Peggy R. Goldfader

The neurobehavioural rating scale-revised: sensitivity and validity in closed head injury assessment

OBJECTIVES To investigate the factor structure and psychometric properties of the neurobehavioural rating scale-revised (NRS-R) and to determine its usefulness in clinical trials. METHODS A consecutive series of patients sustaining severe closed head injury were evacuated to one of 11 large regional North American trauma centres and entered into a randomised, phase III, multicentre clinical trial investigating the therapeutic use of moderate hypothermia. Acute care personnel were blinded to outcome and outcome personnel were blinded to treatment condition. The Glasgow outcome scale (GOS) was the primary outcome measure. Secondary outcome measures included the disability rating scale (DRS) and the NRS-R. RESULTS Exploratory factor analysis of NRS-R data collected at 6 months after injury (n=210) resulted in a five factor model including: (1) executive/cognition, (2) positive symptoms, (3) negative symptoms, (4) mood/affect, and (5) oral/motor. These factors showed acceptable internal consistency (0.62 to 0.88), low to moderate interfactor correlations (0.19 to 0.61), and discriminated well between GOS defined groups. Factor validity was demonstrated by significant correlations with specific neuropsychological domains. Significant change was measured from 3 to 6 months after injury for the total score (sum of all 29 item ratings) and all factor scores except mood/affect and positive symptoms. The total score and all factor scores correlated significantly with concurrent GOS and DRS scores. CONCLUSIONS The NRS-R is well suited as a secondary outcome measure for clinical trials as its completion rate exceeds that of neuropsychological assessment and it provides important neurobehavioural information complementary to that provided by global outcome and neuropsychological measures.

Head injury, a multivariate study: Predicting long-term productivity and independent living outcome

As the second of a two-part research project, this study attempted to build three clinically useful prediction equations; these equations would be used to predict three long-term functional outcomes: productivity status, living arrangement status, number of hours of assistance required per week. There were ten predictor variables used in each analysis. These ten variables belonged to four theoretical classes: pre-injury demographics, pre-injury social characteristics, severity of injury, and post-injury environmental variables. The analytical method used was the General Linear Model of multiple regression, rather than the most often used Stepwise regression procedure. The results indicate that in none of the three prediction equations was more than 28% of the criterion variance accounted for, and only a minority of the predictor variables were significant predictors. It is concluded that, while the equations are of only very limited utility, the theoretical model and the analytical technique will be useful for future investigators.

Case report. Aphasia in thalamic stroke: CT stereotactic localization.

We present a patient in whom dysphasia followed suddenly upon an apparently discrete thalamic infarct proven by computed tomography (CT). Detailed psychometric data of the patients speech and memory disorder obtained during the acute and chronic stages were correlated with the evaluation of a focal thalamic lesion as demonstrated by serial CT. The findings and deductions drawn from selective reports in the literature form the basis of this presentation.

Factor analysis of the wechsler memory scale-revised and the halstead-reitan neuropsychological battery

Abstract A principal components factor analysis of the 12 subtests of the WMS-R, WAIS Verbal and Performance IQ scores, and measures of a modified Halstead-Reitan Neuropsychological Battery was performed on a sample of 135 patients. The Visual Reproduction subtests I and II factored with other spatial measures and Performance IQ while Logical Memory I and II and Verbal Paired Associates I and II emerged as separate verbal memory factors. Additionally, two attention/concentration factors were found, one primarily verbal and one primarily visual. Further study in the interpretation of the Verbal and Visual Memory Indexes was advised.

Race differences in a sample of vocational rehabilitation clients with traumatic brain injury

Objective : To evaluate race differences in demographics, injury severity, and vocational outcomes for persons with TBI. Participants : Seventy-five individuals with TBI (13 African American, 62 Caucasian) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a 2-year period. Measures : Demographics (i.e. age, race, level of education), injury severity (i.e. LOC, PTA, length of hospitalization, neuropsychological test scores), VR services provided (e.g. transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs unsuccessfully employed; cost per case). Procedure : All participants completed a standard neuropsychological evaluation and completed VR services (i.e. were followed from enrolment to case closure). Hypotheses : African Americans and Caucasians would not differ in demographics or injury severity, although fewer African Americans would be successfully employed through DVR. Analyses : Chi-squares and non-parametric MANOVAs to evaluate race differences in terms of demographics, injury severity, vocational services provided and vocational outcomes. Results : As hypothesized, there were few race differences in demographics or injury severity, although African Americans received significantly more transportation services (62 vs 21%). Contrary to hypotheses, there was no difference in the number of successfully employed African Americans (23%) vs Caucasians (18%). Conclusions : African Americans and Caucasians with TBI achieve similar vocational successes if they receive state VR services

Factor analysis of an outcome interview for use in clinical trials of traumatically brain-injured patients: a preliminary study.

Brown SA, McCauley SR, Levin HS, Boake C, Goldfader PR, McCormick SD, Rockers D, Butters M, Kareken DA, Gostnell D, Clifton GL: Factor analysis of an outcome interview for use in clinical trials of traumatically brain-injured patients: a preliminary study. Am J Phys Med Rehabil 2001; 80:196–205. ObjectiveTo study the factor structure, internal consistency, concurrent validity, and sensitivity to detect change in patient report of problems of a structured interview in relationship with accepted outcome measures. DesignOutcome status of patients with severe traumatic brain injury participating in a randomized, phase III, multicenter clinical trial was assessed at 6 mo postinjury using the Glasgow Outcome Scale, the Disability Rating Scale, and the Severe Traumatic Brain Injury Outcome Interview. ResultsExploratory factor analysis of the Severe Traumatic Brain Injury Outcome Interview produced a meaningful five-factor model: (1) activities of daily living; (2) cognitive; (3) affective; (4) behavioral; and (5) instrumental activities of daily living. The internal consistency of the factors ranged from moderate (0.61 instrumental activities of daily living) to high (0.94 activities of daily living); the interfactor correlations were moderate. The summed factor scores were significantly correlated with measures of global outcome: the Glasgow Outcome Scale (r = 0.66;P < 0.0001) and the Disability Rating Scale (r = 0.61;P < 0.0001). Patient report of cognitive problems correlated moderately with the neuropsychological tests. The summed factor scores were sensitive to change over time. ConclusionsOverall, the interview assessed the major important features of outcome pertinent to traumatic brain injury and demonstrated greater sensitivity to subtle changes over time than the unidimensional approaches, such as the Glasgow Outcome Scale and Disability Rating Scale.