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Biomedical subjects

J D Corrigan

Publications and source records attributed to J D Corrigan.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1985

Amitriptyline for agitation in head injury.

Agitated behavior is frequently associated with traumatic closed head injury. Proactive behavioral intervention is often not successful, and psychopharmacologic agents may result in increasing the targeted behavior through sedation. We describe a 32-year-old woman who developed severe agitation after frontal lobe closed head injury. After failing conservative behavioral management, a therapeutic trial of amitriptyline was initiated. Within two weeks, aggressive outbursts nearly ceased and attention span improved. Serial neuropsychologic assessment before and during amitriptyline therapy documented preservation of cognitive indices along with improvement in Trailmaking tasks. This case suggests that a trial of amitriptyline or other tricyclic antidepressant may be helpful in diminishing agitation associated with frontal lobe damage without impeding cognitive recovery.

Adult↗
PubMed1985

Reality orientation for brain injured patients: group treatment and monitoring of recovery.

A reality orientation group for brain injured patients was developed to improve attention deficits, confusion and anterograde amnesia during post-traumatic amnesia (PTA). Seven behavioral objectives are used to define adequate orientation, attention, immediate retention, episodic recall and use of memory aids. Daily performance in each of these areas is aggregated to establish a weekly summary score. Inter-rater reliability was found to be 0.875. The weekly aggregate score assesses recovery during PTA with increases corresponding to qualitative changes in patient progress. This weekly score has proven valuable as a management tool in rehabilitation by indicating when advanced training is warranted, whether a plateau in progress has been reached and when deterioration may be occurring.

Adolescent↗
PubMedDate not supplied

Vocational evaluation of traumatic brain injury patients using the functional assessment inventory.

Impaired work capacity is one of the most common residual impairments encountered after either a severe or moderate traumatic brain injury (TBI), yet no instrument is available for screening TBI victims regarding their readiness to participate in more comprehensive vocational planning and evaluation. In the study reported here, the Functional Assessment Inventory (FAI) was administered to 76 subjects who suffered a moderate or severe TBI and the results obtained were compared to the Rancho Los Amigos Hospital Levels of Cognitive Functioning, the Mini-Mental State and the Glasgow Outcome Scale for sensitivity in discerning vocational readiness. The results obtained indicated that the FAI composite score has the greatest discriminating power in screening the vocational readiness of this population, followed by the Glasgow Outcome Scale. In addition, the FAI cluster scores demonstrated reasonable discriminative ability, which may prove useful in directing ongoing remediation.

Adolescent↗
PubMedDate not supplied

The structure of head-injured patients' neurobehavioural complaints: a preliminary study.

Psychological functioning in 55 severely head-injured individuals was investigated in order to extend findings on the long-term nature of psychological sequelae after closed head injury. Results showed that head-injured subjects reported numerous psychological deficits many years post-injury, were psychologically distressed by their own report (Brief Symptom Inventory) and that of care-giving relatives (Katz Adjustment Scale--Relatives Version), and also exhibited a different pattern of coping from that of a normative group. A three-factor model of residual psychological complaints that contained a 'General Complaints' factor, a 'Somatization' factor and a 'Severity' factor was identified; this showed some similarity to a model proposed by van Zomeren and van den Burg (1985). Results indicate support for the 'coping hypothesis' of post-injury psychological deficits, although effects consistent with a 'gradations of severity' hypothesis were also present.

Activities of Daily Living↗
PubMedDate not supplied

The Neurobehavioural Rating Scale: replication in an acute, inpatient rehabilitation setting.

The Neurobehavioural Rating Scale (NRS) was developed to allow quantification of clinical observations of the behaviour of individuals following traumatic head injury. Initial validation of this instrument reported satisfactory interobserver reliability, as well as preliminary support for its validity in differentiating both severity and chronicity of head injury. In the present study, reliability and content validity of the NRS were replicated using a population of severe head injury patients undergoing inpatient rehabilitation. Concurrent, independent assessment using the NRS was conducted weekly by two members of an inpatient, traumatic head injury team. Acceptable levels of interobserver reliability were found, despite less control over observed behaviour in the naturalistic setting used. Content validity was also supported in this replication, although recommendations for 'tightening' the NRS included better definition of the seven-point severity rating for each item, as well as potential deletion of two items that contributed little to differential variance in the total NRS score. The NRS appears to be a promising clinical and research tool for assessing the neurobehavioural sequelae of traumatic head injury. Its strengths include efficiency of administration and the flexibility to administer through brief, structured interviews or observations in a naturalistic setting. Continued research on the NRS in different settings and with different populations is required to establish its validity.

Adolescent↗
PubMedDate not supplied

The ataxic subgroup: a discrete outcome after traumatic brain injury.

We have observed five individuals who appear to represent a unique subgroup of patients with traumatic brain injury (TBI). Because of the prominence of severe ataxia, this group has been labelled the 'ataxic subgroup'. These individuals are distinguished by both clinical course and outcome, including severe ataxia, prolonged coma and prolonged post-traumatic amnesia (PTA). They distinguish themselves from other severely impaired TBI patients in that they spend a relatively longer length of time prior to the establishment of volition, but progress rapidly through the period of confusion. We hypothesized that this group is unique in that they have suffered Grade III diffuse axonal injury (DAI) with no or minimal complications due to other primary or secondary brain damage. In order to investigate these hypotheses, a retrospective file review of a selected group of 72 patients was undertaken to determine the specificity and sensitivity of two diagnostic criteria. The existence of severe Grade III DAI without other primary or secondary brain damage was presumed if severe ataxia was present in conjunction with normal CT scans. Results of this review indicated that 33% of the population demonstrated severe ataxia, although only 11% also had normal CT scans. These dual criteria were neither adequately sensitive nor specific to define the five patients who comprised the 'ataxic subgroup'. When rate of clearing the confused period of PTA was added to the diagnostic criteria, specificity improved. Although this attempt to define this subgroup empirically was not entirely successful, further attempts to delineate this group are important in that prognosis for clearing PTA is good despite early indicators of poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Agitation, cognition and attention during post-traumatic amnesia.

During the early phases of recovery from traumatic head injury, the level of functional cognition and the presence of agitation in patients appear to co-vary. However, it has been observed that there appears to be some temporal disassociation in the recovery of cognition and agitation. The purpose of this study was to investigate the degree to which attention accounts for the co-variation previously observed. Over a 1-year period, 130 patient-weeks of independent monitoring of cognition, agitation and attention were obtained from 20 head-injured patients in the acute phase of recovery. Weekly scores for measures of cognition, agitation and attention were each found to share approximately 50% of the variance when paired with one of the other two. When attention was extracted, only 7% of the variation in cognition was accounted for by agitation, and 40% of the variance could not be accounted for by either agitation or attention. These results support previous findings that cognition and agitation co-vary with most of the co-variance due to the effect of attention on each. Concomitantly, these results allow that significant portions of the variance in cognition and agitation may be temporally dissociated during the acute phases of recovery from traumatic head injury.

Adolescent↗
PubMedDate not supplied

Predicting clearing of post-traumatic amnesia following closed-head injury.

The ability to predict the resolution of post-traumatic amnesia (PTA) early in the course of acute rehabilitation was studied in a sample of 98 closed-head injury (CHI) patients admitted for acute rehabilitation. The subjects' age, length of coma, time post-injury and Orientation Group Monitoring System (OGMS) subscale and aggregate scores were evaluated for the ability to predict if and when a patient would clear PTA. The results indicated that the combination of time post-injury and week one OGMS aggregate score provided the best prediction of whether and when PTA would clear. A shorter time from injury to acute rehabilitation was a positive prognostic indicator, accounting for more variance than either age or duration of coma. Whereas the aggregate OGMS score was a better indicator than any of the subscale scores, the results also suggested that specific aspects of cognition have differential predictive power, which may derive from different types of injury to the brain. Although the prediction model was statistically significant, its practical significance was limited. In particular, the high base rate for clearing PTA, 83.7%, attenuated the potential for differential prediction. Finally, this study provided additional support for the construct validity of the OGMS as a measure of cognitive function during the acute phase of recovery from CHI.

Adolescent↗