J. T. Lindsay Wilson

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.

Visual persistence at both onset and offset of stimulation

Subjects identified dot bigrams appearing within or disappearing from random dot patterns. Each letter could be split into two predefined parts; the cues concerning the complete letter were minimized in each half. Identification performance was investigated as the interval between the appearance or disappearance of bigram halves was varied in the range 0 to 300 msec. The results indicate that the durations of persistence of information concerning stimulus onset and offset are at least 180 and 120 msec, respectively.

Anxiety and Depression after Spontaneous Subarachnoid Hemorrhage

OBJECTIVERelatively little attention has been paid to emotional outcome after subarachnoid hemorrhage (SAH). This study assessed levels of anxiety and depression among SAH survivors and related these to clinical indices. METHODSSeventy SAH patients from a consecutive series of neurosurgical admissions participated in semistructured assessments of functional outcome; 52 of the patients also returned standardized measures of emotional outcome. These data were compared with clinical indices collected during the initial hospital admission. RESULTSModerate to severe levels of anxiety were present in approximately 40% of patients 16 months after hemorrhage, with approximately 20% experiencing moderate to severe levels of depression. Although anxiety was more likely to be reported at interview by those with an SAH of Fisher Grade 4, the standardized measures of anxiety and depression were not associated with severity of hemorrhage or any other clinical variables. Both anxiety and depression were significantly associated with outcome indices such as return to work and engagement in social activities. CONCLUSIONAnxiety is a significant and lasting problem for approximately 40% of survivors of SAH. It is suggested that measures taken to prevent or treat such anxiety among survivors of SAH may serve to significantly improve functional outcome.

Observer Variation in the Assessment of Outcome in Traumatic Brain Injury:Experience From A Multicenter, International Randomized Clinical Trial

OBJECTIVE Accurate and consistent outcome assessment is essential to randomized clinical trials. We aimed to explore observer variation in the assessment of outcome in a recently completed trial of dexanabinol in head injury and to consider steps to reduce such variation. METHODS Eight hundred sixty-one patients with severe traumatic brain injury who were admitted to 86 centers were included in a multicenter, placebo-controlled, Phase III trial. Outcome was assessed at 3 and 6 months postinjury using the extended Glasgow Outcome Scale; standardized assessment was facilitated by the use of a structured interview. Before initiation of trial centers, outcome ratings were obtained for sample cases to establish initial levels of agreement. Training sessions in outcome assessment were held, and problems in assigning outcome were investigated. During the trial, a process of central review was established to monitor performance. Interobserver variation was analyzed using the κ statistic. RESULTS Substantial observer variation was found in the rating of sample cases (weighted κ, 0.72; confidence interval, 0.68–0.75) and in assigning outcome based on completed structured interviews (weighted κ, 0.61; confidence interval, 0.57–0.64). In the early stages of the trial, a relatively large number of discrepancies (29–37%) were identified on central review. This number declined as the trial progressed and coincided with investigator training and feedback from central review. Centers with higher enrollment rates showed better performance. CONCLUSION Observer variation in outcome assessment is a significant problem for head injury trials. Consistency can be improved by standardizing procedures, training assessors, and monitoring the quality of assessments and providing feedback to interviewers.

A neuropsychological study of active amateur boxers.

Neuropsychological examinations were carried out on 29 amateur boxers and 19 controls matched for age, ethnicity, and education. There was no evidence of significantly impaired performance in the boxers. Within the boxing group, a variety of features of boxing history were examined as possible predictors of cognitive performance (such as number of knockouts, duration of boxing). No feature was a significant predictor of lower cognitive performance.

Apolipoprotein E polymorphism and neuropsychological outcome following subarachnoid haemorrhage

Objectives– To investigate the association between APOE genotype and cognitive and emotional outcome following spontaneous subarachnoid haemorrhage (SAH).

The Glasgow Outcome Scale - 40 years of application and refinement.

The Glasgow Outcome Scale (GOS) was first published in 1975 by Bryan Jennett and Michael Bond. With over 4,000 citations to the original paper, it is the most highly cited outcome measure in studies of brain injury and the second most-cited paper in clinical neurosurgery. The original GOS and the subsequently developed extended GOS (GOSE) are recommended by several national bodies as the outcome measure for major trauma and for head injury. The enduring appeal of the GOS is linked to its simplicity, short administration time, reliability and validity, stability, flexibility of administration (face-to-face, over the telephone and by post), cost-free availability and ease of access. These benefits apply to other derivatives of the scale, including the Glasgow Outcome at Discharge Scale (GODS) and the GOS paediatric revision. The GOS was devised to provide an overview of outcome and to focus on social recovery. Since the initial development of the GOS, there has been an increasing focus on the multidimensional nature of outcome after head injury. This Review charts the development of the GOS, its refinement and usage over the past 40 years, and considers its current and future roles in developing an understanding of brain injury.

Premorbid intelligence and brain injury

OBJECTIVES To determine whether NART scores are associated with severity of brain injury and therefore presumably affected by brain injury. In addition, to compare the Cambridge Contextual Reading Test (CCRT) with injury severity in head-injured individuals. DESIGN AND METHODS Participants were 55 survivors of traumatic head injury, who completed the NART and the CCRT. The scores on these premorbid measures were then compared with indices of injury severity from their initial neurosurgical admission. RESULTS The NART was significantly correlated with Glasgow coma scale, with greater severity of injury associated with poorer performance. Poorer NART performance was also significantly more likely amongst those whose injury resulted in coma. The CCRT was preferred by patients, though it was also significantly associated with Glasgow coma scale and presence of coma. CONCLUSIONS The data suggest that performance on both the NART and the CCRT are affected by brain injury severity and thus may underestimate true premorbid ability in these individuals. Similar findings would be likely with the conceptually identical WTAR measure. These measures should be used with appropriate caution and may be usefully supplemented by predictions based on demographic information.

Effects of stimulus luminance and duration on responses to onset and offset.

The visual responses to stimulus onset and offset can be isolated psychophysically from the response to steady-state stimulation. Six experiments investigated the perception of onset and offset of dot bigrams within random-dot patterns. Onset and offset persistence were studied at two levels of stimulus luminance (8 and 45ft-L). Similar performance was obtained for targets defined by onset and offset; the lower luminance produced a decrement in response at offset. Onset and offset perceptibility were studied at six stimulus durations between 20 and 1260 msec. Effects of stimulus duration were distinguished from masking effects due to pattern offset. Decreasing stimulus duration had little or no effect on recognition of bigrams defined by onset but produced a large decrement in the perceptibility of bigrams defined by offset. A brief stimulus therefore seems to give a relatively strong on-response and a weak off-response. These psychophysical results are consistent with electrophysiological findings concerning on- and off-responses and contrast with the idea that persistence consists of a decaying trace of the steady-state properties of the stimulus.

Interaction of Simultaneous Visual Events

Five experiments are reported in which a perceptual interaction between simultaneous brief events was investigated. Subjects judged whether a briefly presented stimulus was flickering or not. Performance was much more error prone when a similar unattended stimulus was presented at a relatively remote position in the visual field, thus confirming previous findings. Interference was obtained for stimuli presented both peripherally and centrally in the visual field. The effect was not confined to large stimuli, but the larger the interfering stimulus the greater the effect it had. Events in the auditory modality interfered with judgements made in the visual modality. Possible mechanisms for the interaction are discussed.