Relationship between the Neurobehavioral Cognitive Status Examination - Dissertation Example

Running head: COMPARING COGNITIVE EXAMINATIONS Relationship between the Neurobehavioral Cognitive Status Examination, the Functional Independence Measure, and the Patient Treatment Form in Traumatic Brain Injury Patients Abstract The purpose of this study is to examine the validity of the selected Patient Treatment Form (PTF) when used with traumatic brain injury patients. This assessment will be correlated with two other well normed and well researched assessments. These assessments will be the Neurobehavioral Cognitive Status Examination (Cognistat), and the Functional Independence Measure (FIM). Mental status examinations are a series of detailed but simple questions designed to test cognitive ability, including the patients state of consciousness, appearance and general behavior, mood, content of thought, and intellectual resources such as orientation with reference to time, place, and person and comprehension. If it is found that the PTF is correlated to the Cognistat and FIM (valid for measuring the brain injured population), this would give health professionals another tool to use in evaluating patients and providing rehabilitation services. Relationship between the Neurobehavioral Cognitive Status Examination, the Functional Independence Measure, and the Patient Treatment Form in Traumatic Brain Injury Patients The purpose of this study is to examine the validity of the selected Patient Treatment Form (PTF) when used with traumatic brain injury patients. The results of this study should provide evidence that the PTF is a valid indication of the brain injured populations cognitive functioning. In an effort to validate this assessment, two other well normed and well researched assessments will be used to conduct a comparison study. These assessments will be the Neurobehavioral Cognitive Status Examination (Cognistat), and the Functional Independence Measure (FIM), which are both widely used in by health care providers today. Cognition and Mental Status Exams Mental status examinations are a series of detailed but simple questions designed to test cognitive ability, including the patients state of consciousness, appearance and general behavior, mood, content of thought, and intellectual resources such as orientation with reference to time, place, and person and comprehension(Koelfan, Freund, Dinter, & Schmidt, 1997). The patient may be asked to remember objects that had been listed earlier in the course of the exam, repeat sentences, solve simple mathematical problems, or copy a three-dimensional drawing. When speech and language are tested, the examiner listens to the character and fluency of the speech, the patient’s ability to understand and carry out simple or complex commands, and to read and write. In addition to specific questions that make up the actual mental status exam, it is also important that the examiner observes the patient’s general behavior during the examination(Showalter, Chatham, & Netsky, 2000). The Assessments Being Compared The Patient Treatment Form The PTF being studied is an in-house form developed as a gauge for assessing cognitive issues and assisting staff towards effective rehabilitation. Though the assessment is being studied in this research for face and construct validity, more specific reliability and validity information will need to be obtained as the study is conducted. The PTF measures various areas of cognitive level through items relating to the pateint’s orientation, awareness, attention, memory, problem solving and reasoning, executive function, visual perception, comprehension, expression, and social / behavior emotional competencies. If it is found that the PTF is correlated to the Cognistat and FIM, this would give health professionals another tool to use in evaluating patients and providing rehabilitation services(Finch, Sandel, Mack, & Spivack, 1997). The Neurological Cognitive Status Examination The Neurological Cognitive Status Examination is a screening assessment that is used to determine cognitive ability. This assessment first uses a variety of independent tests to assess a patient’s level of consciousness, attention, and orientation. Then it evaluates the patients level of functioning in five cognitive ability areas. They are language, constructions, memory, calculations, and reasoning. If the patient passes the screening for a particular skill, then that skill is considered intact and no further testing of that specific skill is required. If the patient fails, a series of questions asked that will provide a quantitative evaluation of the level of disability. The Cognistat was designed to focus on the degree of disability. The test does not discriminate between average and superior performance, therefore, the range of scores within the non-disabled population is very small(Doninger, Bode, Heinemann, & Ambrose, 2000). At the end of the examination, there is space provided for the examiner’s explanation of an factors that may have affected the patient’s performance on the exam, such as medications the patient is taking, any sensory-motor deficits they may have, or performance anxiety. The Functional Independence Measure The Functional Independence Measure is well known throught the world of mental health and medicine. It is used to assess the burdon of care of patients who have suffered brain injury and may no longer be able to live without assistive care. This measure is often recommended for use in hospitals and mental health facilities for helping halth care workers in setting goals for patients during their rehabilitation. The Functional Independence measure measures 18 items across 6 different domains. These domains include self care, sphincter control, mobility, locomotion, communication, and social cognition. The individual is scored on an ordered scale of 7 down to 1 on each item in each domain. A score of 7 is achieved if the individual is able to perform the task independently and 1 indicates that the individual is fully dependent on another to complete the task. Originally the FIM had four levels and was developed from other instruments for assessing daily activities. Recently, wider range of levels was included in the assessment in order to be able to detect changes over a period of time(Piguet, King, & Harrison, 1999). The addition of three level gives the examination the ability to measure the extent to which ratings change when patients improve or deteriorate. The Functional Independence Measure has been recommended for use with stroke survivors and is considered to be the most appropriate one measure in this situation. FIM is one of the most widely used instruments of its kind. Literature Review There have been a number of studies and research conducted in the area of traumatic brain injury and how it is diagnosed. Borg et al. (2004) examined diagnostic procedures in mild traumatic brain injury by a systematic literature search. Their research found that there is little evidence for the diagnostic validity of cognitive testing and other diagnostic tools for mild traumatic brain injury. Hsueh, Lin, and Hsieh (2002)compared the reliability, validity, and responsiveness of the motor subscale of the functional independence measure (FIM), the original 10 item Barthel index (BI), and the 5 item short form BI (BI-5) in inpatients with stroke receiving rehabilitation. The results showed that the BI and FIM motor subscale had very acceptable and similar psychometric characteristics. The BI-5 appeared to have limited discriminative ability at admission, particularly for patients with severe disability; otherwise the BI-5 had very adequate psychometric properties. In another study compared the results of a medical examination, the proton magnetic resonance spectroscopy (H-MRS) to those of the Functional Independence measure. The purpose of this study was to determine whether H-MRS could be useful for the detection of a specific brain injury in TBI patients. According to results, the scores were significantly correlated (Yoon, S., Lee, J., Kim, S., & Chun, M. 2005). Research Method Participants The demographic sample will be randomly selected from a larger sample of patients admitted to a brain injury program at a rehabilitation hospital. All participants must be diagnosed with mild to severe head trauma. Each patient will be evaluated using the three forms mentioned. Etiology of injury will include motor vehicle accidents, assaults, falls, work related accidents, anoxia/hypoxia, sports or recreation-related accidents, penetrating head injuries, and disease. The statistics used will be a multiple regression comparing the cognitive items of the FIM, Cognistat, and the PTF. Instruments The PTF is utilized once a week by staff to subjectively evaluate each patient’s progress cognitively and ADL’s. The FIM is utilized by the staff to subjectively evaluate the patient upon admission to the rehabilitation hospital and discharge. The Cognistat is an objective tool utilized to evaluate the cognitive functioning of a TBI patient during the patient’s hospital stay. This study will compare the cognitive items of the Cognistat and cognitive items of the FIM against the cognitive items on the PTF form. If it is found that the PTF is correlated to the Cognistat and FIM (valid for measuring the brain injured population), this would give health professionals another tool to use in evaluating patients and providing rehabilitation services. Procedures This will be a retrospective study of TBI patients who were admitted to an inpatient rehabilitation unit from March 2004 through July of 2005 and referred for neuropsychological evaluation. This will be a quantitative, retrospective, study utilizing data (FIM, Cognistat, PTF) from a brain injured population at a rehabilitation institute from March 2004 to August 2005. . This study will be designed to assess the clinical utility and concurrent validity of the PTF with a TBI sample by determining the relationship of the PTF with other standard measures of cognitive functioning. Conclusion A comprehensive cognitive functioningl assessment requires the evaluation of a variety of different cognitive functions. Thus, these assessments often include tests that offer assessment to all of the areas of functioning that were discussed in this prospectus. Obviously, repeated cognitive functioning assessments allow the monitoring of cognitive functions over time. The cognitive functioning results provided by these assessments are generally used to provide indications as to whether a cognitive deficit associated with brain damage is changing and, if so, in what way. This gives professionals the knowledge they need to make informed decisions regarding a patients level of functioning and burdon of care. Given that the purpose of repeated assessments is to monitor changes in cognitive function over time, makes the reliability and validity measures of these tests that mush more important. Test–retest reliability gives an indication of how much variability can be expected between assessments. Knowing this information will provide a measure of how large an individual’s change in scores between two assessments will indicate significant improvement or decline. References Borg, J., Holm, L., Cassidy, J., Peloso, P., Carroll, L., Von Holst, H., et al. (2004). Diagnostic procedures in minld traumatic brain injury: results of the collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 36, 61-76. Crenshaw, S. (2002). A critical re-examination and analysis of cognitive ability tests using the Thornsike model of fairness. Journal of Occupational ans Organizational Psychology, 75(4), 489-500. Doninger, N., Bode, R., Heinemann, A., & Ambrose, C. (2000). Rating scale analysis of the neurobehavioral cognitive status examination. Journal of Head Trauma Rehabilitation, 15(1), 683-696. Finch, M., Sandel, M., Mack, A., & Spivack, G. (1997). Admission examination factors predicting cognitive improvemtn during acute brain injury rehabilitation. Brain Injury, 11(10), 713-723. Hammond, F., Hart, T., & Bushnik, T. (2004). Change and predictors of change in communication cognition after traumatic brain injury. Journal of Head Trauma Rehabilitation, 19(4), 314-329. Hsueh, J., Lin, J., & Hsieh, C. (2002). Comparison of the psychometric characteristics of the functional indepence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke. Journal of Neurology, Neurosurgery and Psychiatry, 73(2), 188-191. Koelfan, W., Freund, M., Dinter, D., & Schmidt, b. (1997). long term follow up of children with head injuries-classified as "good recovery". European Journal of Pediatrics, 156(3), 230-236. Mackintosh, S., Hill, K., Dodd, K., Goldie, P., & Culham, E. (2005). Falls and injury prevention should be part of every stroke rehabilitation plan: brain injury assessment. Clinical Rehabilitation, 19(4), 441-452. Piguet, O., King, A., & Harrison, D. (1999). Assessment of minimally responsive patients: clinical difficulties of single-case design. Brain Injury, 13(10), 9. Showalter, P., Chatham, K., & Netsky, D. (2000). Stimulating consciousness and cognition forllowing severe brain injury. Brain Injury, 14(11), 997-1002. Swirsky-Sacchetti, T., Field, H., & Mitchell, D. (1999). The sensitivity of the mini-mental state exam. Journal of Clinical Psychology, 48(6), 779-786. Wilczenski, F., Bontrager, T., & Ferguson, T. (2001). Functional independence measures for students with disabilities. Jouranl of Head trauma Rehabilitation, 42(8), 123-127. William, P., & Shapiro, J. (1999). Head injury and post-traumatic syndrome. View, 24(4), 153-159. Winstein, C. (2004). Why is the functional independence measure used to identify some rehabilitation needs in stroke victims when there are better tools? Physiotherapy Research International, 9(4), 182-185. Yoon, S., Lee, J., Kim, S., & Chun, M. (2005). Evaluation of traumatic brain injured patients in correlation with functional status. Clinical Rehabilitation, 19(2), 209-219. If you need to type anything after the reference list then start it on this page Read More