Impact of demographic and medical factors on satisfaction with life after spinal cord injury: a normative study.

OBJECTIVE: The aim of this study was (1) to examine demographic and medical predictors of the Satisfaction With Life Scale (SWLS) among individuals with spinal cord injury (SCI) and (2) to provide a normative table for the SWLS that includes appropriate adjustments for the most important predictors of life satisfaction. STUDY DESIGN: We examined predictors of the SWLS including age, education, sex, race, injury duration, number of rehospitalizations, marital status, employment status, SCI etiology, and level of neurological impairment. PARTICIPANTS: Individuals in the National Spinal Cord Injury Statistical Center database [from 18 SCI model systems (1995-1999)] undergoing follow-up assessment were included for study. OUTCOME MEASURE: Satisfaction With Life Scale. RESULTS: Univariate analyses indicated that marital and employment status, race, sex, education, and injury duration were significant factors associated with scores on the SWLS. In general, individuals who were female, white, married, and currently employed and had a higher education and longer injury duration reported significantly higher scores on the SWLS (P < .01). Effect-size estimates for these factors ranged from 0.16 to 0.41. Regression analyses showed that education, employment status, and injury duration were the strongest unique predictors of satisfaction with life but accounted for only 10% of the variance. CONCLUSION: The SWLS is a global measure of life satisfaction and is relatively unrelated to demographic and medical characteristics. Normative tables are provided for epidemiologic comparison.

Validity of the Orientation Log, relative to the Galveston Orientation and Amnesia Test.

OBJECTIVE: To establish the validity of the Orientation Log (O-Log) by comparison with the Galveston Orientation and Amnesia Test (GOAT). DESIGN: Correlation of daily measures of orientation. SETTING: Acute rehabilitation hospital. SUBJECTS: Sixty-eight inpatients receiving rehabilitation following traumatic brain injury (TBI). PRIMARY MEASURES: The O-Log and GOAT. RESULTS: There was a significant correlation between the GOAT and O-Log (r = .901, P<.001). A cutoff of 25 on the O-Log was found to be comparable with the 75 cutoff on the GOAT. The scales were equivalent in measuring duration of posttraumatic amnesia. CONCLUSIONS: The O-Log is a valid measure of orientation for people with TBI and offers some advantages in administration over the GOAT.

Cognitive orientation in rehabilitation and neuropsychological outcome after traumatic brain injury.

This study evaluated the ability of the Orientation Log (O-Log) to predict cognitive outcome at rehabilitation discharge, as well as future neuropsychological outcome. The hypothesis was that patients who demonstrated better orientation upon admission would achieve superior functional cognitive outcome at discharge and on subsequent neuropsychological assessment. Sixty individuals receiving inpatient rehabilitation following a new-onset TBI participated. Orientation data was collected using the O-Log during morning bedside rounds. Outcome data was collected at 6 and 12 months post-injury. Significant correlations were found between the O-log and measures of memory, executive functioning, basic verbal skills, and estimated intellectual ability. When compared to the other predictor variables, step-wise multiple regression analyses revealed that the minimum O-Log score was the primary significant predictor of performance on six neuropsychological and functional outcome measures. Results of this study suggest that evaluating orientation with the O-Log during acute rehabilitation may reflect level of injury severity and aid in predicting cognitive outcome.

Cognitive consequences of coexisting temporal lobe developmental malformations and hippocampal sclerosis.

OBJECTIVE: To characterize patterns of cognitive functioning in a well-defined group of patients with MRI-identified coexisting left temporal lobe developmental malformations (TLDM) and mesial temporal sclerosis (MTS), and to examine neuropsychological outcome in this dual-pathology group following epilepsy surgery. METHODS: Cognitive functioning in patients with left TLDM and MTS (n = 15) was compared with patients with isolated left MTS (n = 40). TLDM and MTS were identified by high-quality MRI protocol. Patients were administered a battery of neuropsychology tests as part of their presurgical workup for possible epilepsy surgery. Unilateral temporal lobe resection was performed on 10 of the dual-pathology patients and 34 of the isolated MTS patients. Postoperative cognitive performance was also assessed. RESULTS: Both groups displayed impairments in verbal and visual memory, language, and academic achievement. Performance on measures of psychometric intelligence, executive function, and attention were not impaired and were similar between groups. Presence of dual pathology was associated with a significantly less efficient verbal encoding strategy on the word list learning task. Postoperatively, declines were noted for both groups across tasks of verbal memory and language. Groups were not different significantly in terms of neuropsychological outcome after surgery. CONCLUSION: Patients with coexisting TLDM and MTS have impaired cognitive functioning similar to MTS patients-in particular, with regard to episodic memory and language deficits. Temporal lobe resection produces similar cognitive changes in both groups.

Effective serial measurement of cognitive orientation in rehabilitation: the Orientation Log.

OBJECTIVE: To introduce a brief quantitative measure of cognitive orientation (to place, time, and situation) developed for daily use at bedside with rehabilitation inpatients. The Orientation Log (O-Log) is a 10-item scale that allows for partial credit based on responsiveness to logical, multiple-choice, or phonemic cueing. It is formatted for rapid visual analysis of orientation trends that can be used to evaluate pharmacologic and cognitive-behavioral interventions. DESIGN: Descriptive study of the O-Log's reliability (interrater and internal consistency). SETTING: Inpatient rehabilitation center affiliated with a large university medical school. PATIENTS: Fifteen neurorehabilitation inpatients. RESULTS: For individual items, Spearman rho interrater reliability coefficients ranged from .851 to 1.00. The interrater reliability of the total score was .993. O-Log internal consistency (coefficient alpha) was .922. CONCLUSIONS: The O-Log is a reliable and easily administered scale that promises to be a useful tool in monitoring cognitive recovery during rehabilitation.

Profiles of cognitive functioning in chronic spinal cord injury and the role of moderating variables.

A traumatic spinal cord injury (SCI) is accompanied by a documented moderate to severe head injury in significant numbers of SCI patients. In a previous study (Dowler et al., 1995), cognitive deficits were found in 41% of the SCI individuals who were studied with a chronic injury from a traumatic event. The present study investigated whether clinically useful subtypes of normal and impaired cognition could be identified in a chronic (M = 17 years postinjury) SCI sample using a cluster analysis of neuropsychological test performance. A battery of 16 neuropsychological tests was administered to 91 SCI patients and 75 control participants. Composite scores, reflecting performance in different cognitive domains, were derived from a factor analysis of the battery, and these scores were then used in the cluster analysis. A six-cluster solution generated the most distinct and clinically relevant SCI group profiles. Two of the cognitive profiles were characterized by normal functioning in all cognitive domains, but they were distinguished by differences in performance levels. The remaining four SCI groups (60% of the sample) showed clinically significant deficits in one or more cognitive domains, with different groups showing moderate attention and processing speed deficits, mild deficits in processing speed, executive processing difficulties, or moderate memory impairments. Though age and premorbid intellectual ability were strong predictors of the cognitive profiles of some SCI groups, when these factors were controlled, the findings suggested that the patterns of cognitive impairment were likely due to a potential concomitant head injury.

Neuropsychological functioning following a spinal cord injury.

Studies indicate that 10-60% of the spinal cord injury (SCI) population retains residual cognitive deficits following the injury. However, previous studies have not used a comprehensive neuropsychological battery and/or a well-matched control group. In addition, no study has determined if cognitive deficits continue more than one year after injury. The present study addressed these limitations by comparing the performance of a chronic SCI group (Mean = 17 years post-injury) and a well-matched control group in four cognitive areas. Memory, visuospatial skills, attention/executive functioning, and processing speed were assessed. Results from a discriminant function analysis indicated that information processing speed best differentiated between the SCI and control groups. Twenty-nine percent of the SCI group performed 1 to 2 standard deviations below the control group mean. These results could not be attributed to psychological status or history of alcohol consumption. The findings emphasize the importance of neuropsychological evaluation after SCI.

Host associations of ticks (Acari: Ixodidae) parasitizing medium-sized mammals in a Lyme disease endemic area of southern New York.

Ticks of eight medium-sized mammal species were studied in an area of endemic Lyme disease in Westchester County, N.Y., from 1 April 1984 to 31 March 1985. Most (81%) of the 266 total mammal captures were raccoon, Procyon lotor (L.) (47%), opossum, Didelphis virginiana (Kerr) (19%), and striped skunk, Mephitis mephitis Schreber (15%); these host species accounted for 91% of the 1,519 ticks collected. Although the total number of ticks was rather evenly distributed among these mammals, species composition of ticks on each host species differed markedly. Ixodes dammini Spielman, Clifford, Piesman, and Corwin was the most abundant tick species and accounted for 45% (690) of the total ticks collected. Immatures were most prevalent (56%) on opossum, and nearly all (86%) adults were found on this host species. I. cookei Marx was second in abundance (34%) and was most prevalent (60%) on skunk. I. texanus Banks and Dermacentor variabilis (Say) were less abundant (less than 20% collectively) and were most prevalent on raccoon. I. dentatus Marx on eastern cottontail, Sylvilagus floridanus (Allen), and I. marxi Banks on gray squirrel, Sciurus carolinensis Gmelin, were least abundant (less than 2% collectively). The prevalence of I. dammini on medium-sized mammals in southern New York may influence the epizoötiology of Lyme disease.