Nele Demeyere

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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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.

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.

In this new paper, led by Hannah Hobson, we found that self-reported communication difficulties associated with higher scores of alexithymia.

Lay summary:

Some people report that they struggle to identify and communicate their emotions after experiencing a stroke. Problems recognising your own feelings – sometimes called “alexithymia” – has been found to be a predictor of mental health difficulties in people who have not had a stroke, so understanding what causes this problem could be useful to supporting the mental health of stroke patients.

One idea is that disrupted language abilities might contribute to emotional problems: we might use language to help us make sense of, label, and communicate how we are feeling. If our language abilities are disrupted, our emotional abilities might suffer as a result.

This project examined the links between alexithymia and language problems in stroke survivors. Interestingly, while behavioural language abilities (those measured with a task, such as being able to give the right word for a picture) did not predict alexithymia. However, when patients were asked about how they felt their communication abilities had changed, these self-reported measures of language were associated with alexithymia.

These findings partly replicate previous results from studies with Traumatic Brain Injury patients. One reason that we see differences between the task-based and self-reported measures could be that the task-based measures only reflect quite severe language impairments, while asking patients might reflect more subtle impairments.

The full text (accepted author-version of the paper) can be accessed here.

In December 2019, the Translational Neuropsychology Group travelled to Telford for the 14^th annual UK Stroke Forum, hosted at the Telford International Centre. The UK Stroke Forum is a multidisciplinary conference for any stroke care professional. There was a mix of practicing clinicians, occupational therapists, physiotherapists, doctors, researchers, and also stroke survivors and their families. This unique mixture of those involved in stroke care enabled us to focus our efforts on disseminating information related to our new and improved cognitive screening tools. Thanks to the efforts of our Research Coordinator Romina Basting we were able to coordinate the group’s efforts through three intense days of talks, training workshops, demonstrations, and networking.

Talks and Demonstrations

On the first day, Prof. Nele Demeyere & Dr Kathleen Vancleef ran two back to back interactive workshops for over 200 attendees as part of the clinical training stream hosted by Dr Charlie Chung (Stroke Specialist Occupational Therapist), to explain the how, what and why of the Oxford Cognitive Screen (OCS) for screening post-stroke cognitive impairment.

Another talk by Prof. Nele Demeyere was our most anticipated, where we launched the OCS-Plus. The OCS-Plus is a stand-alone computer-tablet based extension of the OCS which screens for milder cognitive impairments, teasing out subtle impairments which are missed by gross level cognitive screens. As expected, this talk garnered much interest from the attendees and our stall was flooded with interested clinicians. Sam Webb was kept busy for the bulk of the Stroke Forum, where he demonstrated the OCS-Plus in action to many interested groups. Through sign-up sheets we were able to see just how many clinicians and clinical groups are interested in running the OCS-Plus in their own settings. We are currently only able to set up research collaborations, but will be keeping everyone posted on when the tests will be available clinically.

Posters

Both of our DPhil Students, Elise Milosevich and Margaret Moore presented on their latest projects, as well our Postdoctoral research fellow Dr Kathleen Vancleef and our Research Assistant Sam Webb. During 3 minute-slot poster tours our group were able to test our quick dissemination skills by running groups through our projects from start to finish. It was an excellent opportunity to show stroke care professionals what our research group does and how our individual projects are merging to improve current clinical practice regarding screening for impairments.

Sam Webb presented our ongoing norming and validation study of the COMPASS tool, his poster is uploaded here. Prof. Nele Demeyere presented the poster for our newly launched OCS-Plus app, including healthy normative data and validation information, the poster is accessible here. All other posters were logged in the UK Stroke Forum 2019 app and journal indexed.

On Sunday 20th October, Nele and Richard teamed up to talk to members of the general audience as part of the public engagement IF festival (Oxford Science and Ideas Festival).

Richard Raynor described how his world was turned upside down at the age of 31, when a severe stroke led to a loss of language. In this vibrant, colourful and coming-to-terms talk, Richard described the day of his stroke, his recovery, intensive rehabilitation, and his involvement in our neuropsychology research. Associate Professor of Psychology, Nele Demeyere, explained how cognitive neuropsychology studies of these often hidden consequences of brain injuries have provided essential windows into understanding how our brains work.

Richard’s positive outlook and message on living life is awe-inspiring, and led him to be awarded as Stroke Association Life after Stroke Award

Last weekend (14th and 15th September 2019) the Department of Experimental Psychology hosted an Open Doors events. The Open Doors event is “is an annual celebration of Oxford across all walks of life, its places and its people” and you can find more information on Oxford Open Doors. Having the department open for the public meant that over 450 people attended over the weekend and we received quite a large proportion of people who wanted to sign up as volunteers to take part in research. Sam Webb, Grace Chiu, and Michael Colwell were able to entertain 207 people on the first day by showcasing the OCS-plus, COMPASS, and other neuropsychological tests used in the lab. This involved demonstrating the tasks to the audience as well as talking individual groups through why we do what we do. It was great to get the public on board with our message about clinical tools development and so motivating to see the reactions and enthusiasm of people for our research. A great experience for our lab-members who got to practice explaining their research in an accessible way. A great experience all round!

The Translational Neuropsychology Group traveled to Milan this month to present several new research projects at the Federation of European Societies for Neuropsychology’s 2019 conference (FESN 2019). This conference featured researchers from around Europe presenting on many related topics in Cognitive and Clinical Neuropsychology. The conference itself was hosted by the Catholic University of the Sacred Heart or Universita Cattolica del Sacro Cuore. For our time in Milan we stayed in the cities heart and visited the Piazza del Duomo which was host to a famous study about representational neglect which is still talked about even though it was published over 40 years ago by Bisiach & Luzzatti. Considering research moves quickly and this study is still discussed we felt we had to go there and check it out. 

The program itself was packed with excellent symposia and speakers from across the globe, including our very own Margaret Moore who presented her work. Her talk focused on her theoretical research teasing apart whether having attentional/spatial issues with words is part of the same cognitive mechanism as attentional/spatial issues with visual space. Turns out whether we can definitively say they are one shared mechanism or different is contentious and stirred up a lot of discussion and lively talk, and led to new potential collaborations with other neglect researchers. So her talk certainly was a winner for us.

Sam Webb also presented a poster on our COMPASS project,  sharing one of the Translational Neuropsychology Group’s newest tools, the COMPASS, a brief neuropsychological screen to supplement and guide mental capacity assessment. The poster presentation gave Sam a unique opportunity to share this new tool with other groups and gain thoughtful feedback, some of which has now influenced the research pathway we intended, which was fantastic. Of course there were plenty of speakers who we had not collaborated with who were very interesting to listen to, and thought provoking symposia. For instance, there were many (at least 3) symposia/talks on spatial neglect, others on body movements and how they are represented in the brain, and plenty on memory loss, including discussion of Alzheimer’s disease and dementia.

All in all FESN 2019 was a fantastic conference in an inspiring venue, located in a city which has historical routes in neglect research (see photo of the Piazza del Duomo – famous for being the base for the first paper to investigate attentional issues towards our mental representation of a place/object), and has allowed us to bridge new international collaborations and fine tune our research.

Our paper on the multi-site OCS-Care study is now available on AMRC open research, an open access and open review pre- and post-print service by F1000 Research. The study was one of the last large projects led by the late Prof Humphreys, to whom the grant by the Stroke Association was awarded. Prof Humphreys designed and led the majority of this project and unfortunately was unable to see its completion. Although it has taken us a while to curate all the data, we finally completed the data cleaning and analysis with visiting MSc student Shuo Sun and are now closing this study by publishing this overall report.

The study found a null result in the primary registered, outcome measure:  in a comparison of patients screened with MoCA or OCS, overall broad stroke outcomes after 6 months did not differ. Exploratory analyses highlight the varying trajectories post stroke in a large group of 467 stroke survivors for who data was collected acutely and 6 month post stroke with a proportion of patients demonstrating stable cognitive performance, most demonstrating recovery, and around a fifth of patients showing cognitive decline.

The paper reflects some of our core values, in collaborative and open research:

This study ran in 37 different hospital sites with the help of UKCRN, and with the excellent coordination by the Study Management Team of Dr Tracy Nevatte and Mrs Alison Buttery. The analysis and write up was a true collaborative effort in the lab, and we set time aside as a group to work on this, kick-starting the write up with the ‘paper in a day’ approach (thanks to Prof Jennifer Tackett for inspiration!), organised by our postdoctoral fellow Dr Kathleen Vancleef. 

The experience of submitting our first paper to AMRC Open Research was very positive. Clear instructions, clear ways of presenting data, all data openly available in a public repository for other groups to use and all code attached and available (all available under the project on Figshare). The paper even includes one of Shuo’s beautiful interactive Figures. AMRC Open also uses CRediT statements to make author contributions fully transparent. Finally, we look forward to the open and signed reviews, which will be a first for us too.

The lay summary of the paper can be found here.

Sam Webb, who completed his MSc project in the lab is starting a new role as research assistant on a collaboration of our lab with Monash University’s Prof Mark Bellgrove‘s group (including Dr Méadhbh Brosnan) and University of Queensland’s Prof Jason Mattingley‘s lab.

This project uses recent advances in electroencephalography (EEG) to investigate a new test of visual attention difficulties in chronic stroke survivors. EEG is a technique which measures brain waves by recording from electrodes on the head. This new EEG-based test will distinguish between different processes in the brain that may be contributing to visual attention difficulties. These include how alert and attentive an individual is, how well they can select and process visual information, and how well they can signal motor movements.

Across 3 sites (Melbourne, Dublin and Oxford), we will recruit 100 stroke survivors (with and without attentional difficulties) and assess how they process and respond to visual information using EEG. We will explore how these EEG signals relate to standardised assessments currently used in clinical practice.