Validation of the NIH Toolbox in Individuals with Neurologic Disorders

Abstract

Objective: Individuals with spinal cord injury (SCI), traumatic brain injury (TBI), and stroke experience a variety of neurologically related deficits across multiple domains of function. The NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) examines motor, sensation, cognition, and emotional functioning. The purpose of this paper is to establish the validity of the NIHTB in individuals with neurologic conditions.

Methods: Community-dwelling individuals with SCI (n = 209), TBI (n = 184), or stroke (n = 211) completed the NIHTB. Relative risks for impaired performance were examined relative to a matched control groups.

Results: The largest group differences were observed on the Motor domain and for the Fluid Cognition measures. All groups were at increased risk for motor impairment relative to normative standards and matched controls. Fluid cognitive abilities varied across groups such that individuals with stroke and TBI performed more poorly than individuals with SCI; increased relative risks for impaired fluid cognition were seen for individuals in the stroke and TBI groups, but not for those in the SCI group. All three neurologic groups performed normally on most measures in the Sensation Battery, although TBI participants evidenced increased risk for impaired odor identification and the stroke group showed more vision difficulties. On the Emotion Battery, participants in all three groups showed comparably poor psychological well-being, social satisfaction, and self-efficacy, whereas the TBI group also evidenced slightly increased negative affect.

Conclusions: Data provide support for the validity of the NIHTB in individuals with neurologic conditions.

Keywords: Assessment; Cognition; Disability; Emotion; Motor; NIHTB; Outcomes assessment (health care); Sensory; Spinal cord injury; Stroke; Traumatic brain injury.

Fig. 1.

The NIHTB motor battery: average T scores for individuals with SCI, TBI, and stroke. Notes: NIHTB = NIH Toolbox; SCI = spinal cord injury; TBI = traumatic brain injury. Scores earlier are fully corrected for age, sex, race, and education. Scores are standardized T scores with a mean of 50 and SD of 10. Stars indicate significant group differences for a given test.

Fig. 2.

The NIHTB cognition battery: average T scores for individuals with SCI, TBI, and stroke. Notes: NIHTB = NIH Toolbox; SCI = spinal cord injury; TBI = traumatic brain injury; DCCS = Dimensional Change Card Sort. Scores earlier are fully corrected for age, sex, race, and education. Scores are standardized T scores with a mean of 50 and SD of 10. Stars indicate significant group differences for a given test.