Jeri Morris

A controlled study of neuropsychological deficits in acute spinal cord injury patients.

According to a number of studies, between 40% and 60% of acute traumatic spinal cord injury (SCI) patients demonstrate cognitive dysfunction resulting from various forms of cerebral damage, including concurrent or premorbid closed head injury, chronic alcohol or substance abuse, and other causes. However, applicability of findings from these reports has been limited due to the use of inadequate neuropsychological testing techniques and the lack of control data. In a collaborative investigation, 81 acute SCI patients and 61 non-injured control subjects between 18 and 55 years of age completed a comprehensive motor-free neuropsychological test battery, including: Halstead Category Test (HCT), Vocabulary Subtest (VOCAB) of the Wechsler Adult Intelligence Scale - Revised; Mental Control (MC) Subtest, and Initial and Recall trials of Logical Memory (LM) and Paired Associates (PA) Subtests of the Wechsler Memory Scale; and the 8 trials of the Rey Auditory Verbal Learning Test (RAVLT). Percentages of retained information on the LM and PA were also calculated. Impairment levels for each test were defined as values which exceeded two standard deviations (one-tailed) from the control mean. Based on this definition, the prevalence of neuropsychological abnormality on each test ranged between 10% and 40%. Mean performance levels of patients were significantly more impaired than those of control subjects for all tests except for the Interference trial of the RAVLT and for the percentages of retained information on the LM and PA subtests. Comparison of test results of SCI patients with those of control subjects demonstrates that poor attention span and limited initial learning ability are frequent problems among SCI patients. Other common neuropsychological deficits among these patients include poor concentration ability, impaired memory function, and altered problem solving ability. These deficits may interfere with rehabilitation following SCI.

Administering the category test by computer: Equivalence of results

Abstract A computerized version of the Halstead Category Test (CT) was compared to the standard projector version of the test using adult neurologically impaired patients. Every subject was tested with both versions and the order of administration was alternated. Results indicated that the difference in mean number of errors made between the two versions of the test was not significant. The scores obtained with the two versions were seen as similar to what would be expected from a test-retest administration of the same instrument. Implications for the validity of the computer version are discussed.

Assessment of Closed Head Injury in Trauma-related Spinal Cord Injury

The complete medical records of 122 patients who sustained traumatic spinal cord injuries were reviewed to determine the frequency and results of emergency room assessments for loss of consciousness (LOC) and post-traumatic amnesia (PTA). Eighty-eight percent of the patients were assessed for LOC and 19% were assessed for PTA. Fifty patients (41% of the total population) admitted to LOC, PTA or both. Fourteen of these 50 patients underwent subsequent radiographic examinations of the skull, all of which were negative. Because of the association of intracranial complications and long-term cognitive sequelae with even brief LOC or PTA, early recognition of craniocerebral trauma is an important component of the acute management of spinal cord injured patients.

Development of alternate paragraphs for the logical memory subtest of the Wechsler Memory Scale-Revised

Abstract The paragraphs that compose the Logical Memory subtest of the Wechsler Memory Scale-Revised were examined and alternate paragraphs that were equivalent in structure, affective tone, and number of scorable units were developed. Objective scoring criteria for this alternate form, the Morris Revision, yielded significant interscorer reliability. Concurrent validity for the Moms Revision paragraphs was established using multiple criteria. The correlation between the summed scores for the original paragraphs and the Morris Revision paragraphs was significant, as were the correlations between individual scores for analogous paragraphs across the two forms. The Morris Revision was determined to be a psychometrically equivalent alternate form of the original Logical Memory subtest. Clinical use of the Morris Revision is recommended to eliminate serial testing artifacts when reevaluating verbal memory in neuropsychological patients.

Depression and neuropsychological test peformance in acute spinal cord injury patients: Lack of correlation

Factors which have been causally related to neuropsychological deficits in acute spinal cord injury (SCI) patients include advanced age, limited educational level, acute traumatic brain injury, alcohol and/or substance abuse. Concomitant depression may impair motivation, prolong reaction time, and produce fatigue during neuropsychological testing, resulting in impaired performance. To test the hypothesis that abnormal neuropsychologic test results may be associated with depression, the Zung Self-Rating Depression Scale (ZUNG) and a comprehensive, predominantly motor-free neuropsychological test battery were administered to 66 acute SCI patients approximately 8 weeks following injury. Spinal cord injury groups were dichotomized based on their ZUNG scores. Comparison of neuropsychological test scores between SCI groups failed to demonstrate any impairment in neuropsychological performance, within the limits of the test battery administered, suggesting that cognitive performance in this sample of acute SCI patients may not be influenced by the presence of depression.

Effects of Right Hemisphere Strokes on Personality Functioning

Abstract Strokes affecting large areas of the right hemisphere are common. However, many of the most frequently seen deficits that accompany such strokes are underassessed, go untreated, and are never reported or described to family members or patients. Too often, this creates devastating but avoidable consequences. As a result, many individuals return to their homes with family members who cannot understand their behavior changes, who do not seek appropriate treatment for the stroke-injured person, and who cannot come to an acceptance of the individual’s strengths and limitations. This article discusses those deficits to remind those working with right hemisphere stroke patients of the importance of considering them when assessing and treating these individuals and when working with their family members.

Utility of the seven subtest WAIS-R short form in a female sample with brain damage.

We examined the accuracy of the WAIS-R seven subtest short form (Ward, 1990) for predicting IQs of 130 females with brain damage or dysfunction. Means for age, education, and FSIQ were 44.37 years (SD = 18.46), 12.74 years (SD = 2.42), and 87.64 (SD = 13.62). Results indicated that 93%, 84%, and 93% of short form estimated VIQs, PIQs, and FSIQs were within +/-5 points of their actual WAIS-R scores. In terms of Wechslers (1981) seven category intelligence classification, levels of agreement were 83%, 72%, and 82% for the Verbal, Performance, and Full scales, respectively. These findings support the use of the seven subtest short form with brain-damaged women when time is at a premium and only a general estimate of intellectual functioning is required.

Application of the Seven-Subtest Short Form of the WAIS-R in African Americans with Brain Damage

This study examined the accuracy of Wards (1990) seven-subtest short form for predicting WAIS-R IQs of 54 African Americans with brain damage. Means for age, education, and FSIQ were 47.1 years (SO= 16.6), 10.8 years (SD= 2.4), and 79.3 (SD = 11.6). Short-form VIQs, PIQs, and FSIQs were within ±1 standard error of measurement of the actual WAIS-R scores 81.5%, 83.3%, and 83.3% of the time. This abbreviation may be applied to African Americans with brain damage when general estimates of intellectual functioning are required. However, the shortened scale detected reliable VIQ.PIQ discrepancies on the WAIS-R only 53% of the time. Therefore, interpretation of significant short-form-based VIQ-PIQ discrepancies should be avoided.

Effects on WAIS-III Performance IQ (PIQ) and Full Scale IQ (FSIQ) When Object Assembly Is Substituted for Each Standard Performance Scale Subtest

According to the WAIS-III Administration and Scoring Manual, Object Assembly (OA) may be substituted for any spoiled Performance subtest. This assertion has not been evaluated in a clinical sample. The present investigation reports differences that resulted in Performance IQ (PIQ) and Full Scale IQ (FSIQ) when OA replaced each of the Performance subtests. Participants were 47 referrals for neuropsychological assessment (age M = 45.98 years, SD = 9.82; education M = 13.82 years, SD = 2.78). Results indicated that OA may replace any Performance subtest without seriously altering the summary scores. Differences between the standard IQs and OA-based composites were < 2 points for PIQ and < 1 point for FSIQ. More than 90% of the OA-based composites fell within the 90% confidence limits of the corresponding IQ.

Evaluation of Closed Head Injury and Cognitive Deficits in Patients with Traumatic Spinal Cord Injury

Publisher Summary This chapter discusses the simultaneous occurrence of closed head injury (CHI) and traumatic spinal cord injury (SCI). Early recognition of CHI in the patient sustaining a traumatic SCI is important to facilitate timely implementation of prudent evaluation and treatment strategies. Early identification in an emergency room (ER) of a mild CHI in a patient with a traumatic SCI influences acute management. Failure to identify the presence of mild CHI in SCI patients may enhance the risk of missing significant impairments in concentration, memory, and learning and, therefore, may alter their rehabilitation course. Because CHI also is associated with risks of intracranial complications and cognitive dysfunction, early recognition of this problem in SCI patients may favorably alter both acute and long-term outcomes by enhancing the likelihood that these sequelae will be anticipated and appropriately managed.