RESUMO
The current investigation is a replication and extension of a previously published study by Cooper, Vanderploeg, Armistead-Jehle, Lewis, and Bowles (2014) demonstrating that performance validity test scores accounted for more variance in cognitive testing among service members with a history of concussion than did demographic variables, etiology of and time since injury, and symptom severity. The present study included a sample of 142 active-duty service members evaluated following a suspected or confirmed history of mild traumatic brain injury. Participants completed a battery of neuropsychological measures that included scales of performance and symptom validity (specifically the Medical Symptom Validity Test, Nonverbal Medical Symptom Validity Test, and Personality Assessment Inventory). Among the factors considered in the current study, performance validity test results accounted for the most variance in cognitive test scores, above demographic, concussion history, symptom validity, and psychological distress variables. Performance validity test results were modestly related to symptom validity as measured by the Personality Assessment Inventory Negative Impression Management scale. In sum, the current results replicated the original Cooper et al. study and highlight the importance of including performance validity tests as part of neurocognitive evaluation, even in clinical contexts, within this population.
Assuntos
Concussão Encefálica/diagnóstico , Disfunção Cognitiva/diagnóstico , Militares/psicologia , Testes Neuropsicológicos/normas , Adulto , Concussão Encefálica/psicologia , Disfunção Cognitiva/psicologia , Feminino , Humanos , Masculino , Simulação de Doença/diagnóstico , Análise de Regressão , Reprodutibilidade dos Testes , Adulto JovemRESUMO
BACKGROUND: Both the Departments of Defense and Veterans Health Administration have developed and implemented screening procedures for identification of possible deployment-related traumatic brain injury (TBI). OBJECTIVE: To review population-based screening procedures for TBI, particularly mild TBIs, and discuss potential harms/costs versus benefits of such TBI screening. METHODS: The principles commonly used in population-based screening for various medical conditions are identified. These principles are applied to screening for TBI. The potential harms and costs are compared with potential benefits of screening for mild TBI. RESULTS: The core conditions essential for beneficial medical screening-progressive disease, symptoms related to the identified disease, suitable tests or examinations for accurate diagnosis, and accepted and effective treatment-are not present within the context of TBI screening. Potential harms/costs outweigh any potential benefits of population-based screening for TBI. CONCLUSION: On the basis of generally accepted medical screening principles and assumptions, population screening for mild TBI is unnecessary at best and potentially harmful at worst. Because nonspecific, postconcussion-like symptoms can be effectively treated in a symptom-specific manner, tying them to concussion through a screening and evaluation process is wasteful and potentially harmful.
Assuntos
Lesões Encefálicas/diagnóstico , Disfunção Cognitiva/diagnóstico , Veteranos , Campanha Afegã de 2001- , Lesões Encefálicas/economia , Lesões Encefálicas/epidemiologia , Disfunção Cognitiva/economia , Disfunção Cognitiva/epidemiologia , Análise Custo-Benefício , Custos e Análise de Custo , Humanos , Guerra do Iraque 2003-2011 , Programas de Rastreamento , Fatores de Tempo , Estados Unidos , United States Department of Veterans Affairs/economia , Procedimentos DesnecessáriosRESUMO
OBJECTIVE/METHOD: Military personnel returning from Iraq and Afghanistan have been exposed to physical and emotional trauma. Challenges related to assessment and intervention for those with posttraumatic stress disorder (PTSD) and/or history of mild traumatic brain injury (TBI) with sequelae are discussed, with an emphasis on complicating factors if conditions are co-occurring. Existing literature regarding cumulative disadvantage is offered as a means of increasing understanding regarding the complex symptom patterns reported by those with a history of mild TBI with enduring symptoms and PTSD. IMPLICATIONS: The importance of early screening for both conditions is highlighted. In addition, the authors suggest that current best practices include treating symptoms regardless of etiology to decrease military personnel and veteran burden of adversity.
Assuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/psicologia , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Campanha Afegã de 2001- , Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/psicologia , Explosões , Humanos , Guerra do Iraque 2003-2011 , Índice de Gravidade de Doença , Estados Unidos , United States Department of Veterans Affairs , Veteranos/psicologiaRESUMO
The Veterans Health Administration's (VHA's) Polytrauma System of Care, developed in response to a new cohort of patients back from Iraq and Afghanistan, is described with particular focus on the assessment and treatment of mild traumatic brain injury (mild TBI). The development of systemwide TBI screening within the VHA has been an ambitious and historic undertaking. As with any population-wide screening tool, there are benefits and costs associated with it. The purpose of this article is to identify and discuss the strengths and weaknesses of the VHA's TBI clinical reminder and subsequent evaluation and treatment processes. Complicating factors such as increased media attention and other contextual factors are discussed.
Assuntos
Lesões Encefálicas/economia , Sistemas de Apoio a Decisões Clínicas , Custos de Cuidados de Saúde , Sistemas Computadorizados de Registros Médicos , Coleta de Dados , Humanos , Reprodutibilidade dos Testes , Índices de Gravidade do Trauma , VeteranosRESUMO
We examined the degree to which individuals with a history of moderate to severe traumatic brain injury (TBI) are unaware of their postinjury deficits. We also examined correlates between awareness problems and injury acuteness and severity and whether awareness problems differed across behavioral domains. Self- and significant other (family member) ratings on the Key Behaviors Change Inventory (KBCI) were examined in 36 individuals an average of 2 years post-TBI. Family members reported greater problems postinjury than patients did, depending on the behavior in question and the level of patient awareness overall. Postinjury awareness problems were as prevalent as other behavioral problems measured by the KBCI but were not universally present. Some patients exhibited no awareness problems, others emergent awareness, and a minority poor awareness. Correlations revealed that as time postinjury increased, patients showed more accurate self-awareness than those whose injuries were more recent. Family members and patients agreed about preinjury functioning.
Assuntos
Conscientização , Lesões Encefálicas/epidemiologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Adaptação Psicológica , Adulto , Lesões Encefálicas/reabilitação , Transtornos Cognitivos/reabilitação , Comorbidade , Feminino , Nível de Saúde , Humanos , Masculino , Militares/estatística & dados numéricos , Prevalência , Psicometria , Recuperação de Função Fisiológica , Autoimagem , Inquéritos e Questionários , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricosRESUMO
While medicine typically proceeds in a sequential fashion based on primary symptoms, sometimes relying on a parallel, mechanism-of-injury-based approach is advantageous, particularly when the mechanism of injury is associated with a variety of known sequelae. A mechanism-of-injury-based approach relies on knowledge of the typical sequelae associated with that mechanism of injury to guide assessment and treatment. Thus, it represents an active, rather than passive, case-finding approach. This article describes an example of a mechanism-of-injury-based program, namely, a Blast Injury Program at the James A. Haley Veterans Hospital in Tampa, Florida. Case examples illustrate the utility of this approach with regard to more comprehensive assessment and treatment, as well as the possibility for secondary prevention.
Assuntos
Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/terapia , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/terapia , Medicina Militar/métodos , Traumatismo Múltiplo/classificação , Avaliação de Processos em Cuidados de Saúde/métodos , Adulto , Idoso de 80 Anos ou mais , Florida , Humanos , Iraque , Masculino , Anamnese/métodos , Medicina Militar/organização & administração , Traumatismo Múltiplo/terapia , Estados Unidos , United States Department of Veterans Affairs , Veteranos , GuerraRESUMO
OBJECTIVE: To describe the development and initial validation of a neurobehavioral outcome measure, the Key Behaviors Change Inventory (KBCI), for individuals with traumatic brain injury (TBI). DESIGN: Scale construction and development, and validity study. SETTING: Large state university and postal survey. PARTICIPANTS: Seventy-five volunteer undergraduate students and 25 volunteer collateral informants of individuals with TBI participated in the item-analysis phase. Thirty members of the Brain Injury Association and 20 members of the National Multiple Sclerosis Society rated both an identified patient and an age- and gender-equated control in the validation phase. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Content validity was examined through expert panel item sorts. Scale internal consistencies were examined with the Cronbach alpha. Construct validity was examined by comparing scale elevations between controls and 2 neurologic groups. RESULTS: Item-analysis procedures resulted in 8 scales of 8 items each: inattention, impulsivity, unawareness of problems, apathy, interpersonal difficulties, communication problems, somatic difficulties, and emotional adjustment. Internal consistency reliability coefficients ranged from.82 to.91. Multivariate analysis of variance revealed significant (P=.001) differences in scale elevations among TBI, multiple sclerosis (MS), and control groups. The TBI and MS groups scored significantly higher than the control group on all scales; a subset of KBCI scales discriminated between the 2 neurologic groups. CONCLUSION: The KBCI was both sensitive and specific to typical behavioral changes after TBI, thus supporting its usefulness in rehabilitation settings. Cross-validation and development of a normative database are future steps necessary in its development.