Malec, James F.

Objective: To present a method for examining associations among items and total T-score for the Mayo-Portland Adaptability Inventory (4th edition; MPAI-4) that can assist in rehabilitation planning. Setting: Advanced postacute brain injury rehabilitation programs. Method: Description and presentation of a rehabilitation planning guide based on Rasch analysis of the MPAI-4 and application in 2 cases of participants with traumatic brain injury. Results: Initial individualized rehabilitation treatment recommendations derived from examination of the rehabilitation planning guide for specific participants are described. Conclusions: Systematic examination of a visual depiction of associations among MPAI-4 items and total T-score identified through Rasch analysis is useful for rehabilitation planning and in communication and education with participants and families.

This study aims to characterize the patterns of functional change experienced between 5 and 10 years after moderate-severe traumatic brain injury (TBI). The study included TBI Model Systems national database participants ( N = 372) at six sites who experienced TBI, received inpatient rehabilitation, and were followed at 5 and 10 years post-TBI. Outcome measures included self- or proxy-reported Functional Independence Measure (FIM TM ) structured interview at 5 and 10 years post-TBI and domain change indices (DCIs) at 10 years to assess subjective change over the previous 5 years. When all seven FIM and subjective DCI subscales were considered together, 69% reported improvement in at least one subscale and 41% reported decline in at least one subscale; 51% reported more domains improved than declined, and 20% reported more domains declined than improved. Age at injury, post-traumatic amnesia duration, FIM, and depression and anxiety at year 5 were associated with FIM change and DCI measures. Although most persons with moderate-severe TBI do not experience widespread change from year 5 to 10 on individual FIM subscales or perceived domain-specific subscales, the vast majority do report change in one or more domains, with more improvement than decline and more change in subjective DCI than in FIM. Clinicians and researchers should be alert to the possibility of both positive and deleterious changes many years after TBI.

Objective: To review principles of person-centered, participation-oriented (PCPO) rehabilitation and introduce their implementation in Veterans Administration (VA) Polytrauma Transitional Rehabilitation Programs (PTRPs). Background: Post–hospital rehabilitation for individuals with acquired brain injury (ABI) has evolved toward PCPO rehabilitation, an approach that makes participation goals identified by the person served and his or her significant others the primary focus of rehabilitation. Goals to reduce impairments and increase activities contribute to the achievement of primary participation goals. Research, primarily in the nonveteran population, confirms the effectiveness of PCPO rehabilitation. Overview: In the civilian sector, PCPO programs are generally provided locally or regionally in outpatient or community settings to individuals with moderate-severe ABI associated with other traumatic injuries and comorbidities. Because of the geographical dispersion of veterans, the VA provides these services in residential centers serving larger geographical areas. The group of veterans served more often has sustained milder traumatic ABI associated with neuropsychiatric comorbidities, particularly posttraumatic stress disorder and depression. Measuring progress and outcome is important to establish a feedback loop for process improvement. VA PTRPs use state-of-the-science standardized outcome measures and methods for identifying successful cases, that is, the minimal clinically important difference. Vocational reintegration is an important element of PCPO rehabilitation. Articles in this special section detail the development and effectiveness of PTRPs.

The present analyses provide separate norms for persons ages 56 to 93 years for each story from the Logical Memory subtests of the revised edition of the Wechsler Memory Scale. Norms for immediate (I) and delayed (II) trials are presented. Following our past Mayo's Older Americans Normative Studies (MOANS) methods, we established the need for age adjustments (but not education adjustments) based on multiple regression analyses. Norms with added reliability based on the method of overlapping intervals were developed. We present means and standard deviations for 3-year interval age groups from age 61 to 88 years.