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Find out in this Q&A with the developers of the Pediatric Test of Brain Injury™ (PTBI™) |
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About the authors
 Gillian Hotz, Ph.D., CCC-SLP, is the co-director of the Pediatric Brain & Spinal Cord Injury Program; the director of Neurotrauma Outcome Research, Concussion, and WalkSafe Programs; and an associate research professor in the Department of Neurosurgery at the University of Miami Miller School of Medicine. Dr. Hotz is the principal investigator on a variety of funded research projects for acute care and rehabilitation of children with traumatic brain injury and injury prevention. She is co-author of the Brief Test of Head Injury.
Nancy Helm-Estabrooks, Sc.D., CCC-SLP, is the Brewer-Smith Distinguished Professor in the Department of Communication Disorders and Sciences at Western Carolina University. She was affiliated with the Harold Goodglass Aphasia Research Center and Boston University School of Medicine for 32 years; was a research scientist at th National Center for Neurogenic Communication Disorders at the University of Arizona; and was a research professor at the University of North Carolina, where she retains an adjunct position.
Dr. Helm-Estabrooks is co-author of the Brief Test of Head Injury.
Nickola Wolf Nelson, Ph.D., CCC-SLP, is a professor in the Department of Speech Pathology and Audiology and Director of the Ph.D. program in Interdisciplinary Health Sciences at Western Michigan University. For the past 35 years, she has provided services and conducted research related to language and literacy development and disorders in childhood.
Dr. Nelson is editor of Topics in Language Disorders.
Elena Plante, Ph.D., CCC-SLP, is a professor and Head of the Department of Speech, Language, and Hearing Sciences at The University of Arizona. Her areas of research interest include language learning and assessment practices.
Dr. Plante has been using neuroimaging to explore the brain bases of language and cognition for the last two decades. Questions? Customer Service: |
 Q: Your new Pediatric Test of Brain Injury™ (PTBI™) helps professionals assess the skills of children recovering from brain injury. What type of abilities does it look at? A: The PTBI is used to track changes in neurocognitive and language functioning as a child recovers from brain injury. Children with brain injury from accident or illness can face many challenges in the early recovery process and as they return to school. They tend to be especially susceptible to memory and retrieval problems that affect their ability to concentrate, and to remember and respond to questions. Clinicians use the PTBI to look at 10 tasks that are critical for learning: Orientation; Following Commands; Word Fluency; What Goes Together; Digit Span; Naming; Story Retelling—Immediate; Yes/No/Maybe; Picture Recall; and Story Retelling—Delayed. Q: How does the test work? A: After a child sustains a traumatic brain injury (TBI) or other acquired brain injury (ABI), the clinician administers the PTBI. The test takes approximately 30 minutes to administer and is given in an interview format, where the clinician asks the child to perform specific tasks. The whole test must be administered on the same day, but it can be broken up into two sessions if the clinician observes the child getting agitated or fatigued. Scores are assessed in 10 critical areas and measured against criterion-referenced scores. The results give the clinician a picture of areas that are particularly strong or impaired, enabling them to recommend appropriate treatment. Q: The PTBI helps you assess current functioning levels as well as track changes over time. At what points would you recommend administering the test? A: It's a good idea to administer the test initially in the acute care phase to record a baseline level, and then to re-administer on admission and discharge from rehab. For continued monitoring, you may wish to administer it again if a child is seen in an outpatient setting and then when returning to school. Q: PTBI makes use of item response theory (IRT), an advanced method of weighting items based on their relative difficulty. What is the advantage of this method? A: IRT produces scores that more accurately convey skill level [than more typical scoring methods]. Knowing that children can pass items that are twice as hard as items they could pass before is more informative than just knowing they passed, say, 3 more items than before. By using these scores to track change, you get a much more accurate estimate of how much change has occurred because the relative difficulty of each item has been taken into account. Q: Can you provide an example of a case where PTBI was used? A: In the PTBI examiner's manual, we provide the case example of "J.D.," a 14-year-old boy who was in the 10th grade when he had a motor bike accident. He was not wearing a helmet. J.D. sustained a traumatic brain injury and required surgery and rehabilitation. J.D. was tested for the first time about a month after the accident, once he was medically stable. He scored poorly in all areas except for short-term numerical recall. Activities were recommended to improve J.D.'s attention and concentration, as well as short- and long-term memory and comprehension of stories. From the time of initial testing, J.D. received occupational, physical, and speech therapy on a daily basis in an inpatient rehabilitation program. Five months later, when he transferred to outpatient therapy, the PTBI was re-administered. The re-test showed significant improvement in all areas except for immediate and delayed story retelling and picture recall. It was recommended that J.D. be provided with listening and reading comprehension activities with opportunities to discuss personally relevant texts in a non-testlike manner. It was also recommended that J.D. have a full neuropsychological evaluation to assist in plans for school reentry and for recommendation of appropriate classroom accommodations, such as extra help, breaks, and note taking. J.D. will continue to be retested quarterly to monitor his recovery and to refine treatment plans. Q: How did you come to develop PTBI? A: [Gillian Hotz] I have been one of the Co-Directors of the Pediatric Brain & SCI Program at the University of Miami Miller School of Medicine/Jackson Memorial Health System for the last 10 years. After co-developing a neurocognitive adult assessment tool called the Brief Test of Head Injury, I wanted to develop a test for children that was specific and standardized for children recovering from brain injury. A: [Nancy Helm-Estabrooks] Although the bulk of my work in the field of communication disorders relates to acquired neurologic disorders in adults, my earliest interest was in children. Of course, traumatic brain injury can occur across the life span as can tumors, strokes and other such conditions, so I've remained interested in brain-related disorders of children throughout my work with adults. Very soon after Gillian Hotz and I developed the Brief Test of Head Injury for adults, we were motivated to develop a similarly brief test for the pediatric population. This project required the added expertise of a person with good knowledge of developmental milestones in children's cognitive-linguistic skills, which led us to Nickola Nelson. It was clear that we also needed a person with experience in the field of psychometrics, as well as communication disorders, which led us to Elena Plante. Together, we four have collaborated to create a critically needed test of pediatric brain injury. A: [Nickola Wolf Nelson] When I was working as a consultant for Berrien County Michigan schools, I became aware of how poorly existing systems were suited to meeting the needs of school-age children when they returned to school after TBI or other forms of ABI. The opportunity to work on the PTBI to help clinicians do a better job of meeting the needs of these students has been an amazingly rewarding journey. A: [Elena Plante] I have had a longstanding interest in how the brain supports behavior. My role in this project has centered around my interest in test development and the procedures for ensuring that the evidence needed to support good diagnostic practices is available to clinicians. |
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