Lisa J. Rapport

Predictors of caregiver and family functioning following traumatic brain injury: social support moderates caregiver distress.

Objective:This study examined predictors of family dysfunction and caregiver distress among 60 pairs of persons who sustained a traumatic brain injury and their caregivers. Design:A cross-sectional design that used hierarchical multiple regression analyses evaluated the relative influences of time since injury, awareness of deficit, and neurobehavioral and neuropsychological functioning of the person with injury, and caregiver perceived social support. Results:The predictor model accounted for 52% of the variance in family dysfunction and 39% in caregiver psychological distress. Neurobehavioral disturbance in the person with injury was the strongest predictor of caregiver distress. Social support showed a direct and linear relationship to family functioning, and it was the strongest predictor of family functioning. Social support was a powerful moderator of caregiver psychological distress. In the absence of adequate social support, caregiver distress increased with longer time after injury, cognitive dysfunction, and unawareness of deficit in care recipients, whereas these characteristics were not associated with distress among caregivers with adequate social support. Conclusions:Rehabilitation professionals should stress the importance of caregivers and families of persons with TBI seeking and obtaining adequate social support.

Measures of executive functioning as predictors of functional ability and social integration in a rehabilitation sample

OBJECTIVE To examine the utility of executive function tests in predicting rehabilitation outcome. DESIGN A prospective, descriptive study of the value of neuropsychologic and motor functioning measures in the prediction of functional outcome 6 months after acute rehabilitation. SETTING A Midwestern, urban, university-affiliated rehabilitation hospital. PATIENTS Ninety consecutive admissions to traumatic brain injury, orthopedic, and spinal cord injury units. Age of the participants ranged from 17 to 73. MAIN OUTCOME MEASURES Community Integration Questionnaire (CIQ), Disability Rating Scale (DRS), SF-36 Health Survey. RESULTS Canonical correlation analyses indicated that measures of executive functioning and verbal memory were strongly related to measures of functional outcome 6 months after rehabilitation, as measured by the DRS and the CIQ. In contrast, perceived health status as measured by the SF-36 was highly related to estimated premorbid IQ and modestly related to visuospatial impairment. CONCLUSIONS Executive functioning, verbal memory, and estimated premorbid intelligence predict functional dependence after discharge from rehabilitation beyond information regarding basic sensory and motor skills. Moreover, there is a dissociation between measures of functional outcome, such that objective and behaviorally oriented measures of disability (CIQ and DRS) are strongly related to each other; however, they are not related to perceptions of general health status (SF-36).

Experienced emotion and affect recognition in adult attention-deficit hyperactivity disorder

Emotional competence and deficits that may disrupt interpersonal interactions were evaluated in 28 adults with attention-deficit hyperactivity disorder (ADHD) and 28 demographically equivalent controls. Participants completed tasks assessing affect recognition and experienced emotional intensity. Adults with ADHD performed worse in affect recognition than did adults without the disorder; however, the impairment was unrelated to gross perceptual processes, fundamental abilities in facial recognition, or attentional aspects of affect perception. Moreover, intensity of experienced emotion moderated affect recognition: Among controls, experienced emotion facilitated affect recognition. Among adults with ADHD, who reported significantly greater intensity, experienced emotion was inversely related to affect recognition. Results are consistent with theories of ADHD as a deficit in behavioral inhibition; yet, results may merely reflect a constellation of deficits associated with the disorder.

Face emotion perception and executive functioning deficits in depression.

Frontal, limbic and temporal regions of the brain important in emotion perception and executive functioning also have been implicated in the etiology and maintenance of depression; yet, the relationships among these topics remain poorly understood. The present study evaluated emotion perception and executive functioning among 21 depressed women and 20 nondepressed women controls. Depressed women performed significantly worse than controls in emotion perception accuracy and in inhibitory control, an aspect of executive functioning, whereas the groups did not differ in other cognitive tests assessing memory, visual-spatial, motor, and attention skills. The findings suggest that emotion perception and executive functioning are disproportionately negatively affected relative to other cognitive functions, even in a high-functioning group of mildly depressed women. Measures of emotion perception and executive functioning may be of assistance in objectively measuring functional capability of the ventral and dorsal neural systems, respectively, as well as in the diagnosis of depression. We would like to thank Rachel Burns, Luis Casenas, Najat Hamid, Jessica Layne, Justin Miller, Rebecca Reiten and Megan Shaheen for their assistance in data collection and coding. We gratefully acknowledge the comments and suggestions for this manuscript by Dr. Angela Freymuth Caveney, Ph.D. This project was supported in large part by a Rachel Upjohn Clinical Scholars Award and through the assistance of the Neuropsychology Division

Executive functioning and predictors of falls in the rehabilitation setting.

OBJECTIVE To examine the incremental utility of executive function tests in the prediction of inpatient falls. DESIGN Evaluation of neuropsychologic and medical risk factors for fall was completed at admission. Inpatient falls were tabulated following discharge. SETTING A freestanding, urban rehabilitation hospital. PATIENTS Ninety consecutive admissions to traumatic brain injury, orthopedic, and spinal cord injury wards. Age of the participants ranged from 17 to 73 years old. MAIN OUTCOME MEASURE Incident reports of inpatient falls. RESULTS Standard multiple regression analyses indicated that measures of executive functioning sensitive to self-monitoring accounted for unique variance in falls beyond that explained by age and functional motor ability as assessed by the Functional Independence Measure. Visuospatial functioning, although not directly related to falls, was a significant predictor in combination with measures of executive functioning. Together, these variables accounted for 30.3% of the variance in inpatient falls (multiple r = .55; p < .001). CONCLUSION The findings suggest that the influence of motor and sensory impairments on falls are moderated, in part, by executive functioning. Patients with intact executive functioning are less likely to act in ways that could result in a fall; thus, aggressive fall prevention measures may be unnecessary. In contrast, executive dysfunction may signal the need for intervention, even among patients whose profiles are unremarkable with regard to traditional risk factors for fall.

Aspects of Social and Emotional Competence in Adult Attention-Deficit/Hyperactivity Disorder

Social and emotional competence were evaluated using self-report and behavioral measures in adults with attention-deficit/hyperactivity disorder (ADHD) and controls. Adults with ADHD viewed themselves as less socially competent but more sensitive toward violations of social norms than controls. Films depicting emotional interactions were used to assess linguistic properties of free recall and perceived emotional intensity. Although adults with ADHD used more words to describe the scenes, they used fewer emotion-related words, despite rating the emotions depicted as more intense than did controls. In contrast, no group differences for words depicting social or cognitive processes were observed. Overall, adults with ADHD appear more aware of their problems in social versus emotional skills. Findings may have implications for improving the psychosocial functioning of these adults.

Neuropsychological performance and sleep disturbance following traumatic brain injury.

ObjectiveTo examine the relation between sleep disturbance and neurocognitive ability among persons with traumatic brain injury (TBI). DesignCorrelational research evaluating demographic and neuropsychological predictors of sleep disturbance using multiple regression analysis and analysis of variance. ParticipantsEighty-seven patients with mild to severe TBI admitted to a comprehensive outpatient neurorehabilitation program. Main Outcome MeasuresSleep disturbance assessed using the Pittsburgh Sleep Quality Index. ResultsHierarchical regression analysis revealed that performance on selected measures of cognitive functioning significantly improved prediction of sleep disturbance, accounting for 14% of variance beyond that accounted for by injury severity and gender. The total model accounted for 31% of the variance in Pittsburgh Sleep Quality Index scores. Patients with mild TBI reported more sleep disturbance (P < .01) than did patients with severe TBI. ConclusionsSleep disturbance among patients with TBI may be associated with a particular constellation of neuropsychological abilities. These issues are discussed in relation to prior findings that indicate the involvement of additional neuropsychiatric factors associated with sleep disturbance in mild TBI.

Executive functioning in adult Attention-Deficit Hyperactivity Disorder

The present study examined the executive abilities of 35 adults diagnosed with Attention-Deficit Hyperactivily Disorder (ADHD) and 32 adults without the disorder (n = 67) who were equivalent in age, gender, years of education, and Full Scale IQ. The ADHD group performed significantly worse on Stroop Color-Word (? 2 = .18) and Interference (? 2 = .08), as well as time to complete Trails B (? 2 = .08) than the controls (all ps < . 05). Analysis of Design Fluency indicated that the ADHD group committed more perseverative (? 2 = .06) and non-perseverative (? 2 = .12) errors than did controls; however, novel output was equivalent for the groups. No group differences were observed on tests measuring cognitive initiation, thinking, or working memory (all ps > .30; ? 2 = .00–.01). The distributions of WCST variables showed severe skew associated with high-functioning performance on the test among both groups. The pattern of results suggests the presence of specific deficits in response inhibition, with intact abilities in other cognitive domains, such as primary verbal and visuospatial skills. These findings are consistent with the literature on neuropsychological deficits among children with ADHD. That persons with ADHD present a primary deficit of behavioral inhibition supports Barkleys (1997) theory of ADHD, as opposed to theories by Denckla (1996) and Roberts and Pennington (1996) that emphasize intention and working memory.

Full scale IQ as mediator of practice effects: The rich get richer

Abstract Differential effects of practice over four administrations of the WAIS-R were examined as a function of Full Scale IQ at initial testing (N = 36). Twelve education-matched normal adults represented each of three groups: Low-Average (80—90), Average (95—105), and High-Average (110—120) Full Scale IQ. Participants were tested at 2-week intervals. Repeated measures analysis of variance indicated that Average and High-Average groups made greater gains across retest intervals than did the Low-Average group (p < .002). Across groups, gains were greater at the first retest than at the second or third retest (p < .001). A Scale × Time interaction indicated disproportionate gain in Performance IQ versus Verbal IQ, particularly at the first retest (p < .001). Previous exposure to the WAIS-R dramatically alters performance: Traditional interpretations regarding expected gain and profile analysis are not valid at retest.

Rightward orienting bias, wheelchair maneuvering, and fall risk

OBJECTIVE To investigate whether rightward orienting bias, without neglect of left hemispace, increased accident risk. DESIGN Case-control study. SETTING Inpatient rehabilitation unit of department of government medical center. PATIENTS Successive right-cerebrovascular accident (CVA) admissions were reviewed over a 2-year period. Only patients with left hemisphere damage, recent abusive drinking, dementia, or inpatient stays of less than 3 weeks were excluded. Fifty-five right-CVA subjects were divided into three groups, based on starting point and omissions in left hemispace on the Rey-Osterreith Complex Figure Drawing and Random Letter Cancellation test. Thirty-two patients were placed in the L-OMIT group (omitted stimuli in left hemispace), 11 patients were placed in the R-BIAS group (began tasks to the right without omissions), and 12 patients were placed in the Non-Neglect Stroke group (no evidence of unilateral neglect). Twenty male inpatients with no history of brain damage served as controls (Normal Control). MAIN OUTCOME MEASURES Frequency of hospital falls and wheelchair obstacle course contacts. RESULTS Both the L-OMIT and the R-BIAS groups had more inpatient falls than the other groups F(3,71) = 6.11, p < .001. On the wheelchair obstacle course, the L-OMIT group made more left-sided wheelchair collisions than any other group. However, the R-BIAS group also made more errors than the Non-Neglect Stroke and the Normal Control groups, F(3,55) = 5.72, p < .01). CONCLUSIONS Results suggest that rightward orienting bias has clinical significance, even without more serious symptoms of unilateral neglect.