Perceived cognitive difficulties and cognitive impairment are important determinants of employment in people with multiple sclerosis (pwMS). However, it is not clear how they are related to adverse work outcomes and whether the relationship is influenced by depressive symptoms. Thus, this study examined perceived and actual general cognitive and prospective memory function, and cognitive appraisal accuracy, in relation to adverse work outcomes. The possible mediating and/or moderating role of depression was also examined. A cross-sectional community-based sample of 111 participants (33 males, 78 females) completed the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ), Beck Depression Inventory – Fast Screen (BDI-FS), and questions related to their current or past employment. They then underwent cognitive testing using the Screening Examination for Cognitive Impairment, Auditory Consonant Trigrams test, Zoo Map Test, and Cambridge Prospective Memory Test. Perceived general cognitive and prospective memory difficulties in the workplace and performance on the respective cognitive tests were found to predict unemployment and reduced work hours since MS diagnosis due to MS. Depression was also related to reduced work hours, but it did not explain the relationship between perceived cognitive difficulties and the work outcomes. Nor was it related to cognitive test performance. The results highlight a need to address the perceptions of cognitive difficulties together with cognitive impairment and levels of depression in vocational rehabilitation programs in pwMS. (JINS, 2015,21, 156–168)

The ability to see things from another's perspective, that is, have a theory of mind (ToM), is essential to effective communication. So too is the ability to regulate verbal output, that is, to exercise executive control. People with traumatic brain injuries (TBIs) have impaired communication abilities, but the extent to which this reflects ToM versus executive dysfunction is unclear. This study explored the relative contributions of executive abilities, specifically flexibility and inhibition and ToM abilities in language production post-TBI. Twenty-five adults (18 males: mean age of 48.2 years, SD = 12.0 years) with moderate to severe TBI (posttraumatic amnesia = 69.2, SD = 54.6 days) and 28 noninjured adults (19 males: mean age 49.0, SD = 12.2 years) completed three sets of communication tasks with low executive demands, high flexibility, and high inhibition demands. Within each, parallel versions had low or high ToM requirements. For low executive and high flexibility tasks, scores on the high ToM versions were predicted by scores on the low ToM versions, suggesting that poor performance was explained by the executive demands the parallel tasks had in common. The exception was the high inhibition task. In this case, speakers with TBI had differential difficulty with the high ToM version, that is, they had specific difficulty inhibiting self-referential thoughts in order to cater for another's perspective. We found problems with inhibiting the self-perspective accords with descriptive accounts of the egocentric nature of some communication patterns following TBI, which points to potential targets for remediation.

Background: Traumatic brain injury (TBI) can reduce psychosocial functioning, causing relationship, family, and employment difficulties. The present study by Moving Ahead: Centre for Research Excellence (CRE) in Brain Recovery aimed to identify a set of adult outcome instruments for moderate-to-severe TBI psychosocial research. Procedure: A review of 115 instruments (identified through nomination, literature search, and international expert opinion) was conducted over a 15-month period. Eleven psychosocial areas were examined: Global Outcome, Communication, Social Cognition, Behavioural and Executive Function, Other Neuropsychological Functioning, Psychological Status, TBI-related Symptoms, Activities and Participation, Support and Relationships, Sense of Self, and Health-related Quality of Life. Individual instruments were considered against selection guidelines, and specific measures that best met the guidelines were identified as core (common across all studies), supplemental (dependent on study type) or emerging. Results: The final recommendations, organised in accordance with the World Health Organisation’s International Classification of Functioning taxonomy, comprised 56 instruments for use in early recovery, outcome, and intervention studies. Conclusion: These recommendations provide a coherent framework along with identified outcome instruments to guide psychosocial research in moderate-to-severe TBI. Adherence to the recommendations will enable data-pooling and comparison across studies and research settings facilitating consistent measurement across the lifespan.

Background: A better understanding of the workplace difficulties experienced by people with multiple sclerosis (PwMS) may be critical to developing appropriate vocational and rehabilitative programs. Objective: We aimed to assess the factor structure, internal consistency and validity of the new Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ). Methods: Work difficulty items were developed and reviewed by a panel of experts. Using the MSWDQ, cross-sectional self-report data of work difficulties were obtained in addition to employment status and MS disease information, in a community-based sample of 189 PwMS. Results: Exploratory Maximum Likelihood Factor Analysis on the draft questionnaire yielded 50 items measuring 12 factors. Subscale internal consistencies ranged from 0.74 to 0.92, indicating adequate to excellent internal consistency reliability. The MSWDQ explained 40% of the variance in reduced work hours since diagnosis, 40% of the variance in expectations about withdrawing from work, 34% of the variance in expectations about reducing work hours, and 39% of the variance in expectations about changing type of work due to MS. Conclusion: The MSWDQ is a valid and internally reliable measure of workplace difficulties in PwMS. Physical difficulties, as well as cognitive and psychological difficulties were important predictors of workplace outcomes and expectations about future employment.

Objective: The Awareness of Social Inference Test (TASIT) is an ecologically valid test of complex social perception. Despite its utility for detecting social perception deficits in clinical groups, its lengthy administration time has limited its routine use in clinical practice. This paper describes the development and validation of a shortened version of the TASIT (TASIT-S) in 160 individuals (males = 129) with moderate to severe acquired brain injury (ABI). Method: Both Rasch and confirmatory factor analysis modeling were used to create the TASIT-S, which, consistent with the original test, included the following subtests: (1) Emotion Evaluation Test (10 items), assessing basic emotion recognition; (2) Social Inference (Minimal) Test (9 items), assessing understanding of sincere and sarcastic exchanges; and (3) Social Inference (Enriched) Test (9 items), assessing comprehension of lies and sarcasm. Results: The TASIT-S demonstrated excellent construct validity as evidenced by its high correlations with the original TASIT and correlations with social cognition and cognitive neuropsychological measures. Importantly, the TASIT-S also successfully differentiated between ABI participants and healthy controls (n = 43). Conclusions: The new shortened version of the TASIT is a promising new tool with excellent psychometric properties that can assist clinicians with the detection of complex social perception deficits in ABI.