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    This article was downloaded by:[Universidad de Sevilla]On: 8 January 2008Access Details: [subscription number 786928174]Publisher: Informa HealthcareInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

    Brain InjuryPublication details, including instructions for authors and subscription information:http://www.informaworld.com/smpp/title~content=t713394000

    A QEEG index of level of functional dependence forpeople sustaining acquired brain injury: The SevilleIndependence Index (SINDI)Jose Leon-Carrion ab; Juan Francisco Martin-Rodriguez ab; Jesus Damas-Lopez b;Juan Manuel Barroso Y. Martin a; Maria Del Rosario Dominguez-Morales ba Human Neuropsychology Laboratory, School of Psychology, Department ofExperimental Psychology, University of Seville, Seville, Spainb Center for Brain Injury Rehabilitation (CRECER), Seville, Spain

    Online Publication Date: 01 January 2008

    To cite this Article: Leon-Carrion, Jose, Martin-Rodriguez, Juan Francisco,Damas-Lopez, Jesus, Martin, Juan Manuel Barroso Y. and Dominguez-Morales,Maria Del Rosario (2008) 'A QEEG index of level of functional dependence for

    people sustaining acquired brain injury: The Seville Independence Index (SINDI)', Brain Injury, 22:1, 61 - 74To link to this article: DOI: 10.1080/02699050701824143URL: http://dx.doi.org/10.1080/02699050701824143


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    Brain Injury, January 2008; 22(1): 6174

    A QEEG index of level of functional dependence for peoplesustaining acquired brain injury: The Seville Independence

    Index (SINDI)




    1Human Neuropsychology Laboratory, School of Psychology, Department of Experimental Psychology, University of

    Seville, Seville, Spain and 2Center for Brain Injury Rehabilitation (CRECER), Seville, Spain

    (Received 31 August 2007; accepted 23 November 2007)

    AbstractPrimary objective: To find an easy-to-use, valid and reliable tool for evaluating the level of functional dependence ofan individual with brain damage who seeks a diagnosis of his/her functional dependence in daily activities.

    Methods: Eighty-one patients with acquired brain injury (ABI) in post-acute phase, 40 traumatic brain injury (TBI) and 41cerebral vascular accident (CVA), were assessed using quantitative electroencephalography (QEEG) and grouped accordingto the FIM FAM scale. Discriminant analysis was performed on QEEG variables to obtain a discriminant function withthe best discriminative capacity between functionality groups.Results: Discriminant analysis showed classification accuracy of 100% in the training set sample and 75% in an externalcross-validation sample; 100% sensitivity and 100% specificity were reached. Coherence measures were the most numerous

    variables in the function.Conclusions: These results point out that the discriminant function may be a useful tool in objective evaluations of patientsseeking a diagnosis of their level of dependence and that it could be included in current functionality assessment protocols.

    Keywords: Traumatic brain injury, stroke, functional independence, QEEG, neuropsychological assessment, forensic assessment


    Neurological damage and acquired brain injury

    affect a large portion of the population in western

    countries. An estimated 1.5 million Americans

    sustain traumatic brain injury (TBI) every year in

    the US. Of these, 1.1 million are now living with

    disabilities related to TBI [1]. In the European

    Union, brain injury accounts for 1 million hospital

    admissions per year. At discharge, most of these

    patients show impairments in multiple areas, which

    affect their ability to carry out daily life activities and

    cause important legal, professional and personal


    In Europe, new laws are being established by

    national governments to assist people in accordance

    with their level of dependency. In Spain, a new law

    was approved on 15 December 2006 called

    The Law to Promote Personal Autonomy and toAssist People in a State of Dependence. This law

    has created a bureaucracy and a medical system that

    regulate promoting the autonomy of dependent

    individuals as well as the state-funded care they

    receive. As a result, medical and social resources are

    needed to implement this law, which will serve more

    than 2 000 000 people in Spain alone. More than a

    third of these individuals are dependent in their daily

    Correspondence: Jose Leon-Carrion, PhD, Human Neuropsychology Laboratory, School of Psychology, Department of Experimental Psychology, C/Camilo

    Jose Cela s/n. University of Seville, Seville-41018. Spain. Tel: 34 95 457 4137. Fax: 34 95 437 4588. E-mail: leoncarrion@us.es

    ISSN 02699052 print/ISSN 1362301X online

    2008 Informa UK Ltd.DOI: 10.1080/02699050701824143

  • 8/2/2019 2008 Qeeg Index


    life activities due to neurological disorders, the more

    prevalent being cerebrovascular disorders and TBIs.

    Any individual in a state of dependency that asks to

    be included in the new state-funded system must be

    clinically evaluated to determine whether they are

    dependent or not and, if so, at what level. If they are

    clinically proven to be in a dependent state, then,

    apart from the state-funded care, they may also

    receive financial support and other benefits.

    Under this new legal action, and in order to avoid

    malingering, an objective evaluation of the func-

    tional state of these patients is needed, with new

    tools that offer high reliability and validity.

    Nowadays, few objective instruments exist to eval-

    uate independence in people seeking social and legal

    assistance. Existent tools generally rely on the

    subjective impressions of caregivers, whose inter-

    pretations may distort results and thus provoke false

    positives. Moreover, exaggerating and malingering

    symptoms are very common among patients withacquired brain injury, especially when monetary

    compensation is expected or in litigation, where

    they make up 1520% of all cases [2]. Individuals

    with mild brain damage and post-concussional

    disorders constitute 40% of those seeking compen-

    sation [3].

    Functionality is considered a multidimensional

    concept, where the whole cannot be explained by the

    mere sum of its parts. Instruments that evaluate

    functionality must be capable of detecting malinger-

    ing. In current clinical practice, functionality assess-

    ment evaluates both the level of independence in

    basic tasks, such as eating or bathing, as well asin more complex and instrumental tasks, such as

    getting on a bus. Thus, a full assessment has

    multiple levels of complexity involving multiple

    assessors. The need for objective functional assess-

    ments would require summarizing this complex

    concept in an index that informs on the impact of

    certain medical conditions on the lives of patients.

    In recent years, advanced technology has been

    used to locate affected areas of the brain with greater

    precision. The use of sophisticated imaging software

    has made it possible to create defined cerebral maps

    that can be adapted to a patients brain in order to

    determine which functional areas are affected. In thefield of brain injury, this technology is needed in

    order to make objective evaluations and determine

    the severity of the condition. When applying

    neuroimaging techniques to the assessment of brain

    injury, the electroencephalography (EEG) plays a

    crucial role, with its relatively low cost, simple

    application procedure, high testre-test reliability

    and inherent stability [47]. Moreover, the develop-

    ment of mathematical tools and data visualization

    has made it possible to quantitatively analyse the

    human EEG, a technique known as quantitative

    EEG (QEEG). Human QEEG measures have been

    correlated with certain diagnostic categories, both in

    healthy [8,9] and clinical populations [10]. By

    meeting certain statistical requirements, these stu-

    dies have obtained a set of QEEG variables, known

    as discriminant functions, which can predict