This study examined the efficacy of computer-assisted cognitive rehabilitation (CACR) in persons with traumatic brain injury (TBI). Twenty persons with TBI who received hierarchically based CACR following inpatient neurorehabilitation were compared to a group of 20 persons with TBI matched for age, education, days in coma and time between testing. The comparison group received various other therapies including speech therapy and occupational therapy. The difference between pre- and post-treatment neuropsychological test scores was used to measure improvements in the domains of attention, visual spatial ability, memory and problem-solving. CACR and the comparison group showed significant post-treatment gains on the neuropsychological test scores, with CACR making significant gains on 15 measures and the comparison group on seven measures. However, we found no significant differences between the groups on their post-treatment gains. Results from this preliminary study found that, though significant cognitive gains were obtained after CACR, the extent and nature of these gains remains to be shown in controlled, prospective group studies.

The Cognitive Behavioral Driver's Inventory (CBDI) was analyzed for its ability to discriminate brain-damaged patients from intact subjects who feigned brain-damage. In a sample of 251 neurologically impaired patients and 48 malingering volunteers, the computer-administered distinguished most malingerers from genuine patients. A jackknifed count revealed that the CBDI had 90% sensitivity for detecting malingerers, and 98% specificity for detecting non-malingering brain damaged patients. Success was due to the inability of malingerers to avoid quantitative errors: excessive response latencies, unusual error rates, inflated variability in response latencies, and excessive within-subject, between-item variability. The computer-administered battery may be an effective clinical tool for identifying patients who malinger brain-damage in neuropsychological testing.

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