Faculty Bibliography

PRIMARY OBJECTIVE: To explore whether baseline diffusion tensor imaging (DTI) metrics are predictive of cognitive functioning 6 months post-injury in patients with mild traumatic brain injury (MTBI). RESEARCH DESIGN: Seventeen patients with MTBI and 29 sex- and age-matched healthy controls were studied. METHODS AND PROCEDURES: Participants underwent an MRI protocol including DTI, at an average of 4.0 (range: 1-10) days post-injury. Mean diffusivity (MD) and fractional anisotropy (FA) were measured in the following white matter (WM) regions: centra semiovale, the genu and the splenium of the corpus callosum and the posterior limb of the internal capsule. Participants underwent neuropsychological (NP) testing at baseline and at 6-month follow-up. Least squares regression analysis was used to evaluate the association of MD and FA with each NP test score at baseline and follow-up. MAIN OUTCOMES AND RESULTS: Compared to controls, average MD was significantly higher (p = 0.02) and average FA significantly lower (p = 0.0001) in MTBI patients. At the follow-up, there was a trend toward a significant association between baseline MD and response speed (r = -0.53, p = 0.087) and a positive correlation between baseline FA and Prioritization form B (r = 0.72, p = 0.003). CONCLUSIONS: DTI may provide short-term non-invasive predictive markers of cognitive functioning in patients with MTBI

PRIMARY OBJECTIVE: To investigate the relationship between the number of dilated Virchow-Robin spaces (VRS) and neurocognitive findings in patients with traumatic brain injury (TBI). RESEARCH DESIGN: Thirty-eight patients with TBI and 21 controls were studied. METHODS AND PROCEDURES: Fifteen patients underwent MRI within a mean interval of 5.4 (range 1-12) days from the brain injury and 23 after an average period of 5.5 (range 0.2-31) years. All subjects were examined with a battery of 13 neuropsychological tests (NP). MAIN OUTCOMES AND RESULTS: The average number of VRS was significantly higher in patients than in controls. There were no significant differences between patients and controls in terms of NP tests. The number of VRS showed a significant inverse correlation with processing speed and a positive correlation with visual perceptual of attention only in patients studied within a short delay of trauma. CONCLUSIONS: VRS are not directly associated to neurocognitive findings, suggesting that they may represent a result of the shear-strain injury

Cognitive rehabilitation is an empirically based field driven by multiple sources of activities and knowledge bases. Drawing on frames of reference provided by rehabilitation, neuropsychology, and rehabilitation psychology, cognitive rehabilitation has evolved to a point where studies have been generated to qualify for consideration in tables of evidence. At the center of cognitive rehabilitation is the effort to teach people to overcome or adapt to limitations. While rehabilitation has traditionally been focused on activity, a recent trend in the literature is to incorporate the individuals experience into a frame of reference for rehabilitation. Emphasizing the experience of the person in the situation fits into cognitive rehabilitation and raises the bar for rehabilitation not only in viewing rehabilitation as an activity to relieve burdens but also in terms of how rehabilitants come to grips with limitations. Dealing with limitations is an important indicator of mental health

Three inter-related studies examine the construct of problem solving as it relates to the assessment of deficits in higher level outpatients with traumatic brain injury (TBI). Sixty-one persons with TBI and 58 uninjured participants completed measures of problem solving and conceptually related constructs, which included neuropsychological tests, self-report inventories, and roleplayed scenarios. In Study I, TBI and control groups performed with no significant differences on measures of memory, reasoning, and executive function, but medium to large between-group differences were found on timed attention tasks. The largest between-group differences were found on psychosocial and problem-solving self-report inventories. In Study II, significant-other (SO) ratings of patient functioning were consistent with patient self-report, and for both self-report and SO ratings of patient problem solving, there was a theoretically meaningful pattern of correlations with timed attention tasks. In Study III, a combination of self-report inventories that accurately distinguished between participants with and without TBI, even when cognitive tests scores were in the normal range, was determined. The findings reflect intrinsic differences in measurement approaches to the construct of problem solving and suggest the importance of using a multidimensional approach to assessment

OBJECTIVE: To develop a survey instrument that assesses implementation of key components of outpatient neurorehabilitation programs and test the capacity of this instrument to differentiate between rehabilitation approaches. DESIGN: The Neurorehabilitation Program Styles Survey (NPSS) was administered to 18 outpatient facilities: 10 specialized and 8 discipline-specific outpatient neurorehabilitation programs. Scores were compared between types of programs using independent samples t tests. RESULTS: The NPSS showed good reliability and contrasted groups validity, significantly differentiating between types of programs. CONCLUSIONS: The NPSS holds considerable promise as a tool for distinguishing among different types of brain injury programs, and for assessing the differential effectiveness of specialized versus discipline-specific outpatient brain rehabilitation programs. Future research on the NPSS will assess the stability of the instrument over time, its content validity, and capacity to differentiate the full continuum of neurorehabilitation programs