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Textbook Neuropsychological Rehabilitation The International Handbook 1St Edition Barbara A Wilson Et Al Eds Ebook All Chapter PDF
Textbook Neuropsychological Rehabilitation The International Handbook 1St Edition Barbara A Wilson Et Al Eds Ebook All Chapter PDF
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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.
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
2 Evidence-based treatment 17
Caroline M. van Heugten
SECTION TWO
Populations referred for neuropsychological rehabilitation 59
vi
Contents
SECTION THREE
Rehabilitation of cognitive disorders 159
vii
Contents
SECTION FOUR
Rehabilitation of psychosocial disorders 311
SECTION FIVE
Recent and emerging approaches in neuropsychological
rehabilitation389
viii
Contents
SECTION SIX
Global and cultural perspectives on neuropsychological
rehabilitation467
ix
Contents
SECTION SEVEN
Evaluation and general conclusions 535
Index575
x
FIGURES
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
xiv
CONTRIBUTORS
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
Andrew Bateman, The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely,
United Kingdom
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
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
Rachel Goodwin, The Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely,
United Kingdom
xvi
Contributors
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
Olga Kamaeva, Federal State Budgetary Educational Institution of Higher Education, St Petersburg,
Russia
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
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
Tom Manly, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge,
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
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
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
Sara da Silva Ramos, The Disabilities Trust, Burgess Hill, United Kingdom
xviii
Contributors
Theo Tsaousides, Icahn School of Medicine at Mount Sinai, New York, USA
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
Shari L. Wade, Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
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
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.
5
1
THE DEVELOPMENT OF
NEUROPSYCHOLOGICAL
REHABILITATION
An historical examination of theoretical and
practical issues
Barbara A. Wilson
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.
6
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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]
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:
and
and
(Note the last example, where the intentional contrast between piano
and forte is distinctly indicated.)
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:
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:
or
or
or
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.
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.
Gige
Sarabande. Presto
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