All ETDs from UAB

Advisory Committee Chair

Richard E Kennedy

Advisory Committee Members

Edwin W Cook

Document Type

Thesis

Date of Award

2020

Degree Name by School

Master of Arts (MA) College of Arts and Sciences

Abstract

Moderate-severe traumatic brain injury (TBI) is a leading cause of permanent disability, and cognition plays a critical role in overall function and life after TBI. Moderate-severe TBI often creates long-term deficits in the domains of attention, processing speed, memory, and executive function. Given the prevalence of cognitive deficits following injury and the debilitating effects these deficits can have on functioning, it is important to monitor cognition directly following injury and across recovery. Routine cognitive assessment is essential in order to identify deficits, track recovery, and better guide rehabilitation and educational efforts. It is also critical to identify accurate and feasible means of predicting long-term disability to gauge the need for ongoing services and advise TBI survivors and caregivers. In particular, a better understanding of how well acute orientation following injury predicts long-term outcomes is needed. The first study sought to validate the use of a brief cognitive test battery, the Brief Test of Adult Cognition by Telephone (BTACT), relative to established neuropsychological tests among individuals with moderate-to-severe TBI. The BTACT composite scores of overall cognition, episodic verbal memory, and executive function are valid measures in a TBI inpatient population. The second study sought to evaluate the predictive capacity of initial orientation, rate of change in orientation, and duration of post-traumatic amnesia during acute rehabilitation. Initial orientation during acute inpatient rehabilitation is a strong predictor of verbal memory, executive function, and overall cognitive status one year following injury. Overall, these studies examined acute orientation factors and cognitive outcomes following moderate-severe TBI. The BTACT is feasible to administer in an inpatient rehabilitation setting or by telephone for longitudinal research, and the composite scores are valid measures of cognition to use in a moderate-severe TBI population. Initial level of orientation is important to consider in the prediction of cognitive impairments one year following moderate-severe TBI, particularly in the domains of verbal memory and executive function. Altogether, these studies offer support for the need to assess orientation early in the recovery process and for the use of the BTACT composite scores as measures of cognition following moderate-severe TBI.

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