Validity Assessment in Traumatic Brain Injury Impairment and Disability Evaluations - 20/06/19

Doi : 10.1016/j.pmr.2019.03.009

Nathan D. Zasler, MD, DABPMR, BIM-C, FIAIME, DAIPM, CBIST ^a,^b,^c,^d,^⁎ , Scott D. Bender, PhD, ABPP-CN ^e
^a Concussion Care Centre of Virginia, Ltd, Tree of Life Services, Inc, 3721 Westerre Parkway, Suite B, Richmond, VA 23233, USA
^b Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
^c Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA
^d International Brain Injury Association, Alexandria, VA, USA
^e Institute of law, psychiatry and Public policy, Department of Psychiatry and Neurobehavioral Science, University of Virginia, 1230 Cedars Court, Suite 108, Charlottesville, VA 22903, USA

^∗Corresponding author. Concussion Care Centre of Virginia, Ltd, Tree of Life Services, Inc, 3721 Westerre Parkway, Suite B, Richmond, VA 23233, USA.Concussion Care Centre of Virginia, LtdTree of Life Services, Inc3721 Westerre ParkwaySuite BRichmondVA23233

Résumé

This article provides an overview of validity assessment in persons with traumatic brain injury including evaluation caveats. Specific discussion is provided on post-concussive disorders, malingering, examination techniques to assess for validity, response bias, effort and non-organic/functional presentations. Examinee and examiner biases issues will also be explored. Discussion is also provided regarding judicial trends in limiting examiner scope of testing and/or testimony, and risk of liability when providing expert witness opinions on validity of examinee presentations. The hope is to encourage physiatrists to become more aware and skilled in validity assessment given its importance in differential diagnosis of impairment following traumatic brain injury.

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Keywords : Traumatic brain injury, Validity, Response bias, Malingering, Physical examination, Cognition, Behavior, Forensic

Plan

Key points

Introduction

The concept of validity assessment

The concept of effort assessment in forensic evaluations

Performance Validity

Symptom Validity

The concept of response bias assessment in impairment evaluations

Forensic Implications of Response Bias in the Examiner

Postconcussive disorders (syndrome) and controversy

Malingering: caveats and controversies

Legal trends in limiting validity testimony in cases involving traumatic brain injury: obstructionism driven by ignorance or greed?

What physiatrists should know about forensic neuropsychological assessment and traumatic brain injury

What physiatrists should know about the forensic neurologic examination of persons with acquired brain injury

Clinical caveats

Summary

Disclosure Statement: Dr N.D. Zasler reports no funding support for this work. He acknowledges ownership of Concussion Care Center of Virginia Ltd and Tree of Life Services, Inc, which are providers of health care services to persons with acquired brain injury and ongoing engagement in brain injury education, health care, and medicolegal consultation. Dr S.D. Bender reports no funding support for his work on this article.