TBI ACTION is a web-based resource that is intended to aid clinicians working with persons with TBI with developing case conceptualizations and considering treatment options. Development of TBI ACTION was funded by a Rehabilitation Research Training Center grant (H133B090023) from the National Institute on Disability and Rehabilitation Research (NIDRR) to TIRR Memorial Hermann.

TIRR Memorial Hermann, Baylor College of Medicine, and Harris Health System, Houston, Texas

Mark Sherer, Ph.D., Project Principal Investigator

Angelle Sander, Ph.D., Grant Principal Investigator

Wayne State University Medical School and Rehabilitation Institute of Michigan, Detroit, Michigan

Robin Hanks, Ph.D., Local Site Principal Investigator

University of Alabama – Birmingham, Birmingham, Alabama

Thomas A. Novack, Ph.D. Local Site Principal Investigator

University of Delaware College of Health Sciences in Newark, Delaware

David S. Tulsky, Ph.D. Consultant

Pamela Kisala, M.A.

University of Arkansas for Medical Sciences in Little Rock, Arkansas

Todd G. Nick, Ph.D., Project Biostatistician

Maria Melguizo, M.S.

Development of the TBI ACTION system was based on data collected from 504 persons with medically documented TBI who were given an extensive battery of cognitive tests and questionnaires. Study participants were community dwelling and all had capacity to give their own consent for this investigation. The initial analysis of data from this group resulted in identification of 12 dimensions of the experience of persons in the post-hospital period of recovery. Further analysis of dimension scores for the 504 participants resulted in 5 clusters of persons with TBI that differed on dimensions scores as well as on participation (community integration) status. Finally, an expert consensus conference attended by nationally recognized experts in TBI rehabilitation was held in Galveston, Texas in May, 2014. The expert panel developed case conceptualizations as well as possible treatment options for each cluster.

The original cluster analysis of the 504 person cohort did not result in all persons with poor performance validity being assigned to Cluster 5. Based on analysis of data from a new cohort of persons with TBI, we determined that this might result in suboptimal findings. To remedy this problem, we changed the website programming so that all persons who showed poor performance validity on the Word Memory Test using the standard criteria were assigned to Group 5. We excluded 13 persons who did have full Word Memory Test data whose missing data had been imputed for the original cluster analysis. This new analysis had a substantial effect on the mean profile for persons in Group 5. We next recomputed the cluster analysis for the first four clusters. The profiles of these four clusters showed essentially no change from the original cluster analysis. As a result, we have substantially modified the report for Group 5, but no more that very minor changes were made to the reports for Groups 1 to 4. More recently, changes were made to formulae for calculating and displaying respondents’ profiles and scores to ensure that these scores are easily interpreted. If you have any questions regarding the differences between the original TBI ACTION website and TBI ACTION version 1.2, please contact Mark Sherer at

Tests/Questionnaires that Determine the 12 Dimensions




WAIS-IV Letter Number Sequencing

Rey Auditory Verbal Learning Test Trials I-V Total

Cognitive Process Speed

Trailmaking Test Part A

WAIS-IV Coding

Verbal Fluency

FAS Letter Fluency Test

Self-reported Cognitive Impairment

TBI-QOL Cognition – General Concerns

Independence and Self-esteem

TBI-QOL Self-esteem

TBI-QOL Independence


TBI-QOL Resilience

Emotional Distress

TBI-QOL Anxiety

TBI-QOL Emotional and Behavioral Dyscontrol

Postconcussive Symptoms

Neurobehavioral Symptoms Inventory

Physical Symptoms

TBI-QOL Headache

TBI-QOL Pain Interference

Physical Functioning

TBI-QOL Upper Extremity

Economic and Family Support

Economic Quality of Life, Family Assessment

Device General Functioning Scale

Performance Validity

Word Memory Test

Clinicians working with persons with TBI can administer (or have administered) the 5 cognitive tests and the Word Memory Test and then have their client complete the 12 questionnaires on line. The clinician will then be provided a case conceptualization and treatment options for the cluster group to which the client is most similar. These materials are intended to be used as an aid to clinical reasoning and planning when combined with clinician judgment and other sources of information. No personal health information or identifying information is entered. Users are not tracked in anyway so use of this website is completely confidential and both client and clinician privacy are protected. There is no charge for using the TBI ACTION website.

Case conceptualizations and treatment options provided by this website are meant to be an aid to clinical care for persons with TBI. They are meant to supplement rather than replace clinician judgment and they are not intended for use in disability determination, litigation, or other contexts.


The contents of this website were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90RT5007 and 90DP0028). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this website do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.