Assessment of feigned cognitive impairment in severe traumatic brain injury patients with the Forced-choice Graphics Memory Test.

INTRODUCTION: The Forced-choice Graphics Memory Test (FGMT) is a newly developed measure to assess feigned cognitive impairment. This study investigated the ability and reliability of FGMT for identification of malingering in patients with traumatic brain injury (TBI). METHODS: The FGMT was administered to 40 healthy volunteers instructed to respond validly (Healthy Control, H-C), 40 healthy volunteers instructed to feign cognitive impairment (Healthy Malingering, H-M), 40 severe TBI patients who responded validly (TBI control, TBI-C), and 30 severe TBI patients who evidenced invalid performance (TBI malingering, TBI-M). RESULTS: Both malingering groups (H-M and TBI-M) performed much more poorly than the nonmalingering groups (H-C and TBI-C). The FGMT overall total score, score on easy items, and score on hard items differed significantly across the four groups. The total score showed the highest classification accuracy in differentiating malingering from nonmalingering. A cutoff of less than 18 (total items) successfully identified 95% of TBI-C and 93.3% of TBI-M participants. The FGMT also demonstrated high test-retest reliability and internal consistency. FGMT scores were not affected by TBI patients' education, gender, age, or intelligence. CONCLUSION: Our results suggest that the FGMT can be used as a fast and reliable tool for identification of feigned cognitive impairment in patients with TBI.

Effort in acute traumatic brain injury: considering more than pass/fail.

PURPOSE/OBJECTIVE: Performance validity is often conceptualized as a dichotomous process. Effort likely lies on a continuum, however, and psychologists' tendency to rely on pass/fail descriptors of one's effort may not be the only approach. The current study aims to show that when performance validity is considered on a continuum, it may provide clinical information related to cognitive functioning. RESEARCH METHOD/DESIGN: Forty-four patients with moderate or severe traumatic brain injury were evaluated with the Repeatable Battery for the Assessment of Neuropsychological Status upon their emergence from posttraumatic amnesia. From this data, previously developed effort index scores and "other cognitive functions" index scores were calculated. RESULTS: Performance on the effort index significantly accounted for the patients' performance on a cognitive composite score after considering education and severity of injury. CONCLUSIONS/IMPLICATIONS: Findings suggest that more in-depth analysis of validity test performance is beneficial to gauge a patient's level of effort and is important to consider when interpreting results and in 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 (ß = - 0.365, p < 0.007) and Total Score (ß = -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.

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 traumatic brain 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 improving social communication abilities through phone contacts and joint participation in social events within the community over a 3-month period. 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 SPM and PP participants reported high satisfaction with the mentoring program. Statistically significant improvements in perceived social support after mentoring were observed for the mentored group than for WL participants; however, an increase in depressive symptoms was also observed. While significant improvements in social activity level and social network size were not found, a trend toward increased satisfaction with social life was present for mentored participants. CONCLUSIONS: Satisfaction ratings for the SPM program were uniformly high and selected positive findings encourage further investigation of social mentoring as an intervention to effect improvements in social integration. Small sample size and reduced "dosage" of mentor interactions were limitations of this pilot study. Benefits of and challenges to implementation of an SPM program are outlined.

Changes in supervision needs following participation in a residential post-acute brain injury rehabilitation programme.

OBJECTIVE: Supervision needs typically increase following moderate-to-severe traumatic brain injury (TBI). Research assessing the impact of TBI residential rehabilitation programmes on supervision needs is limited. RESEARCH DESIGN: Prospective cross-sectional study. METHODS AND PROCEDURES: Ninety-four participants with moderate-to-severe TBI admitted to a post-acute brain injury rehabilitation programme (PABIR) were administered the supervision rating scale (SRS) at admission and at 1 month post-discharge. To account for spontaneous neurological recovery, patients were separated into those who were less than 1 year (L1Y, n = 55) or greater than 1 year (G1Y, n = 39) post-injury. EXPERIMENTAL INTERVENTION: None. MAIN OUTCOMES AND RESULTS: A mixed factorial design yielded a significant interaction (F(1, 92) = 18.2; p < 0.0001) with post-hoc results revealing that the L1Y group improved more dramatically in terms of supervision needs than the G1Y group. Using reliable change methodologies, 52.7% of the L1Y demonstrated decreasing scores on the SRS vs 20.5% of the G1Y group. CONCLUSIONS: Decreases in supervision needs following PABIR can be found, even after accounting for the impact of spontaneous neurological recovery both at the group and individual level.

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.

Concurrent counting and typing: lateralized interference depends on a difference between the hands in motor skill.

In previous demonstrations of differences between left- and right-handers in dual-task performance, participants' hand preference has been confounded with asymmetry of manual skill. The present study was designed to disentangle those two factors as sources of lateralized interference in the concurrent-task paradigm. Forty-eight normal adults (24 females and 24 males) counted backward by ones or by twos while typing an easy or difficult sequence of letters with either hand. When participants were grouped according to self-reported hand preference, both groups showed bilaterally symmetric slowing, relative to single-task conditions. However, when the same participants were grouped according to manual asymmetry in the baseline condition, the cognitive task interfered significantly more with the faster hand than with the slower hand. Baseline typing rate, averaged across hands, did not influence dual-task interference. Both self-reported left-hand preference and left-hand superiority in baseline typing were associated with reduced interference on the cognitive task, and the reduced interference in those groups seemed to reflect relatively loose coupling between manual and cognitive tasks. The results support and extend Caroselli et al.'s (1997) findings regarding the effect of baseline manual asymmetry on the pattern of dual-task interference. Irrespective of the participant's hand preference, the presence or absence of baseline asymmetry may be sufficient to determine whether dual-task interference is lateralized.

Dual-task interference in right- and left-handers: typical laterality patterns are obtained despite reversal of baseline asymmetries.

Lateralized interference between concurrent cognitive and manual activities is used to infer cerebral hemisphere specialization for the cognitive activity. However, some evidence indicates that lateralized interference depends largely on manual asymmetry in the single-task (baseline) condition. To test the competing explanations, we asked 40 right-handed (RH) and 40 left-handed (LH) adults to key press and calculate concurrently. Baseline manual asymmetries were manipulated by increasing the complexity of the task performed by the dominant hand. Nevertheless, in the dual-task conditions, RHs showed more overall interference when performing with the right hand and LHs showed a nonsignificant tendency in the opposite direction. The results indicate that differential interference patterns, similar to those previously reported for right- and left-handers, may be obtained even when the usual baseline manual asymmetries are reversed.

Relationship of family functioning to progress in a post-acute rehabilitation programme following traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the relationship of family functioning to patients' progress in a post-acute TBI rehabilitation programme. RESEARCH DESIGN: Cohort study investigating predictors of change from admission to follow-up. METHODS AND PROCEDURES: Caregivers of 37 persons with severe TBI consecutively admitted to a residential post-acute rehabilitation facility completed the Family Assessment Device (FAD) within a few weeks of admission. The Disability Rating Scale (DRS) was completed upon admission and approximately 1 month after discharge. FAD scores were used to predict DRS change scores after controlling for injury severity, admit FAD scores, and time from admission to follow-up. MAIN OUTCOMES AND RESULTS: Persons with unhealthy family functioning showed less improvement on DRS total, level of functioning (LOF), and employability (EMP) scores. CONCLUSIONS: The results emphasize that family functioning is an important variable to include in future models predicting rehabilitation outcome, and the importance of family intervention as part of the rehabilitation process.

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.