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Is it possible to assess a person’s thinking skills a month after a moderate-severe TBI?

Categories: Cognitive Assessments - Thinking and Emotional Skills

The Question

Is it possible to assess a person’s thinking skills a month after a moderate-severe traumatic brain injury?


Brief Neuropsychological Assessment During Acute Rehabilitation

Early Studies

The typical practice has been to assess thinking skills (such as concentration, memory, and reasoning) only after a person has become oriented following a moderate-severe TBI. The thinking was that assessment earlier than this would not be valid because the person was still too confused. Unfortunately, following this rule means that people may not be assessed for many weeks, and sometimes months, after a TBI. There is often a need to evaluate people during acute rehabilitation to assist with treatment and discharge planning. This study was undertaken to determine if people about a month after a moderate-severe TBI can complete a short battery of objective tests to evaluate thinking skills, even in the presence of confusion.

This study

This study included 403 people receiving acute rehabilitation for moderate-severe TBI at one of six sites across the US. The tests administered included the Galveston Orientation and Amnesia Test (evaluating orientation to self, time, and place), the California Verbal Learning Test-II (evaluating verbal learning and memory), the Trail Making Test A and B (evaluating response speed and flexibility in thinking), the Symbol Digit Modalities Test (evaluating response speed), the Verbal Fluency Test (evaluating word retrieval and thinking speed), the Grooved Pegboard Test (evaluating fine motor skills with each hand), the Wisconsin Card Sorting Test-64 (evaluating problem solving skills), and the Wechsler Test of Adult Reading (evaluating reading accuracy). People were assessed within 2 to 6 weeks after injury (creating a window of 2 weeks around one month after injury). Forty-nine people could not participate in that window because they were not conscious or were so severely impaired they could not interact sufficiently. For the remainder of the sample (354 people) the battery administration required an average of 66 minutes and all tests could be administered to 70%. The remainder could complete some tests, but not all. Performance on the tests was often poor, reflecting impairment in thinking skills caused by the TBI, but in some cases fell in the low average range. Even people who were confused (disoriented) when the administration took place were able to complete tests. This means that people can be evaluated a month after moderate-severe TBI; there is no reason to wait until confusion clears.

Who May Be Affected By These Findings

People with traumatic brain injury, care providers in acute rehabilitation.


People completing tests at this stage of recovery will often perform poorly and some are not able to perform at all. This is still valuable information in terms of measuring the severity of the injury and predicting an outcome.

Bottom Line

It is possible to administer a brief battery of tests to assess thinking skills a month after a moderate-severe TBI even if the person is still confused.

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Find This Study

Kalmar, K, Novack, TA, Nakase-Richardson, R, Sherer, M, Frol, AB, Gordon, WA, Hanks, RA, Giacino, JT, Ricker JH. Feasibility of a brief neuropsychologic test battery during acute inpatient rehabilitation after traumatic brain injury. Archives of Physical Medicine and Rehabilitation 2008; 89: 942-949.

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