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 NEUROPSYCHOLOGICAL
REHABILITATION

This outstanding new handbook offers unique coverage of all aspects of neuropsychological
rehabilitation. Compiled by the world’s leading clinician-researchers, and written by an exceptional
team of international contributors, the book is vast in scope, including chapters on the many and varied
components of neuropsychological rehabilitation across the life span within one volume.
Divided into sections, the first part looks at general issues in neuropsychological rehabilitation
including theories and models, assessment and goal setting. The book goes on to examine the different
populations referred for neuropsychological rehabilitation and then focuses on the rehabilitation of first
cognitive and then psychosocial disorders. New and emerging approaches such as brain training and
social robotics are also considered, alongside an extensive section on rehabilitation around the world,
particularly in under-resourced settings. The final section offers some general conclusions and an
evaluation of the key issues in this important field.
This is a landmark publication for neuropsychological rehabilitation. It is the stand alone reference
text for the field as well as essential reading for all researchers, students and practitioners in clinical
neuropsychology, clinical psychology, occupational therapy, and speech and language therapy. It will
also be of great value to those in related professions such as neurologists, rehabilitation physicians,
rehabilitation psychologists and medics.

Barbara A. Wilson is a clinical neuropsychologist who has worked in brain injury rehabilitation for 40
years. She has won many awards for her work including an OBE for services to rehabilitation and four
lifetime achievement awards (from the British Psychological Society, the International Neuropsychological
Society, The National Academy of Neuropsychology and The Encephalitis Society). The Division of
Neuropsychology has named a prize after her, the Barbara A. Wilson prize for distinguished contributions
to neuropsychology. She is honorary professor at the University of Hong Kong, the University of
Sydney and the University of East Anglia.

Jill Winegardner is Lead Clinical Psychologist at the Oliver Zangwill Centre in Ely, Cambridgeshire,
UK. Her career has spanned neuropsychological rehabilitation in brain injury settings including acute
inpatient rehabilitation, post-acute residential rehabilitation, and outpatient rehabilitation. She helped
establish the field of neuropsychology in Nicaragua. Her clinical and research interests focus on
evidence-based best practice in brain injury rehabilitation.

Caroline M. van Heugten is professor of Clinical Neuropsychology at the School for Mental Health
and Neuroscience at the Maastricht University Medical Center and the department of Neuropsychology
& Psychopharmacology at Maastricht University, Maastricht, the Netherlands. Her main research
interest is in neuropsychological rehabilitation including assessment and treatment. Over the past five
years she was leader of two national research programs on rehabilitation. Caroline is the initiator and
director of the Limburg Brain Injury Center.

Tamara Ownsworth is a Professor of Clinical Neuropsychology in the School of Applied Psychology

and Menzies Health Institute Queensland, Griffith University, Australia. She has over 20 years of clinical
experience and research in the field. Her broad research interests include rehabilitation and psychological
adjustment to neurological disorders such as traumatic brain injury, stroke and brain tumour.
 NEUROPSYCHOLOGICAL
REHABILITATION
The International Handbook

Edited by Barbara A. Wilson, Jill Winegardner,

Caroline M. van Heugten and Tamara Ownsworth
 First published 2017
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2017 selection and editorial matter, Barbara A. Wilson, Jill Winegardner,
Caroline M. van Heugten and Tamara Ownsworth; individual chapters,
the contributors
The right of the editors to be identified as authors of the editorial material,
and of the authors for their individual chapters, has been asserted in
accordance with sections 77 and 78 of the Copyright, Designs and
Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Names: Wilson, Barbara A., 1941- editor. | Winegardner, Jill, 1953- editor. | Heugten,
Carolina Maria van, 1965- editor. | Ownsworth, Tamara, editor.
Title: Neuropsychological rehabilitation : the international handbook / edited by
Barbara A. Wilson, Jill Winegardner, Caroline M. van Heugten, and Tamara Ownsworth.
Description: Abingdon, Oxon ; New York, NY : Routledge, 2017. | Includes
bibliographical references.
Identifiers: LCCN 2016054572| ISBN 9781138643093 (hardback : alk. paper) | ISBN
9781138643116 (pbk. : alk. paper) | ISBN 9781315629537 (ebook)
Subjects: LCSH: Brain damage--Patients--Rehabilitation--Handbooks, manuals, etc. |
Clinical neuropsychology--Handbooks, manuals, etc.
Classification: LCC RC387.5 .N4847 2017 | DDC 617.4/810443--dc23
LC record available at https://lccn.loc.gov/2016054572

ISBN: 978-1-138-64309-3 (hbk)

ISBN: 978-1-138-64311-6 (pbk)
ISBN: 978-1-315-62953-7 (ebk)
Typeset in Bembo
by Saxon Graphics Ltd, Derby
 CONTENTS

List of figures xi
List of tables xii
List of boxes xiv
List of contributors xv
Acknowledgementsxxi

SECTION ONE
General issues in neuropsychological rehabilitation 1

Introduction 3
Barbara A. Wilson, Jill Winegardner, Caroline M. van Heugten and
Tamara Ownsworth

1 The development of neuropsychological rehabilitation:

an historical examination of theoretical and practical issues 6
Barbara A. Wilson

2 Evidence-based treatment 17
Caroline M. van Heugten

3 Mechanisms of recovery after acquired brain injury 25

Luciano Fasotti

4 Assessment for neuropsychological rehabilitation planning 36

James F. Malec

5 Goal setting in rehabilitation 49

Jonathan J. Evans and Agata Krasny-Pacini
 Contents

SECTION TWO
Populations referred for neuropsychological rehabilitation 59

6 Adults with non-progressive brain injury 61

a) Traumatic brain injury 61
Jennie L. Ponsford and Alicia R. Dymowski
b) Stroke 65
Caroline M. van Heugten
c) Encephalitis 69
Ava Easton and Janet Hodgson
d) Anoxia 74
Barbara A. Wilson and Caroline M. van Heugten
e) Epilepsy 77
Sallie Baxendale

7 Adults with progressive conditions 81

a) Dementia 81
Linda Clare and Sharon Savage
b) Multiple sclerosis 85
Anita Rose
c) Parkinson’s disease 88
Annelien Duits
d) Huntington’s disease 92
Julie S. Snowden
e) Brain tumours 96
Tamara Ownsworth

8 Children with traumatic brain injury 102

Cathy Catroppa, Celia Godfrey, Betony Clasby and Vicki Anderson

9 Other neurological conditions affecting children 113

Louise Crowe, Amy Brown and Mardee Greenham

10 People with disorders of consciousness 124

Jitka Annen, Steven Laureys and Olivia Gosseries

11 Neuropsychological rehabilitation for psychiatric disorders 136

Tara Rezapour, Brent Wurfel, Sara Simblett and Hamed Ekhtiari

vi
 Contents

12 Other populations seen for rehabilitation 149

a) HIV 149
Michael Perdices
b) Blast injuries 153
Matthew D. Grilli and Mieke Verfaellie

SECTION THREE
Rehabilitation of cognitive disorders 159

13 Rehabilitation of slowed information processing  161

Luciano Fasotti

14 Rehabilitation of attention disorders 172

a) Adults 172
Jessica Fish
b) Children 179
Anna-Lynne Ruth Adlam, Jenny Limond and Suncica Lah

15 Rehabilitation of working memory disorders 186

Jessica Fish and Tom Manly

16 Rehabilitation of memory disorders in adults and children 196

Giverny Parker, Catherine Haslam, Jennifer Fleming and David Shum

17 Rehabilitation of executive functions 207

a) Adults 209
Jacoba M. Spikman
b) Children 213
Agata Krasny-Pacini, Jenny Limond and Mathilde Chevignard

18 Rehabilitation of language disorders in adults and children 220

Anastasia Raymer and Lyn Turkstra

19 Rehabilitation of visual perceptual and visual spatial disorders in

adults and children 234
Barbara A. Wilson, Joe Mole and Tom Manly

20 Rehabilitation of apraxia in adults and children 244

Caroline M. van Heugten and Chantal Geusgens

21 Managing acquired social communication disorders 251

Jacinta Douglas and Leanne Togher

22 Rehabilitation of social cognition disorders 266

Skye McDonald and Anneli Cassel

vii
 Contents

23 Managing disorders of social and behavioural control and disorders

of apathy 282
Nick Alderman and Caroline Knight

24 Rehabilitation of challenging behaviour in community settings:

the Empowerment Behavioural Management Approach (EBMA) 298
Shai Betteridge, Emma Cotterill and Paula Murphy

SECTION FOUR
Rehabilitation of psychosocial disorders 311

25 Cognitive behavioural therapy for people with brain injury 313

Tamara Ownsworth and Fergus Gracey

26 Third wave cognitive and behavioural therapies: compassion

Focused Therapy, Acceptance and Commitment Therapy and
Positive Psychotherapy 327
Fiona Ashworth, Jonathan J. Evans and Hamish McLeod

27 Managing self-awareness and identity issues following brain injury 340

Tamara Ownsworth

28 Psychosocial interventions for children/working with schools

and families 354
Shari L. Wade and Ann Glang

29 Family-based support for people with brain injury 364

Pamela S. Klonoff, Bibi Stang and Kavitha Perumparaichallai

30 Vocational and occupational rehabilitation for people with

brain injury 378
Andy Tyerman, Mick Meehan and Ruth Tyerman

SECTION FIVE
Recent and emerging approaches in neuropsychological
rehabilitation389

31 Managing fatigue in adults after acquired brain injury 391

Donna Malley

32 Sexuality and rehabilitation following acquired brain injury 403

Jennie L. Ponsford, Marina Downing and Rene Stolwyk

33 Neurologic music therapy in neuropsychological rehabilitation 414

Michael H. Thaut and Volker Hoemberg

viii
 Contents

34 Novel forms of cognitive rehabilitation 425

Caroline M. van Heugten

35 Using technology to overcome impairments of mental functions 434

Brian O’Neill, Matthew Jamieson and Rachel Goodwin

36 Technology-based delivery of neuropsychological rehabilitation 447

Theo Tsaousides and Teresa Ashman

37 Social robotics in dementia care  458

Wendy Moyle

SECTION SIX
Global and cultural perspectives on neuropsychological
rehabilitation467

38 The cost-effectiveness of neuropsychological rehabilitation 469

Andrew Worthington, Sara da Silva Ramos and Michael Oddy

39 A global perspective on neuropsychological rehabilitation:

Maximising outcomes when funds are short 480
Jill Winegardner and Rudi Coetzer

40 The importance of culture in holistic neuropsychological

rehabilitation: suggestions for improving cultural competence 492
Ana Paula Pereira, Jessica Fish, Donna Malley and Andrew Bateman

41 Rehabilitation around the world 500

Neuropsychological rehabilitation: a global overview 500
Ann D. Watts
a) Rehabilitation in India 502
Urvashi Shah
b) Rehabilitation in Iran 505
Mohammad Taghi Joghataei
c) Rehabilitation in Russia 508
Pauline Monro and Olga Kamaeva
d) Rehabilitation in Taiwan 511
Chi-Cheng Yang {James}
e) Rehabilitation in mainland China 514
Raymond C.K. Chan and Ya Wang
f) Rehabilitation in Hong Kong 517
David Man, Calvin Yip, Cynthia Lai and Grace Lee

ix
 Contents

g) Rehabilitation in Brazil 520

Anita Taub and Fabricia Quintão Loschiavo-Alvares
h) Rehabilitation in Argentina 523
Natalia Sierra Sanjurjo and Teresa Torralva
i) Rehabilitation in South Africa 526
Leigh Schrieff-Elson and Kevin Thomas
j) Rehabilitation in Botswana 530
Lingani Mbakile-Mahlanza and Jennie L. Ponsford

SECTION SEVEN
Evaluation and general conclusions 535

42 Outcome measures 537

Caroline M. van Heugten

43 Avoiding bias in evaluating rehabilitation 547

Robyn Tate and Michael Perdices

44 Challenges in the evaluation of neuropsychological rehabilitation

effects559
Tessa Hart

45 Summary and guidelines for neuropsychological rehabilitation 569

Jill Winegardner, Caroline M. van Heugten, Tamara Ownsworth
and Barbara A. Wilson

Index575

x
 FIGURES

2.1 Process of clinical decision-making 19

3.1 rCBF increase for the language-rest contrast between sessions one (two months
post-onset) and two (one year after stroke) (de Boissezon et al., 2005) 29
6.1 The consequences of encephalitis. Reproduced with kind permission of The
Encephalitis Society 72
6.2 Factors influencing performance on neuropsychological tests in epilepsy (adapted
from Baxendale and Thompson, 2010: copyright ILAE, 2010) 77
10.1 Brain glucose consumption in a patient with unresponsive wakefulness syndrome
(UWS), in a minimally conscious state (MCS) and in a healthy subject. CMRglc =
Cerebral metabolic rate of glucose 127
10.2a Location of tDCS stimulation
10.2b Brain metabolism difference between responders and non-responders 130
11.1 Tiers and targets for neuropsychological rehabilitation in psychiatric disorders
based on the RDoC framework 144
13.1 Reaction times of closed head injury (CHI) patients versus controls 163
13.2 How patients with slow information processing can use the TPM strategies in
performing speed tasks by preventing and dealing with time pressure 167
14.1 The central components of attention and their conceptual overlap with other
domains of cognition. Note: SoIP refers to Speed of Information Processing 174
21.1 Factors to consider in the management of acquired social communication disorders
in adults
24.1 TS’s average number of behavioural incidents per week  309
25.1 An updated version of the Y-shaped model providing a transdiagnostic account
(Gracey et al., 2009) 316
27.1 Cycle of appraisal, anxiety and avoidance and the impact on self-concept
(Ownsworth, 2014; reproduced with permission)344
27.2 Amy’s metaphoric identity map (adapted from Ylvisaker et al., 2008)351
31.1 Clinical model for understanding responses (adapted from Malley et al., 2014)396
37.1 Paro, a robotic harp seal developed in Japan by Dr Takanori Shibata. Credit:
AIST, Japan 460
 TABLES

2.1 Setting up a treatment plan 18

4.1 Cognitive domains and example measures 39
4.2 Functional domains and example measures 40
4.3 Translating assessment into a treatment plan: illustrative case example 44
4.4 Examples of GAS 46
6.1 The two broad causes of encephalitis, how they might present, their symptoms
and treatment options 70
6.2 Steps in the cognitive rehabilitation of people with epilepsy 79
7.1 Clinical trials evaluating supportive care interventions for primary brain tumour 99
11.1 Samples of published evidence for efficacy of NR programmes in the cognitive
intervention tier for psychiatric disorders 142
12.1 CDC classification system for HIV infection (adapted from CDC, 1992) 149
12.2 Revised criteria for HIV-Associated Neurocognitive Disorder (HAND) 150
14.1 The clinical assessment of attention, example tests and their relation to attentional
theory175
14.2 Interactions between attention, other cognitive domains and environmental factors 176
14.3 Recommendations on the rehabilitation of attention from the INCOG review
group177
16.1 Practice guidelines and recommendations for memory rehabilitation in adults 202
16.2 Practice suggestions for memory rehabilitation in children 202
18.1 Aphasia syndromes 221
18.2 Partner strategies to facilitate or reduce barriers in the aphasic communication
dyad228
21.1 Features of social communication impairment in acquired communication
disorders252
21.2 Example tools and procedures used to assess acquired social communication
disorders256
21.3 INCOG recommendations for cognitive communication rehabilitation of people
with severe traumatic brain injury (Togher et al., 2014) 259
25.1 Randomised controlled trials evaluating the efficacy of CBT for depression after
TBI320

xii
 Tables

26.1 Core ACT processes underpinning psychological flexibility and their application
to ABI treatment 332
26.2 Published studies examining ACT in the context of ABI 333
27.1 Intervention approaches for improving self-awareness after brain injury 348
35.1 The ICF seven global and 11 specific mental functions (WHO, 2002) 435
42.1 ICF brief core sets for stroke and traumatic brain injury (www.icf-sets.org) 539
42.2 ICF categories that have been measured in RCTs evaluating the effectiveness of
neuropsychological rehabilitation in patients with ABI 540
42.3 Descriptive features of the CIQ, CHART and SPRS (see also Tate, 2014) 542
43.1 Common types of bias and threats to validity 549
43.2 Items of selected critical appraisal tools 554

xiii
 BOXES

14.1 Stages involved in the rehabilitation of attention as a component of holistic

neuropsychological rehabilitation at the Oliver Zangwill Centre 178
14.2 Applying the Paediatric Neurocognitive Interventions model (PNI; Limond,
Adlam and Cormack, 2014) to support attention difficulties in children 182
21.1 Key components of training programme for communication partners
(Togher et al., 2013b) 261
22.1 Reading a Smile: an emotion perception treatment programme 272
22.2 Metacognitive Training 273
22.3 Mini-Theory of Mind Intervention 275
22.4 Social Cognition and Interaction Training 276
22.5 Improving First Impressions: a step-by-step social skills programme 278
24.1 Key EBMA questions to help define the presenting problem  301
24.2 Case example 303
24.3 Case example  304
24.4 Case example 305
24.5 Excerpt of a behavioural agreement (BA) 305
24.6 Content of staff training  307
24.7 Case examples 308
26.1 Key components of CFT 329
29.1 Grief and loss data from the MM-CGI ABI revised (N=41) 372

xiv
 CONTRIBUTORS

Anna-Lynne Ruth Adlam, University of Exeter, Exeter, United Kingdom

Nick Alderman, Priory Brain Injury Services, Priory Healthcare and Partnerships in Care, Grafton
Manor, Grafton Regis, Department of Psychology, Swansea University, Swansea, United Kingdom

Vicki Anderson, Royal Children’s Hospital, Melbourne, and Murdoch Children’s Research
Institute, Parkville, Australia

Jitka Annen, University of Liege, Liege, Belgium

Teresa Ashman, University of Delaware, Newark, Delaware, USA

Fiona Ashworth, Anglia Ruskin University, Cambridge, United Kingdom

Andrew Bateman, The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely,
United Kingdom

Sallie Baxendale, University College London, London, United Kingdom

Shai Betteridge, St Georges Hospital, London, United Kingdom

Amy Brown, Murdoch Children’s Research Institute, Parkville, Australia

Anneli Cassel, University of New South Wales, Sydney, Australia

Cathy Catroppa, University of Melbourne, Melbourne, Australia

Raymond C.K. Chan, Chinese Academy of Sciences, Beijing, China

Mathilde Chevignard, St. Maurice Hospital, St Maurice, France

Linda Clare, University of Exeter, Exeter, United Kingdom

 Contributors

Betony Clasby, Murdoch Children’s Research Institute, Parkville, Australia and University of
Exeter, Exeter, United Kingdom

Rudi Coetzer, North Wales Brain Injury Service, Bangor, United Kingdom

Emma Cotterill, Croydon Primary Health Care Trust, Croydon, United Kingdom

Louise Crowe, Murdoch Children’s Research Institute, Parkville, Australia

Jacinta Douglas, La Trobe University, Melbourne, Australia

Marina Downing, Monash University, Melbourne, Australia

Annelien Duits, Maastricht University Medical Center Maastricht, The Netherlands

Alicia R. Dymowski, Monash University, Melbourne, Australia

Ava Easton, The Encephalitis Society, Malton, United Kingdom

Hamed Ekhtiari, Tehran University, Tehran, Iran

Jonathan J. Evans, Glasgow University, Glasgow, United Kingdom

Luciano Fasotti, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, and The
Klimmendaal Rehabilitation Centre, Arnhem, The Netherlands

Jessica Fish, The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, United
Kingdom

Jennifer Fleming, The University of Queensland, Brisbane, Australia

Chantal Geusgens, Maastricht University Medical Centre, Maastricht, The Netherlands

Ann Glang, University of Oregon, Eugene, Oregon, USA

Celia Godfrey, Murdoch Children’s Research Institute, Parkville, Australia

Rachel Goodwin, The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely,
United Kingdom

Olivia Gosseries, University of Liege, Liege, Belgium

Fergus Gracey, University of East Anglia, Norwich, United Kingdom

Mardee Greenham, Murdoch Children’s Research Institute, Parkville, Australia

Matthew D. Grilli, University of Arizona, Tucson, Arizona, USA

Tessa Hart, Moss Rehabilitation Research Institute, Philadelphia, Pennsylvania, USA

xvi
 Contributors

Catherine Haslam, University of Queensland, Brisbane, Australia

Caroline M. van Heugten, Maastricht University and Maastricht University Medical Center,
Maastricht, The Netherlands

Janet Hodgson, The Brain Injury Rehabilitation Trust (formerly of the Encephalitis Society),
York, United Kingdom

Volker Hoemberg, Gesundheitszentrum Bad Wimpfen, Dusseldorf, Germany

Matthew Jamieson, University of Glasgow, Glasgow, United Kingdom

Olga Kamaeva, Federal State Budgetary Educational Institution of Higher Education, St Petersburg,
Russia

Pamela S. Klonoff, Center for Transitional Neurorehabilitation, Phoenix, Arizona, USA

Caroline Knight, Brain Injury Services, Priory Healthcare and Partnerships in Care, Burton Park,
Melton Mowbray, UK School of Psychology, University of Leicester, Leicester, United Kingdom

Agata Krasny-Pacini, University Rehabilitation Institute Clemenceau Strasbourg, France

Suncica Lah, University of Sydney, Sydney, Australia

Cynthia Lai, Hong Kong Polytechnic University, Hong Kong, China

Steven Laureys, University of Liege, Liege, Belgium

Grace Lee, Kwai Chung Hospital, Hong Kong, China

Jenny Limond, University of Exeter, Exeter, United Kingdom

James F. Malec, Indiana University School of Medicine and Rehabilitation Hospital of Indiana,
Indianapolis, Indiana, USA

Donna Malley, The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, United
Kingdom

David Man, Hong Kong Polytechnic University, Hong Kong, China

Tom Manly, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge,
United Kingdom

Lingani Mbakile-Mahlanza, Department of Psychology, University of Botswana, Gaborone,

Botswana

Skye McDonald, University of New South Wales, Sydney, Australia

Hamish McLeod, University of Glasgow, Glasgow, United Kingdom

xvii
 Contributors

Mick Meehan, Department for Work and Pensions, London, United Kingdom

Joe Mole, Oxford Institute of Clinical Psychology Training, Oxford, United Kingdom

Pauline Monro, Founder and organiser of the Anglo-Russian neurological partnership on behalf of
the association of British neurologists, London, United Kingdom and St Petersburg, Russia

Wendy Moyle, Griffith University, Brisbane, Australia

Paula Murphy, St George’s Hospital, London, United Kingdom

Michael Oddy, The Disabilities Trust, Burgess Hill, United Kingdom

Brian O’Neill, Brain Injury Rehabilitation Trust, Glasgow, United Kingdom

Tamara Ownsworth, School of Applied Psychology and Menzies Health Institute Queensland,
Griffith University, Brisbane, Australia

Giverny Parker, School of Applied Psychology and Menzies Health Institute Queensland, Griffith
University, Brisbane, Australia

Michael Perdices, University of Sydney and Royal North Shore Hospital, Sydney, Australia

Ana Paula Pereira, Universidade Federal do Paraná, Sao Paulo, Brazil

Kavitha Perumparaichallai, Center for Transitional Rehabilitation, Phoenix, Arizona, USA

Jennie L. Ponsford, Monash University, Melbourne, Australia

Fabricia Quintão Loschiavo-Alvares, Nexus Neuropsychology Clinic, Belo Horizonte, Brazil

Anastasia Raymer, Old Dominion University, Norfolk, Virginia, USA

Tara Rezapour, Institute for Cognitive Science Studies, Tehran, Iran

Anita Rose, The Raphael Medical Centre, Tonbridge, United Kingdom

Sharon Savage, University of Exeter, Exeter, United Kingdom

Leigh Schrieff-Elson, Psychology Department, University of Cape Town, South Africa

Urvashi Shah, Department of Neurology, King Edward Memorial K.E.M. Hospital, Mumbai India

David Shum, School of Applied Psychology and Menzies Health Institute Queensland, Griffith
University, Brisbane, Australia

Natalia Sierra Sanjurjo, Institute of Cognitive Neurology, Buenos Aires, Argentina

Sara da Silva Ramos, The Disabilities Trust, Burgess Hill, United Kingdom

xviii
 Contributors

Sara Simblett, Institute of Psychiatry, London, United Kingdom

Julie S. Snowden, University of Manchester, Manchester, United Kingdom

Jacoba M. Spikman, University of Groningen and University Medical Center Groningen,

Groningen, The Netherlands

Bibi Stang, Center for Transitional Rehabilitation, Phoenix, Arizona, USA

Rene Stolwyk, Monash University, Melbourne, Australia

Mohammad Taghi Joghataei, University of Medical Science, Tehran, Iran

Robyn Tate, University of Sydney, Sydney, Australia

Anita Taub, University of Sao Paulo, Sao Paulo, Brazil

Michael H. Thaut, University of Toronto, Toronto, Canada

Kevin Thomas, University of Cape Town, Cape Town, South Africa

Leanne Togher, University of Sydney, Sydney, Australia

Teresa Torralva, Institute of Cognitive Neurology, Buenos Aires, Argentina

Theo Tsaousides, Icahn School of Medicine at Mount Sinai, New York, USA

Lyn Turkstra, McMaster University, Hamilton, Canada

Andy Tyerman, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust,
Amersham, United Kingdom

Ruth Tyerman, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust,
Amersham, United Kingdom

Mieke Verfaellie, Boston University, Boston, Massachusetts, USA

Shari L. Wade, Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA

Ya Wang, Neuropsychology and Applied Cognitive Neuroscience Laboratory, Institute of

Psychology, Chinese Academy of Sciences, Beijing, China

Ann D. Watts, Entabeni Hospital, Durban, South Africa

Barbara A. Wilson, The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, and
The Raphael Medical Centre, Tonbridge, United Kingdom

Jill Winegardner, The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, United
Kingdom

xix
 Contributors

Andrew Worthington, Headwise Innovation Centre, Longbridge Technology Park, Birmingham,

United Kingdom

Brent Wurfel, University of Oklahoma, Norman, Oklahoma, USA

Chi-Cheng Yang, Department of Psychology, National ChengChi University, Taipei, Taiwan

Calvin Yip, Hong Kong Polytechnic University, Hong Kong, China

xx
 ACKNOWLEDGEMENTS

We would like to thank Mick Wilson for his practical help, support and proof reading. Dr Malec
wishes to acknowledge the support of the Fürst Donnersmarck Foundation 2015 Research Award.
Dr Easton thanks the Encephalitis Society for permission to reproduce Figure 6.1. Dr Baxendale
thanks the International League Against Epilepsy for permission to reproduce Figure 6.2. Tara
Rezapour and her colleagues wish to thank Tae-yeon Hwang, Robin Aupperle, Javad Hatami, Ali
Farhoudian, Collin O’Leary, Milad Kassaei, Mahdieh Mirmohammad and Reza Daneshmand for
their insightful comments and suggestions in different versions of the manuscript. Dr Turkstra wishes
to thank the Walker Fund for supporting, in part, her work when writing her chapter. Drs Klonoff,
Stang and Perumparaichallai wish to acknowledge their appreciation for the data compilation and
editorial input by Mr Edward Koberstein and Ms Rivian Lewin. Dr Taghi Joghataei wishes to thank
Drs Hamed Ekhtiari, Fatmeh Mousavi and Marzieh Shirazikhah for their help in preparing the
section on ‘Rehabilitation in Iran’. Drs Monro and Kamaeva are grateful for the assistance of Y.V.
Miadze, I.F. Roschina, N.A. Varako, M.V. Ivanova and V.N. Grigoryeva in the preparation of their
section on ‘Rehabilitation in Russia’. All four editors are grateful to Lucy Kennedy for her enthusiastic
backing of this handbook. The following permissions have been granted for the use of material in
Chapter 13 ‘Rehabilitation of Slowed Information Processing’ by Luciano Fasotti: ‘Time Pressure
Management as a Compensatory Strategy Training after Closed Head Injury’ by Luciano Fasotti,
Feri Kovacs, Paul A.T.M. Eling, et al: Table 3 in Neuropsychological Rehabilitation, Volume 10, Issue
1 (2000) reprinted by permission of Taylor & Francis Ltd, www.tandfonline.com. Clinical
Neuropsychology of Attention by A.H. van Zomeren and W.H. Brouwer (1994): Figure 4.4 reprinted
by permission of Oxford University Press, USA.
 SECTION ONE

General issues in
neuropsychological rehabilitation
 INTRODUCTION
Barbara A. Wilson, Jill Winegardner, Caroline M. van Heugten
and Tamara Ownsworth

This is an exciting time to be involved in neuropsychological rehabilitation (NR), and the production
of this international handbook reflects the rapidly growing interest in and development of knowledge,
new treatments and assessment procedures from around the world aimed at improving the lives of
people with an acquired brain injury whether caused by an accident or by an illness, whether static
or progressive. There has been a recent acceptance that no matter how impaired people with brain
injury are, and whatever their particular problems might be, there are improvements to their lives
and the lives of their families that can be made. This handbook reflects a rapidly growing expertise
among therapists that is being stimulated by specialist academics in higher education and by their
subsequent involvement in neuropsychological rehabilitation ‘at the coalface’. The contributions in
this handbook are informed by rigorous research conducted by both academics and practitioners,
sometimes working separately and sometimes working together; and by the clients themselves and
their families. Indeed, an overriding principle in the work described and explained in this handbook
is that rehabilitation after brain injury is at its most effective when researchers, practitioners, and
clients and their families work together to find solutions to problems caused by an injury to the brain.
The work of a neuropsychologist, as is recognised in the contributions of the authors of chapters
in this handbook, can involve specialist interaction with children or adults, with people who lack
consciousness, with highly motivated clients having good insight, with people with poor insight,
with those who sustained brain injury recently or those who sustained their injuries many years ago.
All of these groups are addressed in this volume and may include people with disorders of
consciousness, with dementia, with mental health difficulties, with epilepsy, stroke, traumatic brain
injury (TBI), encephalitis, HIV, blast injuries, tumours and/or anoxic brain damage. The effects of
Parkinson’s disease are also examined, as are those of Huntington’s disease and multiple sclerosis.
Assessment, treatment and research issues are discussed in depth as major cognitive functions are
considered, including speed of information processing, attention, working memory, memory,
executive functions, language, visual processing, praxis, social communication and social cognition.
All discussions of these functions are informed by practical and professional work with families and
with individuals. Tried and tested methods are evaluated as well as new and upcoming therapies.
Theoretical models and theories as well as practical applications are addressed in this volume. NR
is a field that needs a broad theoretical base incorporating frameworks, theories and models from a
number of different areas. No one model, theory or framework is sufficient to address the complex

3
 Wilson, Winegardner, van Heugten and Ownsworth

problems facing people with difficulties resulting from damage to the brain. At the same time, real
life problems must be addressed. The purpose of NR is to enable people with disabilities to achieve
their optimum level of well-being, to reduce the impact of their problems on everyday life and to
help them return to their own most appropriate environments. For many people, this is return to
home but for those too impaired to go home, the most appropriate environment may be long-term
care. Even here, however, we should be concerned with helping patients and clients to achieve their
optimum well-being and reducing the impact of their problems on their everyday lives.
The contributors to this handbook range from world experts in their field to rising new stars. We
have tried to make this book as comprehensive and as international as possible. It could be argued
that a number of so-called ‘International Handbooks’ are not really international at all as they emanate
from and thereby focus primarily on the work going on in the one country or continent from which
the volume is conceived and developed. The four editors of this book are citizens of four different
countries: the United Kingdom, the United States of America, The Netherlands and Australia. In all,
contributors to the handbook come from 18 different countries, thus making it truly international
and compiled in the expectation that it will become an important reference work for psychologists,
occupational therapists, speech and language therapists, rehabilitation physicians and other
rehabilitation professionals throughout the world.
One important group of people who need to be convinced of the value of rehabilitation are the
health-care purchasers. A major problem facing those of us in rehabilitation is the cynicism with
which our discipline is greeted by certain bureaucrats, which can be accompanied by an unwillingness
to prioritise resources for survivors of any kind of insult to the brain. This is true in the high income
countries where access to rehabilitation may be denied, it is true in the low income countries where
there may be no rehabilitation services on offer, and it is true in the developing countries where
there may be less than a handful of neuropsychologists for large populations. However, arguments
are presented in this volume that although neuropsychological rehabilitation may appear initially to
be expensive in the short term, it is often cost effective in the long term. People with brain injury
who do not receive rehabilitation can ultimately become a much larger financial burden upon the
state and on their families if rehabilitation funding is not provided. There is plenty of evidence, as we
will see in these pages, that NR is clinically effective and that quality of life can be improved and
family stress reduced as a result of neuropsychological interventions.
At one time it was thought that rehabilitation for people with dementia and other progressive
conditions was not worthwhile in the face of deterioration, but this is no longer accepted in countries
with positive attitudes towards rehabilitation and positive approaches in rehabilitation. Readers of
this handbook will discover many examples of improved daily lives following on from rehabilitation.
We may not be able to restore lost functioning but this does not mean that nothing can be done to
reduce or moderate the actual problems faced by people with brain damage. On the contrary, they
can be helped to cope with, bypass or compensate for their problems; they can learn how to come
to terms with their condition and its effects through an understanding of their life circumstances; and
their anxiety and distress can be reduced. NR is concerned with the amelioration of cognitive,
emotional, psychosocial and behavioural deficits caused by an insult to the brain. Not only does such
rehabilitation make life better for people with brain injury and their families, it also makes economic
sense. As discussed by some of the contributors to this volume, the costs of not rehabilitating people
with brain injury are considerable.
The handbook is structured in seven sections. The first section on general issues in NR looks at
the development and history of NR together with evidence-based treatment, mechanisms of
recovery, assessment and goal planning. Section Two is concerned with the different populations we
encounter in our rehabilitation services: TBI, stroke, encephalitis, anoxic brain damage, epilepsy,
dementia, multiple sclerosis, Parkinson’s disease, Huntington’s disease, brain tumours, HIV, blast
injuries, schizophrenia, substance abuse and mood disorders. There is a chapter on people with

4
 Introduction

disorders of consciousness and two chapters focusing on children with TBI and other neurological
conditions. The third section addresses cognitive disorders, namely those of speed of information
processing, attention, working memory, memory, executive functions, language, visual processing,
and praxis. We also address acquired social communication disorders, social cognition deficits,
difficulties with social and behavioural control and with apathy, and challenging behaviours. Again,
the content covers both children and adults. Section Four focuses on the management of psychosocial
problems with a focus on cognitive behavioural therapy, third wave therapies, self-awareness and
identity issues, working with schools and with families for both children and adults, and vocational
and occupational rehabilitation. The next section addresses recent and emerging approaches in NR
and includes management of fatigue, sexuality, neurologic music therapy, novel forms of cognitive
rehabilitation such as brain training, new technologies for cognitive impairments, and social robotics
in dementia care. The sixth and penultimate section addresses the issue of rehabilitation with limited
resources. The cost-effectiveness of NR is tackled, followed by a global perspective on NR when
funds are short. Rehabilitation around the world with views from ten different countries conclude
this section. The final section discusses evaluation and conclusions, looking at outcome measures,
avoiding bias in evaluating NR, the challenges we face in measuring the effectiveness of NR and
guidelines for good practice.
In summary, this handbook provides a comprehensive and contemporary perspective of NR
around the world. The following chapters provide an integration of theory, research and practical
applications of NR and cover a breadth of topics relevant to clinicians, researchers, educators, health-
care administrators and policy makers. Major advances and cutting edge developments in the field
are outlined and priority areas for future research and service development foreshadowed. To achieve
its ultimate aim of improving the lives of people with neurological disorders and their families, the
principles and practice of NR must keep pace with ongoing scientific discoveries, particularly in the
cognitive and social neurosciences, and changes in the socio-cultural landscape of the world.

Barbara A. Wilson, Jill Winegardner,

Caroline M. van Heugten and Tamara Ownsworth
February 2017

5
 1
THE DEVELOPMENT OF
NEUROPSYCHOLOGICAL
REHABILITATION
An historical examination of theoretical and
practical issues

Barbara A. Wilson

A brief history of the growth of neuropsychological rehabilitation

Ancient Egypt
The earliest known description of the treatment of brain injury is from an Egyptian document of
2500–3000 years ago. The papyrus was discovered by Edwin Smith in Luxor in 1862 (described by
Walsh, 1987). It describes the treatment of 48 cases of injury of which 27 were brain trauma cases.
It contains the first known descriptions of the cranial structures, the meninges, the external surface
of the brain, the cerebrospinal fluid and the intracranial pulsations. The word ‘brain’ appears for the
first time in any language. The treatment procedures demonstrate an Egyptian level of knowledge
that surpassed that of Hippocrates, who lived 1000 years later. Among the first cases described are a
man with a gaping wound in his head penetrating the bone of his skull, rending open the brain. It
has to be said, however, that the procedures described in the Smith Papyrus were more about
treatment than rehabilitation.
A few reports describing treatment appear over the centuries, including a case of Paul Broca’s
(1865 and reported in Boake, 1996). Broca was seeing an adult patient who was no longer able to
read words aloud. He was first taught to read letters, then syllables before combining syllables into
words. He failed however to learn to read words of more than one syllable so the treatment was then
switched to a whole word approach and the patient learnt to recognise a number of words.

World War One

Modern rehabilitation, as we understand it, began in World War One (WW1). This was because
more soldiers with gunshot wounds to the head survived. During the American Civil War (1861–
1865), gunshot wounds to the head were seen in large numbers and, although accurate statistics for
mortality rates are not available for the nineteenth century, the survival rate was known to be poor
because of infection. Improved antiseptic techniques in the late nineteenth century and more
effective neurosurgical procedures led to reduced mortality in WW1. Other contributing factors

6
Another random document with
no related content on Scribd:
and violinists could not play two or more notes with ‘one bow.’
Neither did they endeavor to conquer the technical difficulties of
playing on the G string. They made practically no use of the fourth
string until the end of the century. In addition, the instruments were
badly constructed, equipped with strings of inferior quality and tuned
in a low pitch, all of which militated strongly against purity and
accuracy of intonation. Hans Gerle (a flute player of Nuremberg), in
his 'Musica Teutsch, auf die Instrument der grossen und kleinen
Geigen’ (1532), advised that intonation marks be placed on the
fingerboard, and this naïve advice was in use as late as the middle of
the eighteenth century.[45]

The same writer points out that instrumentalists in improvising their

parts were prone to vie with each other in demonstrating their ability
as contrapuntists, a perfectly comprehensible habit, which must have
affected instrumental music in the sixteenth century as badly as the
vagaries of coloratura singers affected operatic music in the
eighteenth.

Gerle’s book, incidentally, contained a number of German, Welsh,

and French songs, and a fugue for four violins. Among other early
books on the violin mention may be made of these:

S. Virdung: Musica getuscht, 1511.

Judenkönig: A truly artistic instruction * * * of learning upon

the lute and violin, 1523. (Contains 25 numbers for violin and
flute.)

Agricola: Musica Instrumentalis, 1528. (Here the author refers

to the vibrato as a device that ‘makes the playing more
sweet.’)

La Franco: Scintille di Musica, 1533.

Silvestro Ganassi: Regola Rubertina che insegna suon di

Viola d’arco, 1543.
 Ludovico Zacconi: Prattica di Musica, 1592 (Zacconi stated
here that the compass of the violin was g-ciii).

M. Prätorius: Syntagma Musicum, 1619.

Touching upon the use of the violin in the sixteenth century there is
extant a wealth of historical references. From one of these, for
example, we gather that at a public festival in 1520 viols were used
to accompany songs. We may assume their popularity in England
from the fact that they were used in the family of Sir Thomas More
(1530), an ardent music lover, and that during the reign of Edward VI
the royal musical establishment increased the number of its viols to
eight. Violins were used at public performances in Rouen in 1558; at
a fête in Bayonne for dance music in 1565, and in a performance of a
Mass at Verona in 1580. In the year 1572 Charles XI of France
purchased violins from Cremona and a little later ordered the famous
twenty-four violins from Andrea Amati. In 1579, at the marriage of the
Duke of Joyeuse, violins were used to play for dances, and
Montaigne in his Journal (1580) refers to a marriage ceremony in
Bavaria, where ‘as a newly married couple went out of church, the
violinists accompanied them.’ From this passage of Montaigne we
may infer that, in Germany at least, the popularity of violin music was
not confined to the upper classes. It must be remembered, however,
that the terms ‘viola,’ ‘violin,’ ‘viol,’ etc., were often applied
indifferently to stringed instruments of various kinds, and in view of
this inaccurate nomenclature historical references must be accepted
with a certain amount of reserve.

We know little of the music that was played on the violin before the
last decade of the sixteenth century. Violins, we are aware, were
employed in ensembles, in orchestras, and in unison with voices, and
in looking for violin music we have not necessarily to consider
compositions written especially for violin. By way of illustration we
may cite a collection of French Dances (1617), published for
‘instruments,’ presumably for all kinds of instruments, and a
collection of ‘Songs’ edited in Venice (1539) bearing the remark ‘to
sing and play,’ and indicating no special instruments. Probably much
of this sort of music was played by violin. Among examples of
specific writing for the violin there has come down to us previous to
1539 a Fugue (Fugato rather) for four violins, composed by Gerle. It
is in four parts: Discant (first violin), Alto (second violin), Tenor (viola)
and Bass ('cello), perhaps the earliest specimen of a composition for
string quartet. The style is purely vocal, as we may see from the
theme:

There is no suggestion of the violin idiom in the piece and it throws

no light on the development of violin music. Cortecci and Striggio in
1565 scored their intermezzi for two gravecembali, violins, flutes,
cornets, trombones, and several other instruments. D’Etrée, an oboe
player, wrote down the common lively tunes which had been
previously learned by ear and published them in 1564. As a practical
musician he undoubtedly considered also the violin. In the
performance of Beaulieu’s Circe (1581) ten bands were used and in
the first act ten violin players in costumes appeared. The famous
violinist, Beaujoyeaulx (an Italian in the service of Henry III whose
real name was Baltasarini), wrote ballets (1584), dances, festival
music, and other compositions, which were very successful at the
court. Doubtless he played them himself. Castiglione in his
Cortigiano mentions a composition as being written for 'quattro viole
da arco’ which almost seems to indicate another specimen of early
string quartet. Toward the end of the century we meet with the Balletti
of Gastoldi and of Thomas Morley, some of which are printed without
words and may have been intended for instrumental performances.
Still, they are vocal in character and do not exceed the compass of
the human voice. Besides these, there are other compositions and
collections of dances, etc., that may be considered musical material
for violinists of the time. Most of them, however, deserve no detailed
notice.

Up to 1587 the leading instrument of the orchestra was the Cornetto

(German ‘Zinke,’ an instrument of wood, not of metal). The earliest
instance where the Cornetto alternates with the violins in taking the
lead and where a part was inserted especially for violino is to be
found in Concerto di Andrea e Giovanni Gabrieli—per voci e
strumenti musicali, 1587. Some of G. Gabrieli’s compositions,
however, are still in vocal style, but some are decidedly instrumental
in character, as we may see from the following illustrations.

and

From a Sonata à 3 (1615).

and

(Note the last example, where the intentional contrast between piano
and forte is distinctly indicated.)

In 1593 Florentino Maschera, one of the celebrated organists of his

time, published a book of ‘Songs to play’ (Canzoni a sonar). The
work consisted of seventy-one pieces which had family names for
their titles, a custom that was often repeated in the first half of the
sixteenth century. It is important to note that these pieces were
printed in separate parts, so that they may be considered as the first
specimens of independent though not direct writing for the violin.
These canzoni were vocal in character and there was little that
suggested instrumental technique. The style was that of the vocal
compositions of the time—contrapuntal.

A genuine and daring innovator in the field of violin music was

Claudio Monteverdi (1567-1643), who in some violin passages went
up as high as the fifth position. Besides broadening the technique of
the left hand, he demanded tremolos for dramatic effects in
accompanying recitative:

This passage from Combattimento di Tanceredi e Clorinda (1624)

offered so many difficulties to the musicians that at first they refused
to play it. As we shall see presently, however, Monteverdi was not the
first to introduce this effect (cf. p. 381). Another of his new effects
was the introduction of the pizzicato, which he marked thus: Qui si
lascia l’arco, e si strappano le chorde con duo diti, and afterwards
Qui si ripiglia l’arco. That Monteverdi expected violins to produce a
crescendo with the bow is apparent with the instruction Questa ultima
note va in arcato morendo. ‘Monteverdi with his two violins “alla
Francese” in the score of Orfeo (the first printed reference to the
violin as an orchestral instrument in the modern sense), probably
meant nothing more than that the violins were to be in the fashion of
the French, but in place of accompanying a dance, the character
indicated in the opera was accompanied by two violins in a particular
part of its music.’[46] In other violin pieces by Monteverdi, as in his
Scherzi musicali and Ritornelle (1607), we see his superiority to his
contemporaries, just as in his Sonata sopra Sancta Maria detratta,
etc. (1610), he showed plainly his desire to improve violin music.
 III
The first attempt at independent violin composition was made by
Biagio Marini (1590-1660), maestro di cappella in Santa Eufemia in
Brescia and a court concert-master in Germany, who may be
regarded as the first professional composer-violinist. In his early
compositions the violin parts were not difficult for the players. There
were mostly half and quarter notes in slow tempi, displaying the
quality of vocal compositions, and without much use of the G string.
Witness the following example from his Martinenga Corrente (1622):

A passage from his Il Priulino Balletto e Corrente (marked canto

primo, secondo, and basso)

is more instrumental in quality, though the second part of the Balletto

reveals again the character of vocal music. The whole may be played
on the A and E strings. More violinistic passages are to be found in
his sinfonia La Gardana; for example:

Marini’s dance compositions are characteristic of all dance music at

the beginning of the seventeenth century. Among them, however, is
one that possesses particular interest for us from the fact that it is the
first extant composition marked distinctly ‘for violin solo.’ It is entitled
La Romanesca per Violino Solo e Basso (ad libitum), and has four
sections, each consisting of two parts. The first section, Parte prima,
has six measures in the first and second part; the second section has
five measures in the first part and six in the second. The form of the
third section is not so clear as that of the previous ones, although, as
we may see from the basses, the composer endeavored to give
clear-cut melodies. The same may be said of the fourth section,
where the figures are in the bass. The third section—terza parte in
altro modo—with new melodic and rhythmic material, has the
character of a dance. The violin part moves in figures of eight, and
there are sustained notes in the bass. The first few measures of each
section will serve as illustration.

Section I

Section II

Section III

Section IV
In his technique Marini does not go beyond the first position;
consequently the fluency of the melody suffers many a break, for
when he reaches the limit of the first position, he continues the
melody an octave lower. Yet he is responsible for several technical
innovations for the violin. He was the first to mark the bowing (legato
playing) and to introduce—seven years before Monteverdi’s
Combattimento—the coloring effect of the tremolo, thus:

Tremolo con arco.

Other innovations are to be found in his Sonate e Sinfonie Canzoni

(1629) where in a Capriccio ‘two violins play four parts’ (due violini
sonano quattro parti), thus:

and a ‘Capriccio to be played on the violin solo with three strings

after the manner of a lyre’ (Capriccio per sonare il Violino solo con tre
corde a modo di Lyra).

Besides Marini there were others who seriously endeavored to write

in a distinctive violin idiom. Before considering them we may mention
here Paolo Quagliati, who in his Sfera armoniosa (1623) made the
violin accompany the voices and used it also as a solo instrument
with the accompaniment of the theorbo in a toccata of the same
opus. The violin part usually consisted of sustained tones that were
to be embellished by the players according to the custom of the time.
Quagliati himself was not a violinist and this fact serves to explain the
simple technique of his violin parts.

Four years later Carlo Farina, a Saxon chamber virtuoso and concert
master, who may be termed the founder of the race of violin
virtuosos, published a composition for the violin, called Capriccio
stravagante. Here he strove toward new and unusual violinistic
effects. The very title, ‘an extravagant caprice,’ explains his object.
While the piece shows little improvement in form, the technique is
noticeably advanced. Farina goes to the third position and points out
how the change of position should be executed. Besides broadening
violin technique Farina was among the first to venture into the field of
realistic ‘tone painting.’ For he tried to imitate the whistling of a
soldier, the barking of a dog, the calling of a hen, the crying of a cat,
the sound of a clarinet and the trumpet. Farina’s experiments in tone-
painting were, however, rather the product of a desire for sensational
novelty than of a legitimate seeking after artistic expression. He lacks
the genuine qualities of a true artist.

Although Farina did not use the G string, and did not go further than
the third position, he recognized the power of expression latent in the
violin. Besides rapid figures of sixteenth notes and considerable
variety in bowing there are double stops:

and a series of consecutive chords with the instruction that it should

be executed with the stick of the bow:
It was also his idea—not at all a bad one—to mark double stops with
figures:

The fact that he found it necessary to give instruction for the

execution of double stops and tremolos, and the production of the
required effects in his imitations indicates that these devices were
entirely new in violin playing.

According to Gerber he published besides the Capriccio, a collection

of 'Sonatas’ and 'Pavanes’ (1628), which, if they existed at all, are
entirely lost. Of his other compositions (Dances, Arias) we possess
the first violin parts containing the melody. He used the G clef and
the term ‘violino.’

The compositions of Marini, Quagliati and Farina represent the

beginnings of independent violin solo music. The first to write
sonatas for violin solo was the violinist-composer Giovanni Battista
Fontana (1630). His works, compared with the sonatas of Gabrieli,
show a marked improvement in violin technique; they are
characterized by the same polyphonic style, but they are not so
conclusively vocal in character. The following selections will show the
great improvement in violin technique; they virtually comprise the first
‘runs’ composed for the violin:

From a Sonata for Violin Solo.

or
or

or

Fontana strove toward a broader form and in doing so he took a part

in the evolution of the later sonata. But he was not capable of fluent
and even expression, hence the effect of his works on the whole is
stiff and dry. We should not forget, however, that he lived during the
period of transition from the old tonal systems to the new, and that,
while he endeavored to write in the new style, the old one had not
lost its hold upon him. The result was awkwardness in modulation
and a general vagueness and uncertainty.

About the same time (1629) another composer, Bartolomeo Mont’

Albano, published his Sinfonie for one and two violins (and
trombones, with the accompaniment of the organ). These pieces are
incoherent and lack inspiration and power. Their value is far below
that of Fontana’s compositions. Mont’ Albano is only worthy of
mention as showing that Fontana was not absolutely alone in his
attempts to improve violin music. It may be noticed that he called his
compositions Sinfonie, meaning nothing more nor less than Fontana
meant in his sonatas—a proof that the technical terms at that time
were not yet strictly defined.
Great improvement in technique is obvious in the works of Tarquinno
Merula (1633). He used the G string freely, demanded skips from the
G to the E string, also tremolos, changes of position:

and octave passages:

Mont’ Albano’s music was thought out rather than invented and it
would give little pleasure to the modern ear. In the history of the
development of violin music these early compositions should be
considered simply as efforts or studies to advance violin technique
and musical form.

While Merula helped the progress of left hand technique, Marco

Ucellini (1669) made more demands on the bow, writing rapid thirty-
second notes for certain tremolo effects in his sinfonia entitled La
gran Bataglia.

A more pleasing musical quality is to be found in the sonatas of

Massimiliano Neri, who was the first to make a distinction between
the Sonata da chiesa and the Sonata da camera. In his Sonate e
Canzoni a quattro and in his Sonate da suonarsi con vari strumenti,
Neri followed the path of Gabrieli in writing for as many as twelve
instruments. The frequent change of time and the restless rhythm are
also reminiscent of Gabrieli’s peculiarities. Although Neri’s structure
of phrases and periods is more normal, his modulation more fluent,
and his music on the whole more agreeable to the modern ear than
that of Fontana and Merula, his works still belong to the practical
experiments of violin music, and are without great intrinsic merits.
The same may be said of the sonatas of Biagio Marini whom we
have already discussed. He may be termed one of the originators of
the cyclical form of the modern sonata, since his sonatas were in four
movements. The first, usually in slow tempo, was followed by an
Allegro, this by a longer or shorter piece that led to the last
movement (Allegro). While his style was still distinctly polyphonic, the
development of his motives was considerably more pleasing.
Improvement in harmony and modulation is found in the Sonate da
chiesa and Sonate da camera of Giovanni Legrenzi (1655), who did
not otherwise accomplish much in forwarding solo violin music.

Turning to Germany, it is to be regretted that the works, which, to

judge by their titles, might have shed some light on the development
of early violin music, are irretrievably lost to us. They are
Auserlesene Violinen Exercitium aus verschiedener Sonaten nebst
ihre Arien, Balladen, Sarabanden, etc., and Musicalische
Tafelbedienung von fünf Instrumenten, als zwei Violinen, zwei Violen,
nebst den General Bass, by Wilhelm Furcheim (1674), concert-
master at Dresden. The most important figure, among the earliest
German composers for the violin from the standpoint of technical
advance, is evidently Jacob Walter. His twelve Scherzi da violino solo
are in the style of the Sonate da Camera (Suite) or in the form of
variations. Eight of them are called sonatas, and contain three or four
movements, mostly in the same key but in a variety of tempi. From a
musical point of view most of Walter’s compositions are unattractive,
as the form is stiff, the rhythm awkward, modulation poor, and the
melody heavy and clumsy. His importance lies exclusively in the
advanced claims his writings make upon execution, for he ascends
as far as and writes many difficult double stops, chords, and
arpeggios. Walter was also fond of imitating other instruments, birds,
echoes, and so forth. In a set of variations we meet with imitations of
the guitar by playing pizzicato, of the pipes by going up high on the E
string, of fanfares by playing on the G string. In another composition
the imitation of the call of the cuckoo was his chief purpose; but we
would hardly recognize the cuckoo’s call, had he not in every case
taken the pains to mark the imitation. In another instance, in Hortulus
Chelicus, he endeavored to imitate the voice of some other bird. This
work as a piece of art is more valuable, since here he attempted to
write a duet for one violin. Another composition that is characteristic
of Walter’s musical ideas is a Capriccio, where the C major scale is
used as basso ostinato in forty-nine variations, as though the
composer wanted to give as many kinds of motions and figures as he
could.
Stradivarius at Work: Antonio Stradivari.
Walter was not an innovator in the art of tone painting, for Farina had
tried the same devices seventy years before. Still he cannot be
dubbed a mere imitator of Farina, though he was without doubt
strongly influenced by the latter. Walter’s technique is much more
advanced than that of Farina, but at the same time he shows little
improvement in a purely musical way.

IV
There is an obvious advance in musical value in the Correnti e
balletti da camera a due violini, 1666; Balletti, Sonate, 1667, 1669;
Correnti e capricci per camera a due violini e violone, 1683, and
other instrumental pieces by Giovanni Battista Vitali, 'sonatore di
Violino di brazzo’ in the orchestra of Bologna. Vitali’s melodies
contain much more pleasing qualities than those of his
contemporaries. In regard to form, his sonatas, in which rapid
changes from quick to slow movements mark the various sections,
show the transition from the suite to the sonata da camera. Vitali was
one of those early inspired composers, whose greatest merit lies in
their striving toward invention and toward the ideal of pure absolute
music. In technique Vitali does not show any material progress.

Of particular importance is Tommaso Antonio Vitali, a famous

violinist of his time. Of his works, Sonate a tre, due violini e
violoncello, 1693; Sonate a due violini, col basso per l’organo, 1693,
and Concerto di sonate a violino, violoncello e cembalo, 1701, the
most famous and most valuable is his Ciaccona, which is very often
played on the concert stage by present-day violinists. The Ciaccona
is full of poetic moods and its short, pregnant theme shows deep
feeling and genuine inspiration, qualities which we find here for the
first time. The whole is a set of variations upon a short theme,
constituting a series of contrasting pictures. Noteworthy are the
harmony and the advanced treatment of modulation. The ornamental
figures, too, are derived from the logical development of the theme,
hence do not serve the sole purpose of providing the virtuoso with an
opportunity to display his technical skill.

The first representative virtuoso-composer was Giuseppe Torelli

(1658-1708), to whom is ascribed the invention of the concerto, that
is, the application of the sonata form of his time to concerted music.
In Torelli’s concertos the solo-violins were accompanied not only by a
bass as in the sonatas, but by a stringed band, to which sometimes
a lute or organ was added. The solo-violins in his ‘Concerti grossi’
(1686) usually played together, though not always. That he had the
virtuoso in mind when he wrote may be gathered from the following
examples:
In his concertos Torelli was the direct precursor of Corelli, Vivaldi,
and Handel. His influence, however, was not so intense as that of
Giovanni Battista Bassani (1657-1716), whose music had more unity
and definiteness and on the whole ranked very much higher
artistically. This, added to the fact that he was Corelli’s teacher, gives
him a prominent place in the history of violin music. While the single
movements of Bassani’s sonatas on the whole show little
improvement in form, the composer established a higher standard in
the evenness and uniformity of his figures, in the smoothness of his
modulation and chromatics, in rhythms that were far superior to
those of earlier composers, in phrasing that was clear, especially in
slow movements, and in the almost complete abandonment of the
‘fugal’ treatment. His influence upon Corelli is so evident that one
could hardly distinguish one of his later compositions from an early
sonata of his famous pupil.

A few examples of Bassani’s writing may be of interest:

Grave. From a Sonata for two Violins and Bass.

 Largo. From a Baletto e Corrente.

Gige

Sarabande. Presto

Before closing our account of the seventeenth century, reference

should be made to the prominent Antonio Veracini, the uncle and
teacher of Francesco Maria Veracini, whose sonatas are still played
by violinists today. Antonio Veracini’s sonatas, composed in the form
of the sonata da chiesa, do not lack a certain amount of beauty,
inspiration, and repose; they show, moreover, clearness, fluency and
roundness. His melodies are original, his modulations and
contrapuntal combinations good. While his Allegro movements show
no improvement in comparison with Bassani’s works, the Adagios
and Largos are of more independent finish.

There were numerous contemporaries, followers, and pupils of the

composers already discussed. Their works, however, were
academic, lacked individuality, and contained little that was worthy of
special consideration. The list of these minor composers includes
Laurenti, Borri, Mazzolini, Bononcini, Buoni, Bernardi, d’Albergati,
Mazzaferrata, Tonini, Grossi, Ruggeri, Vinacesi, Zanata, and others.

V
The first German composer of violin music of æsthetic value was
Heinrich Ignaz Franz von Biber (born 1638), a very prominent
violinist and composer of his time. Although frequently his form is
vague and his ideas often dry, some of his sonatas contain
movements that not only exhibit well-defined forms, but also contain
fine and deeply felt ideas and a style which, though closely related to
that of the best Italians of his time, has something characteristically
German in its grave and pathetic severity. His sonatas on the whole
are of a much higher artistic quality than those of his
contemporaries. His sixth sonata, in C minor, published in 1687, is a
genuinely artistic piece of work. ‘It consists of five movements in
alternately slow and quick time. The first is an introductory largo of
contrapuntal character, with clear and consistent treatment in the
fugally imitative manner. The second is a passacaglia, which
answers roughly to a continuous string of variations on a short, well-
marked period; the third is a rhapsodical movement consisting of
interspersed portions of poco lento, presto, and adagio, leading into
a Gavotte; and the last is a further rhapsodical movement alternating
adagio and allegro. The work is essentially a violin sonata with
accompaniment and the violin parts point to the extraordinary rapid
advances toward mastery. The writing for the instrument is decidedly
elaborate and difficult, especially in the double stops and
contrapuntal passages. In the structure of the movements the fugal
influences are most apparent and there are very few signs of the
systematic repetition of keys which in later times became
indispensable.’[47] It was characteristic of Biber that his ambition was
to create something original and that his works always showed
individuality. He was fond of variations and this form was not lacking
in any of his eight sonatas. Besides the variation form he frequently
used the form of gavotte and giga, which he began and ended with