Changes in Activity Participation After Multiple Sclerosis Diagnosis.

BACKGROUND: Multiple sclerosis (MS) results in impairments in cognitive and motor skills, which may reduce the level of activity participation in people with MS. This study compares past and current levels of activity participation in adults with MS and controls. The relationship between retained activity participation (since diagnosis) and cognitive, motor, functional status, and depression symptoms of persons with MS was examined. METHODS: Twenty-seven individuals with MS living in the community and 21 controls completed cognitive and motor tests and rated their activity participation (using the Activity Card Sort), depression symptoms, and functional status. RESULTS: The MS group reported significantly lower current activity participation than the control group. Percentage of retained activity participation (from prediagnosis to current) in the MS group correlated with time since diagnosis, executive function and motor skill ability, depression symptoms, and current functional status. CONCLUSIONS: Persons with MS report negative changes in activity participation in most aspects of life after diagnosis. These findings call attention to changes in activity participation in people with MS that are directly related to disease symptoms. Therefore, using a quantitative measure of activity participation-the Activity Card Sort-can provide important information to aid the clinician in developing individualized treatment goals for people with MS.

Impact of frontal neurobehavioral symptoms on employment in individuals with TBI.

OBJECTIVE: To explore the contribution of frontal systems behavioral dysfunction on employment outcomes in individuals with traumatic brain injury (TBI), in the context of relevant predictors of work status. METHOD: Forty-two participants with history of moderate-to-severe TBI were classified as either "Employed" or "Unemployed." Groups did not differ on most demographic or injury variables, although the Unemployed sample reported greater symptoms of depression, pain, and fatigue (ps < 0.05). Participants completed a neuropsychological evaluation emphasizing frontal systems and Frontal Systems Behavior Scale (FrsBe; self- and informant-rated forms). RESULTS: T tests using cognitive indicators of frontal dysfunction revealed no significant differences between groups (ps > 0.05). T tests using neurobehavioral indicators of frontal dysfunction (i.e., FrSBe) revealed differences between groups on both self- (Hedge's g = 0.71; p = .046) and informant-rated (g = 1.12; p = .001) FrSBe total T scores. Two logistic regressions for each FrSBe score were conducted, including relevant variables on which samples differed as covariates. Only the informant-rated FrSBe score remained a significant predictor of employment (FrSBe-informant: p = .038; R-squared change = 0.177). Self- and informant-rated FrSBe scores were significantly correlated in the Unemployed group (r = .403; p = .037) but not in the Employed sample (r = .102; p = .717). CONCLUSIONS: These results suggest that behavioral indicators of frontal systems dysfunction are predictive of employment status in individuals with TBI. Future work should aim to test the efficacy of strategies to reduce dysfunctional frontal behaviors as a means to gain and maintain employment. (PsycINFO Database Record

The Feasibility of Telephone-Administered Cognitive Testing in Individuals 1 and 2 Years after Inpatient Rehabilitation for Traumatic Brain Injury.

Traumatic brain injury (TBI) often results in cognitive impairment, and trajectories of cognitive functioning can vary tremendously over time across survivors. Traditional approaches to measuring cognitive performance require face-to-face administration of a battery of objective neuropsychological tests, which can be time- and labor-intensive. There are numerous clinical and research contexts in which in-person testing is undesirable or unfeasible, including clinical monitoring of older adults or individuals with disability for whom travel is challenging, and epidemiological studies of geographically dispersed participants. A telephone-based method for measuring cognition could conserve resources and improve efficiency. The objective of this study is to examine the feasibility and usefulness of the Brief Test of Adult Cognition by Telephone (BTACT) among individuals who are 1 and 2 years post-moderate-to-severe TBI. A total of 463 individuals participated in the study at Year 1 post-injury, and 386 participated at Year 2. The sample was mostly male (73%) and white (59%), with an average age of (mean ± standard deviation) 47.9 ± 20.9 years, and 73% experienced a duration of post-traumatic amnesia (PTA) greater than 7 days. A majority of participants were able to complete the BTACT subtests (61-69% and 56-64% for Years 1 and 2 respectively); score imputation for those unable to complete a test due to severity of cognitive impairment yields complete data for 74-79% of the sample. BTACT subtests showed expected changes between Years 1-2, and summary scores demonstrated expected associations with injury severity, employment status, and cognitive status as measured by the Functional Independence Measure. Results indicate it is feasible, efficient, and useful to measure cognition over the telephone among individuals with moderate-severe TBI.

Test-Retest Reliability of Traumatic Brain Injury Outcome Measures: A Traumatic Brain Injury Model Systems Study.

OBJECTIVE: Evaluate the test-retest reliability of measures that comprise the Traumatic Brain Injury Model Systems follow-up data set. PARTICIPANTS: A total of 224 persons with a moderate-severe traumatic brain injury (TBI) enrolled in the Traumatic Brain Injury Model Systems National Database. DESIGN: Following standard administration of the follow-up interview, a second interview was administered 14 to 28 days later using the same interviewer and the same mode of administration. MAIN MEASURES: Traumatic Brain Injury Model Systems follow-up interview that includes 66 variables comprised (a) single item measures of demographics; employment; general health as well as specific health conditions; rehospitalization; tobacco, alcohol, and other drug use; transportation; and mental health and (b) multi-item instruments: FIM; Participation Assessment With Recombined Tools-Objective; Disability Rating Scale; Glasgow Outcome Scale-Extended; Supervision Rating Scale; Satisfaction With Life Scale; TBI Quality of Life Anxiety and Depression items; and The Ohio State University TBI Identification Method. RESULTS: Intraclass correlation coefficient values ranged from 0.65 to 0.99, weighted kappa values ranged from 0.54 to 0.99, and kappa values ranged from 0.43 to 1.00. Four kappa/weighted kappa estimates fell below 0.60: arrested, psychiatric hospitalization, number of days not in good physical health, and rating of general emotional health. CONCLUSIONS: With few exceptions, good to excellent test-retest reliability estimates were obtained. The findings support the use of these measures in prior and future studies and indicate that persons with moderate-severe TBI can provide reliable self-report.

An investigation of the impact of facial affect recognition impairments in moderate to severe TBI on fatigue, depression, and quality of life.

Individuals with moderate to severe traumatic brain injury (TBI) have been shown to experience significant problems in facial affect recognition (FAR). However, it is not known how these impairments relate to overall functioning and quality of life (QoL) following TBI. The aim of the current study was to test the hypothesis that worse performance on an FAR task would be associated with reduced QoL (related to social and emotional functioning), worse mood, and increased fatigue. Forty-seven individuals with TBI and 27 healthy controls (HCs) completed the facial emotion identification task (FEIT), as well as questionnaires assessing social and emotional QoL, mood, and fatigue. The TBI group performed significantly worse than HCs on the FEIT. A significant relationship between FAR and fatigue and QoL related to social and emotional functioning was documented, but in an unexpected direction: individuals who performed better on the FEIT reported poorer QoL and greater fatigue. Individuals who have better FAR may require increased effort to perform this task, and thus experience greater fatigue and poorer social and emotional QoL.

Facial affect recognition linked to damage in specific white matter tracts in traumatic brain injury.

Emotional processing deficits have recently been identified in individuals with traumatic brain injury (TBI), specifically in the domain of facial affect recognition. However, the neural networks underlying these impairments have yet to be identified. In the current study, 42 individuals with moderate to severe TBI and 23 healthy controls performed a task of facial affect recognition (Facial Emotion Identification Test (FEIT)) in order to assess their ability to identify and discriminate six emotions: happiness, sadness, anger, surprise, shame, and fear. These individuals also underwent structural neuroimaging including diffusion tensor imaging to examine white matter (WM) integrity. Correlational analyses were performed to determine where in the brain WM damage was associated with performance on the facial affect recognition task. Reduced performance on the FEIT was associated with reduced WM integrity (fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity) in the inferior longitudinal fasciculus and inferior-fronto-occipital fasciculus in individuals with TBI. Poor performance on the task was additionally associated with reduced gray matter (GM) volume in lingual gyrus and parahippocampal gyrus. The results implicate a pattern of WM and GM damage in TBI that may play a role in emotional processing impairments.

Assessing frontal behavioral syndromes and cognitive functions in traumatic brain injury.

This study examined the relationship between individual and family ratings on a measure of frontal behaviors using the Frontal Systems Behavior Scale (FrSBe). Additionally, this study investigated whether self-reported symptoms of frontal-lobe dysfunction correspond to neuropsychological performance, particularly those tests measuring executive functions. Thirty-three individuals with moderate-to-severe traumatic brain injury (TBI) and 19 healthy individuals completed the FrSBe and neuropsychological measures. Results indicated that the self-ratings of individuals' apathy, disinhibition, and executive dysfunction significantly increased from before to after injury, as did the family members' ratings, with no significant difference between the patients' and family members' reports for any of the three FrSBe subscales. Although individuals with TBI demonstrated impairments in neuropsychological measures, including measures of executive functioning, few significant correlations were found between the patients' FrSBe ratings and measures of cognitive functioning. This suggests that information from the FrSBe may differ from information gathered during a cognitive evaluation and may enhance our understanding of the behavioral sequelae following TBI that may not be captured by neuropsychological assessment alone.

Processing speed versus working memory: contributions to an information-processing task in multiple sclerosis.

Individuals with multiple sclerosis (MS) often experience cognitive impairments in information processing. However, the relative contributions of processing speed abilities and working memory abilities to information-processing tasks are not yet fully understood. The current study examined the extent to which processing speed and/or working memory abilities contributed to an information-processing task, the Keeping Track Task (KTT). Forty-nine individuals with MS were given tests to assess processing speed and working memory, as well as the KTT. Regression analyses indicated that in the MS group, processing speed abilities accounted for the majority of the explained variance in KTT performance. The findings suggest that processing speed plays a significant role on KTT performance in MS. Implications for cognitive rehabilitation treatments aimed at improving processing speed abilities in MS are discussed.

Retrieval practice: a simple strategy for improving memory after traumatic brain injury.

Memory impairment is common following traumatic brain injury (TBI), but interventions to improve memory in persons with TBI have been ineffective. Retrieval practice is a robust memory strategy among healthy undergraduates, whereby practice retrieving information shortly after it is presented leads to better delayed recall than simple restudy. In a verbal paired associate paradigm, we investigated the effect of retrieval practice relative to massed and spaced restudy on delayed recall in 14 persons with chronic memory impairment following a TBI and 14 age-matched healthy controls. A significant learning condition (massed restudy, spaced restudy, retrieval practice) by group (TBI, healthy) interaction emerged, whereby only healthy controls benefited from spaced restudy (i.e., distributed learning) over massed restudy, but both groups greatly benefited from retrieval practice over massed and spaced restudy. That is, retrieval practice greatly improves memory in persons with TBI, even when other mnemonic strategies (e.g., distributed learning) are less effective.

An investigation of the differential effect of self-generation to improve learning and memory in multiple sclerosis and traumatic brain injury.

The generation effect (GE) is a phenomenon in which material that is produced by an individual is learned and remembered better than information that is provided to that individual. The current study examined the potential benefits of self-generation on learning and memory in individuals with traumatic brain injury (TBI) and multiple sclerosis (MS). The impact of cognitive impairment on the benefits of self-generation was also examined. Subjects consisted of 18 individuals with TBI and 31 individuals with clinically definite MS. Both the TBI and MS groups recalled significantly more words in the self-generated condition versus the provided condition. Those impaired in the domains of working memory, episodic memory, or executive functioning demonstrated a significant benefit from self-generation (all ps < .05). Furthermore, although individuals with impairments in multiple cognitive domains recalled fewer words overall compared to those with no or one impaired cognitive domain, this group demonstrated a large effect size in the difference in recall for generated versus provided words. Results demonstrate that people with cognitive impairments can benefit from self-generation to improve learning and memory. Future research should focus on how to amplify the benefit of the GE for impaired groups, apply it to everyday functional tasks, and sustain its effect over time.

Does the scoring of late responses affect the outcome of the paced auditory serial addition task (PASAT)?

The Paced Auditory Serial Addition Task (PASAT) is a cognitive task purported to measure working memory, speed of information processing, and sustained and divided attention (Spreen, O. & Strauss, E. (1998). A compendium of neuropsychological tests: administration, norms, and commentary (2nd ed.). New York, NY: Oxford University Press.) The current study examined whether treating late responses on the PASAT as correct or as incorrect can significantly affect the outcome of the test in individuals with Multiple Sclerosis (MS). Subjects consisted of 59 individuals with MS and 37 healthy controls (HC). Scoring method was found to affect the number of individuals who were considered impaired on the PASAT. When participants were penalized for late responses significantly more participants, in both groups, were found to be impaired on the 2s trial of the task (MS: p<0.01; HC: p<0.05). Results indicate that that the specific scoring of the PASAT should be reported in studies that use the test.