The symbol trail making test: test development and utility as a measure of cognitive impairment.

Although the Trail Making Test (TMT) has proven to be an exceptional clinical tool, its applications have been limited by the instrument's use of the Arabic numeral system and Latin alphabet. Clearly an instrument not limited by a specific alphabet or numerical system could fill this void. This study presents the development and validation of an alternative to the TMT that offers modestly similar psychometric properties and can be used with populations that have no familiarity with the Arabic numerical system or a specific alphabet. The Symbol Trail Making Test (STMT), which employs symbols that are not language or numerically based was administered to a normative sample of 210 participants, including 54 individuals whose first language was not English, for the purpose of collecting normative data. Reliability, assessed through an alternate form administration, and convergent validity, assessed through correlation with the TMT in a nonpatient sample, was deemed acceptable. Significant discriminant validity was obtained comparing non-brain-injured patients to brain-injured patients, particularly on time measures. An analysis of variance found no significant difference between native English speakers and individuals speaking English as a second language on performance on the STMT. This preliminary study provides evidence that the STMT is a clinically useful instrument for discriminating brain-injured from non-brain-injured participants without employing a specific culture-bound symbol system.

A correction procedure for the Minnesota Multiphasic Personality Inventory-2 for persons with spinal cord injury.

OBJECTIVE: To develop a procedure that adjusts scoring of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) for the items related to spinal cord injury (SCI) that skew interpretations with this population, and to assess the accuracy of interpretations resulting from this procedure, standard MMPI-2 scoring, and a previously offered procedure. DESIGN: A criterion study with masked comparisons. SETTING: Hospital inpatient physical medicine and rehabilitation unit. PATIENTS: Thirty-four SCI patients between the ages of 18 and 77 years, 19 with complete SCI and 15 with incomplete SCI. OTHER PARTICIPANTS: Twenty-one nurses, 23 physicians, and 17 psychologists. MAIN OUTCOME MEASURES: Masked MMPI-2 profiles, judged by clinicians for accuracy. Paired t tests comparing profile scales. RESULTS: A correction procedure was arrived at for the MMPI-2 and MMPI-A incorporating adjustments for physical complaints frequently arising from SCI. The new procedure was judged superior to both the standard procedure and the previously offered procedure. Paired t tests of MMPI-2 scales showed that differences from scoring procedures were significant with many scales measuring significance at the p < .0001 level. CONCLUSIONS: Statistically significant changes in MMPI-2 profiles occur when somatic complaints related to SCI are corrected for. Preliminary results suggest that the application of the new correction procedure increases clinical accuracy.

Paper or plastic: another ecological consideration in neuropsychological assessment.

The high volume of paper involved in the generation of neuropsychological evaluations has implications for the environment, for the cost of providing services, and for the space required to store records. One solution is to insert single-use test forms into plastic sheet protectors and provide the test taker with a fine-tipped washable marker. This study investigated whether this modification in test administration practice affects performance. Comparisons were made for 6 different neuropsychological tests. No significant differences in performance were found when comparing standard administration practice to this more ecologically minded alternative.