Transcript Title in 48 point font Authors and Affiliations in 24

Concurrent Validity of the Script Analysis
Measure (SAM) as a Test of Executive Functioning
for Persons with Traumatic Brain Injury (TBI).
Physical Medicine and Rehabilitation
Margaret A. Struchen, Ph.D., Angelle M. Sander, Ph.D., Allison N. Clark, Ph.D.,
Diana M. Kurtz, B.A., Monique R. Mills, B.S., Lynne C. Davis, Ph.D.
RESULTS
METHODS
INTRODUCTION
•Executive deficits are a common sequelae
following TBI,1 likely due to the vulnerability of
frontal lobe structures to injury from trauma.2
•Frontal lobe damage have been hypothesized
to be related to impairments in the
representation and manipulation of script
information, which are considered deficits in
executive functioning.3
•Script information and the organization and
manipulation of information have been
measured using script generation and
evaluation tasks.4
•Patients with frontal lesions were found to
differ from controls and those with parietal
lesions with regard to sequencing errors,
failure to close scripts, reporting actions
outside of the task boundaries, and had
difficulty with estimating action importance.4
Participants:
•120 adults with TBI were recruited from a
longitudinal outcome study sample following
comprehensive inpatient brain injury
rehabilitation (NIDRR TBI Model Systems
Study) to participate in a study examining
social communication and executive
functioning.
•Of these, 110 participants had complete data
available on additional measures of
executive functioning and were included in
the current analyses.
SAMPLE
CHARACTERISTICS
•There has been interest in utilizing script
generation and evaluation tasks to measure
executive functioning in clinical settings.
•A standard scoring procedure for a modified
“non-routine activity” task of the Script
Analysis Measure (SAM) was developed.
Interrater reliability for this scoring system
was found to be acceptable and significant
differences for performance on key measures
was found between participants with TBI and
age, education, and gender-matched controls.5
Relationship to Executive Functioning Measures:
TBI
Sample
(N=110)
Age [M(SD)]
36.5 (11.4)
Education [M(SD)]
13.4 (2.3)
Male Gender [%]
70.9%
•To investigate concurrent validity for the
SAM by examining relationships between the
SAM indices and commonly measures of
executive functioning.
•To investigate the relationship between SAM
performances and measures of community
integration.
Trails B
Time
COWA
Total
Score
D-KEFS
CWIT
Condition
Three
D-KEFS
Sorting
Confirmed
Sorts
D-KEFS
Sorting
Free Sort
Descript
D-KEFS
Sorting
Sort
Descript
# Actions
-0.19*
-0.19*
0.29**
-0.21*
0.22*
0.20*
0.14 NS
Total Script
Errors
0.40**
0.40**
-0.18*
0.19
-0.34**
-0.32**
-0.23*
0.31**
0.32**
-0.17*
0.24**
-0.27**
-0.25**
-0.12 NS
-0.31**
-0.11 NS
0.19*
-0.26**
0.25**
0.26**
0.12 NS
SAM
Measures
Key
Element
(KE)
Errors
Mean
Ratings
KE
Pearson correlations. (* p<0.05; ** p<0.01)
ER-GCS [M(SD)]
6.7 (3.8)
Yrs. Post-Inj. [Md (Min-Max)] 6.0 (1.1-14.3)
Procedure:
PURPOSE
Trails A
Time
•Participants completed the SAM as part of a
battery of social communication measures,
executive functioning measures, and
measures of functional status.
•Measures of functional status included:
•Community Integration Questionnaire
(CIQ)
•Craig Handicap Assessment & Reporting
Technique-Short Form (CHART-SF)
•Executive functioning measures included:
•Trail Making Test
•Controlled Oral Word Association
•D-KEFS Color-Word Interference Test
•D-KEFS Sorting Test
•Relationships with Functional Outcome Measures:
•Separate multiple regression analyses were utilized to investigate the contribution of two key SAM
measures to functional outcomes after covarying for age, education, and injury severity (ER-GCS).
•Mean Key Element Importance Ratings were shown to account for a significant unique proportion of
variance in CIQ total scores (R2 change=0.065, p<0.01) and CHART-SF Social Integration scores (R2
change=0.044, p<0.05).
•Total SAM Errors were shown to account for a significant unique proportion of variance in CIQ total
scores (R2 change=0.034, p=0.05) and CHART-SF Social Integration scores (R2 change=0.039, p<0.05).
DISCUSSION
• Preliminary evidence for concurrent validity for the SAM is suggested with respect to modest
correlations with other executive functioning measures. The current exploratory study utilized
uncorrected scores for these variables, which may have affected the degree to which scores
correlated.
• SAM performances were also found to account for variance in functional outcomes, after
controlling for other relevant variables including age, education, and injury severity.
• Such preliminary data support the potential utility of the SAM as a clinical measure of executive
functioning for persons with TBI.
[Please see handouts below for SAM scoring
criteria and for references.]