Residual sensorimotor deficits in the adult head-injured patient. A treatment approach

Agreement of classification decisions using two measures of motor co-ordination in persons with a traumatic brain injury

Identification of motor co-ordination deficits in persons with a traumatic brain injury (TBI) is a vital part of both assessment and rehabilitation. The purpose of this study was to investigate the agreement of classification decisions based on clinical (subjective) and instrumented (objective) tests for measuring upper-limb co-ordination in persons with a TBI. Twenty-two subjects with TBI performed the 'finger-to-nose' test and a 'lateral reach tapping test' 12 months post-injury. After reduction to categorical form (deficit/no deficit), the data were interpreted using a generalized kappa statistic, to estimate the agreement between the two tests. The kappa values for the right and left upper extremities were 0.625 and 0.360, respectively, while the combined (right and left) value was 0.500, representing only 'moderate' agreement between the two testing protocols. This indicates that motor co-ordination deficits in persons with TBI can be documented using either clinical or instrumented tests. The choice of test does not appear to be based on the subjective/objective nature (dimension) of each test, but rather on more practical factors such as administration time, cost and level of objectivity desired by the clinician.

Expert opinion in the identification of variables for the measurement of early recovery in adults with traumatic brain injury

The expert opinion of 27 experienced physical therapists was systematically sought using a modified Delphi technique in order to identify the important variables to be included in the neurophysical evaluation of the traumatic brain-injured (TBI) adult during the acute stage of rehabilitation (first 3 months). An initial survey of the therapists generated 63 items which were later regrouped into 23 categories. Each category was then rated using a five-point scale (1 = of no importance to 5 = extremely important) by each therapist as to its importance in the early clinical neurophysical evaluation of the TBI patient. Those variables identified as extremely important by at least 50% of experts include: state of consciousness, voluntary movements, spontaneous movement and transfers. The results of this study highlight, for physical therapists and other health professionals, the important variables to be included in the evaluation of neurophysical deficits in persons with TBI in the acute stage of rehabilitation.