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ObjectiveTo establish a consensus on the structure and process of healthcare services for patients with concussion in England to facilitate better healthcare quality and patient outcome.DesignThis consensus study followed the modified Delphi methodology with five phases: participant identification, item development, two rounds of voting and a meeting to finalise the consensus statements. The predefined threshold for agreement was set at ≥70%.SettingSpecialist outpatient services.ParticipantsMembers of the UK Head Injury Network were invited to participate. The network consists of clinical specialists in head injury practising in emergency medicine, neurology, neuropsychology, neurosurgery, paediatric medicine, rehabilitation medicine and sports and exercise medicine in England.Primary outcome measureA consensus statement on the structure and process of specialist outpatient care for patients with concussion in England.Results55 items were voted on in the first round. 29 items were removed following the first voting round and 3 items were removed following the second voting round. Items were modified where appropriate. A final 18 statements reached consensus covering 3 main topics in specialist healthcare services for concussion; care pathway to structured follow-up, prognosis and measures of recovery, and provision of outpatient clinics.ConclusionsThis work presents statements on how the healthcare services for patients with concussion in England could be redesigned to meet their health needs. Future work will seek to implement these into the clinical pathway.

Ensuring reliable administration and reporting of cognitive screening tests are fundamental in establishing good clinical practice and research. This study captured the rate and type of errors in clinical practice, using the Addenbrooke's Cognitive Examination-III (ACE-III), and then the reduction in error rate using a computerized alternative, the ACEmobile app. In study 1, we evaluated ACE-III assessments completed in National Health Service (NHS) clinics (n = 87) for administrator error. In study 2, ACEmobile and ACE-III were then evaluated for their ability to capture accurate measurement. In study 1, 78% of clinically administered ACE-IIIs were either scored incorrectly or had arithmetical errors. In study 2, error rates seen in the ACE-III were reduced by 85%–93% using ACEmobile. Error rates are ubiquitous in routine clinical use of cognitive screening tests and the ACE-III. ACEmobile provides a framework for supporting reduced administration, scoring, and arithmetical error during cognitive screening.

It is important to recognise that migraine is a 'biological' and not a 'psychological' entity. However, psychological factors can be involved in migraine in 4 different ways:- 1) Migraines can be triggered by psychological stressors; 2) Severe migraine can itself be a cause of significant psychological stress which can, in turn, exacerbate the problem; 3) Even if psychological stress is not significantly involved in the genesis of the headache, pain management techniques can help people cope with their pain more effectively; 4) Longitudinal data demonstrate a complex bidirectional association between mood disorders and migraine. Treatment of a co-existing mood disorder, for example with cognitive behavioural techniques, may therefore reduce the impact of migraine. It would thus appear logical to view medical and psychological approaches as potentially synergistic rather than mutually exclusive. Functional imaging indicates that cognition, emotions, and pain experiences change the way the brain processes pain inputs. This may provide a physiological rationale for psychological interventions in pain management. As most studies of psychological management of migraine have been relatively small and the approach often varies between clinicians, the magnitude of benefit, optimum method of delivery, and the length of intervention are uncertain.

BackgroundIn order to facilitate neuroprotective trials in Parkinson's disease (PD), there is a need for improved means of early disease detection and measuring disease progression. Computerised assessment may afford easier and increasingly accurate administration of motor and cognitive tests, as well as measurement of indices not readily accessible with standard testing paradigms.AimTo develop and validate iPad-based cognitive and motor measures in PD.Method62 PD patients and 42 age-matched controls completed traditional and iPad versions of the Trail Making Test (TMT) (executive function) and Knox Cube Test (visual memory), as well as a range of other measures.ResultsMedian age was 68 years; median MOCA score was 26. No participant had previously used an iPad. There was significant correlation between traditional and iPad measures: TMTa r=0.74, p<0.001; TMTb r=0.76, p<0.001; Knox r=0.63, p<0.001. Usability data were strong, 90% of participants providing positive feedback.ConclusionThis initial study has demonstrated that two iPad-based measures of cognition are acceptable to PD patients and perform similarly to traditional pen-and-paper tests. Further work will extend the analysis of the measured indices in longitudinal studies to determine correlation with disease progression, and extend the battery of iPad-based tests available for PD assessment.

The current gold standard for assessment and monitoring of Parkinson's disease (PD) is the unified PD rating scale (UPDRS). While a useful evaluation tool, its application for research is limited by the need for an experienced rater, intra and inter-rater reliability and a 5-point scale. The UPDRS is time-consuming with the specific motor assessment taking >15 minutes to administer. Rapid, objective tools are needed to aid monitoring of PD for research utility. A finger-tapping app (PD-Tap), developed for use on an iPod Touch, was used to test finger tapping performance in 16 patients with idiopathic Parkinson's disease (mean age 66 years and disease duration 12 months) and 16 age-matched-controls (AMC). A fast finger-tapping task taking <1 minute to complete, was found to distinguish PD patients from AMC (t(30)=2.27, p=0.03). Moreover, PD-Tap scores showed high correlation with UPDRS motor scores (r=.69, p=.003). These results support the use of the tool in a research setting. PD-Tap is quick to administer, meaning there is potential to provide a more sensitive indicator of motor function than a 15 minute UPDRS assessment. The app-based nature of the tool is practical, and reproducible in a research environment. Future research aims to define the sensitivity of PD-Tap to evaluate motor fluctuations.

Background:Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.Method:Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.Results:Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.Conclusions:Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.Key learning aims(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.(2) To understand the facilitators of and barriers to ACT for plwMND.(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.

IntroductionClinical psychologists have traditionally focused on understanding and treating psychological distress, and psychological theories have rarely been applied to understand positive psychological well-being. This project is interested in applying the principles of Cognitive Theory, a well-established model for the mechanisms underpinning psychological disorders, to understanding positive psychological states.MethodSemi-structured interviews were conducted with undergraduate students to investigate how they think when they feel well. Items derived from these interviews were used in the design of two measures of positive cognition (one of positive core-beliefs and one of positive assumptions). These measures were administered to a larger sample of students, in a battery of questionnaires, examining other psychological variables and well-being. The results were analysed, to investigate the relationship between positive cognition and psychological well-being.ResultsThe findings provide evidence in support of the psychometric properties of the two measures, suggesting that positive cognitions can be reliably and validly measured. Correlation analyses indicated a positive relationship between positive cognition and psychological well-being. Regression analyses indicated that positive core-beliefs predict psychological well-being, although self-esteem was the best predictor. Core-beliefs had some unique predictive power, when other variables were accounted for.DiscussionThe findings provide some support for the hypothesis that positive cognitions exist and are related to psychological well-being in a way predicted by cognitive theory. The study also produces two measures of positive cognition, which have the potential to be developed and used in future research. Methodological issues are discussed along with the implications of the findings for theory, clinical practice and future research.