Henning Gibbons

Quality of Life after Brain Injury (QOLIBRI): Scale Validity and Correlates of Quality of Life

The QOLIBRI (Quality of Life after Brain Injury) is a novel health-related quality-of-life (HRQoL) instrument specifically developed for traumatic brain injury (TBI). It provides a profile of HRQoL in six domains together with an overall score. Scale validity and factors associated with HRQoL were investigated in a multi-center international study. A total of 795 adults with brain injury were studied from 3 months to 15 years post-injury. The majority of participants (58%) had severe injuries as assessed by 24-h worst Glasgow Coma Scale (GCS) score. Systematic relationships were observed between the QOLIBRI and the Glasgow Outcome Scale-Extended (GOSE), Hospital Anxiety and Depression Scale (HADS), and SF-36. Within each scale patients with disability reported having low HRQoL in two to three times as many areas as those who had made a good recovery. The main correlates of the total QOLIBRI score were emotional state (HADS depression and anxiety), functional status (amount of help needed and outcome on the GOSE), and comorbid health conditions. Together these five variables accounted for 58% of the variance in total QOLIBRI scores. The QOLIBRI is the first tool developed to assess disease-specific HRQoL in brain injury, and it contains novel information not given by other currently available assessments.

Quality of life after traumatic brain injury: The clinical use of the QOLIBRI, a novel disease-specific instrument

Objective: To report the clinical use of the QOLIBRI, a disease-specific measure of health-related quality-of-life (HRQoL) after traumatic brain injury (TBI). Methods: The QOLIBRI, with 37 items in six scales (cognition, self, daily life and autonomy, social relationships, emotions and physical problems) was completed by 795 patients in six languages (Finnish, German, Italian, French, English and Dutch). QOLIBRI scores were examined by variables likely to be influenced by rehabilitation interventions and included socio-demographic, functional outcome, health status and mental health variables. Results: The QOLIBRI was self-completed by 73% of participants and 27% completed it in interview. It was sensitive to areas of life amenable to intervention, such as accommodation, work participation, health status (including mental health) and functional outcome. Conclusion: The QOLIBRI provides information about patients subjective perception of his/her HRQoL which supplements clinical measures and measures of functional outcome. It can be applied across different populations and cultures. It allows the identification of personal needs, the prioritization of therapeutic goals and the evaluation of individual progress. It may also be useful in clinical trials and in longitudinal studies of TBI recovery.

Dynamics of response-conflict monitoring and individual differences in response control and behavioral control : An electrophysiological investigation using a stop-signal task

OBJECTIVES The aim of the present study was to investigate the functional significance of error (related) negativity Ne/ERN and individual differences in human action monitoring. A response-conflict model of Ne/ERN should be tested applying a stop-signal paradigm. After a few modifications of Ne/ERN response-conflict theory (Yeung N, Botvinick MM, Cohen JD. The neural basis of error detection: conflict monitoring and the error-related negativity. Psychological Review 2004:111(4);931-959), strength and time course of response conflict could be modeled as a function of stop-signal delay. METHOD In Experiment 1, 35 participants performed a visual two-choice response-time task but tried to withhold the response if an auditory stop signal was presented. Probability of stopping errors was held at 50% using variable delays between visual and auditory stimuli. Experiment 2 (n=10) employed both auditory go and stop signals and confirmed that Ne/ERN effects are due to conflict induced by the auditory stop signal, and not the mere presence or absence of an additional stimulus. RESULTS As predicted, amplitudes of both the stimulus-locked and response-locked Ne/ERN were largest for non-stopped responses, followed by successfully stopped and go responses. However, independently of response type Ne/ERN also increased with increasing stop-signal delay. Since longer delay invokes stronger response conflict, results specifically support the notion of Ne/ERN reflecting response-conflict monitoring. Furthermore, individual differences related to measures of response control and behavioral control were observed. Both low response control estimated from stop-task performance and high psychometric impulsivity were accompanied by smaller Ne/ERN amplitude on stop trials, suggesting reduced response-conflict monitoring. CONCLUSIONS The present study supported the response-conflict view of Ne/ERN. Furthermore, the observed relationship between impulsivity and Ne/ERN amplitude suggested that individuals with low behavioral control were characterized by lower activity in anterior cingulate cortex, the neural generator of Ne/ERN, in situations of strong response conflict. SIGNIFICANCE The present study, for the first time, employed a stop-signal paradigm to verify predictions regarding the temporal dynamics of response-conflict processing as derived from response-conflict theory of ERN.

Evaluative priming from subliminal emotional words: Insights from event-related potentials and individual differences related to anxiety

The present ERP study investigated effects of subliminal emotional words on preference judgments about subsequent visual target stimuli (paintings, portraits). Each target was preceded by a masked 17-ms emotional adjective. Four classes of prime words were distinguished according to the combinations of positive/negative valence and high/low arousal. Targets were liked significantly more after positive-arousing primes (e.g., happy), relative to negative-arousing (brutal), positive-nonarousing (mild), and negative-nonarousing primes (lazy). In the target ERP, amplitude of right-hemisphere positive slow wave was increased after positive-arousing compared to negative-arousing primes. Evaluative priming effects on judgments and ERPs were more pronounced in high state-anxious participants. The results suggest that (1) there is indeed affective/semantic processing of unconscious words, (2) evaluative priming operates relatively late during target processing, (3) to be effective, prime words need to score high on the arousal dimension, and (4) individual differences in state anxiety modulate the susceptibility to subliminal evaluative priming.

Latent inhibition deficits in high-schizotypal normals: symptom-specific or anxiety-related?

Latent inhibition (LI) is the phenomenon in which subjects who have repeatedly experienced an irrelevant stimulus perform more poorly on a new learning task with that stimulus than with a novel stimulus, presumably because of a decline in stimulus-specific attention. The present article reviews the literature on LI deficits in high-schizotypal normal subjects and schizophrenic patients. Although LI-deficits have been thought to be specific to these groups, evidence is presented that the effects may be related to the anxiety components of high-schizotypality and related pathologies.

QOLIBRI Overall Scale: a brief index of health-related quality of life after traumatic brain injury

Background The Quality of Life after Brain Injury (QOLIBRI) scale is a recently developed instrument that provides a profile of health-related quality of life (HRQoL) in domains typically affected by brain injury. However, for global assessment it is desirable to have a brief summary measure. This study examined a 6-item QOLIBRI Overall Scale (QOLIBRI-OS), and considered whether it could provide an index of HRQoL after traumatic brain injury (TBI). Methods The properties of the QOLIBRI-OS were studied in a sample of 792 participants with TBI recruited from centres in nine countries covering six languages. An examination of construct validity was undertaken on a subsample of 153 participants recruited in Germany who had been assessed on two relevant brief quality of life measures, the Satisfaction With Life Scale and the Quality of Life Visual Analogue Scale. Results The reliability of the QOLIBRI-OS was good (Cronbachs α=0.86, test–retest reliability =0.81) and similar in participants with higher and lower cognitive performance. Factor analysis indicated that the scale is unidimensional. Rasch analysis also showed a satisfactory fit with this model. The QOLIBRI-OS correlates highly with the total score from the full QOLIBRI scale (r=0.87). Moderate to strong relationships were found among the QOLIBRI-OS and the Extended Glasgow Outcome Scale, Short-Form-36, and Hospital Anxiety and Depression scale (r=0.54 to -0.76). The QOLIBRI-OS showed good construct validity in the TBI group. Conclusions The QOLIBRI-OS assesses a similar construct to the QOLIBRI total score and can be used as a brief index of HRQoL for TBI.

An Event-Related Potential Investigation of Varieties of Negative Priming

In an event-related potential (ERP) study of varieties of negative priming (NP), 20 participants performed two basic tasks, identification and localization. NP was established in response times (RTs) for two different conditions employed in the literature, DT (distractor-target shifts between subsequent displays), and DTTD (distractor-target reversals). With identification, there were two findings specific to DTTD: reduced amplitude of frontocentral P200 and earlier onset of response-locked lateralized readiness potential (R-LRP). The pattern suggests that DTTD probes were perceived as highly similar to the prime, causing a tendency to repeat the prime response. Identity-based DT had no significant ERP correlate but was accompanied by wrong preactivation in the stimulus-locked LRP (S-LRP). Regarding localization, P300 seemed reduced with the DTTD condition. However, current-source density (CSD) analysis suggested additional frontal and occipital N2 components, indicating inhibition of a tendency to repeat...

Multiple Sources of Positive- and Negative-Priming Effects: An Event-Related Potential Study

Event-related potential correlates of positive priming (PP) and negative priming (NP) were investigated in order to further elucidate the cognitive mechanisms involved. Thirty-six participants performed both an identity- and a location-based priming task. Repeating the target stimulus/location from the immediately preceding display produced behavioral PP. With localization, but not with identification, behavioral NP was observed when the target stimulus/location matched the preceding distractor stimulus/location. Smaller P300 amplitude accompanied identity-based PP, suggesting persisting target-specific activation. The lateralized readiness potential, an index of correct/incorrect response activation, indicated persisting central motor activation as another source of PP. Both location-based PP and NP were accompanied by reduced P1/N1 and P300 amplitudes, pointing to the involvement of inhibition of return in location-based priming. The results support the view that multiple brain processes underlie behavioral priming.

Concept activation and coordination of activation procedure require two different networks.

IN the present study, we used EEG-coherence analysis to assess general regional changes in neuronal activity related to semantic retrieval, testing the hypothesis that concept activation and coordination procedures are neurobiologically distinguishable. Four subjects had to decide whether or not a capital letter and a lower case letter have the identical name (e.g. Aa). This task requires two mental procedures: (i) the activation of concepts and (ii) their coordination, particularly when the interstimulus interval is shorter than the duration of concept activation. This memory retrieval of a concept appears to be subserved by two distinct networks: the left parietotemporal region for concept activation and the prefrontal region for coordination.

Self-awareness and health-related quality of life after traumatic brain injury

Objective:To investigate the relations among self-awareness (SA), impaired SA, and health-related quality of life (HRQOL) after traumatic brain injury (TBI). Participants:One hundred forty-one adults hospitalized with TBI and their significant others from a cross-sectional multicenter study. Using Glasgow Coma Scale classification, 32 participants had severe injuries, 29 moderate, 44 mild, and 25 complicated mild TBI. Measures:Patient Competency Rating Scale for Neurorehabilitation; Short Form-36 Health Survey; Cognitive Quality of Life; Quality Of Life after Brain Injury; Hospital Anxiety and Depression Scale; Profile of Mood States; Glasgow Outcome Scale Extended. Method:Patient Competency Rating Scale for Neurorehabilitation ratings made by participants and their significant others were used to assess SA and discrepancies between the 2 ratings were used to define impaired SA. Results:Significant associations were identified between SA and HRQOL, anxiety, depression, and severity of injury. Participants with and without impaired SA differed in cognitive HRQOL and leisure activities. Using multiple regression, no direct predictors of SA were identified, although interaction effects were observed. Conclusion:After TBI, lower SA is associated with higher estimates of HRQOL, particularly in the cognitive domain. Although the associations are modest, the assessment of SA should play a role in the interpretation of reported HRQOL after TBI.