The Modified Five-Point Test: normative data for a sample of Italian healthy adults aged 16-60.

The Five-Point Test is one of the various measures of figural fluency functions that have been developed as nonverbal analogues to word fluency tasks, and used in neuropsychological assessment to evaluate the ability to initiate and sustain mental productivity, and to self-monitor and regulate responding in the visual-spatial domain. The aim of the current study was to collect normative data for a version of the Five-Point Test (M-FPT) administered to a sample of Italian healthy adults aged 16-60 (n = 332). Performance on the M-FPT was scored by computing the cumulative number of unique designs (UDs) performed on a 3-min administration time. Two supplemental scores were also computed: (a) the cumulative strategies (CSs) consisting with the number of UDs incorporated into enumerative or rotational strategies; (b) the error index (ErrI), consisting with the percentage between the number of perseverative or rule-breaking errors and the number of designs overall. Multiple regression analyses revealed a significant effect of age and education, but not gender, for both UDs and CSs. Equivalent scores and cut-off scores were then determined for UDs and CSs. Descriptive statistical analyses and cut-off scores were reported for ErrI. The availability of normative data for the M-FPT will be valuable in clinical settings for assessing of executive dysfunctions on the visual-spatial subdomain of subjects with brain injury. However, in order to increase the usefulness of the test, the upper limits of the age range of the normative sample should be widened. Moreover, further analyses should be required for determining the inter-rater and test-retest reliability for M-FPT performances, and providing evidence of the sensitivity of this measure to brain disturbances generally and to frontal lobe dysfunction specifically.

Rehabilitation treatments for adults with behavioral and psychosocial disorders following acquired brain injury: a systematic review.

This review was aimed at systematically investigating the treatment efficacy and clinical effectiveness of neurobehavioral rehabilitation programs for adults with acquired brain injury and making evidence-based recommendations for the adoption of these rehabilitation trainings. Using a variety of search procedures, 63 studies were identified and reviewed using a set of questions about research methods, treatments, results and outcomes for the 1,094 participants. The 63 studies included treatments falling into three general categories: approaches based on applied behavior analysis, interventions based on cognitive-behavior therapy (CBT), and comprehensive-holistic rehabilitation programs (CHRPs). Considerable heterogeneity exists in the reviewed literature among treatment methods and within reported sample subjects. Despite the variety of methodological concerns, results indicate that the greatest overall improvement in psychosocial functioning is achieved by CHRP that can be considered a treatment standard for adults with behavioral and psychosocial disorders following acquired brain injury. Both approaches based on applied behavior analysis and CBT can be said to be evidence-based treatment options. However, findings raise questions about the role of uncontrolled factors in determining treatment effects and suggest the need for rigorous inclusion/exclusion criteria, with greater specification of theoretical basis, design, and contents of treatments for both interdisciplinary-comprehensive approaches and single-case methodologies.

Competitive re-employment after severe traumatic brain injury: clinical, cognitive and behavioural predictive variables.

PRIMARY OBJECTIVE: To contribute to the identification of relationships between the return to pre-trauma competitive activities at the final discharge from rehabilitation facilities, and neuroanatomical, neuropsychological and behavioural data collected at different phases of the recovery from a traumatic brain injury (TBI). METHODS AND PROCEDURES: Thirty-five severe TBI subjects were retrospectively selected from 228 consecutive admissions over a 3-year period, according to pre-morbid, clinical and demographic characteristics matching the established selection criteria, and submitted to comprehensive neurophysiological, intellectual, cognitive and behavioural examinations carried out at different stages of the recovery (acute, subacute and chronic phases). EXPERIMENTAL INTERVENTIONS: Barthel Activity of Daily Living (BADL) index, Wechsler Adult Intelligence Scale-Revised (WAIS-R), checklists aimed to detect cognitive and behavioural dysfunction. MAIN OUTCOMES AND RESULTS: TBI subjects successfully re-employed obtained significantly better scores on length of coma and PTA, intellectual status, cognitive functioning and behavioural competence. Other specific measures of injury severity (CT-scan abnormalities, GCS score level, BADL index) resulted as being unrelated to the resumption of pre-trauma competitive activities. CONCLUSIONS: Findings seem to confirm the opinion that a significant relationship exists between the initial TBI severity level, especially as indicated by the duration of coma and PTA, and eventual return to work at the final discharge from facilities.