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Industry: Email Alert RSS FeedTraumatic brain injury occurring with spinal cord injury: significance for rehabilitation
Journal of Rehabilitation, April-June, 1993 by Mary Alice Povolny, Steven P. Kaplan
Providing further evidence of cognitive impairment among persons with recent SCI, Stutts, Kreutzer, Barth, Ryan, Hickman, Devany and Marwitz (1991) collected neuropsychological and demographic data in addition to administering a comprehensive battery of 11 neuropsychological tests on 89 persons with recent SCI. Between one-fourth and one-half of the subjects demonstrated impairment in most areas of cognitive functioning.
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The literature makes a convincing case that brain injury is often concomitant with traumatic SCI. However, neurological evaluation and radiographic work-up of suspected head injury is not performed consistently with this population (Davidoff, Morris, Roth & Bleiberg, 1984). A retrospective study of closed head injury in SCI revealed that loss of consciousness (LOC) was assessed in only 67% of all rehabilitation hospital admissions and 87% of all emergency room admissions (Davidoff et al., 1984). Fewer than 25% of all patients in both settings were assessed for post-traumatic amnesia (PTA); LOC of 20 minutes' duration or a PTA lasting 24 hours have been associated with deficits in concentration, attention, memory, and higher-level cognitive functions (Jennett, 1972).
Neuropsychological
Assessment Procedures
Given the motor impairment characteristically seen in SCI, special considerations are necessary to assess neuropsychological status in this population. One method relies on modified batteries that eliminate the tests' motor requirements. The previously discussed studies utilized several combinations of instruments with modifications for motor impairment. Motor free scales most frequently used included the Halstead Category Test (Davidoff et al., 1985; Richards et al., 1988; Roth et al., 1989), Weschler Memory Scale and Associate Learning Tests (Wilmot et al, 1985; Richards et al, 1988; Roth et al., 1989), the Rey Auditory Verbal Learning Test (Richards et al., 1988; Roth et al., 1989) and the Stroop Color/Word Test (Wilmot et al., 1985; Richards et al., 1988). Other tests meeting motor free criteria include the Galveston Orientation and Amnesia Test (GOAT), Quick Test, Raven Progressive matrices, serial 7s, and the Shipley Hartford (Wilmot et al., 1985). Richards et al. (1988) also included the Benton Visual Retention Test, Benton Facial Recognition Test, Benton Judgment of Line Orientation Test, Russell Memory Test, Controlled Oral Word Association Test and Selective Reminding Task.
Research is limited as to the utility of these measurement tools in determining closed head injury in patients with SCI. However, Davidoff, Doljanac, Berent, Johnson, Thomas, Dijkers and Klisz (1988) conducted a study aimed at exploring the appropriateness of the Galveston Orientation and Amnesia Test (GOAT; Levin, O'Donnell & Grossman, 1979; Levin, Benton & Grossman, 1982) in establishing the diagnosis of head injury among persons with SCI. The GOAT consists of questions relating to orientation and memory such as "where were you born?; describe the last event you recall before the accident", etc. Davidoff et al. (1988) serially administered the GOAT to a group of inpatients over a period of several days. Based on a review of medical records alone, 23% of the patients were shown to have sustained a LOC and 20% experienced a period of PTA. The researchers found that the GOAT increased the demonstrable rate of PTA for 20% to 44% of the subjects. Davidoff et al. (1988) concluded that utilization of the GOAT inventory increased the sensitivity of the assessment of PTA, which becomes an indicator for further assessment of head injury.
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