Supervision Rating Scale Research Articles

Changes in supervision needs following participation in a residential post-acute brain injury rehabilitation programme

Objective: Supervision needs typically increase following moderate-to-severe traumatic brain injury (TBI). Research assessing the impact of TBI residential rehabilitation programmes on supervision needs is limited.Research design: Prospective cross-sectional study.Methods and procedures: Ninety-four participants with moderate-to-severe TBI admitted to a post-acute brain injury rehabilitation programme (PABIR) were administered the supervision rating scale (SRS) at admission and at 1 month post-discharge. To account for spontaneous neurological recovery, patients were separated into those who were less than 1 year (L1Y, n = 55) or greater than 1 year (G1Y, n = 39) post-injury.Experimental intervention: None.Main outcomes and results: A mixed factorial design yielded a significant interaction (F(1, 92) = 18.2; p < 0.0001) with post-hoc results revealing that the L1Y group improved more dramatically in terms of supervision needs than the G1Y group. Using reliable change methodologies, 52.7% of the L1Y demonstrated decreasing scores on the SRS vs 20.5% of the G1Y group.Conclusions: Decreases in supervision needs following PABIR can be found, even after accounting for the impact of spontaneous neurological recovery both at the group and individual level.

The Predictive Validity of a Brief Inpatient Neuropsychologic Battery for Persons With Traumatic Brain Injury

Hanks RA, Millis SR, Ricker JH, Giacino JT, Nakese-Richardson R, Frol AB, Novack TA, Kalmar K, Sherer M, Gordon WA. The predictive validity of a brief inpatient neuropsychologic battery for persons with traumatic brain injury. Objective To examine the predictive validity of a brief neuropsychologic test battery consisting of the Galveston Orientation and Amnesia Test, the California Verbal Learning Test–II, Trail-Making Test (TMT), Symbol Digit Modalities Test, grooved pegboard, phonemic and categorical word generation tasks, the Wechsler Test of Adult Reading (WTAR), and the Wisconsin Card Sorting Test–64 relative to functional outcome at 1 year in persons with traumatic brain injury. Design Inception cohort study. Follow-up period of 12 months. Setting Seven Traumatic Brain Injury Model System centers. Neuropsychologic testing was conducted during the acute inpatient rehabilitation stay and functional outcome measures were obtained at 1-year outpatient follow-up. Participants Adults (N=174) who met criteria for admission to inpatient brain injury rehabilitation. Interventions Not applicable. Main Outcome Measures FIM instrument, Disability Rating Scale, Supervision Rating Scale, Satisfaction With Life Scale (SWLS), and Glasgow Outcome Scale−Extended. Results Multiple regression analyses revealed that performance on the neuropsychologic test battery was predictive of outcome at 1 year postinjury for all outcome measures, except FIM motor scores and the SWLS. Cognitive performance using this battery was found to predict 1-year outcomes above and beyond functional variables and injury severity variables collected during inpatient rehabilitation, thereby indicating incremental validity for this test battery. Individual tests that were found to be significant predictors of 1-year outcomes included the WTAR and TMT part B. Conclusions These findings support the clinical utility and ecological validity of this battery with respect to level of disability, functional independence, and supervision required.

Cognitive status at discharge from the hospital determines discharge destination in traumatic brain injury patients

Purpose: To determine which basic and functional status characteristics of patients with a moderate or severe traumatic brain injury (TBI) are associated with discharge destination.Method: Cross-sectional study among TBI patients. The study included 111 patients aged 16–67 years with a moderate-to-severe TBI (Glasgow Coma Scale (GCS) score 3–14). Functional outcome was assessed with Barthel Index (BI), Functional Independence Measurement (FIM), Level of Cognitive Functioning Scale (LCFS), Functional Assessment Measurement (FAM), Supervision Rating Scale (SRS) and Neurobehavioural Rating Scale (NRS). Patients were interviewed at the time of being discharged from hospital. Outcome variable was discharge destination; (1) home vs. institution and (2) rehabilitation centre vs. nursing home.Results: Gender, age and length of stay were not associated with discharge destination. TBI severity, physical status, level of arousal and cognitive status were univariately associated. Multivariate analyses, however, showed that the risk of being admitted to an institution was significantly higher for those with severe TBI (adjusted OR = 14) and/or lowered cognitive status at the time of discharge from hospital (adjusted OR = 12).Conclusions: Discharge destination is associated with TBI-severity at admittance to the hospital and cognitive status at discharge from the hospital.

Wisconsin Card Sorting Test: Factor structure and relationship to productivity and supervision needs following severe traumatic brain injury

Primary objective: The Wisconsin Card Sorting Test (WCST) has been demonstrated to have a relatively stable factor structure in traumatic brain injury (TBI) samples. What is less clear is whether the scores derived from WCST factors are related to functional outcomes. The purpose of the current study was to replicate the WCST factor structure in a sample with severe TBI, and to evaluate the relationship between the factor scores and outcome.Research design: Retrospective correlational study.Methods and procedures: Participants (n = 143) who had suffered severe TBI were administered a battery of neuropsychological tests including the WCST within one month of admission to a brain injury rehabilitation program. In addition, participants were administered supervision (Supervision Rating Scale; SRS) and productivity measures (Community Integration Questionnaire- Productivity subscale; CIQ-P) at admission and following discharge.Experimental intervention: None.Main outcomes and results: For individuals who were more than one year post injury, more failure to maintain set errors were associated with better occupational outcomes, while more nonperseverative errors were associated with increased supervision needs.Conclusions: The WCST factor scales are related to functional outcomes in severe TBI. Specifically, the inability to establish a series of correct responses is associated with poorer outcome.

The Supervision Rating Scale

The Supervision Rating Scale

Reliability and sensitivity to change of measurement instruments used in a traumatic brain injury population

Objective: To compile a minimum data set for the follow-up of traumatic brain injury patients from discharge from hospital to one year post injury to assess functioning and participation in the physical, cognitive and psychosocial domains, and in quality of life. Design: Repeated questionnaire interviews by two observers to establish interobserver reliability of the measurement instruments at discharge and at one year post injury, as well as their sensitivity to change over time in traumatic brain injury patients. Setting: Department of neurosurgery of an academic hospital, department of a rehabilitation centre, and at the patients' homes in the Netherlands. Subjects: The study at discharge included 25 patients aged 18-50 years with a moderate to severe traumatic brain injury (Glasgow Coma Scale score 3-14), whereas the one year post injury study included 14 patients aged 19-51 years. Main (outcome) measures: Physical domain: Barthel Index (BI), Functional Independence Measurement (FIM), Glasgow Outcome Scale (GOS), GOS Extended (GOSE). Cognitive domain: Disability Rating Scale (DRS), Functional Assessment Measurement (FAM), Levels of Cognitive Functioning Scale (LCFS), Neurobehavioural Rating Scale (NRS). Psychosocial domain: Community Integration Questionnaire (CIQ), Employability Rating Scale (ERS), Frenchay Activity Index (FAI), Multi Health Locus of Control (MHLC), Rehabilitation Activities Profile (RAP), Social Support List (SSL), Supervision Rating Scale (SRS), Wimbledon Self Reporting Rating Scale (WSRS). Quality of life: Coop/Wonca Charts (Coop), Rand SF-36 (Rand-36), Sickness Impact Profile-68 (SIP-68). Results: At both discharge and at one year post injury, in the physical domainthe FIM showed excellent squared weighted kappa (SWK ranging from 0.75 to 0.80), and intraclass correlation coefficient (ICC ranging from 0.75 to 0.92), and a relatively small standard error of measurement (SEM 3.22) and smallest detectable difference (SDD 8.92). In the cognitive domain the FAM and the NRS showed excellent SWK, and ICC, and a relatively small SEM and SDD. In the psychosocial domainthe FAI showed excellent SWK (0.89), and ICC (0.87), and a relatively small SEM (2.64) and SDD (7.31). For quality of life, at both discharge and at one year post injury the SIP-68 and the Coop showed excellent SWK (0.87), and ICC (0.89), and a relatively small SEM (3.79) and SDD (10.51). At both time points SWK and ICC ranged from 0.80 to 0.89, SEM ranged from 1.47 to 1.98, and the SDD was 4.07. Conclusions: An example of a reliable minimum data set that is also able to detect changes over time is: the FIM, the FAM and the Coop for the early stages in recovery, extended with the NRS, the FAI, and the SIP-68 later in recovery, thereby covering all relevant domains after traumatic brain injury.

Early Versus Later Admission to Postacute Rehabilitation: Impact on Functional Outcome After Traumatic Brain Injury

High WM Jr, Roebuck-Spencer T, Sander AM, Struchen MA, Sherer M. Early versus later admission to postacute rehabilitation: impact on functional outcome after traumatic brain injury. Objective To examine the impact of participation in a postacute community reentry program on functional outcome after traumatic brain injury (TBI). Design Cohort, nonrandomized, intervention study. Pretest-posttest, follow-up design. Setting Nonprofit outpatient community reentry program affiliated with an inpatient rehabilitation hospital. Participants Three groups of persons with moderate to severe TBI differing in length of time between injury and admission. The first group entered postacute rehabilitation within 6 months of injury (n=115); the second group, between 6 and 12 months (n=23); and the third group, greater than 12 months (n=29). Interventions Persons with TBI participated in a postacute community reentry program (average, 4.3mo) that emphasized (1) teaching compensatory strategies to address residual cognitive deficits; (2) arranging environmental supports to maximize functioning; (3) counseling and education to address personal and family adjustment and to improve accurate self-awareness; and (4) transition from simulated activities in the clinic to productive activities in the community. Main Outcome Measures Disability Rating Scale, Supervision Rating Scale, and the Community Integration Questionnaire. Results All groups showed improvements between admission and discharge on measures of overall disability, independence, home competency, and productivity, and these gains were maintained at follow-up. For the group beginning postacute rehabilitation the earliest (<6mo postinjury) independence continued to improve after discharge. Community integration total score and home competency also continued to improve even after discharge. Conclusions The results point toward the effectiveness of postacute rehabilitation in improving functional outcome after TBI even for persons who have reached stable neurologic recovery at 12 or more months postinjury.

Outpatient rehabilitation of patients with chronic cognitive impairments after ruptured anterior communicating artery aneurysms reduces the burden of care: A pilot study

Primary objective: To describe the functional outcome of 19 patients with anterior communicating artery aneurysm following the completion of an inter-disciplinary out-patient rehabilitation programme.Research design: Retrospective descriptive study. Setting: Community-based inter-disciplinary outpatient programme. Patients: n = 19; consecutive referred sample, mean 182 days post-onset; in-patient rehabilitation completed. Intervention: Inter-disciplinary treatment of functional activities; 2–5 hours/day, 3–5 days/week; mean duration: 55–57 days.Main outcome measures: Supervision rating scale (SRS) and change in prevalence at admission and discharge of executive impairments, memory, confabulation, apathy, initiation, social inappropriateness and incontinence.Results: Sixty per cent of the patients showed a clinically significant improvement in their SRS from requiring full-time supervision to part-time supervision. Change in SRS was correlated with change in the impairments of executive function, memory and confabulation.Conclusion: Although pervasive impairments associated with this disorder may limit capacity for even moderate independence, substantial reduction in direct supervision by family members may be achieved.

Psychosocial adjustment 17 years after severe brain injury

Objectives: To examine very long term psychosocial outcome following severe brain injury in a large cohort, with the aim of evaluating Thomsen’s observation that even after very serious head trauma...

Clinical Elements that Predict Outcome after Traumatic Brain Injury: A Prospective Multicenter Recursive Partitioning (Decision-Tree) Analysis

Traumatic brain injury (TBI) often presents clinicians with a complex combination of clinical elements that can confound treatment and make outcome prediction challenging. Predictive models have commonly used acute physiological variables and gross clinical measures to predict mortality and basic outcome endpoints. The primary goal of this study was to consider all clinical elements available concerning a survivor of TBI admitted for inpatient rehabilitation, and identify those factors that predict disability, need for supervision, and productive activity one year after injury. The Traumatic Brain Injury Model Systems (TBIMS) database was used for decision tree analysis using recursive partitioning (n = 3463). Outcome measures included the Functional Independence Measure(), the Disability Rating Scale, the Supervision Rating Scale, and a measure of productive activity. Predictor variables included all physical examination elements, measures of injury severity (initial Glasgow Coma Scale score, duration of post-traumatic amnesia [PTA], length of coma, CT scan pathology), gender, age, and years of education. The duration of PTA, age, and most elements of the physical examination were predictive of early disability. The duration of PTA alone was selected to predict late disability and independent living. The duration of PTA, age, sitting balance, and limb strength were selected to predict productive activity at 1 year. The duration of PTA was the best predictor of outcome selected in this model for all endpoints and elements of the physical examination provided additional predictive value. Valid and reliable measures of PTA and physical impairment after TBI are important for accurate outcome prediction.

Assessing support needs for people with traumatic brain injury: the care and needs scale (CANS)

Background: After traumatic brain injury (TBI), many individuals have support needs, but the variety, frequency and intensity of such needs vary widely. Currently available scales do not assess all facets of required supports and the eight-category Care and Needs Scale (CANS) was developed in order to capture the range of support needs. The aim of the present study was to examine the sensitivity and validity of the CANS. Method: Using a sample of 67 people who sustained severe TBI 20-26 years previously, the CANS was compared with the Supervision Rating Scale (SRS), five scales from the Craig Handicap Assessment and Reporting Technique (CHART) and the Sydney Psychosocial Reintegration Scale (SPRS). Results: The data showed a spread across all CANS categories: 28.4% of participants were fully independent, 46.3% had support needs on less than a daily basis (25.4% intermittently, 13.4% at least weekly and 7.5% every few days) and the remaining 25.4% had needs on a daily basis (ranging from 11.9% for up to 11 hours per day to 4.5% for 24 hours per day). By contrast, the 13-category SRS classified 61.2% in the best category and five categories did not contain any individuals. The CANS showed strong correlation with the SRS (rs = 0.75), as well as CHART and SPRS scores (range rs = −0.46 to −0.85) and statistically significant differences were found among participant sub-groups. Logistic regression analyses, using variables collected at the time of discharge from rehabilitation, were able to predict independence on the CANS with classification accuracy of 77% and presence of neuropsychological disability was an individual predictor. Conclusion: These results suggest that the CANS shows promise as a sensitive and valid instrument to measure care and support needs after TBI, particularly in the longer term, and further examination of its psychometric properties is warranted.

The relationship between neuropsychologic function and level of caregiver supervision at 1 year after traumatic brain injury

Hart T, Millis S, Novack T, Englander J, Fidler-Sheppard R, Bell KR. The relationship between neuropsychologic function and level of caregiver supervision at 1 year after traumatic brain injury. Arch Phys Med Rehabil 2003;84:221-30. Objectives: To evaluate distribution of levels of caregiver supervision at 1 year after traumatic brain injury, and to determine neuropsychologic predictors of supervision level. Design: Prospective longitudinal design, concurrent measurement of neuropsychologic function and supervision level. Setting: Seventeen Traumatic Brain Injury Model Systems centers. Participants: A total of 563 adults tested at 1 year postinjury; and a subgroup of 452 studied for neuropsychologic function in the absence of impairment in mobility or basic self-care, as assessed by high FIM[trade ] instrument motor scores. Interventions: Not applicable. Main Outcome Measure: Supervision level measured by scores on Supervision Rating Scale (SRS). Results: Two thirds (69%) of the sample was rated as independent of supervision. Participants without significant dysfunction on motor FIM were grouped into supervision groups differing in intensity of time commitment from caregiver (independent, moderate supervision, heavy supervision). In univariate analyses, groups differed on demographic variables (education, race, productivity prior to injury), duration of altered consciousness, and all but 1 neuropsychologic measure. A binomial regression model (complementary log-log model) revealed that supervision at 1 year was predicted by education and scores on the Trail Making Test Part B and digits backward. Conclusions: Findings confirm the importance of preinjury status and measures of working memory and cognitive flexibility in predicting functional independence after TBI. The SRS appears prone to ceiling effects in persons followed prospectively after moderate to severe TBI. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

The association of early computed tomography scan findings and ambulation, self-care, and supervision needs at rehabilitation discharge and at 1 year after traumatic brain injury

Englander J, Cifu DX, Wright JM, Black K. The association of early computed tomography scan findings and ambulation, self-care, and supervision needs at rehabilitation discharge and at 1 year after traumatic brain injury. Arch Phys Med Rehabil 2003;84:214-20. Objective: To ascertain the association between early computed tomography (CT) scan findings and the need for assistance with ambulation, activities of daily living (ADLs), and supervision at rehabilitation discharge and at 1 year after traumatic brain injury (TBI). Design: Prospective longitudinal design. Setting: Seventeen Traumatic Brain Injury Model Systems (TBIMS) centers. Participants: A total of 1839 adults with TBI admitted to TBIMS trauma centers with subsequent acute rehabilitation; 849 were followed to 1 year after injury. Interventions: Not applicable. Main Outcome Measures: Accumulated CT scan pathology from the first week after injury; FIM[trade ] instrument and Disability Rating Scale at rehabilitation discharge and 1 year after injury; and Supervision Rating Scale at 1 year. Results: Chi-square analyses showed that individuals with a midline shift greater than 5mm (lateral compression) were more likely to require the assistance of another person at discharge from acute rehabilitation with ambulation (29% vs 17%[ndash ]19%, P=.02), toileting (47% vs 33%[ndash ]38%, P=.05), lower-body dressing (57% vs 39%[ndash ]46%, P=.015), bladder continence (32% vs 19%[ndash ]23%, P=.03), and overall supervision (53% vs 44%, P=.0006) than patients with a midline shift of lesser degree. At 1 year, 57% of patients with a midline shift greater than 5mm on acute CT scans were being supervised in the home versus 30% to 39% of those with a shift of lesser degree (P=.003); there were no significant differences in the percentages of those needing assistance for ambulation or ADLs. The association of subdural hematoma with ambulation, self-care, and supervision needs was related to the degree of midline shift but not to the presence of subdural hematoma. Individuals with subcortical contusions were more likely to require assistance at rehabilitation discharge for ambulation (32% vs 18%, P[lt ].0001), lower-body dressing (61% vs 44%), toileting (52% vs 35%), bladder continence (34% vs 22%), and overall supervision (61% vs 44%) than those without subcortical contusions (P[lt ].0001). At 1 year, individuals with acute subcortical contusions were more likely to need assistance with ambulation (15% vs 8%, P=.004) and stair climbing (15% vs 9%, P=.03). Those with bilateral frontal (54% vs 46%, P=.009) or bilateral temporal (58% vs 46%, P=.03) contusions were more likely to need assistance with overall supervision at rehabilitation discharge, compared with those with unilateral or no cortical contusions. Conclusions: The presence of either a midline shift greater than 5mm or a subcortical contusion on acute CT scans is associated with a greater need of assistance with ambulation, ADLs, and global supervision at rehabilitation discharge. Patients with bilateral cortical contusions require more global supervision at rehabilitation discharge but no more supervision for ambulation and ADLs. These findings may aid health care professionals and potential caregivers in planning for rehabilitation and supervision needs after rehabilitation discharge and, to a lesser extent, at 1 year after TBI. [copy ] 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals

Hall KM, Bushnik T, Lakisic-Kazazic B, Wright J, Cantagallo A. Assessing traumatic brain injury outcome measures for long-term follow-up of community-based individuals. Arch Phys Med Rehabil 2001;82:367-74. Objectives: To determine which outcome measures are best and least suited for assessing long-term functional outcome of individuals with traumatic brain injury (TBI) in the community. Design: Survey of participants in the community an average of 5 years after TBI. A battery of outcome measures was given. Setting: Community in northern California after inpatient rehabilitation. Participants: Forty-eight adult individuals with prior moderate to severe TBI. All subjects had received inpatient rehabilitation 2 to 9 years previously and could be reached for telephone interview. Main Outcome Measures: The Community Integration Questionnaire, Neurobehavioral Functioning Inventory (NFI), Patient Competency Rating Scale (PCRS), Level of Cognitive Functioning Scale (LCFS), FIM™ instrument, Functional Assessment Measure (FIM+FAM), Supervision Rating Scale (SRS), Disability Rating Scale (DRS), Revised Craig Handicap Assessment and Reporting Technique (R-CHART), and Glasgow Outcome Scale (GOS). The number of maximal scores on each of the surveys was studied to determine which instruments continued to reveal deficits years after TBI. Results: Most individuals obtained maximum scores, ie, functional independence, on these scales: LCFS, FIM motor subscale and total score, R-CHART physical independence subscale, FIM+FAM, GOS, and the SRS. Measures with the fewest maximum scores (<36%, measuring deficits still extant in the group) were the R-CHART cognition subscale and the NFI memory/attention and communication subscales, and employment subscales. Items, subscales, and total scores that showed good variability and correlated most highly and frequently with other scales also demonstrating good variability were the PCRS, the DRS and FIM+FAM employment items, the R-CHART cognition subscale, and the NFI motor, memory/attention, communication, and depression subscales (the R-CHART cognition subscale and NFI memory/attention subscale were highly correlated with the PCRS;.84,.83). Conclusions: Measures that appeared to contribute little to assessing functional status of a TBI sample years postinjury were the FIM, FIM+FAM, SRS, GOS, and LCFS. Measures that showed a range of deficits across participants were DRS employability, the NFI, PCRS, and the R-CHART cognition subscale.

The supervision rating scale (SRS): A program evaluation tool for postacute brain injury rehabilitation

The supervision rating scale (SRS): A program evaluation tool for postacute brain injury rehabilitation

The supervision rating scale (SRS): A program evaluation tool for postacute brain injury rehabilitation

The supervision rating scale (SRS): A program evaluation tool for postacute brain injury rehabilitation

Supervision rating scale: A measure of functional outcome from brain injury

Objective: To introduce a new outcome rating scale, the Supervision Rating Scale (SRS), which measures the level of supervision that a patient receives from caregivers. The SRS rates level of supervision on a 13-point ordinal scale that can optionally be grouped into five ranked categories (Independent, Overnight Supervision, Part-Time Supervision, Full-Time Indirect Supervision, and Full-Time Direct Supervision). Design: Descriptive correlational study of the scale's interrater reliability and criterion-related validity. Setting: Brain injury program of a freestanding rehabilitation hospital. Patients: Referred case series of 114 patients with moderate to severe traumatic brain injury (mean time postinjury = 3.8 years) who resided in the community or a nonhospital facility. Intervention: None. Main Outcome Measures: Functional outcome as measured by the Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), type of living arrangement, and independence in self-care and instrumental activities of daily living (ADL). Results: SRS ratings showed consistent relationships with type of living arrangement and with independence in self-care and instrumental ADL. SRS ratings were also strongly associated with ratings on the DRS and GOS. Interrater reliability of the SRS was evaluated in a subsample of 19 patients and found to be satisfactory (intraclass correlation = .86, weighted kappa = .64). Conclusions: The results suggest that the SRS should have sufficient reliability and validity to serve as a measure of functional outcome from brain injury. Because SRS ratings are based on observed behaviors, the SRS may have a smaller subjective component as compared to the DRS and GOS.