The Italian version of the Mayo-Portland Adaptability Inventory-4. A new measure of brain injury outcome.

AIM: The assessment of major obstacles to community integration which may result from an acquired brain injury (ABI) is needed for rational planning and effective management of ABI patients' social adjustment. Currently, such a generally acceptable measure is not available for the Italian population. This paper reports the translation process, the internal consistency, and the inter-rater reliability data for the Italian version of the Mayo-Portland Adaptability Inventory-4 (MPAI-4), a useful measure with highly developed and well documented psychometric properties. The MPAI-4 is specifically designed to assess socially relevant aspects of physical status and cognitive-behavioural competence following ABI. It is a 29-item inventory which is divided into three subdomains (Abilities, Adjustment, and Participation indices) covering a reasonably representative range METHODS: Twenty ABI patients with at least one-year discharge from the rehabilitation facilities were submitted to the Italian MPAI-4. They were independently rated by two different rehabilitation professionals and a family member/significant other serving as informant (SO). Internal consistency was assessed by calculating the Cronbach's alpha values. Inter-rater agreement for individual items was statistically examined by determining the interclass correlation coefficient (ICC). RESULTS: In addition to the 8% of perfectly correspondent sentences, a clear prevalence (75.5%) of minor semantic variations and formal variations with no semantic value at the sentence-to-sentence matching was found. Full-scale Cronbach's alpha was 0.951 and 0.947 for the two professionals (rater #1 and rater #2, respectively), and was 0.957 for the family member serving as informant (rater #3). Full-Scale ICC (2.1) between professionals and SOs was 0.804 (CI=95%; lower-upper bound=0.688-0.901). CONCLUSIONS: The Italian MPAI-4 shares many psychometric features with the original English version, demonstrates both good internal consistency and good inter-rater reliability. The MPAI-4 confirms to be suitable for research applications in postacute settings as an efficient, broad and inclusive outcome measure for adult subjects with ABI.

Adverse effects of apathy and neurobehavioral deficits on the community integration of traumatic brain injury subjects.

AIM: The aim of this study was to provide insight into the adverse effects of neurobehavioral features on the community integration of young adults who have had prior severe traumatic brain injury (TBI) with a positive long-term outcome in either functional or intellectual abilities. TBI subjects were compared with patients suffering from a health condition classified as mild intellectual disability (MID). METHODS: Twenty-five subjects with prior severe TBI, but with substantially normalized perceptual-motor and intellectual functioning, were retrospectively selected according to demographic and clinical admission criteria. The TBI subject group was compared with a selected group of 34 MID subjects. The measures used were: the Wechsler Adult Intelligence Scale-Revised (WAIS-R), Instrumental Activity of Daily Living Scale (IADLS), Community Integration Questionnaire (CIQ), and Social Behaviour Check-list (SBC). The presence/absence of dysfunctional family environment and affective close relationships were also reported. RESULTS: Significant differences between TBI and MID subjects (with greatest scores in TBI group) refer to: WAIS-R Full Scale IQ (FSIQ, indicating an average intellectual level), CIQ-Social integration (indicating a greater level than MID group), and SBC-Defective-type behaviour (indicating a greater level of apathy than MID group). CONCLUSION: Defective-type behaviour--synthesized into the term apathy' has the following features: 1) can explain the unsatisfying community integration of TBI subjects with respect to the general population; and 2) best explains the similar CIQ-home integration and CIQ-productive activities compared to subjects presenting a higher intellectual disadvantage (MID patients). The multidisciplinary approach to the complex community integration process of TBI subjects might consider the high frequency of apathy as a primarily target of the community integration management.

Traumatic brain injury in childhood: intellectual, behavioural and social outcome into adulthood.

In order to obtain indicative data regarding intellectual, behavioural and social outcome into adulthood of subjects with a history of childhood head injury (CHI), twenty adults were selected who had been referred to the Neuropsychology Unit at the University of Parma at the time of a traumatic brain injury (TBI) at an age between 8 and 14 years. The level of intellectual and behavioural impairment was determined and rated by WISC and WAIS IQa and by the frequency of maladjustive behaviour. GOS score and Barthel index were used to detect the level of disability. Social adjustment and community integration were determined by the Social Adjustment Scale (SAS) and the Community Integration Questionnaire (CIQ) respectively. Results indicate that (1) subjects who suffer a severe CHI present a higher pre-injury incidence of character disturbances than the normal population and injury-related difficulties to socialize which persist long-term and add to other problems; (2) even though intellectual and functional sequelae are frequent in these children in adulthood and do not improve in their correlation to age, these do not appear to be the prevailing problems and (3) the prevailing problems seem to be social maladjustment and poor quality of life, which are still present several years post-injury and seem to be related to behavioural and psychosocial disorders in spite of an increased ADL-functioning. This has already been clearly demonstrated in the case of adulthood trauma.

Post-concussive syndrome: paraclinical signs, subjective symptoms, cognitive functions and MMPI profiles.

In order to investigate the organic and psychogenic components of post-concussive syndrome (PCS), the subjective complaints, the cognitive findings and the Minnesota Multiphasic Personality Inventory (MMPI) profiles of 53 consecutive mild head injury patients (MHI) with persistent PCS were evaluated. The results seem to suggest the presence of two groups: in the first, minimal lesional signs were associated with more prolonged loss of consciousness (LC) and post-traumatic amnesia (PTA), as well as an MMPI profile not indicative of a neurotic state, whereas in the second the absence of any lesional sign was associated with shorter LC and PTA duration, as well as evidence of neurotic MMPI scores. A female prevalence was observed in the first group and a male prevalence in the other one.

Head-injured subjects aged over 50 years: correlations between variables of trauma and neuropsychological follow-up.

Neuropsychological follow-up was studied in 70 consecutive head-injured subjects aged over 50 years. Diffuse deterioration (28%), moderate deterioration (25%) and dementia (21%) were the most frequent sequelae. Analysis of correlations between neuropsychological sequelae and trauma variables showed that: (1) mild trauma did not necessarily imply good prognosis and could be followed by very severe consequences; (2) duration of post-traumatic amnesia was correlated with coma duration but not with neuropsychological outcome; (3) on the whole, no prognostic predictor of the outcome was found.

Hemispheric prevalence changes in partial epileptic patients on perceptual and attentional tasks.

In relation to the general issue of the long-term effects of epileptic activity on the higher nervous functions, monohemispheric epileptic patients--divided into "lesional" [i.e., with computed tomography (CT) scan-visible lesions] and "nonlesional" (i.e., with CT scan-nonvisible lesions)--were submitted to dichotic verbal and tonal tasks, dichoptic verbal and spatial tasks, and a visual tachistoscopic attentional task. The aim was to investigate whether the typical patterns of hemispheric prevalence, which were observed in normal subjects by using these tests, undergo significant changes in epileptic patients. The findings versus normal subjects seem to demonstrate that (a) in lesional epileptic patients, the prevalence of the hemisphere without macroscopic lesions is a constant rule, whether or not this hemisphere is prevalent in normal subjects; (b) in nonlesional epileptic patients, the patterns are the following: when the epileptic hemisphere is the one that is prevalent in normal subjects, its prevalence is enhanced, whichever the hemisphere; when the epileptic hemisphere is not the hemisphere prevalent in normal subjects, the left one attracts and maintains prevalence, whereas the right one reduces and variously interferes with contralateral prevalence. It is concluded that, with respect to the functions tested, the nature of the epileptic foci seems to influence markedly the interhemispheric prevalence pattern.

[Neuropsychologic and behavioral sequelae of cranial injuries: remarks on classification, diagnosis and correlation with injury variables]. / I postumi neuropsicologici e comportamentali dei traumi cranici: osservazioni sulla classificazione, sulla diagnostica e sulle correlazioni con le variabili del trauma.

The psychological and behavioural impairment following head injury has been investigated in order to throw light on and assess the related epidemiological aspects, methodological approaches, clinical manifestations, and the correlations between the sequelae and the variables of head trauma, i.e. degree of severity of trauma, age of patients, presence or absence of fractures and haematoma. This study was conducted on 117 head- injured patients and 43 matched "control" subjects. The findings point out the following: a) Even the medical staff is often largely misinformed about this type of sequelae. The methods used for assessment should therefore be further developed and a more systematic evaluation of the higher functions following head injury appears to be necessary. b) The syndromes observed are mostly of a composite and diffuse type. It is therefore difficult to classify them according to strict criteria; indeed, it appears that the only possible approach is to define large groups of head- injured patients based on clinical description, which are partly borne out and partly described ex novo in the present series. c) As regards the correlations between the variables of the injury and the resulting neuropsychological impairment, the age factor should be distinguished from the severity of injury. If it is true that the older patients, the greater the impairment, such a direct correlation no longer exists when severity of the injury is considered. Indeed, the latter does not appear to be a significant differential factor in determining the degree of impairment. Similarly, whether the injury is an "open" or "closed" one, or the presence of haematoma do not appear to be differential factors, either.

Hemispheric prevalence in acoustical attention.

Two experiments were conducted in which monaural clicks were presented to the right or left ear preceded by binaural verbal (Experiment 1) and musical (Experiment 2) warnings. After the "neutral" warnings, the clicks could be presented to the right or left ear equally often (50%); after the warnings which directed the attention to the left or right ear, the clicks could be presented to either the "expected" (67%) or to the "unexpected" (33%) ear. In Experiment 1 there was a cost effect for the "unexpected" ear and reaction times were significantly faster when the clicks were presented to the right ear. In Experiment 2, the musical warnings brought about a cost effect while no significant ear advantage was observed.

[Lateralization of attention in the acoustic modality]. / Lateralizzazione dell'attenzione per la modalità acustica.

Posner reported that knowledge of where in space a visual stimulus will occur ("expected" condition), improves detection ("benefit"), as measured by response latencies, while response latencies became longer ("cost") when visual stimulus position is "unexpected" and intermediate when the visual stimulus position is "neutral". The authors have tried to replicate this finding in the acoustical modality. One hundred-twenty acoustical stimuli (clicks) were presented to the right and the left ear of ten right handed subjects, preceded by the biaural verbal warnings "right", "left" or "center". After the "center" verbal warning, the clicks could be presented to the right or the left ear equally often (50%): "neutral" condition; after the "right" or "left" verbal warnings, the clicks could be presented in 80% of cases to the "expected" ear and in 20% of cases in "unexpected" ear. The results suggested that: a) reaction times are significantly faster when the clicks are presented to the right ear; b) the "cost" effect is present but not the "benefit" effect, since no difference was shown between reaction times in the "neutral" and in the "expected" conditions; c) the right ear advantage disappears in the "unexpected" condition after the "right" verbal warning only. The authors discuss the results in relation to the attentional interhemispheric theories.

Hemispheric dominance in the perception of tonal sequences in relation to sex, musical competence and handedness.

Sixty right-handed non-musician subjects, thirty males and thirty females, and thirty right-handed musician subjects, seventeen males and thirteen females, were submitted to dichotically presented tonal sequences. Immediate identification procedure with preliminary training was used. The results point out that both, musicians and non-musicians, males and females, show significant left ear dominance. The left ear dominance was more frequent in musicians. The results are discussed in the light of the "analytic-synthetic" theory of Bever and Chiarello and the "temporal" theory of Gordon.

[The effect of Deanol on amnesic disorders. A preliminary trial (author's transl)]. / Gli effetti del Deanol nelle sindromi amnesiche. Dati preliminari.

Twenty-one patients showing memory deficits were submitted to neuropsychological battery, before and after treatment with Deanol. No significant effect has been found. Arguments suggesting further investigation are discussed.