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Biomedical subjects

J D Corrigan

Publications and source records attributed to J D Corrigan.

At least 19 recordsLinked to original sources
PubMed1998

Outcomes in the first 5 years after traumatic brain injury.

OBJECTIVE: To examine the extent to which outcomes from traumatic brain injury differ as a function of time and can be predicted at discharge from inpatient rehabilitation. DESIGN: Survey method employing cross-sectional analyses. SETTING: An inpatient brain injury rehabilitation unit in a large midwestern academic medical center. SUBJECTS: Ninety-five adults with traumatic brain injuries, 6 months to 5 years after inpatient rehabilitation, stratified by time postdischarge. MAIN OUTCOME MEASURES: Functional Independence Measure (FIM), Sickness Impact Profile (SIP), Medical Outcomes Survey SF-36, Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique (CHART), Brief Symptom Inventory (BSI), Satisfaction With Life Scale (SWLS), and indices of current psychosocial functioning. RESULTS: Substance abuse, need for supervision, life satisfaction, and selected subscales of the CIQ and CHART differed over the period 6 months to 5 years after discharge. Approximately 75% of the variance in current FIM scores, and 40% to 50% of CHART, CIQ, and SIP total scores, could be predicted at time of discharge. CONCLUSIONS: Outcomes over the first 5 years after discharge were dynamic, with most change being improvement, at least after the first 2 years. Important aspects of outcome could not be predicted based on premorbid characteristics, injury severity, and initial functional abilities.

Activities of Daily Living↗
PubMed1998

Primary caregivers of persons with brain injury: life change 1 year after injury.

The impact of a traumatic brain injury on the family of the injured person is just beginning to be explored. In the current study, 61 primary caregivers were contacted at 1 year following injury. They completed the Relative and Friend Support Index, Social Support Index, Trauma Complaints List and the Life Change Question. The majority of caregivers indicated at least mild negative life change following the brain injury. Greater social support was correlated with less life change and greater injury severity was correlated with negative life change. Neither of these relationships was found to be significant at the 0.05 level. A significant positive correlation was found between caregivers' perception of deficits and the degree of negative life change. Perceived deficits accounted for the greatest amount of variance in life change followed by relative and friend support when all variables were entered into a stepwise regression. Further analyses indicated that the most significant factor of the Trauma Complaints List in predicting life change may be problems with cognition, which accounted for a significant amount of the variance in life change. Implications for counselling and further research regarding caregivers of persons with brain injury are discussed.

Adolescent↗
PubMed1997

Validity of the functional independence measure for persons with traumatic brain injury.

OBJECTIVE: Replicate and extend studies of the construct validity of the Functional Independence Measure (FIM) for persons with traumatic brain injury (TBI). DESIGN: A cross-sectional study of admissions to acute rehabilitation evaluated 6 months to 5 years after discharge. SETTING: An inpatient brain injury rehabilitation unit in a large, academic medical center. SUBJECTS: Ninety-five patients with primary diagnosis of TBI stratified by time postdischarge. MAIN OUTCOME MEASURES: Prediction of (1) average daily minutes of assistance and (2) supervision required in comparison to the Sickness Impact Profile (SIP) and SF-36. RESULTS: The FIM was highly predictive of minutes of assistance (83% accuracy), supervision (82% accuracy), and the need for either type of assistance (78% accuracy). Prediction was only minimally improved by measures of neurobehavioral impairment. The accuracy of the FIM was superior to the SIP and SF-36. CONCLUSIONS: Results provided substantial support for the validity of the FIM as a measure of functional independence for persons with TBI. The importance of supervision as a type of assistance required after TBI was evident, with the FIM highly predictive of this need, as well.

Activities of Daily Living↗
PubMed1997

Systematic bias in outcome studies of persons with traumatic brain injury.

OBJECTIVE: (1) Examine systematic biases created by subjects lost at 1-year follow-up in samples of persons with traumatic brain injury; (2) identify potential threats to generalization of outcomes data. DESIGN: A consecutive sample of admissions to acute rehabilitation studied 1 year following discharge. SETTING: An inpatient brain injury rehabilitation unit in a large, academic medical center. SUBJECTS: Eighty-eight patients with primary diagnosis of traumatic brain injury. MAIN OUTCOME MEASURES: Subjects were considered lost to follow-up when phone calls, mail, clinic visits, and assistance from family failed to allow contact 1 year after discharge from acute rehabilitation. Potential effects of the biased follow-up sample were examined for seven suboptimal outcomes. RESULTS: A total of 38.6% of subjects were lost to follow-up. Subjects intoxicated at time of injury and those with history of substance abuse were more-likely to be lost. Among subjects followed, the likelihood of working or being in school 1 year after discharge was significantly less for those intoxicated at time of injury and those with a history of substance abuse. CONCLUSIONS: Systematic bias in longitudinal studies may result from subjects with substance use problems being lost to follow-up. Population estimates for return to work or school will be overestimated if those lost who have substance use problems resemble those followed.

Adolescent↗
PubMed1996

Predicting functional independence from neuropsychological tests following traumatic brain injury.

The relationship between impairment, measured by the Halstead-Reitan Neuropsychological Test Battery (HRNTB), and disability, measured by the Functional Independence Measure (FIM), was investigated in 164 subjects completing acute, inpatient rehabilitation following traumatic brain injury. Exploratory factor analysis of the FIM supported a two-factor model of disability, with 13 items loading on a motor disability factor and five items loading on a cognitive disability factor. HRNTB findings and injury-related variables were predictive of motor disability, as five variables accounted for 39-44% of the variance in FIM Motor scores. Contrary to expectations, the relationship with cognitive disability was comparable to, but did not exceed, that for motor disability, as only 29-40% of the variance in FIM Cognitive scores was accounted for. The WAIS-R Comprehension subtest was the single best predictor of cognitive disability, accounting for 20% of variance, and suggesting that the FIM Cognitive subscale is measuring social-cognitive ability, as intended by its authors. Results are discussed in terms of the relationships among impairment and disability, including the need to further scrutinize the operationalization of these constructs as they relate to cognitive functions.

Activities of Daily Living↗
PubMed1995

Substance abuse as a mediating factor in outcome from traumatic brain injury.

A review of recent research addressed two questions: how common are problems of substance abuse in traumatic brain injury (TBI), and to what extent does alcohol and other drug use mediate outcome? Studies showed alcohol intoxication present in one third to one half of hospitalizations; data for other drug intoxication were not available. Nearly two thirds of rehabilitation patients may have a history of substance abuse that preceded their injuries. Intoxication was related to acute complications, longer hospital stays, and poorer discharge status; however, these relationships may have been caused by colinearity with history. History of substance abuse showed the same morbidity, and was further associated with higher mortality rates, poorer neuropsychological outcome, and greater likelihood of repeat injuries and late deterioration. The effect of history may be caused by subgroups with more severe substance abuse problems. Implications for rehabilitation are discussed, including the potential negative impact of untreated substance abuse on the ability to document efficacy of rehabilitation efforts.

Alcoholic Intoxication↗
PubMed1995

A programme of intervention for substance abuse following traumatic brain injury.

This article describes a pilot programme initiated in 1991 to address the problems of substance abuse among persons who have experienced traumatic brain injury (TBI). The model of treatment is community-based, using an interdisciplinary staff with expertise in TBI, vocational rehabilitation, and substance abuse treatment, to support and enhance existing services in the client's own community. The primary method of intervention is resource and service coordination. Six principles that serve as the underpinnings of the model are described, as are core and supplemental services and staffing patterns. Innovative components of the programme include the theoretical model of changing addictive behaviours used to guide treatment, and the development of community teams to facilitate a coordinated and integrated approach. The programme has relatively low start-up costs and can serve both urban and rural populations. Clinical experience and initial programme evaluation results suggest that substance abuse and vocational rehabilitation goals can be effectively attained using this model of service delivery.

Brain Damage, Chronic↗
PubMed1994

The relationship between cognition and functional independence in adults with traumatic brain injury.

This study investigates the relationship between cognitive impairment, as measured by Orientation Group Monitoring System (OGMS) scores, and disability as measured by Functional Independence Measure (FIM) scores in a sample of 122 persons with traumatic brain injury admitted to an inpatient rehabilitation unit. The relationships between Aggregate OGMS and FIM Total, FIM Motor, and FIM Cognitive scores were significant (rho = .49, p < .001; .40, p < .001; and .64 p < .001 respectively). Lower cognition was related to greater disability; with this relationship stronger for FIM Cognitive versus FIM Motor scores. Consistent with prior research, time to rehabilitation was significantly related to FIM Total (rho = -.42 p < .001) at admission to rehabilitation, with shorter time to rehabilitation related to greater functional independence. Stepwise regression indicated that the Aggregate OGMS score contributed 24%, and time to rehabilitation 5% unique variance to FIM Total score. These results support previous findings of distinct cognitive and motor subscales of the FIM, and suggest the importance of cognitive impairment to both.

Activities of Daily Living↗
PubMed1994

Factor structure of the Agitated Behavior Scale.

The Agitated Behavior Scale (ABS; Corrigan, 1989) is a 14-item scale developed to monitor agitation during the acute phase of recovery from acquired brain injury. While previous studies have supported the reliability, internal consistency, and concurrent validity of the ABS, the current study was designed to investigate its underlying factor structure, as well as to determine systematic effects of time-of-day on the occurrence of agitation. Subjects were 212 patients with traumatic or other recently acquired brain injury who exhibited agitation during their treatment on a specialized brain-injury unit of an acute rehabilitation hospital. Confirmatory factor analysis revealed that agitation is best represented by one general construct with three underlying factors: Aggression, Disinhibition, and Lability. Analysis of agitation by nursing shift in which ratings were made confirmed that overall level was lowest during the night shift; however, the relationship between time-of-day and underlying factors deviated from this pattern. Results are discussed in terms of the necessity for objective measurement, definition of the construct of agitation, and time-of-day issues in sampling agitated behavior.

Adolescent↗
PubMed1994

Whatever it takes: a model for community-based services.

The Whatever It Takes model is presented as an extension of the medical/rehabilitation model. It is not presented as an alternative to the rehabilitation model, although it does represent an opposition to the manner in which the model is typically implemented in community-based programmes for individuals with acquired brain injury. After brain injury, medical complications persist and a strictly anti-medical model in a community-based programme is unwise. On the other hand, community-based programmes that attempt to treat the individual, or provide rehabilitation services, in the absence of careful consideration of environmental barriers or the need for natural supports, are not likely to meet the long-term community reintegration needs of the individual, and may be unjustly using up finite resources. There are numerous complications associated with living with the effects of acquired brain injury. There also is considerable complexity associated with a health-care system and reimbursement system that emphasize acute care. Given these complexities, and the strong probability that a cure for brain injury is not likely to be found within the next decade, even the most learned professionals in brain injury are likely to say that practical solutions are needed for the present. Most notable is the late Dr Sheldon Berroll, who provided so much leadership to the field, but when asked about solving the day-to-day problems for an individual, would often respond: 'Do whatever it takes'. This advice was not presented in desperation, but rather as practical guidance. We have attempted to describe the whatever it takes approach, and to provide some guidelines for its implementation in community integration programmes.

Activities of Daily Living↗
PubMed1989

Effects of mode of presentation on head-injured patients' recall of narrative information.

A 2 x 3 x 3 factorial design was used to examine the recall of units of verbal information by head-injured (n = 12) and hospitalized controls (n = 12) under three modes of presentation and three recall times. Presentation of three instruments commonly used in memory assessment was counterbalanced among overt passive (standard administration), covert active (silent reading), and overt active (reading aloud) modes. Information recall was taken immediately after presentation, 20 minutes, and 48 hours later. Analysis of variance revealed a significant main effect for group, but no main effect for either mode of presentation or recall time. Confirmatory nonparametric analysis supported initial results. Findings are discussed with regard to potential implications for clinical assessment on brain-injured patients and further research in memory assessment on this population.

Adolescent↗
PubMed1989

Development of a scale for assessment of agitation following traumatic brain injury.

Development and initial validation of a scale for assessment of agitation in traumatic brain-injured individuals is described. Items were selected from an initial 39-item pool based on their testability, differentiation of agitation, frequency of occurrence, and representation of the full domain of the construct. The resulting 14-item instrument, called the Agitated Behavior Scale (ABS), was subsequently tested on an independent sample of 35 head-injured subjects. Reliability was examined via measures of internal consistency and qualitative evaluation of principal components factor analysis. Cronbach's alpha exceeded .80 for all rates. Comparable values of theta were found and qualitative criteria of internal consistency were met. The ABS score accounted for between 36% and 62% of the variance in 15 of 16 correlations with simultaneous, independent observations of agitation. Results of initial validation are discussed in light of classic test theory and research necessary for determination of construct validity.

Adult↗
PubMed1989

Orientation Group Monitoring System: an indicator for reversible impairments in cognition during posttraumatic amnesia.

During posttraumatic amnesia (PTA), confusion, attention deficits, impaired memory, disorientation, and inability to process external stimuli often preclude accurate assessment of subtle neurologic changes. The Orientation Group Monitoring System (OGMS) has proven to be a simple, useful strategy for assessing cognitive status. Retrospective analysis of weekly aggregate OGMS scores indicated that a decline in performance of 0.23 or greater is clinically significant. Over a one-year period, 27 patients demonstrated significant decrements in OGMS performance, and in 93% of these instances, the decrease was attributable to a medical problem. Adverse effects of medication was the most common etiology of decreased performance (n = 13). Overwhelmingly, the decline in the OGMS score was the first indication of impaired cognition. This monitoring device is therefore useful as an indicator during PTA of declining cognitive function, warranting further medical evaluation.

Adult↗
PubMed1988

Amitriptyline for post-traumatic agitation.

Agitated behavior is exhibited in up to 30% of patients recovering from a traumatic brain injury. Past treatment protocols have included proactive behavioral management and major tranquilizers. We now report the use of amitriptyline for control of agitation. For a period of over 2 years, 43 male and 15 female patients with a "recent" severe brain injury were admitted for inpatient rehabilitation and subjected to traditional structured programming for treatment of post-traumatic amnesia (PTA). In 20 patients, 18 men and 2 women, where agitation persisted sufficiently to impede rehabilitation despite initiation of structure, amitriptyline was instituted. These patients were of a comparable age (29.4 years for the agitated group versus 25.6 years for the nonagitated group), but the agitated patients had a lower median Rancho Los Amigos Hospital Level of Cognitive Functioning in a comparison to nonagitated patients (V versus VI). All patients were monitored for cognitive performance by the Orientation Group Monitoring System, and a daily account of frequency, severity and type of agitation was recorded. Within 7 days of initiation of therapy, 12 of 17 patients within PTA had dramatic decrease in agitation (5/5 patients at Rancho IV; 4/8 at Rancho V; 3/4 at Rancho VI). Two of the three patients at Rancho VII had agitation that was unresponsive to amitriptyline. The amitriptyline-responsive patients were maintained on the drug through PTA, and the Orientation Group Monitoring System scale demonstrated no impedance in cognitive recovery. Thus, amitriptyline appears most useful as an adjunct for treatment of nondirected agitation; it also has a role in reducing the severity of the directed agitation that is seen during but not after PTA.

Adolescent↗
PubMed1988

Agitation following traumatic head injury: equivocal evidence for a discrete stage of cognitive recovery.

Agitation and confusion appear to be associated in the early period of recovery from traumatic head injury. Eighteen severely head-injured patients were assessed during acute rehabilitation for both the extent of agitation and level of cognitive functioning. Agitation was measured by the Agitated Behavior Scale developed by Corrigan. Simultaneous independent measurements of cognitive functioning were obtained from the Orientation Group Monitoring System and Mini-Mental State. Agitation was significantly correlated with both measures of cognitive functioning, indicating that as cognition improved, agitation diminished. Agitation was partitioned into high and low levels, and cognitive functioning was partitioned into low, middle, and high levels for each of the two measures of cognitive functioning. Chi-square analysis of the distribution of agitation and cognition indicated significant differentiation, with high agitation prevalent in low levels of cognition, and low agitation prevalent in high levels of cognition. Patients in the middle level of cognition were equally likely to demonstrate high and low agitation. Further descriptive analysis indicated that improvement from low levels of cognition preceded improved agitation, and improved agitation preceded clearing from posttraumatic amnesia. These results provide equivocal support for the long-held clinical observation that a period of pronounced confusion and agitation represents a discrete stage of recovery from traumatic head injury.

Adolescent↗
PubMed1987

Psychometric characteristics of the category test: replication and extension.

This investigation reexamined and extended previous research on the psychometric characteristics of the Halstead Category Test (HCT), one part of the Halstead-Reitan Neuropsychological Test Battery (HNTB). Protocols for 102 subjects with a diagnosis of either closed head injury or cerebrovascular accident were examined and analyzed for relationships between the HCT and Verbal IQ (VIQ), Performance IQ (PIQ), age, education, time since onset of injury (onset), diagnosis, and the Impairment Index (Index) of the HNTB. Results indicated a significant relationship between HCT performance, age, and PIQ; and significant differences between the two diagnostic groups for HCT, VIQ, age, onset, and Index. Stepwise multiple regression analysis showed a measure of performance intelligence, uncorrected for age, to be the best predictor for performance on the HCT. These results replicated earlier findings with regard to correlates of HCT performance and provided additional data on its optimal prediction. Results were discussed in light of clinical interpretation of the HCT.

Adult↗
PubMed1987

Relationships between parts A and B of the Trail Making Test.

Two measures of relationship between Parts A and B of the Trail Making Test (TMT) were examined in a large, acute rehabilitation population (N = 497). A difference (B-A) and a ratio (B/A) score were calculated and compared to other neuropsychological measures. The difference score was found to be correlated highly with intelligence and severity of impairment and, to a lesser degree, with age, education, and memory functioning. The ratio measure was correlated moderately or showed no significant relationship with other variables. This finding supported the curvilinear nature of the relationship between the ratio measure and cerebral impairment, as suggested by Golden, Osmon, Moses, and Berg (1981). Both measures were examined for their ability to distinguish between right and left cerebral damage. Only a trend toward differentiating lateralized damage was found; the ratio measure and a geometric transformation of the ratio showed greater sensitivity than did the difference measure. Results are discussed in terms of the potential usefulness of TMT relationship measures in neuropsychological inference.

Brain Damage, Chronic↗