'Less is more': validation with Rasch analysis of five short-forms for the Brain Injury Rehabilitation Trust Personality Questionnaires (BIRT-PQs).

BACKGROUND: Previous analyses demonstrated a lack of unidimensionality, item redundancy, and substantial administrative burden for the Brain Injury Rehabilitation Trust Personality Questionnaires (BIRT-PQs). OBJECTIVE: To use Rasch Analysis to calibrate five short-forms of the BIRT-PQs, satisfying the Rasch model requirements. METHODS: BIRT-PQs data from 154 patients with severe Acquired Brain Injury (s-ABI) and their caregivers (total sample = 308) underwent Rasch analysis to examine their internal construct validity and reliability according to the Rasch model. RESULTS: The base Rasch analyses did not show sufficient internal construct validity according to the Rasch model for all five BIRT-PQs. After rescoring 18 items, and deleting 75 of 150 items, adequate internal construct validity was achieved for all five BIRT-PQs short forms (model chi-square p-values ranging from 0.0053 to 0.6675), with reliability values compatible with individual measurements. CONCLUSIONS: After extensive modifications, including a 48% reduction of the item load, we obtained five short forms of the BIRT-PQs satisfying the strict measurement requirements of the Rasch model. The ordinal-to-interval measurement conversion tables allow measuring on the same metric the perception of the neurobehavioral disability for both patients with s-ABI and their caregivers.

Neuropsychological changes and cranioplasty: A group analysis.

BACKGROUND: Cranioplasty is the surgical answer to cranial defect due to decompressive craniectomy in order to increase patient's safety and for cosmetic reasons. Two main neurological sequelae of skull breaches have been described and cranioplasty has been suggested as a way to treat these neurological symptoms, but its effects on cognitive and motor functions are still unclear. MATERIALS AND METHODS: In order to better elucidate if and to what extent the cranioplasty affects the whole array of cognitive functions or just some specific domains, 29 patients were studied pre- and post-cranioplasty, with structured assessments of memory, attention, language and executive functioning performed ~ 4 months and 1 month before cranioplasty and 1 month and 6 months after surgery. RESULTS AND CONCLUSION: Cranioplasty affects the cognitive profile with a non-specific pattern of change. Timing of the cranioplasty plays a key role to enucleate cognitive improvement, indeed greater cognitive changes were seen in patients who had cranioplasty within 6 months following the injury. Thus, cranioplasty must be considered a key factor in neuropsychological recovery and should be performed as soon as possible following the injury in order to take advantage of the window of opportunity for rehabilitation.

Effectiveness of prism adaptation in neglect rehabilitation: a controlled trial study.

BACKGROUND AND PURPOSE: This study was conducted to investigate the effectiveness on neglect recovery of a 2-week treatment based on prism adaptation (PA) in comparison to an analogous visuomotor training performed without prisms, ie, neutral pointing (NP). METHODS: Twenty neglect patients were divided into 2 matched groups, one was submitted to PA (PA group) and the other to NP (NP group) for 10 daily sessions over a period of 2 weeks. After the end of NP treatment, the patients in the NP group were also submitted to PA treatment. Neglect was assessed before and after each treatment and 1 month after the end of the PA treatment. RESULTS: Visuospatial abilities improved after both PA and NP treatment; however, the improvement was significantly higher in the patients in the PA group than in the patients in the NP group. Moreover, when the patients in the NP group were submitted to PA, they further improved up to the level reached by patients in the PA group, ie, to nonpathological scores. Long-lasting beneficial effects of PA were confirmed 1 month from the end of treatment. CONCLUSIONS: The leftward recalibration of sensorimotor reference frames induced by PA is effective to obtain proper neglect recovery, although visuomotor training based on pointing might partially improve neglect symptoms.

Can vision of the body ameliorate impaired somatosensory function?

Viewing the body is reported to improve tactile acuity [Kennett, S., Taylor-Clarke, M., & Haggard, P. (2001). Non-informative vision improves the spatial resolution of touch in humans. Current Biology, 11, 1188-1191]. The aim of the present study was to investigate whether this effect might be useful in improving somatosensory deficits of brain damaged patients. To support this proposal, we firstly tested the hypothesis that vision might modulate tactile performance when tactile information is limited. Thirty-two healthy subjects performed a two points discrimination task (2PDT) in three conditions: looking at their stimulated forearm, at a neutral object or at a rubber foot. The results showed that the effectiveness of visual enhancement of touch varies as a function of subjects' tactile acuity. Moreover, the accuracy in 2PDT was higher when viewing their arm only in subjects with lower tactile sensitivity. To directly demonstrate that viewing the body might ameliorate tactile deficits, the same experiment was conducted on 10 brain damaged patients suffering a reduced somatosensory sensitivity. An amelioration of the performance was found in viewing arm condition. These findings suggest that the interaction between different sensory modalities might be effective in ameliorating deficits in single modalities.