Relationship between neuropsychological test performance and productivity at 1-year following traumatic brain injury.

While there has been strong evidence for the ability of neuropsychological performance at resolution of posttraumatic amnesia to predict later productivity, there has been less conclusive evidence for the relationship of neuropsychological test scores to concurrent productivity status. The purpose of the current study was to evaluate the relationship of neuropsychological test performance at 1 year post-injury to productivity assessed at the same time point. Participants were 518 persons with medically documented TBI who were enrolled in the TBI Model Systems Research and Demonstration Project. Stepwise logistic regression was utilized to determine the contributions of neuropsychological test scores to productivity after accounting for demographic characteristics, injury severity, and pre-injury productivity. Missing neuropsychological test scores were accounted for in the model. Variables that remained in the model and accounted for a significant proportion of the variance included age, duration of impaired consciousness, pre-injury productivity, and scores on measures of GOAT, Logical Memory II, and Trail Making Test, part B. The results indicate that neuropsychological test performance provides important information regarding the ability of persons with injury to return to productive activities. The results also indicate that inability to complete neuropsychological tests at 1 year post-injury is associated with non-productive activity.

Interhemispheric transfer in children with heavy prenatal alcohol exposure.

BACKGROUND: Prenatal alcohol exposure has long been associated with alterations in brain structure and behavioral changes. The corpus callosum can be affected by heavy prenatal alcohol exposure, and agenesis (absence) of this structure occurs more often in children with fetal alcohol syndrome than in the general population or in other developmentally delayed populations. Although the majority of children with fetal alcohol syndrome do not have agenesis of the corpus callosum, callosal area is reduced in this population, particularly in the anterior and posterior regions. However, the functional implication of these size reductions has not been examined. METHODS: The current study used a finger localization task to measure the transfer of information across the corpus callosum in children and adolescents with histories of heavy prenatal alcohol exposure and age- and sex-matched controls. In a subset of children, correlational analysis was also conducted between behavioral data and cross-sectional area of the corpus callosum. RESULTS: When compared with nonexposed controls, alcohol-exposed children made more errors on trials for which information had to cross the corpus callosum ("crossed" trials) than on trials for which it did not ("uncrossed" trials), and they also made more errors as the task increased in complexity. Additionally, correlations with magnetic resonance imaging data in a subset of children revealed that impairment in interhemispheric transfer was related to reductions in the size of the corpus callosum. These correlations were independent of effects expected from the relationship between corpus callosum size and general intellectual functioning alone. CONCLUSIONS: These findings suggest that children with heavy prenatal alcohol exposure display subtle deficits in the interhemispheric transfer of information in the somatosensory domain. Such deficits in interhemispheric transfer are likely to be related to the myriad of other behavioral and cognitive impairments observed in these children.

Acquisition and retention of verbal and nonverbal information in children with heavy prenatal alcohol exposure.

BACKGROUND: Memory deficits are reported commonly in children with fetal alcohol syndrome. However, little is known about nonverbal memory performance in this population. METHODS: The current study examined learning and memory abilities in alcohol-exposed children and nonexposed controls. Multiple verbal and nonverbal measures were used that incorporated repeated learning trials and delayed recall trials. The alcohol-exposed group included children with heavy prenatal alcohol exposure with and without fetal alcohol syndrome. Children ranged in age from 8 to 16 years, and groups were matched on age, sex, ethnicity, and socioeconomic status. RESULTS: Children with heavy prenatal alcohol exposure displayed deficits in learning and recall of verbal and nonverbal information across all measures. On learning trials, they recalled fewer words and displayed a lower rate of acquisition. However, when we analyzed delayed verbal recall data after controlling for initial verbal learning, group differences were not apparent. The same pattern did not occur for nonverbal information; children with prenatal alcohol exposure recalled less on delayed recall even when we accounted for initial learning. CONCLUSIONS: These data are consistent with previous studies that indicate immediate memory deficits but suggest that, at least for verbal information, delayed recall deficits in this population are better accounted for by deficits in initial learning. Importantly, a different pattern of results was demonstrated for verbal versus nonverbal information, which suggests the need for additional research in this area.

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.