Changes in neuropsychological performance after traumatic brain injury from inpatient rehabilitation to 1-year follow-up in predicting 2-year functional outcomes.

The present study explored the predictive value of interval change in neuropsychological performance at three time-points following moderate-to-severe TBI (inpatient rehabilitation, 1-year, and 2-year follow-up) on functional outcome measures collected at 2-year follow-up. Symmetrized percent change scores were calculated and used to predict scores on functional measures using linear regression while controlling for age and injury severity. Results showed that change in performance from inpatient to 1-year on total list learning (CVLT-II or RAVLT) and oral SDMT significantly predicted 2-year ratings of functional status. By comparison, most neuropsychological measures taken at 1-year follow-up also accounted for unique variance in 2-year functional outcomes. These results indicate that changes in learning and processing speed during the first year of recovery are sensitive indicators when predicting long-term disability and degree of functional independence, though absolute performance at 1 year is also highly associated with functional outcome at 2 years post-injury.

The fake bad scale in atypical and severe closed head injury litigants.

The correlational and diagnostic properties of Lees-Haley's MMPI-2 Fake Bad Scale (FBS) were examined in litigating atypical minor, litigating moderate-severe, and non-litigating moderate-severe head injury samples. Overall, the FBS was sensitive to both litigation status and nonconforming versus conforming symptom courses. The FBS appeared superior to the MMPI-2 F and F-K scales in differentiating atypical from real brain-injury outcomes. High FBS scorers also had higher scores on somatic complaining (Hs, Hy) and to a lesser degree with psychotic complaints (F, Pa, Sc). FBS showed significant associations with various neuropsychological symptom validity measures. FBS appears to capture a hybrid of infrequent symptom reporting styles with an emphasis on unauthentic physical complaints. However, FBS also correlated with documented abnormal neurological signs within a litigating moderate-severe brain-injury group. Its use as a symptom infrequency measure may have to be modified in more severe injury litigants, as some FBS items may reflect true long-term outcome in severe cerebral dysfunction.

Brief report: anosmia and remote outcome in closed head injury.

The value of posttraumatic anosmia as a predictor of late social outcomes was examined in a sample of closed head injury (CHI) patients. Unemployment rates were equally high in both the anosmic and nonanosmic closed head injury patients. The groups also did not differ in psychiatric or neuropsychological status. Anosmic patients had longer initial hospital stays and deeper initial comatose/confusional states. Anosmia does not appear to add incrementally to disability status and it does not automatically imply the presence of basal-frontal damage.