[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury (TBI) is the most common cause of brain damage, resulting in long-term disability. The ever increasing life expectancies among TBI patients necessitate a critical examination of the factors that influence long-term outcome. Our objective was to evaluate the contribution of premorbid factors (which were identified in our previous work) and acute injury indices to long-term functioning following TBI.
Eighty-nine participants with moderate-to-severe TBI were evaluated at an average of 14.2 years postinjury (range: 1-53 years) with neuropsychological battery, medical examination, clinical interviews, and questionnaires.
TBI severity predicted cognitive, social, and daily functioning outcomes. After controlling for injury severity, preinjury intellectual functioning predicted cognitive status, as well as occupational, social, emotional, and daily functioning. Preinjury leisure activity also predicted cognitive, emotional, and daily functioning, whereas socioeconomic status failed to predict any of these variables.
Findings offer further support for the cognitive reserve construct in explaining significant variance in TBI outcome, over and above the variance explained by injury severity.
Full-text · Article · Apr 2015 · Journal of Clinical and Experimental Neuropsychology
[Show abstract][Hide abstract] ABSTRACT: Regressive behavior is a known sequela after severe traumatic brain injury (TBI). However, prolonged "infantile-like" behavior has received little attention in the literature, suggesting that this is a rare phenomenon. It is typically characterized by long-lasting childish, extremely dependent, and sometimes aggressive behavior, which is distinguished from the expected recovery process. The relevant theoretical framework lies in the field of disorders called "Neuropathologies of the self" (NPS). We report three cases of young adults who, following a severe TBI, developed continual regressive behavior. The Disability Rating Scale (DRS) was used to assess possible change in their condition. First, while admitted, which was performed in retrospect, and again 6 years later at the time stated. Inter-rater reliability for the scale items showed adequate correlation. Results showed no significant difference in patients' scores, indicating persistent functional difficulties. We conclude that this "regressive syndrome" presents an unusual form of behavior that is stable over time. It seems to be in line with other NPS disorders, and may stem from an interaction of organic factors and primary mental complexity. Nevertheless, further research is required to examine the factors affecting the emergence and recovery from this phenomenon.
[Show abstract][Hide abstract] ABSTRACT: The concept of "reserve" has been proposed to account for the mismatch between brain pathology and its clinical expression. Prior efforts to characterize this concept focused mostly on brain or cognitive reserve measures. The present study was a preliminary attempt to evaluate premorbid personality and emotional aspects as potential moderators in moderate-to-severe traumatic brain injury. Using structural equation modeling and multiple regression analyses, we found that premorbid personality characteristics provided the most robust moderator of injury severity on occupational outcome. Findings offer preliminary support for premorbid personality features as another relevant reserve construct in predicting outcome in this population.
Full-text · Article · May 2013 · Journal of Clinical and Experimental Neuropsychology
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury (TBI) is the most common cause of brain damage, resulting in long-term disability. The "reserve" construct has been proposed to account for the reported mismatch between brain damage and its clinical expression. Although numerous studies have used various measures thought to reflect this construct, few studies have examined its underlying structure in clinical populations, and no studies have systematically studied this construct in TBI. In the present study, structural equation modeling technique was used to evaluate several models hypothesized to represent cognitive reserve (CR) in TBI. A broad range of data typically reported in the literature as representing CR was collected from 89 individuals who sustained moderate-to-severe TBI. Analyses revealed a best fitting model that consisted of three separate factors representing premorbid intelligence, socioeconomic status and leisure activity, with distinct pattern of associations among the three factors. Findings provide empirical support for the notion of a multi-factorial CR and suggest a coherent framework for further investigation. (JINS, 2013, 19, 1-8).
No preview · Article · Apr 2013 · Journal of the International Neuropsychological Society
[Show abstract][Hide abstract] ABSTRACT: Neuropsychological tests are often used to evaluate executive function (EF) deficits in patients suffering traumatic brain injuries (TBIs). This study compared the sensitivity of three such tests--namely, the Delis-Kaplan Executive Function System Sorting Test (D-KEFS ST), the Wisconsin Card Sorting Test (WCST), and the Trail Making Test (TMT)--in differentiating between severe TBI patients and healthy controls. The differences between the two groups were significant for 5/5 variables evaluated through the D-KEFS ST, for 4/6 variables evaluated through the WCST, and for 2/2 variables evaluated through the TMT. Receiver operating characteristic analysis revealed that the variables "attempted sorts" in the D-KEFS ST and completion time in Part B of the TMT were the most powerful predictors of group assignment, with cutoff points of 9.5 sorts and 84.5 seconds, respectively. Our results highlight the possible value of the D-KEFS ST in the evaluation of postinjury EF deficits in TBI patients.
No preview · Article · Nov 2011 · Journal of Clinical and Experimental Neuropsychology
[Show abstract][Hide abstract] ABSTRACT: This paper examines switching and clustering in phonemic and semantic fluency tasks in individuals with traumatic brain injury (TBI). Fluency tasks were administered to 30 Hebrew-speaking patients with TBI and 30 age-matched control participants. Significant group differences were found in total output, number of switches, and number of clusters on both tasks, but not in mean cluster size. Unlike prediction, z scores of the number of semantic switches and clusters were lower than the equivalent z scores on the phonemic test. Results highlight the executive component of semantic fluency and the importance of using this task when assessing cognitive functioning after TBI.
Full-text · Article · Nov 2010 · Journal of Clinical and Experimental Neuropsychology