The California Verbal Learning Test (CVLT; Delis, Kramer, Kaplan, & Ober, 1987) data of 150 patients with traumatic brain injury (TBI) were evaluated to determine the latent underlying constructs as well as the possibility of performance subtypes with criterion validity. Confirmatory factor analysis of eight competing latent variable models suggested that a four-factor model (composed of Attention Span, Learning Efficiency, Delayed Recall, and Inaccurate Recall) fit the data relatively well. Two-stage cluster analysis of marker variables of each of these four factors suggested the presence of four reliable subtypes. Level of performance differences between these clusters were related to injury severity parameters. It is concluded that the CVLT is a sensitive and mulitfactorial measure of learning and memory after TBI. Specific recommendations for interpretation of clinically obtained CVLT profiles are provided.

This study investigated the relationship between child functional independence, family dynamics, psychosocial factors, and level of distress in parents of children with congenital disabilities. The Vineland Adaptive Behavior Scales, the Family Assessment Device (FAD), and the Brief Symptom Inventory (BSI) were administered to 60 parents of children with cerebral palsy, 34 parents of children with spina bifida, and 27 parents of children with limb deficiencies. Stepwise multiple regression analyses indicated that the Roles scale from the FAD and the presence of a significant new psychosocial stressor within the previous 6 months were statistically significant predictors of the level of parental distress as assessed by the BSI. Exploration of the extent to which families have adaptive distributions of responsibilities for dealing with domestic tasks, as well as with unrelated life stressors, may be helpful in identifying those parents of children with congenital disabilities who are at risk for distress.

Symptom-specific reactivity to stress (lower paraspinal muscle reactivity) among chronic low back pain (CLBP) patients may exacerbate chronic pain. It was hypothesized that among CLBP patients (N = 107) only stress-induced lower paraspinal reactivity, and not reactivity in other indexes, would predict pain severity (PS), and that lower paraspinal reactivity would mediate or moderate links between depression and PS. Electromyogram readings from lower paraspinal and trapezius muscles, systolic and diastolic blood pressures, and heart rate were collected during mental arithmetic (MA) and an anger recall interview. The moderator hypothesis was supported: Only lower paraspinal reactivity during MA was related significantly to PS, but only among patients with high levels of depression. Thus, a profile of lower paraspinal hyperreactivity plus depressed affect may aggravate CLBP.

The performance of 100 patients with traumatic brain injury (TBI) on the Wisconsin Card Sorting Test (WCST) was examined to determine the underlying latent structure as well as profile subtypes. Exploratory factor analysis with oblique rotation identified three factors: response accuracy, learning, and failure to maintain set. Marker variables from each factor were then included in a two-stage cluster analysis, which identified two reliable subtypes. Level of performance differences between these subtypes were meaningfully related to both demographic background and length of coma. It is concluded that interpretation of the WCST results of patients with TBI should consider the multifactorial nature of the instrument in combination with injury severity characteristics and demographic variables.

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