Validation of the NIH Toolbox in Individuals with Neurologic Disorders.
OBJECTIVE
Individuals with spinal cord injury (SCI), traumatic brain injury (TBI), and stroke experience a variety of neurologically related deficits across multiple domains of function. The NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) examines motor, sensation, cognition, and emotional functioning. The purpose of this paper is to establish the validity of the NIHTB in individuals with neurologic conditions.


METHODS
Community-dwelling individuals with SCI (n = 209), TBI (n = 184), or stroke (n = 211) completed the NIHTB. Relative risks for impaired performance were examined relative to a matched control groups.


RESULTS
The largest group differences were observed on the Motor domain and for the Fluid Cognition measures. All groups were at increased risk for motor impairment relative to normative standards and matched controls. Fluid cognitive abilities varied across groups such that individuals with stroke and TBI performed more poorly than individuals with SCI; increased relative risks for impaired fluid cognition were seen for individuals in the stroke and TBI groups, but not for those in the SCI group. All three neurologic groups performed normally on most measures in the Sensation Battery, although TBI participants evidenced increased risk for impaired odor identification and the stroke group showed more vision difficulties. On the Emotion Battery, participants in all three groups showed comparably poor psychological well-being, social satisfaction, and self-efficacy, whereas the TBI group also evidenced slightly increased negative affect.


CONCLUSIONS
Data provide support for the validity of the NIHTB in individuals with neurologic conditions.
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA.
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NE
Carlozzi
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109, USA.
S
S
Goodnight
Department of Neurology, University of California, San Francisco, CA 94122, USA.
K B
KB
Casaletto
Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA.
A
A
Goldsmith
Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA.
R K
RK
Heaton
Occupational Therapy and Department of Neurology, Washington University, St. Louis, MO 63108, USA.
A W K
AWK
Wong
Occupational Therapy and Department of Neurology, Washington University, St. Louis, MO 63108, USA.
C M
CM
Baum
Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA.|Department of Preventative Medicine, Northwestern University, Chicago, IL 60611, USA.
R
R
Gershon
Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA.|Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
A W
AW
Heinemann
Department of Physical Therapy, Center for Assessment Research and Translation, University of Delaware, Newark, DE 19713, USA.|Kessler Foundation, West Orange, NJ 07052, USA.
D S
DS
Tulsky
D000328:Adult; D000342:Affective Symptoms / Q000175:diagnosis* / Q000209:etiology; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000175:diagnosis*; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000209:etiology; D003943:Diagnostic Techniques, Neurological / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000175:diagnosis* / Q000209:etiology; D009316:National Institutes of Health (U.S.); D009483:Neuropsychological Tests / Q000592:standards*; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D015203:Reproducibility of Results; D012678:Sensation Disorders / Q000175:diagnosis* / Q000209:etiology; D012919:Social Behavior; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis*; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D014481:United States; D055815:Young Adult
Assessment; Cognition; Disability; Emotion; Motor; NIHTB; Outcomes assessment (health care); Sensory; Spinal cord injury; Stroke; Traumatic brain injury