Relationship between cognitive impairment and disability following stroke and traumatic brain injury

Allen Walter Heinemann*, E. Kan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objectives. The objectives of this study were to develop a linear measure of cognitive impairment from Folstein's Mini Mental State Exam and to compare measures of cognitive impairment and disability in a sample of persons with brain injury and stroke. Experimental design. Assessment study without follow-up. Setting. Seven comprehensive inpatient medical rehabilitation programs in the United States. Patients. 237 admission and discharge ratings were obtained from 204 patients, 95% of whom experienced strokes and 5% traumatic brain injuries. Median age was 68.7 years (SD = 16.1); 53% were women. All were admitted for first rehabilitation following the onset of the incident condition. Interventions. Usual rehabilitation. Measures. Folstein's Mini Mental State Examination, Functional Independence Measure. Results. Item reliability was excellent and person separation was good; no individual item misfit badly. The hierarchy of item difficulties reflects clinical experience. The items are spaced fairly equally with the exception of serial sevens and sentence writing. Person separation was improved by collapsing intermediate values of three items. The item calibrations were equivalent at admission and discharge administrations with the exception of these items. The MMSE fulfills well its purpose of screening for cognitive impairment; however, it does not distinguish higher levels of cognitive function. The MMSE measures impairment which is related to but distinct from what the FIM cognitive items measure, disability-level functioning. Conclusions. Rehabilitation clinicians can use these measures to describe their patients more precisely and identify those who function in unexpected ways.

Original languageEnglish (US)
Pages (from-to)195-205
Number of pages11
JournalEuropa Medicophysica
Issue number4
StatePublished - Dec 1 1996


  • brain injuries
  • cerebrovascular disorders
  • cognition disorders
  • disability evaluation

ASJC Scopus subject areas

  • Rehabilitation

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