Validation of the NIH Toolbox in Individuals with Neurologic Disorders

OBJECTIVE

Individuals with spinal cord injury (SCI), traumatic brain injury (TBI), and stroke experience a variety of neurologically related deficits across multiple domains of function. The NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) examines motor, sensation, cognition, and emotional functioning. The purpose of this paper is to establish the validity of the NIHTB in individuals with neurologic conditions.

METHODS

Community-dwelling individuals with SCI (n = 209), TBI (n = 184), or stroke (n = 211) completed the NIHTB. Relative risks for impaired performance were examined relative to a matched control groups.

RESULTS

The largest group differences were observed on the Motor domain and for the Fluid Cognition measures. All groups were at increased risk for motor impairment relative to normative standards and matched controls. Fluid cognitive abilities varied across groups such that individuals with stroke and TBI performed more poorly than individuals with SCI; increased relative risks for impaired fluid cognition were seen for individuals in the stroke and TBI groups, but not for those in the SCI group. All three neurologic groups performed normally on most measures in the Sensation Battery, although TBI participants evidenced increased risk for impaired odor identification and the stroke group showed more vision difficulties. On the Emotion Battery, participants in all three groups showed comparably poor psychological well-being, social satisfaction, and self-efficacy, whereas the TBI group also evidenced slightly increased negative affect.

CONCLUSIONS

Data provide support for the validity of the NIHTB in individuals with neurologic conditions.

Factor index score patterns in the WAIS-III standardization sample

Representative profile subtypes, based on factor index scores, were examined in the standardization sample of the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). Two-stage cluster analysis identified five reliable subtypes. Three clusters were differentiated primarily by level of performance across all factor index scores (ranging from below average, to average, to above average). The other two clusters were characterized by distinct patterns of performance, with relative efficacy on the Processing Speed index being the most prominent distinction (ranging from a relative weakness to a relative strength). The clusters did not differ significantly in age, but ethnicity and income covaried directly with level of WAIS-III performance, whereas gender affected differential patterns of performance. Furthermore, education and memory were associated primarily with level and, to a relatively minor degree, pattern of WAIS-III performance. Implications for clinical practice are discussed.