Geriatric Neuropsychology Laboratory

New England Geriatric Research, Education and Clinical Center (GRECC)


BAT-L: Boston Assessment of Traumatic Brain Injury- Lifetime

The Translational Research Center for TBI and Stress Disorders (TRACTS) Center of Excellence at the VA Boston Healthcare System is a Veterans Administration Rehabilitation Research & Development supported VA Center of Excellence committed to conducting the highest quality research aimed at understanding the unique problems faced by our nation's newest Veterans from Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND).

Mild Traumatic Brain Injury (mTBI) is the so-called signature injury of OEF/OIF/OND, yet its identification and diagnosis is controversial and fraught with challenges. Diagnosis of military-related mTBI in Veterans is complex and unique from the diagnosis of civilian acquired brain injuries in a number of ways. This is due to the novel mechanism of injury (exposure to blast(s) such as an improvised explosive device or IED), the frequent co-occurrence of head injury and psychological trauma during the chaos of combat that make the determination of altered mental status difficult, and the difficulty obtaining in-theater documentation of symptoms at the time of injury for determining the presence or absence of mTBI. The detection of TBI, and mTBI in particular, in returning Veterans is thus primarily reliant on self-report of a historical event, which often occurs in the context of a military trauma.

For these reasons, we developed the Boston Assessment of Traumatic Brain Injury- Lifetime (BAT-L) (Fortier et al., In Press). The BAT-L is the first validated post-combat semi-structured clinical interview to characterize head injuries and diagnose TBIs throughout the lifespan. Guidelines for establishing a timeline for alteration of mental status, posttraumatic amnesia, and loss of consciousness, the forensic approach to the interview, and diagnostic categories were all refined over time as the distinctive experiences of OEF/OIF/OND Veterans were realized. The BAT-L, unlike existing TBI interviews, includes detailed assessment of blast exposure and blast-related TBI, evaluates TBIs acquired throughout a veteran's lifetime, and includes specific probes targeting the unique experiences of this cohort of Veterans in an effort to help guide the examiner assess the physiological disruption of consciousness in the context of co-occurring traumatic events. TBI is assessed during 3 time epochs: (1) prior to military service (Pre-Military), (2) during active military training and duties (Military: blast-related & other mechanism(s) during combat, training, or other activities during active duty), and (3) after returning stateside (Post-Deployment). The three most severe injuries in each epoch are evaluated.

Fortier, C.B., Amick, M.A., Grande, L.J., McGlynn, S., Kenna, A., Morra, L., Clark, A., Milberg, W.P., and McGlinchey, R.E. The Boston Assessment of Traumatic Brain Injury-Lifetime (BAT-L) Semi-structured Interview: Evidence of Research Utility and Validity (In Press). The Journal of Head Trauma Rehabilitation.


Administration

The BAT-L is designed to be used by doctoral level neuropsychologists or other comparably trained professionals (e.g., neuropsychology graduate students, fellows or clinical psychologists with supervision of a licensed neuropsychologist) and was validated as a consensus diagnostic instrument (Fortier et al., In Press). It was created for use in a research setting where detailed information regarding TBI incidence and severity is necessary. The instrument guides the examiner in gathering necessary information from Veterans and service members about the three worst TBIs for each category of injury (military blast, military other, pre-military, and post-military). Information is reviewed by a TBI diagnostic consensus team consisting of at least three doctoral-level psychologists, including at least one neuropsychologist. The consensus approach is integral to the instrument. If used without a consensus team, review of selected cases is suggested to assure a consistent diagnostic approach. It may be used both independently as well as part of a larger clinical interview. Please contact the TRACTS team for consultation and training requests.

Click here to read the article at The Journal of Head Trauma Rehabilitation.

Download a copy of (1) the BAT-L semi-structured interview, (2) the Boston Assessment of Traumatic Brain Injury-Lifetime Questionnaire (BAT-LQ) and (3) the BAT-L manual by filling out the form below. Please provide accurate contact information so that we may keep you informed of updates.



Fill out my online form.