Supervision Rating Scale Research Articles

Relative contribution of acute cognitive and motor functioning on community integration 1 year after moderate-severe TBI

ABSTRACT Objectives The objective of this study was to understand the relative contribution of acute motor versus cognitive functioning on community integration 1 year after moderate-severe traumatic brain injury (TBI). Methods Secondary data analysis of 779 participants in the TBI Model Systems National Database who experienced a moderate-severe TBI requiring inpatient rehabilitation. Participants were categorized into four groups: low motor/low cognition, low motor/high cognition, high motor/low cognition, or high motor/high cognition. Community integration outcomes measured 1 year post-TBI included the Participation Assessment with Recombined Tools-Objective (PART-O), driving status, Supervision Rating Scale, residence, re-injury, and employment status. Results Participants with both high motor/high cognition had higher scores on the PART-O total score (p < 0.001), living independently (p = 0.023), living in a private residence (p = 0.002), and being employed (p = 0.026) at 1 year. Participants with high motor/high cognition and high motor/low cognition had higher odds of driving (p = 0.001 and p = 0.034, respectively) when compared to low motor/low cognition. All groups relative to the low motor/low cognition group had higher odds of being re-injured. Discussion and Conclusions High motor and high cognitive function at rehabilitation are associated with favorable community integration outcomes 1 year post-injury, though greater participation afforded by high function may confer elevated risk of re-injury.

Influence of Foreign Versus US Nativity on the Trajectory of Functional Independence Over the 10 Years After Traumatic Brain Injury: A Model Systems Study.

Although racial/ethnic disparities have been documented in numerous outcomes after traumatic brain injury (TBI), research has yet to explore differences in rehabilitation outcomes based upon nativity (foreign-born vs US-born individuals). The purpose of this study was to compare the functional outcomes over the first 10 years after TBI for individuals born in the United States with those who were foreign-born. A sample of 10 695 individuals in the TBI Model Systems database with a coding for country of birth the United States ( n = 9435) versus other than the United States ( n = 1260) was used. Outcome measures at 1, 2, 5, and 10 years after TBI included the Motor and Cognitive subscales of the Functional Independence Measure and the Supervision Rating Scale. Foreign-born individuals exhibited lower motor functional independence trajectories than those born in the United States, even after controlling for demographic and injury-related covariates. However, foreign-born individuals generally showed a stronger upward quadratic trajectory in motor functional independence with the greatest gains between the 5- and 10-year time points, whereas those born in the United States improved more quickly but then plateaued between the 5- and 10-year time points; these differential effects over time dissipated with the addition of demographic and injury-related covariates. Foreign-born individuals also exhibited lower cognitive functional independence trajectories, as well as greater supervision needs trajectories, than those born in the United States, even after controlling for demographic and injury-related covariates. These findings dovetail with literature suggesting that racially/ethnically diverse groups exhibit reduced functional independence after TBI. The findings may also suggest potential systematic barriers such as healthcare access and language barriers that may influence the frequency, rate, and quality of care received. The results highlight the importance of uncovering cultural distinctions and can aid in facilitating research examining foreign nativity-based disparities following TBI.

An Observational Cohort Study of the Role of Level of Effort in Residential Brain Rehabilitation

<h3>Research Objectives</h3> To investigate the role of participant level of effort (LoE) on outcome in residential brain rehabilitation with the hypothesis that greater effort is associated with more positive outcomes. <h3>Design</h3> Observational cohort study. <h3>Setting</h3> Comprehensive integrated brain rehabilitation program within a skilled nursing facility. <h3>Participants</h3> 101 consecutive admissions with acquired brain injury. <h3>Interventions</h3> Individualized interdisciplinary brain rehabilitation; therapist rating of participant LoE during physical therapy, occupational therapy, and speech and language pathology sessions. <h3>Main Outcome Measures</h3> Mayo-Portland Adaptability Inventory (MPAI-4); Supervision Rating Scale (SRS) <h3>Results</h3> Linear regression showed that discharge MPAI-4 Total scores were significantly associated with mean LoE rating, admission MPAI-4 scores, age at admission, and days from injury (Adj R2 = 0.72; F=65.28; p< 0.0001) but not with LoE variability, sex, type of injury, length of stay, or treatment before or during the COVID pandemic. Discharge SRS scores were significantly associated with mean LoE rating, admission SRS scores, and age. After controlling for other variables, a one-unit increase in mean LoE rating was associated with an improvement of 5.1 in discharge Total MPAI-4 score and 1.5 in discharge SRS score. Logistic regression showed the odds of achieving a Minimal Clinically Important Difference on the MPAI-4 were 8.34 times higher with each one-unit LoE increase. Admission MPAI-4 was negatively associated with mean LoE (β= -0.07, t=-8.85, p< 0.0001). Exploratory propensity score analysis suggests a potential causal effect of mean LoE on outcome. <h3>Conclusions</h3> Average LoE is positively associated with and, pending further study, may be causally related to outcome. Age, time since injury, and initial level of disability are also associated with outcome; initial level of disability is negatively associated with LoE. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose.

An Observational Cohort Study of the Role of Level of Effort in Post-Acute Brain Injury Rehabilitation

ObjectiveTo investigate the role of participant level of effort (LoE) on outcome in post-acute brain injury rehabilitation with the hypothesis that greater effort is associated with more positive outcomes. DesignObservational cohort study. SettingComprehensive integrated rehabilitation program for brain injury within a skilled nursing facility. ParticipantsConsecutive admissions with acquired brain injury (N=101). InterventionsIndividualized interdisciplinary brain injury rehabilitation; therapist rating of participant LoE with Acquired Brain Injury LoE Scale (ABI-LoES) during physical therapy, occupational therapy, and speech and language pathology sessions. Main Outcome MeasuresMayo-Portland Adaptability Inventory, fourth edition (MPAI-4); Supervision Rating Scale (SRS). ResultsLinear regression showed that discharge MPAI-4 Total T scores were significantly associated with mean ABI-LoES rating, admission MPAI-4 Total T scores, age at admission, and days from injury but not with standard deviation of ABI-LoES rating, sex, injury type, length of stay, or treatment before or during the COVID-19 pandemic. Discharge SRS scores were significantly associated with mean ABI-LoES rating, admission SRS scores, and age. A 1-unit increase in mean ABI-LoES rating was associated with 5.1-unit lower discharge MPAI-4 Total T scores and 1.5 lower discharge SRS scores, after controlling for other variables. Logistic regression showed that the odds of achieving a minimal clinically important difference on the MPAI-4 were 8.34 times higher with each 1-unit increase in mean ABI-LoES rating after controlling for other variables. Admission MPAI-4 was negatively associated with mean ABI-LoES rating (β=−0.07, t=−8.85, P<.0001). ConclusionsAfter controlling for nonmodifiable variables, average ABI-LoES rating is positively associated with outcome. Initial level of disability is negatively associated with mean ABI-LoES rating.

Care Partner Carryover Day: A Formalized Training Program to Improve Care Partner Preparedness for Patients With Acquired Brain Injury Prior to Discharge Home

<h3>Research Objectives</h3> To measure the effectiveness of Care Partner Carryover Day (CPCD) to improve care partners' preparedness in caring for patients with acquired brain injury (ABI) prior to discharge home from an adult inpatient neurorehabilitation unit. <h3>Design</h3> Current care partner training procedures were evaluated using available evidence and staff feedback from a survey. A formalized care partner training program titled CPCD was developed. The Preparedness for Caregiving Scale was utilized as a pre and post program outcome measure. <h3>Setting</h3> 48 bed adult inpatient neurorehabilitation unit in an academic teaching hospital in NYC. <h3>Participants</h3> Patients with ABI who are projected to require assistance upon discharge home as identified by the Supervision Rating Scale and their unskilled care partners. <h3>Interventions</h3> CPCD allows care partners to independently practice skills previously learned in preparatory therapy training sessions. The CPCD program facilitates earlier identification of care partners, discharge planning, and initiation of training sessions. <h3>Main Outcome Measures</h3> The Preparedness for Caregiving Scale is administered to the care partner prior to training and repeated after completing CPCD. <h3>Results</h3> Preliminary results show improvements in scores on the Preparedness for Caregiving Scale after participation in CPCD, indicating increased discharge preparedness and program efficacy. <h3>Conclusions</h3> Improved scores on the Preparedness for Caregiving Scale indicate participation in a formalized care partner training program is beneficial for care partners and patients with ABI. CPCD aims to improve their confidence by practicing skills learned in a controlled environment. As a result of the CPCD program, discharge planning and training occur earlier, leading to decreased perceived burden of care and increased preparedness for home discharge. Further investigation is warranted to determine staff's perception towards CPCD and whether the new program resolves barriers of former care partner training procedures. <h3>Author(s) Disclosures</h3> None.

Systemic supervision, the last frontier: Towards a scale that measures systemic supervision

This paper describes the development of a scale for measuring systemic supervision which is called the Systemic Supervision Rating Scale (the 3D‐SSRS). This scale was developed through a thematic synthesis of the systemic supervision literature, which included 137 papers on the subject. The scale was then subjected to a face validity investigation via a series of qualitative focus groups. These groups included both supervisors of supervision and students on an AFT Accredited Supervision training. Focus groups were held at the beginning and at the end of the course to understand how useful the 3D‐SSRS was to supervision practice. The 3D‐SSRS uses a seven‐point scale to rate supervision practice and prioritises qualitative comments in 11 dimensions, including the supervisory relationship, context of supervision, developmental stage of supervisee, development of systemic skills and thinking, and attention to power and difference.Practitioner points Systemic supervision draws on knowledges and skills unique to systemic practice within specific contexts. A new Systemic Supervision Rating Scale (the 3D‐SSRS) has been developed for use in clinical and training contexts of supervision. Initial investigations into the usefulness and face validity of the scale find it able to capture many of the unique aspects of systemic supervisory practice. More research is needed into what makes for effective live supervision, perhaps unique to systemic supervisory practice, and supervision provided to groups.

The Traumatic Brain Injury Model Systems National Database: A Review of Published Research.

The Traumatic Brain Injury Model Systems (TBIMS) is the largest longitudinal TBI data set in the world. Our study reviews the works using TBIMS data for analysis in the last 5 years. A search (2015–2020) was conducted across PubMed, EMBASE, and Google Scholar for studies that used the National Institute on Disability, Independent Living and Rehabilitation Research NIDILRR/VA-TBIMS data. Search terms were as follows: [“TBIMS” national database] within PubMed and Google Scholar, and [“TBIMS” AND national AND database] on EMBASE. Data sources, study foci (in terms of data processing and outcomes), study outcomes, and follow-up information usage were collected to categorize the studies included in this review. Variable usage in terms of TBIMS' form-based variable groups and limitations from each study were also noted. Assessment was made on how TBIMS' objectives were met by the studies. Of the 74 articles reviewed, 23 used TBIMS along with other data sets. Fifty-four studies focused on specific outcome measures only, 6 assessed data aspects as a major focus, and 13 explored both. Sample sizes of the included studies ranged from 11 to 15,835. Forty-two of the 60 longitudinal studies assessed follow-up from 1 to 5 years, and 15 studies used 10 to 25 years of the same. Prominent variable groups as outcome measures were “Employment,” “FIM,” “DRS,” “PART-O,” “Satisfaction with Life,” “PHQ-9,” and “GOS-E.” Limited numbers of studies were published regarding tobacco consumption, the Brief Test of Adult Cognition by Telephone (BTACT), the Supervision Rating Scale (SRS), general health, and comorbidities as variables of interest. Generalizability was the most significant limitation mentioned by the studies. The TBIMS is a rich resource for large-sample longitudinal analyses of various TBI outcomes. Future efforts should focus on under-utilized variables and improving generalizability by validation of results across large-scale TBI data sets to better understand the heterogeneity of TBI.

Early Supported Discharge for Neurorehabilitation Following Acquired Brain Injury.

Introduction: Early Supported Discharge (ESD) is a clinical flow management service offering interdisciplinary rehabilitation, wherein patients are provided supported in-home rehabilitation treatment; in comparison to conventional hospital-based rehabilitation model of service delivery. There has been little research into the functional outcomes for other types of acquired brain injury (ABI).Methods: In this prospective cohort study, ABI patients presenting at a level I trauma center in Calgary, Canada were placed in either an ESD program or conventional inpatient rehabilitation (IPR) program based on their medical history and presentation. A small number of patients completed both programs (ESD+IPR group). ESD therapies were designed to emulate IPR. Participants completed professionally-rated Mayo-Portland Adaptability Index-4 (MPAI), Quality of Life after Brain Injury (QOLIBRI), Generalized Anxiety Questionnaire-7 (GAD7), Montreal Cognitive Assessment (MoCA), and Patient Health Questionnaire-9 (PHQ9) surveys at 1, 3, and 6 months following initial assessment pre-rehabilitation. Caregivers completed the Zarit Burden Interview (ZBI) at the same time points. The Supervision Rating Scale (SRS) and Disability Rating Scale (DRS) were completed at admission to rehabilitation and all follow-ups. Generalized estimate equations models were used to describe the three groups over time, including age as a covariate.Results: Significant effects of time were reported in the MPAI participant sub-score in the ESD and IPR groups ( = 42.429, p < 0.000; = 9.773, p = 0.008), showing significantly higher scores between 1 and 3 month timepoints for both groups. ZBI scores were significantly lower in the ESD group at 1 month compared to 3 and 6 months ( = 31.252, p < 0.001). The proportion of patients with medical complications during rehabilitation was 25.3% in ESD compared to 74.7% patients in IPR.Conclusions: Improvements in functional outcomes were evident in patients participating in ESD and IPR, with more medical complications reported in the IPR group. Caregiver burden lessened over time in the ESD group but not in the IPR group. Both ESD and ESD+IPR groups can be considered viable alternatives to traditional inpatient rehabilitation. A randomized control trial would be required to properly compare rehabilitation streams. Further investigation into affective and lifestyle elements of ABI recovery would also improve our understanding of targeted neurorehabilitation in this population.

Traumatic brain injury and post-traumatic amnesia: a retrospective review of discharge outcomes

ABSTRACTPrimary objective: To investigate if patients with traumatic brain injury, who are discharged to the community before emergence from post-traumatic amnesia (PTA), experience more adverse outcomes than those discharged after emergence from PTA. Research design: A retrospective review of previously collected data and medical records. Methods and procedures: Occurrences of adverse events including hospital readmissions, disengagement from follow-up services, non-compliance with discharge precautions, support system breakdown or undue carer strain at the post-discharge clinic review were recorded. The Glasgow Outcome Scale – Extended (GOS-E) and Supervision Rating Scale (SRS) were completed, retrospectively. Twenty-seven patients discharged to the community, prior to emergence from PTA, were compared to 20 patients discharged within seven days of emergence from PTA. Main outcomes and results: Patients discharged prior to emergence from PTA did not experience an increase in adverse outcomes and showed a higher level of engagement in follow-up services (p = 0.015). There was no difference between groups in the improvements from discharge to clinic review on the GOS-E (p = 0.113) and SRS (p = 0.165). Conclusions: Patients can be discharged prior to emergence from PTA, if all other discharge criteria have been met, without an increase in adverse outcomes.

Preliminary investigation of the reliability and validity of the BIRT Independent Living Scale

Purpose: Neurorehabilitation aims to increase independence and participation in ordinary life. It is argued that the fundamental indices of this are independent living and engagement in occupational or productive activity. The Brain Injury Rehabilitation Trust Independent Living Scale was designed to capture change in levels of participation and independence following neurorehabilitation. With greater use of outcome measures in health care, it becomes necessary to develop tools which are simple to use and that capture the holistic impact of rehabilitation. This study examines the inter-rater reliability and validity of the Brain Injury Rehabilitation Trust Independent Living Scale, which comprises two single item, multiple-choice sub-scales.Method: Inter-rater reliability was assessed by comparing the ratings on the Brain Injury Rehabilitation Trust Independent Living Scale, by five pairs of graduate psychologists, of 37 individuals who had undergone neurorehabilitation. Retrospective data collected by other members of the clinical team for the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and Care And Needs Scale were correlated with the Brain Injury Rehabilitation Trust Independent Living Scale to establish concurrent validity.Results: Weighted kappa coefficients revealed moderate (occupation) to strong (accommodation) inter-rater reliability for the two sub-scales. All correlations between the Brain Injury Rehabilitation Trust Independent Living Scale and the Mayo-Portland Adaptability Inventory-4, Supervision Rating Scale and the Care And Needs Scale were high, demonstrating good concurrent validity.Conclusions: This study highlights some of the psychometric properties of the Brain Injury Rehabilitation Trust Independent Living Scale and demonstrates its utility in assessing independent living ability and level of social participation after neurorehabilitation.Implications for rehabilitationThe BIRT Independent Living Scale is a validated method for ranking accommodation and occupation status as an indicator of independent living ability and occupational activity.The two freely available single-item scales emerging from this study provide a brief method for measuring independent living ability and participation following rehabilitation in research and clinical practice.The BIRT Independent Living Scale’s simplicity means it does not require specific training to administer, facilitating its use by a wide range of multidisciplinary staff members and researchers.

Supervision Needs Following Veteran and Service Member Moderate to Severe Traumatic Brain Injury: A VA TBI Model Systems Study.

To characterize supervision levels across residential settings at 1 year post-TBI and explore predictors of supervision in a Veteran and Service-member population. Five VA Polytrauma Rehabilitation Centers. A total of 302 individuals enrolled in the VA TBI Model Systems (TBIMS) research program. Prospective, longitudinal, multisite. Primary residence and supervision levels measured via scores on the Supervision Rating Scale. For predictive modeling, scores were dichotomized into 2 groups: those that were fully independent/living alone or required only some supervision during the day (independent group, n = 195) and those that required overnight supervision, full-time indirect supervision, and full-time direct supervision (dependent group, n = 107). Thirty-five percent were receiving supervision at 1 year post-TBI across residential settings and 28% were living in alternative settings. Multivariate modeling indicated that older age and longer posttraumatic amnesia (PTA) were predictive of having a need for supervision at 1 year postinjury. Supervision needs are long-term features of moderate and severe TBI. Results of this study lend support to the shift toward conceptualizing TBI as a chronic disease.

The Minimal Clinically Important Difference for the Mayo-Portland Adaptability Inventory.

To determine the Minimal Clinically Important Difference (MCID) and Robust Clinically Important Difference (RCID) of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as measures of response to intervention. Retrospective analysis of existing data. Both distribution- and anchor-based methods were used to triangulate on the MCID and to identify a moderate, that is, more robust, level of change (RCID) for the MPAI-4. These were further evaluated with respect to clinical provider ratings. Data for individuals with acquired brain injury in rehabilitation programs throughout the United States in the OutcomeInfo Database (n = 3087) with 2 MPAI-4 ratings. MPAI-4, Supervision Rating Scale, Clinician Rating of Global Clinical Improvement. Initial analyses suggested 5 T-score points (5T) as the MCID and 9T as the RCID. Eighty-one percent to 87% of clinical raters considered a 5T change and 99% considered a 9T change to indicate meaningful improvement. 5T represents the MCID for the MPAI-4 and 9T, the RCID. Both values are notably less than the Reliable Change Index (RCI). While the RCI indicates change with a high level of statistical confidence, it may be insensitive to change that is considered meaningful by providers and participants as indicated by the MCID.

Preliminary evaluation of a measure for reliable assessment of need for constant visual observation in adults with traumatic brain injury

Primary objective: To develop and provide initial validation of a measure for accurately determining the need for Constant Visual Observation (CVO) in patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation.Research design: Rating scale development and evaluation through Rasch analysis and assessment of concurrent validity.Methods and procedures: One hundred and thirty-four individuals with moderate–severe TBI were studied in seven inpatient brain rehabilitation units associated with the National Institute for Disability, Independent Living and Rehabilitation Research (NIDILRR) TBI Model System. Participants were rated on the preliminary version of the CVO Needs Assessment scale (CVONA) and, by independent raters, on the Levels of Risk (LoR) and Supervision Rating Scale (SRS) at four time points during inpatient rehabilitation: admission, Days 2–3, Days 5–6 and Days 8–9.Outcomes and results: After pruning misfitting items, the CVONA showed satisfactory internal consistency (Person Reliability = 0.85–0.88) across time points. With reference to the LoR and SRS, low false negative rates (sensitivity > 90%) were associated with moderate-to-high false positive rates (29–56%).Conclusions: The CVONA may be a useful objective metric to complement clinical judgement regarding the need for CVO; however, further prospective study is desirable to further assess its utility in identifying at-risk patients, reducing adverse events and decreasing CVO costs.

Finding Your Cadence: Introducing the Dynamic Developmental Framework of Supervision

Supervision is a critical aspect of family therapy training. Previous literature has focused on applying therapy models to the process of supervision. Less emphasis has been given to the vital ingredients that make up the supervision system. The supervision system (SVS), the core of our approach, refers to the relationship between the supervisor and the supervisee. While such a relational system is informed by cultural, social, economic, and personal variables, we emphasize seven pivot points for this relationship: power, trust, communication, respect, flexibility, creativity, and self-of-the-supervisee. Using case illustrations, we explore how these seven pivot points can be used to adapt to the developmental level of the supervisee in a process that we introduce as the dynamic developmental framework of supervision. Last, we provide a supervision rating scale to help supervisees explore their supervision system in practice.

Impact of late post-traumatic seizures on physical health and functioning for individuals with brain injury within the community

Primary objective: To better characterize, describe and highlight issues that individuals with TBI and active LPTS may face in their daily lives.Design: Prospective multi-centre mixed method qualitative and quantitative interview.Participants: Twenty-five individuals, 5–13 years post-injury, who had reported having LPTS and TBI.Measures: Disability Rating Scale (DRS); Supervision Rating Scale (SRS); Glasgow Outcome Scale–Extended (GOS-E); Perceived Stress Scale (PSS); Craig Handicap Assessment Reporting Technique-Short Form (CHART-SF) sub-scales: Physical Independence, Cognitive Independence, Mobility, Occupation, Social Integration; and Craig Hospital Inventory of Environmental Factors (CHIEF); and qualitative interview questions pertaining to management of the seizure disorder and its effect on the individual's health, function, community integration and participation.Results: Data are presented regarding seizure activity and management; return to driving post-seizure; coping and participation; and standardized outcome measures.Conclusions: Individuals with TBI and LPTS are at a double-barrelled disadvantage regarding ongoing physical, cognitive, psychosocial and reintegration issues following brain injury and epilepsy. Clearer clinical guidelines and treatment strategies need to be developed to help ameliorate these ongoing issues. Additional research is needed to identify what the rehabilitation community can do to continue to facilitate people living safely and independently.

Disability Rating Scale

T DISABILITY RATING SCALE (DRS) is an 8-item outcome measure that is one of the more frequently used measures in traumatic brain injury (TBI) research.1 The scale is sometimes referred to as the Rappaport DRS to discriminate the Disability Rating Scale from the Dementia Rating Scale (also abbreviated DRS). The popularity of the DRS is derived from its brief administration time, its usefulness in a large variety of settings or levels of care, its widespread acceptance and use in research, and its free availability in the public domain. The DRS was designed to measure changes in recovery in adults with TBI, where total scores are meant to reflect a level of disability.2 It has been recommended as a useful outcome measure for clinical trials involving individuals with brain injury and is currently classified as a Supplemental Measure within the National Institute of Neurological Disorders and Stroke Common Data Elements Project (www.commondataelements.ninds.nih. gov). The DRS has also been used to validate other brain injury outcome scales, including the Coma Recovery Scale, Mayo Portland Adaptability Inventory, Supervision Rating Scale, and the Community Integration Questionnaire.3 Because of the brief administration time, one important benefit of the DRS is the efficiency at which it can be administered and the ability for researchers to complete it over the phone. The DRS is also unusual in that it has the ability to describe disability for individuals in a wide variety of settings, from acute care hospitals

Assessment of Principals’ Supervisory Roles for Quality Assurance in Secondary Schools in Ondo State, Nigeria

This study identified the nature of principals’ supervisory roles and the perceived effectiveness of principals in the supervision of teachers’ instructional tasks. Furthermore, it investigated the constraints faced by principals in the performance of supervisory duties in the teaching-learning process. This was with a view to providing information on the utilisation of principals’ roles in enhancing quality assurance in secondary schools. The study employed the descriptive survey design. The target population comprised principals and teachers in secondary schools in Ondo state. The sample consisted of 60 principals and 540 teachers randomly selected from 60 secondary schools. The secondary schools were selected using stratified random sampling method from 5 Local Government Area [LGAs]. Three research instruments were used for data collection; they are Principals’ Supervision Rating Scale (PSRS), Interview Guide for Principals (IGP) and Teachers’ Focus Group Discussion Guide (FGDG). Three research questions were resolved based on percentage and mean scores. The results showed that most principals accorded desired attention to monitoring of teachers’ attendance, preparation of lesson notes and adequacy of diaries of work while tasks such as the provision of instructional materials, reference books, feedback and review of activities with stakeholders were least performed by many principals in secondary schools. The study concluded that challenges that principals faced in the tasks of institutional governance, resource inputs, curriculum delivery and students’ learning require effective collaboration and goal-oriented synergetic interrelationship between the school and the relevant stakeholders in its environment.

Longitudinal Outcome of Patients with Disordered Consciousness in the NIDRR TBI Model Systems Programs

Few studies address the course of recovery from prolonged disorders of consciousness (DOC) after severe traumatic brain injury (TBI). This study examined acute and long-term outcomes of persons with DOC admitted to acute inpatient rehabilitation within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS). Of 9028 persons enrolled from 1988 to 2009, 396 from 20 centers met study criteria. Participants were primarily male (73%), Caucasian (67%), injured in motor vehicle collision (66%), with a median age of 28, and emergency department Glasgow Coma Scale (GCS) score of 3. Participant status was evaluated at acute rehabilitation admission and discharge and at 1, 2, and 5 years post-injury. During inpatient rehabilitation, 268 of 396 (68%) regained consciousness and 91 (23%) emerged from post-traumatic amnesia (PTA). Participants demonstrated significant improvements on GCS (z=16.135, p≤0.001) and Functional Independence Measure (FIM) (z=15.584, p≤0.001) from rehabilitation admission (median GCS=9; FIM=18) to discharge (median GCS=14; FIM=43). Of 337 with at least one follow-up visit, 28 (8%) had died by 2.1 years (mean) after discharge. Among survivors, 66 (21%) improved to become capable of living without in-house supervision, and 63 demonstrated employment potential using the Disability Rating Scale (DRS). Participants with follow-up data at 1, 2, and 5 years post-injury (n=108) demonstrated significant improvement across all follow-up evaluations on the FIM Cognitive and Supervision Rating Scale (p<0.01). Significant improvements were observed on the DRS and FIM Motor at 1 and 2 years post-injury (p<0.01). Persons with DOC at the time of admission to inpatient rehabilitation showed functional improvement throughout early recovery and in years post-injury.

The Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI): II. Reliability and Convergent Validity

A standardized measure of neurological dysfunction specifically designed for TBI currently does not exist and the lack of assessment of this domain represents a substantial gap. To address this, the Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) was developed for TBI outcomes research through the addition to and modification of items specifically relevant to patients with TBI, based on the National Institutes of Health Stroke Scale. In a sample of 50 participants (mean age = 33.3 years, SD = 12.9) <or=18 months (mean = 3.1, SD = 3.2) following moderate (n = 8) to severe (n = 42) TBI, internal consistency of the NOS-TBI was high (Cronbach's alpha = 0.942). Test-retest reliability also was high (rho = 0.97, p < 0.0001), and individual item kappas between independent raters were excellent, ranging from 0.83 to 1.0. Overall inter-rater agreement between independent raters (Kendall's coefficient of concordance) for the NOS-TBI total score was excellent (W = 0.995). Convergent validity was demonstrated through significant Spearman rank-order correlations between the NOS-TBI and the concurrently administered Disability Rating Scale (rho = 0.75, p < 0.0001), Rancho Los Amigos Scale (rho = -0.60, p < 0.0001), Supervision Rating Scale (rho = 0.59, p < 0.0001), and the FIM (rho = -0.68, p < 0.0001). These results suggest that the NOS-TBI is a reliable and valid measure of neurological functioning in patients with moderate to severe TBI.

Validity and Responsiveness of the Care and Needs Scale for Assessing Support Needs After Traumatic Brain Injury

So C, Tate RL, Aird V, Allaous J, Browne S, Carr B, Coulston C, Diffley L, Gurka J, Hummell J. Validity and responsiveness of the Care and Needs Scale for assessing support needs after traumatic brain injury. Objective To investigate the validity and responsiveness of the Care and Needs Scale (CANS), which was designed to assess support needs of people with traumatic brain injury (TBI). Design Two samples of community clients (n=38, n=30) were recruited to examine concurrent, convergent/divergent, and discriminant validity. The ability of the CANS to detect change over a 6-month period from the time of inpatient rehabilitation discharge (predictive validity and responsiveness) was investigated in a third sample of 40 rehabilitation inpatients. Setting Two Brain Injury Rehabilitation Units in Sydney, Australia. Participants People (N=108) aged between 16 and 70 years admitted for rehabilitation after TBI. Interventions Not applicable. Main Outcome Measures The CANS, Supervision Rating Scale, FIM, Sydney Psychosocial Reintegration Scale, and Disability Rating Scale. Results Evidence for concurrent validity was shown with fair to moderate correlation coefficients between the CANS and measures of supervision, functional independence, and psychosocial functioning (absolute value, r s=.43–.68; P<.01). Support for convergent and divergent validity was provided by correlation coefficients that were higher for measures tapping similar constructs (absolute value, r s=46; P<.01) but lower for measures of dissimilar constructs (absolute value, r s=.07–.26; not significant). In addition, the CANS discriminated between levels of injury severity, functional independence, and overall functioning ( P<.01). In terms of predictive validity and responsiveness, CANS scores at inpatient rehabilitation discharge predicted the participant's functioning 6 months later. Conclusions These results show the CANS is a valid and responsive tool and, together with its previously shown reliability, is suitable for routine application in clinical and research practice.