The validity of the Katz Adjustment Scale among people with traumatic brain injury.

Deficits in self- and social awareness can impair adjustment following traumatic brain injury (TBI) and draw into question the accuracy of self-report measures of adjustment. This study evaluates the validity of Katz Adjustment Scale (KAS) factor components identified by R. J. Fabiano and D. A. Goran (1992). The KAS is an observer rating scale often used to assess the social adjustment of people with traumatic brain injury. The responses of 105 individuals with TBI to the Symptom Checklist 90—Revised (SCL-90–R; L. R. Derogatis, 1983), a self-report measure of distress, were correlated with observer ratings on the KAS. Results support the use of observer ratings and self-report to assess adjustment and social behavior following TBI. Each contributes valuable information that can guide treatment and enhance adaptive functioning. (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)     

Care continuum in traumatic brain injury rehabilitation.

Discusses the range of services needed in traumatic brain injury (TBI) rehabilitation within the context of a services continuum owing to the nature of the recovery process. The TBI care continuum includes treatment during the following phases: injury onset, trauma center and emergency care, neurosurgery unit and acute hospitalization, coma stimulation, nursing home and long-term care programs, transitional living centers, day treatment and outpatient rehabilitation, supervised independent living center and support services, and vocational rehabilitation services. Obstacles to care continuity include funding concerns, lack of knowledge about TBI, the complex nature of TBI, and program accessibility issues. It is noted that major legislative, educational, and outreach efforts are under way to overcome these barriers to services provision. A comment by J. E. Sargent follows. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles of the psychologist on a traumatic brain injury rehabilitation team.

Asserts that to be optimally effective, the psychologist on a head injury rehabilitation team requires proficiency in neuropsychological assessment, behavior management, understanding of family systems, psychology of disability, cognitive rehabilitation, and short-term psychotherapy. The psychologist's special role as a team facilitator, behavior management and family intervention specialist, proponent of scientific method, and program evaluator is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the Wechsler Adult Intelligence Scale-Revised in a traumatic brain injury sample.

The Wechsler Adult Intelligence Scale—Revised (WAIS—R) protocols administered to 102 traumatically brain injured (TBI) patients (aged 14–74 yrs) an average of 9.74 mo postinjury were factor analyzed using principal axes factoring with varimax rotation. Although high levels of congruence with psychiatric and standardization samples were achieved, Wechsler's Verbal/Performance dichotomy, strictly defined, did not hold in this sample. In addition, the 3rd factor, consisting of Digit Span, Arithmetic, Digit Symbol, and Picture Arrangement, replicated a factor analytic study using psychiatric patients. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in orientation during acute rehabilitation after traumatic brain injury.

Objective: To examine the profile of scores on a measure of orientation in a sample of patients with traumatic brain injury (TBI) during acute rehabilitation as a means of (a) assessing the extent of neural compromise, (b) assessing recovery of functioning, and (c) determining the relative difficulty of different indicators of orientation. Design: Repeated measures. Setting: Acute rehabilitation hospital. Participants: Forty-three patients with severe TBI interviewed daily throughout rehabilitation. Measures: The Orientation Log (O-Log) is a 10-item measure of orientation to place, time, and situation. Items are scored 0–3 on the basis of whether they are recalled spontaneously (3), with cueing (2), via recognition (1), or not at all (0). Results: O-Log score was correlated with severity of TBI. Return of orientation followed a consistent trajectory, with initial gains preceding a plateau effect. Patients had relatively more difficulty orienting to hospital name and date than to year, month, and city. Conclusions: The O-Log is sensitive to the severity of TBI. Progress in orientation, on average, occurs at a similar rate across patients, including those who present as severely disoriented, although those with severe disorientation may not achieve orientation by rehabilitation discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive functioning ten years following traumatic brain injury and rehabilitation.

Many previous studies investigating long-term cognitive impairments following traumatic brain injury (TBI) have focused on extremely severely injured patients, relied on subjective reports of change and failed to use demographically relevant control data. The aim of this study was to investigate cognitive impairments 10 years following TBI and their association with injury severity. Sixty TBI and 43 control participants were assessed on tests of attention, processing speed, memory, and executive function. The TBI group demonstrated significant cognitive impairment on measures of processing speed (Symbol Digit Modalities Test [SDMT], Smith, 1973; Digit Symbol Coding, Wechsler, 1997), memory (Rey Auditory Verbal Learning Test [RAVLT]; Rey, 1958; Lezak, 1976), Doors and People tests; Baddeley, Emslie & Nimmo-Smith, 1994) and executive function (Hayling C [Burgess & Shallice, 1997] and SART errors, Robertson, Manly, Andrade, Baddeley & Yiend, 1997). Logistic Regression analyses indicated that the SDMT, Rey AVLT and Hayling C and SART errors most strongly differentiated the groups in the domains of attention/processing speed, memory and executive function, respectively. Greater injury severity was significantly correlated with poorer test performances across all domains. This study shows that cognitive impairments are present many years following TBI and are associated with injury severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring outcome in community-based rehabilitation services for people who have suffered traumatic brain injury: the Community Outcome Scale

OBJECTIVE: To develop a way of measuring long-term outcomes after traumatic brain injury (TBI) that takes account of individual circumstances. DESIGN: Reports by head-injured people and their families about problems and coping strategies were elicited via semi-structured interviews. Specially designed computer software was used to record problems and strengths and to measure their impact for the individual on four handicap dimensions. SETTING: Interviews took place in the respondents' homes. SUBJECTS: Between 1992 and 1997 the services at 10 rehabilitation centres in England were evaluated. Subjects were men and women aged between 16 and 65 who had suffered TBI and who had been referred for treatment to one of the centres under study. INTERVENTIONS: Head-injured people and their families were interviewed three months, 18 months and in some cases 36 months after recruitment. MAIN OUTCOME MEASURES: The Hospital Anxiety and Depression Scale (HAD) and the Functional Independence/Assessment Measure (FIM/FAM) were used to validate relevant dimensions of the new scale. RESULTS: A measure of long-term outcome was developed and called the Community Outcome Scale. Relevant dimensions of the scale showed significant correlation with the HAD and with items of the FIM/FAM. CONCLUSION: The scale captures information which no other instrument does, and merits further validation.     

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)     

Misconceptions about traumatic brain injury among educators and rehabilitation staff: A comparative study.

This study compared the responses of 184 educators and 111 rehabilitation specialists on a measure of knowledge about childhood traumatic brain injury (TBI). Educators displayed more misconceptions about TBI overall compared to rehabilitation staff. They underestimated the effect of TBI on cognition, behavior, and continued development. More specifically, educators showed more misconceptions than the rehabilitation staff in the following areas: coma, memory and new learning, anger management, and factors affecting recovery. An important task for rehabilitation staff members is to clarify educator misconceptions about TBI as children transition to school. Information provided should increase the level of teacher preparation and help to maximize children's academic success and adaptation following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of family focused therapy in rehabilitation for veterans with traumatic brain injury.

Objective: Military personnel returning from Iraq and Afghanistan with traumatic brain injury (TBI) present with a complex array of stressors encountered during combat as well as upon re-entry, often with additional physical and mental health comorbidities. This requires an intensive approach to treatment that includes family intervention as a part of rehabilitation. There is a small but growing literature addressing the needs of families when a family member has sustained a TBI. An established treatment intervention for individuals with serious mental illness, such as family focused therapy (FFT), is uniquely suited to address the complexity of issues presented by returning military personnel, and may be adapted for moderate to severe TBI populations. In this article, we discuss the rationale for adapting this family intervention for this population and present a case vignette illustrating adaptations for TBI. Conclusions: The adaptation of an existing family intervention for a chronic condition that focuses on enhancing both individual and family functioning is a useful starting point. With further research to modify FFT for this unique population and establish feasibility, this approach may supplement existing models of family intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bring it up in milieu: Toward effective traumatic brain injury rehabilitation interaction.

Reviews the emotional and motivational problems faced by the rehabilitation therapist dealing with traumatic brain injury (TBI) patients and describes a neuropsychologically oriented method to help rehabilitation team members improve their effectiveness in returning post-TBI patients to work. A clinical vignette describing the use of milieu therapy is presented. Topics that rehabilitation team members need to be taught about cognitive and personality problems of TBI patients are discussed, focusing on teaching staff to give feedback in milieu. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to "Roles of the psychologist on a traumatic brain injury rehabilitation team."

Asserts that the blend of talents suggested by P. Barry and J. O'Leary (see record 1990-02635-001) to be necessary for psychologists on a head injury rehabilitation team is an excellent outline but that the issues presented (e.g., team facilitation, behavior management) need to be more fully described. The present authors suggest that other elements, such as the development of a working model of personality, should be integrated into a comprehensive brain injury rehabilitation environment. (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)     

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)     

The effectiveness of computer-assisted cognitive rehabilitation for persons with traumatic brain injury

Electroencephalographic (EEG) findings in syncope are reviewed. There are four major categories of syncope: neurally mediated (neurocardiogenic), neurologic, decreased cardiac output, and orthostatic hypotension. However, regardless of cause, whether the syncope is due to a vasovagal effect, a cardiac arrhythmia, an epileptic seizure, or hypotension, EEG findings are similar and reflect cerebral hypoperfusion. Initially there may be a slowing of background rhythms. This is followed by high amplitude delta activity, maximal anteriorly. If the hypoperfusion persists there is subsequent flattening of the EEG. The EEG returns to normal in the reverse sequence. In cases with severe and prolonged ischemia, convulsive syncope may occur at the time of the EEG flattening. Although not an epileptic phenomena, clinically this is often mistaken for epilepsy. Conversely, epileptic disorders, such as the ictal bradycardia syndrome, may occasionally mimic syncope. Therefore, in patients in whom EEGs are performed for the evaluation of an episode of loss of consciousness, simultaneous ECG should be used.     

Attentional skills following traumatic brain injury in childhood: a componential analysis

Recent research has documented residual deficits in attention following traumatic brain injury in childhood. The present study aimed to investigate whether such deficits are global, or affect specific components of attention differentially. Four attentional domains were examined using a newly developed test of attention, the Test of Everyday Attention for Children: sustained attention, focussed attention, divided attention, and response inhibition. Eighteen children with a history of traumatic brain injury, aged between 8 and 14 years, and 18 non-injured matched controls participated in the study. Results indicated that attentional skills may be differentially impaired after TBI, with children who have sustained moderate-to-severe TBI exhibiting significant deficits for sustained and divided attention, and response inhibition, but relatively intact focussed attention.     

Task performance in virtual environments used for cognitive rehabilitation after traumatic brain injury

OBJECTIVE: This report describes a reliability study using a prototype computer-simulated virtual environment to assess basic daily living skills in a sample of persons with traumatic brain injury (TBI). The benefits of using virtual reality in training for situations where safety is a factor have been established in defense and industry, but have not been demonstrated in rehabilitation. SUBJECTS: Thirty subjects with TBI receiving comprehensive rehabilitation services at a residential facility. METHODS: An immersive virtual kitchen was developed in which a meal preparation task involving multiple steps could be performed. The prototype was tested using subjects who completed the task twice within 7 days. RESULTS: The stability of performance was estimated using intraclass correlation coefficients (ICCs). The ICC value for total performance based on all steps involved in the meal preparation task was .73. When three items with low variance were removed the ICC improved to .81. Little evidence of vestibular optical side-effects was noted in the subjects tested. CONCLUSION: Adequate initial reliability exists to continue development of the environment as an assessment and training prototype for persons with brain injury.     

Long-term follow-up of post-acute traumatic brain injury rehabilitation: a statistical analysis to test for stability and predictability of outcome

A high percentage of the estimated 500,000 traumatic brain injuries (TBI) in the US every year occur with young people who will face many years of neurobehavioral and economic consequences. This study examined the long-term stability of outcome after post-acute TBI rehabilitation and possible predictors of long-term outcome based on a 127-item survey of 332 clients up to 14 years post-discharge. Correlational, factor, and multiple regression analysis indicated positive long-term outcome stability following rehabilitation with the exception of vocational status, which decreased over the same time period. A number of possible explanations for this occupational anomaly are suggested. Rating scale scores and latency-to-rehabilitation proved to be better predictors of long-term outcome than demographic data.     

Use of the Neuropsychiatric Inventory in traumatic brain injury: A pilot investigation.

Objective: The goal of this investigation was to pilot the Neuropsychiatric Inventory (NPI) among individuals with traumatic brain injury (TBI) and their caregivers, assessing its screen-metric approach. Design and Participants: Using the NPI, caregivers rated neurobehavioral disturbances in 51 individuals with moderate-to-severe TBI. The NPI was completed 1 or 2 years after the individuals were injured. Results: Caregivers reported the highest symptom levels for participants on Irritability/Lability, Apathy, and Agitation/Aggression, and rated greater levels of distress tied to those domains and to Dysphoria. Caregivers endorsing domain screening items endorsed significantly more metric items (vs. screen non-endorsers) within that domain, as would be expected if the screen accurately measured the psychopathology under consideration. In addition, the screen-metric yielded extremely low false-positive rates, although 5 of the 12 domains had elevated false-negative rates. Conclusions: Findings provide preliminary support for the accuracy of the NPI's screen-metric in this population and are consistent with prior work detailing common problematic neurobehavioral consequences of TBI. These results lay groundwork for research and clinical use of this measure in populations with TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)