Use of the Halstead Category Test as a cognitive predictor of functional recovery in the hemiplegic upper limb: a cross-validation study.

Current motor learning theory suggests that recovery in the hemiplegic upper limb partially depends on the client's cognitive ability to maximize sensory feedback in order to activate appropriate efferent motor pathways. Study 1 investigated the use of the Category Test as a predictor of functional recovery. Initial scores on the Upper Extremity Function Test and the Category Test explained 81% of the variance of the discharge Upper Extremity Function score (N = 29). Psychological factors such as the client's attitude and motivation were less significant than more direct measures of the biological event. Study 2 (N = 16) confirmed these results and also found that stroke survivors who made fewer errors on the Category Test performed better on a functional disability test. Survivors making the fewest errors on the Category Test also showed the greatest amount of change in arm and hand function. The results are discussed in terms of the role of cognitive and biological factors that might influence recovery.

An evaluation of subjective and objective measures of fatigue in patients with brain injury and healthy controls.

Three self-report scales and an objective measure were examined for their value in assessing fatigue in patients with brain injury. Patients with brain injury and healthy controls completed the Fatigue Impact Scale (FIS), Visual Analogue Scale for Fatigue (VAS-F) and Fatigue Severity Scale (FSS). Fatigue was objectively measured via a continuous thumb pressing task. Patients scored higher on all fatigue measures than did participants without brain injury. Significant group differences were found on the FIS, the vigour subscale of the VAS-F, and the FSS. The FIS provided a comprehensive assessment of patients' fatigue experience. The FSS, although differentiating between groups, did not provide as comprehensive an examination of fatigue as the FIS and the scale's internal consistency requires review. No significant group differences in fatigue ratings were found on the VAS-F, possibly due to the scale's failure to differentiate between fatigue and sleepiness. The objective measure of fatigue found patients with brain injury fatigued more quickly than participants without brain injury. Although group differences were not significant, this trend suggest that further examination of this fatigue measure is warranted. Overall, patients with brain injury were found to experience significant levels of fatigue and the FIS provided the most comprehensive examination of fatigue.

Reaction time and variability 5 and 10 years after traumatic brain injury.

Improvement in performance can occur up to 10 years after traumatic brain injury (TBI). Few previous studies have examined the long-term effects of TBI on information processing. This study used reaction time (RT) tasks of increasing complexity with 10-year post-injury, 5-year post-injury, and control groups to assess any such effects. There were no significant group differences in mean RT; however, in the groups of persons with head injury only, response latency was related to age and to task demands. Older members of the groups of persons with head injury were slower than controls. The variability in performance was significantly higher in the 5-year post-injury group than in both the 10-year group and the control group. There were no significant differences among the groups in their ability to inhibit the processing of redundant information. There were no correlations between any dependent measure and severity of injury. Speed of processing is more sensitive to task complexity in individuals with head injury, but only when age at injury is considered. Most importantly, for rehabilitation purposes, recovery of consistency in performance can be expected more than 5 years after a TBI.

Psychiatric disorders after traumatic brain injury.

Substantial psychological and neurobehavioural evidence is available to support the hypothesis that traumatic brain injury (TBI) is a risk factor for subsequent psychiatric disorders. However, studies utilizing established psychiatric diagnostic schemes to study these outcomes after TBI are scarce, and no studies have included an assessment of personality disorders in addition to the major psychiatric disorders. This study utilizes structured psychiatric interviews to measure the prevalence of DSM-III(R) disorders in a sample of 18 subjects derived from a TBI rehabilitation programme. Results revealed high rates for major depression, bipolar affective disorder, generalized anxiety disorder, borderline and avoidant personality disorders. Co-morbidity was also high. A preliminary study of postulated predictive factors revealed possible roles for sex and for initial severity of injury. The study supports the association between TBI and psychiatric disorder, and suggests the need for monitoring, for prevention, and for treatment of psychiatric disorders after TBI.

Repeat neurobehavioral study of borderline personality disorder.

Previous research has tentatively identified a large subgroup of patients with borderline personality disorder (BPD) with histories of developmental or acquired brain insults. Similarly, these studies have demonstrated a possible biological correlation between the severity of BPD and the number of previous brain insults. The possibility of frontal system cognitive dysfunction in BPD has been raised. This single-blind, case-control study of BPD showed that 13 of 24 subjects with BPD had suffered a brain insult. Correlations between neurodevelopmental/acquired brain injury score and the diagnostic interview for borderline (DIB) score (r = 0.47), and between frontal system cognitive functioning and DIB score (r = -0.37) were seen. Neurocognitive testing and comparison with a cohort of subjects with traumatic brain injury (TBI) showed a pattern of similar cognitive functioning between the 2 groups, with the only differences on individual tests being in the direction of worse functioning in the group with BPD on 2 tasks. These results support the hypotheses described above. The main limitation reflects the low numbers of subjects.

Dimensions of neurobehavioural dysfunction: cross-validation using a head-injured sample.

Principal-components analysis of 44 items from the Minnesota Multiphasic Personality Inventory (MMPI) identified as neurologically related was conducted on profiles obtained from 196 individuals with head injury. Four principal factors, that accounted for 36.5% of the total variance, were extracted. The first factor was composed of items tapping attention and memory complaints. The second factor consisted of items focusing on somatic complaints. Items primarily tapping behavioural disturbance made up the third factor, and the fourth factor was composed of items reflecting specific somatic or neurological complaints. These findings partially confirmed those obtained in previous research, and further illuminate the need for developing a specific and brief measure to characterize neurobehavioural dysfunction for neurological samples.

The interplay between emotional and cognitive recovery after closed head injury.

This study examined 59 patients who had suffered closed head injuries with respect to their MMPI scores and Category Test scores as assessed shortly post-injury and on subsequent assessment. The number of MMPI scales elevated above t = 70 on the first assessment was negatively correlated with the magnitude of improvement made on the Category Test. Multiple regression analyses showed that the extent of cognitive deficit, as indicated by the Category Test, could be predicted from the degree of psychopathology, with MMPI scales 2 (depression), 7 (psychasthenia) and 8 (schizophrenia) being highly predictive of Category Test performance. These results suggest that patients with better psychological functioning perform at a higher level and make a greater post-traumatic recovery on neurocognitive tests. Although we cannot determine if the emotional impairment is due to neuropathology or is reactive in nature, there are clear implications for rehabilitation.

Long-term vocational functioning after severe closed head injury: a controlled study.

Vocational functioning at least 2 years postinjury was examined in a group of 57 severely closed-head injured (CHI) patients and 50 nonbrain-injured spinal-cord injured (SCI) patients. The two groups were equated on the following preinjury parameters: age, education, socioeconomic status (SES), male/female ratio, and marital status. The CHI and SCI patients had a similar number of members who were employed at follow-up. However, mean follow-up socioeconomic status was significantly lower in the CHI group and premorbidly employed CHI patients suffered a greater loss of SES than did premorbidly employed SCI patients. These results indicate that the degree of vocational impairment after severe CHI goes beyond impairment seen with another chronic disabling condition (i.e., SCI) that is associated with severe physical impairment but not neuropsychological impairment. In the CHI group, the following variables were all correlated with SES at follow-up: preinjury education, posttraumatic amnesia duration, degree of neuropsychological impairment soon after injury, and emotional adjustment at follow-up.

How useful is the WAIS-R in closed head injury assessment?

The present study examined whether head-injury assessment findings based on the WAIS could be generalized to the WAIS-R. It also investigated whether WAIS-R findings from individuals with focal mass lesions could be generalized to closed-head-injured patients with mass lesions. Subjects were 71 CHI patients assessed with the WAIS-R an average of 1.38 years post-injury. Results were not always consistent with previous research. Patients with left or right mass lesion loci did not exhibit previously reported Verbal IQ-Performance IQ discrepancies.

Asperger's syndrome and autism: neurocognitive aspects.

The objectives of this study were to see: (1) whether children with Asperger's Syndrome (AS) have similar neurocognitive deficits compared to nonretarded, or high-functioning autistic (HFA) children; and (2) whether the essential cognitive deficit among these children is in language or abstract problem solving. Subjects with AS, HFA, and a control group of socially impaired child psychiatric outpatient controls (OPC) were compared on a battery of neuropsychological tests. The results indicated that the AS and HFA groups differed little but that large differences from the OPC were observed on all tests. When the AS and HFA with FSIQ above 85 were compared to the OPC, outstanding deficits on motor coordination, language comprehension, and facial recognition were observed. Finally, some evidence is presented to suggest that the pattern of deficits of AS and HFA subjects varied by developmental level. The implications of these results for a neurological theory of autism are discussed.

The clinical significance of neurocognitive impairments among children with psychiatric disorders: diagnosis and situational specificity.

The overall objective of this paper is to assess the clinical significance of neurocognitive impairments (NCI) among children with psychiatric disorders. One hundred and fifty-three children referred to a mental health clinic underwent neuropsychological testing. Their parents were interviewed to obtain background information and data on their children's behavior. Parents and teachers also filled out behavior checklists. The results suggest that neurocognitive impairments are: (1) more strongly associated with externalizing rather than internalizing psychiatric diagnoses; and (2) are correlated with psychiatric symptoms at school, but not at home. The implications for understanding the impact of neurocognitive impairments on the situational specificity of psychiatric symptoms are discussed.

Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs.

This was a controlled study of the efficacy of two forms of therapy on upper limb functions of hemiparetic patients--one heavily behavioral and the other based on Bobath therapeutic exercises. It arose from an earlier pilot study comparing EMG biofeedback with physical therapy from which it was concluded that both the elapsed time since the acute stroke and the severity of residual disability were particularly important factors. Of 29 patients included and randomly assigned to one or the other heavily systematized therapies, 18 were classified as having early-severe and 11 as late-mild conditions. Multiple function tests by a "blinded" special technician in another location revealed that overall both forms of therapy obtained worthwhile clinical and statistical improvement, which was maintained at nine-month recheck testing; but there was no statistically significant superiority of one therapy over the other under the very specific circumstances of the research design. Ease of delivering care and other socioeconomic considerations become important factors in choosing either or both of these methods.

Halstead's Category Test: withstanding the test of time.

In spite of demonstrated validity, Halstead's Category Test has been criticized as overly time consuming. In order to evaluate this assumption, groups of severely head-injured and general neurological cases were administered the Category Test as part of routine evaluation, and the time to completion of the test was recorded. The results indicated that 93% of the patients completed the test in less than 1 h and that 50% completed it in less than 40 min. In 81% of the cases, the test lasted from 20-50 min.

Locus of control as a predictor variable in rehabilitation medicine.

Reports the results of preliminary work with the Adult Nowicki-Strickland Internal-External Locus of Control Scale. It was predicted that treatment motivation and treatment success would be related to the dimension of locus of control. Independent physiotherapist's ratings confirmed the first hypothesis, but not the second. This appears to be a fruitful area for further research with this instrument.

Neuropsychological significance of variations in patterns of academic performance: verbal and visual-spatial abilities.

Forty-five 9- to 14-year-old children with learning disabilties whose WISC Full Scale IQs fell within the range of 86-114 were divided into three groups on the basis of their patterns of reading, spelling, and arithmetic achievement. Group 1 was composed of children who were uniformly deficient in reading, spelling, and arithmetic; children in Group 2 were relatively adept at arithmetic as compared to their performance in reading and spelling; Group 3 was composed of children whose reading and spelling performances were average or above, but whose arithmetic performance was relatively deficient. The performances of these children on 16 dependent measures were compared. The performances of Groups 1 and 2 were superior to that of Group 3 on measures of visual-perceptual and visual-spatial abilities; Group 3 performed at a superior level to that of Groups 1 and 2 on measures of verbal and auditory-perceptual abilities. The results are discussed in terms of the relationships between varying patterns of academic abilities and patterns of brain-related behaviors, and the nature of the neuropsychological abilities that may limit performance on arithmetic calculation tasks.

Computed tomography after psychosurgery.

The computed tomography scans of patients who had frontal leukotomy show bilateral cysts in the frontal lobes that have attenuation values similar to cerebrospinal fluid, and are not contrast enhanced.

Test complexity and brain damage at different educational levels.

This investigation attempted to determine whether the complexity (problem-solving component) of selected tests of the Reitan-Halstead Neuropsychological Test Battery was related to their ability to discriminate groups of brain-damaged and non-brain-damaged adults at different educational levels. Twenty tests from the Wechsler-Bellevue and the Reitan-Halstead Battery were administered to 51 brain-damaged and 51 non-brain-damaged adults at three educational levels (grade school, high school, university). Spearman rank-order correlations were obtained for the relationship of task complexity with global scores that reflected the effects of education and brain damage for each variable and with the differences between group means for each education level. The ability of these measures to discriminate the groups was correlated significantly with problem-solving level, whereas the effects of education were correlated negatively with this dimension.

Handedness in relation to measures of motor and tactile-perceptual functions in normal children.

10 boys and 10 girls were tested at each of six age levels (6, 7, 8, 12, 13, and 14 yr). All of the children were right-handed, and at each age level the groups did not differ in age, WISC Full Scale IQ, or educational attainment. The groups were compared on motor tasks (strength and speed) and tactile-perceptual tasks (finger localization and symbol recognition). The performances of the right and left hands were compared. The results indicated clear right-hand motor superiority, but no "sidedness" effect for the tactile-perceptual measures. The implication of these results for brain-behaviour relationships was discussed.