Brigid Waldron-Perrine

Determining an appropriate cutting score for indication of impairment on the Montreal Cognitive Assessment

The Montreal Cognitive Assessment (MoCA) is a brief yet comprehensive cognitive instrument used to assess level of impairment in neurological populations. The purpose of the present study was to assess the ability of the MoCA to detect cognitive impairment in a veteran patient population referred for neuropsychological testing and to determine optimal cutoff scores on the MoCA when compared with widely used neuropsychological measures.

WAIS-IV Reliable Digit Span is no More Accurate Than Age Corrected Scaled Score as an Indicator of Invalid Performance in a Veteran Sample Undergoing Evaluation for mTBI

Reliable Digit Span (RDS) is a measure of effort derived from the Digit Span subtest of the Wechsler intelligence scales. Some authors have suggested that the age-corrected scaled score provides a more accurate measure of effort than RDS. This study examined the relative diagnostic accuracy of the traditional RDS, an extended RDS including the new Sequencing task from the Wechsler Adult Intelligence Scale-IV, and the age-corrected scaled score, relative to performance validity as determined by the Test of Memory Malingering. Data were collected from 138 Veterans seen in a traumatic brain injury clinic. The traditional RDS (⩽ 7), revised RDS (⩽ 11), and Digit Span age-corrected scaled score (⩽ 6) had respective sensitivities of 39%, 39%, and 33%, and respective specificities of 82%, 89%, and 91%. Of these indices, revised RDS and the Digit Span age-corrected scaled score provide the most accurate measure of performance validity among the three measures.

Predictors of life satisfaction among caregivers of individuals with multiple sclerosis

Research on life satisfaction among caregivers of persons with multiple sclerosis (MS) is sparse. This study examined the extent to which MS-specific disease and psychosocial characteristics predict caregiver life satisfaction. Participants were 64 caregivers of patients with MS and the patients for whom they care. Multiple regression analysis indicated that caregiver perception of illness uncertainty and patients’ unawareness of deficits have unique value in predicting caregiver life satisfaction, even after accounting for general financial status. Gender and level of social support were also important contributing factors to caregiver life satisfaction. The findings suggest that duration and severity of the patients’ illness take a greater toll on life satisfaction of caregivers with low versus high social support, particularly among women caregivers.

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.

Role of resilience in the rehabilitation of adults with acquired brain injury

ABSTRACT Purpose: The goals of this review paper are to present an overview of the literature on resilience in adults with ABI, to describe approaches to measuring resilience in clinical practice and to discuss practical suggestions for promoting resilience in rehabilitation of adults with ABI. Method: We employed systematic review of journal articles, books, and websites related to resilience in adults with acquired brain injury (ABI). Results: Resilience was associated with adaptation and adjustment for individuals faced with serious injury such as ABI. However, research examining the construct of resilience is limited. Conclusion: While rehabilitation typically focuses on the identification and reduction of impairments for improving functioning, a focus on resilience may allow for recovery in a broader sense that exceeds expected outcomes.

Role of Character Strengths in Outcome After Mild Complicated to Severe Traumatic Brain Injury: A Positive Psychology Study

OBJECTIVE To examine the effects of character strengths on psychosocial outcomes after mild complicated to severe traumatic brain injury (TBI). DESIGN Prospective study with consecutive enrollment. SETTING A Midwestern rehabilitation hospital. PARTICIPANTS Persons with mild complicated to severe TBI (N=65). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Community Integration Measure, Disability Rating Scale, Modified Cumulative Illness Rating Scale, Positive and Negative Affect Schedule, Satisfaction with Life Scale, Values in Action Inventory of Strengths, and Wechsler Test of Adult Reading. RESULTS Character virtues and strengths were moderately associated with subjective outcomes, such that there were fewer and less strong associations between character virtues/strengths and objective outcomes than subjective outcomes. Specifically, positive attributes were associated with greater life satisfaction and perceived community integration. Fewer and less strong associations were observed for objective well-being; however, character strengths and virtues showed unique value in predicting physical health and disability. Positive affectivity was not meaningfully related to objective outcomes, but it was significantly related to subjective outcomes. In contrast, negative affectivity was related to objective but not subjective outcomes. CONCLUSIONS Given the strength of the associations between positive aspects of character or ways of perceiving the world and positive feelings about ones current life situation, treatments focused on facilitating these virtues and strengths in persons who have experienced TBI may result in better perceived outcomes and potentially subsequently lower comorbidities.

Neuropsychological test validity in Veterans presenting with subjective complaints of ‘very severe’ cognitive symptoms following mild traumatic brain injury

Abstract Objective: This study explored the utility of combining data from measures of performance validity and symptom validity among Veterans undergoing neuropsychological evaluation for mild traumatic brain injury (mTBI). Background: Persistent cognitive impairments following mTBI are often reported by returning combat veterans. However, objectively-measured cognitive deficits are not common among individuals with mTBI, raising the question of whether negative impression management influences self-ratings. Methods: Self-report ratings were obtained for memory, concentration, decision-making, and processing speed/organization using a 5-point scale ranging from ‘none’ to ‘very severe’. Veterans also completed brief neuropsychological testing which included measures of performance validity. Results: Study 1 examined data from 122 participants and demonstrated that veterans reporting a ‘very severe’ cognitive deficit were over three times as likely to demonstrate poor effort on a validity test than those without a very severe rating. Study 2 replicated these findings in an independent sample of 127 veterans and also demonstrated that both severity of self-report ratings and performance on an embedded measure of effort were predictive of poor effort on a stand-alone performance validity test. Conclusion: Veterans with suspected mTBI who report ‘very severe’ cognitive impairment have a greater likelihood of putting forth sub-optimal effort on objective testing.

Affect and psychiatric symptoms in a veteran polytrauma clinic

Although the relationship between negative affect and psychiatric symptoms has been well-demonstrated in research, less is known about positive affect relative to negative affect, and its relationship to psychiatric symptoms, especially among veterans. This study examined how levels of positive and negative affect are associated with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). Data were collected in a veteran polytrauma clinic; analyses were conducted using data from 94 veterans (87 males) with and without a mild traumatic brain injury (mTBI) diagnosis. Results demonstrate that positive and negative affect were separate dimensions and that both were independently related to each symptom measure. After removing the contribution of negative affect from symptom reports, strong relationships remained between positive affect and psychiatric symptoms. Furthermore, the magnitude of the associations for positive affect and for negative affect with symptoms of depression, anxiety, and PTSD were not impacted by a mTBI diagnosis. Altogether, findings suggest that both positive and negative affect should be uniquely considered when conceptualizing, assessing, and treating returning service members; in addition, positive affect may be an appropriate target of assessment and interventions of persons who have experienced polytrauma.

Informational literature influences symptom expression following mild head injury: An analog study

Abstract Primary objective: Many Veterans involved in recent OEF/OIF conflicts return with reports of having experienced an mTBI. The Veteran’s Affairs (VA) and Department of Defense (DoD) have gone to great lengths to provide information to Veterans regarding possible effects of TBI. Although well intended, this information may possibly have an iatrogenic effect. Conversely, setting positive expectations for recovery from mTBI has been shown to result in decreased symptomatology. Research design: One-way ANOVA and Tukey post-hoc analyses were used to determine whether there were significant differences on reported severity and number of PCS symptoms (NSI) among the three experimental groups (recovery focused information; expectation for persistent symptoms; and no information given). Methods and procedures: Undergraduate students, who were told to imagine they had experienced a military-related TBI, reported varying levels of expected symptoms when given either positive or negative information about symptom expectation. Main outcomes and results: The results indicate that presenting recovery-oriented literature resulted in the lowest report of expected symptoms, whereas presenting no information resulted in the highest report of expected symptoms. Conclusions: Providing Veterans with information regarding a likely positive trajectory of recovery may result in less symptom persistence during rehabilitation.

Cognitive Log performance among individuals without brain injury in an inpatient rehabilitation setting.

Purpose/Objective: Despite the widespread use of the Cognitive Log, information regarding normative performance is only available in individuals with known brain injury and in healthy college students. The purpose of the current research is to provide information about Cognitive Log performance in a regional group of rehabilitation patients without history of brain injury. Secondarily, non-neurological factors that may predict performance are considered. Research Method/Design: Participants included in this study were 121 consecutive patients admitted to an inpatient rehabilitation hospital spinal cord and orthopedic floor. Based on history, only patients without insult to the brain were included. Results: This study provides normative information for Cognitive Log performance in a nonbrain injured population, showing that these patients score in between those with acquired brain injury and healthy controls. Variables including age, estimated intelligence, and self-reported pain, fatigue, and affective distress accounted for 47.5% of the variance in Cognitive Log scores, although age and estimated intelligence, which accounted for 43.3% of the variance, were the only individually significant contributors to performance. Conclusions/Implications: This study provides an estimate of normative Cognitive Log performance in a nonbrain injured population. This information is especially useful in that it signifies that both neurological and non-neurological factors contribute to Cognitive Log performance, and this information may shape how clinicians conceptualize scores in patients with and without brain injury. Age and longstanding intellectual abilities should be taken into consideration when interpreting Cognitive Log performances, developing rehabilitation strategies, and determining need for additional testing.