An examination of the Wechsler Adult Intelligence Scales, Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate and Severe traumatic brain injury (TBI)

This study examined the clinical utility of the Wechsler Adult Intelligence Scales-Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate or severe TBI. One hundred individuals with TBI (n = 35 complicated mild or moderate TBI; n = 65 severe TBI) and 100 control participants matched on key demographic variables from the WAIS-IV normative dataset completed the WAIS-IV. Univariate analyses indicated that participants with severe TBI had poorer performance than matched controls on all index scores and subtests (except Matrix Reasoning). Individuals with complicated mild/moderate TBI performed more poorly than controls on the Working Memory Index (WMI), Processing Speed Index (PSI), and Full Scale IQ (FSIQ), and on four subtests: the two processing speed subtests (SS, CD), two working memory subtests (AR, LN), and a perceptual reasoning subtest (BD). Participants with severe TBI had significantly lower scores than the complicated mild/moderate TBI on PSI, and on three subtests: the two processing speed subtests (SS and CD), and the new visual puzzles test. Effect sizes for index and subtest scores were generally small-to-moderate for the group with complicated mild/moderate and moderate-to-large for the group with severe TBI. PSI also showed good sensitivity and specificity for classifying individuals with severe TBI versus controls. Findings provide support for the clinical utility of the WAIS-IV in individuals with complicated mild, moderate, and severe TBI.

The effect of lateralized dynamic stimuli on unilateral spatial neglect following right hemisphere lesions

Patients with unilateral (left-sided) spatial neglect following right-hemisphere stroke were tested for the effects of visual stimulation on performance of a line-bisection task. As predicted from research on brain mechanisms of spatial orientation and attention, dynamic visual stimuli presented on the left side substantially reduced neglect in the task. In contrast, left sided static stimuli reduced neglect significantly less and dynamic stimuli presented in the center had no effect on neglect. Neglect patients with hemianopia did not show significantly less benefit of left-sided dynamic stimuli compared to neglect patients without hemianopia, suggesting that the effect of these stimuli was unconscious and automatic. The potential advantages of lateralized dynamic stimuli in the rehabilitation of neglect are discussed.

Evaluating a clinical measure of reaction time: an observational study

The present study was an initial evaluation into the reliability and validity of a novel clinical measure of reaction time that consists of a vertical cylinder that is released and caught as quickly as possible. 65 healthy adults performed clinical and computerized reaction time tasks (RT(clin) and RT(comp)) under simple and dual-task conditions. RT(clin) demonstrated excellent test-retest and interrater reliabilities and was significantly correlated with the criterion standard RT(comp). RT(clin) increased with increasing age and when tested under dual-task conditions. These preliminary results suggest that RT(clin) is a reliable and valid measure of reaction time.

A generic, ‘in-house’, alphanumeric paging system for prospective activity impairments after traumatic brain injury

OBJECTIVE

For settings having suitable infrastructure, generic, 'in-house' alphanumeric paging systems can be constructed that are fully under clinician control. Development of such a system for therapeutic application is described and a single-case study presented that assessed whether the system could improve repetitive, prospective use of a daily planner.

DESIGN

ABA' single case.

METHODS

The participant was male, in his mid-30s, having cognitive impairments subsequent to recent TBI superimposed on remote neurological changes. The pager reminded him to record therapeutic information in a daily planner, for discussion with a family member each evening.

RESULTS

During intervention (B) trials, reliable memory log usage was noted. By trial five of return-to-baseline (A') trials, there was decreased memory log use.

CONCLUSIONS

Alphanumeric paging facilitated reliable use of a memory log compensation technique. The 'in-house' paging system proved particularly suitable for intervention development. Limits of the study are discussed and other therapeutically useful wireless technologies are noted.

Baseline predictors of fatigue 1 year after mild head injury

OBJECTIVE

To compare reports of fatigue 12 months after minor trauma by participants with mild head injury (MHI) with those with other injury, and identify injury and baseline predictors of fatigue.

DESIGN

An inception cohort study of participants with MHI and other nonhead injuries recruited from and interviewed at the emergency department (ED), with a follow-up telephone interview at 12 months.

SETTING

Level II community hospital ED.

PARTICIPANTS

Participants (n=58) with MHI and loss of consciousness (LOC) of 30 minutes or less and/or posttraumatic amnesia (PTA) less than 24 hours, 173 with MHI but no PTA/LOC, and 128 with other mild nonhead injuries.

INCLUSION CRITERIA

age 18 years or older, within 24 hours of injury, Glasgow Coma Scale score of 13 or higher, and discharge from the ED.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Medical Outcomes Study 36-Item Short-Form Health Survey Vitality subscale.

RESULTS

Significant predictors of fatigue severity at 12 months were baseline fatigue, having seen a counselor for a mental health issue, medical disability, marital status, and in some stage of litigation. Injury type was not a significant predictor.

CONCLUSIONS

Fatigue severity 12 months after injury is associated with baseline characteristics and not MHI. Clinicians should be cautious about attributing persisting fatigue to MHI without comprehensive consideration of other possible etiologic factors.

Health status, not head injury, predicts concussion symptoms after minor injury

OBJECTIVE

Postconcussion (PC) syndrome etiology remains poorly understood. We sought to examine predictors of persistent PC symptoms after minor injury.

METHODS

Health status, symptom, and injury information were obtained on a sample of patients presenting to the emergency department after minor injury. Postconcussion and cognitive symptoms were assessed at 1, 3, and 12 months.

RESULTS

Among 507 patients enrolled, 339 had head injury. Repeated-measures logistic regression modeling of PC and cognitive symptom presence across time indicated that baseline mental health status and physical health status were most predictive of persistent symptoms. In contrast, head injury presence did not predict persistent PC syndrome.

DISCUSSION

Baseline mental health status and physical health status were associated with persistent PC syndrome after minor injury, but head injury status was not. Further studies of PC syndrome pathogenesis are needed.

An Assistive-Technology Intervention for Verbose Speech After Traumatic Brain Injury

OBJECTIVE

To assess an assistive-technology intervention for neurobehavioral change, coordinated with a Web-based data recording system.

PARTICIPANT

Male, mid-thirties, with a complex history, having verbose speech subsequent to traumatic brain injury.

DESIGN

BAB' single-case. INTERVENTION AND MEASURES: The intervention (B and B' trials) was a digital recording of the participant's voice, stating "be brief," delivered at fixed intervals by a personal digital assistant. Utterance start and stop times were monitored with a wireless, Web-enabled device and were recorded in a server-side database.

RESULTS

Utterance frequency did not change. However, the total utterance time was reduced during B trials, attributable to the reduced frequency of lengthier utterances.

CONCLUSIONS

The target behavior was modified successfully. The participant adopted a specific cue-appropriate strategy. Since a variety of alternative response strategies may be required of a person, given a range of context-specific social practices and community settings, the importance of context-sensitive assistive technology cue repertoires is discussed.

Engineering therapy: an approach to treatment of a patient with severe cognitive and physical handicaps

"Engineering therapy" may be defined as therapeutic intervention based on technologic aids. The concept is illustrated by the case of a 63-year-old woman who sustained a traumatic brain injury that resulted in severely limited functional capabilities and inability to communicate or interact with her environment in any meaningful way. Although she participated in an intensive rehabilitation program, no significant improvement occurred and she was transferred to a nursing home. Two years postinjury a microcomputer and other technical aids were used to facilitate communication and interaction with her environment. During the course of the engineering therapy, voluntary motor skills and endurance significantly improved and communication skills markedly increased. Many secondary benefits were also noted such as increased participation by the nursing home staff in her therapy. It is concluded that engineering therapy can benefit severely handicapped patients even after many years of disability.