NeuroRehabilitation - Volume 2, issue 4

Article Type: Other

DOI: 10.3233/NRE-1992-2401

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. iv-iv, 1992

Authors: Hall, Karyl M.

Article Type: Introduction

DOI: 10.3233/NRE-1992-2402

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. vi-vii, 1992

Authors: Rosenthal, Mitchell | Millis, Scott

Article Type: Research Article

Abstract: This review provides a framework for understanding the predictive power and validity of neuropsychological tests which have been correlated with psychosocial outcome after traumatic brain injury (TBI). Besides the methodological shortcomings of previous studies, reliance on single neuropsychological test scores or traditional measures alone may be a shortsighted approach. Multivariate and multidimensional procedures using a variety of metabolic, demographic, and neuropsychological measures may result in more accurate predictions of real-world behavior. Greater attention to the sensitivity of predictive measures and the required time frame for which prediction is sought is also necessary. It is further recommended that psychosocial outcome measures …be chosen which encompass a broader definition of productivity and are more reflective of the many dimensions of community integration after TBI. Show more

DOI: 10.3233/NRE-1992-2403

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. 1-8, 1992

Authors: Hibbard, Mary R. | Gordon, Wayne A.

Article Type: Research Article

Abstract: In this paper, traditional approaches to the neuropsychological assessment of individuals with stroke are reexamined in light of research suggesting the breadth of post-stroke cognitive and affective impairments that are independent of laterality of brain damage. A domain-specific approach to neuropsychological evaluation is presented which includes the evaluation of a patients level of awareness of both cognitive and affective sequelae of stroke, an in-depth mood assessment, delineation of an individual’s cognitive strengths and limitations, and assessment of learning potential.

DOI: 10.3233/NRE-1992-2404

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. 9-20, 1992

Authors: Wright, Jerry

Article Type: Research Article

Abstract: Functional outcome scales occupy an important place in rehabilitation documentation and research. Because of the ordinal nature of most assessment data, interpretation of these measures is not always straightforward. Outcome measures are discussed in terms of the four levels of measurement (nominal, ordinal, interval, and ratio). A rationale is given for the designation of most assessment measures as being ordinal in nature. Many statistical and mathematical operations may not be appropriate for use with ordinal data. In particular, change scores, total scores, average scores, and most parametric statistics may be misleading when applied to ordinal data. Potential solutions and safeguards …are commented on, including criterion scores, Rasch transformations, and nonparametric statistics. Show more

DOI: 10.3233/NRE-1992-2405

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. 21-30, 1992

Authors: Whiteneck, Gale G.

Article Type: Research Article

Abstract: The evaluation of spinal cord injury outcomes can be approached from several perspectives, with each strategy emphasizing different outcomes, different evaluation instruments, different assessment timetables, and different analytic techniques. A synthesis of various conceptual models of spinal cord injury, including the World Health Organization’s model of disablement, the medical model, the psychosocial model, and the economic model, results in the identification of six primary outcomes of spinal cord injury: impairment, disability, handicap, health, life satisfaction, and cost. Methods of measuring each of these outcomes are reviewed and the interrelationships among them and the many predictive factors which influence them are …explored. A comprehensive outcome evaluation model is proposed which combines selected evaluation tools to assess the primary outcomes in a practical but thorough approach. The need for such a broad-based evaluation plan to capture the complexity of spinal cord injury outcomes is emphasized. Show more

DOI: 10.3233/NRE-1992-2406

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. 31-41, 1992

Authors: Adamovich, Brenda L.B.

Article Type: Research Article

Abstract: Functional meaningful gains that improve the level of independence in day-to-day activities are used to judge the benefit of rehabilitation. let, existing functional assessment tools lack reliability and validity. A study was conducted to compare the functional communication ratings of registered nurses and speech-language pathologists on the Functional Independence Measure (FIM). Fourteen patients with left hemisphere brain damage and fourteen patients with right hemisphere brain damage served as subjects. The nurses assigned significantly higher FIM scores than speech-language pathologists when rating the communication of left hemisphere-damaged patients. However, the average ranks of patients from least to most impaired were the …same for nurses and speech-language pathologists. Follow-up analyses revealed potential reasons for the discrepancies including the fact that the nurses and speech-language pathologists were using different evaluation procedures. There is a need for additional research to evaluate functional assessment tools. Show more

DOI: 10.3233/NRE-1992-2407

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. 42-51, 1992

Authors: Forer, Stephen

Article Type: Research Article

Abstract: The integration of program evaluation with other management information systems can provide an effective management tool to assist in quality assessment and program modification, individual care modification, outcome and research studies, determining the cost benefits of rehabilitation, planning for future program development, monitoring changes in patient characteristics or needs, marketing rehabilitation services and programs to current and potential referral sources, and promoting better community acceptance and awareness. Program evaluation results presented in a concise, timely, understandable, and relevant manner can become a powerful aid to management decision making and program development. Program evaluation models are discussed, and different methods of …presenting results are explored. The entire team should be involved in developing, implementing, and analyzing program evaluation results. Considerations in designing and implementing a program evaluation system are reviewed. Rehabilitation providers should participate in data-sharing activities, allowing comparisons between facilities and regional or national averages, which may lead to improving the outcome and quality of rehabilitation care. Show more

DOI: 10.3233/NRE-1992-2408

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. 52-71, 1992

Authors: Johnston, Mark V. | Kirshblum, Steven | Zorowitz, Richard | Shiflett, Samuel C.

Article Type: Research Article

Abstract: This article gives an overview of major predictors of outcomes following stroke rehabilitation. The emphasis is on functional outcomes, but mortality is also considered. The literature on predictors of outcome following stroke is now large. Optimal predictors of rehabilitation outcome differ from early acute predictors, although there is much overlap. Measures of severity of impairment associated with the initial stroke are robust predictors, but measures of functional limitations upon admission to rehabilitation in conjunction with chronicity improve the accuracy of prediction of functional outcomes. Basic features of recovery curves are emphasized. Accuracy of prediction has improved to the point that …the better studies now predict the majority of the variance of functional outcomes. Accurate, clinically useful prediction requires use of multiple predictors, with different predictive sets for different outcome dimensions. Further improvement in the accuracy and robustness of prediction is needed. The emerging bottleneck is an inadequate means of applying an abundance of predictive findings to routine clinical practice. Show more

DOI: 10.3233/NRE-1992-2409

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. 72-97, 1992

Authors: Hall, Karyl M.

Article Type: Research Article

Abstract: This article defines the steps toward choosing a functional assessment measure for the adult brain-injured population. The questions to ask in choosing an appropriate scale are described, reflecting individual facility needs. Seventeen criteria for determining the attributes a scale requires for your program are discussed. General scales available that meet most of the criteria are described and rated on the seventeen attributes. Additional scales are also listed by area of emphasis. Some single-concept outcome measures are defined, such as length of program stay, charges, and discharge disposition. These can be alternatives or supplements to functional scale information in a database. …Future work must reflect the need for greater reliability and validity testing of existing scales, and a consideration for practical approaches to data collection in resource-limited environments. Show more

DOI: 10.3233/NRE-1992-2410

Citation: NeuroRehabilitation, vol. 2, no. 4, pp. 98-113, 1992