Theresa Pape | Northwestern University Feinberg School of Medicine (original) (raw)

Papers by Theresa Pape

BMJ Open

IntroductionHistorically, heterogeneous outcome assessments have been used to measure recovery of... more IntroductionHistorically, heterogeneous outcome assessments have been used to measure recovery of consciousness in patients with disorders of consciousness (DoC) following traumatic brain injury (TBI), making it difficult to compare across studies. To date, however, there is no comprehensive review of clinical outcome assessments that are used in intervention studies of adults with DoC. The objective of this scoping review is to develop a comprehensive inventory of clinical outcome assessments for recovery of consciousness that have been used in clinical studies of adults with DoC following TBI.Methods and analysisThe methodological framework for this review is: (1) identify the research questions, (2) identify relevant studies, (3) select studies, (4) chart the data, (5) collate, summarise and report results and (6) consult stakeholders to drive knowledge translation. We will identify relevant studies by searching the following electronic bibliographic databases: PubMed, Scopus, EM...

I OUR 2016 ARTICLE, examining the responsiveness of the Disorders of Consciousness Scale (DOCS-25... more I OUR 2016 ARTICLE, examining the responsiveness of the Disorders of Consciousness Scale (DOCS-25), we reported the minimal detectable change (MDC) along with several other indices of responsiveness including anchor and distribution-based minimally clinically important differences (MCIDs).1 Similar to others, we used a formula in which the SEM was included within the square root. Bland2 points out the correct formula for the MDC is when the standard error of measurement (SEM) is external to the square root (MDC95 = 1.96 × SEM × √ 2).2 We have recalculated the MDC for Rasch-transformed DOCS-25 person measures using this formula: 9.98, 11.22, and 11.47 for nonimprovers, improvers, and all participants, respectively. These MDC indices apply to Rasch-transformed person measures and not to total raw scores. The revised MDC is somewhat larger than our previously reported anchor-based MCID (8.6).1 As noted in our earlier article, MDCs can be clinically useful, particularly in early phases of recovery when patients may demonstrate fluctuating levels of neurobehavioral function on a day-to-day basis. Knowing when such change is beyond measurement error better enables clinicians to identify when variation is consequential enough to warrant attention. Clinicians may find MCIDs useful for informing treatment decisions such as when a change in intervention strategy may be warranted. In addition, anchor-based MCIDs may support clinicians to engage families in discussions about treatment goals. We encourage readers to use discretion when applying this type of MDC since the calculation assumes that measurement error is consistent across all total raw scores, which it is not.3 For Rasch-based measures, the standard error is larger at the ends of the range and smaller in the middle of the range; for raw score scales the standard error is larger at the middle of the range and smaller in the ends.3 To provide rehabilitation clinicians with person-centered indices of change, future studies could examine alternative MDC approaches conditioned on patient admission and discharge measures.4

Journal of Neurotrauma

This study aimed to empirically evaluate the hierarchical structure of the Coma Recovery Scale-Re... more This study aimed to empirically evaluate the hierarchical structure of the Coma Recovery Scale-Revised (CRS-R) rating scale categories and their alignment with the Aspen consensus criteria for determining disorders of consciousness (DoC) following a severe brain injury. CRS-R data from 262 patients with DoC following a severe brain injury were analyzed applying the partial credit Rasch Measurement Model. Rasch Analysis produced logit calibrations for each rating scale category. Twenty-eight of the 29 CRS-R rating scale categories were operationalized to the Aspen consensus criteria. We expected the hierarchical order of the calibrations to reflect Aspen consensus criteria. We also examined the association between the CRS-R Rasch person measures (indicative of performance ability) and states of consciousness as determined by the Aspen consensus criteria. Overall, the order of the 29 rating scale category calibrations reflected current literature regarding the continuum of neurobehavioral function: category 6 ''Functional Object Use'' of the Motor item was hardest for patients to achieve; category 0 ''None'' of the Oromotor/ Verbal item was easiest to achieve. Of the 29 rating scale categories, six were not ordered as expected. Four rating scale categories reflecting the Vegetative State (VS)/Unresponsive Wakefulness Syndrome (UWS) had higher calibrations (reflecting greater neurobehavioral function) than the easiest Minimally Conscious State (MCS) item (category 2 ''Fixation'' of the Visual item). Two rating scale categories, one reflecting MCS and one not operationalized to the Aspen consensus criteria, had higher calibrations than the easiest eMCS item (category 2 ''Functional: Accurate'' of the Communication item). CRS-R person

Journal of Head Trauma Rehabilitation, 2020

BACKGROUND Biomarkers that can advance precision neurorehabilitation of the traumatic brain injur... more BACKGROUND Biomarkers that can advance precision neurorehabilitation of the traumatic brain injury (TBI) are needed. MicroRNAs (miRNAs) have biological properties that could make them well suited for playing key roles in differential diagnoses and prognoses and informing likelihood of responsiveness to specific treatments. OBJECTIVE To review the evidence of miRNA alterations after TBI and evaluate the state of science relative to potential neurorehabilitation applications of TBI-specific miRNAs. METHODS This scoping review includes 57 animal and human studies evaluating miRNAs after TBI. PubMed, Scopus, and Google Scholar search engines were used. RESULTS Gold standard analytic steps for miRNA biomarker assessment are presented. Published studies evaluating the evidence for miRNAs as potential biomarkers for TBI diagnosis, severity, natural recovery, and treatment-induced outcomes were reviewed including statistical evaluation. Growing evidence for specific miRNAs, including miR21, as TBI biomarkers is presented. CONCLUSIONS There is evidence of differential miRNA expression in TBI in both human and animal models; however, gaps need to be filled in terms of replication using rigorous, standardized methods to isolate a consistent set of miRNA changes. Longitudinal studies in TBI are needed to understand how miRNAs could be implemented as biomarkers in clinical practice.

Journal of Head Trauma Rehabilitation, 2020

I OUR 2016 ARTICLE, examining the responsiveness of the Disorders of Consciousness Scale (DOCS-25... more I OUR 2016 ARTICLE, examining the responsiveness of the Disorders of Consciousness Scale (DOCS-25), we reported the minimal detectable change (MDC) along with several other indices of responsiveness including anchor and distribution-based minimally clinically important differences (MCIDs).1 Similar to others, we used a formula in which the SEM was included within the square root. Bland2 points out the correct formula for the MDC is when the standard error of measurement (SEM) is external to the square root (MDC95 = 1.96 × SEM × √ 2).2 We have recalculated the MDC for Rasch-transformed DOCS-25 person measures using this formula: 9.98, 11.22, and 11.47 for nonimprovers, improvers, and all participants, respectively. These MDC indices apply to Rasch-transformed person measures and not to total raw scores. The revised MDC is somewhat larger than our previously reported anchor-based MCID (8.6).1 As noted in our earlier article, MDCs can be clinically useful, particularly in early phases of recovery when patients may demonstrate fluctuating levels of neurobehavioral function on a day-to-day basis. Knowing when such change is beyond measurement error better enables clinicians to identify when variation is consequential enough to warrant attention. Clinicians may find MCIDs useful for informing treatment decisions such as when a change in intervention strategy may be warranted. In addition, anchor-based MCIDs may support clinicians to engage families in discussions about treatment goals. We encourage readers to use discretion when applying this type of MDC since the calculation assumes that measurement error is consistent across all total raw scores, which it is not.3 For Rasch-based measures, the standard error is larger at the ends of the range and smaller in the middle of the range; for raw score scales the standard error is larger at the middle of the range and smaller in the ends.3 To provide rehabilitation clinicians with person-centered indices of change, future studies could examine alternative MDC approaches conditioned on patient admission and discharge measures.4

Archives of Physical Medicine and Rehabilitation, 2014

PM & R : the journal of injury, function, and rehabilitation, Jan 7, 2015

The aim of this study was to describe the association between mild traumatic brain injury (mTBI) ... more The aim of this study was to describe the association between mild traumatic brain injury (mTBI) and persisting postconcussive symptoms according to symptom category, number, and severity. The study design was observational. The study sample comprised veterans (≥18 years of age) deployed in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) conflicts who had not received any treatment for mTBI in the 30 days preceding study enrollment. Veterans were interviewed and completed testing in a single day. The Standard TBI Diagnostic Interview and the Clinician-Administered PTSD Scale were used. Testing included the Neurobehavioral Symptom Inventory and a full neuropsychological battery. Gold standard classification methods were utilized to determine presence/absence of mTBI. For each of the 5 symptom outcomes, an adjusted multiple linear regression model (negative binomial count models) accounting for effects of socio-demographic variables and behavioral health conditions wa...

The Scientific World Journal, 2014

Background.Despite a lack of clear evidence, multiple neurostimulants are commonly provided after... more Background.Despite a lack of clear evidence, multiple neurostimulants are commonly provided after severe brain injury (BI). The purpose of this study is to determine if the number of neurostimulants received during rehabilitation was associated with recovery of full consciousness or improved neurobehavioral function after severe BI.Method.Data from 115 participants were extracted from a neurobehavioral observational study database for this exploratory, retrospective analysis. Univariate optimal data analysis was conducted to determine if the number of neurostimulants influenced classification of four outcomes: recovery of full consciousness during rehabilitation, recovery of full consciousness within one year of injury, and meaningful neurobehavioral improvement during rehabilitation defined aseitherat least a 4.7 unit (minimal detectable change) or 2.58 unit (minimal clinically important difference) gain on the Disorders of Consciousness Scale-25 (DOCS-25).Results.Number of neurost...

Neurorehabilitation and neural repair, Jan 22, 2015

Background. Sensory stimulation is often provided to persons incurring severe traumatic brain inj... more Background. Sensory stimulation is often provided to persons incurring severe traumatic brain injury (TBI), but therapeutic effects are unclear. Objective. This preliminary study investigated neurobehavioral and neurophysiological effects related to sensory stimulation on global neurobehavioral functioning, arousal, and awareness. Methods. A double-blind randomized placebo-controlled trial where 15 participants in states of disordered consciousness (DOC), an average of 70 days after TBI, were provided either the Familiar Auditory Sensory Training (FAST) or Placebo of silence. Global neurobehavioral functioning was measured with the Disorders of Consciousness Scale (DOCS). Arousal and awareness were measured with the Coma-Near-Coma (CNC) scale. Neurophysiological effect was measured using functional magnetic resonance imaging (fMRI). Results. FAST (n = 8) and Placebo (n = 7) groups each showed neurobehavioral improvement. Mean DOCS change (FAST = 13.5, SD = 8.2; Placebo = 18.9, SD = ...

The Journal of Rehabilitation Research and Development, 2005

The Journal of Rehabilitation Research and Development, 2012

Since there remains a need to examine the nature of the neural effect and therapeutic efficacy/ef... more Since there remains a need to examine the nature of the neural effect and therapeutic efficacy/effectiveness of sensory stimulation provided to persons in states of seriously impaired consciousness, a passive sensory stimulation intervention, referred to as the Familiar Auditory Sensory Training (FAST) protocol, was developed for examination in an ongoing, double-blind, randomized clinical trial (RCT). The FAST protocol is described in this article according to the preliminary framework, which is a synthesis of knowledge regarding principles of plasticity and capabilities of the human brain to automatically and covertly process sensory input. Feasibility issues considered during the development of the intervention are also described. To enable replication of this intervention, we describe procedures to create the intervention and lessons learned regarding the creation process. The potential effect of the intervention is illustrated using functional brain imaging of nondisabled subjects. This illustration also demonstrates the relevance of the rationale for designing the FAST protocol. To put the intervention within the context of the scientific development process, the article culminates with a description of the study design for the ongoing RCT examining the efficacy of the FAST protocol.

Journal of Rehabilitation Research and Development, 2013

Over 12 mo following their initial evaluation, Veterans screening positive on a traumatic brain i... more Over 12 mo following their initial evaluation, Veterans screening positive on a traumatic brain injury (TBI) clinical reminder had over 85 percent higher total costs than Veterans who screened negative. Understanding healthcare utilization and cost patterns following TBI screening is important for policymakers as they address the ongoing and future healthcare needs of returning Operation Iraqi Freedom/Operation Enduring Freedom Veterans.

Biological Psychiatry, 1995

Archives of physical medicine and rehabilitation, 2014

To provide evidence for psychometric properties of the Disorders of Consciousness Scale (DOCS). P... more To provide evidence for psychometric properties of the Disorders of Consciousness Scale (DOCS). Prospective observational cohort. Seven rehabilitation facilities. Patients (N=174) with severe brain injury. Not applicable. Initial analyses suggested eliminating 6 items to maximize psychometrics, resulting in the DOCS-25. The 25 items form a unidimensional hierarchy, rating scale categories are ordered, there are no misfitting items, and differential item functioning was not found according to sex, type of brain injury, veteran status, and days from onset. Person separation reliability (.91) indicates that the DOCS-25 is appropriate for individual patient measurement. Items are well targeted to the sample, with the difference between mean person and item calibrations less than 1 logit. DOCS-25 Rasch measures result in a 62% gain in relative precision over total raw scores. Internal consistency is very good (Cronbach α=.86); interrater agreement is excellent (intracIass correlation coe...

Archives of physical medicine and rehabilitation, 2020

OBJECTIVE To examine the construct validity and measurement precision of the Coma-Near Coma Scale... more OBJECTIVE To examine the construct validity and measurement precision of the Coma-Near Coma Scale (CNC) in measuring neurobehavioral function (NBF) in patients with disorders of consciousness receiving post-acute care rehabilitation. DESIGN Rasch analysis of retrospective data. PARTICIPANTS 48 participants with disordered consciousness admitted to post-acute care rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Coma Near Coma Scale. RESULTS Assessment with CNC repeated weekly until participant was conscious or discharged from post-acute care facility (451 participant records). Rating scale steps were ordered for all items. Eight of the 10 CNC items evaluated in this study fit the measurement model (ꭓ2=5332.58; df=11; P=0.17); pain items formed a distinct construct. The ordering of the 8 items from most to least challenging makes clinical sense and compares favorably with other published hierarchies of NBF. Tactile items are more easily responded to. Visual and audi...

Archives of Physical Medicine and Rehabilitation, 2019

BMJ Open

IntroductionHistorically, heterogeneous outcome assessments have been used to measure recovery of... more IntroductionHistorically, heterogeneous outcome assessments have been used to measure recovery of consciousness in patients with disorders of consciousness (DoC) following traumatic brain injury (TBI), making it difficult to compare across studies. To date, however, there is no comprehensive review of clinical outcome assessments that are used in intervention studies of adults with DoC. The objective of this scoping review is to develop a comprehensive inventory of clinical outcome assessments for recovery of consciousness that have been used in clinical studies of adults with DoC following TBI.Methods and analysisThe methodological framework for this review is: (1) identify the research questions, (2) identify relevant studies, (3) select studies, (4) chart the data, (5) collate, summarise and report results and (6) consult stakeholders to drive knowledge translation. We will identify relevant studies by searching the following electronic bibliographic databases: PubMed, Scopus, EM...

I OUR 2016 ARTICLE, examining the responsiveness of the Disorders of Consciousness Scale (DOCS-25... more I OUR 2016 ARTICLE, examining the responsiveness of the Disorders of Consciousness Scale (DOCS-25), we reported the minimal detectable change (MDC) along with several other indices of responsiveness including anchor and distribution-based minimally clinically important differences (MCIDs).1 Similar to others, we used a formula in which the SEM was included within the square root. Bland2 points out the correct formula for the MDC is when the standard error of measurement (SEM) is external to the square root (MDC95 = 1.96 × SEM × √ 2).2 We have recalculated the MDC for Rasch-transformed DOCS-25 person measures using this formula: 9.98, 11.22, and 11.47 for nonimprovers, improvers, and all participants, respectively. These MDC indices apply to Rasch-transformed person measures and not to total raw scores. The revised MDC is somewhat larger than our previously reported anchor-based MCID (8.6).1 As noted in our earlier article, MDCs can be clinically useful, particularly in early phases of recovery when patients may demonstrate fluctuating levels of neurobehavioral function on a day-to-day basis. Knowing when such change is beyond measurement error better enables clinicians to identify when variation is consequential enough to warrant attention. Clinicians may find MCIDs useful for informing treatment decisions such as when a change in intervention strategy may be warranted. In addition, anchor-based MCIDs may support clinicians to engage families in discussions about treatment goals. We encourage readers to use discretion when applying this type of MDC since the calculation assumes that measurement error is consistent across all total raw scores, which it is not.3 For Rasch-based measures, the standard error is larger at the ends of the range and smaller in the middle of the range; for raw score scales the standard error is larger at the middle of the range and smaller in the ends.3 To provide rehabilitation clinicians with person-centered indices of change, future studies could examine alternative MDC approaches conditioned on patient admission and discharge measures.4

Journal of Neurotrauma

This study aimed to empirically evaluate the hierarchical structure of the Coma Recovery Scale-Re... more This study aimed to empirically evaluate the hierarchical structure of the Coma Recovery Scale-Revised (CRS-R) rating scale categories and their alignment with the Aspen consensus criteria for determining disorders of consciousness (DoC) following a severe brain injury. CRS-R data from 262 patients with DoC following a severe brain injury were analyzed applying the partial credit Rasch Measurement Model. Rasch Analysis produced logit calibrations for each rating scale category. Twenty-eight of the 29 CRS-R rating scale categories were operationalized to the Aspen consensus criteria. We expected the hierarchical order of the calibrations to reflect Aspen consensus criteria. We also examined the association between the CRS-R Rasch person measures (indicative of performance ability) and states of consciousness as determined by the Aspen consensus criteria. Overall, the order of the 29 rating scale category calibrations reflected current literature regarding the continuum of neurobehavioral function: category 6 ''Functional Object Use'' of the Motor item was hardest for patients to achieve; category 0 ''None'' of the Oromotor/ Verbal item was easiest to achieve. Of the 29 rating scale categories, six were not ordered as expected. Four rating scale categories reflecting the Vegetative State (VS)/Unresponsive Wakefulness Syndrome (UWS) had higher calibrations (reflecting greater neurobehavioral function) than the easiest Minimally Conscious State (MCS) item (category 2 ''Fixation'' of the Visual item). Two rating scale categories, one reflecting MCS and one not operationalized to the Aspen consensus criteria, had higher calibrations than the easiest eMCS item (category 2 ''Functional: Accurate'' of the Communication item). CRS-R person

Journal of Head Trauma Rehabilitation, 2020

BACKGROUND Biomarkers that can advance precision neurorehabilitation of the traumatic brain injur... more BACKGROUND Biomarkers that can advance precision neurorehabilitation of the traumatic brain injury (TBI) are needed. MicroRNAs (miRNAs) have biological properties that could make them well suited for playing key roles in differential diagnoses and prognoses and informing likelihood of responsiveness to specific treatments. OBJECTIVE To review the evidence of miRNA alterations after TBI and evaluate the state of science relative to potential neurorehabilitation applications of TBI-specific miRNAs. METHODS This scoping review includes 57 animal and human studies evaluating miRNAs after TBI. PubMed, Scopus, and Google Scholar search engines were used. RESULTS Gold standard analytic steps for miRNA biomarker assessment are presented. Published studies evaluating the evidence for miRNAs as potential biomarkers for TBI diagnosis, severity, natural recovery, and treatment-induced outcomes were reviewed including statistical evaluation. Growing evidence for specific miRNAs, including miR21, as TBI biomarkers is presented. CONCLUSIONS There is evidence of differential miRNA expression in TBI in both human and animal models; however, gaps need to be filled in terms of replication using rigorous, standardized methods to isolate a consistent set of miRNA changes. Longitudinal studies in TBI are needed to understand how miRNAs could be implemented as biomarkers in clinical practice.

Journal of Head Trauma Rehabilitation, 2020

I OUR 2016 ARTICLE, examining the responsiveness of the Disorders of Consciousness Scale (DOCS-25... more I OUR 2016 ARTICLE, examining the responsiveness of the Disorders of Consciousness Scale (DOCS-25), we reported the minimal detectable change (MDC) along with several other indices of responsiveness including anchor and distribution-based minimally clinically important differences (MCIDs).1 Similar to others, we used a formula in which the SEM was included within the square root. Bland2 points out the correct formula for the MDC is when the standard error of measurement (SEM) is external to the square root (MDC95 = 1.96 × SEM × √ 2).2 We have recalculated the MDC for Rasch-transformed DOCS-25 person measures using this formula: 9.98, 11.22, and 11.47 for nonimprovers, improvers, and all participants, respectively. These MDC indices apply to Rasch-transformed person measures and not to total raw scores. The revised MDC is somewhat larger than our previously reported anchor-based MCID (8.6).1 As noted in our earlier article, MDCs can be clinically useful, particularly in early phases of recovery when patients may demonstrate fluctuating levels of neurobehavioral function on a day-to-day basis. Knowing when such change is beyond measurement error better enables clinicians to identify when variation is consequential enough to warrant attention. Clinicians may find MCIDs useful for informing treatment decisions such as when a change in intervention strategy may be warranted. In addition, anchor-based MCIDs may support clinicians to engage families in discussions about treatment goals. We encourage readers to use discretion when applying this type of MDC since the calculation assumes that measurement error is consistent across all total raw scores, which it is not.3 For Rasch-based measures, the standard error is larger at the ends of the range and smaller in the middle of the range; for raw score scales the standard error is larger at the middle of the range and smaller in the ends.3 To provide rehabilitation clinicians with person-centered indices of change, future studies could examine alternative MDC approaches conditioned on patient admission and discharge measures.4

Archives of Physical Medicine and Rehabilitation, 2014

PM & R : the journal of injury, function, and rehabilitation, Jan 7, 2015

The aim of this study was to describe the association between mild traumatic brain injury (mTBI) ... more The aim of this study was to describe the association between mild traumatic brain injury (mTBI) and persisting postconcussive symptoms according to symptom category, number, and severity. The study design was observational. The study sample comprised veterans (≥18 years of age) deployed in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) conflicts who had not received any treatment for mTBI in the 30 days preceding study enrollment. Veterans were interviewed and completed testing in a single day. The Standard TBI Diagnostic Interview and the Clinician-Administered PTSD Scale were used. Testing included the Neurobehavioral Symptom Inventory and a full neuropsychological battery. Gold standard classification methods were utilized to determine presence/absence of mTBI. For each of the 5 symptom outcomes, an adjusted multiple linear regression model (negative binomial count models) accounting for effects of socio-demographic variables and behavioral health conditions wa...

The Scientific World Journal, 2014

Background.Despite a lack of clear evidence, multiple neurostimulants are commonly provided after... more Background.Despite a lack of clear evidence, multiple neurostimulants are commonly provided after severe brain injury (BI). The purpose of this study is to determine if the number of neurostimulants received during rehabilitation was associated with recovery of full consciousness or improved neurobehavioral function after severe BI.Method.Data from 115 participants were extracted from a neurobehavioral observational study database for this exploratory, retrospective analysis. Univariate optimal data analysis was conducted to determine if the number of neurostimulants influenced classification of four outcomes: recovery of full consciousness during rehabilitation, recovery of full consciousness within one year of injury, and meaningful neurobehavioral improvement during rehabilitation defined aseitherat least a 4.7 unit (minimal detectable change) or 2.58 unit (minimal clinically important difference) gain on the Disorders of Consciousness Scale-25 (DOCS-25).Results.Number of neurost...

Neurorehabilitation and neural repair, Jan 22, 2015

Background. Sensory stimulation is often provided to persons incurring severe traumatic brain inj... more Background. Sensory stimulation is often provided to persons incurring severe traumatic brain injury (TBI), but therapeutic effects are unclear. Objective. This preliminary study investigated neurobehavioral and neurophysiological effects related to sensory stimulation on global neurobehavioral functioning, arousal, and awareness. Methods. A double-blind randomized placebo-controlled trial where 15 participants in states of disordered consciousness (DOC), an average of 70 days after TBI, were provided either the Familiar Auditory Sensory Training (FAST) or Placebo of silence. Global neurobehavioral functioning was measured with the Disorders of Consciousness Scale (DOCS). Arousal and awareness were measured with the Coma-Near-Coma (CNC) scale. Neurophysiological effect was measured using functional magnetic resonance imaging (fMRI). Results. FAST (n = 8) and Placebo (n = 7) groups each showed neurobehavioral improvement. Mean DOCS change (FAST = 13.5, SD = 8.2; Placebo = 18.9, SD = ...

The Journal of Rehabilitation Research and Development, 2005

The Journal of Rehabilitation Research and Development, 2012

Since there remains a need to examine the nature of the neural effect and therapeutic efficacy/ef... more Since there remains a need to examine the nature of the neural effect and therapeutic efficacy/effectiveness of sensory stimulation provided to persons in states of seriously impaired consciousness, a passive sensory stimulation intervention, referred to as the Familiar Auditory Sensory Training (FAST) protocol, was developed for examination in an ongoing, double-blind, randomized clinical trial (RCT). The FAST protocol is described in this article according to the preliminary framework, which is a synthesis of knowledge regarding principles of plasticity and capabilities of the human brain to automatically and covertly process sensory input. Feasibility issues considered during the development of the intervention are also described. To enable replication of this intervention, we describe procedures to create the intervention and lessons learned regarding the creation process. The potential effect of the intervention is illustrated using functional brain imaging of nondisabled subjects. This illustration also demonstrates the relevance of the rationale for designing the FAST protocol. To put the intervention within the context of the scientific development process, the article culminates with a description of the study design for the ongoing RCT examining the efficacy of the FAST protocol.

Journal of Rehabilitation Research and Development, 2013

Over 12 mo following their initial evaluation, Veterans screening positive on a traumatic brain i... more Over 12 mo following their initial evaluation, Veterans screening positive on a traumatic brain injury (TBI) clinical reminder had over 85 percent higher total costs than Veterans who screened negative. Understanding healthcare utilization and cost patterns following TBI screening is important for policymakers as they address the ongoing and future healthcare needs of returning Operation Iraqi Freedom/Operation Enduring Freedom Veterans.

Biological Psychiatry, 1995

Archives of physical medicine and rehabilitation, 2014

To provide evidence for psychometric properties of the Disorders of Consciousness Scale (DOCS). P... more To provide evidence for psychometric properties of the Disorders of Consciousness Scale (DOCS). Prospective observational cohort. Seven rehabilitation facilities. Patients (N=174) with severe brain injury. Not applicable. Initial analyses suggested eliminating 6 items to maximize psychometrics, resulting in the DOCS-25. The 25 items form a unidimensional hierarchy, rating scale categories are ordered, there are no misfitting items, and differential item functioning was not found according to sex, type of brain injury, veteran status, and days from onset. Person separation reliability (.91) indicates that the DOCS-25 is appropriate for individual patient measurement. Items are well targeted to the sample, with the difference between mean person and item calibrations less than 1 logit. DOCS-25 Rasch measures result in a 62% gain in relative precision over total raw scores. Internal consistency is very good (Cronbach α=.86); interrater agreement is excellent (intracIass correlation coe...

Archives of physical medicine and rehabilitation, 2020

OBJECTIVE To examine the construct validity and measurement precision of the Coma-Near Coma Scale... more OBJECTIVE To examine the construct validity and measurement precision of the Coma-Near Coma Scale (CNC) in measuring neurobehavioral function (NBF) in patients with disorders of consciousness receiving post-acute care rehabilitation. DESIGN Rasch analysis of retrospective data. PARTICIPANTS 48 participants with disordered consciousness admitted to post-acute care rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Coma Near Coma Scale. RESULTS Assessment with CNC repeated weekly until participant was conscious or discharged from post-acute care facility (451 participant records). Rating scale steps were ordered for all items. Eight of the 10 CNC items evaluated in this study fit the measurement model (ꭓ2=5332.58; df=11; P=0.17); pain items formed a distinct construct. The ordering of the 8 items from most to least challenging makes clinical sense and compares favorably with other published hierarchies of NBF. Tactile items are more easily responded to. Visual and audi...

Archives of Physical Medicine and Rehabilitation, 2019