Using the NIH Toolbox Cognition Battery (NIHTB-CB) in individuals with traumatic brain injury.
David S Tulsky, Noelle E Carlozzi, James Holdnack and 4 others
PMID 29265862WHAT IT FOUND
NIH Toolbox tests of memory, attention, processing speed and problem solving separated adults with severe and mild/moderate TBI from controls.
Vocabulary and reading scores did not reliably differ.
Key findings
01Picture Sequence Memory was the most sensitive NIH Toolbox test. At a T-score of 40 or lower, about one standard deviation below expected, sensitivity was .36 for complicated mild/moderate TBI and .52 for severe TBI.
02Fluid cognition scores, including memory, working memory, processing speed, attention and problem solving, were lower in both TBI groups than controls, and the severe group was lower than the complicated mild/moderate group.
03Vocabulary and reading scores did not show significant group differences, although the severe TBI group had a greater proportion of low scores than controls.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The sample may not represent all people living with TBI because participants had to be willing and able to complete eight hours of testing over two days. Participants had to be at least one year after injury, speak and understand English at a fifth-grade level, and have no other condition causing cognitive impairment, so results may not apply to acute, non-English, or mixed-diagnosis cases. The complicated mild/moderate group was older and had less time since injury than the severe group. Missing data were not random: 20% of participants with 12 or fewer years of education had missing data, compared with 9% of those with at least some college. Tests requiring rapid responses were more often missing in the TBI groups. The study used the original dual-screen format, so it is unclear whether results generalize to the newer iPad version. The control group did not complete the established neuropsychological tests, so the study could not directly compare sensitivity of NIH Toolbox and gold standard measures or fully explain correlation patterns. Volunteers were not excluded if they had prior test exposure, which may have affected performance. The NIHTB-CB does not include methods for estimating invalid performance, so low scores may not always reflect true impairment.
The easy way to misread this
Do not treat a normal NIH Toolbox language score as proof that language is intact. The vocabulary and reading tests did not show significant group differences, so they are less sensitive to TBI-related impairment.