Centre for Neurorehabilitation @UCLP
SYMPOSIUM: Friday 15th November 2013
Decision-making in neurological rehabilitation
How can advances in the field of decision-making lead to
improvements in the delivery of neuro-rehab?
Programme
8.30-9.00
Registration
9.00-9.45
David Sharp: Cognitive function, inflammation and
neurodegeneration after traumatic brain injury
9.45-10.30
Benedetto De Martino: Comparing Apples and Pears: The
Neurobiology of Value-based Choice
10.30-11.00
Coffee break
11.00-11.45
Brad Love: Improving Cognitive Function Through Gaming
11.45-12.30
Mitul Mehta: Pharmacological modulation of response
inhibition - target identification using fMRI
12.30-13.45
Lunch break (see last page for places to go)
13.45-14.30
Sarah Edwards: TBC
14.30-15.15
Carl Thompson: "Faith, trust and pixie dust” professional
judgement in healthcare, is it broken and can we fix it?
15.15-16.30
Priscilla Harries: Using judgement analysis to research
experts' clinical decision making and develop effective
training for novices
16.30-
Tea/Coffee & Finish
Introduction
We welcome you to the inaugural symposium of The Centre for
Neurorehabilitation. The Centre is a collaboration between the
clinicians and researchers within UCLPartners. Our aim at CNR@UCLP
is to improve the lives of people with neurodisability by delivering
solutions to major challenges in neurorehabilitation care, research
and education: http://www.ucl.ac.uk/cnr
The aim of our one-day symposium is to better understand how
decision making influences patient outcomes. Our wide range of
speakers will explore decision making at a variety of scales: from
cortical networks to rehabilitation strategies; from the processes
clinicians adopt when confronted with complex problems, to the
analysis of risk and ethical considerations.
We hope that you all have a good time. Perhaps you will feel inspired
to join one of our working groups. Sign up to the mailing list by
sending an email to: cnr@ucl.ac.uk or follow us on twitter
@NeurorehabUCLP.
On Behalf of CNR@UCLP
Dr Alex Leff
Dr Diane Playford
Dr Richard Sylvester
Prof David Sharp
The Computational, Cognitive and Clinical Neuroimaging
Laboratory Division of Brain Sciences, Imperial College
London.
Cognitive function, inflammation and
neurodegeneration after traumatic brain injury
Abstract: Patient outcome after traumatic brain injury (TBI) is highly variable. The reasons
for this are poorly understood, but persistent inflammation and neurodegeneration are
potentially important factors. Brain injury can result in prolonged inflammation, and this
can be studied in vivo in humans using positron emission tomography (PET). I will discuss
recent work using PET that shows increased microglial activation can be present many years
after TBI. This suggests that TBI triggers a chronic inflammatory response particularly in subcortical regions, and highlights the importance of considering the response to TBI as
evolving over time. Modifying this persistent inflammatory response is a promising strategy
for improving long-term outcome for TBI patients, and I will also discuss work linking
inflammation, diffuse axonal injury and neurodegeneration triggered by TBI.
Biog: David Sharp is a National Institute of Health Research Professor and consultant
neurologist based at Imperial College London. He has a degree in Psychology, Physiology
and Philosophy from the University of Oxford (1993), a degree in Medicine from the
Universities of Oxford and London (1996), and a PhD from the University of London (2006).
He was appointed to an NIHR Professorship in 2012 and his programme of research aims to
improve clinical outcome after traumatic brain injury. The work focuses on common
cognitive impairments in domains such as memory and attention. He uses advanced
neuroimaging to diagnose the underlying cause of these cognitive problems, particularly
focusing on the effect of brain injury on brain network function and the role of inflammation
in brain repair and neurodegeneration.
Dr Benedetto De Martino
Department of Psychology, Royal Holloway University of
London.
Comparing Apples and Pears: The Neurobiology of
Value-based Choice
Abstract: Most of the decisions we make are value-based
choices, and these range from the most trivial ones (“What should I have for lunch?”) to the
most important choices that we make in our lives (“Shall I sell my house?” “Shall I have this
surgical procedure”). Unlike perceptual choices, in which the goal of the decision maker is
the categorisation of sensory stimuli, in value-based choices the decision-maker needs to
compare options that are very different from one another on a sensory level - the proverbial
apples and pears. Value-based decisions therefore require an intermediate step in which the
brain has to compute a common value currency that allows this type of comparison. In my
talk I will discuss how the brain performs such computations and how in turn these
computations shape choice. I will also discuss why our value-based choices are frequently
‘suboptimal’
Biog: I am a cognitive neuroscientist who works in the field of decision making and
neuroeconomics. I did my PhD (funded by the Wellcome Trust) at University College London
(UCL). Here I began to study human decision-making, integrating economics models with
the tools of cognitive neuroscience with the aim of developing a more realistic account of
economic behaviour. In 2008 I was awarded a Wellcome postdoctoral fellowship with Daniel
Kahneman as mentor. I worked two years in the Department of Economics at Caltech with
Colin Camerer. I am now at Royal Holloway University of London Department of Psychology
as Senior Research Fellow in Neuroeconomics, I hold a position as Visiting Associate in
Economics and Neuroscience at CalTech.
Prof Brad Love
Cognitive, Perceptual & Brain Sciences,
Division of Psychology & Language
Sciences, Faculty of Brain Sciences, UCL.
Improving Cognitive Function
Through Gaming
Abstract: Video gaming can be an immersive and intense activity. One important question is
whether video games can shape core components of human cognition, such as cognitive
flexibility. We find that directed experience in a real-time strategy (RTS) game, which
stresses maintenance and rapid manipulation of multiple information sources, boosts
cognitive flexibility. Key questions centre on the robustness of such improvements and their
root causes. I will discuss several methods that address these questions, including a new
method for analysing brain imaging data that allows one to infer the cognitive model
underlying behaviour and performance gains.
Biog: Brad Love completed his Ph.D. at Northwestern University in Cognitive Psychology. He
is interested in basic aspects of learning and decision making with an emphasis on using
computational methods to draw linkages across various measures, such as choice, response
time, genetic, and brain data. He moved to UCL in early 2012.
Dr Mitul Mehta
Head of the Neuropharmacology Group in the
Department of Neuroimaging at the Institute of
Psychiatry, King’s College London.
Pharmacological modulation of response
inhibition - target identification using fMRI
Abstract: Response inhibition refers to the process attributed to the cancellation of an
initiated response or the overriding of a pre-potent response. Response inhibition is usually
tested with a variety of tasks including the Stroop, go-nogo and stop signal tasks. The stroop
task involves overriding the prepotent reading response, the go-nogo task involves
overriding a prepotent motor response and the stop-signal task involves cancellation of an
initiated response. These tasks are impaired across a range of neurological and psychiatric
conditions and thus response inhibition represent an important treatment target. However,
these tasks engage other cognitive functions, most notably attentional and strategic
processes, which may also represent important treatment targets. Psychopharmacology
combined with imaging is beginning to provide insights into the brain mechanisms and
putative processes that can be modulated by treatment. The extant literature will be
reviewed in order to understand the effects of existing treatments.
Biog: Mitul graduated from the University of Cambridge, where he completed his PhD on
the role of dopamine in cognition in humans. An MRC Fellowship took him to Hammersmith
Hospital to train in PET imaging. He moved onto fMRI with a Wellcome Trust Award at the
Institute of Psychiatry, where he now heads the Neuropharmacology Group there as a
Senior Lecturer. His research focuses on the measurement of drug effects in the brain and
the role of pharmacological interventions in cognitive function. This includes clinical trials to
understand mechanisms of novel compounds. His work has been recognised by a British
Association for Psychopharmacology Young Investigator’s award, and he is now an elected
member of their council. He is also on the editorial team for the journal
Psychopharmacology.
Dr Sarah Edwards
Senior Lecturer in Research Ethics and Governance,
Centre for Philosophy, Justice and Health, UCL.
Title and abstract: TBC
Biog: Sarah’s research interests lie in the specific context of health research, drawing on
methods in philosophy, law and empirical social science to answer different practical and
policy questions raised by new health technologies and by research designed to evaluate
them.
She is particularly interested in how traditional disciplines can work effectively together to
answer common problems. As a result, she often works collaboratively with academics from
different departments, having recently been involved with the UCL ESRC funded network on
supported decision making with the Department of Psychology, the UCL Grand Challenge’s
Group on Vulnerable Populations with the Centre for Disability Studies, and with the UCL
Anthropology and Sociology Forum on Resilience with the Institute for Risk and Disaster
Studies. She is currently organising a series of interdisciplinary conferences on
contemporary problems faced by experimental medicine for the BRC.
Prof Carl Thompson
Health Sciences, The University of York.
"Faith, trust and pixie dust”: professional
judgement in healthcare, is it broken and can
we fix it?
Abstract: When a critical gaze is cast on professional
judgements and decisions then the quality that the
public often assume is present in the outcomes and
processes of clinical reasoning is simply not there. Healthcare is inherently uncertain, but
even after accounting for this, decisions and judgements are sometimes (and systematically)
suboptimal, and the effectiveness of corrective strategies often unknown (but not often
underplayed). Drawing on some decision research “classics”, some contemporary ideas, my
team’s research program of 15 years, and focusing on the largest part of the NHS workforce:
nurses, I will argue that at least some of the techniques we put so much faith in to improve
professional judgement might not be as effective as the public (and professionals) might
assume.
Biog: Professor Thompson has held a personal Chair at the University of York since 2009. He
is a nurse and health services researcher. £14m of ESRC, MRC and NIHR research funding,
and a long standing interest in the role of decision making and judgement in the
implementation of research findings and NHS quality has led to more than 120 peer
reviewed and professional articles, book chapters and reports. Carl has produced three
books on health service evaluation, and clinical decision making and judgement. He is head
of the University of York’s, Health Sciences’ Graduate School and is a non-executive Director
of Leeds York Partnerships Foundation NHS Trust and an honorary Chair at the Universities
of East Anglia and Alberta, Canada.
Dr Priscilla Harries
Occupational Therapy Division Director, School of Health
Sciences and Social Care, Brunel University.
Using judgement analysis to research experts'
clinical decision making and develop effective
training for novices
Abstract: The presentation will demonstrate differences in expert and novice clinical
decision-making styles and illustrate how experts’ judgements can be captured and used to
develop effective online decision training to improve novices’ decision making. A study of
clinicians' referral prioritisation ability will be used to illustrate how judgement analysis can
be used to statistically model information use, and how CWS analysis can be used to
examine individual's capacity to discriminate effectively in complex cases. The effect of
using experts' judgement policies to train novices’ capacity will be demonstrated.
Biog: Dr Priscilla Harries is a Reader and Divisional Director of Occupational Therapy at
Brunel University, West London. Priscilla worked as an occupational therapist in the fields
of neurosurgery, neurology and mental health at the Maudsley Hospital. Her research
interests are in judgement and decision-making, clinical reasoning, and the study of intuitive
expert thinking. She has held grants from the ESRC, MRC, UKOTRF and HEA to study
professional decision-making in various clinical domains. She has developed a range of online training resources to support the acquisition of professional decision-making skills in a
number of fields, which are freely available on her web page. She is former Chair of the
Editorial Board of the British Journal of Occupational Therapists and a Fellow of the College
of Occupational Therapists. She has been appointed to the Peer Review College of the ESRC
and as a mentor for the NIHR Research Fellowship Scheme.