TBI ACTION Instructions

The cognitive tests and the Word Memory Test must be administered and normed by the clinician who is using the TBI ACTION website or by an associate. The questionnaires are administered and scored online. Persons with TBI assessed should be oriented to time, person, place, and situation. They should be able to tolerate a testing session lasting several minutes. Cognitive tests and the Word Memory Test should be administered before the website is accessed to administer the questionnaires. Order of administration is Word Memory Test, Rey Auditory Verbal Learning Test, Trail Making Test, Part A, WAIS-IV Coding, WAIS-IV Letter Number Sequencing, and FAS Letter Fluency Test. None of the creators of this website has any financial interest in the Word Memory Test, WAIS-IV, the Heaton Norm Manual, or the Schmidt Metanorm Manual.

The Word Memory Test (WMT) can be obtained at http://wordmemorytest.com/word-memory-test/ . This test is a computer program that one must install on a local computer. A yearly site license is purchased. The publisher provides instructions and the program scores the test. Scores needed to calculate dimension scores are the Immediate Recognition (IR), Delayed Recognition (DR) and Consistency (CNS) scores. Other trials of this test need not be administered.

Administration instructions for the Wechsler Adult Intelligence Scale – IV Letter Number Sequencing and Coding tests are found in the WAIS-IV Manual (Wechsler D. WAIS-IV: Wechsler Adult Intelligence Scale – Fourth Edition Administration and Scoring Manual. Bloomington, Minnesota: Pearson; 2008). Raw scores should be converted to Scaled Scores using the age group norms found in Table A.1. The WAIS-IV is available at: http://www.pearsonclinical.com/psychology/products/100000392/wechsler-adult-intelligence-scalefourth-edition-wais-iv.html.

Administration instructions for Trailmaking Test, Part A, and the FAS Letter Fluency Test are partially provided in the Heaton Norm Manual (Heaton RK, Miller W, Taylor MJ, Grant I. Revised Comprehensive Norms for an Expanded Halstead-Reitan Battery: Demographically Adjusted Neuropsychological Norms for African American and Caucasian Adults. Lutz, Florida: Psychological Assessment Resources, Inc.; 2004). This Manual provides references for additional instructions if these are needed by the user. Note that Trailmaking Test Part B need not be administered to calculate the dimension score and cluster result. Raw scores are converted to T-scores using the norms in Appendices C, D, and E. The Heaton Norm Manual is available at: http://www4.parinc.com/Products/Product.aspx?ProductID=RCNAAC.

The Rey Auditory Verbal Learning Test (RAVLT) is administered using instructions provided in the Schmidt Metanorms Manual (Schmidt M. Rey Auditory and Verbal Learning Test: A Handbook. Los Angeles, California: Western Psychological Services; 1996). Note that Trial B and recall trials need not be administered as the only score needed is the total number of words repeated on the five learning trials. The List A form of the RAVLT should be used (see Appendix A of the Manual). Raw scores are converted to z-scores (mean = 0, standard deviation = 1) using values for the age groups shown in Table 7. As upper age groups overlap, use the age group that best matches your client. For example use the 50-59 age group norms for persons 50-58 and the 57-65 age group norms for persons 59-65.To calculate the z-score for Trial I-V Total, add the numbers of words repeated after the five learning trials to obtain the raw score total. Subtract the age group mean (M) from the raw score total and divide by the standard deviation (SD). Z-scores can be negative. The Schmidt Metanorms Manual can be obtained at: http://www.wpspublish.com/store/p/2933/rey-auditory-verbal-learning-test-ravlt.

Once these normed scores are available, the clinician can access the TBI ACTION website and initiate the assessment for the client by clicking the BEGIN button. The website will show questions and allow responses to be entered using mouse clicks. In our studies, the examiner read the questions to the client and entered the responses. It is possible to have the client read the questions him/herself and enter responses. The possible impact of having clients enter responses instead of entering responses for the client is unknown. It is important that a response is provided for each question. The website will temporarily retain client responses so that normed scores can be calculated and used to generate output. Once the questionnaires are completed the clinician should enter the WMT and cognitive test scores.

Scores to be Entered for the WMT and Cognitive Tests

Measure Scores to be Entered Source
Word Memory Test Immediate Recognition (IR), Delayed Recognition (DR),
Consistency (CNS) percentages
Detailed report obtained under the Reporting menu of
WMT software
Rey Auditory Verbal Learning Test Z-score for the Trials I-V Total Table 7 of the Schimidt Metanorms Manual
Trail Making Test Part A T-score Appendices C, D, and E of the Heaton Norm Manual
Wechsler Adult Intelligence Scale-IV Coding Scaled score Table A.1. of the WAIS-IV Manual
Wechsler Adult Intelligence Scale-IV Letter Number
Scaled score Table A.1. of the WAIS-IV Manual
FAS Letter Fluency Test T-score Appendices C, D, and E of the Heaton Norm Manual

(1) The IR, DR, and CNS scores are typed into the appropriate boxes. (2) The z-score for the RAVLT Trials I-V Total is entered. (3) The Trailmaking Test, Part A, T-score is entered. (4) the WAIS-IV scaled scores for Coding and Letter Number Sequencing are entered. (5) The FAS Letter Fluency Test T-score is entered. Once all scores are entered, click the GENERATE REPORT button.

Output will include: (1) A narrative case conceptualization including treatment options, (2) a figure showing the profile of the cluster most similar to your client on the 12 dimensions along with dimension scores for your client, and (3) a table showing your client’s scores on all 18 measures. For the figure, higher scores are always more “favorable.” So a high score on the memory dimension means that the client showed good memory. A high score on Emotional Distress means that the client is reporting low levels of emotional distress. By referring to this table, you can get a sense of how similar your client is to the cluster group and how he/she differs from the cluster group. For example, your client might have slower (lower) Cognitive Processing Speed than the overall group, but have stronger (higher) Economic and Family Support. Any questions or comments regarding TBI ACTION can be directed to Dr. Mark Sherer at Mark.Sherer@memorialhermann.org.