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Behavior Rating Inventory of Executive Function BRIEF TM. Gerard A. Gioia Peter K. Isquith Steven C. Guy Lauren Kenworthy Kimberly Espy. Impetus:. Clinical need for external validation, ecological validity, real-world anchor Common parent descriptions ALL research - observations - PowerPoint PPT Presentation
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Behavior Rating Inventory of Behavior Rating Inventory of Executive FunctionExecutive Function
BRIEFBRIEFTM
Gerard A. GioiaGerard A. Gioia
Peter K. IsquithPeter K. Isquith
Steven C. GuySteven C. Guy
Lauren KenworthyLauren Kenworthy
Kimberly EspyKimberly Espy
Impetus:Impetus:
Clinical need for external validation, Clinical need for external validation, ecological validity, real-world anchorecological validity, real-world anchor
Common parent descriptionsCommon parent descriptions ALL research - observationsALL research - observations Performance tests vs rating scalesPerformance tests vs rating scales
What’s in a nameWhat’s in a name
Children’s Behavior QuestionnaireChildren’s Behavior Questionnaire Executive Function QuestionnaireExecutive Function Questionnaire Developmental Executive Function TestDevelopmental Executive Function Test Behavioral Evaluation of Executive Function (Youth?)Behavioral Evaluation of Executive Function (Youth?) Behavioral Assessment of Regulatory FunctionBehavioral Assessment of Regulatory Function Planning and Organization Rating QuestionnairePlanning and Organization Rating Questionnaire Parent Observation Rating QuestionnaireParent Observation Rating Questionnaire Behavior Rating Inventory of Executive FunctionBehavior Rating Inventory of Executive Function
The Purpose is to provide a measure of The Purpose is to provide a measure of executive function that is:executive function that is:
psychometrically sound psychometrically sound
sensitive to developmental changessensitive to developmental changes
high in ecological validity high in ecological validity
sufficiently broad to serve as a screen sufficiently broad to serve as a screen
comprehensive in sampling contentcomprehensive in sampling content
theoretically coherenttheoretically coherent
useful in targeting treatmentuseful in targeting treatment
Behavioral Definitions for Executive Behavioral Definitions for Executive Function DomainsFunction Domains
Inhibit - Control impulses; stop behaviorInhibit - Control impulses; stop behavior
Shift - Move freely from one activity/situation to Shift - Move freely from one activity/situation to another; transition; problem-solve flexiblyanother; transition; problem-solve flexibly
Emotional Control - Modulation emotional Emotional Control - Modulation emotional responses appropriatelyresponses appropriately
Behavioral Definitions for Executive Behavioral Definitions for Executive Function DomainsFunction Domains
Initiate - Begin activity; generate ideasInitiate - Begin activity; generate ideas
Working Memory - Hold information in mind for Working Memory - Hold information in mind for purpose of completing a taskpurpose of completing a task
Plan/organize - Anticipate future events; set goals; Plan/organize - Anticipate future events; set goals; develop steps; grasp main ideasdevelop steps; grasp main ideas
Monitor - Check work, assess own performanceMonitor - Check work, assess own performance
Development of the BRIEFDevelopment of the BRIEF
ContentContent
ReliabilityReliability
ValidityValidity
Age/ Gender FindingsAge/ Gender Findings
Modeling of Executive FunctionModeling of Executive Function
Item DevelopmentItem Development
Collected items from clinical workCollected items from clinical work
Idea generation sessions within groupIdea generation sessions within group
Requests from colleaguesRequests from colleagues
Review of behavior scales (CBCL/TRF, BASC, Review of behavior scales (CBCL/TRF, BASC, Conner’s, Vineland, Profile of Executive Control Conner’s, Vineland, Profile of Executive Control System, Cognitive Symptom Checklist)System, Cognitive Symptom Checklist)
Results of Item DevelopmentResults of Item Development
Items reviewed by group, colleagues, reading Items reviewed by group, colleagues, reading specialists:specialists:
180 initial items: redundant & non-specific180 initial items: redundant & non-specific
Item Tryout: 129 Parent/127 TeacherItem Tryout: 129 Parent/127 Teacher
Excess items based on item-total correlationsExcess items based on item-total correlations
Final Scale: 90 items retainedFinal Scale: 90 items retained
BRIEF: InhibitBRIEF: Inhibit Gets in your faceGets in your face Has trouble stopping when sillyHas trouble stopping when silly Is squirmyIs squirmy Does not stop laughing at joke when friends stopDoes not stop laughing at joke when friends stop Has to be closely supervisedHas to be closely supervised Des not think before doingDes not think before doing Acts wilder or sillier than others in groupsActs wilder or sillier than others in groups Makes odd noises, hums, mutters or singsMakes odd noises, hums, mutters or sings Interrupts othersInterrupts others
BRIEF: ShiftBRIEF: Shift Does same thing over and over for no apparent reasonDoes same thing over and over for no apparent reason Is stubbornIs stubborn Cannot get a disappointment off their mindCannot get a disappointment off their mind Resists accepting a different way to solve a problemResists accepting a different way to solve a problem Becomes upset with new situationsBecomes upset with new situations Tries same approach to problems even when it doesn't Tries same approach to problems even when it doesn't
workwork Acts upset by change in plansActs upset by change in plans Not creative in problem solvingNot creative in problem solving
BRIEF: Emotional ControlBRIEF: Emotional Control
Overreacts to small problemsOverreacts to small problems Explosive, angry outburstsExplosive, angry outbursts Tearful easilyTearful easily Mood changes frequentlyMood changes frequently Reacts more strongly than other childrenReacts more strongly than other children Becomes too sillyBecomes too silly
BRIEF: InitiateBRIEF: Initiate
Is not a self-starterIs not a self-starter Needs to be told to begin a task even when willingNeeds to be told to begin a task even when willing Has trouble coming up with ideas for what to do in Has trouble coming up with ideas for what to do in
play or free timeplay or free time Has trouble getting started on homework or choresHas trouble getting started on homework or chores Does not take initiativeDoes not take initiative Complains there is nothing to doComplains there is nothing to do Lies around the house a lot (couch potato)Lies around the house a lot (couch potato)
BRIEF: Working MemoryBRIEF: Working Memory
Is absent-mindedIs absent-minded When given three things to do, remembers only the When given three things to do, remembers only the
first or lastfirst or last Trouble with multi-step choresTrouble with multi-step chores Forgets when he was doingForgets when he was doing Trouble remembering things even for a few minutesTrouble remembering things even for a few minutes Has a short attention spanHas a short attention span Has trouble completing tasksHas trouble completing tasks Is easily distractedIs easily distracted
BRIEF: Plan/OrganizeBRIEF: Plan/Organize Tests poorly despite knowing answersTests poorly despite knowing answers Good ideas but can't get the job doneGood ideas but can't get the job done Written work poorly organizedWritten work poorly organized Starts project without the right materialsStarts project without the right materials Trouble planning for future play activitiesTrouble planning for future play activities Does not connect tonight's homework with gradesDoes not connect tonight's homework with grades Unrealistic GoalsUnrealistic Goals Underestimates time needed to complete tasksUnderestimates time needed to complete tasks
BRIEF: Organization of MaterialsBRIEF: Organization of Materials
Leaves playroom a messLeaves playroom a mess Loses lunch box, lunch money, permission slips, Loses lunch box, lunch money, permission slips,
homeworkhomework Cannot find clothes, glasses, shoes, toys, etcCannot find clothes, glasses, shoes, toys, etc Backpack is disorganizedBackpack is disorganized Forgets to hand in homework even when Forgets to hand in homework even when
completedcompleted
BRIEF: MonitorBRIEF: Monitor
Doesn't ask for help when neededDoesn't ask for help when needed Doesn't check work for mistakesDoesn't check work for mistakes Makes careless errorsMakes careless errors Poor handwritingPoor handwriting Unaware of how behavior affects othersUnaware of how behavior affects others Leaves work incompleteLeaves work incomplete
Reliability: Internal ConsistencyReliability: Internal Consistency
InitiateInitiate
Working MemoryWorking Memory
Plan/OrganizePlan/Organize
Organization of MaterialsOrganization of Materials
MonitorMonitor
InhibitInhibit
ShiftShift
Emotional ControlEmotional Control
ParentParent TeacherTeacher
.82.82 .84 .84
.92.92 .90 .90
.91.91 .87 .87
.88.88 .90 .90
.85.85 .89 .89
.94.94 .95 .95
.88.88 .91 .91
.92.92 .94 .94
Reliability: Internal ConsistencyReliability: Internal Consistency
MetacognitionMetacognition
Behavioral RegulationBehavioral Regulation
Global Executive CompositeGlobal Executive Composite
ParentParent TeacherTeacher
.96.96 .98 .98
.96.96 .97 .97
.98.98 .98 .98
Reliability: Test-RetestReliability: Test-Retest
ScaleScale
InitiateInitiate
Working MemoryWorking Memory
Plan/OrganizePlan/Organize
Org of MaterialsOrg of Materials
MonitorMonitor
InhibitInhibit
ShiftShift
Emotional ControlEmotional Control
ParentParent ParentParent TeacherTeacher
ClinicalClinical NormNorm NormNorm
.77.77 .80 .80 .87 .87
.82.82 .85 .85 .86 .86
.80.80 .85 .85 .88 .88
.84.84 .79 .79 .83 .83
.80.80 .76 .76 .87 .87
.76.76 .84 .84 .91 .91
.72.72 .78 .78 .83 .83
.79.79 .79 .79 .82 .82
Reliability: Test-RetestReliability: Test-Retest
MetacognitionMetacognition
Behavioral Behavioral RegulationRegulation
Global Executive Global Executive CompositeComposite
ParentParent ParentParent TeacherTeacher
ClinicalClinical NormNorm Norm Norm
.83.83 .88 .88 .90 .90
.80.80 .84.84 .92 .92
.81.81 .86.86 .91 .91
ValidityValidity
Content Content Item developmentItem development
Expert AgreementExpert Agreement
Item-Total CorrelationsItem-Total Correlations
ConstructConstruct Multitrait-Multimethod MatrixMultitrait-Multimethod Matrix
Factor StructureFactor Structure
Clinical Group Clinical Group ComparisonsComparisons
Construct Validity - Factor AnalysisConstruct Validity - Factor Analysis
Allows examination of the structure of the Allows examination of the structure of the BRIEF to assist in clinical scale/ index BRIEF to assist in clinical scale/ index developmentdevelopment
Resulting factors can serve as clinical entities; Resulting factors can serve as clinical entities; meta-scale (latent) structural factorsmeta-scale (latent) structural factors
Various extraction methods: PFA, PCAVarious extraction methods: PFA, PCA
Various rotational methods: Varimax, obliqueVarious rotational methods: Varimax, oblique
Summary of Exploratory FASummary of Exploratory FA
Consistent 2-factor model found with normative, clinical Consistent 2-factor model found with normative, clinical samples; BRIEF factors differentiate from other behavior samples; BRIEF factors differentiate from other behavior rating scale factors.rating scale factors.
MetacognitionMetacognition Initiate, Working Memory, Plan/Organize, Organization Initiate, Working Memory, Plan/Organize, Organization
of Materials, Monitorof Materials, Monitor (Inhibit)(Inhibit)
Behavioral RegulationBehavioral Regulation Inhibit, Shift, Emotional ControlInhibit, Shift, Emotional Control (Monitor)(Monitor)
The Structure of Executive FunctionThe Structure of Executive Function
Interest in BRIEF goes beyond its use as a clinical Interest in BRIEF goes beyond its use as a clinical tooltool
Allows an opportunity to explore the theoretical Allows an opportunity to explore the theoretical structure of executive function (EF)structure of executive function (EF)
Others have asked whether EF is a unitary or Others have asked whether EF is a unitary or “fractionated” supervisory/ regulatory system“fractionated” supervisory/ regulatory system
Theory testing also can assist our approach to Theory testing also can assist our approach to clinical application of the BRIEF as a measure of clinical application of the BRIEF as a measure of EFEF
Diagnostic Group StudiesDiagnostic Group Studies ADHD-Inattentive vs ADHD-CombinedADHD-Inattentive vs ADHD-Combined
BRI and Monitor: Combined > Inattentive & ControlsBRI and Monitor: Combined > Inattentive & Controls MCI: Both ADHD groups > ControlsMCI: Both ADHD groups > Controls
• B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. GuyB. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. Guy
• P. Isquith, G. Gioia & S. GuyP. Isquith, G. Gioia & S. Guy
Severe vs Mild/Moderate TBISevere vs Mild/Moderate TBI BRI & Init, Plan/Org, WM, Monitor: Severe > ControlsBRI & Init, Plan/Org, WM, Monitor: Severe > Controls Working Memory: Severe > Mild/Moderate > ControlsWorking Memory: Severe > Mild/Moderate > Controls
• H. G. Taylor et al.H. G. Taylor et al.
TS vs ADHD vs TS+ADHDTS vs ADHD vs TS+ADHD BRI & MCI: ADHD & TS+ADHD > TS & ControlsBRI & MCI: ADHD & TS+ADHD > TS & Controls
• E. M. MahoneE. M. Mahone
Diagnostic Group StudiesDiagnostic Group Studies Reading DisordersReading Disorders
Working Memory: Reading > ControlsWorking Memory: Reading > Controls Plan/Organize: Reading > ControlsPlan/Organize: Reading > Controls
• B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. GuyB. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. Guy
Extremely Low Birth Weight vs VLBWExtremely Low Birth Weight vs VLBW Monitor, WM, Shift, Inhibit, Init, Plan/Org: ELBW > ControlsMonitor, WM, Shift, Inhibit, Init, Plan/Org: ELBW > Controls Initiate & Plan/Org: ELBW > VLBWInitiate & Plan/Org: ELBW > VLBW
• . G. Taylor et al.. G. Taylor et al.
Mental RetardationMental Retardation Working Memory: MR > ControlsWorking Memory: MR > Controls
• B. Pratt & T. ChapmanB. Pratt & T. Chapman
Diagnostic Group StudiesDiagnostic Group Studies High Functioning AutismHigh Functioning Autism
All BRIEF Scales: HFA > ControlsAll BRIEF Scales: HFA > Controls• R. Landa & M. GoldbergR. Landa & M. Goldberg
Pervasive Developmental DisordersPervasive Developmental Disorders All BRIEF Scales: PDD > ControlsAll BRIEF Scales: PDD > Controls
• L. Kenworthy & S. GuyL. Kenworthy & S. Guy
Frontal vs Extrafrontal LesionsFrontal vs Extrafrontal Lesions All Scales: Frontal & Extrafrontal > ControlsAll Scales: Frontal & Extrafrontal > Controls Inhibit:Inhibit: Frontal > Extrafrontal > ControlsFrontal > Extrafrontal > Controls
• R. Jacobs, V. Anderson, S. HarveyR. Jacobs, V. Anderson, S. Harvey
ConclusionConclusion
““The BRIEF is a reliable and valid behavior The BRIEF is a reliable and valid behavior rating scale of executive functions in children rating scale of executive functions in children and adolescents that can (a) become an and adolescents that can (a) become an integral part of the clinical and school integral part of the clinical and school assessment of children and adolescents and (b) assessment of children and adolescents and (b) assist with focussed treatment and educational assist with focussed treatment and educational planning for children with disorders of planning for children with disorders of executive function.” (Gioia, Isquith, Guy & executive function.” (Gioia, Isquith, Guy & Kenworthy, 2000, p. 4)Kenworthy, 2000, p. 4)
Clinical ImplicationsClinical Implications
Two factors and component parts are to be Two factors and component parts are to be considered in interpretationconsidered in interpretation
Behavioral Regulation, esp. Inhibit, must be Behavioral Regulation, esp. Inhibit, must be considered first prior to Metacognitionconsidered first prior to Metacognition
Treatment of Behavioral Regulation is likely Treatment of Behavioral Regulation is likely a necessary precursor to Metacognition a necessary precursor to Metacognition treatmenttreatment
Treatment of metacognition via active Treatment of metacognition via active problem-solving strategiesproblem-solving strategies
BRIEF Administration BRIEF Administration and Scoringand Scoring
BRIEF Administration BRIEF Administration and Scoringand Scoring
Intro to Forms - Parent, TeacherIntro to Forms - Parent, Teacher Scoring SheetScoring Sheet Scoring SummaryScoring Summary Profile SheetProfile Sheet Case ExampleCase Example
Steps to BRIEF InterpretationSteps to BRIEF Interpretation
Examine validity scalesExamine validity scalesInconsistencyInconsistencyNegativityNegativity
Examine clinical scalesExamine clinical scales Examine Indexes, Global Executive Examine Indexes, Global Executive
CompositeComposite Individual item analysisIndividual item analysis
Within scale itemsWithin scale itemsNon-scale itemsNon-scale items
Son of BRIEF: Son of BRIEF: The BRIEF-Preschool VersionThe BRIEF-Preschool Version
Gerard A. GioiaGerard A. Gioia
Kimberly Andrews EspyKimberly Andrews Espy
Peter K. IsquithPeter K. Isquith
Or:Or:
The Developmental Inventory The Developmental Inventory Assessment of Preschool Executive Assessment of Preschool Executive RegulationRegulation
(DIAPER)(DIAPER)
Executive Function in Preschoolers: Executive Function in Preschoolers: Common ViewCommon View
Young children:Young children: lack inhibitory controllack inhibitory controlexhibit significant distractibilityexhibit significant distractibilityhave difficulty shifting among taskshave difficulty shifting among tasksdo not organize, plan, or monitor their actions do not organize, plan, or monitor their actions
or performanceor performance
Views from Developmental Views from Developmental NeuropsychologyNeuropsychology
Executive functions DO originate in infancyExecutive functions DO originate in infancy BUT, not available in full final formBUT, not available in full final form HOWEVER, measurement is possible if HOWEVER, measurement is possible if
developmentally appropriate tasks are useddevelopmentally appropriate tasks are used AND, we must take into account the AND, we must take into account the
preschooler’s behavioral repertoirepreschooler’s behavioral repertoire
BRIEF-Preschool VersionBRIEF-Preschool Version
Sample: n=450 Parents, 300+ TeachersSample: n=450 Parents, 300+ TeachersAge 2- 5 yearsAge 2- 5 yearsDiverse sample: ethnically, regionally, SESDiverse sample: ethnically, regionally, SES
129 97 63 items129 97 63 items
BRIEF-P DomainsBRIEF-P DomainsInhibitInhibitShiftShiftEmotional ControlEmotional ControlWorking MemoryWorking MemoryPlan/ OrganizePlan/ OrganizeOrganization (of Materials)Organization (of Materials)MonitorMonitorInitiationInitiation
Reliability: Internal ConsistencyReliability: Internal Consistency
Working Memory (17)Working Memory (17)
Plan/Organize (10)Plan/Organize (10)
Inhibit (16)Inhibit (16)
Shift (10)Shift (10)
Emotional Control (10)Emotional Control (10)
ParentParent TeacherTeacher
.88.88 .95 .95
.80.80 .86 .86
.90.90 .95 .95
.85.85 .90 .90
.86.86 .94 .94
Stability of Preschool Executive Behaviors:Stability of Preschool Executive Behaviors:Test - Retest Reliability Test - Retest Reliability
ScaleScale rr
InhibitInhibit .90.90
ShiftShift .88.88
Emotional ControlEmotional Control .87.87
Working MemoryWorking Memory .85.85
Plan/OrganizePlan/Organize .78.78
Test-Retest Interval 1 - 9 weeks, M = 4.5 weeksTest-Retest Interval 1 - 9 weeks, M = 4.5 weeks
BRIEF-P BRIEF-P Construct ValidityConstruct Validity
Factor 1 = Emergent Metacognition; Factor 1 = Emergent Metacognition; Factor 2 = FlexibilityFactor 2 = Flexibility Factor 3 = Inhibitory Self-Control.Factor 3 = Inhibitory Self-Control.
Diagnostic Group
Scale Controls Preemie Language ADHD PDD
Inhibit 7.2 11.8 32.1 76.5 87.5
Shift 7.2 20.6 28.6 29.4 68.8
Emotional Control 6.3 8.8 28.6 47.1 75
Working Memory 9.6 35.3 39.3 70.6 75
Plan/Organize 2.8 17.6 28.6 76.5 56.3
Inhibitory Self-Control Index
6.3 14.7 28.6 76.5 93.8
Flexibility Index 6.7 8.8 28.6 29.4 75
Emergent Metacognition Index
7.0 29.4 32.1 70.6 68.8
Global Executive Composite
6.5 17.6 35.7 70.6 81.3
Percentage of Dx Groups With T> 65 on BRIEF-P ScalesPercentage of Dx Groups With T> 65 on BRIEF-P Scales
Clinical vs Control SamplesClinical vs Control Samples
0
0.5
1
1.5
2
2.5
Inhibit Shift EC WM Plan/Org
BRIEF-P Scale
Par
ent
Rat
ing
Clinical (45) Control (45)
**** ** ** **
* p < .001* p < .001
Bride of the BRIEFBride of the BRIEFThe BRIEF-Self-ReportThe BRIEF-Self-Report
ScaleNumberof Items Behavioral description
Clinical scales
Inhibit 13 Controls impulses and behavior; appropriately stops and modulates own behavior at the proper time or in the proper context.
Shift 10 Moves freely from one situation, activity, or aspect of a problem to another as the situation demands; makes transitions; solves problems flexibly.
*Behavioral Shift 5 Adjusts behaviorally to changes in environment or schedule.
*Cognitive Shift 5 Problem solves flexibly.
Emotional Control 10 Modulates emotional responses appropriately to situational demand or context.
Monitor 6 Aware of strengths and weaknesses; aware of own behavior and impact on others.
Working Memory 12 Holds information in mind for the purpose of completing a task or making the appropriate response; stays with, or sticks to, an activity.
Plan/Organize 13 Anticipates future events or consequences; uses goals or instructions to guide behavior in context; develops or implements appropriate steps ahead of time to carry out an associated task or action.
Organization of Materials
7 Keeps work and school materials organized; able to organize environment such as backpack and room.
Task Completion 10 Completes school work or chores in timely fashion; finishes tests within time limits; works at a satisfactory pace.
Scale/Index # Items αInhibit 13 .87Shift 10 .82 Behavioral Shift 5 .74 Cognitive Shift 5 .72Emotional Control 10 .86Monitor 6 .75Working Memory 12 .86Plan/Organize 13 .85Organization of Materials 7 .75Task Completion 10 .86Behavioral Regulation Index 39 .93Metacognition Index 42 .95Global Executive Composite 81 .96
Internal ConsistencyInternal Consistency
Scale/Index ra
Inhibit .77
Shift .71
Behavioral Shift .69
Cognitive Shift .65
Emotional Control .84
Monitor .59
Working Memory .85
Plan/Organize .77
Organization of Materials .79
Task Completion .82
Behavioral Regulation Index .84
Metacognition Index .87
Global Executive Composite (GEC) .89
Test-Retest ReliabilityTest-Retest Reliability
Parent vs Self-Report BRIEF:Parent vs Self-Report BRIEF:
Correlations ranged from .25 (Inhibit) Correlations ranged from .25 (Inhibit) to .64 (Working Memory)to .64 (Working Memory)
Parent ratings higher for MetacognitionParent ratings higher for Metacognition Children’s ratings higher for behavioral Children’s ratings higher for behavioral
regulationregulation Neither Parent nor Child BASC were Neither Parent nor Child BASC were
elevatedelevated
BRI MI GEC
Behavioral Regulation Index
.52
Metacognition Index .57
Global Executive Composite (GEC)
.56
Parent-Self Correlations for IndexesParent-Self Correlations for Indexes
30
40
50
60
70
80
Inhibit
Shift EC
Monitor
WM
Plan/Org
Materials
BRI
MI
GEC
Scale
T S
core
Parent Self-Report
Parent & Self Reports in Adolescents with ASDParent & Self Reports in Adolescents with ASD
Case ExamplesCase Examples
Joshua - 8 year old left handed male, Joshua - 8 year old left handed male,
Attention Deficit Hyperactivity Disorder, Attention Deficit Hyperactivity Disorder,
Combined TypeCombined Type
Juan - 12 year old male, Traumatic Brain Juan - 12 year old male, Traumatic Brain
Injury at age 5 yearsInjury at age 5 years
JoshuaJoshua
ADHD - Combined TypeADHD - Combined Type
JoshuaJoshua
ADHD - Combined TypeADHD - Combined Type
JuanJuan
Traumatic Brain InjuryTraumatic Brain Injury
JuanJuan
Traumatic Brain InjuryTraumatic Brain Injury