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Functional independence measure subscales versus neuropsychological assessment in the rehabilitation of stroke patients
174
Abstracts of 10th Annual Meeting
discussed. Additionally, the implications tems for behavioral fluency are raised.
of the utility of qualitative
scoring sys-
2. Armstrong, C. University of Pennsylvania Medical Center, Department of Neurology Neuropsychological Patterns of Attention in Developmental Learning Disorders and EEG Variants: Case Studies. Neuropsychological cases sometimes present which are best defined by ambiguity - both neurologically and by history. Selected cases are presented which have histories of learning disorders which do not conform to the major types of learning disability. Developmental disability in these cases were judged by their neurologists to be caused by perinatal events. Personal history revealed behaviors suggestive of subtle psychomotor seizures. EEG variants were found in each case which may or may not fall within normal limits. In this group, possible EEG abnormalities usually included, but were not limited to, the temporal lobe areas. Neuropsychological examination typically revealed areas which were in the average to superior ranges, but other areas which fell into the mildly to severely impaired ranges. An exploratory study found that various aspects of attention were the areas in common which were most impaired in this ambiguously defined group, regardless of the individual’s educational achievements. This pattern analysis is a prelude to a study of a concurrent clinical phenomenon of the EEG variants, in which an auditory continuous performance test is administered during the EEG to study the psychomotor variant.
3. Babb, R. S. Department of Rehabilitation University - Harlem Hospital Center
Medicine,
Columbia
Functional Independence Measure Subscales Versus R;L-uropsyci;c::cih~~,~~~ Assessment in the Rehabilitation of Stroke Patients. The Functional Independence Measure (FIM) is used to proayidc a aniform method of subjectively estimating those changes in function which occur during the rehabilitation of patients, including patients with a diagnosis of cerebral vascular accident. The FIM is made up of subscales some of which are intended to estimate communication and cognitive abilities. In this study, these subsca!e scores were compared with the results obtained using a sensitive coL%itive rating scale (Mattis’s Dementia Rating Scale) in a sample of hospitalized stroke patients. Evaluation of scatter plots indicated that there was no relationship between the combined FIM cognitive and communication scores and the overali XXX cf the cognitive rating scale. Further, there were no relationships between any FIM cognitive or communication subscale scores :!nd those obtainc:i from the Conceptualization and Memory subscales of the cognitive rating scale. The results of this study suggest that, in general, there is no relationship between FIM scores and scores obtained by the more objectively based cognitive rating
Session 1
175
scale. Thus, given the prevalence of cognitive impairment in the population of stroke patients, the FIM should not be substituted for neuropsychological assessment in the evaluation of these patients. 4. Barnoski, E. J-1 & Libon, D. L-2 (1) Dept. of Neuropsycbology. Drexel University, Phila., PA & Dept of Clinical Psychology, Philadelphia Geriatric Center. Phila, PA. (2) Dept of Clinical Psychology. Philadelphia Geriatric Center, 5301 Old York Road., Phila., PA 19141. An Abbreviated Version of the Trail Making Test. The Trail Making Test(TMT) was introduced into the neuropsychological
literature by Raph Reitan (1955) and assesses a patients ability to maintain a particular mental set, and is believed to be related to frontal systems functioning. It has been our experience that many moderately/severely demented patients cannot complete the TMT, particularly part B. Although this does not present any clinical difficulty it makes the data difficult to use for research purposes. This prompted us to evaluate the use of the samples from the standardized version of the TMT’s to determine if measurements of time to completion will differentiate demented and non-demented subjects. Data was drawn from 47 outpatients (18 SDAT, 12 MID, 5 Dementia NOS, 5 cognitively intact depressed patients and 7 cognitively intact not depressed patients). The TMT (parts A & B) were administered according to standardized instructions (Reitan and Wolfson, 1985). For both tests the dependent variable was the amount of time to completion on the samples of the standardized tests, regardless of errors or the amount of redirection required. The capacity for these tests to differentiate between the three demented groups was assessed with a one-way ANOVA. Results were not significant on either test. Similarly, there was no significant difference one either test among the two cognitively intact groups. When the groups were combined (TMT-A, demented group M = 22.3 (17.7), intact group- M = 11.5 (5.4); TMT-B, demented group-M = 50.5 (24.1), intact group-M = 20.5 (12.4), highly significant differences were observed (TMT-A, P < .024; TMT-B, P -c .OOl>. Although there were no intragroup differences among the demented and intact groups, when subjects were combined highly significant differences were observed indicating that the use of an abbreviated test may be a viable alternative in differentiating demented from intact subjects. In no way do we suggest that the TMT sample be substituted for the standardized version; but in some circumstances i.e. for research purposes, when it is obvious that the patient will not be able to cope with the task demands, use of the sample may be appropriate. Methodological problems might have been responsible for the inability of the abbreviated TMT to differentiate between patients with SDAT and MID and patients with and without depression. It is possible that some of our MID patients were, in fact, suffering from a mixed dementia. Also, varying levels of
Abstracts of 10th Annual Meeting
discussed. Additionally, the implications tems for behavioral fluency are raised.
of the utility of qualitative
scoring sys-
2. Armstrong, C. University of Pennsylvania Medical Center, Department of Neurology Neuropsychological Patterns of Attention in Developmental Learning Disorders and EEG Variants: Case Studies. Neuropsychological cases sometimes present which are best defined by ambiguity - both neurologically and by history. Selected cases are presented which have histories of learning disorders which do not conform to the major types of learning disability. Developmental disability in these cases were judged by their neurologists to be caused by perinatal events. Personal history revealed behaviors suggestive of subtle psychomotor seizures. EEG variants were found in each case which may or may not fall within normal limits. In this group, possible EEG abnormalities usually included, but were not limited to, the temporal lobe areas. Neuropsychological examination typically revealed areas which were in the average to superior ranges, but other areas which fell into the mildly to severely impaired ranges. An exploratory study found that various aspects of attention were the areas in common which were most impaired in this ambiguously defined group, regardless of the individual’s educational achievements. This pattern analysis is a prelude to a study of a concurrent clinical phenomenon of the EEG variants, in which an auditory continuous performance test is administered during the EEG to study the psychomotor variant.
3. Babb, R. S. Department of Rehabilitation University - Harlem Hospital Center
Medicine,
Columbia
Functional Independence Measure Subscales Versus R;L-uropsyci;c::cih~~,~~~ Assessment in the Rehabilitation of Stroke Patients. The Functional Independence Measure (FIM) is used to proayidc a aniform method of subjectively estimating those changes in function which occur during the rehabilitation of patients, including patients with a diagnosis of cerebral vascular accident. The FIM is made up of subscales some of which are intended to estimate communication and cognitive abilities. In this study, these subsca!e scores were compared with the results obtained using a sensitive coL%itive rating scale (Mattis’s Dementia Rating Scale) in a sample of hospitalized stroke patients. Evaluation of scatter plots indicated that there was no relationship between the combined FIM cognitive and communication scores and the overali XXX cf the cognitive rating scale. Further, there were no relationships between any FIM cognitive or communication subscale scores :!nd those obtainc:i from the Conceptualization and Memory subscales of the cognitive rating scale. The results of this study suggest that, in general, there is no relationship between FIM scores and scores obtained by the more objectively based cognitive rating
Session 1
175
scale. Thus, given the prevalence of cognitive impairment in the population of stroke patients, the FIM should not be substituted for neuropsychological assessment in the evaluation of these patients. 4. Barnoski, E. J-1 & Libon, D. L-2 (1) Dept. of Neuropsycbology. Drexel University, Phila., PA & Dept of Clinical Psychology, Philadelphia Geriatric Center. Phila, PA. (2) Dept of Clinical Psychology. Philadelphia Geriatric Center, 5301 Old York Road., Phila., PA 19141. An Abbreviated Version of the Trail Making Test. The Trail Making Test(TMT) was introduced into the neuropsychological
literature by Raph Reitan (1955) and assesses a patients ability to maintain a particular mental set, and is believed to be related to frontal systems functioning. It has been our experience that many moderately/severely demented patients cannot complete the TMT, particularly part B. Although this does not present any clinical difficulty it makes the data difficult to use for research purposes. This prompted us to evaluate the use of the samples from the standardized version of the TMT’s to determine if measurements of time to completion will differentiate demented and non-demented subjects. Data was drawn from 47 outpatients (18 SDAT, 12 MID, 5 Dementia NOS, 5 cognitively intact depressed patients and 7 cognitively intact not depressed patients). The TMT (parts A & B) were administered according to standardized instructions (Reitan and Wolfson, 1985). For both tests the dependent variable was the amount of time to completion on the samples of the standardized tests, regardless of errors or the amount of redirection required. The capacity for these tests to differentiate between the three demented groups was assessed with a one-way ANOVA. Results were not significant on either test. Similarly, there was no significant difference one either test among the two cognitively intact groups. When the groups were combined (TMT-A, demented group M = 22.3 (17.7), intact group- M = 11.5 (5.4); TMT-B, demented group-M = 50.5 (24.1), intact group-M = 20.5 (12.4), highly significant differences were observed (TMT-A, P < .024; TMT-B, P -c .OOl>. Although there were no intragroup differences among the demented and intact groups, when subjects were combined highly significant differences were observed indicating that the use of an abbreviated test may be a viable alternative in differentiating demented from intact subjects. In no way do we suggest that the TMT sample be substituted for the standardized version; but in some circumstances i.e. for research purposes, when it is obvious that the patient will not be able to cope with the task demands, use of the sample may be appropriate. Methodological problems might have been responsible for the inability of the abbreviated TMT to differentiate between patients with SDAT and MID and patients with and without depression. It is possible that some of our MID patients were, in fact, suffering from a mixed dementia. Also, varying levels of