Jerome S. Caroselli

Use of the Community Integration Questionnaire (CIQ) to characterize changes in functioning for individuals with traumatic brain injury who participated in a post-acute rehabilitation programme

Objective : Evaluate changes in community integration for survivors of traumatic brain injury (TBI) who participated in a post-acute rehabilitation programme. Design : Cohort, prospective study investigating change from admission to post-discharge. Participants : Individuals, the majority of whom were diagnosed with severe TBI, were placed into one of two groups as follows: (1) admitted for treatment less than 1 year post-injury (L1Y) or (2) admitted for treatment between 1-5 years post-injury (G1Y). Measure : The Community Integration Questionnaire (CIQ). Results : Both groups showed significant improvements from admission to follow-up; however, some CIQ findings were more pronounced for the L1Y group. Reliable change (RC) methodology was used to assess individual change. Results of this approach were consistent with group results, but tempered the perception of degree of change. Conclusions : Findings cannot simply be attributed to neurological recovery and individual factors are important to examine when assessing change.

A multidimensional measure of caregiving appraisal: validation of the Caregiver Appraisal Scale in traumatic brain injury.

Objective:To investigate the factor structure and concurrent validity of the Caregiver Appraisal Scale (CAS) in a sample of caregivers of adults with traumatic brain injury (TBI). Design:Prospective cohort study. Setting:Two sites: (1) Outpatient clinics associated with a comprehensive inpatient brain injury rehabilitation program and (2) a comprehensive residential postacute rehabilitation program in the Southern United States. Participants:One hundred forty-nine caregivers of adults with TBI enrolled in the TBI Model Systems Project and 92 caregivers of adults with TBI admitted to a residential postacute rehabilitation program. Most caregivers were women and either parents or spouses of the injured person. Main Outcome Measures:Caregiver Appraisal Scale (CAS); Subjective Burden Scale (SBS); Objective Burden Scale (OBS); General Health Questionnaire (GHQ). Results:Principal components analysis with varimax rotation yielded four factors: perceived burden (PB), caregiver relationship satisfaction (CRS), caregiving ideology (CI), and caregiving mastery (CM), which were found to be fairly stable across treatment settings. Adequate concurrent validity was demonstrated for the perceived burden factor, and adequate internal consistency was found for three of four scales. Conclusions:Preliminary support for the use of the CAS in caregivers of adults with TBI was obtained. However, further scale development, particularly for the CM factor, will likely improve the stability and usefulness of this instrument.

The Simulated Gambling Paradigm Applied to Young Adults: An Examination of University Students' Performance

Simulated gambling tasks have become popular as sensitive tools for identifying individuals with real-time impairment in decision making. Various clinical samples, especially patients with damage to the ventromedial prefrontal cortex, perform poorly on these tasks. The patients typically persist in choosing risky (disadvantageous) card decks instead of switching to safer (advantageous) decks. In terms of Damasios (1994) somatic marker hypothesis, the poor performance stems from defective integration of emotional and rational aspects of decision making. Less information is available about performance in healthy populations, particularly young adults. After administering a computerized gambling task to 141 university students, we found that individuals in this population also tend to prefer disadvantageous decks to advantageous decks. The results indicate that performance is governed primarily by the frequency of positive outcomes on a trial-by-trial basis rather than by the accumulation of winnings in the longer term. These findings are discussed in light of the cognitive literature pertaining to the simulated gambling paradigm.

Making connections after brain injury: development and evaluation of a social peer-mentoring program for persons with traumatic brain injury.

Objective:To describe the development and implementation of a social peer-mentoring program for persons with traumaticbrain injury (TBI) and to explore whether this program yielded increased social functioning outcomes compared with wait-list (WL)controls. Design:Pilot randomized controlled study. Participants:Community-dwelling individuals with TBI(12 matched with social peer mentors and 18 completing the WL condition). Intervention:Trained social peer mentors (SPMs)were matched to partners with TBI (peer partners (PP)) to foster skill-building in planning of social activities and improvingsocial communication abilities through phone contacts and joint participation in social events within the community over a 3-monthperiod. Measures:Social Activity Interview, Center for Epidemiological Studies Depression Scale, UCLA Loneliness Scale, Satisfaction with Life Scale, 6-Item Interpersonal Support Evaluation List (baseline and postmentoring); weekly social activity data(1-month baseline, continuously collected during 3-month mentoring or WL period); satisfaction survey. Results:Both SPMand PP participants reported high satisfaction with the mentoring program. Statistically significant improvements in perceived socialsupport after mentoring were observed for the mentored group than for WL participants; however, an increase in depressive symptoms wasalso observed. While significant improvements in social activity level and social network size were not found, a trend toward increasedsatisfaction with social life was present for mentored participants. Conclusions:Satisfaction ratings for the SPM programwere uniformly high and selected positive findings encourage further investigation of social mentoring as an intervention to effectimprovements in social integration. Small sample size and reduced “dosage” of mentor interactions were limitations of thispilot study. Benefits of and challenges to implementation of an SPM program are outlined.

Predictive validity of the Neurobehavioural Cognitive Status Examination (NCSE) in a post-acute rehabilitation setting

Within the context of a post-acute rehabilitation setting, association and agreement between results from the Neurobehavioural Cognitive Status Examination (NCSE) and from the neuropsychological (NP) evaluation are examined. All participants (n = 48) had sustained a severe traumatic brain injury and NCSE testing preceded NP testing by an average of 1 month. A significant relationship and fair classification agreement (i.e. presence or absence of cognitive impairment) was found between the overall results from NCSE and NP evaluation. Significant relationships were also observed between most NCSE subtests and paired NP tests thought to be assessing the same cognitive domains. However, the classification agreement (i.e. the presence or absence of deficient performance) between most NCSE subtests and paired NP tests was poor. The findings are discussed from the standpoint of individual treatment planning.Within the context of a post-acute rehabilitation setting, association and agreement between results from the Neurobehavioural Cognitive Status Examination (NCSE) and from the neuropsychological (NP) evaluation are examined. All participants (n = 48) had sustained a severe traumatic brain injury and NCSE testing preceded NP testing by an average of 1 month. A significant relationship and fair classification agreement (i.e. presence or absence of cognitive impairment) was found between the overall results from NCSE and NP evaluation. Significant relationships were also observed between most NCSE subtests and paired NP tests thought to be assessing the same cognitive domains. However, the classification agreement (i.e. the presence or absence of deficient performance) between most NCSE subtests and paired NP tests was poor. The findings are discussed from the standpoint of individual treatment planning.

Prognostic Importance of Self-Reported Traits/Problems/Strengths and Environmental Barriers/Facilitators for Predicting Participation Outcomes in Persons With Traumatic Brain Injury: A Systematic Review

OBJECTIVE To conduct a systematic review of the prognostic value of self-reported traits/problems/strengths and environmental barriers/facilitators for participation outcomes in persons with traumatic brain injury (TBI). DATA SOURCES Articles published through August 15, 2013, obtained by conducting electronic searches of PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases and a review of reference lists of reviewed articles. STUDY SELECTION Reviewed articles were written in English and presented findings on adult humans with TBI, participation outcomes, and ≥ 1 self-reported trait/problem/strength (eg, depression, pain, coping style) and/or ≥ 1 environment barrier/facilitator (eg, social support, family functioning, access to services). DATA EXTRACTION Each of the 996 abstracts was examined by 2 reviewers, and those failing to meet all inclusion criteria were excluded. Data were extracted from the 63 retained articles by 2 independent reviewers, who met to resolve any differences in study quality rating or evidence recorded. Study quality was determined using American Academy of Neurology (AAN) criteria. DATA SYNTHESIS Conclusions regarding prognostic importance of self-report and environmental barrier/facilitator variables were made using AAN criteria. Conclusions regarding barrier/facilitator variables indicated that access to transportation, access to services, and participation in social interaction were possibly predictive of employment outcome, whereas living arrangements and social support were possibly not predictive of employment outcome. Conclusions regarding self-report variables indicated that the number of postconcussive symptoms, fatigue, and physical competence were probably predictive of employment and need for supervision, whereas self-efficacy was probably not predictive of employment. Subjective well-being, pain, and social interaction were possibly predictive of employment, whereas coping style was possibly not predictive. CONCLUSIONS Although additional investigation is needed, self-report variables are likely to make important contributions to predicting participation outcomes. Future research should be guided by coherent conceptual models and use a consistent set of assessment instruments to facilitate comparisons between studies.

Sensitivity of the RBANS to acute traumatic brain injury and length of post-traumatic amnesia

Objective: Although the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been shown to be a useful tool in evaluating the cognitive status of patients with dementia, stroke, schizophrenia and post-acute traumatic brain injury (TBI), no studies have examined its utility in an acute TBI setting. The current study investigates the RBANS’ sensitivity to acute TBI, hypothesizing that the presence and severity of injury is predictive of worse RBANS performance. Method: Neuropsychological testing was conducted an average of 6.1 days after emergence from post-traumatic amnesia (PTA). RBANS results were evaluated based on a normative basis, pre-injury estimates, and brain injury severity. Results: In this sample of acute TBI patients (n = 51), the mean index scores on the RBANS ranged from 1.59–2.36 SD below the mean of the standardization sample. Each WRAT-4 Reading sub-test score was above the corresponding RBANS Total Scale Index score (t(31) = 10.32, p < 0.001). Regression analyses revealed that Delayed Memory (β = − 0.365, p < 0.007) and Total Score (β = −0.297, p < 0.023) indices were significantly predicted by PTA length after controlling for age and education. Conclusions: The RBANS appears to be a useful tool in assessing the presence and severity of acute TBI.

Wisconsin Card Sorting Test: Factor structure and relationship to productivity and supervision needs following severe traumatic brain injury

Primary objective: The Wisconsin Card Sorting Test (WCST) has been demonstrated to have a relatively stable factor structure in traumatic brain injury (TBI) samples. What is less clear is whether the scores derived from WCST factors are related to functional outcomes. The purpose of the current study was to replicate the WCST factor structure in a sample with severe TBI, and to evaluate the relationship between the factor scores and outcome. Research design: Retrospective correlational study. Methods and procedures: Participants (n = 143) who had suffered severe TBI were administered a battery of neuropsychological tests including the WCST within one month of admission to a brain injury rehabilitation program. In addition, participants were administered supervision (Supervision Rating Scale; SRS) and productivity measures (Community Integration Questionnaire- Productivity subscale; CIQ-P) at admission and following discharge. Experimental intervention: None. Main outcomes and results: For individuals who were more than one year post injury, more failure to maintain set errors were associated with better occupational outcomes, while more nonperseverative errors were associated with increased supervision needs. Conclusions: The WCST factor scales are related to functional outcomes in severe TBI. Specifically, the inability to establish a series of correct responses is associated with poorer outcome.

The PPVT-R : Validity as a quick screen of intelligence in a postacute rehabilitation setting for brain-injured adults

The utility of the Peabody Picture Vocabulary Test-Revised (PPVT-R) as a surrogate for the Wechsler Adult Intelligence Test-Revised (WAIS-R) was investigated in 61 brain-injured adult participants in a postacute rehabilitation setting. Idiographic comparison revealed substantial disagreement in clinical classification between the two instruments, and it is concluded that the PPVT-R is not a good surrogate for the WAIS-R for this purpose. In contrast, the PPVT-R was judged an adequate surrogate for the WAIS-R for the purpose of group comparison, as is common in biomedical research. Finally, contrary to prior report, the PPVT-R was demonstrated to measure more than simply Vocabulary. As such, in the absence of independent validation research, perhaps the most parsimonious conclusion regarding what the PPVT-R is measuring is that like each of the various subtests of the WAIS-R, the PPVT-R shares some of the variance of the construct termed intelligence, as well as demonstrates some unique variance that is likely comprised of error and, perhaps, a unique or different facet of intelligence.

Performance on paced serial addition tasks indicates an associative network for calculation.

Although paced serial addition (PSA) tasks are considered to be tests of general information-processing capacity, recent work suggests that performance on such tasks is influenced by arithmetic-specific variables. We designed two visual PSA experiments to determine whether the performance of normal adults would support predictions derived from the cognitive psychology of calculation. Experiment 1 showed that mixing familiar (Arabic numeral) and less familiar (Roman numeral) stimulus formats reduced scores below the averaged scores for pure Arabic and Roman lists. The Roman-Arabic order of addends was more difficult than the Arabic-Roman order. Experiment 2, which involved only Arabic numerals as addends, showed that performance could be impaired by constraining the trial-to-trial variability of sums. The results of both experiments confirm the importance of arithmetic-specific variables in PSA and provide support for an associative network model of calculation. In addition, the findings implicate interference from extraneous addends and responses as the performance-limiting factor.