The present research showed highly relevant results in the context of studies connected with the identification of cognitive abilities of patients with TBI. The results showed a high correlation of the selected patient treatment form (PTF) and the Functional Independence Measure (FIM). The result was astounding – all five chosen measures out of five coincided in the efficiency of indicating the abilities of patients, thus proving the efficiency of correlating the discussed two assessment tools for the further investigation of the state of health and intellectual activity of patients going through the period of rehabilitation after the brain injury.
The Spearman’s rho scale showed the high credibility of the research provided by the comparison of the two tools, PTF and FIM, consequently opening a new pathway in combining the assessment tools to conduct a deeper and more realistic investigation of the patients’ dynamics of recovery. Since the PTF assessment tool represents the dynamic interaction between functioning and disability in its essence, the information and statistical data about the patients’ cognitive information and its analysis with the help determine the recovery dynamics with a much higher grade of efficiency.
Basing the judgment solely on the results of the present research, it is first of all possible to state that the PTF scale of assessment turns out to be much more efficient than the application of the FIM and the Cognistat technique separately. This can be proved by the fact that both techniques lack a certain number of characteristics grasped by the PTF scale, thus making it a more efficient evaluation tool for the recovery dynamics. Namely, these are measures of orientation and attention for the FIM scale and the measures of expression or social and emotional function for the Cognistat scale.
The latter characteristics appears to be highly important, coming back to the findings of Franzen (2000), Gentleman (2001) and Shore (2005) about the interrelation of TBI and clear emotional symptoms present with the patient, i.e. irritability, anxiety or depression. For this reason it appears to be a significant drawback of the technique to skip the emotional function of the patient in case it is so essential in the overall estimation of his or her health status.
The results shown by the PTF usage are significant because of the setting of the study that indicated the usage of the HIM scale on a daily basis, and of PTF – on a weekly basis. Logically, the equality of credibility of the results in all indicators shows the way to facilitate the work of the medical personnel and apply a more optimal, less time-consuming and equally efficient evaluation tool.
These findings justify the opinion of van Baalen et al. (2001) who called FIM the most appropriate measurement tool for assessing limitations in the physical domain. It is also notable that all indicators of physical ability tested with the help of FIM and PTF coincided in their outcome, thus justifying the efficiency of both tools in the assessment of equal characteristics.
From the results of comparison of the PTF and Cognistat scales it becomes evident that the findings are highly different – only two characteristics out of five have been proved to coincide. Measure of comprehension assessed with the help of Cognistat (CC) and measure of comprehension by PTF show significant difference, thus proving that the patient who would pass the scoring within one scale is unlikely to pass it with another one.
Other two measures that did not coincide within the two assessment tools are the problem-solving and reasoning ability together with the measure of attention. Here comes the question about a more credible source – whether the PTF or the Cognistat should be considered a sample against which another technique loses its potential. Deciding this question it is necessary to have a look at the results shown in the process of correlating PTF and FIM, which shows the high level of coincidence, thus indicating the black spots in the Cognistat technique functioning and showing the PTF technique as a more efficient one, yielding much better clinical results and giving a clearer idea about the patients’ cognitive abilities and recovery progress.
It is nevertheless interesting to find out the reasons for such discrepancies between the two techniques and such a good correlation of the PTF and FIM technique, leaving Cognistat behind despite the opinion Kiernan et al. (1987) who stated that Cognistat is a breakthrough in the assessment of such essential characteristics as attention, alertness and orientation that comprise the mental status examination of the TBI patient.
The most troubling finding of the present research is the lack of efficiency of Cognistat to properly evaluate the measure of attention – the discrepancy of results between the PTF and Cognistat techniques cannot be checked with the help of the FIM scale since it does not have this measure included into its range of assessed qualities. However, the full coincidence of results on all measures of FIM and PTF makes the credibility of results given out by PTF more possible, thus indicating the inefficiency of Cogistat.
The result is decisive for the reason of such researchers as Shiel and Wilson (2005) and many others indicating that the influence of the measure of attention of TBI patients is highly important in the overall process of assessment of their current state of health, consequently having a huge impact on the outcomes for severely brain injured patients.
It is known that FIM is the evaluation tool more focused on the physical measurements of the patient indicating his or her recovery status. The scale according to which the results of the FIM examination are formed includes the information about the patient’s being disabled or not, being able to perform daily routine operations without others’ help or not, or the way of giving cues he or she is using. This way the range of physical opportunities of the patient, and thus the projected potential for recovery as well as the possible timelines, are indicated.
Cognistat deals with a wider range of assessment measures thus concentrating on the cognitive abilities of the patient. It deals with such measurements as language, constructions, memory, calculations and reasoning. The most important factors this technique is focused on are the level of consciousness, attention and orientation. Thus, one can see that the major emphasis of the study is made on the intellectual activity of the patient and not on his physical, motor skills that have proved to be also highly important in the process of the patient’s state of health evaluation.
However, it is also significant to show that the measures of memory and orientation have been assessed equally well with the help of PTF and Cognistat assessment tools. These measures are none the less important ones in the context of TBI patients’ evaluation, thus showing that both tools used in the present context have an equal validity and can be further applied for the same purposes without any doubt in the credibility of the results.
One should also consider the fact of ranging results yielded from the investigation of the age differences in the performance of certain skills tested by Cognistat with the patients with TBI. These differences were revealed in the study of Kiernan et al. (1987) and resulted in the realization of the fact that such skills as constructions, memory, and similarities. This information may be also relevant when assessing the discrepancies in the results provided by the PTF and Cognistat assessment.
As a result of the utilization of data obtained with the help of the three mentioned instruments for assessment of the TBI patients’ current state of health it has been found out that the PTF scale is highly correlative with the HIM scale, giving the results of equal credibility and producing equally efficient results – thus, there are no doubts in the propriety of common, simultaneous application of both assessment tools in the course of investigation of the current state of health of a TBI patient. However, the attempt of correlation of findings obtained with the help of application of the Cognistat scale and the PTF scale yielded no positive results, showing that the two scales are impossible to be integrated because of the high discrepancy of the results they give on the majority of measures.
As a conclusion, it should be noted that the PTF measurement scale still remains highly relevant for the assessment of the patients’ state of health, but only in a limited range of measures. Not all measures were shown to coincide according to the results of assessment of data from all three instruments, thus eliminating the possibility of multi-faceted integration. Nevertheless, the opportunity of implementing the PTF assessment tool still should not be ignored, since its productivity becomes evident from the results of the present research.