The Predictive Validity of a Brief Inpatient Neuropsychologic Battery for Persons With Traumatic Brain Injury (original) (raw)
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Rehabilitation Psychology, 2006
Objective: Evaluate measurement properties of the Neurobehavioral Cognitive Status Examination (Cognistat) using Rasch analysis. Design: Calibration of item responses from 120 individuals admitted to a rehabilitation medicine service for traumatic brain injury (TBI) and 296 community-dwelling adults with TBI. Results: Three strata of performance were differentiated despite a skewed distribution toward high performance among the community sample. Elimination of easier items created a better targeted instrument (i.e., generated more spread among individuals) without a significant increase in error. Memory and verbal reasoning were the most difficult domains for each sample; however, analyses indicated significant measurement error. Conclusions: As a screening instrument, the Cognistat reliably classifies multiple levels of cognitive status in both acute and postacute TBI settings; however, this measure is unsuitable for generating a profile of neurocognitive strengths and weaknesses.
Journal of neurotrauma, 2018
Traumatic brain injury (TBI) often results in cognitive impairment, and trajectories of cognitive functioning can vary tremendously over time across survivors. Traditional approaches to measuring cognitive performance require face-to-face administration of a battery of objective neuropsychological tests, which can be time- and labor-intensive. There are numerous clinical and research contexts in which in-person testing is undesirable or unfeasible, including clinical monitoring of older adults or individuals with disability for whom travel is challenging, and epidemiological studies of geographically dispersed participants. A telephone-based method for measuring cognition could conserve resources and improve efficiency. The objective of this study is to examine the feasibility and usefulness of the Brief Test of Adult Cognition by Telephone (BTACT) among individuals who are 1 and 2 years post-moderate-to-severe TBI. A total of 463 individuals participated in the study at Year 1 post...
Archives of Clinical Neuropsychology, 1997
Clinical neuropsychology has entered an era of accountability focused on the satisfaction of customer requirements. Our customers now include the patient, the family, the health care team, third party payors, social support agencies, and others invested in understanding the meaning and impact of brain illness or injury. Customer requirements are those criteria by which the customer judges the quality of the services performed (Baxter Healthcare Corporation, 1994). The historical approach to such requirements directs focus to the clinical utility of test measures: The measures' ability to reliably and validly reflect clinically meaningful behaviors for the populations and referral issues in question.
Examining the Cognitive Proficiency Index in rehabilitation patients
Applied Neuropsychology: Adult, 2019
This study examined the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Cognitive Proficiency Index (CPI) in relation to other WAIS-IV indices, overall test battery mean (OTBM), and impairment (IMP) in an outpatient rehabilitation setting. Participants (N ¼ 329) were 35% female and 88% Caucasian with average age and education of 42.9 (SD ¼ 13.5) and 13.6 (SD ¼ 2.4) years, respectively. Participants were grouped by diagnosis and validity: traumatic brain injury (TBI; n ¼ 176; 39% mild), cerebrovascular accident (CVA; n ¼ 52), other neurologic and psychiatric conditions (OTH; n ¼ 49), and questionable performance validity (QPV; n ¼ 52). OTBM was calculated from non-WAIS-IV tests; IMP was dichotomously defined as four or more non-WAIS-IV scores below cutoff (35 T). Significant group differences were observed on CPI, WAIS-IV indices, OTBM, and IMP. CPI significantly contributed (b ¼ .51) to a linear regression model predicting OTBM (R 2 ¼ .63) with education and GAI as covariates. A logistic regression model with IMP as the outcome and education, GAI, and CPI as predictors correctly classified 80% of cases with area under the curve of .86. A previously identified cutoff (CPI < 84) correctly classified 65-78% of clinical groups categorized by IMP. A novel cutoff (CPI 80) differentiated clinical participants with history of mild TBI from the QPV group with sensitivity of 44.2% and specificity of 89.7%. CPI showed incremental validity in predicting OTBM and IMP and warrants further study as a useful clinical addition to other WAIS-IV indices.
Performance characteristics of postacute traumatic brain injury patients on the WAIS-III and WMS-III
The Clinical …, 2001
Publication of the third editions of the Wechsler intelligence and memory batteries in 1997 created a need for research identifying Wechsler Adult Intelligence Scale-Third Edition / Wechsler Memory Scale-Third Edition (WAIS-III/WMS-III) pro®le patterns associated with neuropathology. The WAIS-III/WMS-III Technical Manual offers data on various diagnostic groups, including traumatic brain injury (TBI). Hawkins (1998) employed Technical Manual data to propose certain diagnostic guidelines. In order to validate the conclusions put forth by Hawkins as they apply to brain injury, we examined WAIS-III and WMS-III pro®les in an independent sample of 46 TBI cases. As expected, the WAIS-III Processing Speed Index (PSI) was more sensitive to brain injury than other WAIS-III composites; and speci®c WAIS-III scores were stronger than certain WMS-III scores. On the other hand, the predicted relationship for WMS-III auditory and visual indexes was not found. The lack of speci®city for TBI of the proposed index comparisons con®rms the need to validate such hypotheses in independent samples.
Brain Injury, 2010
Objectives: To describe the functional level during sub-acute rehabilitation after moderate and severe traumatic brain injury (TBI) and to evaluate the impact of pre-injury and injury-related factors as predictors of early recovery. Material and methods: A prospective study of 55 patients with moderate (n ¼ 21) and severe (n ¼ 34) TBI who received specialized, inpatient rehabilitation. Functional level was assessed by the FIM. Possible predictors were analysed in a regression model using FIM total score at discharge as outcome. Results: At discharge from sub-acute rehabilitation, on average 53 (AE24) days post-injury, 57% of moderate TBI patients and 91% of severe TBI patients were still disabled with a FIM score < 126. The disability was mild in 95% with moderate TBI and in 62% with severe TBI. The disability was severe (FIM < 72) in 24% with severe TBI. Only one patient did not improve. Predictors of functional level at discharge from rehabilitation were Glasgow Coma Scale (GCS) score at rehabilitation admission (B ¼ 5.991), FIM total score at rehabilitation admission (B ¼ 0.393), length of stay (LOS) in the rehabilitation unit (B ¼ 0.264) and length of Post-Traumatic Amnesia (PTA) (B ¼ À0.120). Together, these predictors explained 86% of variance of FIM total scores at discharge. Conclusion: Less than half of moderate TBI patients reached a normal functional level at discharge from sub-acute rehabilitation. A short PTA period, a high GCS score and FIM score at admission to rehabilitation and a longer stay in the rehabilitation unit were positive predictors of functional level at discharge.