Transcript The Meyers Short Battery, as Seen through the Lens of the

The Meyers Short Battery
(MSB)
John E. Meyers, Psy.D.
Center for Neuroscience, Orthopedics &
Spine, Dakota Dunes, SD
Martin L. Rohling, Ph.D.
University of South Alabama, Mobile, AL
7/16/2015
Rohling & Meyers NAN 2004
1
Table of Contents
•
•
•
•
•
•
•
Philosophy of MSB
Development of MSB
Norms Development
Sensitivity and Specificity
LOC Dose Response
Profiles
Ecological Validity
7/16/2015
Rohling & Meyers NAN 2004
2
Philosophy of MSB
• MSB began as much longer battery of tests.
– Using Discriminate Function: Selected tests
that discriminated Normal from TBI.
– Did original study years ago.
7/16/2015
Rohling & Meyers NAN 2004
3
Philosophy of MSB
• Goal was to find the best/shortest battery
– Sensitive to Brain Injury
– Commonly used Tests, that most NPs know
– Originally a 6 hour battery cut to 2.5-3 hrs
• Mean for Litigants 2.89 SD = .63 hrs (n = 410)
• Mean for non litigants 2.86 SD = .68 hrs (n = 941)
– Tests were selected not only for sensitivity but
also ease of administration and scoring (i.e.
Category vs WCST).
7/16/2015
Rohling & Meyers NAN 2004
4
Testing Order for MSB
• Short WAIS-III
• Forced Choice (FC)
• Rey Complex Figure
(RCFT) - Copy
• Animal Naming
• 3 min recall of RCFT
• COWA
• Dichotic Listening
• N. Am. Adult Reading
(NAART)
• Sentence Repetition
• 30 min Recall of RCFT
7/16/2015
•
•
•
•
•
•
•
•
•
•
•
•
Recognition Trial of RCFT
(Break offered)
AVLT
JOL
Boston Naming
Finger Tapping
Finger Localization
Trails A & B
Token Test
AVLT 30 minute Recall
AVLT Recognition Trial
Booklet Category Test
Rohling & Meyers NAN 2004
5
Individual Tests in The MSB
•
•
•
•
•
•
•
PICTURE COMPLETION
DIGIT SYMBOL
SIMILARITIES
BLOCK DESIGN
ARITHMETIC
DIGIT SPAN
INFORMATION
– Ward 7 Subtest (Pilgrim, Meyers, et al., 1999)
7/16/2015
Rohling & Meyers NAN 2004
6
MSB Database
• Description of large patient sample
• (N = 2939)
• Descriptive Statistics
Min
Max
Mean Std. Deviation
AGE
6
99
43.3
20.9
ED
0
23
11.9
3.1
•Note: The individual with 0 years of education was from Mexico and
had not completed a single year of education.
7/16/2015
Rohling & Meyers NAN 2004
7
MSB Database
• Gender
– Female
– Male
1334
1605
• Handedness
– Right Handed
– Left Handed
7/16/2015
2583
356
Rohling & Meyers NAN 2004
8
MSB Database
• Ethnicity
–
–
–
–
–
–
7/16/2015
African American
Mixed Racial
Caucasian
Asian
Native American
Hispanic
64
41
2715
11
55
53
Rohling & Meyers NAN 2004
9
MSB Database
Diagnosis
Frequency
ADD/ADHD
Amnestic Disorder
Brain Stem CVA
72
6
16
Brain Tumor
Carbon Monoxide
56
11
13
7
72
6
Cerebellar CVA
Cerebral Palsy
Devel. Delay
Electrical
7/16/2015
Diagnosis
Frequency
Encephalitis
20
Epilepsy L Hemi
23
Epilepsy Pri Gen
Epilepsy R Hemi
24
Fibromialgia
12
Front Lobe Syn
15
Gun Shot Head
7
Rohling & Meyers NAN 2004
15
10
MSB Database
Diagnosis
Huntington’s
Hydrocephalus
Hypoxia/Anoxia
Learning Disability
Left CVA
Left Stenosis >80%
L Temp Lobectomy
Lupus
7/16/2015
Frequency
5
16
37
102
127
1
4
11
Diagnosis
Frequency
Mental Health
Mental Retardation
Multi-Infarct
Dementia
Multiple Sclerosis
Non-Specific Stroke
Non-Verbal
Learning Disability
Normal Controls
Parkinson's Disease
Rohling & Meyers NAN 2004
465
45
46
40
90
13
36
27
11
MSB Database
Diagnosis
Frequency
Prob. Alzheimer's
Prog. Supernuc. Palsy
105
1
Pseudo Dementia
Right CVA
R Temp Lobectomy
3
86
7
Sub-Cortical Dem.
Substance Abuse
38
38
7/16/2015
Diagnosis
Frequency
TBI-Blow to the Head
TBI-Motor Vehicle
Accident
Toxic Exposure
181
394
1
645
2939
Other/Mixed/Unkwn
Total
Rohling & Meyers NAN 2004
12
MSB Database
Mental Health Diagnoses
Primary or Secondary
Freq
•Adjustment DX
•Antisocial Person.
•Anxiety Disorder
3
11
60
•Bipolar
•Borderline Person.
•Rpt TBI - Dx Conv
•Rpt TBI - Dx Soma
•Chronic Pain Conv
52
10
77
•Chronic Pain Soma
78
7/16/2015
26
20
Primary or Secondary
•Chronic Pain
•Depression
•Eating Disorder
•Factitious
•Obsessive Person.
•Oppositional
•Personality NOS
•Schizotypal Person.
•Thought Disorder
Rohling & Meyers NAN 2004
Freq
93
248
1
2
4
16
9
1
49
13
MSB Database Normative Data
• Evaluating normative data, observed variation in test
norms, with age & education.
• AVLT normative data (Spreen & Strauss, 1998)
• M = 11.4 (SD = 2.4) for Trial 6 (IR) Age 30-39
• Now, at age 40, M = 10.4 (SD = 2.7).
• Individual with 10 on this test 1 day before DOB,
& then tested again 1 day after DOB, score (i.e.,
10) would improve from a 44T to 48T (using a
linear transformation).
• Using the Heaton et al. (1991) then score would
improve from Below Average to Average range
following 1 day.
– Common problem w/ non-smoothed normative data.
7/16/2015
Rohling & Meyers NAN 2004
14
MSB Normative Data
• Decided to smooth normative data
• Selected all subjects with validity scores
• 15 years or older
– 15 years selected as age for adult Trails A & B.
7/16/2015
Rohling & Meyers NAN 2004
15
MSB Normative Data
• Subgroup size n = 1727.
– Mean age = 45.7 (sd = 20.7)
– Education = 12.3 (sd = 2.7).
– Gender 779 female & 948 male
– 1543 RH (88%) & 184 LH (12%).
• Ethnicity of sample:
– 32 mixed
– 1617 were Caucasian
– 27 Native American
7/16/2015
22 African America
2 Asian
27 Hispanic.
Rohling & Meyers NAN 2004
16
MSB Normative Data
• Regression equation used:
– Raw score
– Variables, age, education, gender, hand, & race
– Predict T-score previously using standard
normative data.
7/16/2015
Rohling & Meyers NAN 2004
17
MSB Regression Norms
• Process smoothes data
– Also adds dimension of age, ed, sex, hand, &
ethnicity adjustment in patient sample.
• Normal sample, these variables not always sign.
• But injured group, these variables take on
important impact on scores.
7/16/2015
Rohling & Meyers NAN 2004
18
MSB Normative Data
• Therefore, regression equations change the
data (using prior example)
– Female age 39
– Score = 10 AVLT Trial 6 (IR) = 45 (T score)
– Also, 1 day after DOB score = 45 (T score)
7/16/2015
Rohling & Meyers NAN 2004
19
MSB Normative Data
Scale
R
R2
Trails A
.90
.81 .000 .000 (1363), p=1.00
Trails B
.87
.76
.000 -.088 (1354), p=.93
Judgment
.95
.89
.000 -.099 (1263), p=.92
Finger Tap DH
.96
.92
.000 -.079 (1599), p=.94
Finger Tap NDH
.95
.91
.000 .029 (1577), p=.98
Finger Loc DH
.87
.76
.000 .027 (1201), p=.98
*Token Test
.49
.24
.000 .008 (1534), p=.99
Sentence Repetition
.96
.92
.000 .040 (1253), p=.97
Cont Oral Word Assoc
.98
.96
.000 -.022 (1487), p=.98
Sig.
Paired Samples t Test
* Because of the skewedness of the data percentile scores were computed and transformed to T Scores for this test.
7/16/2015
Rohling & Meyers NAN 2004
20
MSB Normative Data
R2
Scale
R
Animal Naming
Boston Naming
.98
.90
.95
.81
.000 .099 (1366), p=.921
.000 72.90 (1312), p=.000
Dichotic Listen Left
Dichotic Listen Right
Dichotic Listen Both
Forced Choice
.89
.89
.92
.99
.79
.79
.85
.98
.000
.000
.000
.000
AVLT 1
AVLT 2
AVLT 3
.94
.95
.96
.88
.90
.92
.000 .034 (1470), p=.973
.000 .076 (1470), p=.940
.000 -.178 (1470), p=.859
AVLT 4
AVLT 5
AVLT Total
.94
.93
.94
.88
.87
.89
.000 -.024 (1469), p=.981
.000 -.008 (1469), p=.993
.000 .064 (1470), p=.949
7/16/2015
Sig.
Rohling & Meyers NAN 2004
Paired Samples t Test
-3.994 (1198), p=.000
-2.460 (1198), p=.014
-2.920 (1198), p=004
-1.065 (1131), p=.287
21
MSB Normative Data
R2
Scale
R
AVLT Distractor
AVLT Immediate
.93
.96
.87
.92
.000
.000
.057 (1467), p=.955
.103 (1468), p=.918
AVLT Delayed
AVLT Recognition
CFT Time
CFT Copy
CFT Immediate
CFT Delayed
CFT False Positive
CFT False Negative
CFT Recognition
.96
.89
.93
.88
.96
.97
.81
.99
.94
.92
.80
.86
.77
.93
.93
.66
.99
.88
.000
.000
.000
.000
.000
.000
.000
.000
.000
-.071 (1470), p=943
-.015 (1470), p=.988
-.075 (1657), p=.941
-.053 (1660), p=.958
-.077 (1658), p=.938
-.068 (1659), p=.946
-.027 (1657), p=.979
-.056 (1657), p=.956
.005 (1658), p=.996
Booklet Cat (Victoria)
.88
.78
.000
.024 (1290), p=981
7/16/2015
Sig.
Rohling & Meyers NAN 2004
Paired Samples t Test
22
MSB Data Children
• Same regression procedures used with
children with similar results.
• Sample size for children N = 348.
7/16/2015
Rohling & Meyers NAN 2004
23
MSB Regression Equations
Test
Age
Ed
Sex
Hand
Race
Raw Constant
Trails A
.26
-.97
-.34
.23
-.16 -.57
67.38
Trails B
JOL
.25 -1.29 1.55
.12 -.26 -2.75
-.76
-.16
-.37 -.17
-.13 1.95
66.41
7.90
FT Dominant
.16
-.55 -9.57
-.51
.06 1.17
6.85
FT NonDom
.10
-.53 -9.92
-.20
-.26 1.31
10.28
F Loc Dom
-.04
.14
-.26
-.94
.41 2.89
-29.00
F Loc NonD
-.05
.31
.36
-1.72
.67 2.26
-17.30
Sentence Rep
COWA
-.01 -1.03
.13 -.97
.18
.13
-.95
.02
-.04 6.70
-.29 .89
-35.37
20.98
.30
1.12
.01
-.50
-.40 2.12
.58 1.78
11.42
-65.27
Animal
Boston
7/16/2015
.14
.17
-.73
.47
Rohling & Meyers NAN 2004
24
MSB Regression Equations
Test
Age
Dichotic L
Dichotic R
Dichotic Both
Force Choice
AVLT 1
AVLT 2
AVLT 3
AVLT 4
AVLT 5
AVLT Total
AVLT Dist.
AVLT Recall
AVLT Delay
7/16/2015
.31
.33
.49
-.00
.28
.29
.32
.32
.33
.45
.30
.25
.28
Ed
-.13
.06
-06
.03
-.23
-.15
-.03
-.10
-.05
-.06
-.02
-.06
-.18
Sex
Hand
-.37
.50
-.46
-.13
6.25
3.18
5.97
4.51
5.63
6.79
1.32
4.55
6.00
-.34
-1.55
-1.37
-.04
-.08
-.04
-.66
-.19
-.46
-.50
-.34
-.04
-.14
Rohling & Meyers NAN 2004
Race
.68
.89
.41
-.05
-.12
.13
.17
.31
.18
.47
.08
.39
.06
Raw
2.89
3.25
2.65
5.87
6.54
5.03
4.87
5.02
5.30
1.34
5.86
4.08
3.83
Constant
-41.07
-55.68
-34.08
-56.79
-10.71
-11.26
-24.35
-27.88
-36.30
-46.42
.83
-10.97
-8.06
25
MSB Regression Equations
Test
Age
Ed
Sex
Hand
Race
Raw
Constant
AVLT Recog
CFT Time
CFT Copy
.19
.17
.24
-.12
-.39
-.14
1.87
-.33
.13
-.24
-.17
-.08
.05
.02
-.30
5.53
-.10
2.31
-36.67
70.86
-42.23
CFT Imm
.41
-.18
-.16
.20
.13
2.00
-7.11
CFT Delayed
.41
-.13
-.04
.80
.06
2.01
-8.82
CFT FP
.29
.11
.14
-.02 -1.30
-.55
-6.06
CFT FN
.13
.01
.06
-.09
-.02 -6.44
60.67
CFT Recogn
.14
.11
-.04
-.56
-.22
4.68
-55.00
Booklet Cat
.25
-.94
1.26 1.35
.29
-.35
59.99
7/16/2015
Rohling & Meyers NAN 2004
26
Norms for the Token Test
Adult Token Test
• Token Test only instrument in battery for
which regression procedure inappropriate.
• As a result, equipotential procedures used to
generate T scores for Token.
• See hand-out for T score conversions.
7/16/2015
Rohling & Meyers NAN 2004
27
MSB Recap
• Step 1: Took battery of well known NP Tests
– Tests with which most clinicians are familiar.
– Tests selected based on
• Utility
• ease of scoring
• assess wide array of functions
– Battery result several preliminary batteries.
7/16/2015
Rohling & Meyers NAN 2004
28
MSB Recap (cont’d)
• Step 2: Large database of S’s collected
– N = 2939
• Step 3: Examined norms for smoothing
• Data smoothed across battery for ages 6-99
– Separate norms for 6-14 and 15-99
– Adjusted for age, education, gender,
ethnicity, & handedness.
7/16/2015
Rohling & Meyers NAN 2004
29
MSB Recap (cont’d)
• Step 4. Recalculate database with new
norms (Step 3)
• Now on to Step 5
– Is this battery of tests valid?
7/16/2015
Rohling & Meyers NAN 2004
30
MSB
Step 5: Is this battery valid?
• Examine Reliability & Validity of MSB
– Meyers, J.E., & Rohling, M.L. (2004).
Validation of the Meyers Short Battery on Mild
TBI patients. Archives of Clinical
Neuropsychology, 19, 637-651.
• Study with 4 groups.
7/16/2015
Rohling & Meyers NAN 2004
31
Validity of MSB
• 30 Medical Controls, in hospital for non CNS
problem (i.e. ingrown toe nails) (Group 1)
– All community dwelling
– No Hx of LD, DD, Substance abuse, TBI, or
Mental Health problem, or anything that would
disqualify as Normal.
– M Age: 38.6 years (SD = 18.9) years.
– M Ed: 13.4 years of education (SD = 3.2).
– Gender: 15 male, 15 female.
– Handedness: 29 R handed & 1 L handed.
– Ethnicity: 29 Caucasian & 1 Native American.
7/16/2015
Rohling & Meyers NAN 2004
32
Validity of MSB
• Depressed Group (Group 2) 41 patients
–
–
–
–
–
–
–
7/16/2015
All on SSRI
M Age = 46.0 years (SD = 15.0)
M ed = 13.5 yrs (SD = 2.7)
Gender: 20 female & 21 male
Handedness: 38 RH & 3 LH
Ethnicity: 1 mixed; 40 Caucasian.
29 of these completed MMPI-2:
• L = 52.1 (SD = 11.4)1 = 63.8 (SD = 12.8)
• F = 60.5 (SD = 11.7) 2 = 70.8 (SD = 14.5)
• K = 50.2 (SD = 10.2) 3 = 66.7 (SD = 16.0)
Rohling & Meyers NAN 2004
33
Validity of MSB
• Chronic Pain = 32 cases treated outpatient.
– None involved in litigation time of assessment,
& no previous litigation.
– Individuals injured in non-work-related
accidents or on own farms
– Chose not to pursue workman’s comp.
7/16/2015
Rohling & Meyers NAN 2004
34
Validity of the MSB
Chronic Pain Group Continued
–
–
–
–
–
7/16/2015
M Age: 40.72 years (SD = 14.17)
M Education: 13.41 years (SD = 2.06).
Gender: 20 females and 12 males
Handedness: 29 R handed & 3 L handed
Ethnicity: 31 Caucasian & 1 Native American.
Rohling & Meyers NAN 2004
35
Validity of MSB
• Group 4 consisted of 59 individuals with history of
Traumatic Brain Injury (TBI).
– All individuals had been seen at the local hospital and
rehabilitation unit and followed through rehab.
– All had identified loss of consciousness (LOC) that
was 20 minutes or less, other data such as GCS and
PTA were not always available; however, LOC data
were available for all participants.
– LOC was defined as the time to follow commands
(e.g., Dikmen, et al., 1995; Volbrecht, et al., 2000).
7/16/2015
Rohling & Meyers NAN 2004
36
Validity of MSB
–
–
–
–
–
–
7/16/2015
M Age: 36.9 (SD = 15.1)
M Ed: 12.6 years (SD = 2.1).
Time Post Injury: 7.6 months (SD = 11).
Gender: 14 female & 43 were male
Handedness: 51 RH Dom & 6 LH Dom
Ethnicity: 2 mixed, 1 Hispanic & 54 Caucasian.
Rohling & Meyers NAN 2004
37
Validity of MSB
Test scores obtained for each of the study groups
Normal
NART
FSIQ
Barona et.
al FSIQ
7/16/2015
Depressed
Chronic Pain
Mild TBI
Mean
108.0
105.0
103.7
98.5
n
29
40
31
51
SD
8.3
8.6
8.0
6.0
Mean
105.6
105.6
106.3
103.7
n
30
41
32
57
SD
7.1
7.1
6.6
6.2
Rohling & Meyers NAN 2004
38
Validity of MSB
Test scores obtained for each of the study groups
Normal
WAIS VIQ
WAIS PIQ
WAIS FIQ
7/16/2015
Mean
n
SD
Mean
n
SD
Mean
n
SD
105.0
30
9.4
107.9
30
9.4
106.5
30
8.4
Depressed
103.2
41
12.9
100.2
41
12.9
101.6
41
11.0
Rohling & Meyers NAN 2004
Chronic Pain
102.3
32
11.2
107.6
32
11.2
105.2
32
10.8
Mild TBI
92.5
56
9.9
96.8
55
9.9
94.2
55
9.2
39
Validity of MSB
• Validity was assessed using a discriminant
function analysis comparing the Non TBI
participants with the TBI participants.
• The resulting function resulted in a 96.1%
correct classification rate with 98.9%
specificity and 90% sensitivity.
7/16/2015
Rohling & Meyers NAN 2004
40
Reliability of MSB
• Reflecting a general clinical sample,
• 63 persons with mixed diagnoses were assessed
more than once, with the first testing at least six
months post injury.
• Some in litigation, all passed all validity checks
• Group descriptive
• Age 38.38 years (SD = 22.8) Ed 12.2 (SD = 2.9)
7/16/2015
Rohling & Meyers NAN 2004
41
Test ReTest Reliability
• First Testing: Months post Injury 21.6
(SD = 22.8)
• ReTest: post injury 40.7 months
(SD = 33.2).
• Time between testing: 19.1 months
(SD = 16.6)
– range 2 to 91 months, and a median
months difference of 13 months.
• Reliability of r = .86
7/16/2015
Rohling & Meyers NAN 2004
42
MSB Correlation with CT/MRI
• From larger database 534 subjects had
CT/MRI data/Passed built in Validity
Checks (will Discuss later)
– Age M = 44.1 (SD = 20.4)
– ED M = 12.0 (SD = 2.81)
– Coded 1 or 0: Based on CT/MRI lesion; lobes
7/16/2015
Rohling & Meyers NAN 2004
43
CT/MRI
•
•
•
•
LF = Left Frontal
LP=Left Pariental
LT=Left Temporal
LO=Left Occipital
7/16/2015
•
•
•
•
RF=Right Frontal
RP=Right Pariental
RT=Right Temporal
RO=Right Occipital
Rohling & Meyers NAN 2004
44
Correlation CT/MRI with MSB
Test
LF
Picture Comp
Digit Symbol
Similarities
Block Design
Arithmetic
Digit Span
Information
Forced Choice
Animal Name
COWA
7/16/2015
LP
LT
LO
RF
RP
RT
RO
.010
.001
.000
.045
.005
.000
.000
.000
.002
.000
.029 .000
.049
.032
.035
.002
.003
.032
.030
Rohling & Meyers NAN 2004
45
Correlation CT/MRI with MSB
Test
LF
LP
LT
LO
Dichotic L
RF
RP
.000
Dichotic Both
.000
Sentence Rep
.044 .000
.002
.000 .009
Judge Line
.001
Boston Name
.000
Finger Tap D
.000
.000
Finger Tap Nd
.001
.016
Finger Loc Nd
7/16/2015
RO
.003 .001
Dichotic R
Finger Loc D
RT
.000
Rohling & Meyers NAN 2004
46
Correlation CT/MRI with MSB
Test
Trails A
Trails B
Token Test
Category Test
AVLT Trial 1
AVLT Total
AVLT Imm
AVLT Del
AVLT Recogn
CFT Copy
CFT Imm
CFT Del
CFT7/16/2015
Recog
LF
LP
LT
LO
RF
RP
RT
RO
.000
.007
.000
.001
.010
.017
.000
.025 .000
.044 .000
.033 .001
.000
.017
.008
Rohling & Meyers NAN 2004
.005
.006 .056
.008 .028
.007
47
MSB
• The MSB
• Assesses wide variety of cognitive areas,
corresponding with each lobe of the brain.
• Significant correlations
• Correlations were significant, but should
not be used as “localizing” info.
7/16/2015
Rohling & Meyers NAN 2004
48
Validity
• Meyers, J.E. & Volbrecht, M. E. (2003). A
validation of multiple malingering detection
methods in a large clinical sample, Archives
of Clinical Neuropsychology, 18, 261-276.
• Other publications
7/16/2015
Rohling & Meyers NAN 2004
49
Internal Validity Check (0% FP Rate cutoff)
Test/Method
Cutoff
•RCFT: MEP
•Reliable Digits
<= 3 (1 = Att, 2 = Encd, 3 =
Store, 4 = Retr/Other)
<= 6
•Forced Choice
<= 10
•Benton JLO
<= 12
•Token Test
<= 150
•Dichotic Listening Both
<= 9
•Sentence Repetition
<= 9
•AVLT-Recognition
<= 9
•FT-Estimated FT
<= -10
7/16/2015
Rohling & Meyers NAN 2004
50
Internal Validity Checks
• A total of 796 participants in the study, ages
ranged from 16 to 86, with education
ranging from 5 years to 23 years.
7/16/2015
Rohling & Meyers NAN 2004
51
Internal Validity Checks 15 Groups
• Non litigant TBI group LOC
<1 hr
• Non litigant TBI group LOC
>1 hour <24 hour
• Non litigant TBI group LOC
>24 hour < 8 days
• Non litigant TBI group LOC
> 9 days
• Non litigant group Chronic
pain
• Depressed group
• Litigants LOC < 1 hour
• Litigants LOC > 1 hour
7/16/2015
•
•
•
•
Litigants chronic pain
Normals
Institutionalized patients
Noninstitutionalized patient &
failed no more than 1 validity
check
• Noninstitutionalized and
failed 2 or more validity
checks (not in litigation).
• Noninstitutionalized and
failed 2 or more validity
checks and in litigation.
• Informed actors (portraying
role of a malingerer).
Rohling & Meyers NAN 2004
52
Internal Validity Checks
• It was found that the 9 neuropsychological
tests (when used together) were able to
correctly identify litigant and nonlitigating
groups. This method showed 83%
sensitivity and 100% specificity.
7/16/2015
Rohling & Meyers NAN 2004
53
Internal Validity Check
• This method showed 83% sensitivity and
100% specificity. A 0% false positive rate
was found.
7/16/2015
Rohling & Meyers NAN 2004
54
Domains used by the MSB
(N = 936)
• Attention and
Working Memory
–
–
–
–
–
7/16/2015
Forced Choice
Digit Span
Sentence Repetition
Animal Naming
AVLT 1
• Processing Speed/Mental
Flexibility
–
–
–
–
–
–
Digit Symbol
Dichotic Both
Trails A
Trails B
RCFT Time
COWA
Rohling & Meyers NAN 2004
55
Domains used by the MSB
(N = 936)
• Verbal Reasoning
–
–
–
–
–
–
–
7/16/2015
Arithmetic
Similarities
Information
Dichotic Right
Dichotic Left
Boston Naming
Token Test
• Visual Reasoning
–
–
–
–
–
Picture Completion
Block Design
JOL
Category
RCFT Copy
Rohling & Meyers NAN 2004
56
Domains used by the MSB
• Verbal Memory
–
–
–
–
7/16/2015
AVLT Total
AVLT Immediate
AVLT Delayed
AVLT Recognition
• Visual Memory
– RCFT Immediate
– RCFT Delayed
– RCFT Recognition
Rohling & Meyers NAN 2004
57
Domains used by the MSB
(N = 936)
• Motor and Sensory
–
–
–
–
7/16/2015
Finger Tapping Dominant Hand
Finger Tapping Non-Dominant Hand
Finger Localization Dominant Hand
Finger Localization Non-Dominant Hand
Rohling & Meyers NAN 2004
58
Domain Consistency
• N = 936
– Passed all Validity Checks
– No missing data
– Not involved in Litigation
• Calculated Domain Means
• Calculated Regression Equation to predict
each Domain Mean based on other Domains
7/16/2015
Rohling & Meyers NAN 2004
59
Domain Means Correlations All were Significant ( p < .001 )
1
2
3
4
5
6
7
8
9
10
.76 .71 .62 .56 .79 .68 .53 .54 .30 .28
1- Premorbid
.98 .81 .82 .84 .81 .77 .77 .54 .53
2- OTBM
.76
3- DTBM
.71 .98
4- Attention/Working Mem
.64 .81 .77
5- Proc. Speed/Mental Flex
.62 .82 .79 .64
6- Verbal Reasoning
.79 .84 .78 .69 .72
7- Visual Reasoning
.68 .81 .81 .54 .64 .64
8- Verbal Memory
.53 .77 .78 .68 .50 .54 .51
9- Visual Memory
.54 .77 .80 .53 .55 .55 .70 .62
10- Dom Motor/Sensory
.30 .54 .62 .37 .44 .36 .41 .34 .37
11- Non-Dom Motor/Sensory
.28 .53 .62 .31 .44 .30 .45 .32 .40 .53
7/16/2015
11
.77 .79 .78 .81 .78 .80 .62 .62
.64 .69 .54 .68 .53 .37 .31
Rohling & Meyers NAN 2004
.72 .64 .50 .55 .44 .44
.64 .54 .55 .36 .30
.51 .70 .41 .45
.62 .34 .32
.37 .40
.53
60
Domains Regression Equations
• Attention & Working Memory
– Verbal Reasoning * .315
– Verbal Memory * .273
– Processing Speed * .193
– Constant = 10.972
7/16/2015
Rohling & Meyers NAN 2004
61
Domains Regression Equations
• Processing Speed/ Mental Flexibility
– Verbal Reasoning * .401
– Visual Reasoning * .284
– Attention & Working Memory * .230
– Constant = 2.434
7/16/2015
Rohling & Meyers NAN 2004
62
Domains Regression Equations
• Verbal Reasoning
– Processing Speed * .361
– Attention & Working Memory * .354
– Visual Reasoning * .243
– Constant = 2.500
7/16/2015
Rohling & Meyers NAN 2004
63
Domains Regression Equations
• Visual Reasoning
– Visual Memory *.322
– Process Speed/Mental Flex * .213
– Verbal Reasoning * .208
– Constant = 11.813
7/16/2015
Rohling & Meyers NAN 2004
64
Domains Regression Equations
• Verbal Memory
– Attention & Working Memory * .738
– Visual Memory * .388
– Constant = -7.615
7/16/2015
Rohling & Meyers NAN 2004
65
Domains Regression Equations
• Visual Memory
– Visual Reasoning * .698
– Verbal Memory * .311
– Processing Speed * .091
– Constant = -5.517
7/16/2015
Rohling & Meyers NAN 2004
66
Regression
R
R2
Adjusted
R2
SE Estimate
Attent/Work Mem
.79
.63
.63
4.88
Processing Speed
.77
.60
.60
5.31
Verbal Reasoning
.80
.64
.64
5.04
Visual Reasoning
.78
.61
.61
4.88
Verbal Memory
.75
.56
.56
7.96
Visual Memory
.77
.59
.59
7.11
7/16/2015
Rohling & Meyers NAN 2004
67
Review So Far
• Took a battery of well known tests
• Developed Norms
• Identified Validity, Reliability, Sensitivity
and Specificity.
• Internal Validity Checks and Internal
Consistency
7/16/2015
Rohling & Meyers NAN 2004
68
The Meyers Short Battery, as
Seen through the Lens of the
Rohling Interpretive Method
John E. Meyers, Psy.D.
Center for Neuroscience, Orthopedics & Spine,
Dakota Dunes, SD
Martin L. Rohling, Ph.D.
University of South Alabama, Mobile, AL
7/16/2015
Rohling & Meyers NAN 2004
69
Neuropsychologist as
Diagnostician
• Most clinicians creatively approach
assessment based upon relevant knowledge
in cognitive neuroscience, clinical
neurology, and test development
– 85% of neuropsychologists recently surveyed
administer a flexible battery.
• Consequently, the omnibus “index scores”
generated from fixed batteries serve little
purpose.
7/16/2015
Rohling & Meyers NAN 2004
70
The Dilemma
• Insurance reimbursements are forcing the
reconsideration of index scores from fixed
batteries.
– Evidence based medicine
– Recent court rulings (e.g., Daubert, Kumho)
• These forces require the presence of
empirical support for diagnostic decisions
based upon neuropsychological testing.
7/16/2015
Rohling & Meyers NAN 2004
71
So Why Consider Index Scores?
• When diagnosis is essentially “yes or no,”
actuarial procedures consistently outperform
clinical decision-making and are more efficient
• However, the omnibus index scores from fixed
batteries are all we’ve got with established rates of
accuracy for identifying “brain damage.”
7/16/2015
Rohling & Meyers NAN 2004
72
Tough – I’m not about to start
giving the HRB because…
• It takes too long to give.
• It’s too psychometrically messy.
– The HRB does not allow separation of neurocognitive
constructs that can be delineated by newer tests.
• It’s too old.
– Norms are out-of-date, as are test materials.
• However, the HRB remains the gold standard,
as far as actuarial procedures for
neuropsychological assessment.
7/16/2015
Rohling & Meyers NAN 2004
73
The RIM Solution
• Wouldn’t it be cool if, for these
“yes – no” evaluations, we could
generate a meaningful summary
index based upon the scores
generated from a flexible battery?
7/16/2015
Rohling & Meyers NAN 2004
74
If such an index existed, it would have to be…
• As useful as common fixed battery indices.
– HII, AIR, & GNDS
• Able to incorporate different measures
without losing substantial utility.
• Practical for everyday clinical use.
• Easy to cross-validate across samples.
7/16/2015
Rohling & Meyers NAN 2004
75
RIM Based on Meta-Analysis:
What Is Meta-Analysis
• A statistical procedure for combining data
across empirical studies.
• Increases the signal-to-noise ratio by
combining true score variance while
distributing error variance.
• Facilitates the investigation of causality and
methodology that cannot be accomplished
by any single empirical design.
7/16/2015
Rohling & Meyers NAN 2004
76
Effect Size Calculations
Me
Mc
55
44
33
22
11
00
00
1010
2020
3030
4040
5050
6060
7070
8080
9090
100
100
• Cohen’s d =
(Me – Mc) / (SDpooled)
• Glass’s D =
(Me – Mc) / (SDc)
• Average effect sizes
across studies to get
more valid and reliable
results.
T Scores
7/16/2015
Rohling & Meyers NAN 2004
77
Sample RIM Summary Graph
100
90
80
70
T Score
60
50
40
30
20
7/16/2015
Rohling & Meyers NAN 2004
PM
PS
AW
VML
AML
EF
PO
VC
ITBM
DTBM
OTBM
EPGA
MC
EP
0
SV
10
78
RIM Summary Statistics: T-scores, variances, ES, & power.
R
O
W
Column #
1
2
3
4
6
5
7
8
9
11
12
1-group
t test
ANOV
A
S&W
Beta
M
sd
n
Hetero.
p value
Classify
%TI
1 Symptom Validity (SV)
28.9
19.6
10
.0002
Moderate
70%
-2.11 + 10.2
39.1
.0200
---
---
2 Emotional Personality (EP)
23.3
12.0
11
---
Mod-Sev
91%
-2.67
+ 6.0
29.3
< .0001
---
---
3 Meta-Cognition (MC)
42.4
10.9
9
---
Blw Avg
33%
-.76
+ 2.0
44.4
.0700
---
---
4 Est. Pre. Gen. Ability (EPGA)
61.4
5.7
5
---
Abv-Exl
0%
---
+ 4.1
57.3
---
---
---
5 Overall TBM (OTBM)
47.4
11.7
53
.09
Average
25%
-1.23
+ 2.6
50.0
< .0001
---
---
6 Domain TBM (DTBM)
46.5
8.0
7
---
Average
14%
-2.08
+ 5.0
51.5
.0030
.0341
---
7 Instrument TBM (ITBM)
45.6
10.0
10
---
Average
30%
-1.78
+ 5.2
50.8
.0005
---
---
8 Verbal Comprehension (VC)
61.2
9.5
5
---
Abv-Exl
0%
-.03
+ 7.0
68.2
---
S
---
9 Perceptual Organization (PO)
47.8
12.6
3
---
Average
33%
-1.57 + 12.0
59.8
---
---
.6010
10 Executive Functioning (EF)
45.8
8.4
14
---
Average
21%
-1.99
+ 3.7
49.5
< .0001
---
---
11 Auditory Memory & Learn (AML)
49.3
11.8
9
---
Average
22%
-1.19
+ 6.5
55.8
.0200
---
---
12 Visual Memory & Learn (VML)
42.7
15.1
10
.03
Blw Avg
50%
-1.44
+ 7.9
50.6
.0040
---
---
13 Attention/Working Memory (AW)
51.1
4.0
7
---
Average
0%
-2.17
+ 2.5
53.6
.0005
---
---
14 Processing Speed (PS)
38.4
10.6
5
---
Mild
40%
-2.70
+ 7.8
46.2
.0100
---
---
15 Psychomotor (PM)
34.8
5.6
6
---
Mld-Mod
83%
-4.71
+ 3.8
38.6
< .0001
---
---
16 Language/Aphasia (LA)
---
---
---
---
---
---
---
---
---
---
---
---
17 Sensory Perceptual (SP)
---
---
---
---
---
---
---
---
---
---
---
---
1
2
Cognitive Domain
ES
CI
PreM
Nec.
10
Significantly different from the normal population mean of 50 with a standard deviation of 10.
Significantly different from both the EPGA and the normal population mean of 50 with a standard deviation of 10.
7/16/2015
Rohling & Meyers NAN 2004
79
RIM Steps to Generate Summary
Scores & Interpret Data
1) Design & administer
battery.
2) Estimate premorbid
general ability.
3) Convert test scores to
a common metric.
4) Assign scores to
domains.
7/16/2015
5) Calculate domain M,
sd, & n.
6) Calculate test battery
means (TBM).
7) Calculate p for
heterogeneity.
8) Determine categories
of impairment.
Rohling & Meyers NAN 2004
80
RIM Steps to Generate Summary
Scores & Interpret Data
9) Determine % of test
impaired.
10) Calculate ES for all
domains and TBMs.
11) Calculate CI.
12) Determine the
upper limit of
performance.
7/16/2015
13) Conduct t tests.
14) Conduct a betweensubjects ANOVA.
15) Power analyses.
16) Sort scores.
17) Display summary
statistics.
Rohling & Meyers NAN 2004
81
RIM Steps to Generate Summary
Scores & Interpret Data
18) Assess battery
validity.
19) Examine influence
of psychopathology
20) Use OTBM,
DTBM, & ITBM
to determine if
impairment exists.
7/16/2015
21) Determine current
strengths and
weaknesses.
22) Examine noncognitive domains.
23) Explore for Type II
errors.
24) Examine sorted Tscores.
Rohling & Meyers NAN 2004
82
RIM Studies Related to MSB
• TBI Dose Response – MSB & HRB.
– Rohling, M. L., Meyers, J. E., & Millis, S. (2003).
Neuropsychological impairment following TBI: A dose
response analysis. The Clinical Neuropsychologist, 17, 289-302.
• RIM Analysis of the HRB.
– Rohling, M. L., Williamson, D. J., Miller, L. S., & Adams, R.
(2003). Using the Halstead Reitan Battery to diagnose brain
damage: A comparison of the predictive power of traditional
techniques to Rohling’s Interpretive Method. The Clinical
Neuropsychologist, 17, 531-544.
• Return to Work after Injury - MSB data used.
– Rohling, Meyers, & Blanton (in submission).
7/16/2015
Rohling & Meyers NAN 2004
83
Study 1: TBI Dose Response
• Summary statistics to generate ES’s from:
Dikmen, S. S., Machamer, J. E., Winn, H. R., & Temkin,
N. R. (1995). Neuropsychological outcome at 1-yr post
head injury. Neuropsychology, 9, 80-90.
• Raw data requested, but not accessible.
Therefore, meta-analysis used to calculate
ES’s from published summary statistics.
7/16/2015
Rohling & Meyers NAN 2004
84
Study 1: TBI Dose Response
• Initial analysis presented at NAN (2000) was
based on n= 150 and came from:
– Volbrecht, M. E., Meyers, J. E., & Kaster-Bundgaard, J.
(2000). Neuropsychological outcome of head injury
using a short battery. Archives of Clinical
Neuropsychology, 15, 251-265.
• Later, raw data accessed with larger sample
(n= 317).
– Symptom validity used to clean sample (n = 68)
– ES’s calculated for each subject & averaged.
• Overall Test Battery Mean (OTBM)
7/16/2015
Rohling & Meyers NAN 2004
85
Study 1: TBI Dose Response
• Dikmen et al.’s (1995) - TBI assessed 1 yr post
• Divided into 6 severity of injury groups based
on “Time to follow verbal commands.”
– (1) < 1 hr, (2) 1-23 hrs, (3) 1-6 d, (4) 7-13 d, (5) 14-28 d, & (6) > 28 d.
• ESs generated as part of a prior meta-analysis
(Binder, Rohling, & Larrabee, 1997).
• Halstead Impairment Index used as measure of
global severity of cognitive impairment.
7/16/2015
Rohling & Meyers NAN 2004
86
Study 1: TBI Dose Response
• Meyers data classified using same 6
severity groups as Dikmen et al. (1995).
• Flexible battery administered with number
of tests varying across patients.
– Average test time was 2.6 hrs.
– Max. number of measures examined = 26.
– Only 4 measures used by both researchers.
7/16/2015
Rohling & Meyers NAN 2004
87
Study 1: OTBM Regressed using
HRB & MSB Summary Stats
• Mostly severely impaired group differences
between the two samples.
– Dikmen et al. estimated for untestable pts.
– Meyers excluded untestable pts.
• Regression across 5 severity groups found
high degree of agreement between samples.
– R = .97
– Slope = .92 (NS from 1)
– Intercept = 4.7 (NS from 0)
7/16/2015
Rohling & Meyers NAN 2004
88
TBI Demographics: Dikmen & Meyers
Dikmen Sample
• Age = 29.9 (12.5)
• Ed = 12.0 (2.3)
• Sex = 72% male
• T since TBI = 1 yr
• Barona IQ = 95.8
(est.)
7/16/2015
Meyers Sample
• Age = 32.8 (14.7)
• Ed = 12.0 (2.4)
• Sex = 64% male
• T since TBI = 3 yrs
• Barona IQ = 94.3
• NART IQ = 97.3
Rohling & Meyers NAN 2004
89
Dikmen ES’s
Meyers’ T Scores
60
0
55
50
Max y = -2.1x + 56.2
Overall Test Battery Mean-T
-.5
-1
-1.5
45
90%ile y = -2.2x + 53.5
75%ile y = -2.3x + 50.4
40
50%ile y = -2.6x + 47.6
35
25%ile y = -3.1x + 44.6
30
10%ile y = -3.7x + 42.2
25
-2
Min y = -3.5x + 36.4
20
15
-2.5
10
< 1 hr
-3
hrs < 1
hrs 1-23
7/16/2015
day 1-6
day 7-13
day 14-28
day > 28
Rohling & Meyers NAN 2004
1-23 hrs
1-6 days
7-13 days
14-28 days
> 28 days
Severity of TBI based on LOC
90
Combined Dikmen & Meyers
Estimates: ES, T, & Difference
LOC
n
ES
T
Mean Diff.
(EPGA – OTBM)
Trauma Control
G1: < 1hr
121
299
.00
-.11
48.1
46.5
--1.5
G2: 1-24 hr
G3: 1-6 day
G4: 7-13 day
G5: 14-28 day
152
99
56
46
-.22
-.33
-.68
-1.29
44.2
42.7
38.1
29.4
3.8
5.6
10.2
19.1
G6: > 28 day
43
-1.49
27.7
20.6
7/16/2015
Rohling & Meyers NAN 2004
91
Study 1: HRB & TBI Severity
• Correlation = .98 for
OTBM & HII across 6
groups for Dikmen et al.
(1995) sample.
• Later to be used in crossvalidation study with the
Oklahoma HRB sample
7/16/2015
.9
.8
.7
.6
HII
– Slopes = -.039
– Intercept = 1.98
– T for Imp. high (43.0)
1
.5
.4
.3
.2
.1
0
25
Rohling & Meyers NAN 2004
30
35
40
OTBM-MSB
45
50
92
Domains of Cognition:
Combined Dikmen & Meyers
ES (d)
Cognitive Construct
M
(sd)
T Score
M
Group
(sd)
Differences
Learning Memory
-.80 (.75) 36.9
(9.9)
LM < VC
Psychomotor Speed
-.77 (.67) 39.8
(9.8)
Inconsistent
Executive Function
-.76 (.61) 41.7
(6.2)
Inconsistent
Attention/Work Mem
-.66 (.69) 38.0 (11.8)
AW < VC
Perceptual Organize
-.42 (.62) 34.2 (16.1)
Inconsistent
Verbal Comprehend
-.29 (.46) 42.5
VC>LM,AW
7/16/2015
Rohling & Meyers NAN 2004
(5.4)
93
TBI Dose Response Summary
• The OTBM from the MSB is as sensitive to
degrees of impairment as is the HRB.
• Practical advantages to the MSB-RIM:
–
–
–
–
–
< 3 hrs to administer vs. 8 for HRB.
Domain scores generated for interpretation.
Better to detect suboptimal performance.
Easy to view graphics for greater Dx accuracy.
Indices robust across multiple studies.
7/16/2015
Rohling & Meyers NAN 2004
94
Study 2: HRB Validation of RIM
• Sherer et al. (1993) published a cross-validation of
the GNDS (Reitan & Wolfson, 1991), using the
University of Oklahoma Health Science Center
database generated from 1977 to 1989.
• Vanderploeg et al. (1997) responded to Reitan &
Wolfson’s (1995) statement that “age and
education don’t matter with the same dataset.
7/16/2015
Rohling & Meyers NAN 2004
95
Study 2: HRB Sample from Okla.
• Originally 114 patients.
– 73 Brain Damaged patients (TBI, CVA, etc.).
– 41 Pseudoneurological pts (i.e., psychiatric).
• Role of research on “pseudoneurological”
controls looking at cut scores for most
accurate classification of patients to groups.
– These were predominantly psychiatric cases
with schizophrenia, depression, anxiety dx, etc.
7/16/2015
Rohling & Meyers NAN 2004
96
What is the Halstead
Impairment Index (HII)?
• A measure of overall neurocognitive functioning
designed by Retain for the HRB.
• Variables rated from 0 (normal) to 1 (impaired)
– Number of variables = 7
– Range 0 (normal ) to 1.0 (severe)
• HII a rounded ratio to the nearest 10ths of the # of
scores impaired by total number of scores.
• Tests: Category, TPT (time, mem, loc), Rhythm, Speech,
& Tapping (dom).
– Cutoff score for impairment recommended = .30
7/16/2015
Rohling & Meyers NAN 2004
97
What is the Average Impairment
Rating (AIR)?
• Russell (1970) measure of global cognitive
functioning designed to improve on HII.
• Each variable rated 0 (normal) to 3 (severe)
– Number of variables is flexible
– Range from 0 (normal ) to 6 (profound)
• 0.5 intervals
• Measures normed on this scale by Russell
(1970). Tables to convert scores to AIR’s
– Cutoff score for impairment = 1.30
7/16/2015
Rohling & Meyers NAN 2004
98
What is the Global Neurological
Deficit Scale (GNDS)?
• Retain & Wolfson (1993) - measure of cognition
designed to improve HII & AIR.
• Each variable rated 0 (normal) to 3 (severe)
– Performance Level Variables (n = 19)
– Pathognomic Sign Variables (n = 13)
– Pattern Variables (n = 2)
• Anterior/Posterior
• Right/Left Laterality
– Range (n = 34) = 0 to 102.
– Cutoff Recommended = 28.
7/16/2015
Rohling & Meyers NAN 2004
99
Study 2: OTBM vs. HII
• Heaton et al.’s (1991)
HRB norms used to get
OTBM
1.0
0.9
0.8
– T Score (M=50, sd=10)
– (p < .0001)
– 62% variance accounted
• Over predicts low
• Under predicts high
7/16/2015
0.6
HII
• OTBM Correlation with
HII = -.79
0.7
0.5
0.4
0.3
0.2
0.1
0
20
Rohling & Meyers NAN 2004
25
30
35
40
45
50
55
OTBM
100
60
Study 2: OTBM vs. GNDS
• OTBM Correlates with
GNDS = -.87
7/16/2015
70
60
50
GNDS
– 76% variance accounted
– OTBM neither under nor
over predicts across the
range of the GNDS
– Intercept for impairment
as defined by Reitan &
Wolfson (GNDS = 29) is a
T Score = 46.0
80
40
30
20
10
0
20
Rohling & Meyers NAN 2004
25
30
35
40
45
50
55
OTBM
101
60
Study 2: OTBM’s Relationship
to Other Global Indices
INDICES OF FUNCTION
Correlation Coefficient
Halstead Impairment Index
.79
Average Impairment Rating
.90
Global Neuro. Deficit Scale
.87
RIM: Domain TBM
.99
RIM: Instrument TBM
.95
RIM: % Tests Impaired
.96
7/16/2015
Rohling & Meyers NAN 2004
102
Study 2: Diagnostic
Classification Using the HII
BR 65% Sens.
Spec.
PPV
NPV
% Corr.
HII
.64
.66
.77
.51
65%
AIR
.58
.78
.82
.51
65%
GNDS
.78
.63
.79
.62
73%
OTBM
.90
.32
.70
.65
69%
ITBM
.86
.37
.71
.60
69%
%TI
.85
.56
.78
.68
74%
7/16/2015
Rohling & Meyers NAN 2004
103
Study 2: Cross-Validation of RIM
using the HRB in 2 Samples
• Regressed Dikmen & Meyers TBI data:
– Generated a predicted HII for pts in OK dataset.
– Correlation actual & predicted HII = .95
• Sense = .60, Spec = .77, PPV = .78, NPV = .59
• Overall % Correct Classification = 71%
• Predicted HII from MSB’s OTBM more accurate
indicator of impairment than actual HII.
7/16/2015
Rohling & Meyers NAN 2004
104
Study 2: Summary of Results
•
The RIM as good a predictor of cognitive
functioning as validated indices of HRB.
•
•
(i.e., HII, AIR, & GNDS).
RIM’s diagnostic accuracy as good or
better than HII, AIR, & GNDS in
discriminating abnormal cognition.
7/16/2015
Rohling & Meyers NAN 2004
105
Study 3: Return to Work after Injury
• Three main hypotheses using MSB-RIM
– OTBM will predict return to work level
– Cognitive domain that will be most
predictive will be executive function
– Adding the Patient Competency Rating
Scale will improve work prediction
• PCRS is by Prigatano (1985)
7/16/2015
Rohling & Meyers NAN 2004
106
Study 3: ANOVA Results for OTBM
Group
Disabled
n
M
SD
ES
17
32.8
6.4
-2.29
Unemployed
96
39.5
6.1
-1.01
Below Previous 32
43.3
4.6
-.36
137
45.1
5.2
-.45
At Previous
7/16/2015
Rohling & Meyers NAN 2004
107
Logistic Regression using OTBM
Predicted
Observed
UnDisable employ
Below
Prev
At
Prev
% Corr
Disabled
2
12
0
3
12%
Unemployed
1
48
0
47
50%
Below Previous
0
9
0
23
0%
At Previous
0
25
0
112
82%
7/16/2015
Rohling & Meyers NAN 2004
108
Study 3: Summary of OTBM
• Significant OTBM differences between
return to work groups.
• Logistic results Disabled /Unemployed not
able to separate.
• Logistic results Below/At Previous not able
to separate.
• Collapsed groups result in 71% correct, well
above base rate of 52% correct.
7/16/2015
Rohling & Meyers NAN 2004
109
Study 3: Results of Domain Analysis
• Executive function not the most predictive.
– Most of the Logistic results variance cared by
Perceptual Organization followed by Attention
& Working Memory.
• Using Cognitive Domains
– OTBM increases % Correct from 71% to 74%.
• Incremental validity of PCRS is very low.
– 7% of the variance.
7/16/2015
Rohling & Meyers NAN 2004
110
Study 3: Results of Domain Analysis
• By including premorbid variables, increases
diagnostic accuracy; most helpful being:
– Premorbid IQ, level of occupation, & education
• Including acute measures also increases
accuracy; most helpful being:
– LOC group
– Time since injury
7/16/2015
Rohling & Meyers NAN 2004
111
Interpreting the MSB
1. Profiles: What the data is like, type of
injury
2. RIM: How bad is it (OTBM)
3. Domains: What deficits
4. Rehab: Individual Scales
7/16/2015
Rohling & Meyers NAN 2004
112
Comparisons
• Normals are normal hospital controls, were seen
for some malady other than neurological (i.e. in
grown toe nails) (Blue Line)
• Hospital Patients with identified brief LOC, by
witness report of seconds to minutes. Mild TBI
with brief LOC (Black Line) All reporting some
Post Concussive Syndrome Characteristics
including Headache
• Moderate TBI 1 hr to 24 hrs LOC, Documented in
medical records (Red Line)
• Severe TBI 8 days or more LOC, Documented in
medical records (Green Line)
7/16/2015
Rohling & Meyers NAN 2004
113
Traumatic Brain Injury
7/16/2015
Rohling & Meyers NAN 2004
114
Correlations between Profiles
• Correlations are with the Mild TBI Group
• Notice consistency with the TBI groups
–
–
–
–
7/16/2015
Correlations (My rule of thumb .30 +)
Configurations (My rule of thumb .59+)
Group N
OTBM
Rohling & Meyers NAN 2004
115
Profiles
• Similar types of injuries produce similar type profiles
– i.e. Left Learning Disability, Left Hemisphere
originating Seizure Disorder and MS.
• Why?
– Because all three have / can have impairment in
Left hemisphere
– Similar type impairments produce similar patterns
of performance
– Dissimilar injuries produce dissimilar patterns
7/16/2015
Rohling & Meyers NAN 2004
116
Example
• Learning Disability (Black Line)
• Epilepsy (Red Line) Left hemisphere
originating
• Left Temporal Lobectomy (Blue line)
• RCVA (Green Line)
• Notice that the RCVA group is different
from the other groups
7/16/2015
Rohling & Meyers NAN 2004
117
Similar and Dissimilar profiles
7/16/2015
Rohling & Meyers NAN 2004
118
Case Study BB
MVA
•
•
•
•
•
•
Age 19
Ed 12
Male
Right Handed
Caucasian
Single Vehicle
Accident
• Not Forensic
7/16/2015
• NART 57 T
• Barona 50 T
• Short Form WAIS-III
–
–
–
–
7 subtest
VIQ 110
PIQ 117
FIQ 113
Rohling & Meyers NAN 2004
119
Case Study BB
• LOC: at scene described by other passenger
“Knocked Out for couple of minutes he didn’t
wake up when I shook him a little, and then he
started to groan a little bit.”
• PTA: Ambulance records “Confused, but could
answer his name
• ER: Able to answer questions with repeated
Questions, some mild confusion
• Whole time from accident to only “mild”
confusion less than one hour
7/16/2015
Rohling & Meyers NAN 2004
120
Case Study BB
7/16/2015
Rohling & Meyers NAN 2004
121
Case Study BB
• Step 1 : Check for Validity
– Validity Checks
– Internal Consistency
• Step 2: Profile
– Is the pattern of performance similar to what
you expect for a TBI
7/16/2015
Rohling & Meyers NAN 2004
122
Case Study BB
• History
– NO LD, ADD
– No Previous Head
Injury
• College Freshman
(first semester)
7/16/2015
• Internal Validity
Checks
– Passed All 8
– And Motor
performance
Rohling & Meyers NAN 2004
123
Case Study BB
• Internal Consistency Check
– (Must be Greater than 15 to be clinically
significant). He passed all
»
–
–
–
–
–
–
7/16/2015
Estimated
Attention & Wk Mem
Proc Speed/Ment Flex
Verbal Reasoning
Visual Reasoning
Verbal Memory
Visual Memory
48
49
50
50
47
48
Rohling & Meyers NAN 2004
Actual Difference
47
49
52
52
41
52
1
0
-2
-2
7
-4
124
Case Study BB
7/16/2015
Rohling & Meyers NAN 2004
125
Case Study BB
7/16/2015
Rohling & Meyers NAN 2004
126
Case Study BB
• From this you can see
– 1. Objective method of assessing validity and
internal validity
– 2. Objective method of assessing the
characteristics of the profile. To see if the
pattern of scores is as expected
7/16/2015
Rohling & Meyers NAN 2004
127
Summary of MSB
1. Check Internal Validity Check
2. Check the expected level of performance
3. Profiles tells what performance is similar
to (.30 correlation, .59 Configuration)
4. Impaired Domains tell what type of
deficits
5. Individual test scores useful for designing
cognitive rehab
7/16/2015
Rohling & Meyers NAN 2004
128
Any ?
• Questions
7/16/2015
Rohling & Meyers NAN 2004
129