Utility of a demographic equation in detecting impaired NART performance after TBI.

OBJECTIVES: This study applies a demographic regression equation devised by Crawford, Allan, Cochrane, and Parker (1990) to determine its utility in New Zealand, and to determine the proportion of persons with traumatic brain injury (TBI) with impaired performance on the National Adult Reading Test (NART). METHOD: The NART was administered to 80 community participants, 65 people with traumatic brain injury (TBI), and 27 orthopaedic controls. The Crawford et al. (1990) equation was applied to all three samples. RESULTS: The Crawford et al. (1990) equation was applicable in the New Zealand community sample. It was found that 30% of the TBI sample had impaired performance on the NART. Using corrected NART scores, a significantly larger proportion of the TBI sample was detected as intellectually impaired than in the control sample. CONCLUSION: Nearly one-third of the TBI sample evidenced impaired performance on the NART. Consequently, clinicians that use the NART in assessing people with TBI should use the demographic equation to check the accuracy of NART performances, and correct the NART scores if this is indicated.

Caregiver depression following traumatic brain injury (TBI): a consequence of adverse effects on family members?

Many studies have demonstrated that the behaviour of individuals with traumatic brain injury (TBI) predicts the emotional adjustment of their caregivers. The primary objective of the present study was to obtain an understanding of potential moderating and mediating variables between carer depression and analogous stressors. Seven sets of predictor variables (demographic variables, concurrent stressful life events, behavioural problems, social role problems, extent of adverse effects on family members, appraisal, and support) and the criterion variable of depression in caregivers were examined. Fifty-eight carers participated in the study at 6 months, 1 year, 2 years, or 3 years following injury. The number of adverse effects on family members (other than the informant) was the only stressor significantly related to carer depression. However, carer appraisal of adverse family effects was found to mediate the relationship between stressor and depression, and carer perception of support effectiveness was found to moderate the effect of adverse family effects on depression. Forty-six per cent of the variance in caregiver depression was accounted for by carers appraisal of adverse family effects and the interaction of adverse family effects and support effectiveness. These findings highlight the importance of supporting families as a whole in the rehabilitation of persons with TBI.

Priming deficits in patients with dementia of the Alzheimer type.

In a study that replicated the procedures used by Salmon et al. (1988), the effect on stem completion performance of two different semantic orientation tasks has been assessed in patients with Alzheimer's disease. Previously reported findings of impairment in repetition priming in Alzheimer patients were confirmed. Performance was not affected by the nature of the orientation task. No significant correlations were found between explicit and implicit memory tests. The results are discussed in the context of a hypothesized parallel decline in explicit and implicit memory systems.

Course of insight disorder and emotional dysfunction following closed head injury: a controlled cross-sectional follow-up study.

Closed-head injury (CHI) patients at either 6 months (n = 24), 1 year (n = 19), or 2 to 3 years (n = 23) postinjury, were compared with a group of orthopedic control (OC) patients (n = 27). CHI patients assessed at 6 months postinjury experienced a Post-Traumatic Insight Disorder, in which they underreported the severity of their behavioural impairments. CHI patients in the 1 year and 2 to 3 year follow-up groups evidenced both greater insight about their level of behavioural impairment, and higher levels of emotional dysfunction. These findings suggested that the return of insight is associated with increased risk for emotional dysfunction. Implications of these findings for assessment and treatment of closed-head injury patients are discussed.

Neuropsychological impairment and return to work following severe closed head injury: implications for clinical management.

AIMS: To study the rate and timing of return to work following severe closed head injury, and to compare the neuropsychological functioning of patients who successfully return to work with that of patients who fail to return to work. METHODS: The vocational status, level of cognitive functioning and personality functioning of a consecutive series of 66 patients who survived severe closed head injury was assessed between six months and three years postinjury. The level of cognitive and personality functioning of patients who returned to work were compared with that of patients who failed to return to work. RESULTS: Twenty five percent of patients failed to return to work, and a further 17% returned to work under special conditions of employment. Failure to return to work was related to the degree of neuropsychological impairment (cognitive deficit and adverse personality change), injury severity (duration of posttraumatic amnesia), and age. Multiple regression analysis found the total number of neuropsychological symptoms to be the strongest predictor of the patients' return to work. CONCLUSIONS: These findings suggest that neuropsychological symptoms are the main mechanism through which severe brain injury affects the ability to return to work. It is recommended that vocational rehabilitation of severe closed head injury patients be based on a comprehensive neuropsychological assessment.

Post-traumatic amnesia and Glasgow Coma Scale related to outcome in survivors in a consecutive series of patients with severe closed-head injury.

A consecutive series of 93 severe closed-head injury (SCHI) patients, discharged from hospital in a conscious state, were rated on the Glasgow Outcome Scale at 6 and 12 months post-injury. Patients were included in this study if they had a period of post-traumatic amnesia (PTA) exceeding 24 h. Approximately 80% of patients had made a good recovery by 12 months post-injury; a better outcome than has been found in studies using the presence of coma during the first 6 h post-admission to hospital to define severe head injury. When analysed individually, duration of PTA and Glasgow Coma Scale scores on admission to hospital were both strongly correlated with outcome. Only duration of PTA, however, contributed significantly to outcome variance when potential outcome predictors were assessed using a stepwise multiple regression analysis. The definition of severe head injury, the higher than usual incidence of good recovery in the present study, and the relationship between injury severity and outcome are discussed.

Direct and indirect memory performance in patients with senile dementia.

The performance of patients with a presumptive clinical diagnosis of Senile Dementia of the Alzheimer's Type was compared to that of a group of normal elderly on several memory and neuropsychological tasks. The patients were impaired on tasks of free and cued recall, but exhibited normal performance on a word-completion procedure similar to that used by Graf et al. (1984). Reasons for the discrepancy between these findings and those from related research which reports impairment of word completion in patients with Alzheimer's Disease are discussed. Of particular interest is the role the orientating task plays in word-completion performance.