Gender differences in awareness and outcomes during acute traumatic brain injury recovery.

BACKGROUND: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcomes, seems collectively to suggest possible gender advantage for women in postinjury recovery, especially in executive functions. Hormonal neuroprotection, through female reproductive hormones, is often proposed as an underlying factor in these results. We explored potential gender differences in an aspect of executive functions, self-awareness (SA), which is often impaired after TBI, limits patient effort in critical rehabilitation, and increases caregiver burden. METHODS: Within a prospective survey, repeated-measures design, 121 patients with moderate or severe TBI undergoing acute rehabilitation in a Level 1 trauma center, a family member or caregiver informant, and a treating clinician were asked to complete the Patient Competency Rating Scale (PCRS) and the Frontal Systems Behavior Scale (FrSBe) at admission and discharge. RESULTS: Although overall, women and men with TBI showed generally similar levels of SA, women had significantly better awareness of their injury-related deficits at acute rehabilitation discharge, even when controlling for age, education, and injury severity. CONCLUSIONS: Mixed findings in this study mirror the pattern of results that dominate the published literature on gender and TBI. Gender differences in executive dysfunction may not be as large or robust as some researchers argue. In addition, complex interplays of socialization, gender-role expectations, naturally occurring male and female ability differences, and differences in access to postinjury rehabilitation are understudied potential moderators.

Factor structure, reliability, and validity of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury population.

OBJECTIVE: This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury (TBI) population across indices of factor structure, reliability, and validity. METHOD: Data were collected from 101 individuals undergoing acute rehabilitation for moderate and severe TBI both upon emergence from posttraumatic amnesia and at hospital discharge, as well as from their family members or caregivers. RESULTS: Four separate confirmatory factor analyses (CFAs) suggested that the FrSBe's three-factor/three-subscale solution did not fit the data well, and follow-up CFAs employing a one-factor structure similarly yielded poor fit indices. Four exploratory factor analyses (EFAs) failed to produce factor solutions consistent with each other or that resembled the factor solution retained in the EFA during the FrSBe's initial construction. The FrSBe had sufficiently high internal consistency at the total-score and subscale-score levels, good convergent validity with other indices of TBI functioning, and good test-retest reliability in the family administration of the measure, but not in the patient administration. CONCLUSIONS: The FrSBe is an appropriate measure for use in an inpatient TBI population when using the total score and the family administration, though its subscales and patient administration warrant more rigorous examination.