Performance In Traumatic Brain Injury Research Articles

Narrative Discourse Performance in Traumatic Brain Injury: Does Story Comprehension Predict Story Retelling?

Little is known about the relationship between discourse comprehension and production in traumatic brain injury (TBI), especially for spoken language. This study examined to what extent narrative discourse comprehension accounts for narrative discourse production outcomes (story grammar, story completeness). A secondary aim was to provisionally test an assumption of a discourse model, the structure building framework (SBF), that discourse comprehension and production share cognitive processes by investigating the strength of the relationship between them. Twenty-one individuals with TBI completed story comprehension and story retelling tasks. Discourse measures included the Discourse Comprehension Test, a picture story comprehension task, story grammar, and story completeness. Correlational and multiple regression analyses were performed using comprehension measures as predictors for production measures. There were significant moderate-to-large correlations between all comprehension and production measures. Comprehension measures approached but did not reach significance for predicting story grammar performance but strongly predicted story completeness outcomes. The story comprehension measures likely tapped content aspects of discourse more so than organization. Results provided support for a link between content-focused discourse comprehension measures and discourse production outcomes, which may have clinical implications for approaches to discourse intervention. Findings were interpreted as providing preliminary support for the SBF's claim that discourse production deploys the same processes involved in discourse comprehension. https://doi.org/10.23641/asha.26338045.

Ocular Manifestations, Visual Field Pattern, and Visual Field Test Performance in Traumatic Brain Injury and Stroke.

Purpose To analyze ocular manifestations, visual field (VF) pattern, and VF test performance in traumatic brain injury (TBI) and stroke patients. Methods This retrospective, cross-sectional study included 118 patients (236 eyes) with TBI and stroke who had undergone VF testing by standard automated perimetry with the central 24-2 threshold test. Clinical features including best-corrected visual acuity (BCVA), intraocular pressure (IOP), ocular manifestations, and VF test results including VF defect pattern, reliability, and global indices were analyzed and compared between the TBI and stroke patients. Results In TBI patients, ocular manifestations included strabismus (11.1%), cataract (4.2%), and glaucoma suspect (2.8%), whereas in stroke patients, cataract (15.2%), strabismus (8.5%), diabetic retinopathy (4.9%), extraocular movement (EOM) limitation (3.0%), glaucoma suspect (3.0%), nystagmus (2.4%), drusen (1.2%), and vitreous hemorrhage (1.2%) were found. The VF test results showed that 47 eyes (85.5%) in TBI and 86 (65.2%) in stroke had VF defect; in TBI, the scattered pattern was the most common (56.4%), followed by homonymous hemianopsia (14.5%), homonymous quadrantanopia (10.9%), and total defect (3.6%), whereas in stroke, homonymous hemianopsia was the most common (31.8%), followed by scattered pattern (16.7%), homonymous quadrantanopia (12.1%), and total defect (4.5%). Only 15 eyes (27.3%) in TBI and 32 (24.2%) in stroke showed reliable VF indices. The mean deviation (MD) was −10.5 ± 7.1 dB in TBI and −9.5 ± 6.8 dB in stroke, and the pattern standard deviation (PSD) was 4.9 ± 3.3 dB in TBI and 6.1 ± 3.9 dB in stroke, without statistically significant differences between the two groups. Conclusion Various ocular manifestations were found, and a considerable proportion of patients were experiencing VF defects and showed unreliable VF test performance. Our findings suggest that accurate evaluation and rehabilitation of visual function should be a matter of greater concern and emphasis in the management of TBI and stroke patients, besides systemic diseases.

A-92 Assessing Perceived Workload on the Brief Visual Memory Test in Traumatic Brain Injury Survivors

Abstract Objective We examined perceived workload as it is related to Brief Visual Memory Test-Revised (BVMT-R) short-delay and long-delay performance in traumatic brain injury (TBI) and healthy comparison (HC) participants. Method The sample consisted of 39 TBI participants and 54 HC participants. Demographically corrected BVMT-R scores were used to evaluate short-delay and long-delay performances. The perceived workload was measured using the NASA-TLX. Results ANOVA revealed that the HC group outperformed the TBI group on the BVMT-R short-delay and long-delay score, p < 05, η p 2 = 0.05. ANCOVAs controlling for age were used to evaluate NASA-TLX group differences. In regards to the NASA-TLX, TBI participants reported higher levels of physical demand, effort, frustration and overall subjective workload on the BVMT-R short-delay compared to HC participants, p < 05, η p 2 = 0.01–0.09. Furthermore, on the long-delay of the BVMT-R, the NASA-TLX revealed that the TBI group reported higher levels of temporal demand, effort, frustration and overall subjective workload compared to the HC group, p < 0.05, η p 2 = 0.05–0.14. Conclusions Results revealed that TBI participants demonstrated worse BVMT-R performances than HC participants. However, TBI survivors reported higher perceived workload demands compared to the HC group in both short-delay and long-delay of the BVMT-R. Our findings suggest that TBI impacts non-verbal memory performance in both BVMT-R short-delay and long-delay. Also, brain injury may be impacting TBI survivors’ awareness of their non-verbal memory performance. Further work is required to determine what drives the impaired perception of non-verbal memory performance among TBI survivors.

TDCS effects on task-related activation and working memory performance in traumatic brain injury: A within group randomized controlled trial

ABSTRACT Non-invasive transcranial direct current stimulation (tDCS) has been reported to facilitate working memory in normal adults. There is some evidence in people with Traumatic Brain Injury (TBI) but overall evidence is mixed. This study aimed to address shortcomings of prior study designs in TBI to examine whether a single dose of tDCS would lead to benefits in working memory. Thirty people with severe, chronic TBI were administered a single session of either anodal tDCS (2 mA for 20 min) or sham tDCS (2 mA for 30 s), in a counterbalanced order, over the left parietal cortex while performing 1-back and 2-back working memory tasks. Skin conductance levels were examined as a measure of task activated arousal, a possible functional analogue of cortical excitability. We found that tDCS led to no improvements in accuracy on the working memory tasks. A slight increase in variability and reaction time with tDCS was related to decreased task activated arousal. Overall, this study yielded no evidence that a single session of tDCS can facilitate working memory for people with TBI.

Influence of Negative Stereotypes and Beliefs on Neuropsychological Test Performance in a Traumatic Brain Injury Population

The impact of stereotype threat and self-efficacy beliefs on neuropsychological test performance in a clinical traumatic brain injury (TBI) population was investigated. A total of 42 individuals with mild-to-moderate TBI and 42 (age-, gender-, educationally matched) healthy adults were recruited. The study consisted of a 2 (Type of injury: control, TBI) × 2 (Threat Condition: reduced threat, heightened threat) between-participants design. The purpose of the reduced threat condition was to reduce negative stereotyped beliefs regarding cognitive effects of TBI and to emphasize personal control over cognition. The heightened threat condition consisted of an opposing view. Main effects included greater anxiety, motivation, and dejection but reduced memory self-efficacy for head-injured-groups, compared to control groups. On neuropsychological testing, the TBI-heightened-threat-group displayed lower scores on Initial Encoding (initial recall) and trended toward displaying lower scores on Attention (working memory) compared to the TBI-reduced-threat-group. No effect was found for Delayed Recall measures. Memory self-efficacy mediated the relation between threat condition and neuropsychological performance, indicating a potential mechanism for the threat effect. The findings highlight the impact of stereotype threat and self-referent beliefs on neuropsychological test performance in a clinical TBI population.

Benchmarking trauma center performance in traumatic brain injury

Trauma centers (TCs) generally use mortality to gauge performance. However, differences in mortality outcomes might reflect different approaches or philosophies toward end-of-life care. We postulate that discharge home (DH) as a proxy for functional outcome may be a more useful measure of quality and may have significant implications on the assessment of TC performance and external benchmarking efforts. Data were derived from the National Trauma Data Bank (2007-2009). We included patients (18 years or older) with isolated, severe blunt head injuries who were admitted to Level I and Level II TCs. Observed-to-expected (O/E) mortality ratios were calculated and used to rank TC performance by mortality and then DH. Concordance between performance measures was calculated using a weighted kappa statistic. In total, 19,705 patients in 240 TCs were identified. Crude mortality ranged from 4% to 60%, whereas rates of DH ranged from 3% to 66%. When O/E ratios for mortality were evaluated, five centers were identified as high performers. Of these five centers, only two were also high performers for DH. The concordance of outlier status and correlation across O/E ratios between mortality and DH high performers was 0.16 (poor). Centers that are characterized as high performers when evaluating mortality are not high performers for functional outcome as evaluated by DH. DH may provide an alternative way of assessing quality of care delivered to patients with traumatic brain injury. Care management study, level III.

Transcranial Low-Level Laser Therapy Improves Neurological Performance in Traumatic Brain Injury in Mice: Effect of Treatment Repetition Regimen

Low-level laser (light) therapy (LLLT) has been clinically applied around the world for a spectrum of disorders requiring healing, regeneration and prevention of tissue death. One area that is attracting growing interest in this scope is the use of transcranial LLLT to treat stroke and traumatic brain injury (TBI). We developed a mouse model of severe TBI induced by controlled cortical impact and explored the effect of different treatment schedules. Adult male BALB/c mice were divided into 3 broad groups (a) sham-TBI sham-treatment, (b) real-TBI sham-treatment, and (c) real-TBI active-treatment. Mice received active-treatment (transcranial LLLT by continuous wave 810 nm laser, 25 mW/cm2, 18 J/cm2, spot diameter 1 cm) while sham-treatment was immobilization only, delivered either as a single treatment at 4 hours post TBI, as 3 daily treatments commencing at 4 hours post TBI or as 14 daily treatments. Mice were sacrificed at 0, 4, 7, 14 and 28 days post-TBI for histology or histomorphometry, and injected with bromodeoxyuridine (BrdU) at days 21–27 to allow identification of proliferating cells. Mice with severe TBI treated with 1-laser Tx (and to a greater extent 3-laser Tx) had significant improvements in neurological severity score (NSS), and wire-grip and motion test (WGMT). However 14-laser Tx provided no benefit over TBI-sham control. Mice receiving 1- and 3-laser Tx had smaller lesion size at 28-days (although the size increased over 4 weeks in all TBI-groups) and less Fluoro-Jade staining for degenerating neurons (at 14 days) than in TBI control and 14-laser Tx groups. There were more BrdU-positive cells in the lesion in 1- and 3-laser groups suggesting LLLT may increase neurogenesis. Transcranial NIR laser may provide benefit in cases of acute TBI provided the optimum treatment regimen is employed.

Impaired National Adult Reading Test (NART) performance in traumatic brain injury

Some research suggests the National Adult Reading Test (NART) may be impaired by traumatic brain injury (TBI). To investigate this, a prospective, longitudinal study included 214 Australian TBI participants given the NART within 1 month post-injury, and at 6 and 12 months. TBI severity, age, education, sex, and mood (HADS) were examined, and significant improvement in NART- estimated full-scale IQ (FSIQ) was noted over time (p < .001). A three-way interaction of time, severity, and age showed younger and middle-aged mild TBI sub-groups improved significantly between 1 and 6 months post-injury, and the older sub-group between 6 and 12 months. In severe TBI, significant NART-estimated FSIQ improvement was noted only for the middle-aged and only between 6 and 12 months post-TBI. NART administration soon after TBI underestimated premorbid IQ, with a complex relationship between time post-injury, severity, and age. Participants with a longer education had higher NART FSIQs, although those with less education gained more IQ points between initial and 6 months assessments suggesting higher initial NART impairment. Regression equations predicted NART FSIQ at 6 (R = 0.813) and 12 months post-trauma (R = 0.792–0.845), their effectiveness being confirmed via cross-validation. No significant relationships were noted between NART-estimated FSIQ and mood variables, or evidence of significant gains in estimated FSIQ between 12 and 24 months post-injury.

The relationship between naming difficulty and FAS performance following traumatic brain injury

Primary objective: To investigate the relationship between naming difficulty (ND) and FAS performance in traumatic brain injury (TBI).Methods and procedure: Sixty-three patients with a TBI were divided into two groups based on the presence of a ND and were compared with a control group on FAS performance.Results: Whilst the group with a TBI performed more poorly than the control group on the FAS task, there was no difference between those participants who featured a ND and those who did not. The TBIs produced fewer words than the control group in the first time slice of the task, but there was no difference between the group with a ND and the non-ND group on this measure.Conclusion: The results indicate that the effect of word finding deficits is not the principal cause of the diminution of phonemic verbal fluency performance in TBI, which is probably more likely due to compromise in speed of information processing associated with the injury.

Gambling Task Performance in Traumatic Brain Injury

To determine the sensitivity of the Gambling Test (GT) to the neurocognitive effects of traumatic brain injury (TBI) and to examine the cognitive, neural, and psychosocial correlates of impaired GT performance in patients with TBI. The GT is sensitive to behavioral deficits in patients with prefrontal brain damage, especially in ventral regions. Patients with TBI and behavioral deficits often have focal ventral prefrontal damage as well as diffuse damage. Analysis of the correlates of the GT in this population has implications for interpretation of the GT in other groups. Seventy-one TBI patients were administered the GT, neuropsychological tests, and psychosocial outcome questionnaires. Patients also had high-resolution structural magnetic resonance imaging analyzed for both lesion location and tissue compartment volumes. The GT was sensitive to TBI in general, but not to TBI severity or quantified chronic phase atrophy. Marked impairment was observed in (but not limited to) patients with large frontal lesions. There were modest correlations between the GT and tests of working memory and executive functioning as well as between self- and other-rated real-life memory, executive, and emotional problems. The GT can be a useful adjunct to assessment of patients with TBI. Interpretation of GT performance in patients with complex neuropsychological deficits such as TBI should consider the influence of domain-general resources in addition to specific ventral prefrontal function.