Biomedical subjects

Brick Johnstone

Publications and source records attributed to Brick Johnstone.

12 recordsLinked to original sources

PubMed2004

Comparison of Predicted-difference, Simple-difference, and Premorbid-estimation methodologies for evaluating IQ and memory score discrepancies.

Discrepancies between WAIS-III and WMS-III scores for a group of 39 males and 48 females with a history of TBI were examined using three methodologies: Predicted-difference, Simple-difference, and Premorbid-estimation methods. Overall, the Predicted-difference method tended to classify the fewest individuals as impaired based on statistical rarity of discrepancies (11-16% classified as impaired), while the regression-based Premorbid method tended to classify the fewest individuals as impaired based on clinical rarity of discrepancies (4-8% classified as impaired). Degree of agreement is reported and was substantial. The only comparison between methods to reach statistical significance was the Predicted-difference method classifying subjects as impaired at a higher rate than other methods for Auditory Delayed memory index (Cochran's Q = 7.00, P < .05). Findings suggest a combination of estimates of premorbid functioning and regression-based predicted scores is optimal for interpreting IQ/memory score discrepancies. Clinical implications are discussed.

Adult↗

PubMed2003

Financial and vocational outcomes 1 year after traumatic brain injury.

OBJECTIVE: To characterize financial and vocational outcomes among persons with traumatic brain injury (TBI) in terms of employment status, earned and private income, and public assistance received at the time of injury and at 1 year after injury. DESIGN: Nonexperimental, longitudinal study. SETTING: Inpatient TBI rehabilitation unit and participants' community of residence. PARTICIPANTS: Thirty-five persons with new TBI from 1 national Traumatic Brain Injury Model Systems center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Employment status, earned and private monthly income, and public assistance received monthly at the time of injury and at 1-year follow-up. RESULTS: From the time of injury until 1-year follow-up, the percentage of persons employed decreased from 69% to 31%; the percentage unemployed increased from 11% to 49%; the average earned monthly income declined 51% (from US dollars 1,491 to US dollars 726); and the mean total public assistance received per month increased 275% (from US dollars 153 to US dollars 421). CONCLUSION: Assuming that this study sample is representative of national statistics for TBI, during the first year after injury, TBI is associated with an estimated $642 million in lost wages, US dollars 96 million in lost income taxes, and US dollars 353 million in increased public assistance.

Adult↗

PubMed2003

Predictors of success for state vocational rehabilitation clients with traumatic brain injury.

OBJECTIVES: To determine the characteristics of individuals with traumatic brain injury (TBI) who request state vocational rehabilitation services and to determine the best predictors of their successful vocational outcomes. DESIGN: Observational study. SETTING: Vocational services data from the Missouri Division of Vocational Rehabilitation (DVR). PARTICIPANTS: Seventy-eight individuals with TBI who requested services from the Missouri DVR. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic, injury severity, neuropsychologic variables, vocational services offered, and vocational status at time of case closure (successful, unsuccessful, services interrupted, no services provided). RESULTS: Individuals requesting DVR services were primarily men (71%), white (82%), single (47%), of low average intelligence (Wechsler Adult Intelligence Scales-III full scale IQ score, 84.8), and of limited education (11.8 y). The majority experienced a significant TBI (ie, 66% were hospitalized after their TBI; 56% reported loss of consciousness; 37% reported posttraumatic amnesia; 32% reported multiple TBIs; avg time since injury, 9.2 y). At DVR case closure, 17% were rated as being successfully employed, with nearly all working in industrial, service, or clerical positions (2 in a sheltered workshop, 1 in a professional position). Stepwise logistic regressions indicated that delivery of DVR services (ie, vocational guidance and counseling, on-the-job training) predicted vocational outcome and demographic, injury severity, and neuropsychologic variables did not. CONCLUSIONS: DVR clients have multiple impairments that affect them several years postinjury; the provision of DVR services may be more important in determining vocational outcomes than traditional medical, psychologic, and demographic variables.

Adult↗

PubMed2003

Race differences in a sample of vocational rehabilitation clients with traumatic brain injury.

OBJECTIVE: To evaluate race differences in demographics, injury severity, and vocational outcomes for persons with TBI. PARTICIPANTS: Seventy-five individuals with TBI (13 African American, 62 Caucasian) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a 2-year period. MEASURES: Demographics (i.e. age, race, level of education), injury severity (i.e. LOC, PTA, length of hospitalization, neuropsychological test scores), VR services provided (e.g. transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs unsuccessfully employed; cost per case). PROCEDURE: All participants completed a standard neuropsychological evaluation and completed VR services (i.e. were followed from enrollment to case closure). HYPOTHESES: African Americans and Caucasians would not differ in demographics or injury severity, although fewer African Americans would be successfully employed through DVR. ANALYSES: Chi-squares and non-parametric MANOVAs to evaluate race differences in terms of demographics, injury severity, vocational services provided and vocational outcomes. RESULTS: As hypothesized, there were few race differences in demographics or injury severity, although African Americans received significantly more transportation services (62 vs 21%). Contrary to hypotheses, there was no difference in the number of successfully employed African Americans (23%) vs Caucasians (18%). CONCLUSIONS: African Americans and Caucasians with TBI achieve similar vocational successes if they receive state VR services.

Adult↗

PubMed2003

Cognitive decline over time following electrical injury.

Electrical injury (EI) is on the rise in the US, with more than 2400 injuries occurring annually. Consequences of EI often include diffuse neurological damage and a myriad of emotional and behavioural sequelae. While delayed onset of cognitive dysfunction is frequently alluded to in the literature, few cases have been published that document the progressive neuropsychological manifestations of EI over time. This paper offers a case study of a 49 year-old female who suffered a high voltage EI and who underwent neuropsychological evaluations at 6 and 56 months post-injury. Comparison of test results suggested a progressive pattern of global decline in cognitive functioning, with particular impairment in memory, verbal learning, abstract reasoning and sensory-motor functions. This case study illustrates the delayed onset and progression of neuropsychological dysfunction that may occur following EI, as well as the importance of long-term follow-up with patients after high voltage EI.

Adult↗

PubMed2003

Traumatic brain injury and Alzheimer's: deficit profile similarities and the impact of normal ageing.

Research has suggested that sustaining a traumatic brain injury (TBI) may increase one's risk of developing Dementia of the Alzheimer's Type (DAT) later in life. Several neuropathological models have been proposed to explain the association between TBI and DAT and studies using a neuropsychological deficit profile methodology suggest that the pattern and extent of cognitive decline associated with these conditions are similar. This paper presents a new conceptual model, derived from deficit profile methodology, regarding the relationship between TBI and DAT. This model proposes that, for some individuals, TBI may not lead to true DAT neuropathology, but rather produces a profile of neuropsychological deficits similar to DAT, which increasingly mimics the symptoms of true DAT as the TBI survivor ages. Understanding how TBI may contribute to the development of DAT has important social and medical implications, influencing the direction of prevention efforts and contributing to one's understanding of DAT.

Adult↗

PubMed2003

Gender differences in a sample of vocational rehabilitation clients with TBI.

Because traumatic brain injury affects between 1.5 and 2 million individuals per year and results in long term vocational and financial difficulties, there is growing interest in determining those factors that predict successful outcomes for specific groups of individuals with TBI. An NIH consensus panel on TBI has suggested that women are one group that needs more attention, particularly given the studies indicating that men and women experience different cognitive [14], emotional [19], and vocational outcomes following TBI [5]. The current study evaluated differences in injury severity, demographics, neuropsychological abilities, and vocational and financial outcomes for 78 persons with TBI (55 male, 23 female) who received services from a state Vocational Rehabilitation Division (DVR). Despite similar injury severity, neuropsychological and demographic characteristics, more men (43.6%) received Maintenance services from MO-DVR than women (21.7%). Of note, only 4.4% of the women were successfully employed through DVR, compared to 23.6% of the men. In addition, 73.9% of the women had services terminated after being accepted by DVR but before services were initiated, compared to 56.4% of the men. The significance of these results is discussed, as are the limitations of the current project.

Adult↗

PubMed2003

Rural/urban differences in vocational outcomes for state vocational rehabilitation clients with TBI.

OBJECTIVE: To evaluate differences in demographics, injury severity, and vocational outcomes for persons with TBI based on rural vs. urban residency. PARTICIPANTS: 78 individuals with TBI (28 from rural counties, 50 from urban counties) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a two year period. MEASURES: Demographics (i.e., age, race, education), injury severity (i.e., loss of consciousness, post traumatic amnesia, length of hospitalization, neuropsychological test scores), VR services provided (e.g., transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs. unsuccessfully employed; cost per case). PROCEDURE: All participants completed a standard neuropsychological evaluation and completed VR services (i.e., were followed from enrollment to case closure). Rural and urban residency was determined using U.S Office of Management and Budget definitions of metropolitan and non-metropolitan areas. ANALYSIS: Chi-squares, Fisher's Exact tests, Wilcoxon Rank Sums test, and MANOVAs. RESULTS: Few if any differences were found between the groups in demographics (i.e., more African Americans in urban areas), injury severity (i.e., more rural residents with multiple TBIs), or neuropsychological test scores. However, individuals from urban areas received significantly more maintenance funds (46% vs. 21%), transportation services (36% vs. 11%), and on-the-job training (28% vs. 7%), and had more spent on them ($1,816 vs $1,242). Although statistically non-significant (p < 0.15), 24% of individuals from urban areas were successfully employed at VR case closure, compared to only 7% of individuals from rural areas. CONCLUSIONS: Individuals with TBI from rural and urban settings have generally similar demographic, injury severity, and neuropsychological abilities, although they appear to differ in terms of vocational outcomes and number of VR services received, possibly related to limited availability of resources in rural areas.

Adult↗

PubMed2002

Applicability of the 15-item versions of the Judgement of Line Orientation Test for individuals with traumatic brain injury.

PRIMARY OBJECTIVE: To determine if short forms (i.e. 15 item) of the Judgment of Line Orientation (JOLO) test are equivalent to the full JOLO (i.e. 30 item). RESEARCH DESIGN: Retrospective analysis of JOLO test performance. METHODS AND PROCEDURES: Seventy-two persons with TBI evaluated at a Midwestern University neuropsychology laboratory were administered the JOLO test, Form V, as part of a larger battery of neuropsychological tests. Short forms (i.e. odd and even number short forms) were correlated with the 30 item to determine equivalency of forms. The Statistical Package for the Social Sciences (version 10) was used for the data analyses (SPSS). MAIN OUTCOMES AND RESULTS: Pearson's correlations indicate that the JOLO odd and even short forms are significantly correlated with the full JOLO score (r = 0.90 and 0.93, respectively), and that 100% of the participants' estimated JOLO full score fell within 2 points of the actual full JOLO score. CONCLUSIONS: The results confirm the validity of the short forms of the JOLO for persons with TBI and that gender effects were not significant.

Adolescent↗

PubMed2002

Distribution of services and supports for people with traumatic brain injury in rural and urban Missouri.

New paradigms of disability suggest that many variables interact to influence the community functioning of people with traumatic brain injury (TBI), including injury severity and social, psychological, and environmental factors. Unfortunately, the majority of TBI outcome research to date has primarily focused on injury severity variables (e.g., neuroradiologic findings, loss of consciousness, posttraumatic amnesia) to the exclusion of environmental variables. Limited environmental resources such as rehabilitation professionals, facilities, and services may be significant barriers that affect outcome for people with TBI, particularly for those in rural areas. Using data from Missouri, where 32% of the population lives in rural counties, this study researched the availability of rehabilitation resources for individuals with TBI, with an emphasis on differences between rural and urban areas. Data indicated that there is a scarcity of rehabilitation professionals (i.e., physiatrists, mental health providers, rehabilitation therapists),facilities (i.e., hospitals offering comprehensive rehabilitation therapies), and services (i.e., support groups) in rural areas of the study state. The results suggest that (1) future rehabilitation researchers need to evaluate the impact of accessibility to rehabilitation services and resources on the outcome of people with TBI and (2) TBI health policy administrators need to consider how to increase rehabilitation resources for people with TBI in rural areas, including the use of rural-based training programs, rural debt-forgiveness training programs, and telehealth systems.

Brain Injuries↗

PubMed2002

Memory functioning following traumatic brain injury in children with premorbid learning problems.

This study examines the memory functioning of 25 children who sustained a traumatic brain injury (TBI) and who had prior learning problems, 48 children with TBI who did not have prior learning problems, and 23 noninjured controls. The children with TBI and prior learning problems displayed significantly worse memory abilities than both the control participants and the children with TBI and no prior learning problems. They differed significantly from these 2 groups on measures of general memory, verbal memory, sound-symbol learning, and attention. The results suggest that children with premorbid learning problems who sustain TBI have less cognitive reserve and a lower threshold for the expression of cognitive impairments in areas that reflect preexisting learning and language problems, compared to children without premorbid learning problems.

Adolescent↗

PubMed2002

Neuropsychological deficit profiles in senile dementia of the Alzheimer's type.

Recent studies using Wide Range Achievement Test-Revised (WRAT-R) Reading scores as estimates of premorbid abilities have demonstrated that distinct neuropsychological deficit profiles may be associated with specific cognitive disorders such as traumatic brain injury [Brain Inj. 9 (1995) 377] and lupus [Appl. Neuropsychol. 7 (2000) 96], and that these deficit scores predict both functional and financial outcomes [J. Head Trauma Rehab. 14 (1999) 220]. Although the main cognitive deficits associated with senile dementia of the Alzheimer's type (SDAT) are well known, the relative degree of impairment in each has yet to be adequately determined. The present study calculated indices of relative decline (zDiff) for 32 patients with probable SDAT by comparing estimates of premorbid functioning to concurrent neuropsychological test scores. The results suggest that intelligence is least declined in SDAT [Wechsler Adult Intelligence Scale-Revised (WAIS-R) FIQ, zDiff=-0.72], followed by attention [Wechsler Memory Scale-Revised (WMS-R) Attention Index, zDiff=-1.14], memory (WMS-R General Memory, zDiff=-2.12; WMS-R Delay Memory, zDiff=-2.33), speed of processing (Trails A, zDiff=-2.85), and cognitive flexibility (Trails B, zDiff=-5.33). Clinical and research implications are discussed.

Journal Article↗