Anthony H. Lequerica

Objective Assessment of Functional Ambulation in Adults with Hemiplegia using Ankle Foot Orthotics after Stroke

To objectively evaluate the effect of ankle foot orthotics (AFOs) on functional ambulation in individuals with hemiplegia secondary to stroke using quantifiable outcome measures.

Pilot Study on the Effect of Ramelteon on Sleep Disturbance After Traumatic Brain Injury: Preliminary Evidence From a Clinical Trial.

OBJECTIVE To investigate the effect of ramelteon on sleep and daytime functioning among individuals with traumatic brain injury (TBI). DESIGN A double-blind, placebo-controlled study with a crossover design. SETTING A research facility attached to an acute rehabilitation hospital. PARTICIPANTS Individuals with TBI (N=13) complaining of sleep difficulties with a Pittsburgh Sleep Quality Index score >5. INTERVENTIONS A nightly dosage of ramelteon (8 mg) was given over a period of 3 weeks. MAIN OUTCOME MEASURES An actigraph and a daily sleep log were used to measure sleep/wake patterns. Daytime functioning was measured after 3 weeks of treatment using a computer-administrated neuropsychological test battery in conjunction with subjective questionnaires measuring mood, daytime sleepiness, and fatigue. RESULTS A significant increase in objectively measured total sleep time and a small increase in sleep latency were observed after 3 weeks of treatment compared with placebo. Treatment also showed a significant increase in standardized neuropsychological test scores, with a particular improvement on an index of executive functioning. CONCLUSIONS Preliminary evidence for the effectiveness of 8 mg of ramelteon taken nightly over a 3-week period was found in the treatment of sleep difficulties among individuals with TBI. Improvements in total sleep time and some aspects of cognitive functioning are discussed.

The Community Integration Questionnaire: factor structure across racial/ethnic groups in persons with traumatic brain injury.

Objective:To examine the factor structure and construct validity of the Community Integration Questionnaire, a widely used measure of community participation among individuals with traumatic brain injury (TBI), among 3 racial/ethnic groups. Design:Prospective longitudinal cohort study. Setting:Enrollment in acute inpatient TBI rehabilitation with follow-up at 1 year after injury. Participants:A total of 1756 persons with TBI enrolled in the Traumatic Brain Injury Model Systems (TBIMS) national Database. Main Outcome Measure:Community Integration Questionnaire at 1 year after injury. Results:The goodness of fit for the factor structure of the Community Integration Questionnaire, separating items into Home Competency, Social Integration, and Productive Activity, was satisfactory for whites but not for blacks or Hispanics. Conclusions:Clinicians and researchers should take race/ethnicity into account when utilizing measures of community integration.

The usefulness of self-generation to improve learning and memory in Spanish-speaking individuals with traumatic brain injury from Colombia

Objective: To examine the effect of self-generation on learning and memory in Spanish-speaking individuals with traumatic brain injury (TBI). Method: Thirty Spanish-speaking individuals with moderate-to-severe TBI and 31 healthy controls were recruited to read 32 individual sentences and required to remember the last word in each sentence. Target words were presented both in a self-generated and provided condition for each participant. Recall and recognition of the words were examined immediately, after 30 minutes and after 1 week. Results: Findings indicated that both healthy controls and individuals with TBI showed significantly better recall and recognition for words in the generated condition than words that had been provided to them at immediate, 30-minute and 1-week time intervals. Conclusion: The self-generation technique effectively improves learning and memory in Spanish-speaking individuals with TBI. Results should encourage researchers and clinicians to use the principles of cognitive psychology to adapt (as opposed to simply translate) cognitive rehabilitation protocols for use in Spanish-speaking populations with neurological conditions.

The therapeutic value of cranioplasty in individuals with brain injury

ABSTRACT Primary objective: To examine the effect of cranioplasty on recovery. Research design: Retrospective cohort study. Method and procedures: Retrospective chart review conducted in 2011 and 2012 on adult inpatients with craniectomy who completed a continuous episode of inpatient rehabilitation before and after receiving their cranioplasty. Patients were matched 1:1 or age, gender, functional level at admission, injury severity and length of stay with inpatients who completed rehabilitation before cranioplasty. Main outcome measures include FIMTM (Functional Independence Measure) and FIMTM efficiency [(FIMTM discharge – FIMTMadmission)/number of days in rehabilitation]. To examine within and between group differences, analyses included paired and independent t-tests, Pearson correlations and chi-square analyses. Results: Twenty-six individuals (13 from the cranioplasty group and 13 from the comparison group) were analysed. FIMTM efficiency increased following cranioplasty [0.29 to 0.61; t(12) = −2.77, p = 0.017]. The mean FIMTM efficiency for the cranioplasty group was below that of the comparison group prior to cranioplasty [0.28 ± 0.37 and 0.39 ± 0.32, p = .41], but increased following cranioplasty [0.61 ± 0.71 and 0.39 ± 0.32, p = .32]. An improvement in FIMTM efficiency following cranioplasty was more commonly seen among individuals with less severe brain injuries (75%, χ2 = 3.8, df = 1, p = 0.053). Conclusion: Rate of recovery increased following cranioplasty and exceeded that of the comparison group suggesting that cranioplasty may contribute to improvement.

The Multidimensional Influence of Acculturation on Digit Symbol-Coding and Wisconsin Card Sorting Test in Hispanics

Objective: The purpose of the current study was to evaluate the relative contribution of acculturation to two tests of nonverbal test performance in Hispanics. Method: This study compared 40 Hispanic and 20 non-Hispanic whites on Digit Symbol-Coding (DSC) and the Wisconsin Card Sorting Test (WCST) and evaluated the relative contribution of the various acculturation components to cognitive test performance in the Hispanic group. Results: Hispanics performed significantly worse on DSC and WCST relative to non-Hispanic whites. Multiple regressions conducted within the Hispanic group revealed that language use uniquely accounted for 11.0% of the variance on the DSC, 18.8% of the variance on WCST categories completed, and 13.0% of the variance in perseverative errors on the WCST. Additionally, years of education in the United States uniquely accounted for 14.9% of the variance in DSC. Conclusions: The significant impact of acculturation on DSC and WCST lends support that nonverbal cognitive tests are not necessarily culture free. The differential contribution of acculturation proxies highlights the importance of considering these separate components when interpreting performance on neuropsychological tests in clinical and research settings. Factors, such as the country where education was received, may in fact be more meaningful information than the years of education of education attained. Thus, acculturation should be considered an important factor in any cognitive evaluation of culturally diverse individuals.

Cognitive Problems After Traumatic Brain Injury

How family members can help: Use kind words and a gentle tone of voice. Be careful not to “talk down” to the person. When talking with the injured person, ask every so often if he or she understands what you are saying. Do not speak too fast or say too much at once. Develop a signal that will let the injured person know when he or she has gotten off-topic. Limit conversations to 1 person at a time.

Item analysis of the Spanish version of the Boston Naming Test with a Spanish speaking adult population from Colombia

Abstract Objective: The Boston Naming Test (BNT) is a widely used measure of confrontation naming ability that has been criticized for its questionable construct validity for non-English speakers. This study investigated item difficulty and construct validity of the Spanish version of the BNT to assess cultural and linguistic impact on performance. Methods: Subjects were 1298 healthy Spanish speaking adults from Colombia. They were administered the 60- and 15-item Spanish version of the BNT. A Rasch analysis was computed to assess dimensionality, item hierarchy, targeting, reliability, and item fit. Results: Both versions of the BNT satisfied requirements for unidimensionality. Although internal consistency was excellent for the 60-item BNT, order of difficulty did not increase consistently with item number and there were a number of items that did not fit the Rasch model. For the 15-item BNT, a total of 5 items changed position on the item hierarchy with 7 poor fitting items. Internal consistency was acceptable. Conclusions: Construct validity of the BNT remains a concern when it is administered to non-English speaking populations. Similar to previous findings, the order of item presentation did not correspond with increasing item difficulty, and both versions were inadequate at assessing high naming ability.

Feasibility and Preliminary Validation of an Online Version of the Ohio State University Traumatic Brain Injury Identification Method

OBJECTIVE To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI). DESIGN Cross-sectional. SETTING General community. PARTICIPANTS A volunteer sample of individuals (N= 265) from the general population across the United States. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Online version of the Ohio State University Traumatic Brain Injury Identification Method, Rivermead Postconcussion Symptoms Questionnaire (RPQ), Patient-Reported Outcomes Measurement Information System Cognitive Concerns Scale. RESULTS The measure was completed by 89.4% of the sample with most participants completing the measure in <8 minutes. After controlling for age, sex, psychiatric history, drug or alcohol history, and history of developmental disability, worst TBI severity was significantly associated with scores on the RPQ, F(2,230)=4.56, P=.011, and having a TBI within the past 2 years was associated with higher scores on the cognitive factor subscale of the RPQ, F(1,75)=7.7, P=.007. CONCLUSIONS The online administration of the Ohio State University Traumatic Brain Injury Identification Method appears to be feasible in the general population. Preliminary validity was demonstrated for the indices of worst TBI severity and time since most recent TBI.