In the past 15 years continuing advances in medical technology has led to significant growth in traumatic brain injury rehabilitation. It is important to plan rehabilitation within the context of available resources. Improved employment status and communication skills were listed as high priorities for recovering patients. Interpersonal dynamics between the individual with a traumatic brain injury and family members may change dramatically as family members take the role of caregiver. Neuropsychological assessment was found to be useful in predicting employability, which was defined as a successful completion of a vocational evaluation. Injury related factors including coma duration and age of onset have been associated with the outcome.
Individuals who are engaged in competitive employment or higher education will have scored significantly higher than individuals who are unemployed or are in a supported or sheltered employment situations on neuropsychological tests designed to asses general intellectual functioning, memory, and concentration.
Correlations were significant for the majority of the test scores including the Wechsler Memory Scale Memory Outpatient and the Wechsler Adult Intelligence Scale Performance and Full Scale IQ scores.
Participants were adults admitted for residential rehabilitation services at a Midwestern brain injury rehabilitation facility between the years of 1991 to 1996. They had to meet two criteria for inclusion in the study. One criterion was the completion of standard administrations of the neuropsychological assessment instruments involved in the study. The second criterion included was their accessibility to be reached for collection of follow-up data between 6 months and 1 year after discharge from the program. Sixty-six of the original 95 adult admissions were accepted and 58 individuals were able to be reached for follow-up data collection, and were included in the study.
Of the three tests given to participants as measures, two of them proved to have enough reliability to be included in the study. The Wechsler Adult Intelligence Scale-Revised (WAIS -R) was used as a comprehensive memory assessment instrument. It is comprised of eight subtests which produce five scores. The scores are attention/concentration, verbal memory, visual memory, general memory, and relayed recall. The attention/concentration score has the highest reliability coefficient at .90.
The second test given was the Stroop Color and Word Test. This test consists of three separate tasks: reading names of colors in black ink, identifying the color of several printed X's, and reading a list of color names that do not correspond with the actual color. The tasks yielded four scores. Three of which corresponded to the total number completed within 90 seconds and a fourth that compared the actual with the predicted word score.
Patients admitted to a residential rehabilitation facility after an acute brain injury served as the subjects for this research design. Typically these patients received a comprehensive evaluation that included neuropsychological assessment such as the WAIS-R, WMS-R, Stroop color, and Word test. These evaluations were ultimately scored by psychologists or trained technicians and used to design a specialized treatment plan for the patients. The specialized treatments included occupational therapy, speech and language therapy, physical therapy and psychological services. 6-12 months after their discharge from the rehabilitation facility patients were administered a follow up exam. Data was collected from the patients to determine the level of assistance needed and their current employment status and position.
A Chi-square analysis was used for the gender variable and t-test were performed on the remaining variables of age at injury, age at testing, education and length of stay. Length of stay was found to be significant between both the employment groups and the two levels of the assistance group. Hotelling T analysis was also performed on the data to identify differences between the two employment groups and the two levels of assistance across 3 sets of dependent variables which were identified as overall intellectual functioning (WAIS-R), memory (WMS-R) and attentional concentration (Stroop color and Word test). The scores for testing overall intellectual functioning did show a significance between the level of assistance received. Patients require no assistance scored significantly higher than those requiring some level of assistance. The employment groups showed no significant difference on overall intellectual functioning test. Memory functioning and attentional concentration showed no significant difference between the employment and level of assistance groups. Levels of assistance groups and employment status groups scored significantly different on the Stroop color test and Word test.
The results are conflicting regarding the utility of neuropsychological test in predicting long-term outcome. Neither employment nor assistance groups significantly differed on the WMS-R scores. The Stroop Color and Word Test was the only test that resulted in significant differences for both the assistance and employment groups. This could be due to the fact that the Stroop Color and Word Test measure concentration and ability to deal with distraction, which are elementary in everyday thinking. As for the WAIS-R, different patterns of performance may result in the same scores, and scores may be affected by abilities or impairment in areas less critical for day-to-day functioning. The number of participants, and lack of distinctions in outcome give serious limitations to the study. 82.8% of the participants were male, and 90% were Caucasian, also limiting the generalizibility of the data. Although, 82.8% of the participants were male, this is consistent with the incidence of head injury in the population as a hole, but there is variability with ethnicity. All participants in the study were in rehabilitation, which is not an opportunity that all individuals who have suffered brain injuries have, mainly due to funding issues. Determining the appropriate outcome goals early in rehabilitation can be of tremendous benefit in planning for services and allocating funds. The present study does provide support for the use of some neuropsychological test in predicting basic distinctions between levels of employment and independent living at outcome. Future direction of the research should refine the prediction models and continue in developing interventions in the rehabilitation setting to maximize functional outcome.
Neuropsychological Testing and Functional Outcome for Individuals with traumatic Brain Injury
-Recent advances in medical technology has led to significant growth in traumatic brain rehabilitation.
-Plan rehabilitation according to available resources
-Family dynamics change as the injured person becomes a dependent on the rest of the family
-Injury factors are associated with future employability
-Correlations showed a significance in the tests given.
-Adults admitted to a Midwestern brain injury facility between 1991-1996
-Completed the standard administration of the neuropsychological assessment instruments involved in the study
-Subjects were available to be reached for a collection of follow up data one year to six months after discharge
-Comprehensive memory assessment instrument
-comprised of eight subtests with five scores
II. Wechsler Memory Scale (WMS-R)
-used to evaluate patients memory
III. Stroop Color and Word Test
-consists of three separate tasks
-The task yields four scores
-Four Scores: attention/concentration, verbal memory, general memory and relayed recall
-Neuropsychological assessment test scores from initial admittance
-6-12 months after discharge data collected from the patients to determine levels of assistance
-Current employment status and position
-3 sets of Dependent Variable
a. overall intellectual functioning (WAIS-R)
c. Attentional Concentration (Stroop Color and Word Test)
-Level of assistance received showed significant difference in overall intellectual functioning.
-p>.001, for employment status and overall intellectual functioning
-Memory and attentional concentration showed no significant difference b/w employment and level of assistance groups.
-Levels of assistance groups and employment groups scored significantly different on Stroop Color and Word Test.
-The use of neuropsychological test in predicting long term outcome?
-No significant difference between employment or level of assistance groups found.
-Stroop Color and Word Test yield sig.
-Generalizability of Sample? Is sample representative of general population?
-Future research should refine the prediction models and continue developing interventions in rehabilitation settings to maximize functional outcome.
-Explore alternate sampling methods to include patients in which rehabilitation facilities are not a viable option.
-Obtain a representative sample
1) Neuropsychological test can be used to plan a treatment course specific to the patients needs and limitations.
2) Neuropsychological assessment was found to be useful in predicting employability, which was defined as a successful completion of a vocational evaluation
3) Individuals who are engaged in competitive employment or higher education will have scored significantly higher than individuals who are unemployed or are in a supported or sheltered employment situations on neuropsychological tests designed to asses general intellectual functioning, memory, and concentration.
Problems with the Study:
1) The number of participants, and lack of distinctions in outcome give serious limitations to the study. 82.8% of the participants were male, and 90% were Caucasian, also limiting the generalizibility of the data.
2) All participants in the study were in rehabilitation, which is not an opportunity that all individuals who have suffered brain injuries have, mainly due to funding issues.
3) Since every head injury and the proceeding recovery is different, why are standardized test being used to predict employability and outcome?