Feasibility of a Brief Neuropsychologic Test Battery During Acute Inpatient Rehabilitation After Traumatic Brain Injury

JFK Johnson Rehabilitation Institute at JFK Medical Center, Edison, NJ 08818, USA.
Archives of physical medicine and rehabilitation (Impact Factor: 2.57). 05/2008; 89(5):942-9. DOI: 10.1016/j.apmr.2008.01.008
Source: PubMed


To determine (1) if more than 50% of patients with moderate to severe traumatic brain injury (TBI) who met study criteria can complete a battery of neuropsychologic tests in less than 75 minutes 2 to 6 weeks after injury regardless of posttraumatic amnesia (PTA) status; (2) which tests are most likely to be completed; and (3) range of scores obtained.
Prospective multicenter observational study.
Acute inpatient neurorehabilitation hospitals.
Screened 543 Traumatic Brain Injury Model System patients with moderate to severe TBI; 354 were tested at 2 to 6 weeks postinjury.
Not applicable.
Percentage of patients able to complete the neuropsychologic tests in less than 75 minutes.
Two hundred eighteen (62%) patients completed the battery in 66 minutes on average. Mean interval from injury to testing was 28.3+/-7.1 days. Tests completed with the highest frequency were California Verbal Learning Test-II, FAS, and animal naming. Performance was less impaired (P<.001) on all measures for patients who had emerged from PTA.
Approximately two thirds of screened patients were able to complete a brief neuropsychologic test battery at 2 to 6 weeks postinjury, regardless of PTA status. Although patients out of PTA were less impaired on all test measures, confusion did not preclude participation in the test battery or prohibit assignment of test scores. Early neuropsychologic assessment after TBI is feasible even for many patients who are still in PTA.

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    • "In this approach, neuropsychological tests are administered some time after injury, and results are used to establish the severity of impairment in specifi c abilities that are ostensibly the result of brain injury. For TBI, the feasibility of this approach has support from studies that demonstrate neuropsychological testing with brief test batteries can be conducted within weeks following moderate to severe TBI (Boake et al., 2001 ; Sherer et al., 2002 ), even before PTA has fully resolved in some patients (Kalmar et al., 2008 ; Wilson et al., 1999 ). Kalmar and colleagues (2008) found that 32 % ( n = 112) of their patients with moderate to severe TBI who were still experiencing PTA were able to complete a brief battery of neuropsychological tests designed to take 60–75 min to administer. "

    Cluster Analysis in Neuropsychological Research: Recent Applications, Edited by Daniel N. allen, Gerald Goldstein, 01/2013: chapter Classification of Traumatic Brain Injury Severity: A Neuropsychological Approach: pages 95-123; Springer Publishing Company., ISBN: 978-1461467434
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    ABSTRACT: Background: Mortality and morbidity of patients following traumatic brain injury (TBI) remains extremely high. TBI sets into motion a cascade of apoptotic events that includes bcl-2, which inhibits apoptosis. Patients with higher levels of bcl-2 protein after TBI appear to have smaller areas of ischemia and better functional outcomes as measured by Glasgow Outcome Scores (GOS). Purpose: The purpose of this study was to examine the relationship between BCL-2 genotypes in patients with severe TBI and global functional outcomes, cognitive-behavioral outcomes, mortality, and biological/clinical data. Methods: This pilot study was an ancillary study that examined biological/clinical markers in TBI patients and global functional and cognitive-behavioral outcomes after severe TBI (n=230). Nuclear DNA was extracted from CSF or blood. Based on HapMap, the DNA was analyzed for the genotypes of 17 high priority tagging single nucleotide polymorphisms (tSNPs) with a minor allele frequency ≥0.3 via TaqMan® allele discrimination. Biological/clinical data (bcl-2 protein levels, neurometabolites (lactate, pyruvate, and lactate pyruvate (LP) ratio) and cerebral blood flow (CBF) were analyzed following the first five to six (protein only) days post injury. Mortality and global functional outcomes [GOS & Disability Rating Scale (DRS)], analyzed at 3, 6, 12, and 24 months. The cognitive behavioral outcomes [Neurobehavioral Rating Scale -Revised (NRS-R), Trails A, and Trails B] were analyzed at 3, 6, and 12 months post injury. Statistical analysis for BCL-2's relationship with neuropsychological outcomes and biological/ clinical data overtime utilized was mixed modeling, (mortality utilized generalized mixed modeling). Results: There were 3 tSNPs of particular interest: Rs1801018: homozygous variant (GG) significant associated with decreased mortality (p=0.0055; OR=5.01), higher GOS (p=0.0004), lower DRS (p=0.0002), lower Global CBF (p=0.0031), [presence of the variant allele (G)] lower LP ratios (p=0.024); all better outcomes. Rs17756073: presence of variant allele (G) was associated with higher NRS-R (p=0.0331) and longer Trails B times (p=0.0516); both poorer outcomes. Rs7236090: homozygous wild type (CC) was associated with lower bcl-2 protein concentrations when analyzed without outliers (p=0.0056); the literature associates this with poor outcomes.Conclusion: BCL-2 genotypes had a significant relationship with global functional outcomes, cognitive behavioral outcomes, bcl-2 protein concentrations, neurometabolites, and CBF.
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    ABSTRACT: During the years 2002 to 2007, 16 Traumatic Brain Injury Model Systems of Care (TBIMS) were funded by the National Institute on Disability and Rehabilitation Research to conduct site-specific and collaborative research projects, including contribution to a longitudinal database, within comprehensive systems of care specialized for people with traumatic brain injury. The TBIMS program has been in existence since 1987 and has undergone significant modifications over these years. Herein I provide an overview of the changes that occurred in the 2002-2007 funding cycle, the research initiatives that were carried out during that time, and brief descriptions of the 13 original TBIMS research articles included in this issue of Archives.
    Archives of physical medicine and rehabilitation 06/2008; 89(5):894-5. DOI:10.1016/j.apmr.2008.03.001 · 2.57 Impact Factor
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