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The Meyers Neuropsychological Battery (MNB)

The Meyers Neuropsychological Battery (MNB). John E. Meyers, Psy.D. Center for Neuroscience, Orthopedics & Spine, Dakota Dunes, SD Martin L. Rohling, Ph.D. University of South Alabama, Mobile, AL. Table of Contents. Philosophy of MNB Development of MNB Norms Development

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The Meyers Neuropsychological Battery (MNB)

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  1. The Meyers Neuropsychological Battery (MNB) John E. Meyers, Psy.D. Center for Neuroscience, Orthopedics & Spine, Dakota Dunes, SD Martin L. Rohling, Ph.D. University of South Alabama, Mobile, AL

  2. Table of Contents • Philosophy of MNB • Development of MNB • Norms Development • Sensitivity and Specificity • Internal Validity Checks • LOC Dose Response • CT/MRI Data • Profiles

  3. Philosophy of MNB • MNB began as a longer battery of tests. • Using Discriminate Function: Selected tests that were able to discriminate Normal vs TBI. • Did original study years ago

  4. Philosophy of MNB • Goal was to find the best/shortest battery • Sensitive to Brain Injury • Commonly used Tests, that most NPs know • Originally a 6 hour battery cut to 2.5 - 3 hrs • Tests were selected not only for sensitivity but also ease of administration and scoring (i.e., Category vs. WCST)

  5. Short WAIS-III Forced Choice (FC) Rey Complex Figure (RCFT) - Copy Animal Naming 3 minute recall of RCFT COWA Dichotic Listening North American Adult Reading (NART) Sentence Repetition 30 Minute Recall of RCFT Recognition Trial of RCFT (Break offered) AVLT JOL Boston Naming Finger Tapping Finger Localization Trails A & B Token Test AVLT 30 minute Recall AVLT Recognition Trial Booklet Category Test Testing Order for MNB

  6. Individual Tests in The MSB • Picture Completion • Digit Symbol • Similarities • Block Design • Arithmetic • Digit Span • Information • Ward 7 Subtest (Pilgrim, Meyers, Bayless, & Whetstone, 1999)

  7. The MNB database • Familiarize yourself with the database to be discussed.

  8. MNB Database • Description of large pt sample (N = 4050+) • Descriptive Statistics: • Min. Max. M SD • Age 6 99 43.3 20.9 • Educ. 0 23 11.7 3.12 • Note: The individual with 0 yrs education from Mexico and had not completed a single year of education.

  9. MNB Database • Gender • Female = 1816 (45%) Male = 2196 (55%) • Handedness • Right = 3549 (89%) Left = 462 (11%)

  10. MNB Database • Ethnicity - Sample Sizes • African American 82 (2%) • Mixed Racial 47 (1%) • Caucasian 3688 (92%) • Asian 16 (< 1%) • Native American 78 (2%) • Hispanic 101 (3%)

  11. MNB Database • Lots of different diagnoses, as you would find in rehab hospital-based practice.

  12. MNB Smoothed Normative Data • In evaluating the norms, note there were variations in test norms, apparently due to age, & education. • For example, AVLT norms Spreen & Strauss (1998) • At Age = 30-39; M = 11.4 (sd = 2.4) for Trial 6 • At Age = 40; M = 10.4 (sd = 2.7) for Trial 6. • Therefore, pt. scoring 10 a day before b-day, after b-day, score (i.e. 10) would improve from 44T to 48T, using a linear. • Using Heaton et al. (1991) classification system, pts’ score would improve from the Below Average to Average just by becoming a day older. • A common problem with non-smoothed normative data.

  13. MNB Normative Data • Therefore, decided to smooth the norms. • Done by selecting all pts. from dataset who: • had a validity score of 0 or 1 (failures) • were age 15 years or older • 15 yrs old used for the adult version of the Trail Making Test • this was done to keep consistency. • The total sample size N = 1727 • Age: M = 45.7 yrs (sd = 20.7) • Education: 12.3 yrs (sd = 2.7) year of education. • Gender: 779 females; 948 males • Handedness: 1543 were RH and 184 were LH. • Ethnic: 32 mixed; 22 African Americians; 1617 white; 2 Asian; 27 Native American; and 27 Hispanics.

  14. MNB Normative Data • A Regression equation was then calculated using the raw score and the variables, age, education, gender, handedness, and race to predict the T score previously calculated using the standard normative data for the tests.

  15. MNB Regression Norms • Not only does process smooth the data • Also adds adjustments for age, education, gender, handedness, and ethnicity. • In Normals these variables may not always be significant. In injured group variables take on additional impact on test performance.

  16. MNB Normative Data • Once the regression equations were calculated they were used • to calculate a Regression T score for each test • It was found that this procedure worked well for all test variables except Token Test (adult) due to excessive skew • For Token Test, percentile scores were calculated and converted to T score equivalents.

  17. MNB Normative Data • With Regression Equations, with a raw score 10 on AVLT Imm. Recall • In the example used, would change the data (for person tested 1 day before b’day), at age 39 • T Score equivalent would be 45T; a day after her b’day 45T. • Using the regression equation normative data, comparisons can be more reliable made over time. The individual subtests for the WAIS-III or WISC-III were not subjected to the Regression Equation method as only the Scale Scores were coded in the database, not raw scores. Therefore, the scores for these tests are based on normative data from the test manuals.

  18. MNB Normative Data • Scale R R2 Significance Paired Samples t Test • Trails A .902 .814 .000 .000 (1363), p=1.00 • Trails B .873 .762 .000 -.088 (1354), p=.930 • Judgment .946 .894 .000 -.099 (1263), p=.921 • Finger Tapping DH .961 .924 .000 -.079 (1599), p=.937 • Finger Tapping NDH .952 .906 .000 .029 (1577),p=.977 • Finger Localization DH .874 .764 .000 .027 (1201), p=.979 • Finger Localization NDH .801 .641 .000 -.017 (1196), p=.987 • *Token Test .486 .236 .000 .008 (1534),p=.993 • Sentence Repetition .957 .915 .000 .040 (1253),p=.968 • Controlled Oral Word Association .977 .955 .000 -.022 (1487),p=.982 • Animal Naming .976 .953 .000 .099 (1366), p=.921 • Boston Naming .902 .814 .000 72.900 (1312), p=.000 • Dichotic Listening Left .887 .787 .000 -3.994 (1198), p=.000 • Dichotic Listening Right .891 .794 .000 -2.460 (1198), p=.014 • Dichotic Listening Both .921 .849 .000 -2.920 (1198), p=004

  19. MNB Normative Data • Forced Choice .992 .984 .000 -1.065 (1131), p=.287 • AVLT 1 .939 .883 .000 .034 (1470), p=.973 • AVLT 2 .949 .901 .000 .076 (1470), p=.940 • AVLT 3 .959 .920 .000 -.178 (1470), p=.859 • AVLT 4 .939 .882 .000 -.024 (1469), p=.981 • AVLT 5 .934 .872 .000 -.008 (1469),p=.993 • AVLT Total .941 .886 .000 .064 (1470), p=.949 • AVLT Distractor .933 .871 .000 .057 (1467), p=.955 • AVLT Immediate .957 .915 .000 .103 (1468), p=.918 • AVLT Delayed .957 .915 .000 -.071 (1470), p=943 • AVLT Recognition .892 .796 .000 -.015 (1470), p=.988 • CFT Time .927 .859 .000 -.075 (1657), p=.941 • CFT Copy .879 .773 .000 -.053 (1660), p=.958 • CFT Immediate .964 .930 .000 -.077 (1658), p=.938 • CFT Delayed .966 .934 .000 -.068 (1659), p=.946 • CFT False Positive .811 .657 .000 -.027 (1657), p=.979 • CFT False Negative .993 .985 .000 -.056 (1657), p=.956 • CFT Recognition .938 .879 .000 .005 (1658), p=.996 • Booklet Category (Victoria Version) .883 .780 .000 .024 (1290), p=981 • * Because of the skewedness of the data percentile scores were computed and transformed to T Scores for this test.

  20. MNB Data Children • Child Regression Equation R R2 Significance Paired Samples t Test • Trails A .765 .585 .000 .001(99),p=1.000 • Trails B .839 .704 .000 -.050(99),p=.960 • Judgment of Line .944 .891 .000 .072(96),p=.942 • Finger Tapping Dom .913 .833 .000 .017(106),p=.986 • Finger Tapping NonDom .916 .840 .000 -.016(106),p=.987 • Finger Localization Dom .953 .908 .000 .109 (95), p=.914 • Finger Localization NonDom .895 .801 .000 .136 (95), p=.892 • Token Test .847 .718 .000 .229 (106), p=.819 • Sentence Repetition .956 .914 .000 .088 (105), p=.930 • Controlled Oral Word Association .930 .865 .000 .-1.515 (109), p=.133 • Animal Naming .953 .908 .000 .113 (100), p=.910 • Boston Naming .855 .731 .000 -.986 (105), p=326 • Dichotic Listening Left .946 .894 .000 -.748 (99), p=.457 • Dichotic Listening Right .862 .743 .000 -.538 (99), p=.592 • Dichotic Listening Both .937 .878 .000 -.052 (99), p=.959

  21. MNB Data Children • Forced Choice .996 .992 .000 -3.089 (94), p=.003 • AVLT 1 .996 .991 .000 .183 (111), p=.855 • AVLT 2 .998 .996 .000 -.457 (111), p=.648 • AVLT 3 .995 .990 .000 -.295 (111), p=.768 • AVLT 4 .998 .995 .000 .483 (111), p=.630 • AVLT 5 .919 .845 .000 -.022 (111), p=.983 • AVLT Total .932 .869 .000 .047 (111), p=.963 • AVLT Distractor .903 .816 .000 .066 (111),p=.948 • AVLT Immediate .903 .815 .000 .097 (111),p=.923 • AVLT Delayed .959 .919 .000 .143 (111),p=.887 • AVLT Recognition .868 .755 .000 -.041 (111),p=.968 • CFT Time .868 .754 .000 .067 (111),p=.947 • CFT Copy .866 .750 .000 .000 (111),p=1.000 • CFT Immediate .897 .805 .000 .015 (111),p=.988 • CFT Delayed .970 .941 .000 -.028 (111),p=.977 • CFT False Positive .886 .784 .000 -.766 (111),p=.446 • CFT False Negatives .997 .995 .000 .303 (111),p=.762 • CFT Recognition .955 .913 .000 .000 (111),p=1.000 • Booklet Category .620 .384 .000 .000 (92),p=1.000

  22. MNB Regression Equations • Adult • Test Age Ed Sex Hand Race Raw Constant • Trails A .257 -.971 -.337 .229 -.155 -.568 67.381 • Trails B .251 -1.289 1.547 -.756 -.367 -.166 66.414 • JOL .121 -.257 -2.754 -.156 -.126 1.949 7.897 • FT Dominant .164 -.552 -9.566 -.511 .063 1.172 6.846 • FT NonDom .096 -.533 -9.922 -.200 -.260 1.308 10.284 • F Loc Dom -.042 .140 -.264 -.936 .412 2.885 -29.003 • F Loc NonD -.048 .308 .358 -1.717 .669 2.255 -17.303 • Sentence Rep -.008 -1.031 .182 -.946 -.040 6.699 -35.368 • COWA .132 -.973 .134 .021 -.288 .893 20.980 • Animal .135 -.725 .304 .010 -.403 2.115 11.416 • Boston .172 .465 1.12 -0.502 .578 1.78 -65.273 • Dichotic Left .314 -.128 -.365 -.339 .678 2.894 -41.070 • Dichotic Right .333 .056 .498 -1.547 .885 3.253 -55.675 • Dichotic Both .497 -.062 -.463 -1.370 .418 2.653 -34.083

  23. MNB Regression Equations • Forced Choice -.003 .028 -.131 -.041 -.045 5.873 -56.788 • AVLT 1 .279 -.226 6.251 -.077 -.115 6.544 -10.705 • AVLT 2 .287 -.145 3.184 -.039 .127 5.025 -11.264 • AVLT 3 .316 -.031 5.971 -.664 .168 4.867 -24.346 • AVLT 4 .320 -.102 4.511 -.193 .309 5.020 -27.875 • AVLT 5 .330 -.054 5.631 -.464 .176 5.303 -36.296 • AVLT Total .451 -.060 6.787 -.499 .468 1.339 -46.423 • AVLT Distractor .303 -.017 1.319 -.340 .078 5.863 .833 • AVLT Recall .253 -.060 4.545 -.037 .385 4.084 -10.967 • AVLT Delay .278 -.178 6.004 -.138 .056 3.827 -8.061 • AVLT Recognition .186 -.120 1.873 -.236 .046 5.529 -36.667 • CFT Time .172 -.391 -.329 -.169 .018 -.099 70.855 • CFT Copy .238 -.138 .131 -.083 -.297 2.309 -42.228 • CFT Immediate .411 -.181 -.157 .202 .130 2.003 -7.109 • CFT Delayed .407 -.133 -.041 .798 .061 2.009 -8.819 • CFT FP .108 .143 -.015 -1.302 -.547 -6.062 47.265 • CFT FN .127 .006 .059 -.086 -.019 -6.442 60.667 • CFT Recognition .138 .114 -.043 -.564 -.215 4.682 -55.000 • Booklet Category .247 -.941 1.257 1.352 .290 -.345 59.989

  24. Norms for the Token Test • Adult Token Test • Raw T score • 163 67 • 162 55 • 161 50 • 160 47 • 159 46 • 158 45 • 157 41 • 156 39 • 155 38 • 154 37 • 153 34 • 152 29 • 151 25 • 150 20 • 149 15 • 148 10 • 147 5 • <=146 1

  25. MNB Children’s Norms • CHILD Regression Equation Variables • Test Age Ed Sex Hand Race Raw Constant • Trails A -3.207 -.257 5.854 1.701 -2.595 -.703 93.266 • Trails B -3.479 -.047 3.651 .415 .610 -.246 88.233 • JOL -3.643 -.175 -5.216 .062 .667 2.311 44.984 • Finger T Dom -1.819 -.022 -2.739 .651 .223 1.678 1.937 • Finger T Non -1.494 -.010 -2.845 1.890 -.109 1.770 4.069 • Finger Loc D -.241 .227 1.908 -1.322 -.046 3.775 -57.038 • Finger Loc N 2.12 -.237 1.109 -1.681 -.328 2.768 -30.782 • Token Test -2.001 .007 1.206 -2.836 -1.024 1.991 -240.809 • Sentence Rep -3.960 .014 -.347 -.058 .107 6.890 4.453 • COWA -3.121 -.146 8.035 -1.418 -.413 1.358 37.838 • Animal -1.775 .091 -1.377 .868 .186 2.371 31.811 • Boston -3.059 .017 -2.961 .190 -2.037 1.712 11.657 • Dichotic L -5.288 .077 -.110 -2.465 .306 2.772 36.103 • Dichotic R -3.357 -.451 .249 -.184 -.717 2.916 7.665 • Dichotic B -5.049 -.106 .827 -3.59 -.441 2.377 48.833

  26. MNB Children’s Norms • Forced Choice -.058 -.013 -.438 -.152 -.126 5.857 -54.660 • AVLT 1 -1.632 -.010 -.279 -.220 -.111 5.939 37.621 • AVLT 2 -1.629 -.016 -.118 -.055 -.008 5.006 31.756 • AVLT 3 -1.869 .017 -.352 -.509 -.037 4.611 31.297 • AVLT 4 -1.795 -.030 -.170 -.246 .040 4.059 31.447 • AVLT 5 -1.660 .013 1.074 2.025 -.316 3.326 29.722 • AVLT Total -1.759 .042 .720 .343 -.163 .946 27.808 • AVLT Distractor -1.413 -.049 1.213 -.275 .071 5.396 36.710 • AVLT Recall -1.056 -.033 .022 1.740 -.172 2.919 35.148 • AVLT Delay -1.158 .042 .383 1.186 -.220 3.062 37.016 • AVLT Recognition -1.135 .035 1.209 -.205 -.218 3.676 11.398 • CFT Time -.662 .121 -1.890 -1.519 -.383 -.076 88.585 • CFT Copy -2.479 -.436 -4.073 .974 -.397 1.762 26.018 • CFT Immediate -2.279 -.175 -.701 -.1564 -.023 1.640 45.341 • CFT Delayed -2.418 -.056 -.1250 .117 -.409 1.800 42.874 • CFT FP -.398 -.632 -.575 -3.243 -1.161 -6.577 69.205 • CFT FN -.362 .005 .066 -.527 .073 -5.985 68.261 • CFT Recognition -.952 -.117 -.094 -.466 .627 4.971 -44.599 • Booklet Category -.166 -.181 .946 -2.188 .662 -.378 57.818

  27. MNB Recap • Step 1. Took battery of well known NP Tests • Tests with which most clinicians would be familiar • Tests selected based on utility, ease of scoring, and to assess wide array of cognitive functions • This battery is the result several preliminary batteries

  28. MNB Recap Continued • Step 2. Large database of pts. collected • Step 3. Examined results for need smooth • Step 4. Data smoothed across battery • ages ranged from 6 – 99 years old • Separate norms for 6 - 14 and 15 - 99 • Adjust for age, ed, gender, ethnicity & handed

  29. MNB Recap Continued • Step 4. Recalculate database with new norms (Step 3) • Now on the Step 5 • Is this battery of tests valid?

  30. MNB Step 5: Is this battery valid? • Need to examine Reliability/Validity MSB • Meyers, J. E., & Rohling, M. L. (2004). Validation of the Meyers Short Battery on Mild TBI patients. Archives of Clinical Neuropsychology, 19, 637-651. • Study included 4 Groups

  31. Validity of MNB • 30 Medical Controls (Group 1) • in hospital for non CNS problem (i.e. ingrown toe nails) • All community dwelling • No Hx of LD, DD, Substance abuse, TBI, or Mental Health problem, or anything that would disqualify as Normal.

  32. Validity of MNB: 30 Medical Controls (cont.) • Mean Age: 38.6 yrs (sd = 18.9) • Mean Educ: 13.4 yrs (sd = 3.19) • Gender: 15 females; 15 males • Handedness: 29 were RH; 1 was LH • Ethnicity: 29 white; 1 Native American

  33. Validity of MNB • Depressed Group (Group 2) 41 patients • All on SSRI • Mean Age: 46.0 yrs (sd = 15.0) • Mean Education: 13.5 yrs (sd = 2.7) • Gender: 20 females; 21 males • Handedness: 38 were RH; 3 were LH • Ethnicity: 1 mixed race; 40 white • 29 completed MMPI-2 with M scores as follows • L = 52.1 (sd=11.4), F = 60.5 (sd=11.7), K = 50.2 (sd=10.2) • 1 = 63.8 (sd = 12.8) • 2 = 70.8 (sd =14.5) • 3 = 66.7 (sd = 16.0)

  34. Validity of MNB • Chronic Pain (Group 3) comprised of 32 pts who were being treated as outpt. for chronic pain. • None involved in litigation at time of assessment • None had previous litigation histories • Pts. were injured in non-work-related injuries or were injured on their own farms, or had chosen not to pursue Workman’s compensation and were being treated at an outpatient pain clinic.

  35. Validity of the MNBChronic Pain Group Continued Mean Age: 40.7 yrs (sd = 14.2) Mean Education: 13.4 yrs (sd = 2.1) Gender: 20 females and 12 males Handedness: 29 were RH; 3 were LH Ethnicity: 31 white; 1 Native American

  36. Validity of MNB • Group 4: 59 pts. history of TBI • All pts. seen at local hospital and rehab unit • followed by the senior author (JEM) • All pts. had identified LOC 20 min. or less • other data (i.e., GCS or PTA) not often recorded • however, LOC data available for all pts. • LOC defined as “Time to Follow Commands” • (e.g., Dikmen et al., 1995; Volbrecht et al., 2000)

  37. Validity of MNB • Mean Age: 36.9 yrs (sd = 15.1) • Mean Education: 12.6 yrs (sd = 2.1) • Time Post Injury: 7.6 mo. (sd = 10.0) • Gender: 14 females; 43 males • Handedness: 51 were RH; 6 were LH • Ethnicity: 2 mixed; 1 Hispanic; 54 white

  38. Validity of MSB • Test scores obtained for each of the study groups • Normal Chronic Mild • Controls Depressed Pain TBI • NART FSIQ Mean 108.03 105.03 103.71 98.45 • n 29 40 31 51 • SD 8.34 8.57 8.03 6.02 • Barona et. al FSIQ Mean 105.63 105.61 106.25 103.74 • n 30 41 32 57 • SD 7.07 7.12 6.57 6.21 • WAIS VIQ Mean 104.97 103.15 102.28 92.45 • n 30 41 32 56 • SD 9.36 12.86 11.17 9.87 • WAIS PIQ Mean 107.93 100.22 107.59 96.80 • n 30 41 32 55 • SD 11.55 13.24 13.04 10.50 • WAIS FIQ Mean 106.53 101.56 105.19 94.18 • n 30 41 32 55 • SD 8.43 11.04 10.78 9.15

  39. Validity of MNB • Validity assessed using a discriminant function analysis comparing Non-TBI pts. with the TBI pts. • Resulted: 96% correct classification rate • 99% specificity • 90% sensitivity

  40. Reliability of MNB • Reflecting a general clinical sample, • 63 persons with mixed diagnoses assessed more than once, with the first testing at least 6 mo. post injury • Some in litigation, but all passed validity checks • Group descriptive • Age: Mean = 38.4 yrs (sd = 22.8) • Education: Mean = 12.2 yrs (sd = 2.9)

  41. Test Re-test Reliability • 1st Test: Post Injury 21.6 mo. (sd = 22.8) • Re-test: Post Injury 40.7 mo. (sd = 33.2) • Time btwn Sessions: 19.1 mo. (sd = 16.6) • range 2 to 91 mo., median 13 mo. • Reliability r = .86

  42. Internal Validity Checks • Meyers, J. E., & Volbrecht, M. E. (2003). A Validation of Multiple Malingering Detection Methods in a Large Clinical Sample, Archives of Clinical Neuropsychology, 18, 261-276. • Other publications

  43. Internal Validity Check (0%FP Rate cutoff) • Test/Method Cutoff • RCFT: MEP <= 3 (1= Attent, 2=Encode, 3=Store, 4= Retrieve) • Reliable Digits <= 6 • Forced Choice <= 10 • JOL <= 12 • Token Test <= 150 • Dichotic Listening Both <= 9 • Sentence Repetition <= 9 • AVLT-Recognition <= 9 • FT-Estimated FT <= -10

  44. Internal Validity Checks • A total of 796 participants in the study, ages ranged from 16 yrs to 86 yrs, with education ranging from 5 yrs to 23 yrs.

  45. Internal Validity Checks • 15 Groups • Non-litigant groups • Litigant groups

  46. Internal Validity Check • This method showed 83% sensitivity and 100% specificity. Also, there was a 0% false positive rate.

  47. Validity of Neuropsychological Tests • 9 validity checks used (Combination of studies) • Meyers, J. E. & Volbrecht, M. E. (2003). A Validation of Multiple Malingering Detection Methods in a Large Clinical Sample, Archives of Clinical Neuropsychology, 18, 3, 261-276. • Meyers, J. E., & Diep, A. (2000). Assessment of malingering in chronic pain patients using neuropsychological tests. Applied Neuropsychology, 7, 133-139. • Meyers, J. E., & Volbrecht, M. (1999). Detection of malingerers using the Rey Complex Figure and Recognition Trial. Applied Neuropsychology, 6, 4, 201-207. • Meyers, J. E., Galinsky, A., & Volbrecht, M. (1999). Malingering and mild brain injury: How low is too low. Applied Neuropsychology, 6, 208-216. • Meyers, J. E., & Volbrecht, M. (1998). Validation of reliable digits for detection of malingering. Assessment, 5, 301-305. • Meyers, J. E., & Morrison, A. L., & Miller, J. C. (2001). How low is too low revisited: Sentence repetition and AVLT Recognition in the detection of malingering. (Submitted to Applied Neuropsychology). • Meyers, J. E., & Volbrecht, M. E. (2001). A validation of multiple malingering detection methods in a large clinical sample. (under review at Archives of Clinical Neuropsychology)

  48. Validity checks for Neuropsychological tests Frequency of failing validity checks for NON LITIGATING Groups 8 7 6 5 4 3 2 1 7 3 8 7 5 1 1 0 49 7 21 4 33 24 31 < 1hr LOC 1hr <24 LOC 1-8 days LOC 9 days+ LOC Pain Normals Depression

  49. Validity checks for Neuropsychological tests Frequency of failing validity checks for LITIGATING groups 9 0 0 0 2 8 3 0 1 2 7 0 0 0 4 6 2 1 1 1 5 4 0 2 3 4 1 0 3 1 3 5 1 7 4 2 2 1 3 0 1 16 6 16 4 0 49 10 31 0 <1hr LOC > 1 hr LOC Pain Malingering Actors

  50. TBI Dose Response - Dr. Rohling

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