Findings suggest that assessing rehabilitation potential is a complex process that goes beyond strictly appraising patients' characteristics. Additional factors influence clinicians' perception of patients' rehabilitation potential. Clinicians should pay more attention to these factors when making evidence-based decisions regarding patients' potential to benefit from rehabilitation.
The objective of the study was to investigate the factorial validity and internal consistency of the Instrumental Activities of Daily Living (IADL) Profile. A group of 96 patients aged 16 to 65 years, with moderate to severe traumatic brain injuries, was recruited from 12 rehabilitation hospitals in Quebec. The IADL Profile was administered by an occupational therapist in each subject's home and community environment. Principal axis factoring and confirmatory factor analysis provide preliminary support for six correlated factors (F): (F1) going to grocery store/shopping for groceries, (F2) having a meal with guests/cleaning up, (F3) putting on outdoor clothing, (F4) obtaining information, (F5) making a budget, (F6) preparing a hot meal for guests. Total explained variance was 73.6%. Cronbach's alpha analysis revealed high to very high internal consistency for all scales ranging from .81 to .98; internal consistency of the total scale was very high (0.95). The findings suggest that the IADL Profile is a promising means of documenting both IADL independence and the repercussions of executive function deficits on everyday tasks in real-world environments.
Symptoms persisting beyond the acute phase (>2 months) after a mild traumatic brain injury (MTBI) are often reported, but their origin remains controversial. Some investigators evoke dysfunctional cerebral mechanisms, while others ascribe them to the psychological consequences of the injury. We address this controversy by exploring possible cerebral dysfunction with functional magnetic resonance imaging (fMRI) and event-related potentials (ERP) in a group of patients during the post-acute phase. Fourteen MTBI symptomatic patients (5.7±2.9 months post-injury) were tested with fMRI and ERP using a visual externally ordered working memory task, and were compared with 23 control subjects. Attenuated blood oxygen level dependent (BOLD) signal changes in the left and right mid-dorsolateral prefrontal cortex (mid-DLPFC), the putamen, the body of the caudate nucleus, and the right thalamus were found in the MTBI group compared with the control group. Moreover, symptom severity and BOLD signal changes were correlated: patients with more severe symptoms had lower BOLD signal changes in the right mid-DLPFC. For ERP, a group×task interaction was observed for N350 amplitude. A larger amplitude for the working memory task than for the control task was found in control subjects, but not in MTBI subjects, who had weak amplitudes for both tasks. This study confirms that persistent symptoms after MTBI cannot be uniquely explained by psychological factors, such as depression and/or malingering, and indicates that they can be associated with cerebral dysfunction. ERP reveals decreased amplitude of the N350 component, while fMRI demonstrates that the more severe the symptoms, the lower the BOLD signal changes in the mid-DLPFC.
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