Conducting statewide needs assessments for persons with traumatic brain injury.

The Traumatic Brain Injury Act of 1996 (Public Law 104-166) gave new authority to the Health Resources and Services Administration (HRSA) in the United States Department of Health and Human Services (DHHS) to establish a grant program for states to assist in addressing the needs of persons with traumatic brain injury (TBI). The resulting State Demonstration Grant Program has made available two categories of grants: planning and implementation. Planning grants are awarded to assist states in building infrastructure through the development of four core components. One of the core components is a statewide needs and resource assessment encompassing the full spectrum of services, from initial acute treatment through rehabilitation and long-term community supports. In 1999, assessments completed in 11 states were subjected to a comparative analysis to identify trends across states and to extract salient issues for the State Demonstration Grant Program. This article summarizes the context of the HRSA-funded needs assessments and contrasts the methods of needs assessment utilized. Over-arching issues are discussed, including exemplary qualitative and quantitative methods, and the diversity of theoretical models employed in designing assessments and interpreting findings. Several limitations in approaches were also identified, including shortcomings of convenience samples for conducting mail surveys and the unlikely validity of using a needs and resource discrepancy approach to identify gaps in services.

Primary caregivers of persons with brain injury: life change 1 year after injury.

The impact of a traumatic brain injury on the family of the injured person is just beginning to be explored. In the current study, 61 primary caregivers were contacted at 1 year following injury. They completed the Relative and Friend Support Index, Social Support Index, Trauma Complaints List and the Life Change Question. The majority of caregivers indicated at least mild negative life change following the brain injury. Greater social support was correlated with less life change and greater injury severity was correlated with negative life change. Neither of these relationships was found to be significant at the 0.05 level. A significant positive correlation was found between caregivers' perception of deficits and the degree of negative life change. Perceived deficits accounted for the greatest amount of variance in life change followed by relative and friend support when all variables were entered into a stepwise regression. Further analyses indicated that the most significant factor of the Trauma Complaints List in predicting life change may be problems with cognition, which accounted for a significant amount of the variance in life change. Implications for counselling and further research regarding caregivers of persons with brain injury are discussed.

Validity of the functional independence measure for persons with traumatic brain injury.

OBJECTIVE: Replicate and extend studies of the construct validity of the Functional Independence Measure (FIM) for persons with traumatic brain injury (TBI). DESIGN: A cross-sectional study of admissions to acute rehabilitation evaluated 6 months to 5 years after discharge. SETTING: An inpatient brain injury rehabilitation unit in a large, academic medical center. SUBJECTS: Ninety-five patients with primary diagnosis of TBI stratified by time postdischarge. MAIN OUTCOME MEASURES: Prediction of (1) average daily minutes of assistance and (2) supervision required in comparison to the Sickness Impact Profile (SIP) and SF-36. RESULTS: The FIM was highly predictive of minutes of assistance (83% accuracy), supervision (82% accuracy), and the need for either type of assistance (78% accuracy). Prediction was only minimally improved by measures of neurobehavioral impairment. The accuracy of the FIM was superior to the SIP and SF-36. CONCLUSIONS: Results provided substantial support for the validity of the FIM as a measure of functional independence for persons with TBI. The importance of supervision as a type of assistance required after TBI was evident, with the FIM highly predictive of this need, as well.

Assessment of agitation following brain injury.

Advances in clinical interventions for agitation, as well as progress in research toward better understanding of the construct, have been limited by the lack of a reliable and valid measure. This article provides a practical overview of the measurement characteristics of the Agitated Behavior Scale (ABS) (Corrigan, J. Clin Exp Neuropsychol 1989; 11: 261-277) [1]. This 14-item scale has shown significant inter-rater reliability for all items; Total Score inter-rater correlations exceeding 0.70; and internal consistencies based on Cronbach's alphas have consistently exceeded 0.80. The original development of the ABS emphasized the content validity of items and demonstrated the concurrent validity of the Total Score. Subsequent studies have shown the ABS to be predictive of change in cognitive status, and able to differentiate confusion and inattention from agitation. Construct validity has been further substantiated by the identification of underlying factors that have proven stable over multiple samples.

Development of a scale for assessment of agitation following traumatic brain injury.

Development and initial validation of a scale for assessment of agitation in traumatic brain-injured individuals is described. Items were selected from an initial 39-item pool based on their testability, differentiation of agitation, frequency of occurrence, and representation of the full domain of the construct. The resulting 14-item instrument, called the Agitated Behavior Scale (ABS), was subsequently tested on an independent sample of 35 head-injured subjects. Reliability was examined via measures of internal consistency and qualitative evaluation of principal components factor analysis. Cronbach's alpha exceeded .80 for all rates. Comparable values of theta were found and qualitative criteria of internal consistency were met. The ABS score accounted for between 36% and 62% of the variance in 15 of 16 correlations with simultaneous, independent observations of agitation. Results of initial validation are discussed in light of classic test theory and research necessary for determination of construct validity.

Vocational evaluation of traumatic brain injury patients using the functional assessment inventory.

Impaired work capacity is one of the most common residual impairments encountered after either a severe or moderate traumatic brain injury (TBI), yet no instrument is available for screening TBI victims regarding their readiness to participate in more comprehensive vocational planning and evaluation. In the study reported here, the Functional Assessment Inventory (FAI) was administered to 76 subjects who suffered a moderate or severe TBI and the results obtained were compared to the Rancho Los Amigos Hospital Levels of Cognitive Functioning, the Mini-Mental State and the Glasgow Outcome Scale for sensitivity in discerning vocational readiness. The results obtained indicated that the FAI composite score has the greatest discriminating power in screening the vocational readiness of this population, followed by the Glasgow Outcome Scale. In addition, the FAI cluster scores demonstrated reasonable discriminative ability, which may prove useful in directing ongoing remediation.