A-102 Performance Validity Testing in Telehealth Research: A VA Traumatic Brain Injury Model Systems Study

2021 ◽  
Vol 36 (6) ◽  
pp. 1151-1151
Author(s):  
Justin O'Rourke ◽  
Robert J Kanser ◽  
Marc A Silva
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Digit Span ◽  
Secondary Analysis ◽  
Primary Objective ◽  
Model Systems ◽  
Performance Validity ◽  
Cut Scores ◽  
Chi Square ◽  
Severe Tbi

Abstract Objective Studies on Performance Validity Tests (PVTs) for tele-neuropsychology (TeleNP) are sparse. Verbal PVTs appear to better translate to TeleNP, so the primary objective of this study was to provide initial data on two well-established, verbal PVTs administered via TeleNP for research participants with traumatic brain injury (TBI). Methods This secondary analysis of the Veterans Affairs TBI Model Systems data included 53 participants enrolled in a PVT module study (3/01/2020–09/20/2020) with documented moderate-to-severe TBI per Glasgow Coma Score (M = 6.5, SD = 4.4), posttraumatic amnesia duration (M = 42.7 days, SD = 47.1), and/or time to follow commands (M = 10.5 days, SD = 16.3). Participants completed two PVTs—Reliable Digit Span (RDS) and the 21-Item Test (21-IT)—alongside telephone-based cognitive assessment 1–7 years after TBI. Descriptive analyses were performed to compare PVT performances to previously established cut scores. Chi square analyses were employed to examine 21-IT and RDS as dichotomous outcomes (pass/fail) at selected cutoffs. Results RDS ranged from 5 to 16 (M = 10.5, SD = 2.4). 21-IT ranged from 7 to 21 (M = 16.4, SD = 3.1). For RDS, 9.8% were invalid with a cutscore of ≤7 and 19.6% using a cutscore of ≤8. For the 21-IT, 7.8% were in invalid using a cutscore of ≤11, and 13.7% using a cutscore of ≤12. Conclusion(s) Using previously established cut scores, telephone-administered RDS and 21-IT resulted in relatively low rates of invalid performance among individuals with moderate-to-severe TBI. These findings provide preliminary support for the RDS and 21-IT in TeleNP.

scholarly journals Performance validity testing via telehealth and failure rate in veterans with moderate-to-severe traumatic brain injury: A veterans affairs TBI model systems study

2021 ◽  
pp. 1-9
Author(s):  
Robert Kanser ◽  
Justin O’Rourke ◽  
Marc A. Silva
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Digit Span ◽  
Model Systems ◽  
Performance Validity ◽  
Face To Face ◽  
Neuropsychological Evaluations ◽  
Validity Tests ◽  
Positive Classification

BACKGROUND: The COVID-19 pandemic has led to increased utilization of teleneuropsychology (TeleNP) services. Unfortunately, investigations of performance validity tests (PVT) delivered via TeleNP are sparse. OBJECTIVE: The purpose of this study was to examine the specificity of the Reliable Digit Span (RDS) and 21-item test administered via telephone METHOD: Participants were 51 veterans with moderate-to-severe traumatic brain injury (TBI). All participants completed the RDS and 21-item test in the context of a larger TeleNP battery. Specificity rates were examined across multiple cutoffs for both PVTs. RESULTS: Consistent with research employing traditional face-to-face neuropsychological evaluations, both PVTs maintained adequate specificity (i.e., >  90%) across previously established cutoffs. Specifically, defining performance invalidity as RDS <  7 or 21-item test forced choice total correct <  11 led to <  10%false positive classification errors. CONCLUSIONS: Findings add to the limited body of research examining and provide preliminary support for the use of the RDS and 21-item test in TeleNP via telephone. Both measures maintained adequate specificity in veterans with moderate-to-severe TBI. Future investigations including clinical or experimental “feigners” in a counter-balanced cross-over design (i.e., face-to-face vs. TeleNP) are recommended.

Reinjury After Moderate to Severe TBI: Rates and Risk Factors in the NIDILRR Traumatic Brain Injury Model Systems

2020 ◽  
Vol 36 (1) ◽  
pp. E50-E60
Author(s):  
Sarah M. Bannon ◽  
Raj G. Kumar ◽  
Jennifer Bogner ◽  
Therese M. O'Neil-Pirozzi ◽  
Lisa Spielman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Model Systems ◽  
Traumatic Brain Injury Model ◽  
Injury Model ◽  
Severe Tbi

Examining Driving and Participation 5 Years After Traumatic Brain Injury

2018 ◽  
Vol 38 (3) ◽  
pp. 143-150 ◽  
Author(s):  
Kimberly S. Erler ◽  
Shannon B. Juengst ◽  
Diane L. Smith ◽  
Therese M. O’Neil-Pirozzi ◽  
Thomas A. Novack ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Community Dwelling ◽  
Model Systems ◽  
National Database ◽  
Significant Independent Predictor ◽  
Independent Contribution ◽  
Functional Factors ◽  
Severe Tbi ◽  
Evidenced Based

Participation is often considered a primary goal of traumatic brain injury (TBI) rehabilitation, but little is known about the influence of driving on participation after TBI. The objective of this study was to examine the independent contribution of driving status to participation at 5 years post TBI, after controlling for demographic, psychosocial, and functional factors. Participants ( N = 2,456) were community-dwelling individuals with moderate to severe TBI, age 18 to 65 at time of injury, and enrolled in the TBI Model Systems (TBIMS) National Database (NDB). Hierarchical linear regressions for the dependent variable of participation at 5 years post TBI were performed. Findings showed that driving was a highly significant independent predictor of participation and was a stronger relative predictor of participation than FIM® Cognitive, FIM® Motor, and depression. The independent contribution of driving to participation suggests the need to develop evidenced-based occupational therapy assessments and interventions that facilitate safe engagement in the occupation of driving to address the long-term goal of improved participation.

Head CT before Transfer Does Not Decrease Time to Craniotomy for TBI Patients

2018 ◽  
Vol 84 (2) ◽  
pp. 201-207 ◽  
Author(s):  
Peter M. Tonui ◽  
Sarah K. Spilman ◽  
Carlos A. Pelaez ◽  
Mark R. Mankins ◽  
Richard A. Sidwell
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Chi Square ◽  
Head Ct ◽  
Image Sharing ◽  
Level Ii ◽  
Severe Tbi ◽  
Level I ◽  
Trauma Education ◽  
Neurosurgical Intervention

Rural trauma education emphasizes that radiologic imaging should be discouraged if it delays transfer to definitive care. With increased capacity for image sharing, however, radiography obtained at referring hospitals (RH) could help providers at trauma centers (TC) prepare for patients with traumatic brain injury. We evaluated whether a head CT prior to transfer accelerated time to neurosurgical intervention at the TC. The study was conducted at a combined adult Level I and pediatric Level II TC with a catchment area that includes rural hospitals within a 150 mile radius. The trauma registry was used to identify patients with traumatic brain injury who went to surgery for a neurosurgical procedure immediately after arrival at the TC. All patients were transferred in from a RH. Differences between groups were assessed using analysis of variance and chi-square. Fifty-six patients met study criteria during the study period (2010-2015). The majority (86%) of patients received head CT imaging at the RH, including a significant percentage of patients (18%) who presented with GCS ≤8. There was no statistically significant decrease in time to surgery when patients received imaging at the RH. CTimaging was associated with a delay in transfer that exceeded 90 minutes. Findings demonstrate that imaging at the RH delayed transfer to definitive care and did not improve time to neurosurgical intervention at the TC. Transfer to the TC should not be obstructed by imaging, especially for patients with severe TBI.

Functional Outcome and Mental Health Symptoms in Military Personnel and Veterans Pursuing Postsecondary Education After Traumatic Brain Injury: A VA TBI Model Systems Study

2019 ◽  
Vol 33 (1) ◽  
pp. 41-55
Author(s):  
Marc A. Silva ◽  
Christina Dillahunt-Aspillaga ◽  
Nitin Patel ◽  
Jeffrey S. Garofano ◽  
Kristina M. Martinez ◽  
...  
Keyword(s):  
Mental Health ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Postsecondary Education ◽  
Military Personnel ◽  
Model Systems ◽  
Community Reintegration ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Severe Tbi

BackgroundTBI is a leading cause of disability among veterans and active duty military personnel, and presents an obstacle to community reintegration. Prior studies examining adult survivors of TBI pursuing postsecondary education have methodological flaws that limit the understanding the scope and severity of sequelae experienced by persons with TBI who attend college.ObjectiveTo describe (a) physical and cognitive functioning, and (b) postconcussion and mental health symptoms in veterans and military personnel (V/M) with traumatic brain injury (TBI) enrolled in postsecondary education programs after discharge from rehabilitation.MethodCross-sectional study. Participants were recruited from five Veterans Affairs (VA) Polytrauma Rehabilitation Centers, enrolled in the VA TBI Model Systems parent study, and attending school during follow-up (N= 155). Outcome measures included the Functional Independence Measure (FIM), Neurobehavioral Symptom Inventory (NSI), Post-traumatic Stress Disorder (PTSD) Checklist-Civilian version (PCL-C), Patient Health Questionnaire-Depression (PHQ-9), and Generalized Anxiety Disorder Questionnaire (GAD-7).FindingsParticipants were mostly male (92.9%) and White (81.4%), with mild (40.0%), moderate (11.5%), severe (34.5%), or very severe TBI (23.0%). Depression, anxiety, PTSD, and postconcussion symptoms were lowest in participants with very severe TBI and highest in those with mild TBI. There were no significant differences in FIM across TBI severity levels.ConclusionThis study supports the need for rehabilitation counselors, educators, and administrators to prepare future practitioners to deliver tailored services to student V/M with TBI. These services can facilitate successful community reintegration and transition into civilian school settings. Symptom profiling may inform personalized cognitive interventions to enhance these students’ academic success.

Visuospatial Learning in Traumatic Brain Injury: An Examination of Impairments using the Computerised Austin Maze Task

2015 ◽  
Vol 16 (1) ◽  
pp. 19-27
Author(s):  
Cynthia A. Honan ◽  
Skye McDonald ◽  
Alana Fisher
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Digit Span ◽  
Maze Task ◽  
Neuropsychological Measures ◽  
Learning Impairments ◽  
Visuospatial Learning ◽  
Convergent And Divergent Validity ◽  
Severe Tbi ◽  
Figure Test

An important aspect of cognitive functioning that is often impaired following traumatic brain injury (TBI) is visuospatial learning and memory. The Austin Maze task is a measure of visuospatial learning that has a long history in both clinical neuropsychological practice and research, particularly in individuals with TBI. The aim of this study was to evaluate visuospatial learning deficits following TBI using a new computerised version of the Austin Maze task. Twenty-eight individuals with moderate-to-severe TBI were compared to 28 healthy controls on this task, together with alternative neuropsychological measures, including the WAIS-III Digit Symbol and Digit Span subtests, the Trail Making Test, WMS-III Logical Memory, and Rey Osterrieth Complex Figure Test. The results demonstrated that TBI individuals performed significantly more poorly on the Austin Maze task than control participants. The Austin Maze task also demonstrated good convergent and divergent validity with the alternative neuropsychological measures. Thus, the computerised version of the Austin Maze appears to be a sensitive measure that can detect visuospatial learning impairments in individuals with moderate-to-severe TBI. The new computerised version of the task offers much promise in that it is more accessible and easier to administer than the conventional form of the test.

scholarly journals Hubungan Skor GCS dengan Fungsi Kognitif pada Pasien Cedera Otak Traumatik di IGD RSUD Ulin Banjarmasin

2020 ◽  
Vol 9 (1) ◽  
pp. 1-7
Author(s):  
Apidha Kartinasari ◽  
Fakhrurrazy Fakhrurrazy ◽  
Kenanga M. Sikumbang
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Function ◽  
Chi Square ◽  
Cross Sectional ◽  
Clock Drawing Test ◽  
Chi Square Test ◽  
Severe Tbi ◽  
Injury Patient ◽  
Gcs Score

Latar Belakang dan Tujuan: Cedera Otak Traumatik (COT) merupakan cedera yang mempengaruhi tingkat kesadaran serta fungsi neurologis. Pemeriksaan GCS dilakukan untuk mengkategorikan keparahan yang terjadi pada COT. Kondisi pasca COT dapat menyebabkan terjadinya penurunan fungsi kognitif karena terjadi kerusakan pada sel-sel otak serta vaskularisasinya. Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan antara skor GCS dengan pemeriksaan fungsi kognitif menggunakan Mini Mental State Examination (MMSE) dan Clock Drawing Test (CDT) pada pasien COT di Instalasi Gawat Darurat (IGD) RSUD Ulin Banjarmasin.Subjek dan Metode: Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional. Sebanyak 48 sampel didapatkan secara consecutive sampling.Hasil: Pada COT ringan terdapat 2 pasien (10%) mengalami penurunan fungsi kognitif, COT sedang 15 pasien (83,3%), dan COT berat 9 pasien (90%). Analisis data menggunakan uji Chi-Square dengan tingkat kepercayaan 95% menunjukkan penurunan fungsi kognitif seiring dengan semakin beratnya COT (p=0,000).Simpulan: Terdapat hubungan antara skor GCS dengan fungsi kognitif menggunakan MMSE dan CDT pada pasien COT. Relationship between Glasgow Coma Scale (GCS) Score with Cognitive Function in Traumatic Brain Injury Patient at Emergency Department of Ulin General Hospital BanjarmasinAbstractBackground and Objective: Traumatic Brain Injury (TBI) is an injury that affects the level of consciousness and neurological function. GCS examination is done to categorize the severity that occurs in TBI. Conditions after traumatic brain injury cause cognitive function impairment due to damage of brain cells and its vascularization. Analyze the relationship between GCS scores and cognitive function test using MMSE and CDT in TBI patients.Subject and Method: This study was observational analytic in design with a cross sectional approach. A total of 48 samples were obtained by consecutive sampling.Result: In mild TBI there were 2 patients (10%) experienced decrease in cognitive function, moderate TBI was 15 patients (83.3%), and 9 patients (90%) in severe TBI. Data analysis used Chi-Square test with 95% confidence level which showed a decrease in cognitive function along with the increasing severity of TBI (p=0.000). Conclusion: There was a relationship between GCS scores and cognitive function using MMSE and CDT in TBI patients. 

scholarly journals Evacuation Strategies for U.S. Casualties with Traumatic Brain Injury (TBI) with and without Polytrauma

2022 ◽  
Author(s):  
Patrick C Ng ◽  
Allyson A Araña ◽  
Shelia C Savell ◽  
William T Davis ◽  
Julie Cutright ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Outcomes ◽  
Secondary Analysis ◽  
Service Members ◽  
Blood Products ◽  
Significant Difference ◽  
Severe Tbi ◽  
Polytrauma Patients ◽  
The Impact

ABSTRACT Introduction According to the Military Health System Traumatic Brain Injury (TBI) Center of Excellence, 51,261 service members suffered moderate to severe TBI in the last 21 years. Moderate to severe TBI in service members is usually related to blast injury in combat operations, which necessitates medical evacuation to higher levels of care. Prevention of secondary insult, and mitigation of the unique challenges associated with the transport of TBI patients in a combat setting are important in reducing the morbidity and mortality associated with this injury. The primary goal of this study was a secondary analysis comparing the impact of time to transport on clinical outcomes for TBI patients without polytrauma versus TBI patients with polytrauma transported out of the combat theater via Critical Care Air Transport Teams (CCATT). Our secondary objective was to describe the occurrence of in-flight events and interventions for TBI patients without polytrauma versus TBI with polytrauma to assist with mission planning for future transports. Materials and Methods We performed a secondary analysis of a retrospective cohort of 438 patients with TBI who were evacuated out of theater by CCATT from January 2007 to May 2014. Polytrauma was defined as abbreviated injury scale (AIS) of at least three to another region in addition to head/neck. Time to transport was defined as the time (in days) from injury to CCATT evacuation out of combat theater. We calculated descriptive statistics and examined the associations between time to transport and preflight characteristics, in-flight interventions and events, and clinical outcomes for TBI patients with and without polytrauma. Results We categorized patients into two groups, those who had a TBI without polytrauma (n = 179) and those with polytrauma (n = 259). Within each group, we further divided those that were transported within 1 day of injury, in 2 days, and 3 or more days. Patients with TBI without polytrauma transported in 1 or 2 days were more likely to have a penetrating injury, an open head injury, a preflight Glascow Coma Score (GCS) of 8 or lower, and be mechanically ventilated compared to those transported later. Patients without polytrauma who were evacuated in 1 or 2 days required more in-flight interventions compared to patients without polytrauma evacuated later. Patients with polytrauma who were transported in 2 days were more likely to receive blood products, and patients with polytrauma who were evacuated within 1 day were more likely to have had at least one episode of hypotension en route. Polytrauma patients who were evacuated in 2–3 days had higher hospital days compared to polytrauma with earlier evacuations. There was no significant difference in mortality between any of the groups. Conclusions In patients with moderate to severe TBI transported via CCATT, early evacuation was associated with a higher rate of in-flight hypotension in polytrauma patients. Furthermore, those who had TBI without polytrauma that were evacuated in 1–2 days received more in-flight supplementary oxygen, blood products, sedatives, and paralytics. Given the importance of minimizing secondary insults in patients with TBI, recognizing this in this subset of the population may help systematize ways to minimize such events. Traumatic Brain Injury patients with polytrauma may benefit from further treatment and stabilization in theater prior to CCATT evacuation.

Sign in / Sign up

Export Citation Format

Share Document