Robin Hanks

Objectives: The purpose of this review is to educate and guide the actions of rehabilitation psychologists by providing a summary of the current literature on pharmacotherapies and treatment effectiveness for the chronic sequelae associated with severe traumatic brain injury (TBI). A number of medications are reviewed for use in treating deficits in arousal, cognition, function, and other problems associated with

To examine the occurrence of and characteristics associated with violent traumatic brain injury (TBI) in the Traumatic Brain Injury Model Systems (TBIMS) project for 4 of the 5 original Model Systems centers and to determine the patient characteristics of this group, as well as the risk factors for sustaining such an injury. Prospective evaluation of individuals with violent TBI over a 10-year period. Four TBIMS centers. A total of 1,229 individuals who received acute hospitalization and inpatient rehabilitation care for TBI. Not applicable. The occurrence of a violent TBI. Twenty-six percent of the participants in the TBIMS project sustained a violent TBI. This type of injury was more common in African-American men who were single and slightly older than the average TBI patient, were unemployed before injury, and had had a previous TBI. A higher injury rate was noted in the earlier part of the evaluation period. Those who sustained a violent TBI had higher levels of caregiver burde...

A number of performance validity tests (PVTs) are used to assess memory complaints associated with traumatic brain injury (TBI); however, few studies examine the concordance and predictive accuracy of multiple PVTs, specifically in the context of combined models in known-group designs. The present study compared five widely used PVTs: the Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), Reliable Digit Span (RDS), Word Choice Test (WCT), and California Verbal Learning Test - Forced Choice (CVLT-FC). Participants were 51 adults with bona fide moderate to severe TBI and 58 demographically comparable healthy adults coached to simulate memory impairment. Classification accuracy of individual PVTs was evaluated using logistic regression and receiver operating characteristic (ROC) curves, examining both the dichotomous cutting scores as recommended by the test publishers and continuous scores for the measures. Results demonstrated nearly equivalent discrimination ab...

Two common measures used to evaluate verbal learning and memory are the Verbal Paired Associates (VPA) subtest from the Wechsler Memory Scales (WMS) and the second edition of the California Verbal Learning Test (CVLT-II). For the fourth edition of the WMS, scores from the CVLT-II can be substituted for VPA; the present study sought to examine the validity of the substitution. For each substitution, paired-samples t tests were conducted between original VPA scaled scores and scaled scores obtained from the CVLT-II substitution to evaluate comparability. Similar comparisons were made at the index score level. At the index score level, substitution resulted in significantly lower scores for the AMI (p = .03; r = .13) but not for the IMI (p = .29) or DMI (p = .09). For the subtest scores, substituted scaled scores for VPA were not significantly different from original scores for the immediate recall condition (p = .20) but were significantly lower at delayed recall (p = .01). These findings offer partial support for the substitution. For both the immediate and delayed conditions, the substitution produced generally lower subtest scores compared to original VPA subtest scores.

This study investigated the ability of the Wechsler Memory Scale-4th Edition (WMS-IV) and the Advanced Clinical Solutions (ACS) package including the new Word Choice test (WCT) to distinguish poor performance due to intentional response bias among simulators of traumatic brain injury (TBI) from poor performance due to actual TBI. Participants were 45 survivors of moderate to severe TBI and 39 healthy adult coached to simulate TBI. Logistic regression indicated that a five-variable model containing all the ACS variables and a single-variable model using only the WCT were statistically reliable. Comparing predictive accuracy of each model found that adding the WCT to the ACS increased predictive accuracy. Diagnostic efficiency for the full ACS model was considered "excellent" according to interpretive guidelines.

This study evaluated the incremental utility of neuropsychological tests to computed tomography (CT) in predicting long-term outcomes of adults with moderate to severe traumatic brain injury (TBI). Participants were 288 adults with mild complicated, moderate, and severe TBI. Longitudinal data were evaluated during inpatient status in an urban rehabilitation hospital with a TBI Model System, as well as 1 and 2 years post injury. Predictors including demographic characteristics, injury severity, CT characteristics, and neuropsychological evaluations were regressed to outcomes of disability, life satisfaction, and employment at 1 and 2 years post injury. Prediction of life satisfaction was not improved with the use of CT characteristics or neuropsychological tests, but prediction of return to work was improved by these variables at 2 years post injury. Neuropsychological evaluations uniquely contributed to outcome predictions of functional disability, even after considering demographic and injury severity characteristics, including information from CT. In contrast, CT characteristics were not predictive of long-term functional disability at 1 or 2 years post TBI. Taken together, the findings indicate that neuropsychological tests add unique predictive information for long-term functional outcomes after TBI.

... Items with extremely high correlations (ie, Participation and Coopera-tion) but little incremental value were combined to decrease redundancy. ... 1. Overall performance 1.52 1.00 0.84 1.44 1.12 0.93 2. Participation/cooperation 1.63 0.98 0.81 1.69 1.20 0.94 ...

Conventional clinical neuroimaging is insensitive to axonal injury in traumatic brain injury (TBI). Immunocytochemical staining reveals changes to axonal morphology within hours, suggesting potential for diffusion-weighted magnetic resonance (MR) in early diagnosis and management of TBI. Diffusion tensor imaging (DTI) characterizes the three-dimensional (3D) distribution of water diffusion, which is highly anisotropic in white matter fibers owing to axonal length. Recently, DTI has been used to investigate traumatic axonal injury (TAI), emphasizing regional analysis in more severe TBI. In the current study, we hypothesized that a global white matter (WM) analysis of DTI data would be sensitive to TAI across a spectrum of TBI severity and injury to scan interval. To investigate this, we compared WM-only histograms of a scalar, fractional anisotropy (FA), between 20 heterogeneous TBI patients recruited from Detroit Medical Center, including six mild TBI (GCS 13-15), and 14 healthy age-matched controls. FA histogram parameters were correlated with admission GCS and posttraumatic amnesia (PTA). In all cases, including mild TBI, patients' FA histograms were globally decreased compared with control histograms. The shape of the TBI histograms also differed from controls, being more peaked and skewed. The mean FA, kurtosis and skewness were highly correlated suggesting a common mechanism. FA histogram properties also correlated with injury severity indexed by GCS and PTA, with mean FA being the best predictor and duration of PTA (r = 0.64) being superior to GCS (r = 0.47). Therefore, in this heterogeneous sample, the FA mean accounted for 40% of the variance in PTA. Increased diffusion in the short axis dimension, likely reflecting dysmyelination and swelling of axons, accounted for most of the FA decrease. FA is globally deceased in WM, including mild TBI, possibly reflecting widespread involvement. FA changes appear to be correlated with injury severity suggesting a role in early diagnosis and prognosis of TBI.

To examine the nature of agitation in patients with brain injury and quantify the relation between agitation and patient progress in rehabilitation. Cross-sectional, correlational. Urban, inpatient rehabilitation facility in the midwestern United States. Sixty-nine patients with acquired brain injury admitted to an acute rehabilitation hospital. Therapy Engagement using the Rehabilitation Therapy Engagement Scale; Functional Status using the Functional Independence Measure. Agitated behavior was inversely associated with engagement in rehabilitation therapy even after controlling for injury severity. Engagement in therapy mediated the relation between agitated behavior and progress in rehabilitation as assessed using a Functional Independence Measure efficiency ratio. Progress in acute brain injury rehabilitation appears to be meaningfully influenced by the complex interplay among injury severity, agitation, and engagement. The findings are consistent with a theoretical model, suggesting that agitated patients make less progress in rehabilitation not only because of greater injury severity but also because agitation disrupts engagement in rehabilitation therapies. Multiple clinical purposes may be better served by measuring behavioral excess on a continuum than in a dichotomous fashion.

Research on previous versions of the Wechsler Memory Scale (WMS) found that index scores could be predicted using a parsimonious selection of subtests (e.g., Axelrod & Woodard, 2000). The release of the Fourth Edition (WMS-IV) requires a reassessment of these predictive formulas as well as the use of indices from the California Verbal Learning Test-II (CVLT-II). Complete WMS-IV and CVLT-II data were obtained from 295 individuals. Six regression models were fit using WMS-IV subtest scaled scores-Logical Memory (LM), Visual Reproduction (VR), and Verbal Paired Associates (VPA)-and CVLT-II substituted scores to predict Immediate Memory Index (IMI) and Delayed Memory Index (DMI) scores. All three predictions of IMI significantly correlated with the complete IMI (r = .92 to .97). Likewise, predicted DMI scores significantly correlated with complete DMI (r = .92 to .97). Statistical preference was indicated for the models using LM, VR, and VPA, in which 97% and 96% of the cases fell within two standard errors of measurement (SEMs) of full index scores, respectively. The present findings demonstrate that the IMI and DMI can be reliably estimated using two or three subtests from the WMS-IV, with preference for using three. In addition, evidence suggests little to no improvement in predictive accuracy with the inclusion of CVLT-II indices.

Neuropsychological and psychosocial predictors of subjective well-being (SWB) were examined among 74 persons with multiple sclerosis (MS). The multidimensional construct of SWB was assessed by self-report measures of acute psychological distress, global life satisfaction, and health-related quality of life (HRQoL). Objective disease-related indices were obtained from medical records and neuropsychological testing. Unawareness of deficit, a frequent aspect of executive function impairments in MS, was measured as the discrepancy between patient self-report of functional abilities and a caregiver's report of the patient's abilities. Results indicate that a substantial proportion of patients experienced diminished SWB and that disease characteristics such as duration and severity have differential relationships to SWB outcomes. Multiple regression analyses indicated that, in the context of a combined predictive model, social support and unawareness of deficit provided unique information in predicting all three aspects of SWB, beyond that accounted for by disease characteristics. Both social support and unawareness of deficit were associated with positive well-being outcomes. Neuropsychological impairment was adversely related to life satisfaction and HRQoL, but it did not add unique information to the prediction of these outcomes. The findings present a unique view of SWB among individuals with MS in the absence of acute exacerbation of the illness.