National Institutes of Health Toolbox Emotion Battery: Application of Summary Scores to Adults With Spinal Cord Injury, Traumatic Brain Injury, and Stroke

Arch Phys Med Rehabil. 2019 Oct;100(10):1863-1871. doi: 10.1016/j.apmr.2019.05.024. Epub 2019 May 31.


Objective: To examine the validity of factor analytically based summary scores that were developed using the National Institutes of Health Toolbox Emotion Battery (NIHTB-EB); (ie, psychological well-being, social satisfaction, negative affect) normative sample in individuals with neurologic conditions.

Design: Cross-sectional, observational cohort.

Setting: Community.

Participants: A total of 1036 English-speaking adults from the National Institutes of Health Toolbox (NIHTB) normative project and 604 community-dwelling adults with neurologic conditions including spinal cord injury (SCI n=209), traumatic brain injury (TBI n=184), and stroke (cerebrovascular accident [CVA] n=211) (N=1640).

Intervention: Not applicable.

Main outcome measures: The NIHTB-EB.

Results: A series of univariate analyses comparing summary scores across the 4 groups (SCI, TBI, CVA, normative group) were conducted to identify group differences. Base rates (defined as >1 SD toward the problematic direction) were also identified. The normative group demonstrated better emotional functioning characterized by greater social satisfaction and psychological well-being (normative group > SCI, TBI, CVA; P's <.0001), and less negative affect (normative group < SCI, P=.016; normative group < TBI, P<.001; normative group < CVA; P=.034) compared with each neurologic group. Using base rates to identify problematic emotions for the 3 summary scores, there were higher rates of problematic emotions on all 3 summary scores for the neurologic groups compared with the normative group.

Conclusions: The NIHTB-EB summary scores demonstrate an increased prevalence of problematic emotions among individuals with 3 neurologic conditions, and might be useful for identifying individuals with similar conditions and potentially in need of psychological support.

Keywords: Emotions; Rehabilitation; Spinal cord injury; Stroke; Traumatic brain injury; Weights and measures.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Affective Symptoms / diagnosis
  • Affective Symptoms / etiology
  • Brain Injuries, Traumatic / psychology*
  • Cohort Studies
  • Cross-Sectional Studies
  • Emotions*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuropsychological Tests*
  • Personal Satisfaction
  • Social Support
  • Spinal Cord Injuries / psychology*
  • Stroke / psychology*