Objective The Functional Status Examination (FSE) is a comprehensive measure of functional status... more Objective The Functional Status Examination (FSE) is a comprehensive measure of functional status post-traumatic brain injury (TBI) that has primarily been used in studies of moderate-to-severe TBI. The present observational study examines functional status using the FSE among patients who sustained mild TBIs (mTBIs; defined as Glasgow Coma Scale [GCS] = 13–15 at admission) seen in a Level 1 trauma center. Study aims included examining the course of functional status following mTBI, as well as exploring relationships of the FSE and other relevant constructs among those with GCS = 13–15. Method Participants were assessed at 2 weeks (n = 112), 3 months (n = 113), 6 months (n = 106), and 12 months (n = 88) post-injury for changes in functional status resulting both (a) from all injuries and (b) from TBI only. Results Among seven domains of day-to-day functioning, participants generally experienced the greatest disruption in their primary activity (work or school) and in leisure and rec...
The assessment of functional status after traumatic brain injury (TBI) is important. The Glasgow ... more The assessment of functional status after traumatic brain injury (TBI) is important. The Glasgow Outcome Scale (GOS) and its revised version, the Glasgow Outcome Scale Extended (GOSE), have been used most frequently in TBI research, but there are concerns about the sensitivity of these measures. The current study evaluated the psychometric properties of the Functional Status Examination (FSE) using a sample of 448 moderately to severely injured subjects with TBI. It was shown that the FSE is significantly related to other measures of functional status including the GOSE, Short Form Health Survey, and European Quality of Life Checklist (p < 0.001), is sensitive to TBI severity (p < 0.001), and is responsive to recovery from 3 to 6 months post-injury (p < 0.001). In addition, there was a significant agreement (r = 0.817, p < 0.001) between the patient and significant other's assessment of functional status on the FSE at 6 months post-injury. The FSE may be a valuable m...
OBJECTIVE. This study investigated performance of home management activities 1 year after traumat... more OBJECTIVE. This study investigated performance of home management activities 1 year after traumatic brain injury (TBI), as reported on the Functional Status Examination. METHOD. Home management performance of 164 rehabilitation inpatients (mean age 35.4 years, 77% men, 75% white) with moderate to severe TBI was examined in relation to demographics, injury severity, neuropsychological functioning, and living situation. RESULTS. Fifty-nine percent reported more difficulty or more assistance with home management at 1 year. Nonperformance of individual activities before injury ranged from 16% to 76%. Age (p = .001), living situation after injury (p = .002), and neuropsychological function at 1 year (p = .001) were associated with more limited home management performance after injury as compared to premorbid function. CONCLUSIONS. Home management is challenging 1 year after TBI, especially for older adults and those with greater cognitive impairments. Accurate preinjury information is ne...
(38%); other neurologic condition 6 (10%). Interventions: BoNT-A (total dose: Dysport 150-1000 un... more (38%); other neurologic condition 6 (10%). Interventions: BoNT-A (total dose: Dysport 150-1000 units or Botox 50-200 units) injected according to presenting pattern of spasticity, followed by physical therapy interventions based on clinical judgement, including splinting, serial casting, positioning, functional electrical stimulation, and targeted task practice. Main Outcome Measures: The Arm Activity Measure (ArmA), the Modified Ashworth Scale (MAS) and Goal Attainment Scaling (GAS). Measurements were undertaken at baseline, 8 weeks, and 16 weeks. Results: Friedman tests were used to identify overall change between baseline and 16 weeks. Significant changes were demonstrated in MAS (Xr2 66.6; P .005); GAS (Xr2 74.2; P .005); and the ArmA passive function subscale (Xr2 11.9; P .005) (eg, improved ease of dressing, hygiene). No significant change was identified in the ArmA active function sub-scale. Comparison of change at individual time points weeks showed the improvement in passive function scores to be maintained at 16 weeks (Z -2.6; P .01), whereas MAS scores had reverted toward their original values. Conclusions: Although no significant change in active function was seen in this cohort, improvements in passive function were maintained at 16 weeks postinjection, after the effect on spasticity had subsided. The role of individual physical therapy interventions in maintaining functional gains after spasticity management with BoNT-A now requires further exploration.
Journal of the International Neuropsychological Society, 2010
This study examines rates of reporting of new or worse post-traumatic symptoms for patients with ... more This study examines rates of reporting of new or worse post-traumatic symptoms for patients with a broad range of injury severity at 1 month and 1 year after traumatic brain injury (TBI), as compared with those whose injury spared the head, and assesses variables related to symptom reporting at 1 year post-injury. Seven hundred thirty two TBI subjects and 120 general trauma comparison (TC) subjects provided new or worse symptom information at 1 month and/or 1 year post-injury. Symptom reporting at 1 year post-injury was compared in subgroups based on basic demographics, preexisting conditions, and severity of brain injury. The TBI group reported significantly more symptoms at 1 month and 1 year after injury than TCs (each p < .001). Although symptom endorsement declined from 1 month to 1 year, 53% of people with TBI and 24% of TC continued to report 3 or more symptoms at 1 year post-injury. Symptom reporting in the TBI group was significantly related to age, gender, preinjury alc...
Three modifications were made to the Sickness Impact Profile, a behavior-based measure of health ... more Three modifications were made to the Sickness Impact Profile, a behavior-based measure of health status, to improve its sensitivity to the effects of head injury. (1) Additional items were included to capture head injury sequelae and behaviors typical of young adults, the age group to which head injury most frequently occurs. (2) Subjects individually excluded behaviors irrelevant to them, thus allowing the score to better reflect injury-related changes. (3) The different areas of functioning on the Sickness Impact Profile were reweighted to reflect global judgments of the construct&#39;s contribution to overall functioning rather than the sum of the item contributions. Only the first modification is head-injury specific. The others, are relevant to any disease or injury. The performance of the modifications was evaluated in a longitudinal study of 102 head injured and 102 comparison subjects tested at 1 and 12 months after injury. The evaluation of the modifications was based on their ability to distinguish head injury from comparison subjects and on the strength of their relationship with measures of brain dysfunction. Despite a few statistically significant improvements in discrimination, differences of a practical degree were not obtained. The standard Sickness Impact Profile performed well and is recommended for evaluation of day-to-day functioning in head injury studies.
Journal of Clinical and Experimental Neuropsychology, 2001
While most would agree that mild traumatic brain injury (TBI) is associated with early neuropsych... more While most would agree that mild traumatic brain injury (TBI) is associated with early neuropsychological problems, disagreement exists regarding their persistence and whether they are the cause of the disabilities experienced by some people. The aim of this study was to examine how the criteria used to define mild TBI and how the pre-injury characteristics of people affect their neuropsychological outcome. A total of 157 unselected hospitalized cases with Glasgow Coma Scale scores of 13-15 and 109 trauma controls were prospectively recruited and administered a number of cognitive measures at 1 month and 12 months after injury. The results indicated early impairments that decreased with time and the stringency of the definition of &#39;mild&#39; TBI. The contribution of demographics was usually significant and often stronger than the mild TBI effect. Subtle variation of the demographics of the brain injured or the comparison subjects can be sufficient to mimic or mask mild brain injury effects.
JAMA: The Journal of the American Medical Association, 1991
... Sureyya S. Dikmen, PhD; Nancy R. Temkin, PhD; Bonnie Miller, MS; Joan Machamer, MA; H ... Fro... more ... Sureyya S. Dikmen, PhD; Nancy R. Temkin, PhD; Bonnie Miller, MS; Joan Machamer, MA; H ... From the Departments of Rehabilitation Medicine (Dr Dikmen and Mss Miller and Machamer), Neurological Surgery (Drs Dikmen, Temkin, and Winn) and Biostatis-tics (Dr Temkin ...
Objective The Functional Status Examination (FSE) is a comprehensive measure of functional status... more Objective The Functional Status Examination (FSE) is a comprehensive measure of functional status post-traumatic brain injury (TBI) that has primarily been used in studies of moderate-to-severe TBI. The present observational study examines functional status using the FSE among patients who sustained mild TBIs (mTBIs; defined as Glasgow Coma Scale [GCS] = 13–15 at admission) seen in a Level 1 trauma center. Study aims included examining the course of functional status following mTBI, as well as exploring relationships of the FSE and other relevant constructs among those with GCS = 13–15. Method Participants were assessed at 2 weeks (n = 112), 3 months (n = 113), 6 months (n = 106), and 12 months (n = 88) post-injury for changes in functional status resulting both (a) from all injuries and (b) from TBI only. Results Among seven domains of day-to-day functioning, participants generally experienced the greatest disruption in their primary activity (work or school) and in leisure and rec...
The assessment of functional status after traumatic brain injury (TBI) is important. The Glasgow ... more The assessment of functional status after traumatic brain injury (TBI) is important. The Glasgow Outcome Scale (GOS) and its revised version, the Glasgow Outcome Scale Extended (GOSE), have been used most frequently in TBI research, but there are concerns about the sensitivity of these measures. The current study evaluated the psychometric properties of the Functional Status Examination (FSE) using a sample of 448 moderately to severely injured subjects with TBI. It was shown that the FSE is significantly related to other measures of functional status including the GOSE, Short Form Health Survey, and European Quality of Life Checklist (p < 0.001), is sensitive to TBI severity (p < 0.001), and is responsive to recovery from 3 to 6 months post-injury (p < 0.001). In addition, there was a significant agreement (r = 0.817, p < 0.001) between the patient and significant other's assessment of functional status on the FSE at 6 months post-injury. The FSE may be a valuable m...
OBJECTIVE. This study investigated performance of home management activities 1 year after traumat... more OBJECTIVE. This study investigated performance of home management activities 1 year after traumatic brain injury (TBI), as reported on the Functional Status Examination. METHOD. Home management performance of 164 rehabilitation inpatients (mean age 35.4 years, 77% men, 75% white) with moderate to severe TBI was examined in relation to demographics, injury severity, neuropsychological functioning, and living situation. RESULTS. Fifty-nine percent reported more difficulty or more assistance with home management at 1 year. Nonperformance of individual activities before injury ranged from 16% to 76%. Age (p = .001), living situation after injury (p = .002), and neuropsychological function at 1 year (p = .001) were associated with more limited home management performance after injury as compared to premorbid function. CONCLUSIONS. Home management is challenging 1 year after TBI, especially for older adults and those with greater cognitive impairments. Accurate preinjury information is ne...
(38%); other neurologic condition 6 (10%). Interventions: BoNT-A (total dose: Dysport 150-1000 un... more (38%); other neurologic condition 6 (10%). Interventions: BoNT-A (total dose: Dysport 150-1000 units or Botox 50-200 units) injected according to presenting pattern of spasticity, followed by physical therapy interventions based on clinical judgement, including splinting, serial casting, positioning, functional electrical stimulation, and targeted task practice. Main Outcome Measures: The Arm Activity Measure (ArmA), the Modified Ashworth Scale (MAS) and Goal Attainment Scaling (GAS). Measurements were undertaken at baseline, 8 weeks, and 16 weeks. Results: Friedman tests were used to identify overall change between baseline and 16 weeks. Significant changes were demonstrated in MAS (Xr2 66.6; P .005); GAS (Xr2 74.2; P .005); and the ArmA passive function subscale (Xr2 11.9; P .005) (eg, improved ease of dressing, hygiene). No significant change was identified in the ArmA active function sub-scale. Comparison of change at individual time points weeks showed the improvement in passive function scores to be maintained at 16 weeks (Z -2.6; P .01), whereas MAS scores had reverted toward their original values. Conclusions: Although no significant change in active function was seen in this cohort, improvements in passive function were maintained at 16 weeks postinjection, after the effect on spasticity had subsided. The role of individual physical therapy interventions in maintaining functional gains after spasticity management with BoNT-A now requires further exploration.
Journal of the International Neuropsychological Society, 2010
This study examines rates of reporting of new or worse post-traumatic symptoms for patients with ... more This study examines rates of reporting of new or worse post-traumatic symptoms for patients with a broad range of injury severity at 1 month and 1 year after traumatic brain injury (TBI), as compared with those whose injury spared the head, and assesses variables related to symptom reporting at 1 year post-injury. Seven hundred thirty two TBI subjects and 120 general trauma comparison (TC) subjects provided new or worse symptom information at 1 month and/or 1 year post-injury. Symptom reporting at 1 year post-injury was compared in subgroups based on basic demographics, preexisting conditions, and severity of brain injury. The TBI group reported significantly more symptoms at 1 month and 1 year after injury than TCs (each p < .001). Although symptom endorsement declined from 1 month to 1 year, 53% of people with TBI and 24% of TC continued to report 3 or more symptoms at 1 year post-injury. Symptom reporting in the TBI group was significantly related to age, gender, preinjury alc...
Three modifications were made to the Sickness Impact Profile, a behavior-based measure of health ... more Three modifications were made to the Sickness Impact Profile, a behavior-based measure of health status, to improve its sensitivity to the effects of head injury. (1) Additional items were included to capture head injury sequelae and behaviors typical of young adults, the age group to which head injury most frequently occurs. (2) Subjects individually excluded behaviors irrelevant to them, thus allowing the score to better reflect injury-related changes. (3) The different areas of functioning on the Sickness Impact Profile were reweighted to reflect global judgments of the construct&#39;s contribution to overall functioning rather than the sum of the item contributions. Only the first modification is head-injury specific. The others, are relevant to any disease or injury. The performance of the modifications was evaluated in a longitudinal study of 102 head injured and 102 comparison subjects tested at 1 and 12 months after injury. The evaluation of the modifications was based on their ability to distinguish head injury from comparison subjects and on the strength of their relationship with measures of brain dysfunction. Despite a few statistically significant improvements in discrimination, differences of a practical degree were not obtained. The standard Sickness Impact Profile performed well and is recommended for evaluation of day-to-day functioning in head injury studies.
Journal of Clinical and Experimental Neuropsychology, 2001
While most would agree that mild traumatic brain injury (TBI) is associated with early neuropsych... more While most would agree that mild traumatic brain injury (TBI) is associated with early neuropsychological problems, disagreement exists regarding their persistence and whether they are the cause of the disabilities experienced by some people. The aim of this study was to examine how the criteria used to define mild TBI and how the pre-injury characteristics of people affect their neuropsychological outcome. A total of 157 unselected hospitalized cases with Glasgow Coma Scale scores of 13-15 and 109 trauma controls were prospectively recruited and administered a number of cognitive measures at 1 month and 12 months after injury. The results indicated early impairments that decreased with time and the stringency of the definition of &#39;mild&#39; TBI. The contribution of demographics was usually significant and often stronger than the mild TBI effect. Subtle variation of the demographics of the brain injured or the comparison subjects can be sufficient to mimic or mask mild brain injury effects.
JAMA: The Journal of the American Medical Association, 1991
... Sureyya S. Dikmen, PhD; Nancy R. Temkin, PhD; Bonnie Miller, MS; Joan Machamer, MA; H ... Fro... more ... Sureyya S. Dikmen, PhD; Nancy R. Temkin, PhD; Bonnie Miller, MS; Joan Machamer, MA; H ... From the Departments of Rehabilitation Medicine (Dr Dikmen and Mss Miller and Machamer), Neurological Surgery (Drs Dikmen, Temkin, and Winn) and Biostatis-tics (Dr Temkin ...
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