Medical Symptom Validity Test Performance Following Moderate-Severe Traumatic Brain Injury: Expectations Based on Orientation Log Classification.

Objective: This study examined performance on the Medical Symptom Validity test (MSVT) during acute rehabilitation for moderate-severe traumatic brain injury (TBI) stratified by Orientation Log (O-Log) scores.

Method: Participants were 77 prospectively enrolled persons who sustained moderate-severe TBI and were acutely hospitalized secondary to the cognitive, medical and physical sequelae of their TBI. Participants were administered neuropsychological metrics, the O-Log and the MSVT a mean of 44 days post injury.

The sensitivity and specificity of clinical measures of sport concussion: three tests are better than one.

Context: A battery of clinical measures of neurocognition, balance and symptoms has been recommended for the management of sport concussion (SC) but is based on variable evidence.

Objective: To examine the sensitivity and specificity of a battery of tests to assess SC in college athletes.

Design: Cross-sectional.

The Safety Assessment Measure for persons with traumatic brain injury: Item pool development and content validity.

Background: Persons with moderate to severe TBI are at increased risk for unintentional injury or harm in the home and community; however, there is currently no standard measure of safety risk they face now and in the future.

Objective: To develop comprehensive and content valid scales and item pools for assessing safety and risk for persons with moderate to severe traumatic brain injuries.

Method: Qualitative psychometric methods for developing scales and items were used including literature review, item development and revision, focus groups with interdisciplinary rehabilitation staff (n = 26) for rating content validity, and cognitive interviewing of TBI family members (n = 9) for assuring item clarity.

A Preliminary Formula to Predict Timing of Symptom Resolution for Collegiate Athletes Diagnosed With Sport Concussion.

Context: Symptom presentation and recovery after sport concussion (SC) are variable. Empirically based models documenting typical symptom duration would assist health care providers in managing return to play after SC.

Objective: To develop a prediction model for SC symptom duration.

Preliminary evidence of equivalence of alternate forms of the ImPACT.

The ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) is a computerized neurocognitive test used to assist in the management of sport concussion management. A number of studies have documented the reliability and sensitivity of the ImPACT, but no studies have examined the equivalence of the ImPACT's alternate forms. The objective of our study was to determine the equivalence of the ImPACT's five alternate forms.

The impact of mild traumatic brain injury on cognitive functioning following co-occurring spinal cord injury.

Meta-analytic studies have shown that mild traumatic brain injury (MTBI) has relatively negligible effects on cognitive functioning at 90 or more days post-injury. Few studies have prospectively examined the effects of MTBI in acute physical trauma populations. This prospective, cohort study compared the cognitive performance of persons who sustained a spinal cord injury (SCI) and a co-occurring MTBI (N = 53) to persons who sustained an SCI alone (N = 64) between 26 and 76 days (mean = 46) post-injury.

ImPact test-retest reliability: reliably unreliable?

Context: Computerized neuropsychological testing is commonly used in the assessment and management of sport-related concussion. Even though computerized testing is widespread, psychometric evidence for test-retest reliability is somewhat limited. Additional evidence for test-retest reliability is needed to optimize clinical decision making after concussion.

Advances in neuropsychological assessment of sport-related concussion.

Objective: To critically review the literature from the past 12 years regarding the following key issues in sports-related neuropsychological assessment: (1) the advantages and disadvantages of different neuropsychological assessment modalities; (2) the evidence for and against the current paradigm of baseline/postinjury testing; (3) the role of psychological factors in the evaluation and management of concussion; (4) advances in the neuropsychological assessment of children; (5) multi-modal assessment paradigms; (6) the role of the neuropsychologist as part of the sports healthcare team and (6) the appropriate administration and interpretation of neuropsychological tests.

Design: Targeted computerised literature review (MEDLINE, PubMed, CINAHL and PsychInfo) from 2000 to the present using key words: neuropsychological, neurocognitive, assessment, testing, concussion and sports.

Results: More than 2600 articles were identified using key word searches of the databases, including many duplicates.

Developing and evaluating prediction models in rehabilitation populations.

This article presents a 3-part framework for developing and evaluating prediction models in rehabilitation populations. First, a process for developing and refining prognostic research questions and the scientific approach to prediction models is presented. Primary components of the scientific approach include the study design and sampling of patients, outcome measurement, selecting predictor variable(s), minimizing methodologic sources of bias, assuring a sufficient sample size for statistical power, and selecting an appropriate statistical model.

Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes.

Objective: To determine the impact of co-occurring traumatic brain injury (TBI) on functional motor outcome and cognition during acute spinal cord injury (SCI) rehabilitation.

Design: Prospective, longitudinal cohort.

Setting: Single-center National Institute of Disability and Rehabilitation Research SCI Model System.

Role of neuropsychologists in the evaluation and management of sport-related concussion: an inter-organization position statement.

Over the past 20 years, clinical neuropsychologists have been at the forefront of both scientific and clinical initiatives aimed at developing evidence-based approaches to the evaluation and management of sport-related concussion (SRC). These efforts have directly impacted current policy on strategies for injury assessment and return-to-play by athletes after concussion. Many states are considering legislation requiring (a) education of athletes, parents, coaches, and school/organization officials on the recognition, evaluation, and management of SRCs; (b) removal from play of any youth athlete that is suspected of having sustained a concussion; and (c) not allowing the student to return to participation until the student is evaluated and cleared for return to participation in writing by an appropriate healthcare professional.

Role of neuropsychologists in the evaluation and management of sport-related concussion: an inter-organization position statement.

Over the past 20 years, clinical neuropsychologists have been at the forefront of both scientific and clinical initiatives aimed at developing evidence-based approaches to the evaluation and management of sport-related concussion. These efforts have directly impacted current policy on strategies for injury assessment and return-to-play by athletes after concussion. Many states are considering legislation requiring (a) education of athletes, parents, coaches, and school/organization officials on the recognition, evaluation, and management of sport-related concussions; (b) removal from play of any youth athlete that is suspected of having sustained a concussion; and (c) not allowing the student to return to participation until the student is evaluated and cleared for return to participation in writing by an appropriate healthcare professional.

Investigation of baseline self-report concussion symptom scores.

Context: Self-reported symptoms (SRS) scales comprise one aspect of a multifaceted assessment of sport-related concussion. Obtaining SRS assessments before a concussion occurs assists in determining when the injury is resolved. However, athletes may present with concussion-related symptoms at baseline.

Clinical considerations for the diagnosis of major depression after moderate to severe TBI.

Major depression (MD) is the most common psychiatric disorder after traumatic brain injury (TBI). Yet, diagnosing MD is often challenging because of cognitive, emotional, and somatic symptoms that overlap with TBI and other psychiatric disorders. Best current evidence suggests that depressed mood is characterized more by irritability, anger, and aggression than by sadness and tearfulness in persons with TBI.

Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence.

Objectives: To examine prospectively the incidence and severity of co-occurring traumatic brain injury (TBI) in persons with traumatic spinal cord injury (SCI) and to describe a TBI assessment process for SCI rehabilitation professionals.

Design: A prospective, cohort design to collect and analyze clinical variables relevant for diagnosing co-occurring TBI.

Setting: An urban, single-center National Institute of Disability and Rehabilitation Research Model Spinal Cord Injury System in the Southeastern United States.

Test-retest reliability of computerized concussion assessment programs.

Context: Computer-based neurocognitive assessment programs commonly are used to assist in concussion diagnosis and management. These tests have been adopted readily by many clinicians based on existing test-retest reliability data provided by test developers.

Objective: To examine the test-retest reliability of 3 commercially available computer-based neurocognitive assessments using clinically relevant time frames.

Neurocognitive performance of concussed athletes when symptom free.

Context: Concussed athletes may underreport concussion-related symptoms in order to expedite return to play. Whether neurocognitive impairments persist once concussion-related symptoms resolve has yet to be determined. Reliance on athlete-reported, postconcussion symptoms when making return-to-play decisions may expose athletes to subsequent injury if complete recovery has not occurred.

Relationships among premorbid alcohol use, acute intoxication, and early functional status after traumatic brain injury.

Objective: To investigate the relationships among intoxication at time of injury, preinjury history of problem drinking, and early functional status in patients with traumatic brain injury (TBI).

Design: Prospective cohort study.

Setting: Acute inpatient TBI rehabilitation.

Evaluation of changes in motor and visual functional activation over time following moderate-to-severe brain injury.

Primary Objective: Relatively little research has documented functional recovery following traumatic brain injury using neuroimaging techniques. This study aimed to examine the effects of moderate-to-severe brain injury on brain functioning over time.

Research Design: Eight brain-injured participants completed motor and visual tasks during fMRI at two time points within the first year following injury.

Variability in Stroop task performance and functional activation among a small brain-injured group.

This study evaluated the effects of moderate to severe brain injury on cognitive task performance and cortical activation. Five participants completed a Stroop task while undergoing functional magnetic resonance imaging (fMRI) at two time points post- injury. Results revealed activation within regions typically activated during a Stroop task (the region of interest: ROI), though variability among participants was evident.

The impact of diabetes mellitus on stroke acute rehabilitation outcomes.

Objective: To examine the impact of diabetes mellitus (DM) on functional outcomes after acute rehabilitation for cerebrovascular accident (CVA).

Design: A retrospective research design was used to analyze outcomes in patients with a primary diagnosis of unilateral stroke (n = 367) admitted to an urban, acute rehabilitation center in the Southeastern United States.

Results: Multivariable hierarchical regression revealed that DM did not contribute statistically significant variance to stroke acute rehabilitation prediction models.

Sensitivity of the concussion assessment battery.

Objective: Sports medicine clinicians commonly use multiple tests when evaluating patients with concussion. The specific tests vary but often include symptom inventories, posturography, and neurocognitive examinations. The sensitivity of these tests to concussion is vital in reducing the risk for additional injury by prematurely returning an athlete to play.

The effect of effort on baseline neuropsychological test scores in high school football athletes.

Objective: Poor effort on baseline neuropsychological tests is expected to influence interpretation of post-concussion assessment scores. Our study examined effort in an athletic population to determine if poor effort effects neuropsychological test performance.

Methods: High school athletes (N=199) were administered a brief neuropsychological test battery, which included the Dot Counting Test (DCT) and the Rey 15-Item Test with recognition trial.

Victoria Symptom Validity Test performance in acute severe traumatic brain injury: implications for test interpretation.

Effort testing has become commonplace in clinical practice. Recent research has shown that performance on effort tests is highly correlated with performance on neuropsychological measures. Clinical application of effort testing is highly dependent on research derived interpretive guidelines.