Use of the Tower of London – Drexel University, Second Edition (TOL^DX) in Adults With Traumatic Brain Injury

Abstract

The Tower of London - Drexel University, Second Edition (TOL(DX)) was investigated in order to determine the efficacy of using this instrument in evaluating the impact of traumatic brain injury on cognitive functioning in adults. Performance on the TOL(DX) was compared among 56 individuals with complicated mild to severe traumatic brain injury ("sTBI"), 68 individuals with uncomplicated, mild traumatic brain injury ("mTBI"), and 124 demographically matched, healthy controls. Both TBI groups performed worse than controls on TOL(DX) measures of executive time (ET) and number of moves used (TMS), but only patients with sTBI were more likely to be impaired on TMS (i.e., performing at least 1.5 SD below the mean). Poorer performance on TMS was associated with increasing length of coma. Although poor sensitivity of this measure limits its use in isolation, the TOL(DX) may provide a complementary measurement of aspects of problem-solving deficit in TBI that may not be captured by other tests.

Risk Taking in Hospitalized Patients with Acute and Severe Traumatic Brain Injury

“…Effects of severity of the head injury on risk taking in TBI patients. Previous work indicates that cognitive deficits such as executive dysfunction are related to severity of TBI [47,49,50]. This was not observed here.…”

“…This may explain the lack of group difference based on severity of the injury. Also, group difference based on the severity of the injury on cognitive skills has mainly been reported in chronic patients [47,[49][50][51]. It is possible that during the acute phase (as tested here), severity of the head injury does not consist of a critical factor on risk taking.…”

Response to Goal Management Training in Veterans with blast-related mild traumatic brain injury

“…The computerized TOL (cTOL) offers unique problems for each session, thus reducing the potential for practice effects associated with a repeated measure. A similar version of the TOL, the TOL DX (TOL-Drexel University) demonstrated that the execution time is impaired in mTBI compared with controls [27]. Levine et al demonstrated a significant change in the D-KEFS TOL subtest following GMT for a mixed neurological sample compared with a control group [15].…”