Developing a Cognition Scale Using Items from Three Federally Mandated Assessments in Post-Acute Care

The purpose of this work is to create a cognitive measure detecting change in cognitive deficits for post-acute stroke patients. Many individuals with stroke experience cognitive impairment contributing to ongoing disability. Identifying change in cognitive skills in response to treatment is important for demonstrating the value of rehabilitation services. Yet, the ability of federally mandated post-acute assessments to detect change has not been described. A total of 147 stroke patients in post-acute care receiving rehabilitation services were assessed using 26 cognition items from the federally mandated assessments. Rasch analysis, using the partial credit model, was conducted to evaluate the construct validity of these items. The standardized effect size (ES), response mean (SRM), and minimal detectable change (MDC) were calculated using MedCalc. Six items created a logical hierarchy for the cognition construct. Two items--long-term and short-term memory—represented the easiest and hardest items, respectively. The remaining items are problem-solving, memory, decision-making, and cognitive function. Evidence of good construct validity: Eigenvalue=2.13, unexplained variance in first contrast=7.5%, and person separation reliability of 0.87, person strata=3.8. Evidence of person-item alignment: adequate person fit, moderate ceiling effect, and person mean=1.53. Evidence of responsiveness: improvers (n=74) large ES 0.72, large SRM 1.19, 10% of patients made a change beyond the MDC. The six identified cognitive items from the federally mandated post-acute care assessment tools represents a continuum of cognitive performance areas, from foundational arousal skill through higher level problem-solving. Advancing meaningful, precise cognitive assessment will help identify effective occupation-based cognitive skill training strategies for stroke survivors

Communication Among Multidisciplinary Team Members Treating Patients with Disorders of Consciousness Following Traumatic Brain Injury

The purpose of this research is to understand how clinicians who work with patients with disorders of consciousness (DoC) following traumatic brain injury (TBI) communicate about patients’ behavior regarding changes in consciousness. Communication and collaboration among multidisciplinary teams is central for person-centered rehabilitation and clinical progress. A deficiency in person-centeredness may decrease the quality of care a patient receives (Epstein & Street, 2007). This process is more complicated in patients with DoC since these patients are unable to participate in the dialog (Papadimitriou & Cott, 2015). This qualitative analysis explores unique challenges clinicians face communicating with team members when treating patients with DoC following TBI in inpatient rehabilitation. A grounded theory interview study explored how clinician’s perceive they communicate patients’ changes in consciousness with team members (Green & Thorogood, 2014). Three hospital systems recruited twenty-one clinicians who have experience working with DoC patients. Clinicians participated in semi-structured interviews with two trained interviewers. Interviews were audio-recorded, transcribed verbatim, and NVivo 11 Plus software was used for open coding. The team developed a codebook using thematic analysis and constant comparative strategies to finalize the codebook (Glaser, 1965). Three major themes emerged: 1) clinicians’ difficulty interpreting patients’ behaviors of change in consciousness, 2) a lack of confidence when selecting a treatment, and 3) an uncertainty of how to leverage caregivers’ interpretation of patients’ behaviors. For example, the data describes challenges clinical teams face in discharge planning. A social worker perceives the caregiver to agree on what it takes to bring their family member home while the occupational therapist did not share this perception. The social worker tried to convey to the team that the caregiver was equipped to take the patient home, “I was turning blue in the face communicating to the team that I did strongly feel that his [caregiver] had a reasonable expectation and an understanding of the severity of his deficit”. This exemplifies how each discipline has a different vantage point surrounding a complex task such as discharge planning. Communication challenges for clinicians treating patients with DoC were grounded within the three themes, which conveyed uncertainty with interpreting patients’ behaviors and linking it to clinical progress, a lack of research to support interventions, and being cautious when talking to family. Uncovering how clinicians make sense of patient’s behaviors and how they communicate these behaviors can aide in creating a foundation for improving the exchange of information and person-centered rehabilitation

Neurobehavioral Function in Adults Recovering Consciousness after Severe Traumatic Brain Injury: A Scoping Review

This scoping review aims to report the findings of current literature examining the assessment of neurobehavioral function and recovery along the continuum of disorders of consciousness (DOC) from coma to full consciousness. •This study is designed to capture the range of constructs researchers have used to measure NBF during recovery of consciousness. •The research question for this review was: “What constructs are most frequently used to assess neurobehavioral function in adults recovering consciousness after severe TBI?

Prescribing Multiple Neurostimulants during Rehabilitation for Severe Brain Injury.

Background. Despite a lack of clear evidence, multiple neurostimulants are commonly provided after severe brain injury (BI). The purpose of this study is to determine if the number of neurostimulants received during rehabilitation was associated with recovery of full consciousness or improved neurobehavioral function after severe BI. Method. Data from 115 participants were extracted from a neurobehavioral observational study database for this exploratory, retrospective analysis. Univariate optimal data analysis was conducted to determine if the number of neurostimulants influenced classification of four outcomes: recovery of full consciousness during rehabilitation, recovery of full consciousness within one year of injury, and meaningful neurobehavioral improvement during rehabilitation defined as either at least a 4.7 unit (minimal detectable change) or 2.58 unit (minimal clinically important difference) gain on the Disorders of Consciousness Scale-25 (DOCS-25). Results. Number of neurostimulants was not significantly (P \u3e 0.05) associated with recovery of full consciousness during rehabilitation, within one year of injury, or meaningful neurobehavioral improvement using the DOCS-25. Conclusions. Receiving multiple neurostimulants during rehabilitation may not influence recovery of full consciousness or meaningful neurobehavioral improvement. Given costs associated with additional medication, future research is needed to guide physicians about the merits of prescribing multiple neurostimulants during rehabilitation after severe BI