Initial Validation of the Mid-Atlantic Mental Illness Research, Education, and Clinical Center Assessment of Traumatic Brain Injury.

With the increasing prevalence of traumatic brain injury (TBI), the need for reliable and valid methods to evaluate TBI has also increased. The purpose of this study was to establish the validity and reliability of a new comprehensive assessment of TBI, the Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC) Assessment of TBI (MMA-TBI). The participants in this study were post-deployment, combat exposed veterans. First, MMA-TBI outcomes were compared with those of independently conducted clinical TBI assessments. Next, MMA-TBI outcomes were compared with those of a different validated TBI measure (the Ohio State University TBI Identification method [OSU-TBI-ID]). Next, four TBI subject matter experts independently evaluated 64 potential TBI events based on both clinical judgment and Veterans Administration/Department of Defense (VA/DoD) Clinical Practice Guidelines. Results of the MMA-TBI algorithm (based on VA/DoD clinical guideline) were compared with those of the subject matter experts. Diagnostic correspondence with independently conducted expert clinical evaluation was 96% for lifetime TBI and 92% for deployment-acquired TBI. Consistency between the MMA-TBI and the OSU-TBI-ID was high (κ = 0.90; Kendall Tau = 0.94). Comparison of MMA-TBI algorithm results with those of subject matter experts was high (κ = 0.97-1.00). The MMA-TBI is the first TBI interview to be validated against an independently conducted clinical TBI assessment. Overall, results demonstrate the MMA-TBI is a highly valid and reliable instrument for determining TBI based on VA/DoD clinical guidelines. These results support the need for application of standardized TBI criteria across all diagnostic contexts.

Improving the clinical assessment of leg muscle in adult clubfoot using magnetic resonance imaging: a case report.

We report on a 37-year-old woman with a left clubfoot with a progressive decrease in ambulatory distance resulting from fatigue of her left calf muscles. She had multiple surgeries for correction of the clubfoot deformity in early childhood and uses an ankle-foot orthosis (AFO) during gait. Physical examination revealed a decrease in left calf girth. T1-weighted spin echo magnetic resonance imaging (MRI) of her legs distal to the knees showed a marked decrease in leg muscle volume in the clubfoot limb. There was increased subcutaneous fat overlying the leg muscles in the clubfoot limb, and the muscles of the clubfoot limb were infiltrated with fatty tissue. The extent of atrophy of the leg muscles on MRI was significantly greater than expected from the clinical examination. In conclusion, MRI provides a true measure of leg muscle volume in the adult clubfoot and offers an explanation for leg muscle fatigue during ambulation.