Martin L. Rohling

Effectiveness of Cognitive Rehabilitation Following Acquired Brain Injury: A Meta-Analytic Re-Examination of Cicerone et al.'s (2000, 2005) Systematic Reviews

The present study provides a meta-analysis of cognitive rehabilitation literature (K = 115, N = 2,014) that was originally reviewed by K. D. Cicerone et al. (2000, 2005) for the purpose of providing evidence-based practice guidelines for persons with acquired brain injury. The analysis yielded a small treatment effect size (ES = .30, d(+) statistic) directly attributable to cognitive rehabilitation. A larger treatment effect (ES = .71) was found for single-group pretest to posttest outcomes; however, modest improvement was observed for nontreatment control groups as well (ES = .41). Correction for this effect, which was not attributable to cognitive treatments, resulted in the small, but significant, overall estimate. Treatment effects were moderated by cognitive domain treated, time postinjury, type of brain injury, and age. The meta-analysis revealed sufficient evidence for the effectiveness of attention training after traumatic brain injury and of language and visuospatial training for aphasia and neglect syndromes after stroke. Results provide important quantitative documentation of effective treatments, complementing recent systematic reviews. Findings also highlight gaps in the scientific evidence supporting cognitive rehabilitation, thereby indicating future research directions.

A Meta-Analysis of Neuropsychological Outcome After Mild Traumatic Brain Injury: Re-analyses and Reconsiderations of Binder et al. (1997), Frencham et al. (2005), and Pertab et al. (2009)

The meta-analytic findings of Binder et al. (1997) and Frencham et al. (2005) showed that the neuropsychological effect of mild traumatic brain injury (mTBI) was negligible in adults by 3 months post injury. Pertab et al. (2009) reported that verbal paired associates, coding tasks, and digit span yielded significant differences between mTBI and control groups. We re-analyzed data from the 25 studies used in the prior meta-analyses, correcting statistical and methodological limitations of previous efforts, and analyzed the chronicity data by discrete epochs. Three months post injury the effect size of −0.07 was not statistically different from zero and similar to that which has been found in several other meta-analyses (Belanger et al., 2005; Schretlen & Shapiro, 2003). The effect size 7 days post injury was −0.39. The effect of mTBI immediately post injury was largest on Verbal and Visual Memory domains. However, 3 months post injury all domains improved to show non-significant effect sizes. These findings indicate that mTBI has an initial small effect on neuropsychological functioning that dissipates quickly. The evidence of recovery in the present meta-analysis is consistent with previous conclusions of both Binder et al. and Frencham et al. Our findings may not apply to people with a history of multiple concussions or complicated mTBIs.

Rates of Bidirectional Versus Unidirectional Intimate Partner Violence Across Samples, Sexual Orientations, and Race/Ethnicities: A Comprehensive Review

One hotly debated topic within the field of intimate partner violence (IPV) is the degree to which IPV can be understood as primarily a unidirectional versus bidirectional phenomena; this topic forms a key component of the gender symmetry versus asymmetry of domestic violence debate. Resolution of this controversy has important prevention and intervention implications. In the current study, a comprehensive review of the literature was conducted, and 48 studies that reported rates of bidirectional versus unidirectional physical violence (male-to-female and female-to-male) were uncovered using a variety of search engines and key terms; one relevant meta-analysis and one seminal book chapter were also identified. Included empirical studies were published in 1990 or later, appeared in peer-reviewed journals, and contained empirical data directly related to bidirectionality of violence. Studies that only reported correlations between self-reported perpetration and victimization were excluded from these analyses. Qualifying studies were then categorized by the nature of the sample they assessed (i.e., large population samples; smaller community; purposive or convenience samples; clinical or treatment-seeking samples; legal/criminal justice-related samples; and samples assessing the relationships of gay, lesbian, and/or bisexual individuals). Rates of bidirectional versus unidirectional violence (male-toward-female vs. female-toward-male) were summarized directly as reported or were derived on the basis of data contained within the article. All obtained studies (48 empirical, 1 meta-analysis, 1 book chapter) were then entered into an online summary table for public review; however, additional results were specifically calculated for the current article. These results indicate that bidirectional violence was common across all types of samples (population-based to criminal justice). This suggests that the role of women in violent relationships is important to consider, even if all aspects of women’s perpetration of IPV are not symmetrical to men’s perpetration of IPV. A second finding to emerge was that the ratio of unidirectional female-to-male compared to male-to-female IPV differed significantly among samples with higher rates of female-perpetrated unidirectional violence found in four of the five sample types considered. Higher ratios of male-to-female unidirectional violence were found only in criminal justice/legal studies that relied on police reports of IPV perpetration and/or in samples drawn from the U.S. military. Competing explanations for the differing ratios were offered in the current discussion. These need to be tested empirically in order to fully understand the expression of IPV across samples and settings. Differences in the directionality of the expression of IPV were not found in samples of gay, lesbian, or bisexual individuals; however, rates of bidirectional violence appear to vary by race/ethnicity with higher rates of bidirectional violence among Black couples. Overall, it is suggested that if one resolution of the gender symmetry/asymmetry debate is to argue that there are subtypes of male and female domestic violence perpetrators (Johnson, 2005; Johnson, 2006), or that there are different patterns of violence among different types of relationships characterized by IPV (Stets & Straus, 1989), researchers and clinicians will need to work together to determine how to reliably and meaningfully make these determinations in ways that will facilitate our ability to effectively prevent and treat all types of IPV.

Breaking up is hard to do: unwanted pursuit behaviors following the dissolution of a romantic relationship.

This study investigated the prevalence and predictors of unwanted pursuit behaviors among college students. Participants (n = 282) had experienced the termination of a meaningful romantic relationship. Two questionnaires were administered. One assessed unwanted pursuit behaviors that were perpetrated by individuals who had not initiated the relationship breakup (breakup sufferers; n = 120); the other assessed individuals who had initiated the relationship breakup (relationship dissolvers; n = 162). Results indicated that most breakup sufferers had engaged in at least one act of unwanted pursuit (i.e., unwanted phone calls, unwanted in-person conversations) after the breakup. Breakup sufferers were more likely than relationship dissolvers to perceive a positive impact from their unwanted pursuit behavior. Partner-specific attachment experiences and love styles emerged as significant predictors of unwanted pursuit behavior perpetration, according to both victims and perpetrators of unwanted pursuit. However, only victims of unwanted pursuit revealed an association between levels of relationship violence and unwanted pursuit behavior perpetration. Victims also reported that their unwanted pursuit was related to a lack of friendship between themselves and their ex-partners. In contrast, there was a positive association between feelings of friendship and unwanted pursuit for perpetrators. The implications of these findings and their application to the stalking literature are discussed.

Depressive symptoms and neurocognitive test scores in patients passing symptom validity tests

This study examined the effect of depression on neurocognitive performance in patients who passed symptom validity testing. The Beck Depression Inventory (BDI) was used to assess depression in 420 patients with heterogeneous referral diagnoses (more than half of these cases were head injury or neurological disease). All patients had demonstrated satisfactory effort by passing two symptom validity tests. No differences were found on objective cognitive and psychomotor measures in groups sorted based on their self-reported depression. In contrast, on the self-report measures [i.e., Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Symptom Checklist-90-Revised (SCL-90-R), and Memory Complaints Inventory (MCI)], differences were found indicating that patients with depression report more emotional, somatic, and cognitive problems. Contrary to expectation, these data suggest that depression has no impact on objective neurocognitive functioning.

Individual, Family, and Peer Correlates of Adolescent Gambling

The primary purpose of this study was to determine the individual, family, and peer factors that correlate with adolescent gambling. High school students from three states (N = 1,846) completed an anonymous questionnaire assessing the behavior of themselves, their parents, and their peers. Participants also reported on their gambling behavior via the SOGS-RA, which was used to create five adolescent gambling groups (i.e., Non-Gamblers, Non-Problem Gamblers, At-Risk Gamblers, Problem Gamblers, and Probable Pathological Gamblers). In a discriminant function analysis using demographic, individual, family, and peer factors as potential discriminators, two functions emerged that accounted for 94% of the variance between groups. The first function was linear, with the Probable Pathological Gamblers reporting the highest level of peer and parent gambling, susceptibility to peer pressure, conduct problems, binge drinking, suicide attempts, drug use, and being male. The second function highlighted three unique qualities of individuals in the two outlying groups: Probable Pathological Gamblers and Non-Gamblers. These findings suggest that demographic, individual, family, and peer variables are all important correlates of probable pathological gambling in adolescents. Results also support the utility of a five-group classification scheme based on the SOGS-RA. The clinical implications of these results are discussed.

Neuropsychological impairment following traumatic brain injury: a dose-response analysis.

Dikmen, Machamer,Winn, and Temkin (1995) administered the Halstead–Reitan Battery (HRB) to a sample of TBI patients. Similar patients were obtained from the second author (JEM) for two main purposes. First, we wished to determine if there is a dose-response relationship between TBI severity and residual cognitive deficit. Second, are Dikmen et al. results generalizable to other TBI samples? Analyses of the Meyers sample replicated the analyses of Dikmen sample. A significant dose-response relationship between loss of consciousness (LOC) and cognitive impairment was found using effect sizes for the Dikmen sample, as well as using regression-based normative T scores for the Meyers sample. The two methods were highly correlated with one another. Using mean scores for the six LOC-severity groups and the two samples resulted in a correlation coefficient r = .97, p < .0001. Results are presented for clinicians to use when assessing individual patients.

A Statistical Interpretive Method for Neuropsychological Test Data

The accurate interpretation of large numbers of neuropsychological tests within a flexible battery approach is a difficult and sometimes controversial process. We present a statistically based method of interpretation (Rohlings Interpretive Method or RIM) and evaluation of neuropsychological data that allows for varying numbers of tests along a varying number of cognitive domains, yet remains psychometrically based. This method requires informed clinical judgment in that the level of confidence for tests, cognitive domains, and global indices are used as the backdrop for interpretive decisions. Specific procedures for use are presented in a systematic, detailed fashion to allow the interested reader to replicate the method. Two case examples are presented: a straightforward case of cerebrovascular insult and a more complicated case of mixed etiology. Examples include a variety of different neuropsychological tests commonly used in a flexible battery approach. A discussion of the practicality, ease of use, and potential limitations of this method are further presented.

Relationships between olfactory discrimination and head injury severity

The goal of this study was to examine the relationship between brain injury severity and scores on both an olfactory identification test and on many widely used neuropsychological tests in 367 patients with head injuries of varying levels of severity. It was hypothesized that valid olfactory test scores would correlate highly with injury severity because both the olfactory nerves and the primary olfactory cortices are especially vulnerable to damage in closed head injury. After removing data of doubtful validity from cases failing effort tests, olfactory test scores were related to Glasgow Coma Scale scores (GCS), post-traumatic amnesia and radiological abnormalities more strongly than any of the neuropsychological test scores. Based on the assumption that post-traumatic amnesia is caused by a different mechanism than loss of core consciousness, it was also predicted that there would be no cases with a GCS less than 13 and with no post-traumatic amnesia. As predicted, there were no cases in this group. The results support previous studies showing greater olfactory impairment with increased severity of head injury.

A Meta-Analysis of the Neuropsychological Effects of Occupational Exposure to Mercury

ABSTRACT This paper reports a meta-analysis of 36 peer-reviewed published studies of the neuropsychological effects of occupational exposure to mercury, which yielded 43 independent samples. These studies included 2,512 exposed participants and 1,846 controls, for a total sample size of 4,358. Because the independent variables defining mercury exposure varied across studies, effect sizes were calculated for exposed versus non-exposed workers. Dose–response relations were considered for measures of mercury levels in urine (81% of studies reported), blood (42% of studies reported), and air samples (33% of studies reported). Level of exposure was also estimated by reported years of exposure (M = 11.3, SD = 5.6). Cohens d statistic yielded a statistically significant weighted study-mean effect size of −.23, p < .0001 for occupational mercury exposure. However, an effect this small is typically undetectable when evaluating individuals because it is smaller than the typical 95% confidence interval used for most neuropsychological measures. None of the exposure variables analyzed reached statistical significance. The magnitude of self-reported symptoms (−.30) was slightly larger than that obtained from objective test scores (−.22), though the difference was not statistically significant. Also, the weighted mean effect size for psychomotor skills (−.34) was the largest in magnitude, whereas the weighted mean effect size for verbal comprehension measures had the smallest (−.06). However, an analysis of the differential effects of mercury exposure across cognitive domains found significant differences between verbal comprehension measures and all other domains. None of the other domains were significantly different from one another. The weighted study-mean effect size suggests that the prevalence of neuropsychological deficits due to occupational exposure to mercury is small and difficult to detect on an individual case-by-case basis.