word-centred neglect dyslexia.