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Simon Fleminger

Publications and source records attributed to Simon Fleminger.

10 recordsLinked to original sources
PubMed2006

The Rivermead Post Concussion Symptoms Questionnaire: a confirmatory factor analysis.

OBJECTIVE: To investigate the factor structure of the Rivermead Post Concussion Symptoms Questionnaire (RPQ) among individuals seen as part of routine follow-up following traumatic brain injury. METHODS: RPQ data from 168 participants was examined (mean age 35.2, SD 14.3; 89% with post traumatic amnesia duration<24 hours) six months after admission to an Accident & Emergency Department following TBI. Structural equation modelling was carried out to evaluate proposed models of the underlying structure of post-concussion symptoms (PCS). RESULTS: The results support the existence of separate cognitive, emotional and somatic factors, although there was a high degree of covariation between the three factors. A two-factor model that collapsed the emotional and somatic factors together showed a similar goodness-of-fit to the data, whilst a one-factor model proved a poor fit. CONCLUSION: The results support the notion of post-concussion symptoms as a collection of associated but at least partially separable cognitive, emotional and somatic symptoms, although questions persist regarding symptom specificity. The use of the RPQ is discussed, and classification bands for use in clinical practice are suggested.

Adolescent↗
PubMed2006

The size of demand for specialized neuropsychiatry services: rates of referrals to neuropsychiatric services in the South thames region of the United kingdom.

The authors assessed the number of referrals to neuropsychiatry services covering South London, Kent, Surrey, and Sussex (population 6,887,000) over a 2-year period. The average referral rate was 11.2 per 100,000 per population for each year. Geographical distance from the specialist provider strongly affected referral rates, with clinicians in South London making more referrals than those from outside London. Assessment of appropriateness of referrals indicated that more than 86% of referrals were highly appropriate, and thus the higher level of referrals from close proximity cannot be attributed to inappropriate referrals. A survey of clinicians reported lower awareness of services and how to access these services among those clinicians working at a greater distance from the service provider, which likely results in unmet needs. Greater attempts should be made to improve access to neuropsychiatric services for clinicians who do not practice within close proximity of a specialist neuropsychiatry service.

England↗
PubMed2004

Allocentric spatial memory in humans with hippocampal lesions.

An immersive virtual reality (IVR) system was used to investigate allocentric spatial memory in a patient (PR) who had selective hippocampal damage, and also in patients who had undergone unilateral temporal lobectomies (17 right TL and 19 left TL), their performance compared against normal control groups. A human analogue of the Olton [Olton (1979). Hippocampus, space, and memory. Behavioural Brain Science, 2, 315] spatial maze was developed, consisting of a virtual room, a central virtual circular table and an array of radially arranged up-turned 'shells.' The participant had to search these shells in turn in order to find a blue 'cube' that would then 'move' to another location and so on, until all the shells had been target locations. Within-search errors could be made when the participants returned to a previously visited location during a search, and between-search errors when they revisited previously successful, but now incorrect locations. PR made significantly more between-search errors than his control group, but showed no increase in within-search errors. The right TL group showed a similar pattern of impairment, but the left TL group showed no impairment. This finding implicates the right hippocampal formation in spatial memory functioning in a scenario in which the visual environment was controlled so as to eliminate extraneous visual cues.

Adult↗
PubMed2004

Allocentric spatial memory activation of the hippocampal formation measured with fMRI.

Hippocampal activation was investigated, comparing allocentric and egocentric spatial memory. Healthy participants were immersed in a virtual reality circular arena, with pattern-rendered walls. In a viewpoint-independent task, they moved toward a pole, which was then removed. They were relocated to another position and had to move to the prior location of the pole. For viewpoint-dependent memory, the participants were not moved to a new starting point, but the patterns were rotated to prevent them from indicating the final position. Hippocampal and parahippocampal activation were found in the viewpoint-independent memory encoding phase. Viewpoint-dependent memory did not result in such activation. These results suggest differential activation of the hippocampal formation during allocentric encoding, in partial support of the spatial mapping hypothesis as applied to humans.

Adult↗
PubMed2002

Brain injury rehabilitation: what works for whom and when?

PRIMARY OBJECTIVE: This paper reviewed the available evidence that patient characteristics may determine the type of intervention that works best in brain injury rehabilitation. REASONING BEHIND LITERATURE SELECTION: A broad search strategy was used to identify papers which enabled conclusions to be drawn about patient characteristics which determined rehabilitation effectiveness. Six main areas were considered: severity of the brain injury, presenting problem, complicating factors, rehabilitation readiness, demographic, and socio-geographic variables. CRITICAL ANALYSIS OF LITERATURE: A levels of evidence analysis was used to evaluate the studies. MAIN OUTCOMES AND RESULTS: Very few studies on rehabilitation effectiveness were found which attempted to define the patient characteristics which predict a good response to rehabilitation. The best evidence relates to injury severity; more intense programmes may be unnecessary for those with less severe injuries. There is some evidence that dysexecutive problems, i.e. difficulties with organization and control of behaviour and emotion, interfere with rehabilitation. CONCLUSIONS: Patient characteristics may well determine individual benefits from particular rehabilitation programmes. However, few studies have attempted to provide evidence about this. As health provision focuses on needs-led services, it becomes paramount to investigate effectiveness from the client's perspective.

Brain Injuries↗
PubMedDate not supplied

Experience and perspectives on the classification of organic mental disorders.

The official diagnostic classification systems have been increasingly employed in the last few years, and this is true of both ICD-10 and DSM-IV. We will propose a few principles which should be considered when revisions are attempted. Our existing classifications should be simplified, but new syndromes incorporated where they have pathological justification. Links to other specialist diagnostic classifications should be made (e.g. in epilepsy, sleep disorders, dementias) wherever possible. A broader range of 'Neuropsychiatric Disorders' should be incorporated, including alcohol-related organic disorders, head injury, sleep disorders, if possible including the 'psychogenic syndromes'. Progressive, degenerative disorders need to be clearly distinguished from non-progressive syndromes, and some gradation of severity needs to be built into the classificatory system. Finally, the definitions need to be concise and accurate.

Humans↗
PubMedDate not supplied

Neuropsychiatry.

Explore the source record for details and available documents.

Delirium↗