Self-evaluation of driving simulator performance after stroke.

BACKGROUND AND PURPOSE: Despite the potential dangers associated with premature return to driving after stroke, very little research has examined the relationship between impaired self-awareness (ISA) and driving. This study examined self-awareness of driving simulator and neuropsychological performance among stroke patients, comparing them with healthy control participants. METHODS: Thirty stroke survivors and 30 controls each were asked for prediction and postdiction ratings of their performance on various driving simulator and neuropsychological tasks. Self-estimates versus actual performance discrepancy scores were calculated for various simulator and neuropsychological measures by converting scores to a shared metric. RESULTS: Across all measures, the stroke survivors greatly overestimated their performance in comparison with the accuracy of self-evaluations among the controls, thus suggesting ISA. This pattern of overestimating was observed on both novel (neuropsychological) and familiar (driving) tasks. However, there was some evidence to suggest that stroke survivors can benefit from feedback, as seen by increased accuracy in postdiction versus prediction self-evaluation scores. Both stroke survivors and controls also showed a greater shift toward accurate self-estimation on postdiction of driving performance than on postdiction of neuropsychological test performance. CONCLUSION: Although the temporal stability of the shift in awareness is not known, these results support the use of driving simulators as a useful and safe method of assessing and potentially improving stroke survivors' ISA.

Cognitive reserve in paediatric traumatic brain injury: relationship with neuropsychological outcome.

PRIMARY OBJECTIVE: The current study examined the relationship between neuropsychological performance and cognitive reserve (as measured by word reading and vocabulary tasks) in children with TBI. RESEARCH DESIGN: Retrospective records analysis of the neuropsychological test results of 52 participants with medically documented traumatic brain injuries, ranging from 6-16 years of age. MAIN OUTCOME AND RESULTS: Indicators of cognitive reserve were not correlated with the majority of well-recognized neuropsychological measures. CONCLUSIONS: Although past research has found that verbal ability is a valid indicator of CR in adult populations, the present study found evidence against the validity of this traditional reserve proxy when applied to the paediatric population. These findings suggest one of two conclusions: (1) measures used to indicate CR in adult populations (word reading, vocabulary) are not valid indicators of cognitive reserve in paediatric populations; and/or (2) the measures themselves are valid, yet there is simply not a significant relationship between cognitive reserve and short-term (i.e. less than 6 months) neuropsychological outcome in paediatric TBI.

Self-assessment of driving ability and the decision to resume driving following stroke.

The decision to resume driving after stroke can be complicated by the sequelae of stroke as well as the established finding that even healthy adults overestimate their driving ability. This study evaluated whether stroke survivors (n = 67) disproportionately overestimated their driving ability as compared to healthy significant others (n = 67). Comparison to a known target reduced self-bias among both groups, but shift toward enhanced accuracy was significantly greater among survivors than significant others. Additionally, self-bias may reflect a pervasive trait of cognitive ability, as overestimation of driving ability was paralleled on a cognitive estimation task. Use of a specific criterion can facilitate accurate self-ratings of driving ability among survivors; however, actual decisions regarding driving status may be unrelated to self-view.

The repeatable battery for the assessment of neuropsychological status (RBANS): clinical utility in a traumatic brain injury sample.

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998), a neuropsychological screening measure initially designed to assess the cognitive deficits associated with dementia, has since been clinically implemented with other neurological populations including traumatic brain injury (TBI). This study evaluated the clinical utility of the RBANS in a TBI population by comparing the profiles of 51 TBI cases and 34 non-head-injured controls. Across RBANS' Index Scores, the TBI group performed at a significantly lower level than the controls; sensitivity to TBI and likelihood ratios ranged from modest to strong; and specificity was high. Particularly efficacious was the clinical efficiency exhibited by the Total Scale Index (summary score) of the RBANS.

Cognitive estimation in traumatic brain injury.

The present study explores the construct and ecological validity of the Biber Cognitive Estimation Test (BCET) in a traumatic brain injury (TBI) sample. Participants completed the BCET in the course of a neuropsychological evaluation at 1-15 years after injury. BCET scores correlated moderately with other standard measures of executive functioning, and contrary to our hypotheses, at least as high with neuropsychological tests with minimal demands on executive functioning. Moreover, partialing out the portion of BCET variance not attributable to executive functioning markedly attenuated the former correlations. With respect to ecological validity, BCET scores did not predict concurrent functional status, as measured by the Disability Rating Scale. By comparison, standard measures of executive functioning strongly correlated with each other, correlated less strongly with nonexecutive functioning measures, and predicted functional status. In conclusion, unlike standard measures of executive functioning, the BCET demonstrated poor construct and ecological validity in TBI patients.

Reliability and validity of the RBANS in a traumatic brain injured sample.

The RBANS has become increasingly utilized in various populations since it reliably assesses individual neurocognitive domains in a rapid, efficient manner. The present study examined the convergent validity of the RBANS to frequently administered instruments in a moderate-severe traumatic brain injured (M-S TBI) sample. Fifty-seven individuals who sustained a M-S TBI were included in this study. The RBANS subtests showed moderate to strong internal reliability within the sample. Most of the subtests displayed moderate to strong correlations with the other neuropsychological tests, including the CVLT-II, COWAT, and WAIS-III subtests. The strongest correlations were within the RBANS Attention Index, with both the Digit Span and Coding subtests showing strong correlations with their WAIS-III counterparts. The RBANS measures distinct abilities that supplement other neuropsychological instruments that assess similar functions within a TBI sample. In addition to its administration advantages, the results of this study provide support for the use of the RBANS as a clinical valid and reliable tool in the brief screening of individuals with M-S TBI.