Publications by authors named "Lisa J Rapport"

67 Publications

Return to Driving Following Moderate-to-Severe Traumatic Brain Injury.

Arch Phys Med Rehabil 2021 Mar 8. Epub 2021 Mar 8.

Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham.

Objective: Describe who returns to driving (RTD) after moderate-to-severe traumatic brain injury (TBI), when this occurs, who maintains that activity, and association with outcome.

Design: Cross-sectional descriptive.

Setting: Eight follow-up sites of the TBI Model System (TBI MS) program.

Participants: 618 participants enrolled in the TBI MS and 88 caregivers.

Intervention: None.

Measurements: A survey was completed from 1 to 30 years post injury focusing on RTD. Descriptors included demographic information, injury severity, and current employment status. Outcome was assessed at the time of the interview, including depression, quality of life, functional status, and community participation.

Results: Of 706 respondents, 78% RTD, but 14% of these did not maintain that activity. Of those who RTD, 42% did so within 6 months of the injury, and 90% did so within 24 months post-injury. The percentage of people driving after TBI did not differ significantly based on age at time of injury or follow-up. There were significant differences between drivers and non-drivers with respect to severity of injury, seizures, race, education, employment, rural versus urban setting, marital status, and family income. A multivariable logistic regression analysis was performed to examine the association between driving status and demographic variable, adjusting for other variable in the model. The strongest associations were with current employment, family income, race, seizures, and severity of injury. Driving was associated with greater in community participation , better functional outcomes, fewer symptoms of depression, and greater life satisfaction.

Conclusion: Over a span of 30 years, three-quarters of people experiencing moderate-to-severe TBI return to driving a personal vehicle, although not everyone maintains this activity. Employment, race, family income, and seizures are strongly associated with RTD.
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http://dx.doi.org/10.1016/j.apmr.2021.02.006DOI Listing
March 2021

Pain anxiety and rehabilitation outcomes after acquired brain injury.

Brain Inj 2021 Jan 21;35(1):32-40. Epub 2020 Dec 21.

Department of Psychology, Wayne State University, Detroit, MI, USA.

: The purpose of this study was to examine pain anxiety after acquired brain injury (ABI) and its relationship to rehabilitation outcomes.: Participants consisted of 89 adults with an ABI participating in outpatient rehabilitation therapy. They completed a battery of neuropsychological tests at baseline along with surveys of mood, health-related self-efficacy, and pain anxiety. Separately, occupational therapists assessed basic and instrumental activities of daily living (ADLs) as well as therapy engagement across treatment after the sixth session.: Individuals who reported high pain anxiety had fewer years of formal education, lower self-efficacy, and more emotional distress than those with low pain anxiety. Although Blacks were about half (56%) of the study sample, they comprised the majority (73.1%) of individuals in the high pain anxiety group. Pain anxiety was negatively related to therapy engagement. Moderation analysis using linear regression indicated that pain anxiety moderated the influence of self-efficacy on basic ADLs.: Pain anxiety, particularly when high, is negatively associated with rehabilitation outcomes for individuals with ABI. Among those with high pain anxiety, health-related self-efficacy is an important resilience characteristic to improve functional outcomes. In rehabilitation therapy, pain anxiety provides a novel intervention target to enhance ABI recovery.
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http://dx.doi.org/10.1080/02699052.2020.1859614DOI Listing
January 2021

Effects of a Sexual Health Interview among Arab American Women: An Experimental Disclosure Study.

Arch Sex Behav 2021 01 31;50(1):373-384. Epub 2020 Mar 31.

Department of Psychology, Wayne State University, Detroit, MI, USA.

Although sexuality is an important aspect of peoples' health and well-being, many people-professionals and patients alike-find sexuality uncomfortable to discuss. In Arab culture, certain sexual thoughts and behaviors are taboo, particularly for women, and it is not known whether an interview in which Arab American women disclose their sexuality to a health professional would be well-received and beneficial or upsetting and harmful. This experimental study tested whether engaging in a disclosure-oriented sexual health interview affects Arab American women's sexual and psychological health. A sample of 134 Arab American women, ages 18-35 years (M = 20.6), completed self-report measures of sexual health and attitudes and psychological symptoms, and then were randomized to an interview or control (waitlist) condition. The 60-min disclosure interview inquired about sexual attitudes, experiences, and conflicts. Five weeks later, all participants completed follow-up measures. Post-interview reports suggest that participants responded favorably to the interview and generally benefited from participation. Analyses of covariance (controlling for baseline levels of the outcome measure) indicated that the interview led to significantly greater sexual satisfaction and less discomfort with sexual self-disclosure at 5-week follow-up, compared to controls; the two conditions did not differ on follow-up sexual self-schema, sexual self-esteem, or psychological symptoms. Moderation analyses revealed that participation in the interview differentially improved the sexual self-schema of women with no past sexual experience, compared to women with sexual experience. These experimental findings suggest the value, rather than the risk, of clinicians encouraging Arab American women to openly disclose and discuss their sexual experiences and attitudes in a confidential, empathic setting.
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http://dx.doi.org/10.1007/s10508-020-01678-yDOI Listing
January 2021

Performance validity assessment using response time on the Warrington Recognition Memory Test.

Clin Neuropsychol 2020 Feb 18:1-20. Epub 2020 Feb 18.

Department of Psychology, Wayne State University, Detroit, MI, USA.

: The present study tested the incremental utility of response time (RT) on the Warrington Recognition Memory Test - Words (RMT-W) in classifying bona fide versus feigned TBI.: Participants were 173 adults: 55 with moderate to severe TBI, 69 healthy comparisons (HC) instructed to perform their best, and 49 healthy adults coached to simulate TBI (SIM). Participants completed a computerized version of the RMT-W in the context of a comprehensive neuropsychological battery. Groups were compared on RT indices including mean RT (overall, correct trials, incorrect trials) and variability, as well as the traditional RMT-W accuracy score.: Several RT indices differed significantly across groups, although RMT-W accuracy predicted group membership more strongly than any individual RT index. SIM showed longer average RT than both TBI and HC. RT variability and RT for incorrect trials distinguished SIM-HC but not SIM-TBI comparisons. In general, results for SIM-TBI comparisons were weaker than SIM-HC results. For SIM-HC comparisons, classification accuracy was excellent for all multivariable models incorporating RMT-W accuracy with one of the RT indices. For SIM-TBI comparisons, classification accuracies for multivariable models ranged from acceptable to excellent discriminability. In addition to mean RT and RT on correct trials, the ratio of RT on correct items to incorrect items showed incremental predictive value to accuracy.: Findings support the growing body of research supporting the value of combining RT with PVTs in discriminating between verified and feigned TBI. The diagnostic accuracy of the RMT-W can be improved by incorporating RT.
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http://dx.doi.org/10.1080/13854046.2020.1716997DOI Listing
February 2020

Detecting feigned traumatic brain injury with eye tracking during a test of performance validity.

Neuropsychology 2020 Mar 16;34(3):308-320. Epub 2020 Jan 16.

Department of Psychology.

Objective: Eye-tracking is a promising technology to enhance assessment of performance validity. Research has established that ocular behaviors are reliable biomarkers of (un)conscious cognitive processes, and they have distinguished deceptive from honest responding in experimental paradigms. This study examined the incremental utility of eye-tracking on a clinical performance validity test (PVT) in distinguishing adults with verified TBI from adults coached to feign cognitive impairment.

Method: Participants were 49 adults with moderate-to-severe TBI (TBI), 47 healthy adults coached to simulate TBI (SIM), and 67 healthy comparisons providing full effort (HC). A PVT linked to eye-tracking was completed in the context of a full neuropsychological battery.

Results: Kruskal-Wallis tests revealed that eye-tracking indices did not differ among the groups during presentation of stimulus items but did differ during forced-choice trials. Compared to TBI and HC, SIM had significantly more transitions, fixations, and time spent looking at correct and incorrect response options. Logistic regressions and ROC curve analyses showed that accuracy was the best predictor of SIM versus HC. For SIM versus TBI, eye-tracking indices exceeded accuracy in distinguishing the groups. Eye-tracking added incremental predictive value to accuracy for both SIM-HC and SIM-TBI discriminations.

Conclusion: Eye-tracking indicated that persons feigning TBI showed multiple signs of greater cognitive effort than persons with verified TBI and healthy comparisons. In the comparison of greatest interest (SIM vs. TBI) eye-tracking best predicted group status and yielded excellent discrimination when combined with accuracy. Eye-tracking may be an important complement to traditional accuracy scores on PVTs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/neu0000613DOI Listing
March 2020

Resilience and well-being after traumatic brain injury.

Disabil Rehabil 2020 07 3;42(14):2049-2055. Epub 2019 Jun 3.

Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan, USA.

This study examined the extent to which resilience is associated with well-being outcomes after traumatic brain injury, and whether those relationships are independent of global personality traits, such as affectivity. Sixty-seven adults with complicated-mild to severe traumatic brain injury participated. Measures included the Connor-Davidson Resilience Scale, Modified Cumulative Illness Rating Scale, Disability Rating Scale, SF-12 Health Survey, Satisfaction with Life Scale, and Community Integration Measure. Objective physical health and disability showed modest relation to resilience, indicating that adverse health conditions and disability decreased with increasing resilience. The three measures of subjective well-being showed modest-to-strong positive relation to resilience. These correlations between resilience and well-being generally remained significant after accounting for negative and positive affectivity. Results also suggest that the influence of resilience on well-being has a threshold effect: a greater influence on outcome among people with low or inadequate resilience than among people with average or high resilience. The experience of brain injury does not diminish the positive influence resilience may have on long-term well-being. Resilience may function as a buffer to trauma even in the challenging context of cognitive insult. Routine assessment of resilience might be beneficial to the rehabilitation team.Implications for rehabilitationResilience is positively associated with subjective and objective well-being among adults with moderate-to-severe traumatic brain injury, and it appears to function among adults with traumatic brain injury similarly to adults without cognitive disabilities.Resilience overlaps with overarching trait personality constructs such as affectivity; yet, it has unique characteristics and unique value in understanding well-being.The adverse effects of low resilience show stronger influence on well-being than do the positive effects of high resilience.Routine assessment of resilience might be beneficial to the rehabilitation team in understanding patients and their families, especially in discharge planning, where beliefs about personal capabilities to rebound from adversity shape likely future behavior.
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http://dx.doi.org/10.1080/09638288.2018.1552327DOI Listing
July 2020

Engagement in rehabilitation therapy and functional outcomes among individuals with acquired brain injuries.

Disabil Rehabil 2021 Jan 17;43(1):33-41. Epub 2019 May 17.

Department of Psychology, Wayne State University, Detroit, MI, USA.

The purpose was to examine the role of therapy engagement as a potential mediator for the relationship between neuropsychological performance and functional outcomes. Participants were 94 adults with medically documented ABI recruited from three outpatient rehabilitation clinics at the start of occupational therapy. Participants (57% men) ranged from 18 to 82 in age, with the majority (81%) having completed 12 or more years of education. They completed a comprehensive neuropsychological assessment at baseline. Separately, occupational therapists (OTs) assessed functional independence and disability at baseline and follow up. The OTs also rated the participants' therapy engagement. Therapy engagement predicted functional outcomes and mediated the relationship between neuropsychological performance and outcomes. Moreover, therapy engagement accounted for unique variance in functional outcome, even after accounting for education, comorbid health conditions, emotional distress, apathy, and baseline functional ability. Engagement in therapy is a crucial patient characteristic in successful rehabilitation outcome. Cognitive deficits associated with ABI undermine full engagement in rehabilitation therapy, which in turn diminishes potential gains made in therapy and functional recovery. Neuropsychological assessment can enhance rehabilitation outcomes by identifying characteristics that underlie therapy engagement, which can ultimately be used to maximize the effectiveness of individualized treatment plans. Implications for rehabilitation Neuropsychological assessment can identify cognitive abilities that are strongly related to functional outcomes during occupational therapy for acquired brain injury. Therapy engagement is an important pathway by which neuropsychological impairment predicts functional outcomes after acquired brain injuries.
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http://dx.doi.org/10.1080/09638288.2019.1613682DOI Listing
January 2021

Characteristics of Adults With Unrecognized Hearing Loss.

Am J Audiol 2019 Jun 14;28(2):384-390. Epub 2019 May 14.

Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI.

Purpose Early detection of hearing loss is important for providing support and intervention for adults with age-related hearing loss. However, many older adults have hearing loss that is unidentified. Because they do not present the problem at health care settings, there is a dearth of research on people with unrecognized hearing loss (URHL). This study elucidates differences between older adults with normal hearing, adults with recognized hearing loss (RHL), and adults with URHL. Method Participants included 130 adults, ages 55-85 years. Of these, 39 had hearing in the normal range (HNR), 61 had RHL, and 30 reported HNR but failed a hearing screen (i.e., URHL). Participants completed the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988 ) and a battery of neuropsychological tests. Results The URHL group reported more positive affectivity than the HNR and RHL groups on the PANAS. In addition, the URHL group was significantly older and more likely to be male compared to the HNR group. Importantly, age was not significantly correlated with PANAS. Positive affectivity accounted for unique variance in group membership even after accounting for age, gender, physical health, and cognitive health. Conclusions Older adults with URHL have more positive affectivity than older adults with HNR or RHL. This group may be prone to downplaying their difficulties; consequently, they may need to experience larger hearing deficits before seeking help. The findings highlight the need for research investigating the effectiveness of psychoeducation on the importance of formal hearing assessment verses relying on self-assessment in facilitating early and effective intervention among people with URHL.
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http://dx.doi.org/10.1044/2019_AJA-18-0152DOI Listing
June 2019

Functional independence after acquired brain injury: Prospective effects of health self-efficacy and cognitive impairment.

Rehabil Psychol 2018 Nov 24;63(4):595-603. Epub 2018 Sep 24.

Department of Psychology, Wayne State University.

Objective: To examine how health self-efficacy and cognitive impairment severity relate to functional independence after acquired brain injury (ABI).

Design: Observational.

Setting: Outpatient rehabilitation hospital.

Participants: Seventy-five adults with predominately stroke or traumatic brain injury who were beginning a course of occupational therapy.

Main Measures: Health self-efficacy was assessed with the Self-Rated Abilities for Health Practices. Cognitive functioning was assessed via a composite z score of neuropsychological tests. Trait affectivity was assessed with the Positive and Negative Affect Schedule. Functional independence was assessed with the Barthel Index and Lawton Instrumental Activities of Daily Living Scale.

Results: Health self-efficacy correlated moderately with functional independence. A moderation threshold effect was detected that revealed for whom health self-efficacy predicted functional independence. Among participants with normal to mildly impaired cognition (>-2 z cognitive composite), health self-efficacy correlated positively with functional independence, which held after accounting for trait affectivity. In contrast, health self-efficacy was not correlated with functional independence among participants with greater impairment (<-2 z cognitive composite).

Conclusions: Health self-efficacy predicts functional independence and may serve as a protective factor after ABI among individuals with relatively intact cognition. However, health self-efficacy does not predict functional independence among individuals with moderate or severe cognitive impairment, possibly due to limited self-awareness. This study extends the literature linking health self-efficacy with rehabilitation outcomes and reinforces the need for promoting self-management in ABI. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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http://dx.doi.org/10.1037/rep0000243DOI Listing
November 2018

Hearing loss and verbal memory assessment among older adults.

Neuropsychology 2019 Jan 13;33(1):47-59. Epub 2018 Sep 13.

Department of Otolaryngology-Head and Neck Surgery.

Objective: Research has found that adults with hearing loss perform worse on cognitive testing than adults without hearing loss; however, heavy emphasis on tests involving auditory stimuli may overdiagnose cognitive impairment among individuals with hearing loss. This study compared visual- and auditory-verbal memory tests among adults with and without hearing loss.

Method: Forty-one adults with hearing loss (HL) and 41 age-matched adults with normal hearing (NH) completed a neuropsychological battery that included auditory and visual versions of the Hopkins Verbal Learning Testing-Revised (HVLT-R). A presented HVLT-R stimuli at normal speaking volume. A presented HVLT-R stimuli to individuals with hearing loss with amplified acoustic intensity and to individuals with normal hearing under hearing loss simulation.

Results: Mixed-model ANOVA indicated significant group (HL vs. NH) by condition (visual, natural auditory, crossed auditory) interactions for HVLT-R performance, with large effect sizes. The HL group performed significantly worse than the NH group on the natural auditory version; however, the NH group performed significantly worse than the HL group on the crossed condition. The groups were equivalent on the visual condition and all other cognitive tests, showing small effect sizes. Moreover, for the HL group, visual HVLT-R correlated with other cognitive tests whereas auditory versions did not.

Conclusion: Cognitively intact older adults with hearing loss appeared impaired on auditory-verbal memory assessment under typical administration conditions. Visual assessment of verbal memory showed evidence of superior validity and is a viable alternative method to assess memory function especially in older populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/neu0000489DOI Listing
January 2019

Outcomes after Concussion Recovery Education: Effects of Litigation and Disability Status on Maintenance of Symptoms.

J Neurotrauma 2019 02 6;36(4):554-558. Epub 2018 Sep 6.

4 Department of Emergency Medicine, Wayne State University School of Medicine , Detroit, Michigan.

This study examined the hypothesis that people who receive concussion recovery education would have better outcomes than those who received usual discharge paperwork from the emergency department (ED) and tested whether participants who were in litigation or seeking disability compensation had more symptoms than individuals not engaged in these activities. Two hundred and fifty-five persons with a diagnosis of concussion were assigned randomly to a brief education group (one-page double-sided document), a longer education group (10-page document), and usual care (standard ED discharge instructions), and were these documents in the ED. A (non-concussion) trauma comparison group was enrolled to determine the symptom rate unrelated to brain injury. The Concussion Symptom Checklist (CSC) and litigation and disability status questions were completed by telephone at one week, three months, and six months. Neither long nor brief information handouts had a significant impact on symptoms over time; the standard form had an average decrease of 1.20 symptoms compared with the brief instructional intervention group (p = 0.031). Litigation status and disability seeking status were significant predictors of symptoms on CSC over time: disability seeking (p = 0.017) and litigation status (p = 0.05). Persons seeking Social Security disability or legal compensation endorsed more symptoms over time than those who were not. Number of symptoms on the CSC for the trauma control group was the same as those who sustained concussion. Type of recovery material was not as important as noting that concussion symptoms resolve over time, and that remaining symptoms are not specific to brain injury. Litigation and disability seeking behavior accounted for maintained symptoms, rather than the concussion itself.
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http://dx.doi.org/10.1089/neu.2018.5873DOI Listing
February 2019

Detecting malingering in traumatic brain injury: Combining response time with performance validity test accuracy.

Clin Neuropsychol 2019 01 22;33(1):90-107. Epub 2018 Feb 22.

b Department of Physical Medicine and Rehabilitation , Wayne State University , Detroit, MI , USA.

Objective: The present study examined the incremental utility of item-level response time (RT) variables on a traditional performance validity test in distinguishing adults with verified TBI from adults coached to feign neurocognitive impairment.

Method: Participants were 45 adults with moderate to severe TBI, 45 healthy adults coached to feign neurocognitive impairment (SIM), and 61 healthy adult comparisons providing full effort (HC). All participants completed a computerized version of the Test of Memory Malingering (TOMM-C) in the context of a larger test battery. RT variables examined along with TOMM-C accuracy scores included mean RTs (Trial 1, Trial 2, correct and incorrect trials) and RT variability indices.

Results: Several RT indices differed significantly across the groups. In general, SIM produced longer, more variable RTs than HC and TBI. Of the RT indices, average RT for Trial 1 and 2 were the best predictors of group membership; however, classification accuracies were greatly influenced by the groups being compared. Average RT for Trial 1 and 2 showed excellent discrimination of SIM and HC. All RT indices were less successful in discriminating SIM and TBI. Average RT for Trial 1 and 2 added incremental predictive value to TOMM-C accuracy in distinguishing SIM from TBI.

Conclusion: Findings contribute to a limited body of research examining the incremental utility of combining RT with traditional PVTs in distinguishing feigned and bona fide TBI. Findings support the hypothesis that combining RT with TOMM-C accuracy can improve its diagnostic accuracy. Future research with other groups of clinical interest is recommended.
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http://dx.doi.org/10.1080/13854046.2018.1440006DOI Listing
January 2019

A life-stress, emotional awareness, and expression interview for primary care patients with medically unexplained symptoms: A randomized controlled trial.

Health Psychol 2018 03 20;37(3):282-290. Epub 2017 Nov 20.

Wayne State University.

Objective: Lifetime trauma, relationship adversities, and emotional conflicts are elevated in primary care patients with medically unexplained symptoms (MUS), and these risk factors likely trigger or exacerbate symptoms. Helping patients disclose stressors, increase awareness and expression of inhibited emotions, and link emotions to physical symptoms may improve health. We developed an emotional awareness and expression interview that targets stressful life experiences and conflicts and then tested its effects on primary care patients with MUS.

Method: Patients (N = 75) with MUS were recruited at a family medicine clinic and randomized to an interview condition or treatment-as-usual (TAU) control condition. In a single 90-min interview in the clinic, the interviewer elicited disclosure of the patient's stressors, linked them to the patient's symptom history, and encouraged emotional awareness and expression about unresolved relationship trauma or conflict. At baseline and 6-week follow-up, patients completed self-report measures of their physical and psychological health.

Results: Analyses of covariance, controlling for baseline symptoms, compared patients in the interview condition with TAU at 6-week follow-up. Compared with TAU, the interview led to significantly lower pain severity, pain interference, sleep problems, and global psychological symptoms.

Conclusions: This study provides preliminary evidence for the value of integrating a disclosure and emotional awareness and expression interview into the primary care setting for patients with MUS. (PsycINFO Database Record
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http://dx.doi.org/10.1037/hea0000566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5848463PMC
March 2018

Strategies of successful and unsuccessful simulators coached to feign traumatic brain injury.

Clin Neuropsychol 2017 04 13;31(3):644-653. Epub 2017 Jan 13.

a Department of Psychology , Wayne State University , Detroit MI , USA.

Objective: The present study evaluated strategies used by healthy adults coached to simulate traumatic brain injury (TBI) during neuropsychological evaluation.

Method: Healthy adults (n = 58) were coached to simulate TBI while completing a test battery consisting of multiple performance validity tests (PVTs), neuropsychological tests, a self-report scale of functional independence, and a debriefing survey about strategies used to feign TBI.

Results: "Successful" simulators (n = 16) were classified as participants who failed 0 or 1 PVT and also scored as impaired on one or more neuropsychological index. "Unsuccessful" simulators (n = 42) failed ≥2 PVTs or passed PVTs but did not score impaired on any neuropsychological index. Compared to unsuccessful simulators, successful simulators had significantly more years of education, higher estimated IQ, and were more likely to use information provided about TBI to employ a systematic pattern of performance that targeted specific tests rather than performing poorly across the entire test battery.

Conclusion: Results contribute to a limited body of research investigating strategies utilized by individuals instructed to feign neurocognitive impairment. Findings signal the importance of developing additional embedded PVTs within standard cognitive tests to assess performance validity throughout a neuropsychological assessment. Future research should consider specifically targeting embedded measures in visual tests sensitive to slowed responding (e.g. response time).
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http://dx.doi.org/10.1080/13854046.2016.1278040DOI Listing
April 2017

Behavioral inhibition and activation systems in traumatic brain injury.

Rehabil Psychol 2016 11;61(4):397-407

Department of Psychology, Wayne State University.

Purpose/objective: Personality has been linked to cognitive appraisal and health outcomes; however, research specific to traumatic brain injury (TBI) has been sparse. Gray's theory of behavioral inhibition system and behavioral activation system (BIS/BAS) offers a neurobiologic view of personality that may be especially relevant to neurobehavioral change associated with TBI. The present study examined theoretical and psychometric issues of using the BIS/BAS scale among adults with TBI as well as BIS/BAS personality correlates of TBI. Research Method/Design: Eighty-one adults with complicated-mild to severe TBI and 76 of their significant others (SOs) participated. Measures included the BIS/BAS scale, Positive and Negative Affect Schedule, and Awareness Questionnaire.

Results: Among adults with TBI, BIS/BAS internal consistency reliabilities were similar to those found in normative samples of adults without TBI. The TBI group endorsed significantly higher BAS than did the SO group, and injury severity was positively correlated to BAS. The SO group showed expected patterns of correlation between personality and affect; positive affect was associated with BAS, and negative affect with BIS. In contrast, in the TBI group, BAS was positively correlated to both positive and negative affect. Impaired awareness of abilities moderated the intensity of relationships between BIS/BAS and affect.

Conclusions/implications: TBI was associated with relatively intensified BAS (approach behavior) but not BIS (avoidance behavior). The observed pattern is consistent with the neurobiology of TBI-related personality change and with theory regarding the independence of the BIS and BAS systems. The BIS/BAS scale shows promise as a personality measure in TBI. (PsycINFO Database Record
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http://dx.doi.org/10.1037/rep0000109DOI Listing
November 2016

Correlates of resilience in the first 5 years after traumatic brain injury.

Rehabil Psychol 2016 08 8;61(3):269-276. Epub 2016 Feb 8.

Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan/Wayne State University.

Purpose/objective: To examine resilience in the context of adjustment to traumatic brain injury (TBI), including the relative roles of demographic and theoretically related constructs such as coping, social support, and positive affectivity on resilience within the first 5 years postinjury.

Research Method/design: This was a cross-sectional, observational study of 67 persons with medically documented mild complicated to severe TBI. Participants completed a battery of measures including cognitive tests; questionnaires assessing self-report of emotional symptoms, perceived social support, and coping style; and a measure of resilience.

Results: Approximately 60% of the sample endorsed moderate to high levels of resilience during the first 5 years postinjury. Brain injury severity, premorbid intelligence, and cognitive flexibility did not predict resilience, as measured by the Connor-Davidson Resilience Scale. By contrast, task-oriented coping and perceived social support were strong and unique covariates of resilience. Positive and negative affectivity were related to resilience but were not unique covariates of it in the presence of task-oriented coping and perceived social support. Discriminant validity of resilience as a concept and the means of assessing it was supported by findings that emotion-oriented and avoidance coping were not meaningfully related to resilience.

Conclusions/implications: Overall, the findings indicate that the majority of individuals in this sample reported high levels of resilience after brain injury and that correlates of resilience in adults with TBI is similar to that observed in adults without the history of cognitive impairment. (PsycINFO Database Record
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http://dx.doi.org/10.1037/rep0000069DOI Listing
August 2016

Rasch analysis of the coping inventory for stressful situations in individuals with moderate to severe traumatic brain injury.

Arch Phys Med Rehabil 2015 Apr 25;96(4):659-66. Epub 2014 Nov 25.

Department of Psychology, Wayne State University, Detroit, MI.

Objective: To evaluate psychometric properties of the Coping Inventory for Stressful Situations (CISS) in individuals with traumatic brain injury (TBI).

Design: Archival study using Rasch analysis.

Setting: Postacute rehabilitation hospital.

Participants: Adults (N=331) 1 to 15 years after moderate to severe TBI, recruited consecutively.

Interventions: Not applicable.

Main Outcome Measure: CISS.

Results: Indices of unidimensionality and model fit supported the scale's proposed multidimensional structure consisting of Task, Emotion, and Avoidant coping style; 3 unidimensional scales showed better fit than a single combined scale. The 3 scales met Rasch expectations of reliability and separation for persons and items, as well as adequate response category functioning. The scales were generally well targeted but showed some evidence of ceiling effect for Task, and floor effects for Emotion and Avoidant coping; item difficulties did not fully capture extreme ranges demonstrated by some participants, suggesting that measurement of coping after TBI on the CISS would be improved with additional items at low and high ranges of difficulty. Results were generally equivalent for cross-sectional groups representing short-term (1y), intermediate (2y), and long-term (5-15y).

Conclusions: The CISS showed good psychometric properties as a measure of coping style among persons with moderate to severe TBI in acute and chronic phases of recovery, and showed evidence of multidimensionality as predicted by theory, consistent with 3 unidimensional scales. Added items tapping broader (or more accessible, less cognitively complex) ranges of coping responses would likely benefit the scale overall and improve correspondence with the response needs of people with TBI.
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http://dx.doi.org/10.1016/j.apmr.2014.11.006DOI Listing
April 2015

Age and gender modulate the neural circuitry supporting facial emotion processing in adults with major depressive disorder.

Am J Geriatr Psychiatry 2015 Mar 23;23(3):304-13. Epub 2014 May 23.

Department of Psychiatry, University of Michigan, Ann Arbor, MI; Department of Psychiatry, University of Illinois at Chicago, Chicago, IL. Electronic address:

Objectives: Emotion processing, supported by frontolimbic circuitry known to be sensitive to the effects of aging, is a relatively understudied cognitive-emotional domain in geriatric depression. Some evidence suggests that the neurophysiological disruption observed in emotion processing among adults with major depressive disorder (MDD) may be modulated by both gender and age. Therefore, the present study investigated the effects of gender and age on the neural circuitry supporting emotion processing in MDD.

Design: Cross-sectional comparison of fMRI signal during performance of an emotion processing task.

Setting: Outpatient university setting.

Participants: One hundred adults recruited by MDD status, gender, and age.

Measurements: Participants underwent fMRI while completing the Facial Emotion Perception Test. They viewed photographs of faces and categorized the emotion perceived. Contrast for fMRI was of face perception minus animal identification blocks.

Results: Effects of depression were observed in precuneus and effects of age in a number of frontolimbic regions. Three-way interactions were present between MDD status, gender, and age in regions pertinent to emotion processing, including frontal, limbic, and basal ganglia. Young women with MDD and older men with MDD exhibited hyperactivation in these regions compared with their respective same-gender healthy comparison (HC) counterparts. In contrast, older women and younger men with MDD exhibited hypoactivation compared to their respective same-gender HC counterparts.

Conclusions: This the first study to report gender- and age-specific differences in emotion processing circuitry in MDD. Gender-differential mechanisms may underlie cognitive-emotional disruption in older adults with MDD. The present findings have implications for improved probes into the heterogeneity of the MDD syndrome.
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http://dx.doi.org/10.1016/j.jagp.2014.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241383PMC
March 2015

Psychosocial outcomes after traumatic brain injury: life satisfaction, community integration, and distress.

Rehabil Psychol 2014 Aug 14;59(3):298-305. Epub 2014 Jul 14.

Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine.

Objective: To examine the relationship between life satisfaction, community integration, and emotional distress in adults with traumatic brain injury (TBI).

Method: This was an archival study of a longitudinal data set on the outcome and recovery process of persons with TBI. Participants were 253 consecutive adults with mild complicated, moderate, and severe TBI who were enrolled in a large, longitudinal study of persons with TBI. Main measures included the Satisfaction with Life Scale, the Positive Affective and Negative Affective Schedule, the Craig Hospital Assessment and Reporting Technique Short-Form, the Community Integration Measure, and the Brief Symptom Inventory-18.

Results: The three-factor model adequately fit the data, and a higher-order model did not necessarily improve model fit but revealed significant relationships with first-order constructs and one second-order construct.

Conclusions: Life satisfaction, community integration, and emotional distress were found to be related yet unique concepts in persons with TBI. Life satisfaction was positively related to community involvement and inversely related to emotional distress. Community integration was inversely related to emotional distress. In addition, these concepts are related to a higher-order concept of psychosocial status, a global representation of subjective and objective functioning. These findings demonstrate the interrelated and dynamic nature of psychosocial well-being after brain injury and highlight the need for integrative and holistic treatment plans.
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http://dx.doi.org/10.1037/a0037164DOI Listing
August 2014

Role of character strengths in outcome after mild complicated to severe traumatic brain injury: a positive psychology study.

Arch Phys Med Rehabil 2014 Nov 7;95(11):2096-102. Epub 2014 Jul 7.

Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI.

Objective: To examine the effects of character strengths on psychosocial outcomes after mild complicated to severe traumatic brain injury (TBI).

Design: Prospective study with consecutive enrollment.

Setting: A Midwestern rehabilitation hospital.

Participants: Persons with mild complicated to severe TBI (N=65).

Interventions: Not applicable.

Main Outcome Measures: Community Integration Measure, Disability Rating Scale, Modified Cumulative Illness Rating Scale, Positive and Negative Affect Schedule, Satisfaction with Life Scale, Values in Action Inventory of Strengths, and Wechsler Test of Adult Reading.

Results: Character virtues and strengths were moderately associated with subjective outcomes, such that there were fewer and less strong associations between character virtues/strengths and objective outcomes than subjective outcomes. Specifically, positive attributes were associated with greater life satisfaction and perceived community integration. Fewer and less strong associations were observed for objective well-being; however, character strengths and virtues showed unique value in predicting physical health and disability. Positive affectivity was not meaningfully related to objective outcomes, but it was significantly related to subjective outcomes. In contrast, negative affectivity was related to objective but not subjective outcomes.

Conclusions: Given the strength of the associations between positive aspects of character or ways of perceiving the world and positive feelings about one's current life situation, treatments focused on facilitating these virtues and strengths in persons who have experienced TBI may result in better perceived outcomes and potentially subsequently lower comorbidities.
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http://dx.doi.org/10.1016/j.apmr.2014.06.017DOI Listing
November 2014

Comparisons of five performance validity indices in bona fide and simulated traumatic brain injury.

Clin Neuropsychol 2014 1;28(5):851-75. Epub 2014 Jul 1.

a Department of Psychology , Wayne State University , Detroit , MI 48202 , USA.

A number of performance validity tests (PVTs) are used to assess memory complaints associated with traumatic brain injury (TBI); however, few studies examine the concordance and predictive accuracy of multiple PVTs, specifically in the context of combined models in known-group designs. The present study compared five widely used PVTs: the Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), Reliable Digit Span (RDS), Word Choice Test (WCT), and California Verbal Learning Test - Forced Choice (CVLT-FC). Participants were 51 adults with bona fide moderate to severe TBI and 58 demographically comparable healthy adults coached to simulate memory impairment. Classification accuracy of individual PVTs was evaluated using logistic regression and receiver operating characteristic (ROC) curves, examining both the dichotomous cutting scores as recommended by the test publishers and continuous scores for the measures. Results demonstrated nearly equivalent discrimination ability of the TOMM, MSVT, and CVLT-FC as individual predictors, all of which markedly outperformed the WCT and RDS. Models of combined PVTs were examined using Bayesian information criterion statistics, with results demonstrating that diagnostic accuracy showed only small to modest growth when the number of tests was increased beyond two. Considering the clinical and pragmatic issues in deriving a parsimonious assessment battery, these findings suggest that using the TOMM and CVLT in conjunction or the MSVT and CVLT in conjunction maximized predictive accuracy as compared to a single index or an assortment of these widely used measures.
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http://dx.doi.org/10.1080/13854046.2014.927927DOI Listing
October 2014

Brief narrative exposure therapy for posttraumatic stress in Iraqi refugees: a preliminary randomized clinical trial.

J Trauma Stress 2014 Jun 27;27(3):314-22. Epub 2014 May 27.

Department of Psychology, Wayne State University, Detroit, Michigan, USA.

Many Iraqi refugees suffer from posttraumatic stress. Efficient, culturally sensitive interventions are needed, and so we adapted narrative exposure therapy into a brief version (brief NET) and tested its effects in a sample of traumatized Iraqi refugees. Iraqi refugees in the United States reporting elevated posttraumatic stress (N = 63) were randomized to brief NET or waitlist control conditions in a 2:1 ratio; brief NET was 3 sessions, conducted individually, in Arabic. Positive indicators (posttraumatic growth and well-being) and symptoms (posttraumatic stress, depressive, and somatic) were assessed at baseline and 2- and 4-month follow-up. Treatment participation (95.1% completion) and study retention (98.4% provided follow-up data) were very high. Significant condition by time interactions showed that those receiving brief NET had greater posttraumatic growth (d = 0.83) and well-being (d = 0.54) through 4 months than controls. Brief NET reduced symptoms of posttraumatic stress (d = -0.48) and depression (d = -0.46) more, but only at 2 months; symptoms of controls also decreased from 2 to 4 months, eliminating condition differences at 4 months. Three sessions of brief NET increased growth and well-being and led to symptom reduction in highly traumatized Iraqi refugees. This preliminary study suggests that brief NET is both acceptable and potentially efficacious in traumatized Iraqi refugees.
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http://dx.doi.org/10.1002/jts.21922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080404PMC
June 2014

Rasch analysis of the community integration measure in persons with traumatic brain injury.

Arch Phys Med Rehabil 2014 Apr 18;95(4):734-40. Epub 2013 Dec 18.

Department of Psychology, Wayne State University, Detroit, MI.

Objective: To examine the measurement properties of the Community Integration Measure (CIM) in persons with traumatic brain injury (TBI).

Design: Rasch analysis was used to retrospectively evaluate the CIM.

Setting: Rehabilitation hospital.

Participants: Persons (N=279) 1 to 15 years after a TBI.

Interventions: None.

Main Outcome Measure: CIM RESULTS: The CIM met Rasch expectations of unidimensionality and reliability (person separation ratio=2.01, item separation ratio=4.52). However, item endorsibility was poorly targeted to the participants' level of community integration. A ceiling effect was found with this sample.

Conclusions: The CIM is a relatively reliable and unidimensional scale. Future iterations might benefit from the addition of items that are more difficult to endorse (ie, improved targeting).
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http://dx.doi.org/10.1016/j.apmr.2013.11.020DOI Listing
April 2014

Personality differences among patients with chronic aphasia predict improvement in speech-language therapy.

Top Stroke Rehabil 2013 Sep-Oct;20(5):421-31

Department of Psychology, Wayne State University, Detroit, Michigan.

Background: Negative affectivity and neurocognitive deficits including executive dysfunction have been shown to be detrimental to rehabilitation therapies. However, research on the relationship between neuropsychological deficits and improvement in speech-language therapy (SLT) for aphasia is sparse.

Objective: To examine the relationships among neurocognitive and psychological functioning and improvement in SLT following aphasia due to stroke.

Methods: Fifty patients who were ≥ 9 months post stroke and enrolled in outpatient SLT to treat aphasia participated. Using standard language assessment measures, the authors evaluated language functioning at initiation of the study and after participants completed various SLT protocols. Executive functioning, visuospatial skills, attention, and memory also were assessed to provide indices of convergent and discriminant validity. Participants' mood and affectivity were evaluated by self-report, and their functional abilities and recovery of function since stroke were assessed via caregiver report.

Results: A multiple regression model testing the combined powers of neurocognitive and psychological variables was significant (P = .004, R2 = 0.33), with psychological and neurocognitive functioning accounting for 15% of the variance in relative language change beyond that accounted for by stroke severity and gross cognitive functioning. Negative affectivity expressed on the Positive and Negative Affectivity Scale made unique contributions to the model.

Conclusions: Improvement in SLT is substantially related to neurocognitive and psychological functioning, particularly affectivity. Assessment of these characteristics may assist in identifying patients who are likely to improve and in tailoring treatment programs to yield optimal outcomes.
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http://dx.doi.org/10.1310/tsr2005-421DOI Listing
November 2013

Incremental validity of neuropsychological evaluations to computed tomography in predicting long-term outcomes after traumatic brain injury.

Clin Neuropsychol 2013 8;27(3):356-75. Epub 2013 Feb 8.

Department of Psychology, Wayne State University, Detroit, MI 48202, USA.

This study evaluated the incremental utility of neuropsychological tests to computed tomography (CT) in predicting long-term outcomes of adults with moderate to severe traumatic brain injury (TBI). Participants were 288 adults with mild complicated, moderate, and severe TBI. Longitudinal data were evaluated during inpatient status in an urban rehabilitation hospital with a TBI Model System, as well as 1 and 2 years post injury. Predictors including demographic characteristics, injury severity, CT characteristics, and neuropsychological evaluations were regressed to outcomes of disability, life satisfaction, and employment at 1 and 2 years post injury. Prediction of life satisfaction was not improved with the use of CT characteristics or neuropsychological tests, but prediction of return to work was improved by these variables at 2 years post injury. Neuropsychological evaluations uniquely contributed to outcome predictions of functional disability, even after considering demographic and injury severity characteristics, including information from CT. In contrast, CT characteristics were not predictive of long-term functional disability at 1 or 2 years post TBI. Taken together, the findings indicate that neuropsychological tests add unique predictive information for long-term functional outcomes after TBI.
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http://dx.doi.org/10.1080/13854046.2013.765507DOI Listing
October 2013

Reduced emotion processing efficiency in healthy males relative to females.

Soc Cogn Affect Neurosci 2014 Mar 29;9(3):316-25. Epub 2012 Nov 29.

Department of Psychiatry, University of Michigan Medical School, 2101 Commonwealth Boulevard, Suite C, Ann Arbor, MI, USA.

This study examined sex differences in categorization of facial emotions and activation of brain regions supportive of those classifications. In Experiment 1, performance on the Facial Emotion Perception Test (FEPT) was examined among 75 healthy females and 63 healthy males. Females were more accurate in the categorization of fearful expressions relative to males. In Experiment 2, 3T functional magnetic resonance imaging data were acquired for a separate sample of 21 healthy females and 17 healthy males while performing the FEPT. Activation to neutral facial expressions was subtracted from activation to sad, angry, fearful and happy facial expressions. Although females and males demonstrated activation in some overlapping regions for all emotions, many regions were exclusive to females or males. For anger, sad and happy, males displayed a larger extent of activation than did females, and greater height of activation was detected in diffuse cortical and subcortical regions. For fear, males displayed greater activation than females only in right postcentral gyri. With one exception in females, performance was not associated with activation. Results suggest that females and males process emotions using different neural pathways, and these differences cannot be explained by performance variations.
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http://dx.doi.org/10.1093/scan/nss137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980801PMC
March 2014

Randomized controlled trial of peer mentoring for individuals with traumatic brain injury and their significant others.

Arch Phys Med Rehabil 2012 Aug;93(8):1297-304

Dept of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, 261 Mack Blvd, Detroit, MI 48201, USA.

Objectives: To examine the efficacy of a peer-mentoring program for persons with traumatic brain injury (TBI) and their significant others, and to determine the relationship of this mentoring program to 3 main outcomes: (1) emotional well-being; (2) post-TBI quality of life; and (3) community integration.

Design: Randomized controlled trial.

Setting: Midwestern rehabilitation hospital.

Participants: Persons with TBI (n=96) and significant others/caregivers (n=62).

Interventions: Persons with TBI and friends/caregivers who knew the person prior to their injury were randomly assigned to a treatment (mentored) or no-treatment (no mentoring) control group immediately prior to discharge from the rehabilitation unit and were mentored for up to 2 years.

Main Outcome Measures: Peer Mentoring Questionnaire; Brief Symptom Inventory-18; Family Assessment Device; Coping Inventory for Stressful Situations; Short Michigan Alcohol Screening Test; Medical Outcomes Study 12-Item Short-Form Health Survey; and Community Integration Measure.

Results: Eighty-eight percent of individuals who were involved in the mentoring program reported positive experiences. t tests revealed that among persons with TBI, individuals who received mentoring had significantly better behavioral control and less chaos in the living environment (P=.04), lower alcohol use (P=.01), less emotion-focused (P=.04) and avoidance coping (P=.03), and good physical quality of life (P=.04) compared with those who did not receive mentoring. Among significant others, mentored individuals demonstrated greater community integration (P=.03) than the nonmentored control group.

Conclusions: Mentoring can be an effective way to benefit mood and healthy coping after TBI, and it can help to prevent maladaptive behaviors, such as substance abuse and behavioral dyscontrol, in the living situation.
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http://dx.doi.org/10.1016/j.apmr.2012.04.027DOI Listing
August 2012

Substitution of California Verbal Learning Test, second edition for Verbal Paired Associates on the Wechsler Memory Scale, fourth edition.

Clin Neuropsychol 2012 30;26(4):599-608. Epub 2012 Mar 30.

Department of Psychology, Wayne State University, Detroit, MI, USA.

Two common measures used to evaluate verbal learning and memory are the Verbal Paired Associates (VPA) subtest from the Wechsler Memory Scales (WMS) and the second edition of the California Verbal Learning Test (CVLT-II). For the fourth edition of the WMS, scores from the CVLT-II can be substituted for VPA; the present study sought to examine the validity of the substitution. For each substitution, paired-samples t tests were conducted between original VPA scaled scores and scaled scores obtained from the CVLT-II substitution to evaluate comparability. Similar comparisons were made at the index score level. At the index score level, substitution resulted in significantly lower scores for the AMI (p = .03; r = .13) but not for the IMI (p = .29) or DMI (p = .09). For the subtest scores, substituted scaled scores for VPA were not significantly different from original scores for the immediate recall condition (p = .20) but were significantly lower at delayed recall (p = .01). These findings offer partial support for the substitution. For both the immediate and delayed conditions, the substitution produced generally lower subtest scores compared to original VPA subtest scores.
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http://dx.doi.org/10.1080/13854046.2012.677478DOI Listing
September 2012

Parsimonious prediction of Wechsler Memory Scale, Fourth Edition scores: immediate and delayed memory indexes.

J Clin Exp Neuropsychol 2012 2;34(5):531-42. Epub 2012 Mar 2.

Department of Psychology, Wayne State University, Detroit, MI, USA.

Research on previous versions of the Wechsler Memory Scale (WMS) found that index scores could be predicted using a parsimonious selection of subtests (e.g., Axelrod & Woodard, 2000). The release of the Fourth Edition (WMS-IV) requires a reassessment of these predictive formulas as well as the use of indices from the California Verbal Learning Test-II (CVLT-II). Complete WMS-IV and CVLT-II data were obtained from 295 individuals. Six regression models were fit using WMS-IV subtest scaled scores-Logical Memory (LM), Visual Reproduction (VR), and Verbal Paired Associates (VPA)-and CVLT-II substituted scores to predict Immediate Memory Index (IMI) and Delayed Memory Index (DMI) scores. All three predictions of IMI significantly correlated with the complete IMI (r = .92 to .97). Likewise, predicted DMI scores significantly correlated with complete DMI (r = .92 to .97). Statistical preference was indicated for the models using LM, VR, and VPA, in which 97% and 96% of the cases fell within two standard errors of measurement (SEMs) of full index scores, respectively. The present findings demonstrate that the IMI and DMI can be reliably estimated using two or three subtests from the WMS-IV, with preference for using three. In addition, evidence suggests little to no improvement in predictive accuracy with the inclusion of CVLT-II indices.
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http://dx.doi.org/10.1080/13803395.2012.665437DOI Listing
August 2012

Self-evaluation of driving simulator performance after stroke.

Top Stroke Rehabil 2011 Sep-Oct;18(5):549-61

Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.

Background And Purpose: Despite the potential dangers associated with premature return to driving after stroke, very little research has examined the relationship between impaired self-awareness (ISA) and driving. This study examined self-awareness of driving simulator and neuropsychological performance among stroke patients, comparing them with healthy control participants.

Methods: Thirty stroke survivors and 30 controls each were asked for prediction and postdiction ratings of their performance on various driving simulator and neuropsychological tasks. Self-estimates versus actual performance discrepancy scores were calculated for various simulator and neuropsychological measures by converting scores to a shared metric.

Results: Across all measures, the stroke survivors greatly overestimated their performance in comparison with the accuracy of self-evaluations among the controls, thus suggesting ISA. This pattern of overestimating was observed on both novel (neuropsychological) and familiar (driving) tasks. However, there was some evidence to suggest that stroke survivors can benefit from feedback, as seen by increased accuracy in postdiction versus prediction self-evaluation scores. Both stroke survivors and controls also showed a greater shift toward accurate self-estimation on postdiction of driving performance than on postdiction of neuropsychological test performance.

Conclusion: Although the temporal stability of the shift in awareness is not known, these results support the use of driving simulators as a useful and safe method of assessing and potentially improving stroke survivors' ISA.
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http://dx.doi.org/10.1310/tsr1805-549DOI Listing
December 2011