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Projects

Living Status Scale

The Centre For Neuro Skills developed the Living Status Scale which has been used to assess the amount of required living supervision. This ordinal 10-point scale includes living arrangements ranging from "independent" to "locked facility". Although this measures has demonstrated clinical utility in this postacute setting since 1983, the CREF team has initiated a formal study to show reliability and validity of this measure.

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Centre for Neuro Skills Rating Scale

The Centre For Neuro Skills developed the Centre For Neuro Skills Rating Scale which has been used to assess ability in the areas of cognition, withdrawal, agitation and aggression, physical therapy, occupational therapy, speech, language, education, and vocation on an 80-point scale. Although this measures has demonstrated clinical utility in this postacute setting since 1983, the CREF team has initiated a formal study to show reliability and validity of this measure.

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Using Computerized Visual Representations of the Brain to provide Educate Specifics of Traumatic Brain Injury

Case Managers are often faced with the challenging task of communicating the nature of injuries or disease to patients or families. Many times this involves the translation of detailed and complex medical jargon to everyday understanding. In the case of Traumatic Brain Injury (TBI), this becomes increasingly difficult due to the specific knowledge set necessary to comprehend these injuries fully.

Generally speaking, magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) are techniques frequently used in the treatment and care of individuals with TBI. However, these modalities are highly technical and are not easily interpreted by individuals outside the medical or research world. Nonetheless, information that they yield can provide individuals with further understanding of the physiological changes in the brain that occur after injury and result in deficits.

For those without an extensive background in neuroanatomy or cognitive neuroscience, excessively technical explanations may not be helpful due to their complexity and can thus create further distress for patients or families in an already difficult situation.

The CREF team is currently exploring ways to utilize MRI and DTI images to create user friendly visual representations of the brain. These images can provide the client, family, treating therapist, case managers, insurance adjusters or any other professional involved in patient care with valuable information regarding the patient's injury. For all of these listed parties, this technology can provide a readily understandable, visuospatial model of what is otherwise an abstract, conceptually difficult type of injury.

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Outcome Prediction Following Traumatic Brain Injury: A Preliminary Model

Lisa A. Kreber, Ph.D., Mark J. Ashley, Sc.D., CCC-SLP, CCM, CBIS, Craig. S. Persel, B.A., Michal C. Clark, Ph.D., Richard E. Helvie, M.D., & Robert P. Lehr, Jr., Ph.D.

Centre for Neuro Skills (CNS), Clinical Research and Education Foundation (CREF), Bakersfield, CA

Objective: Develop a reliable model that predicts treatment cost, treatment duration, level of supervision, occupational status and disability outcome at discharge from postacute, residential rehabilitation for traumatic brain injury (TBI).

Design: Retrospective data analysis using two cohorts of patients admitted to the rehabilitation program from 1983 to 2006.

Setting: Inpatient, postacute residential brain-injury rehabilitation program where patients with TBI received speech/cognitive, occupational, physical, education, and counseling therapies in a clinic setting 5 days per week and individualized, prescribed therapies in a residential setting during evenings and weekends.

Participants: 478 adult, inpatients who suffered a TBI and met inclusion criteria. Data from 443 patients (Baseline Group) admitted to the program between 1983 and November 2004, were used to create outcome prediction formulas that were applied to a group of 35 patients (Outcome Group) admitted to the program between November 2004, and November 2006.

Main Outcome Measures: Disability Rating Scale (DRS), Independent Living Scale (ILS), CNS Scale (CNS), Living Status Scale (LSS), and Occupational Status Scale (OSS).

Results: Six variables (latency, DRS, ILS, CNS, LSS and OSS scores) were found to be independent predictors in the final regression model and reliably predicted program cost, length of stay, level of disability, supervision, and independence, as well as living and vocational discharge placements. Scores predicted by this model differed from actual scores by a range of 0.42-12.53%. One scale (CNS) influenced all other variables in this model and, thus, appeared to have the most predictive capability of all outcome measures.

Conclusions: Results from this preliminary predictive model should encourage access to effective treatment, changes in healthcare benefits and resource allocation for postacute, residential rehabilitation following TBI.

Copyright 2009 CNS-CREF