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Biomedical subjects

J F Malec

Publications and source records attributed to J F Malec.

At least 19 recordsLinked to original sources
PubMed2005

Non-declarative memory in the rehabilitation of amnesia.

The ability of amnesic patients to learn and retain non-declarative information has been consistently demonstrated in the literature. This knowledge provided by basic cognitive neuroscience studies has been widely neglected in neuropsychological rehabilitation of memory impaired patients. This study reports the case of a 43 year old man with severe amnesia following an anterior communicating artery (ACoA) aneurysm rupture. The patient integrated a comprehensive (holistic) day treatment programme for rehabilitation of brain injury. The programme explored the advantages of using preserved non-declarative memory capacities, in the context of commonly used rehabilitation approaches (i.e. compensation for lost function and domain-specific learning). The patient's ability to learn and retain new cognitive and perceptual-motor skills was found to be critical for the patient's improved independence and successful return to work.

Adult↗
PubMed2003

Prediction of IQ in the Mayo Older Adult Normative sample using multiple methods.

Using the Mayo Older Adult Normative sample (Ivnik et al., 1992) as our database, we developed regression models for estimating premorbid Full Scale (FSIQs), Verbal (VIQs), and Performance (PIQs) IQs for elderly adults. Age, years of education, and sex were the only demographic variables that showed sufficient variability; therefore, they were used as predictor variables in three stepwise procedures. The Mayo Normative FSIQs, VIQs, and PIQs served as the dependent variables. Both education and sex added significantly to the accounting of variance of both FSIQ and VIQ ( p < .001), whereas education ( p < .001) and age ( p < .05) were significant predictors of PIQ. These models produced statistically significant multiple Rs of .54, .58, and .35 ( p < .0001), with standard errors of estimate of 9.02, 8.28, and 10.77 for FSIQ, VIQ, and PIQ, respectively. Estimated FSIQs generated with the present model and the model developed by Barona and colleagues (Barona, Reynolds, & Chastain, 1984) were compared. The correlation between estimated IQs was large, the mean difference between IQs was very small, the standard deviations were nearly equal, and the categorical distributions of the two were similar. Because the Barona model is likely to be familiar to most clinicians, these findings argue in favor of the continued use of the Barona model, even when assessing people older than the WAIS-R normative sample. Extensions of these models to the WAIS-III also are discussed.

Age Factors↗
PubMed2001

Impact of comprehensive day treatment on societal participation for persons with acquired brain injury.

OBJECTIVES: To evaluate comprehensive day treatment (CDT) for survivors of brain injury by time since injury and to identify outcome predictors. DESIGN: Before and after. SETTING: Rehabilitation center. PARTICIPANTS: Ninety-six program graduates; 17 dropouts with acquired brain injury. INTERVENTIONS: Comprehensive Day Treatment Program: daily group sessions to build cognitive and behavioral skills through a transdisciplinary approach, supportive feedback, and a variety of therapeutic modalities. Obtained outcome measures before and after the program, and at 1-year follow-up. MAIN OUTCOME MEASURES OUTCOME: Independent living status, vocational independence scale at program end and 1-year follow-up; and Rasch-analyzed Mayo-Portland Adaptability Inventory (MPAI-22) and goal attainment scaling (GAS) at program end. PREDICTORS: age, education, severity of initial injury, time since injury, and preadmission MPAI-22. RESULTS: Significant goal achievement on GAS and improvement on MPAI-22; increased societal participation at 1-year follow-up for those treated postacutely and many years after injury: 72% of graduates living independently; 39% working independently, 10% in transitional placements, and 18% in supported or volunteer work. Long-term outcomes were modestly related linearly to preadmission MPAI-22 and nonlinearly to time since injury. CONCLUSIONS: CDT improves societal participation even among persons with a long history of limited participation after brain injury. This de facto extended baseline analysis indicates the effectiveness of CDT and paves the way for randomized control trials of active treatment components. Relationships of predictors to outcomes are not sufficiently strong for patient selection. More effective interventions for vocational reintegration are needed for those most severely disabled after brain injury.

Activities of Daily Living↗
PubMed2000

Evidence-based cognitive rehabilitation: recommendations for clinical practice.

OBJECTIVE: To establish evidence-based recommendations for the clinical practice of cognitive rehabilitation, derived from a methodical review of the scientific literature concerning the effectiveness of cognitive rehabilitation for persons with traumatic brain injury (TBI) or stroke. DATA SOURCES: A MEDLINE literature search using combinations of these key words as search terms: attention, awareness, cognition, communication, executive, language, memory, perception, problem solving, reasoning, rehabilitation, remediation, and training. Reference lists from identified articles also were reviewed; a total bibliography of 655 published articles was compiled. STUDY SELECTION: Studies were initially reviewed according to the following exclusion criteria: nonintervention studies; theoretical, descriptive, or review papers; papers without adequate specification of interventions; subjects other than persons with TBI or stroke; pediatric subjects; pharmacologic interventions; and non-English language papers. After screening, 232 articles were eligible for inclusion. After detailed review, 61 of these were excluded as single case reports without data, subjects other than TBI and stroke, and nontreatment studies. This screening yielded 171 articles to be evaluated. DATA EXTRACTION: Articles were assigned to 1 of 7 categories according to their primary area of intervention: attention, visual perception and constructional abilities, language and communication, memory, problem solving and executive functioning, multi-modal interventions, and comprehensive-holistic cognitive rehabilitation. All articles were independently reviewed by at least 2 committee members and abstracted according to specified criteria. The 171 studies that passed initial review were classified according to the strength of their methods. Class I studies were defined as prospective, randomized controlled trials. Class II studies were defined as prospective cohort studies, retrospective case-control studies, or clinical series with well-designed controls. Class III studies were defined as clinical series without concurrent controls, or studies with appropriate single-subject methodology. DATA SYNTHESIS: Of the 171 studies evaluated, 29 were rated as Class I, 35 as Class II, and 107 as Class III. The overall evidence within each predefined area of intervention was then synthesized and recommendations were derived based on consideration of the relative strengths of the evidence. The resulting practice parameters were organized into 3 types of recommendations: Practice Standards, Practice Guidelines, and Practice Options. CONCLUSIONS: Overall, support exists for the effectiveness of several forms of cognitive rehabilitation for persons with stroke and TBI. Specific recommendations can be made for remediation of language and perception after left and right hemisphere stroke, respectively, and for the remediation of attention, memory, functional communication, and executive functioning after TBI. These recommendations may help to establish parameters of effective treatment, which should be of assistance to practicing clinicians.

Brain Injuries↗
PubMed2000

A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes.

OBJECTIVE: To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. PARTICIPANTS: One hundred fourteen Minnesota residents, ages 18 to 65 years, with acquired BI. MAIN OUTCOME MEASURES OUTCOME: Five levels of Vocational Independence Scale (VIS). PREDICTOR: Preinjury employment status (VIS) and years of education, severity of initial injury, time since injury, current impairment/disability as measured by the Rasch-analyzed Staff Mayo-Portland Adaptability Inventory (MPAI), and impaired self-awareness measured by staff rating and the difference between Staff MPAI and Survivor MPAI. RESULTS: At placement, 46% in independent work; 25% in transitional placements; 9% in long-term supported employment; 10% in sheltered work; and 10% not placed. At 1-year follow-up (n = 101), 53% in independent work; 19% in transitional placement; 9% in supported work; 6% in sheltered work; and 13% unemployed. Regression analyses showed time since injury and Rasch Staff MPAI predicted VIS at placement; only VIS at placement independently predicted VIS at 1-year follow-up; Rasch Staff MPAI and preinjury education level predicted time to placement. CONCLUSIONS: The MVCCS optimized vocational outcome after BI. Time since injury and impairment/disability best predicted vocational placement. Level of initial placement best predicted employment status at follow-up. Persons with greater disability required more extended time and more extensive rehabilitation services before placement.

Adult↗
PubMed2000

Refining a measure of brain injury sequelae to predict postacute rehabilitation outcome: rating scale analysis of the Mayo-Portland Adaptability Inventory.

OBJECTIVE: Evaluate the psychometric properties of the Mayo-Portland Adaptability Inventory (MPAI). DESIGN: Rating scale (Rasch) analysis of MPAI and principal component analysis of residuals; the predictive validity of the MPAI measures and raw scores was assessed in a sample from a day rehabilitation program. SETTING: Outpatient brain injury rehabilitation. PARTICIPANTS: 305 persons with brain injury. RESULTS: A 22-item scale reflecting severity of sequelae of brain injury that contained a mix of indicators of impairment, activity, and participation was identified. Scores and measures for MPAI scales were strongly correlated and their predictive validities were comparable. CONCLUSIONS: Impairment, activity, and participation define a single dimension of brain injury sequelae. The MPAI shows promise as a measure of this construct.

Activities of Daily Living↗
PubMed1997

Factor analysis of the Mayo-Portland Adaptability Inventory: structure and validity.

Principal-components (PC) factor analysis of the Mayo-Portland Adaptability Inventory (MPAI) was conducted using a sample of outpatients (n = 189) with acquired brain injury (ABI) to evaluate whether outcome after ABI is multifactorial or unifactorial in nature. An eight-factor model was derived which explained 64-4% of the total variance. The eight factors were interpreted as representing Activities of Daily Living, Social Initiation, Cognition, Impaired-Self-awareness/Distress, Social Skills/ Support, Independence, Visuoperceptual, and Psychiatric, respectively. Validation of the Cognition factor was supported when factor scores were correlated with various neuropsychological measures. In addition, 117 patient self-rating total scores were used to evaluate the Impaired Self-awareness/Distress factor. An inverse relationship was observed, supporting this factor's ability to capture the two-dimensional phenomena of diminished self-awareness or enhanced emotional distress. A new subscale structure is suggested, that may allow greater clinical utility in understanding how ABI manifests in patients, and may provide clinicians with a better structure for implementing treatment strategies to address specific areas of impairment and disability for specific patients. Additionally, more precise measurement of treatment outcomes may be afforded by this reorganization.

Adolescent↗
PubMed1997

Using word recognition tests to estimate premorbid IQ in early dementia: longitudinal data.

This study examined the utility of word recognition scores for estimating actual Verbal IQ scores obtained from 1-5 years earlier. Participants were 271 persons remaining normal and 24 initially normal persons who developed cognitive impairment over longitudinal follow-up. A previously published regression equation based on education and the American modification of the National Adult Reading Test (Nelson, 1982) was used to estimate Mayo Verbal IQ. In spite of correlating well with prior obtained scores (r = .7) the predicted score tended to overestimate the obtained Mayo Verbal IQ. A revised equation was developed in the normal sample, which improved accuracy of prediction. Among the 24 persons who developed cognitive impairment over a 5-year span, the revised predicted scores provided reasonable estimates of initial Mayo Verbal IQ. To aid in clinical interpretation, a table of the normal frequencies of predicted Mayo Verbal IQ minus contemporaneously obtained Mayo Verbal IQ is provided.

Aged↗
PubMed1996

Postacute brain injury rehabilitation.

This review compares outcomes of adult postacute brain injury rehabilitation (PABIR) with natural recovery after brain injury. Potential outcome predictors and the effectiveness of behavioral, cognitive, pharmacologic, and vocational interventions are also appraised. The importance of standardized outcome assessment is discussed in the context of other research considerations. Although generally uncontrolled, the studies reviewed document benefits for many individuals with brain injury, including increased independence and a rate of return to independent work or training that exceeds 50% and may reach 60% to 80% for intensive comprehensive (holistic) day treatment programs. Available research is sufficiently encouraging to recommend more carefully controlled randomized studies. Future research should emphasize the development of standardized measures of patient characteristics and outcomes, and matching of patient characteristics with optimal rehabilitation approaches.

Activities of Daily Living↗
PubMed1996

Subjective memory complaints, psychological distress, and longitudinal change in objective memory performance.

Between 1992 and 1993, the Memory Function Questionnaire General Frequency of Forgetting Scale (MFQ-GEN), the Symptom Checklist-90-Revised General Severity Index (GSI), and Mayo Cognitive Factor Scales Learning and Retention (MCFS-LRN and MCFS-RET) current and change scores were obtained for 294 of 397 (74%) participants, ages 55-97 years, originally assessed in a 1988-1990 normative study. In multiple regression modeling, the GSI and MCFS-LRN current score contributed 20% and 3%, respectively, to MFQ-GEN variance. Thus, emotional status was a better predictor of subjective memory ratings than either absolute objective memory performance or objective longitudinal memory change. Persons who developed cognitive impairment over the longitudinal interval reported greater memory problems, but memory complaints had little sensitivity in identifying these persons. In an approximate census sample of these older people, minor memory problems were reported to be frequent but not serious.

Aged↗
PubMed1996

Ethical conflict resolution based on an ethics of relationships for brain injury rehabilitation.

An ethics of relationships for brain injury (BI) rehabilitation is described based on three principles; (1) human relationships are important; (2) human relationships are as important as individual survival; (3) human relationships are important enough to extend throughout the family of humankind. Within the context of this ethics of relationships, ethical conflict resolution (ECR) is offered as a process to address disagreements among those involved in BI rehabilitation. ECR provides a means to arrive at moral decisions in situations in which people disagree about the appropriate course of action because of differing values. ECR recognizes that, although disagreements in BI rehabilitation settings can be associated with multiple other factors, including disturbed self-awareness, emotions, communication, and interpersonal dynamics, such disagreements may also be value-based, either in whole or part. ECR invites the professional team to identify the value-based portion of these disagreements and provides a rational and supportive process to address disagreements. In this discussion of ECR, common and potentially universal areas of ethical concern in BI rehabilitation are identified, as well as potential risks. Specific examples of the application of ECR in cases of vegetative state, coma stimulation, and cognitive rehabilitation are described.

Brain Damage, Chronic↗
PubMed1995

Maximizing vocational outcome after brain injury: integration of medical and vocational hospital-based services.

OBJECTIVE: To describe a medical and vocational case-management system that has been implemented at the Mayo Medical Center in Rochester, Minnesota, to decrease the time between onset of brain injury and successful community reintegration. DESIGN: Barriers to employment are identified and targeted as part of a system that integrates medical center- and community-based services. MATERIAL AND METHODS: The success of the project will be determined by several sources, including the Mayo-Portland Adaptability Inventory, a vocational rating scale, and traditional measures of vocational success (for example, level of independent living, job type and setting, rate of pay, and the type and cost of vocational supports being used). Overall study outcomes will be compared against benchmarks derived from the literature on vocational outcome after brain injury. RESULTS: Preliminary data are encouraging that project goals are attainable. The medical case-management system has decreased the amount of time between injury and initiation of vocational and other rehabilitation services. During the first year, 67 persons with brain injury began receiving vocational services through the project, and 34% are in community-based nonsheltered work or training programs. Second-year data will reveal whether the goal of 70% placement within 9 months after admission to the project can be maintained.

Activities of Daily Living↗
PubMed1993

Comparison of Wechsler vs. Mayo summary scores in a clinical sample.

Normative bases for the Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Wechsler Memory Scale-Revised (WMS-R) recently were extended through age 97 with the publication of norms that permit computation of MAYO IQs for the WAIS-R and MAYO Memory Indices for the WMS-R. This study compares traditional Wechsler summary scores with their corresponding MAYO values in a clinical sample. MAYO summary scores are correlated highly with traditional Wechsler values, and concordance rates are also strong. Despite their similarities MAYO summary scores and traditional Wechsler values are not interchangeable. Cautions are discussed relative to the use of both MAYO and traditional Wechsler IQs and Memory Indices.

Aged↗
PubMed1993

Traditional and computerized assessment procedures applied to the evaluation of memory change after temporal lobectomy.

After establishing that 40 temporal lobectomy patients (20 right, 20 left) demonstrated the same pattern of memory compromise as has been reported in prior studies, we examined the sensitivity of computerized tests of everyday memory skills to the cognitive change associated with temporal resection. Multiple cognitive deficits occur after left, but not after right, temporal lobectomies. Memory impairment after surgery is not limited to traditionally structured memory tests but is also evident on tasks designed to simulate activities of daily life.

Journal Article↗
PubMed1992

Mayo Medical Center Brain Injury Outpatient Program: treatment procedures and early outcome data.

The rehabilitation of persons with brain injuries has proved challenging; community reintegration is often unsuccessful. Herein we describe our intensive group-oriented outpatient treatment program for persons with brain injury and report outcome data for the graduates of the program thus far. This interdisciplinary program emphasizes the development of cognitive skills, compensation techniques, social skills, emotional adjustment, leisure skills, physical fitness, and health maintenance. Although goals are individually determined, independent living and employment are goals for most participants in the program. Before initial participation, all candidates undergo an extensive 2-day assessment. Typically, a patient remains in the program for approximately 6 months. The specific group treatment approaches used in the program are discussed. Outcome data are assessed with use of the Portland Adaptability Inventory and goal attainment scaling, as well as comparisons of preprogram and postprogram employment status and level of independent living. Our initial results support the conclusion that this comprehensive and integrated treatment program is efficacious in rehabilitating persons with mild to moderate sequelae of brain injury.

Adolescent↗
PubMed1992

Validity of the construct of nonverbal memory: a factor-analytic study in a normal elderly sample.

One problem in evaluating the construct of nonverbal memory is finding a purely nonverbal memory measure. Encouraged by initial research with a new measure, the Visual Spatial Learning Test (VSLT), we examined nonverbal memory in a normal elderly sample. Subjects were 460 community-dwelling individuals between the ages of 55-95. All received neuropsychological batteries which included the Wechsler Adult Intelligence Scale-Revised, the Wechsler Memory Scale-Revised, the Rey Auditory Verbal Learning Test, and the VSLT. Two variable sets were created to avoid overlapping immediate and delayed recall trials for the same stimulus materials. Exploratory factor analyses using two different extraction methods were performed. Across analyses a single general memory factor was observed, no modality or time specific factors were found. If it can be assumed that we used adequate measures of nonverbal memory, our results combine with prior research to challenge the validity of the construct of nonverbal memory as distinct from verbal memory, especially in older normal adult populations.

Aged↗