Jeffrey Wertheimer

Detecting Incomplete Effort with Digit Span from the Wechsler Adult Intelligence Scale—Third Edition

The current study evaluated the utility of the Digit Span subtest in discriminating patients with mild head trauma from individuals referred for independent neuropsychological evaluation with objective evidence of poor effort. Various indices from the Digit Span subtest were evaluated to determine the best discriminator of brain injury from poor motivation patient groups: Digit Span Forward, Digit Span Backwards, Reliable Digit Span, Digit Span Age-Corrected Scaled Score, and the difference score between the Vocabulary and Digit Span scaled scores. The Digit Span scaled score was found to be the best discriminating index. A cutoff score of less than or equal to 7 accurately classified 75% of persons in the incomplete effort group and 69% of persons in the TBI group. Application of this cutoff score to a non-litigating mild brain injury group yielded a 77% correct classification rate. However, Digit Span scaled score accounted for a modest amount of variation and it is not recommended as a stand-alone validity measure.

An Effort Index for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)

The present study aimed to develop an internal validity indicator for a brief general purpose screening battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Two subtests of the RBANS were predicted to be relatively resilient to cognitive dysfunction on the basis of previous research. An Effort Index (EI) was created by combining them via a scaling system. The frequency of EI scores was first examined in a heterogenous clinical sample. A subsequent validation study showed good discriminability. In conclusion, the EI appears to be useful for detecting insufficient effort on a screening battery.

The Rationale Driving the Evolution of Deep Brain Stimulation to Constant-Current Devices

Deep brain stimulation (DBS) is an effective therapy for the treatment of a number of movement and neuropsychiatric disorders. The effectiveness of DBS is dependent on the density and location of stimulation in a given brain area. Adjustments are made to optimize clinical benefits and minimize side effects. Until recently, clinicians would adjust DBS settings using a voltage mode, where the delivered voltage remained constant. More recently, a constant‐current mode has become available where the programmer sets the current and the stimulator automatically adjusts the voltage as impedance changes.

Randomized Controlled Trial of Peer Mentoring for Individuals With Traumatic Brain Injury and Their Significant Others

OBJECTIVES To examine the efficacy of a peer-mentoring program for persons with traumatic brain injury (TBI) and their significant others, and to determine the relationship of this mentoring program to 3 main outcomes: (1) emotional well-being; (2) post-TBI quality of life; and (3) community integration. DESIGN Randomized controlled trial. SETTING Midwestern rehabilitation hospital. PARTICIPANTS Persons with TBI (n=96) and significant others/caregivers (n=62). INTERVENTIONS Persons with TBI and friends/caregivers who knew the person prior to their injury were randomly assigned to a treatment (mentored) or no-treatment (no mentoring) control group immediately prior to discharge from the rehabilitation unit and were mentored for up to 2 years. MAIN OUTCOME MEASURES Peer Mentoring Questionnaire; Brief Symptom Inventory-18; Family Assessment Device; Coping Inventory for Stressful Situations; Short Michigan Alcohol Screening Test; Medical Outcomes Study 12-Item Short-Form Health Survey; and Community Integration Measure. RESULTS Eighty-eight percent of individuals who were involved in the mentoring program reported positive experiences. t tests revealed that among persons with TBI, individuals who received mentoring had significantly better behavioral control and less chaos in the living environment (P=.04), lower alcohol use (P=.01), less emotion-focused (P=.04) and avoidance coping (P=.03), and good physical quality of life (P=.04) compared with those who did not receive mentoring. Among significant others, mentored individuals demonstrated greater community integration (P=.03) than the nonmentored control group. CONCLUSIONS Mentoring can be an effective way to benefit mood and healthy coping after TBI, and it can help to prevent maladaptive behaviors, such as substance abuse and behavioral dyscontrol, in the living situation.

The Impact of Inpatient Rehabilitation on Function and Survival of Newly Diagnosed Patients With Glioblastoma

To examine the impact of an inpatient rehabilitation program on functional improvement and survival among patients with newly diagnosed glioblastoma multiforme (GBM) who underwent surgical resection of the brain tumor.

Comparing Functional Status and Community Integration in Severe Penetrating and Motor Vehicle–Related Brain Injuries

OBJECTIVE To examine the functional status of persons surviving a severe penetrating traumatic brain injury (TBI) resulting from a gunshot wound who require inpatient rehabilitation. DESIGN Data were collected prospectively at 4 different time periods: rehabilitation admission and discharge and year 1 and year 2 postinjury. SETTING Rehabilitation hospital within a Traumatic Brain Injury Model System. PARTICIPANTS Forty-five persons with severe penetrating brain injury and 45 persons involved in a motor vehicle crash (MVC). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Disability Rating Scale (DRS), FIM instrument, and Community Integration Questionnaire (CIQ). RESULTS Results indicated functional improvements for both the penetrating and motor vehicle severe TBI groups on the DRS and the FIM from rehabilitation admission to discharge. Follow-up data at 1 and 2 years postinjury revealed continued improvements on the DRS and FIM measures for both groups, with the greatest improvement in recovery during the first year. In addition, improved community reintegration emerged between 1 and 2 years postinjury for both groups, as measured by the CIQ. There was a small significant difference on the outcome measures between the 2 groups in the course of their recovery. CONCLUSIONS Persons who survive severe penetrating brain injuries and who require inpatient rehabilitation may show continuing improvement in functioning over time. For persons receiving inpatient rehabilitation services, initial improvement is most likely to occur during the hospital stay and continue postinjury, with the largest improvement in the first year after injury. Community reintegration can also be expected over time. One can expect similar outcomes for individuals who sustain a severe penetrating brain injury and a severe brain injury ensuing from an MVC.

Collaboration between neuropsychologists and speech-language pathologists in rehabilitation settings.

ObjectiveThe purpose of this study was to understand the barriers and facilitators of communication and collaboration between speech-language pathologists (SLPs) and neuropsychologists (NPs) in rehabilitation settings. MethodFocus groups were held at 3 rehabilitation hospitals. Participants were a convenience sample and were considered representatives of acquired brain injury rehabilitation teams that include SLPs and NPs. There were a total of 28 SLPs and 10 NPs in the sample. The study used a semistructured interview guide for the focus group discussions, using questions centered on major areas known to be related to interdisciplinary collaboration. Written notes and audio recordings were analyzed for recurring and strongly stated themes. ResultsConsistent themes emerged across focus groups, which included (1) structure of collaboration, (2) perceived roles of NPs and SLPs in assessment and intervention, (3) similarities and differences in training and philosophic perspectives, (4) barriers to successful collaboration, and (5) facilitators of collaboration. ConclusionThe SLPs and NPs valued the contributions of both professions in the management of patients with acquired brain injuries. Effective collaboration appeared to be influenced by several factors and is discussed. It was evident that effective communication was a key and powerful element in successful collaboration.

Assessment of executive functioning in brain injury: collaboration between speech-language pathology and neuropsychology for an integrative neuropsychological perspective.

Background: Executive functioning (EF) deficits are common sequelae of traumatic brain injury (TBI). These deficits extend beyond the acute stages of recovery and pose a significant challenge in rehabilitation efforts. Current theories of EF propose a multidimensional construct. This paper provides an integrative theoretical framework with interactive dimensions for the assessment and treatment of EF that can assist the interdisciplinary team to successfully manage EF deficits secondary to TBI. Methods: This paper is a review of pertinent literature related to assessment of EF. It concludes with a case presentation that illustrates the utility of the proposed theoretical framework in the rehabilitation context. Conclusions: Formal neuropsychological, standardized psychometric measures and informal clinical observations, particularly as they relate to contextual assessment, should be incorporated in order to effectively assess EF difficulties in survivors of TBI. The paper concludes with recommendations for effective assessment and treatment of EF by the interdisciplinary team consisting of speech-language pathologists and neuropsychologists.

Behavior management on an acute brain injury unit: evaluating the effectiveness of an interdisciplinary training program

ObjectiveTo measure the effect of behavior management training on restraint use and prn medication delivery on an acute inpatient brain injury unit. Setting/participantsInterdisciplinary staff and hospitalized brain injury patients on a 20-bed unit within a freestanding rehabilitation hospital. InterventionStaff participated in the Nonviolent Crisis Intervention® (NCI) program from the Crisis Prevention Institute®. Main outcome measuresApplied physical restraints and delivered prn medications. ResultsDespite comparable patient levels of agitation severity across the duration of the study, the use of physical restraints initially declined and then increased after training. Data collected on prn medication delivery also indicated a trend for an increase in the delivery of select medication categories across time. ConclusionNCI training resulted in a temporary, short-lived reduction in physical restraint use, but had an inverse effect on prn medication delivery for select categories of medication. Medication delivery significantly increased over time and restraint use eventually exceeded baseline level. Ramifications of these results are discussed.

Perceived Roles and Collaboration Between Neuropsychologists and Speech-Language Pathologists in Rehabilitation

The purpose of the current study was to determine perceptions of neuropsychologists (NPs) and speech-language pathologists (SLPs) regarding each others roles in the rehabilitation setting, and to assess the type and extent of collaborations. Participants were 311 SLPs and 77 NPs working in a rehabilitation setting. Results indicated a great deal of overlap between the roles of SLPs and NPs. While there was much agreement about roles, misperceptions were evident with regard to some of the domains of assessment and treatment. A need for increased collaboration on planning assessments and treatment was evident. The results suggest the need for training of both disciplines in interdisciplinary collaboration and in roles of rehabilitation team members.