College of Public Health and Health Professions
Department of Clinical and Health Psychology
Psychology Clinic
1600 SW Archer Rd, Room G-901
PO Box 100165
Gainesville, FL 32610-0165
Phone: (352) 265-0294
Fax: (352) 265-0096
April 9, 2007
NEUROPSYCHOLOGICAL EXAMINATION
Re:
MR#:
BATTAGLIA, Anthony
01640644
Referral. Anthony Battaglia is a 41-year-old male referred for neuropsychological
evaluation by attorney Bradford Jefferson. Reports indicate that Mr. Battaglia was struck in
the head by a bowling ball after falling into or near an adjacent lane on 3/31/03. The
examination lasted from 8:30am until 5:15pm with an hour break for lunch. The
examination began with a brief description of its purpose and nature, along with an
explanation that I would not become a treating doctor but would render an opinion about
his current status for use in litigation. After this discussion, Mr. Battaglia expressed
understanding of these matters and agreed to proceed.
Pre-Examination Interview. Mr. Battaglia and his girlfriend Linda provided the following
background information via clinical interview and background questionnaire.
Trauma Narrative. Mr. Battaglia stated that he was celebrating his birthday at the bowling
alley where he worked as a bartender. hea reported that he remembers bowling, being on
his back, and thinking “what the ‘F’ is wrong.” He indicated that his first recollection was
being in the hospital room 4 days after the incident. He denied recollection of being
transported by helicopter. Mr. Battaglia stated that initially he “couldn’t read, write, speak,
[or] sleep.” He reported that he was told that he lost consciousness for less than 5 minutes.
Please refer to reviewed medical records below for a complete trauma narrative.
Current Symptoms and Complaints. Cognitively, Mr. Battaglia reported difficulty
remembering people’s names, stuttering, and reading. Linda stated that she often finds
herself completing Mr. Battaglia’s sentences, especially when he is frustrated. He also
reported difficulty in “using the right words, concentrating” on a background
questionnaire. He stated that he is forgetful, as evidenced by forgetting people who called
the house. He related that he manages his medications with assistance and occasionally
misses doses. His girlfriend stated that if he did not have “visual reminders” of his
medications, he would not remember to take them. He also reported currently difficulty in
managing finances. Emotionally, Mr. Battaglia reported that he is more “jittery,” upset, and
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BATTAGLIA, Anthony
April 9, 2007
frustrated since the incident. He also reported “mood swings, low energy” on background
questionnaire. He reported that he experiences daily crying spells, is often sad and anxious,
since the incident. He denied current or past treatment by a psychologist/psychiatrist for
these difficulties. Linda stated that she observed a “change in his personality” after the
accident that manifested as jitteriness, depression, and difficulty interacting socially (though
this is still a strength for him, by report.) Physically, Mr. Battaglia reported headaches 2-3
times per week. They are experienced as sharp pain underneath the eyes. He stated that he
does not take medication, but is able to manage them by lying down. Overall, these
cognitive, emotional, and physical symptoms were reported to have improved somewhat
since the incident.
Mr. Battaglia reported that his symptoms have led to difficulty in managing his medications
(as stated above), and that his finances are now handled by his family since the incident.
Medical History and Health Behaviors. Mr. Battaglia reported that he was born with a
kidney obstruction, and underwent nephrectomy at 25 years old. He stated that he is
otherwise healthy.
Mr. Battaglia’s history (according to medical records) is significant for seizure. By report, he
experienced a generalized seizure in 2004, was subsequently medicated, and is currently
asymptomatic.
Mr. Battaglia reported drinking 3-4 beers per day after work. He denied significant
difficulties related to alcohol use, but noted that he “may have called in once or twice [to
work]” due to drinking. Currently smokes 1 pack of cigarettes per day, and stated that he
began smoking in the 7th grade. This approximates a 20 year ppd history. He denied current
or past use of recreational drugs/illicit substances.
Sleep was reported as “ok”; he related that he feels rested upon waking but has some
daytime fatigue. Appetite was described as “normal.”
Current medications include Trileptal and Phenytoin, by report. He indicated that he
experiences some side-effects from these medications, including drowsiness and upset
stomach.
Family history is significant for cancer (biological father) and back pain (mother).
Occupational and Academic History. Mr. Battaglia indicated that he currently assists with
pressure washing and painting, 5 times per week for the past 3 ½ years “off and on.” Mr.
Battaglia reported a steady job from 1987-2000 working on oxygen regulation systems in a
supervisory role. Upon moving to Vero Beach in 2000, he worked as a painter and
bartender. Mr. Battaglia reported that he has applied and has been denied Social Security
Disability thee times.
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BATTAGLIA, Anthony
April 9, 2007
Mr. Battaglia reported that he dropped out of school in the 9th grade. He subsequently
obtained a GED around 18 years old. Grades in high school were “C’s and D’s.” He
indicated that he was in mainstream classes, and was “not sure” why he dropped out. He
denied formal diagnoses of learning disability, academic accommodations, or being held
back.
Social History. Mr. Battaglia was born in Miami on 3/31/1966. He was primarily raised by
his mother, and his biological parents divorced. Mr. Battaglia became close with his stepfather and calls him “dad.” His mother and step-father recently divorced.
Mr. Battaglia moved to Vero Beach, Fl in 2000. He currently lives with his mother and is
supported financially by her, his girlfriend, and stepfather, in addition to what he earns as a
painter. He was described by his girlfriend as sociable and outgoing (which has not
changed since the accident, by report), but these activities have become more challenging
than in the past.
Review of Medical Records
A list of records reviewed is provided in the Appendix. Information pertinent to the
neuropsychological evaluation will be reviewed here.
First Flight, Holmes Regional Medical Center (4/1/03). Mr. Battaglia was transferred from
Indian River memorial Hospital emergency department to Holmes Regional Medical Center
via helicopter. This report indicates a GCS of 12 (E3, V3, M6). The consent noted that Mr.
Battaglia refused to sign to be transported due to intoxication.
Trauma Center, Holmes Regional Medical Center (4/1/03-4/11/03). Notes indicate that Mr.
Battaglia was admitted on 4/1/03. Dr. Imamai, M.D. reported intraparenchymal left
temporal hemorrhage with subarachnoid hemorrhage, alcohol intoxication (alcohol level of
281), both chronic and acute, scalp laceration, hypokalemia and hypocalcemia. A 4/4/3 note
stated that Mr. Battaglia’s exam showed “expressive aphasia in addition to be terribly
confused, unable to carry on a simple conversation, disoriented to person, place, and time.”
A 4/7/3 note indicated that Mr. Battaglia complained of mild headache, and showed good
conversation for 30 seconds, at which time he became “confused and unable to express his
thoughts.” Throughout his stay at Holmes, he was described as “confused.” He was treated
with Halidol and Ativan for agitation. He was described generally as intermittently aphasic,
with poor naming of simple objects. Trauma Psychologist Brian Celso reported in a 4/9/3
note that Mr. Battaglia complained of not being able to remember people’s names. He
further indicated that Mr. Battaglia had “severe word finding difficulties, frequent
perseverations, and circumstantial speech. His speech deficits appear to be a speech apraxia.
He also demonstrate difficulty comprehending simple instructions… his insight and
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BATTAGLIA, Anthony
April 9, 2007
judgment were considered poor.” Dr. Celso recommended cognitive rehabilitation and
supervision when returned home; however, speech therapy was canceled “due to no
funds.” He was discharged on 4/11/03.
CTs were gathered throughout Mr. Battaglia’s stay to monitor progress of his brain injury.
CT (4/1/03) was interpreted as “Left temporal hematoma with diffuse left hemisphere
subarachnoid hemorrhage and also along the temporoparietal side of the tentorium and falx
with midline shift of a few millimeters.” CT (4/9/03) scan showed “left temporal parietal
hematoma with evolutionary changes…2. Small area of subarachnoid hemorrhage or small
subdural hematoma projecting prosterioroly and extending over the tentorium on the left.”
Neuropsychological Evaluation (7/15/03). Mr. Battaglia was referred for outpatient
neuropsychological evaluation by Jose Calderon of the Brain and Spinal Cord Injury
program. He was seen by Michael Riordan, Psy.D. and Lisa Winnings, Psy.D. Their report
states that “the client’s overall neuropsychological test results did not place him in the
brain-damaged ranged at this time. However, results suggested several deficits that are
likely related to history of brain damage and a subsequent recovery of function process that
did not result in a return to his premorbid level.” They outlined these deficits as difficulty in
immediate and delayed recall of complex visual stimuli, tactile memory, and non-dominant
(left) hand fine motor speed. They also indicated a discrepancy between his performance IQ
of 87 and a verbal IQ of 77. These findings were in the context of intact working memory,
auditory memory, processing speed, and executive skill. This evaluation also contained
personality assessment, which Riordan and Winnings interpreted as showing signs of
distress and turmoil, difficulty in adjusting to his abilities, and “anxiety, tension, depression,
irritability, frustration, and somatic symptoms.”
Gulfstream Goodwill Industries (1/5/04). Cynthia Francoeur provided a detailed evaluation
of community integration, an evaluation that spanned 10/28/03-1/5/04. The report contained
a brief trauma narrative, wherein she reported an initial GCS of 12 which improved to a 13
during helicopter transport. She detailed his living situation, health and safety knowledge,
home management skills, money management knowledge and behaviors, basic academics,
community and social skills. Overall, the evaluation suggested strong ADL and iADL
functioning. She noted some difficulties in basic academic skills, such as reading and
writing. She suggested a referral to rehab for speech therapy focused on reading and
writing. In addition, she recommended counseling for assistance in dealing with frustration,
stress, and alcohol use.
Fernando G. Miranda, Neurology (6/3/04-6-28-04). Mr. Battaglia was seen by Dr. Miranda
on June 3, 2004 following a reported generalized seizure. He was prescribed Trileptal and
Dilantin and ordered to not drive for one year. Dr. Miranda stated that the seizure was a
consequence of closed head injury and subsequent scarring of the brain (6/28/04). Dr.
Miranda referenced post-traumatic left temporal enceolapathy seen on CT. At that time, Mr.
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BATTAGLIA, Anthony
April 9, 2007
Battaglia performed a 20/30 on a Mini Mental Status Exam, with slurred speech, poor
attention, working memory, and recent memory.
Tropical MRI of the Treasure Coast (6/8/04). Mr. Battaglia was referred by neurologist
Miranda for a brain MRI after his seizure event. Joel Schwartz, M.D. interpreted the 6/8/04
scans as showing evidence of “1. Well-defined rather large area of heterogeneous pathologic
signal involving the periphery of the left temporal lobe as described associated with ex
vacuuo prominence of the left temporal horn indicating and old insult, presumably
traumatic in nature. 2. Greater than 1 cm area of contrast enhancement related to the
inferolateral surface of the left temporal lobe possibly a small chronic hematoma,
significance unclear. 3. Some irregular contrast enhancement is identified within the
presumed contused area like a manifestation of the traumatic event rather than more
significant pathologic process. 4. Some thickening enhancement of the adjacent
pachymeniges is identified also likely due to this insult.”
Trauma Narrative: Based on the above medical records and patient report, the following is
offered as a potential narrative believed to be consistent with available information. Mr.
Battaglia, legally intoxicated by alcohol consumption at Vero Bowl, fell, lost his balance, or
otherwise became prone in, or near, an adjacent bowling lane. He was struck in the head
with a 16 lbs. ball thrown by another bowler. He was positive for a <5 minute loss of
consciousness (witnessed). He was transported to Indian River Memorial hospital, his scalp
laceration was treated, and then flown via helicopter to Holmes regional medical center.
GCS at the time of the transport was 13. At Holmes, he was monitored, evaluated, and
treated as per brain injury protocol. CTs revealed contusion and hemorrhage. Posttraumatic amnesia was not formally assessed (based on available records); however,
confusion and “short term memory” difficulties were documented in neuro checks for
several days. By patient report, approximately 4 days elapsed until he had clear recollection.
Language difficulty and “confusion” was noted throughout his stay, with some
improvement in the interval. He was discharged when medically stable after 10 days, but
apparently did not receive recommended speech language therapy due to financial
constraints. He was seen for neuropsychological assessment approximately 3 months post
discharge to evaluate his cognitive and emotional functioning. He was then seen by a
neurologist (over one year post TBI) after suffering a generalized seizure, by report. MRI
completed at that time confirmed post traumatic brain changes.
Behavioral Observations
Mr. Battaglia arrived on time for the appointment. He was met in the waiting room sitting
on the floor, with papers strewn about, in apparent mild distress about organizing the
paperwork for the evaluation. Movement was WNL. He initially presented as somewhat
jittery, and his girlfriend was allowed to stay through portions of the interview to provide
support. He was cooperative and friendly throughout the evaluation. Affect was somewhat
labile but appropriately ranged with content; he became tearful when discussing his
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BATTAGLIA, Anthony
April 9, 2007
difficulties and somewhat bombastic during other portions of the interview. He was
generally articulate, with occasional apparent word-finding difficulties. Rate of speech was
somewhat slow but WNL. He deferred to his girlfriend to provide details during the
interview, but not overly so. Verbal comprehension appeared intact; no repetitions of task
instructions were required. He showed somewhat poor frustration tolerance (for example,
on the WCST), but was able to be redirected and responded well to encouragement. He was
sensitive to his errors (e.g., saying, “I used to be able to do this.”), and appeared to be
overwhelmed when new tasks that appeared complicated were given (e.g., CVLT-ii, RCFT).
For example, on the RCFT, he said “I’m lost” after copying a figure; however, upon retest he
performed much better. He appeared to give his full effort to all tasks. In sum, it is believed
the current evaluation represents an accurate assessment of Mr. Battaglia’s current cognitive
and emotional functioning.
Tests Administered
Effort/Response Bias: Victoria Symptom Validity Test, Test of Memory Malingering;
General Intellectual: Wechsler Abbrevaited Scale of Intelligence (WASI), Barona procedure;
Memory Functioning: Wechsler Memory Scale III (WMS-III), California Verbal Learning
Test, second edition (CVLT-II), Rey Complex Figure Test; Language and Related Skills:
Boston Naming Test, Controlled Oral Word Association, Semantic (Animal) Fluency
Visuoperceptual/Visuospatial Functioning: Benton Facial Recognition Test (FRT), Benton
Judgment of Line Orientation – Form H (JLO); Executive Skills: Trails A & B, Wisconsin
Card Sorting Test; Motor Skills: Finger Tapping Test, Grooved Pegboard; Personality and
Emotional Functioning: Minnesota Multiphasic Personality Inventory-2 (MMPI-2).
Test Results
Measures of Effort and Response Bias
Free-standing and embedded measures of effort and response bias were given at various
points during the examination to provide a check on the validity of test performances. On
the Victoria Symptom Validity Test, Mr. Battaglia earned scores of 24/24 on the easy items
and 24/24 on the difficult items, both valid scores. On the Test of Memory Malingering, Mr.
Battaglia attained 50/50 on Trial 2 and 50/50 after a delay, both valid performances. Forced
choice was 16/16 on the CVLT-ii. Reliable Digit Span was 11, well above the cutoff for
suspect effort. Combined Finger Tapping score was 102.9, also above the cutoff. Thus, Mr.
Battaglia passed all five measures of effort, providing strong evidence for valid performance
across the examination.
General Intellectual. Results of the 4 subtest WASI are presented in the Table 1 below.
Performance IQ was in the average range, but Verbal IQ was in the below average range,
producing a Full Scale WASI IQ of 83 (13th percentile; below average). Predicted Full Scale
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BATTAGLIA, Anthony
April 9, 2007
IQ based on demographic factors ranged from 87- 93 (BARONA). These scores are highly
consistent to those achieved in the 7/15/03 evaluation with Dr. Riordan.
Scale
Verbal IQ
Performance IQ
Full Scale
Table 1. WASI Results
Sum of
Composite
Scaled
Score
Scores
68
77
91
93
159
83
Percentile
Rank
6
32
13
Simple Attention and Processing Speed. Mr. Battaglia was alert and fully oriented, with an
auditory attention span of 7 digits forward and 4 digits backwards, for a composite score in
the average range (Digit Span, 50th %ile). His performance was in the superior range on a
measure of basic visual search (Trails A; T=66, 95th %ile).
Recent Memory Function. Results of the WMS-III are presented in Table 2. Performance
on the WMS-III ranged from low average (Visual Delayed, General memory), to Average.
He had particular difficulty encoding and recall of visual scenes (Family Pictures I and II
Age-Adjusted Scaled Scores=6, below average). He showed low average retention of
information learned on two subtests (Faces & Logical memory Age-Adjusted Scale
Scores=7); however, he showed average retention on two other tasks (Verbal Paired
Associates Age-Adjusted Scaled Score=9; Family Pictures Age Adjusted Scaled Score=8)
suggesting sufficient hippocampal-system function.
Index
Auditory Immediate
Visual Immediate
Immediate Memory
Auditory Delayed
Visual Delayed
Aud Recognition Delayed
General Memory
Working Memory
Table 2. WMS-III Results
Index Score
Percentile
99
47
97
42
98
45
94
34
82
21
95
37
89
23
91
27
On a word list learning task, the CVLT-II, performance was average across learning trials 15 (48T, 45%ile). Long delayed free recall and long delayed cued recall of words was average
(31st %ile) as was his performance on recognition trials (Recognition Discrimination Index,
31st %ile). Of note, he produced an elevated number of repetitions across all trials
(Repetitions 11, 98th %ile).
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BATTAGLIA, Anthony
April 9, 2007
Performance on the Rey Complex Figure was in the average range on both immediate (Raw
Score = 20.5; T=48; 42nd %ile) and delayed (Raw Score = 21; T=49; 46%ile) recall. Recognition
of design elements was also average (T=45; 31st %ile). Of note, he was allowed a second copy
of the figure after he became flustered during his first copy attempt.
Taken together, results suggest low average to average memory ability. He did show some
relative, and variable, weaknesses in retention of semantically rich information (both
verbal and nonverbal), as well as encoding and recall of complex visual scenes.
Language and Related Skills: On a test of visual confrontation naming, Mr. Battaglia scored
in the average range (Boston Naming Test = 51, 27th percentile). He did not significantly
benefit from semantic (0/2) or phonemic cueing (2/9), suggesting low fund knowledge
consistent with educational background. Performance on a task of letter fluency was
average (T=48, 45%ile) as was category fluency (T=51, 55%ile). As measured, language
function is without significant impairment.
Visuoperceptual/Visuospatial Functioning: Mr. Battaglia performed in the average range on
a measure of unfamiliar facial matching (Benton Facial Recognition Test, 47, 71st percentile)
and in the low average range on a test of spatial ability (Judgment of Line Orientation = 21,
22nd %ile). His mistakes were predominantly in his right visual field. His first copy of a
complex figure (RCFT) was impaired due to poor approach. He stated partway thought the
copy that “I’m way off.” His second copy was better organized and his approach indicated
that he appreciated the gestalt of the figure; his score for this second copy fell in the average
range. Performance in this area is considered grossly intact.
Executive and Reasoning Skills: Performance on a task of visual search and switching
(Trails B; T-75, 75%ile) was average for speed, and without error. This is in the context of
superior performance on a simpler measure of visual search (Trails A; T=66, 95th %ile). On
the Wisconsin Card Sorting Test, a measure of problem solving, he attained 2 categories (25%ile) with and 60 errors (7th percentile) in 128 cards. He failed to maintain set twice (6-10th
%ile). As mentioned above, his approach to a complex drawing/copy task was initially
disorganized, without apparent strategy. He improved markedly upon his second attempt.
Performance on a measure of verbal reasoning (WASI Similarities) was impaired (T=33, 5th
%ile). This is in the context of below average word knowledge (WASI Vocabulary, T=35, 9th
%ile)).In contrast, his performance on a measure of visuospatial reasoning (WASI Matrix
Reasoning) was average (T=48, 37th %ile). Taken together, current results suggest significant
weaknesses in select executive skills. He seems to have most difficulty on tests of problem
solving that require integration of feedback to improve performance.
Motor Skills: On the Finger Tapping Test, a test of motor speed, Mr. Battaglia performed in
the average range with his dominant (right) hand (51.3, T = 53) and in the high average
range for his nondominant hand (51.6, T = 60). In contrast, performance was below average
bilaterally on a measure of fine motor dexterity, the Grooved Pegboard (R hand: 87”, 1 drop;
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BATTAGLIA, Anthony
April 9, 2007
8th %ile; L hand: 90”, 1 drop; 7th %ile). Mr. Battaglia showed intact motor speed, but below
average dexterity.
Brief Comparison to 7/15/03 performance. Since his last evaluation (Riordan, 7/15/03), Mr.
Battaglia’s performances on comparable measures have largely remained stable, or
improved; consistent with what is expected after mild/moderate Traumatic Brain Injury.
The exceptions to this being somewhat worse performance on the WCST (as compared to
the Categories Test) and some minor variability in several measures (still within the average
range).
Personality and Emotional Functioning: Results of the MMPI-2 revealed a Welsh code of
1’2+36-705/894:F+-L/:K#. The elevation on the FBS suggests Mr. Battaglia approached the
test endorsing items that made him appear impaired, consistent with the low S (T=37);
however the raw score of 24 is below stringent clinical cutoffs for blatant symptom
exaggeration. Thus, his score on the Symptom Validity Scale (FBS), which measures the
attempt to appear to be honest, to appear psychologically normal except for the impact of
the alleged injury, and to present the effects of the injury in a plausible manner, was
approached, but fell below established clinical cutoffs.
Clinical scale elevations suggest complaints revolve around physical (somatic) symptoms;
organic and functional. Attention is focused on these somatic symptoms (RC1 T=84).
Depression symptoms may be reactive toward the event, in response to limiting effects of
the condition. Depression subscale elevations suggest a focus on physical malfunctioning
and mental dysfunction. Content scales suggest Mr. Battaglia is generally fearful, concerned
with health (specifically gastrointestinal and neurological symptoms), angry, and impatient.
These elevations are not inconsistent with those in similar circumstances (i.e. litigation). Mr.
Battaglia is also forthcoming about his addiction (AAS T=70).
The personality assessment from Riordan (7/15/03) was similar in that there was an
elevation on scale 1; however, Mr. Battaglia responded in a way such that scale 9 was also
elevated. This in contrast to his present presentation, where depressive symptoms are
predominant.
Summary and Conclusions
Anthony Battaglia is a 41-year-old male now approximately 48 months post traumatic brain
injury. He was struck in the head with a 16 lbs bowling ball and subsequently hospitalized.
Injury characteristics are estimated as follows: loss of consciousness < 5 minutes,
posttraumatic amnesia is estimated between 1-4 days, initial GCS was between 12-13. This
pattern suggests severity characteristic between mild and moderate Traumatic Brain Injury.
Assessment of his status at the time of the event was complicated by alcohol intoxication.
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BATTAGLIA, Anthony
April 9, 2007
Initial neuroimaging (CT scans) in the acute phase showed left temporal hematoma with
left hemisphere subarachnoid hemorrhage with midline shift of several millimeters.
Subsequent MRI in the chronic phase confirmed abnormal signal change in the left temporal
lobe. This follow up screening was cued by apparent generalized seizure, interpreted as a
result of scarring of the brain. Neuropsychological evaluation three months after the
incident showed some mild dysfunction as described above.
Cognitively, Mr. Battaglia appears to be a man of average-low average intelligence. The
majority of his performances fall neatly within this range. Specifically, he showed intact
basic attention, working memory, language, recent memory, visuospatial skills, cognitive
flexibility, processing speed, and frontal motor speed. He showed some relative weaknesses
in fine motor dexterity, executive problem solving, and organizational skill. Further, he
showed impairment in verbal reasoning in the context of poor word knowledge. This profile
is consistent with his previous evaluation. Further, he showed some expected
improvements. Overall however, this profile is indicative of relatively favorable recovery
post TBI.
Portions of his cognitive profile are somewhat inconsistent with what is expected from TBI.
Specifically, his lowest score was on a measure of verbal knowledge, but this ability
typically “holds” in the face of cortical insult. Integrating information from Mr. Battaglia’s
background, we consider it possible, if not likely, that his low score on Vocabulary, and to
some extent, Similarities subtests to be attributable to low educational attainment rather
than solely from the TBI per se. His relative strength in nonverbal processing is also in line
with his occupational history. This interpretation is generally in line with the lack of
observable comprehension or expressive difficulties shown in testing.
Results of the emotional/personality evaluation, in line with behavioral observations,
suggest some contribution of psychological factors to his cognitive symptoms. Specifically,
Mr. Battaglia became overwhelmed by tasks that were ostensibly more complex than others.
This emotional reaction was to the detriment of his performance. When allowed another
opportunity, his performance improved. Neuropsychological literature suggests that while
initial symptoms of TBI (headache, cognitive complaints) are caused by a combination of
organic (brain damage) and psychological (trauma/stress) factors, they are largely
maintained by psychological factors. We believe this is true in Mr. Battaglia’s case,
specifically stress, limitations, and poor coping skills. The presence of Mr. Battaglia’s
seizure disorder is not believed to significantly contribute to his cognitive profile or
symptom report. Mr. Battaglia’s neurologist’s report that the seizure disorder was caused by
scar tissue in the brain is consistent with the literature suggesting substantial increase in risk
of seizures post TBI.
In sum, we believe that the brain injury incurred on 3/31/03 resulted in mild long term
deficits in higher-order “executive” processes. We have seen some resolution of cognitive
difficulties since his first evaluation; however, his adjustment reaction to the incident has
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BATTAGLIA, Anthony
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further complicated his ability to recover and perform well in the real-world. As he has not
received psychological intervention for his symptoms, it is highly recommended that Mr.
Battaglia receive such care as it is likely to help him function optimally. Specific treatments
should target the experience and attribution of current symptoms, depressive symptoms,
and apparent alcohol use.
We appreciate the opportunity to evaluate Mr. Battaglia.
___________________________________________
Jason T. Gravano, M.S.
Graduate Practicum Student
Clinical and Health Psychology University of Florida
___________________________________________
Russell M. Bauer, Ph.D., ABPP/CN
Professor
Clinical and Health Psychology University of Florida
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