Objectives-To investigate the factor structure and psychometric properties of the neurobehavioural rating scale-revised (NRS-R) and to determine its usefulness in clinical trials. Methods-A consecutive series of patients sustaining severe closed head injury were evacuated to one of 11 large regional North American trauma centres and entered into a randomised, phase III, multicentre clinical trial investigating the therapeutic use of moderate hypothermia. Acute care personnel were blinded to outcome and outcome personnel were blinded to treatment condition. The Glasgow outcome scale (GOS) was the primary outcome measure. Secondary outcome measures included the disability rating scale (DRS) and the NRS-R. Results-Exploratory factor analysis of NRS-R data collected at 6 months after injury (n=210) resulted in a five factor model including: (1) executive/cognition, (2) positive symptoms, (3) negative symptoms, (4) mood/aVect, and (5) oral/motor. These factors showed acceptable internal consistency (0.62 to 0.88), low to moderate interfactor correlations (0.19 to 0.61), and discriminated well between GOS defined groups. Factor validity was demonstrated by significant correlations with specific neuropsychological domains. Significant change was measured from 3 to 6 months after injury for the total score (sum of all 29 item ratings) and all factor scores except mood/aVect and positive symptoms. The total score and all factor scores correlated significantly with concurrent GOS and DRS scores. Conclusions-The NRS-R is well suited as a secondary outcome measure for clinical trials as its completion rate exceeds that of neuropsychological assessment and it provides important neurobehavioural information complementary to that provided by global outcome and neuropsychological measures. (J Neurol Neurosurg Psychiatry 2001;71:643-651)
The Y-Model is used to teach evidence-based psychotherapy to mental health care trainees. We adapt the Y-Model to help teach psychotherapy to providers in medical settings (e.g., physicians, nurses, dietitians, physical therapists, etc.). This elaboration of the Y-Model aids educators to help learners overcome multiple barriers that inherently exist as new psychotherapy concepts are being assimilated in medical settings. The stem of the Y-Model represents foundational therapeutic principles and techniques common to all psychotherapy approaches. One branch of the Y-Model represents cognitive-behavioral therapy (CBT) techniques, while the other represents psychodynamic therapy (PT). Because motivational interviewing (MI) is highly utilized in medical settings and share foundational therapeutic principles, we conceptually integrate MI with the stem of the Y-Model to present one cohesive, unified teaching model that utilizes high yield interventions in behavioral medical settings. Furthermore, helping the trainee to identify their default communication style also tends to improve learning of foundational psychotherapy principles. Theoretical differences, therapist relationships, and therapeutic techniques are outlined and contrasted in user-friendly charts to facilitate teaching and learning. Finally, a case example demonstrates how this model is applied with behavioral medicine providers.
The Wechsler Adult Intelligence Scale-Revised as a Neuropsychological Instrument (WAIS-R NI) provides methods to uniformly interpret atypical responses or response patterns. To date, little research has examined the primary population for which the supplemental measures of the WAIS-R NI were intended. The purpose of the present study was to compare the performance of individuals with brain injuries versus healthy adults on the supplemental measures of the WAIS-R NI. Forty-nine healthy adults and 45 individuals with brain injuries were tested. MANOVA indicated a significant main effect for group membership and the results suggest the WAIS-R NI supplemental measures differentiate individuals with brain injuries from healthy adults.
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