Expectancies for Performance in Persons With Mild Traumatic Brain Injury Angelle M' Sander, Ph'D', M

1
Expectancies for Performance in Persons With Mild
Traumatic Brain Injury Angelle M. Sander, Ph.D.,
Margaret A. Struchen, Ph.D.,Allison N. Clark,
Ph.D., Walter M. High, Jr., Ph.D., H.J. Hannay,
Ph.D.
Physical Medicine and Rehabilitation
RESULTS Cognitive performance did not differ
between persons with complicated and
uncomplicated mild TBI for any of the cognitive
domains. Mean expectancy ratings for each of
the cognitive domains are shown in Figure 1.
Persons with complicated mild TBI expected to
perform worse than persons with uncomplicated
mild TBI on measures of learning and memory
(t-2.4, plt.05). For the complicated mild
group, number of stressful life events was
inversely related to expectancies for
learning/memory (r-.50, plt.01) and speed of
processing performance (r-.47, plt.01). For the
uncomplicated mild group, self-efficacy was
positively correlated with expectancies for
performance on executive functioning measures
(r.29, plt.05). Depressive symptoms, as assessed
by the CES-D, were not related to cognitive
performance. For the entire sample,
expectancies added significantly to the variance
in performance on learning/memory tasks (R2
change.10, plt.01) and processing speed tasks (R2
change.05, plt.05) after accounting for injury
severity and self-efficacy scores.
METHOD, CONT. Procedure and Measures Within 1
week of injury, participants completed a battery
of tests and questionnaires that included those
shown in Table 1. After instructions for each
cognitive measure, but prior to beginning the
task, participants rated on a 5-point scale how
they expected to perform compared to others of
similar age and education. All scores on
cognitive measures were converted to standardized
T-scores. Mean T-scores were calculated for each
cognitive domain. For each domain, a participant
was classified into one of the following
categories below average (mean T-scorelt40)
average (mean T-score 40 to 60) above average
(mean T-score gt60). Mean expectancy ratings for
each of the cognitive domains were also
calculated. For each domain, each participants
expectancy rating was coded as (1) worse
compared to peers or (2) the same or better
compared to peers. Expectancy Question How do
you think you will perform on this test compared
with people who are of the same age and
educational level as yourself? (1much worse
2somewhat worse 3about the same 4somewhat
better 5much better)

• DISCUSSION/CONCLUSIONS
• It is possible that within the time limit of one
  week after injury, persons with complicated
  mild TBI have greater daily experience with
  learning and memory problems than with problems
  in speed of processing or executive functioning.
• While the actual performance did not differ
  between persons with complicated and
  uncomplicated mild injury, it is possible that
  persons with complicated mild injury experienced
  greater everyday changes in learning and memory,
  leading them to have lower expectancies for
  performance.
• Experience with previous stressful life events
  and/or low self-efficacy can decrease ones
  perception of their abilities, and thus lower
  their expectancies for cognitive performance.
• The relationship between self-efficacy and
  expectancies for the uncomplicated mild group
  suggests that their feelings of general
  self-esteem can impact their predictions of
  performance on cognitive tests.
• Expectancies contribute to cognitive performance
  on tasks of learning/memory and processing speed,
  even after accounting for injury severity and
  self-efficacy. This should not be taken to mean
  that expectancies cause performance, as this is a
  correlational design. It is possible that persons
  who have cognitive difficulties in these areas
  develop realistic expectancies regarding their
  abilities. Future studies should look at
  discrepancies between expectancies and
  performance. It would also be beneficial to
  assess post-test perceptions of performance, in
  order to assess whether appraisal of performance
  is impacted after experience with the task.
• Depression was not related to expectancies for
  this sample. However, total scores on the CES-D
  were used and future studies should investigate
  this relationship for the subset of persons who
  show depression.
• The results have implications for education and
  intervention in persons with mild TBI, since
  altering expectations of performance has the
  potential to impact performance.

INTRODUCTION Early after injury, persons with
mild traumatic brain injury (TBI) have been shown
to experience physical, cognitive, and emotional
difficulties.1-4 Several studies have shown that,
for most persons, these symptoms resolve by
approximately 3 months following injury.5-7
However, other studies have shown persistence of
symptoms at periods ranging from 3 to 6
months.8,9 There has been some evidence that
persistence of symptoms following a mild TBI is
related to a pre-injury history of depression
and/or anxiety10-12 and/or to pre-existing
personality or coping styles.12-14 Depression
following mild TBI has been shown to be
associated with increased report of subjective
cognitive complaints,15-17as well as with
decreased cognitive test performance.17-19
Depression may directly lead to impairments in
attention, memory, and processing speed, but may
also contribute indirectly by impacting a
persons self-efficacy regarding performance.
Expectancies regarding cognitive performance have
been shown to be related to actual performance in
normal persons20 and in alcoholics.21
PURPOSE The purpose of the current study was
to examine expectancies for cognitive performance
in persons with mild TBI, as well as to
investigate the relationship of expectancies to
cognitive performance, stress, self-efficacy, and
depression. METHOD Participants 104 persons
with mild TBI who were consecutively admitted to
a Level I trauma center emergency room (ER). The
majority of participants (n68) had sustained a
complicated mild TBI, as defined by a Glasgow
Coma Scale (GCS) score of 13 to 15 upon
admission, but with the presence of abnormal
findings on neuroimaging.22 The remainder (n36)
had sustained uncomplicated mild TBI, as defined
by a GCS score of 13 to 15 and no abnormalities
on neuroimaging.22 The majority of participants
were male (67), with a mean age of 34
(SD14.46). Recruitment from a County Level I
trauma center resulted in a sample composed
primarily of minorities (44 Black, 30 White,
24 Hispanic, 1 Asian) and relatively low
education (Mean yrs.12 SD2.6 Range4 to 20).
Table 1. Cognitive and Self-Report Measures
Administered
Figure 1. Pre-Test Expectancies By Cognitive
Domain
plt.05

References Available on Handout