Faculty Bibliography

Sixty higher-level outpatients with traumatic brain injury (TBI), all at least 1 year post-injury, were randomly assigned to either conventional group neuropsychological rehabilitation or an innovative group treatment focused on the treatment of problem-solving deficits. Incorporating strategies for addressing underlying emotional self-regulation and logical thinking/reasoning deficits, the innovative treatment is unique in its attention to both motivational, attitudinal, and affective processes and problem-solving skills in persons with TBI. Participants in the innovative group improved in problem solving as assessed using a variety of measures, including (1) executive function, (2) problem-solving self-appraisal, (3) self-appraised emotional self-regulation and clear thinking, and (4) objective observer ratings of roleplayed scenarios. These improvements were maintained at follow-up. Baseline performance on timed attention tasks was related to improvement; individuals who processed the most slowly benefited the most. These participants did not show improvements on timed attention tasks, but did improve on problem-solving measures. Such findings are consistent with successful compensatory strategy use-the person may still have deficits and symptoms, but now has effective strategies for reducing their impact on daily functioning.

To enhance understanding of the role that social problem solving (SPS) plays in community integration following traumatic brain injury (TBI). Study Design: Regression analysis. Participants: Forty-five adults with TBI participating in higher level outpatient cognitive rehabilitation and 15 uninjured adults. Main Outcome Measures: Measures of community integration, problem-solving ability, and SPS self-appraisal and performance. Results: Individuals with TBI demonstrated poorer problem-solving as measured by both neuropsychological and SPS methods; however, the largest effect size was observed for SPS self-appraisal. Only SPS self-appraisal predicted a significant proportion of the variance in community integration. Conclusions: It is important to assess brain-injured persons' confidence in their ability to cope with problems. A focus on objective test scores alone may lead to underdetection of disabling problem-solving deficits.

The inability of substantial numbers of battered women to terminate or extricate themselves from violent relationships is of grave concern to clinical practitioners. Despite professional intervention, many victims of domestic violence return to the batterer and to repetitive battering, demonstrating that, for these women, traditional psychosocial interventions are ineffective. In a sample of 53 battered women, 92% reported having received blows to the head in the course of their battering; 40% reported loss of consciousness. Correlations between frequency of being hit in the head and severity of cognitive symptoms were significant, strongly suggesting that battered women should be routinely screened for traumatic brain injury and postconcussive syndrome. Development of treatment strategies to address the potentially damaging sequelae of head trauma in this population is essential

OBJECTIVE: To compare the relative utility of conventional neuropsychological and social problem-solving approaches to measuring functional problem solving deficits in individuals with acquired brain damage (ABD). DESIGN: In Study I, scores for individuals with ABD were compared to scores for control and normative samples. In Study II, pre- and posttest scores were compared for individuals with ABD who completed a program of outpatient cognitive rehabilitation. PARTICIPANTS: In Study I, individuals with ABD were compared to healthy controls. In Study II, pre- and posttreatment assessments were obtained for 34 individuals with ABD. MAIN OUTCOME MEASURES: Two approaches were used, conventional neuropsychological (WAIS-R/II Comprehension subtest and Wisconsin Card Sorting Test) and social problem solving (Problem Solving Inventory and Rusk Problem Solving Role Play Test). RESULTS: In Study I, the ABD group demonstrated significant deficits on both social problem solving measures; however, neither conventional neuropsychological measure detected significant deficits in the ABD group, relative to control and normative groups. In Study II, significant treatment gains were demonstrated on both social problem-solving measures, however neither conventional neuropsychological measure was sensitive to improvements in functional problem-solving ability. CONCLUSIONS: In higher-level cognitive rehabilitation settings, the evaluation of functional problem-solving deficits in individuals with ABD can be facilitated by augmenting neuropsychological test data with results from social problem-solving measures