Predicting community integration following traumatic brain injury with health and cognitive status measures.

Objective: To examine measurement properties of the Community Integration Questionnaire (CIQ) and the Short-Form Health Survey (SF-36) and assets the contributions of cognitive functioning and health to community integration. Design: Rating scale analyses and regression analysis data on basic cognitive functioning and health collected from 289 individuals with traumatic brain injury. Results: Person reliabilities indicated substantial measurement error. Ceiling effects weakened the model (adjusted R2 = .143) specifying the contributions of age, gender, cognitive functioning, and health to community integration. Conclusions: Poor measurement properties and definitional problems associated with community integration weakened the results. The extent to which potential familial and environmental characteristics contributing to role fulfillment change across time requires further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social problem solving and community integration in postacute rehabilitation outpatients with traumatic brain injury.

Objective: To enhance understanding of the role that social problem solving (SPS) plays in community integration following traumatic brain injury (TBI). Study Design: Regression analysis. Participants: Forty-five adults with TBI participating in higher level outpatient cognitive rehabilitation and 15 uninjured adults. Main Outcome Measures: Measures of community integration, problem-solving ability, and SPS self-appraisal and performance. Results: Individuals with TBI demonstrated poorer problem-solving as measured by both neuropsychological and SPS methods; however, the largest effect' size was observed for SPS self-appraisal. Only SPS self-appraisal predicted a significant proportion of the variance in community integration. Conclusions: It is important to assess brain-injured persons' confidence in their ability to cope with problems. A focus on objective test scores alone may lead to underdetection of disabling problem-solving deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of the generation effect in improving new learning in persons with traumatic brain injury.

Objective: To evaluate the usefulness of the generation effect in improving learning and memory abilities in neurologically impaired individuals. The generation effect is the observation that items self-generated by participants are better remembered than items provided by the examiner. Although this effect has shown to be relatively robust in healthy adults, few studies have examined the usefulness of the generation effect in neurological populations. Participants: 18 individuals with moderate-severe traumatic brain injury (TBI) and 18 healthy adults. Main Outcome Measure: The measure was the generation effect protocol. Results: Results indicated recall and recognition of generated information was significantly higher than that of provided information across testing conditions. However, healthy adults showed greater benefit from the generation effect than did individuals with TBI. As expected, recall and recognition performance diminished over time (i.e., immediate recall, 30 min, 1 week) however, rates of forgetting did not differ between groups. Conclusion: Self-generation significantly improved verbal learning and memory in individuals with TBI. The results of self-generation in improving learning suggest that applying that technique may be beneficial in the cognitive rehabilitation of persons with TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Construct validity of an attention rating scale for traumatic brain injury.

Attention deficits are nearly ubiquitous after traumatic brain injury (TBI). In the subacute phase of moderate to severe TBI, these deficits may be difficult to measure with the precision needed to predict outcomes, assess degree of recovery, and monitor treatment response. This article reports the findings of four studies, three observational and one a randomized, controlled treatment trial of methylphenidate (MP), designed to provide construct validation of the Moss Attention Rating Scale (MARS), an observational measure of attention dysfunction following TBI. One hundred seven participants with moderate to severe TBI were enrolled during treatment on an inpatient rehabilitation unit. MARS scores were provided independently by four rehabilitation disciplines (Physical, Occupational and Speech Therapies and Nursing). Results indicated that the MARS: (1) is more strongly related to concurrent measures of cognitive versus physical disability, supporting its validity as a measure of cognition, (2) is more strongly related to concurrent psychometric measures of attention versus measures thought to rely less on attention, supporting its validity as a measure of attention; and (3) predicts 1-year outcomes of TBI better than psychometric measures of attention. However, the MARS (4) was not differentially affected by MP versus placebo treatment. Results support the construct validity and utility of the MARS, with further research needed to clarify its role in treatment outcome assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religion and spirituality in rehabilitation outcomes among individuals with traumatic brain injury.

Objective: The long-term consequences of traumatic brain injury affect millions of Americans, many of whom report using religion and spirituality to cope. Little research, however, has investigated how various elements of the religious and spiritual belief systems affect rehabilitation outcomes. The present study sought to assess the use of specifically defined elements of religion and spirituality as psychosocial resources in a sample of traumatically brain injured adults. Participants: The sample included 88 adults with brain injury from 1 to 20 years post injury and their knowledgeable significant others (SOs). The majority of the participants with brain injury were male (76%), African American (75%) and Christian (76%). Measures: Participants subjectively reported on their religious/spiritual beliefs and psychosocial resources as well as their current physical and psychological status. Significant others reported objective rehabilitation outcomes. Analyses: Hierarchical multiple regression analyses were used to determine the proportion of variance in outcomes accounted for by demographic, injury related, psychosocial and religious/spiritual variables. Results: The results indicate that religious well-being (a sense of connection to a higher power) was a unique predictor for life satisfaction, distress and functional ability whereas public religious practice and existential well-being were not. Conclusions: The findings of this project indicate that specific facets of religious and spiritual belief systems do play direct and unique roles in predicting rehabilitation outcomes whereas religious activity does not. Notably, a self-reported individual connection to a higher power was an extremely robust predictor of both subjective and objective outcome. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Two abbreviated versions of the Wechsler Adult Intelligence Scale-III: Validation among persons with traumatic brain injury.

Objective: To examine the clinical value of two 7-subtest versions of the Wechsler Adult Intelligence Scale-III (WAIS-111): one using Block Design (WAIS-III/BD7) and another using Matrix Reasoning (WAIS-III/MR7) among persons with traumatic brain injury (TBI). Study Design: Actual obtained scores from the full WAIS-111 were compared with scores that would have been obtained using each of the two abbreviated versions. Participants: One hundred eighteen persons with TBI tested consecutively in an academic medical center outpatient neuropsychology laboratory. Results: For the WAIS-IIVBD7, corrected validity coefficients were .97 (Verbal IQ [VIQI), .94 (Performance IQ [PIQ]), and .97 (Full Scale IQ [FSIQJ); 92%, 70%, and 92% of scores fell within 5 points of full version scores for VIQ, PIQ, and FSIQ, respectively. WAIS-III/MR7 corrected validity coefficients were .97 (VIQ), .95 (PIQ), and .97 (FSIQ); 92%, 76%, and 92% of short-form scores were within 5 points of actual scores for VIQ, PIQ, and FSIQ, respectively. Conclusions: Both abbreviated versions demonstrated acceptable psychometric characteristics, but the matrix reasoning version may be more advantageous in assessing persons with TBI because it can be used with persons who have TBI-related motor skills impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beery-Buktenica Developmental Test of Visual-Motor Integration performance in children with traumatic brain injury and attention-deficit/hyperactivity disorder.

Evaluation of visuoconstructional abilities is a common part of clinical neuropsychological assessment, and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI; K. E. Beery & N. A. Beery, 2004) is often used for this purpose. However, few studies have examined its psychometric properties when used to assess children and adolescents with traumatic brain injury (TBI) or attention-deficit/hyperactivity disorder (ADHD), even though these are among the most common acquired and neurodevelopmental forms of brain dysfunction in children. This study examined the validity of VMI scores in 123 children with TBI and 65 with ADHD. The TBI and ADHD groups performed significantly worse than the standardization sample, obtaining VMI mean scores of 87.2 (SD = 13.7) and 93.5 (SD = 11.27). Previous research has noted decrements in visuoconstructional abilities in TBI but relative sparing in ADHD. To examine the criterion validity of VMI scores, the authors therefore compared these 2 groups. As anticipated, the TBI group performed significantly worse than the ADHD group, but receiver operator characteristic analysis indicated that VMI scores were poor at discriminating between groups. Nonetheless, convergent validity evidence supported interpretation of VMI scores as measuring perceptual organization in both groups. In particular, principal components analysis indicated that VMI total scores loaded with perceptual organization tests from the Wechsler Intelligence Scale for Children, 3rd ed. (WISC-III; D. Wechsler, 1997), and its highest correlation was with the WISC-III Perceptual Organization Index. Also, the VMI correlated significantly with the Grooved Pegboard test for the group with TBI. These findings suggest that VMI scores are sensitive to visuoconstructional and motor deficits in children with developmental and acquired brain dysfunction. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Response to "Care continuum in traumatic brain injury rehabilitation".

Comments on the original article "Care continuum in traumatic brain injury rehabilitation," by J. M. Uomoto and A. McLean (see record 1990-02670-001). As someone working within the insurance industry with the responsibility for purchasing services for TBI patients, I think that the TBI care continuum, as presented by Uomoto and McLean, represents a sensible response to a critical need. It does not offer, however, any specific information on what is effective and simply restates what has already been recognized by many in the insurance industry: head trauma rehabilitation is long, complex, multidisciplinary, intensely individualistic, and enormously expensive. The insurance industry is aware that a continuum care approach is necessary. Clearly, no one can dispute that treatment has to be ongoing and multifaceted to address a disability that has such a colossal medical, social, vocational, and psychological impact. In addition, the need for acute hospitalization, acute rehabilitation, and a protective environment to provide care and address basic needs is readily accepted. The problem for the insurance industry is what constitutes effective treatment beyond the acute phase of trauma stabilization and maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdeployment traumatic brain injury screening questions: Sensitivity, specificity, and predictive values in returning soldiers.

Objective: To evaluate the sensitivity, specificity, and predictive values of Post-Deployment Health Assessment traumatic brain injury (TBI) screening questions employed by the Department of Defense (DOD). Participants: Complete data was obtained from 3,072 soldiers upon return from a 15-month deployment to Iraq. Method: Comparisons were made between responses to the DOD four-item screener and a brief structured clinical interview for likely deployment-related TBI history. The interview process was facilitated using responses to the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT). Results: The sensitivity and specificity of the DOD screening tool (positive response to all four items) in comparison to the clinician-confirmed diagnosis was 60% and 96%, respectively. The sensitivity increased to 80%, with a slight decrease in specificity to 93%, for positive TBI screening when affirmative responses to questions 1 and 2 only were included. Conclusions: Affirmative responses to questions 1 and 2 of the DOD TBI screening tool demonstrated higher sensitivity for clinician-diagnosed deployment-related TBI. These two items perform better than positive responses to all four questions; the criteria presently being used for documentation and referral of a deployment-related TBI. These findings support further exploration of TBI screening and assessment procedures. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Driving, aging, and traumatic brain injury: Integrating findings from the literature.

Objective: In order to address the potential compounded risk in the population of aging traumatic brain injury (TBI) survivors who continue to drive, the authors synthesized literatures regarding the impact of aging or TBI on driving. Study Design: PubMed searches were conducted utilizing combinations of the following terms: driving, aging, elderly, TBI, cognition, seizures, vision, hearing, rehabilitation, sleep, fatigue, and assessment. Additional sources were also identified from the bibliographies of articles obtained and the Transportation Research Information Service electronic database. Clinically relevant human studies written in English were reviewed. Results: Using a conceptual framework developed by W. H. Brouwer and F. K. Withaar (1997), the authors of the current review highlight driving-related obstacles for TBI survivors and aging adults and suggest that individuals aging with TBI may be at increased risk for driving-related problems. Implications: Areas for clinical consideration include seizures, sleepiness and fatigue, vision, cognition, driving assessment, and caregiver involvement. The need for further study of postacute driving assessment and rehabilitation is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incentive effects on event-based prospective memory performance in children and adolescents with traumatic brain injury.

Prospective memory (PM) is the formation of an intention and remembering to perform this intention at a future time or in response to specific cues. PM tasks are a ubiquitous part of daily life. Currently, there is a paucity of information regarding PM impairments in children with traumatic brain injury (TBI) and less empirical evidence regarding effective remediation strategies to mitigate these impairments. The present study employed two levels of a motivational enhancement (i.e., a monetary incentive) to determine whether event-based PM could be improved in children with severe TBI. In a crossover design, children with orthopedic injuries and mild or severe TBI were compared on two levels of incentive (dollars vs. pennies) given in response to accurate performance. All three groups performed significantly better under the high- versus low-motivation conditions. However, the severe TBI group's high-motivation condition performance remained significantly below the low-motivation condition performance of the orthopedic injury group. PM scores were positively and significantly related to age-at-test, but there were no age-at-injury or time-postinjury effects. Overall, these results suggest that event-based PM can be significantly improved in children with severe TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacotherapy for postacute traumatic brain injury: A literature review for guidance in psychological practice.

Objectives: The purpose of this review is to educate and guide the actions of rehabilitation psychologists by providing a summary of the current literature on pharmacotherapies and treatment effectiveness for the chronic sequelae associated with severe traumatic brain injury (TBI). A number of medications are reviewed for use in treating deficits in arousal, cognition, function, and other problems associated with TBI. Findings for their use in this population are summarized. Cautions, limitations, and directions for future research are discussed. Conclusions: Pharmacological management of chronic symptoms of TBI is commonplace in rehabilitation practice. Clear clinical guidelines for the use of pharmacotherapy in TBI are lacking, however, because of the few conclusive findings regarding the effectiveness of any particular agent. Rehabilitation psychologists frequently encounter patients treated with numerous medications and, therefore, need to be aware of potential effects on cognitive and functional abilities. Additionally, rehabilitation psychologists should be aware of available and empirically supported pharmacotherapies as they are in a position to comprehensively assess the patient and provide requested consultation to the treating physician concerning the patient's need for and likelihood of benefiting from various pharmacological agents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of memory beliefs in individuals with traumatic brain injury.

Objective: To explore metamemory (memory beliefs) and affective functioning in individuals with traumatic brain injury (TBI). Participants: Twenty-six individuals with mild TBI (MTBI), 16 individuals with severe TBI (STBI), and 42 uninjured adults. Outcome Measures: Metamemory in Adulthood questionnaire, Postconcussion Syndrome Checklist, Perceived Stress Scale, Beck Depression Inventory (2nd ed.), Beck Anxiety Inventory. Results: The control group endorsed higher memory self-efficacy, fewer depressive symptoms, fewer memory strategies, and fewer postconcussion symptoms than the MTBI or STBI group. The MTBI group placed high importance on success in memory tasks. Memory self-efficacy and memory-strategies use mediated the relation between TBI and depression. Conclusion: Individuals with brain injury hold negative beliefs about their memory functioning, and such beliefs contribute to depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age differences in a sample of state vocational rehabilitation clients with traumatic brain injury.

Objective: To examine the relations among age, neuropsychological functioning, and vocational rehabilitation following traumatic brain injury (TBI). Study Design and Participants: Prospective study of 78 adults (18-57 years) who qualified for services with the Missouri Division of Vocational Rehabilitation (DVR), based on a history of TBI followed from enrollment to case closure. Group differences based on age were examined for neuropsychological and vocational outcome with multivariate analysis of variance and nonparametric methods. Main Outcome Measures: Neuropsychological test data and DVR data regarding vocational placement. Results: Age-related differences were present for a measure of mental flexibility, isolated demographic characteristics, and 1 DVR service category. Contrary to hypotheses, there were no age-related differences in vocational outcome. Conclusions: In contrast to hospital-based samples, age does not appear to be a negative indicator for individuals admitted to a state DVR program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measurement properties of the neurobehavioral cognitive status examination (Cognistat) in traumatic brain injury rehabilitation.

Objective: Evaluate measurement properties of the Neurobehavioral Cognitive Status Examination (Cognistat) using Rasch analysis. Design: Calibration of item responses from 120 individuals admitted to a rehabilitation medicine service for traumatic brain injury (TBI) and 296 community-dwelling adults with TBI. Results: Three strata of performance were differentiated despite a skewed distribution toward high performance among the community sample. Elimination of easier items created a better targeted instrument (i.e., generated more spread among individuals) without a significant increase in error. Memory and verbal reasoning were the most difficult domains for each sample; however, analyses indicated significant measurement error. Conclusions: As a screening instrument, the Cognistat reliably classifies multiple levels of cognitive status in both acute and postacute TBI settings; however, this measure is unsuitable for generating a profile of neurocognitive strengths and weaknesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and functional outcome following traumatic brain injury.

Objective: To investigate pre- to postinjury personality change in relation to outcomes following traumatic brain injury (TBI). Design: Prospective analysis of personality ratings, depression, and outcome using multiple regression analyses. Participants: Cohort of 3 clinical trauma groups (mild TBI, moderate-severe TBI, orthopedic injury) and their significant others (SO). Outcome Measures: Independent Living Scale, Vocational Independence Scale, and Mayo-Portland Adaptability Inventory, 1-2 years postinjury. Predictor Variables: Posttraumatic amnesia (PTA); patient and SO NEO Personality Inventory-Revised ratings of preinjury personality taken at 1-2 months postinjury. Results: Personality function was normal for all groups (regardless of rating source) and stable over time. Neuroticism, and specifically depression, accounted for small proportions of variance in functional outcome, beyond PTA. Conclusions: There is little empirical evidence for significant personality disturbance or change up to 2 years post-TBI. Personality and depression contribute modestly to functional outcomes. Results support a distinction between "personality change" and behavior change following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Post-concussive symptoms in children with mild traumatic brain injury.

To investigate postconcussive symptoms (PCS) following pediatric mild traumatic brain injury (mTBI), 8- to 15-year-old children with mTBI (n = 186) and a comparison group with uncomplicated orthopedic injuries (OI, n = 99) were recruited from two emergency departments. Parent and child ratings of PCS and symptom counts were obtained within 3 weeks after injury (baseline) and at 1, 3, and 12 months postinjury. The mTBI group also completed magnetic resonance imaging at baseline. Group differences were examined using growth modeling, controlling for age at injury, sex, socioeconomic status, and (for parent-based measures) preinjury symptom levels. Relative to the OI group, the mTBI group had higher ratings of somatic PCS and parent counts of PCS at the initial assessments, but higher parent ratings of cognitive PCS and child counts of PCS throughout follow-up. Higher levels of PCS in the mTBI group were associated with motor-vehicle-related trauma, loss of consciousness, neuroimaging abnormalities, and hospitalization. The findings validate both transient and persistent PCS in children with mTBI and document associations of symptoms with injury and noninjury factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development, reliability, and validity of the Measure of Sexual Identity Exploration and Commitment (MOSIEC).

Four studies were conducted on the development and validation of the Measure of Sexual Identity Exploration and Commitment (MoSIEC). Exploratory factor analysis of an initial item pool yielded a 22-item measure with 4 distinct factors assessing commitment, exploration, sexual orientation identity uncertainty, and synthesis/integration. Exploratory factor analysis findings support the argument that sexual identity is a broad, multidimensional construct and that the MoSIEC assesses the construct of sexual identity in a manner consistent with J. E. Marcia's (1966) model of identity development. Confirmatory factor analyses demonstrated the stability of the MoSIEC factor structure, providing evidence of construct validity. Test-retest stability, internal consistency, and validity coefficients supported the use and continued development of the MoSIEC. Significant differences in levels of exploration and sexual orientation identity uncertainty were found among different sexual orientation identity groups, establishing the criterion-related validity of the MoSIEC. Implications for further development and use of the MoSIEC are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of causal attributions in public misconceptions about brain injury.

Objective: Social psychological theories such as attribution theory have been applied to conditions such as depression and physical disability, but not to traumatic brain injury (TBI). The goal of this paper is to show that that attribution theory and related concepts help to explain the public's misconceptions about TBI and other challenges faced by clinicians and families of persons with TBI. Results: Research shows that misconceptions about brain injury occur because people misattribute the actions of persons with brain injury. These misattributions reflect two features: (a) the absence of visible markers of the injury, and (b) the tendency to compare persons with TBI with their peers rather than their own preinjury performance. These two processes lead to the opposite pattern to the stigma that occurs with visible disabilities: specifically, a failure among members of the public to recognize that problematic behaviors may result from the injury. This analysis suggests several therapeutic strategies for managing public misconceptions in ways that enhance coping and recovery. Conclusion: Clarifying the attribution processes that underpin misconceptions about brain injury provides a framework for enhancing rehabilitation and addressing these misconceptions effectively. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Selective attention deficits and subjective fatigue following traumatic brain injury.

The present study aimed to investigate the relationship between subjective fatigue and selective attention deficits following traumatic brain injury (TBI). Forty-six participants with mild-severe TBI and 46 healthy controls completed fatigue scales (Visual Analogue Scale--Fatigue, Fatigue Severity Scale [FSS] and Causes of Fatigue Questionnaire [COF]), and attentional measures including subtests from the Test of Everyday Attention, and the Complex Selective Attention Task (C-SAT). TBI participants reported greater fatigue on the FSS and COF, performed more slowly on attentional measures, and made more errors on the C-SAT. After controlling for anxiety and depression, fatigue was significantly correlated with performance only on the C-SAT. Findings suggest a relationship between subjective fatigue and impairment on tasks requiring higher order attentional processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)