Anthony Lequerica

Subjective and objective assessment methods of mental imagery control: construct validation of self-report measures.

A study was conducted to examine the relationship between subjective and objective measures of mental imagery control. Eighty college undergraduates completed a battery of imagery tests and self-report measures to examine whether questionnaires that purport to measure imagery control or dynamic imagery ability (imagery of movement) would show a stronger relationship with objective measures of mental manipulation than would subjective measures that tap vividness of static imagery. Neither subjective measures of movement imagery nor subjective measures of stationary imagery showed meaningful relationships with objective measures of visuospatial manipulation. Additionally, subjective and objective imagery measures generally tended to dissociate. Basic component skills thought to be involved in mental manipulation, however, showed a much stronger relationship with the objective imagery tasks than did the self-report questionnaires. Findings suggest that subjective measures of imagery control do not tap the same cognitive processes involved in objective tests that require accurate imagery manipulation.

Early predictors of employment outcomes 1 year post traumatic brain injury in a population of Hispanic individuals

OBJECTIVE To determine which demographic, injury, and rehabilitation factors are associated with employment rates in Hispanic individuals 1 year post traumatic brain injury (TBI). DESIGN Retrospective study. SETTING Longitudinal dataset of the TBI Model Systems National Database. PARTICIPANTS 418 Hispanic individuals with TBI hospitalized between 1990 and 2009 having year 1 follow-up data (18-55 years and not retired at injury). MAIN OUTCOME MEASURE Competitive employment status 1 year post-injury (yes/no). RESULTS A multiple logistic regression model indicated that pre-injury employment status, pre-injury level of education, etiology, days of posttraumatic amnesia (PTA), associated spinal cord injury, Functional Independence Measure (FIM) motor at rehabilitation discharge, and length of stay in rehabilitation were significant predictors of competitive employment post-injury, controlling for the effects of each other (all p-values ≤ 0.014). Increases in the odds of not being employed post-injury were associated with not being employed pre-injury, having lower levels of education pre-injury, etiologies due to violence or falls, increased PTA, an associated spinal cord injury, lower FIM motor scores, and greater lengths of stay in rehabilitation. CONCLUSIONS The first year post-TBI is critical for recovery and gainful employment, particularly for Hispanic individuals. Early identification of factors influencing successful gainful employment and expeditious implementation of services to ameliorate these issues are paramount in improving employment outcomes for Hispanic individuals with TBI.

Cognitive initiation and depression as predictors of future instrumental activities of daily living among older medical rehabilitation patients.

This study investigated relationships among depressive symptoms, cognitive initiation, and instrumental activities of daily living (IADL) in 128 older African American medical rehabilitation patients. Participants were administered the Geriatric Depression Scale and measures of cognitive initiation—Initiation/Perseveration subtest of the Dementia Rating Scale and verbal fluency (Controlled Oral Word Association Test letter C and Animal Naming)—at hospital discharge. Cognitive initiation predicted IADL 3 and 6 months after hospital discharge, independently of baseline IADL. While depression was related to current IADL, it did not independently predict future IADL. Results suggest that executive dysfunction, specifically cognitive initiation, is a key predictor of future IADL.

Characteristics associated with satisfaction with life 1 year post traumatic brain injury in a population of Hispanic individuals.

OBJECTIVE To determine which demographic, injury, rehabilitation, and follow-up characteristics are associated with satisfaction with life in a population of Hispanic individuals 1 year post-traumatic brain injury (TBI). DESIGN Retrospective study. SETTING Longitudinal dataset of the TBI Model Systems National Database. PARTICIPANTS 291 Hispanic adults with TBIs occurring between 1999 and 2008 having year 1 follow-up data. MAIN OUTCOME MEASURE Satisfaction with Life Scale (SWLS) measured 1 year post-TBI. RESULTS The relationships between SWLS 1 year post-injury and a variety of demographic, injury, rehabilitation, and follow-up characteristics were modeled using generalized linear models. The final multivariable model explained 25.2% of variability in SWLS (F (7, 261)=12.6, p < 0.001) and included quadratic effects for both age at injury and FIM cognitive scores 1 year post-injury, as well as effects for associated SCI and employment status 1 year post-injury (all p-values ≤ 0.036). In general, higher age, no associated SCI, not being unemployed at 1 year post-injury, and very high or very low FIM cognitive scores were associated with greater SWLS scores 1 year post-injury. CONCLUSIONS These results suggest a variety of demographic, injury, and follow-up characteristics are related with SWLS 1 year post-TBI in Hispanic individuals. Focusing rehabilitation efforts on improving cognition and vocational skills may improve SWLS in Hispanics 1 year post-TBI.

Issues of cultural diversity in acquired brain injury (ABI) rehabilitation

INTRODUCTION With the general population in the United States becoming increasingly diverse, it is important for rehabilitation professionals to develop the capacity to provide culturally sensitive treatment. This is especially relevant when working with minority populations who have a higher risk for brain injury and poorer rehabilitation outcomes. OBJECTIVES This article presents a number of clinical vignettes to illustrate how cultural factors can influence behavior in patients recovering from brain injury, as well as rehabilitation staff. The main objectives are to raise awareness among clinicians and stimulate research ideas by highlighting some real world examples of situations where a specialized, patient-centered approach needs to consider factors of cultural diversity. CONCLUSION Because ones own world view impacts the way we see the world and interpret behavior, it is important to understand ones own ethnocentrism when dealing with a diverse population of patients with brain injury where behavioral sequelae are often expected. Being able to see behavior after brain injury with an open mind and taking into account cultural and contextual factors is an important step in developing culturally competent rehabilitation practices.

Presence of a dedicated trauma center physiatrist improves functional outcomes following traumatic brain injury.

BACKGROUND Maximizing long-term recovery following traumatic brain injury (TBI) is an important end point. We hypothesized that the addition of a dedicated physiatrist specializing in brain injury medicine to the trauma team would lead to improved functional outcomes. METHODS Data from the Northern NJ TBI Model Systems were queried for all patients admitted to rehabilitation from four regional trauma centers, one with a full-time TBI physiatrist (PHYS) and three without (NO-PHYS). Patient demographics, mechanism of injury, Glasgow Coma Scale (GCS) score, length of posttraumatic amnesia, length of stay, and Functional Independence Measure (FIM) were abstracted. TBI severity was determined by GCS score and length of posttraumatic amnesia. FIM motor and cognitive scores at rehabilitation admission and discharge were the primary outcome measure. TBI medications (stimulants, sleep, and neurodepressants) administered in acute care were reviewed to evaluate prescription patterns. RESULTS A total of 148 patients treated at four trauma centers and discharged to a single acute inpatient rehabilitation center between 2005 to 2013 were divided into two groups, PHYS with 44 patients and NO-PHYS with 104 patients. Compared with those in the NO-PHYS group, patients from the PHYS group had significant improvement in FIM motor and cognitive scores (p < 0.05). Prescription patterns differed. Patients from the PHYS group received significantly more neurostimulants (p < 0.001) and sleep medications (p = 0.02) compared with the NO-PHYS group. Analysis of covariance was conducted to examine FIM (motor and cognitive) changes from rehabilitation admission to discharge based on medications initiated in acute care. Those who received neither a neurostimulant nor a sleep medication had significantly lower FIM motor scores compared with those who received at least one of these medications (p = 0.047) and compared with those who received both types of medication (p = 0.17). No significant differences were found in FIM cognitive scores. CONCLUSION The addition of a dedicated physiatrist providing early specialized care to patients who sustained a moderate or severe TBI was associated with improved functional outcomes upon discharge from rehabilitation. The presence of a dedicated trauma center physiatrist, trained in TBI rehabilitation, was also associated with a change in neuroprotective medication management in the acute care setting. LEVEL OF EVIDENCE Therapeutic study, level IV.

Comparison of FIM™ communication ratings for English versus non-English speakers in the traumatic brain injury model systems (TBIMS) national database

Abstract Objective: To examine the effect of primary language on admission and discharge FIM™ communication ratings in a sample of individuals with moderate-to-severe traumatic brain injury (TBI). Design and methods: Secondary data analysis of rehabilitation admission and discharge FIM™ communication ratings of 2795 individuals hospitalized at a Traumatic Brain Injury Model Systems (TBIMS) centre between 2007–2012. Results: Individuals who spoke no English were rated worse on functional communication outcomes at inpatient rehabilitation discharge relative to individuals whose primary language was English. Conclusions: These findings may reflect systematic bias in FIM™ communication ratings of non-English-speaking individuals with TBI and/or TBI-induced communication difficulties in non-English-speaking individuals. Clinical and research implications are discussed.

The factor structure of the Disability Rating Scale in individuals with traumatic brain injury

Abstract Purpose: To examine the factor structure of the Disability Rating Scale and the predictive validity of the scale’s factors among individuals with traumatic brain injury. Materials and methods: Five hundred and eight individuals with moderate-to-severe traumatic brain injury were administered the Disability Rating Scale. The sample was randomly divided into two groups. An exploratory factor analysis was conducted on Group 1, and a confirmatory factor analysis on Group 2. Regressions were performed to determine the predictive ability of the factors. Results: The exploratory factor analysis generated a three-factor structure, explaining 82.1% of the variance. Factor 1, comprising three disability items (feeding, toileting, and grooming), accounted for 58.4% of the variance. Factor 2, comprising three impairment items (eye opening, communication ability, and motor response), accounted for 14.8% of the variance. Factor 3, comprising two handicap items (level of functioning and employability), accounted for 8.9% of the variance. The three-factor solution was confirmed by confirmatory factor analysis. Regressions revealed the impairment factor at admission and the disability factor at discharge accounted for unique variance in predicting functional outcomes at one year post-injury. Conclusion: Each factor of the Disability Rating Scale may independently serve as a clinically useful outcome predictor after traumatic brain injury. Implications for rehabilitation The Disability Rating Scale is a measure used in brain injury rehabilitation that generates a total score indicating level of disability. This study confirmed a three-factor structure and showed that the individual factor scores provide unique information in predicting rehabilitation outcomes at one year post-injury.

Reciprocal Causation Between Functional Independence and Mental Health 1 and 2 Years After Traumatic Brain Injury: A Cross-Lagged Panel Structural Equation Model.

Objective The research attempting to disentangle the directionality of relationships between mental health and functional outcomes after traumatic brain injury (TBI) is growing but has yielded equivocal findings or focused on isolated predictors or isolated outcomes. The purpose of the current study was to use cross-lagged panel and structural equation modeling (SEM) techniques to examine causality between comprehensive indices of mental health (depression, anxiety, and life satisfaction) and functional independence in a national sample of individuals with TBI over the first 2 years after injury. Design Participants were 4,674 individuals with TBI from the TBI Model Systems Database. Results The SEM, which yielded good fit indices, suggested that individuals with TBI with greater mental health problems at 1 and 2 years after injury had lower functional independence at those same time points. The standardized path loadings for mental health problems and for functional independence over time were large, suggesting a high degree of consistency in mental health and functional independence across 1 and 2 years. In terms of cross-lag, mental health at Time 1 did not exert a unique effect on functional independence at Time 2, but functional independence at Time 1 exerted a statistically significant but quite small unique effect on mental health at Time 2. Conclusions This combination of results suggests that functional independence is only slightly more causal than mental health in the relationship between mental health and functional independence over the first 2 years post-TBI, and that instead, reciprocal causality is a more likely scenario. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) understand the nature of the relationship between mental health problems and functional independence after traumatic brain injury; (2) learn about a novel methodological technique for examining the connections between variables over time; and (3) understand when ongoing support for individuals with traumatic brain injury is necessary. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.