Informational literature influences symptom expression following mild head injury: An analog study.

PRIMARY OBJECTIVE: Many Veterans involved in recent OEF/OIF conflicts return with reports of having experienced an mTBI. The Veteran's Affairs (VA) and Department of Defense (DoD) have gone to great lengths to provide information to Veterans regarding possible effects of TBI. Although well intended, this information may possibly have an iatrogenic effect. Conversely, setting positive expectations for recovery from mTBI has been shown to result in decreased symptomatology. RESEARCH DESIGN: One-way ANOVA and Tukey post-hoc analyses were used to determine whether there were significant differences on reported severity and number of PCS symptoms (NSI) among the three experimental groups (recovery focused information; expectation for persistent symptoms; and no information given). METHODS AND PROCEDURES: Undergraduate students, who were told to imagine they had experienced a military-related TBI, reported varying levels of expected symptoms when given either positive or negative information about symptom expectation. MAIN OUTCOMES AND RESULTS: The results indicate that presenting recovery-oriented literature resulted in the lowest report of expected symptoms, whereas presenting no information resulted in the highest report of expected symptoms. CONCLUSIONS: Providing Veterans with information regarding a likely positive trajectory of recovery may result in less symptom persistence during rehabilitation.

Report of traumatic brain injury information sources among OIF/OEF Veterans undergoing polytrauma evaluations.

Servicemembers returning from recent conflicts frequently report symptoms associated with traumatic brain injury (TBI) and are subsequently assessed within the Department of Veterans Affairs (VA) medical system. Information on potential cognitive and behavioral correlates of TBI is available from multiple sources. A Veteran's symptom presentation may be significantly influenced by the information he or she has received. Despite knowledge of the relationship between information source and symptom presentation, little work has focused on a characterization of where Veterans receive their information. The present study aims to fill this gap in the literature. We asked 152 Veterans who screened positive for possible TBI within the VA healthcare system about the sources of information they have encountered regarding TBI and its sequelae. "Friends in the military" was the most frequently cited source of information, followed by the Internet, medical professionals, and informational pamphlets. The results of this survey indicate that Veterans are being exposed to information about TBI prior to a formal evaluation and that this information comes from multiple sources of varying reliability. Future research should focus on evaluating and ultimately improving the reliability of this information in order to positively influence the treatment of Veterans.

Wechsler Adult Intelligence Scale-Fourth Edition performance in relapsing-remitting multiple sclerosis.

Forty patients with relapsing-remitting multiple sclerosis (MS) completed the 10 core Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) subtests. Means for age and education were 42.05 years (SD = 9.94) and 14.33 years (SD = 2.40). For all participants, the native language was English. The mean duration of MS diagnosis was 8.17 years (SD = 7.75), and the mean Expanded Disability Status Scale (EDSS; Kurtzke, 1983 ) score was 3.73 (SD = 1.41) with a range from 2.0 to 6.5. A control group of healthy individuals with similar demographic characteristics also completed the WAIS-IV and were provided by the test publisher. Compared to controls, patients with MS earned significantly lower subtest and composite scores. The patients' mean scores were consistently in the low-average to average range, and the patterns of performance across groups did not differ significantly, although there was a trend towards higher scores on the Verbal Comprehension Index (VCI) and lower scores on the Processing Speed Index (PSI). Approximately 78% of patients had actual Full Scale IQs that were significantly lower than preillness, demographically based IQ estimates.

Administration frequencies of WAIS-III supplementary and optional subtests of board-certified clinical neuropsychologists.

The present investigation surveyed board-certified clinical neuropsychologists in four geographic regions of the United States regarding their administration practices of the WAIS-III supplementary subtests (Letter-Number Sequencing, Symbol Search), optional subtest (Object Assembly), and optional procedures (Digit Symbol-Incidental Learning and Digit Symbol-Copy). Approximately 56% of the surveys were returned and usable. Regardless of geographic region, Letter-Number Sequencing and Symbol Search were the most popular of the supplementary/optional components because they were administered more than 70% of the time. The Digit Symbol-Incidental Learning and Digit Symbol-Copy procedures were the second most frequently administered tasks. Object Assembly was the least frequently administered component by practitioners across the four geographic regions.

Gender differences on WAIS-III incidental learning, pairing, and free recall.

Gender differences on Digit-Symbol-Coding-Incidental Learning, Pairing, and Free Recall were examined using the standardization sample of the WAIS-III. Males earned significantly higher scores on both Pairing and Free Recall, but effect sizes were small. Gender effects were not significant when age and educational level were included in the model or when differences in ability level were considered. The results showed a tendency for increased performance on both Pairing and Free Recall for individuals with higher levels of education or higher ability levels and for younger examinees. The findings support the use of combined norms on these procedures for males and females but indicate a need for adjusting scores based on differences in age and education.

Validity of WAIS-III performance scale subtests completed with the non-dominant hand.

Many patients with hemiplegia use only the non-dominant hand to complete the WAIS-III. It is not known to what degree this administrative change alters scores on specific subtests. To answer this question, we compared scores on Digit Symbol-Coding, Block Design, Picture Arrangement, Object Assembly, and Symbol Search via standard administration (SA) with scores from non-dominant hand administration (NDA). Fifty-eight college students were assigned to either SA or NDA groups. There were 29 SAs and 29 NDAs with means for age of 19.48 years (SD=1.15) and 25.68 years (SD=7.46). Relative to the SA group, the average Digit Symbol-Coding and Symbol Search scores were reduced by 4.04 and 1.62 points by NDA. Scores on the other subtests were not adversely affected by NDA.

Thirty-second interval patterns for WAIS-III Digit Symbol and Symbol Search.

For Digit Symbol-Coding (CD) and Symbol Search (SS) we tested the hypothesis that young adults (44 males, 60 females) would start out quickly and demonstrate steady increases in symbols/items completed across each of four 30-s intervals. The average number of CD symbols was 23.19 (S.D.=3.46) for 0-30s, 21.11 (S.D.=3.75) for 30-60 s, 21.98 (S.D.=3.70) for 60-90 s, and 22.46 (S.D.=3.55) for 90-120 s. For SS, the average number of items was 11.91 (S.D.=1.91) for 0-30s, 9.96 (S.D.=1.92) for 30-60s, 9.95 (S.D.=1.53) for 60-90 s, and 9.98 (S.D.=2.46) for 90-120 s. The hypothesis was not supported for either subtest. Cluster analysis revealed two CD groups with similar patterns which differed only in level of performance. On SS, cluster analysis identified two groups which differed in level of performance and pattern across the four 30-s intervals.

Wechsler Adult Intelligence Scale-III inter-subtest scatter: a comparison of brain-damaged patients and normal controls.

This study assessed the validity of Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) inter-subtest scatter (as measured by the scaled score range) as an indication of cognitive impairment due to brain dysfunction. Participants were 174 individuals with documented brain damage. Means for age, education, and WAIS-III full-scale IQ were 49.19 years (SD = 15.33), 12.57 years, (SD = 2.78), and 88.45 (SD = 17.78). The scatter ranges for brain-damaged participants were compared with those of the WAIS-III standardization sample. Results indicated that the full-scale IQ is significantly correlated with amount of scatter, r(172) = .42, p < .0001, so that a definitive answer to the question requires control of full-scale IQ. In the present analyses, inter-subtest scatter among the individuals for the sample as a whole was no greater than that for persons in the standardization sample, but subtest scatter was significantly greater for participants with IQs > or = 90. This finding suggests that there may be small differences in scatter between brain-damaged persons and normal controls, but that scatter is relatively insensitive to the presence of brain damage or dysfunction. Therefore, interpretation of marked inter-subtest variability as a sign of brain damage appears unwarranted.

Wechsler Adult Intelligence Scale-Third Edition Picture Arrangement subtest: impact of vertical administration.

We compared the Wechsler Adult Intelligence Scale-Third Edition Picture Arrangement (PA) scores via standard administration (SA) or vertical administration (VA). Fifty-seven college students were assigned to one of two conditions. Thirty SAs had means for age, education, and American College Testing (ACT) of 19.47 (SD = 1.14), 13.60 (SD = 1.16), and 22.27 (SD = 2.65), respectively. Twenty-seven VAs had means for age, education, and ACT of 21.26 years (SD = 2.99), 14.44 years (SD = .93), and 22.63 years (SD = 3.79), respectively. An analysis of covariance revealed nonsignificant results for age and education, Fs < 1, but a significant difference emerged for type of administration, F(1, 53) = 4.42, p < .05. SA (M = 10.33, SD = 2.97) yielded a significantly higher mean PA score than did VA (M = 8.30, SD = 2.84).

WAIS-III Digit Symbol-Incidental Learning base rates: findings for college student and patient samples.

Frequencies for Pairing and Free Recall of the WAIS-III Digit Symbol-Incidental Learning procedure were determined separately for 104 college students and 73 patients with substance abuse disorders. Means for age and education were 22.2 yr. (SD=5.1) and 14.7 yr. (SD=1.0) and 46.0 yr. and 12.2 yr. (SD=9.4), respectively. Base rate tables indicated that for Pairing, 93% of students and 89% of patients paired the number 1 with the appropriate symbol. Conversely, only 43% of students correctly paired the number 3 with its associated symbol, while 30% of patients paired the number 4 with its appropriate symbol. When Free Recall was assessed, 98% of students remembered the first symbol, but only 61% recalled the third. The most frequently recalled symbol by patients was the ninth (97%) and the most infrequently recalled symbol was the fourth (50%). The present base rate tables may be helpful for detecting unusual recall frequencies on the Incidental Learning procedures.