Amanda Lane-Brown

Measuring apathy after traumatic brain injury: Psychometric properties of the Apathy Evaluation Scale and the Frontal Systems Behavior Scale

Objectives: To evaluate the reliability and validity of the Apathy Evaluation Scale (AES) and Apathy sub-scale of the Frontal Systems Behavior Scale (FrSBe-A) for people with traumatic brain injury (TBI). To identify an optimal cut-off score indicating presence of apathy according to the AES. Methods and procedures: A sample of 34 participants with severe TBI currently residing in the community underwent neuropsychological and psychosocial assessment to evaluate reliability, discriminant, convergent and divergent validity. Receiver Operating Characteristic (ROC) curve analysis was undertaken to identify an optimal cut-off score on the AES. Results: AES and FrSBe-A correlated moderately with each other (r = 0.71). Both AES and FrSBe-A have good internal consistency and discriminant validity with measures of depression and fatigue. Support for hypothesized correlations with similar and dissimilar constructs was not shown. ROC analysis identified a cut-off score of 37 or higher on AES indicated presence of apathy. Conclusions: AES and FrSBe-A are reliable and valid measures of apathy following TBI. It is suggested that the two scales measure slightly differing aspects of the apathy construct, with AES addressing emotional-affective aspects of apathy more than FrSBe-A, which focuses more heavily on cognitive and behavioral elements of goal-directed behavior.

Apathy after acquired brain impairment: A systematic review of non-pharmacological interventions

Apathy commonly occurs after acquired brain impairment. It is characterised by impaired initiative, diminished activity, and lack of concern; formally delineated as a decrease in cognitive, behavioural and emotional components of goal-directed activity. The impact is widespread, hampering rehabilitation and outcome. This systematic review identifies and assesses the efficacy of non-pharmacological treatments for apathy following four types of acquired brain impairment (traumatic brain injury, dementia, cerebrovascular accident, encephalitis). Nine databases were searched. Studies were reviewed according to the following criteria: age over 16 years, acquired brain impairment, non-pharmacological intervention for apathy, and data reported on treatment efficacy. The methodological quality of the studies was assessed. Searches yielded 1754 articles, with 28 meeting criteria. Methodological quality ranged greatly. The majority of trials involved the dementia population. Cognitive interventions were the most frequent mode of treatment. For those with severe impairments, the strongest evidence suggested music therapy and for milder impairment, the strongest evidence was for cognitive rehabilitation. This review reveals a need for more high quality, methodologically rigorous treatment studies for apathy, particularly within the milder ranges of impairment. Initially, however, a uniform operational definition needs to be utilised in all research studies to minimise variability. Additionally, employing a standardised outcome measure specific to apathy would greatly enhance comparison among treatments.

A multicentre, randomised trial examining the effect of test procedures measuring emergence from post-traumatic amnesia

Background: Post-traumatic amnesia (PTA) tests that record different PTA durations in the same patient, thereby raising measurement accuracy issues, have been reported previously. A major problem lies in determining the end point of PTA. Aims: To delineate areas of discrepancy in PTA tests and to provide independent verification for a criterion signalling emergence from PTA. Methods: In a randomised design, two related PTA procedures were compared, one purportedly more difficult (Westmead PTA Scale, WPTAS) than the other (Modified Oxford PTA Scale, MOPTAS). Eighty two patients in the early stages of PTA were examined daily until emergence, by using the Galveston Orientation and Amnesia Test (GOAT) and the WPTAS/MOPTAS. A short battery of cognitive and behavioural measurements was made on three occasions: at the early stage of PTA (time 1), towards the end of PTA when the maximum score (12/12) was first obtained (time 2) and at the traditional criterion for emergence (scoring 12/12 for 3 consecutive days; time 3). Results: No significant difference was recorded in PTA duration between the MOPTAS and WPTAS. Both scales recorded longer PTA durations than the GOAT. By using Kaplan–Meier survival analyses, the WPTAS was found to show a more protracted pattern of emergence at the end stage of PTA than the MOPTAS. A time lag of ⩾1 week in the resolution of disorientation as compared with amnesia was observed in 59% cases. Significant improvements occurred on all independent measurements between time 1 and time 2, but on only 2 of 5 cognitive measurements between time 2 and time 3. Conclusions: Although no significant differences in the duration of PTA on the MOPTAS/WPTAS were recorded, emergence from the late stages of PTA occurred more promptly with the MOPTAS. The need for inclusion of both orientation and memory items in PTA tests is highlighted by the frequency of disorientation–amnesia dissociations. The patterns of results on the independent measures suggest that patients who are in PTA for > 4 weeks have probably emerged from PTA when they first score 12/12 on the MOPTAS/WPTAS, and this criterion can replace the traditional criterion.

Participation after acquired brain injury: Clinical and psychometric considerations of the Sydney Psychosocial Reintegration Scale (SPRS)

OBJECTIVE To examine the psychometric qualities and develop the clinical utility of the Sydney Psychosocial Reintegration Scale (SPRS) as a measure of participation in people with traumatic brain injury. DESIGN Data generated from previous prospective studies. SUBJECTS/PATIENTS Convenience samples of healthy community-based volunteers (n=105) and people with severe brain injury (n=510). METHODS (i) The equivalence of a new 5-point version of the SPRS was determined vs the original 7-point version; (ii) construct validity was tested using Rasch analyses; (iii) normative and comparative data tables were produced, and data examined for floor/ceiling effects; (iv) a reliable change index score was generated. RESULTS Patterns of psychometric properties for the 5- and 7-point versions were almost identical (e.g. total scores rs=0.98). Rasch analyses on Forms A and B found good fit to the model, for person (3.36 and 3.03, respectively) and item (7.78 and 7.25, respectively) separation; reliability coefficients were high (all ≥ 0.90). Mean infit statistics met standard criteria (between 0.7 and 1.3). No floor/ceiling effects were detected. The reliable change index value was calculated for the total score for Form A using logit scores, and a conversion table provided. CONCLUSION The 5-point version of the SPRS demonstrates strong psychometric qualities as a measure of participation after traumatic brain injury.

Evaluation of an Intervention for Apathy After Traumatic Brain Injury: A Multiple-baseline, Single-case Experimental Design

Background:Apathy is diminished initiation, sustained activity, and concern about goal-directed behaviors. It occurs in between 46% and 71% of adults with traumatic brain injury and has widespread effects. Despite this, evidence for treatment of apathy is sparse, with no evidence for treatments aimed at sustaining activity toward goal-directed behavior. Method:A multiple-baseline, single-case experimental design evaluated a novel treatment for apathy in a 32-year-old man with traumatic brain injury. This treatment incorporated motivational interviewing and external compensation to increase sustained activity toward cumulative goals. Results:A specific treatment effect was demonstrated. Reliable Change Indices indicated a significant decrease in apathy that was maintained at 1-month follow-up. Conclusion:Treatment had a strong and specific effect on treated goal-directed activity and decreased apathy. The success of treatment was dependent on initiation as well as sustaining goal-directed activity.

Do People With Severe Traumatic Brain Injury Benefit From Making Errors? A Randomized Controlled Trial of Error-Based and Errorless Learning:

Background. Errorless learning (ELL) and error-based learning (EBL) are commonly used approaches to rehabilitation for people with traumatic brain injury (TBI). However, it is unknown whether making errors is beneficial in the learning process to promote skills generalization after severe TBI. Objective. To compare the efficacy of ELL and EBL for improving skills generalization, self-awareness, behavioral competency, and psychosocial functioning after severe TBI. Method. A total of 54 adults (79% male; mean age = 38.0 years, SD = 13.4) with severe TBI were randomly allocated to ELL or EBL and received 8 × 1.5-hour therapy sessions that involved meal preparation and other goal-directed activities. The primary outcome was total errors on the Cooking Task (near-transfer). Secondary outcome measures included the Zoo Map Test (far-transfer), Awareness Questionnaire, Patient Competency Rating Scale, Sydney Psychosocial Reintegration Scale, and Care and Needs Scale. Results. Controlling for baseline performance and years of education, participants in the EBL group made significantly fewer errors at postintervention (mean = 36.25; 95% CI = 32.5-40.0) than ELL participants (mean = 42.57; 95% CI = 38.8-46.3). EBL participants also demonstrated greater self-awareness and behavioral competency at postintervention than ELL participants (P < .05). There were no significant differences on other secondary outcomes (P > .05), or at the 6-month follow-up assessment. Conclusion. EBL was found to be more effective than ELL for enhancing skills generalization on a task related to training and improving self-awareness and behavioral competency.