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Persistent postconcussional sequelae: Neuropsychological correlates of high and low symptom reporters
42
Abstracts from the 18th Annual Meeting
Ruff, R., Colligan, S., Jurica, P., Chen, T., Adey, G., Gaub, K., Taekman, H., & Woicott, C. A Multidisciplinary Approach to the Prediction of Poor Outcome from Mild Traumatic Brain Injury. The aim of this study was to develop a reliable tool which can be used by Emergency Room and Trauma Center teams to identify those patients with mild traumatic brain injury (TBI) who need follow-up services. Past research has shown that while the majority of mild TBI patients experience a full recovery, approximately 10-20% suffer a poor recovery. Patients in this population are found at follow-up to possess a constellation of deficits including disrupted personal relationships, emotional problems, cognitive deficits and vocational/educational difficulties. Pre-injury factors may differentiate between those with a healthy versus poor outcome. These may include more obvious factors such as prior head injury, history of substance abuse or psychiatric illness. Less obviously, it has been hypothesized that pre-existing personality traits (e.g., histrionic, depressive, perfectionistic) may also predict outcome. Our goal was to flag patients in need of additional treatment and follow-up care subsequent to discharge while in the acute, or in-patient, phase of treatment. Patients were evaluated by each member of the multi-disciplinary team (neuropsychologist, neurosurgeon, nurse), completed a brief neuropsychological battery, a personality inventory and gave a pre-injury history. Outcome at 3 months was assessed by phone interview during which patients again completed a symptom checklist as well as a standardized measure of outcome. Results indicated that staff predictions of outcome were successfully able to identify at-risk patients and pre-existing personality traits (as assessed by standardized testing) also successfully predicted patients who would suffer a poor outcome while inpatient neuropsychological testing was a less accurate predictor outcome. Preliminary results suggest that if staff are given the opportunity to assess mild TBI patients, they can successfully identify the minority of patients who are in need of additional education and follow-up services.
Ryan, L. M., Gouvier, W. D., & Schrager, D. Persistent Postconcussional Sequelae: Neuropsychological Correlates of High and Low Symptom Reporters. Individuals sustaining mild head injuries frequently complain of a number of physical, cognitive, and behavioral symptoms referred to as postconcussion symptoms (PCS). These symptoms can persist from months to years following injury and may even be permanent and cause disability, (e.g., Gouvier et al., 1992). It has been reported that mildly head-injured individuals who continue to complain of significant PCS demonstrate greater cognitive impairment and more psychological symptoms than mildly head-injured individuals who do not (e.g., Bohnen et al., 1995). However, the results have not been consistent across studies. Given this inconsistency, the present study sought to examine cognitive and emotional functioning in mild head injury subjects reporting a high level of persistent PCS compared with those reporting few symptoms. A sample of mildly head injured college students (N = 173) was divided into high (n -- 59) and low persistent PCS reporters (n = 57). It was hypothesized that high PCS subjects would demonstrate greater cognitive dysfunction, specifically decreased information processing (Ruff 2 & 7 Selective Attention Test, Symbol Digit Modalities Test), higher psychological distress (Profile of Mood States--POMS), and greater external locus of control (Revised Internal External Scale--RIES) than low PCS subjects. Subjects were divided into high and low PCS groups by taking the top and bottom third of scores on the Post Concussion Syndrome Checklist (PCSC). There were no differences between the groups for age, education, race, number of mild head injuries, or premorbid history of psychological disturbance. There was, however a significant difference for gender, X2:(1, N = 116) =
Abstracts from the 18th Annual Meeting
43
11.80, p < .008. There was a greater proportion of females in the high PCS group (46 females/13 males) compared to the low PCS group (22 females/35 males). A M A N O V A performed on the cognitive and psychosocial measures indicated a significant group difference, Wilks' A = 0.189, F(9, 106) = 50.44, p < .0001. Follow-up univariate A N O V A s revealed that the high PCS subjects had significantly higher POMS total scores (M = -67.07 vs. 22.09), F(1,114) = 51.25, p < .0001, RIES-Powerful Others External scores (M = 25.41 vs. 22.09), F(1,114) = 7.37, p < .008, and RIES-Chance External scores (M = 24.81 vs. 20.39), F(1,114) = 14.82, p < .0001, than low PCS subjects. There was no significant group difference for the information processing measures. The results of these analyses support the hypothesis that high PCS subjects would demonstrate higher levels of psychological distress and greater external locus of control than low PCS subjects but, these results do not support the prediction that high PCS subjects would demonstrate poorer information processing.
Santa Maria, M. P., Pinkston, J. B., Gouvier, W. D., & Miller, S. R. Stability of the Postconcussive Symptom Checklist with Head-Injured and Non-HeadInjured Extreme Responders. A large sample of undergraduates (n = 2326) were screened for general health and postconcussive symptomatology. A subsample (n = 98) of Ss whose Postconcussive Symptom Checklist (PCSC) scores were >.5 SD above the mean of the entire sample (symptomatic; n = 53) or <.5 SD below the mean (asymptomatic; n = 45) were re-administered the PCSC between 3 and 90 days later. The sample included 50 participants who reported history of a mild head injury (MHI) and 48 controls. MHI was defined as loss of consciousness of 30 minutes or less within the past 10 years but no more recent than 3 months. Persons with history of more than one head injury or with other neurologic history were not included in the study. Pearson's r between administrations was calculated for each group. Test-retest reliabilities were .44 for MHI Ss, .67 for non-MHI Ss, .71 for males, .51 for females. Fisher's z transformation was used to compare the resultant correlations between groups. Test-retest reliability coefficients did not differ for MHI vs. non-MHI or for male vs. female groups. The stability and utility of the PCSC are discussed for extreme and mid-range, head-injured and non-head-injured responders. Thompson, A., Crewe, N., & Andary, M. Parental Marital Functioning Following Traumatic Brain Injury in an Adolescent~Young Adult Child. Marriages can be particularly challenged after an adolescent young adult child sustains a traumatic brain injury (TBI) for two reasons. First, marital dissatisfaction is common during this stage in the family life cycle in which the child is striving for emancipation and parents are typically reevaluating their marriage. Second, studies have shown that marital distress is associated with chronic disability in a child. However, no studies to date have examined how TBI in young people, between 15 and 24 years old, affects parental marital functioning. This study examines the relationship between multiple aspects of marital functioning and each parent's psychological status and coping style. Nineteen couples who are parents of adolescent/young adult children with brain injury, each completed the Marital Satisfaction Inventory (MSI), Brief Symptom Inventory (BSI), the Coping Responses Inventory (CRI) and a background questionnaire. A control group of couples, with children in the same age range, were utilized as a reference to identify if TB1 group parents' reactions were due to TBI related stressors or to characteristics common to other families in the same life cycle stage. Data analysis consisted of Repeated Measures M A N O V A and Multiple Regression. The results indicated that par-
Abstracts from the 18th Annual Meeting
Ruff, R., Colligan, S., Jurica, P., Chen, T., Adey, G., Gaub, K., Taekman, H., & Woicott, C. A Multidisciplinary Approach to the Prediction of Poor Outcome from Mild Traumatic Brain Injury. The aim of this study was to develop a reliable tool which can be used by Emergency Room and Trauma Center teams to identify those patients with mild traumatic brain injury (TBI) who need follow-up services. Past research has shown that while the majority of mild TBI patients experience a full recovery, approximately 10-20% suffer a poor recovery. Patients in this population are found at follow-up to possess a constellation of deficits including disrupted personal relationships, emotional problems, cognitive deficits and vocational/educational difficulties. Pre-injury factors may differentiate between those with a healthy versus poor outcome. These may include more obvious factors such as prior head injury, history of substance abuse or psychiatric illness. Less obviously, it has been hypothesized that pre-existing personality traits (e.g., histrionic, depressive, perfectionistic) may also predict outcome. Our goal was to flag patients in need of additional treatment and follow-up care subsequent to discharge while in the acute, or in-patient, phase of treatment. Patients were evaluated by each member of the multi-disciplinary team (neuropsychologist, neurosurgeon, nurse), completed a brief neuropsychological battery, a personality inventory and gave a pre-injury history. Outcome at 3 months was assessed by phone interview during which patients again completed a symptom checklist as well as a standardized measure of outcome. Results indicated that staff predictions of outcome were successfully able to identify at-risk patients and pre-existing personality traits (as assessed by standardized testing) also successfully predicted patients who would suffer a poor outcome while inpatient neuropsychological testing was a less accurate predictor outcome. Preliminary results suggest that if staff are given the opportunity to assess mild TBI patients, they can successfully identify the minority of patients who are in need of additional education and follow-up services.
Ryan, L. M., Gouvier, W. D., & Schrager, D. Persistent Postconcussional Sequelae: Neuropsychological Correlates of High and Low Symptom Reporters. Individuals sustaining mild head injuries frequently complain of a number of physical, cognitive, and behavioral symptoms referred to as postconcussion symptoms (PCS). These symptoms can persist from months to years following injury and may even be permanent and cause disability, (e.g., Gouvier et al., 1992). It has been reported that mildly head-injured individuals who continue to complain of significant PCS demonstrate greater cognitive impairment and more psychological symptoms than mildly head-injured individuals who do not (e.g., Bohnen et al., 1995). However, the results have not been consistent across studies. Given this inconsistency, the present study sought to examine cognitive and emotional functioning in mild head injury subjects reporting a high level of persistent PCS compared with those reporting few symptoms. A sample of mildly head injured college students (N = 173) was divided into high (n -- 59) and low persistent PCS reporters (n = 57). It was hypothesized that high PCS subjects would demonstrate greater cognitive dysfunction, specifically decreased information processing (Ruff 2 & 7 Selective Attention Test, Symbol Digit Modalities Test), higher psychological distress (Profile of Mood States--POMS), and greater external locus of control (Revised Internal External Scale--RIES) than low PCS subjects. Subjects were divided into high and low PCS groups by taking the top and bottom third of scores on the Post Concussion Syndrome Checklist (PCSC). There were no differences between the groups for age, education, race, number of mild head injuries, or premorbid history of psychological disturbance. There was, however a significant difference for gender, X2:(1, N = 116) =
Abstracts from the 18th Annual Meeting
43
11.80, p < .008. There was a greater proportion of females in the high PCS group (46 females/13 males) compared to the low PCS group (22 females/35 males). A M A N O V A performed on the cognitive and psychosocial measures indicated a significant group difference, Wilks' A = 0.189, F(9, 106) = 50.44, p < .0001. Follow-up univariate A N O V A s revealed that the high PCS subjects had significantly higher POMS total scores (M = -67.07 vs. 22.09), F(1,114) = 51.25, p < .0001, RIES-Powerful Others External scores (M = 25.41 vs. 22.09), F(1,114) = 7.37, p < .008, and RIES-Chance External scores (M = 24.81 vs. 20.39), F(1,114) = 14.82, p < .0001, than low PCS subjects. There was no significant group difference for the information processing measures. The results of these analyses support the hypothesis that high PCS subjects would demonstrate higher levels of psychological distress and greater external locus of control than low PCS subjects but, these results do not support the prediction that high PCS subjects would demonstrate poorer information processing.
Santa Maria, M. P., Pinkston, J. B., Gouvier, W. D., & Miller, S. R. Stability of the Postconcussive Symptom Checklist with Head-Injured and Non-HeadInjured Extreme Responders. A large sample of undergraduates (n = 2326) were screened for general health and postconcussive symptomatology. A subsample (n = 98) of Ss whose Postconcussive Symptom Checklist (PCSC) scores were >.5 SD above the mean of the entire sample (symptomatic; n = 53) or <.5 SD below the mean (asymptomatic; n = 45) were re-administered the PCSC between 3 and 90 days later. The sample included 50 participants who reported history of a mild head injury (MHI) and 48 controls. MHI was defined as loss of consciousness of 30 minutes or less within the past 10 years but no more recent than 3 months. Persons with history of more than one head injury or with other neurologic history were not included in the study. Pearson's r between administrations was calculated for each group. Test-retest reliabilities were .44 for MHI Ss, .67 for non-MHI Ss, .71 for males, .51 for females. Fisher's z transformation was used to compare the resultant correlations between groups. Test-retest reliability coefficients did not differ for MHI vs. non-MHI or for male vs. female groups. The stability and utility of the PCSC are discussed for extreme and mid-range, head-injured and non-head-injured responders. Thompson, A., Crewe, N., & Andary, M. Parental Marital Functioning Following Traumatic Brain Injury in an Adolescent~Young Adult Child. Marriages can be particularly challenged after an adolescent young adult child sustains a traumatic brain injury (TBI) for two reasons. First, marital dissatisfaction is common during this stage in the family life cycle in which the child is striving for emancipation and parents are typically reevaluating their marriage. Second, studies have shown that marital distress is associated with chronic disability in a child. However, no studies to date have examined how TBI in young people, between 15 and 24 years old, affects parental marital functioning. This study examines the relationship between multiple aspects of marital functioning and each parent's psychological status and coping style. Nineteen couples who are parents of adolescent/young adult children with brain injury, each completed the Marital Satisfaction Inventory (MSI), Brief Symptom Inventory (BSI), the Coping Responses Inventory (CRI) and a background questionnaire. A control group of couples, with children in the same age range, were utilized as a reference to identify if TB1 group parents' reactions were due to TBI related stressors or to characteristics common to other families in the same life cycle stage. Data analysis consisted of Repeated Measures M A N O V A and Multiple Regression. The results indicated that par-