Biomedical subjects

Scott Millis

Publications and source records attributed to Scott Millis.

10 recordsLinked to original sources

PubMed2006

Dimensions of disordered attention in traumatic brain injury: further validation of the Moss Attention Rating Scale.

OBJECTIVES: To investigate the factor structure of disordered attention in moderate to severe, acute traumatic brain injury (TBI) and to use factor analysis and item response theory to further validate and refine an observational rating scale of attention for clinical and research purposes. DESIGN: Multicenter inception cohort. SETTING: Inpatient rehabilitation units. PARTICIPANTS: Patients with TBI (N=372) consecutively admitted to 8 Traumatic Brain Injury Model System centers within 2 weeks prior to observation, who consistently followed commands and who were on stable doses of all psychotropic medications for a 3-day rating period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Participants were rated independently by treating occupational and physical therapists at an average of 1 month postinjury on the Moss Attention Rating Scale (MARS), a 45-item, Likert-type scale of attention-related behavior. RESULTS: Exploratory and confirmatory factor analyses revealed 3 correlated factors of disordered attention, interpreted as restlessness/distractibility, initiation, and sustained/consistent attention. Item response (Rasch) analysis was used to eliminate redundant items and to fill gaps in item difficulty. The resulting MARS consists of 22 items that can produce 3 factor scores and a total score that covers the broad construct of disordered attention. CONCLUSIONS: The factor-scored MARS has potential utility as a quantitative observational method with which to assess and study different dimensions of disordered attention in acute TBI, and to monitor change over time and treatment response within these dimensions.

Adolescent↗

PubMed2004

Late neurologic recovery after traumatic spinal cord injury.

OBJECTIVE: To present Model Spinal Cord Injury System (MSCIS) data on late neurologic recovery after 1 year after spinal cord injury (SCI). DESIGN: Longitudinal study of neurologic status as determined by annual evaluations at 1 and 5 years postinjury. SETTING: MSCIS centers contributing data on people with traumatic SCI to the National Spinal Cord Injury Statistical Center database. PARTICIPANTS: People with traumatic SCI (N=987) admitted to an MSCIS between 1988 and 1997 with 1- and 5-year follow-up examinations. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification, motor index scores (MIS), motor level, and neurologic level of injury (NLI), measured and compared for changes over time. RESULTS: The majority of subjects (94.4%) who had a neurologically complete injury at 1 year remained complete at 5 years postinjury, with 3.5% improving to AIS grade B, and up to 1.05% each improving to AIS grades C and D. There was a statistically significant change noted for MIS. There were no significant changes for the motor level and NLI over 4 years; however, approximately 20% of subjects improved their motor level and NLI. People with complete and incomplete injuries had similar improvements in motor level, but subjects with an incomplete injury had a greater chance of improvement in NLI and MIS. CONCLUSIONS: There was a small degree of neurologic recovery (between 1 and 5 y postinjury) after a traumatic SCI. Late conversion, between 1 and 5 years, from a neurologically complete to an incomplete injury occurred in 5.6% of cases, but in only up to 2.1% was there a conversion from motor complete to motor incomplete status. Limitations of this study included changes in the ASIA classification during the study and in the intra- and interrater reliability typically seen in longitudinal studies of the ASIA standards. Functional changes were not studied. Knowledge of the degree of late recovery may help in analyzing newer interventions to enhance recovery.

Activities of Daily Living↗

PubMed2004

Perceived quality of care and outcomes following spinal cord injury: minority status in the context of multiple predictors.

OBJECTIVE: To determine whether patients with spinal cord injury (SCI) who are members of minority groups experience a disadvantage with regard to quality of care, and investigate predictors of perceived quality of care and indicators of outcome. DESIGN: Correlational analysis of longitudinal data. SAMPLE: One hundred and forty-three individuals with SCI in the first year following injury (43.3% tetraplegia, 56.7% paraplegia; 53.6% of total had complete injuries). SETTING: Hospital and postdischarge (usually outpatient) care at 3 SCI model systems. MAIN OUTCOME MEASURES: Perceived quality of acute, rehabilitative, and continuing care rated by patients according to standard format. Objective indicators of amount of care (eg, length of stay [LOS], charges) and outcomes (eg, medical complications, Functional Independence Measure [FIM] scores, a life satisfaction measure [the Diener Scale], and the Craig Handicap and Reporting Technique [CHART; a community participation scale]). RESULTS: Minorities did not report statistically significant differences in perceived quality of care or other indicators (eg, amount of care, medical complications, FIM gain, life satisfaction, and CHART scores) compared with other groups. Severity of injury affected LOS and activity outcomes. Satisfaction with medical care before the injury significantly predicted perceived quality of acute hospital care, inpatient rehabilitation, and continuing care (P < 0.03, 0.02, and 0.02, respectively). CONCLUSION: A number of factors may affect variations in perceived quality of care and outcomes, but ethnicity is not always the most important predictor. Asking patients about their satisfaction with previous care can assist in distinguishing satisfaction with current care from pre-existing biases.

Adult↗

PubMed2003

Concordance of patient and family report of neurobehavioral symptoms at 1 year after traumatic brain injury.

OBJECTIVE: To determine concordance between patient and family report of neurobehavioral symptoms and problems across 6 domains of function and 3 levels of injury severity at 1 year after traumatic brain injury (TBI). DESIGN: Prospective longitudinal design with follow-up between 10 and 14 months postinjury. SETTING: Seventeen Traumatic Brain Injury Model Systems centers. PARTICIPANTS: A total of 267 adults with primarily moderate and severe TBI who had completed self-ratings and whose neurobehavioral symptoms had also been rated by their significant others. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Neurobehavioral Functioning Inventory-Revised, a 70-item scale with subscales assessing frequency of symptoms in motor, somatic, memory and attention, depression, communication, and aggression domains. RESULTS: Twenty-three items showed significant differences or trends between the self- and other ratings; 18 of these were in the direction of the injured individual reporting less frequent problems. Differences were most pronounced on the depression, aggression, and memory and attention subscales. On the latter 2 subscales, patient-family concordance was higher for those with less severe injuries. However, severity effects were not clear cut. Analyses of selected rating patterns indicating clinically significant "underreporting" of symptoms revealed that these affected the depression, aggression, and memory and attention subscales more than the motor or somatic subscales. CONCLUSIONS: At 1 year post-TBI, concordance between self- and other report of neurobehavioral symptoms was moderately high overall, but varied by symptom domain. For persons with moderate and severe TBI, reports from significant others may be needed for a full picture of the range, severity, and clinical importance of the patient's emotional, behavioral, and cognitive difficulties.

Adolescent↗

PubMed2003

The relationship between neuropsychologic function and level of caregiver supervision at 1 year after traumatic brain injury.

OBJECTIVES: To evaluate distribution of levels of caregiver supervision at 1 year after traumatic brain injury, and to determine neuropsychologic predictors of supervision level. DESIGN: Prospective longitudinal design, concurrent measurement of neuropsychologic function and supervision level. SETTING: Seventeen Traumatic Brain Injury Model Systems centers. PARTICIPANTS: A total of 563 adults tested at 1 year postinjury; and a subgroup of 452 studied for neuropsychologic function in the absence of impairment in mobility or basic self-care, as assessed by high FIM instrument motor scores. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Supervision level measured by scores on Supervision Rating Scale (SRS). RESULTS: Two thirds (69%) of the sample was rated as independent of supervision. Participants without significant dysfunction on motor FIM were grouped into supervision groups differing in intensity of time commitment from caregiver (independent, moderate supervision, heavy supervision). In univariate analyses, groups differed on demographic variables (education, race, productivity prior to injury), duration of altered consciousness, and all but 1 neuropsychologic measure. A binomial regression model (complementary log-log model) revealed that supervision at 1 year was predicted by education and scores on the Trail Making Test Part B and digits backward. CONCLUSIONS: Findings confirm the importance of preinjury status and measures of working memory and cognitive flexibility in predicting functional independence after TBI. The SRS appears prone to ceiling effects in persons followed prospectively after moderate to severe TBI.

Adolescent↗

PubMed2003

Violent traumatic brain injury: occurrence, patient characteristics, and risk factors from the Traumatic Brain Injury Model Systems project.

OBJECTIVES: To examine the occurrence of and characteristics associated with violent traumatic brain injury (TBI) in the Traumatic Brain Injury Model Systems (TBIMS) project for 4 of the 5 original Model Systems centers and to determine the patient characteristics of this group, as well as the risk factors for sustaining such an injury. DESIGN: Prospective evaluation of individuals with violent TBI over a 10-year period. SETTING: Four TBIMS centers. PARTICIPANTS: A total of 1,229 individuals who received acute hospitalization and inpatient rehabilitation care for TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The occurrence of a violent TBI. RESULTS: Twenty-six percent of the participants in the TBIMS project sustained a violent TBI. This type of injury was more common in African-American men who were single and slightly older than the average TBI patient, were unemployed before injury, and had had a previous TBI. A higher injury rate was noted in the earlier part of the evaluation period. Those who sustained a violent TBI had higher levels of caregiver burden and disability, as well as decreased productivity and community reintegration at rehabilitation discharge and at 1 and 2 years postinjury. CONCLUSIONS: The occurrence of violent TBI in the TBIMS project is consistent with national trends of decreasing incidence of violent injuries in the 1990s. These results present a profile of those who have been injured through violence. The relative risks for sustaining such an injury appear to be well defined when considering demographic and temporal factors.

Adult↗

PubMed2003

Statistical practices: the seven deadly sins.

This paper discusses selected problems in applied statistical analysis: (a) over-reliance on null hypothesis statistical testing, (b) failing to perform a power analysis prior to conducting the study, (c) using asymptotic statistical approximations with small samples, (d) ignoring missing data, (e) failing to deal with the multiplicity problem when performing multiple statistical comparisons, (f) using stepwise procedures to select variables in regression analysis, and (g) failing to perform or report model diagnostics. Suggestions and guidelines to address these issues in manuscripts concerning child neuropsychological research are offered.

Child↗

PubMed2002

Redefining the factor structure of the Wechsler Memory Scale-III: confirmatory factor analysis with cross-validation.

The purpose of this study was to revisit the underlying factor structure of the Wechsler Memory Scale-III. The WMS-III Technical Manual (Wechsler, 1997) presented findings from confirmatory factor analyses that support a three- and five-factor solution with separate immediate and delayed memory factors. A rigorous structural equation modeling approach was used to examine the factor structure of the test. The results verify that a three-factor model composed of verbal (immediate and delayed), visual (immediate and delayed), and working memory factors accurately represents the factor structure of the WMS-III. Results were cross-validated on an independent sample.

Adolescent↗

PubMed2002

Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial.

BACKGROUND: Neuropathic pain is a common complaint after traumatic spinal cord injury (SCI). Gabapentin, a synthetic structural analogue of GABA, has been shown to have beneficial effects in the treatment of neuropathic pain in other diagnostic groups; however, no standardized clinical trial has been performed to evaluate its efficacy after SCI. DESIGN: A 10-week, prospective, randomized, double-blind, crossover, and placebo-controlled clinical trial. OBJECTIVE: To determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain. METHODS: Seven subjects with neuropathic pain, who were more than 30 days post-SCI, completed the study. Two groups received a 4-week course of gabapentin and placebo in a randomized crossover design with a 2-week washout period. The Neuropathic Pain Scale was used to record daily pain levels. Data were analyzed using the Wilcoxon signed rank test. RESULTS: Gabapentin has some beneficial effects on certain types of neuropathic pain. There was a significant decrease of "unpleasant feeling" and a trend toward a decrease in both the "pain intensity" and "burning sensation" at the fourth week of gabapentin treatment compared with those on the placebo. No significant difference was found among other pain descriptors during the gabapentin and placebo treatment, although this may have been limited by the small sample size and low maximum dosage of gabapentin. CONCLUSIONS: Gabapentin reduces certain types of neuropathic pain in the SCI population. Future studies with larger sample sizes, higher dosages, and quicker titration will help further determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain.

Acetates↗

PubMed2002

Comparison of the revised 2000 American Spinal Injury Association classification standards with the 1996 guidelines.

OBJECTIVE: This study was undertaken to determine the level of agreement between the most recent change in the American Spinal Injury Association International Standards (2000) and the previous (1996) classification. DESIGN: In a spinal cord injury rehabilitation hospital, data were collected on 94 subjects who had an initial neurologic examination according to the International Standards within 1 wk of injury and again at 1 yr. Comparisons were examined of the level of agreement between the 1996 and 2000 revisions in classification of the motor incomplete levels and ability to prognosticate outcome at 1 yr on the basis of the initial examination. RESULTS: Near perfect agreement between the 1996 and 2000 revised guidelines in the classification of motor incomplete injuries was found, with no statistically significant difference for prognosticating neurologic recovery at 1 yr on the basis of the initial examination. CONCLUSION: The 2000 revisions do not offer a significant difference in American Spinal Injury Association impairment classification or in predicting neurologic recovery at 1 yr.

Female↗