Objective Research shows traumatic brain injury (TBI) survivors underperform compared to healthy comparison participants (HC) on verbal fluency tasks. Verbal fluency is typically comprised of two tasks: letter fluency and semantic fluency. During verbal fluency trials, participants often cluster responses and switch between clusters, which can serve as measures of executive control and organization. Also, research shows that Anglo-Americans (AA) outperformed ethnic minorities on various aspects of cognitive functioning. We examined the relationship between TBI and ethnic diversity on letter fluency, semantic fluency, switching, and clustering. Method The sample included 45 HC adults (21 Hispanics; 24 AA), 33 acute TBI adults (ATBI; 11 Hispanics; 22 AA), and 26 chronic TBI adults (CTBI; 9 Hispanics; 17 AA). Results The groups were well matched, with the exception of gender. ANCOVAs, controlling for gender, revealed HC outperformed ATBI participants on letter fluency, p = .007, ηp2 = .10, letter switching, p = .006, ηp2 = .10, and semantic switching, p = .018, ηp2 = .08. We also found HC outperformed both TBI groups in sematic fluency performances, p = .000, ηp2 = .15. Next, we found Hispanics outperformed AA on letter clustering, p = .003, ηp2 = .09 and semantic clustering, p = .010, ηp2 = .07. Finally, an interaction emerged in letter clustering, p = .044, ηp2 = .06, with the Hispanic ATBI outperforming the AA ATBI group. Conclusion The HC group outperformed both TBI groups only on semantic fluency, but they outperformed the ATBI survivors on letter fluency, letter switching, and semantic switching. Hispanics outperformed AA on letter clustering and semantic clustering, suggesting the use of clustering over switching strategies to provide verbal fluency responses in this group.

Objective McCaul et al. (2018) recently revised the Dot Counting Test (DCT) cut-off score from ≥17 to 13.80; we evaluated the new cut-off in monolingual and bilingual traumatic brain injury survivors (TBIS) and healthy comparison participants (HCP). Method The sample consisted of 43 acute TBI [ATBI; 23 English monolinguals (EM); 11 English first language bilinguals (EFLB); and 9 English second language bilinguals (ESLB)]; 30 chronic TBI (CTBI; 13 EM; 9 EFLB; 8 ESLB), and 56 HCP (23 EM; 11 EFLB; 22 ESLB). Results An ANCOVA, controlling for age and education, revealed an interaction where ATBI-EFLB had higher E-scores than the other groups and the CTBI-EFLB had lower E-scores than the other groups. Both the conventional and proposed new cut-off (PNC) scores had different failure rates in ATBI (conventional cut-off: 9%; PNC: 28%), CTBI (conventional cut-off: 10%; PNC: 20%), and HCP (conventional cut-off: 11%; PNC: 13%). For language groups, EM (conventional cut-off: 14%; PNC: 22%), EFLB (conventional cut-off: 10%; PNC: 26%), and ESLB (conventional cut-off: 5%; PNC: 10%) demonstrated different failure rates across cut-off scores. Group differences were found with McCaul et al. (2018) cut-off, but not the conventional cut-off score. Also, chi-squared analysis revealed ATBI EFLB and EM had greater failure rates than ATBI ESLB. Conclusion Unfortunately, the new DCT cut-off score resulted in greater failure rates in TBIS. Furthermore, ATBI EM and EFLB were impacted more by the new cut offs than ATBI ESLB who learned English later in life, although the reason for this finding is unclear and requires additional study.

Objective We examined two established Spanish-English bilingual norms to assess if traumatic brain injury (TBI) deficits were still found if language was no longer a variable influencing Boston Naming Test (BNT) performance. Method The sample consisted of 47 healthy comparison (HC; 24 English-Monolinguals; 23 Spanish-English Bilinguals), 33 acute TBI (ATBI; 20 English-Monolinguals; 13 Spanish-English Bilinguals), and 25 Chronic TBI (CTBI: 13 English-Monolinguals; 12 Spanish-English Bilinguals) participants. Raw scores and adjusted demographic T-scores (Roberts et al., 2002; Rosselli et al., 1997) were used to evaluate BNT performance. Results An ANCOVA controlling for age, revealed the HC group outperformed the TBI group on the BNT (raw score), p = 0.003, ηp2 = 0.11. We also found monolinguals outperformed bilinguals on the BNT, p = 0.000, ηp2 = 0.24. Using the Roberts et al., (2002) norms, we found the HC group outperformed the TBI group, p = 0.003, ηp2 = 0.11, but no language differences were found. Next, using Rosselli et al., (1997) norms, we found the HC group outperformed the TBI group on the BNT, p = 0.003, ηp2 = 0.11, and monolingual speakers outperformed bilingual speakers, p = 0.014, ηp2 = 0.06. No interactions were found. Conclusions As expected, the TBI group demonstrated worse BNT performance compared to HC group on both language norms. However, when using Roberts et al., (2002) Spanish-English bilingual norms, no language group differences were found. Our data indicates that when examining BNT performance in a Spanish-English bilingual and English-monolingual TBI sample, Roberts et al., (2002) normative data may be better suited to evaluate BNT deficits in a TBI while taking language into account.

Introduction We examined the impact of perceived workload and depressive symptoms on Rey-15 plus recognition (RMT) in ethnic minority participants with traumatic brain injury (TBI). Methods The sample consisted of 63 healthy comparison [HC: 38 with ethnic minority status (EM) & 25 non-ethnic minority Caucasian (NEM)] participants and 40 persons with TBI (18 EM; 22 NEM). The Hospital Anxiety and Depression Scale to measure depressive symptoms (HADS-D) and the NASA-Task Load Index (NASA TLX) to measure perceived workload. Results ANCOVAs revealed that NEM outperformed EM on the RMT, p = 0.000, ηp2 = 0.37. TBI survivors reported higher levels of HADS-D compared to HC participants, p = 0.018, ηp2 = 0.06. Additionally, the EM group reported higher levels of frustration on the RMT compared to NEMs, p = 0.033, ηp2 = 0.05. Interactions emerged for physical demand where NEM participant’s with TBI had higher ratings than EM participants with TBI. For HCs, the EM participants provided higher physical demand ratings than their NEM counterparts, p = 0.029, ηp2 = 0.05. Additionally, a significant relationship between HADS-D and RMT was observed in the healthy NEM participants (r = −0.558, p = 0.004) and NEM participants with TBI (r = −0.288, p = 0.080). Finally, significant relationships between HADS-D and mental demand, physical demand, temporal demand, frustration, and overall subjective workload were observed in healthy EM participants, r = 0.342–0.431, p < 0.05. Conclusion Consistent with previous research, TBI survivors reported higher levels of depressive symptoms, which were associated with RMT performances. Overall, our data suggest the relationship between perceived workload, depression, and performance is complex and that investigators should interpret performance validity scores in person with TBI, depression, and/or EM status with great care.