The symbol trail making test: test development and utility as a measure of cognitive impairment.

Although the Trail Making Test (TMT) has proven to be an exceptional clinical tool, its applications have been limited by the instrument's use of the Arabic numeral system and Latin alphabet. Clearly an instrument not limited by a specific alphabet or numerical system could fill this void. This study presents the development and validation of an alternative to the TMT that offers modestly similar psychometric properties and can be used with populations that have no familiarity with the Arabic numerical system or a specific alphabet. The Symbol Trail Making Test (STMT), which employs symbols that are not language or numerically based was administered to a normative sample of 210 participants, including 54 individuals whose first language was not English, for the purpose of collecting normative data. Reliability, assessed through an alternate form administration, and convergent validity, assessed through correlation with the TMT in a nonpatient sample, was deemed acceptable. Significant discriminant validity was obtained comparing non-brain-injured patients to brain-injured patients, particularly on time measures. An analysis of variance found no significant difference between native English speakers and individuals speaking English as a second language on performance on the STMT. This preliminary study provides evidence that the STMT is a clinically useful instrument for discriminating brain-injured from non-brain-injured participants without employing a specific culture-bound symbol system.

A correction procedure for the Minnesota Multiphasic Personality Inventory-2 for persons with spinal cord injury.

OBJECTIVE: To develop a procedure that adjusts scoring of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) for the items related to spinal cord injury (SCI) that skew interpretations with this population, and to assess the accuracy of interpretations resulting from this procedure, standard MMPI-2 scoring, and a previously offered procedure. DESIGN: A criterion study with masked comparisons. SETTING: Hospital inpatient physical medicine and rehabilitation unit. PATIENTS: Thirty-four SCI patients between the ages of 18 and 77 years, 19 with complete SCI and 15 with incomplete SCI. OTHER PARTICIPANTS: Twenty-one nurses, 23 physicians, and 17 psychologists. MAIN OUTCOME MEASURES: Masked MMPI-2 profiles, judged by clinicians for accuracy. Paired t tests comparing profile scales. RESULTS: A correction procedure was arrived at for the MMPI-2 and MMPI-A incorporating adjustments for physical complaints frequently arising from SCI. The new procedure was judged superior to both the standard procedure and the previously offered procedure. Paired t tests of MMPI-2 scales showed that differences from scoring procedures were significant with many scales measuring significance at the p < .0001 level. CONCLUSIONS: Statistically significant changes in MMPI-2 profiles occur when somatic complaints related to SCI are corrected for. Preliminary results suggest that the application of the new correction procedure increases clinical accuracy.

Paper or plastic: another ecological consideration in neuropsychological assessment.

The high volume of paper involved in the generation of neuropsychological evaluations has implications for the environment, for the cost of providing services, and for the space required to store records. One solution is to insert single-use test forms into plastic sheet protectors and provide the test taker with a fine-tipped washable marker. This study investigated whether this modification in test administration practice affects performance. Comparisons were made for 6 different neuropsychological tests. No significant differences in performance were found when comparing standard administration practice to this more ecologically minded alternative.

Profiles of functional recovery in fifty traumatically brain-injured patients after acute rehabilitation.

Research to demonstrate the efficacy of head injury rehabilitation is important at a time when cost-containment efforts are intensifying. A useful tool that would predict the functional improvement during hospitalization and length of stay (LOS) of persons with traumatic brain injury would be of benefit to patients and their families, insurance carriers, and rehabilitation specialists. This study examines functional improvements made by 50 traumatic brain-injured patients admitted to the rehabilitation unit at the University of California, Davis, Medical Center (UCDMC) as measured by the UCDMC Davis Functional Status Measure (DFSM), which was adapted from the Functional Independence Measure (FIM). The DFSM incorporates additional items to provide a more thorough measure of skills to be rehabilitated. The purpose of this study was to compare scores and profiles on the DFSM items obtained by patients with LOS greater than and less than and equal to the median rehabilitation LOS (23 days). Relationships were explored among admission DFSM scores, LOS for rehabilitation, discharge destination, and functional outcome. Results indicate that patients admitted to the rehabilitation unit attained a similar profile or level of function by discharge, regardless of admission Glasgow Coma Scale scores or admission DFSM scores. There were no significant differences in admission Glasgow Coma Scale score, age, acute LOS, or discharge disposition between the LOS groups. There was a significant difference in median admission DFSM score in 26 of 31 categories between the LOS groups. There was a significant difference in median DFSM change (admission to discharge) in 24 of 31 categories between the LOS groups. The admission DFSM total score was inversely proportional to the length of stay, with a correlation coefficient of 0.78. DFSM change and admission to discharge was linearly correlated with LOS (R = 0.66). The DFSM documents functional outcome and measures gains during inpatient rehabilitation. The DFSM profile is helpful in predicting the LOS needed to achieve those gains.

Employment profiles in neuromuscular diseases.

Consumer and rehabilitation provider factors that might limit employment opportunities for 154 individuals with six slowly progressive neuromuscular diseases (NMD) were investigated. The NMDs were spinal muscular atrophy (SMA), hereditary motor sensory neuropathy (HMSN), Becker's muscular dystrophy (BMD), facioscapulohumeral muscular dystrophy (FSHD), myotonic muscular dystrophy (MMD), and limb-girdle syndrome (LGS). Forty percent were employed in the competitive labor market at the time of the study, 50% had been employed in the past, and 10% had never been employed. The major consumer barrier to employment was education. Other important factors were type of occupation, intellectual capacity, psychosocial adjustment, and the belief by most individuals that their physical disability was the only or major barrier to obtaining a job. Psychological characteristics were associated with level of unemployment. However, physical impairment and disability were not associated with level of unemployment. There also were differences among the types of NMDs. Compared with the SMA, HMSN, BMD, and FSHD groups, the MMD and LGS groups had significantly higher levels of unemployment, lower educational levels, and fewer employed professional, management, and technical workers. Nonphysical impairment factors such as a low percentage of college graduates, impaired intellectual function in some individuals, and poor psychological adjustment were correlated with higher unemployment levels in the MMD group. Unemployment in the LGS group was correlated with a failure to complete high school. Major provider barriers to employment were the low level of referrals to Department of Rehabilitation by physicians and the low percentage of acceptance into the State Department of Rehabilitation. The low rate of acceptance was primarily attributable to the low number of referrals compounded by a lack of counselor experience with individuals with NMD. Both consumer and provider barriers may contribute to the lack of interest in obtaining a job.

Profiles of neuromuscular diseases. Myotonic dystrophy.

Ninety-two individuals with myotonic dystrophy (MD) were evaluated prospectively over a 10-yr period and separated into two types, 75 noncongenital (NC-MD) and 17 congenital (C-MD) MD. Muscle weakness was relatively mild and similar in both types, 4.0 +/- 0.7 manual muscle test (MMT) scores for NC-MD and 3.8 +/- 0.7 in C-MD. However, weakness was progressive in the former, -0.36 MMT units per decade, and nonprogressive in C-MD. Weakness was usually generalized in both types, with no significant differences between upper and lower extremities or the proximal and distal muscles. Flexor and extensor differences were variable. Quantitative strength measurements showed a similar pattern but were more sensitive showing marked strength losses of 40-50% in muscle groups with MMT scores of four or more. There was a high frequency (47%) of relatively mild, nonprogressive scoliosis in C-MD, whereas spine deformity was unusual in NC-MD. Contractures, usually at the ankles, were also more common in C-MD. In NC-MD and C-MD, respectively, there was a low frequency of severe restrictive lung disease (14 and 20%) but a high percentage of significant electrocardiographic (ECG) abnormalities (75 and 81%), including conduction defects. There was a marked difference between the two types of MD in intellectual and cognitive function. Seventy-five percent of C-MD subjects showed impairment, frequently severe, compared with 35% impairment, usually mild, for NC-MD individuals. Functional evaluation was not markedly affected, but timed motor performance showed significant disability especially for individuals with C-MD.

Communication among rehabilitation staff: "mild," "moderate," or "severe" deficits?

Effective communication among members of the various rehabilitation disciplines is considered an essential component of the modern team approach. Inconsistency in the use of terminology within and across disciplines poses a significant barrier to effective communication. To systematically examine the extent of this problem, 132 respondents representing 14 rehabilitation facilities in six states were surveyed regarding their use of the descriptive labels "mild," "moderate," and "severe" as they pertain to level of cognitive impairment. They were also questioned regarding their use of terms to characterize different types of memory. As predicted, the results reflect a lack of consensus regarding the use of such terminology. The implications of this communication failure for rehabilitation staff, family members, patients, and third-party payers are discussed, and recommendations are made for ameliorating this problem.

Effects of sex education on sexual guilt, anxiety, and attitudes: a comparison of instruction formats.

Previous sex education research has neglected to examine systematically the effects of different types of instruction formats. In the present study, 193 undergraduates were assigned to one of the following conditions: (1) lecture only; (2) small group discussion only; (3) lecture + small group discussion; (4) lecture + extra lecture/review; and (5) no intervention control. Pre- and posttest measures assessed the dimensions of sexual guilt, sexual attitudes, and sexual anxiety. Results revealed significantly greater reductions in sexual guilt for the lecture only, lecture + small group discussion, and lecture + extra lecture/review conditions than for the no intervention control condition. Significantly greater changes in the direction of more tolerant sexual attitudes were found for the small group discussion only and lecture + extra lecture/review conditions than for the no intervention control condition. No other significant results were found. Contrary to expectation, the addition of 9 hours of small group discussion to a semester-long lecture format course did not result in significantly greater positive changes on the dimensions assessed than those achieved by lecture alone. The implications of these findings for the design of sex education courses are discussed. Recommendations for future research include assessment of the long-term effects of sex education on dimensions such as quality of sexual adjustment and consistency of contraceptive usage.

Sexual orientation and sex role conformity.

Homosexuals are stereotypically viewed as deviating from the conventional sex role standards of our society. Homosexual males are regarded as effeminate, while homosexual females are seen as masculine. Some limited empirical support for these stereotypes has been reported in the literature. However, results remain inconclusive. In order to provide a further test of these stereotypes, 186 male and female homosexual, bisexual, and heterosexual subjects were administered the Bem Sex Role Inventory. Results showed no significant support for prevailing stereotypes. Possible reasons for the discrepancy between these findings and previous reports are explored and suggestions are offered for future research.

Sex education: a review of its effects.

This paper reviewed 33 empirical studies which assessed the effectiveness of sex education. Methodological issues were considered within six sections: (a) populations, (b) instructors, (c) program formats, (d) time format, (e) program goals, and (f) outcome measures. College students were the most frequently assessed population, followed by educators and counselors, and then medical-school populations. Most investigators did not include control subjects. In the studies which included them, they were usually nonequivalent to the experimental subjects. The results were almost exclusively dependent upon questionnaire data. Only a few studies included a follow-up. In general, the subjects reported gains in sexual knowledge and shifts toward more tolerant and liberal sexual attitudes. However, it was not clear whether or to what extent these changes affected the subjects' behavior. The surprising lack of studies evaluating the effects of sex education on elementary, junior high, and high school students was noted in light of the controversy surrounding the presentation of sex-related information to these populations. In addition to the recommendation that sex education presented to "normal" students who are below the college level should be evaluated, suggestions for future research included the use of equivalent experimental and control subjects, the reporting of instructor characteristics, the specification of program goals, and the inclusion of follow-up evaluations.

Locus of control and perceived adjustment to life events.

Investigated the relationship between locus of control orientation and perceived adjustment to critical life events. The Locus of Control scale and a modification of the Life Events scale were group administered to undergraduate students. No significant difference was found between internal and external scorers in the number of life events experienced during the 2-year assessment period. As predicted, external scorers reported a significantly more difficult adjustment to life events than internal scorers. The results suggest that it may be important for educators and mental health professionals to promote an internal locus of control orientation as a preventive and remedial approach to adjustment problems.