Publication YearTitlePublication Reference typeAccession NoJournalPublication VolumePublication IssuePublication PagesPublication WebsiteAbstractStaff MembersPublication Author(s)Participating CentersPublished statusName
2021Recovery of consciousness and functional outcome in moderate and severe traumatic brain injury.JournalJAMA Neurology March 2021https://jamanetwork.com/journals/jamaneurology/article-abstract/2776794Importance: Traumatic brain injury (TBI) leads to 2.9 million visits to US emergency departments annually and frequently involves a disorder of consciousness (DOC). Early treatment, including withdrawal of life-sustaining therapies and rehabilitation, is often predicated on the assumed worse outcome of disrupted consciousness. Objective: To quantify the loss of consciousness, factors associated with recovery, and return to functional independence in a 31-year sample of patients with moderate or severe brain trauma. Design, Setting, and Participants: This cohort study analyzed patients with TBI who were enrolled in the Traumatic Brain Injury Model Systems National Database, a prospective, multiyear, longitudinal database. Patients were survivors of moderate or severe TBI who were discharged from acute hospitalization and admitted to inpatient rehabilitation from January 4, 1989, to June 19, 2019, at 1 of 23 inpatient rehabilitation centers that participated in the Traumatic Brain Injury Model Systems program. Follow-up for the study was through completion of inpatient rehabilitation. Exposures: Traumatic brain injury. Main Outcomes and Measures: Outcome measures were Glasgow Coma Scale in the emergency department, Disability Rating Scale, posttraumatic amnesia, and Functional Independence Measure. Patient-related data included demographic characteristics, injury cause, and brain computed tomography findings. Results: The 17 470 patients with TBI analyzed in this study had a median (interquartile range [IQR]) age at injury of 39 (25-56) years and included 12 854 male individuals (74%). Of these patients, 7547 (57%) experienced initial loss of consciousness, which persisted to rehabilitation in 2058 patients (12%). Those with persisting DOC were younger; had more high-velocity injuries; had intracranial mass effect, intraventricular hemorrhage, and subcortical contusion; and had longer acute care than patients without DOC. Eighty-two percent (n = 1674) of comatose patients recovered consciousness during inpatient rehabilitation. In a multivariable analysis, the factors associated with consciousness recovery were absence of intraventricular hemorrhage (adjusted odds ratio [OR], 0.678; 95% CI, 0.532-0.863; P = .002) and intracranial mass effect (adjusted OR, 0.759; 95% CI, 0.595-0.968; P = .03). Functional improvement (change in total functional independence score from admission to discharge) was +43 for patients with DOC and +37 for those without DOC (P = .002), and 803 of 2013 patients with DOC (40%) became partially or fully independent. Younger age, male sex, and absence of intraventricular hemorrhage, intracranial mass effect, and subcortical contusion were associated with better functional outcome. Findings were consistent across the 3 decades of the database. Conclusions and Relevance: This study found that DOC occurred initially in most patients with TBI and persisted in some patients after rehabilitation, but most patients with persisting DOC recovered consciousness during rehabilitation. This recovery trajectory may inform acute and rehabilitation treatment decisions and suggests caution is warranted in consideration of withdrawing or withholding care in patients with TBI and DOC. Robert G. Kowalski, MBBCh, MS; Flora M. Hammond, MD; Alan H. Weintraub, MD; Risa Nakase-Richardson, PhD; Ross D. Zafonte, DO; John Whyte, MD, PhD; Joseph T. Giacino, PhDBoston-Harvard Burn Injury Model System, Pediatric Burn Injury Rehabilitation Model SystemYescheberle
2016Preliminary Evaluation of a Measure for the Reliable Assessment of the Need for Constant Visual Observation in Adults with Traumatic Brain InjuryJournalBrain Injury30111343-1349PRIMARY OBJECTIVE: To develop and provide initial validation of a measure for accurately determining the need for Constant Visual Observation (CVO) in patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation. RESEARCH DESIGN: Rating scale development and evaluation through Rasch analysis and assessment of concurrent validity. METHODS AND PROCEDURES: One hundred and thirty-four individuals with moderate-severe TBI were studied in seven inpatient brain rehabilitation units associated with the National Institute for Disability, Independent Living and Rehabilitation Research (NIDILRR) TBI Model System. Participants were rated on the preliminary version of the CVO Needs Assessment scale (CVONA) and, by independent raters, on the Levels of Risk (LoR) and Supervision Rating Scale (SRS) at four time points during inpatient rehabilitation: admission, Days 2-3, Days 5-6 and Days 8-9. OUTCOMES AND RESULTS: After pruning misfitting items, the CVONA showed satisfactory internal consistency (Person Reliability = 0.85-0.88) across time points. With reference to the LoR and SRS, low false negative rates (sensitivity > 90%) were associated with moderate-to-high false positive rates (29-56%). CONCLUSIONS: The CVONA may be a useful objective metric to complement clinical judgement regarding the need for CVO; however, further prospective study is desirable to further assess its utility in identifying at-risk patients, reducing adverse events and decreasing CVO costs.Moessner, A.M, Malec, J.F., Beveridge, S., Camiolo Reddy, C. Huffman, T., Marton, J., Schmerzler, A. J.Yesdevopsadmin
2016Long-Term Survival Following Traumatic Brain Injury: A Population-Based Parametric Survival Analysis.JournalNeuroepidemiology47143110BACKGROUND: Long-term mortality may be increased following traumatic brain injury (TBI); however, the degree to which survival could be reduced is unknown. We aimed at modelling life expectancy following post-acute TBI to provide predictions of longevity and quantify differences in survivorship with the general population. METHODS: A population-based retrospective cohort study using data from the Rochester Epidemiology Project (REP) was performed. A random sample of patients from Olmsted County, Minnesota with a confirmed TBI between 1987 and 2000 was identified and vital status determined in 2013. Parametric survival modelling was then used to develop a model to predict life expectancy following TBI conditional on age at injury. Survivorship following TBI was also compared with the general population and age- and gender-matched non-head injured REP controls. RESULTS: Seven hundred and sixty nine patients were included in complete case analyses. The median follow-up time was 16.1 years (interquartile range 9.0-20.4) with 120 deaths occurring in the cohort during the study period. Survival after acute TBI was well represented by a Gompertz distribution. Victims of TBI surviving for at least 6 months post-injury demonstrated a much higher ongoing mortality rate compared to the US general population and non-TBI controls (hazard ratio 1.47, 95% CI 1.15-1.87). US general population cohort life table data was used to update the Gompertz model's shape and scale parameters to account for cohort effects and allow prediction of life expectancy in contemporary TBI. CONCLUSIONS: Survivors of TBI have decreased life expectancy compared to the general population. This may be secondary to the head injury itself or result from patient characteristics associated with both the propensity for TBI and increased early mortality. Post-TBI life expectancy estimates may be useful to guide prognosis, in public health planning, for actuarial applications and in the extrapolation of outcomes for TBI economic models.Fuller GW, Ransom J, Mandrekar JN, Brown AWYesdevopsadmin
2013Prediction of headache severity (density and functional impact) after traumatic brain injury: A longitudinal multicenter studyJournalCephalalgia.3312998-1008BACKGROUND: Headache (HA) following traumatic brain injury (TBI) is common, but predictors and time course are not well established, particularly after moderate to severe TBI. METHODS: A prospective, longitudinal cohort study of HA severity post-TBI was conducted on 450 participants at seven participating rehabilitation centers. Generalized linear mixed-effects models (GLMMs) were used to model repeated measures (months 3, 6, and 12 post-TBI) of two outcomes: HA density (a composite of frequency, duration, and intensity) and HA disruptions to activities of daily living (ADL). RESULTS: Although HA density and ADL disruptions were nominally highest during the first three months post-TBI, neither showed significant changes over time. At all time points, history of pre-injury migraine was by far the strongest predictor of both HA density and ADL disruptions (odds ratio (OR)?=?8.0 and OR?=?7.2, averaged across time points, respectively). Furthermore, pre-injury non-migraine HA (at three and six months post-TBI), penetrating-type TBI (at six months post-TBI), and female sex (at six and 12 months post-TBI) were each associated with an increase in the odds of a more severe HA density. Severity of TBI (post-traumatic amnesia (PTA) duration) was not associated with either outcome. CONCLUSION: Individuals with HA at three months after moderate-severe TBI do not improve over the ensuing nine months with respect to HA density or ADL disruptions. Those with pre-injury HA, particularly of migraine type, are at greatest risk for HA post-TBI. Other independent risk factors are penetrating-type TBI and, to a lesser degree and post-acutely only, female sex. Individuals with these risk factors should be monitored and considered for aggressive early intervention.Walker WC, Marwitz JH, Wilk AR, Ketchum JM, Hoffman JM, Brown AW, Lucas S. Yesdevopsadmin
2012Medical care costs associated with traumatic brain injury over the full spectrum of disease: a controlled population-based study.JournalJournal of Neurotrauma29112038-2049Data on traumatic brain injury (TBI) economic outcomes are limited. We used Rochester Epidemiology Project (REP) resources to estimate long-term medical costs for clinically-confirmed incident TBI across the full range of severity after controlling for pre-existing conditions and co-occurring injuries. All Olmsted County, Minnesota, residents with diagnoses indicative of potential TBI from 1985-2000 (n=46,114) were identified, and a random sample (n=7175) was selected for medical record review to confirm case status, and to characterize as definite (moderate/severe), probable (mild), or possible (symptomatic) TBI. For each case, we identified one age- and sex-matched non-TBI control registered in REP in the same year (±1 year) as case's TBI. Cases with co-occurring non-head injuries were assessed for non-head-injury severity and assigned similar non-head-injury-severity controls. The 1145 case/control pairs for 1988-2000 were followed until earliest death/emigration of either member for medical costs 12 months before and up to 6 years after baseline (i.e., injury date for cases and comparable dates for controls). Differences between case and control costs were stratified by TBI severity, as defined by evidence of brain injury; comparisons used Wilcoxon signed-rank plus multivariate modeling (adjusted for pre-baseline characteristics). From baseline until 6 years, each TBI category exhibited significant incremental costs. For definite and probable TBI, most incremental costs occurred within the first 6 months; significant long-term incremental medical costs were not apparent among 1-year survivors. By contrast, cost differences between possible TBI cases and controls were not as great within the first 6 months, but were substantial among 1-year survivors. Although mean incremental costs were highest for definite cases, probable and possible cases accounted for>90% of all TBI events and 66% of total incremental costs. Preventing probable and possible events might facilitate substantial reductions in TBI-associated medical care costs.Leibson CL, Brown AW, Hall Long K, Ransom JE, Mandrekar J, Osler TM, Malec JF. Yesdevopsadmin
2014Meta-analysis of the effects of acetylcholinesterase inhibitors on verbal memory deficits among persons with traumatic brain injuryJournalBrain Injury128781Arciniegas, D, Nick, T, Sander, A, Sherer, MYesdevopsadmin
2014Factors that predict self-reported duration of coma for persons with traumatic brain injuryJournalBrain Injury128704-705Sherer, M, Maestas, K, Sander, A, Nick, TYesdevopsadmin
2014Psychological Sequelae of the Station Nightclub Fire: Comparing Survivors with and without Physical Injuries Using a Mixed-Methods AnalysisJournalJ70145PLOS One1e115013.Study surveyed survivors of The Station nightclub fire in Rhode Island to explore the impact of emotional trauma on psychological outcomes. One hundred four participants completed a 130-question survey that assessed demographic (gender, age, race, marital status, number of children, pre-fire employment status); medical (presence and percentage of burn injury); and occupational (time off work, post-fire employment status) factors. The mean age of respondents was 32 years, 62 percent were male, and 47 percent experienced a physical injury. Primary outcomes were posttraumatic stress (Impact of Event Scale – Revised) and depressive (Beck Depression Inventory) symptoms. Linear regression was used to examine differences in symptom profiles between those with and without physical injuries. The free-response section of the survey was analyzed qualitatively to compare psychological sequelae of survivors with and without physical injuries. The primary analysis found that the survivors who sustained burn injuries from the fire had no more likelihood of experiencing posttraumatic stress symptoms or depressive symptoms than those without burn injuries. In the qualitative analysis, the emotional trauma that survivors experienced was a major, common theme regardless of physical injury. Survivors without physical injuries were more likely to experience survivor guilt, helplessness, self-blame, and bitterness. Despite the post-fire challenges described, most survivors wrote about themes of recovery and renewal. These findings suggest a need to understand individual factors influencing positive outcomes for fire survivors.Hart T, Kozlowski A, Whyte J, Poulsen I, Kristensen K, Nordenbo A, Heinemann AWYesdevopsadmin
2014Subtypes of Post-Traumatic Epilepsy: Clinical, Electrophysiologic, and Imaging FeaturesJournalJ71123JOURNAL OF NEUROTRAUMA1PubMed PMID 24693960Study identified and described the subtypes of post-traumatic epilepsy (PTE) that arise a consequence of traumatic brain injury (TBI). A retrospective chart review was performed of patients with moderate-to-severe TBI with subsequent development of medically refractory epilepsy referred for video-electroencephalography (EEG) monitoring at a single center over a 10-year period. Information regarding details of injury, neuroimaging studies, seizures, video-EEG, and surgery outcomes were collected and analyzed. There were 123 patients with PTE identified, representing 4.3 percent of all patients evaluated in the epilepsy monitoring unit. Most of them had localization-related epilepsy, of which 57 percent had temporal lobe epilepsy (TLE), 35 percent had frontal lobe epilepsy (FLE), and 3 percent each had parietal and occipital lobe epilepsy. Of patients with TLE, 44 percent had mesial temporal sclerosis (MTS), 26 percent had temporal neocortical lesions, and 30 percent were nonlesional. There was no difference in age at injury between the different PTE subtypes. Twenty-two patients, 13 of whom had MTS, proceeded to surgical resection. At a mean follow-up of 2.5 years, Engel Class I outcomes were seen in 69 percent of those with TLE and 33 percent of those with FLE. The findings suggest that PTE is a heterogeneous condition, and careful evaluation with video-EEG monitoring and high resolution magnetic resonance imaging can identify distinct syndromes. These results have implications for the design of clinical trials of antiepileptogenic therapies for PTE.Gupta P, Ding K, Sayed N, Agostini M, Van Ness P, Madden C, Mickey B, D'Ambrosio R, Diaz-Arrastia RYesdevopsadmin
2011Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008.JournalArchives of Physical Medicine and Rehabilitation924519-30OBJECTIVE: To update our clinical recommendations for cognitive rehabilitation of people with traumatic brain injury (TBI) and stroke, based on a systematic review of the literature from 2003 through 2008. DATA SOURCES: PubMed and Infotrieve literature searches were conducted using the terms attention, awareness, cognitive, communication, executive, language, memory, perception, problem solving, and/or reasoning combined with each of the following terms: rehabilitation, remediation, and training for articles published between 2003 and 2008. The task force initially identified citations for 198 published articles. STUDY SELECTION: One hundred forty-one articles were selected for inclusion after our initial screening. Twenty-nine studies were excluded after further detailed review. Excluded articles included 4 descriptive studies without data, 6 nontreatment studies, 7 experimental manipulations, 6 reviews, 1 single case study not related to TBI or stroke, 2 articles where the intervention was provided to caretakers, 1 article redacted by the journal, and 2 reanalyses of prior publications. We fully reviewed and evaluated 112 studies. DATA EXTRACTION: Articles were assigned to 1 of 6 categories reflecting the primary area of intervention: attention; vision and visuospatial functioning; language and communication skills; memory; executive functioning, problem solving and awareness; and comprehensive-holistic cognitive rehabilitation. Articles were abstracted and levels of evidence determined using specific criteria. DATA SYNTHESIS: Of the 112 studies, 14 were rated as class I, 5 as class Ia, 11 as class II, and 82 as class III. Evidence within each area of intervention was synthesized and recommendations for Practice Standards, Practice Guidelines, and Practice Options were made. CONCLUSIONS: There is substantial evidence to support interventions for attention, memory, social communication skills, executive function, and for comprehensive-holistic neuropsychologic rehabilitation after TBI. Evidence supports visuospatial rehabilitation after right hemisphere stroke, and interventions for aphasia and apraxia after left hemisphere stroke. Together with our prior reviews, we have evaluated a total of 370 interventions, including 65 class I or Ia studies. There is now sufficient information to support evidence-based protocols and implement empirically-supported treatments for cognitive disability after TBI and stroke.Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T, Azulay J, Cantor J, Ashman T.Yesdevopsadmin
2014Mood disorders after traumatic brain injuryJournalJ71275Psychiatric Clinics of North America13713-29Article provides an overview of the evaluation and management of disorders of mood following traumatic brain injury (TBI). Methods of assessing mood disorders are described briefly, and the importance of considering the differential diagnoses for these clinical phenomena is highlighted. Depressive disorders are the most common neuropsychiatric sequels of TBI. Mania, hypomania, and mixed mood states are less frequent but serious complications of TBI. In many respects, the evaluation and management of these conditions is similar to that provided to persons with primary (idiopathic) mood disorders. Mood disorders are highly comorbid with anxiety, substance misuse, and other behavioral alterations like impulsivity and aggression. Furthermore, once developed, they may have a chronic and refractory course. The functional repercussion of these disorders is huge, affecting the rehabilitation process as well as the long-term outcome of patients with TBI. The current treatment options are based on current standards of practice rather that empirically based controlled treatment trials. Randomized, double-blind, placebo-controlled trials are needed to establish the most effective treatments for the variety of mood disorders associated with TBI.Jorge, RE, Arciniegas, DBYesdevopsadmin
2014The Impact of Self-Awareness and Depression on Subjective reports of Memory, Quality of Life, and Satisfaction with Life in Persons with TBIJournalJ68284Brain Injury128174-80Study investigated the extent to which self-awareness and depressive symptomatology are associated with self-reports of memory, quality-of-Life (QoL), and satisfaction with life in individuals with traumatic brain injury (TBI). Thirty community-dwelling adults, who sustained a TBI at least 1 year prior to study enrollment, completed questionnaires to assess the constructs of depression, self-awareness, QoL, satisfaction with life and memory. Analyses revealed that symptoms of depression were significantly associated with self-reports of poor memory abilities, lower QoL, and lower satisfaction with life. Additionally, higher levels of self-awareness were associated with lower ratings of QoL, reduced memory abilities, and better strategy use regarding memory. However, when examining the contribution of each construct individually, depressive symptomatology, and not self-awareness, was significantly associated with subjective self-reports of memory, QoL, and satisfaction with life. This pattern of relationships illustrates that, when a person has a low level of depressive symptoms, his/her reports of QoL, memory, and satisfaction with life will be more positive; however, he/she will demonstrate more difficulty with self-awareness. The authors conclude that psychological aspects of recovery must be taken into account when using self-reported measures in the evaluation of people with TBI.Goverover, Y., Chiaravalloti, N.D.Yesdevopsadmin
2014Ultrasonographic Measurement of the Acromiohumeral Distance in Spinal Cord Injury: Reliability and Effects of Shoulder PositioningJournalJournal of Spinal Cord Medicine1379Cantor JB, Ashman T, Bushnik T, Cai X, Farrell-Carnahan L, Gumber S, Hart T, Rosenthal J, Dijkers MP.Yesdevopsadmin
2014A heuristic for the clinical evaluation of traumatic brain injury and aggressionJournalJournal of Neuropsychiatry and Clinical Neurosciences126179-183Wortzel, HS, Arciniegas, DBYesdevopsadmin
2014Prognostic importance of self-reported traits/problems/strengths & environmental barriers/facilitators for predicting participation outcomes in persons with traumatic brain injury: A systematic reviewJournalJ69094Archives of Physical Medicine and Rehabilitation1951162-1173This systematic review examined evidence for the prognostic value of self-reported traits/problems/strengths and environmental barriers/facilitators of participation outcomes in people with traumatic brain injury (TBI). PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases were searched for articles published through August 15, 2013. Each of the 996 abstracts identified by the search and those failing to meet all inclusion criteria were excluded. Data were extracted from the 63 retained articles by 2 independent reviewers and study quality was determined using American Academy of Neurology (AAN) criteria. Conclusions regarding prognostic importance of self-report and environmental barrier/facilitator variables were made using AAN criteria. The highest level of available evidence regarding barrier/facilitator variables indicated that access to transportation, access to services, and participation in social interaction were possibly predictive of employment outcome. In contrast, living arrangements and social support were possibly not predictive of employment outcome. The evidence regarding self-report variables indicated that the number of postconcussive symptoms, fatigue, and physical competence were probably predictive of employment and need for supervision, whereas self-efficacy was probably not predictive of employment. Subjective well-being, pain, and social interaction were possibly predictive of employment, whereas coping style was possibly not predictive. Although additional investigation is needed, the findings suggest that self-report variables are likely to make important contributions to predicting participation outcomes. Future research should be guided by coherent conceptual models and use a consistent set of assessment instruments to facilitate comparisons between studiesSherer, M, Davis, LC, Sander, AM, Caroselli, JS, Clark, AN, Pastorek, NJYesdevopsadmin
2014Ultrasonographic Changes of the Median Nerve Indicative of Carpal Tunnel Syndrome are Related to Hand Placement During TransfersJournalProceedings of the Rehabilitation Engineering and Assistive Technology Society of North America1NULLCantor J, Ashman T, Bushnik T, Cai X, Farrell-Carnahan L, Gumber S, Hart T, Rosenthal J, Dijkers MYesdevopsadmin
2014Neuroendocrine--Immune Dysfunction in Individuals with Unfavorable Outcome after Severe Traumatic Brain InjuryJournalBRAIN BEHAVIOR AND IMMUNITY14515-27Dahdah, M; Barnes, S; Schmidt, K; Buros, A; Dubiel, R; Dunklin, C; Callender, L, Shafi, SYesdevopsadmin
2011Incidence of traumatic brain injury across the full disease spectrum: a population-based medical record review study.JournalEpidemiology226836-44BACKGROUND: Extremely few objective estimates of traumatic brain injury incidence include all ages, both sexes, all injury mechanisms, and the full spectrum from very mild to fatal events. METHODS: We used unique Rochester Epidemiology Project medical records-linkage resources, including highly sensitive and specific diagnostic coding, to identify all Olmsted County, MN, residents with diagnoses suggestive of traumatic brain injury regardless of age, setting, insurance, or injury mechanism. Provider-linked medical records for a 16% random sample were reviewed for confirmation as definite, probable, possible (symptomatic), or no traumatic brain injury. We estimated incidence per 100,000 person-years for 1987-2000 and compared these record-review rates with rates obtained using Centers for Disease Control and Prevention (CDC) data-systems approach. For the latter, we identified all Olmsted County residents with any CDC-specified diagnosis codes recorded on hospital/emergency department administrative claims or death certificates during 1987-2000. RESULTS: Of sampled individuals, 1257 met record-review criteria for incident traumatic brain injury; 56% were ages 16-64 years, 56% were male, and 53% were symptomatic. Mechanism, sex, and diagnostic certainty differed by age. The incidence rate per 100,000 person-years was 558 (95% confidence interval = 528-590) versus 341 (331-350) using the CDC data-system approach. The CDC approach captured only 40% of record-review cases. Seventy-four percent of missing cases presented to the hospital/emergency department; none had CDC-specified codes assigned on hospital/emergency department administrative claims or death certificates; and 66% were symptomatic. CONCLUSIONS: Capture of symptomatic traumatic brain injuries requires a wider range of diagnosis codes, plus sampling strategies to avoid high rates of false-positive events.Leibson CL, Brown AW, Ransom JE, Diehl NN, Perkins PK, Mandrekar J, Malec JF.Yesdevopsadmin
2014Game play following traumatic brain injury: Applying an activity-based model for using games during neurorehabilitationJournalBrain Injury128776Hengst, J, Kortte, K, Neils-Strunjas, J, Clark, A, Maestas, K, Paul, D, Mudar, RYesdevopsadmin
2014Novel risk factors associated with current suicidal ideation and lifetime suicide attempt in individuals with spinal cord injuryJournalJ71476Archives of Physical Medicine and Rehabilitation196799-808Study investigated the unique associations of suicidal ideation (SI) and lifetime suicide attempts (SAs) in individuals with spinal cord injury (SCI). Data were collected from 2,453 adults with a history of traumatic SCI recruited from 4 SCI Model System sites and 2 additional sites as part of the Project to Improve Symptoms and Mood after SCI. The main outcome measure was any SI in the past 2 weeks (9-item Patient Health Questionnaire) and any lifetime SA. Three hundred twenty-three individuals (13.3 percent) reported SI in the past 2 weeks and 179 (7.4 percent) reported lifetime SA. After controlling for other factors, both lifetime SA and current SI were associated with study site and current level of depression. In addition, SA was associated with less education, younger age at injury, having current or past treatment of depression, and having bipolar disorder or schizophrenia. SI was associated with more years since injury and lifetime SA. Several psychological factors were associated with current SI and lifetime SAs, including lower environmental reward and less positive affect. In addition, control of one's community activities and spiritual well-being were associated with current SI. In bivariate comparisons, severity of SCI was also associated with the 47 percent of the SAs that occurred after injury. Several unique associations of SI and lifetime SA in individuals with SCI were identified, including level of environmental reward and control, spiritual well-being, and severity of SCI. These factors bear further investigation as prospective risk factors for suicidal behavior after SCI.Sullivan-Singh SJ, Sawyer K, Ehde DM, Bell KR, Temkin N, Dikmen S, Williams RM, Hoffman JMYesdevopsadmin
2014Use of a Burn Specific Patient Reported Outcome Measure (PROM) with Real-Time Feedback in a Clinical Setting: A Pilot Study using the ipad Administered Young Adult Burn Outcome Questionnaire (YABOQ)JournalJournal of Burn Care & Research136S78Gerard P, Zafonte R, Giacino JYesdevopsadmin
2014The factor structure of the Pittsburgh Sleep Quality Index in persons with traumatic brain injuryJournalJ70550Neurorehabilitation1xStudy examined the factor structure of the Pittsburgh Sleep Quality Index (PSQI) in a sample of individuals with traumatic brain injury (TBI) and tested the one-, two-, and three-factor models derived from previous studies in other populations. The PSQI is a measure of sleep quality in which respondents are asked to answer questions about their sleep over the past month. PSQI data was collected during telephone interviews conducted with 243 subjects who had sustained a TBI. Participants were a subset of individuals with TBI enrolled in the National Institute of Disability and Rehabilitation Research (NIDRR) TBI Model Systems program, a prospective, longitudinal multi-center study that collects data about individuals with TBI, their injury, and their outcomes. All participants were approximately one year post-injury. Factor analyses were conducted (exploratory and confirmatory) to examine the factor structure of the PSQI. Consistent with previous research, this study found that the single-factor model is not the optimal factor structure for the PSQI in people with TBI. Results confirm the fit of models previously tested but also reveal an alternative conceptualization of sleep containing both qualitative and quantitative factors. While the 3-factor model best fits the data in this TBI sample, the use of a 2-factor model is acceptable and may be more clinically relevant due to the grouping of time-related variables that could provide important information with regard to circadian rhythm disorders.Lequerica, A. Chiaravalloti, N. Cantor, J. Dijkers, M. Wright, J. Kolakowsky-Hayner, S.A. Bushnik, T. Hammond, F. Bell, K.Yesdevopsadmin
2014Feasibility of acceptance and commitment therapy for treating emotional distress in persons with traumatic brain injuryJournalBrain Injury128698Sander, AM, Maestas, KL, Arciniegas, D, Clark, A, Sherer, MYesdevopsadmin
2015Measuring Psychological Trauma after Spinal Cord Injury: Development, Validation and Psychometric Characteristics of the SCI-QOL Trauma Item Bank and Short FormJournalJ71737Journal of Spinal Cord Medicine138326-334Article describes the development and psychometric properties of the Spinal Cord Injury – Quality of Life (SCI-QOL) Psychological Trauma item bank and short form. Using a mixed-methods design, a Psychological Trauma item bank was developed and tested with patient and provider focus groups and cognitive interviews. A 31-item pool was tested at several medical institutions across the United States, including 5 SCI Model System centers and one Veterans Affairs medical center. A total of 716 individuals with SCI completed the items assessing trauma. Analyses included item response theory based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision. The 31 items fit a unidimensional model and demonstrated good precision. Nine items demonstrated negligible DIF with little impact on score estimates. The final calibrated item bank contains 19 items. The SCI-QOL Psychological Trauma item bank is a psychometrically robust measurement tool from which a short form and a computer adaptive test version are available.Hammond FM, Davis CS, Cook JR, Philbrick P, Hirsch MAYesdevopsadmin
2015The cognition battery of the NIH Toolbox for assessment of neurological and behavioral function: validation in adult sampleJournalJournal of the International Neuropsychological Society16567-78Santarsieri, M., Kumar, R., Kochanek, P., Berga, S., Wagner, A.Yesdevopsadmin
2011Natural History of Headache Five Years after Traumatic Brain Injury.JournalJournal of Neurotrauma2891719-25Headache is one of the most frequently reported symptoms following traumatic brain injury (TBI). Little is known about how these headaches change over time. We describe the natural history of headache in individuals with moderate to severe TBI over 5 years after injury. A total of 316 patients were prospectively enrolled and followed at 3, 6, 12, and 60 months after injury. Individuals were 72% male, 73% white, and 55% injured in motor vehicle crashes, with an average age of 42. Pre-injury headache was reported in 17% of individuals. New or worse headache prevalence remained consistent with at least 33% at all time points. Incidence was >17% at all time points with first report of new or worse headache in 20% of participants at 60 months. Disability related to headache was high, with average headache pain (on 0-10 scale) ranging from 5.5 at baseline to 5.7 at 60 months post-injury, and reports of substantial impact on daily life across all time points. More than half of classifiable headaches matched the profile of migraine or probable migraine. Headache is a substantial problem after TBI. Results suggest that ongoing assessment and treatment of headache after TBI is needed, as this symptom may be a problem up to 5 years post-injury.Stacey A, Lucas S, Dikmen S, Temkin N, Bell KR, Brown A, Brunner R, Diaz-Arrastia R, Watanabe TK, Weintraub A, Hoffman JM.Yesdevopsadmin
2014A randomized controlled trial of a modified group cognitive-behavioral intervention for depressed mood following traumatic brain injuryJournalBrain Injury128753Clark, AYesdevopsadmin
2014Transfer skill deficits among Veterans who use wheelchairsJournalInternational Seating Symposium1NULLBergquist, T.F., Yutsis, M., Sullan, M.JYesdevopsadmin
2014The Uniform Data System for Medical Rehabilitation: report of follow-up information on patients discharged from inpatient rehabilitation programs in 2002-2010JournalAmerican Journal of Physical Medicine & Rehabilitation193231-244Fisher L, Pedrelli P, Giacino J, Cardoos A, Hammond F, Bogner J, Bombardier C, Hart T, Berquist T, Ketchum J, Zafonte RYesdevopsadmin
2015Neuronal glutamate transporter genetic variation: impact on epileptogenesis and epilepsy risk following severe TBIJournalJournal of Neurotrauma1AcceptedKushner, D.S., Johnson-Greene, D.Yesdevopsadmin
2014Neuropsychological aspects of substance use disorders: Evidence-based perspectivesJournal1341-363Roebuck-Spencer, TM, Sander, AM, Wilde, LYesdevopsadmin
2014Zoledronic acid administration failed to prevent bone loss at the knee in persons with acute spinal cord injury: an observational cohort studyJournalJournal of Bone and Mineral Metabolism1EpubLu W, Cantor J, Aurora R, Nguyen M, Ashman T, Spielman L, Ambrose A, Krellman JW, Gordon WYesdevopsadmin
2014The association of assistive mobility devices and social participation in people with spinal cord injuries. Tsai IH; Graves DE; Lai CHJournalJ68745Spinal Cord152209-215Study examined the relationship between the type of mobility devices used and social participation in wheelchairs users who have spinal cord injuries (SCI). It was hypothesized that using wheelchairs with external power and driving a modified vehicle (MV), with or without driving in a wheelchair, facilitates social participation for wheelchairs users with SCI. Data were collected from 2,986 individuals who had undergone rehabilitation at one of the regional centers of the Model SCI System in the United States. Participants used a wheelchair 40 or more hours per week and could not ambulate at least 150 feet at home. A secondary data analysis was performed using a mixed-effect model on data from 3,498 follow-up interviews. Outcomes included participation as measured by the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) and employment status, and wheelchair and MV use. Among the participants, 33 percent drove an MV, and 44 percent used an external-powered wheelchair. The use of an MV was positively related to employment and CHART-SF score, regardless of driving directly or driving with a wheelchair. People who drove an MV were found to have approximately two more business associates to contact to once a month and approximately 2 additional days out of home per week compared with those without an MV. No significant association was shown between the type of wheelchair used and participation.Santarsieri, M., Kumar, R, Niyonkuru, C., Berga, S., Kochanek, P., Wagner, A.Yesdevopsadmin
2014Chronic Inflammation after Severe Traumatic Brain Injury: Characterization and Associations with Outcome 6- and 12- months Post-InjuryJournalJournal of Head Trauma Rehabilitation1EpubKumar RG, Boles JA, Wagner AK.Yesdevopsadmin
2014Hair cortisol: a potential biomarker of emotional distress among persons with traumatic brain injuriesJournalBrain Injury128785Arciniegas, D, Sander, A, Maestas, K, Clark, A, Sherer, MYesdevopsadmin
2014Handbook on the Neuropsychology of Traumatic Brain InjuryJournal1213-232Struchen, MAYesdevopsadmin
2015The Relationship Between Transfer Skills and Upper Limb Joint Loading in Wheelchair UsersJournalWorld Congress of Biomechanics1NULLEum R, Seel R, Goldstein R, Brown AW, Watanabe T, Zasler ND, Roth EJ, Zafonte RD, Glenn MBYesdevopsadmin
2014Preserved Covert Cognition in Non-Communicative Patients With Severe Brain InjuryJournalJ71628Archives of Physical Medicine and Rehabilitation195e14Study assessed covert cognition, or the presence of top-down cognitive processing in the absence of discernible motor or verbal responses, in patients in a minimally conscious state (MCS) or vegetative state (VS) using an active event-related potential (ERP) paradigm. Twenty-six patients were included in the analysis: 8 patients diagnosed as MCS+ (those in whom any reproducible response to command was obtained), 8 patients diagnosed as MCS- (no reproducible response to command was obtained), and 10 patients in a VS (no localizing or voluntary response was obtained). There were also 14 healthy controls. The ERP paradigm included a passive condition and an active condition, wherein the participant was instructed to voluntarily focus attention on his/her own name. In each condition, the participant’s own name was presented 100 times (4 blocks of 25 stimuli). In 5 MCS+ patients as well as in 3 MCS- patients and 1 VS patient, an enhanced P3 amplitude was observed in the active versus passive condition. Relative to controls, patients showed a response that was widely distributed over frontoparietal areas and not present in all blocks (3 of 4). In patients with covert cognition, the amplitude of the response was lower in frontocentral electrodes compared with controls but did not differ from that in the MCS+ group. The results indicate that volitional top-down attention is impaired in patients with covert cognition.Le D, Shafi S, Gwirtz P, Bennett M, Reeves R, Callender L, Dunklin C, Cleveland S.Yesdevopsadmin
2012Preinjury predictors of life satisfaction at 1 year after traumatic brain injury.JournalArchives of Physical Medicine and Rehabilitation9381324-1330OBJECTIVE: To investigate the predictive value of preinjury factors for satisfaction with life (SWL) at 1-year posttraumatic brain injury (TBI). DESIGN: Secondary analysis of prospective, longitudinal registry using data collected during inpatient rehabilitation and at 1-year post-TBI. SETTING: Fifteen specialized brain injury units providing acute rehabilitation care as part of the Traumatic Brain Injury Model Systems (TBIMS) program. PARTICIPANTS: Community-dwelling persons (N=444) with moderate to severe TBI aged 16 to 64 years enrolled in the TBIMS program between October 2007 and October 2008 with 1-year follow-up data. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Satisfaction With Life Scale (SWLS). RESULTS: Hierarchical stepwise linear regression revealed that injury-related and demographic variables did not contribute significantly to the explained variance in SWLS scores. In contrast, the preinjury functioning (education, productivity/employment) and preinjury condition (psychiatric and substance use problems, severe sensory dysfunction, learning problems, prior TBI) blocks each contributed significantly to the explained variance in SWLS scores. Preinjury functioning accounted for 2.9% of the variance and preinjury conditions for 3.8%. CONCLUSIONS: Although their contributions are small, preinjury functioning and preinjury conditions are important to consider in the prediction of SWL post-TBI. Educational level and history of psychiatric and other premorbid difficulties are particularly important for clinicians to consider when implementing or developing interventions for persons with moderate to severe TBI.Davis LC, Sherer M, Sander AM, Bogner JA, Corrigan JD, Dijkers MP, Hanks RA, Bergquist TF, Seel RT.Yesdevopsadmin
2014The role of resilience in predicting depression, anxiety, and participation in persons with traumatic brain injuryJournalBrain Injury128789-790Maestas, K, Sherer, M, Sander, A, Tulsky, D, Nick, TYesdevopsadmin
2015Spinal Cord Injury in the Child and Young AdultJournal115Brooks J, Shavelle RM, Strauss DJ, Hammond FM, Harrison-Felix CLYesdevopsadmin
2014Evaluation of the STEP intervention for executive dysfunction after traumatic brain injury: a randomized controlled trial with minimizationJournalJ67771Archives of Physical Medicine and Rehabilitation19543109Study evaluated the efficacy of the Short-Term Executive Plus (STEP) cognitive rehabilitation program for improving executive dysfunction, attention, and emotional regulation after traumatic brain injury (TBI). The goal of STEP is to teach a core set of metacognitive skills that can be applied across a wide range of real-life activities. The treatments included in STEP are problem solving training, emotional regulation training, attention training, and use of cognitive supports. Ninety-eight participants with TBI and executive dysfunction were randomly to immediately start the STEP program (12 weeks of group training in problem solving and emotional regulation and individual sessions of attention and compensatory strategies training) or to the waitlist. Factor analysis was used to create a composite executive function measure using the Problem Solving Inventory (PSI), Frontal Systems Behavior Scale (FSBS), Behavioral Assessment of the Dysexecutive Syndrome, and Self-Awareness of Deficits Interview. Emotional regulation was assessed with the Difficulties in Emotion Regulation Scale. The primary attention measure was the Attention Rating and Monitoring Scale. Secondary measures included neuropsychological measures of executive function, attention, and memory and measures of affective distress, self-efficacy, social participation, and quality of life (QOL). Intention-to-treat mixed-effects analyses revealed significant treatment effects for the composite executive function measure and the FSBS and PSI. No between-group differences were found on the neuropsychological measures or on measures of attention, emotional regulation, self-awareness, affective distress, self-efficacy, participation, or QOL. Results suggest that the STEP program is efficacious in improving self-reported post-TBI executive function and problem solving.Cantor, J, Ashman, T, Dams-O'Connor, K, Dijkers, MP, Gordon, W, Spielman, L, Tsaousides, T, Allen, H, Nguyen, M, Oswald, JYesdevopsadmin
2014Physical Medicine and Rehabilitation Board ReviewJournal10-0Tsaousides, T, D'Antonio, E, Varbanova, V, Spielman, LYesdevopsadmin
2015The Spinal Cord Injury – Quality of Life Measurement System: Development, psychometrics, and item bank calibrationJournalR09339Journal of Spinal Cord Medicine138251-256Articles in this special journal issue describe the development and calibration of the item banks for the Spinal Cord Injury – Quality of Life (SCI-QOL) measurement system. Following an introductory overview of the SCI-QOL project, subsequent articles present one or more SCI-QOL item banks and review the included construct, item development/selection and reduction, item response theory analyses, calibration data, and short-form versions developed for each bank. Individual articles are available for document delivery under accession numbers J71731 through J71745.Whiteneck, G. G., Cuthbert, J. P., Corrigan, J. D., Bogner, J. 2015.Yesdevopsadmin
2014Exporatory associations with Tumor Necrosis Factor-alpha, disinhibition, and suicidal endorsement after traumatic brain injuryJournalBRAIN BEHAVIOR AND IMMUNITY1EpubJuengst, S.B., Kumar, R.G., Arenth P.M., Wagner, A.K.Yesdevopsadmin
2015Type and frequency of reported wheelchair repairs and adverse consequences among people with spinal cord injury: preliminary resultsJournalProceedings of the Rehabilitation Engineering and Assistive Technology Society of N.A. Conference1NULLKumar, R., Ritter, A., Kochanek, P., Berga, S., Wagner, A.Yesdevopsadmin
2014Preparation skills impact upper limb joint loading during toilet transfersJournalInternational Seating Symposium1NULLKatz D, Whyte J, Chang H, Eshkar N, Kalmar K, Long D, Yablon S, Bagiella E, Giacino JYesdevopsadmin
2015Multiple aromatization mechanisms influence mortality and CNS secondary injury profiles after severe TBIJournalJournal of Neurotrauma1AcceptedJuengst, S., Arenth, P., Wagner, A.Yesdevopsadmin
2015The Coma Recovery Scale-Revised: Evidentiary Support for Hierarchical Grading of Level of ConsciousnessJournalJ70227ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION1952335-2341Study examined the construct validity of the subscales of the Coma Recovery Scale-Revised (CRS-R) in measuring the neurobehavioral pattern of recovery of consciousness. Item response theory (IRT) and factor analyses were applied to CRS-R subscales scores collected from 180 rehabilitation inpatients with posttraumatic disturbance in consciousness who participated in a double-blinded, randomized, controlled drug trial. The CRS-R was found to fit factor analytic models adhering to the assumptions of unidimensionality and monotonicity. In addition, subscales were mutually independent based on residual correlations. Nonparametric IRT reaffirmed the finding of monotonicity. A highly constrained confirmatory factor analysis model, which imposed equal factor loadings on all items, was found to fit the data well and was used to estimate a 1-parameter IRT model. The CRS-R adhered to the 4 critical scaling criteria of unidimensionality, monotonicity, mutual independence, and equivalent loadings of all items. These results support the hierarchical structure of the CRS-R and suggest that it is an effective tool for establishing diagnosis and monitoring recovery of consciousness after severe traumatic brain injury.Ritter, A., Brooks, M., Kammerer, C., Conley, Y., Wagner, A.Yesdevopsadmin
2010The reliability and validity of the community integration measure in persons with traumatic brain injuryJournalJ59430Rehabilitation Psychology553292-297Study investigated the psychometric properties of the Community Integration Measure (CIM), a scale that assesses self-perceived quality of community integration, among people with a history of traumatic brain injury (TBI). A total of 279 people with TBI completed the CIM, as well as other measures of community integration and quality of life, and were followed up to 15 years after injury. The CIM was found to be a reliable instrument with adequate internal consistency. Validity was demonstrated in its relationship to other measures of community integration and life satisfaction. Utility was evident in its prediction of perceived social support. Results suggest that the CIM is an adequate measure of community integration for people with histories of TBI of up to 15 years.Griffen, J.A., Hanks, R.A., Meachen, S.J. Yesdevopsadmin
2014Overview of the Spinal Cord Injury - Quality of Life (SCI-QOL) measurement systemJournalJ71732Journal of Spinal Cord Medicine138257-269Article describes the background and development of the Spinal Cord Injury -- Quality of Life (SCI-QOL) measurement system, a spinal cord injury (SCI)-specific, patient-reported outcome measure of health-related quality of life (HRQOL) covering physical, emotional, and social domains of functioning. The SCI-QOL was developed using item response theory (IRT) and comprises 22 subdomains that include 19 IRT-calibrated item banks and 3 fixed-length scales measuring physical, emotional, and social aspects of HRQOL. Its design ensures that each item is relevant to individuals with SCI. Each item bank may be administered as a full bank, short form, or computer adaptive test, while scales may be administered in fixed-length format only.Sherer M, Dijkers MP, Whyte J, Nick TGYesdevopsadmin
2014Measuring enfranchisement: Importance of and control over participation by people with disabilitiesJournalJ67495Archives of Physical Medicine and Rehabilitation193775-781Study evaluated the psychometric properties and validity of an expanded set of community enfranchisement items that are suitable for computer adaptive testing. Enfranchisement is a complex construct reflecting individuals’ assessment of whether they perceive that the communities in which they want to participate respect their full participation. Data were obtained from 1,163 individuals with disabilities recruited from multiple sources, including an online panel generation company, former rehabilitation inpatients, disability community organizations, a registry of rehabilitation patients, and Traumatic Brain Injury and Spinal Cord Injury Model Systems facilities. Exploratory and confirmatory factor analyses of the 48 enfranchisement items suggested 2 distinct subsets of items: (1) importance of participation and (2) control over participation. Principal components analysis of the residuals suggested that the 2 item sets are unidimensional. Rating scale analysis provided evidence that the 2 item sets fit the Rasch model. Importance and control were moderately correlated with each other and with disability severity. The findings indicate that importance of participation and control over participation define 2 distinct sets of participation enfranchisement that can be measured reliably and the preliminary evidence supports their validity.Heinemann, A. W., Magasi, S., Bode, R. K., Hammel, J., Whiteneck, G. G., Bogner, J., & Corrigan, J.Yesdevopsadmin
2014Mortality following traumatic brain injury among individuals unable to follow commands at the time of rehabilitation admission: a NIDRR TBIMS studyJournalJournal of Neurotrauma100Juengst, S., Skidmore, E., Wagner, A.Yesdevopsadmin
2014Quality of Life Assessments in Persons with Spinal Cord Injury with Neurogenic Bowel and BladderJournalQuality of Life Research12358-58Dams-O'Connor K, Pretz C, Billah T, Hammond FM, Harrison-Felix CYesdevopsadmin
2014Disorders of consciousness: The state of the scienceJournalJ68867Nature Reviews Neurology11099-114Article provides an overview of the clinical management of patients with prolonged disorders of consciousness after acquired brain injury. The authors review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. The article concludes with a provocative discussion of bioethical and medico-legal issues that are unique to this population and that have a profound impact on care.Giacino J, Fins J, Laureys S, Schiff N.Yesdevopsadmin
2014Pruritus in Pediatric Burn Survivors:Defining the Clinical CourseJournalJ70746Journal of Burn Care & Research1151-158Study examined the characteristics of postburn itch and associated symptoms in the pediatric population. A retrospective review was conducted of 430 pediatric burn survivors who were enrolled in the Burn Model System program from 2006 to 2013. Demographic data, injury characteristics, associated symptoms (skin-related problems, pain, and sleep), and incidence and intensity (Numerical Rating Scale) of itch were examined. Measures were completed at hospital discharge and at 6, 12, and 24 months after injury. Spearman’s correlations were used to examine the correlation between itch intensity and associated symptoms. Multivariate regression analyses examined the impact of associated symptoms on itch intensity. There were 430 pediatric burn survivors with a mean age of 7.8 years and a mean total body surface area burned of 40.8 percent. Pruritus is present in most children (93 percent) and is of moderate intensity (5.7) at discharge. The frequency and intensity of pruritus decreases over time; a majority of children continue to report symptoms at 2 years (63 percent). Itch was significantly correlated with associated symptoms. Regression analyses showed a correlation between itch intensity and pain at each time point. There was no association between itch intensity and burn etiology, age, gender, or burn size. The findings suggest that pruritus is a frequent complication that lasts for at least 2 years after injury in a majority of pediatric burn survivors. This information will enable better tracking of outcomes and will serve as a baseline for assessing interventions.Juengst, S., Achille, S., Arenth, P., Skidmore, E., Wagner, A.Yesdevopsadmin
2015Overview of the Spinal Cord Injury-Quality of Life (SCI-QOL) measurement systemJournalJ71732 Journal of Spinal Cord Medicine138251-256Article describes the background and development of the Spinal Cord Injury -- Quality of Life (SCI-QOL) measurement system, a spinal cord injury (SCI)-specific, patient-reported outcome measure of health-related quality of life (HRQOL) covering physical, emotional, and social domains of functioning. The SCI-QOL was developed using item response theory (IRT) and comprises 22 subdomains that include 19 IRT-calibrated item banks and 3 fixed-length scales measuring physical, emotional, and social aspects of HRQOL. Its design ensures that each item is relevant to individuals with SCI. Each item bank may be administered as a full bank, short form, or computer adaptive test, while scales may be administered in fixed-length format only.Myrga, J., Juengst, S., Failla, M., Arenth, P., Conley, Y., Galang, G., Wagner, A.Yesdevopsadmin
2010Impact of the presence of alcohol at the time of injury on acute and one-year cognitive and functional recovery after traumatic brain injuryJournalJ59636International Journal of Neuroscience1208551-556Study examined the impact of blood alcohol level (BAL) at the time of injury on injury severity, and functional or cognitive outcome after traumatic brain injury (TBI). A total of 482 patients admitted to a large urban medical center with documented TBI and blood alcohol testing results were included in the study. Functional outcomes were measured by the Functional Independence Measure (FIM) and cognitive outcomes were measured using neuropsychological tests known to be sensitive to the consequences of TBI. Analyses revealed a statistically significant negative impact of alcohol intoxication at the time of injury on Glasgow Coma Scale (GCS); however intoxication only lowered GCS by an average of 1.9 points. There was a statistically significant relationship between BAL and FIM at the time of admission to inpatient rehabilitation, but BAL accounted for only 3 percent of the variance in FIM total score. There was no relationship between BAL and FIM at discharge from rehabilitation or at 1-year follow-up. There was no statistically significant relationship between BAL at the time of injury and cognitive functioning at 1-year follow-up; however, contrary to the hypotheses GCS failed to show a strong relationship with cognitive outcome.Schutte, C., Hanks, R.A.Yesdevopsadmin
2014What Would Brain Computer Interface Users Want: Opinions and Priorities of Potential Users With Spinal Cord InjuryJournalJ70940Archives of Physical Medicine and Rehabilitation19638-45Study surveyed people with spinal cord injury (SCI) to determine their priorities for brain-computer interface (BCI) applications and design features along with the time investment and risk acceptable to obtain a BCI. Forty people with SCI participated, including of 30 individuals identified from the SCI research registry who were surveyed by telephone and 10 participants from a BCI usage study who were surveyed in person before BCI use. Descriptive statistics of functional independence, living situations and support structures, ratings of importance of different task and design features, and acceptable levels of performance, risk, and time investment were calculated from the survey data. Participants were classified as having low function or high function based on their Functional Independence Measure motor scores. Results indicated that BCIs were of interest to 96 percent of the low-function group. Emergency communication was the top priority task. The most important design features were “functions the BCI provides” and “simplicity of BCI setup.” Desired performance was 90 percent accuracy, with standby mode errors no more than once every 4 hours and speeds of more than 20 letters per minute. Dry electrodes were preferred over gel or implanted electrodes. Median acceptable setup time was 10 to 20 minutes, satisfying 65 percent of participants. Creating BCI functions appropriate to the needs of those with SCI will be of ultimate importance for BCI acceptance with this population.Lu., W., Cantor, J., Aurora, R.N., Nguyen, M., Ashman, T.A., Spielman, L., Ambrose, F.A., Krellman, J.W., Gordon, W.A.Yesdevopsadmin
2014Serum Tumor Necrosis Factor-alpha as a biomarker for all-cause mortality in the first six months after traumatic brain injury: mechanistic relationships with estradiolJournalJournal of Neurotrauma1AcceptedHarrison-Felix C, Pretz C, Hammond FM, Cuthbert JP, Bell J, Corrigan J, Miller AC, Haarbauer-Krupa J.Yesdevopsadmin
2014Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A NIDRR TBI Model Systems Study. J Neurotrauma 2015 Mar 25JournalJOURNAL OF NEUROTRAUMA1naJuengst, S., Skidmore, E., Wagner, A.Yesdevopsadmin
2015Relation of abdominal and stool symptoms on PAC-SYM questionnaires to patient sex and anatomic level of neurologic damage in spinal cord injury patientsJournalNeurogastroenterology and Motility12652-52Brown, A.W., Watanabe, T.K., Hoffman, J.M., Bell, K.R., Lucas, S., Dikmen, S.Yesdevopsadmin
2015Neurophysiology. Decoding motor imagery from the posterior parietal cortex of a tetraplegic humanJournalScience1348906-910Chatelle C, Lesenfants D, Guller Y, Laureys S, Noirhomme QYesdevopsadmin
2014Exploratory associations with Tumor Necrosis Factor-a, disinhibition, and suicidal endorsement after traumatic brain injuryJournalBrain Behavior and Immunity1EpubJuengst, S. B., Kumar, R. G., Arenth P. M., Wagner, A. K.Yesdevopsadmin
2015Reliability of S3 pressure sensation and agreement with deep anal pressureJournalJournal of Spinal Cord Medicine137437-8Kesinger, M., Kumar, R., Wagner, A., Puyana, J., Peitzman, A., Billiar, T., Sperry, J.Yesdevopsadmin
2014Retrieval Practice Improves Memory in Survivors of Severe Traumatic Brain InjuryJournalArchives of Physical Medicine & Rehabilitation 952390-396Objective To investigate whether retrieval practice (RP) improves delayed recall after short and long delays in survivors of severe traumatic brain injury (TBI) relative to massed restudy (MR) and spaced restudy (SR). Design 3(learning condition: MR, SR, RP)×2(delayed recall: 30min, 1wk) within-subject experiment. Setting Nonprofit medical rehabilitation research center. Participants Memory-impaired (James Sumowski, PhD, Julia Coyne, PhD, Amanda Cohen, BA, and John DeLuca, PhDYesdevopsadmin
2014Predictors of follow-up completeness in longitudinal research on traumatic brain injury: findings from the NIDRR TBI model systems programJournalJ68567Archives of Physical Medicine and Rehabilitation195633-641Study identified baseline participant variables in the domains of demographics, medical/psychosocial history, injury characteristics, and post-injury functional status associated with longitudinal follow-up completeness among participants with traumatic brain injury (TBI) using the TBI Model Systems (TBIMS) National Database (NDB). The sample analyzed included 8,249 individuals enrolled in the TBIMS NDB between 1989 and 2009 who were eligible for at least the first (year 1) follow-up up to the fifth (year 15) follow-up. Exhaustive chi-square automatic interaction detection was used to identify factors that classified participants according to level of follow-up completeness. Follow-up completeness was defined by 6 different longitudinal response patterns (LRPs): completing all follow-ups, wave nonresponse, dropping out, completing no follow-ups without formally withdrawing, formally withdrawing before completing any follow-ups, and formally withdrawing after completing some follow-ups. Completing all follow-ups was associated with higher levels of education, living with parents or others, and having acute care payer data entered in the NDB. Subgroups more vulnerable to loss to follow-up (LTFU) included those with less education, racial/ethnic minority backgrounds, those with better motor functioning on rehabilitation discharge, and those for whom baseline data on education, employment, and acute care payer were not collected. No subgroups were found to be more likely to have the LRPs of dropping out or formal withdrawal. The findings identify subgroups in which retention strategies beyond those most commonly used might reduce LTFU in longitudinal studies of people with TBI, and suggest future investigations into factors associated with missing baseline data.Krellman, J, Kolakowsky-Hayner, SA, Spielman, L, Dijkers, M, Hammond, FM, Bogner, J, Hart, T, Cantor, JB, Tsaousides, TYesdevopsadmin
2015Racial/ethnic disparities in mental health over the first two years after traumatic brain injury: A model systems studyJournalARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION19512Rosenbaum A, Giacino JYesdevopsadmin
2015The experience of litigation after TBI: Coping with litigation after TBIJournalPsychological Injury and Law1888-93Juengst, S., Graham, K., Pulantara, I, McCue, M., Whyte, E,. Dicianno, B., Parmanto, B., Arenth, P., Skidmore, E., Wagner, A.Yesdevopsadmin
2010Indicators within the California Verbal Learning Test - II (CVLT-II)JournalJ58966CLINICAL NEUROPSYCHOLOGIST241153-168Study examined whether performance patterns on the California Verbal Learning Test-II (CVLT-II) could differentiate participants with traumatic brain injury (TBI) showing adequate effort from those with mild TBI exhibiting poor effort. The TBI group consisted of 124 individuals with moderate to severe TBI. The poor effort group consisted of 77 people with mild head injury who were involved in litigation and failed at least one stand-alone symptom validity measure and also either a second SVT or an effort indicator embedded within a standard clinical test. A total of 18 CVLT-II variables were investigated using Bayesian model averaging for logistic regression to determine which variables best differentiated the groups. Results indicated that the CVLT-II variables having the most support were: (1) long-delay free recall, (2) total recognition discriminability, and (3) total recall discriminability.Wolfe, P., Millis, S.R., Hanks, R.A., Fictenberg, N., Larabee, G., Sweet, J.Yesdevopsadmin
2014The spirit and the dustJournalJournal of General Internal Medicine129818-8201. Fisher L, Pedrelli P, Giacino J, Cardoos A, Hammond F, Bogner J, Bombardier C, Hart T, Berquist T, Ketchum J, Zafonte RYesdevopsadmin
2015Neuroendocrine-Immune Dysfunction in Individuals with Poor outcome after Severe Traumatic Brain InjuryJournalJournal of Neurotrauma131A14Failla, M., Kumar, R., Peitzman, M., Conley, Y., Ferrell, R., Wagner, A.Yesdevopsadmin
2014Acute inflammatory biomarker profiles predict depression risk following moderate to severe traumatic brain injuryJournalJ71790Journal of Head Trauma Rehabilitation1EpubStudy investigated whether acute in?ammation pro?les predict posttraumatic depression (PTD) risk 6 and 12 months after moderate-to-severe traumatic brain injury (TBI). A total of 41 participants had acute cerebrospinal ?uid (CSF) inflammatory biomarker values, and 50 participants had acute serum inflammatory biomarker values. Outcome variables included the Patient Health Questionnaire and in?ammatory biomarkers: interleukin (IL)-1ß, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, tumor necrosis factor a, soluble vascular adhesion molecule (sVCAM-1), soluble intracellular adhesion molecule (sICAM-1), and soluble Fas (sFAS). Higher levels of acute CSF cytokine surface markers (sVCAM-1, sICAM-1, and sFAS) in an in?ammatory biomarker risk (IBR) score were associated with a 3.920-fold increase in the odds of developing PTD at 6 months. Having sICAM-1, sVCAM-1, or sFAS above the 75th percentile had a positive predictive value of 85.7 percent for PTD risk at 6 months. An IBR score including in?ammatory biomarkers IL-7 and IL-8 showed a trending association with 12-month PTD risk. Acute CSF IBR scores show promise for identifying individuals with TBI at risk for PTD. Further research should assess acute CSF in?ammatory biomarkers’ relationships to chronic in?ammation as a mechanism of PTD and should explore anti-in?ammatory treatments for PTD, as well as prevention and screening protocols, and link in?ammatory biomarkers to symptom tracking.Juengst, S.B., Kumar, R.G., Failla, M.D., Goyal, A., Wagner, A.K.Yesdevopsadmin
2015Rates of suicidal behavior following traumatic brain injury (TBI): Five year follow-up data from the Traumatic Brain Injury Model Systems (TBIMS)JournalBrain Injury128842Gordon WA, Cantor J, Dams-O'Connor K, Tsaousides T.Yesdevopsadmin
2014Post-traumatic brain injury cognitive performance is moderated by variation within ANKK1 and DRD2 genesJournalJournal of Head Trauma Rehabilitation1EpubLeung, L. Cohn, R. Fan L., Guller Y, O'Neil-Pirozzi, T., Iyer, S., Pan, H. Stern, E. Giacino J.Yesdevopsadmin
2015The experience of litigation after TBI: Barriers to recoveryJournalPsychological Injury and Law17388-396Juengst, S., Graham, K., Pulantara, I, McCue, M., Whyte, E,. Dicianno, B., Parmanto, B., Arenth, P., Skidmore, E., Wagner, A.Yesdevopsadmin
2015Overview of the Spinal Cord Injury – Quality of Life (SCI-QOL) Measurement SystemJournalJ71732Journal of Spinal Cord Medicine138257-269.Article describes the background and development of the Spinal Cord Injury -- Quality of Life (SCI-QOL) measurement system, a spinal cord injury (SCI)-specific, patient-reported outcome measure of health-related quality of life (HRQOL) covering physical, emotional, and social domains of functioning. The SCI-QOL was developed using item response theory (IRT) and comprises 22 subdomains that include 19 IRT-calibrated item banks and 3 fixed-length scales measuring physical, emotional, and social aspects of HRQOL. Its design ensures that each item is relevant to individuals with SCI. Each item bank may be administered as a full bank, short form, or computer adaptive test, while scales may be administered in fixed-length format only.Ritter, A., Wagner, A, TBI-MS Post-Traumatic Seizure Writing GroupYesdevopsadmin
2010Effort Indicators within the California Verbal Learning Test - II (CVLT-II)JournalJ58966CLINICAL NEUROPSYCHOLOGIST241153-168This study determined whether performance patterns on the California Verbal Learning Test-II (CVLT-II) could differentiate participants with traumatic brain injury (TBI) showing adequate effort from those with mild TBI exhibiting poor effort using a casecontrol design. The TBI group consisted of 124 persons with moderate to severe traumatic brain injury (TBI). The poor effort group consisted of 77 persons with mild head injury whowere involved in litigation (LG) and failed at least one stand-alone symptom validity measure (SVT) and also either a second SVT or an effort indicator embedded within a standard clinical test. A total of 18 CVLT-II variables were investigated using Bayesian model averaging (BMA) for logistic regression to determine which variables best differentiated the groups. The CVLT-II variables having the most support were Long-Delay Free Recall, Total Recognition Discriminability (d0), and Total Recall Discriminability.Wolfe, P., Millis, S.R., Hanks, R.A., Fichtenberg, N., Larabee, G., Sweet, J.Yesdevopsadmin
2007Fatigue after TBI: Association with neuroendocrine abnormalitiesJournalBrain Injury21559-566.Objective: Evaluate the association between neuroendocrine findings and fatigue after traumatic brain injury (TBI) Research design: Prospective, observational. Methods and procedures: Sixty-four individuals at least 1 year post-TBI underwent neuroendocrine testing including thyroid, adrenal, gonadal axes and growth hormone (GH) after glucagon stimulation with assessment of fatigue using the Global Fatigue Index (GFI) and the Fatigue Severity Scale (FSS). Main outcomes and results: GFI and FSS scores were significantly higher within this sample compared to published control data. At least one pituitary axis was abnormal in 90% of participants. Higher GH levels were significantly associated with higher FSS scores. There was a noted trend between lower basal cortisol and higher scores on both the FSS and GFI. Conclusions: The association between higher GH levels and greater fatigue contradicted the prevailing hypothesis that postacute TBI fatigue is associated with GH deficiency. The association between lower basal cortisol and greater fatigue was in the expected direction. While no other trends were noted, the fatigue derived from neuroendocrine abnormalities alone may be masked by fatigue induced by other factors commonly experienced following TBI. Given the high prevalence of pituitary abnormalities, screening for hypopituitarism after TBI is a reasonable recommendation. The contribution of GH deficiency to diminished quality of life post-TBI remains unclear.Bushnik, T.; Englander, J.; Katznelson, L.Yesdevopsadmin
2003Incidence, risk factors, and outcomes of fecal incontinence after acute brain injury: Findings from the traumatic brain injury model systems national databaseJournalJ45028.Archives of Physical Medicine and Rehabilitation842231-237Article discusses findings from a study of the incidence, and risk factors, and outcomes of patients with fecal incontinence who were admitted to inpatient rehabilitation at a Traumatic Brain Injury Model Systems (TBIMS) center. Relationships between fecal incontinence and demographic, injury severity, and functional outcome variables were examined using analysis of variance. The incidence of fecal incontinence was 68 percent at admission to rehabilitation, 12.4 percent at rehabilitation discharge, and 5.2 percent at 1-year follow-up. Several factors were found to be associated with a greater likelihood of bowel incontinence including increased age and greater injury severity.Foxx-Orenstein, Amy; Kolakowsky-Hayner, Stephanie; Marwitz, Jennifer H.; Cifu, David X.; Dunbar, Ann; Englander, Jeffrey; Francisco, GerardYesdevopsadmin
2001Factors associated with balance deficits on admission to rehabilitation after traumatic brain injury: A multicenter analysisJournalJournal of Head Trauma Rehabilitation163232-258Objective: To evaluate how demographics, measures of injury severity, and acute care complications relate to sitting and standing balance in patients with traumatic brain injury ( TBI ). Design: Multicenter analysis of consecutive admissions to designated TBI Model Systems of Care (TBIMS). Setting: Ten National Institute for Disability and Rehabilitation Research TBI Model System centers for coordinated acute and rehabilitation care. Participants: 908 adults with TBI were included in the study. Main Outcome Measures: Sitting and standing balance were assessed within 72 hours of admission to inpatient rehabilitation. Results: Age less than 50 years had a significant association with normal sitting and standing balance (P D:001 and .05, respectively). Measures of severity of traumatic brain injury, including admission Glasgow Coma Score, length of posttraumatic amnesia (PTA), length of coma, and acute care length of stay were each significantly related to impaired sitting and standing balance ratings (P Greenwald, Brian D.; Cifu, David X.; Marwitz, Jennifer H.; Enders, Lisa J.; Brown, Allen W.; Englander, Jeffrey S.; Zafonte, Ross D.Yesdevopsadmin
2003Moderating factors in return to work and job stability after traumatic brain injuryJournalJ46705.Journal of Head Trauma Rehabilitation182128-138Study examines the contribution of demographic variables, injury severity, and functional status at 1 year postinjury to job stability and return to work for people with traumatic brain injury (TBI). Data were collected at 6 model systems rehabilitation centers on individuals with TBI who returned for follow-up at 1, 2, and 3 or 4 years postinjury, were of working age, and were working before injury. Results indicated that after injury, 34 percent were employed at all 3 follow-up intervals, 27 percent were employed at 1 or 2 of the intervals, and 39 percent were employed at all 3 intervals. Minority group members, people who did not complete high school, and unmarried people were more likely to be unemployed. A discriminant function analysis accurately predicted job stability groupings.Kreutzer, Jeffrey S.; Marwitz, Jennifer H.; Walker, William; Sander, Angelle; Sherer, Mark; Bogner, Jennifer; Fraser, Robert; Bushnik, TamaraYesdevopsadmin
2003Concordance of patient and family report of neurobehavioral symptoms at 1 year after traumatic brain injuryJournalJ45025.Archives of Physical Medicine and Rehabilitation842204-213Study investigated the level of agreement between patient and family ratings of cognitive, emotional, and behavioral functioning using the 70-item Neurobehavioral Functioning Inventory-Revised (NFI-R) at 1 year after traumatic brain injury (TBI). Twenty-three items on the NFI-R showed significant differences between patient and other ratings, usually with the patient reporting less frequent problems. The greatest differences were found on the depression, aggression, and memory and attention subscales.Hart, Tessa; Whyte, John; Polansky, Marcia; Millis, Scott; Hammond, Flora M.; Sherer, Mark; Bushnik, Tamara; Hanks, Robin; Kreutzer, JeffreyYesdevopsadmin
2009Effort indicators within the California Verbal Learning Test-II (CVLT-II).JournalThe Clinical Neuropsychologist241153-168This study determined whether performance patterns on the California Verbal Learning Test-II (CVLT-II) could differentiate participants with traumatic brain injury (TBI) showing adequate effort from those with mild TBI exhibiting poor effort using a casecontrol design. The TBI group consisted of 124 persons with moderate to severe traumatic brain injury (TBI). The poor effort group consisted of 77 persons with mild head injury who were involved in litigation (LG) and failed at least one stand-alone symptom validity measure (SVT) and also either a second SVT or an effort indicator embedded within a standard clinical test. A total of 18 CVLT-II variables were investigated using Bayesian model averaging (BMA) for logistic regression to determine which variables best differentiated the groups. The CVLT-II variables having the most support were Long- Delay Free Recall, Total Recognition Discriminability (d0), and Total Recall Discriminability.Wolfe, P.L.; Millis S.R.; Hanks, R.; Fichtenberg, N.; Larrabee, G.J.; Sweet, J.J.Yesdevopsadmin
2004Five years after traumatic brain injury: A study of individual outcomes and predictors of change in functionJournalJ50325.NeuroRehabilitation19125-35Study examined the direction and predictors of change in the Disability Rating Scale (DRS) level of functioning and employability items between 1 and 5 years after traumatic brain injury (TBI). Data were obtained from 3,787 subjects enrolled in the TBI Model Systems National Database. The Functional Independence Measure was assessed at year 1 post-injury and the DRS were assessed at year 1 and year 5 post-injury. Analyses revealed that although the majority of subjects (76 to 79 percent) did not experience significant changes in functional level and employability between year 1and year 5, some individuals (17 to 18 percent) made dramatic improvements while a few (5 to 7 percent) declined in function.Hammond, Flora M.; Grattan, Karyn D.; Sasser, Howell; Corrigan, John D.; Rosenthal, Mitchell; Bushnik, Tamara; Shull, WilliamYesdevopsadmin
2019The relation between cognitive dysfunction and diffusion tensor imaging parameters in traumatic brain injury.JournalBrain Injury333355-363https://pubmed.ncbi.nlm.nih.gov/30563361/Purpose of the study: To investigate the association among global and regional white matter fractional anisotropy (FA) values following traumatic brain injury (TBI) and cognitive functioning. Materials and methods: This research was conducted in an urban rehabilitation hospital. Participants included adults who were healthy controls (n = 18) or who had a TBI (n = 27). Diffusion tensor imaging using a Siemens VERIO 3T scanner and calculation of global and regional FA values were undertaken. FA values were correlated with neuropsychological test scores and injury severity variables. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to investigate discriminative ability of the FA values. Neuropsychological measures, including the Symbol Digit Modalities Test (SDMT), Trail Making Test, Wechsler Test of Adult Reading, California Verbal Learning Test 2nd Edition, Digit Vigilance Test, and Wisconsin Card Sorting Test, comprised the cognitive measures. Results: Within the TBI group, regional FA values were significantly lower across regions compared with controls; global FA and five brain regions were associated with SDMT scores. The FA value within the body of the corpus callosum (CC) yielded excellent discrimination between groups. Conclusions: Convergent findings support the discriminability and potential clinical utility of the CC body FA value in the context of TBI. Hanks R, Millis S, Scott S, Gattu R, O'Hara NB, Haacke M, Kou Z. Southeastern Michigan Traumatic Brain Injury System Yescheberle
2020Emotional suppression and hypervigilance in military caregivers: Relationship to negative and positive affect.JournalThe Journal of Head Trauma Rehabilitation351E10-E20https://pubmed.ncbi.nlm.nih.gov/31365438/Objective: To investigate the relationship of 2 health-related quality-of-life (QOL) item banks (Emotional Suppression and Caregiver Vigilance), developed for caregivers of service members/veterans with traumatic brain injury (TBI), to caregivers' positive and negative affect. Setting: Community. Participants: One hundred sixty-five caregivers of service members/veterans with TBI. Design: Retrospective database analysis. Main measures: TBI-CareQOL Emotional Suppression; TBI-CareQOL Caregiver Vigilance; measures of negative (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression, PROMIS Anger, TBI-CareQOL Caregiver-Specific Anxiety, National Institutes of Health Toolbox [NIHTB] Perceived Stress, GAD-7) and positive affect (Neuro-QOL Positive Affect and Well-being, NIHTB Self-efficacy, NIHTB General Life Satisfaction, Family Resilience Scale for Veterans, TBI-QOL Resilience). Results: When considered separately, linear regression showed that higher levels of Emotional Suppression and greater Caregiver Vigilance were individually associated with more negative affect and less positive affect. When considered together, the pattern of findings was generally consistent for both Emotional Suppression and Caregiver Vigilance with regard to negative affect and for Emotional Suppression with regard to positive affect. However, when considered together, Caregiver Vigilance was no longer related to positive affect. Conclusions: Caregivers with high emotional suppression and/or vigilance are more likely to show emotional distress and less likely to have positive affect than caregivers with lower levels of emotional suppression and vigilance. A combination of education and individual counseling targeting coping with negative emotions and TBI-related problems may be beneficial. Sander, A. M., Boileau, N. R., Hanks, R. A., Tulsky, D. S., & Carlozzi, N. E. Southeastern Michigan Traumatic Brain Injury System , Texas TBI Model System of TIRR, North Texas Traumatic Brain Injury Model SystemYescheberle
2020Spirituality and outcomes in caregivers of persons with traumatic brain injury (TBI).JournalRehabilitation Psychology644347–359https://pubmed.ncbi.nlm.nih.gov/31916806/Purpose/objective: Spiritual well-being has been associated with better quality of life outcomes in caregivers, but the associations among the care recipient's functional status, the caregiver's spiritual well-being, and the caregiver's health-related quality of life (HRQOL) is unknown. Research Method/Design: The study examined the Spiritual Well-Being Scale in caregivers of persons with traumatic brain injury (TBI; n = 335). Participants completed measures from the Patient-Reported Outcomes Measurement Information System, the Quality of Life in Caregivers of TBI, and the Caregiver Appraisal Scale. The Mayo-Portland Adaptability Inventory-4 (MPAI-4) measured care recipient's functional status. The association between religious well-being and existential well-being and HRQOL were examined with Pearson correlation coefficients. Multiple linear regressions examined the interaction between caregiver well-being and care recipient functional status on HRQOL outcomes accounting for demographic variables. Results: Less favorable caregiver HRQOL was associated with military affiliation, male status, spousal caregiver relationship, and White race. MPAI-4 was moderately associated with all HRQOL subdomains. For spiritual well-being, existential well-being was moderately correlated with 9 of 16 HRQOL subdomains in comparison to religious well-being that demonstrated small correlations with 3 of 16 subdomains. MPAI-4 had negative effects on HRQOL regardless of spiritual well-being with higher existential well-being reducing the negative impact of the care recipient's functional impairment on HRQOL for significant HRQOL interactions. Conclusions/implications: Interventions that encourage development and maintenance of life purpose and meaning in caregivers of persons with TBI, and less so, spirituality, might have beneficial effects on HRQOL when the person with injury has more functional limitations. (PsycInfo Database Record (c) 2020 APA, all rights reserved). Hanks, R. A., Boileau, N. R., Norman, A. L., Nakase-Richardson, R., Mariouw, K. H., & Carlozzi, N. E.Southeastern Michigan Traumatic Brain Injury System Yescheberle
2018Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-InjuryJournalJournal of Neurotrauma71136-1146Hammond FM, Giacino JT, Nakase-Richardson R, Sherer M, Zafonte RD, Whyte J, Arciniegas DB, Tang XIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2018Psychological well-being in individuals living in the community with traumatic brain injuryJournalBrain Injury Professional32980-985Payne, Lisa, Hawley, Lenore, Ketchum, Jessica, Philippus, Angela, Eagye, CB, Morey, Clare, Gerber, Don, Harrison-Felix, Cynthia, Diener, EdRocky Mountain Regional Brain Injury SystemYesdevopsadmin
2017Functional MRI Motor Imagery Tasks to Detect Command Following in Traumatic Disorders of ConsciousnessJournalFrontiers in Neurology8688Bodien YG,  Giacino JT, Edlow BLSpaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2019Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014JournalArchives of Physical Medicine and Rehabilitation99p1-19Cicerone KD, Goldin Y, Ganci K, Rosenbaum A, Wethe JV, Langenbahn DM, Malec JF, Bergquist TF, Kingsley K, Nagele D, Trexler L, Fraas M, Bogdanova Y, Harley JP.Mayo Clinic Traumatic Brain Injury Model System Yesdevopsadmin
2017Early detection of consciousness in patients with acute severe traumatic brain injuryJournalBrain1402399-2414Edlow BL, Chatelle C, Spencer CA, Chu CJ, Bodien YG, O'Connor KL, Hirschberg RE, Hochberg LR, Giacino JT, Rosenthal ES, Wu OSpaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2019Using Decision Tree Methodology to Predict Employment After Moderate to Severe Traumatic Brain InjuryJournalJournal of Head Trauma Rehabilitation34E64-E74Stromberg KA, Agyemang AA, Graham KM, Walker WC, Sima AP, Marwitz JH, Harrison-Felix C, Hoffman JM, Brown AW, Kreutzer JS, Merchant R, Mayo Clinic Traumatic Brain Injury Model System Yesdevopsadmin
2017Suicide and trumatic brain injury: A reveiw by clinical researchers from the NIDILRR and Veterans Health Admistration TBI MSJournalCurrent Opinion in Psychology2273-78Dreer, L., Tang, X., Nakase-Richardson, R., Pugh, M., Cox, M., Bailey, E., Finn, J., Zafonte, R., Brenner, L.UAB Traumatic Brain Injury Model SystemYesdevopsadmin
2019Moderating Effects of Location on the Relationship Between Nativity and Productive Activity Among Hispanic Individuals with Traumatic Brain InjuryJournalJournal of Head Trauma RehabilitationE46-E54Lequerica AH, Botticello A, O’Neill J, Lengenfelder J, Krch D, Chiaravalloti ND, Sander A, Bushnik T, Ketchum J, Hammond FM, Dams-O'Connor K, Felix E, Johnson-Greene DIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2018Change in body mass index within the first-year post-injury: A VA Traumatic Brain Injury (TBI) Model Systems studyJournalBrain Injury32986-993Brown, R., Tang, X., Dreer, L., Driver, S., Pugh, M., Martikn, A., McKenzie-Hartman, T., Shea, T., Silva, M., Nakase-Richardson, R.UAB Traumatic Brain Injury Model SystemYesdevopsadmin
2018Living Well After Traumatic Brain InjuryJournalARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION991441-2Hawley L, Hart T, Waldman W, Glenn M, Hammond F, Dams-O'Connor KIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2017Functional Networks in Disorders of ConsciousnessJournalSeminars in Neurology37485-502Bodien YG, Chatelle C, Eldow BLSpaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2020Outcomes 1 and 2 years after moderate to severe traumatic brain injury: An international comparative study.JournalArchives of Physical Medicine & RehabilitationEpubhttps://pubmed.ncbi.nlm.nih.gov/33190797/Objective: This study compared traumatic brain injury (TBI) outcomes from 2 cohorts: the National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) in the United States and Longitudinal Head Injury Outcome Study conducted in Victoria, Australia, by the Monash Epworth Rehabilitation Research Centre (MERRC). Design: Cohort study with 1- and 2-year follow-up. Setting: Acute trauma care and inpatient rehabilitation with follow-up. Participants: Patients (N=1056) with moderate-severe TBI admitted in 2000-2012 to inpatient rehabilitation after motor vehicle-related collisions, who completed follow-up, were matched using 1:2 matching algorithm based on age at injury, days of posttraumatic amnesia, and years education, resulting in groups of 352 (MERRC) and 704 patients (TBIMS). Intervention: The cohorts had received acute trauma care and inpatient rehabilitation for a median 38 (MERRC) or 33 days (TBIMS). The MERRC group also had routine access to community-based support and rehabilitation for return to work or school, attendant care, and home help as justified, funded by an accident compensation system, whereas the TBIMS cohort had variable access to these services. Main outcome measures: Outcomes were assessed 1 and 2 years post injury in terms of employment, living situation, marital status, and Glasgow Outcome Scale-Extended (GOS-E) scores. Results: At 2 years post injury, MERRC participants were more likely to be competitively employed. At both 1 and 2 years post injury, MERRC participants were more likely to be married and living independently. On GOS-E, the TBIMS group had higher percentages of patients in Lower Severe Disability/Vegetative State and Upper Good Recovery than MERRC participants, whereas the MERRC cohort had higher percentages of Lower Moderate Disability than TBIMS. Conclusions: Findings may suggest that routine provision of community-based supports could confer benefits for long-term TBI outcomes. Further studies documenting rehabilitation services are needed to explore this. Jennie Ponsford, Cynthia Harrison-Felix, Jessica M Ketchum, Gershon Spitz, A Cate Miller, John D CorriganRocky Mountain Regional Brain Injury System, Ohio Regional Traumatic Brain Injury Model System Yescheberle
2017Groupings of persons with traumatic brain injury: A new approach to classifying traumatic brain injury in the post-acute periodJournalJ75640Journal of Head Trauma Rehabilitation322125-133Study identified groups of people with traumatic brain injury (TBI) who differ on 12 dimensions of experience or functioning. These dimensions include: (1) memory, (2) cognitive processing speed, (3) verbal fluency, (4) self-reported cognitive symptoms, (5) independence and self-esteem, (6) resilience, (7) emotional distress, (8) postconcussive symptoms, (9) physical symptoms, (10) physical functioning, (11) economic and family support, and (12) performance validity. The study also described patterns of differences among the groups on these dimensions and in participation outcomes. A total of 504 individuals with TBI living in the community who were an average of 6.3 years after injury participated. Data were collected by review of pertinent medical records, interview, and administration of tests and questionnaires. Outcome measures included: selected scales from the Traumatic Brain Injury Quality of Life measures, Neurobehavioral Symptom Inventory, Economic Quality of Life Scale, Family Assessment Device General Functioning Scale, measures of cognitive function, Word Memory Test, and Participation Assessment with Recombined Tools–Objective (PART-O) scale. Cluster analysis identified 5 groups of participants with TBI who differed in clinically meaningful ways on the 12 dimension scores and the PART-O scale. Cluster groupings identified in this study could assist clinicians with case conceptualization and treatment planning.Sherer, Mark, Nick, Todd G., Sander, Angelle M., Melguizo, Maria, Hanks, Robin, Novack, Thomas A., Tulsky, David, Kisala, Pamela, Luo, Chunqiao, Tang, XinyuTexas TBI Model System of TIRR, Southeastern Michigan Traumatic Brain Injury SystemNodevopsadmin
2020Post-traumatic confusional state: A case definition and diagnostic criteria.JournalArchives of Physical Medicine and Rehabilitation10111P2041-2050https://www.archives-pmr.org/article/S0003-9993(20)30448-2/fulltextIn response to the need to better define the natural history of emerging consciousness after traumatic brain injury and to better describe the characteristics of the condition commonly labeled posttraumatic amnesia, a case definition and diagnostic criteria for the posttraumatic confusional state (PTCS) were developed. This project was completed by the Confusion Workgroup of the American Congress of Rehabilitation Medicine Brain Injury Interdisciplinary Special Interest group. The case definition was informed by an exhaustive literature review and expert opinion of workgroup members from multiple disciplines. The workgroup reviewed 2466 abstracts and extracted evidence from 44 articles. Consensus was reached through teleconferences, face-to-face meetings, and 3 rounds of modified Delphi voting. The case definition provides detailed description of PTCS (1) core neurobehavioral features, (2) associated neurobehavioral features, (3) functional implications, (4) exclusion criteria, (5) lower boundary, and (6) criteria for emergence. Core neurobehavioral features include disturbances of attention, orientation, and memory as well as excessive fluctuation. Associated neurobehavioral features include emotional and behavioral disturbances, sleep-wake cycle disturbance, delusions, perceptual disturbances, and confabulation. The lower boundary distinguishes PTCS from the minimally conscious state, while upper boundary is marked by significant improvement in the 4 core and 5 associated features. Key research goals are establishment of cutoffs on assessment instruments and determination of levels of behavioral function that distinguish persons in PTCS from those who have emerged to the period of continued recovery. Full article available at link. Mark Sherer, PhD; Douglas I. Katz, MD; Yelena G. Bodien, PhD; David B. Arciniegas, MD; Cady Block, PhD; Sonja Blum, MD; Matt Doiron, MS;, Kim Frey, PhD; Joseph T. Giacino, PhD; Min Jeong P. Graf, MD; Brian Greenwald, MD; Flora M. Hammond, MD; Kathleen Kalmar, PhD; Jacob Kean, PhD;, Marilyn F. Kraus, MD; Risa Nakase-Richardson, PhD; Shital Pavawalla, PhD; Amy Rosenbaum, PhD; Donald T. Stuss, PhD; Stuart A. Yablon, MDTexas TBI Model System of TIRR, Spaulding-Harvard Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, Ohio Regional Traumatic Brain Injury Model System , JFK Johnson Rehabilitation Institute Traumatic Brain Injury Model System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Mayo Clinic Traumatic Brain Injury Model System , South Florida Traumatic Brain Injury Model SystemYescheberle
2020Which behaviours are first to emerge during recovery of consciousness after severe brain injury?JournalAnnals of Physical and Rehabilitation Medicine634263-269https://www.sciencedirect.com/science/article/abs/pii/S1877065719301757Background: Early detection of consciousness after severe brain injury is critical for establishing an accurate prognosis and planning appropriate treatment. Objectives: To determine which behavioural signs of consciousness emerge first and to estimate the time course to recovery of consciousness in patients with severe acquired brain injury. Methods: Retrospective observational study using the Coma Recovery Scale-Revised and days to recovery of consciousness in 79 patients (51 males; 34 with traumatic brain injury; median [IQR] age 48 [26–61] years; median time since injury 26 [20–36] days) who transitioned from coma or unresponsive wakefulness syndrome (UWS)/vegetative state (VS) to the minimally conscious state (MCS) or emerged from MCS during inpatient rehabilitation. Results: Visual pursuit was the most common initial sign of MCS (41% of patients; 95% CI [30–52]), followed by reproducible command-following (25% [16–35]) and automatic movements (24% [15–33]). Ten other behaviours emerged first in less than 16% of cases. Median [IQR] time to recovery of consciousness was 44 [33–59] days. Etiology did not significantly affect time to recovered consciousness. Conclusion: Recovery of consciousness after severe brain injury is most often signalled by reemergence of visual pursuit, reproducible command-following and automatic movements. Clinicians should use assessment measures that are sensitive to these behaviours because early detection of consciousness is critical for accurate prognostication and treatment planning. GeraldineMartens, YelenaBodien, KristenSheau, Andrea Christoforou, Joseph T. GiacinoSpaulding-Harvard Traumatic Brain Injury Model SystemYescheberle
2019Can a couples' intervention reduce unmet needs and caregiver burden after brain injury?JournalRehabilitation Psychology10012E204https://pubmed.ncbi.nlm.nih.gov/31855018/Objective: To examine the effectiveness of the Therapeutic Couples Intervention (TCI) on caregiver needs and burden after brain injury. Research method: Individuals with brain injury and their intimate partners/caregivers (n = 75) participated in a 2-arm, parallel, randomized trial with a waitlist control. The TCI consisted of 5 2-hr sessions, with a sixth optional session for parents. The Family Needs Questionnaire-R (FNQ-R) and the Zarit Burden Interview (ZBI) were secondary outcome measures. Results: After adjusting for baseline characteristics, caregivers in the TCI group demonstrated reduction in unmet needs for 5 of the 6 FNQ-R subscales, whereas those in the waitlist control group did not. ZBI scores improved significantly for TCI caregivers but not for controls. At the 3-month follow-up, benefits were maintained for the ZBI and 4 of the 6 FNQ-R subscales (Health Information, Emotional Support, Professional Support, and Community Support Network). Conclusions: The present investigation provided evidence that, following brain injury, a structured couples intervention can reduce unmet needs and burden in caregivers. Future multicenter research examining long-term durability of treatment gains and specific characteristics of positive responders is warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved). Kristin M Graham, Jeffrey S Kreutzer, Jennifer H Marwitz, Adam P Sima, Nancy H HsuVirginia Commonwealth Traumatic Brain Injury Model SystemYescheberle
2019Scoping review of clinical rehabilitation research pertaining to traumatic brain injury: 1990-2016.JournalNeuroRehabilitation442207-215https://pubmed.ncbi.nlm.nih.gov/30856129/Introduction: Understanding the impact of disease on function and improving functional outcomes is an important goal of rehabilitation. This scoping review analyzes 25 years of published traumatic brain injury (TBI) clinical rehabilitation research (CRR) to determine the frequency with which function is a research goal. Methods: The review protocol was prepared by experienced clinical researchers in the field. We used these search terms: "moderate traumatic brain injury" and "severe traumatic brain injury" and "functional outcomes"; and "rehabilitation" and "educational outcomes" or "cognition" or "community roles" or "community integration" "behavior" or "neuropsychology" or "quality of life", or "vocational outcomes" or "work" or "return to work". Publications from January 1, 1990-December 31, 2016 were included. Results: 1,815 articles met initial criteria, of which 202 were intervention studies, 84 were randomized controlled trials and 353 prospective non-intervention studies. The combination of intervention and prospective non-intervention studies (n = 555) were analyzed for the kind of measurement tools used. Impairment measures (60%) and symptom measures (43%) either singly or in combination were most frequently used. Measures of function were employed in fewer than 30%. For single outcomes, 95 publications used impairment measures, 60 used symptoms and only18 used function. There were 117 studies that used neurocognitive measures. Participation/societal integration evaluation tools were used for community integration(n = 77) employment (n = 50) and independent living status (n = 37). Discussion: This scoping review identifies a need for additional types of clinical research in the field of TBI CRR. Much of the research is aimed at mitigating impairment and controlling symptoms rather than promoting function. Future efforts by the CRR community studying TBI should address this need. Lynn H Gerber, Haley Bush, Cindy Cai, Steven Garfinkel, Leighton Chan, Bridget Cotner, Amy WagnerSouth Florida Traumatic Brain Injury Model System, Moss Traumatic Brain Injury Model SystemYescheberle
2019Care partner problem solving training (CP-PST) for care partners of adults with traumatic brain injury during inpatient rehabilitation: Study protocol for a multisite, randomized, single-blind clinical feasibility trial.JournalContemporary Clinical Trials809-15https://pubmed.ncbi.nlm.nih.gov/30885800/Traumatic brain injury (TBI) often leads to immediate and chronic functional impairments that affect care partners, or those providing physical and/or emotional support to individuals with TBI. The many challenges associated with being a care partner often lead to caregiver burden and can compromise the well-being and quality of life of care partners and individuals with TBI under their care. Equipping care partners with problem-solving skills could facilitate and sustain their transition into this supportive role. Problem-solving training (PST) has demonstrated efficacy for providing such skills to care partners of individuals with TBI after discharge from inpatient rehabilitation. We propose that PST delivered to care partners during inpatient rehabilitation of individuals with TBI will provide care partners with the skills to manage their caregiving roles across the transition from hospital to home. Herein, we describe the methodology of a current randomized controlled trial that examines the feasibility and efficacy of PST plus TBI education compared to TBI education alone to improve care partner burden, emotional distress, and adaptive coping when delivered during the inpatient rehabilitation stay of individuals with moderate-severe TBI. Shannon B Juengst, Valeria Silva, Yelena Goldin, Keith Cicerone, Jean Lengenfelder, Nancy Chiaravalloti, Simon Driver, David Mellick, Georgianna Dart, Chung Lin Kew, Andrew Nabasny, Kathleen R BellNorth Texas Traumatic Brain Injury Model System, JFK Johnson Rehabilitation Institute Traumatic Brain Injury Model System, Northern New Jersey Traumatic Brain Injury System , Rocky Mountain Regional Brain Injury SystemYescheberle
2019The intersection of lifetime history of traumatic brain injury and the opioid epidemic.JournalAddictive Behaviors90143-145https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6496936/Full article available at link.  John D. Corrigan, PhD and Rachel Sayko Adams, PhD, MPHOhio Regional Traumatic Brain Injury Model System Yescheberle
2018Responsiveness of the Traumatic Brain Injury - Quality of Life (TBI-QOL) measurement system.JournalArchives of Physical Medicine and Rehabilitation10154-61https://www.archives-pmr.org/article/S0003-9993(18)30043-1/pdfObjective: To assess the responsiveness of the Traumatic Brain InjuryeQuality of Life (TBI-QOL) measurement system. Design: Participants completed the 20 TBI-QOL item banks and the Participation Assessment with Recombined ToolseObjective (PART-O) Productivity Subscale at baseline and 6-month follow-up assessments. Participants were categorized into 4 groups (increased productivity, unchanged productivity, and decreased productivity) based on PART-O Productivity scores. Paired sample t tests were used to compare TBI-QOL scores at baseline and 6 months, and standardized response means and Cohen’s d were computed to estimate effect sizes. Setting: Three traumatic brain injury (TBI) Model Systems rehabilitation centers in the United States. Participants: Two hundred one community-dwelling adults with TBI. Interventions: Not applicable. Main Outcome Measures: 20 TBI-QOL item banks. Results: As expected, given that there was no intervention, group mean TBI-QOL subdomain scores for the entire sample showed no change or small improvement over the 6-month study period. At the follow-up assessment, 72 participants reported increased productivity, 71 reported decreased productivity, and 58 reported the same level of productivity as they had 6 months prior. When compared with participants who reported unchanged or decreased productivity, participants who reported increased productivity on the PART-O subscale had clinically meaningful (d0.30) improvements on 7 TBI-QOL measures. The largest improvement was in the Independence subdomain (mean change, 7.06; dfZ0.84), with differences also observed in the Mobility, Positive Affect and Well-Being, Resilience, Grief/Loss, Ability to Participate, and Satisfaction with Participation subdomains. Conclusions: The 20 TBI-QOL item banks demonstrate responsiveness to change and measurement stability in a community-dwelling sample. Researchers may use the TBI-QOL to detect changes in HRQOL after a clinical intervention and clinicians may use it in their daily practices to monitor patient recovery. Full article available at link.  Julia M.P. Poritz, PhD; Mark Sherer, PhD, ABPP; Pamela A. Kisala, MA; David Tulsky, PhD; Luis Leon-Novelo, PhD; Esther Ngan, MSTexas TBI Model System of TIRR, North Texas Traumatic Brain Injury Model SystemYescheberle
2020Patterns of cognitive test scores and symptom complaints in persons with TBI who failed performance validity testing.JournalJournal of the International Neuropsychological SocietyEpub - 27 May 2020https://pubmed.ncbi.nlm.nih.gov/32456725/Objective: To determine clinically meaningful subgroups of persons with traumatic brain injury (TBI) who have failed performance validity testing. Method: Study participants were selected from a cohort of 674 participants with definitive medical evidence of TBI. Participants were those who failed performance validity testing (the Word Memory Test, using the standard cutoffs). Participants were administered cognitive tests and self-report questionnaires. Test and questionnaire results were summarized as 12 dimension scores. Cluster analysis using the k-means method was performed. Results: Cluster analysis for the 143 retained participants indicated three subgroups. These subgroups differed on patterns of scores. Subgroup 1 was impaired for memory and had no excessive complaints. Subgroup 2 had impaired memory and processing speed as well as concern regarding cognition function. Subgroup 3 showed impairment on all cognitive tests and excess complaints in multiple areas. Conclusions: These results provide a preliminary basis for improved understanding of poor performance validity. Mark Sherer, Angelle M Sander, Jennie Ponsford, Leia Vos, Julia M P Poritz, Esther Ngan, Luis Leon NoveloTexas TBI Model System of TIRRYescheberle
2020Development of composite scores for the TBI-QOL.JournalArchives of Physical Medicine and Rehabilitation1011P43-53https://www.archives-pmr.org/article/S0003-9993(18)30432-5/fulltextObjective: To develop a set of composite scores that can be used for interpreting quality of life (QOL) after traumatic brain injury (TBI) using 9 of the patient-reported outcomes measures from the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system. Design: Participants completed 20 item banks from the TBI-QOL as part of a larger assessment. Composite index scores were created with normalized transformation with nonlinear area conversion using scores from 9 of the banks, and are expressed in index score units, with higher composite scores indicating better functioning. For descriptive purposes, associations among composites and individual banks were evaluated using regression, along with patterns of composite scores by injury severity groups using analysis of variance. Setting: Three medical centers in the United States. Participants: Community-dwelling adults (n=504) with a history of TBI. Interventions: Not applicable. Main Outcomes Measure: TBI-QOL. Results: Five composite indices were generated: global QOL, physical health, emotional health, cognitive health, and social health. Lookup tables are provided herein. Composite scores were highly intercorrelated (all r>.60, P<.0001), and individual TBI-QOL banks all correlate strongly with the global QOL composite in the expected direction (all r>.50, P<.0001). Conclusion: Researchers and clinicians can use the TBI-QOL global QOL, physical health, emotional health, cognitive health, and social health composite scores to aggregate results from multiple TBI-QOL banks, which is anticipated to ease interpretation and reliability. This work additionally highlights the importance of considering nonphysical symptoms as outcomes variables for TBI research, as cognitive, social, and emotional domains were some of the most strongly correlated banks with the global QOL composite. Full article available at link.  Callie E. Tyner, PhD; Aaron J. Boulton, PhD; Mark Sherer, PhD; Pam A. Kisala, MA; Joseph J. Glutting, PhD; David S. Tulsky, PhDNorthern New Jersey Traumatic Brain Injury System , Texas TBI Model System of TIRRYescheberle
2020Development and psychometric characteristics of the TBI-QOL Independence item bank and short form and the TBI-QOL Asking for Help scale.JournalArchives of Physical Medicine and Rehabilitation1011P33-42https://www.archives-pmr.org/article/S0003-9993(19)31045-7/fulltextObjective: To develop an item response theory (IRT)-calibrated, patient-reported outcome measure of subjective independence for individuals with traumatic brain injury (TBI). Design: Large-scale item calibration field testing; confirmatory factor analysis (CFA) and graded response model IRT analyses. Setting: Five TBI Model System centers across the United States. Participants: Adults with complicated mild, moderate, or severe TBI (N=556). Outcome Measures: Traumatic Brain Injury–Quality of Life (TBI-QOL) Independence item bank and the TBI-QOL Asking for Help scale. Results: A total of 556 individuals completed 44 items in the Independence item pool. Initial factor analyses indicated that items related to the idea of “asking for help” were measuring a different construct from other items in the pool. These 9 items were set aside. Twenty-two other items were removed because of bimodal distributions and/or low item-total correlations. CFA supported unidimensionality of the remaining Independence items. Graded response model IRT analysis was used to estimate slopes and thresholds for the final 13 Independence items. An 8-item fixed-length short form was also developed. The 9 Asking for Help items were analyzed separately. One misfitting item was deleted, and the final 8 items became a fixed-length IRT-calibrated scale. Reliability was high for both measures. Conclusions: The IRT-calibrated TBI-QOL Independence item bank and short form and TBI-QOL Asking for Help scale may be used to measure important issues for individuals with TBI in research and clinical applications. Full article available at link.  Pamela A. Kisala, MA; David S. Tulsky, PhD; Aaron J. Boulton, PhD; Allen W. Heinemann, PhD; David Victorson, PhD; Mark Sherer, PhD Angelle M. Sander, PhD; Nancy Chiaravalloti, PhD; Noelle E. Carlozzi, PhD; Robin Hanks, PhDMidwest Regional Spinal Cord Injury Care System, Texas TBI Model System of TIRR, Northern New Jersey Traumatic Brain Injury System , Southeastern Michigan Traumatic Brain Injury System Yescheberle
2010Development and calibration of the TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks and short forms.JournalArchives of Physical Medicine and Rehabilitation1011P20-32https://www.archives-pmr.org/article/S0003-9993(19)31046-9/fulltextObjective: To develop traumatic brain injury (TBI)-optimized versions of the Quality of Life in Neurological Disorders (Neuro-QoL) Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks, evaluate the psychometric properties of the item banks developed for adults with TBI, develop short form and computer adaptive test (CAT) versions, and report information to facilitate research and clinical applications. Design: We used a mixed methods design to develop and evaluate Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities items. Focus groups defined the constructs, cognitive interviews guided item revisions, and confirmatory factor analysis and item response theory methods helped calibrate item banks and evaluate differential item functioning related to demographic and injury characteristics. Setting: Five TBI Model Systems centers in the United States. Participants: Community-dwelling adults with TBI (N=556). Interventions: None. Outcome Measures: Traumatic Brain Injury–Quality of Life (TBI-QOL) Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks. Results: Forty-five Ability to Participate in Social Roles and Activities and 41 Satisfaction with Social Roles and Activities items demonstrated good psychometric properties. Although some of the items are new, most were drawn from analogous banks in the Neuro-QoL measurement system. Consequently, the 2 TBI-QOL item banks were linked to the Neuro-QoL metric, and scores are comparable with the general population. All CAT and short forms correlated highly (>0.90) with the full item banks and demonstrate comparable construct coverage and measurement error. Conclusion: The TBI-QOL Ability to Participate in Social Roles and Activities and TBI-QOL Satisfaction with Social Roles and Activities item banks are TBI-optimized versions of the Neuro-QoL Ability to Participate in Social Roles and Activities and Satisfaction with Social Roles and Activities item banks and demonstrate excellent measurement properties in individuals with TBI. These measures, particularly in CAT or short form format, are suitable for efficient and precise measurement of social outcomes in clinical and research applications. Full article available at link.  Allen W. Heinemann, PhD; Pamela A. Kisala, MA; Aaron J. Boulton, PhD; Mark Sherer, PhD; Angelle M. Sander, PhD; Nancy Chiaravalloti, PhD; Tamara Bushnik, PhD; Robin Hanks, PhD; Elliot Roth, PhD; David S. Tulsky, PhDMidwest Regional Spinal Cord Injury Care System, Texas TBI Model System of TIRR, Northern New Jersey Traumatic Brain Injury System , Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, Southeastern Michigan Traumatic Brain Injury System Yescheberle
2020Comparison of diagnostic sleep studies in hospitalized neurorehabilitation patients with moderate to severe traumatic brain injury.JournalCHESTEpub - 6 May 2020https://journal.chestnet.org/article/S0012-3692(20)30863-1/fulltextBackground: OSA is prevalent during a time of critical neural repair after traumatic brain injury (TBI). The diagnostic utility of existing sleep studies is needed to inform clinical management during acute recovery from TBI. Research Question: This study aimed to evaluate the non-inferiority and diagnostic accuracy of a portable level 3 sleep study relative to level 1 polysomnography in hospitalized neurorehabilitation patients with TBI. Study Design and Methods: This is a prospective clinical trial conducted at six TBI Model System study sites between May 2017 and February 2019. Of 896 admissions, 449 were screened and eligible for the trial, with 345 consented. Additional screening left 263 eligible for and completing simultaneous administration of both level 1 and level 3 sleep studies, with final analyses completed on 214 (median age = 42 years; ED Glasgow Coma Scale = 6; time to polysomnography [PSG] = 52 days). Results: Agreement was moderate to strong (weighted kappa = 0.78, 95% CI, 0.72-0.83) with the misclassification commonly occurring with mild sleep apnea due to underestimation of apnea hypopnea index (AHI). Most of those with moderate to severe sleep apnea were correctly classified (n = 54/72). Non-inferiority was not demonstrated: the minimum tolerable specificity of 0.5 was achieved across all AHI cutoff scores (lower confidence limits [LCL] range, 0.807-0.943), but the minimum tolerable sensitivity of 0.8 was not (LCL range, 0.665-0.764). Interpretation: Although the non-inferiority of level 3 portable diagnostic testing relative to level 1 was not established, strong agreement was seen across sleep apnea indexes. Most of those with moderate to severe sleep apnea were correctly identified; however, there was risk of misclassification with level 3 sleep studies underestimating disease severity for those with moderate to severe AHI and disease presence for those with mild AHI during early TBI neurorehabilitation. Full article available in link. Risa Nakase-Richardson, PhD; Daniel J. Schwartz, MD; Jessica M. Ketchum, PhD; Leah Drasher-Phillips, MPH; Marie N. Dahdah, PhD; Kimberley R. Monden, PhD; Kathleen Bell, MD; Jeanne Hoffman, PhD; John Whyte, MD, PhD; Jennifer Bogner, PhD; Karel Calero, MD;, Ulysses Magalang, MD South Florida Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, North Texas Traumatic Brain Injury Model System, University of Washington Traumatic Brain Injury Model System, Moss Traumatic Brain Injury Model System, Ohio Regional Traumatic Brain Injury Model System Yescheberle
2020A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury.JournalNeuropsychological RehabilitationEpubhttps://www.tandfonline.com/doi/full/10.1080/09602011.2020.1762670Psychological distress is common in persons with traumatic brain injury (TBI) but treatments remain underdeveloped. This randomized controlled trial of Acceptance and Commitment Therapy (ACT) was designed to address this gap. Ninety-three persons with medically-documented complicated mild to severe TBI, normal-to-mildly impaired memory, and clinically significant psychological distress in the chronic phase of recovery were randomized to receive eight weeks of ACT (manualized with adaptations to address TBI-related cognitive impairments) or a single session of needs assessment, brief counseling/education, and referral. The ACT group showed significantly greater reduction of psychological distress (Brief Symptom Inventory 18) and demonstrated improvements in psychological flexibility and commitment to action (Acceptance and Action Questionnaire-II (AAQ-II) scores). The number of treatment responders (post-treatment BSI 18 GSI T scores <63) was larger in the ACT group than in the control group. Entry of AAQ-II scores into the model of between-group differences in BSI 18 GSI T scores indicated that core ACT processes explained the variance in treatment group outcomes. Provision of ACT reduces psychological distress in persons with TBI in the chronic phase of recovery when adaptations are made to accommodate TBI-related cognitive impairments. Additional clinical trials with a structurally equivalent control group are needed. Angelle M Sander 1 2 3, Allison N Clark, David B Arciniegas, Kim Tran, Luis Leon-Novelo, Esther Ngan, Jay Bogaards, Mark Sherer, Robyn WalserNorth Texas Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury SystemYescheberle
2020Voting is my Superpower! Voting tips for people living with disabilities.JournalArchives of Physical Medicine and Rehabilitation10161101-1103https://www.archives-pmr.org/article/S0003-9993(20)30168-4/fulltextNo abstract available. Full text available in link.  Flora M. Hammond, MD, FACRM; Mark A. Hirsch, PhD, FACRM; Christine S. Davis, PhD; Julia Nelson Snow, MA; Martha Kropf, PhD; Jason Karlawish, MDIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYescheberle
2020Improving well-being after traumatic brain injury through volunteering: A randomized controlled trial.JournalBrain Injury346697-707https://pubmed.ncbi.nlm.nih.gov/32343631/Objective: To evaluate the efficacy of a novel intervention facilitating volunteer activity to improve well-being in individuals with traumatic brain injury (TBI). Design: Randomized two-arm controlled trial, with a wait-list control condition (ClinicalTrials.gov NCT#01728350). Setting: Community-based setting. Participants: Seventy-four community-dwelling individuals at least 1-year post TBI, who had completed inpatient or outpatient TBI rehabilitation. Interventions: A novel intervention, HOPE - Helping Others through Purpose and Engagement, involving orientation/training and a 3-month volunteer placement for the participant, along with training for community agencies regarding TBI. Main outcome measure(s: ): Satisfaction With Life Scale (SWLS); Flourishing Scale (FS); Brief Symptom Inventory-18 (BSI-18); Scale of Positive and Negative Experience (SPANE); Purpose in Life subscale (one of six in the Ryff Scale of Psychological Well-Being - 54 item version). Results: There were significantly greater improvements in life satisfaction (SWLS) and self-perceived success (FS) in the intervention group compared to the control group. There were no significant treatment effects on the additional secondary measures of well-being, although they trended in a positive direction. Conclusions: This study supports our primary hypothesis that individuals who take part in a volunteer intervention will demonstrate greater psychological well-being in comparison to a control group. Lisa Payne, Lenore Hawley, Clare Morey, Jessica M Ketchum, Angela Philippus, Mitch Sevigny, Cynthia Harrison-Felix, Ed DienerRocky Mountain Regional Brain Injury SystemYescheberle
2018The feasibility of telephone-administered cognitive testing in individuals 1 and 2 years after inpatient rehabilitation for traumatic brain injury.JournalJournal of Neurotrauma 35101138-1145https://pubmed.ncbi.nlm.nih.gov/29648959/Traumatic brain injury (TBI) often results in cognitive impairment, and trajectories of cognitive functioning can vary tremendously over time across survivors. Traditional approaches to measuring cognitive performance require face-to-face administration of a battery of objective neuropsychological tests, which can be time- and labor-intensive. There are numerous clinical and research contexts in which in-person testing is undesirable or unfeasible, including clinical monitoring of older adults or individuals with disability for whom travel is challenging, and epidemiological studies of geographically dispersed participants. A telephone-based method for measuring cognition could conserve resources and improve efficiency. The objective of this study is to examine the feasibility and usefulness of the Brief Test of Adult Cognition by Telephone (BTACT) among individuals who are 1 and 2 years post-moderate-to-severe TBI. A total of 463 individuals participated in the study at Year 1 post-injury, and 386 participated at Year 2. The sample was mostly male (73%) and white (59%), with an average age of (mean ± standard deviation) 47.9 ± 20.9 years, and 73% experienced a duration of post-traumatic amnesia (PTA) greater than 7 days. A majority of participants were able to complete the BTACT subtests (61-69% and 56-64% for Years 1 and 2 respectively); score imputation for those unable to complete a test due to severity of cognitive impairment yields complete data for 74-79% of the sample. BTACT subtests showed expected changes between Years 1-2, and summary scores demonstrated expected associations with injury severity, employment status, and cognitive status as measured by the Functional Independence Measure. Results indicate it is feasible, efficient, and useful to measure cognition over the telephone among individuals with moderate-severe TBI. Kristen Dams-O'Connor, Karla Therese L Sy, Alexandra Landau, Yelena Bodien, Sureyya Dikmen, Elizabeth R Felix, Joseph T Giacino, Laura Gibbons, Flora M Hammond, Tessa Hart, Doug Johnson-Greene, Jeannie Lengenfelder, , Anthony Lequerica, Jody Newman, Thomas Novack, Therese M O'Neil-Pirozzi, Gale WhiteneckNew York Traumatic Brain Injury Model System, Spaulding-Harvard Traumatic Brain Injury Model System, University of Washington Traumatic Brain Injury Model System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Moss Traumatic Brain Injury Model System, Northern New Jersey Traumatic Brain Injury System , Rocky Mountain Regional Brain Injury System, UAB Traumatic Brain Injury Model SystemYescheberle
2020The longitudinal effects of comorbid health burden on functional outcomes for adults with moderate to severe traumatic brain injury.JournalJournal of Head Trauma Rehabilitation35472-81https://pubmed.ncbi.nlm.nih.gov/32108718/Objective: To evaluate the impact of physical, mental, and total health condition burden on functional outcome and life satisfaction up to 10 years after moderate to severe traumatic brain injury (TBI). Setting: Six TBI Model Systems centers. Participants: Three hundred ninety-three participants in the TBI Model Systems National Database. Design: Retrospective cohort study. Main measures: Self-reported physical and mental health conditions at 10 years postinjury. Functional Independence Measure Motor and Cognitive subscales and the Satisfaction With Life Scale measured at 1, 2, 5, and 10 years. Results: In 10-year longitudinal individual growth curve models adjusted for covariates and inverse probability weighted to account for selection bias, greater physical and mental health comorbidity burden was negatively associated with functional cognition and life satisfaction trajectories. Physical, but not mental, comorbidity burden was negatively associated with functional motor trajectories. Higher total health burden was associated with poorer functional motor and cognitive trajectories and lower life satisfaction. Conclusions: This study offers evidence that comorbidity burden negatively impacts longitudinal functional and life satisfaction outcomes after TBI. The findings suggest that better identification and treatment of comorbidities may benefit life satisfaction, functional outcome, reduce healthcare costs, and decrease reinjury. Specific guidelines are needed for the management of comorbidities in TBI populations. Raj G Kumar, Jessica M Ketchum, John D Corrigan, Flora M Hammond, Mitch Sevigny, Kristen Dams-OʼConnorNew York Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, Ohio Regional Traumatic Brain Injury Model System , Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYescheberle
2020Measuring pain in TBI: Development of the TBI-QOL Pain Interference item bank and short form.JournalArchives of Physical Medicine and Rehabilitation101111-19https://pubmed.ncbi.nlm.nih.gov/31562878/Objective: To develop a pain interference item bank, computer adaptive test (CAT), and short form for use by individuals with traumatic brain injury (TBI). Design: Cross-sectional survey study. Setting: Five TBI Model Systems rehabilitation hospitals. Participants: Individuals with TBI (N=590). Interventions: Not applicable. Outcome measures: Traumatic Brain Injury-Quality of Life (TBI-QOL) Pain Interference item bank. Results: Confirmatory factor analysis provided evidence of a single underlying trait (χ2 [740]=3254.030; P<.001; Comparative Fix Index=0.988; Tucker-Lewis Index=0.980; Root Mean Square Error of Approximation=0.076) and a graded response model (GRM) supported item fit of 40 Pain Interference items. Items did not exhibit differential item functioning or local item dependence. GRM calibration data were used to inform the selection of a 10-item static short form and to program a TBI-QOL Pain Interference CAT. Comparative analyses indicated excellent comparability and reliability across test administration formats. Conclusion: The 40-item TBI-QOL Pain Interference item bank demonstrated strong psychometric properties. End users can administer this measure as either a 10-item short form or CAT. Noelle E Carlozzi, Pamela A Kisala, Aaron J Boulton, Elliot Roth, Anna L Kratz, Mark Sherer, Angelle M Sander, Allen W Heinemann, Nancy D Chiaravalloti, Tamara Bushnik, David S TulskySoutheastern Michigan Traumatic Brain Injury System , Midwest Regional Spinal Cord Injury Care System, Texas TBI Model System of TIRR, North Texas Traumatic Brain Injury Model System, Northern New Jersey Traumatic Brain Injury System , Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue HospitalYescheberle
2020A standard method for determining the minimal clinically important difference for rehabilitation measures.JournalArchives of Physical Medicine and Rehabilitation10191090-1094https://pubmed.ncbi.nlm.nih.gov/31953077/The minimal clinically important difference (MCID) is receiving increasing interest and importance in medical practice and research. The MCID is the smallest improvement in scores in the domain of interest that patients perceive as beneficial. In clinical trials, comparing the proportion of individuals between treatment and control groups who obtain a MCID may be more informative than comparisons of mean change between groups because a statistically significant mean difference does not necessarily represent a difference that is perceived as meaningful by treatment recipients. The MCID may also be useful in advancing personalized medicine by characterizing those who are most likely to benefit from a treatment. In clinical practice, the MCID can be used to identify if a participant is experiencing a meaningful change in status. A variety of methods have been used to determine the MCID with no clear agreement on the most appropriate approach. Two major sets of methods are either (1) distribution-based, that is, referencing the MCID to a measure of variability or effect size in the measure of interest or (2) anchor-based, that is, referencing the MCID to an external assessment of change in the condition, ability, or activity represented by the measure of interest. In prior literature, using multiple methods to "triangulate" on the value of the MCID has been proposed. In this commentary, we describe a systematic approach to triangulate on the MCID using both distribution-based and anchor-based methods. Adaptation of a systematic approach for obtaining the MCID in rehabilitation would facilitate communication and comparison of results among rehabilitation researchers and providers. James F Malec, Jessica M Ketchum Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Rocky Mountain Regional Brain Injury SystemYescheberle
2019Volunteering and its association with participation and life satisfaction following traumatic brain injury.JournalBrain I34152-61https://pubmed.ncbi.nlm.nih.gov/31615280/Background: Volunteering has been found to improve life satisfaction and participation in the general population, but its impact has not been thoroughly studied among those with traumatic brain injury (TBI). It is important to investigate whether volunteering is helpful in addressing participation and life satisfaction to inform future treatment. Objective: To characterize those who volunteer after moderate-severe TBI and to investigate the association of volunteering with participation and life satisfaction after TBI. Methods: Using data from a single site contributing to the TBI Model Systems National Database, a retrospective analysis of 725 individuals with TBI was conducted. General Linear Models were used to compare outcomes of those who volunteer and those who do not after controlling for important covariates. Results: Volunteers were more likely to be employed/students, have better current functioning, be further post-injury, non-Hispanic white, and have more education. Significant relationships, after controlling for covariates, were found between volunteering and higher life satisfaction, more frequent community engagement, and greater social relations. No significant relationship between volunteering and productivity emerged. Conclusions: Given the positive relationship between volunteer status with life satisfaction and aspects of participation, future research should investigate the barriers/facilitators of volunteering to improve well-being and participation after TBI. Angela Philippus, Jessica M Ketchum, Lisa Payne, Lenore Hawley, Cynthia Harrison-FelixRocky Mountain Regional Brain Injury SystemYescheberle
2019Functional outcome trajectories following inpatient rehabilitation for TBI in the United States: A NIDILRR TBIMS and CDC interagency collaboration.JournalJournal of Head Trauma Rehabilitation352127-139https://pubmed.ncbi.nlm.nih.gov/31033744/Objective: To describe trajectories of functioning up to 5 years after traumatic brain injury (TBI) that required inpatient rehabilitation in the United States using individual growth curve models conditioned on factors associated with variability in functioning and independence over time. Design: Secondary analysis of population-weighted data from a multicenter longitudinal cohort study. Setting: Acute inpatient rehabilitation facilities. Participants: A total of 4624 individuals 16 years and older with a primary diagnosis of TBI. Main outcome measures: Ratings of global disability and supervision needs as reported by participants or proxy during follow-up telephone interviews at 1, 2, and 5 years postinjury. Results: Many TBI survivors experience functional improvement through 1 and 2 years postinjury, followed by a decline in functioning and decreased independence by 5 years. However, there was considerable heterogeneity in outcomes across individuals. Factors such as older age, non-White race, lower preinjury productivity, public payer source, longer length of inpatient rehabilitation stay, and lower discharge functional status were found to negatively impact trajectories of change over time. Conclusions: These findings can inform the content, timing, and target recipients of interventions designed to maximize functional independence after TBI. Kristen Dams-OʼConnor, Jessica M Ketchum, Jeffrey P Cuthbert, John D Corrigan, Flora M Hammond, Juliet Haarbauer-Krupa, Robert G Kowalski, A Cate MillerNew York Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, Ohio Regional Traumatic Brain Injury Model System , Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYescheberle
2020Mortality secondary to unintentional poisoning after inpatient rehabilitation among individuals with moderate to severe traumatic brain injury.JournalJournal of Neurotrauma Epub - 8 Jul 2020https://pubmed.ncbi.nlm.nih.gov/32438850/Studies have shown reduced life expectancy following moderate-severe traumatic brain injury (TBI) with death from unintentional poisoning (UP) being 11 times higher following TBI than in the general population. The characteristics of those who die of unintentional poisoning are compared with the characteristics of those who die of other causes (OC) in a retrospective cohort who received inpatient rehabilitation following TBI and enrolled in the TBI Model Systems National Database between 1989 and 2017 (n = 15,835 cases with 2,238 deaths recorded). Seventy-eight cases (3.5%) of deaths were the result of UP, 76% were the result of OC, and 20.5% were from an unknown cause. Among the UP deaths, 90% involved drugs (of these, 67% involved narcotic drugs and 14% involved psychostimulants), and 8% involved alcohol. Age-adjusted risk for UP death was associated with: white/non-Hispanic race/ethnicity, living alone, non-institutionalization, pre- and post-injury illicit drug use and alcohol/drug problem use, any alcohol use at last follow-up, better Functional Independence MeasureTM (FIM) scores, history of arrest, moderate disability (vs. severe disability or good recovery), less supervision needed, and greater anxiety. Adults who receive inpatient rehabilitation for TBI who die from UP are distinguishable from those who die of OC. Factors such as pre-injury substance use in the context of functional independence may be regarded as targets for prevention and/or intervention to reduce substance use and substance-related mortality among survivors of moderate-severe TBI. The current findings may have implications for medical care, surveillance, prevention, and health promotion. Flora M. Hammond, MD; Lance E. Trexler, PhD;, Jessica McKinney Ketchum, PhD; Cindy Harrison-Felix, PhD, FACRM;, Kristen Dams-O’Connor, PhD;, Cate A. Miller, PhD;, Juliet Haarbauer-Krupa, PhD; Mark Faul, PhDIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, New York Traumatic Brain Injury Model System, Ohio Regional Traumatic Brain Injury Model System Yescheberle
2020The Association Between Community Participation and Social Internet Use Among Adults With Traumatic Brain Injury.JournalJournal of Head Trauma Rehabilitation354254-261https://www.ncbi.nlm.nih.gov/pubmed/32108716To examine the association between social Internet use and real-world societal participation in survivors of moderate-severe traumatic brain injury. Objective: To examine the association between social Internet use and real-world societal participation in survivors of moderate-severe traumatic brain injury. Design: Prospective cross-sectional observational study. Setting: Ten Traumatic Brain Injury Model Systems Centers. Participants: A total of 331 participants in the Traumatic Brain Injury Model Systems, interviewed at any follow-up year between April 2014 and March 2015. Main measures: Survey on Internet use, including social media and other online socialization; Participation Assessment with Recombined Tools-Objective with separate analyses of Productivity, Social Relations, Out and About subscales; covariates included demographics, injury variables, and functional and emotional status at follow-up. Results: Participants were classified as social Internet users (N = 232) or nonusers (N = 99). Users had significantly higher Participation Assessment with Recombined Tools-Objective Social Relations scores than nonusers. A similar finding pertained to Out and About scores, with the between-group difference significantly greater for those with greater depressive symptoms severity. Users and nonusers did not differ significantly on Productivity subscale. Conclusions: The positive association between social Internet use and real-world social participation suggests that people with traumatic brain injury do not use social media as an alternative to real-world socialization. Rather, it is likely that similar barriers and facilitators affect both online and real-world social participation following traumatic brain injury. Emotional function should be considered as a moderating factor in further studies.   Ketchum, Jessica, Sevigny, Mitch, Hart, Tessa, O’Neil-Pirozzi, Teresa, Sander, Angelle, Juengst, Shannon, Bergquist, Thomas, Dreer, Laura, Whiteneck, GaleUAB Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, Moss Traumatic Brain Injury Model System, Spaulding-Harvard Traumatic Brain Injury Model System, Texas TBI Model System of TIRR, Mayo Clinic Traumatic Brain Injury Model System Yesmbelay
2020Concordance between current AASM and CMS scoring criteria for obstructive sleep apnea in hospitalized persons with TBI: A VA TBI Model System study.JournalJournal of Clinical Sleep MedicineEpubhttps://www.ncbi.nlm.nih.gov/pubmed/32043962STUDY OBJECTIVES: To compare OSA, demographic, and TBI characteristics across the American Academy of Sleep Medicine (AASM) and Centers for Medicare and Medicare (CMS) scoring rules in moderate to severe TBI undergoing inpatient neurorehabilitation. METHODS: This is a secondary analysis from a prospective clinical trial of sleep apnea at six TBI Model System study sites (n=248). Scoring was completed by a centralized center using both the AASM and CMS criteria for OSA. Hospitalization and injury characteristics were abstracted from the medical record and demographics obtained by interview by trained research assistants using TBI Model System standard procedures. RESULTS: OSA was prevalent using the AASM (66%) and CMS (41.5%) criteria with moderate to strong agreement (weighted kappa = 0.64 (95%CI = 0.58, 0.70). Significant differences were observed for participants meeting AASM and CMS criteria (Concordant Group; CG) compared to those meeting criteria for AASM but not CMS (Discordant Group; DG). At AHI ≥ 5, the DG (n=61) had lower Emergency Department Glasgow Coma Scale Scores consistent with greater injury severity (median 5 vs. 13, p = 0.0050), younger age (median 38 vs 58, p<0.0001), and lower BMI (median 24.8 vs 22.1, p = 0.0007) compared to the CG (n=103). At AHI ≥ 15, female gender and but no other differences were noted possibly due to the smaller sample size. CONCLUSIONS: The underestimation of sleep apnea using CMS criteria is consistent with prior literature; however, this is the first study to report the impact of the criteria in persons with moderate to severe TBI during a critical stage of neural recovery. Management of comorbidities in TBI has become an increasing focus for optimizing TBI outcomes. Given the chronic morbidity after moderate to severe TBI, the impact of CMS policy for OSA diagnosis for persons with chronic disability and young age are considerable. Nakase-Richardson, R , Dahdah, MN , Almeida, E , Ricketti, P , Silva, MA , Calero, K , Magalang, U , Schwartz, DJNorth Texas Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, Ohio Regional Traumatic Brain Injury Model System , Moss Traumatic Brain Injury Model System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, University of Washington Traumatic Brain Injury Model SystemYescheberle
2020Comparative Effectiveness of Sleep Apnea Screening Instruments During Inpatient Rehabilitation Following Moderate to Severe TBI.JournalArchives of Physical Medicine and Rehabilitation1012283-296https://www.ncbi.nlm.nih.gov/pubmed/31705855OBJECTIVE: To determine the diagnostic sensitivity and specificity and comparative effectiveness of traditional sleep apnea screening tools in traumatic brain injury (TBI) neurorehabilitation admissions. DESIGN: Prospective diagnostic comparative effectiveness trial of sleep apnea screening tools relative to the criterion standard, attended level 1 polysomnography including encephalography. SETTING: Six TBI Model System Inpatient Rehabilitation Centers. PARTICIPANTS: Between May 2017 and February 2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Area under the curve (AUC) of screening tools relative to total apnea hypopnea index≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (interquartile range, 29-47). RESULTS: The Berlin high-risk score (receiving operating curve [ROC] AUC=0.634) was inferior to the Multivariable Apnea Prediction Index (MAPI) (ROC AUC=0.780) (P=.0211; CI, 0.018-0.223) and Snoring, Tired, Observed, Blood Pressure, Body Mass Index, Age, Neck Circumference, and Gender (STOPBANG) score (ROC AUC=0.785) (P=.001; CI, 0.063-0.230), both of which had comparable AUC (P=.7245; CI, -0.047 to 0.068). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI≥5. The pattern was similar across TBI severity subgroups except for posttraumatic amnesia (PTA) status wherein the MAPI outperformed the Berlin. Youden's index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples. CONCLUSION: This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome. Nakase-Richardson, R, Schwartz, DJ, Drasher-Phillips, L, Ketchum, JM, Calero, K, Dahdah, MN, Monden, KR, Bell, K, Magalang, U, Hoffman, JM, Whyte, J, Bogner, J, Zeitzer, JMRocky Mountain Regional Brain Injury System, North Texas Traumatic Brain Injury Model System, Ohio Regional Traumatic Brain Injury Model System , University of Washington Traumatic Brain Injury Model System, Moss Traumatic Brain Injury Model SystemYescheberle
2019Linking the GAD-7 and PHQ-9 to the TBI-QOL Anxiety and Depression item banks.Journal Journal of Head Trauma Rehabilitation345353-363https://www.ncbi.nlm.nih.gov/pubmed/31498233OBJECTIVE: To link scores on commonly used measures of anxiety (7-item Generalized Anxiety Disorder Scale; GAD-7) and depression (9-item Patient Health Questionnaire; PHQ-9) to the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system. SETTING: 5 Traumatic Brain Injury Model Systems. PARTICIPANTS: A total of 385 individuals with traumatic brain injury (TBI) (31% complicated mild; 14% moderate; and 54% severe). DESIGN: Observational cohort. MAIN MEASURES: GAD-7, PHQ-9, TBI-QOL Anxiety v1.0 and TBI-QOL Depression v1.0. RESULTS: Item response theory-based linking methods were used to create crosswalk tables that convert scores on the GAD-7 to the TBI-QOL Anxiety metric and scores on the PHQ-9 to the TBI-QOL Depression metric. Comparisons between actual and crosswalked scores suggest that the linkages were successful and are appropriate for group-level analysis. Linking functions closely mirror crosswalks between the GAD-7/PHQ-9 and the Patient-Reported Outcomes Measurement Information System (PROMIS), suggesting that general population linkages are similar to those from a TBI sample. CONCLUSION: Researchers and clinicians can use the crosswalk tables to transform scores on the GAD-7 and the PHQ-9 to the TBI-QOL metric for group-level analyses. Angelle M. Sander , Mark Sherer , Allen W. Heinemann, Tamara Bushnik, Nancy Chiaravalloti, Aaron J. Boulton , Callie E. Tyner , Seung W. Choi , Pamela A. Kisala , David S. TulskyTexas TBI Model System of TIRR, Midwest Regional Spinal Cord Injury Care System, Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, Northern New Jersey Spinal Cord Injury SystemYescheberle
2019Measuring self-reported cognitive function following TBI: Development of the TBIQOL Executive Function and Cognition-General Concerns item banks.Journal Journal of Head Trauma Rehabilitation345298-307https://www.ncbi.nlm.nih.gov/pubmed/31498229OBJECTIVE: To develop, calibrate, and evaluate the test-retest reliability of a new patient-reported outcome measure of headache pain relevant for individuals with traumatic brain injury (TBI). SETTING: Six TBI Model Systems rehabilitation centers in the United States. PARTICIPANTS: Adults with medically confirmed documentation of TBI. DESIGN: Cross-sectional calibration field testing and test-retest reliability analyses. MAIN MEASURES: Traumatic Brain Injury-Quality of Life Headache Pain item bank. RESULTS: Thirteen headache pain items were calibrated as a unidimensional measure using data from 590 participants. The new measure was reliable (α = .98; item-total correlation range: 0.71-0.91). Item parameter estimates were estimated using Samejima's Graded Response Model and a 10-item calibrated short form was created. Simulation testing confirmed that both the computer-adaptive test and the short-form administrations were equivalent to the full item bank. One- to-2-week test-retest reliability of the computer-adaptive test was high (Pearson r and intraclass correlation coefficients = 0.81). Approximately two-thirds of the sample reported at least 1 headache symptom. CONCLUSION: The Traumatic Brain Injury-Quality of Life Headache Pain item bank and short form provide researchers and clinicians with reliable measures of the subjective experience of headache symptoms for individuals with a history of TBI. Mark Sherer , Nancy Chiaravalloti, Noelle E. Carlozzi , Callie E. Tyner , Pamela A. Kisala , Aaron J. Boulton , David S. TulskyTexas TBI Model System of TIRR, Northern New Jersey Spinal Cord Injury SystemYescheberle
2019Development of the TBI-QOL Headache Pain item bank and short form.JournalJournal of Head Trauma Rehabilitation345298-307https://www.ncbi.nlm.nih.gov/pubmed/31498229OBJECTIVE: To develop, calibrate, and evaluate the test-retest reliability of a new patient-reported outcome measure of headache pain relevant for individuals with traumatic brain injury (TBI). SETTING: Six TBI Model Systems rehabilitation centers in the United States. PARTICIPANTS: Adults with medically confirmed documentation of TBI. DESIGN: Cross-sectional calibration field testing and test-retest reliability analyses. MAIN MEASURES: Traumatic Brain Injury-Quality of Life Headache Pain item bank. RESULTS: Thirteen headache pain items were calibrated as a unidimensional measure using data from 590 participants. The new measure was reliable (α = .98; item-total correlation range: 0.71-0.91). Item parameter estimates were estimated using Samejima's Graded Response Model and a 10-item calibrated short form was created. Simulation testing confirmed that both the computer-adaptive test and the short-form administrations were equivalent to the full item bank. One- to-2-week test-retest reliability of the computer-adaptive test was high (Pearson r and intraclass correlation coefficients = 0.81). Approximately two-thirds of the sample reported at least 1 headache symptom. CONCLUSION: The Traumatic Brain Injury-Quality of Life Headache Pain item bank and short form provide researchers and clinicians with reliable measures of the subjective experience of headache symptoms for individuals with a history of TBI. Allen W. Heinemann, Elliot J. Roth, David S. Tulsky, Callie E. Tyner , Aaron J. Boulton , Pamela A. Kisala , Noelle E. CarlozziMidwest Regional Spinal Cord Injury Care SystemYescheberle
2019Measuring fatigue in TBI: Development of the TBI-QOL Fatigue item bank and short form.JournalJournal of Head Trauma Rehabilitation345289-297https://www.ncbi.nlm.nih.gov/pubmed/31498228OBJECTIVE: To develop a traumatic brain injury (TBI)-specific, item response theory (IRT)-calibrated Fatigue item bank, short form, and computer adaptive test (CAT) as part of the Traumatic Brain Injury-Quality of Life (TBI-QOL) measurement system. SETTING: Five TBI Model Systems rehabilitation centers in the US PARTICIPANTS:: Adults with complicated mild, moderate, or severe TBI confirmed by medical record review. DESIGN: Cross-sectional field testing via phone or in-person interview. MAIN MEASURES: TBI-QOL Fatigue item bank, short form, and CAT. RESULTS: A total of 590 adults with TBI completed 95 preliminary fatigue items, including 86 items from the Patient-Reported Outcomes Measurement Information System (PROMIS) and 9 items from the Quality of Life in Neurological Disorders (Neuro-QOL) system. Through 4 iterations of factor analysis, 22 items were deleted for reasons such as local item dependence, misfit, and low item-total correlations. Graded response model IRT analyses were conducted on the 73-item set, and Stocking-Lord equating was used to transform the item parameters to the PROMIS (general population) metric. A short form and CAT, which demonstrate similar reliability to the full item bank, were developed. Test-retest reliability of the CAT was established in an independent sample (Pearson's r and intraclass correlation coefficient = 0.82 [95% confidence interval: 0.72-0.88]). CONCLUSIONS: The TBI-QOL Fatigue item bank, short form, and CAT provide rehabilitation researchers and clinicians with TBI-optimized tools for assessment of the patient-reported experience and impact of fatigue on individuals with TBI. Tamara Bushnik, Robin A. Hanks, Stephanie A. Kolakowsky-Hayner, Pamela A. Kisala, Aaron J. Boulton, David S. TulskyRusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, Southeastern Michigan Traumatic Brain Injury System , New York Traumatic Brain Injury Model SystemYescheberle
2019The relation between cognitive dysfunction and diffusion tensor imaging parameters in traumatic brain injury.JournalBrain Injury333355-363https://www.ncbi.nlm.nih.gov/pubmed/30563361PURPOSE OF THE STUDY: To investigate the association among global and regional white matter fractional anisotropy (FA) values following traumatic brain injury (TBI) and cognitive functioning. MATERIALS AND METHODS: This research was conducted in an urban rehabilitation hospital. Participants included adults who were healthy controls (n = 18) or who had a TBI (n = 27). Diffusion tensor imaging using a Siemens VERIO 3T scanner and calculation of global and regional FA values were undertaken. FA values were correlated with neuropsychological test scores and injury severity variables. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to investigate discriminative ability of the FA values. Neuropsychological measures, including the Symbol Digit Modalities Test (SDMT), Trail Making Test, Wechsler Test of Adult Reading, California Verbal Learning Test 2nd Edition, Digit Vigilance Test, and Wisconsin Card Sorting Test, comprised the cognitive measures. RESULTS: Within the TBI group, regional FA values were significantly lower across regions compared with controls; global FA and five brain regions were associated with SDMT scores. The FA value within the body of the corpus callosum (CC) yielded excellent discrimination between groups. CONCLUSIONS: Convergent findings support the discriminability and potential clinical utility of the CC body FA value in the context of TBI. Hanks, R, Millis, S, Scott, S, Gattu, R, O'Hara, NB, Haacke, M, Kou, ZSoutheastern Michigan Traumatic Brain Injury System Yescheberle
2019Predictors of 1-year global outcomes after traumatic brain injury among older adults: A NIDILRR Traumatic Brain Injury Model Systems studyJournal of Aging and Health 3168S-96SHammond, F.M, Baker-Sparr, C.A, Dreer, L.E, O’Neil-Pirozzi, T.M, Novack, T.A, Harrison-Felix, C, Dahdah, M, Dams-O’Conner, KIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Rocky Mountain Regional Brain Injury System, North Texas Traumatic Brain Injury Model System, New York Traumatic Brain Injury Model System, UAB Traumatic Brain Injury Model System, Spaulding-Harvard Traumatic Brain Injury Model SystemYesmbelay
2014Role of character strengths in outcome after mild complicated to severe traumatic brain injury: a positive psychology study.JournalArchives of Physical Medicine and Rehabilitation95112096-102https://www.ncbi.nlm.nih.gov/pubmed/25010535OBJECTIVE: To examine the effects of character strengths on psychosocial outcomes after mild complicated to severe traumatic brain injury (TBI). DESIGN: Prospective study with consecutive enrollment. SETTING: A Midwestern rehabilitation hospital. PARTICIPANTS: Persons with mild complicated to severe TBI (N=65). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Community Integration Measure, Disability Rating Scale, Modified Cumulative Illness Rating Scale, Positive and Negative Affect Schedule, Satisfaction with Life Scale, Values in Action Inventory of Strengths, and Wechsler Test of Adult Reading. RESULTS: Character virtues and strengths were moderately associated with subjective outcomes, such that there were fewer and less strong associations between character virtues/strengths and objective outcomes than subjective outcomes. Specifically, positive attributes were associated with greater life satisfaction and perceived community integration. Fewer and less strong associations were observed for objective well-being; however, character strengths and virtues showed unique value in predicting physical health and disability. Positive affectivity was not meaningfully related to objective outcomes, but it was significantly related to subjective outcomes. In contrast, negative affectivity was related to objective but not subjective outcomes. CONCLUSIONS: Given the strength of the associations between positive aspects of character or ways of perceiving the world and positive feelings about one's current life situation, treatments focused on facilitating these virtues and strengths in persons who have experienced TBI may result in better perceived outcomes and potentially subsequently lower comorbidities. Hanks, RA, Rapport, LJ, Waldron-Perrine, B, Millis, SRSoutheastern Michigan Traumatic Brain Injury System Yescheberle
2012Randomized controlled trial of peer mentoring for individuals with traumatic brain injury and their significant others.JournalArchives of Physical Medicine and Rehabilitation9381297-304https://www.ncbi.nlm.nih.gov/pubmed/22840826OBJECTIVES: To examine the efficacy of a peer-mentoring program for persons with traumatic brain injury (TBI) and their significant others, and to determine the relationship of this mentoring program to 3 main outcomes: (1) emotional well-being; (2) post-TBI quality of life; and (3) community integration. DESIGN: Randomized controlled trial. SETTING: Midwestern rehabilitation hospital. PARTICIPANTS: Persons with TBI (n=96) and significant others/caregivers (n=62). INTERVENTIONS: Persons with TBI and friends/caregivers who knew the person prior to their injury were randomly assigned to a treatment (mentored) or no-treatment (no mentoring) control group immediately prior to discharge from the rehabilitation unit and were mentored for up to 2 years. MAIN OUTCOME MEASURES: Peer Mentoring Questionnaire; Brief Symptom Inventory-18; Family Assessment Device; Coping Inventory for Stressful Situations; Short Michigan Alcohol Screening Test; Medical Outcomes Study 12-Item Short-Form Health Survey; and Community Integration Measure. RESULTS: Eighty-eight percent of individuals who were involved in the mentoring program reported positive experiences. t tests revealed that among persons with TBI, individuals who received mentoring had significantly better behavioral control and less chaos in the living environment (P=.04), lower alcohol use (P=.01), less emotion-focused (P=.04) and avoidance coping (P=.03), and good physical quality of life (P=.04) compared with those who did not receive mentoring. Among significant others, mentored individuals demonstrated greater community integration (P=.03) than the nonmentored control group. CONCLUSIONS: Mentoring can be an effective way to benefit mood and healthy coping after TBI, and it can help to prevent maladaptive behaviors, such as substance abuse and behavioral dyscontrol, in the living situation. Hanks, RA, Rapport, LJ, Wertheimer, J, Koviak, CSoutheastern Michigan Traumatic Brain Injury System Yescheberle
2013Number of impaired scores as a performance validity indicator.JournalJournal of Clinical and Experimental Neuropsychology354413-20https://www.ncbi.nlm.nih.gov/pubmed/23514206This study examined embedded performance validity indicators (PVI) based on the number of impaired scores in an evaluation and the overall test battery mean (OTBM). Adult participants (N = 175) reporting traumatic brain injury were grouped using eight PVI. Participants who passed all PVI (n = 67) demonstrated fewer impaired scores and higher OTBM than those who failed two or more PVI (n = 66). Impairment was defined at three levels: T scores < 40, 35, and 30. With specificity ≥.90, sensitivity ranged from .51 to .71 for number of impaired scores and .74 for OTBM. Davis, JJ, Axelrod, BN, McHugh, TS, Hanks, RA, Millis, SRSoutheastern Michigan Traumatic Brain Injury System Yescheberle
2017Neuropsychological test validity in Veterans presenting with subjective complaints of 'very severe' cognitive symptoms following mild traumatic brain injury.JournalBrain Injury31132-38https://www.ncbi.nlm.nih.gov/pubmed/27819490OBJECTIVE: This study explored the utility of combining data from measures of performance validity and symptom validity among Veterans undergoing neuropsychological evaluation for mild traumatic brain injury (mTBI). BACKGROUND: Persistent cognitive impairments following mTBI are often reported by returning combat veterans. However, objectively-measured cognitive deficits are not common among individuals with mTBI, raising the question of whether negative impression management influences self-ratings. METHODS: Self-report ratings were obtained for memory, concentration, decision-making, and processing speed/organization using a 5-point scale ranging from 'none' to 'very severe'. Veterans also completed brief neuropsychological testing which included measures of performance validity. RESULTS: Study 1 examined data from 122 participants and demonstrated that veterans reporting a 'very severe' cognitive deficit were over three times as likely to demonstrate poor effort on a validity test than those without a very severe rating. Study 2 replicated these findings in an independent sample of 127 veterans and also demonstrated that both severity of self-report ratings and performance on an embedded measure of effort were predictive of poor effort on a stand-alone performance validity test. CONCLUSION: Veterans with suspected mTBI who report 'very severe' cognitive impairment have a greater likelihood of putting forth sub-optimal effort on objective testing. Spencer, RJ, Waldron-Perrine, B, Drag, LL, Pangilinan, P, Axelrod, BN, Bieliauskas, LASoutheastern Michigan Traumatic Brain Injury System Yescheberle
2012Longitudinal outcome of patients with disordered consciousness in the NIDRR TBI Model Systems Programs.JournalJournal of Neurotrauma29159-65https://www.ncbi.nlm.nih.gov/pubmed/21663544Few studies address the course of recovery from prolonged disorders of consciousness (DOC) after severe traumatic brain injury (TBI). This study examined acute and long-term outcomes of persons with DOC admitted to acute inpatient rehabilitation within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS). Of 9028 persons enrolled from 1988 to 2009, 396 from 20 centers met study criteria. Participants were primarily male (73%), Caucasian (67%), injured in motor vehicle collision (66%), with a median age of 28, and emergency department Glasgow Coma Scale (GCS) score of 3. Participant status was evaluated at acute rehabilitation admission and discharge and at 1, 2, and 5 years post-injury. During inpatient rehabilitation, 268 of 396 (68%) regained consciousness and 91 (23%) emerged from post-traumatic amnesia (PTA). Participants demonstrated significant improvements on GCS (z=16.135, p≤0.001) and Functional Independence Measure (FIM) (z=15.584, p≤0.001) from rehabilitation admission (median GCS=9; FIM=18) to discharge (median GCS=14; FIM=43). Of 337 with at least one follow-up visit, 28 (8%) had died by 2.1 years (mean) after discharge. Among survivors, 66 (21%) improved to become capable of living without in-house supervision, and 63 demonstrated employment potential using the Disability Rating Scale (DRS). Participants with follow-up data at 1, 2, and 5 years post-injury (n=108) demonstrated significant improvement across all follow-up evaluations on the FIM Cognitive and Supervision Rating Scale (p<0.01). Significant improvements were observed on the DRS and FIM Motor at 1 and 2 years post-injury (p<0.01). Persons with DOC at the time of admission to inpatient rehabilitation showed functional improvement throughout early recovery and in years post-injury. Nakase-Richardson, R, Whyte, J, Giacino, JT, Pavawalla, S, Barnett, SD, Yablon, SA, Sherer, M, Kalmar, K, Hammond, FM, Greenwald, B, Horn, LJ, Seel, R, McCarthy, M, Tran, J, Walker, WCSoutheastern Michigan Traumatic Brain Injury System Yescheberle
2019The Development of a New Computer-Adaptive Test to Evaluate Strain in Caregivers of Individuals With TBI: TBI-CareQOL Caregiver StrainArchives of Physical Medicine and Rehabilitation1004SS13-S21https://www.ncbi.nlm.nih.gov/pubmed/29966647To develop a new measure of caregiver strain for use in caregivers of individuals with traumatic brain injury (TBI), Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver Strain. Carlozzi, NE, Kallen, MA, Ianni, PA, Hahn, EA, French, LM, Lange, RT, Brickell, TA, Hanks, R, Sander, AMSoutheastern Michigan Traumatic Brain Injury System , Texas TBI Model System of TIRRYesmbelay
2019Interviewer- versus self-administration of PROMIS® measures for adults with traumatic injury.JournalHealth Psychology385435-444https://www.ncbi.nlm.nih.gov/pubmed/31045427OBJECTIVE: To assess differential item functioning and observed mean differences across two modes of administration for PROMIS® measure scores in a sample of adults with traumatic injury. METHOD: Items from 7 PROMIS® adult measures (v1.0 Physical Function, Fatigue, Pain Interference, Anger, Anxiety, and Depression and v2.0 Social Health-Emotional Support) were administered as fixed-length short forms in random order to a cross-sectional sample. Participants were randomly assigned to interviewer-administered (phone or in-person) or self-administered (via the Assessment Center website) conditions. The research was conducted at 5 medical rehabilitation institutions across the U.S. Participants included 277 adults with spinal cord injury (n = 148) or traumatic brain injury (n = 129). RESULTS: DIF analyses indicated that all items were invariant to mode of administration. There was no significant effect of mode of administration for the majority of PROMIS® measures tested. Regarding observed scores, there were small but significant effects of mode of administration on the Emotional Support and Depression measures, with participants in the interview condition reporting better support/fewer symptoms. CONCLUSIONS: PROMIS® instruments demonstrated measurement equivalence across interviewer-administered and self-administered conditions. These findings are particularly important for research or clinical applications where administration of PROMIS® measures by independent web- or tablet-based administration is not ideal, for example with individuals with physical or cognitive disabilities or with individuals who lack computer and/or Internet access. PROMIS® v1.0 Depression and PROMIS® v2.0 Emotional Support scores displayed a tendency toward social desirability that should be considered when these measures are interviewer-administered. (PsycINFO Database Record (c) 2019 APA, all rights reserved). Kisala, PA, Boulton, AJ, Cohen, ML, Slavin, MD, Jette, AM, Charlifue, S, Hanks, R, Mulcahey, MJ, Cella, D, Tulsky, DSSoutheastern Michigan Traumatic Brain Injury System , Rocky Mountain Regional Brain Injury System, Spaulding-Harvard Traumatic Brain Injury Model System, Moss Traumatic Brain Injury Model SystemYescheberle
2019The Development of a New Computer Adaptive Test to Evaluate Anxiety in Caregivers of Individuals With Traumatic Brain Injury: TBI-CareQOL Caregiver-Specific Anxiety.Archives of Physical Medicine and Rehabilitation1004SS22-S30https://www.ncbi.nlm.nih.gov/pubmed/29958902To design a new measure of caregiver-specific anxiety for use in caregivers of individuals with traumatic brain injury (TBI), the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL) Caregiver-Specific Anxiety item bank. Carlozzi, NE, Kallen, MA, Sander, AM, Brickell, TA, Lange, RT, French, LM, Ianni, PA, Miner, JA, Hanks, RSoutheastern Michigan Traumatic Brain Injury System , Texas TBI Model System of TIRRYesmbelay
2015Integrating Resilience-Building into the Neurorehabilitation ProcessJournalBrain Injury Professional16122-25Waldron-Perrine, B , Neils-Strunjas, J, Paul, D , Clark, A, Mudar, R, Maestas, K, Duff, M, Bechtold, KTSoutheastern Michigan Traumatic Brain Injury System , Texas TBI Model System of TIRRYescheberle
2019The Development of Two New Computer Adaptive Tests To Evaluate Feelings of Loss in Caregivers of Individuals With Traumatic Brain Injury: TBI-CareQOL Feelings of Loss-Self and Feelings of Loss-Person With Traumatic Brain InjuryArchives of Physical Medicine and Rehabilitation1004SS31-S42https://www.ncbi.nlm.nih.gov/pubmed/29958904To develop new patient-reported outcome (PRO) measures to better understand feelings of loss in caregivers of individuals with traumatic brain injury (TBI) Carlozzi, NE, Kallen, MA, Ianni, PA, Sander, AM, Hahn, EA, Lange, RT, Brickell, TA, French, LM, Miner, JA, Hanks, RTexas TBI Model System of TIRR, Southeastern Michigan Traumatic Brain Injury System Yesmbelay
2017Groupings of Persons With Traumatic Brain Injury: A New Approach to Classifying Traumatic Brain Injury in the Post-Acute Period.JournalJournal of Head Trauma Rehabilitation322125–133https://www.ncbi.nlm.nih.gov/pubmed/26709583OBJECTIVE: To (1) identify groups of persons with traumatic brain injury (TBI) who differ on 12 dimensions of cognitive function: cognitive, emotional, and physical symptoms; personal strengths; physical functioning; environmental supports; and performance validity; and (2) describe patterns of differences among the groups on these dimensions and on participation outcome. SETTING: Three centers for rehabilitation of persons with TBI. PARTICIPANTS: A total of 504 persons with TBI living in the community who were an average (standard deviation) of 6.3 (6.8) years postinjury and who had capacity to give consent, could be interviewed and tested in English, and were able to participate in an assessment lasting up to 4 hours. DESIGN: Observational study of a convenience sample of persons with TBI. MAIN MEASURES: Selected scales from the Traumatic Brain Injury Quality of Life measures, Neurobehavioral Symptom Inventory, Economic Quality of Life Scale, Family Assessment Device General Functioning Scale, measures of cognitive function, Word Memory Test, and Participation Assessment with Recombined Tools-Objective (PART-O) scale. RESULTS: Cluster analysis identified 5 groups of persons with TBI who differed in clinically meaningful ways on the 12 dimension scores and the PART-O scale. CONCLUSION: Cluster groupings identified in this study could assist clinicians with case conceptualization and treatment planning. Sherer, M, Nick, TG, Sander, AM, Melguizo, M, Hanks, R, Novack, TA, Tulsky, D, Kisala, P, Luo, C, Tang, XTexas TBI Model System of TIRR, North Texas Traumatic Brain Injury Model System, Southeastern Michigan Traumatic Brain Injury System , UAB Traumatic Brain Injury Model System, Northern New Jersey Traumatic Brain Injury System Yescheberle
2019The TBI-CareQOL Measurement System: Development and Preliminary Validation of Health-Related Quality of Life Measures for Caregivers of Civilians and Service Members/Veterans With Traumatic Brain InjuryArchives of Physical Medicine and Rehabilitation1004S1S1-12https://www.ncbi.nlm.nih.gov/pubmed/30195987To develop a new measurement system, the Traumatic Brain Injury Caregiver Quality of Life (TBI-CareQOL), that can evaluate both general and caregiving-specific aspects of health-related quality of life (HRQOL) in caregivers of persons with traumatic brain injury (TBI). Carlozzi, NE, Kallen, MA, Hanks, R, Hahn, EA, Brickell, TA, Lange, RT, French, LM, Kratz, AL, Tulsky, DS, Cella, D, Miner, JA, Ianni, PA, Sander, AMSoutheastern Michigan Traumatic Brain Injury System , Texas TBI Model System of TIRRYesmbelay
2018Functional independence after acquired brain injury: Prospective effects of health self-efficacy and cognitive impairment.JournalRehabilitation Psychology634595-603https://www.ncbi.nlm.nih.gov/pubmed/30247052OBJECTIVE: To examine how health self-efficacy and cognitive impairment severity relate to functional independence after acquired brain injury (ABI). DESIGN: Observational. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Seventy-five adults with predominately stroke or traumatic brain injury who were beginning a course of occupational therapy. MAIN MEASURES: Health self-efficacy was assessed with the Self-Rated Abilities for Health Practices. Cognitive functioning was assessed via a composite z score of neuropsychological tests. Trait affectivity was assessed with the Positive and Negative Affect Schedule. Functional independence was assessed with the Barthel Index and Lawton Instrumental Activities of Daily Living Scale. RESULTS: Health self-efficacy correlated moderately with functional independence. A moderation threshold effect was detected that revealed for whom health self-efficacy predicted functional independence. Among participants with normal to mildly impaired cognition (>-2 z cognitive composite), health self-efficacy correlated positively with functional independence, which held after accounting for trait affectivity. In contrast, health self-efficacy was not correlated with functional independence among participants with greater impairment (<-2 z cognitive composite). CONCLUSIONS: Health self-efficacy predicts functional independence and may serve as a protective factor after ABI among individuals with relatively intact cognition. However, health self-efficacy does not predict functional independence among individuals with moderate or severe cognitive impairment, possibly due to limited self-awareness. This study extends the literature linking health self-efficacy with rehabilitation outcomes and reinforces the need for promoting self-management in ABI. (PsycINFO Database Record (c) 2018 APA, all rights reserved). Parker, HA, Rapport, LJ, Williams, MW, Hanks, RA, Lumley, MA, Bogg, TSoutheastern Michigan Traumatic Brain Injury System Yescheberle
2019Understanding Health-related Quality of Life in Caregivers of Civilians and Service Members/Veterans With Traumatic Brain Injury: Establishing the Reliability and Validity of PROMIS Mental Health MeasuresArchives of Physical Medicine and Rehabilitation1004SS94-S101https://www.ncbi.nlm.nih.gov/pubmed/29932885To provide important reliability and validity data to support the use of the Patient-Reported Outcomes Measurement Information System (PROMIS) mental health measures in caregivers of civilians or service members/veterans (SMVs) with traumatic brain injury (TBI). Carlozzi, NE, Hanks, R, Lange, RT, Brickell, TA, Ianni, PA, Miner, JA, French, LM, Kallen, MA, Sander, AMSoutheastern Michigan Traumatic Brain Injury System , Texas TBI Model System of TIRRYesmbelay
2013Education quality, reading recognition, and racial differences in the neuropsychological outcome from traumatic brain injury.JournalArchives of Clinical Neuropsychology285485-91https://www.ncbi.nlm.nih.gov/pubmed/23858087Ethnically diverse examinees tend to perform lower on neuropsychological tests. The practice of adjusting normative comparisons for the education level and/or race to prevent overpathologizing low scores is problematic. Education quality, as measured by reading recognition, appears to be a more accurate benchmark for premorbid functioning in certain populations. The present study aimed to extend this line of research to traumatic brain injury (TBI). We hypothesized that a measure of reading recognition, the Wechsler Test of Adult Reading (WTAR), would account for racial differences in neuropsychological performance after TBI. Fifty participants (72% African American, 28% Caucasian) with moderate to severe TBI underwent neuropsychological testing at 1-year post-injury. Reading recognition accounted for all the same variance in neuropsychological performance as race and education (together), as well as considerable additional variance. Estimation of premorbid functioning in African Americans with TBI could be refined by considering reading recognition. Silverberg, ND, Hanks, RA, Tompkins, SCSoutheastern Michigan Traumatic Brain Injury System Yescheberle
2019Determining a transitional scoring link between PROMIS pediatric and adult physical health measures.JournalQuality of Life Research2851217-1229https://www.ncbi.nlm.nih.gov/pubmed/30539361PURPOSE: Having independent versions of the PROMIS® scales (for Pediatric and Adults) is problematic as scores cannot be evaluated longitudinally as individuals move from childhood into adulthood. The primary aim of this research project is to use item response theory (IRT) to develop a transitional scoring link (or "crosswalk") between the PROMIS adult and pediatric physical health measures. SETTING: Sample 1 was collected at 6 rehabilitation hospitals in the U.S., and participants in Sample 2 were recruited from public health insurance programs and an online research panel. METHODS: PROMIS pediatric and adult physical function, mobility, upper extremity, fatigue, and pain measures were administered to a sample of 874 individuals aged 14-20 years old with special health needs and a sample of 641 individuals aged 14-25 years with a disability. IRT-based scores were linked using a linear approximation to calibrated projection. RESULTS: Estimated latent variable correlations ranged between 0.84 and 0.95 for the PROMIS pediatric and adult scores. Root Expected Mean Square Difference values were below the 0.08 threshold in all cases except when comparing genders on the Mobility (0.097) and Pain (0.10) scales in the special health care needs sample. Sum score conversion tables for the pediatric and adult PROMIS measures are presented. CONCLUSIONS: The linking coefficients can be used to calculate scale scores on PROMIS adult measures from pediatric measure scores and vice versa. This may lead to more accurate measurement in cross-sectional studies spanning multiple age groups or longitudinal studies that require comparable measurement across distinct developmental stages. Tulsky, DS, Kisala, PA, Boulton, AJ, Jette, AM, Thissen, D, Ni, P, DeWalt, DA, Huang, IC, Liu, Y, Mulcahey, MJ, Slavin, M, Magnus, B, Crump, H, Hanks, R, Charlifue, S, Reeve, BBSpaulding-Harvard Traumatic Brain Injury Model System, Moss Traumatic Brain Injury Model System, Southeastern Michigan Traumatic Brain Injury System , Rocky Mountain Regional Brain Injury SystemYescheberle
2019Detecting malingering in traumatic brain injury: Combining response time with performance validity test accuracy.JournalClinical Neuropsychologist33190-107https://www.ncbi.nlm.nih.gov/pubmed/29469640OBJECTIVE: The present study examined the incremental utility of item-level response time (RT) variables on a traditional performance validity test in distinguishing adults with verified TBI from adults coached to feign neurocognitive impairment. METHOD: Participants were 45 adults with moderate to severe TBI, 45 healthy adults coached to feign neurocognitive impairment (SIM), and 61 healthy adult comparisons providing full effort (HC). All participants completed a computerized version of the Test of Memory Malingering (TOMM-C) in the context of a larger test battery. RT variables examined along with TOMM-C accuracy scores included mean RTs (Trial 1, Trial 2, correct and incorrect trials) and RT variability indices. RESULTS: Several RT indices differed significantly across the groups. In general, SIM produced longer, more variable RTs than HC and TBI. Of the RT indices, average RT for Trial 1 and 2 were the best predictors of group membership; however, classification accuracies were greatly influenced by the groups being compared. Average RT for Trial 1 and 2 showed excellent discrimination of SIM and HC. All RT indices were less successful in discriminating SIM and TBI. Average RT for Trial 1 and 2 added incremental predictive value to TOMM-C accuracy in distinguishing SIM from TBI. CONCLUSION: Findings contribute to a limited body of research examining the incremental utility of combining RT with traditional PVTs in distinguishing feigned and bona fide TBI. Findings support the hypothesis that combining RT with TOMM-C accuracy can improve its diagnostic accuracy. Future research with other groups of clinical interest is recommended. Kanser, RJ, Rapport, LJ , Bashem, JR, Hanks, RASoutheastern Michigan Traumatic Brain Injury System Nocheberle
2016Correlates of Resilience in the First 5 Years After Traumatic Brain InjuryJournalRehabilitation Psychology613269-276https://www.ncbi.nlm.nih.gov/pubmed/26855130PURPOSE/OBJECTIVE: To examine resilience in the context of adjustment to traumatic brain injury (TBI), including the relative roles of demographic and theoretically related constructs such as coping, social support, and positive affectivity on resilience within the first 5 years postinjury. RESEARCH METHOD/DESIGN: This was a cross-sectional, observational study of 67 persons with medically documented mild complicated to severe TBI. Participants completed a battery of measures including cognitive tests; questionnaires assessing self-report of emotional symptoms, perceived social support, and coping style; and a measure of resilience. RESULTS: Approximately 60% of the sample endorsed moderate to high levels of resilience during the first 5 years postinjury. Brain injury severity, premorbid intelligence, and cognitive flexibility did not predict resilience, as measured by the Connor-Davidson Resilience Scale. By contrast, task-oriented coping and perceived social support were strong and unique covariates of resilience. Positive and negative affectivity were related to resilience but were not unique covariates of it in the presence of task-oriented coping and perceived social support. Discriminant validity of resilience as a concept and the means of assessing it was supported by findings that emotion-oriented and avoidance coping were not meaningfully related to resilience. CONCLUSIONS/IMPLICATIONS: Overall, the findings indicate that the majority of individuals in this sample reported high levels of resilience after brain injury and that correlates of resilience in adults with TBI is similar to that observed in adults without the history of cognitive impairment.  Hanks, RA, Rapport, LJ , Waldron Perrine, B, Millis, SRSoutheastern Michigan Traumatic Brain Injury System Yescheberle
2014Comparisons of Five Performance Validity Indices in Bona Fide and Simulated Traumatic Brain InjuryJournalThe Clinical Neuropsychologist285851-875https://www.ncbi.nlm.nih.gov/pubmed/24983387A number of performance validity tests (PVTs) are used to assess memory complaints associated with traumatic brain injury (TBI); however, few studies examine the concordance and predictive accuracy of multiple PVTs, specifically in the context of combined models in known-group designs. The present study compared five widely used PVTs: the Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), Reliable Digit Span (RDS), Word Choice Test (WCT), and California Verbal Learning Test - Forced Choice (CVLT-FC). Participants were 51 adults with bona fide moderate to severe TBI and 58 demographically comparable healthy adults coached to simulate memory impairment. Classification accuracy of individual PVTs was evaluated using logistic regression and receiver operating characteristic (ROC) curves, examining both the dichotomous cutting scores as recommended by the test publishers and continuous scores for the measures. Results demonstrated nearly equivalent discrimination ability of the TOMM, MSVT, and CVLT-FC as individual predictors, all of which markedly outperformed the WCT and RDS. Models of combined PVTs were examined using Bayesian information criterion statistics, with results demonstrating that diagnostic accuracy showed only small to modest growth when the number of tests was increased beyond two. Considering the clinical and pragmatic issues in deriving a parsimonious assessment battery, these findings suggest that using the TOMM and CVLT in conjunction or the MSVT and CVLT in conjunction maximized predictive accuracy as compared to a single index or an assortment of these widely used measures. Bashem, JR, Rapport, LJ, Miller, JB, Hanks, RA, Axelrod, BN, Millis, SRSoutheastern Michigan Traumatic Brain Injury System Yescheberle
2013Assessing Effort: Differentiating Performance and Symptom ValidityJournalThe Clinical Neuropsychologist2781234-1246https://www.ncbi.nlm.nih.gov/pubmed/24028487The current study aimed to clarify the relationship among the constructs involved in neuropsychological assessment, including cognitive performance, symptom self-report, performance validity, and symptom validity. Participants consisted of 120 consecutively evaluated individuals from a veteran's hospital with mixed referral sources. Measures included the Wechsler Adult Intelligence Scale-Fourth Edition Full Scale IQ (WAIS-IV FSIQ), California Verbal Learning Test-Second Edition (CVLT-II), Trail Making Test Part B (TMT-B), Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), WAIS-IV Reliable Digit Span (RDS), Post-traumatic Check List-Military Version (PCL-M), MMPI-2 F scale, MMPI-2 Symptom Validity Scale (FBS), MMPI-2 Response Bias Scale (RBS), and the Postconcussive Symptom Questionnaire (PCSQ). Six different models were tested using confirmatory factor analysis (CFA) to determine the factor model describing the relationships between cognitive performance, symptom self-report, performance validity, and symptom validity. The strongest and most parsimonious model was a three-factor model in which cognitive performance, performance validity, and self-reported symptoms (including both standard and symptom validity measures) were separate factors. The findings suggest failure in one validity domain does not necessarily invalidate the other domain. Thus, performance validity and symptom validity should be evaluated separately. Van Dyke, SA, Millis, SR, Axelrod, BN, Hanks, RASoutheastern Michigan Traumatic Brain Injury System Yescheberle
2019The Development of a New Computer Adaptive Test to Evaluate Feelings of Being Trapped in Caregivers of Individuals With Traumatic Brain Injury: TBI-CareQOL Feeling Trapped Item BankArchives of Physical Medicine and Rehabilitation1004SS43-S51https://www.ncbi.nlm.nih.gov/pubmed/30075146To develop a new patient-reported outcome measure that captures feelings of being trapped that are commonly experienced by caregivers of individuals with traumatic brain injury (TBI). Carlozzi, NE, Kallen, MA, Hanks, R, Kratz, AL, Hahn, EA, Brickell, TA, Lange, RT, French, LM, Ianni, PA, Miner, JA, Sander, AMSoutheastern Michigan Traumatic Brain Injury System Yesmbelay
2012Symptom validity indicators embedded in the Controlled Oral Word Association TestThe Clinical Neuropsychologist2671230-41https://www.ncbi.nlm.nih.gov/pubmed/22856612Embedded symptom validity measures facilitate the detection of below-capacity performance in neuropsychological assessment. A number of such indicators have been proposed for the Controlled Oral Word Association Test (COWAT), a widely used test of word generation. However, several of these embedded indicators have not been cross-validated and it is currently unclear which represent the optimal combination of predictors. This study used Bayesian Model Averaging (BMA) to determine the set of predictors that best differentiate between patients presenting with (n = 46) and without (n = 55) malingered neurocognitive dysfunction (MND). Mild traumatic brain injury was the most common diagnosis in the MND group (96%). BMA selected the COWAT total score and a measure of change in output over time. A logistic regression model combining these variables yielded good discriminability, with an AUC of. 774, (95% confidence interval = .679 to. 869), 78% of cases were classified correctly, with 67% sensitivity and 88% specificity. Two alternative models performed similarly, but the variables involved required slightly longer administration and/or calculation time, making them somewhat less desirable. These results support the use of a weighted combination of embedded symptom validity measures in the COWAT. Johnson, SC, Silverberg, ND, Millis, SR, Hanks, RASoutheastern Michigan Traumatic Brain Injury System Yesmbelay
2016Susceptibility Weighted Imaging and Mapping of Micro-Hemorrhages and Major Deep Veins after Traumatic Brain InjuryJournal of Neurotrauma33110-21https://www.ncbi.nlm.nih.gov/pubmed/25789581Micro-hemorrhages are a common result of traumatic brain injury (TBI), which can be quantified with susceptibility weighted imaging and mapping (SWIM), a quantitative susceptibility mapping approach. A total of 23 TBI patients (five women, 18 men; median age, 41.25 years old; range, 21.69-67.75 years) with an average Glasgow Coma Scale score of 7 (range, 3-15) at admission were recruited at mean 149 d (range, 57-366) after injury. Susceptibility-weighted imaging data were collected and post-processed to create SWIM images. The susceptibility value of small hemorrhages (diameter ≤10 mm) and major deep veins (right septal, left septal, central septal, right thalamostriate, left thalamostriate, internal cerebral, right basal vein of Rosenthal, left basal vein of Rosenthal, and pial veins) were evaluated. Different susceptibility thresholds were tested to determine SWIM's sensitivity and specificity for differentiating hemorrhages from the veins. A total of 253 deep veins and 173 small hemorrhages were identified and evaluated. The mean susceptibility of hemorrhages was 435±206 parts per billion (ppb) and the mean susceptibility of deep veins was 108±56 ppb. Hemorrhages showed a significantly higher susceptibility than all deep veins (p<0.001). With different thresholds (250, 227 and 200 ppb), the specificity was 97%, 95%, and 92%, and the sensitivity was 84%, 90%, and 92%, respectively. These results show that SWIM could be used to differentiate hemorrhages from veins in TBI patients in a semi-automated manner with reasonable sensitivity and specificity. A larger cohort will be needed to validate these findings. Liu, J, Xia, S, Hanks, R, Wiseman, N, Peng, C, Zhou, S, Haacke, EM, Kou, ZSoutheastern Michigan Traumatic Brain Injury System Yesmbelay
2019Survey response burden in caregivers of civilians and service members/veterans with traumatic brain injuryDove Press Journal: Patient Related Outcomes Measures1059-66https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398416/Caregivers have expressed interest in survey research, yet there is limited information available about survey response burden, ie, the time, effort, and other demands needed to complete the survey. This may be particularly important for caregivers due to excessive time demands and/or stress associated with caregiving. Hahn, EA, Ianni, PH, Hanks, RA, Miner, JA, Freedman, J, Carlozzi, NESoutheastern Michigan Traumatic Brain Injury System Yesmbelay
2019Sociocultural Factors Influencing Caregiver Appraisals Following Traumatic Brain InjuryArchives of Physical Medicine and Rehabilitation1004SS58-S64https://www.ncbi.nlm.nih.gov/pubmed/30365926To investigate the association of the sociocultural variables race/ethnicity, education, and poverty level to caregivers' positive and negative appraisals following traumatic brain injury. Sander, AM, Hanks, RA, Ianni, PA, Boileau, NR, Kratz, AL, Hahn, EA, Tulsky, DS, Carlozzi, NESoutheastern Michigan Traumatic Brain Injury System , Texas TBI Model System of TIRRYesmbelay
2017Role of resilience in the rehabilitation of adults with acquired brain injuryBrain injury312131-139https://www.ncbi.nlm.nih.gov/pubmed/28055235The goals of this review paper are to present an overview of the literature on resilience in adults with ABI, to describe approaches to measuring resilience in clinical practice and to discuss practical suggestions for promoting resilience in rehabilitation of adults with ABI. Neils-Strunjas, J, Paul, D, Clark, AN, Mudar, R, Duff, MC, Waldron-Perrine, B, Bechtold, KTSoutheastern Michigan Traumatic Brain Injury System , Texas TBI Model System of TIRRYesmbelay
2019Predictive validity of a brief outpatient neuropsychological battery in individuals 1-25 years post traumatic brain injuryThe Clinical Neuropsychologist3071074-86https://www.ncbi.nlm.nih.gov/pubmed/27270111The purpose of this research was to examine the predictive validity of a brief, outpatient neuropsychological battery relative to concurrent functional outcomes 1-25 years post traumatic brain injury. Hanks, RA, Jackson, AM, Crisanti, LKSoutheastern Michigan Traumatic Brain Injury System Yesmbelay
2012Performance validity and neuropsychological outcomes in litigants and disability claimantsThe Clinical Neuropsychologist265850-65https://www.ncbi.nlm.nih.gov/pubmed/22630329This study examined the relationship of performance validity and neuropsychological outcomes in a sample of individuals referred for independent neuropsychological examination in the context of reported traumatic brain injury (82% mild). Archival data were examined on 175 participants aged 20 to 65 who were administered at least two performance validity measures. Participants who passed all effort measures (Pass; n = 61) outperformed those who failed two or more (Fail; n = 70) on the majority of tests in the neuropsychological battery. The Fail group showed a higher percentage of impaired test scores than the Pass group with impairment defined at three levels (T scores < 40, 35, and 30). At the most conservative impairment cutoff (T < 30), 16% of the Pass group demonstrated impaired scores on more than three measures, while 79% of the Fail group showed impaired scores on more than three measures. The number of effort measures failed correlated highly with the overall test battery mean (r = -.73). On cognitive domain summary scores, effect sizes based on levels of effort (d = 1.12 to 1.86) were higher than those based on injury severity (d = 0.03 to 0.36). Davis, JJ, McHugh, TS, Axelrod, BN, Hanks, RASoutheastern Michigan Traumatic Brain Injury System Yesmbelay
2019Outcomes after Concussion Recovery Education: Effects of Litigation and Disability Status on Maintenance of SymptomsJournal of Neurotrauma364554-558https://www.ncbi.nlm.nih.gov/pubmed/30117361This study examined the hypothesis that people who receive concussion recovery education would have better outcomes than those who received usual discharge paperwork from the emergency department (ED) and tested whether participants who were in litigation or seeking disability compensation had more symptoms than individuals not engaged in these activities. Two hundred and fifty-five persons with a diagnosis of concussion were assigned randomly to a brief education group (one-page double-sided document), a longer education group (10-page document), and usual care (standard ED discharge instructions), and were these documents in the ED. A (non-concussion) trauma comparison group was enrolled to determine the symptom rate unrelated to brain injury. The Concussion Symptom Checklist (CSC) and litigation and disability status questions were completed by telephone at one week, three months, and six months. Neither long nor brief information handouts had a significant impact on symptoms over time; the standard form had an average decrease of 1.20 symptoms compared with the brief instructional intervention group (p = 0.031). Litigation status and disability seeking status were significant predictors of symptoms on CSC over time: disability seeking (p = 0.017) and litigation status (p = 0.05). Persons seeking Social Security disability or legal compensation endorsed more symptoms over time than those who were not. Number of symptoms on the CSC for the trauma control group was the same as those who sustained concussion. Type of recovery material was not as important as noting that concussion symptoms resolve over time, and that remaining symptoms are not specific to brain injury. Litigation and disability seeking behavior accounted for maintained symptoms, rather than the concussion itself. Hanks, RA, Rapport, LJ, Seagly, K, Millis, SR, Scott, C, Pearson, CSoutheastern Michigan Traumatic Brain Injury System Yesmbelay
2019Return to productivity projections for individuals with moderate to severe TBI following inpatient rehabilitation: A NIDILRR TBIMS and CDC interagency collaborationJournalThe Journal of Head Trauma RehabilitationepubOBJECTIVE: Return to work and school following traumatic brain injury (TBI) is an outcome of central importance both to TBI survivors and to society. The current study estimates the probability of returning to productivity over 5 years following moderate to severe brain injury. DESIGN: A secondary longitudinal analysis using random effects modeling, that is, individual growth curve analysis based on a sample of 2542 population-weighted individuals from a multicenter cohort study. SETTING: Acute inpatient rehabilitation facilities. PARTICIPANTS: Individuals 16 years and older with a primary diagnosis of TBI who were engaged in school or work at the time of injury. MAIN OUTCOME MEASURES: Participation in productive activity, defined as employment or school, as reported during follow-up telephone interviews at 1, 2, and 5 years postinjury. RESULTS: Baseline variables, age of injury, race, level of education and occupational category at the time of injury, disability rating at hospital discharge, substance abuse status, and rehabilitation length of stay, are significantly associated with probability of return to productivity. Individual-level productivity trajectories generally indicate that the probability of returning to productivity increases over time. CONCLUSIONS: Results of this study highlight the importance of preinjury occupational status and level of education in returning to productive activity following moderate to severe TBI. Pretz, CR, Kowalski, RG, Cuthbert, JP, Ketchum, JM, Whiteneck, GG, Dams-O’Connor, KRocky Mountain Regional Brain Injury System, New York Traumatic Brain Injury Model SystemYescheberle
2018Longitudinal Examination of Resilience After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems StudyJournalArchives of Physical Medicine and Rehabilitation992264-271https://www.ncbi.nlm.nih.gov/pubmed/28734937To evaluate (1) the trajectory of resilience during the first year after a moderate-severe traumatic brain injury (TBI); (2) factors associated with resilience at 3, 6, and 12 months postinjury; and (3) changing relationships over time between resilience and other factors. Marwitz, JH, Sima, AP, Kreutzer, JS, Dreer, LE, Bergquist, TF, Zafonte, R, Johnson-Greene, D, Felix, ERVirginia Commonwealth Traumatic Brain Injury Model System, UAB Traumatic Brain Injury Model System, Mayo Clinic Traumatic Brain Injury Model System , Spaulding-Harvard Traumatic Brain Injury Model System, South Florida Traumatic Brain Injury Model SystemYesmbelay
2018Thirty Years of National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Center Research—An UpdateJournalJournal of Head Trauma Rehabilitation336363-374https://www.ncbi.nlm.nih.gov/pubmed/30395041The Traumatic Brain Injury Model Systems Center (TBIMSC) program was established by the National Institute on Disability, Independent Living, and Rehabilitation Research in 1987, with the goal of conducting research to improve the care and outcomes for individuals with moderate-to-severe traumatic brain injury (TBI). This article provides an update on TBIMSC research program activities since 2010 when a similar article was published. It includes (1) discussion of TBIMSC program management and infrastructure; (2) detail on the management, data quality, access, use, and knowledge translation of the TBIMSC National Database, with more than 16 000 participants with follow-up out to 25 years postinjury to date; (3) an overview of the TBIMSC site-specific studies and collaborative module research; (4) highlights of several collaborative initiatives between the TBIMSCs and other federal, advocacy, and research stakeholders; (5) an overview of the vast knowledge translation occurring through the TBIMSC program; and (6) discussion of issues that impact on the data collection methods for and contents of the TBIMSC National Database. On the occasion of the 30th anniversary of the TBIMSC program, this article highlights many of the accomplishments of this well-established, multicenter TBI research consortium. Dijkers, MP, Marwitz, JH, Harrison-Felix, CNew York Traumatic Brain Injury Model System, Virginia Commonwealth Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury SystemYesmbelay
2018Traumatic brain injury education for adult patients and families: a scoping reviewJournalBrain injury32111295-1306https://www.ncbi.nlm.nih.gov/pubmed/30084694Traumatic brain injury (TBI) is increasingly viewed as a chronic condition, bringing long-term needs for patient and caregiver knowledge pertaining to symptom and problem management over time. In light of these needs, we performed a scoping review of the literature on brain injury education provided to adult patients and/ or family members affected by TBI. Objectives were to describe the types of educational interventions that have been developed; to review the effects of these interventions; and to determine gaps that might be filled by future research efforts. Of 88 articles meeting search criteria and subjected to data extraction, 34 concerned education about mild TBI and 54, moderate to severe TBI. Most mild TBI articles focused on education in the Emergency Room, while most moderate/ severe TBI education was directed toward family members/ caregivers and was frequently combined with other treatment components, making the effects of education difficult to discern. Only 1 article incorporated elements of self-management training (SMT), a model proved effective in other chronic health conditions. We recommend further exploration of SMT principles in long-term TBI care, as well as more precise definition of treatment components in all patient and family interventions, so that the specific effects of education and other treatment elements may be more readily evaluated. Hart, T, Driver, S, Sander, A, Pappadis, M, Dams-O'Connor, K, Bocage, C, Hinkens, E, Dahdah, MN, Cai, XMoss Traumatic Brain Injury Model System, North Texas Traumatic Brain Injury Model System, Texas TBI Model System of TIRR, New York Traumatic Brain Injury Model SystemYesmbelay
2018Amantadine Did Not Positively Impact Cognition in Chronic Traumatic Brain Injury: A Multi-Site, Randomized, Controlled TrialJournalJournal of Neurotrauma35192298-2305https://www.ncbi.nlm.nih.gov/pubmed/29742960Despite limited evidence to support the use of amantadine to enhance cognitive function after traumatic brain injury (TBI), the clinical use for this purpose is highly prevalent and is often based on inferred belief systems. The aim of this study was to assess effect of amantadine on cognition among individuals with a history of TBI and behavioral disturbance using a parallel-group, randomized, double-blind, placebo-controlled trial of amantadine 100 mg twice-daily versus placebo for 60 days. Included in the study were 119 individuals with two or more neuropsychological measures greater than 1 standard deviation below normative means from a larger study of 168 individuals with chronic TBI (>6 months post-injury) and irritability. Cognitive function was measured at treatment days 0, 28, and 60 with a battery of neuropsychological tests. Composite indices were generated: General Cognitive Index (included all measures), a Learning Memory Index (learning/memory measures), and Attention/Processing Speed Index (attention and executive function measures). Repeated-measures analysis of variance revealed statistically significant between-group differences favoring the placebo group at day 28 for General Cognitive Index (p = 0.002) and Learning Memory Index (p = 0.001), but not Attention/Processing Speed Index (p = 0.25), whereas no statistically significant between-group differences were found at day 60. There were no statistically significant between-group differences on adverse events. Cognitive function in individuals with chronic TBI is not improved by amantadine 100 mg twice-daily. In the first 28 days of use, amantadine may impede cognitive processing. However, the effect size was small and mean scores for both groups were generally within expectations for persons with history of complicated mild-to-severe TBI, suggesting that changes observed across assessments may not have functional significance. The use of amantadine to enhance cognitive function is not supported by these findings. Hammond, FM, Sherer, M, Malec, JF, Zafonte, RD, Dikmen, S, Bogner, J, Bell, KR, Barber, J, Temkin, NIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Carolinas Traumatic Brain Injury Rehabilitation and Research System, Texas TBI Model System of TIRR, Spaulding-Harvard Traumatic Brain Injury Model System, University of Washington Traumatic Brain Injury Model System, Ohio Regional Traumatic Brain Injury Model System , North Texas Traumatic Brain Injury Model SystemYesmbelay
2018Physical, Cognitive, and Psychosocial Characteristics Associated with Mortality in Chronic TBI Survivors: A National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems StudyJournalJournal of Head Trauma Rehabilitation334237-245https://www.ncbi.nlm.nih.gov/pubmed/29271788To compare a group of individuals who died more than 1 year posttraumatic brain injury (TBI) with a matched group of survivors and to identify physical function, cognitive function, and/or psychosocial function variables associated with mortality. OʼNeil-Pirozzi, TM, Ketchum, JM, Hammond, FM, Philippus, A, Weber, E, Dams-OʼConnor, KSpaulding-Harvard Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Northern New Jersey Traumatic Brain Injury System , New York Traumatic Brain Injury Model SystemYesmbelay
2019Relationship Between Hispanic Nativity, Residential Environment, and Productive Activity Among Individuals With Traumatic Brain Injury: A TBI Model Systems StudyJournalJournal of Head Trauma Rehabilitation341E46-E54https://www.ncbi.nlm.nih.gov/pubmed/29863616To examine the influence of nativity and residential characteristics on productive activity among Hispanics at 1 year after traumatic brain injury (TBI). Lequerica, AH, Botticello, A, OʼNeill, J, Lengenfelder, J, Krch, D, Chiaravalloti, ND, Sander, AM, Bushnik, T, Ketchum, JM, Hammond, FM, Dams-OʼConnor, K, Felix, E, Johnson-Greene, DNorthern New Jersey Traumatic Brain Injury System , Texas TBI Model System of TIRR, Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, New York Traumatic Brain Injury Model System, South Florida Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury SystemYesmbelay
2019A randomized controlled trial protocol for people with traumatic brain injury enrolled in a healthy lifestyle program (GLB-TBI)JournalContemporary Clinical Trails Communicationshttps://www.ncbi.nlm.nih.gov/pubmed/30775611Weight gain is prevalent among people with traumatic brain injury (TBI) and may be attributable to environmental or injury-specific factors such as mobility impairment, endocrine dysfunction, behavioral and emotional disorders, and sensory loss. Few weight management programs exist to meet the unique needs of this population. Researchers modified a nationally recognized, evidence-based weight-loss program, Group Lifestyle Balance™ (GLB), to address the needs of over-weight and obese people post TBI (GLB-TBI). This current randomized controlled trial (RCT) examines the efficacy of the GLB-TBI on weight and secondary outcomes compared to an attention control educational support group. Furthermore, researchers have developed a mobile technology app to further engage participants in the program. This RCT will enroll and randomize 66 participants over a two-year period. It is anticipated that findings from this current RCT will contribute to the knowledge and evidence for an effective weight-loss intervention among this underserved population, with a goal of achieving full recognition by the Centers for Disease Control and Prevention-National Diabetes Prevention Program and subsequent Center for Medicare and Medicaid Services reimbursement for participation. Driver, S, Juengst S,, McShan, EE, Bennett, M, Bell, K, Dubiel, RNorth Texas Traumatic Brain Injury Model SystemYesmbelay
2019Predictive utility of an adapted Marshall head CT classification scheme after traumatic brain injuryJournalBrain injury335610-617https://www.ncbi.nlm.nih.gov/pubmed/30663426To study the predictive relationship among persons with traumatic brain injury (TBI) between an objective indicator of injury severity (the adapted Marshall computed tomography [CT] classification scheme) and clinical indicators of injury severity in the acute phase, functional outcomes at inpatient rehabilitation discharge, and functional and participation outcomes at 1 year after injury, including death. Brown, AW, Pretz, CR, Bell, KR, Hammond, FM, Arciniegas, DB, Bodien, YG, Dams-O'Connor, K, Giacino, JT, Hart, T, Johnson-Greene, D, Kowalski, RG, Walker, WC, Weintraub, A, Zafonte, RMayo Clinic Traumatic Brain Injury Model System , Rocky Mountain Regional Brain Injury System, North Texas Traumatic Brain Injury Model System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Texas TBI Model System of TIRR, Spaulding-Harvard Traumatic Brain Injury Model System, New York Traumatic Brain Injury Model System, Moss Traumatic Brain Injury Model System, Virginia Commonwealth Traumatic Brain Injury Model SystemYesmbelay
2019Detecting malingering in traumatic brain injury: Combining response time with performance validity test accuracy.JournalThe Clinical Neuropsychologist33190-107https://www.ncbi.nlm.nih.gov/pubmed/29469640OBJECTIVE: The present study examined the incremental utility of item-level response time (RT) variables on a traditional performance validity test in distinguishing adults with verified TBI from adults coached to feign neurocognitive impairment. METHOD: Participants were 45 adults with moderate to severe TBI, 45 healthy adults coached to feign neurocognitive impairment (SIM), and 61 healthy adult comparisons providing full effort (HC). All participants completed a computerized version of the Test of Memory Malingering (TOMM-C) in the context of a larger test battery. RT variables examined along with TOMM-C accuracy scores included mean RTs (Trial 1, Trial 2, correct and incorrect trials) and RT variability indices. RESULTS: Several RT indices differed significantly across the groups. In general, SIM produced longer, more variable RTs than HC and TBI. Of the RT indices, average RT for Trial 1 and 2 were the best predictors of group membership; however, classification accuracies were greatly influenced by the groups being compared. Average RT for Trial 1 and 2 showed excellent discrimination of SIM and HC. All RT indices were less successful in discriminating SIM and TBI. Average RT for Trial 1 and 2 added incremental predictive value to TOMM-C accuracy in distinguishing SIM from TBI. CONCLUSION: Findings contribute to a limited body of research examining the incremental utility of combining RT with traditional PVTs in distinguishing feigned and bona fide TBI. Findings support the hypothesis that combining RT with TOMM-C accuracy can improve its diagnostic accuracy. Future research with other groups of clinical interest is recommended. Kanser, RJ, Rapport, LJ, Bashem, JR, Hanks, RASoutheastern Michigan Traumatic Brain Injury System Yesmbelay
2018Predicting long-term global outcome after traumatic brain injury (TBI): Development of a practical prognostic tool using the TBI Model Systems National DatabaseJournalJournal of Neurotrauma35141587-1595https://www.ncbi.nlm.nih.gov/pubmed/29566600For patients surviving serious traumatic brain injury (TBI), families and other stakeholders often desire information on long-term functional prognosis, but accurate and easy-to-use clinical tools are lacking. We aimed to build utilitarian decision trees from commonly collected clinical variables to predict Glasgow Outcome Scale (GOS) functional levels at 1, 2, and 5 years after moderate-to-severe closed TBI. Flexible classification tree statistical modeling was used on prospectively collected data from the TBI-Model Systems (TBIMS) inception cohort study. Enrollments occurred at 17 designated, or previously designated, TBIMS inpatient rehabilitation facilities. Analysis included all participants with nonpenetrating TBI injured between January 1997 and January 2017. Sample sizes were 10,125 (year-1), 8,821 (year-2), and 6,165 (year-5) after cross-sectional exclusions (death, vegetative state, insufficient post-injury time, and unavailable outcome). In our final models, post-traumatic amnesia (PTA) duration consistently dominated branching hierarchy and was the lone injury characteristic significantly contributing to GOS predictability. Lower-order variables that added predictability were age, pre-morbid education, productivity, and occupational category. Generally, patient outcomes improved with shorter PTA, younger age, greater pre-morbid productivity, and higher pre-morbid vocational or educational achievement. Across all prognostic groups, the best and worst good recovery rates were 65.7% and 10.9%, respectively, and the best and worst severe disability rates were 3.9% and 64.1%. Predictability in test data sets ranged from C-statistic of 0.691 (year-1; confidence interval [CI], 0.675, 0.711) to 0.731 (year-2; CI, 0.724, 0.738). In conclusion, we developed a clinically useful tool to provide prognostic information on long-term functional outcomes for adult survivors of moderate and severe closed TBI. Predictive accuracy for GOS level was demonstrated in an independent test sample. Length of PTA, a clinical marker of injury severity, was by far the most critical outcome determinant. Walker, WC, Stromberg, KA, Marwitz, JH, Sima, AP, Agyemang, AA, Graham, KM, Harrison-Felix, C, Hoffman, JM, Brown, AW, Kreutzer, JS, Merchant, RVirginia Commonwealth Traumatic Brain Injury Model System, University of Washington Traumatic Brain Injury Model System, Mayo Clinic Traumatic Brain Injury Model System , Rocky Mountain Regional Brain Injury SystemYesmbelay
2018The Association of Rehospitalization With Participation 5 Years After Traumatic Brain InjuryJournalJournal of Head Trauma Rehabilitation336E77-E84https://www.ncbi.nlm.nih.gov/pubmed/29601342To determine whether rehospitalization during the first 2 years after moderate to severe traumatic brain injury (TBI) is associated with poor participation at 5 years post-TBI, after controlling for demographic and severity factors. Erler, KS, Juengst,SB, Whiteneck, GG, Locascio, JJ, Bogner, JA, Kaminski, J, Giacino, JTSpaulding-Harvard Traumatic Brain Injury Model System, North Texas Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, Ohio Regional Traumatic Brain Injury Model System Yesmbelay
2017Uncorrected versus demographically-corrected scores on the NIH Toolbox Cognition Battery in persons with traumatic brain injury and strokeJournalRehabilitation Psychology624485-495https://www.ncbi.nlm.nih.gov/pubmed/29265869The association between demographic characteristics and neurocognitive performance is well established; however, clinicians may have difficulty selecting when to use uncorrected versus demographically corrected scores. We compared these score types in individuals with traumatic brain injury (TBI) and stroke, on the National Institutes of Health Toolbox-Cognition Battery (NIHTB-CB). Nitsch, KP, Casaletto, KB, Carlozzi, NE, Tulsky, DS, Heinemann, AW, Heaton, RKMidwest Regional Traumatic Brain Injury Model SystemYesmbelay
2017NIH toolbox cognition tests following traumatic brain injury: Frequency of low scoresJournalRehabilitation Psychology624474-484https://www.ncbi.nlm.nih.gov/pubmed/29265868To apply multivariate base rate analyses to the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) to facilitate the identification of cognitive impairment in individuals with traumatic brain injury (TBI). Research Method/Design: In a multisite cross-sectional design, 158 participants who sustained a complicated mild or moderate TBI (n = 74) or severe TBI (n = 84) at least 1 year earlier were administered the NIHTB-CB. The NIHTB-CB is comprised of 2 crystallized cognition tests (reflecting premorbid ability) and 5 fluid cognition tests, measuring processing speed, memory, and executive functioning. Base rates for obtaining 0 to 5 low fluid cognition scores were calculated across a range of cutoffs for defining a low test score (≤25th to 5th percentiles). Base rates of low scores in the TBI sample were compared to the NIHTB-CB normative sample using diagnostic accuracy statistics. Holdnack, JA, Iverson, GL, Silverberg, ND, Tulsky, DS, Heinemann, AWMidwest Regional Traumatic Brain Injury Model SystemYesmbelay
2016Longitudinal sex and stress hormone profiles among reproductive age and post-menopausal women after severe TBI: A case series analysisJournalBrain injury304452-461https://www.ncbi.nlm.nih.gov/pubmed/26963638To describe hormone profiles for pre-/post-menopausal women, to monitor time to resumption of menstruation among pre-menopausal women and to describe cortisol associated LH suppression and phasic variation in other sex hormones over timeMethods and procedures: This study determined amenorrhea duration and characterized acute (days 0-7) and chronic (months 1-6) gonadotropins [luteinizing hormone and follicle stimulating hormone (LH, FSH)], sex hormones (progesterone, estradiol) and stress hormone (cortisol) profiles. Women were pre-menopausal (n = 3) or post-menopausal (n = 3). Among pre-menopausal women, menstrual cycle resolution and phase association (luteal/follicular) was monitored using self-report monthly reproductive history questionnaires. This study compared post-TBI hormone profiles, stratified by menopausal status, to hormone levels from seven controls and described 6- and 12-month outcomes for these women. Ranganathan, P, Kumar, RG, Davis, K, McCullough, EH, Berga, SL, Wagner, AKUniversity of Pittsburgh Model Center for Traumatic Brain Injury Yesmbelay
2017Post-traumatic epilepsy associations with mental health outcomes in the first two years after moderate to severe TBI: A TBI Model Systems analysisJournalEpilepsy and behavior73240-246https://www.ncbi.nlm.nih.gov/pubmed/28658654Research suggests that there are reciprocal relationships between mental health (MH) disorders and epilepsy risk. However, MH relationships to post-traumatic epilepsy (PTE) have not been explored. Thus, the objective of this study was to assess associations between PTE and frequency of depression and/or anxiety in a cohort of individuals with moderate-to-severe TBI who received acute inpatient rehabilitation. Juengst, SB, Wagner, AK, Ritter, AC, Szaflarski, JP, Walker, WC, Zafonte, RD, Brown, AW, Hammond, FM, Pugh, MJ, Shea, T, Krellman, JW, Bushnik, T, Arenth, PMSpaulding-Harvard Traumatic Brain Injury Model System, Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Mayo Clinic Traumatic Brain Injury Model System , Virginia Commonwealth Traumatic Brain Injury Model System, North Texas Traumatic Brain Injury Model SystemYesmbelay
2017Factors associated with remission of post-traumatic brain injury fatigue in the years following TBIJournalNeuropsychological rehabilitation2771019-1030https://www.ncbi.nlm.nih.gov/pubmed/27633955Post-traumatic brain injury fatigue (PTBIF) is a major problem in the years after traumatic brain injury (TBI), yet little is known about its persistence and resolution. The objective of the study was to identify factors related to PTBIF remission and resolution. TBI Model System registrants at five centres participated in interviews at either one and two years post-injury (Y1-2 Cohort), or two and five years post-injury (Y2-5 Cohort). Characteristics of participants with PTBIF remission were compared to those with PTBIF persistence. Variables studied included the presence of and changes in disability, sleep dysfunction, mood, and community participation. The Functional Independence Measure did not differ significantly between groups or over time. In the Y1-2 Cohort the Fatigue Resolved group scored significantly better on the Disability Rating Scale and Pittsburgh Sleep Quality Index. In the Y2-5 Cohort the Fatigue Resolved group scored significantly higher on a measure of community participation. It was concluded that fewer than half of the sample in each cohort experienced a remission of PTBIF between time points. Persistence of PTBIF 1-2 years post-injury is associated with disability, sleep disturbance, and depression while persistence of fatigue beyond 2 years post-injury appears to be related to participation level, underscoring the potential impact of effective surveillance, assessment, and treatment of this condition in optimising life after TBI. Differences in fatigue progression may point to the presence of different types of PTBIF. Lequerica, AH, Botticello, AL, Lengenfelder, J, Chiaravalloti, N, Bushnik, T, Dijkers, MP, Hammond, FM, Kolakowsky-Hayner, SA, Rosenthal, JNorthern New Jersey Traumatic Brain Injury System , Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, New York Traumatic Brain Injury Model System, Ohio Regional Traumatic Brain Injury Model System , Northern California Traumatic Brain Injury Model SystemYesmbelay
2019Outcome prediction from post-injury resilience in patients with TBI.JournalRehabilitation PsychologyepubPURPOSE/OBJECTIVE: The objective of the study was to evaluate the extent to which 1- and 2-year outcomes after traumatic brain injury (TBI) are predicted by resilience. Research Method/Design: This was an observational, longitudinal study of persons (n = 158) with moderate or severe TBI who completed both 1- and 2-year outcome assessments. Outcomes included anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), life satisfaction (Satisfaction with Life Scale), substance misuse, and return-to-work measures. The Connor-Davidson Resilience Scale was used to assess resilience at 3 or 6 months after injury. RESULTS: Greater resilience predicted less anxiety, depression, and substance use and better satisfaction with life and return to work at 1 year after injury for both adjusted and unadjusted models. Standardized regression coefficients were all greater than 0.38 for continuous outcomes, whereas odds ratios were 1.34 and 0.81 for the return to work and substance misuse outcomes, respectively (p < .05). Similar but weaker trends were found at 2 years after injury, with statistical significance no longer met for all outcomes. CONCLUSIONS/IMPLICATIONS: Resilience was shown to have predictive ability for outcomes at 1 and 2 years after TBI. Resilience appears to be a salient and important variable for long-term outcomes in person with TBI after adjusting for injury and demographic characteristics. (PsycINFO Database Record (c) 2019 APA, all rights reserved). Sima, Adam P., Yu, Hao, Marwitz, Jennifer H., Kreutzer, Jeffrey S., Kolakowsky-Hayner, Stephanie A., Bergquist, Thomas F., Whiteneck, GaleVirginia Commonwealth Traumatic Brain Injury Model System, New York Traumatic Brain Injury Model System, Mayo Clinic Traumatic Brain Injury Model System , Rocky Mountain Regional Brain Injury SystemYescheberle
2019Healthy lifestyle after traumatic brain injury: a brief narrativeJournalBrain InjuryepubIndividuals living with traumatic brain injury (TBI) are at an increased risk for developing chronic conditions such as diabetes, heart disease, and hypertension compared to the non-injured population. Furthermore, TBI-specific challenges such as physical limitations, pain, mood, and impaired cognition make it difficult to live a healthy lifestyle. Key health behaviors that contribute to overall health and well-being after TBI include physical activity and healthy eating, sleep, participation, eliminating substance abuse, and managing stress. The objectives of this narrative are to (1) describe the key components of a healthy lifestyle for individuals with a TBI, (2) identify the challenges that individuals with TBI face when attempting to establish these health behaviors, and (3) discuss approaches and supports to achieve these health behaviors after TBI, including the role of self-management. Driver, Simon, Juengst, Shannon, Reynolds, Megan, McShan, Evan, Kew, Chung Lin, Vega, Marlene, Bell, Kathleen, Dubiel, RandiNorth Texas Traumatic Brain Injury Model SystemYescheberle
2018Sleep after TBI: How the TBI Model Systems have advanced the fieldNeuroRehabilitation433287-296https://content.iospress.com/articles/neurorehabilitation/nre182538 Bell, Kathleen R, Bushnik, Tamara, Dams-O’Connor, Kristen, Goldin, Yelena, Hoffman, Jeanne M, Lequerica, Anthony H., Nakase-Richardson, Risa, Zumsteg, Jennifer MNorth Texas Traumatic Brain Injury Model System, Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, New York Traumatic Brain Injury Model System, JFK Johnson Rehabilitation Institute Traumatic Brain Injury Model System, University of Washington Traumatic Brain Injury Model System, Northern New Jersey Traumatic Brain Injury System Yesmbelay
2018The effects of statin treatment on outcomes following traumatic brain injuryJournal of NeurotraumaWhyte, J, Ketchum, J, Bogner, J, Brunner, R, Hammond, F, Zafonte, R, Whiteneck, G, Weintraub, AUAB Traumatic Brain Injury Model SystemYesmbelay
2018Obesity and overweight problems among individuals 1 to 25 years following acute rehabilitation for traumatic brain injury: A NIDILRR Traumatic Brain Injury Model Systems studyJournal of Head Trauma Rehabilitation33246-256Dreer, L, Ketchum, J, Novack, T, Bogner, J, Hammond, F, Felix, E, Corrigan, J, Johnson-Greene, DUAB Traumatic Brain Injury Model SystemYesmbelay
2019Employment stability in the first 5 years after moderate to severe traumatic brain injuryArchives of Physical Medicine and Rehabilitation100412-421DiSanto, D, Kumar, R, Juengst, S, Hart, T, O'Neil-Pirozzi, T, Zasler, N, Novack, T, Dillahunt-Aspillaga, C, Graham, K, Cotner, B, Rabinowitz, A, Dikmen, S, Niemeier, J, Kesinger, M, Wagner, AUAB Traumatic Brain Injury Model SystemYesmbelay
2019Longitudinal effects of medical comorbidities on functional outcome and life satisfaction after traumatic brain injury: An individual growth curve analysis of NIDILRR Traumatic Brain Injury MS dataJournal of Head Trauma RehabilitationMalec, J, Ketchum, J, Hammond, F, Corrigan, J, Dams-O-Conner, K, Hart, T, Novack, T, Dahdah, M, Whiteneck, G, Bogner, JUAB Traumatic Brain Injury Model SystemYesmbelay
2019Prevalence of medical and psychiatric comorbidities following traumatic brain injuryJournal of Head Trauma RehabilitationHammond F, Corrigan, J, Ketchum, J, Malec, J, Dams-O'connor, K, Hart, T, Novack, T, Bogner, J, Dahdah, M, Whiteneck, GUAB Traumatic Brain Injury Model SystemYesmbelay
2018Examining driving and participation 5 years after traumatic brain injury.JournalOTJR-OCCUPATION PARTICIPATION AND HEALTH383143-150https://www.ncbi.nlm.nih.gov/pubmed/29457535Participation is often considered a primary goal of traumatic brain injury (TBI) rehabilitation, but little is known about the influence of driving on participation after TBI. The objective of this study was to examine the independent contribution of driving status to participation at 5 years post TBI, after controlling for demographic, psychosocial, and functional factors. Participants ( N = 2,456) were community-dwelling individuals with moderate to severe TBI, age 18 to 65 at time of injury, and enrolled in the TBI Model Systems (TBIMS) National Database (NDB). Hierarchical linear regressions for the dependent variable of participation at 5 years post TBI were performed. Findings showed that driving was a highly significant independent predictor of participation and was a stronger relative predictor of participation than FIM® Cognitive, FIM® Motor, and depression. The independent contribution of driving to participation suggests the need to develop evidenced-based occupational therapy assessments and interventions that facilitate safe engagement in the occupation of driving to address the long-term goal of improved participation. Erler,K, Juengst, S, Smith, D, O'Neil-Pirozzi, T, Novack, T, Bergquist, T, Kaminski, J, Giancino, J, Whiteneck, GUAB Traumatic Brain Injury Model SystemYesmbelay
2014Measuring self-esteem after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Self-esteem item bank and short formJournalJ71742Journal of Spinal Cord Medicine138377-385Article describes the development and psychometric properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) Self-esteem item bank. Using a mixed-methods design, a self-esteem item bank was developed and tested through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item response theory-based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision. A pool of 30 items was tested at several medical institutions across the United States, including 5 SCI Model System centers and one Veterans Affairs medical center. A total of 717 individuals with SCI completed the self-esteem items. A unidimensional model was observed and measurement precision was good. Eleven items were flagged for DIF; however, effect sizes were negligible with little practical impact on score estimates. The final calibrated item bank resulted in 23 retained items. This study indicates that the SCI-QOL Self-esteem item bank represents a psychometrically robust measurement tool. Short-form items are also suggested and computer adaptive tests are available.Guller Y, Pan H, Iyer S, Leung L, Cohn R, Fuchs BH, Haley CJ, O'Neil-Pirozzi T, Giacino JT, Stern EYesdevopsadmin
2014Measuring Resilience after Spinal Cord Injury: Development, Validation and Psychometric Characteristics of the SCI-QOL Resilience Item Bank and Short FormJournalJ71741Journal of Spinal Cord Medicine138366-376Article describes the development and psychometric properties of the Spinal Cord Injury - Quality of Life (SCI-QOL) Resilience item bank and short form. Using a mixed-methods design, a resilience item bank was develop and tested through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item response theory based analytic approaches, including tests of model fit and differential item functioning (DIF). A 32-item pool was tested at several medical institutions across the United States; a total of 717 individuals with SCI completed the Resilience items. A unidimensional model was observed and measurement precision was good. Ten items were flagged for DIF; however, after examination of effect sizes, this was found to be negligible with little practical impact on score estimates. The final calibrated item bank resulted in 21 retained items. This study indicates that the SCI-QOL Resilience item bank is a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.Guller, Y. Pan, H. Iyer, S. Leung, L. Cohn, R. Fuchs, B. Haley, C. O'Neil-Pirozzi, T. Giacino, J. Stern, E.Yesdevopsadmin
2014Tracking Functional Status Across the Spinal Cord Injury Lifespan: Linking Pediatric and Adult Patient-Reported Outcome ScoresJournalJ70063Archives of Physical Medicine and Rehabilitation1952078-2085Study used item response theory (IRT) methods to link scores from 2 recently developed functional outcome measures for people with spinal cord injury (SCI), the adult Spinal Cord Injury-Functional Index (SCI-FI) and the Pedi SCI (both the parent version and the child version). Linking was conducted so that the adult SCI-FI and Pedi SCI scaled scores could be compared. Pedi SCI items were administered to a sample of 381 children with SCI aged 8 to 21 years, and of 322 parents/caregivers of children with SCI aged 4 to 21 years. Adult SCI-FI items were administered to 855 adults with SCI aged 18 to 92 years. Five scales common to both instruments were included in the analysis: Wheeled Mobility, Daily Routine/Self-care, Daily Routine/Fine Motor, Ambulation, and General MobilityStudy used item response theory (IRT) methods to link scores from 2 recently developed functional outcome measures for people with spinal cord injury (SCI), the adult Spinal Cord Injury-Functional Index (SCI-FI) and the Pedi SCI (both the parent version and the child version). Linking was conducted so that the adult SCI-FI and Pedi SCI scaled scores could be compared. Pedi SCI items were administered to a sample of 381 children with SCI aged 8 to 21 years, and of 322 parents/caregivers of children with SCI aged 4 to 21 years. Adult SCI-FI items were administered to 855 adults with SCI aged 18 to 92 years. Five scales common to both instruments were included in the analysis: Wheeled Mobility, Daily Routine/Self-care, Daily Routine/Fine Motor, Ambulation, and General Mobility. Confirmatory factor analysis and exploratory factor analysis results indicated that the 5 scales are unidimensional. A graded response model was used to calibrate the items. Misfitting items were identified and removed from the item banks. Items that function differently between the adult and child samples were identified and removed from the common items used for linking. Domain scores from the Pedi SCI instruments were transformed onto the adult SCI-FI metric. IRT linking allowed estimation of adult SCI-FI scale scores based on Pedi SCI scale scores and vice versa; therefore, it provides clinicians with a means of tracking long-term functional data for children with SCI across their entire lifespan.Kumar RG, Bracken MB, Cloark AN, Nick TG, Melguizo MS, Sander AMYesdevopsadmin
2015Measuring psychological trauma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Psychological Trauma item bank and short formJournalJ71737Journal of Spinal Cord Medicine138326-334Article describes the development and psychometric properties of the Spinal Cord Injury – Quality of Life (SCI-QOL) Psychological Trauma item bank and short form. Using a mixed-methods design, a Psychological Trauma item bank was developed and tested with patient and provider focus groups and cognitive interviews. A 31-item pool was tested at several medical institutions across the United States, including 5 SCI Model System centers and one Veterans Affairs medical center. A total of 716 individuals with SCI completed the items assessing trauma. Analyses included item response theory based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision. The 31 items fit a unidimensional model and demonstrated good precision. Nine items demonstrated negligible DIF with little impact on score estimates. The final calibrated item bank contains 19 items. The SCI-QOL Psychological Trauma item bank is a psychometrically robust measurement tool from which a short form and a computer adaptive test version are available.McDonnell E, Giacino JT, Kolakowsky-Hayner SYesdevopsadmin
2015Reliability and validity of the capabilities of upper extremity test (CUE-T) in subjects with chronic spinal cord injuryJournalJ72157Journal of Spinal Cord Medicine100Study examined the reliability and validity of the Capabilities of Upper Extremity Test (CUE-T), a measure of functional limitations in the arm and hand, in patients with chronic tetraplegia. Data were obtained from 50 subjects (36 male/14 female) with chronic stable spinal cord injury (SCI). Test-retest reliability was examined using the intraclass correlation coefficient (ICC). Construct validity was evaluated using Spearman correlations of CUE-T with upper extremity motor scores (UEMS), and the self-care and mobility portions of the Spinal Cord Independence Measure (SCIM). Weighted kappa and repeatability values were also calculated. Score ranges were 8 to 50 for UEMS, 7 to 135 for CUE-T, 0 to 20 for self-care SCIM, and 0 to 40 for mobility SCIM. The ICC values for total, right, and left side scores were excellent (0.97–0.98). Item weighted kappa values were =0.60 for all but five items, four of which were right and left pronation and supination. Repeatability of total score was 10.8 points, right and left sides 6.3 and 6.1 points. Spearman correlations of the total CUE-T with the UEMS and SCIM self-care and mobility scores were 0.83, 0.70, and 0.55 respectively. Results indicate that the CUE-T displays excellent test-retest reliability, and good-to-excellent correlation with impairment and capacity measures in people with chronic SCI.Carlozzi NE, Kratz AL, Sander AM, Chiaravalloti ND, Brickell TA, Lange RT, Hahn EA, Austin A, Miner JA, Tulsky DSYesdevopsadmin
2014Measuring positive affect and well-being after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Positive Affect and Well-being bank and short formJournalJ71740Journal of Spinal Cord Medicine138356-365Article describes the development and psychometric properties of the Spinal Cord Injury – Quality of Life (SCI-QOL) Positive Affect and Well-Being (PAWB) item bank and short form. Qualitative feedback from patient and provider focus groups was used to expand on the Neurological Disorders and Quality of Life (Neuro-QOL) positive affect and well-being item bank for use in SCI. New items were created and revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis, item response theory calibration, and evaluation of differential item functioning (DIF). A 32-item pool at several rehabilitation centers across the United States, including 5 SCI Model System centers and one Veterans Affairs medical center. A total of 717 individuals with SCI answered the PAWB questions. A unidimensional model was observed and measurement precision was good. Twelve items were flagged for DIF, however, after examination of effect sizes, the DIF was determined to be negligible and would have little practical impact on score estimates. The final calibrated item bank resulted in 28 retained items. The SCI-QOL PAWB bank represents a psychometrically robust measurement tool. Short form items are also suggested and a computer adaptive test is available.Kratz A, Carlozzi N, Brickell TA, Sander AMYesdevopsadmin
2014Methodology for the development and calibration of the SCI-QOL item banksJournalJ71733Journal of Spinal Cord Medicine138270-287Article describes the development and calibration of the Spinal Cord Injury -- Quality of Life (SCI-QOL), a patient-reported outcomes measurement system for individuals with spinal cord injury (SCI). Specifically, the authors detail the methods and results of the five phases of the SCI-QOL development: (1) domain/subdomain selection, (2) item development and refinement, (3) field testing, (4) psychometric analysis and item response theory (IRT) calibration, and (5) testing in a new sample to assess of psychometric properties. Individual interviews and focus groups were conducted to select key domains and to develop items for the SCI-QOL. Items were field tested in a sample of 877 individuals with traumatic SCI recruited from 5 SCI Model Systems centers and one Veterans Affairs medical center. Dimensionality was assessed with confirmatory factor analysis. Local item dependence and differential item functioning were assessed, and items were calibrated using IRT methods. Finally, computer adaptive tests (CATs) and short forms were administered in a new sample of 245 individuals with SCI to assess test-retest reliability and stability. Fourteen unidimensional calibrated item banks and 3 calibrated scales were developed across physical, emotional, and social health domains. When combined with the 5 Spinal Cord Injury – Functional Index physical function banks, the final SCI-QOL system consists of 22 IRT-calibrated item banks/scales. Item banks may be administered as CATs or short forms. Scales may be administered in a fixed-length format only.Barker MD, Whyte J, Pretz CR, Sherer M, Temkin N, Hammond FM, Saad Z, Novack TYesdevopsadmin
2014Measuring stigma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Stigma item bank and short formJournalJ71743Journal of Spinal Cord Medicine138386-396Article describes the development and psychometric properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) item bank and computer adaptive test (CAT) to assess the effects of stigma on health-related quality of life in individuals with spinal cord injury (SCI). The project included grounded-theory based qualitative item development methods, large-scale item calibration field testing, confirmatory factor analysis (CFA), and item response theory (IRT)-based psychometric analyses. A sample of 611 individuals with traumatic SCI, recruited from 5 SCI Model Systems and 1 Veterans Affairs medical center, completed 30 items assessing SCI-related stigma. After 7 items were iteratively removed, CFA confirmed a unidimensional pool of items. Graded response model IRT analyses were used to estimate slopes and thresholds for the final 23 items. The SCI-QOL Stigma item bank is unique not only in the assessment of SCI-related stigma but also in the inclusion of individuals with SCI in all phases of its development. Use of confirmatory factor analytic and IRT methods provide flexibility and precision of measurement. The item bank may be administered as a CAT or as a 10-item fixed-length short form and can be used for research and clinical applications.Wagner AKYesdevopsadmin
2015Tapering opioid prescriptions and reducing polypharmacy for inpatients with spinal cord injury at Rancho Los Amigos National Rehabilitation CenterJournalJOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT151vii-xivWagner, A., Kumar, R., Conley, Y., Kochanek, P., Berga, S.Yesdevopsadmin
2014Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort StudyJournalJ71853Physical Therapy19543112Study identified predictors of shoulder joint pain in people with paraplegia who used a manual wheelchair for at least 50 percent of their mobility and were asymptomatic for shoulder pain at study entry. Participants were classi?ed as having developed shoulder pain if they experienced an increase of 10 points on the Wheelchair User’s Shoulder Pain Index in the 3-year follow-up period. Measurements of maximal isometric shoulder torques were collected at study entry (baseline), 18 months, and 3 years. Daily activity was measured using a wheelchair odometer, and self-reported daily transfer and raise frequency data were collected by telephone every 6 weeks. Of the 223 participants enrolled in the study; 39.8 percent developed shoulder pain over the 3-year follow-up period. Demographic variables and higher activity levels were not associated with shoulder pain onset. Baseline maximal isometric torque (normalized by body weight) in all shoulder muscle groups was 10 to 15 percent lower in participants who developed shoulder pain compared with those who remained pain-free. Lower shoulder adduction torque was a signi?cant predictor of shoulder pain development, but the model explained only 7.5 percent of shoulder pain onset and consequently is of limited clinical utility. Overall, the results indicated that participants who developed shoulder pain had decreased muscle strength, particularly in the shoulder adductors, and lower levels of physical activity prior to the onset of shoulder pain. Neither factor was a strong predictor of shoulder pain onset.Harrison-Felix C, Pretz C, Hammond FM, Cuthbert JP, Bell J, Corrigan J, Miller CAYesdevopsadmin
2015Review of Cross-Cultural Issues Related to Quality of Life After Spinal Cord InjuryJournalJ69365Topics in Spinal Cord Injury Rehabilitation120181-190Article reviews cross-cultural issues related to the conceptualization of quality of life (QOL) in individuals with spinal cord injury (SCI). The World Health Organization’s International Classification of Function, Disability and Health is used in this article as a framework to better understand factors that may influence QOL after SCI. A number of important steps are summarized with respect to measurement issues in QOL. A comparison between data from 2 countries (United States and Brazil) using the International SCI QOL Basic Data Set shows similarities in scores and good reliability in the Brazilian sample. Substantial, significant correlations were observed among the SCI QOL Basic Data Set items and the WHOQOL-BREF within the American sample. The article concludes with recommendations for the development of cross-cultural measures of QOL for use in the SCI population and a discussion of future directions for cross-cultural research on QOL after SCI.Juengst, S., Arenth, P., Wagner, A.Yesdevopsadmin
2014Responsiveness and concurrent validity of the revised Capabilities of Upper Extremity-Questionnaire (CUE-Q) in patients with acute tetraplegiaJournalJ69765Spinal Cord1625-628Study evaluated the responsiveness of the revised Capabilities of Upper Extremity-Questionnaire (CUE-Q), in which the item responses were reduced from seven to five levels, relative to the upper-extremity motor score (UEMS) and to the self-care subscale of Functional Independence Measure (FIMsc). A total of 46 subjects with acute traumatic tetraplegia (19 motor complete, 27 motor incomplete) completed the revised CUE-Q, UEMS, and FIMsc at admission and discharge from rehabilitation. Subjects were mostly male and Caucasian. The mean age was 44 years. Predominant etiologies were falls and motor vehicle accidents. During rehabilitation, mean CUE-Q scores increased from 49.8 to 73.7, UEMS increased from 19.6 to 26.3, and FIMsc increased from 9.8 to 21.5. At admission and discharge, CUE scores had excellent to good Spearman correlations with UEMS and FIMsc, but change scores had little to moderate correlations, suggesting that the CUE, UEMS and FIM measure related but different constructs. Effect size of the change score was 0.92 for CUE-Q, 0.87 for UEMS, and 1.38 for FIMsc. This compares to an effect size of 0.73 for the original 7-level response CUE-Q. Results indicate that the simplified response set of the CUE-Q maintains the responsiveness of the original version, while it increases the ease of use for the patient.Pappadis MR, Sander AM, Leung P, Parrish DE, Epstein MWYesdevopsadmin
2014Urological Surveillance and Medical Complications after Spinal Cord Injury in the United StatesJournalJ73050Neurourology and Urodynamics134S40-S40Study assessed national patterns of urologic follow-up after spinal cord injury (SCI) to determine how many received adequate surveillance and evaluated the occurrence and predictors of urological complications. The minimum adequate urologic surveillance was defined as: (1) a urologist visit, (2) serum creatinine evaluation, and (3) upper urinary tract imaging study within the 2-year period. Patients were classified to their most severe complication in a multivariate linear regression model. Of the 7,162 Medicare patients with SCI included in the analysis, 4.9 percent received no screening studies over the 2-year study period; 70.5 percent received some, but not all screening; and 24.6 percent received all 3 screening tests. Patients traveled a mean of 21.3 miles to receive care. A total of 35.7 percent of patients saw a urologist during the 2-year period; 48.6 percent had some form of upper tract evaluation, with the majority being computed tomography scans; and 90.7 percent had serum creatinine evaluation. Among all patients, 35.8 percent had a minor complication during their 2-year follow up, 17.1 percent had a moderate complication, and 8.0 percent had a severe complication. In the prediction model, patient factors that correlated with increased complications included male gender, African American race, paraplegia, and receiving some or all of the neurogenic bladder recommended screening. Patients’ distance of travel to their treating physician did not affect the rate of complications. Findings suggest that urological complications are common in Medicare patients with SCI; however, most of these patients are not receiving even the minimum recommended surveillance for these complications.Weintraub, S., Dikmen, S.S., Heaton, R.K., Tulsky, D.S., Zelazo, P.D., Slotkin, J, Carlozzi, N.E., Bauer, P.J., Wallner-Allen, K., Fox, N., Havlik, R., Beaumont, J.L., Mungas, D., Manly, J.J., Moy, C., Conway, K., Edwards, E., Nowinski, C.J., Gershon, R.Yesdevopsadmin
2014Prevention of Urinary Tract Infection for Patients with Neurogenic BladderJournalJ70264Current Bladder Dysfunction Reports19282-288Article summarizes the most recent data on the prevention of urinary tract infection (UTI) in patients with neurogenic bladder, with a focus on patients with incomplete bladder emptying requiring catheterization who are specifically at risk. UTI is a common problem among patients with neurogenic bladder dysfunction that can be costly and challenging to manage. It occurs frequently in this population given their unique susceptibility to bacteria both entering the urinary tract and causing infection. Current literature on the topic of preventing UTIs in this heterogeneous patient population is challenged by the difficulty in defining UTIs and by the lack of long-term data from controlled randomized studies. New research suggests that intradetrusor injection of onabotulinumtoxin A may be a useful adjunct in preventing UTIs, and further studies are needed to determine if probiotics, bacterial interference, and/or vaccines will prove to be of use in the population.Hammond FM, Knotts A, Pershad R, Norton HJYesdevopsadmin
2014Neurological and functional recovery after thoracic spinal cord injuryJournalJournal of Spinal Cord Medicine100Santarsieri, M., Niyonkuru, C., McCullough, E., Dobos, J, Dixon, C., Berga, S., Wagner, A.Yesdevopsadmin
2014Mobility, continence, and life expectancy in persons with ASIA impairment scale grade D spinal cord injuriesJournalJ70904AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION194180Study examined how survival in incomplete spinal cord injury (SCI) depends on ambulatory function and the extent of bowel or bladder dysfunction, computed the life expectancies for various subgroups, and determined whether survival has improved over time. Data were obtained from the SCI Model Systems database for 8,206 adults with American Spinal Injury Association (ASIA) Impairment Scale (AIS) Grade D SCI who were not ventilator dependent and who survived more than 1 year after injury. The database included a total of 114,739 person-years of follow-up and 1,730 deaths during the 1970 - 2011 study period. Empirical age- and sex-specific mortality rates were computed. Regression analysis of survival data with time-dependent covariates was used to determine the effect of risk factors, to test for a time trend, and to estimate mortality rates for subgroups. Life expectancies were obtained from life tables constructed for each subgroup. Results indicated that the ability to walk, whether independently or with an assistive device, was associated with longer survival than wheelchair dependence. The need for an indwelling catheter, and to a lesser extent intermittent catheterization, was associated with increased mortality risk. Patients who walked unaided and who did not require catheterization had life expectancies roughly 90 percent of normal. Those who required a wheelchair for locomotion had life expectancies comparable with that in paraplegia, less than 75 percent of normal. No time trend in survival was found. Findings suggest that the life expectancy of people with AIS D SCI depends strongly on the ability to walk and the need for catheterization.Barker, M.D., Whyte, J., Pretz, C.R., Sherer, M., Temkin, N., Hammond, F.M., Saad, Z., Novack, T.Yesdevopsadmin
2014Mechanisms Underlying Chronic Whiplash: Contributions from an Incomplete Spinal Cord Injury?JournalPain Medicine1151938-1944Kumar, R., Diamond, M., Boles, J., Carlisle, K., Berger, R., Tisherman, S., Kochanek, P., Wagner, A.Yesdevopsadmin
2014Racial and ethnic disparities in functioning at discharge and follow-up among patients with motor complete spinal cord injuryJournalJ70070Archives of Physical Medicine and Rehabilitation1952140-51Study examined racial and ethnic differences in self-care and mobility outcomes for people with a motor complete, traumatic spinal cord injury (SCI) at discharge and 1-year follow-up. Participants were 1,766 adults with traumatic, motor complete SCI enrolled in the Spinal Cord Injury Model Systems database between 2000 and 2011. Selected cases had complete self-reported data on race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic) and Functional Independence Measure (FIM) scores assessed at inpatient rehabilitation admission, discharge, and 1-year follow-up. Functional outcomes were measured by FIM self-care and mobility scores on a 1 to 7 FIM scale, at discharge and 1-year follow-up. Multiple regression models stratified by neurologic category and adjusted for sociodemographic and injury characteristics assessed racial and ethnic group differences in FIM self-care and mobility change scores at discharge and 1-year follow-up. At discharge, non-Hispanic black participants with tetraplegia and paraplegia had significantly poorer gains in FIM self-care and mobility scores relative to non-Hispanic white and Hispanic participants. At 1-year follow-up, similar FIM self-care and mobility change scores were found across racial and ethnic groups within each neurologic category. Additional research is needed to identify potential modifiable factors that may contribute to racially and ethnically different patterns of functional outcomes observed during inpatient rehabilitation.Dams-O?Connor, K., Pretz, C., Billah, T., Hammond, F. M., & Harrison-Felix, C.Yesdevopsadmin
2019Neuropsychological Characteristics of the Confusional State Following Traumatic Brain InjuryJournal30681046Journal of the International Neuropsychological Society253302-313https://www.ncbi.nlm.nih.gov/pubmed/30681046Individuals with moderate-severe traumatic brain injury (TBI) experience a transitory state of impaired consciousness and confusion often called posttraumatic confusional state (PTCS). This study examined the neuropsychological profile of PTCS. Keelan, R. E., Mahoney, E. J., Sherer, M., Hart, T., Giacino, J., Bodien, Y. G., Nakase-Richardson, R., Dams-O'Connor, K., Novack, T. A., Vanderploeg, R. D.UAB Traumatic Brain Injury Model SystemYesaberdyyeva
2014Pruritus in pediatric burn survivors: defining the clinical courseJournalJ70746JOURNAL OF BURN CARE & RESEARCH136151-158Study examined the characteristics of postburn itch and associated symptoms in the pediatric population. A retrospective review was conducted of 430 pediatric burn survivors who were enrolled in the Burn Model System program from 2006 to 2013. Demographic data, injury characteristics, associated symptoms (skin-related problems, pain, and sleep), and incidence and intensity (Numerical Rating Scale) of itch were examined. Measures were completed at hospital discharge and at 6, 12, and 24 months after injury. Spearman’s correlations were used to examine the correlation between itch intensity and associated symptoms. Multivariate regression analyses examined the impact of associated symptoms on itch intensity. There were 430 pediatric burn survivors with a mean age of 7.8 years and a mean total body surface area burned of 40.8 percent. Pruritus is present in most children (93 percent) and is of moderate intensity (5.7) at discharge. The frequency and intensity of pruritus decreases over time; a majority of children continue to report symptoms at 2 years (63 percent). Itch was significantly correlated with associated symptoms. Regression analyses showed a correlation between itch intensity and pain at each time point. There was no association between itch intensity and burn etiology, age, gender, or burn size. The findings suggest that pruritus is a frequent complication that lasts for at least 2 years after injury in a majority of pediatric burn survivors. This information will enable better tracking of outcomes and will serve as a baseline for assessing interventions.Juengst, S., Achille, S., Arenth, P., Skidmore, E., Wagner, A.Yesdevopsadmin
2014Recovery Trajectories After Burn Injury in Young Adults: Does Burn Size Matter?JournalJ70745Journal of Burn Care & Research1118-129Study examined the relationship between long-term functional recovery and total body surface area (TBSA) burned. Data were analyzed for 147 burned subjects who completed the Young Adult Burn Outcome Questionnaire at initial baseline contact, 2 weeks, and at 6 and 12 months after initial questionnaire administration. One hundred twelve non-burned adults of comparable ages also completed the questionnaire as a reference group. Functional status was characterized in 15 domains. Examination of effect of burn size on recovery over time was performed by comparing patients with small burn size (TBSA Sherer M, Giacino J, Doiron M, LaRussa A, Taylor SYesdevopsadmin
2018Race/Ethnicity and Retention in Traumatic Brain Injury Outcomes Research: A Traumatic Brain Injury Model Systems National Database StudyJournalJournal of Head Trauma Rehabilitation33237-245Sander AM, Lequerica AH, Ketchum JM, Hammond FM, Gary KW, Pappadis MR, Felix ER, Johnson-Greene D, Bushnik TIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYescheberle
2017User authentication in smartphones for telehealthJournalJ78296International Journal of Telerehabilitation9212-Marhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716614/Article presents several types of authentication methods available to smartphone users to help ensure security of sensitive data from attackers and describes the applications of these authentication methods in telehealth. Specific to telehealth, use of mobile health (mHealth) apps for telehealth services has expanded in recent years. A plethora of mHealth apps are available to download to smartphones that can help patients be more aware and in control of their healthcare. When smartphones are used to conduct telehealth services, sensitive data is invariably accessed, rendering the devices in need of user authentication to ensure data protection. User authentication of smartphones can help mitigate potential Health Insurance Portability and Accountability Act (HIPAA) breaches and keep sensitive patient information protected, while also facilitating the convenience of smartphones within everyday life and healthcare.Smith, Katherine A., Zhou, Leming, Watzlaf, Valerie J. M.Yesdevopsadmin
2015What works in inpatient traumatic brain injury rehabilitation? Results from the TBI-PBE studyJournalR09356Archives of Physical Medicine and Rehabilitation968, Supplement 3S173-S340Articles in this journal issue analyzed the results of the Traumatic Brain Injury-Practice Based Evidence (TBI-PBE) project, a comparative effectiveness study conducted at 9 rehabilitation centers across the United States and 1 in Canada over a 2.5-year time period. Three of the 10 study sites were part of the TBI Model Systems, funded by the National Institute on Disability and Rehabilitation Research. The specific aims of the TBI-PBE project were to: (1) identify individual patient characteristics, including demographic data, severity of brain injury, and severity of illness (complications, comorbidities), that may be associated with significant variation in treatments selected and in outcomes of acute rehabilitation for TBI; (2) identify medical procedures and therapy interventions, alone or in combination, that are associated with better outcomes, controlling for patient characteristics; and (3) determine whether specific treatment interactions with age, severity/impairment, or time are associated with better outcomes. Through Individual articles are available for document delivery under accession numbers J72079 through J72094.Chan, Leighton, Heinemann, Allen W. (Eds.)Nodevopsadmin
2017Validation of the participation measure--3 domains, 4 dimensions (PM-3D4D)JournalJ77428Archives of Physical Medicine and Rehabilitation98122498-2506Study examined the construct validity of the Participation Measuree-3 Domains, 4 Dimensions (PM-3D4D), a multidimensional participation measure developed for use in rehabilitation practice. The PM-3D4D is a 19-item measure designed to evaluate participation in 3 domains (productivity, social, and community) across 4 dimensions (diversity, frequency, desire for change, and difficulty). Data were collected from 556 rehabilitation patients. Intercorrelations among the 4 dimensions of the PM-3D4D and correlations between the PM-3D4D and 3 legacy instruments (Participation Assessment with Recombined Tools-Objective, Participation Measure for Post-Acute Care, and Satisfaction With Life Scale) were examined to establish the convergent and divergent validity of the PM-3D4D. Known-group validity was evaluated by comparing PM-3D4D scores across age groups and groups of people classified by functional level. Results indicated that the Diversity scale of the PM-3D4D was strongly correlated with the Frequency scale (Spearman correlation coefficient =.83 to .96 across the 3 domains), and these 2 scales showed moderate to strong correlations with the Difficulty scale (.42 to .70) but weak (.4 to 0) and insignificant correlations with the Desire for change scale. The Frequency and Difficulty scales of the PM-3D4D showed moderate to strong correlations with the Participation Assessment with Recombined Tools-Objective and Participation Measure for Post-Acute Care, respectively, and the Desire for change scale had weak correlations with the Satisfaction With Life Scale. Significant differences in PM-3D4D scores were found by age and functional level. Findings support the construct validity of the PM-3D4D to assess rehabilitation patients’ participation performance and helping practitioners identify intervention priorities to improve patients’ participation outcomes.Chang, Feng-Hang, Chang, Kwang-Hwa, Liou, Tsan-Hon, Whiteneck, Gale G.Rocky Mountain Regional Brain Injury SystemYesdevopsadmin
2014Virtual reality-based therapy for the treatment of balance deficits in patients receiving inpatient rehabilitation for traumatic brain injuryJournalJ68285Brain Injury282181-188Study evaluated the feasibility and safety of utilizing a commercially available virtual reality gaming system as a treatment intervention for balance training in patients undergoing inpatient rehabilitation for traumatic brain injury (TBI). Twenty patients were randomly assigned to one of two treatment conditions: (1) balance-based physical therapy using a Nintendo Wii, monitored by a physical therapist; or (2) one-on-one balance-based physical therapy using standard physical therapy modalities available for use in the therapy gym. Participants in the standard physical therapy group were found to have slightly higher enjoyment at mid-intervention, while those receiving the virtual reality-based balance intervention were found to have higher enjoyment at study completion. Both groups demonstrated improved static and dynamic balance over the course of the study, with no significant differences between groups. Correlational analyses suggest a relationship exists between Wii balance board game scores and Berg Balance Scale scores for measures taken beyond the baseline assessment. The results provide a modest level of evidence to support using commercially available virtual reality gaming systems for the treatment of balance deficits in patients with a primary diagnosis of TBI receiving inpatient rehabilitation.Cuthbert, Jeffrey P., Staniszewski, Kristi, Hays, Kaitlin, Gerber, Don, Natale, Audrey, O'Dell, DeniseRocky Mountain Regional Brain Injury SystemYesdevopsadmin
2017Working with schools: What employment providers need to know for successful collaborationJournalJ76368Journal of Vocational Rehabilitation463355-359Article describes a collaborative transition model and the preliminary results and lessons learned from a 5-year study evaluating the effects on embedded employment resources in schools, the impact of agency connections, and employment outcomes. The goal of the collaborative was to provide employment opportunities for transition-age youth by embedding employment resources into the school to focus on agency connections, employment outcomes, and reducing or eliminating duplication of services. Specifically, a provider employment specialist or career coach was embedded in the school to serve as a single point of contact to represent a “coalition” of providers serving on the collaborative. The collaborative also included vocational rehabilitation (VR), schools, families, and other agencies. Schools with an embedded career coach had students connected to VR services and other community agencies than the comparison sites. Students had more opportunities for work experiences, internships, and paid employment prior to leaving school with the employment providers continuing services after school. By working together, schools and employment providers offer each other value in serving students and enhancing agency connections and employment outcomes.Grossi, Teresa, Thomas, FaithNodevopsadmin
2015Usability and reliability of a remotely administered adult autism assessment, the autism diagnostic observation schedule (ADOS) module 4JournalJ73673Telemedicine Journal and e-Health213176-184http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365428/Study examined the feasibility, usability, and reliability of the Autism Diagnostic Observation Schedule (ADOS) Module 4 administrations delivered remotely using the Versatile and Integrated System for Telerehabilitation (VISYTER). The ADOS Module 4 is a semi-structured diagnostic assessment tool designed for verbally fluent adolescents and adults with possible autism spectrum disorder (ASD). VISYTER consists of computer stations at the client site and clinician site, and a web portal server for managing and coordinating all elements of the assessment process. Twenty-three adults with an ASD diagnosis participated in a within-subject crossover design study in which both a remote and face-to-face ADOS were administered. Weighted kappa was calculated for all 31 ADOS items. Usability and satisfaction of the remote assessment system was evaluated from the participants’ perspectives. There was substantial agreement on ADOS classification (diagnosis) between assessments delivered face-to-face versus assessments delivered remotely (intraclass correlation coefficient = .92). Non-agreement may have been due to outside factors or practice effect despite a washout period. Participant satisfaction with the remote ADOS delivery system was high. Results of this study demonstrate that an ASD assessment designed to be delivered face-to-face can be administered remotely using an integrated web-based system, with high levels of usability and reliability.Schutte, Jamie L., McCue, Michael P., Parmanto, Bambang, McGonigle, John, Handen, Benjamin, Lewis, Allen, Pulantara, I. Wayan, Saptono, AndiNodevopsadmin
2016Variations in inpatient rehabilitation functional outcomes across centers in the traumatic brain injury model systems study and the influence of demographics and injury severity on patient outcomesJournalJ74750Archives of Physical Medicine and Rehabilitation97111821-1831Study compared patient functional outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers and identified sociodemographic, clinical, and injury characteristics that influenced patient those outcomes. Data were analyzed for 5,505 patients with traumatic brain injury (TBI) admitted to 19 TBIMS rehabilitation centers over a 10-year period (2003-2012). Functional outcomes were measured using the Disability Rating Scale and the Functional Independence Measure at discharge and at the 1-year follow-up. Individuals with lower functional status at the time of admission, longer duration of posttraumatic amnesia, and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at the 1-year follow-up, whereas those who were employed at the time of injury had better outcomes at both time periods. Risk-adjusted patient functional outcomes for patients in most TBIMS centers were consistent with previous research. However, there were wide performance differences for a few centers even after using more recently collected data, improving on the regression models by adding predictors known to influence functional outcomes, and using bootstrapping to eliminate confounds. Specific patient, injury, and clinical factors are associated with differences in functional outcomes within and across TBIMS rehabilitation centers. However, these factors did not explain all the variance in TBI patient outcomes, suggesting a role of some other predictors that remain unknown.Dahdah, Marie N., Barnes, Sunni, Buros, Amy, Dubiel, Rosemary, Dunklin, Cynthia, Callender, Librada, Harper, Caryn, Wilson, Amy, Diaz-Arrastia, Ramon, Bergquist, Thomas, Sherer, Mark, Whiteneck, Gale, Pretz, Christopher, Vanderploeg, Rodney D., Shafi, ShahidNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2015What makes an exhibition inclusive? A 20-year conversation about universal designJournalJ73735Exhibitionist78-81The authors reflect on more than 20 years of experience in designing accessible museums and exhibitions. They urge exhibition designers to think not only of minimum accessibility standards but of more inclusive design that works better for museum audiences made up of diverse family groups, different age groups, and people of varied abilities.Brown, Clare, Majewski, JaniceNodevopsadmin
2017Utility of the neurobehavioral symptom inventory as an outcome measure: A VA TBI model systems studyJournalJ75307Journal of Head Trauma Rehabilitation32146-54Study examined the utility of the Neurobehavioral Symptom Inventory (NSI), a measure of postconcussion symptoms used within the Veterans Health Administration (VA), as an index of rehabilitation outcome. Participants were 159 veterans (14 percent with mild TBI; 86 percent with moderate-severe TBI) enrolled in the VA Polytrauma Rehabilitation Centers Traumatic Brain Injury (TBI) Model Systems program. Outcome measures included: Disability Rating Scale; Functional Independence Measure; Glasgow Outcome Scale–Extended; NSI; Participation Assessment with Recombined Tools–Objective; Posttraumatic Stress Disorder Checklist–Civilian Version; Satisfaction With Life Scale; Supervision Rating Scale. Correlations and exploratory factor analyses examined the interrelations among outcome measures. Hierarchical regression analyses were utilized to determine if the NSI predicted rehabilitation outcome measures after controlling for demographic variables, TBI severity, and time since injury. NSI reliable changes from pretreatment to 1-year follow-up were examined. Receiver operating characteristics curve analyses were conducted to evaluate the ability of changes in the NSI to predict meaningful change in functioning and employment status. Results indicated that the NSI correlated with psychological distress measures. The NSI administered prior to brain injury rehabilitation had limited predictive utility beyond satisfaction with life. A minority of patients (32 percent) demonstrated reliable changes on the NSI from baseline to 1-year follow-up. Changes on the NSI were not predictive of meaningful change in employment or functioning. The results of this study suggest that the NSI is not useful for assessing meaningful change in a sample of mixed-severity TBI patients.Belanger, Heather G., Silva, Marc A., Donnell, Alison J., McKenzie-Hartman, Tamara, Lamberty, Greg J., Vanderploeg, Rodney D.National Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2014Virtual reality and cognitive rehabilitation: A review of current outcome researchJournalJ69963Neurorehabilitation344759-772Article reviews recent outcome studies examining virtual reality applications for cognitive rehabilitation. The purpose of this review is to facilitate comparisons of therapeutic efficacy of different virtual reality interventions. A systematic approach for the review addressed the nature of each sample, treatment apparatus, experimental treatment protocol, control treatment protocol, statistical analysis and results. Using this approach, 17 studies conducted over the past eight years that provide valid evidence of efficacy of virtual reality applications are summarized. Applications that have not yet undergone controlled outcome study but which have promise are introduced. The few randomized controlled trials that have been completed show that some applications are effective in treating cognitive deficits in people with neurological diagnoses although further study is needed. Innovations requiring further study include the use of enriched virtual environments that provide haptic sensory input in addition to visual and auditory inputs and the use of commercially available gaming systems to provide tele-rehabilitation services. Recommendations are offered to improve efficacy of rehabilitation, to improve scientific rigor of rehabilitation research, and to broaden access to the evidence-based treatments that this research identifiedLarson, Eric B., Feigon, Maia, Gagliardo, Pablo, Dvorkin, Assaf Y.Midwest Regional Traumatic Brain Injury Model SystemYesdevopsadmin
2015Working memory capacity links cognitive reserve with long-term memory in moderate to severe TBI: A translational approachJournalJ70266Journal of Neurology262159-64This translational study tested a theoretical model linking cognitive reserve (CR), working memory (WM) and long-term memory (LTM) and used mediation modeling to better understand the relationship between the three constructs in traumatic brain injury (TBI). There is variability among memory impairment resulting from TBI; some individuals exhibit long-term memory (LTM) impairment while others do not. This variability has been explained, at least in part, by the theory of CR, which suggests that individuals who have spent significant time engaged in intellectually enriching activities (higher CR) are less likely to experience LTM decline. Recent evidence suggests that WM capacity may be one mediating variable that can help explain how or why CR protects against LTM impairment. The study tested this hypothesis in 50 patients with moderate-to-severe TBI. Specific neuropsychological tests were administered to estimate CR, LTM, and WM. The results were congruent with a recent theoretical model that implicates WM capacity as a mediating variable in the relationship between CR and LTM. These data corroborate recent findings in an alternate neurological population and suggest that WM is an underlying mechanism of CR. Additional research is necessary to establish whether (1) WM is an important individual difference variable to include in memory rehabilitation trials and (2) to determine whether rehabilitation and treatment strategies that specifically target WM may also lead to complimentary improvements on diagnostic tests of delayed LTM in TBI and other memory impaired populations.Sandry, Joshua, DeLuca, John, Chiaravalloti, NancyNorthern New Jersey Traumatic Brain Injury System Yesdevopsadmin
2014US population estimates of health and social outcomes 5 years after rehabilitation for traumatic brain injuryJournalJ68851Journal of Head Trauma Rehabilitation296E1-E9Study estimated selected health and social outcomes for adults in the United States 5 years after a traumatic brain injury (TBI) that required acute inpatient rehabilitation, using data from the TBI Model Systems National Database. Mortality, functional independence, societal participation, subjective well-being, and global outcome were estimated among aged patients 16 years and older who received acute inpatient rehabilitation for a primary diagnosis of TBI between October 1, 2001, and December 31, 2007. Approximately 1 in 5 patients had died by the 5-year postinjury assessment. Among survivors, 12 percent were institutionalized and 50 percent had been rehospitalized at least once. Approximately one-third of patients were not independent in everyday activities. Twenty-nine percent were dissatisfied with life, with 8 percent reporting markedly depressed mood. Fifty-seven percent were moderately or severely disabled overall, with 39 percent having deteriorated from a global outcome attained 1 or 2 years postinjury. Of those employed preinjury, 55 percent were unemployed. Poorer medical, functional, and participation outcomes were associated with, but not limited to, older age. Younger age groups had poorer mental and emotional outcomes. Deterioration in global outcome was common and not age-related. The deterioration in global outcomes observed regardless of age suggests that multiple influences contribute to poorer outcomes.Corrigan, John D., Cuthbert, Jeffrey P., Harrison-Felix, Cynthia, Whiteneck, Gale G., Bell, Jeneita M., Miller, A. Cate, Coronado, Victor G., Pretz, Christopher R.Ohio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2015Variation in the BDNF gene interacts with age to predict mortality in a prospective, longitudinal cohort with severe TBIJournalJ70724Neurorehabilitation and Neural Repair293234-246Study examined brain-derived neurotrophic factor (BDNF) functional single nucleotide polymorphisms rs6265 and rs7124442 in relation to mortality in 315 individuals, aged 16 to 74 years, receiving care for severe traumatic brain injury (TBI). It was hypothesized the addition of BDNF genetic variation would improve mortality prediction models and that BDNF Met-carriers (rs6265) and C-carriers (rs7124442) would have the highest mortality rates post-TBI. Mortality was examined acutely (0 to 7 days after injury) and postacutely (8 to 365 days after injury). A gene risk score (GRS) was developed to examine both BDNF loci. Cox proportional hazards models were used to calculate hazard ratios for survivability post-TBI while controlling for covariates. Results showed that BDNF GRS was significantly associated with acute mortality, regardless of age. Interestingly, subjects in the hypothesized no-risk allele group had the lowest survival probability. Postacutely, BDNF-GRS interacted with age such that younger participants in the no-risk group had the highest survival probability, while older participants in the hypothesized no-risk group had the lowest probability of survival. These data suggest complex relationships between BDNF and TBI mortality that interact with age to influence survival predictions beyond clinical variables alone. Evidence supporting dynamic, temporal balances of pro-survival/pro-apoptotic target receptors may explain injury and age-related gene associations.Failla, Michelle D., Kumar, Raj G., Peitzman, Andrew B., Conley, Yvette P., Ferrell, Robert E., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2016Vocational rehabilitation services and outcomes for transition-age youth with traumatic brain injuriesJournalJ74119Journal of Head Trauma Rehabilitation314288-295Study evaluated the influence of demographic variables and vocational rehabilitation (VR) services on the employment outcomes of 1,546 transition-age youth (16-25 years of age) with traumatic brain injuries (TBI). Purposeful selection of multivariate logistic regression was employed to analyze the data. Results indicated that receipt of more VR services at higher expenditure levels over shorter periods of time was related to case closure in successful competitive employment status. Also, higher levels of education at the time of enrollment in the VR program (bachelor’s degrees or higher); nonreceipt of social security disability benefits at the time of enrollment in the VR program; and receipt of VR services such as occupational/vocational training, job search, job placement, on-the-job support, maintenance, and information/referral were associated with competitive employment outcomes.Rumrill, Phillip, Wehman, Paul, Cimera, Robert, Kaya, Cahit, Dillard, Chad, Chan, FongNodevopsadmin
2017Using a telehealth service delivery approach to working with an undergraduate student with a traumatic brain injury: A case studyJournalJ77605Work: A Journal of Prevention, Assessment, and Rehabilitation58117-21This case study provides an understanding of one participant’s experience using a telehealth service delivery approach to working with Project Career for academic and career support. Project Career is a five-year interprofessional demonstration project aimed to improve the academic and career success of undergraduate students who have a traumatic brain injury (TBI). The program provided the undergraduate student a combination of cognitive support technology in the form of an iPad and recommended software applications, and individualized case management services provided by a technology and employment coordinator. The participant’s case notes, direct communication with the intern, and outcome assessments were used to perform a qualitative analysis. The participant reported that he believed Project Career was an effective support service for him. However, his initial and 6-month outcome assessment scores are inconclusive regarding improvements in his academic abilities and satisfaction with academic and career attainment. Further research on the effectiveness of using a telehealth service delivery approach to working with undergraduate students with a TBI is needed.Quaco, CarrieNodevopsadmin
2016Virtual reality and brain computer interface in neurorehabilitationJournalJ75728Proceedings (Baylor University Medical Center)292124-127Article presents two original studies to demonstrate how advanced technology may be integrated into subacute rehabilitation after central nervous system injuries. The first study addresses the feasibility of brain-computer interface with patients on an inpatient spinal cord injury unit. The second study explores the validity of two virtual environments with acquired brain injury as part of an intensive outpatient neurorehabilitation program. These preliminary studies support the feasibility of advanced technologies in the subacute stage of neurorehabilitation. These modalities were well tolerated by participants and could be incorporated into patients' inpatient and outpatient rehabilitation regimens without schedule disruptions. This research expands the limited literature base regarding the use of advanced technologies in the early stages of recovery for neurorehabilitation populations and speaks favorably to the potential integration of brain-computer interface and virtual reality technologies as part of a multidisciplinary treatment program.Salisbury, David B., Dahdah, Marie, Driver, Simon, Parsons, Thomas D., Richter, Kathleen M.North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2017Work and traumatic brain injuryJournalJ77602Work: A Journal of Prevention, Assessment, and Rehabilitation5812-JanArticle briefly provides an overview of Project Career, an interprofessional demonstration designed to support the academic and career success of college students who have sustained traumatic brain injuries (TBI). Project Career merges the use of cognitive support technology (CST) and vocational rehabilitation practices to improve academic outcomes of civilian and veteran post-secondary students with TBI, ultimately leading to enhance employment opportunities. The project attains this goal through: (1) psychometric evaluation of postsecondary students with TBI relative to their assistive technology, personal, academic, and career objectives and needs; (2) provision of CST training to 150 students over the 5-year demonstration; (3) matching students with mentors; (4) provision of vocational case management; (5) provision of job development and placement assistance; and (6) provision of an electronic portal regarding accommodation and career resources.Rumrill, Phillip, Hendricks, Deborah J., Elias, Eileen, Jacobs, Karen, Leopold, Anne, Nardone, Amanda, Sampson, Elaine, Minton, Deborah, Scherer, MarciaNodevopsadmin
2015Upper limb joint kinetics of three sitting pivot wheelchair transfer techniques in individuals with spinal cord injuryJournalJ72156Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)384485-497Study compared the effects of three wheelchair transfer techniques on the upper-extremity (UE) joint kinetics of manual wheelchair users with spinal cord injury (SCI). Twenty individuals with SCI performed three sitting-pivotal transfer techniques from their wheelchair to a level tub bench. Two of the techniques involved a head-hips relationship where the trunk was forward flexed with the leading hand close to the body and internally rotated (HH-I) and with the leading hand abducted and far away (HH-A) from the body. The third technique was performed with the trunk upright (TU) and the hand far from the body. Motion analysis equipment recorded upper-body movements and force sensors recorded their hand and feet reaction forces during the transfers. Results showed several significant differences between HH-A and HH-I and between TU and HH-I transfers, suggesting that hand placement had a greater effect on the UE kinetics than did the amount of trunk flexion. Peak resultant hand, elbow, and shoulder joint forces were significantly higher for the HH-A and TU techniques at the trailing arm and lower at the leading arm, compared to the HH-I technique. Findings suggest that always trailing with the same arm if using HH-A or TU could predispose that arm to overuse-related pain and injuries. The authors conclude that technique training should focus on initial hand placement close to the body followed by the amount of trunk flexion needed to facilitate movement.Kankipati, Padmaja, Boninger, Michael L., Gagnon, Dany, Cooper, Rory A., Koontz, Alicia M.Nodevopsadmin
2015Variable neuroendocrine-immune dysfunction in individuals with unfavorable outcome after severe traumatic brain injuryJournalJ73539Brain, Behavior, and Immunity4515-27http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342288/Study examined relationships between cerebrospinal fluid (CSF) cortisol and inflammation after traumatic brain injury (TBI) and determined how these relationships differ by outcome. CSF samples were collected from 91 subjects with severe TBI, analyzed for cortisol and inflammatory markers, and compared to healthy controls (13 controls were analyzed for cortisol, 11 for inflammatory markers). Group-based trajectory analysis (TRAJ) delineated subpopulations with similar longitudinal CSF cortisol profiles (high versus low cortisol). Glasgow Outcome Scale (GOS) scores at 6 months served as the primary outcome measure reflecting global outcome. Inflammatory markers that displayed significant bivariate associations with both GOS and cortisol TRAJ were used to generate a cumulative inflammatory load score (ILS). Subsequent analysis revealed that cortisol TRAJ group membership mediated ILS effects on outcome. Correlational analysis between mean cortisol levels and ILS were examined separately within each cortisol TRAJ group and by outcome. Within the low cortisol TRAJ group, subjects with unfavorable 6-month outcome displayed a negative correlation between ILS and mean cortisol. Conversely, subjects with unfavorable outcome in the high cortisol TRAJ group displayed a positive correlation between ILS and mean cortisol. The results suggest that unfavorable outcome after TBI may result from dysfunctional neuroendocrine-immune communication wherein an adequate immune response is not mounted or, alternatively, neuroinflammation is prolonged. Importantly, the nature of neuroendocrine-immune dysfunction differs between cortisol TRAJ groups. These findings present a novel biomarker-based index from which to discriminate outcome and emphasize the need for evaluating tailored treatments targeting inflammation early after injury.Santarsieri, Martina, Kumar, Raj G., Kochanek, Patrick M., Berga, Sarah L., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2018Vocational rehabilitation outcomes for students participating in a model transition programJournalJ76304Rehabilitation Counseling Bulletin (RCB)613154-163Study compared vocational rehabilitation (VR) services and outcome differences between youth with disabilities who did and did not participate in a model transition intervention. The Maryland Seamless Transition Collaborative (MSTC), a transition service delivery model, featured research-supported components integrated into a single service model and was implemented across 11 Maryland school districts from 2007 to 2013. Using administrative data extracted from the Maryland Division of Rehabilitation Services for the analysis, the final sample included 377 MSTC youth and 6,111 non-MSTC youth. Several major findings emerged. First, MSTC participants experienced a shorter time from eligibility to development of the Individual Plan for Employment, but cases remained open longer. In addition, MSTC youth received more job-related services and less assessment and diagnostic services; cost less to serve; achieved significantly higher employment rates at case closure; and worked slightly fewer hours and earned less per week at closure. The findings demonstrate the potential effectiveness of a career/work-focused transition intervention on improving employment outcomes for transitioning youth, regardless of disability. Implications for VR practice are discussed.Luecking, Richard G., Fabian, Ellen S., Contreary, Kara, Honeycutt, Todd C., Luecking, Debra M.Nodevopsadmin
2016Use of assistive technology with transition-aged youthJournalJ75664SiS Quarterly Practice Connections124-FebArticle explores a sampling of assistive technologies that hold promise for improving outcomes in three primary environments associated with physical and social contexts in which major changes are occurring for transition-age youth: secondary education, self-management, and employment. These examples are by no means comprehensive, but are meant to illustrate possibilities.Fairman, Andrea D., Bendixen, Roxana, Younkin, Haley, Krecko, Julie R.Nodevopsadmin
2015Video game accessibility: A legal approachJournalJ73702Disability Studies Quarterly351http://dsq-sds.org/article/view/4513/3833Article presents an argument for legally requiring that video games are accessible to everyone, including people with disabilities. Video game accessibility may not seem of significance to some, and it may sound trivial to anyone who does not play video games. This assumption is false. With the digitalization of culture, video games are an ever increasing part of life. They contribute to peer to peer interactions, education, music and the arts. A video game can be created by hundreds of musicians and artists, and they can have production budgets that exceed modern blockbuster films. Inaccessible video games are analogous to movie theaters without closed captioning or accessible facilities. The movement to have accessible video games is small, unorganized, and misdirected. Just like the other battles to make society accessible were accomplished through legislation and law, the battle for video game accessibility must be focused toward the law and not the market.Powers, George M.Nodevopsadmin
2016Wheelchair skills capacity and performance of manual wheelchair users with spinal cord injuryJournalJ74704Archives of Physical Medicine and Rehabilitation97101761-1769Study examined the wheelchair skills capacity and performance of experienced manual wheelchair users with spinal cord injury (SCI) and assessed measurement properties of the Wheelchair Skills Test (WST) and Wheelchair Skills Test Questionnaire (WST-Q). One hundred seventeen manual wheelchair users with SCI from 4 Spinal Cord Injury Model Systems centers completed the WST and WST-Q version 4.2 as well as measures for Confidence, Basic Mobility, Independence, Ability to Participate, Satisfaction, and Pain Interference. The median values for WST capacity, WST-Q capacity, and WST-Q performance were 81.0, 88.0, and 76.0 percent, respectively. The total WST capacity scores correlated significantly with the total WST-Q capacity scores and WST-Q performance scores. The total WST-Q capacity and WST-Q performance scores were correlated significantly. Success rates were Kirby, R. Lee, Worobey, Lynn A., Cowan, Rachel, Pedersen, Jessica P., Heinemann, Allen W., Dyson-Hudson, Treveor A., Shea, Mary, Smith, Cher, Rushton, Paula W., Boninger, Michael L.Nodevopsadmin
2015Unemployment in the United States after traumatic brain injury for working-age individuals: Prevalence and associated factors 2 years postinjuryJournalJ71787Journal of Head Trauma Rehabilitation303160-174Study estimated the prevalence of unemployment and part-time employment in the United States for working-age individuals completing rehabilitation for a primary diagnosis of traumatic brain injury (TBI) between 2001 and 2010, using data from the TBI Model Systems National Database. The prevalence of unemployment for individuals in the selected cohort was 60.4 percent at the 2-year follow-up. Prevalence of unemployment was significantly associated with the majority of categories of age group, race, gender, marital status, primary inpatient rehabilitation payment source, education, preinjury vocational status, length of stay, and Disability Rating Scale (DRS) score. The direction of association for the majority of these variables complement previous research in this area, with only Hispanic ethnicity and the Functional Independence Measure cognitive subscale demonstrating disparate findings. For those employed at 2 years post injury, the prevalence of part-time employment was 35.0 percent. The model of prevalence for part-time employment at 2 years after injury was less robust, with significant relationships with some categorical components of age group, gender, marital status, primary payment source, preinjury vocational status, and DRS score. Further investigation of both unemployment and part-time employment is warranted to help identify the key components to maximize the potential for employment after TBI and reduce the negative consequences associated with unemployment.Cuthbert, Jeffrey P., Harrison-Felix, Cynthia, Corrigan, John D., Bell, Jeneita M., Haarbauer-Krupa, Juliet K., Miller, A. CateOhio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2014Variability of respiration and sleep during polysomnography in individuals with TBIJournalJ70519Neurorehabilitation352245-251Study investigated the night-to-night consistency of diagnosing and classifying obstructive sleep apnea (OSA) using nocturnal polysomnography (NPSG) in individuals with traumatic brain injury (TBI). NPSG is considered the gold standard for detecting the presence of sleep apnea. However, there is a limitation with its use known as the “first-night effect” (aberrant polysomnography findings on the first night in a sleep lab). Forty-seven adults with self-reported mild-to-severe TBI underwent two nights of in-laboratory NPSG to examine variability between the first and second night with regards to OSA diagnosis and severity as well as sleep architecture. Results showed that OSA detection and severity were consistent from night-to-night in 89 percent of participants with TBI. Participants demonstrated longer rapid eye movement latency on the first night compared to the second night of the sleep study. These findings indicate that two nights of in-laboratory NPSG are generally consistent in reliably diagnosing OSA in individuals with TBI and that first-night effects are minimal. One night of NPSG has diagnostic utility in the evaluation of sleep disorders in individuals with TBI.Lu, William, Cantor, Joshua, Aurora, R. Nisha, Nguyen, Michael, Ashman, Teresa, Spielman, Lisa, Ambrose, Anne, Krellman, Jason W. , Gordon, WayneNew York Traumatic Brain Injury Model SystemYesdevopsadmin
2017Vocational interests by gender and race 10 years after spinal cord injuryJournalJ77641Rehabilitation Psychology624545-552Study examined vocational interests among individuals with spinal cord injury (SCI) as a function of gender and race approximately 10 years after SCI onset. A total of 247 participants completed the Strong Interest Inventory, a 291-item measure of vocational interests. Results showed that male participants more often indicated a preference for working in physically challenging jobs, and female participants more often indicated interests in caring for others. Racial differences were also seen, with White participants indicating interests in physical challenging jobs, whereas Black participants reported interests in organizational systems (e.g., information systems, accounting) and positions of leadership. For both female and Black participants, interests are more physically compatible with employment post-SCI than male and White participants. Yet, employment rates in White males with SCI are greater than those of female and Black individuals with SCI. These findings suggest further research is needed on factors influencing gender and racial disparities in employment and underscore the importance of helping people with SCI to find opportunities matching their vocational interests.Clark, Jillian M. R., Krause, James S.Nodevopsadmin
2015Use of a self-monitoring application to reduce stereotypic behavior in adolescents with autism: A preliminary investigation of I-ConnectJournalJ73541Journal of Autism and Developmental Disorders (JADD)4551146-1155Study evaluated the functional relationship between I-Connect, a technology-delivered self-monitoring program, and decreases in the level of stereotypic behavior for two students with autism in a school setting. I-Connect is an Android application that was loaded onto a smartphone to provide scheduled prompts for participants to self-evaluate and self-monitor targeted behaviors. The effect of the intervention was evaluated utilizing a withdrawal design with an embedded multiple baseline across participants. Both students demonstrated an immediate decrease in stereotypy with the introduction of the self-monitoring application. The results and implications for practice and future research are discussed.Crutchfield, Stephen A., Mason, Rose A., Chambers, Angela, Wills, Howard P., Mason, Benjamin A.Nodevopsadmin
2015Venlafaxine Extended-Release for Depression following Spinal Cord Injury: A Randomized Clinical TrialJournalJ72704JAMA Psychiatry172247-258Study examined the efficacy and tolerability of venlafaxine hydrochloride extended-release (XR) for major depressive disorder (MDD) or dysthymic disorder in people with chronic spinal cord injury (SCI). A total of 2,536 patients from outpatient clinics at 6 SCI treatment centers in the United States were screened and 133 were randomized into a 12-week trial of venlafaxine XR vs placebo using a flexible-dose algorithm. The primary depression outcome measures were the Hamilton Depression Rating Scale (HAM-D) and the Maier subscale. Secondary outcomes were self-rated depression severity, global improvement, and SCI-related disability. Mixed-effects linear regression models were used to compare treatment efficacy of venlafaxine XR with placebo Primary analyses included observations at baseline and at 1, 3, 6, 8, 10, and 12 weeks, analyzed according to the intent-to- treat principle. Severity of adverse effects (none, mild, moderate, or severe) was recorded at baseline and at each follow-up. Results revealed a significant difference between the venlafaxine XR and placebo groups in improvement on the Maier subscale from baseline to 12 weeks but not on the HAM-D. Participants receiving venlafaxine XR reported significantly less SCI-related disability at 12 weeks compared with placebo. Blurred vision was the only significantly more common new or worsening adverse effect in the venlafaxine XR group compared with the placebo group over 12 weeks. The data suggest that venlafaxine XR was well-tolerated by most patients and is an effective antidepressant for decreasing core symptoms of depression and improving SCI-related disability.Williamson ML, Elliott TR, Bogner J, Dreer LE, Arango-Lasprilla JC, Kolakowsky-Hayner SA, Pretz CR, Lequerica A, Perrin PB.Yesdevopsadmin
2017Translation and validation of an online suite of assessments in American sign languageJournalJ78514JADARA (formerly Journal of the Rehabilitation of the Deaf)511Article describes a project underway to increase accessibility of standardized instruments for individuals who are deaf and hard of hearing (DHH) and communicate using American Sign Language (ASL). The researchers propose the development of an online suite of valid assessment instruments in ASL focusing on substance abuse, mental health, and a career-related interest inventory. The criterion to determine which instruments would be selected includes brevity, psychometric properties, and current use of instruments utilized by service providers working with DHH individuals. Based on these criteria, the eight instruments selected to be translated from English to ASL and validated for use with DHH individuals were: Alcohol Use Disorders Identification Test, Drug Abuse Screening Test, Satisfaction with Life Scale, Rosenberg Self-Esteem Scale, Beck Depression Inventory, Patient Health Questionnaire, Generalized Anxiety Disorder, and Occupational Information Network Interest Profiler. In addition, the Global Appraisal of Individual Needs - Short Screener, which was translated to ASL in an earlier project, is being validated in the current project. The ultimate goal of this research team is to provide an online portal that will make available a variety of screening and assessment instruments in ASL. Nearly all of these instruments are public access, which means that they are free to the public.Guthmann, Deb, Titus, Janet, Embree, Jared, Wilson, JosephineNodevopsadmin
2015Ten-year employment patterns of working age individuals after moderate to severe traumatic brain injury: A national institute on disability and rehabilitation research traumatic brain injury model systems studyJournalJ72878Archives of Physical Medicine and Rehabilitation96122128-2136Study examined patterns of employment over a 10-year period for working-age individuals discharged from a Traumatic Brain Injury Model Systems (TBIMS) center. Data were analyzed for 3,618 patients with moderate-to-severe traumatic brain injury (TBI), aged 16 to 55 years, who were not retired at injury. The subjects received inpatient rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and completed at least 3 follow-up interviews at years 1, 2, 5, and 10 after injury. Patterns of employment were generated using a generalized linear mixed model, where these patterns were transformed into temporal trajectories of probability of employment via random effects modeling. Covariates demonstrating significant relations to growth parameters that govern the trajectory patterns were similar to those noted in previous cross-sectional research and included age, sex, race/ethnicity, education, preinjury substance misuse, preinjury vocational status, and days of posttraumatic amnesia. The calendar year in which the injury occurred also greatly influenced trajectories. An interactive tool was developed to provide visualization of all postemployment trajectories, with many showing decreasing probabilities of employment between 5 and 10 years after injury. These results indicate that post-injury employment after moderate-to-severe TBI is a dynamic process, with varied patterns of employment for individuals with specific characteristics. The overall decline in trajectories of probability of employment between 5 and 10 years after injury suggests that moderate-to-severe TBI may have unfavorable chronic effects and that employment outcome is highly influenced by national labor market forces.Cuthbert, Jeffrey P., Pretz, Christopher R., Bushnik, Tamara, Fraser, Robert T., Hart, Tessa, Kolakowsky-Hayner, Stephanie A., Malec, James F., O'Neil-Pirozzi, Therese M., Sherer, MarkTexas TBI Model System of TIRR, Rocky Mountain Regional Brain Injury System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Moss Traumatic Brain Injury Model System, Spaulding-Harvard Traumatic Brain Injury Model System, Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue HospitalYesdevopsadmin
2017Understanding physical activity in the group home setting: A qualitative inquiryJournalJ76506American Journal of Orthopsychiatry397653-662Study qualitatively explored physical activity in the group home setting and determined what key stakeholders want from a physical activity program. Twenty stakeholders (residents with intellectual disability, support staff, and program coordinators) participated in one of three focus groups, separated by stakeholder status. Discussions were transcribed, coded, and analyzed. A number of factors emerged that would assist rehabilitation professionals in understanding physical activity within the group home setting. The following six meta-themes were identified: nature of residents’ physical activity, facilitators to physical activity, barriers to physical activity, personal factors, organizational factors, and solutions to increase physical activity. The findings suggest that residents with intellectual disabilities have low physical activity and opportunities for participation. Key attributes of the group home setting were identified between barriers and facilitators to activity. Consideration for the development of physical activity programs should focus on the unique needs of the group home setting as expressed by stakeholders. The results of this study will provide critical information on how to implement activity programs to fit the needs of the group home environment.Dixon-Ibarra, Alicia, Driver, Simon, Vanderbom, Kerri, Humphries, KathleenNodevopsadmin
2018The effects of vocational rehabilitation for people with physical disabilitiesJournalJ78671Journal of Human Capital121Jan-37Study evaluated the impact of vocational rehabilitation (VR) services on employment outcomes of adults with physical disabilities. Using detailed panel data from the Virginia Department of Aging and Rehabilitation Services in state fiscal year 2000, researchers estimated a structural model of participation that accounts for the potentially sudden onset of physical impairments and the endogenous selection of VR services. The results imply that VR services have large, positive long-run labor market effects that substantially exceed the cost of providing services.Dean, David, Schmidt, Robert, Pepper, John, Stern, StevenNodevopsadmin
2016The relationship between sleep-wake cycle disturbance and trajectory of cognitive recovery during acute traumatic brain injuryJournalJ73354Journal of Head Trauma Rehabilitation312108-116Study examined the relationship between ratings of sleep dysfunction and serial cognitive assessments among patients with moderate-to-severe traumatic brain injury (TBI) over the first 3 week of acute neurorehabilitation. Sleep-wake cycle disturbance (SWCD) was assessed using the Delirium Rating Scale-Revised 98 and cognitive recovery was measure with the Cognitive Test for Delirium (CTD) at admission and with subsequent weekly examinations. A total of 106 participants were grouped based on the presence (SWCD+) or absence (SWCD−) of sleep dysfunction for each examination; groups were equivalent on demographic and injury variables. Individual growth curve (IGC) modeling was used to examine course of CTD performance across examinations. IGC modeling revealed a significant interaction between examination number (i.e., time) and SWCD group on total CTD score. The SWCD+ ratings on later examinations were predicted to result in lower CTD scores and greater cognitive impairment over time. These findings suggest that those with persisting sleep disturbance could be prone to different and potentially poorer courses of cognitive recovery. This study has implications for improving neurorehabilitation treatment, as targeting sleep dysfunction for early intervention may facilitate cognitive recovery.Holcomb, Erin M., Towns, Stephanie , Kamper, Joel E., Barnett, Scott D., Sherer, Mark, Evan, Clea, Nakase-Richardson, RisaTexas TBI Model System of TIRRYesdevopsadmin
2015Trajectories of life satisfaction after traumatic brain injury: Influence of life roles, age, cognitive disability, and depressive symptomsJournalJ72926Rehabilitation Psychology604353-364Study identified life satisfaction trajectories after moderate-to-severe traumatic brain injury (TBI), identified factors at 1-year postinjury that predict these life satisfaction trajectories, and determined how individuals in distinct life satisfaction trajectory groups differ from one another. Data were collected at 1, 2, and 5 years post TBI from 3,012 participants aged 16 years old and older with moderate-to-severe TBI who were enrolled in the TBI Model Systems National Database. Four life satisfaction trajectories were identified across the first 5 years after injury, including: stable satisfaction, initial satisfaction declining, initial dissatisfaction improving, and stable dissatisfaction. Age, depressive symptoms, cognitive disability, and life role participation as a worker, leisure participant, and/ or religious participant at 1-year postinjury significantly predicted trajectory group membership. Life role participation and depressive symptoms were strong predictors of life satisfaction trajectories across the first 5 years after TBI. The previously documented loss of life roles and prevalence of depression after moderate-to-severe TBI make this a vulnerable population for whom low or declining life satisfaction is a particularly high risk. The findings highlight the importance of addressing depressive symptoms and participation early after TBI.Juengst, Shannon B., Adams, Leah M., Bogner, Jennifer A., Arenth, Patricia M., O'Neil-Pirozzi, Therese M., Dreer, Laura E., Hart, Tessa, Bergquist, Thomas F., Bombardier, Charles H., Dijkers, Marcel P., Wagner, Amy K.Mayo Clinic Traumatic Brain Injury Model System , Moss Traumatic Brain Injury Model System, New York Traumatic Brain Injury Model System, Spaulding-Harvard Traumatic Brain Injury Model System, Ohio Regional Traumatic Brain Injury Model System , University of Pittsburgh Model Center for Traumatic Brain Injury , UAB Traumatic Brain Injury Model SystemYesdevopsadmin
2017Systematic review and knowledge translation: A framework for synthesizing heterogeneous research evidenceJournalJ77655Work: A Journal of Prevention, Assessment, and Rehabilitation584485-499https://content.iospress.com/articles/work/wor2577This article considers how knowledge translation strategies can support and advance systematic reviews that include diverse types of research. Lessons learned from conducting a systematic review of Americans with Disabilities Act (ADA) employment research are explained and contextualized within research on barriers and facilitators to successful knowledge translation. A key challenge in developing systematic reviews in the social sciences is to consider how to meet the knowledge translation needs of varying stakeholders when reviewing large and complex bodies of research, such as with the current state of ADA evidence. Steps from the research protocol are described to provide a procedural framework for integrating stakeholder feedback into the review process. Descriptive mapping, an analytical technique most commonly used in scoping reviews, was deemed necessary to provide a clearer understanding and overview of the diverse body of research evidence. Stakeholder feedback can address barriers to knowledge translation by engaging end-users of research products throughout the review process. Given the growing scholarly recognition of qualitative and mixed-methods techniques as suitable approaches for systematic review, there is further need for consideration on how these approaches can benefit from more participatory research processes.Gould, Robert, Harris, Sarah P., Fujiura, GlennNodevopsadmin
2015Traumatic brain injury patient, injury, therapy, and ancillary treatments associated with outcomes at discharge and 9 months postdischargeJournalJ72093Archives of Physical Medicine and Rehabilitation968, Supplement 3S304-S329Study examined the contribution patient and injury characteristics, inpatient rehabilitation therapy activities, and neurotropic medications to outcomes at discharge and 9 months postdischarge for patients with traumatic brain injury (TBI). Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. Outcomes of interest were rehabilitation length of stay, discharge to home, and Functional Independence Measure (FIM) scores at discharge and 9 months postdischarge. The admission FIM cognitive score was used to create 5 relatively homogeneous subgroups for subsequent analysis of treatment outcomes. Within each subgroup, significant associations were found between outcomes and patient and injury characteristics, time spent in therapy activities, and medications used. Patient and injury characteristics explained on average 35.7 percent of the variation in discharge outcomes and 22.3 percent in 9-month outcomes. Adding time spent and level of effort in therapy activities and percentage of stay using specific medications explained approximately 20 percent more variation for discharge outcomes and 12.9 percent for 9-month outcomes. After patient, injury, and treatment characteristics were used to predict outcomes, center differences added only approximately 1.9 percent additional variance explained.Horn, Susan D., Corrigan , John D., Beaulieu, Cynthia L., Bogner, Jennifer, Barrett, Ryan S., Giuffrida, Clare G., Ryser, David K., Cooper, Kelli, Carroll, Deborah M., Deutscher, DanielNodevopsadmin
2017The diversity partners project: Multi-systemic knowledge translation and business engagement strategies to improve employment of people with disabilitiesJournalJ76358Journal of Vocational Rehabilitation463273-285Article describes how a systematic approach to knowledge translation (KT) was used in an iterative intervention development process that engaged key stakeholders at every phase. The goal of the Diversity Partners Project is to develop, test, and launch an innovative learning intervention to improve the relationships between employment service professionals (including disability services, workforce development, and staffing organizations) and employers seeking to hire individuals with disabilities. The Diversity Partners intervention aims to facilitate KT among stakeholders who play a role in improving employment opportunities for people with disabilities. The intervention consists of one website that contains online training modules for organizational leadership and frontline personnel. The self-paced modules are reinforced through on-demand technical assistance and training events offered by subject matter experts to support both business partnerships and overall excellence in serving job seekers with disabilities. In the disability arena, KT requires a willingness to challenge strongly held assumptions on the part of the project team, to move swiftly and repeatedly between inquiry and development, and to honestly engage with potential stakeholders who have a vested interest in the development efforts being undertaken.Harris, Carolina, Switzer, Ellice, Gower, Wendy S.Nodevopsadmin
2017The impacts of limited transportation access on persons with disabilities' social participationJournalJ78689Journal of Transport & Health7Part B227-234Study examined individuals with disabilities’ social and community participation in relation to their access to transportation. A self-administered online questionnaire was disseminated to individuals with disabilities throughout the United States. Although 693 individuals responded, only 420 respondents were both 18 years of age or older and reported having a disability. Respondents were found to use private vehicles less often and public transportation more often than previous studies have shown. Individuals with increasingly significant disabilities were more likely to face transportation-related exclusion. Almost half of the participants had to cancel an appointment because of a transportation-related conflict. The majority of participants felt that the level of access to transportation hindered their social life. In general, the results suggest that family help meet transportation needs for socializing, while friends and close friends do not.Bascom, Graydon W., Christensen, Keith M.Nodevopsadmin
2018The youth transition demonstration project in Miami, Florida: Design, implementation, and three-year impactsJournalJ78392Journal of Vocational Rehabilitation48179-81Broadened Horizons, Brighter Futures (BHBF), a transition project in Miami-Dade County, Florida, was the focus of an evaluation of services and work incentives for youth who were receiving disability payments. Notable features of BHBF included paid work experiences for youth and the application of external technical assistance in implementing the program model. The evaluation documented the design and implementation of BHBF and assessed its impacts on outcomes for youth three years after they enrolled in the study. A total of 859 youth who were receiving disability payments were randomly assigned to either a treatment group that was eligible to receive both BHBF services and waivers of certain disability program rules, or to a control group that was not eligible for either the services or the waivers. Three years after they enrolled in the study, treatment group youth were more likely than youth in the control group to be employed, their earnings were 50 percent higher, and they were less likely to have had contact with the justice system. Findings suggest that interventions that include work experiences as a service component can improve outcomes for youth with disabilities. Empirical monitoring of project staff, combined with technical assistance, may be necessary to ensure a consistent focus on helping youth to find jobs.Fraker, Thomas, Crane, Kelli T., Honeycutt, Todd C., Luecking, Richard G., Mamun, Arif A., O'Day, Bonnie L.Nodevopsadmin
2015Transition services for youth with autism: A systematic reviewJournalJ70147Research on Social Work Practice25120-OctThis review was conducted to determine the effectiveness of pre-graduation behavioral and social interventions that prepare transition-age youth with autism spectrum disorders (ASD) for mainstream competitive employment after graduation. Relevant studies were identified through electronic searches of 30 computerized databases. The searches produced a total of 5,665 citations. Of these, a total of 85 citations were advanced for collection of a full text copy of the study. Upon review of the full-text for each of the 85 studies, no studies were identified that met all the inclusion criteria specified for the review. This review was not able to identify definitive interventions that predictably and positively supported the development of transition programs designed to produce employment outcomes for individuals with ASD. While no definitive conclusions can be drawn based upon the current review, the authors did identify qualitative research and other related studies that addressed elements of potential successful employment placements for transition-age individuals with ASD.Westbrook, John D., Fong, Carlton J., Nye, Chad, Williams, Ann, Wendt, Oliver, Cortopassi, TaraNodevopsadmin
2016Telephone problem-solving treatment improves sleep quality in service members with combat-related mild traumatic brain injury: Results from a randomized clinical trialJournalJ73358Journal of Head Trauma Rehabilitation312147-157Study evaluate sleep quality, its correlates, and the effect of telephone-based problem-solving treatment (PST) in active duty post-deployment service members with mild traumatic brain injury (mTBI). A total of 356 service members with combat-related mTBI were randomly assigned to education-only (EO) and PST groups (178 in each group). Both groups received printed study materials and 12 educational brochures. The PST group additionally received up to 12 PST telephone calls addressing participant-selected issues. Outcomes were evaluated at baseline and 6- and 12-month follow-ups using the Pittsburgh Sleep Quality Index. Sleep quality was manifestly poor in both groups at baseline. Overall sleep quality was significantly different between the PST and EO groups at 6 months but not at 12 months. Low sleep quality was associated with concussion symptoms, pain, depression, and posttraumatic stress disorder at all time points. The findings suggest that sleep disorders, common in post-deployment service members with mTBI, are strongly associated with the presence of pain, posttraumatic stress disorder, and depression. Telephone-based PST may be an effective therapeutic approach for reducing sleep disorders in this population. Research should focus on maintenance of treatment gains.Vuletic, S., Bell, K. R., Jain, S., Bush, N., Temkin, N., Fann, J. R., Stanfill, K. E., Dikmen, S., Brockway, J. A., He, F., Ernstrom, K., Raman, R., Grant, G., Stein, M. B., Gahm, G. A.North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2016Type and frequency of reported wheelchair repairs and related adverse consequences among people with spinal cord injuryJournalJ74703Archives of Physical Medicine and Rehabilitation97101753-1760Study investigated the frequency and types of wheelchair repairs and associated adverse consequences among people with spinal cord injury (SCI). Individuals who received care at 9 SCI Model Systems Centers and who use a wheelchair more than 40 hours each week were surveyed. Survey questions addressed the number of repairs needed and resulting adverse consequences, number and types of repairs completed, and location where main repair was completed in the previous 6 months. Of the 591 participants who responded to the survey, 63.8 percent of them needed at least 1 repair; of these, 27.6 percent experienced at least 1 adverse consequence, including 18.2 percent who were stranded. Of those who needed repairs, 6.9 percent did not have them completed. Repairs completed on the wheels and casters were the most frequent repair to manual wheelchairs, whereas repairs to the electrical and power and control systems were the most frequent type of repair on power wheelchairs. Forty percent of manual wheelchair users reported completing repairs at home themselves compared with 14 percent of power wheelchair users. Twelve percent of the variance in the odds of facing an adverse consequence because of a wheelchair breakdown can be described as a function of occupation, funding source, and type of wheelchair. Findings suggest that wheelchair repairs are highly prevalent. There are differences in types of repairs and who completes the repairs based on the type of wheelchair and there is a deficit between repairs needed and those completed, highlighting the need for interventions that address these problems.Toro, Maria L., Worobey, Lynn, Boninger, Michael L., Cooper, Rory A., Pearlman, JonathanNodevopsadmin
2015The effects of vocational rehabilitation for people with cognitive impairmentsJournalJ71279International Economic Review562399-426Article utilizes administrative data to examine both short- and long-term employment impacts for people with cognitive impairments who applied for vocational rehabilitation (VR) services in Virginia in 1988 and 2000. These data provide long-term quarterly information on VR services and employment outcomes before and after the provision of services. The authors model the behavior of service provision and labor market outcomes, allow for multiple service choices, use long-run labor market data, and use valid instruments. The results imply that services generally have positive long-run labor market outcome effects that appear to substantially exceed the cost of providing services.Dean, David, Pepper, John, Schmidt, Robert, Stern, StevenNodevopsadmin
2015The relationship between self-reported sleep disturbance and polysomnography in individuals with traumatic brain injuryJournalJ72555Brain Injury29111342-1350Study examined self-reported and objective sleep disturbance in individuals with traumatic brain injury (TBI) and explored possible relationships among sleep architecture and self-reported sleep quality, fatigue, and daytime sleepiness. Forty-four community-dwelling adults with TBI completed the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Assessment of Fatigue (MAF), and the Epworth Sleepiness Scale (ESS). They underwent two nights of in-laboratory nocturnal polysomnography (NPSG). Pearson product-moment correlation coefficients and hierarchical linear regression was used to analyze the data. Based on the PSQI cut-off score of ≥10, 22 participants were characterized as poor sleepers. Twenty-seven participants met criteria for clinically significant fatigue as measured by the Global Fatigue Index of the MAF. Fourteen participants met criteria for excessive daytime sleepiness as measured by the ESS. Poor sleep quality was associated with poor sleep efficiency, short duration of stage 2 sleep, and long duration of rapid eye movement sleep. There was little-to-no association between high levels of fatigue or daytime sleepiness with NPSG sleep parameters. Results show that a high proportion of the sample endorsed poor sleep quality, fatigue, and daytime sleepiness. Those who reported poorer sleep quality exhibited a shorter proportion of time spent in stage 2 sleep. These findings suggest that disruptions in stage 2 sleep might underlie the symptoms of sleep disturbance experienced following TBI.Lu, William, Cantor, Joshua B., Aurora, R. Nisha, Gordon, Wayne A., Krellman, Jason W., Nguyen, Michael, Ashman, Teresa A., Spielman, Lisa, Ambrose, Anne F.New York Traumatic Brain Injury Model SystemYesdevopsadmin
2014Toward a theory-driven classification of rehabilitation treatmentsJournalJ67520Archives of Physical Medicine and Rehabilitation951 (Supplement 1)S33-S44Article describes efforts underway to create a rehabilitation treatment taxonomy (RTT) for classifying rehabilitation interventions by the underlying treatment theories that explain their effects. In the RTT, treatments are grouped together according to their targets, or measurable aspects of functioning they are intended to change; ingredients, or measurable clinician decisions and behaviors responsible for effecting changes; and the hypothesized mechanisms of action by which ingredients are transformed into changes in the target. Four treatment groupings are proposed (structural tissue properties, organ functions, skilled performances, and cognitive/affective representations) that differ from one another in all aspects of treatment theory. That is, they are different in terms of the types of targets addressed, ingredients used, and mechanisms of action that account for change. The typical ingredients and examples of clinical treatments associated with each of these groupings are explored, and the challenges of further subdivision are discussed.Hart, Tessa, Tsaousides, Theodore, Zanca, Jeanne M., Whyte, John, Packel, Andrew, Ferraro, Mary, Dijkers, Marcel P.Nodevopsadmin
2016Traumatic brain injury history is associated with earlier age of onset of frontotemporal dementiaJournalJ75729Journal of Neurology, Neurosurgery and Psychiatry878817-820Study examined whether a history of traumatic brain injury (TBI) is associated with an earlier age of symptom onset and diagnosis in a large sample of patients with behavioral variant frontotemporal dementia (bvFTD). Data on 678 patients with bvFTD were obtained from the National Alzheimer's Coordinating Center Uniform Data Set. TBI was categorized based on reported lifetime history of TBI with loss of consciousness (LOC) but no chronic deficits occurring more than 1 year prior to diagnosis of bvFTD. Analysis of covariance was used to determine if clinician-estimated age of symptom onset and age at diagnosis of bvFTD differed between those who reported a history of TBI with LOC (TBI+) and those who did not (TBI−). Controlling for sex, the TBI+ bvFTD group had an age of symptom onset and age of diagnosis that was on average 2.8 and 3.2 years earlier, respectively, than the TBI− bvFTD group. The findings suggest that TBI history with LOC occurring more than 1 year prior to diagnosis is associated with an earlier age of symptom onset and diagnosis in patients with bvFTD. TBI may be related to the underlying neurodegenerative processes in bvFTD, but the implications of age at time of injury, severity, and repetitive injuries remain unclear.LoBue, Christian, Wilmoth, Kristin, Cullum, C. Munro, Rossetti, Heidi C., Lacritz, Laura H., Hynan, Linda S., Hart Jr., John, Womack, Kyle B.North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2018The disability employment puzzle: A field experiment on employer hiring behaviorJournalJ78688ILR Review712329-364Study investigated potential discrimination against people with disabilities through a field experiment that sent 6,016 job applications for open accounting positions using fictional résumés and cover letters. One-third of the cover letters disclosed that the applicant had a spinal cord injury, one-third disclosed the presence of Asperger’s syndrome, and one-third did not mention disability. These disabilities were chosen because they would not be expected to limit productivity in accounting positions. The disability applications received 26 percent fewer expressions of employer interest. This gap was concentrated among experienced applicants and small private companies that are not covered by the Americans with Disabilities Act (ADA). Tests suggest possible positive effects of the ADA, but not of state laws, in reducing the disability gap. The results indicate there may be substantial room for employer and policy initiatives to improve employment opportunities for people with disabilities.Ameri, Mason, Schur, Lisa, Adya, Meera, Bentley, F. Scott, McKay, Patrick, Kruse, DouglasNodevopsadmin
2016The impact of health behaviors and health management on employment after SCI: Physical health and functioningJournalJ73146Topics in Spinal Cord Injury Rehabilitation22139-48Study examined the relationship between employment and the management of physical health and functioning as described by individuals with spinal cord injury (SCI) who had worked at some time after injury. Six focus groups were conducted at 2 sites and included 44 participants with SCI. Heterogeneous and homogeneous groups were created based on specific characteristics, such as education, gender, or race. A semi-structured interview format asked questions about personal, environmental, and policy-related factors influencing employment after SCI. Discussions were recorded, transcribed, and entered into NVivo software before being coded by 2 reviewers. Four overlapping themes were identified: (1) relearning one’s own body and what it can do; (2) general health and wellness behaviors; (3) communication, education, and advocacy; and (4) dealing with secondary conditions and aging. Specific themes describe the many types of behaviors individuals must master and their impact on return to work as well as on finding, maintaining, and deciding to leave employment. Individuals who are successfully employed after SCI must learn how to perform necessary behaviors to manage health and function in a work environment. The decision to leave employment often appears to be associated with secondary complications and other conditions that occur as the person with SCI ages.Meade, Michelle A., Reed, Karla S., Krause, James S.Nodevopsadmin
2015The workplace discrimination experiences of older workers with disabilities: Results from the national EEOC ADA research projectJournalJ72213Journal of Vocational Rehabilitation432137-148Study examined the employment discrimination experiences of older workers (55 and over) with disabilities in comparison to younger adult workers with disabilities. The study utilized data from the Integrated Mission System of the United States Equal Employment Opportunity Commission (EEOC) to investigate the nature of employment discrimination charges that cite the Americans with Disabilities Act (ADA). Analyses examined age as a differential indicator of demographic characteristics of the charging parties, the characteristics of employers against whom allegations were filed, the discrimination issues alleged to occur, and the legal outcome of allegation investigations. Results indicates that allegations filed by older charging parties were more likely to come from males and Caucasians and to involve more nonparalytic orthopedic, cardiovascular, vision, hearing, endocrinological, respiratory, and other age-related impairments. Allegations filed by older charging parties involved fewer mental health concerns, substance use disorders, blood and immune disorders, developmental disabilities, and chronic illnesses such as multiple sclerosis and epilepsy. Allegations filed by older workers were less likely to involve involuntary termination and more likely to involve work assignments, the terms and conditions of employment, layoff, and involuntary retirement. No significant differences in the proportions of allegations were observed related to the size of respondent employers or the outcomes of the EEOC’s investigatory process. Findings suggest that many of the workplace discrimination experiences of people with disabilities are common across age groups, and that partial support is evident for double jeopardy in the treatment of older workers with disabilities. Implications for policy and practice are discussed.Cichy, Kelly E., Li, Jian, McMahon, Brian T., Rumrill, Phillip D.Nodevopsadmin
2014Transition planning for youth with traumatic brain injury: Findings from the national longitudinal transition survey 2JournalJ69542NeuroRehabilitation342365-372Study examined the prevalence of employment and characteristics of transition planning practices that promoted positive school-to-work transition for students with traumatic brain injury (TBI). Data on the 200 participants was drawn from the National Longitudinal Transition Study-2 (NLTS-2), a ten-year study which followed a large nationally representative sample of youth with disabilities through secondary education in into young adulthood. Logistic regression was used to investigate the associations between student, school, and collaborative engagement in the planning process and employment outcomes up to 8 years after high school. Among youth with TBI, 51 percent were currently employed at the time of interview and 73 percent had been employed at any time after high school. Results showed that students with TBI who had transition goals for postsecondary education were more likely to be employed at some point since leaving high school. The findings also support active student engagement and leadership in the transition planning process, and the inclusion of outside organizations and individuals. Implications for educational practices and future research are discussed.Wehman, Paul, Chen, Chin-Chih, West, Michael, Cifu, GabriellaNodevopsadmin
2016TBI-QOL: Development and calibration of item banks to measure patient reported outcomes following traumatic brain injuryJournalJ73342Journal of Head Trauma Rehabilitation31140-51Article describes the development and calibration of the Traumatic Brain Injury Quality-of-Life (TBI-QOL), a comprehensive patient-reported outcomes (PRO) measurement system specifically for individuals with traumatic brain injury (TBI). The TBI-QOL was developed in 2 distinct phases. The initial phase focused on development of the domain structure, evaluation of extant items, and creation and refinement of new item pools. Qualitative input was obtained from individuals with TBI, TBI clinicians, and caregivers of individuals with TBI through multiple methods, including focus groups, individual interviews, patient consultation, and cognitive debriefing interviews. The TBI-QOL preliminary subdomains and items consisted of 28 item pools across 4 larger domains of physical, emotional, cognitive, and social health. The second phase focused on large-scale field testing, item calibration, finalization of item banks, and creation of computer adaptive tests (CATs) and short forms. Item pools were field tested in a sample of 675 individuals with TBI recruited from 5 TBI Model Systems centers across the United States and calibrated using item response theory methods. Twenty calibrated item banks, 2 brief, fixed-length scales, and 6 uncalibrated item pools were developed. Once all analyses were completed and all parameters transformed, CATs and static short forms were developed for each item bank. The final TBI-QOL consists of 20 independent calibrated item banks and 2 uncalibrated scales that measure physical, emotional, cognitive, and social aspects of health-related quality of life.Tulsky, David S., Kisala, Pamela A., Victorson, David, Carlozzi, Noelle, Bushnik, Tamara, Sherer, Mark, Choi, Seung W., Heinemann, Allen W., Chiaravalloti, Nancy, Sander, Angelle M., Englander, Jeffrey, Hanks, Robin, Kolakowskt-Hayner, Stephanie, Roth, Elliot, Gershon, Richard, Rosenthal, Mitchell, Cella, DavidTexas TBI Model System of TIRR, Northern New Jersey Traumatic Brain Injury System , Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, Northern California Traumatic Brain Injury Model System, Southeastern Michigan Traumatic Brain Injury System, Midwest Regional Traumatic Brain Injury Model SystemYesdevopsadmin
2014Treatment taxonomy for rehabilitation: Past, present, and prospectsJournalJ67517Archives of Physical Medicine and Rehabilitation951 (Supplement 1)S6-S16Article reviews various treatment taxonomies current used in health care and the attempts at building classifications in rehabilitation. Discussion focuses on the need to base a rehabilitation treatment taxonomy (RTT) on the “active ingredients” of treatments and their link to patient/client deficits/problems that are targeted in therapy. This is followed by a description of a fruitful approach to the development of an RTT that crosses disciplines, settings, and patient diagnoses, and a discussion of the potential uses in and benefits of a well-developed RTT for clinical service, research, education, and service administration.Dijkers, Marcel P., Hart, Tessa, Tsaousides, Theodore, Whyte, John, Zanca, Jeanne M.Nodevopsadmin
2016The effects of an enhanced simulation programme on medical students' confidence responding to clinical deteriorationJournalJ75579BMC Medical Education16161https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902916/Study evaluated the effects of an enhanced simulation exercise known as RADAR (Recognizing Acute Deterioration: Active Response), on medical students’ confidence in recognizing and responding to the deteriorating patient. A questionnaire survey was conducted; the instrument contained three sections. Section 1 focused on students’ perceptions of the learning experience; section 2 investigated confidence. Both sections employed Likert-type scales. A third section invited open responses. Questionnaires were distributed to 158 third-year medical students in the North East of Scotland; 130 (82 percent) were returned for analysis. Students’ responses pointed to many benefits of the sessions. In the first section, students responded positively to the educational underpinning of the sessions, with all scores above 4.00 on a 5-point scale. There were clear learning outcomes; the sessions were active and engaging for students with an appropriate level of challenge and stress; they helped to integrate theory and practice; and effective feedback on their performance allowed students to reflect and learn from the experience. In section 2, the key finding was that scores for students’ confidence to recognize deterioration increased significantly as a result of the sessions. Effect sizes were high (0.68–0.75). In the open-ended questions, students pointed to many benefits of the RADAR course, including the opportunity to employ learned procedures in realistic scenarios. The authors recommend the use of RADAR as a safe and cost-effective approach in the area of clinical deterioration and suggest that there is a need to investigate its use with different patient groups.Hogg, George, Miller, DavidNodevopsadmin
2014The potential of technology for enhancing individual placement and support supported employmentJournalJ69285Psychiatric Rehabilitation Journal (formerly Psychosocial Rehabilitation Journal)37299-106Article describes ways that technology may enhance delivery and outcomes of individual placement and support (IPS) supported employment across the care continuum and stakeholder groups. Technology has the potential to enhance direct service as well as workflow in the IPS supported employment process, which may lead to improved fidelity and client outcomes. Mobile and cloud technologies open opportunities for collaboration, self-directed care, and ongoing support to help clients obtain and maintain meaningful employment. Research is needed to evaluate efficacy of technology-based approaches for promoting client employment outcomes, to identify provider and organization barriers to using technology for IPS delivery, and to determine effective strategies for implementing technology with IPS indifferent settings and with diverse client audiences.Lord, Sarah E., McGurk, Susan R., Nicholson, Joanne, Carpenter-Song, Elizabeth A., Tauscher, Justin S., Becker, Deborah R., Swanson, Sarah J., Drake, Robert E., Bond, Gary R.Nodevopsadmin
2014Toward a rehabilitation treatment taxonomy: Summary of work in progressJournalJ68607Physical Therapy943319-321Article summarizes key concepts from a study aimed at the development of a rehabilitation treatment taxonomy that has the potential to improve the way that physical therapist and other rehabilitation professionals describe the care they provide to patients.Dijkers, Marcel P., Ferraro, Mary K., Hart, Tessa, Packel, Andrew , Whyte, John, Zanca, Jeanne M.Nodevopsadmin
2017Traumatic brain injury caregivers: A qualitative analysis of spouse and parent perspective on quality of lifeJournalJ78248Neuropsychological Rehabilitation27116-37https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673040/Study examined how family caregivers of individuals with traumatic brain injury (TBI) describe their quality of life in the context of their caregiving role. Fifty-two caregivers of adults with moderate or severe TBI (31 parents and 21 partners/spouses) were recruited from three data collection sites to participate in focus groups. Thematic content analysis was used to identify two main meta-themes: (1) caregiver role demands and (2) changes in Person with TBI. Prominent subthemes indicated that caregivers are (1) overburdened with responsibilities, (2) lack personal time and time for self-care, (3) feel that their life is interrupted or lost, (4) grieve the loss of the person with TBI, and (5) endorse anger, guilt, anxiety, and sadness. Caregivers identified a number of service needs. A number of subthemes were perceived differently by partner versus parent caregivers. The day-to-day responsibilities of being a caregiver as well as the changes in the person with the TBI present a variety of challenges and sources of distress for caregivers. Although services that address instrumental as well as emotional needs of caregivers may benefit caregivers in general, the service needs of parent and partner caregivers may differ.Kratz, Anna L., Brickell, Tracey A., Lange, Rael T., Carlozzi, Noelle E.Texas TBI Model System of TIRRYesdevopsadmin
2014The cognition battery of the NIH toolbox for assessment of neurological and behavioral function: Validation in an adult sampleJournalJ73507Journal of the International Neuropsychological Society206567-578http://www.the-ins.org/includes/ckfinder/userfiles/files/NIH_Toolbox_Series_JINS2014.pdfThis study introduces a special series on validity studies of the Cognition Battery (CB) from the United States National Institutes of Health (National Institutes of Health (NIH) Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) in an adult sample. The NIHTB-CB is designed to provide a brief, comprehensive, common set of measures to allow comparisons among disparate studies and to improve scientific communication. It contains four modules, each addressing a different domain of neurologic/behavioral function: Cognition, Emotion, and Motor, and Sensory Function. This first study in the series describes the sample, each of the seven instruments in the NIHTB-CB briefly, and the general approach to data analysis. Data are provided on test-retest reliability and practice effects, and raw scores (mean, standard deviation, range) are presented for each instrument and the gold standard instruments used to measure construct validity. Accompanying papers provide details on each instrument, including information about instrument development, psychometric properties, age and education effects on performance, and convergent and discriminant construct validity. One study in the series is devoted to a factor analysis of the NIHTB-CB in adults and another describes the psychometric properties of three composite scores derived from the individual measures representing fluid and crystallized abilities and their combination.Weintraub, Sandra, Dikmen, Sureyya, Heaton, Robert K., Tulsky, David S., Zelazo, Philip D., Slotkin, Jerry, Carlozzi, Noelle E., Bauer, Patricia J., Wallner-Allen, Kathleen, Fox, Nathan, Havlik, Richard, Beaumont, Jennifer L., Mungas, Dan, Manly, Jennifer J., Moy, Claudia, Conway, Kevin, Edwards, Emmeline, Nowinski, Cindy J., Gershon, RichardUniversity of Washington Traumatic Brain Injury Model SystemYesdevopsadmin
2016The first "A" in the ADA: And 25 more "A"s toward equality for Americans with disabilitiesJournalJ73569Inclusion4146-51Article focuses on the first ‘‘A’’ in the Americans with Disabilities Act (ADA). That first ‘‘A’’ in the ADA’s law and policy framework is to apply to all qualified individuals with disabilities residing, working, recreating, using the web, and engaged in daily life activities with private and public organizations in the United States. The author uses the first ‘‘A’’ in the ADA as a starting point to consider 25 other such ‘‘A’’s as being important to understanding the past and useful for framing future action in disability rights.Blanck, PeterNodevopsadmin
2017The top 100 cited neurorehabilitation papersJournalJ75987Neurorehabilitation40163-174Article reports findings from a citation analysis of the top 100 most frequently cited neurorehabilitation papers to describe the research trends in the field. A search of papers indexed in the Web of Science Core Collection database yielded 52,581 papers. A candidate pool of the 200 most-cited papers published between 2005 and 2016 was reviewed by the authors. The papers in the top 100 deemed to be irrelevant were discarded and replaced by the most highly-cited articles in the second tier deemed to be clinically relevant. The type of article (e.g., review or evaluation, treatment study), clinical diagnosis of focus (e.g., Parkinson’s disease, stroke), and symptom type (e.g., aphasia, cognitive impairment) were determined by consensus between the clinician authors Results indicated the most frequently cited neurorehablitation papers appeared in the journals Stroke, Movement Disorders, and Neurology. Papers tended to focus on treatments, especially for stroke. Authorship trends suggest that top cited papers result from group endeavors, with 90 percent of the papers involving a collaboration among 3 or more authors.Kreutzer, Jeffrey S., Agyemang, Amma A., Weedon, David, Zasler, Nathan, Oliver, Melissa, Sorensen, Aaron A., van Wijngaarden, Saskia, Leahy, EileenVirginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2014Transition from school to adulthood for youth with autism spectrum disorder: What we know and what we need to knowJournalJ68897Journal of Disability Policy Studies25130-40Article provides a critical review of the key aspects of the transition from school to adulthood for youth with autism spectrum disorders and identifies recommendations for policy and practice. The review highlights the literature and explores recommendations across the various elements of this transition, including social and psychological development, high school curriculum, work, and college. Five policy recommendations are outlined in the areas of school curriculum, employment development, postsecondary education, inclusion with nondisabled peers, and systematic instruction. Finally, the authors offer recommendations for further research in the areas of social interaction, increased academic and vocational rigor, employment, technology, independence, and postsecondary education.Wehman, Paul, Schall, Carol, Carr, Staci, Targett, Pam, West, Michael, Cifu, GabriellaNodevopsadmin
2017Systematic reviews and meta-analysesJournalJ78673In Valerie J. Watzlaf and Elizabeth Forrestal (Eds.), Health Informatics Research Methods: Principles and Practice, Second EditionThis chapter describes the steps and techniques for performing systematic reviews and meta-analyses. It presents step-by-step procedures, starting from an overview, then moving on to defining research questions, searching research articles in journal article indexing databases, selecting articles based on the research question and inclusion and exclusion criteria, extracting data from selected articles, and finally, analyzing data and reporting results. The research team performed a systematic review and meta-analysis to evaluate the efficacy of mobile phone apps to promote weight loss and increase physical activity and this real-world care is used as an example throughout this chapter.Zhou, Leming, DeAlmeida, Dilhari, Watzlaf, ValerieNodevopsadmin
2015Traumatic brain injury-practice based evidence study: Design and patients, centers, treatments, and outcomesJournalJ72083Archives of Physical Medicine and Rehabilitation968, Supplement 3S178-S196, S196.e1-S196.e15Article provides an overview of the study design, patients, centers, treatments, and outcomes of a traumatic brain injury (TBI) practice-based evidence (PBE) study and examines the generalizability of the findings to the United States TBI inpatient rehabilitation population. Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. This study developed treatment taxonomies for each rehabilitation discipline to document the interventions occurring each time a clinician had a treatment session with a consented patient, or a nurse interacted with or on behalf of the patient. Extensive medical record abstracting documented patient and injury characteristics, severity of principal and comorbid conditions, and ancillary treatments (e.g., medications, nutritional support) to augment in-formation collected on therapy sessions. In addition, in-depth follow-up interviews were conducted at 3 and 9 months postdischarge to capture outcomes in the first year postinjury for most participants. Outcomes examined at discharge included return to acute care during rehabilitation, rehabilitation length of stay, Functional Independence Measure (FIM) score at discharge, and discharge destination. In addition, outcomes examined at 9 months postdischarge included rehospitalization, FIM, participation, and subjective well-being. The level of admission FIM cognitive score was found to create relatively homogeneous subgroups for the subsequent analysis of best treatment combinations. There were significant differences in patient and injury characteristics, treatments, rehabilitation course, and outcomes by admission FIM cognitive subgroups.Horn, Susan D., Corrigan, John D., Bogner, Jennifer, Hammond, Flora M., Seel, Ronald T., Smout, Randall J., Barrett, Ryan S., Dijkers, Marcel P., Whiteneck, Gale G.Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2014The dynamics of disability and chronic conditionsJournalJ67621Disability and Health Journal715-FebArticle introduces manuscripts that emerged from a recent forum that examined the dynamics of disability and chronic conditions. The author begins with an overview of definitions of disability and chronic conditions, then presents several reasons why disentangling chronic conditions and disability is important. Finally, he briefly describes the forum manuscripts (see accession numbers J67622, J67623, and J67624) before making a call for understanding the dynamics of chronic condition and disability to promote the health of all.Drum, Charles E.Nodevopsadmin
2015The multisensory museum: Cross-disciplinary perspectives on touch, sound smell, memory, and spaceJournalJ73714Exhibitionist91-93Author reviews a book that highlights new trends and opportunities for using the senses of touch, sound smell, taste, and proprioception in museums to offer more immersive experiences available to patrons with visual impairments.Fletcher, ValerieNodevopsadmin
2015Tools for analysis in assistive technology research, development, and productionJournalJ71563Assistive Technology Outcomes and Benefits9120-37http://www.atia.org/i4a/pages/index.cfmArticle describes a development project intended to increase awareness and use of new product development (NPD) tools within a specific segment of new product developers: federally funded “technology grantees” who are charged with generating innovations that have socioeconomic impacts. The authors review the creation of the NPD tool repository, designed to improve grantees’ ability to generate outputs that are relevant to industry partners and the marketplace alike. A recently established operational model for NPD, called the Need to Knowledge (NtK) Model, frames this work. Tools specifically concerned with the inclusion and accommodation of user characteristics, particularly those reflecting the principles of universal design, are highlighted in order to improve the accessibility of products in the marketplace for all users.Flagg, Jennifer L., Lockett, Michelle M., Condron, James, Lane, Joseph P.Nodevopsadmin
2016Traumatic brain injury as a risk factor for Alzheimer's disease: Current knowledge and future directionsJournalJ78473Neurodegenerative Disease Management65417-429This scoping review summarizes clinical research from the past 10 years that evaluates the relationship between traumatic brain injury (TBI) and Alzheimer’s disease. This review identified five studies that found increased risk for dementia after TBI, two studies that found no increased risk, and four studies that found a relationship only under certain conditions or in specified subsamples. Methodological differences across studies preclude direct comparison of results, and discrepant findings elucidate the complex course of post-TBI neurodegeneration. The authors discuss the factors that influence the strength and direction of the relationship between TBI and Alzheimer’s disease, and the implications of this body of research for patient care and future research.Dams-O'Connor, Kristen, Guetta, Gabrielle, Hahn-Ketter, Amanda E., Fedor, AndrewNew York Traumatic Brain Injury Model SystemYesdevopsadmin
2017Test-retest reliability of traumatic brain injury outcome measures: A traumatic brain injury model systems studyJournalJ76515Journal of Head Trauma Rehabilitation325E1-E16Study evaluated the test-retest reliability of measures that comprise the follow-up interview of the Traumatic Brain Injury Model Systems (TBIMS) study. Follow-up interviews are typically conducted with the participant or proxy by phone at 1, 2, and 5 years postinjury and every 5 years thereafter. Participants were 224 persons with a moderate-severe traumatic brain injury (TBI) enrolled in the TBIMS National Database. Following standard administration of the follow-up interview, a second interview was administered 14 to 28 days later using the same interviewer and the same mode of administration. Reliability was examined for all 66 variables included in the follow-up interview, including: (1) single-item measures of demographics; employment; general health as well as specific health conditions; rehospitalization; tobacco, alcohol, and other drug use; transportation; and mental health; and (2) multi-item instruments: Functional Independence Measure, Participation Assessment With Recombined Tools-Objective; Disability Rating Scale; Glasgow Outcome Scale-Extended; Supervision Rating Scale; Satisfaction With Life Scale; TBI Quality of Life Anxiety and Depression items; and The Ohio State University TBI Identification Method. Intraclass correlation coefficient values ranged from 0.65 to 0.99, weighted kappa values ranged from 0.54 to 0.99, and kappa values ranged from 0.43 to 1.00. Four kappa/weighted kappa estimates fell below 0.60: arrested, psychiatric hospitalization, number of days not in good physical health, and rating of general emotional health. With few exceptions, good to excellent test-retest reliability estimates were obtained. The findings support the use of these measures in prior and future studies and indicate that individuals with moderate-severe TBI can provide reliable self-report.Bogner, Jennifer A., Whiteneck, Gale G., MacDonald, Jessica, Juengst, Shannon B., Brown, Allen W., Philippus, Angela M., Marwitz, Jennifer H., Lengenfelder, Jeannie, Mellick, Dave, Arenth, Patricia, Corrigan, John D.Mayo Clinic Traumatic Brain Injury Model System , Northern New Jersey Traumatic Brain Injury System , Virginia Commonwealth Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, Ohio Regional Traumatic Brain Injury Model System , University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2014The factor structure of the Pittsburgh sleep quality index in persons with traumatic brain injury. A NIDRR TBI model systems module studyJournalJ70550NeuroRehabilitation353485-492Study examined the factor structure of the Pittsburgh Sleep Quality Index (PSQI) in a sample of individuals with traumatic brain injury (TBI) and tested the one-, two-, and three-factor models derived from previous studies in other populations. The PSQI is a measure of sleep quality in which respondents are asked to answer questions about their sleep over the past month. PSQI data was collected during telephone interviews conducted with 243 subjects who had sustained a TBI. Participants were a subset of individuals with TBI enrolled in the National Institute of Disability and Rehabilitation Research (NIDRR) TBI Model Systems program, a prospective, longitudinal multi-center study that collects data about individuals with TBI, their injury, and their outcomes. All participants were approximately one year post-injury. Factor analyses were conducted (exploratory and confirmatory) to examine the factor structure of the PSQI. Consistent with previous research, this study found that the single-factor model is not the optimal factor structure for the PSQI in people with TBI. Results confirm the fit of models previously tested but also reveal an alternative conceptualization of sleep containing both qualitative and quantitative factors. While the 3-factor model best fits the data in this TBI sample, the use of a 2-factor model is acceptable and may be more clinically relevant due to the grouping of time-related variables that could provide important information with regard to circadian rhythm disorders.Lequerica, Anthony, Chiaravalloti, Nancy, Cantor, Joshua, Dijkers, Marcel, Wright, Jerry, Kolakowsky-Hayner, Stephanie A., Bushnick, Tamara, Hammond, Flora, Bell, KathleenNorthern New Jersey Traumatic Brain Injury System , New York Traumatic Brain Injury Model System, Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue HospitalYesdevopsadmin
2016The reliability of a computer-assisted telephone interview version of the Ohio state university traumatic brain injury identification methodJournalJ73348Journal of Head Trauma Rehabilitation311E36-E42Study assessed the test-retest reliability of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID), modified for use as a computer-assisted telephone interview (CATI), to capture traumatic brain injury (TBI) and other substantial bodily injuries. Four subsamples of 50 individuals, including people with no major lifetime injury, a major lifetime injury but no TBI, TBI with no loss of consciousness, and TBI with loss of consciousness, were interviewed using the CATI OSU TBI-ID between 6 and 18 months after an initial interview. Cumulative, Severity, and Age-related indices were assessed for long-term reliability. Cumulative indices were those that summed the total number of specific TBI severities across the lifetime. Severity indices included measures of the most severe type of injury incurred throughout the lifetime. Age-related indices assessed the timing of specific injury types across the lifespan. Test-retest reliabilities ranged from poor to excellent. The indices demonstrating the greatest reliability were Severity measures, with intraclass correlations (ICCs) for ordinal indices ranging from 0.62 to 0.78 and Cohen kappas ranging from 0.50 to 0.62. One Cumulative outcome demonstrated high reliability (0.70 for number of TBIs with loss of consciousness ≥30 minutes), while the remaining Cumulative outcomes demonstrated low reliability, ranging from 0.06 to 0.21. Age-related test-retest reliabilities were fair to poor, with ICCs of 0.38 to 0.49 and Cohen kappas of 0.32 and 0.34. The findings suggest that the CATI-modified OSU TBI-ID is an effective measure for evaluating the maximum TBI severity incurred throughout the lifetime within a general population survey.Cuthbert, Jeffrey P., Whiteneck, Gale G., Corrigan, John D., Bogner, JenniferOhio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2016Trajectories of life satisfaction over the first 10 years after traumatic brain injury: Race, gender, and functional abilityJournalJ73643Journal of Head Trauma Rehabilitation313167-179Study investigated the influence of race, gender, functional ability, and an array of preinjury, injury-related, and sociodemographic variables on life satisfaction trajectories over 10 years following moderate-to-severe traumatic brain injury (TBI). Using data from the TBI Model Systems database, a total of 3,157 individuals with TBI were included in this study. Hierarchical linear modeling analyses were conducted to examine the trajectories of life satisfaction. Patient characteristics (race, gender); the Functional Independence Measure and the Glasgow Coma Scale (functional ability); and the Satisfaction With Life Scale (life satisfaction) were utilized. Initial models suggested that life satisfaction trajectories increased over the 10-year period and Asian/Pacific Islander participants experienced an increase in life satisfaction over time. In a comprehensive model, time was no longer a significant predictor of increased life satisfaction. Black race, however, was associated with lower life satisfaction, and significant interactions revealed that Black participants’ life satisfaction trajectory decreased over time while White participants’ trajectory increased over the same time period. Life satisfaction trajectories did not significantly differ by gender, and greater motor and cognitive functioning were associated with increasingly positive life satisfaction trajectories over the 10 years. Findings suggest that individuals with more functional impairments are at risk for decreases in life satisfaction over time. Further research is needed to identify the mechanisms and factors that contribute to the lower levels of life satisfaction observed among Black individuals after TBI. This data is needed to determine strategic ways to promote optimal adjustment for these individuals.Williamson, Meredith L. C., Elliott, Timothy R., Bogner, Jennifer, Dreer, Laura E., Arango-Lasprilla, Juan C., Kolakowsky-Hayner, Stephanie A., Pretz, Christopher R., Lequerica, Anthony , Perrin, Paul B.New York Traumatic Brain Injury Model System, UAB Traumatic Brain Injury Model SystemYesdevopsadmin
2014Systematic review of interventions for fatigue after traumatic brain injury: A NIDRR traumatic brain injury model systems studyJournalJ70291Journal of Head Trauma Rehabilitation296490-497Study systematically reviewed the evidence on interventions for posttraumatic brain injury fatigue (PTBIF). Multiple databases were searched for peer-reviewed studies published in English through January 22, 2014, on interventions targeting PTBIF as a primary or secondary outcome. Reference sections were also reviewed to identify additional articles. Articles were rated using the 2011 American Academy of Neurology Classification of Evidence Scheme for therapeutic studies. The searches yielded 1,526 articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a primary outcome. Interventions were pharmacological and psychological or involved physical activity, bright blue light, electroencephalographic biofeedback, or electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral therapy with fatigue management) were evaluated in more than 1 study. Modafinil is not likely to be effective for PTBIF. Piracetam may reduce it, as may bright blue light. Cognitive behavioral therapy deserves additional study. The authors conclude that despite areas of promise, there is insufficient evidence to recommend or contraindicate any treatments of PTBIF. High-quality research incorporating appropriate definition and measurement of fatigue is required to explore the potential benefits of promising interventions, evaluate fatigue treatments shown to be effective in other populations, and develop new interventions for PTBIF. This study was conducted by the Sleep Wake Fatigue Special Interest Group of the Traumatic Brain Injury Model Systems and supported by National Institute for Disability and Rehabilitation Research (NIDRR).Cantor, Joshua B., Ashman, Teresa, Bushnik, Tamara, Cai, Xinsheng, Farrell-Carnahan, Leah, Gumber, Shinakee, Hart, Tessa, Rosenthal, Joseph, Dijkers, Marcel P.Moss Traumatic Brain Injury Model System, New York Traumatic Brain Injury Model System, Ohio Regional Traumatic Brain Injury Model System , Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue HospitalYesdevopsadmin
2015Traumatic brain injury rehabilitation comparative effectiveness research: Introduction to the traumatic brain injury-practice based evidence Archives supplementJournalJ72082Archives of Physical Medicine and Rehabilitation968, Supplement 3S173-S177Article introduces a journal issue devoted to the Traumatic Brain Injury-Practice Based Evidence (TBI-PBE) study, thought to be the first practice-based evidence study of traumatic brain injury (TBI) rehabilitation. The study enrolled individuals with TBI receiving initial inpatient rehabilitation at 9 rehabilitation centers across the United States and 1 in Canada over a 2.5-year time period. Three of the 10 study sites were part of the TBI Model Systems, funded by the National Institute on Disability and Rehabilitation Research. The specific aims of the TBI-PBE project were to: (1) identify individual patient characteristics, including demographic data, severity of brain injury, and severity of illness (complications, comorbidities), that may be associated with significant variation in treatments selected and in outcomes of acute rehabilitation for TBI; (2) identify medical procedures and therapy interventions, alone or in combination, that are associated with better outcomes, controlling for patient characteristics; and (3) determine whether specific treatment interactions with age, severity/impairment, or time are associated with better outcomes.Horn, Susan D., Corrigan, John D., Dijkers, Marcel P.Nodevopsadmin
2014The DSM-5 approach to the evaluation of traumatic brain injury and its neuropsychiatric sequelaeJournalJ69959Neurorehabilitation344613-623Article reviews the issues pertaining to traumatic brain injury (TBI) and its neuropsychiatric sequelae in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the changes relative to the outgoing DSM-IV-TR. The primary context for discussion of TBI in the DSM-5 is the section on Neurocognitive Disorders, where a basic framework is provided for the retrospective diagnosis of TBI and characterization of the clinical presentation as a Mild or Major Neurocognitive Disorder. The distinctions between these conditions rest not on the initial severity of TBI but instead on the severity of posttraumatic cognitive impairments and their effects on everyday function. The text succinctly reviews the epidemiology, phenomenology, and natural history of TBI and highlights the need to consider the differential diagnosis for persistent postconcussive symptoms. The approach taken to the diagnosis of TBI and its neuropsychiatric consequences in the DSM-5 is improved substantially over that of the DSM-IV-TR, and it is likely to improve the evaluations of people with TBI by mental health professionals. However, challenges borne of this approach are likely to be revealed as it is implemented in everyday practice and will guide the development of this section of DSM-5.1.Wortzel, Hal S., Arciniegas, David B.Texas TBI Model System of TIRRYesdevopsadmin
2015The march goes on: Community access for people with disabilitiesJournalJ70892Journal of Community Psychology433348-363Study used a participatory action research approach to examine the accessibility experiences of people with and without disabilities seeking information about local and state government facilities, programs, and services. Overall, results indicated that some progress in providing access has been achieved but that other barriers persist; access for individuals with vision-related disabilities may be most problematic. Findings suggest that more needs to be done to achieve full accessibility and inclusion.McDonald, Katherine E., Williamson, Pamela, Weiss, Sally, Adya, Meera, Blanck, PeterNodevopsadmin
2015Theoretical foundations for the measurement of environmental factors and their impact on participation among people with disabilitiesJournalJ71243Archives of Physical Medicine and Rehabilitation964569-577Article reviews the theoretical foundations of environmental factors (EFs) as they relate to their impact on participation, and suggests how theory can support the development of environmental measures. The authors discuss different approaches to the measurement of EFs, emphasize the need for greater conceptual clarity in the dynamic relationship between EFs and participation, and call for the development and application of EF measures that build on these conceptual foundations. The thoughtful application of theories and the use of advanced measurement techniques are critical steps for understanding the environment-participation relationship and providing rehabilitation stakeholders with information needed to modify environments to facilitate social participation for individuals with disabilities.Magasi, Susan, Wong, Alex, Gray, David B., Hammel, Joy, Baum, Carolyn, Wang, Chia-Chiang, Heinemann, Allen W.Nodevopsadmin
2014Rural disparities in receipt of colorectal cancer screening among adults ages 50-64 with disabilitiesJournalJ70152Disability and Health Journal74394-401Study investigated whether urban/rural disparities in colorectal cancer screening exist among people with disabilities, similar to the disparities found in the general population. The Medical Expenditure Panel Survey annual data files were analyzed from 2002 to 2008. Logistic regression analyses examined the relationship between urban/rural residence and ever having received screening for colorectal cancer (via colonoscopy, sigmoidoscopy, or fecal occult blood test). Results showed that among adults aged 50 to 64 years with disabilities, those living in rural areas were significantly less likely to have ever received any type of screening for colorectal cancer. The urban/rural difference was statistically significant regardless of whether or not the analysis controlled for demographic, socioeconomic, health, and health care access variables. Disparity in screening for colorectal cancer places rural residents with disabilities at greater risk for late stage diagnosis and mortality relative to people with disabilities in urban areas. The results suggest that there is a need for strategies to improve screening among people with disabilities in rural areas.Horner-Johnson, Willi, Dobbertin, Konrad, Lee, Jae C., Andresen, Elena M.Nodevopsadmin
2016Sensitivity and specificity of the coma recovery scale-revised total score in detection of conscious awarenessJournalJ73386Archives of Physical Medicine and Rehabilitation973490-492Study evaluated the sensitivity and specificity of Coma Recovery Scale-Revised (CRS-R) total scores in detecting conscious awareness. Data were retrospectively extracted from the medical records of 252 patients enrolled in a specialized disorders of consciousness program. Sensitivity and specificity analyses were completed using CRS-R-derived diagnoses of minimally conscious state (MCS) or emerged from minimally conscious state (EMCS) as the reference standard for conscious awareness and the total CRS-R score as the test criterion. A receiver operating characteristic (ROC) curve was constructed to demonstrate the optimal CRS-R total cutoff score for maximizing sensitivity and specificity. Results show that a CRS-R total score of 10 or higher yielded a sensitivity of .78 for correct identification of patients in MCS or EMCS, and a specificity of 1.00 for correct identification of patients who did not meet criteria for either of these diagnoses (i.e., were diagnosed with vegetative state or coma). The area under the curve in the ROC curve analysis is .98. A total CRS-R score of 10 or higher provides strong evidence of conscious awareness but resulted in a false-negative diagnostic error in 22 percent of patients who demonstrated conscious awareness based on CRS-R diagnostic criteria. A cutoff score of 8 provides the best balance between sensitivity and specificity, accurately classifying 93 percent of cases. The optimal total score cutoff will vary depending on the user’s objective.Bodien, Yelena G., Carlowicz, Cecilia A., Chatelle, Camille, Giacino, Joseph T.Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2014Stigma, agency and recovery amongst people with severe mental illnessJournalJ70837Social Science & Medicine1078-JanStudy explored behavioral and psychological strategies of stigma management and control in a group of people in recovery from severe mental illness. Participants were recruited from small-scale congregate housing units (recovery communities) for people in recovery, provided by a public mental health agency. Regular focus groups were conducted at these communities, augmented by in-depth participant observation. The grounded theory approach was used to analyze the data collected over a five-year period. The results are discussed in four areas: (1) sources of stigma, (2) behavioral strategies to prevent stigma, (3) psychological strategies to prevent stigma, and (4) peer support as a mediator of stigma. A key finding of this study is that stigma and discrimination were not perceived as commonly experienced problems by participants. Instead, stigma and discrimination were perceived as omnipresent potential problems to which participants remained eternally vigilant. This fear of stigma led participants to engage in various behavioral and psychological strategies to prevent the actual experience of stigma. Most notable among these measures was a concerted and self-conscious effort to behave and look “normal”, through dress, appearance, conduct, and demeanor. In this endeavor, participants possessed and deployed a degree of agency to prevent, avoid or preempt stigma and discrimination. These behavioral and psychological strategies of normalization appeared to be consolidated within the recovery communities, which provided physical shelter and highly-valued peer support. This fostered participants’ ability to face and embrace the outside world with confidence, pride and dignity.Whitley, Rob, Campbell, Rosalyn D.Nodevopsadmin
2017Rehospitalization over 10 years among survivors of TBI: A national institute on disability, independent living, and rehabilitation research traumatic brain injury model systems studyJournalJ75992Journal of Head Trauma Rehabilitation323147-157Study examined the rates and causes for rehospitalization in the 10 years after moderate-severe traumatic brain injury (TBI), and identified individual factors associated with the probability of rehospitalization over time. Secondary analysis was conducted of data for individuals 16 years and older with a primary diagnosis of TBI who were enrolled in the Traumatic Brain Injury Model System National Data Base. Rehospitalization (and reason for rehospitalization) as reported by participants or proxy during follow-up telephone interviews at 1, 2, 5, and 10 years postinjury were analyzed. Generalized linear mixed models and individual growth curve models were applied to help explain individual variability in rehospitalization risk over time. The greatest number of rehospitalizations occurred in the first year postinjury (27.8 percent of the sample), and the rates of rehospitalization remained largely stable (22.1 to 23.4 percent) at 2, 5, and 10 years. Reasons for rehospitalization varied over time: Orthopedic and reconstructive surgery rehospitalizations were most common in year 1, whereas general health maintenance was most common by year 2 with rates increasing at each follow-up. The longitudinal models indicate that multiple demographic and injury-related factors are associated with the probability of rehospitalization over time. These findings can inform the content and timing of interventions to improve health and longevity after TBI.Dams-O'Connor, Kristen, Mellick, Dave, Dreer, Laura E., Hammond, Flora M., Hoffman, Jeanne, Landau, Alexandra, Zafonte, Ross, Pretz, Christopher R.UAB Traumatic Brain Injury Model System, Virginia Commonwealth Traumatic Brain Injury Model System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, New York Traumatic Brain Injury Model System, Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2016Resilience following traumatic brain injury: A traumatic brain injury model systems studyJournalJ73802Archives of Physical Medicine and Rehabilitation975708-713Study examined resilience, defined as the ability to “bounce back” after a trauma or tragedy, at 3 months after traumatic brain injury (TBI). Participants were community-dwelling adults with moderate-to-severe TBI enrolled in the resilience module of the TBI Model System study. Of the 223 participants recruited from 5 inpatient rehabilitation centers, data were obtained from 160 at 3 months postinjury. The Connor-Davidson Resilience Scale was used to measure characteristics of resilience. Secondary measures included the TBI Quality of Life anxiety and depression scales, the Participation Assessment with Recombined Tools-Objective social relations score, the Satisfaction With Life Scale, and the Disability Rating Scale. Analysis revealed that resilience scores were lower than those of the general population. A multivariable regression model, adjusting for other predictors, showed that higher education, absence of preinjury substance abuse, and less anxiety at follow-up were significantly related to greater resilience. Findings suggest that lack of resilience may be an issue for some individuals after moderate-to-severe TBI. Identifying individuals most likely at risk for low resilience may be useful in planning clinical interventions.Kreutzer, Jeffrey S., Marwitz, Jennifer H., Sima, Adam P., Bergquist, Thomas F., Johnson-Greene, Douglas, Felix, Elizabeth R., Whiteneck, Gale G., Dreer, Laura E.Mayo Clinic Traumatic Brain Injury Model System , Virginia Commonwealth Traumatic Brain Injury Model System, Rocky Mountain Regional Brain Injury System, UAB Traumatic Brain Injury Model System, South Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2014Screening for neuropathic pain after spinal cord injury with the spinal cord injury pain instrument (SCIPI): A preliminary validation studyJournalJ68717Spinal Cord (formerly Paraplegia)525407-412Study evaluated the validity of the Spinal Cord Injury Pain Instrument (SCIPI), an interview-based spinal cord injury (SCI) neuropathic pain screening instrument. Clinician diagnoses of neuropathic pain (NP) and non-neuropathic pain subtypes were collected independently of descriptions of the pain characteristics provided by the patient with SCI using the Spinal Cord Injury Pain Instrument (SCIPI). The SCIPI information and physician diagnoses for 82 pain sites of which they were most confident were subsequently compared. Four of the SCIPI items correlated significantly with the NP subtype as determined by the clinician. The best cutoff score for identifying NP was an endorsement of two or more of these four items. Using this cutoff, sensitivity of the SCIPI was 78 percent, specificity was 73 percent, and overall diagnostic accuracy was 76 percent. In this preliminary study, the SCIPI, which can be administered by a nonclinician, appears to have good sensitivity, specificity, and diagnostic accuracy in a SCI population; it may have a role as a screening tool for NP after SCI. More studies to further investigate the SCIPI’s validity are recommended.Bryce, T. N., Richards, J. S., Bombardier, C. H., Dijkers, M. P., Fann, J. R., Brooks, L., Chiodo, A., Tate, D. G., Forchheimer, M.Nodevopsadmin
2014Sexual functioning and the effect of fatigue in traumatic brain injuryJournalJ69860Journal of Head Trauma Rehabilitation295418-426Study examined specific aspects of sexual functioning (frequency, desired frequency, importance, and satisfaction) and their relationship to fatigue in individuals with traumatic brain injury (TBI) compared with those without brain injury. The relationship of demographic variables, emotional well-being, and health-related quality of life to sexual functioning was also explored. Data were collected through administration of self-report measures and interviews as part of a larger study of post-TBI fatigue. Two hundred twenty community-dwelling adults with self-reported mild-to-severe TBI and 83 individuals without brain injury completed the following measures: the Participation Objective, Participation Subjective, (a measure of community integration); the Fatigue Assessment Instrument and the Global Fatigue Index (fatigue); the Beck Depression Inventory (depression), and the Medical Outcomes Study 36-Item Short-Form Health Survey (health-related quality of life). Several aspects of sexual activity (frequency, desired frequency, and importance) were closely related to specific features of fatigue among individuals with TBI. Women with TBI reported lower frequency and lower importance of sex than men. In individuals without brain injury, the impact of fatigue was limited to the frequency of sexual activity with no sex differences observed. The findings suggest that fatigue plays a different role in the subjective experience of sexual activity for men and women with TBI than for those without brain injuries.Goldin, Yelena, Cantor, Joshua B., Tsaouides, Theodore, Spielman, Lisa, Gordon, Wayne A.New York Traumatic Brain Injury Model SystemYesdevopsadmin
2014Recovery in a family context: Experiences of mothers with serious mental illnessesJournalJ68849Psychiatric Rehabilitation Journal (formerly Psychosocial Rehabilitation Journal)373162-169Study examined the lived experiences of 3 urban, low-income, African American mothers diagnosed with serious mental illnesses (SMI). Ethnographic observations and informal interviews were conducted over 12 months with the mothers and their children. Data were analyzed using a case study approach to identify prominent themes, perspectives, and experiences within and across participating families. Five themes emerged to characterize the lived experiences of African American mothers with SMI: (1) mental illness and mental health services are not a prominent focus in everyday life; (2) families live in a context of ubiquitous violence, loss, and everyday stress; (3) family life is the main focus for mothers as they strive for a better life; (4) mothers have limited social support; and (5) religion is a source of meaning and a resource for the everyday work of recovery. The findings suggest that rehabilitative efforts tailored for this population should not focus on, or reside in, professional mental health services. Meaningful rehabilitative strategies for families might include supported employment, social support, youth mentoring, faith-based supports, and community-based antiviolence efforts.Carpenter-Song, Elizabeth A., Holcombe, Billy D., Torrey, John, Hipolito, Maria M. S., Peterson, Loretta D.Nodevopsadmin
2014Subtypes of post-traumatic epilepsy: Clinical, electrophysiological, and imaging featuresJournalJ71123Journal of Neurotrauma31161439-1443Study identified and described the subtypes of post-traumatic epilepsy (PTE) that arise a consequence of traumatic brain injury (TBI). A retrospective chart review was performed of patients with moderate-to-severe TBI with subsequent development of medically refractory epilepsy referred for video-electroencephalography (EEG) monitoring at a single center over a 10-year period. Information regarding details of injury, neuroimaging studies, seizures, video-EEG, and surgery outcomes were collected and analyzed. There were 123 patients with PTE identified, representing 4.3 percent of all patients evaluated in the epilepsy monitoring unit. Most of them had localization-related epilepsy, of which 57 percent had temporal lobe epilepsy (TLE), 35 percent had frontal lobe epilepsy (FLE), and 3 percent each had parietal and occipital lobe epilepsy. Of patients with TLE, 44 percent had mesial temporal sclerosis (MTS), 26 percent had temporal neocortical lesions, and 30 percent were nonlesional. There was no difference in age at injury between the different PTE subtypes. Twenty-two patients, 13 of whom had MTS, proceeded to surgical resection. At a mean follow-up of 2.5 years, Engel Class I outcomes were seen in 69 percent of those with TLE and 33 percent of those with FLE. The findings suggest that PTE is a heterogeneous condition, and careful evaluation with video-EEG monitoring and high resolution magnetic resonance imaging can identify distinct syndromes. These results have implications for the design of clinical trials of antiepileptogenic therapies for PTE.Gupta, Puneet K., Sayed, Nasreen, Ding, Kan, Agostini, Mark A., Van Ness, Paul C., Yablon, Stuart, Madden, Christopher, Mickey, Bruce, D'Ambrosio, Raimondo, Diaz-Arrastia, RamonNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2017Relationship stability after traumatic brain injury among veterans and service members: A VA TBI model systems studyJournalJ76521Journal of Head Trauma Rehabilitation324234-244Study explored the stability of relationships and predictors of change in relationship status for service members and veterans 2 years after traumatic brain injury (TBI)/polytrauma. Participants were 357 active duty service members and veterans enrolled in the Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers TBI Model Systems database with complete marital status information at 2 years postinjury. Relationship status change was defined as change in marital status (single/never married; married; divorced/separated) at 2-year follow-up, compared with status at enrollment. At the time of enrollment, 134 participants (38 percent) were single/never married; 151 (42 percent) were married, and 72 (20 percent) were divorced/separated. Of those married at enrollment, 78 percent remained married at year 2 while 22 percent underwent negative change. Multivariable analyses revealed that age and education at the time of injury and mental health utilization prior to injury were significant predictors of relationship change. Among those who were single/divorced/separated at the time of enrollment, 87 percent remained so at year 2 while 13 percent underwent positive change. Injury during deployment significantly predicted positive relationship change.Stevens, Lillian F., Lapis, Yanna, Tang, Xinyu, Sander, Angelle M., Dreer, Laura E., Hammond, Flora M., Kreutzer, Jeffrey S., O'Neil-Pirozzi, Therese M., Nakase-Richardson, RisaUAB Traumatic Brain Injury Model System, Texas TBI Model System of TIRR, Mayo Clinic Traumatic Brain Injury Model System , Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2016Risk of negative outcomes after traumatic brain injury: A statewide population-based surveyJournalJ73349Journal of Head Trauma Rehabilitation311E43-E54Study investigated the rates of negative outcomes associated with all severities of traumatic brain injury (TBI), treated in all settings or not treated at all, in comparison to the general population. A statewide population-based survey of 2,701 Coloradoans was conducted using the computer-assisted, modified Ohio State University TBI Identification Method; Behavioral Risk Factor Surveillance System and National Health Interview Survey questions; Satisfaction with Life Scale; and measures of postconcussive symptoms. Each respondent was categorized into 1 of 6 injury severity groups based on the most severe injury they reported in their lifetime: no injury, injury without TBI, mild TBI without loss of consciousness, mild TBI, moderate TBI, or severe TBI. Up to 42.5 percent of participants reported a lifetime history of at least 1 TBI. Results demonstrate clear associations between a lifetime history of TBI and both current negative outcomes and postconcussive symptoms. Multiple negative outcomes were found to increase in prevalence in a stepwise fashion in association with greater TBI severity, with the clearest patterns observed for disability, poor life satisfaction, and impaired memory.Whiteneck, Gale G., Cuthbert, Jeffrey P., Corrigan, John D., Bogner, JenniferOhio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2014Self-scoring templates for motor and cognitive subscales of the FIM instrument for persons with spinal cord injuryJournalJ68573Archives of Physical Medicine and Rehabilitation954676-679Article provides self-scoring templates for the motor and cognitive scales of the Functional Independence Measure (FIM) that enable clinicians to monitor progress during rehabilitation using equal-interval Rasch-calibrated measures instead of ordinal raw scores. The FIM instrument is a measure of independence consisting of 13 physical and 5 cognitive functioning items rated by trained clinicians at admission and discharge and by self-report via telephone or in-person interview at follow-up. FIM data were obtained from 1,146 individuals with new traumatic spinal cord injuries (SCI) discharged from 6 geographically dispersed hospital-based rehabilitation centers in the United States. The SCI Keyforms were created from subscores of the FIM instrument, including a 13-item motor scale, a 5-item cognitive scale, an 11-item (without sphincter control items) motor scale, a 3-item transfer scale, a 6-item self-care scale, a 3-item self-care upper extremity scale, and a 3-item self-care lower extremity scale. The SCI KeyForms for the FIM instrument scales allow clinicians and investigators to estimate patients’ functional status and monitor progress. In cases with no missing data, the look-up tables provide more accurate estimates of patients’ functional status.Bode, Rita K., Heinemann, Allen W., Koslowski, Allan J., Pretz, Christopher R.Nodevopsadmin
2015Standards for assistive technology funding: What are the right criteria?JournalJ71564Assistive Technology Outcomes and Benefits9138-53http://www.atia.org/i4a/pages/index.cfmArticle addresses the expectation of an evidence-based standard to determine assistive technology (AT) product efficacy, and the impact of this standard on the transfer, use, and payment for assistive technologies designed for persons with disabilities. The authors discuss alternative options for evidence of AT effectiveness, recommendations on how to develop a useful and workable outcomes-reporting system to further demonstrate evidence of AT efficacy for AT funding, and pending and proposed federal legislative changes. Unless addressed, the lack of documented AT outcomes may limit future innovation as well as limit access to existing rehabilitation and assistive technologies for those who need it most.Clayback, Don, Hostak, Rita, Leahy, James A., Minkel, Jean, Piper, Margaret, Smith, Roger O., Vaarwerk, ToddNodevopsadmin
2017Rehospitalization in the first year following veteran and service member TBI: A VA TBI model systems studyJournalJ76524Journal of Head Trauma Rehabilitation324264-270Study determined the incidence and causes of rehospitalization following traumatic brain injury (TBI) among 401 military service members and veterans enrolled in the Department of Veterans Affairs (VA) TBI Model System study. One-year follow-up measures were collected within a 2-month window before or after the anniversary date of injury to document rehospitalization status. Results showed that 164 (41 percent) of the 401 participants were rehospitalized. Rehospitalization status was associated with greater injury severity and receipt of TBI while on active duty. Of those rehospitalized, 30 percent had 2 or more readmissions. Participants experiencing multiple rehospitalizations (2 or more) were more likely to have sustained their TBI during deployment than those with none or single rehospitalization. This group also sustained more severe injuries and spent more time in inpatient rehabilitation. Common reasons for rehospitalization included inpatient rehabilitation (33 percent), unspecified (26 percent), orthopedic (10 percent), seizures (8 percent), infection (8 percent), and psychiatric (7 percent). Findings indicate frequent rehospitalizations occurred in the first year postinjury, suggesting the need for preventive models of health maintenance following inpatient rehabilitation discharge. Greater surveillance of those with deployment-related TBI or active duty at the time of injury and greater TBI severity may be warranted.Tran, Johanna, Hammond, Flora, Dam-O'Connor, Kristen, Tang, Xinyu, Eapen, Blessen, McCarthy, Marissa, Nakase-Richardson, RisaIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, New York Traumatic Brain Injury Model SystemYesdevopsadmin
2015Reporting on interventions: Issues and guidelines for rehabilitation researchersJournalJ71830Archives of Physical Medicine and Rehabilitation9661170-1180Article describes checklists that can be helpful to developers of research proposals in specifying what treatments will be delivered and how they will be measured as well as to authors who, when all data have been analyzed, set out to inform others of their findings. Observers commonly note the poor reporting of research, including rehabilitation research. The Consolidated Standards of Reporting Trials (CONSORT) checklist (supplemented by the CONSORT extension for non-pharmacologic interventions) has been published for improving the reporting of intervention research. However, the items on these checklists are considered to be inadequate to guide authors as to which information to include when reporting on the intervention(s) studied, and the Template for Intervention Description and Replication, Journal Article Reporting Standards, and the checklist of the Western Journal of Nursing Research are recommended to rehabilitation researchers. The Rehabilitation Treatment Taxonomy framework is recommended as a conceptual scheme to assist authors in thinking through the linkages between intervention ingredients, targets of treatment, and the mechanisms of action linking these 2 areas. Recommendations are made for prospective authors and journal editors who desire to see improved reporting of rehabilitation interventions.Dijkers, Marcel P.New York Traumatic Brain Injury Model SystemYesdevopsadmin
2014Systematic framework to evaluate the status of physical activity research for persons with multiple sclerosisJournalJ68203Disability and Health Journal72151-156Study examined the current state of physical activity research for people with multiple sclerosis (MS) by utilizing the Behavioral Epidemiological Framework, which describes a sequence of 5 phases used to categorize health-related behavioral research. After searching MEDLINE, PUBMED, PsycINFO, Google Scholar and several major areas within EBSCOHOST (2000 to present), retrieved articles were categorized according to the framework phases and coding rules. Of the 139 articles included, 49 percent were in phase 1 (establishing links between behavior and health), 18 percent phase 2 (developing methods for measuring behavior), 24 percent phase 3 (identifying factors influencing behavior and implications for theory), and 9 percent phase 4 and 5 (evaluating interventions to change behavior and translating research into practice). The emphasis on phase 1 research indicates that the field is in its early stages of development. Providing those with MS with necessary tools through health promotion programs is needed to reduce secondary conditions and co-morbidities. Exploring the current state of health behavior research for individuals with MS is essential to understanding the next steps required to reducing preventable disability. Reassessment of the field of physical activity and MS in the future could provide insight into whether the field is evolving over time or remaining stagnant.Dixon-Ibarra, Alicia , Vanderbom, Kerri, Dugala, Anisia, Driver, SimonNodevopsadmin
2014Scoping review of the Americans with disabilities act: What research exists, and where do we go from here?JournalJ71554Disability Studies Quarterly343http://dsq-sds.org/article/view/3883/3645Article describes a scoping review of the research conducted on the Americans with Disabilities Act (ADA). A broad range of research on the ADA tracks its progress and impact. Much of the research is inconclusive or conflicting, creating a fragmented evidence base about the ADA's effectiveness as a social policy. In response, academic researchers and disability organizations have called for an extensive review of the existing research. To address the need for a systematic assessment of existing research, the University of Illinois at Chicago has begun a five-year project systematically reviewing the ADA research as part of the ADA Knowledge Translation Center at the University of Washington. This article details the activities and findings from stage one of the project, a scoping review of the ADA. A total of 980 separate research records were included in the review. Findings were descriptive analyzed and synthesized into the following categories: record type, stakeholder groups, topics, and research method. The authors discusses the broader implications of the scoping review findings in relation to understanding emerging issues of disability policy and future ADA research.Harris, Sarah P., Gould, Robert, Ojok, Patrick, Fujiura, Glenn, Jones, Robin, Olmstead, AveryNodevopsadmin
2016Sex-based differences in perceived pragmatic communication ability of adults with traumatic brain injuryJournalJ73173Archives of Physical Medicine and Rehabilitation972, Supplement 1S26-S32Study examined sex-based differences in self-reported and close other-reported perceptions of pragmatic communication skills in adults with traumatic brain injury (TBI). Participants included 160 adults with medically documented TBI and 81 adults without TBI who served as a control group. One family member or friend was nominated by each participant with TBI as a close other who could rate that participant’s communication ability. Pragmatic communication problems, which can be defined as difficulty using language and nonverbal communication in social contexts, were assessed using the La Trobe Communication Questionnaire (LCQ), a standardized measure of communication problems in everyday life. Participants with TBI, their close others, and adults in the control group completed the LCQ. Analyses of variance and t tests were used to compare TBI versus control group self-ratings and to compare self-ratings and close-others’ ratings of men versus women with TBI. Results showed that participants with TBI endorsed more communication problems than controls. There were no significant differences in self-ratings or in the ratings of close others in communication behaviors of men with TBI compared with women with TBI. There was no difference between the self-ratings of women with TBI and their close others. However, men with TBI significantly underreported communication problems compared with reports of close others. The findings suggest that women with TBI might be more accurate than men with TBI in recognizing their own pragmatic communication problems.Despins, Emily H., Turkstra, Lyn S., Struchen, Margaret A., Clark, Allison N.Texas TBI Model System of TIRRYesdevopsadmin
2017Reciprocal causation between functional independence and mental health 1 and 2 ears after traumatic brain injury: A cross-lagged panel structural equation modelJournalJ76113American Journal of Physical Medicine and Rehabilitation966374-380Study used cross-lagged panel and structural equation modeling (SEM) techniques to examine causality between comprehensive indices of mental health (depression, anxiety, and life satisfaction) and functional independence in a national sample of individuals with traumatic brain injury (TBI) over the first 2 years after injury. Participants were 4,674 individuals with TBI from the TBI Model Systems Database. The SEM, which yielded good fit indices, suggested that individuals with TBI with greater mental health problems at 1 and 2 years after injury had lower functional independence at those same time points. The standardized path loadings for mental health problems and for functional independence over time were large, suggesting a high degree of consistency in mental health and functional independence across 1 and 2 years. In terms of cross-lag, mental health at Time 1 did not exert a unique effect on functional independence at Time 2, but functional independence at Time 1 exerted a statistically significant but quite small unique effect on mental health at Time 2. This combination of results suggests that functional independence is only slightly more causal than mental health in the relationship between mental health and functional independence over the first 2 years post-TBI, and that instead, reciprocal causality is a more likely scenario.Perrin, Paul B., Stevens, Lillian F., Sutter, Megan, Lequerica, Anthony H., Krch, Denise, Kolakowsky-Hayner, Stephanie A., Arango-Lasprilla, Juan C.Virginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2014Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuriesJournalJ75730Journal of Neurosurgery1203773-777Study measured compliance with evidence-based management (EBM) guidelines for management of severe traumatic brain injury (TBI) and its impact on patient outcome. This was a secondary analysis of data collected from 2,056 patients with blunt TBI from 11 Level I trauma centers over a 2-year period. The authors measured compliance with 6 non-operative EBM processes of care: endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure (ICP) monitoring, ICP-directed therapy, and discharge to rehabilitation. Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. The overall compliance rate was 73 percent, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80 percent. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate. Findings indicate that despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.Shafi, Shahid, Barnes, Sunni A., Millar, D., Sobrino, Justin, Kudyakov, Rustam, Berryman, Candice, Rayan, Nadine, Dubiel, Rosemary, Coimbra, Raul, Magnotti, Louis J., Vercruysse, Gary, Scherer, Lynette A., Jurkovich, Gregory J., Nirula, RaminderNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2014Relationship of preinjury depressive symptoms to outcomes 3 months after complicated and uncomplicated mild traumatic brain injuryJournalJ69752American Journal of Physical Medicine and Rehabilitation938687-702Study examined the effect of preinjury depressive symptoms on outcomes 3 months after complicated and uncomplicated cases of mild traumatic brain injury (mTBI). Preinjury depressive symptoms, experienced in the 30 days before injury, as measured by retrospective self-report, were assessed within the first 2 weeks after injury. The outcome measures assessed at 3 months after injury included affective/behavioral, cognitive, and physical problems and health-related quality-of-life (HRQOL). There were 177 patients who completed both the baseline and 3-month follow-up interviews. The sample was categorized by severity of depressive symptoms in the month before injury as normal, mild, or moderate-severe. Compared with those reporting no preinjury depressive symptoms, patients reporting moderate-severe depressive symptoms had significantly worse outcomes on the Affective and Behavioral and the Cognitive subscales of the Head Injury-Family Interview Problem Checklist and on the 36-item Short-Form Health Survey Mental Component Summary score. The group reporting mild preinjury depressive symptoms scored worse on a measure of cognitive symptoms compared with those with no preinjury depressive symptoms. There was no interaction between preinjury depressive symptoms and severity of the mTBI (complicated or uncomplicated) for any of the outcomes. The findings suggest that moderate-to-severe depressive symptoms in the month before injury may be a possible risk factor for poor affective/behavioral, cognitive, and mental HRQOL outcomes at 3 months after mTBI. Clinicians and researchers should consider the impact of preinjury depression on the recovery process to provide at-risk patients adequate treatment soon after injury.Kumar, Raj G., Bracken, Michael B., Clark, Allison N., Nick, Todd G., Melguizo, Maria S., Sander, Angelle M.Texas TBI Model System of TIRRYesdevopsadmin
2017Risk factors for institutionalization after traumatic brain injury inpatient rehabilitationJournalJ75993Journal of Head Trauma Rehabilitation323158-167Study developed a profile of individuals with traumatic brain injury (TBI) who received inpatient rehabilitation and were discharged to an institutional setting using characteristics measured at rehabilitation discharge. Data were analyzed data for participants enrolled in the Traumatic Brain Injury Model Systems National Database from January 2002 to June 2012 who had lived in a private residence before TBI. Logistic regression analyses were used to identify sociodemographic factors, lengths of stay, and cognitive and physical functioning levels that differentiated patients discharged to institutional versus private settings. The results indicated that older age, living alone before TBI, and lower levels of function at rehabilitation discharge (independence in locomotion, bladder management, comprehension, and social interaction) were significantly associated with higher institutionalization rates and provided the best models identifying factors associated with institutionalization. Institutionalization was also associated with decreased independence in bed-chair-wheelchair transfers and increased duration of posttraumatic amnesia. Research evaluating the effect of increasing post-discharge support and improving treatment effectiveness in these functional areas is recommended.Eum, Regina S., Brown, Allen W., Watanabe, Thomas K., Zasler, Nathan D., Goldstein, Richard, Seel, Ronald T., Roth, Elliot J., Zafonte, Ross D., Glenn, Mel B.Mayo Clinic Traumatic Brain Injury Model System , Virginia Commonwealth Traumatic Brain Injury Model System, Moss Traumatic Brain Injury Model System, Spaulding-Harvard Traumatic Brain Injury Model System, Midwest Regional Traumatic Brain Injury Model SystemYesdevopsadmin
2017Selflessness as a universal neuropsychological foundation of spiritual transcendence: Validation with Christian, Hindu, and Muslim traditionsJournalJ78715Mental Health, Religion & CultureStudy evaluated 109 individuals with traumatic brain injury from the United States and India, including Christians, Hindus, and Muslims, to determine if right hemisphere/right parietal lobe (RH/RPL) selflessness is a universal neuropsychological foundation for spiritual transcendence across cultures and religions. Research has shown that increased spiritual transcendence is related to decreased RH/RP functioning, which has been inferred as relating to increased selflessness. Participants completed measures of spiritual transcendence and spatial perception as an index of the functional integrity of the RH/RPL. Spearman correlations indicated that decreased RH/RPL functioning is significantly associated with increased spiritual transcendence for the entire sample, but not for different cultures or religions, likely due to decreased statistical power. The results suggest that decreased RH/RPL-related selflessness is a universal neuropsychological foundation for spiritual transcendence across cultures and faith traditions, which is interpreted individually based on cultural and religious background (e.g., closeness to God, Allah, and Brahman).Johnstone, Brick, Hanks, Robin, Bhushan, Braj, Cohen, Daniel, Roseberry, Jarett, Yoon, Dong P.Southeastern Michigan Traumatic Brain Injury System Yesdevopsadmin
2015Stability of vocational interests after recent spinal cord injuryJournalJ69610Rehabilitation Psychology159321-328Study determined the stability of vocational interests among people with spinal cord injury (SCI) over time using the 1994 Strong Interest Inventory, Form T317, a 317-item measure of vocational interests. Initial assessments were completed during inpatient rehabilitation an average of 50 days after SCI onset. Follow-up measures, collected by mail, were obtained an average of 16.6 months postinjury and 29.1 months postinjury. A total of 135 participants completed all 3 assessments. Comparison of scale means across 3 times of measurement indicated significant changes in 2 of 6 general occupational themes (GOT), 8 basic interest scales (BIS), and 2 special scales (leadership style, risk taking/adventure). With 1 exception, a linear trend indicating an increase in reported interests accounted for observed relationships. An age-by-time interaction occurred with 1 GOT and 3 BIS. The average stability coefficient was 0.61 for the GOT, 0.59 for the BIS, and 0.70 for the special scales. The average coefficients were somewhat lower for the oldest participants. Results indicate that vocational interests do not appear to be static when first measured during inpatient rehabilitation after SCI. Rather, they evolve with average increases on select themes more compatible with the limitations of SCI. Stability coefficients suggest that interests are likely to change more than indicated in earlier studies.Brooks J, Shavelle RM, Strauss DJ, Hammond FM, Harrison-Felix CLYesdevopsadmin
2015Rehospitalization during 9 months after inpatient rehabilitation for traumatic brain injuryJournalJ72094Archives of Physical Medicine and Rehabilitation968, Supplement 3S330-S339, S339.e1-S339.e4Study assessed the frequency of, causes for, and factors associated with acute rehospitalization during 9 months after discharge from inpatient rehabilitation for traumatic brain injury (TBI). Data were obtained from 1,850 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. The occurrences of proxy or self-report of postrehabilitation acute care rehospitalization, as well as length of and causes for the rehospitalizations were examined. Results showed that a total of 510 participants (28 percent) had experienced 775 acute rehospitalizations. All experienced 1 admission, whereas 154 (20 percent) had 2 admissions, 60 (8 percent) had 3, 23 (3 percent) had 4, 27 had between 5 and 11, and 1 had 12. The most common rehospitalization causes were infection, neurological, neurosurgical, injury, psychiatric, and orthopedic. The mean time from rehabilitation discharge to first rehospitalization was 113 days. The mean rehospitalization duration was 6.5 days. Logistic regression analyses revealed that older age, history of seizures before injury or during acute care or rehabilitation, history of brain injuries, and nonebrain injury medical severity increased the risk of rehospitalization. Injury etiology of motor vehicle collision and high motor functioning at discharge decreased rehospitalization risk.Hammond, Flora M., Horn, Susan D., Smout, Randall J., Seel, Ronald T., Beaulieu, Cynthia L., Corrigan , John D., Barrett, Ryan S., Giuffrida, Clare G., Cullen, Nora, Sommerfeld, Teri, Brandstater, Murray E.Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2014Reliability and validity of composite scores from the NIH toolbox cognition battery in adultsJournalJ76332Journal of the International Neuropsychological Society206588-598https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103963/Study evaluated the psychometric properties of the NIH Toolbox Cognition Battery (NIHTB-CB) composite scores in an adult sample. The NIHTB-CB was designed for use in epidemiologic studies and clinical trials for ages 3 to 85 years. The NIHTB-CB contains seven computer-based instruments assessing five cognitive sub-domains: language, executive function, episodic memory, processing speed, and working memory. A total of 268 healthy adults were recruited at four university-based sites, using stratified sampling guidelines to target demographic variability for age (20–85 years), gender, education, and ethnicity. Participants completed the NIHTB-CB, corresponding gold standard validation measures selected to tap the same cognitive abilities, and sociodemographic questionnaires. A subgroup of 89 participants completed a retest 7 to 21 days after initial testing to assess test–retest reliability and practice effects. Three cognition composite scores were derived for both the NIHTB-CB and gold standard measures: crystallized, fluid, and total. The NIHTB composite scores showed acceptable internal consistency, excellent test–retest reliability, strong convergent and discriminant validities versus gold standard composites, and expected age effects. Significant relationships with self-reported prior school difficulties and current health status, employment, and presence of a disability provided evidence of external validity. The NIHTB-CB composite scores have excellent reliability and validity, suggesting they can be used effectively in epidemiologic and clinical studies.Heaton, Robert K., Akshoomoff, Natacha, Tulsky, David, Mungas, Dan, Weintraub, Sandra, Dikmen, Sureyya, Beaumont, Jennifer, Casaletto, Kaitlin B., Conway, Kevin, Slotkin, Jerry, Gershon, RichardNodevopsadmin
2014Supporting people with intellectual and developmental disabilities to participate in their communities through support staff pilot interventionJournalJ68662Journal of Applied Research in Intellectual Disabilities272154-162Article describes the development, implementation, and evaluation of a pilot staff intervention designed to support adults with intellectual and developmental disabilities (I/DD) in community participation by collaborating with agency staff and administrators to strategize change in service provision and programming. The aims of the intervention were to: (1) share results of needs assessment with staff members and administrators from community agencies to identify factors driving community programming and consumer-directed choice and control, (2) provide a forum where staff members could learn from each other’s experiences, (3) offer resources and strategies to the staff on increasing community participation, and (4) increase staff members’ confidence in supporting community participation of people with I/DD. Evaluation findings indicated that staff who participated in pilot intervention report increased confidence in supporting adults with I/DD to participate in their communities. Offering opportunities to develop staff communication and problem-solving skills in order to strategize community participation has the potential of not only supporting the empowerment of people with I/DD, but also the empowerment and long-term job satisfaction of staff members.Zakrajsek, Andrea, Hammel, Joy, Scazzero, Joseph A.Nodevopsadmin
2015Scholarship of practice: Scholars, practitioners, and communities working together to promote participation and healthJournalJ72645Occupational Therapy in Health Care294347-351Article introduces a special journal issue focusing on “scholarship of practice”, conceptualized as the close relationship and ongoing dynamic interplay between scholars, practitioners, and community members working together in a complex context. This approach proposes that community members and participants become the critical players and collaborators in the creation of new knowledge. The challenge to the profession of occupational therapy, is to create scholars of practice, who can generate new research and evidence about practice, as well as practice scholars, who can then change actual practice to meet changing needs and priorities of community members.Suarez-Balcazar, Yolanda, Hammel, JoyNodevopsadmin
2015Services and supports for students with traumatic brain injury: Survey of state educational agenciesJournalJ72782Exceptionality234211-224Study examined current state-level efforts to identify and provide special education and related services to children with traumatic brain injury (TBI). A 1999 survey of State Directors of Special Education revealed that most states had emerging initiatives for children with TBI and were expanding their capacity to serve this growing population. To determine whether significant changes in patterns of identification and service delivery had occurred, state education agencies (SEAs) and brain injury consumer organizations were surveyed in 2012. Survey results show some improvement, but significant gaps remain. More than half of the SEA directors reported that students with TBI are not appropriately identified for special education and related services, and fewer states reported a TBI specialist within the SEA than in 1999. Recommendations for policy changes and research are provided.Glang, Ann, Ettel, Deborah, Todis, Bonnie, Gordon, Wayne A., Oswald, Jenniifer M., Vaughn, Susan L., Connors, Susan H., Brown, MargaretNew York Traumatic Brain Injury Model SystemYesdevopsadmin
2015Strategy training during inpatient rehabilitation may prevent apathy symptoms after acute strokeJournalJ74464PM & R76562-570Study examined the effects of strategy training, a behavioral intervention used to augment usual inpatient rehabilitation, on apathy symptoms over the first 6 months after stroke. Thirty participants with acute stroke who exhibited cognitive impairments and were admitted for inpatient rehabilitation were randomized to receive strategy training (1 session per day, 5 days per week, in addition to usual inpatient rehabilitation) or reflective listening (same dose). Strategy training sessions focused on participant-selected goals and participant-derived strategies to address these goals, using a global strategy training method (Goal-Plan-Do-Check). Reflective listening sessions focused on participant reflections on their rehabilitation goals and experiences, facilitated by open-ended questions and active listening skills (attending, following, and responding). Trained raters blinded to group assignment administered the Apathy Evaluation Scale at study admission, 3 months, and 6 months. Data were analyzed with repeated-measures fixed-effects models. Participants in both groups had similar subsyndromal levels of apathy symptoms at study admission. A significant group-by-time interaction indicated that changes in apathy symptom levels differed between groups over time. The magnitude of group differences in change scores was large at month 3 and moderate to large at month 6. Strategy training shows promise as an adjunct to usual rehabilitation for maintaining low levels of post-stroke apathy.Skidmore, Elizabeth R., Whyte, Ellen M., Butters, Meryl A., Terhorst, Lauren, Reynolds III, Charles F.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2015Relationship between resilience, adjustment, and psychological functioning after traumatic brain injury: A preliminary reportJournalJ72024Journal of Head Trauma Rehabilitation304241-248Study examined the relationship among resilience, psychological distress, adjustment, and community participation in 96 adult survivors of mild-to-severe traumatic brain injury (TBI). The Connor-Davidson Resilience Scale (10-item version) was used to assess resilience, the Brief Symptom Inventory (BSI-18) was used to characterize psychological distress, and the Mayo-Portland Adaptability Index (MPAI-4) was used to measure ability, adjustment, and participation. Results showed that resilience scores were substantially lower than those of the general population. Significant relationships were found among resilience, psychological distress, and adjustment. Partial correlations (adjusting for the other MPAI-4 indices) showed significant correlation between MPAI-4 adjustment and resilience. Partial correlations (adjusting for the other BSI-18 scales) also showed significance for depression and resilience. Resilience scores differed significantly between the 55 individuals meeting BSI-18 caseness criteria for psychological distress and the 41 subjects not meeting the criteria. The results indicate that individuals with TBI are at risk for low resilience, which was found to correlate with psychological distress and psychosocial maladjustment. Developing interventions to strengthen resilience skills has the potential to improve post-injury psychosocial adjustment.Lukow, Herman R., Godwin, Emilie E., Marwitz, Jennifer H., Mills, Ana, Hsu, Nancy H., Kreutzer, Jeffrey S.Virginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2017Revisiting grade 3 diffuse axonal injury: Not all brainstem microbleeds are prognostically equalJournalJ78719Neurocritical Care272199-207Study investigated whether the extent of brainstem traumatic axonal injury (TAI), measured by the number of dorsal brainstem traumatic microbleeds (TMBs), correlates with 1-year functional outcome more strongly than does the number of TMBs in the ventral brainstem, corpus callosal, or entire brain. Further, it was hypothesized that TMBs within brainstem nuclei of the ascending arousal network (AAN) correlate with 1-year outcome. Recovery of functional independence is possible in patients with brainstem TAI, also referred to as "grade 3 diffuse axonal injury," but acute prognostic biomarkers are lacking. Data were collected from 39 patients who underwent acute gradient-recalled echo (GRE) magnetic resonance imaging as part of the Traumatic Brain Injury Model Systems study. TMBs were counted on the acute GRE scans globally and in the dorsal brainstem, ventral brainstem, and corpus callosum. TMBs were also mapped onto an atlas of AAN nuclei. The primary outcome was the Disability Rating Scale (DRS) score at 1 year post-injury. Associations between regional TMBs, AAN TMB volume, and 1-year DRS score were assessed by calculating Spearman rank correlation coefficients. Mean number of TMBs was: dorsal brainstem = 0.7, ventral brainstem = 0.2, corpus callosum = 1.8, and global = 14.4. The mean TMB volume within AAN nuclei was 6.1 millimeters cubed. Increased dorsal brainstem TMBs and larger AAN TMB volume correlated with worse 1-year outcomes. Global, callosal, and ventral brainstem TMBs did not correlate with outcomes. These findings suggest that dorsal brainstem TAI, especially involving AAN nuclei, may have greater prognostic utility than the total number of lesions in the brain or brainstem.Izzy, Saef, Mazwi, Nicole L., Martinez, Sergi, Spencer, Camille A., Klein, Joshua P., Parikh, Gunjan, Glenn, Mel B., Greenberg, Steven M., Greer, David M., Wu, Ona , Edlow, Brian L.Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2017Seizure prophylaxis guidelines following traumatic brain injury: An evaluation of complianceJournalJ75643Journal of Head Trauma Rehabilitation322E13-E17Study examined the rate of prophylactic seizure medication usage following traumatic brain injury (TBI) and the extent to which the guidelines for seizure prophylaxis after TBI were followed in a tertiary care level 1 trauma center and affiliated inpatient rehabilitation facility. A retrospective medical records review was conducted of 173 individuals with TBI enrolled in the TBI Model Systems program. Overutilization rate of prophylactic antiepileptic drugs (AEDs); failure to stop rate of AED utilization upon admission to and during inpatient rehabilitation; and duration of overutilization were the main outcomes of interest. Of the 173 participants included, 77 were started on seizure prophylaxis at hospital presentation and 96 were not. Of the 77 participants, 11 had a posttraumatic seizure. Of the 66 remaining, 18 participants (10.4 percent) were continued on AEDs for more than 7 days after injury. Of these 18 participants, 12 were continued on AEDs without indication upon admission to inpatient rehabilitation. Finally, 8 of the 12 were continued on AEDs at discharge from rehabilitation, resulting in a failure to stop rate of 66.67 percent. Results indicate that despite existing guidelines for stopping seizure prophylaxis after TBI, some patients remain on AEDs and may be inappropriately exposed to possible medication side effects. These findings highlight the importance of communication at the time of rehabilitation transfer and the need for ongoing education about AED guidelines.Zaman, Anwar, Dubiel, Randi, Driver, Simon, Bennett, Monica, Diggs, Vincent, Callender, LibradaNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2017Socially constructed hierarchies of impairments: The case of Australian and Irish workers' access to compensation for injuriesJournalJ78114Journal of Occupational Rehabilitation274507-519This article critically analyzes the social hierarchy of physical versus mental impairment. The authors posit that a hierarchy of impairment attributes exists in law and practice that regulate the compensation available to employees who are injured at work resulting in physical and sensory versus mental disabilities. Using legal doctrinal research methods, they illustrate how Australian and Irish workers’ compensation and negligence laws regard workers with mental injuries and impairments as less deserving of compensation and protection than workers who have physical and sensory injuries or impairments. This research finds that workers who acquire and manifest mental injuries and impairments at work are less able to obtain compensation and protection than workers who have developed physical and sensory injuries of equal or lesser severity. Organizational cultures and governmental laws and policies that treat workers less favorably because they have mental injuries and impairments perpetuates unfair and artificial hierarchies of disability attributes. The authors conclude that these “sanist” attitudes undermine equal access to compensation for workplace injury as prohibited by the United Nations Convention on the Rights of Persons with Disabilities.Harpur, Paul, Connolly, Ursula, Blanck, PeterNodevopsadmin
2014Rehabilitation treatment taxonomy: Implications and continuationsJournalJ67521Archives of Physical Medicine and Rehabilitation951 (Supplement 1)S45-S54Article discusses a number of issues relevant to the development of a conceptual framework for a rehabilitation treatment taxonomy (RTT). A number of issues still need to be addressed before an RTT can be created and used by various stakeholder groups in their work in rehabilitation. They include: (1) creating distinctions within the major target classes; (2) the nature and quantity of allowable targets of treatment; and (3) bracketing as a way of specifying the skill or knowledge taught; the nature of compensation afforded by changes in the environment, assistive technology, and orthotics/prosthetics; and the ingredients in homework a clinician assigns. Clarification is provided regarding the role of the International Classification of Functioning, Disability and Health, focusing a taxonomy on ingredients versus other observable aspects of treatment, and regarding the lack of knowledge and its impact on taxonomy development. The immediate implications of the work to date and the need for rehabilitation stakeholders of all disciplines to be involved in further RTT development are discussed.Dijkers, Marcel P., Hart, Tessa, Whyte, John, Zanca, Jeanne M., Packel, Andrew, Tsaousides, TheodoreNodevopsadmin
2017Relationships between environmental factors and participation in adults with traumatic brain injury, stroke, and spinal cord injury: A cross-sectional multi-center studyJournalJ78245Quality of Life Research26102633-2645Study developed and evaluated a model to describe relationships between environmental factors and participation for people with traumatic brain injury (TBI), stroke, and spinal cord injury (SCI). Researchers also examined whether this model differed across the three diagnostic groups, as well as other demographic and clinical characteristics. A cross-sectional observational study included 545 community-dwelling adults with neurological disorders (166 with TBI, 189 with stroke, and 190 with SCI) recruited at three academic medical centers. Participants completed patient-reported measures of environmental factors and participation. The final structural equation model had acceptable fit to the data, explaining 63 percent of the variance in participation in social roles and activities. Systems, services, and policies had an indirect influence on participation and this relationship was mediated by social attitudes and the built and natural environment. Access to information and technology was associated with the built and natural environment which in turn influence on participation. The model was consistent across sex, diagnosis, severity/type of injury, education, race, age, marital status, years since injury, wheelchairs use, insurance coverage, personal or household income, and crystallized cognition. Social and physical environments appear to mediate the influence of systems, services, and policies on participation after acquired neurological disorders. These relationships are stable across the three diagnostic groups and many personal and clinical factors. The findings inform health and disability policy, and provide guidance for implementing the initiatives in Healthy People 2020 in particular for people with acquired neurological disorders.Wong, Alex W. K., Ng, Sheryl, Dashner, Jeddica, Bau, M. Carolyn, Hammel, Joy, Magasi, Susan, Lai, Jin-Shei, Carlozzi, Noelle E., Tulsky, David S., Miskovic, Ana, Goldsmith, Arielle, HeinemanNodevopsadmin
2017Supported decision-making: Implications from positive psychology for assessment and intervention in rehabilitation and employmentJournalJ78113Journal of Occupational Rehabilitation274498-506Article reviews existing literature on positive psychology, supported decision-making (SDM), employment, and disability. It examines interventions and assessments that have been empirically evaluated for the enhancement of decision-making and overall well-being of people with disabilities. Additionally, conceptual themes present in the literature were explored. Seven database searches were conducted across two databases (ERIC and PsychINFO) using various combination of keywords of 'disabilit*', work rehabilitation, and employment terms, positive psychology terms, and SDM components. The search strategy identified 1,425 results in total to be screened for relevance using their titles and abstracts. The database search was supplemented with hand searches of oft-cited journals, ancestral search, and supplemental search from grey literature. Only four studies were identified in the literature targeting SDM and positive psychology-related constructs in the employment and job development context. Results across the studies indicated small to moderate impacts of the assessment and interventions on decision-making and engagement outcomes. Conceptually there are thematic areas of potential overlap, although they are limited in the explicit integration of theory in supported decision-making, positive psychology, disability, and employment. The results suggest a need for additional scholarship in this area that focuses on theory development and integration as well as empirical work. Such work should examine the potential utility of considering positive psychological interventions when planning for SDM in the context of career development activities to enhance positive outcomes related to decision-making, self-determination, and other positive psychological constructs.Uyanik, Hatice, Shogren, Karrie A., Blanck, PeterNodevopsadmin
2014Satisfaction with cognitive rehabilitation delivered via the Internet in persons with acquired brain injuryJournalJ73641International Journal of Telerehabilitation6239-50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353005/Study examined the level of satisfaction with cognitive rehabilitation delivered via the Internet in participants with moderate-to-severe acquired brain injury (ABI). Fifteen adults with moderate-to-severe ABI were randomized to 30 days of Internet-based active treatment or to a wait list group, and crossed over to the opposite condition after 30 sessions. Both caregivers and participants were assessed at three time points during the study. Analysis focused on participant satisfaction with receiving treatment in this manner. Though the results showed no significant treatment effect, the vast majority of participants (more than 87 percent) were satisfied with treatment. Treatment satisfaction accounted for 25 percent of additional variance in predicting lower family ratings of mood difficulties after final assessment. Greater satisfaction with treatment was positively correlated with greater employment rate after treatment, as well as lower family ratings of memory and mood difficulties after final assessment. The findings suggest that treatment satisfaction in people with ABI is related to less activity limitations, and to maintaining employment after cognitive rehabilitation delivered via the Internet.Bergquist, Thomas F., Yutsis, Maya, Sullan, Molly J.Mayo Clinic Traumatic Brain Injury Model System Yesdevopsadmin
2016Service system collaboration in transition: An empirical exploration of its effects on rehabilitation outcomes for students with disabilitiesJournalJ75095Journal of Rehabilitation82310-MarStudy explored the effect of interagency collaboration on student vocational rehabilitation outcomes in a statewide model demonstration project for youth with disabilities. Using two different measures of perceptions of collaboration among inter-agency teams, results of the study were paradoxical. The findings suggested that instrumental or task-oriented perceptions of collaboration had a positive effect on vocational rehabilitation outcomes, while perceptions of team 'synergy' had a slight, but negative effect on vocational rehabilitation outcomes. The authors discuss the meaning of the construct of collaboration, and its implications for transition and rehabilitation personnel.Fabian, Ellen, Dong, Shengli, Simonsen, Monica, Luecking, Debra M., Deschamps, AnnNodevopsadmin
2017Strategies of successful and unsuccessful simulators coached to feign traumatic brain injuryJournalJ78679The Clinical Neuropsychologist313644-653Study evaluated strategies used by healthy adults coached to simulate traumatic brain injury (TBI) during neuropsychological evaluation. Fifty-eight healthy adults were coached to simulate TBI while completing a test battery consisting of multiple performance validity tests (PVTs), neuropsychological tests, a self-report scale of functional independence, and a debriefing survey about strategies used to feign TBI. The 16 "successful" simulators were classified as participants who failed 0 or 1 PVT and also scored as impaired on one or more neuropsychological index. The 42 "unsuccessful" simulators failed 2 or more PVTs or passed PVTs but did not score impaired on any neuropsychological index. Compared to unsuccessful simulators, successful simulators had significantly more years of education, higher estimated IQ, and were more likely to use information provided about TBI to employ a systematic pattern of performance that targeted specific tests rather than performing poorly across the entire test battery. The results contribute to a limited body of research investigating strategies utilized by individuals instructed to feign neurocognitive impairment. Findings signal the importance of developing additional embedded PVTs within standard cognitive tests to assess performance validity throughout a neuropsychological assessment. Future research should consider specifically targeting embedded measures in visual tests sensitive to slowed responding (e.g. response time).Kanser, Robert J., Rapport, Lisa J., Bashem, Jesse R., Billings, Nia M., Hanks, Robin A., Axelrod, Bradley N., Miller, Justin B.Southeastern Michigan Traumatic Brain Injury SystemYesdevopsadmin
2014Relationship between employment status and sexual functioning after traumatic brain injuryJournalJ69131Brain Injury2881063-1069Study investigated whether correlations exist between employment status and sexual functioning in people with traumatic brain injury (TBI). Participants were 146 community dwelling adults either enrolled in the TBI Model Systems sexuality study database or admitted to Rehabilitation Institute of Chicago with a primary diagnosis of TBI between 2004 and 2006. Data collected included employment status, annual income, Derogatis Interview for Sexual Functioning Self Report (DISF-SR) sum and sub-scale scores, Global Sexual Satisfaction Index (GSSI). Participants were grouped according to employment status. No significant difference was found in GSSI scores between employed, unemployed or students/volunteers; however, lower income marginally correlated with lower GSSI scores. Marginally significant lower DISF-SR Sexual Cognition sub-group scores were found in unemployed versus employed. Lower annual income also correlated with lower DISF-SR sum scores, Sexual cognition/fantasy, Orgasm/ejaculation and Sexual drive and relationship scores. Results indicated that lower-quality sexual functioning and satisfaction was present in subjects with TBI and concomitant unemployment or lower annual income. Efforts are needed to increase awareness among the TBI population and rehabilitation professionals of the potential impact unemployment or financial stress has on sexual functioning and satisfaction.Bellamkonda, Erica, Zollman, FeliseTexas TBI Model System of TIRR, Southeastern Michigan Traumatic Brain Injury SystemYesdevopsadmin
2018Results from a randomized trial evaluating a hospital-school transition support model for students hospitalized with traumatic brain injuryJournalJ78121Brain Injury325608-616Study evaluated the utility of the School Transition and Re-entry Program (STEP) model, a systematic hospital-to-school transition protocol for children hospitalized for traumatic brain injury (TBI). One hundred families of children with mild, complicated mild, moderate, or severe TBI were randomized while hospitalized to receive STEP or usual care. The study’s primary outcomes were identification for special education services and increased receipt of accommodations and modifications. Parents completed a questionnaire documenting their child’s hospital-to-school transition and the supports provided by the school at one month post discharge and approximately one year later. At these assessments, parents also completed surveys about their child’s behavior and their participation in school and community. Parent satisfaction with their child’s school program was assessed at one-year follow-up. There were no significant effects, indicating that STEP participants did not differ from usual care participants on any study outcome at one month after discharge or at one-year follow-up. The lack of significant findings in this study does not imply that effective hospital-to-school transition programming is unnecessary. Rather, the findings raise important questions regarding timing and dosage/intensity of intervention, appropriate measurement of outcomes, and fidelity of program delivery.Glang, Ann, Todis, Bonnie, Ettel, Debbie, Wade, Shari L., Yeates, Keith O.Nodevopsadmin
2014Searching for disability in electronic databases of published literatureJournalJ67634Disability and Health Journal71114-118Article describes a process for operationalizing the World Health Organization’s International Classification of Disability, Functioning, and Health concept of disability for MEDLINE, PsycINFO, and CINAHL databases. Translating a comprehensive conceptual definition of “disability” into an operational definition that utilizes electronic databases in the health sciences is a difficult step necessary for performing systematic literature reviews in the field. The authors created an electronic search strategy in conjunction with a reference librarian and an expert panel. Quality control steps included comparison of search results to results of a search for a specific disabling condition and to articles nominated by the expert panel. The complete search strategy is presented. Results of the quality control steps indicated that the strategy was sufficiently sensitive and specific and will be valuable to researchers conducting literature reviews on broad populations with disabilities.Walsh, Emily S., Peterson, Jana J., Judkins, Dolores Z.Yesdevopsadmin
2016Sleep disordered breathing in spinal cord injury: A systematic reviewJournalJ73838Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)394374-382This literature review examined specific issues related to sleep disordered breathing (SDB) in spinal cord injury (SCI), including the incidence, prevalence, symptoms, evaluation, treatment, and outcomes. An extensive search of PubMed, Cochrane Library, CINAHL and Web of Science databases was conducted to identify relevant studies. Of the 703 articles identified, 13 met the criteria for inclusion in the review. Results indicate that the prevalence of SDB after SCI is high, approaching 60 percent in people with motor complete tetraplegia. Obstructive sleep apnea is best documented as the most common form of SDB, although some studies have indicated an appreciable prevalence of central sleep apnea (CPA) as well. CPA is more common in patients with tetraplegia than in patients with paraplegia. It is also well established that the development of sleep disordered breathing after SCI occurs early. Based on the findings, early formal sleep study in patients with acute complete tetraplegia is recommended. In patients with incomplete tetraplegia and with paraplegia, the incidence of SDB is significantly higher than the general population. With the lack of correlation between symptoms and SDB, formal study would be reasonable. There is insufficient evidence in the literature on the impact of treatment on morbidity, mortality, and quality of life outcomes.Chiodo, Anthony E., Sitrin, Robert G., Bauman, Kristy A.Nodevopsadmin
2014Rehabilitation treatment taxonomy: Establishing common groundJournalJ67516Archives of Physical Medicine and Rehabilitation951 (Supplement 1)S1-S5Article introduces a journal supplement presenting a conceptual framework for the creation of a rehabilitation treatment taxonomy (RTT). It describes the key theoretical and empirical articles and their role, and the commentaries that were solicited. More importantly, based on feedback received to date, it sketches what the RTT is proposed to address, and what it explicitly excludes; therefore, the readers will have appropriate expectations and criteria for what is offered.Dijkers, Marcel P.Nodevopsadmin
2014Relationships after TBI: A grounded research studyJournalJ68927Brain Injury284398-413This qualitative study was conducted to develop a framework for conceptualizing and assessing couples after traumatic brain injury (TBI). Additionally, it purposes to establish a foundation built upon the practices of successful couples that have subsisted TBI from which methods of treatment can be drawn. Existing personal narratives written by survivors of TBI and their caregivers were analyzed. Data triangulation was performed with clinician-authored literature referencing the impact of TBI on coupled relationships. Constant comparative analysis of the data was then performed through an interactive process data reduction, coding, and theoretical sampling. Five primary themes emerged: (1) Ambiguous Losses, (2) Identity Reformations, (3) Tenuous Stability, (4) Non Omnes Moriar (the Latin phrase meaning “not all of us has died”), and (5) The New Us. From these, two grounded theories were developed: Relational Coring (the impact of TBI on coupled relationships) and Relational Recycling (the pathway that resilient couples take toward healing after TBI). These theories will allow researchers and practitioners to grasp the impact of TBI on the coupled relationship, familiarize themselves with the process by which relational experiences following TBI interact and understand the ways in which couples respond to these interacting experiences to work toward relational healingGodwin, Emilie, Chappell, Brittney, Kreutzer, JeffreyVirginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2017Supervision needs following veteran and service member moderate to severe traumatic brain injury: A VA TBI model systems studyJournalJ76522Journal of Head Trauma Rehabilitation324245-254Study examined the level of supervision needed across residential settings at 1 year following traumatic brain injury (TBI) and explored predictors of supervision in a military service member and veteran population. Data were obtained from 302 participants with moderate-to-severe TBI enrolled in the Department of Veterans Affairs (VA) TBI Model Systems research program. Primary residence and supervision levels were measured via scores on the Supervision Rating Scale. For predictive modeling, scores were dichotomized into 2 groups: those that were fully independent/living alone or required only some supervision during the day (independent group) and those that required overnight supervision, full-time indirect supervision, and full-time direct supervision (dependent group). Thirty-five percent were receiving supervision at 1 year after TBI across residential settings and 28 percent were living in alternative settings. Multivariate modeling indicated that older age and longer posttraumatic amnesia were predictive of having a need for supervision at 1 year postinjury. Findings suggest that supervision needs are long-term features of moderate and severe TBI. The results of this study lend support to the shift toward conceptualizing TBI as a chronic disease.Bailey, Erin K., Nakase-Richardson, Risa, Patel, Nitin, Dillahunt-Aspillaga, Christina, Ropacki, Susan A., Sander, Angelle M., Stevens, Lillian, Tang, XinyuTexas TBI Model System of TIRRYesdevopsadmin
2015Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitationJournalJ71048Physical Therapy953397-405This perspective article reviews the evolution of mHealth technologies and presents insights as to how this evolution informed the development of a novel mHealth system, iMHere (interactive mobile health and rehabilitation), and other technologies, including those used by the Veterans Administration. The term “mHealth” refers to the concept of using mobile devices, such as mobile phones, tablets, and smartphones, in medicine and public health. The authors discuss the novel applications of mHealth for rehabilitation and specifically physical therapy. Perspectives on the roles of rehabilitation professionals in the delivery of health care using mHealth systems are included. Challenges to mHealth, including regulatory and funding issues, are discussed. This article also describes how mHealth can be used to improve patient satisfaction and delivery of care and to promote health and wellness.Dicianno, Brad E., Parmanto, Bambang, Fairman, Andrea D., Crytzer, Theresa M., Yu, Daihua X., Pramana, Gede, Coughenour, Derek, Petrazzi, Alan A.Nodevopsadmin
2016Promoting cognitive support technology use and employment success among postsecondary students with traumatic brain injuriesJournalJ74431Journal of Vocational Rehabilitation45153-61Article describes Project Career, a five-year, federally funded initiative to provide cognitive support technology (CST) training and career preparatory services for undergraduate college students with mild and moderate traumatic brain injuries (TBI). The goal of Project Career is to develop, implement, and test a technology-driven, long-term, and resource-rich individualized support program that merges CST and vocational rehabilitation practices to improve career readiness and employment outcomes. Across the three implementation sites in Massachusetts, Ohio, and West Virginia, Project Career recruits a total of 30 undergraduate students with TBI each year. These students include both civilian and veteran undergraduate students who are enrolled in 2- and 4-year colleges and universities. Specific cognitive supports are delivered using iPads and iPad applications (apps) related to cognitive enhancement, especially in the areas of memory, attention, and organizational skills. Positive psychology interventions such as Best Possible Self, Intensely Positive Experiences, and Asset-based Assessments provide a framework for examining the activities of this multi-site development project. A total of 48 students with TBI have participated in the project during its first 18 months of operation – 14 of whom are military veterans with disabilities who served in the Iraq and/or Afghanistan theaters. Preliminary findings indicate that project participants have an increase in satisfaction with their academic experience, decreased negative affect, less resistance to change, and improved feelings of positive support.Rumrill, Phillip, Elias, Eileen, Hendricks, Deborah J., Jacobs, Karen, Leopold, Anne, Nardone, Amanda, Sampson, Elaine, Scherer, Marcia, Stauffer, Callista, McMahon, Brian T.Nodevopsadmin
2014Predictors of driving avoidance and exposure following traumatic brain injuryJournalJ68697Journal of Head Trauma Rehabilitation292185-192Study examined driving behavior following traumatic brain injury (TBI) in terms of driving avoidance and exposure based on demographic, injury, and outcome factors. A total of 184 participants who experienced moderate to severe TBI completed a telephone survey regarding return to driving and current driving behavior. Structural equation modeling was used to analyze predicted relationships between demographic and injury-related variables with driving exposure and avoidance within 5 years of injury. The model indicated that participants who were older and female tended to avoid a greater number of challenging everyday driving scenarios. Participants who had more severe injuries and those with poorer performance on cognitive measures at the time of rehabilitation discharge were likely to drive less frequently and over less distances at follow-up, though they did not avoid challenging driving situations. Findings suggest that young men and those with more severe injuries may require additional attention regarding their driving behavior following TBI.Labbe, Donald R., Vance, David E., Wadley, Virginia, Novack, Thomas A.UAB Traumatic Brain Injury Model SystemYesdevopsadmin
2014Rasch analysis of the community integration measure in persons with traumatic brain injuryJournalJ68581Archives of Physical Medicine and Rehabilitation954734-740Study examined the measurement properties of the Community Integration Measure (CIM) in people with traumatic brain injury (TBI). The CIM was designed to quickly assess an individual’s subjective sense of integration into his or her community. Rasch analysis was used to retrospectively evaluate CIM data obtained from 279 individuals from the Southeastern Michigan TBI Model System 1 to 15 years after a TBI. The CIM met Rasch expectations of unidimensionality and reliability (person separation ratio = 2.01, item separation ratio = 4.52). However, item endorsibility was poorly targeted to the participants’ level of community integration. A ceiling effect was found with this sample. The results indicate that the CIM is a relatively reliable and unidimensional scale. The findings provide support for the CIM to assess community integration after TBI, particularly when the clinician or investigator seeks a brief instrument.Millis, Scott R., Meachen, Sarah-Jane, Griffen, Julie A., Hanks, Robin A., Rapport, Lisa J.Southeastern Michigan Traumatic Brain Injury SystemYesdevopsadmin
2017Prevalence and reasons for delaying and foregoing necessary care by the presence and type of disability among working-age adultsJournalJ75013Disability and Health Journal10139-47Study examined whether subgroups of people with disabilities are more likely than people without disabilities to delay/forgo necessary care, in general and among the insured. Pooled Medical Expenditure Panel Survey data (2004-2010) were used to examine delaying or forgoing medical, dental, and pharmacy care among five disability subgroups (physical, cognitive, visual, hearing, multiple) and the non-disabled population. Logistic regression was conducted to examine delayed/forgone care, controlling for sociodemographic, health, and health care factors. Results indicated that more than 13 percent of all working-age adults had delayed/forgone necessary care; lack of insurance was the strongest predictor of unmet needs. Among the insured, disability subgroups were greater than two times more likely to report delayed/forgone care than adults without disabilities. Insured working-age adults with multiple chronic conditions and those with activities of daily living (ADL) or instrumental ADL assistance needs had higher odds of delayed or forgone care than their peers without these characteristics. Reasons related to affordability were most often listed as leading to unmet needs, regardless of disability. This study showed that, although insurance status most strongly predicted unmet needs for care, many people with insurance delayed/forewent necessary care. Even among the insured, all disability subgroups had significantly greater likelihood of having to delay/forgo care than those without disabilities. Differences also existed between the disability subgroups. Cost was most frequently cited reason for unmet needs.Reichard, Amanda, Stransky, Michelle, Phillips, Kimberly, McClain, Monica, Drum, CharlesNodevopsadmin
2015Patient effort in traumatic brain injury inpatient rehabilitation: Course and associations with age, brain injury severity, and time postinjuryJournalJ72087Archives of Physical Medicine and Rehabilitation968, Supplement 3S235-S244Study examined patients’ daily level of effort in occupational, physical, and speech therapy sessions during traumatic brain injury (TBI) inpatient rehabilitation and evaluated how age, injury severity, cognitive impairment, and time are associated with effort. A secondary analysis was conducted of data from 1,946 patients with a primary diagnosis of TBI who were admitted to 10 acute inpatient rehabilitation facilities and received a total of 138,555 therapy sessions. Effort in rehabilitation sessions was rated using the Rehabilitation Intensity of Therapy Scale (RITS). Data on the Functional Independence Measure (FIM), Comprehensive Severity Index (CSI) brain injury severity score, posttraumatic amnesia (PTA), and Agitated Behavior Scale (ABS) were also collected. The RITS effort ratings in individual therapy sessions closely conformed to a normative distribution for all 3 disciplines. Mean RITS ratings for patients’ therapy sessions were higher in the discharge week than in the admission week. For patients who completed 2, 3, or 4 weeks of rehabilitation, differences in effort ratings were observed between 5 subgroups stratified by admission FIM cognitive scores and over time. In linear mixed-effects modeling, age and CSI brain injury severity score at admission, days from injury to rehabilitation admission, days from admission, and daily ratings of PTA and ABS score were predictors of level of effort.Seel, Ronald T., Corrigan, John D., Dijkers, Marcel P., Barrett, Ryan S., Bogner, Jennifer, Smout, Randall J., Garmoe, William, Horn, Susan D.New York Traumatic Brain Injury Model SystemYesdevopsadmin
2016Prognostic models for predicting posttraumatic seizures during acute hospitalization, and at 1 and 2 years following traumatic brain injuryJournalJ74088EpilepsiaStudy developed and internally validated preliminary prognostic regression models to predict Posttraumatic seizures (PTS) during acute care hospitalization, and at 1 year and 2 years after traumatic brain injury (TBI). Prognostic models predicting PTS during acute care hospitalization and year 1 and year 2 post-injury were developed using a recent cohort from the TBI Model Systems National Database. Potential PTS predictors were selected based on previous literature and biologic plausibility. Bivariable logistic regression identified variables with a p-value less than 0.20 that were used to fit initial prognostic models. Multivariable logistic regression modeling with backward-stepwise elimination was used to determine reduced prognostic models and to internally validate using 1,000 bootstrap samples. Fit statistics were calculated, correcting for overfitting (optimism). The prognostic models identified sex, craniotomy, contusion load, and preinjury limitation in learning/remembering/concentrating as significant PTS predictors during acute hospitalization. Significant predictors of PTS at year 1 were subdural hematoma (SDH), contusion load, craniotomy, craniectomy, seizure during acute hospitalization, duration of posttraumatic amnesia, preinjury mental health treatment or psychiatric hospitalization, and preinjury incarceration. Year 2 significant predictors were similar to those of year 1: SDH, intraparenchymal fragment, craniotomy, craniectomy, seizure during acute hospitalization, and preinjury incarceration. Corrected concordance statistics were 0.599, 0.747, and 0.716 for acute hospitalization, year 1, and year 2 models, respectively. The prognostic model for PTS during acute hospitalization did not discriminate well. Year 1 and year 2 models showed fair to good predictive validity for PTS. Future studies should externally validate the models and determine clinical utility.Ritter, Anne C., Wagner, Amy K., Szaflarski, Jerzy P., Brooks, Maria M., Zafonte, Ross D., Pugh, Mary Jo V., Fabio, Anthony, Hammond, Flora M., Dreer, Laura E., Bushnik, Tamara, Walker, William C., Brown, Allen W., Johnson-Green, Doug, Shea, Timothy, Krellman, Jason W., Rosenthal, Joseph A.Virginia Commonwealth Traumatic Brain Injury Model System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, New York Traumatic Brain Injury Model System, University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2014Post-traumatic growth following spinal cord injuryJournalJ68419Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)372218-225Study examined the relationship of depression and personal and injury characteristics to post-traumatic psychological growth (PTG) in 824 adults with spinal cord injury (SCI). PTG was measured using the Post-traumatic Growth Inventory, reflecting positive change after injury in life priorities, closeness to others, new opportunities being available, stronger faith, and personal strength. Depression was assessed using the Patient Health Questionnaire. Demographic and injury characteristics were also collected from participants. Initial structural equation model testing of a conceptual model of personal and injury characteristics, violent etiology, depression, and PTG resulted in a poor fit. Model modifications resulted in an improved fit, but explained only 5 percent of the variance in PTG. Being female, younger, having less formal education, and less time since injury had significant relationships with PTG, whereas depression, violent etiology, and injury level/severity did not. In each PTG domain, between 54 and 79 percent of the sample reported at least some positive change after injury. The results explained only a small portion of the variance in PTG. A majority of the sample experienced some positive change after injury, with the greatest change in discovering that they were stronger than they thought they were. Comparing means previously reported in a non-SCI sample of those who experienced trauma, positive change after injury was comparable for each PTG item except for new opportunities being available, which was significantly lower for those with SCI. Future directions of research include the development of theoretical models of PTG after SCI.Kalpakjian, Claire Z., McCullumsmith, Cheryl B., Fann, Jesse R., Richards, John S., Stoelb, Brenda L., Heinemann, Allen W., Bombardier, Charles H.Nodevopsadmin
2015Psychotropic medication use during inpatient rehabilitation for traumatic brain injuryJournalJ72089Archives of Physical Medicine and Rehabilitation968, Supplement 3S256-S273, S273.e1-S273.e.14Study identified psychotropic medication administration patterns during inpatient rehabilitation for traumatic brain injury (TBI) and examined their relationship to patient preinjury and injury characteristics. Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. Most frequently administered were narcotic analgesics, followed by antidepressants, anticonvulsants, anxiolytics, hypnotics, stimulants, antipsychotics, antiparkinson agents, and miscellaneous psychotropics. The psychotropic agents studied were administered to 95 percent of the sample, with 8.5 percent receiving only 1 and 31.8 percent receiving 6. Degree of psychotropic medication administration varied widely between sites. Univariate analyses indicated younger patients were more likely to receive anxiolytics, antidepressants, antiparkinson agents, stimulants, antipsychotics, and narcotic analgesics, whereas older patients were more likely to receive anticonvulsants and miscellaneous psychotropics. Men were more likely to receive antipsychotics. All medication classes were less likely administered to Asians and more likely administered to those with more severe functional impairment. Use of anticonvulsants was associated with having seizures at some point during acute care or rehabilitation stays. Narcotic analgesics were more likely for those with history of drug abuse, history of anxiety and depression, and severe pain during rehabilitation. Psychotropic medication administration increased rather than decreased during the course of inpatient rehabilitation in each of the medication categories except for narcotics.Hammond, Flora M., Barrett, Ryan S., Shea, Timothy, Seel, Ronald T., McAlister, Thomas W., Kaelin, Darryl, Ryser, David K., Corrigan, John D., Cullen, Nora, Horn, Susan D.Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2015Predictors of successful transition from school to employment for youth with disabilitiesJournalJ75656Journal of Occupational Rehabilitation252323-334Study examined data from the second National Longitudinal Transition Study to identify variables associated with post-high school competitive employment, and to develop a logistic regression model for predicting successful employment outcomes. Data were analyzed for 2,900 special education students who exited high school in the 2002-2003 school year. The primary outcome variable of interest was any competitive employment during the 6-year study period. Competitive employment was defined as any paid job where the youth was making at least minimum wage and employed in a setting where the most of the employees did not have disabilities. A number of predictors of competitive employment were confirmed, including high school employment experiences, parental expectations of post-high school employment, arrest record, and school type. The strongest predictors were high school employment experiences and parental expectations of a post-high school employment. The findings highlight two aspects of the transition process that are critical for success: (1) employment training and work experiences in high school and (2) high parental expectations for their child’s future.Wehman, Paul, Sima, Adam P., Ketchum, Jessica, West, Michael D., Chan, Fong, Luecking, RichardNodevopsadmin
2015Prevention of pressure ulcers among people with spinal cord injury: A systematic reviewJournalJ73458PM & R76613-636Study evaluated the literature on the effectiveness of bed and wheelchair positioning and repositioning in the prevention of pressure ulcers (PUs) in both the spinal cord injury (SCI) and non-SCI populations. Searches conducted in PubMed, CINAHL, PsycINFO, and EMBASE databases identified 2,820 publications, of which, 49 met inclusion criteria. Among the studies examining pressure related to position or repositioning in bed or sitting, procedures for measuring skin pressure and metabolism were highly variable by anatomic location, measurement technique, outcome measure, study site, participant characteristics, and description of position/turning for bed and seated interventions. Numerous factors can influence tissue interface pressures, and no prospective studies had been performed to determine a causal relationship between interface pressure and skin breakdown. Several studies suggest that skin response to pressure differs between subjects with and without SCI. Conflicting results and insufficient evidence for optimal bed and seated positioning and turning and pressure relief maneuvers to prevent PUs in both SCI and non-SCI populations were limiting factors. Although there is no clear optimal positioning or turning frequency in bed, the evidence suggests avoiding the 90-degree lateral position because of high pressures and PU risk over the trochanters. During sitting, pressures are linearly redistributed from the sitting area during recline and tilt; however, reclining carries with it an increased risk of shear forces on this skin. The evidence does not support conclusive guidelines on positioning or repositioning techniques for PU prevention in bed or during sitting.Groah, Suzanne L., Schladen, Manon, Pineda, Cynthia G., Hsieh, Ching-Hui J.Nodevopsadmin
2016Persistent hypogonadotropic hypgonadism in men after severe traumatic brain injury: Temporal hormone profiles and outcome predictionJournalJ74118Journal of Head Trauma Rehabilitation314277-287Study examined relationships between persistent hypogonadotropic hypogonadism (PHH) and long-term outcomes after severe traumatic brain injury (TBI), and determined whether subacute testosterone levels can predict PHH. Post-TBI blood samples were collected during week 1, every 2 weeks until 26 weeks, and at 52 weeks. Serum hormone levels were measured, and individuals were designated as having PHH if 50 percent or more of samples met criteria for hypogonadotropic hypogonadism. At 6 and 12 months postinjury, the study assessed global outcome, disability, functional cognition, depression, and quality of life. The analysis included 78 men, median age was 28.5 years, for whom at least 2 subacute blood samples were collected. Thirty-four patients (44 percent) had PHH during the first year postinjury. Multivariable regression, controlling for age, demonstrated PHH status predicted worse global outcome scores, more disability, and reduced functional cognition at 6 and 12 months post-TBI. Two-step testosterone screening for PHH at 12 to 16 weeks postinjury yielded a sensitivity of 79 percent and specificity of 100 percent. The findings suggest that PHH status in men predicts poor outcome after severe TBI, and PHH can accurately be predicted at 12 to 16 weeks.Barton, David J., Kumar, Raj G., McCullough, Emily H., Galang, Gary, Arenth, Patricia M., Berga, Sarah L., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2017Project career: Perceived benefits of iPad apps among college students with traumatic brain injury (TBI)JournalJ77609Work: A Journal of Prevention, Assessment, and Rehabilitation58145-50Study examined perceived benefits of cognitive support technology (CST) in the form of iPad applications (apps) among college students with traumatic brain injury (TBI) after 6 and 12 months of use. This study used retrospective data collected as part of Project Career, a demonstration project designed to improve academic and employment success of undergraduate students with a TBI at two- and four-year colleges and universities. As part of Project Career, all participants are provided with an iPad and selected apps to support them in and out of the classroom. The apps for which data was collected included programs for note-taking, study support, planning, organization, behavioral/psychological support, and recreational activities. Participants included 50 college-aged students with TBI. Statistical analysis included data from two Matching Person and Technology assessment forms, including the Survey of Technology Use at baseline and the Assistive Technology Use Follow-Up Survey: Apps Currently Using, administered at 6- and 12-months re-evaluation. Analyses included frequencies and descriptives. Average scores at baseline indicated positive perspectives on technology. At 6 months, 67percent of participants reported that using iPad apps had moderate or a lot of improvement on their quality of life and 76 percent of participants reported that apps provided moderate or a lot of help with academic performance. At 12 months, quality of life (65 percent) and academics (82 percent) improved moderately or more from the use of iPad apps. Results suggest that, on average, students with a TBI have positive perspectives on the use of iPad apps.Jacobs, K., Leopold, A., Hendricks, D. J., Sampson, E., Nardone, A., Lopez, K. B., Rumrill, P., Stauffer, C., Elias, E., Scherer, M., Dembe, J.Nodevopsadmin
2015Predictors of agitated behavior during inpatients rehabilitation for traumatic brain injuryJournalJ72090Archives of Physical Medicine and Rehabilitation968, Supplement 3S274-S281Study identified predictors of the severity of agitated behavior during inpatient traumatic brain injury (TBI) rehabilitation. Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. This included 555 patients who exhibited agitation during their stay according to scores on the Agitated Behavior Scale. Potential predictors of the severity of agitation examined included patient and injury characteristics and comorbidities, and progress/changes in patient status throughout the rehabilitation stay. Results indicated that infection and lower Functional Independence Measure cognitive scores predicted more severe agitation. The medication classes associated with more severe agitation included sodium channel antagonist anticonvulsants, second-generation antipsychotics, and gamma-aminobutyric acid-A anxiolytics/hypnotics. Medication classes associated with less severe agitation included antiasthmatics, statins, and norepinephrine-dopamine-5 hydroxytryptamine (serotonin) agonist stimulants.Bogner, Jennifer, Barrett, Ryan S., Hammond, Flora M., Horn, Susan D., Corrigan, John D., Rosenthal, Joseph, Beaulieu, Cynthia L., Waszkiewicz, Margaret, Shea, Timothy, Reddin, Christopher J., Cullen, Nora, Giuffrida, Clare G., Young, James, Garmoe, WilliamIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2014Racial/ethnic disparities in mental health over the first 2 years after traumatic brain injury: A model systems studyJournalJ70221Archives of Physical Medicine and Rehabilitation95122288-2295Study examined racial/ethnic disparities differences in depression, anxiety, and satisfaction with life among individuals with traumatic brain injury (TBI) participating in the National Institute on Disability and Rehabilitation Research TBI Model Systems project. Participants were 1,662 individuals with moderate or severe TBI, aged 16 years or older, who were discharged between January 2008 and June 2011 from acute care and comprehensive inpatient rehabilitation at a Model Systems hospital. Medical, demographic, and outcome data were obtained from the Model Systems database at baseline, as well as 1 and 2 years after discharge. The Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, and Satisfaction with Life Scale assessed depression, anxiety, and satisfaction with life, respectively, at 1- and 2-year follow-ups. After controlling for all possible covariates, hierarchal linear models found that Black individuals had elevated depression across the 2 time points relative to White individuals. Asian/Pacific Islanders’ depression increased over time in comparison to the decreasing depression in those of Hispanic origin, which was a greater decrease than in White individuals. Black individuals had lower life satisfaction than did White and Hispanic individuals, but only marginally greater anxiety over time than did White individuals and similar levels of anxiety as did Asian/Pacific Islanders and Hispanic individuals. This study provides evidence of racial/ethnic disparities in mental health after TBI during the first 2 years following discharge. Further research is need to understand the complex factors underlying these differences.Perrin, Paul B., Krch, Denise, Sutter, Megan, Snipes, Daniel J., Arango-Lasprilla, Juan C., Kolakowsky-Hayner, Stephanie A., Wright, Jerry, Lequerica, AnthonyNorthern New Jersey Traumatic Brain Injury System Yesdevopsadmin
2016Preliminary evaluation of a measure for reliable assessment of need for constant visual observation in adults with traumatic brain injuryJournalJ77261Brain Injury30111343-1349Study developed and provided initial validation of a measure for accurately determining the need for constant visual observation (CVO) in patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation. An internally consistent measure of the need for CVO was developed and confirmed using Rasch analysis; the concurrent validity of the measure was assessed in relation to subjective clinical judgement recorded using the Levels of Risk scale (LoR) and the current level of supervision as measured by the Supervision Rating Scale (SRS). One hundred thirty-four individuals with moderate-to-severe TBI were studied in seven inpatient brain rehabilitation units associated with the National Institute for Disability, Independent Living and Rehabilitation Research TBI Model System. Participants were rated on the preliminary version of the CVO Needs Assessment (CVONA) and, by independent raters, on the LoR and SRS at four time points during inpatient rehabilitation: admission, days 2–3, days 5–6, and days 8–9. After pruning misfitting items, the CVONA showed satisfactory internal consistency (Person Reliability = 0.85–0.88) across time points. With reference to the LoR and SRS, low false negative rates (sensitivity > 90 percent) were associated with moderate-to-high false positive rates (29 to 56 percent). The CVONA may be a useful objective metric to complement clinical judgement regarding the need for CVO; however, additional prospective studies are needed to further assess its utility in identifying at-risk patients, reducing adverse events, and decreasing CVO costs.Moessner, Anne, Malec, James F., Beveridge, Scott, Reddy, Cara C., Huffman, Tracy, Marton, Julia, Schmerzler, Audrey J.Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2014Prognostic importance of self-reported traits/problems/strengths and environmental barriers/facilitators for predicting participation outcomes in persons with traumatic brain injury: A systematic reviewJournalJ69094Archives of Physical Medicine and Rehabilitation9561162-1173This systematic review examined evidence for the prognostic value of self-reported traits/problems/strengths and environmental barriers/facilitators of participation outcomes in people with traumatic brain injury (TBI). PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases were searched for articles published through August 15, 2013. Each of the 996 abstracts identified by the search and those failing to meet all inclusion criteria were excluded. Data were extracted from the 63 retained articles by 2 independent reviewers and study quality was determined using American Academy of Neurology (AAN) criteria. Conclusions regarding prognostic importance of self-report and environmental barrier/facilitator variables were made using AAN criteria. The highest level of available evidence regarding barrier/facilitator variables indicated that access to transportation, access to services, and participation in social interaction were possibly predictive of employment outcome. In contrast, living arrangements and social support were possibly not predictive of employment outcome. The evidence regarding self-report variables indicated that the number of postconcussive symptoms, fatigue, and physical competence were probably predictive of employment and need for supervision, whereas self-efficacy was probably not predictive of employment. Subjective well-being, pain, and social interaction were possibly predictive of employment, whereas coping style was possibly not predictive. Although additional investigation is needed, the findings suggest that self-report variables are likely to make important contributions to predicting participation outcomes. Future research should be guided by coherent conceptual models and use a consistent set of assessment instruments to facilitate comparisons between studiesSherer, Mark, Davis, Lynne C., Sander, Angelle M., Caroselli, Jerome S., Clark, Allison N., Pastorek, Nicholas J.Texas TBI Model System of TIRRYesdevopsadmin
2015Posttraumatic brain injury cognitive performance is moderated by variation within ANKK1 and DRD2 genesJournalJ73538Journal of Head Trauma Rehabilitation306E54-E66Study investigated relationships between genetic variation that affects dopaminergic signaling and functional recovery at 6 and 12 months after traumatic brain injury (TBI). As dopamine neurotransmission impacts cognition, it was hypothesized that variants in the linked dopamine D2 receptor (DRD2) and ankyrin repeat and kinase domain (ANKK1) genes might account for some individual variability in cognitive recovery following TBI. Data were collected from 108 survivors of severe TBI who were recruited consecutively from a level 1 trauma center. Cognitive performance was evaluated using 8 neuropsychological tests targeting different cognitive domains. An overall cognitive composite was developed using normative data. Functional cognition, depression status, and global outcome were also assessed. Subjects were genotyped for 6 DRD2 tagging single-nucleotide polymorphisms and Taq1A within ANKK1. Results showed that ANKK1 Taq1A heterozygotes performed better than homozygotes across several cognitive domains at both time points post injury. When adjusting for age, Glasgow Coma Scale score, and education, the Taq1A (ANKK1) and rs6279 (DRD2) variants were associated with overall composite scores at 6 months post-TBI. At 12 months, only Taq1A remained a significant genetic predictor of cognition. Following multiple-comparisons correction, there were no significant associations between examined genetic variants and functional cognition, depression status, and global outcome. These data suggest that genetic variation within DRD2 influences cognitive recovery post-TBI. Understanding genetic influences on dopaminergic systems post-TBI may impact current treatment paradigms.Failla, Michelle D., Myrga, John M., Ricker, Joseph H., Dixon, C. Edward, Conley, Yvette P., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2014Psychotic symptoms as manifestations of the posttraumatic confusional state: Prevalence, risk factors, and association with outcomeJournalJ70857Journal of Head Trauma Rehabilitation292E11-E18Study identified factors associated with psychotic-type symptoms in patients in a posttraumatic confusional state (PTCS) during early recovery following a moderate or severe traumatic brain injury (TBI) and investigated the prognostic significance of early psychotic-type symptoms for patient productivity outcome. Participants were recruited from the National Institute on Disability and Rehabilitation Research TBI Model Systems program. The Confusion Assessment Protocol was used to determine the diagnosis of PTCS and to assess psychotic-type symptoms, cognitive impairment, and sleep disturbance. Of the 168 individuals with moderate or severe TBI admitted for inpatient rehabilitation, 107 had psychotic-type symptoms on at least 1 examination. Those who were employed or were in an academic program and were making academic progress were coded as productive. One-year productivity outcome was available for 87 of the 107 participants. Results revealed that the presence of sleep disturbance, a shorter interval from admission to assessment, and greater cognitive impairment were associated with a greater incidence of psychotic-type symptoms. Younger age, more years of education, and lower frequency and severity of psychotic-type symptoms were associated with a greater likelihood of favorable productivity outcome. These findings suggest that improved sleep in early TBI recovery may decrease the occurrence of psychotic-type symptoms.Sherer, Mark, Yablon, Stuart A., Nick, Todd G.Texas TBI Model System of TIRRYesdevopsadmin
2014Predictors of Participation Enfranchisement After Spinal Cord Injury: The Mediating Role of Depression and Moderating Role of Demographic and Injury CharacteristicsJournalJ69087Archives of Physical Medicine and Rehabilitation1951106-1113Study examined the mediating effects of depressive symptoms on the relationships among employment, grief, depression treatment, and participation enfranchisement after spinal cord injury (SCI). It also examined the moderating role of demographic and injury characteristics, including sex, race, marital status, education, and injury level, and completeness on these relationships. Participation enfranchisement reflects the extent to which people view their communities as valuing, respecting, and encouraging their participation. Data were obtained from 522 participants with SCI who were recruited primarily from outpatient clinics and from the SCI Model Systems database. Structural equation modeling was used to test the relationship between participation enfranchisement and other variables by treating the level of depressive symptoms as a mediator, and exploring demographic and injury characteristics as the potential moderators. The final model fit the data relatively well, explaining 32% of the variance in participation enfranchisement. Enfranchisement was positively related to employment and negatively related to depression. Grieving the loss of a loved one and the use of an antidepressant or psychotherapy were related to participation enfranchisement; these relations were mediated by depressive symptoms. Multigroup analyses supported the model’s invariance across sex, marital status, severity of injury, and level of injury. In this study, depression appears to mediate the influence of employment, grief, and depression treatments on participation enfranchisement after SCI. These findings highlight efforts to improve the detection and treatment of depression in SCI rehabilitation programs that may enhance participation.Sander AM, Maestas K, Pappadis MRYesdevopsadmin
2016Prevalence, risk factors, and correlates of anxiety at 1 year after moderate to severe traumatic brain injuryJournalJ73801Archives of Physical Medicine and Rehabilitation975701-707Study examined the rate of clinically significant anxiety at 1 year after moderate-to-severe traumatic brain injury (TBI), specific symptoms of anxiety, risk factors for anxiety; and associations of anxiety with other 1-year outcomes, including participation and quality of life. Participants were 1,838 individuals with moderate-to-severe TBI who were enrolled in the TBI Model Systems database. One-year outcome data were collected using the following measures: 7-item Generalized Anxiety Disorder Scale (anxiety), Patient Health Questionnaire (9-item screen for depression), Functional Independence Measure (cognitive and motor functional status), Participation Assessment with Recombined Tools-Objective (societal participation), and Satisfaction with Life Scale (life satisfaction). Results indicated that clinically significant anxiety was reported by 21 percent of the participants. Of these, more than 80 percent reported interference with daily activities, with the most common symptoms being excessive worry and irritability. A common pattern was comorbid anxiety and depression, with smaller proportions reporting either disorder alone. Anxiety had large effect sizes with respect to life satisfaction and cognitive disability and medium to small effect sizes relative to societal participation and self-care. Middle age, black race, lower socioeconomic status, preinjury mental health treatment, and at least one TBI prior to the index injury were all risk factors for later anxiety. These findings suggest that anxiety should be screened, fully evaluated, and treated after moderate-to-severe TBI. Worry and irritability are common symptoms that might be treated with pharmacologic agents or relatively simple behavioral interventions.Hart, Tessa, Fann, Jesse R., Chervoneva, Inna, Juengst, Shannon B., Rosenthal, Joseph A., Krellman, Jason W., Dreer, Laura E., Kroenke, KurtMoss Traumatic Brain Injury Model System, New York Traumatic Brain Injury Model System, Ohio Regional Traumatic Brain Injury Model System , University of Pittsburgh Model Center for Traumatic Brain Injury , UAB Traumatic Brain Injury Model SystemYesdevopsadmin
2016Patterns of alcohol use after traumatic brain injuryJournalJ75741Journal of Neurotrauma33141390-1396Study examined patterns of alcohol use among 170 adults with a history of complicated mild to severe traumatic brain injury (TBI). Participants were recruited from a Level 1 trauma center at the time of their injury and completed evaluations at 1 month, 6 months, 12 months, and 3 to 5 years after injury. Pre-injury alcohol use was also assessed at the time of the 1-month assessment. A modified Quantity-Frequency Index of alcohol consumption was then calculated for each time point. The results revealed high levels of pre-injury alcohol consumption, followed by a reduction in consumption at 1-month post-injury. A significant increase in consumption was noted by 6 months post-injury, followed by more gradual increases in alcohol consumption at 1 year. Post-injury alcohol consumption was comparable to the general public at 6 months, 12 months, and 3 to 5 years post-injury. These results suggest that the first 6 months after injury may be the critical window of opportunity for alcohol intervention.Pagulayan, Kathleen F., Temkin, Nancy R., Machamer, Joan E., Dikmen, Sureyya S.University of Washington Traumatic Brain Injury Model SystemYesdevopsadmin
2017Project career: An individualized postsecondary approach to promoting independence, functioning, and employment success among students with traumatic brain injuriesJournalJ77608Work: A Journal of Prevention, Assessment, and Rehabilitation58135-43Article provides an overview of Project Career, a five-year interdisciplinary demonstration project funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). It provides technology-driven supports, merging cognitive support technology (CST) evidence-based practices and rehabilitation counseling, to improve postsecondary and employment outcomes for veteran and civilian undergraduate students with traumatic brain injury (TBI). Project staff provide assessments of students’ needs relative to assistive technology, academic achievement, and career preparation; provide CST training to 150 students; match students with mentors; provide vocational case management; deliver job development and placement assistance; and maintain an electronic portal regarding accommodation and career resources. Participating students receive CST training, academic enrichment, and career preparatory assistance from trained professionals at three implementation sites. To date, 117 students with TBI have enrolled in Project Career, with 63 percent reporting improved life quality and 75 percent reporting improved academic performance.Minton, Deborah, Elias, Eileen, Rumrill, Phillip, Hendricks, Deborah J., Jacobs, Karen, Leopold, Anne, Nardone, Amanda, Sampson, Elaine, Scherer, Marcia, Cormier, Aundrea G., Taylor, Aiyana, DeLatte, CairlinNodevopsadmin
2015Predicting institutionalization after traumatic brain injury inpatient rehabilitationJournalJ72348Journal of Neurotrauma32280-286This secondary analysis of a prospective, multi-center traumatic brain injury (TBI) registry examined the risk of institutionalization for individuals who sustained moderate and severe TBI and received inpatient rehabilitation. The study population included 7,219 patients with moderate-severe TBI in the Traumatic Brain Injury Model Systems National Database enrolled from 2002 to 2012. It was hypothesized that among people who had lived at a private residence prior to injury, greater dependence in locomotion, bed-chair-wheelchair transfers, bladder and bowel continence, feeding, and comprehension at admission to inpatient rehabilitation programs would predict institutionalization at discharge. Logistic regression was applied, with adjustment for demographic factors, proxy measures for TBI severity, and acute-care length-of-stay; the c-statistic and predictiveness curves validated a five-variable model. Higher levels of independence in bladder management, bed-chair-wheelchair transfers, and comprehension at admission were associated with lower risks of institutionalization on discharge. For every 10-year increment, age was associated with a 1.38 times higher risk for institutionalization and living alone was associated with a 2.34 times higher risk. The c-statistic was 0.780. The results suggest that this simple model can predict risk of institutionalization after inpatient rehabilitation for patients with TBI.Eum, Regina S., Seel, Ronald T., Goldstein, Richard, Brown, Allen W., Watanabe, Thomas K., Zasler, Nathan D., Roth, Elliot J., Zafonte, Ross D., Glenn, Mel B.Mayo Clinic Traumatic Brain Injury Model System , Virginia Commonwealth Traumatic Brain Injury Model System, Moss Traumatic Brain Injury Model System, Spaulding-Harvard Traumatic Brain Injury Model System, Midwest Regional Traumatic Brain Injury Model SystemYesdevopsadmin
2014Race-ethnicity and poverty after spinal cord injuryJournalJ68408Spinal Cord (formerly Paraplegia)522133-138Study examined the relationship between race/ethnicity and poverty status after spinal cord injury (SCI). A secondary analysis was conducted of data collected from 2,043 adults with traumatic SCI. Poverty status was measured using criteria from the United States (US) Census Bureau. Results indicated that 20.3 percent of the study sample was classified as in poverty. Whereas only 14 percent of non-Hispanic White participants were below the poverty level, 41.3 percent of non-Hispanic Blacks were in poverty. Logistic regression with three different models identified several significant predictors of poverty, including marital status, years of education, level of education, age and employment status. Non-Hispanic Blacks had 2.75 greater odds of living in poverty after controlling for other factors, including education and employment. Findings document the high levels of poverty among those with SCI and an elevated risk of poverty among non-Hispanic Blacks in the US.Krause, J. S., Dismuke, C. E., Acuna, J., Sligh-Conway, C., Walker, E., Washington, K., Reed, K. S.Nodevopsadmin
2016Preliminary associations between brain-derived neurotrophic factor, memory impairment, functional cognition, and depressive symptoms following severe TBIJournalJ77943Neurorehabilitation and Neural Repair305419-430Study evaluated brain-derived neurotrophic factor (BDNF) as a biomarker for post-traumatic brain injury (TBI) depressions (PTD), cognitive impairment, and functional cognitive limitations in the first year following severe TBI. One hundred thirteen participants with TBI were evaluated for PTD using the Patient Health Questionnaire-9 (PHQ-9). Cognitive impairment using a cognitive composite score targeting 4 domains of cognition (attention, language fluency, memory, and executive function) and functional cognition using the Functional Independence Measure-Cognition (FIM-Cog). BDNF levels were measured in cerebrospinal fluid and serum at 0 to 6 days postinjury and in serum at 6 and 12 months postinjury. Nine healthy adult controls were also recruited for comparison in biomarker analysis. Results showed serum BDNF was reduced after TBI versus controls at all time points. Acute serum BDNF positively correlated with memory composites and FIM-Cog scores. Acute serum BDNF negatively correlated with 12-month PHQ-9 scores. At 12 months, chronic serum BDNF tended to be lower in participants with PTD and correlated with PHQ-9 scores. Acute BDNF associations with memory recovery may implicate hippocampal damage/degeneration. Comparatively, BDNF associations with PTD status were not as strong as associations with PTD severity. Further investigation may delineate longitudinal BDNF patterns, and BDNF responsive treatments, reflecting mood and cognitive recovery following TBI.Failla, Michelle D., Juengst, Shannon B., Arenth, Patricia M., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2017Process for developing rehabilitation practice recommendations for individuals with traumatic brain injuryJournalJ78252BMC Neurology1754https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-017-0828-zArticle describes the development of a process for assessing the quality of evidence of clinical practices in traumatic brain injury (TBI) rehabilitative care. A multidisciplinary team of clinicians developed discipline-specific clinical questions using the Population, Intervention, Control, Outcome (PICO) process. A systematic review of the literature was conducted for each PICO question using Pubmed, CINAHL, PsychInfo, and Allied Health Evidence databases. Team members assessed the quality, level, and applicability of evidence utilizing a modified Oxford scale, the Agency for Healthcare Research and Quality Methods Guide, and a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation scale. Draft recommendations for best-practice were formulated and shared with a Delphi panel of clinical representatives and stakeholders to obtain consensus. Evidence-based practice guidelines are essential to improve the quality of TBI rehabilitation care. Using a modified quality of evidence assessment tool, researchers established a process to gain consensus on practice recommendations for individuals with TBI undergoing rehabilitation.Callender, Librada, Brown, Rachel, Driver, Simon, Dahdah, Marie, Collinsworth, Ashley, Shafi, ShahidNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2014Positive psychology in rehabilitation medicine: A brief reportJournalJ69654Neurorehabilitation343573-585Study explored the relationships between positive psychology constructs (character strengths, resilience, and positive mood) and rehabilitation-related variables (perceptions of functional ability post-injury and beliefs about treatment) within a baseline data set, a six-month follow-up data set, and longitudinally across time points. Pearson correlations and supplementary multiple regression analyses were conducted within and across these time points from a starting sample of 39 individuals with acquired brain injury in an outpatient rehabilitation program. Results indicated that positive psychology constructs were related to rehabilitation-related variables within the baseline data set, within the follow-up data set, and longitudinally between baseline positive psychology variables and follow-up rehabilitation-related data. These preliminary findings support relationships between character strengths, resilience, and positive mood states with perceptions of functional ability and expectations of treatment, respectively, which are primary factors in treatment success and quality of life outcomes in rehabilitation medicine settings. The results suggest the need for more research in this area, with an ultimate goal of incorporating positive psychology constructs into rehabilitation conceptualization and treatment planning.Bertisch, Hilary, Rath, Joseph, Long, Coralynn, Ashman, Teresa, Rashid, TayyabRusk Rehabilitation TBIMS at NYU Langone Health and Bellevue HospitalYesdevopsadmin
2014Psychosocial outcomes after traumatic brain injury: Life satisfaction, community integration, and distressJournalJ69607Rehabilitation Psychology593298-305Study examined the relationship among life satisfaction, community integration, and emotional distress in adults with traumatic brain injury (TBI). Participants were 253 adults with mild complicated, moderate, and severe TBI who were enrolled in a large, longitudinal study of individuals with TBI. Main measures included the Satisfaction with Life Scale, the Positive Affective and Negative Affective Schedule, the Craig Hospital Assessment and Reporting Technique Short-Form, the Community Integration Measure, and the Brief Symptom Inventory-18. The three-factor model adequately fit the data, and a higher-order model did not necessarily improve model fit but revealed significant relationships with first-order constructs and one second-order construct. Life satisfaction, community integration, and emotional distress were found to be related yet unique concepts in people with TBI. Life satisfaction was positively related to community involvement and inversely related to emotional distress. Community integration was inversely related to emotional distress. In addition, these concepts are related to a higher-order concept of psychosocial status, a global representation of subjective and objective functioning. These findings demonstrate the interrelated and dynamic nature of psychosocial well-being after brain injury and highlight the need for integrative and holistic treatment plans.Williams, Michael W., Rapport, Lisa J., Millis, Scott R., Hanks, Robin A.Nodevopsadmin
2014Predictors of follow-up completeness in longitudinal research on traumatic brain injury: Findings from the national institute on disability and rehabilitation research traumatic brain injury model systems programJournalJ68567Archives of Physical Medicine and Rehabilitation954633-641Study identified baseline participant variables in the domains of demographics, medical/psychosocial history, injury characteristics, and post-injury functional status associated with longitudinal follow-up completeness among participants with traumatic brain injury (TBI) using the TBI Model Systems (TBIMS) National Database (NDB). The sample analyzed included 8,249 individuals enrolled in the TBIMS NDB between 1989 and 2009 who were eligible for at least the first (year 1) follow-up up to the fifth (year 15) follow-up. Exhaustive chi-square automatic interaction detection was used to identify factors that classified participants according to level of follow-up completeness. Follow-up completeness was defined by 6 different longitudinal response patterns (LRPs): completing all follow-ups, wave nonresponse, dropping out, completing no follow-ups without formally withdrawing, formally withdrawing before completing any follow-ups, and formally withdrawing after completing some follow-ups. Completing all follow-ups was associated with higher levels of education, living with parents or others, and having acute care payer data entered in the NDB. Subgroups more vulnerable to loss to follow-up (LTFU) included those with less education, racial/ethnic minority backgrounds, those with better motor functioning on rehabilitation discharge, and those for whom baseline data on education, employment, and acute care payer were not collected. No subgroups were found to be more likely to have the LRPs of dropping out or formal withdrawal. The findings identify subgroups in which retention strategies beyond those most commonly used might reduce LTFU in longitudinal studies of people with TBI, and suggest future investigations into factors associated with missing baseline data.Krellman, Jason W., Kolakowsky-Hayner, Stephanie A., Spielman, Lisa, Dijkers, Marcel, Hammond, Flora M., Bogner, Jennifer, Hart, Tessa, Cantor, Joshua B., Tsaousides, TheodoreIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Moss Traumatic Brain Injury Model System, New York Traumatic Brain Injury Model System, Ohio Regional Traumatic Brain Injury Model System , Northern California Traumatic Brain Injury Model System, Carolinas Traumatic Brain Injury Rehabilitation and Research SystemYesdevopsadmin
2015Readmission to an acute care hospital during inpatient rehabilitation for traumatic brain injuryJournalJ72092Archives of Physical Medicine and Rehabilitation968, Supplement 3S293-S303Study assessed the incidence of, causes for, and factors associated with readmission to an acute care hospital (RTAC) during inpatient rehabilitation for traumatic brain injury (TBI). Data on RTAC incidence, RTAC causes, rehabilitation length of stay (RLOS), and rehabilitation discharge location were analyzed for 2,130 individuals with TBI admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study. A total of 183 participants (9 percent) experienced RTAC for a total of 210 episodes. Of 183 participants, 161 patients experienced 1 RTAC episode, 17 had 2, and 5 had 3. The mean time from rehabilitation admission to first RTAC was 2,222 days. The mean duration in acute care during RTAC was 78 days. Eighty-four participants (46 percent) had 1 RTAC episodes for medical reasons, 102 (56 percent) had 1 RTAC episodes for surgical reasons, and 6 (3 percent) participants had RTAC episodes for unknown reasons. The most common surgical RTAC reasons were neurosurgical, pulmonary, infection, and orthopedic; the most common medical reasons were infection, neurological, and cardiac. Any RTAC was predicted as more likely for patients with older age, history of coronary artery disease, history of congestive heart failure, acute care diagnosis of depression, craniotomy or craniectomy during acute care, and presence of dysphagia at rehabilitation admission. RTAC was less likely for patients with higher admission Functional Independence Measure motor scores and education less than high school diploma. RTAC occurrence during rehabilitation was significantly associated with longer RLOS and smaller likelihood of discharge home.Hammond, Flora M., Horn, Susan D., Smout, Randall J., Beaulieu, Cynthia L., Barrett, Ryan S., Ryser, David K., Sommerfeld, TeriIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2016Prevalence of suicidal behaviour following traumatic brain injury: Longitudinal follow-up data from the NIDRR traumatic brain injury model systemsJournalJ77259Brain Injury30111311-1318Study examined the prevalence of depression and suicidal behavior in a large cohort of patients who sustained moderate-to-severe traumatic brain injury (TBI). Data were obtained from patients who received acute care and comprehensive rehabilitation in a TBI Model Systems-designated brain injury inpatient rehabilitation program funded by the National Institute on Disability and Rehabilitation Research (NIDRR). Depression and suicidal ideation were measured with the Patient Health Questionnaire (PHQ-9). Self-reported suicide attempts during the past year were recorded at each follow-up examination, at 1, 2, 3, 10, 15 and 20 years post-injury. A total of 8,547 participants comprised the sample for analyses addressing suicide attempts. The results showed that throughout the 20 years of follow-up, rates of depression ranged from 24.8 to 28.1 percent, suicidal ideation ranged from 7.0 to 10.1 percent, and suicide attempts (past year) ranged from 0.8 to 1.7 percent. Participants who endorsed depression and/or suicidal behavior at year 1 demonstrated consistently elevated rates of depression and suicidal behavior 5 years after TBI. Findings suggest that compared to the general population, individuals with TBI are at greater risk for depression and suicidal behavior many years after TBI. The significant psychiatric symptoms evidenced by individuals with TBI highlight the need for routine screening and mental health treatment in this population.Fisher, Lauren B., Pedrelli, Paola, Iverson, Grant L., Bergquist, Thomas F., Bombardier, Charles H., Hammond, Flora M., Hart, Tessa, Ketchum, Jessica M., Giacino, Joseph, Zafonte, RossMayo Clinic Traumatic Brain Injury Model System , Virginia Commonwealth Traumatic Brain Injury Model System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Moss Traumatic Brain Injury Model System, Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2015Patterns in wheeled mobility skills training, equipment evaluation, and utilization: Findings from the SCIRehab projectJournalJ71713Assistive Technology27259-68Study examined the type and quantity of wheelchair skills training (WST) and adaptive equipment provided by occupational therapists and physical therapists during inpatient spinal cord injury (SCI) and the methods used to determine wheelchair prescriptions. The study also examined the timing of receipt of definitive wheelchairs, and patient satisfaction with and continued utilization of the wheelchair at the one-year injury anniversary. Data were obtained from 1,376 patients enrolled in the SCIRehab project, a research collaboration among 6 SCI Model Systems rehabilitation facilities. While most patients participated in WST, variation in type and frequency were found. Propulsion/driving skills were practiced most frequently. A majority of patients participated in equipment evaluations; assessment/prescription and fitting were performed frequently; mat evaluations were done infrequently. Most patients received mobility equipment in a timely manner; they continued to use their wheelchair and were satisfied with its fit and function at the one-year injury anniversary. High levels of respondent satisfaction with fit and function of wheelchairs suggest clinicians are prescribing mobility devices adequately and accurately supplementing information obtained during equipment assessment and fitting sessions with information from general treatment sessions. Variation in type and frequency of wheelchair training provided by level of SCI and in types of wheelchair prescribed use provides a foundation for future research to relate treatment modalities with functional and participation outcomes.Taylor, Sally, Gassaway, Julie, Heisler-Varriale, Lauren A., Kozlowski, Allan, Teeter, Laura, Labarbera, Jacqueline, Vargas, Carolyn, Natale, Audrey, Swirsky, AlisonNodevopsadmin
2015Project career: A qualitative examination of five college students with traumatic brain injuriesJournalJ73337NeuroRehabilitation373459-469Article presents a qualitative examination of five participants in Project Career, an interprofessional, five-year demonstration project designed to promote cognitive support technology (CST) use and employment outcomes among undergraduate college students with traumatic brain injuries (TBI). The goal of Project Career is to assist young adults who want to pursue a college education to be academically successful, to complete an undergraduate degree program, and then to transition successfully into employment or into an advanced degree program. CST is provided in the form of an iPad and applications that are selected to meet each student’s needs. Five case studies are presented to provide an understanding of student participants’ experiences within the project. The case study information was collected and synthesized by the project’s Technology and Employment Coordinators (TECs) at each of the project’s three university sites. Each case study includes background on the student, engagement with technology, vocational supports, and interactions with his/her respective TEC. A qualitative analysis from the student’s case notes is provided within each case study, along with a discussion of the overall qualitative analysis. Across all five students, the theme Positive Outcomes was mentioned most often in the case notes. Of all the different type of challenges, Cognitive Challenges were most often mentioned during meetings with the TECs, followed by Psychological Challenges, Physical Challenges, Other Challenges, and Academic Challenges, respectively. The data provide insight for what is working well and what challenges may need to be addressed for improving the project and its outcomes.Nardone, Amanda, Sampson, Elaine, Stauffer, Callista, Leopold, Anne, Jacobs, Karen, Hendricks, Deborah J., Elias, Eileen, Chen, Hui, Rumrill, PhillipNodevopsadmin
2017Potential impact of amantadine on aggression in chronic traumatic brain injuryJournalJ77067Journal of Head Trauma Rehabilitation325308-318Study assessed the effects of amantadine on anger and aggression among 118 individuals with a chronic traumatic brain injury (TBI) enrolled in a parallel-group, randomized, double-blind, placebo-controlled trial. Participants were randomly allocated to take amantadine (100 mg every morning and noon) or a placebo equivalent for treatment of irritability. Anger and aggression were measured at treatment days 0, 28, and 60 using observer-rated and participant-rated State-Trait Anger Expression Inventory-2 (STAXI-2) and Neuropsychiatric Inventory-Agitation/Aggression domain (NPI-A) Most Problematic and Distress scores. Participant-rated day 60 NPI-A Most Problematic and NPI-A Distress were statistically significant between the 2 groups, but STAXI-2 differences were not significant after adjustment for multiple comparisons. Substantial improvements were noted in both the amantadine and placebo groups (70 versus 56 percent, respectively, improving at least 3 points on day 60 Observer NPI-A). Findings suggest that 100 milligrams of amantadine twice daily in this population with chronic TBI appears to be beneficial in decreasing aggression from the perspective of the individual with TBI. No beneficial impact on anger was found.Hammond, Flora M., Malec, James F., Zafonte, Ross D., Sherer, Mark, Bogner, Jennifer, Dikmen, Sureyya, Whitney, Marybeth P., Bell, Kathleen R., Perkins, Susan M., Moser, Elizabeth A.Nodevopsadmin
2017Qualitative case studies of professional-level workers with traumatic brain injuries: A contextual approach to job accommodation and retentionJournalJ77603Work: A Journal of Prevention, Assessment, and Rehabilitation58114-MarStudy demonstrated the application of a service designed to improve the job retention outcomes of adults with traumatic brain injury (TBI). The intervention combines: (1) the Work Experience Survey (WES), an assessment of areas of incompatibility between worker abilities and job demands; and (2) development of a job accommodation plan to increase worker productivity. Four individuals with TBI participated in an evaluation of barriers to their continued employment following graduation from college. In one telephone interview with a trained interviewer, each participant completed the six sections of the WES: background information, barriers to worksite accessibility, barriers to performance of essential job functions, job mastery concerns, job satisfaction ratings, and job accommodation plan (top priority barriers and feasible solutions). Issues pertaining to balance and light sensitivity emerged in the description of accessibility barriers. Participants reported a wide range of difficulties in performing essential functions of their jobs that have the potential to significantly affect their productivity. Job mastery problems reflected outcomes associated with TBI such as ‘believing that others think I do a good job’ and ‘having the resources (e.g., knowledge, tools, supplies, and equipment) needed to do the job.’ Participants reported high levels of job satisfaction. Results suggest the WES is a cost-effective needs assessment tool to aid health and rehabilitation professionals in providing on-the-job supports to workers with TBI.Roessler, Richard T., Rumrill Jr, Phillip, Rumrill, Stuart P., Minton, Deborah L., Hendricks, Deborah J., Sampson, Elaine, Stauffer, Callista, Scherer, Marcia J., Nardone, Amanda, Leopold, Anne, Jacobs, Karen, Elias, EileenNodevopsadmin
2018Pre-injury psychosocial and demographic predictors of long-term functional outcomes post-TBIJournalJ78126Brain Injury30178-83Study examined whether pre-injury psychosocial and demographic factors differentially influence long-term functional outcomes following traumatic brain injury (TBI). Participants were 149 patients, ages 16–75, who sustained a mild complicated, moderate or severe TBI, were enrolled in a TBI Model System center, and had functional outcome data five to 15 years post-injury. Archival data were analyzed using multiple regression to determine amount of variance accounted for in five functional domains (cognitive independence, physical independence, mobility, occupation, and social integration) measured using the Craig Handicap Assessment and Reporting Technique. Predictors included age at injury, pre-injury education, Glasgow Coma Scale (GCS), pre-injury incarceration, and psychiatric history. Results showed the models were significant for cognitive and physical independence, mobility, and occupation. Incarceration and psychiatric history accounted for the most variance in cognitive and physical independence, over and above GCS and age at injury. Psychiatric history was also the strongest predictor of occupation. Mobility was the only domain in which GCS accounted for the most variance. The findings suggest that pre-injury psychosocial and demographic factors may be more important than injury severity for predicting some long-term functional outcomes after TBI. It would likely be beneficial to assess these factors in the inpatient setting, with input from a multidisciplinary team, as an early understanding of prognostic indicators can help guide treatment for optimal functional outcomes.Seagly, Katharine S., O'Neil, Rochelle L., Hanks, Robin A.Southeastern Michigan Traumatic Brain Injury SystemYesdevopsadmin
2017Probabilistic matching approach to link deidentified data from a trauma registry and a traumatic brain injury model system centerJournalJ75222American Journal of Physical Medicine and Rehabilitation96117-24Article describes the creation of an algorithm used to probabilistically link the Traumatic Brain Injury Model System (TBIMS) data set to trauma data in state and national trauma databases. When linking through probabilistic means, common data elements in two large, independent data sets can be compared to assess the likelihood that two patients are the same, given equal values on a number of variables. The TBIMS data from a single center was randomly divided into two sets. One subset was used to generate a probabilistic linking algorithm to link the TBIMS data to the center's trauma registry. The other subset was used to validate the algorithm. Medical record numbers were obtained and used as unique identifiers to measure the quality of the linkage. Novel methods were used to maximize the positive predictive value. The algorithm generation subset had 121 patients. It had a sensitivity of 88 percent and a positive predictive value of 99 percent. The validation subset consisted of 120 patients and had a sensitivity of 83 percent and a positive predictive value of 99 percent. The probabilistic linkage algorithm can accurately link TBIMS data across systems of trauma care. Future studies can use this database to answer meaningful research questions regarding the long-term impact of the acute trauma complex on healthcare utilization and recovery across the care continuum in traumatic brain injury populations.Kesinger, Matthew R., Kumar, Raj G., Ritter, Anne C., Sperry, Jason L., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2015Pilot feasibility of an mHealth system for conducting ecological momentary assessment of mood-related symptoms following traumatic brain injuryJournalJ72556Brain Injury29111351-1361Study assessed the feasibility and validity of a mobile health (mHealth) system for conducting ecological momentary assessment (EMA) of mood-related symptoms after traumatic brain injury (TBI). EMA involves repeated assessment of individuals in real time, over time, in their natural environments and across different contexts, enabling a more comprehensive understanding of the frequency, intensity, and duration of both physical and emotional symptoms. An mHealth system was developed as a smartphone application specifically for individuals with TBI using previously validated tools for depressive and anxiety symptoms (Patient Health Questionnaire- 9, Generalized Anxiety Disorder-7). Feasibility was evaluated in 20 community-dwelling adults with TBI via an assessment of compliance, satisfaction, and usability of the smartphone application over an 8-week period. Results showed that participants correctly completed 73.4 percent of all scheduled assessments, demonstrating good compliance. Daily assessments took 52 minutes to complete. Participants reported high satisfaction with smartphone applications (6.3 of 7) and found them easy to use (6.2 of 7). Comparison of assessments obtained via telephone-based interview and EMA demonstrated high correlations (.81 to 0.97), supporting the validity of conducting these assessments via smartphone application in this population. EMA conducted via smartphone demonstrates initial feasibility among adults with TBI and presents numerous opportunities for long-term monitoring of mood-related symptoms in real-world settings.Juengst, Shannon B., Graham, Kristin M., Pulantara, I. Wayan, McCue, Michael, Whyte, Ellen M., Dicianno, Brad E., Parmanto, Bambang, Arenth, Patricia M., Skidmore, Elizabeth R. D., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2015Promoting resilience following traumatic brain injury: Application of an interdisciplinary, evidence-based model for interventionJournalJ75740Family Relations643347-362Article outlines the need for resilience-promotion interventions that target traumatic brain injury (TBI), summarizes the empirical justification for the use of an interdisciplinary approach, and provides an overview, with implementation specifics, regarding two newly designed interventions. Using the Brain Injury Family Intervention as a model, clinicians constructed two curriculum-based interventions grounded in resilience theory and drawing from the interdisciplinary approaches of neuropsychology and marriage and family therapy. They interventions developed are: (1) the Resilience and Adjustment Intervention, designed for individual survivors of TBI, and (2) the Therapeutic Couples Intervention, designed to increase relational satisfaction in couples following a TBI. By targeting different but complementary components of the family system, both interventions aim to promote a resilient response to brain injury.Godwin, Emilie E., Lukow II, Herman R., Lichiello, StephanieVirginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2017Predictors of employment outcomes in veterans with traumatic brain injury: A VA traumatic brain injury model systems studyJournalJ76525Journal of Head Trauma Rehabilitation324271-282Study examined the length of time to return to work (RTW) and identified variables predictive of RTW among service members and veterans (SM/V) with traumatic brain injury (TBI). Participants were 293 SM/V enrolled in the Department of Veterans Affairs (VA) TBI Model Systems study who were of 18 to 60 years of age and admitted with the diagnosis of TBI. Data collected at the 1-year post-injury follow-up included employment status and time to employment (i.e., number of days it took to RTW). Results indicated that approximately 21 percent of the participants were employed at 1 year postinjury. Younger individuals who self-identified as nonminority returned to work sooner. Significant associations were observed for time to employment for cause of injury and injury severity. Few SM/V with moderate-to-severe TBI returned to work at 1 year postinjury. Predictors such as younger age at the time of injury, minority status, and severity of TBI affected time to and probability of RTW. Findings from this study have important implications for rehabilitation planning and service delivery across the continuum of recovery.Dillahunt-Aspillaga, Christina, Nakase-Richardson, Risa, Hart, Tessa, Powell-Cope, Gail, Dreer, Laura E., Eapen, Blessen C., Barnett, Scott D., Mellick, Dave, Haskin, Adam, Silva, Marc A.UAB Traumatic Brain Injury Model SystemYesdevopsadmin
2015Rasch analysis of the coping inventory for stressful situations in individuals with moderate to severe traumatic brain injuryJournalJ71252Archives of Physical Medicine and Rehabilitation964659-666Study evaluated psychometric properties of the Coping Inventory for Stressful Situations (CISS) in 331 adults 1 to 15 years after moderate-to-severe traumatic brain injury (TBI). Indices of unidimensionality and model fit supported the scale’s proposed multidimensional structure consisting of Task, Emotion, and Avoidant coping style; 3 unidimensional scales showed better fit than a single combined scale. The 3 scales met Rasch expectations of reliability and separation for persons and items, as well as adequate response category functioning. The scales were generally well-targeted but showed some evidence of ceiling effect for Task, and floor effects for Emotion and Avoidant coping; item difficulties did not fully capture extreme ranges demonstrated by some participants, suggesting that measurement of coping after TBI on the CISS would be improved with additional items at low and high ranges of difficulty. Results were generally equivalent for cross-sectional groups representing short-term (1 year), intermediate (2 years), and long-term (5 to 15 years). The CISS showed good psychometric properties as a measure of coping style among individuals with moderate-to-severe TBI in acute and chronic phases of recovery, and showed evidence of multidimensionality as predicted by theory, consistent with 3 unidimensional scales. Added items tapping broader (or more accessible, less cognitively complex) ranges of coping responses would likely benefit the scale overall and improve correspondence with the response needs of people with TBI.Greene, Hillary A., Rapport, Lisa J., Millis, Scott R., Hanks, Robin A., Williams, Michael W.Nodevopsadmin
2016Prevalence of self-reported lifetime history of traumatic brain injury and associated disability: A statewide population-based surveyJournalJ73350Journal of Head Trauma Rehabilitation311E55-E62Study investigated the prevalence of all severities of traumatic brain injury (TBI), regardless of treatment setting, and their associated negative outcomes. A statewide, population-based, random digit-dialed telephone survey assessed the lifetime history of TBI in 2,701 adult Coloradoans, using a modified version of the Ohio State University TBI Identification Method. Activity limitation and life satisfaction were also assessed. Results showed that the distribution of self-reported lifetime injury was as follows: 19.8 percent, no injury; 37.7 percent, injury but no TBI; 36.4 percent, mild TBI; and 6.0 percent, moderate-severe TBI. Of those reporting a TBI, 23.1 percent were hospitalized, 38.5 percent were treated in an emergency department, 9.8 percent were treated in a physician’s office, and 27.5 percent did not seek medical care. A clear gradient of activity limitations and low life satisfaction was seen, with the highest proportions of these negative outcomes occurring in people reporting more severe TBI and the lowest proportions in those not reporting a TBI. Approximately twice as many people reported activity limitations and low life satisfaction after nonhospitalized TBI compared with hospitalized TBI. This study highlights the seriousness of TBI as a public health problem and the importance of including all severities of TBI, no matter where, or if treated, in estimating the prevalence of disability co-occurring with TBI.Whiteneck, Gale G., Cuthbert, Jeffrey P., Corrigan, John D., Bogner, JenniferOhio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2018Patient perspectives on quality and access to healthcare after brain injuryJournalJ78127Brain Injury324431-441Study explored brain injury (BI) survivors’ experiences in accessing and utilizing health care. Forty-four community-dwelling adults with BI participated in focus groups conducted at clinical research centers in Seattle, Washington and New York, New York. Participants were asked open-ended questions about their experiences with health care in the community with regard to care needs, utilization, access, barriers, and facilitators to health management. Central themes emerged across three categories: (1) barriers to healthcare access/utilization, (2) facilitators to healthcare access/utilization, and (3) suggestions for improving healthcare after BI. The importance of communication as both a facilitator and barrier to care was mentioned by most participants. Compensatory strategies and external tools were identified as key facilitators of medical self-management. Finally, improving clinicians’ knowledge about BI emerged as a potential solution to address health needs of individuals with chronic BI. Additional efforts need to be made to improve access to appropriate health care and increase the ability for individuals to successfully navigate the healthcare system. Findings suggest several specific, low-cost modifications to healthcare delivery and strategies for improving medical self-management that can maximize long-term health maintenance for BI survivors.Dams-O'Connor, Kristen, Landau, Alexandra, Hoffman, Jeanne, St. De Lore, JefUniversity of Washington Traumatic Brain Injury Model System, New York Traumatic Brain Injury Model SystemYesdevopsadmin
2017Project career STAR web portal provides key information on supporting college students with traumatic brain injuryJournalJ77604Work: A Journal of Prevention, Assessment, and Rehabilitation58115Article describes the Project Career web portal designed assist students with traumatic brain injury (TBI) in postsecondary programs. Referred to as STAR, the portal provides information about: students with TBI, the technology that can be used to accommodate them, other accommodations that can be implemented in the classroom and in the workplace, and a multitude of available resources. The portal can be accessed at http://www.projectcareertbi.org .Nodevopsadmin
2017Posttraumatic stress disorder after spinal cord injuryJournalJ76386Rehabilitation Psychology622178-185Study determined the prevalence of posttraumatic stress disorder (PTSD) among racial/ethnic groups with spinal cord injury (SCI) and assessed the relationship of PTSD with demographic characteristics, injury-related characteristics, employment, depressive symptoms, and health events. A total of 1,063 participants with SCI were recruited from 3 sites in different regions (Southeastern, Mountain, and Western) of the United States. Hispanics and non-Hispanic Blacks were oversampled: 369 were non-Hispanic White, followed by 361 non-Hispanic Black, 277 Hispanic, and 56 from other racial-ethnic groups. PTSD was measured by the Purdue PTSD Scale-Revised. All variables were measured by self-report. Multivariate logistic regression models were developed to assess the association between PTSD and multiple variables. Results showed that the overall prevalence of PTSD across all participants was 24.9 percent, and the mean PTSD score of all participants was 34.7. PTSD was associated with depression, frequency of medication use for depression or stress, number of times receiving medical care because of injury in the past year, and race-ethnicity (lower among non-Hispanic Whites).Cao, Yue, Li, Chao, Newman, Susan, Lucas, Jasmine, Charlifue, Susan, Krause, James S.Nodevopsadmin
2017Public transportation: An investigation of barriers for people with disabilitiesJournalJ76378Journal of Disability Policy Studies28152-60Study identified barriers experienced by individuals with disabilities when using the public transportation and the complementary paratransit services. An online survey was developed and disseminated to contacts of the National Network of Americans with Disabilities Act Centers and 4,161 individuals responded. Participants reported physical and attitudinal barriers to public transportation, which affected people with a variety of disabilities. The results highlight significant barriers for people with disabilities who use public transportation and complementary paratransit services. Barriers to these transit systems are physical and attitudinal in nature, and as a result, modifications to the physical environment and educational opportunities to reduce negative attitudes toward individuals with disabilities are recommended.Bezyak, Jill L., Sabella, Scott A., Gattis, Robert H.Nodevopsadmin
2014Preinjury coping, emotional functioning, and quality of life following uncomplicated and complicated mild traumatic brain injuryJournalJ68850Journal of Head Trauma Rehabilitation295407-417Study identified preinjury coping profiles among adults with uncomplicated and complicated mild traumatic brain injury (mTBI) determined whether preinjury coping profiles contribute to the prediction of emotional functioning and quality of life (QOL) at 3 months post-mTBI. One hundred eighty-seven patients, including 89 with uncomplicated mTBI (i.e., negative neurological examination and neuroimaging results) and 98 with complicated mTBI (i.e., either positive neurological examination or neuroimaging results or both) were recruited from the emergency center of a level I trauma center. The Ways of Coping Questionnaire was administered within 2 weeks of injury. Cluster analysis was used to group participants on basis of their preinjury use of problem-focused and avoidant coping strategies. The Brief Symptom Inventory and the 36-item Short-Form Health Survey were administered 3 months postinjury. Cluster analysis distinguished 3 distinct preinjury coping profiles that were differentially associated with outcomes. Participants who used avoidant coping showed the worse emotional functioning and QOL outcomes, although this cluster also reported high usage of problem-focused strategies. Preinjury coping profiles explained a significant proportion of the variance in depression, anxiety, and mental health QOL at 3 months postinjury beyond that accounted for by demographic characteristics and mTBI severity.Maestas, Kacey L., Sander, Angelle M., Clark, Allison N., van Veldhoven, Laura M., Struchen, Margaret A., Sherer, Mark, Hannay, H. JuliaTexas TBI Model System of TIRRYesdevopsadmin
2016Principal components derived from CSF inflammatory profiles predict outcome in survivors after severe traumatic brain injuryJournalJ75737Brain, Behavior, and Immunity53183-193https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783208/Study used principal component analysis (PCA) and cluster analysis to identify the sets of markers that contribute independently to variability in cerebrospinal (CSF) inflammatory profiles after traumatic brain injury (TBI). PCA was applied to CSF inflammatory marker data collected from 114 adults with severe TBI. Using the results, groups (or clusters) of individuals with similar patterns of acute CSF inflammation were defined that were then evaluated in the context of outcome and other relevant CSF and serum biomarkers collected days 0-3 and 4-5 post-injury. Four significant principal components (PC1-PC4) were identified for days 0-3, and PC1 accounted for 31 percent of the variance. Cluster analysis then defined two distinct clusters, such that 100 percent of individuals in cluster 1 had a positive score for PC1, and a majority of individuals (61 percent) in cluster 2 had negative values for PC1. Multinomial logistic regression analyses showed that individuals in cluster 1 had a 10.9-times increased likelihood of severe disability at 6 months compared to cluster 2, after controlling for covariates. Cluster group did not discriminate between mortality compared to good recovery after controlling for age and other covariates. Cluster groupings also did not discriminate mortality or 12 month outcomes in multivariate models. In this study, PCA and cluster analysis established a subset of CSF inflammatory markers measured in days 0-3 post-TBI that distinguished individuals with poor 6-month outcome. Overall, this data-driven approach provides a novel assessment of the potential of patterns among TBI-associated inflammatory biomarkers to predict long-term outcomes after TBI.Kumar, Raj G., Rubin, Jnathan E., Bergerm Rachel P,., Kochanek, Patrick M., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2014Leisure, work, and disability coping: "I mean, you always need that 'in' group"JournalJ71543Leisure Sciences365420-438Study explored the roles of leisure in the lives of employed people with mobility impairments. The three goals of the study were to: (1) understand participants’ perceptions of the significance of leisure in their work and personal lives; (2) examine how participants perceived their disabilities influenced their leisure and work lives; and (3) understand what beliefs, strategies, and relationships contributed to participants’ quality of life and sense of work-life balance. Semi-structured, in-depth interviews were conducted with eight individuals who self-identified as having a physical disability. Responses were analyzed using interpretative phenomenological analysis. Several interesting themes emerged from the data, each highlighting the complexity inherent in negotiating disability along with more typical work-life concerns. The findings related to identity, leisure, disability coping, and the work-life balance of individuals with disabilities. The study highlights the contributions of leisure in managing and coping with disability as well as participants’ changing leisure lifestyles which, in some instances, led them to seek peers with disabilities as leisure companions. Implications for leisure programmers are also addressed.Cook, Lawanda H., Shinew, Kimberly J.Nodevopsadmin
2015Long-term survival after traumatic brain injury part I: External validity of prognostic modelsJournalJ71812Archives of Physical Medicine and Rehabilitation966994-999Study developed and evaluated the external validity of models to predict long-term survival in adults with traumatic brain injury (TBI). Survival/mortality data were obtained from 2 cohorts of long-term survivors of TBI: (1) the Traumatic Brain Injury Model Systems (TBIMS) cohort comprised 7,365 patients who were admitted to a TBIMS facility and were assessed at 1 year after injury, and (2) the California Department of Developmental Services (CDDS) cohort comprised 5,116 individuals who sustained a TBI and received long-term services from the CDDS. Analysis revealed that older age, male sex, and severity of disability in walking and feeding were significant predictors of increased long-term mortality rates. The CDDS model predicted 623 deaths for subjects in the TBIMS cohort, with an observed-to-expected ratio of .94. The TBIMS model predicted a total of 525 deaths for subjects in the CDDS cohort, with an observed-to-expected ratio of 1.08. Regression calibration statistics were satisfactory, and both models ranked survival times well from shortest to longest. Despite underlying differences in the CDDS and TBIMS, statistical models for mortality rates derived from each cohort accurately predicted survival in the other. The external validity of these models provides strong support for their use in practical prognostic work.Brooks, Jordan C., Shavelle, Robert M., Strauss, David J., Hammond, Flora M., Harrison-Felix, Cynthia L.Rocky Mountain Regional Brain Injury System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2015Information/education page: Sleep and traumatic brain injuryJournalJ71831Archives of Physical Medicine and Rehabilitation9661189-1190Article discusses the types, causes, and treatment of common sleep problems after traumatic brain injury (TBI). It includes self-help tips and treatment options for sleep difficulties.Greenwald, Brian, Bell, KathleenNodevopsadmin
2017Mothers with physical disabilities caring for young childrenJournalJ75920Journal of Social Work in Disability and Rehabilitatoin16295-115Study explored how mothers with physical disabilities provide care for their child, including the involvement of the family system and external supports. Seventy-one mothers with a physical disability who had a child aged 0 to 3 years responded to a survey about the system of care used for their child. Questions were asked about: the mother’s disability or medical condition, demographic information, who provides care for their youngest child, the impact of others providing care on a mother’s relationships with her child and partner, strategies mothers use to remain central to their child with others participating in their child’s care, and the use of adapted equipment or techniques in caring for their child. The results indicated that mothers participated in all different types of care (physical, comforting, playing, limit setting, and taking the child outside the home). Partners and participants’ mothers provided the most assistance with care. Mothers were generally satisfied with assistance received from others. The findings identify resources and strategies that might be beneficial to mothers with disabilities and have implications for policies that could be helpful to support mothers with physical disabilities.Jacob, Jean, Kirshbaum, Megan, Preston, PaulNodevopsadmin
2017Introduction to volume 11: Maximizing the benefits of evolving assistive technology solutionsJournalJ77620Assistive Technology Outcomes and Benefits11viii-xhttps://www.atia.org/wp-content/uploads/2017/11/ATOB_ATOBN1V11_INTRO.pdfThis journal issue presents six articles addressing the topic of “Maximizing the Benefits of Evolving Assistive Technology Solutions”. These article focus on ways that mainstream technologies, such as tablets and smartphones, can be used both in place of and as complements to assistive technology (AT) devices, as well as explore new developments related to dedicated AT devices. The individual articles are available under accession numbers J77621 through J77629.Flagg, Jennifer L., Phillips, Carolyn P.Nodevopsadmin
2016Linkage between the PROMIS® pediatric and adult emotional distress measuresJournalJ77135Quality of Life Research254823-833https://link.springer.com/article/10.1007%2Fs11136-015-1143-zStudy linked the Patient-Reported Outcomes Measurement Information System® (PROMIS) pediatric and adult measures for emotional distress using data from participants with diverse health conditions and disabilities. Analyses were conducted and compared in two separate samples to confirm the stability of results. One sample included 874 individuals aged 14–20 years with special health care needs and who require health services. The other sample included 641 individuals aged 14–25 years who have a physical or cognitive disability. All participants completed both PROMIS pediatric and adult measures, which included the following emotional distress domains: depression, anxiety, and anger. Item response theory-based scores were linked using the linear approximation to calibrated projection. Results showed that the estimated latent-variable correlation between pediatric and adult PROMIS measures ranged from 0.87 to 0.94. Regression coefficients β0 (intercept) and β1 (slope), and mean squared error are provided to transform scores from the pediatric to the adult measures, and vice versa. This study used a relatively new linking method, calibrated projection, to link PROMIS pediatric and adult measure scores, thus expanding the use of PROMIS measures to research that includes both populations.Reeve, Bryce B., Thissen, David, DeWalt, Darren A., Huang, I-Chan, Liu, Yang, Magnus, Brooke, Quinn, Hally, Gross, Healther E., Kisala, Pamela A., Ni, Pengsheng, Haley, Stephen, Mulcahey, M. J., Charlifue, Susie, Hanks, Robin A., Slavin, Mary, Jette, Alan, Tulsky, David S.Southeastern Michigan Traumatic Brain Injury System, Southeastern Michigan Traumatic Brain Injury System Yesdevopsadmin
2016Marital instability after brain injury: An exploratory analysisJournalJ74250Neurorehabilitation383271-279Study examined marital stability after traumatic brain injury considering the perspectives of the patient and the uninjured partner and identified predictors of marital stability. Forty-two couples with mild to severe injury completed the Marital Status Inventory, a measure of relationship stability, and the Revised Dyadic Adjustment Scale (RDAS), a measure of relationship quality. Twenty-four percent of patients viewed their marriage as unstable as did 29 percent of partners. Most individuals (72 percent) agreed with their partner regarding the stability of their relationship. About half of patients (52 percent) and partners (50 percent) reported clinically significant levels of marital dissatisfaction. Multivariate logistic regression indicated that the RDAS was a salient predictor of marital stability. Findings indicate relatively high levels of marital stability despite high levels of marital distress. Marital stability can be classified beyond labeling couples as married, separated, or divorced. Researchers have suggested that post-injury marital relationships are prone to instability and divorce in comparison to the general population. The findings of this study suggest otherwise.Kreutzer, Jeffrey S., Sima, Adam P., Marwitz, Jennifer H., Lukow II, Herman R.Virginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2014Novel risk factors associated with current suicidal ideation and lifetime suicide attempts in individuals with spinal cord injuryJournalJ71476Archives of Physical Medicine and Rehabilitation196799-808Study investigated the unique associations of suicidal ideation (SI) and lifetime suicide attempts (SAs) in individuals with spinal cord injury (SCI). Data were collected from 2,453 adults with a history of traumatic SCI recruited from 4 SCI Model System sites and 2 additional sites as part of the Project to Improve Symptoms and Mood after SCI. The main outcome measure was any SI in the past 2 weeks (9-item Patient Health Questionnaire) and any lifetime SA. Three hundred twenty-three individuals (13.3 percent) reported SI in the past 2 weeks and 179 (7.4 percent) reported lifetime SA. After controlling for other factors, both lifetime SA and current SI were associated with study site and current level of depression. In addition, SA was associated with less education, younger age at injury, having current or past treatment of depression, and having bipolar disorder or schizophrenia. SI was associated with more years since injury and lifetime SA. Several psychological factors were associated with current SI and lifetime SAs, including lower environmental reward and less positive affect. In addition, control of one's community activities and spiritual well-being were associated with current SI. In bivariate comparisons, severity of SCI was also associated with the 47 percent of the SAs that occurred after injury. Several unique associations of SI and lifetime SA in individuals with SCI were identified, including level of environmental reward and control, spiritual well-being, and severity of SCI. These factors bear further investigation as prospective risk factors for suicidal behavior after SCI.Dahdah, M; Shafi, SYesdevopsadmin
2015Institutional variation in traumatic brain injury acute rehabilitation practiceJournalJ72084Archives of Physical Medicine and Rehabilitation968, Supplement 3S197-S208Study investigated institutional variation in traumatic brain injury (TBI) inpatient rehabilitation program characteristics and evaluated the extent to which patient factors and center effects explain how TBI inpatient rehabilitation services are delivered. Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. A wide variation was observed between the 10 TBI programs, including census size, referral flow, payer mix, number of dedicated beds, clinician experience, and patient characteristics. At the centers with the longest weekday therapy sessions, the average session durations were 41.5 to 52.2 minutes. At centers with the shortest weekday sessions, the average session durations were approximately 30 minutes. The centers with the highest mean total weekday hours of occupational, physical, and speech therapies delivered twice as much therapy as the lowest center. Ordinary least-squares regression modeling found that center effects explained substantially more variance than patient factors for duration of therapy sessions, number of activities administered per session, use of group therapy, and amount of psychological services provided. Findings provide preliminary evidence that there is significant institutional variation in rehabilitation practice and that center effects play a stronger role than patient factors in determining how TBI inpatient rehabilitation is delivered.Seel, Ronald T., Barrett, Ryan S., Beaulieu, Cynthia L., Ryser, David K., Hammond, Flora M., Cullen, Nora, Garmoe, William, Sommerfeld, Teri, Corrigan, John D., Horn, Susan D.Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2016Knowing what we're doing: Why specification of treatment methods is critical for evidence-based practice in speech-language pathologyJournalJ74087American Journal of Speech-Language Pathology: A Journal of Clinical Practice (AJSLP)252164-171Article describes the conceptual framework of the multidisciplinary rehabilitation treatment taxonomy (RTT) and illustrates its potential use in speech-language pathology (SLP) clinical practice and research. The RTT framework uses treatment targets, ingredients, and mechanisms of action defined by treatment theory to specify SLP and other rehabilitation interventions with greater precision than current methods of treatment labeling and classification. It also makes a distinction between the target of treatment at which ingredients are directed and broader aims of treatment, which may be downstream effects explained instead by enablement/disablement theory. Future application of the RTT conceptual scheme to SLP intervention may enhance clinical practice, research, and knowledge translation as well as training and program evaluation efforts.Turkstra, Lyn S., Norman, Rocio, Whyte, John, Dijkers, Marcel P., Hart, TessaNodevopsadmin
2016Long-term outcomes after moderate-to-severe traumatic brain injury among military veterans: Successes and challengesJournalJ78677Brain Injury303271-279Study assessed long-term outcomes after traumatic brain injury (TBI) among veterans and service members. Data were obtained from 118 veterans and military personnel, aged 23–70 years, who has sustained moderate-to-severe, followed by acute interdisciplinary rehabilitation 5–16 years earlier. The TBI Follow-up Interview (occupational, social, cognitive, neurologic and psychiatric ratings) was conducted by telephone. Measures included the Community Integration Questionnaire, Disability Rating Scale (four indices of independent function), and Satisfaction with Life Scale. At follow-up, 52 percent of participants were working or attending school; 34 percent ended or began marriages after TBI, but the overall proportion married changed little. Finally, 22 percent were still moderately-to-severely disabled. However, 62 percent of participants judged themselves to be as satisfied or more satisfied with life than before injury. Injury severity, especially post-traumatic amnesia, was correlated with poorer outcomes in all functional domains. Results indicate that after moderate-to-severe TBI, most veterans assume productive roles and are satisfied with life. However, widespread difficulties and functional limitations persist. These findings suggest that veteran and military healthcare systems should continue periodic, comprehensive follow-up evaluations long after moderate-to-severe TBI.Schulz-Heik, R. Jay, Poole, John H., Dahdah, Marie N., Sullivan, Campbell, Date, Elaine S., Salerno, Rose M., Schwab, Karen, Harris, OdetteNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2014Information/education page: Sexuality after traumatic brain injuryJournalJ69600Archives of Physical Medicine and Rehabilitation9591801-1802Article describes common sexual problems after traumatic brain injury and offers ways to improve them.Sullivan, Jane E.Texas TBI Model System of TIRRYesdevopsadmin
2015Mortality following traumatic brain injury among individuals unable to follow commands at the time of rehabilitation admission: A national institute on disability and rehabilitation research traumatic brain injury model systems studyJournalJ73552Journal of Neurotrauma32231883-1892Study evaluated long-term mortality, life expectancy, causes of death, and risk factors for death among patients who were unable to follow simple motor commands at the time of admission to inpatient traumatic brain injury (TBI) rehabilitation. Data were obtained from patients treated within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems programs. Of the 8,084 individuals enrolled from October 1988 through December 2009, 387 from 20 centers met the study inclusion criteria. Analysis revealed that individuals with moderate-to-severe TBI who received inpatient rehabilitation were 2.2 times more likely to die than individuals in the United States general population of similar age, gender, and race, with an average life expectancy reduction of 6.6 years. The subset of individuals who were unable to follow commands on admission to rehabilitation was 6.9 times more likely to die, with an average life expectancy reduction of 12.2 years. Relative to the general population matched for age, gender, and race/ethnicity, these non-command-following individuals were more than four times more likely to die of circulatory conditions, 44 times more likely to die of pneumonia, and 38 times more likely to die of aspiration pneumonia. The subset of individuals with TBI who are unable to follow commands upon admission to inpatient rehabilitation are at a significantly increased risk of death when compared with the general population and compared with all individuals with moderate to severe TBI receiving inpatient rehabilitation. Respiratory causes of death predominate, compared with the general population.Greenwald, Brian D., Hammond, Flora M., Harrison-Felix, Cynthia, Nakase-Richardson, Risa, Howe, Laura L. S., Kreider, ScottNodevopsadmin
2014Pain issues in disorders of consciousnessJournalJ69401Brain Injury2891202-1208Article provides an overview of the current knowledge about pain processing and assessment in patients with disorders of consciousness (DOC). Study were identified through a search performed on PubMed using MeSH terms including vegetative state (VS), unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), consciousness disorders, pain, nociception, neuroimaging, and pain assessment. Neuroimaging studies investigating pain processing in patients with DOC and their implication for clinicians are reviewed. Current works on the development of standardized and sensitive tools for assessing nociception are described. The suggested pain perception capacity highlighted by neuroimaging studies in patients in a MCS and in some patients in a VS/UWS supports the idea that these patients need analgesic treatment and monitoring. The first tool which has been developed to assess nociception and pain in patients with DOC is the Nociception Coma Scale. Its revised version represents a rapid, standardized and sensitive scale which can be easily implemented in a clinical setting. Complementary pain assessments are also under validation in order to offer more options to clinicians.Chatelle, Camille, Thibaut, Aurore, Whyte, John, De Val, Marie D., Laureys, Steven, Schnakers, CarolineMoss Traumatic Brain Injury Model SystemYesdevopsadmin
2014Introduction to this special issue: Disability, law and public policy, and the world wide webJournalJ63233Behavioral Sciences and the Law3213-Janhttp://lists.w3.org/Archives/Public/public-cognitive-a11y-tf/2014Feb/att-0048/Blanck_intro_bsl2106_1__2014.pdfArticle provides an overview of a special journal issue that highlights how information and communications technology in general, and the Internet in particular, has fundamentally changed the way in which people with and without disabilities, participate politically, socially, and culturally within a global network of dispersed communities. The included articles examine the implications and promise of the web for people with disabilities across the life span, and from a variety of disciplinary and internationally comparative perspectives. They build on the Americans with Disabilities Act and Convention on the Rights of Persons with Disabilities principles of web content equality, which include full and equal enjoyment of digital knowledge for people with disabilities. Taken together, the articles in this special issue contribute to disability rights scholarship and advocacy.Blanck, PeterNodevopsadmin
2015Life expectancy after inpatient rehabilitation for traumatic brain injury in the United StatesJournalJ73519Journal of Neurotrauma32231893-1901Study examined the characteristics associated with the risk of death among individuals requiring inpatient rehabilitation following traumatic brain injury (TBI). The TBI Model Systems (TBIMS) National Database (NDB) was weighted to represent those 16 years of age or older completing inpatient rehabilitation for TBI in the United States (US) between 2001 and 2010. Analyses included Standardized Mortality Ratios (SMRs), Cox regression, and life expectancy. The US mortality rates by age, sex, race, and cause of death for 2005 and 2010 were used for comparison purposes. The results indicated that a total of 1,325 deaths occurred in the weighted cohort of 6,913 individuals. Those with TBI were 2.23 times more likely to die than individuals of comparable age, sex, and race in the general population, with a reduced average life expectancy of 9 years. Independent risk factors for death were: older age, male gender, less-than-high-school education, previously married at injury, not employed at injury, more recent year of injury, fall-related TBI, not discharged home after rehabilitation, less functional independence, and greater disability. Individuals with TBI were at greatest risk of death from seizures; accidental poisonings; sepsis; aspiration pneumonia; respiratory, mental/behavioral, or nervous system conditions; and other external causes of injury and poisoning, compared with individuals in the general population of similar age, gender, and race. This study confirms prior life expectancy study findings, and provides evidence that the TBIMS NDB is representative of the larger population of adults receiving inpatient rehabilitation for TBI in the US.Harrison-Felix, Cynthia, Pretz, Christopher, Hammond, Flora M., Cuthbert, Jeffrey P., Bell, Jeneita, Corrigan, John, Miller, A. Cate, Haarbauer-Krupa, JulietIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Ohio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2016Information/education page: Pregnancy and women with spinal cord injuryJournalJ73388Archives of Physical Medicine and Rehabilitation973497-498Article provides information related to pregnancy, labor, and delivery for women with spinal cord injury who are pregnant or considering having a baby.McLain, Amie B., Massengill, Taylor, Klebine, PhillipNodevopsadmin
2016Long-term survival following traumatic brain injury: A population-based parametric survival analysisJournalJ75807Neuroepidemiology47110-Jan*Study developed statistical models of life expectancy following acute traumatic brain injury (TBI) to provide predictions of longevity and quantify differences in survivorship with the general population of the United States (US). A population-based retrospective cohort study using data from the Rochester Epidemiology Project (REP) was performed. A random sample of patients from Olmsted County, Minnesota with a confirmed TBI between 1987 and 2000 was identified and vital status determined in 2013. Parametric survival modelling was then used to develop a model to predict life expectancy following TBI conditional on age at injury. Survivorship following TBI was also compared with the general population and age- and gender-matched non-head injured REP controls. Seven hundred sixty nine patients were included in complete case analyses. The median follow-up time was 16.1 years with 120 deaths occurring during the study period. Survival after acute TBI was well represented by a Gompertz distribution. Victims of TBI surviving for at least 6 months after injury demonstrated a much higher ongoing mortality rate compared to the US general population and non-TBI controls. US general population cohort life table data was used to update the Gompertz model’s shape and scale parameters to account for cohort effects and allow prediction of life expectancy in contemporary TBI. Findings suggest survivors of TBI have decreased life expectancy compared to the general population. This may be secondary to the head injury itself or result from patient characteristics associated with both the propensity for TBI and increased early mortality.Fuller, Gordon W., Ransom, Jeanine, Mandrekar, Jay, Brown, Allen W.Mayo Clinic Traumatic Brain Injury Model System Yesdevopsadmin
2016Neighborhood disadvantage and life-space mobility are associated with incident falls in community-dwelling older adultsJournalJ75317Journal of the American Geriatrics Society64112218-2225Study examined the relationship between neighborhood-level socioeconomic characteristics, life-space mobility, and incident falls in community-dwelling older adults. Baseline in-home assessments were conducted with 1,000 community-dwelling Medicare beneficiaries aged 65 and older. Telephone follow-up interviews were conducted at 6-month intervals for up to 8.5 years. Neighborhood disadvantage was measured using a composite index derived from baseline neighborhood-level residential census tract socioeconomic variables. Data on individual-level socioeconomic characteristics, clinical variables, and life-space collected at baseline were included as covariates in a multivariate model using generalized estimating equations to assess the association with incident falls in the 6 months after baseline. Of the 940 participants who completed baseline and follow-up assessments, 126 (13 percent) reported one or more new falls in the 6 months after baseline. There was an independent nonlinear association between neighborhood disadvantage (according to increasing quartiles of disadvantage) and incident falls after adjusting for confounders. Individuals residing in a neighborhood in the highest quartile of neighborhood disadvantage were more than three times as likely to sustain a fall as those residing in neighborhoods in the least disadvantaged quartile. Each 10-point decrement in life-space was associated with a higher risk of falls. Greater neighborhood disadvantage was associated with greater risk of falls. Life-space also contributes separately to fall risk. Community-dwelling older adults in disadvantaged neighborhoods, particularly those with limited mobility, may benefit from a more-rigorous assessment of their fall risk by healthcare providers. Neighborhood level socioeconomic characteristics should also be an important consideration when identifying vulnerable populations that may benefit the most from fall prevention programs.Lo, Alexander X., Rundle, Andrew G., Buys, David, Kennedy, Richard E., Sawyer, Patricia, Allman, Richard M., Brown, Cynthia J.UAB Traumatic Brain Injury Model SystemYesdevopsadmin
2015Insomnia symptoms and behavioural health symptoms in veterans 1 year after traumatic brain injuryJournalJ72814Brain Injury29121400-1408Study examined the prevalence of Insomnia and its association with other behavioral health symptoms in a clinical sample of veterans who received inpatient treatment for traumatic brain injury (TBI)-related issues within the Veterans Health Administration (VHA) 1 year after injury. Data were collected from 112 participants enrolled in the VHA Polytrauma Rehabilitation Centers’ TBI Model System program. Prevalence estimates of insomnia, depression, general anxiety, nightmares, headache and substance use, stratified by injury severity, were derived. Univariate logistic regression was used to examine unadjusted effects for each behavioral health problem and insomnia by injury severity. Participants were primarily male, under 30 years old, and high school educated. Twenty-nine percent met study criteria for insomnia; those with mild TBI were significantly more likely to meet the criteria (43 percent) than those with moderate/severe TBI (22 percent). Univariate logistic regression analyses revealed that depressive symptoms and general anxiety were significantly associated with insomnia symptoms after TBI of any severity. Headache and binge drinking were significantly inversely related to insomnia symptoms after moderate/severe TBI, but not mild TBI. Overall, results suggest veterans with history of TBI, of any severity, who also experience insomnia, are at increased risk for depression and anxiety.Carnahan, Leah F., Barnett, Scott, Lamberty, Gregory, Hammond, Flora M., Kretzmer, Tracy S., Franke, Laura M., Geiss, Meghan, Howe, Laura, Nakase-Richardson, RisaIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2015Key dimensions of impairment, self-report, and environmental supports in persons with traumatic brain injuryJournalJ71979Rehabilitation Psychology602138-146Study identified key dimensions relevant to recovery in the postacute period for people with traumatic brain injury (TBI) and determined the ability of scores on these dimensions to predict participation outcomes for people with TBI. A total of 504 participants with TBI completed a comprehensive battery of measures including cognitive tests; questionnaires assessing self-report of physical, cognitive, and emotional symptoms and strengths; environmental supports; and a measure of participation outcome. Participants were a predominantly male, ethnically/racially diverse sample of persons with complicated mild, moderate, and severe TBI. Variable cluster analysis identified 12 key dimensions of cognitive function, neurobehavioral complaints, personal strengths, physical symptoms and function, environmental supports, and performance validity. In unadjusted analyses, all 12 dimensions were predictive of participation outcome. In multivariable regression analysis with adjustment of all predictors for all other predictors, dimensions measuring memory, independence and self-esteem, resilience, emotional distress, physical functioning, and economic and family support made unique contributions to predicting participation outcome. Knowledge of the profile of an individual patient on these 12 dimensions may assist with development of a treatment approach for the person with TBI.Sherer, Mark, Sander, Angelle M., Nick, Todd G., Melguizo, Maria S., Tulsky, David S., Kisala, Pamela, Hanks, Robin, Novack, Thomas A.Texas TBI Model System of TIRR, Southeastern Michigan Traumatic Brain Injury System, Southeastern Michigan Traumatic Brain Injury System Yesdevopsadmin
2014Longitudinal white matter changes after traumatic axonal injuryJournalJ71124Journal of Neurotrauma31171478-1485Study examined changes in white matter (WM) integrity following after traumatic axonal injury (TAI) using diffusion tensor imaging (DTI). Sixteen patients with complicated mild to severe brain injuries consistent with TAI were recruited in the intensive care unit of a Level I trauma center. Thirteen of these patients were studied longitudinally over the course of the first seven months post-injury. The first scan occurred, on average, 1 day after injury and the second an average of seven months post-injury. Ten healthy individuals, similar to the cohort of patients, were recruited as controls. Whole brain WM and voxel-based analyses of DTI data were conducted. DTI metrics of interest included: fractional anisotropy (FA), mean diffusivity, axial diffusivity (AD), and radial diffusivity (RD). Tract-based spatial statistics were used to examine DTI metrics spatially. Acutely, AD and RD increased and RD positively correlated with injury severity. Longitudinal analysis showed reduction in FA and AD, but no change in RD. Possible explanations for the microstructural changes observed over time are discussed.Perez, Alison M., Adler, Justin, Kilkarni, Nimay, Strain, Jeremy F., Womack, Kyle B., Diaz-Arrastia, Ramon, Marquez de la Plata, Carlos D.North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2014Information/education page: Seizures and traumatic brain injuryJournalJ69098Archives of Physical Medicine and Rehabilitation9561223-1224Article discusses the symptoms, types, and treatment options for seizures related to traumatic brain injury (TBI). It includes tips on safety issues and what a caregiver should do if a person with TBI is having a seizure.Englander, Jeffrey, Cifu, David X., Diaz-Arrastia, RamonNodevopsadmin
2014Mood disorders after TBIJournalJ71275Psychiatric Clinics of North America37113-29Article provides an overview of the evaluation and management of disorders of mood following traumatic brain injury (TBI). Methods of assessing mood disorders are described briefly, and the importance of considering the differential diagnoses for these clinical phenomena is highlighted. Depressive disorders are the most common neuropsychiatric sequels of TBI. Mania, hypomania, and mixed mood states are less frequent but serious complications of TBI. In many respects, the evaluation and management of these conditions is similar to that provided to persons with primary (idiopathic) mood disorders. Mood disorders are highly comorbid with anxiety, substance misuse, and other behavioral alterations like impulsivity and aggression. Furthermore, once developed, they may have a chronic and refractory course. The functional repercussion of these disorders is huge, affecting the rehabilitation process as well as the long-term outcome of patients with TBI. The current treatment options are based on current standards of practice rather that empirically based controlled treatment trials. Randomized, double-blind, placebo-controlled trials are needed to establish the most effective treatments for the variety of mood disorders associated with TBI.Jorge, Ricardo E., Arciniegas, David B.Texas TBI Model System of TIRRYesdevopsadmin
2015Outcomes of an interprofessional simulation curriculumJournalJ75663Journal of Applied Research in Higher Education72453-468Article describes the evaluation of a simulation interprofessional education (IPE) curriculum, including faculty training as debriefers/facilitators, identify learning objectives and outcomes. Providing IPE to health professional students can prepare them in the workforce to have the necessary skills to function in a collaborative practice ready environment. The IPE simulation curriculum was delivered to 445 medical student learners from 8 different health professions and involved 36 faculty members from differing professions. Program evaluation involved seeking feedback from student learners and faculty facilitator/debriefers. The student survey assessed learning objectives, including communication of roles and responsibilities, communication and organization of information, engagement of other health professions in shared patient-centered problem solving, interprofessional assessment of patient status, and preparation of patients from transition of care to home. The faculty survey assessed faculty experience levels in IPE, role as facilitator/debriefer, and future needs for sustainability of the program. Student evaluation of the IPE simulation experience revealed students believed they improved their interprofessional communication skills and had a better understanding of health professional roles and responsibilities. Faculty feedback indicated that students achieved learning objectives and their continued commitment to IPE; however, additional training and development were identified as areas of need.DeMarco, Lisa, Panzarella, Karen, Ferro, Heather, Pownall, Lynn, Case, Andrew, Nowakowski, Patricia, Stewart, Maxine, Cieri, Nicole, Dowd, Colleen, Dunford, DeniseNodevopsadmin
2016Introduction to the special issue: ADA at 25 and people with cognitive disabilities: From action to inclusionJournalJ73566Inclusion415-JanThis article introduces and provides an overview of a special journal issue that examines the Americans with Disabilities Act (ADA) at its 25th anniversary. The journal articles reflect on the past 25 years, examine present opportunities and challenges, and consider the future to ensure continued action toward the civil and human rights of individuals with cognitive and other disabilities for inclusion and active citizenship. Individuals with cognitive conditions that limit daily life activities, such as intellectual and developmental disabilities, are individuals with ADA-covered disabilities.Blanck, PeterNodevopsadmin
2014Leveraging new rules to advance new opportunities: Implications of the rehabilitation act section 503 new rules for employment service providersJournalJ69944Journal of Vocational Rehabilitation413193-208Article describes how employment service providers (ESPs) can prepare for the implementation of the new rules for Section 503 of the Rehabilitation Act by considering how they partner with employers, work with service recipients or, in some cases, function as employers themselves. These new rules could have significant impacts on ESPs who work with individuals with disabilities, offering new opportunities for them to build partnerships, expand services, and create talent pipelines. First, the authors provide a brief overview focusing on the impetus for the new rules and how they could impact the work of ESPs. Second, they take a deeper look at some questions and challenges ESPs could have concerning the new Section 503 rules. Third, they focus on specific ways ESPs can prepare for the new rules and include a checklist for assessing the readiness of ESP organizations or practitioners. Finally, the authors describe resources for ESPs around implementation of the new Section 503 rules. ESPs play a key role in the implementation, effectiveness, and outcome of the new regulations. In preparing to play this role, ESPs need to consider their values, messaging, work with service recipients, and outreach to employers. Some ESPs who are covered under the new rules need to assess their own employment practices for compliance.Rudstam, Hannah, Golden, Thomas P., Gower, Wendy S., Switzer, Ellice, Bruyere, Susanne, Van Looy, SaraNodevopsadmin
2017Information/education page: Memory and traumatic brain injuryJournalJ75367Archives of Physical Medicine and Rehabilitation982407-408Article provides information about some of the memory problems people with traumatic brain injury (TBI) may experience and what they can do to work around these difficulties. Memory is not just one kind of ability. There are several kinds of memory, and TBI affects some more than others.Hart, Tessa, Sander, AngelleTexas TBI Model System of TIRR, Moss Traumatic Brain Injury Model SystemYesdevopsadmin
2014Long-term survival after traumatic brain injury: A population-based analysis controlled for nonhead traumaJournalJ70854Journal of Head Trauma Rehabilitation291E1-E8Study investigated the contribution of co-occurring non-head injuries to hazard of death after traumatic brain injury (TBI). A random sample of Olmsted County, Minnesota, residents with confirmed TBI from 1987 through 1999 was identified for the study. Each case was assigned an age- and sex-matched, non-TBI “regular control” from the population. For “special cases” with accompanying non-head injuries, 2 matched “special controls” with non-head injuries of similar severity were assigned. All cases and both types of controls were followed for vital status from baseline (i.e., injury date for cases, comparable dates for controls) through 2008. Cases were compared first with regular controls and second with regular or special controls, depending on case type. A total of 1,257 cases were identified (including 221 special cases). For both cases versus regular controls and cases versus regular or special controls, the hazard ratio was increased from baseline to 6 months (10.82 and 7.13, respectively) and from baseline through study end (2.92 and 1.48, respectively). Among 6-month survivors, the hazard ratio was increased for cases versus regular controls (1.43) but not for cases versus regular or special controls (1.05). Results indicate that hazard of death was highest within the first 6 months after injury. Among 6-month survivors for any classification category or when all categories are combined, no significant difference in hazard of death was seen compared with controls after adjusting for non-head-injury severity.Brown, Allen W., Leibson, Cynthia L., Mandrekar, Jay, Ransom, Jeanine E., Malec, James F.Mayo Clinic Traumatic Brain Injury Model System Yesdevopsadmin
2017Natural history of headache five years after traumatic brain injuryJournalJ75704Journal of Neurotrauma3481558-1564Study determined the prevalence, characteristics, and risk factors for self-reported headache across a 5-year period in individuals with moderate-to-severe traumatic brain injury (TBI) injury. A total of 316 participants were prospectively enrolled during their inpatient rehabilitation from February 2008 to June 2009 across 7 acute rehabilitation centers designated as TBI Model Systems centers and interviewed at 3, 6, 12, and 60 months after injury. The participants were 72 percent male, 73 percent white, with an average age of 42 years, and 55 percent were injured in motor vehicle crashes. Pre-injury headache was reported in 17 percent of individuals. New or worse headache prevalence remained consistent with at least 33 percent at all time points. Incidence was greater than 17 percent at each time point, with first report of new or worse headache in 20 percent of participants at 60 months. Disability-related to headache was high, with average headache pain (on 0–10 scale) ranging from 5.5 at baseline to 5.7 at 60 months post-injury, and reports of substantial impact on daily life across all time points. More than half of the classifiable headaches matched the profile of migraine or probable migraine. Headache is a substantial problem after TBI; these results suggest that ongoing assessment and treatment of headache after TBI is needed, as this symptom may be a problem up to 5 years after injury.Stacey, Arthur, Lucas, Sylvia, Dikmen, Sureyya, Temkin, Nancy, Bell, Kathleen R., Brown, Allen , Brunner, Robert, Diaz-Arrastia, Ramon, Watanabe, Thomas K., Weintraub, Alan, Hoffman, Jeanne M.UAB Traumatic Brain Injury Model System, Mayo Clinic Traumatic Brain Injury Model System , University of Washington Traumatic Brain Injury Model System, North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2015Information/education page: Vision problems after traumatic brain injuryJournalJ72576Archives of Physical Medicine and Rehabilitation96101933-1934Article discusses the types, causes, impact, and treatment of vision problems after traumatic brain injury (TBI). It includes treatment options and self-help tips, including therapeutic eye exercises, and compensatory devices and strategies.Powell, Janet M., Weintraub, Alan, Dreer, Laura, Novack, TomUAB Traumatic Brain Injury Model SystemYesdevopsadmin
2015It's all of the above: Benefits of working for individuals with spinal cord injuryJournalJ70703Topics in Spinal Cord Injury Rehabilitation2119-JanStudy identified the employment outcomes of greatest importance to individuals with spinal cord injury (SCI) who have worked since injury. A qualitative approach was used with 6 focus groups at 2 sites (Minnesota and Georgia). A combination of homogeneous (race/ethnic minority group, female group) and heterogeneous groups were convened. The 44 participants were a minimum of 10 years post injury and had been employed at some point after SCI. A semi-structured interview format queried participants about personal, environmental, and policy-related factors that impacted obtaining, maintaining, and advancing in employment. Seven overlapping themes were identified under the 2 broad categories of compensation and subjective well-being: (1) salary and what it can support, (2) health insurance and other fringe benefits, (3) promotions and recognition, (4) social connection and support, (5) job satisfaction and enjoyment from working, (6) making a difference and helping others, and (7) psychological and emotional health. The results reveal several common themes among persons with SCI who have successful employment histories, suggesting that the benefits of employment are multifaceted and go beyond monetary compensation.Meade, Michelle A., Reed, Karla S., Saunders, Lee L., Krause, James S.Nodevopsadmin
2015Longitudinal predictors of criminal arrest after traumatic brain injury: Results from the traumatic brain injury model system national databaseJournalJ72659Journal of Head Trauma Rehabilitation305E3-E13Study investigated the influence of pre-traumatic brain injury (TBI) variables and TBI-related characteristics on post-TBI criminal arrest, using longitudinal data from the Traumatic Brain Injury Model System National Database. Subjects and their families were contacted at 1, 2, and 5 years postinjury to assess the subjects’ post-TBI criminal arrests, level of functioning, and medical/social history in the preceding year, as well as substance abuse history. Three study samples were created consisting of individuals with complete data on all relevant measures, resulting in 6315 participants at 1 year post-TBI, 4982 at 2 years post-TBI, and 2690 at 5 years post-TBI. Analyses revealed that post-TBI criminal arrest was associated with gender, age, marital status, educational attainment, pre-TBI felony, pre-TBI drug abuse, pre-TBI alcohol abuse, and violent cause of TBI. Frontal, temporal, parietal, or occipital lobe lesions from computed tomographic scans did not predict post-TBI criminal arrests. Higher numbers of post-TBI arrests were predicted by loss of consciousness (24 or more hours), combined with retention of motor function. Results indicate that premorbid variables, especially pre-TBI felonies, were strongly linked to post-TBI criminal arrests. The relationship between TBI and arrest was complex, and different brain functions (e.g., physical mobility) should be considered when understanding this association. These findings demonstrate that for post-TBI criminal behavior, many risk factors mirror those of the non-TBI general population.Elbogen, Eric B., Wolfe, James R., Cueva, Michelle, Sullivan, Connor, Johnson, JacquelineNational Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2014Information/education page: Returning to school after traumatic brain injuryJournalJ70245Archives of Physical Medicine and Rehabilitation95122507-2508Article presents information about how traumatic brain injury (TBI) can affects students and what parents and teachers can do to support students returning to school following TBI.Wehman, Paul, Targett, PamNodevopsadmin
2014Medication usage patterns for headache treatment after mild traumatic brain injuryJournalJ73506Headache543511-519Study examined self-reported medical treatment and effectiveness of the treatment for headache in the first year following mild traumatic brain injury (TBI). Data were collected from 167 participants admitted to a level 1 trauma hospital with mild TBI who were prospectively enrolled and reported new or worse headache at 3, 6, or 12 months after injury. Participants were primarily male (75 percent), white (75 percent), injured in vehicle crashes (62 percent), and had completed high school (83 percent). The majority of headaches met the diagnostic criteria for migraine/probable migraine, followed by tension-type headache. Despite the diverse nature of headaches, more than 70 percent of those with headache at each time period used acetaminophen or a nonsteroidal anti-inflammatory drug for headache control. Only 8 percent of those with the migraine/probable migraine phenotype used triptans. Of those individuals who used medication, 26 percent of those with migraine/probable migraine phenotype and 70 percent of those with tension headache phenotype endorsed complete relief (versus partial or no relief) because of medication use. The majority of individuals with tension headache reported never taking medication. Results indicate that headaches after mild TBI are frequent and are not optimally treated. The findings suggest that many individuals with mild TBI may be self-treating their headaches by utilizing over-the-counter pain relief medications. These medications, however, are only providing effective treatment for a minority of this population.DiTommaso, Craig, Hoffman, Jeanne M., Lucas, Sylvia, Dikmen, Sureyya, Temkin, Nancy, Bell, Kathleen R.University of Washington Traumatic Brain Injury Model SystemYesdevopsadmin
2014Opening the black box: Lessons learned from an interdisciplinary inquiry into the learning-based contents of brain injury rehabilitationJournalJ67523Archives of Physical Medicine and Rehabilitation951 (Supplement 1)S66-S73Article describes challenges encountered and lessons learned in an effort to explore the black box of rehabilitation. A multidisciplinary team created detailed, mutually exclusive operational definitions for the contents of learning-based treatments administered in a brain injury unit. The function and activity levels of the International Classification of Functioning, Disability and Health were used to organize content definitions, which included examples of therapy activities and therapist behaviors, such as cues. Pairs of trained coders independently identified defined learning episodes within each minute of 128 videotaped physical, occupational, or speech therapy sessions. Interrater agreement was generally acceptable and did not vary by discipline of session, discipline of coder, or whether coders were clinically trained. Disagreements typically involved the threshold for determining that a learning episode had occurred, or deciding between function and activity codes where the surface content of the sessions were similar. The focus on individual therapy sessions allowed for rich qualitative detail, but a less granular analysis will be necessary for comprehensive efforts to characterize the contents of therapy.Hart, Tessa, Ferraro, Mary, Myers, Robin, Ellis, Colin A.Nodevopsadmin
2016Introduction to ATOB volume 10: Assistive technology outcomes: Meeting the evidence challengeJournalJ77613Assistive Technology Outcomes and Benefits10vii-ixhttps://www.atia.org/wp-content/uploads/2016/11/ATOBN1V10_INTRO.pdfThis issue of Assistive Technology Outcomes and Benefits (ATOB) presents six articles on the topic of “Meeting the Evidence Challenge” in the arena of assistive technology (AT) outcomes research. Collectively these articles attempt to improve the quality of life for people who use AT. The individual articles are available under accession numbers J77614 through J77619.Flagg, Jennifer L.Nodevopsadmin
2016Level of knowledge use survey (LOKUS) instrument: Documenting knowledge use by stakeholdersJournalJ74745Technology and Disability282-Jan13-18This article first reviews the socio-economic context in which documenting knowledge uptake and use by non-traditional stakeholders is becoming increasingly important. It then summarizes the creation and initial administration of a new questionnaire called the Level Of Knowledge Use Survey (LOKUS) instrument, a web-based tool designed to survey the level of knowledge use by these stakeholders. The article concludes by discussing the value of the LOKUS instrument for measuring change in knowledge use over time.Lane, Joseph P., Stone, Vathsala I.Nodevopsadmin
2014Information/education page: Headaches after traumatic brain injuryJournalJ68587Archives of Physical Medicine and Rehabilitation954793-794Article discusses the causes, types, and treatment options for headaches after traumatic brain injury (TBI). It includes tips on self-care and when to seek help from a healthcare professional.Bell, Kathleen R., Hoffman, Jeanne, Watanabe, ThomasNodevopsadmin
2015Long-term survival after traumatic brain injury part II: Life expectancyJournalJ71813Archives of Physical Medicine and Rehabilitation9661000-1005Study computed the life expectancy of individuals with traumatic brain injury (TBI) based on validated prognostic models, compared mortality and life expectancy of people with TBI with those of the general population, and investigated trends toward improved survival over the last 2 decades. Life expectancy data were obtained from 2 cohorts of long-term survivors of TBI: (1) the Traumatic Brain Injury Model Systems (TBIMS) cohort comprised 7,365 persons who were admitted to a TBIMS facility with moderate-to-severe TBI and assessed at 1 year after injury, and (2) the California Department of Developmental Services (CDDS) cohort comprised 5,116 persons who sustained a TBI and received long-term services from the CDDS. Analysis indicated that the estimates of age-, sex-, and disability-specific life expectancy of people with TBI derived from the CDDS and TBIMS were similar. The estimates of age- and sex-specific life expectancy were lower than those of the general population. Mortality rates of people with TBI were higher than those of the general population. Mortality rates did not improve and the standardized mortality ratio increased over the study period from 1988 to 2010. The findings suggest that life expectancy of individuals with TBI is lower than that of the general population and depends on age, sex, and severity of disability. When compared, the survival outcomes in the TBIMS and CDDS cohorts are remarkably similar. Because there have been no marked trends in the last 20 years, the life expectancies presented in this article may remain valid in the future.Brooks, Jordan C., Shavelle, Robert M., Strauss, David J., Hammond, Flora M., Harrison-Felix, Cynthia L.Rocky Mountain Regional Brain Injury System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2016Multicenter study of sexual functioning in spouses/partners of persons with traumatic brain injuryJournalJ73809Archives of Physical Medicine and Rehabilitation975753-759Study investigated sexual functioning and its predictors in spouses/partners of individuals with traumatic brain injury (TBI). Participants were 70 adults with complicated mild to severe TBI admitted to 1 of 6 participating TBI Model Systems inpatient rehabilitation units and their spouses/partners who were both living in the community and assessed at 1 year after injury. Outcome measures included the Derogatis Interview for Sexual Functioning Self-Report and the Global Sexual Satisfaction Index. Analysis revealed that 20 percent of spouses/partners of adults with TBI reported sexual dysfunction, and 44 percent reported dissatisfaction with sexual functioning. Sixty-two percent of spouses/partners reported a decrease in sexual activity during the year after injury, 34 percent reported a decrease in sexual drive or desire, and 34 percent indicated that sexuality was less important in comparison to preinjury. Greater sexual dysfunction in spouses/partners was associated with older age and with poorer sexual functioning in the person with TBI. Rehabilitation professionals should provide education on the potential impact of TBI on sexual functioning for both the individuals with TBI and their spouses/partners, and integrate the assessment of sexual functioning into their clinical assessment, making appropriate referrals for therapySander, Angelle M., Maestas, Kacey L., Pappadis, Monique R., Hammond, Flora M., Hanks, Robin A.Texas TBI Model System of TIRR, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Carolinas Traumatic Brain Injury Rehabilitation and Research System, Southeastern Michigan Traumatic Brain Injury SystemYesdevopsadmin
2016Information/education page: Spasticity and traumatic brain injuryJournalJ72911Archives of Physical Medicine and Rehabilitation971179-180Article provides information about spasticity following traumatic brain injury (TBI). Spasticity, the uncontrolled tightening of muscles caused by disrupted signals from the brain, is common in people with severe TBI. People with spasticity may feel as if their muscles have contracted and will not relax or stretch. They may also feel muscle weakness, loss of fine motor control, and overactive reflexes. Ways to manage and cope with spasticity are discussed.Bell, Kathleen, DiTommaso, CraigNodevopsadmin
2016Iterative design and usability testing of the iMHere system for managing chronic conditions and disabilityJournalJ74984International Journal of Telerehabilitation8120-Novhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985279/Article describes the iterative design and usability testing of the Interactive Mobile Health and Rehabilitation (iMHere) system, developed to support wellness and self-management among people with chronic disabilities. The iMHere system currently includes a smartphone app with six modules for use by people with disabilities and a web portal for use by medical and rehabilitation professionals or other support personnel. The usability study was conducted in the context of iterative, participatory development of both the app and the web portal, incorporating lessons learned to refine both the app modules and the clinician portal. The pilot population of people with spina bifida fostered the creation of a system appropriate for people with a wide variety of functional abilities and needs. As a result, the system is appropriate for use by persons with various disabilities and chronic conditions, not only spina bifida. In addition, the diversity of professionals and support personnel involved in the care of patients with spina bifida also enabled the design and implementation of the iMHere system to meet the needs of an interdisciplinary team of providers who treat various conditions. The iMHere system has the potential to foster communication and collaboration among members of an interdisciplinary healthcare team, including individuals with chronic conditions and disabilities, for a client-centered approach to support self-management skills.Fairman, Andrea D., Yih, Erika T., McCoy, Daniel F., Lopresti, Edmund F., McCue, Michael P., Parmanto, Bambang, Dicianno, Brad E.Nodevopsadmin
2016Longitudinal diffusion tensor imaging detects recovery of fractional anisotropy within traumatic axonal injury lesionsJournalJ75738Neurocritial Care243342-352Study used diffusion tensor imaging (DTI) to characterize serial changes in fractional anisotropy (FA) within traumatic axonal injury (TAI) lesions of the corpus callosum (CC). It was hypothesized that recovery of FA within a TAI lesion correlates with better functional outcome. One hundred forty-six patients who underwent both an acute DTI scan (within 7 days) and a subacute DTI scan (day14 to inpatient rehabilitation discharge) at a single TBI Model Systems institution were retrospectively analyzed. TAI lesions were manually traced on the acute diffusion-weighted images. FA, apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD) were measured within the TAI lesions at each time point. FA recovery was defined by a longitudinal increase in CC FA that exceeded the coefficient of variation for FA based on values from healthy controls. Acute FA, ADC, AD, and RD were compared in lesions with and without FA recovery, and correlations were tested between lesional FA recovery and functional recovery, as determined by the Disability Rating Scale score at discharge from inpatient rehabilitation. Eleven TAI lesions were identified in 7 patients. DTI detected FA recovery within 2 of 11 TAI lesions. Acute FA, ADC, AD, and RD did not differ between lesions with and without FA recovery. Lesional FA recovery did not correlate with disability rating scale scores. This retrospective longitudinal study provides initial evidence that FA can recover within TAI lesions. However, FA recovery did not correlate with improved functional outcomes. Additional studies are needed to further elucidate whether lesional FA recovery indicates axonal healing and has prognostic significanceEdlow, Brian L., Copen, William A., Izzy, Saef, van der Kouwe, Andre, Glenn, Mel B., Greenberg, Steven M., Greer, David M., Wu, OnaSpaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2016Information/education page: Respiratory health and spinal cord injuryJournalJ73411Archives of Physical Medicine and Rehabilitation974655-656Article provides information about how the respiratory system works and how it is affected by spinal cord injury.Garshick, Eric, Klebine, Phil, Gottlieb, Daniel J., Chiodo, AnthonyNodevopsadmin
2014Measuring episodic memory across the lifespan: NIH toolbox picture sequence memory testJournalJ73508Journal of the International Neuropsychological Society206611-619http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254833/Article describes a new measure developed for the National Institutes of Health (NIH) Toolbox, called the Picture Sequence Memory Test (PSMT), which is the first measure of episodic memory across the age range from 3 to 85 years. The authors describe the development of the measure and present validation data for ages 20 to 85. The PSMT involves sequences of pictures of objects and activities that are presented in a fixed order, with the content of each picture simultaneously verbally described, that the participant must remember and then reproduce over three learning trials. The results indicate good test-retest reliability and construct validity. Performance is strongly related to well-established “gold standard” measures of episodic memory and, as expected, much less well correlated with those of a measure of vocabulary. It shows clear decline with aging in parallel with a gold standard summary measure and relates to several other demographic factors and to self-reported general health status. The PSMT appears to be a reliable and valid test of episodic memory for adults, a finding similar to those found for the same measure with children.Dikmen, Sureyya, Bauer, Patricia J., Weintraub, Sandra, Mungas, Dan, Slotkin, Jerry, Beaumont,Jennifer L., Gershon, Richard, Temkin, Nancy R., Heaton, Robert K.University of Washington Traumatic Brain Injury Model SystemYesdevopsadmin
2015Occupational, physical, and speech therapy treatment activities during inpatients rehabilitation for traumatic brain injuryJournalJ72086Archives of Physical Medicine and Rehabilitation968, Supplement 3S222-S234, S234.e1-S234.e17Study examined the use of occupational therapy (OT), physical therapy (PT), and speech therapy (ST) treatment activities throughout the acute rehabilitation stay of patients with traumatic brain injury (TBI). Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. Patients were categorized based on rehabilitation admission Functional Independence Measure (FIM) cognitive scores, resulting in 5 fairly homogeneous cognitive groups. Analyses examined the percentage of patients engaged in specific activities and mean amount of time patients engaged in these activities for each 10-hour block of time for OT, PT, and ST combined. Results indicated that therapy activities in OT, PT, and ST across all 5 cognitive groups had a primary focus on basic activities. Although advanced activities occurred in each discipline and within each cognitive group, these advanced activities occurred with fewer patients and usually only toward the end of the rehabilitation stay. The pattern of activities engaged in was both similar to and different from patterns seen in previous practice-based evidence studies with different rehabilitation diagnostic groups.Beaulieu, Cynthia L., Dijkers, Marcel P., Barrett, Ryan S., Horn, Susan D., Giuffrida, Clare G., Timpson, Misti L., Carroll, Deborah M., Smout, Randy J., Hammond, Flora M.Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2015Introduction to ATOB focused issue on knowledge translation & technology transfer in assistive technologyJournalJ7156191vii-xiiihttp://www.atia.org/i4a/pages/index.cfmArticle introduces a special journal issue that includes five papers generated through the work of the Center on Knowledge Translation for Technology Transfer (KT4TT). The five papers address broad questions arising at the intersection of two processes: (1) the Technology Transfer (TT) process, which is concerned with conveying ownership and control over enabling knowledge codified as intellectual property, and (2) the Knowledge Translation (KT) process, which is concerned with successfully communicating the value of enabling knowledge between the knowledge creator and some targeted knowledge user.Lane, Joseph P.Nodevopsadmin
2016Incidence, characterization, and predictors of sleep apnea in consecutive brain injury rehabilitation admissionsJournalJ73352Journal of Head Trauma Rehabilitation31282-100Study examined the incidence, characteristics, and risk factors for sleep apnea among individuals admitted to an acute inpatient brain injury rehabilitation unit. Sleep apnea is a sleep-related breathing disorder characterized by repeated cessation or near cessation of ventilation during sleep and is formally diagnosed using polysomnography. Data were analyzed for 86 patients admitted to a Traumatic Brain Injury (TBI) Model System Veterans Administration Polytrauma Rehabilitation Center. The association of known risk factors used to detect presence of sleep apnea were compared in sleep apnea positive and negative groups to evaluate their sensitivity to presence of sleep disordered breathing. Sleep indices and medication profiles were compared between those with and without apnea. Subgroup analyses were conducted separately for those with TBI versus other forms of acquired brain injury to allow for examination of unique features across etiology groups. Half (49 percent) of the sample was diagnosed with sleep apnea. For the full sample, univariate logistic regression revealed age and hypertension as significant predictors of sleep apnea diagnosis. Logistic regression analyses conducted within the TBI group revealed age as the only significant predictor of apnea after adjustment for other variables. Hierarchical generalized linear regression models for the prediction of apnea severity found that Functional Independence Measure Cognition Score and age were significant predictors. Following adjustment for all other terms, only age remained significant. Findings suggest that sleep apnea is prevalent in acute neurorehabilitation admissions and traditional risk profiles for sleep apnea may not effectively screen for the disorder.Holcomb, Erin M., Schwartz, Daniel J., McCarthy, Marissa, Thomas, Bryan, Barnett, Scott D., Nakase-Richardson, RisaNational Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2016Feasibility of using mobile health to promote self-management in spina bifidaJournalJ74110American Journal of Physical Medicine and Rehabilitation956425-437Study explored the feasibility of using the interactive Mobile Health and Rehabilitation (iMHere) system in spina bifida and examined its effects on psychosocial and medical outcomes. The iMHere system consists of a suite of 6 Android smartphone modules for patients, a web-based clinician portal, and a 2-way communication system. In a randomized controlled trial, 13 intervention participants using the iMHere system and receiving usual care and 10 control participants receiving usual care were followed for 1 year. Feasibility of use of the system was demonstrated by participants using a customized smartphone system for reminders to conduct various self-care tasks, upload photos of wounds, manage medications, complete mood surveys, and for secure messaging. High usage of the system was associated with positive changes in the subscales of the Adolescent Self-Management and Independence Scale II. This study demonstrated that use of the iMHere system in spina bifida is feasible and was associated with short-term self-reported improvements in self-management skill. This system holds promise for use in many diverse chronic care models to support and increase self-management skills.Dicianno, Brad E., Fairman, Andrea D., McCue, Michael, Parmanto, Bambang, Yih, Erika, McCoy, Andrew, Pramana, Gede, Yu, Daihua X., McClelland, Justin , Collins, Diane M., Brienza, David M.Nodevopsadmin
2015Information/education page: Fatigue and traumatic brain injuryJournalJ70934Archives of Physical Medicine and Rehabilitation963567-568Article discusses the types, causes, and treatment of fatigue after traumatic brain injury (TBI). It includes self-help tips for decreasing fatigue, which includes feelings of exhaustion, tiredness, weariness, or lack of energy.Bell, Kathleen R.Nodevopsadmin
2015Global outcome trajectories after TBI among survivors and nonsurvivors: A national institute on disability and rehabilitation research traumatic brain injury model systems studyJournalJ72030Journal of Head Trauma Rehabilitation304283-289Study compared long-term functional outcome trajectories of individuals with traumatic brain injury (TBI) who survive with those who expire more than 5 years after injury, using individual growth curve analysis. Data on the Glasgow Outcome Scale-Extended (GOS-E) and Disability Rating Scale (DRS) were obtained for individuals 16 years and older with a primary diagnosis of TBI who received acute inpatient rehabilitation care in a TBI Model Systems center. Analysis revealed that patients who died several years after injury demonstrated worse functional status at baseline and a steeper rate of decline over time as measured by both the GOS-E and the DRS. There was significant variability in each growth parameter for both instruments. A reduced model was built for each outcome, including all covariates that related significantly to the growth parameters. An interactive tool was created for each outcome to generate individual-level trajectories based on various combinations of covariate values. Findings suggest that individuals with TBI who die several years after injury demonstrate functional trajectories that differ markedly from those of survivors. Opportunities should be sought for health management interventions to improve health and longevity after TBI.Dams-O'Connor, Kristen, Pretz, Christopher, Billah, Tausif, Hammond, Flora M., Harrison-Felix, CynthiaIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, New York Traumatic Brain Injury Model SystemYesdevopsadmin
2015Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after dischargeJournalJ73536Journal of Trauma and Acute Care Surgery782396-402Study examined the significance of hospital-acquired pneumonia (HAP) in the acute setting on outcomes 5 years after traumatic brain injury (TBI) using data from an institutional trauma registry merged with the Traumatic Brain Injury Model Systems outcome data. The primary outcome was Glasgow Outcome Scale-Extended (GOSE) at 1, 2, and 5 years, dichotomized into low (GOSE score < 6) and high (GOSE score ≥ 6) groups. Logistic regression was used to determine adjusted odds of low GOSE score associated with HAP after controlling for age, sex, head and overall injury severity, cranial surgery, Glasgow Coma Scale (GCS) score, ventilation days, and other important confounders. A general estimating equation model was used to analyze all outcome observations simultaneously while controlling for within-patient correlation. A total of 141 individuals met inclusion criteria, with a 30 percent incidence of HAP. Individuals with and without HAP had similar demographic profiles, presenting vitals, head injury severity, and prevalence of cranial surgery. Individuals with HAP had lower presenting GCS score. Logistic regression demonstrated that HAP was independently associated with low GOSE scores at follow-up. Stratifying by GCS score of 8 or lower and early intubation, HAP remained a significant independent predictor of low GOSE score in all strata. In the general estimating equation model, HAP continued to be an independent predictor of low GOSE score. Findings suggest that HAP is independently associated with poor outcomes in severe TBI extending 5 years after injury. This suggests that precautions should be taken to reduce the risk of HAP in individuals with severe TBI.Kesinger, Matthew R., Kumar, Raj G., Wagner, Amy K., Puyana, Juan C., Peitzman, Andrew P., Billiar, Timothy R., Sperry, Jason L.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2016Improved function after deep brain stimulation for chronic, severe traumatic brain injuryJournalJ76088Neurosurgery792204-211Study investigated the safety and potential effectiveness of deep brain stimulation (DBS) for individuals with chronic, disabling traumatic brain injury (TBI) and problems of behavioral and emotional self-regulation. Four participants were included in this study 6 to 21 years after severe TBIs from automobile crashes. Although alert and volitional, all experienced significant executive impairments, including either impulsivity or reduced initiation. DBS implants were placed bilaterally in the nucleus accumbens and anterior limb of the internal capsule to modulate the prefrontal cortex. Serial assessments of behavioral outcomes and positron emission tomography were performed 2 years after DBS implantation. Results indicated that the procedure was safe, and all participants had improved functional outcomes. Two years after implantation, 3 of the 4 subjects met a priori criteria for improvement on the Mayo-Portland Adaptability Inventory-4. Improvement was due largely to better emotional adjustment, although 1 participant showed marked increases in multiple domains. Significant improvement in a composite score of functional capacity indicated improved independence in self-care and activities of daily living. The pattern of change in cognition corresponded with changes in activation of the prefrontal cortex observed in serial scanning. This study of DBS for severe TBI supports its safety and suggests its potential effectiveness to improve function years after injury. The primary impact was on behavioral and emotional adjustment, which in turn improved functional independence.Rezai, Ali R., Sederberg, Per B., Bogner, Jennifer, Nielson, Dylan M., Zhang, Jun, Mysiw, W. Jerry, Knopp, Michael V., Corrigan, John D.Ohio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2016Factor structure of the brief multidimensional measure of religiousness/spirituality in US and Indian samples with traumatic brain injuryJournalJ77136Journal of Religion and Health552572-586Study evaluated the factor structure of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) based on individuals from the United States (US) and India with diverse cultures; ethnicities (i.e., Caucasian, African-American, South Asian); and religions (i.e., Christian, Muslim, Hindu). A total of 109 individuals with traumatic brain injury (TBI) completed the BMMRS as part of a broader study on spirituality, religion, prosocial behaviors, and neuropsychological function. A principal components factor analysis with varimax rotation and Kaiser normalization identified a six-factor solution accounting for 72 percent of the variance in scores. Five of the factors were deemed to be interpretable and were labeled based on face validity as: (1) Positive Spirituality/Religious Practices; (2) Positive Congregational Support; (3) Negative Spirituality/Negative Congregational Support; (4) Organizational Religion; and (5) Forgiveness. The results were generally consistent with previous studies, suggesting the existence of universal religious, spiritual, and congregational support factors across different cultures and faith traditions. For health outcomes research, it is suggested that the BMMRS factors may be best conceptualized as measuring the following general domains: (1) emotional connectedness with a higher power (i.e., spirituality, positive/negative); (2) culturally based behavioral practices (i.e., religion); and (3) social support (i.e., positive/negative). The results indicate that factor relationships may differ among spiritual, religious, and congregational support variables according to culture and/or religious tradition.Johnstone, Brick, Bhushnan, Braj, Hanks, Robin, Yoon, Dong P., Cohen, DanielSoutheastern Michigan Traumatic Brain Injury System, Southeastern Michigan Traumatic Brain Injury System Yesdevopsadmin
2015Information/education page: Balance problems after traumatic brain injuryJournalJ70686Archives of Physical Medicine and Rehabilitation962379-380Article discusses the causes, evaluation, and treatment of problems related to balance after traumatic brain injury (TBI). It includes self-help tips for improving balance issues, which include dizziness and disequilibrium.Peterson, Michelle, Greenwald, Brian D.Nodevopsadmin
2016Genefitc variation in neuronal glutamate transport genes and associations with post-traumatic seizureJournalJ78269Epilepsia576984-993Study investigated whether genetic variation in neuronal glutamate transporter genes is associated with accelerated epileptogenesis and increased risk of posttraumatic seizures (PTS) after severe traumatic brain injury (sTBI). A total of 253 individuals with sTBI 18-75 years of age were assessed for genetic relationships with PTS. Single nucleotide polymorphisms (SNPs) within SLC1A1 and SLC1A6 were assayed. Kaplan-Meier estimates and log-rank statistics were used to compare seizure rates from injury to 3 years post injury for SNPs by genotype. Hazard ratios were estimated using Cox proportional hazards regression for SNPs significant in Kaplan-Meier analyses adjusting for known PTS risk factors. Thirty-two tagging SNPs were examined. Forty-nine subjects (19.37 percent) had PTS. Of these, 18 (36.7 percent) seized within 7 days, and 31 (63.3 percent) seized between 8 days and 3 years post-TBI. With correction for multiple comparisons, genotypes at SNP rs10974620 (SLC1A1) were significantly associated with time to first seizure across the full 3-year follow-up. When seizure follow-up began day 2 post injury, genotypes at SNP rs7858819 (SLC1A1) were significantly associated with PTS risk. After adjusting for covariates, rs10974620 remained significant; rs7858819 also remained significant in adjusted models. Findings indicate that variations within SLC1A1 are associated with risk of epileptogenesis following sTBI. Future studies need to confirm findings, but variation within neuronal glutamate transporter genes may represent a possible pharmaceutical target for PTS prevention and treatment.Ritter, Anne C., Kammerer, Candace M., Brooks, Maria M., Conley, Yvette P., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2015Headache after traumatic brain injury: A national survey of clinical practices and treatment approachesJournalJ73509PM & R718-MarStudy investigated current practice patterns and perceptions of treatment issues among clinicians managing headache after traumatic brain injury (TBI), using a 20-item questionnaire developed by the authors. The survey was sent electronically to 1,782 members of the Central Nervous System Council list survey of the American Academy of Physical Medicine and Rehabilitation and 1,260 members of the American Headache Society membership. The survey queried the physicians’ clinical setting; their use of headache classification systems, headache diaries, checklists, and diagnostic procedures; the pharmacologic and non-pharmacologic treatments prescribed; and headache chronicity and associated symptoms and disorders among their patients with TBI. Completed surveys were received from 193 respondents. The use of standardized classification systems and checklists was commonly reported. Respondents used non-pharmacologic and pharmacologic treatment approaches with similar frequency and modest perceived success rates. A high frequency of headache-associated new sleep and mood disorders was reported. When response differences occurred between practice settings, they reflected a focus on headache diagnosis, classification, and pharmacologic treatment among neurology and specialty headache clinics, whereas a non-pharmacologic approach to management among TBI specialty and general rehabilitation clinicians was more commonly reported. The findings indicate that strategies for diagnosing and treating headache after TBI vary widely among general and specialty clinical practices. This suggests that additional research is needed that would lead to an increase in the use of established headache classification and the development of standardized management approaches so that all practitioners who care for patients after TBI can provide consistent effective care.Brown, Allen W., Watanabe, Thomas K., Hoffman, Jeanne M., Bell, Kathleen R., Lucas, Sylvia, Dikmen, SureyyaMayo Clinic Traumatic Brain Injury Model System , University of Washington Traumatic Brain Injury Model System, Moss Traumatic Brain Injury Model System, North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2016Identifying and understanding the health information experiences and preferences of individuals with TBI, SCI, and burn injuriesJournalJ76321Journal of Patient Experience3388-95Study identified preferred sources of health information and services for individuals with traumatic brain injuries (TBI), spinal cord injuries (SCI), and burn injuries and explored how access to this information could be improved. Thirty-three people with injuries participated in semi-structured interviews (13 with TBI, 8 with SCI, and 12 with burn injuries). Responses to interview questions were coded using NVivo. The results showed that participants’ difficulties accessing health information varied by injury type and individually. The majority of respondents found information via the Internet and advocated its use when asked to describe their ideal health information system. Nearly all participants supported the development of a comprehensive care website. When searching for health information, participants sought doctor and support group networks, long-term health outcomes, and treatments specific to their injury. To optimize the quality of health information resources, Internet-based healthcare platforms should add or highlight access points to connect patients to medical professionals and support networks while aggregating specialized, injury-specific research and treatment information.Coffey, Nathan T., Weinstein, Ali A., Cai, Cindy, Cassese, James, Jones, Rebecca, Shaewitz, Dahlia, Garfinkel, StevenNodevopsadmin
2016Incidence and risk factors of posttraumatic seizures following traumatic brain injury: A traumatic brain injury model systems studyJournalJ74973EpilepsiaStudy determined incidence of posttraumatic seizure (PTS) following traumatic brain injury (TBI) among individuals with moderate-to-severe TBI requiring rehabilitation and surviving at least 5 years. Data obtained from the TBI Model Systems National Database were used to calculate PTS incidence during acute hospitalization, and at 1, 2, and 5 years postinjury in a continuously followed cohort of 795 participants enrolled from 1989 to 2000. Incidence rates were stratified by risk factors, and adjusted relative risk (RR) was calculated. Late PTS associations with immediate (less than 24 hours), early (24 hours to 7 days), or late seizures (more than 7 days) versus no seizure prior to discharge from acute hospitalization was also examined. PTS incidence during acute hospitalization was highest immediately post-TBI (8.9 percent). New onset PTS incidence was greatest between discharge from inpatient rehabilitation and year 1 (9.2 percent). Late PTS cumulative incidence from injury to year 1 was 11.9 percent, and reached 20.5 percent by year 5. Immediate/early PTS RR (2.04) was increased for those undergoing surgical evacuation procedures. Late PTS RR was significantly greater for individuals who self-identified as a race other than black/white (year 1 RR = 2.22), and for black individuals (year 5 RR = 3.02) versus white individuals. Late PTS was greater for individuals with subarachnoid hemorrhage (year 1 RR = 2.06) and individuals age 23–32 (year 5 RR = 2.43) and 33–44 (year 5 RR = 3.02). Late PTS RR years 1 and 5 was significantly higher for those undergoing surgical evacuation procedures. Findings suggest that individuals with immediate/late seizures during acute hospitalization have increased late PTS risk. Race, intracranial pathologies, and neurosurgical procedures also influenced PTS RR.Ritter, Anne C., Wagner, Amy K., Fabio, Anthony, Pugh, Mary Jo, Walker, William C., Szaflarski, Jerzy P., Zafonte, Ross D., Brown, Allen W., Hammond, Flora M., Bushnik, Tamara, Johnson-Green, Doug, Shea, Timothy, Krellman, Jason W., Rosenthal, Joseph A., Dreer, Laura E.Virginia Commonwealth Traumatic Brain Injury Model System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, New York Traumatic Brain Injury Model System, University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2015Factors influencing attrition in a multisite, randomized, clinical trial following traumatic brain injury in adolescenceJournalJ71792Journal of Head Trauma Rehabilitation303E33-E40Study investigated factors associated with shorter length of study participation and lower rates of study completion (i.e., attrition) in a large, multisite, longitudinal, randomized, clinical trial examining the efficacy of a Web-based family problem-solving treatment following traumatic brain injury (TBI) in adolescence. The project was conducted at 5 major trauma centers in the central and western regions of the United States. Participants and their families were asked to complete questionnaires and interviews at each of 4 data collection points: baseline and 6-, 12-, and 18-month follow-ups. Participants and their families who completed all 4 interviews were considered to have successfully completed the study. The final groups included 132 children, aged 12 to 17 years, hospitalized for complicated mild to severe TBI within the previous 6 months: 51 participants with severe TBI and 81 participants with moderate TBI; 101 completers and 31 non-completers. Attrition was 6 percent at the 6-month follow-up, 16 percent at the 12-month follow-up, and 25 percent at the 18-month follow-up, yielding a completion rate of 75 percent. Completers had a higher primary caregiver education and higher family income than non-completers, whereas ethnicity, latency to baseline assessment, and intervention group were not significantly associated with study completion. Findings suggest that research on pediatric TBI populations may be biased toward higher-income families and highlights the importance of designing studies with increased awareness of the impact of participant demographic factors.Blaha, Robert Z., Arnett, Anne B., Kirkwood, Michael W., Taylor, H. Gerry, Stancin, Terry, Brown, Tanya M., Wade, Shari L.Nodevopsadmin
2015Information/education page: Driving after traumatic brain injuryJournalJ71266Archives of Physical Medicine and Rehabilitation964767-768Article provides useful information about safe driving after traumatic brain injury (TBI). Topics include how a TBI can affect driving, how often individuals with TBI return to driving, driving evaluations and training, vehicle modifications, legal and insurance considerations, and other transportation options. If and when a person with TBI may safely return to driving should be addressed early in recovery.Novack, Thomas, Lopez, EduardoNodevopsadmin
2015Global outcome and late seizures after penetrating versus closed traumatic brain injury: A NIDRR TBI model systems studyJournalJ72023Journal of Head Trauma Rehabilitation304231-240Study assessed and compared penetrating traumatic brain injury (TBI) and closed TBI with respect to global outcome and late seizures 2 years after injury. Penetrating TBI consists of TBI accompanied by dural penetration and is usually caused by either projectiles striking the head or the head striking sharp objects. Data were collected at 20 TBI Model Systems rehabilitation centers across the United States. After performing unadjusted penetrating TBI versus closed TBI comparisons, multivariate regression models were built and analyzed for both outcomes by including the following additional predictors: loss of consciousness (LOC), posttraumatic amnesia (PTA) duration, hospital length of stay, age, gender, race, marital status, education level, problem substance abuse, and preinjury employment status. The collapsed Glasgow Outcome Scale (GOS) model showed significant secondary effects of penetrating TBI with employment status. When employed before injury, individuals with penetrating TBI were 2.62 times more likely to have a lower GOS category. The final model for late seizures showed a significant main effect for penetrating TBI. Adjusting for other predictors, individuals with penetrating TBI were 2.78 times more likely than those with closed TBI to be rehospitalized for a seizure. The results of this study demonstrates that penetrating TBI is predictive of poorer global outcome and higher prevalence of late seizures above and beyond what can be predicted by other factors such as LOC, PTA, and age.Walker, William C., Ketchum III, James S., Marwitz, Jennifer H., Kolakowsky-Hayner, Stephanie A., McClish, Donna K., Bushnik, TamaraVirginia Commonwealth Traumatic Brain Injury Model System, Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, Northern California Traumatic Brain Injury Model SystemYesdevopsadmin
2015High fidelity human simulation improves physical therapist student self-efficacy for acute care clinical practiceJournalJ78513Journal of Physical Therapy Education29414-24https://www.researchgate.net/publication/291971477_High_Fidelity_Human_Simulation_Improves_Physical_Therapist_Student_Self-Efficacy_for_Acute_Care_Clinical_PracticeStudy compare self-efficacy between physical therapist (PT) students who did and did not participate in high-fidelity human simulation (HFHS) training prior to acute care clinical experiences. HFHS has been described as structured student learning experiences with the use of a technologically advanced computerized manikin, mimicking realistic patient care situations. Sixteen PT students were randomly assigned to either a control, which received the standard curriculum, or an experimental groups, which participated in 6 HFHS learning experiences in addition to the standard curriculum prior to an acute care clinical experience. Self-efficacy was measured using the Acute Care Confidence Survey on 3 occasions: baseline, after HFHS training, and midterm of the clinical experience. A focus group was conducted with the experimental group upon completion of the clinical experience to examine the students’ perceived value of HFHS training. A significant between-group difference was found on self-efficacy scores following HFHS and on total change in self-efficacy from baseline to midterm of the clinical experience. Focus group qualitative analysis revealed 4 themes: (1) simulation provided a safe, nonjudgmental, and productive learning environment; (2) students gained confidence in preparation for acute care clinical experience in initial interaction with clinical instructor, patient, and interprofessional team communication, and knowledge of the clinical setting; (3) simulation fostered clinical reasoning skills; and (4) simulation facilitated skills in multitasking in a complex setting. Themes were triangulated and supported by quantitative self-efficacy scores. Findings suggest that HFHS in PT education leads to increased self-efficacy for acute care clinical practice.Silberman, Nicki J., Litwin, Bini, Panzarella, Karen J., Fernandez-Fernandez, AliciaNodevopsadmin
2015Impacts of school structural factors and student factors on employment outcomes for youth with disabilitiesJournalJ73787Rehabilitation Counseling Bulletin (RCB)http://rcb.sagepub.com/content/early/2015/07/15/0034355215595515.full.pdfStudy examined school structural factors (i.e., free/reduced lunch percentage, proportion of minority student enrollment, and student-teacher ratio) that may contribute to employment outcomes for transitioning youth with disabilities beyond individual student factors through hierarchical linear modeling analyses. The secondary data for 3,289 students were obtained from the Bridges From School to Work Program, and the school structural data for 121 schools were drawn from the Common Core of Data. The major types of disabilities for the student participants included learning disabilities, emotional and behavioral disabilities, sensory disabilities, and others. Around 41 percent of participants were female. The study found that employment outcomes (i.e., whether a participant secured a paid job and weekly job earnings) were primarily attributed to student individual factors rather than school structural factors, particularly prior paid work experience. The finding suggests the potential importance of effective transition interventions to improve employment outcomes for all youth with disabilities. Implications for rehabilitation professionals are discussed.Dong, Shengli, Fabian, Ellen, Luecking, Richard G.Nodevopsadmin
2018Factor analysis of the everyday memory questionnaire in persons with traumatic brain injuryJournalJ78272The Clinical Neuropsychologist323495-509Study examined the factor structure of the Everyday Memory Questionnaire (EMQ) in people with traumatic brain injury (TBI). A secondary analysis was conducted of baseline data from two clinical trials targeting memory impairment after TBI. Participants were 169 individuals with complicated mild, moderate, or severe TBI at an average of 41 months post-injury. They completed the EMQ via clinical interview. Exploratory factor analysis was conducted using a three-factor principal axis factoring estimation method with a polychoric correlation matrix and oblique rotation. Results indicated that three factors accounted for 49.2 percent of the variance, with moderate correlations observed among the factors. The identified three factors appeared to represent general everyday memory (prospective and episodic), conversational memory, and spatial or action memory. The three factors added significantly to the variance in age-corrected objective learning test scores predicted by injury severity, education, and sex. The three factors of the EMQ are consistent with the heterogeneity of memory impairments observed after TBI. The factor scores may be used to target treatments for impaired memory and to evaluate their effectiveness.Sander, Angelle M., Clark, Allison N., Van Veldhoven, Laura M., Hanks, Robin, Hart, Tessa, Novelo, Luis L., Ngan, Esther, Arciniegas, David B.Texas TBI Model System of TIRRYesdevopsadmin
2014Inflammation: A new biological paradigm for understanding TBI as a chronic conditionJournalJ70265The Challenge!8310-11, 21http://www.rehabilomics.pitt.edu/publications/WAgner_BIAA_TBI-Care.pdfArticle reviews research demonstrating how biological markers of inflammation can be used to improve recovery and enhance quality of life for people with traumatic brain injury. By identifying patterns of inflammatory genes and proteins that increase an individual’s risk for poor outcomes, the authors hope to generate tailored screening, prevention, and treatment protocols.Wagner, Amy K., Juengst, Shannon B., Kumar, Raj G., Ritter, Anne C., Diamond, Matthew L., Failla, Michelle D,University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2017Future directions in employment, occupational rehabilitation, and disability: Introduction to the special sectionJournalJ77905Journal of Occupational Rehabilitation274479-481This article introduces a special journal section that examines, from an array of disciplinary perspectives, opportunities and challenges in the economic, social, and civic participation of individuals across the spectrum of disabilities. At multiple levels of analysis, the contributors consider employment law and policy frameworks, occupational and vocational rehabilitation strategies, and corporate practices in support of the full and equal inclusion of people with disabilities in society. The implications for policymakers, public and private sector stakeholders, and occupational rehabilitation professional are presented to help inform future policies, practices, and strategies to improve employment outcomes for people with disabilities.Blanck, Peter, Adya, MeeraNodevopsadmin
2017Groupings of persons with traumatic brain injury: A new approach to classifying traumatic brain injury in the post-acute period.JournalJ75640Journal of Head Trauma Rehabilitation322125-133https://pubmed.ncbi.nlm.nih.gov/26709583/Objective: To (1) identify groups of persons with traumatic brain injury (TBI) who differ on 12 dimensions of cognitive function: cognitive, emotional, and physical symptoms; personal strengths; physical functioning; environmental supports; and performance validity; and (2) describe patterns of differences among the groups on these dimensions and on participation outcome. Setting: Three centers for rehabilitation of persons with TBI. Participants: A total of 504 persons with TBI living in the community who were an average (standard deviation) of 6.3 (6.8) years postinjury and who had capacity to give consent, could be interviewed and tested in English, and were able to participate in an assessment lasting up to 4 hours. Design: Observational study of a convenience sample of persons with TBI. Main measures: Selected scales from the Traumatic Brain Injury Quality of Life measures, Neurobehavioral Symptom Inventory, Economic Quality of Life Scale, Family Assessment Device General Functioning Scale, measures of cognitive function, Word Memory Test, and Participation Assessment with Recombined Tools-Objective (PART-O) scale. Results: Cluster analysis identified 5 groups of persons with TBI who differed in clinically meaningful ways on the 12 dimension scores and the PART-O scale. Conclusion: Cluster groupings identified in this study could assist clinicians with case conceptualization and treatment planning. Sherer, Mark, Nick, Todd G., Sander, Angelle M., Melguizo, Maria, Hanks, Robin, Novack, Thomas A., Tulsky, David, Kisala, Pamela, Luo, Chunqiao, Tang, XinyuTexas TBI Model System of TIRR, Southeastern Michigan Traumatic Brain Injury System, North Texas Traumatic Brain Injury Model System, UAB Traumatic Brain Injury Model System, Northern New Jersey Traumatic Brain Injury System Yesdevopsadmin
2017Identifying and understanding the health information experiences and preferences of caregivers of individuals with either traumatic brain injury, spinal cord injury, or burn injury: A qualitative investigationJournalJ76320Journal of Medical Internet Research195e159https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443912/Study identified the preferred sources of health information for caregivers supporting individuals with traumatic brain injuries (TBI), spinal cord injuries (SCI), or burn injuries and explored how access to this information could be improved. Thirty-two caregivers participated in semi-structured interviews, which were used in order to develop a more in-depth understanding of these caregivers' information needs. Digital audio recordings of the interviews were used for analysis purposes. These audio recordings were analyzed using a thematic analysis or qualitative content analysis. The results showed that the caregivers endorsed similar behaviors and preferences when seeking and accessing health information. Medical professionals were the preferred source of information, while ease of access made the Internet the most common avenue to obtain information. The challenges faced by participants were frequently a result of limited support. In describing an ideal health system, participants expressed interest in a comprehensive care website offering support network resources, instructive services about the injury and caregiving, and injury-specific materials. According to the participants, an ideal health information system would include a comprehensive care website that offered supportive network resources, instructive services about the injury and caregiving, and materials specific to the type of patient injury.Coffey, Nathan T., Cassese, James, Cai, Xinsheng, Garfinkel, Steven, Patel, Drasti, Jones, Rebecca, Shaewitz, Dahlia, Weinstein, Ali A.Nodevopsadmin
2014In their own words: The career planning experiences of college students with ASDJournalJ68680Journal of Vocational Rehabilitation403195-202Study interviewed 18 college students with autism spectrum disorders (ASD) concerning their career planning experiences. Participants attended community colleges and/or universities in Virginia and ranged from freshmen through graduate school. The structured interviews focused on students’ current status in career planning and preparation, use of campus services and supports, and their satisfaction with these services. Interviewers also sought to obtain students’ perspectives on what information, services, and resources they need to better prepare for their careers. Results describe four themes that emerged based on students’ knowledge of, and participation in, campus services and supports: choosing a major, using career centers, self-disclosure, and career-related services and supports. The students with ASD expressed a need for more experiential learning opportunities through informational interviews, job shadowing or mentoring opportunities, internships, or work experience.Briel, Lori W., Getzel, Elizabeth E.Nodevopsadmin
2015Factors associated with word memory test performance in persons with medically documented traumatic brain injuryJournalJ75805The Clinical Neuropsychologist294522-541Study examined the rate of poor performance validity and identified factors associated with Word Memory Test (WMT) performance in a large, multicenter cohort of community dwelling adults with medically documented traumatic brain injury (TBI). A total of 491 subjects with TBI were administered a battery of cognitive tests and questionnaires on emotional distress and post-concussive symptoms. Performance validity was measured with the WMT. Additional data were collected by interview and review of medical records. One hundred seventeen participants showed poor performance validity using the standard cutoff. Variable cluster analysis was conducted as a data reduction strategy. Findings revealed that the 10 cognitive tests and questionnaires could be summarized as 4 indices: emotional distress, speed of cognitive processing, verbal memory, and verbal fluency. Regression models revealed that verbal memory, emotional distress, age, and injury severity (time to follow commands) made unique contribution to prediction of poor performance validity. This study found poor performance validity was common in a research sample of persons with medically documented TBI who were not evaluated in conjunction with litigation, compensation claims, or current report of symptoms. Poor performance validity was associated with poor performance on cognitive tests, greater emotional distress, lower injury severity, and greater age.Sherer, Mark, Davis, Lynne C., Sander, Angelle M., Nick, Todd G., Luo, Chunqiao, Pastorek, Nicholas, Hanks, RobinTexas TBI Model System of TIRR, Southeastern Michigan Traumatic Brain Injury SystemYesdevopsadmin
2014Information/education page: Depression and spinal cord injuryJournalJ68281Archives of Physical Medicine and Rehabilitation952413-414Article discusses the definition, prevalence, causes, and treatment options for depression in individuals recovering from spinal cord injury (SCI). It also includes tips on how to find help and where to get additional information about SCI and depression.Bombardier, Charles H.Nodevopsadmin
2016Getting to inclusion: People with developmental disabilities and the Americans with disabilities act participatory action research consortiumJournalJ73567Inclusion4115-JunArticle discusses the Americans with Disabilities Act (ADA) Participatory Action Research Consortium (ADA-PARC), which collaborates with ADA centers to fulfill the mission of the ADA: full inclusion, full participation, and equality of opportunity for all people with disabilities. The ADA-PARC project focuses on three primary participation areas: community living, community participation, and work and economic. By assessing and addressing participation disparities in these three areas, the project aims to ultimately help ADA centers and community stakeholders target disparities and increase full participation of people with disabilities, including those with developmental disabilities, in their communities.Hammel, Joy, McDonald, Katherine E., Frieden, LexNodevopsadmin
2015Health-related quality of life in caregivers of individuals with traumatic brain injury: Development of a conceptual modelJournalJ70652Archives of Physical Medicine and Rehabilitation961105-113Study identified aspects of health-related quality of life (HRQOL) that are relevant to caregivers of individuals with traumatic brain injury (TBI) and developed an integrated conceptual framework based on this information. Nine focus groups were conducted with 55 caregivers of individuals with moderate-to-severe TBI to explore the effect that caring for an individual with a TBI has on caregiver HRQOL. Qualitative analysis of the data collected indicated that caregivers were most concerned about their social health (42 percent of comments). Other important issues were emotional health (34 percent), physical health (11 percent), cognitive health (3 percent), and feelings of loss related to changes in the future/potential of the care recipient or related to the caregiver (9 percent). Areas of concern that were discussed that were specific to the caregiver and not fully evaluated by existing patient-reported outcomes (PROs) included feelings of loss; anxiety related to the caregiver role (reinjury concerns, worry about leaving the person alone, etc.); and caregiver strain (burden, stress, feeling overwhelmed, etc.). The findings suggest that although existing PROs capture relevant aspects of HRQOL for caregivers, there are HRQOL domains that are not addressed. A validated and sensitive HRQOL tool for caregivers of individuals with TBI will facilitate initiatives to improve outcomes in this underserved group.Carlozzi, Noelle E., Kratz, Anna L., Sander, Angelle M., Chiaravalloti, Nancy D., Brickell, Tracey A., Lange, Rael T., Hahn, Elizabeth A., Austin, Amy, Miner, Jennifer A., Tulsky, David S.Texas TBI Model System of TIRRYesdevopsadmin
2016Impact of religious attendance on psychosocial outcomes for individuals with traumatic brain injury: A NIDILRR funded TBI model systems studyJournalJ76046Brain Injury3013-141605-1611Study identified the demographic characteristics of individuals with traumatic brain injury (TBI) who attend religious services and examined the relationship between attending religious services and psychosocial outcomes at 1, 5, and 10 years after injury. Data were obtained from TBI Model Systems (TBIMS) National Database (NDB) participants who completed 1, 5, or 10-year follow-up interview with data on religious attendance. Participation in religious activities was assessed with the Participation Assessment with Recombined Tools Objective (PART-O). Outcome measures, included the Satisfaction with Life scale, Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire, and PART-O Social Relations sub-scale were extracted from the TBIMS NDB. In addition, information on participants’ demographics, geographic location, and functional status were acquired at follow-up. A total of 5,573 interviews were analyzed. The results indicated that approximately half of the sample was attending religious services at each time point. Those most likely to attend religious services identified with a minority status, lived in a southern state, were married, and were older. Attendance at religious services was associated with fewer depressive symptoms, more frequent social participation, and greater satisfaction with life at all three time periods. After controlling for demographic characteristics, functional status, and geographic makeup, religious attendance contributed a small but significant amount of unique variance in all models except for GAD-7 at years 1 and 10. The findings highlight the benefits of religious attendance on psychosocial outcomes post-TBI. Implications for rehabilitation are discussed.Philippus, Angela, Mellick, David, O'Neil-Pirozzi, Therese, Bergquist, Thomas, Bodien, Yelena G., Sander, Angelle M., Dreer, Laura E., Giacino, Joseph, Novack, ThomasRocky Mountain Regional Brain Injury SystemYesdevopsadmin
2016Exploring how knowledge translation can improve sustainability of community-based health initiatives for people with intellectual/developmental disabilitiesJournalJ74376Journal of Applied Research in Intellectual Disability295433-444Study explored how knowledge translation (KT) can be used to help sustain community-based health initiatives (CBHI) for people with intellectual and developmental disabilities (IDD). CBHI play an important role in maintaining the health, function, and participation of people with IDD living in the community. However, implementation and long-term sustainability of CBHI is challenging. The Promoting Action on Research Implementation in Health Services (PARiHS) is a KT framework that is particularly relevant to IDD research as it identifies the barriers and facilitators of implementation and action plans. The framework examines the interplay between three key elements, evidence, context, and facilitation, and the effect of these elements on successful research implementation. The PARiHS framework provides a foundation for understanding how KT can be used to aid the implementation and sustainability of CBHI for people with IDD.Spassiani, Natasha A., Harris, Sarah P., Hammel, JoyNodevopsadmin
2016Individual differences in working memory capacity predicts responsiveness to memory rehabilitation after traumatic brain injuryJournalJ73982Archives of Physical Medicine and Rehabilitation9761026-1029Study explored how individual differences affect rehabilitation outcomes by specifically investigating whether working memory capacity (WMC) can be used as a cognitive marker to identify who will and will not improve from memory rehabilitation after traumatic brain injury (TBI). Sixty-five participants with moderate to severe TBI with pre- and posttreatment data participated in a randomized controlled trial. The treatment group completed 10 cognitive rehabilitation sessions in which subjects were taught a memory strategy focusing on learning to use context and imagery to remember information. The placebo control group engaged in active therapy sessions that did not involve learning the memory strategy. The main outcome measure was long-term memory percent retention change scores for an unorganized list of words from the California Verbal Learning Test-II. Results indicated that group and WMC interacted. High WMC participants showed a benefit from treatment compared with low WMC participants. Individual differences in WMC accounted for 45 percent of the variance in whether participants with TBI in the treatment group benefited from applying the compensatory treatment strategy to learn unorganized information. Individuals with higher WMC showed a significantly greater rehabilitation benefit when applying the compensatory strategy to learn unorganized information. WMC is a useful cognitive marker for identifying participants with TBI who respond to memory rehabilitation with the modified Story Memory Technique.Sandry, Joshua, Chiou, Kathy S., DeLuca, John, Chiaravallotti, Nancy D.Northern New Jersey Traumatic Brain Injury System Yesdevopsadmin
2014Functional recovery after severe traumatic brain injury: An individual growth curve approachJournalJ70066Archives of Physical Medicine and Rehabilitation95112103-2110Study examined patient, injury, and treatment characteristics associated with recovery trajectories of people with severe traumatic brain injury (TBI) during inpatient rehabilitation. Participants were 206 adults with severe, non-penetrating TBI admitted directly from acute care to 2 specialized TBI rehabilitation centers (1 in the United States and 1 in Denmark). Naturally occurring treatments delivered within comprehensive multidisciplinary teams were recorded daily in 15-minute units provided to patients and family members, separately. Motor and cognitive Functional Independence Measure (FIM) scores were obtained on admission, discharge, and every 2 weeks in between and were analyzed with individual growth curve methodology. Results indicated that inpatient recovery was best modeled with linear, cubic, and quadratic components: relatively steep recovery was followed by deceleration of improvement, which attenuated prior to discharge. Slower recovery was associated with older age, longer coma, and interruptions to rehabilitation. Patients admitted at lower functional levels received more treatment, and more treatment was associated with slower recovery, presumably because treatment was allocated according to need. Therefore, effects of treatment on outcome could not be distinguished from effects of case mix factors.Hart, Tessa, Kozlowski, Allan J., Whyte, John, Poulsen, Ingrid, Kristensen, Karin, Nordenbo, Annette, Heinemann, Allen W.Moss Traumatic Brain Injury Model SystemYesdevopsadmin
2015Group therapy use and its impact on the outcomes of inpatient rehabilitation after traumatic brain injury: Data from traumatic brain injury-practice based evidence projectJournalJ72091Archives of Physical Medicine and Rehabilitation968, Supplement 3S282-S292Study examined the amount and content of group therapies provided during inpatient rehabilitation for traumatic brain injury (TBI), and assessed the relationship of group therapy with patient, injury, and treatment factors and outcomes. Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. Outcomes examined included: proportion of sessions that were group therapy (2 patients were treated simultaneously by 1 clinician); proportion of patients receiving group therapy; type of activity performed and amount of time spent in group therapy, by discipline; rehabilitation length of stay; discharge location; and Functional Independence Measure (FIM) cognitive and motor scores at discharge. Results indicated 79 percent of the patients received at least 1 session of group therapy, with group therapy accounting for 13.7 percent of all therapy sessions and 15.8 percent of therapy hours. On average, patients spent 2.9 hours per week in group therapy. The greatest proportion of treatment time in group format was in therapeutic recreation (25.6 percent), followed by speech therapy (16.2 percent), occupational therapy (10.4 percent), psychology (8.1 percent), and physical therapy (7.9 percent). Group therapy time and type of treatment activities varied among admission FIM cognitive subgroups and treatment sites. Several factors appear to be predictive of receiving group therapy, with the treatment site being a major influence. However, group therapy as a whole offered little explanation of differences in the outcomes studied.Hammond, Flora M., Barrett, Ryan, Dijkers, Marcel P., Zanca, Jeanne M., Horn, Susan D., Smout, Randall J., Guerrier, Tami, Hauser, Elizabeth, Dunning, Megan R.Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2016How do intensity and duration of rehabilitation services affect outcomes from severe traumatic brain injury? A natural experiment comparing health care delivery systems in 2 developed nationsJournalJ74952Archives of Physical Medicine and Rehabilitation97122045-2053Study investigated the effects of inpatient and outpatient treatment intensity on functional and emotional well-being outcomes at 1 year after severe traumatic brain injury (TBI). The outcomes of patients treated in a specialized TBI treatment center in the United States (US) were compared with those of patients in a Denmark (DK) center providing significantly greater intensity and duration of rehabilitation. Outcome Measures included the Functional Independence Measures, Glasgow Outcome Scale-Extended, Disability Rating Scale, Participation Assessment with Recombined Tools-Objective, Perceived Quality of Life, Medical Outcomes Study 12-Item Short-Form Health Survey, Brief Symptom Inventory--18-item version. Of the 274 participants enrolled, 246 (128 U.S and 118 DK) contributed functional outcomes data at 1 year. Despite identical inclusion criteria, patient severity on admission was greater at the DK site. After adjustment for patient/injury characteristics, there were no site differences in either functional or emotional outcome at 12 months. Significantly more inpatient plus outpatient treatment was administered to DK patients than to those in the US. For functional but not emotional treatments, more severely impaired patients received higher doses. One-year outcomes were predicted by admission severity, age, employment, and other baseline characteristics. Contrary to expectation, DK patients who received significantly more rehabilitation services during the year after severe TBI did not differ in outcome from their less intensively treated US counterparts, after adjusting for initial severity. The negative association of functional treatment dose with extent of early disability suggests that dose was driven by unmeasured factors reflecting need for services. Improved measures of injury-related factors driving treatment allocation are needed to model the independent effects of treatment on outcomes.Hart, Tessa, Whyte, John, Poulsen, Ingrid, Kristensen, Karin S., Nordenbo, Annette M., Chervoneva, Inna, Vaccaro, Monica J.Moss Traumatic Brain Injury Model SystemYesdevopsadmin
2016Improving the employment outcomes of individuals with traumatic brain injury: The effectiveness of knowledge translation strategies to impact the use of evidence-based practices by vocational rehabilitation counselorsJournalJ74436Journal of Vocational Rehabilitation451107-115Study compared the effects of two knowledge translation (KT) strategies on the knowledge and future actions of vocational rehabilitation (VR) counselors when supporting individuals with traumatic brain injury (TBI). Seventy-one participants recruited from a single state VR agency were randomly assigned to one of two groups. Both groups received the same information on supported employment for individuals with TBI over a three-month period. One group received the information via pre-recorded video presentations that were posted on an unlisted YouTube channel. The second group received the identical information via three non-technical briefs. Participants were assessed pre- and post-intervention with a Likert-scale instrument designed to measure knowledge of TBI, the effects of TBI on employment, and the efficacy of the supported employment approach for this group. In addition, participants were asked pre- and posttest how likely they were to fund services related to supported employment for individuals with TBI. Knowledge increased for both groups from baseline to post intervention. No significant group differences were found between the two interventions. However there were changes in perceptions of funding employment activities, barriers to employment, and number of Status 26 (successful employment) closures. While the study did not identify the most effective means of delivering information to VR counselors, implications for future research are discussed.Inge, Katherine J., Graham, Carolyn W., Erickson, Doug, Sima, Adam, West, Michael, Cimera, Rob E.Nodevopsadmin
2017Factors associated with rehabilitation outcomes after traumatic brain injury: Comparing functional outcomes between TBIMS centers using hierarchical linear modelingJournalJ76526Journal of Head Trauma Rehabilitation324E1-E10Study examined differences in patient outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers and identified factors that influence these differences using hierarchical linear modeling (HLM) to analyze prospectively collected data. HLM is a multileveled, linear modeling approach that is especially useful when individuals are nested within centers. Data were obtained from a total of 2,056 individuals 16 years or older with moderate-to-severe traumatic brain injury (TBI) who received inpatient rehabilitation across 16 TBIMS centers Functional outcomes were measured using the Functional Independence Measure and Disability Rating Scale total scores at discharge and 1 year after TBI. Patient demographics and clinical factors that may influence functional outcomes were included in the modeling. Results revealed that duration of posttraumatic amnesia (PTA) demonstrated a significant inverse relationship with functional outcomes. However, the magnitude of this relationship (change in functional status for each additional day in PTA) varied among centers. Functional status at discharge from rehabilitation and at 1-year postinjury could be predicted using the slope and intercept of each TBIMS center for the duration of PTA, by comparing it against the average slope and intercept. HLM was able to demonstrate center effect due to variability in the relationship between PTA and functional outcomes of patients. This variability is not accounted for in traditional linear regression modeling. Future studies examining variations in patient outcomes between centers should utilize HLM to measure the impact of additional factors that influence patient rehabilitation functional outcomes.Dahdah, Marie N., Hoffman,Melissa, Pretz, Christopher, An, Viktoriya, Barnes, Sunni A., Bennett, Monica, Dreer, Laura E., Bergquist, Thomas, Shafi, ShahidUAB Traumatic Brain Injury Model System, North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2015Information/education page: Cognitive problems after traumatic brain injuryJournalJ70661Archives of Physical Medicine and Rehabilitation961177-178Article outlines the types of cognitive problems that can occur after traumatic brain injury (TBI). They include: difficulties with attention and concentration; problems with processing and understanding information; language and communication problems; problems learning and remembering new information; problems with planning and organization; difficulty with reasoning, problem solving, and judgment; and inappropriate, embarrassing, or impulsive behavior. Suggestions for things family members can do to help are offered.Neumann, Dawn, Lequerica AnthonyNodevopsadmin
2017Genetic variation in the vesicular monoamine transporter: Preliminary associations with cognitive outcomes after severe traumatic brain injuryJournalJ75645Journal of Head Trauma Rehabilitation322E24-E34Study investigated associations between the vesicular monoamine transporter-2 (VMAT2) gene variability and cognitive outcomes after traumatic brain injury (TBI). Prior research has demonstrated that genetic variation among monoaminergic genes, such as VMAT2, may affect post-TBI cognitive performance. Researchers evaluated 136 white adults with severe TBI for variation in VMAT2 using a tagging single nucleotide polymorphism (tSNP) approach (rs363223, rs363226, rs363251, and rs363341). Genetic variation interacted with assessed cognitive impairment (cognitive composite [Comp-Cog] T-scores) to influence functional cognition (functional independence measure cognitive [FIM-Cog] subscale] 6 and 12 months postinjury. Multivariate analyses at 6 months postinjury showed rs363226 genotype was associated with Comp-Cog and interacted with Comp-Cog to influence functional cognition. G-homozygotes had the largest cognitive impairment, and their cognitive impairment had the greatest adverse effect on functional cognition. This study provides the first evidence that genetic variation within VMAT2 is associated with cognitive outcomes after TBI. Further work is needed to validate this finding and elucidate mechanisms by which genetic variation affects monoaminergic signaling, mediating differences in cognitive outcomes.Markos, Steven M., Failla, Michelle D., Ritter, Anne C., Dixon, C. Edward, Conley, Yvette P., Ricker, Joseph H., Arenth, Patricia M., Juengst, Shannon B., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2014Health outcome disparities among subgroups of people with disabilities: A scoping reviewJournalJ68202Disability and Health Journal72136-150This scoping review was conducted to describe recent research that has examined health outcome disparities within populations of people with disabilities. MEDLINE, PsycINFO, and CINAHL databases were searched for relevant articles. Three staff independently reviewed abstracts according to inclusion criteria. Two of the authors then independently extracted data from each included article. Extracted items included: definition of disability used in the article, data sources and collection methods, health outcomes, potential disparity factors, analytic methods, comparisons made, and findings. Twenty-nine articles were included in the analysis. For many of the health outcomes of interest, there was no published literature in relation to key disparity factors (e.g. race, income) within the population of people with disabilities. The health outcomes most frequently examined were diabetes and heart disease. The most frequently examined disparity factors were the type of disabling condition and gender. Results suggest that there are significant gaps in available research. Building a body of research that identifies disparities and potentially vulnerable subgroups may improve understanding of the causes of disparities and contribute to efforts to improve quality of life and health outcomes for individuals with disabilities.Rowland, Maya, Peterson-Besse, Jana, Dobbertin, Konrad, Walsh, Emily S., Horner-Johnson, WilliNodevopsadmin
2016Impact of health behaviors and health management on employment after SCI: Psychological health and health managementJournalJ73988Topics in Spinal Cord Injury Rehabilitation222111-120Study examined the impact of psychological functioning and health management behaviors on employment from the perspective of individuals with spinal cord injury (SCI) who were employed at least once following injury. Six focus groups were conducted at 2 sites with 44 participants who were at least 10 years post SCI. All participants had been employed at some point since injury. Heterogeneous and homogeneous groups were delineated based on specific characteristics, such as education, gender, or race. Group sessions followed a semi-structured interview format with questions about personal, environmental, and policy related factors influencing employment following SCI. All group sessions were recorded, transcribed, and coded into conceptual categories to identify topics, themes, and patterns and inferences were drawn about their meaning. Four themes related to psychological health and health management were identified: (1) adjustment and dealing with emotional reactions, (2) gaining self-confidence, (3) preventing burnout, and (4) attitudes and perspectives. Most themes reflected issues that varied based on severity of injury as well as stage of employment. The findings suggest that individuals with SCI who are successful in working following injury must determine how to perform the behaviors necessary to manage their health and prevent emotional or physical complications. The emotional consequences of SCI must be recognized and addressed and specific behaviors enacted in order to optimize employment outcomes.Reed, Karla S., Meade, Michelle A., Krause, James S.Nodevopsadmin
2016Inclusive/universal design: People at the center of the design processJournalJ73299In Mitra Kanaani and Dak Kopec (Eds.). The Routledge Companion for Architecture Design and Practice. New York, NY: Taylor and Francis Group251-267http://athomewithgrowingold.com/wp-content/uploads/Inclusive-Universal-Design-People-at-the-Center-of-the-Design-Process-Routledge-12-15-small.pdfThis chapter frames design as a social art and describes a long, if intermittent, history of designing for people. The author notes the extraordinary demographics of the twenty-first century in which people across the world live longer than ever and survive illness and injury at rates unimaginable even a generation ago. She makes a case for a sense of urgency for design that anticipates diversity of ability as normative and offers examples of promising practices in design that minimize disability and facilitate well-being, performance, and independence.Fletcher, ValerieNodevopsadmin
2017Framing new pathways in transformative exercise for individuals with existing and newly acquired disabilityJournalJ75561Disability and Rehabilitation392173-180Article describes a continuum of customized exercise options for people with an existing and newly acquired disability or diagnosis, referred to as the Transformative Exercise Framework (TEF). After rehabilitation discharge, people with newly acquired disability or diagnoses often never make the transition into usage of community-based exercise services that are tailored, safe, and effective. Transformative exercise is a continuum of individually tailored exercise strategies/programs that aims to assist individuals in moving along a continuum that transitions them from a patient in rehabilitation to a participant in lifelong physical activity. The four focus areas (Rehabilitation, Condition-specific Exercise, Fitness, and Lifetime Physical Activity) emphasize a range of options for people with newly acquired disability and diagnoses, or for people with existing disability and/or chronic health conditions who have a new injury, secondary condition or are severely deconditioned. The TEF supports a patient-to-participant, rehab-to-wellness model that emphasizes a linkage between physical and occupational therapists and community-based exercise trainers. The concept of transformative exercise is to support people with disabilities and diagnoses with a seamless restore–improve–prevent continuum of programs and services. This continuum connects individuals to rehabilitation and exercise professionals in a dynamic framework, which maximizes the expertise of both sets of professionals and provides the most effective interventions to achieve the greatest gains in health and function and/or to avoid future health decline.Rimmer, James, Lai, ByronNodevopsadmin
2014GRAIDs: A framework for closing the gap in the availability of health promotion programs and interventions for people with disabilitiesJournalJ69926Implementation Science9100http://www.implementationscience.com/content/9/1/100Article describes a framework for adapting evidence-based health promotion strategies for people with disabilities. A study illustrates how the framework has been used to adapt the obesity prevention strategies developed by the Centers for Disease Control and Prevention (CDC) for individuals with physical and developmental disabilities. The development of inclusion guidelines, recommendations and adaptations for obesity prevention, referred to as GRAIDs (Guidelines, Recommendations, Adaptations Including Disability), consists of five components: (1) a scoping review of the published and grey literature; (2) an expert workgroup composed of nationally recognized leaders in disability and health promotion who review, discuss, and modify the scoping review materials and develop the content into draft GRAIDs; (3) focus groups with individuals with disabilities and their family members (conducted separately) who provide input on the potential applicability of the proposed GRAIDs in real world settings; (4) a national consensus meeting with 21 expert panel members who review and vote on a final set of GRAIDs; and (5) an independent peer review of GRAIDs by national leaders from key disability organizations and professional groups through an online web portal. This is an ongoing project, and to date, the process has been used to develop 11 GRAIDs to coincide with 11 of the 24 CDC obesity prevention strategies. The study shows that evidence-based programs developed for people without disabilities can now be adapted for people with disabilities using the GRAIDs framework.Rimmer, James H., Vanderbom, Kerri A., Bandini, Linda G., Drum, Charles E., Luken, Karen, Suarez-Balcazar, Yolanda, Graham, Ian D.Nodevopsadmin
2017Hospital-based health care after traumatic brain injuryJournalJ75490Archives of Physical Medicine and Rehabilitation983425-433Study investigated trends of hospital-based healthcare utilization among patients admitted to a level I trauma center between January 1, 2006, and June 30, 2014 after experiencing an acute traumatic brain injury (TBI). The medical records of participants were retrospectively reviewed. Outcome measures included the incidence and type of select hospital-based services received. Analyses were also categorized based on demographic and injury-related information. Of the 5,291 patients with newly acquired TBI who were admitted, 512 died, leaving 4779 patients for inclusion in the final analysis. Additional healthcare utilization from January 1, 2006, and June 30, 2014, was recorded for 3,158 patients, totaling 12,307 encounters, with a median of 3 encounters and a maximum of 102 encounters. Most non-admission urgent or procedural visits (96 percent) and inpatient encounters (93 percent) occurred in the first year. Of all the additional encounters, 9,769 visits were non-admission urgent or procedural visits (79 percent) with a median charge of $1,955. The most common type of encounter was elective (46 percent), followed by medical emergency (29 percent). Of the remaining 2,538 inpatient encounters, the mean length of stay was 6 days with a median charge of $28,450. Medical emergency (39 percent) and elective admissions (33 percent) again were the most common encounter type. This analysis encompasses healthcare utilization across the range of TBI severity and numerous hospital systems, allowing for a more comprehensive and objective identification of reasons for readmission. This represents an initial step to developing a preventive intervention to manage secondary complications postinjury.Salisbury, David B., Driver, Simon J., Reynolds, Megan, Bennett, Monica, Petrey, Laura B., Warren, Anne M.North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2017Improving emotion regulation following web-based group intervention for individuals with traumatic brain injuryJournalJ77071Journal of Head Trauma Rehabilitation325354-365Study evaluated the efficacy of a Web-based group intervention (Online EmReg) to improve emotion regulation (ER) in individuals with traumatic brain injury (TBI). Well-developed ER skills enable individuals to modify their emotional and behavioral responses at will and according to goal objectives and situational demands. Ninety-one individuals with TBI and deficits in ER received 24 one-hour sessions of training in ER skills delivered by group videoconference twice a week over 12 weeks. Participants learned specific EmReg strategies26 and practiced them in session with the guidance of the therapist and feedback from the group. The primary outcome measure was the Difficulties in Emotion Regulation Scale (DERS), a 36-item self-report questionnaire assessing a range of ER skills. Secondary outcome measures included the Positive Affect Negative Affect Schedule (PANAS), Satisfaction With Life Scale (SWLS), Problem Solving Inventory (PSI), Social Problem Solving Inventory-Revised: Short Form (SPSI-R:S), and Dysexecutive Questionnaire (DEX). Primary and secondary measures were administered at baseline, at the end of treatment, and at the 12-week follow-up. Repeated-measures multivariate analysis of variance revealed significant changes with large effect sizes for the DERS at the 12-week follow-up assessment. Significant and moderate changes were found on the SWLS, DEX, PSI, and subscales of the PANAS and SPSI-R:S. Online EmReg appears to be a promising method of delivering a group intervention to improve ER following TBI.Tsaousides, Theodore, Spielman, Lisa, Kajankova, Maria, Guetta, Gabrielle, Gordon, Wayne, Dams-O'Connor, KristenNew York Traumatic Brain Injury Model SystemYesdevopsadmin
2014Factors associated with alcohol-related problems following moderate to severe traumatic brain injuryJournalJ70255Rehabilitation Psychology594453-458Study assessed the contribution of injury severity, demographic variables, and coping style to alcohol-related problems following moderate-to-severe traumatic brain injury (TBI). Participants were enrolled in a longitudinal study and followed up to 15 years following TBI. Data were analyzed for 278 participants with moderate-to-severe TBI who completed questionnaires assessing pre-injury alcohol use, demographic variables, post-injury alcohol-related problems (Short Michigan Alcohol Screening Test [SMAST]), and post-injury coping strategies (Coping Inventory for Stressful Situations). The overall regression model, with time to follow commands, age at the time of TBI, education, time since injury, and task-oriented coping style, was statistically significant. After accounting for other factors, specific post-injury coping strategies were not associated with post-TBI alcohol-related problems. Time to follow commands, education, and time since injury independently explained a unique portion of the variance in the SMAST score. A second multiple regression analysis was conducted for a subset of 95 participants who provided information about premorbid binge drinking. The overall model was not significant, likely due to the reduced power to detect an effect, but premorbid binge drinking explained 4 percent of the variance in SMAST scores. Findings suggest that injury severity, education, and time since injury are important to understanding drinking behaviors should be assessed among those with TBI, and at-risk patients should be informed of the consequences of alcohol use following brain injury.Reslan, Summar, Hanks, Robin A.Southeastern Michigan Traumatic Brain Injury System, Southeastern Michigan Traumatic Brain Injury System Yesdevopsadmin
2016Information/education page: Bowel function after spinal cord injuryJournalJ73168Archives of Physical Medicine and Rehabilitation972339-340Article presents ways to deal with bowel problems after spinal cord injury. Options discussed a bowel program and surgery.Rodriquez, Gianna M.Nodevopsadmin
2015Genetic variation in the adenosine regulatory cycle is associated with posttraumatic epilepsy developmentJournalJ75764Epilepsia5681198-1206https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523397/Study investigate whether genetic variation in enzymes/transporters influencing extracellular adenosine homeostasis, including adenosine kinase (ADK), [ecto-50-nucleotidase (NT5E), cluster of differentiation 73 (CD73)], and equilibrative nucleoside transporter type-1 (ENT-1), is significantly associated with epileptogenesis and posttraumatic epilepsy (PTE) risk. Nine ADK, three CD73, and two ENT-1 tagging single nucleotide polymorphisms (SNPs) were genotyped in 162 white adults with moderate/severe traumatic brain injury (TBI) and no history of premorbid seizures. Kaplan-Meier models were used to screen for genetic differences in time to first seizure occurring more than 1 week after TBI. SNPs remaining significant after correction for multiple comparisons were examined using Cox proportional hazards analyses, adjusting for subdural hematoma, injury severity score, and isolated TBI status. SNPs significant in multivariate models were then entered simultaneously into an adjusted Cox model. Comparing Kaplan-Meier curves, rs11001109 (ADK) rare allele homozygosity and rs9444348 (NT5E) heterozygosity were significantly associated with shorter time to first seizure and an increased seizure rate 3 years after TBI. Multivariate Cox proportional hazard models showed that these genotypes remained significantly associated with increased PTE hazard up to 3 years post TBI after controlling for variables of interest. These findings suggest that genetic variation in ADK and NT5E may help explain variability in time to first seizure and PTE risk, independent of previously identified risk factors, after TBI. Once validated, identifying genetic variation in adenosine regulatory pathways relating to epileptogenesis and PTE may facilitate exploration of therapeutic targets and pharmacotherapy development.Diamond, Matthew L., Ritter, Anne C., Jackson, Edwin K., Conley, Yvette P., Kochanek, Patrick M., Boison, Detlev, Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2015Health care professionals and the employment-related needs of cancer survivorsJournalJ73554Journal of Occupational RehabilitationStudy assessed healthcare professionals’ perceptions of the effects of cancer on patients' employment status, levels of knowledge about supports to address these employment-related needs, and respondents' preferred modes for information receipt. Data were collected via an online survey administered to staff that provide nonmedical services to cancer patients in two Houston-area hospital systems. The findings from 86 respondents were analyzed. Results indicate that tenure as measured by years in oncology is related positively to level of knowledge about disability-related benefits, legislation and programs. Respondents with more years in their profession worked with patients whom they reported had a higher number of cancer side effects that "created work difficulties for patients". The number of side effects was in turn positively associated with negative effects of the diagnosis at work. A higher score of negative effects of the cancer diagnosis at work in turn correlated with unwanted consequences of disclosing the cancer at work. No statistically significant correlations were observed among the variables measuring respondents' reported knowledge of disability-related benefits, laws and programs, their perception of patients' level of understanding of these topics, and reports of patients' receipt of reasonable accommodation. Healthcare professionals who treat cancer patients could benefit from training resources about how survivors might address their employment-related needs, including how to convey that knowledge to their patients. Mentoring programs might also have positive outcomes, since respondents with greater tenure in oncology-related settings reported higher levels of knowledge about disability-related topics.Murphy, Kathleen M., Nguyen, Vinh, Shin, Ki, Sebastian-Deutsch, Amy, Frieden, LexNodevopsadmin
2014Identifying depression severity risk factors in persons with traumatic spinal cord injuryJournalJ68397Rehabilitation Psychology59150-56Study examined the relationship among demographic characteristics, health- and injury-related characteristics, and substance misuse across multiple levels of depression severity in 204 people with traumatic spinal cord injury (SCI). Instruments included the Patient Health Questionnaire-9 depression scale, the Alcohol Use Disorders Identification Test (AUDIT), and the Substance Abuse in Vocational Rehabilitation-Screener (SAVR-S), which contains 3 subscales: drug misuse, alcohol misuse, and a subtle items scale. Each of the SAVR-S subscales contributes to an overall substance use disorder (SUD) outcome. Three proportional odds models were specified, varying the substance misuse measure included in each model. Results indicated that 44 percent of participants had no depression symptoms, 31 percent had mild symptoms, 16 percent had moderate symptoms, 6 percent had moderately severe symptoms, and 3 percent had severe depression symptoms. Alcohol misuse, as indicated by the AUDIT and the SAVR-S drug misuse subscale scores were significant predictors of depression symptom severity. A positive SUD screening outcome as indicated by the SAVR-S was the most predictive variable. Level of education was only significantly predictive of depression severity in the model using the AUDIT alcohol misuse indicator. The findings suggest that drug and alcohol screening are important for identifying individuals at risk for depression after SCI, but screening for both may be optimal.Williams, Ryan T., Wilson, Catherine S., Heinemann, Allen, Lazowski, Linda E., Fann, Jesse R., Bombardier, Charles H.Nodevopsadmin
2016Effects of depression and antidepressant use on cognitive deficits and functional cognition following severe traumatic brain injuryJournalJ74883Journal of Head Trauma Rehabilitation316E62-E73Study evaluated relationships between post–traumatic brain injury (TBI) depression (PTD) and potential associated factors, including antidepressant use, on cognitive recovery following severe TBI. One hundred fifty-four survivors of severe TBI, recruited from a level 1 trauma center, were assessed at 6 and 12 months after injury. Measures included the Patient Health Questionnaire-9 (PTD symptoms), the cognitive composite score from a neuropsychological assessment battery (cognitive impairment), and the Functional Independence Measure-Cognition (FIM-Cog, self-reported functional cognition). Data analysis revealed that individuals with and without PTD did not differ with respect to cognitive impairment. However, antidepressant use, regardless of PTD status, was associated with cognitive impairment. Individuals with PTD reported lower FIM-Cog scores at both time points compared with those without PTD. In a post hoc longitudinal analysis, individuals with late-onset PTD had worse cognitive impairment. These results suggest that antidepressant use impairs cognition among individuals without PTD. Also, PTD did not directly affect cognitive impairment but may affect functional cognitive limitations through self-evaluation and apathy/motivation factors.Failla, Michelle D., Juengst, Shannon B., Graham, Kristin M., Arenth, Patricia M., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2014Employment supports for young adults with autism spectrum disorder: Two case studiesJournalJ68877Journal of Vocational Rehabilitation402117-124Article presents the case studies of successful employment support for two young adults with autism spectrum disorders (ASD). Contrary to reported employment outcomes for young adults with ASD, these two young people experienced success in their transition to employment as a result of intensive job coaching. Their supports included consultation with a positive behavior support facilitator, the implementation of a multi-component behavior intervention plan, and the implementation of supervisor and co-worker training in the implementation of the plan. Both young adults achieved independence at work and maintained successful employment for two years or more with fading supports as a result of this intervention.Ham, Whitney, McDonough, Molinelli, Alissa, Schall, Carol, Wehman, PaulNodevopsadmin
2014Development of a theory-driven rehabilitation treatment taxonomy: Conceptual issuesJournalJ67519Archives of Physical Medicine and Rehabilitation951 (Supplement 1)S24-S32The authors reviewed a range of treatments from published research articles, rehabilitation textbooks, and the clinical experiences of the authors to begin the development of a system of classification of rehabilitation treatments and services that is based on their active ingredients. These treatment examples were used to develop preliminary rules for defining discrete treatments, identifying the area of function they directly treat, and identifying their active ingredients. These preliminary rules were then tested against additional treatment examples and problems in their application were used to revise the rules in an iterative fashion. The following concepts that emerged from this process are defined and discussed in relation to the development of a rehabilitation treatment taxonomy: rehabilitation treatment taxonomy; treatment and enablement theory; recipient (of treatment); essential, active, and inactive ingredients; mechanism of action; targets and aims of treatment; session; progression; dosing parameters; and social and physical environment.Whyte, John, Dijkers, Marcel P., Hart, Tessa, Zanca, Jeanne M., Packel, Andrew, Ferraro, Mary, Tsaousides, TheodoreNodevopsadmin
2017Disability at work: A look back and forwardJournalJ78112Journal of Occupational Rehabilitation274482-497This article presents new evidence on employment barriers and workplace disparities facing employees with disabilities, using data from the 2006 General Social Survey to link the disparities to employee attitudes. Analyses examined the interrelations among employment experiences, perceptions, job preferences, and employment outcomes of respondents with and without disabilities. Compared to employees without disabilities, those with disabilities report: lower pay levels, job security, and flexibility; more negative treatment by management; and, lower job satisfaction but similar organizational commitment and turnover intention. The lower satisfaction is mediated by lower job security, less job flexibility, and more negative views of management and co-worker relations. Prior research and the new evidence presented show that people with disabilities experience employment disparities that limit their income, security, and overall quality of work life. Technology plays an increasingly important role in decreasing employment disparities. However, there also should be increased targeted efforts by government, employers, insurers, occupational rehabilitation providers, and disability groups to address workplace barriers faced by employees with disabilities, and by those with disabilities seeking to return to work.Schur, Lisa, Han, Kyongji, Kim, Andrea, Ameri, Mason, Blanck, Peter, Kruse, DouglasNodevopsadmin
2016Evaluating the psychometric properties and responsiveness to change of 3 depression measures in a sample of persons with traumatic spinal cord injury and major depressive disorderJournalJ73972Archives of Physical Medicine and Rehabilitation976929-937Study compared the measurement properties and responsiveness to change of the Patient Health Questionnaire-9 (PHQ-9), the Hopkins Symptom Checklist-20 (HSCL-20), and the Hamilton Depression Rating Scale (HAM-D) in people with spinal cord injury (SCI) diagnosed with major depressive disorder (MDD). This was a secondary analysis of depression symptoms measured at 6 occasions over 12 weeks as part of a randomized controlled trial of venlafaxine XR for MDD in patients with SCI. A total of 133 adults with traumatic SCI and diagnosis of MDD completed the drug trial. Patients completed the PHQ-9 and the HSCL-20 depression scales; clinical investigators completed the HAM-D and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) Dissociative Disorders, which was used as a diagnostic criterion measure. All 3 instruments were improved with rating scale analysis. The HSCL-20 and the HAM-D contained items that misfit the underlying construct and that correlated weakly with the total scores. Removing these items improved the internal consistency, with floor effects increasing slightly. The HAM-D correlated most strongly with Structured Clinical Interview for DSM-IV Dissociative Disorders diagnoses. Improvement in depression was similar on all outcome measures in both treatment and control groups. The psychometric properties of the revised depression instruments are more than adequate for routine use in adults with SCI and are responsive to clinical improvement. The PHQ-9 is the simplest instrument with measurement properties as good as or better than those of the other instruments and required the fewest modifications.Williams, Ryan T., Heinemann, Allen W., Neumann, Holly D., Fann, Jesse R., Forchheimer, Martin, Richardson, Elizabeth J., Bombardier, Charles H.Nodevopsadmin
2015Effectively communicating knowledge to assistive technology stakeholders: Three randomized controlled case studiesJournalJ71566Assistive Technology Outcomes and Benefits9198-159http://www.atia.org/i4a/pages/index.cfmArticle describes a research project that evaluated the effectiveness of tailor-and-target and target-only approaches designed to communicate new knowledge to multiple stakeholders of assistive technology (AT). A series of 3 randomized controlled studies were conducted focused on knowledge uptake and use by stakeholders in three AT areas: (1) augmentative and alternative communication, (2) recreational access, and (3) wheeled mobility. Participants represented 5 types of stakeholders in each technology area: researchers, clinician practitioners, manufacturers, consumers, and knowledge brokers/consumer advocates. To develop the intervention strategies, each study selected findings from a peer-reviewed research publication in the respective AT area to be communicated to stakeholders. The tailor-and-target strategy tailored the findings to the five types of stakeholders. Each study used both strategies as interventions that communicated new knowledge. The traditional diffusion method was used as the control. Across the studies, both interventions were effective with the total samples as compared to control. However, they did not differ from each other, suggesting that the added effort involved in tailoring new knowledge might be unnecessary as a general rule. Tailoring appeared to be more effective with some stakeholder types as results showed differential effects between stakeholder groups and across the 3 studies. Overall, the results supported effectiveness of the 2 strategies in raising awareness and also in persuading non-users to using the knowledge.Stone, Vasthala I., Lane, Joseph P., Tomita, Machiko R., Flagg, Jennifer L., Leahy, James A., Lockett, Michelle M., Oddo, Christine, Usiak, Douglas J.Nodevopsadmin
2015Emergency room visits and hospitalizations among participants with spinal cord injuryJournalJ72221NeuroRehabilitation363313-321Study assessed the frequency of emergency room visits (ERV) and emergency room related hospitalizations (ERH) and their likelihood as a function of demographic, injury, and socioeconomic characteristics among individuals with long-term spinal cord injury (SCI). A total of 1,579 participants with SCI completed mailed self-report questionnaires. Results showed that 37 percent of participants reported at least one ERV, with an average of 85 ERV per 100 participants. Nineteen percent reported at least one ERH and an average of 33 ERH annually per 100 participants. A greater likelihood of ERV was observed among non-whites, those with more severe SCI, less education, and lower income. Among those with at least one ERV, greater risk of ERH was observed among non-Hispanic whites, those with more severe SCI, lower education, and higher age. The findings suggest that ERV are common after SCI and should be accounted for when predicting SCI related expenses. Those with the most severe SCI and those in the oldest age group were most likely to be hospitalized after an ERV.Krause, James S., Terza, Joseph V., Cao, Yue, Clark, Jillian M. R.Nodevopsadmin
2015Environmental factors item development for persons with stroke, traumatic brain injury, and spinal cord injuryJournalJ71245Archives of Physical Medicine and Rehabilitation964589-595Article presents the results of a research project to develop measures of environmental factors that affect participation and defines an initial item set of facilitators and barriers to participation after stroke, traumatic brain injury, and spinal cord injury. Instrument development included an extensive literature review, item classification and selection, item writing, and cognitive testing following the approach of the Patient-Reported Outcomes Measurement Information System. Ten content area and outcome measurement experts contributed to instrument development; 200 individuals with the target conditions participated in focus groups and 15 participated in cognitive testing. Environmental factor items were categorized in 6 domains: assistive technology; built and natural environment; social environment; services, systems, and policies; access to information and technology; and economic quality of life. The authors binned 2,273 items across the 6 domains, winnowed this pool to 291 items for cognitive testing, and recommended 274 items for pilot data collection. Five of the 6 domains correspond closely to the International Classification of Functioning, Disability and Health taxonomy of environmental factors; the sixth domain, economic quality of life, reflects an important construct that reflects financial resources that affect participation. Testing with a new and larger sample is underway to evaluate reliability, validity, and sensitivity.Heinemann, Allen W., Magasi, Susan, Hammel, Joy, Carlozzi, Noelle E., Garcia, Sofia F., Hahn, Elizabeth A., Lai, Jin-Shei, Tulsky, David, Gray, David B., Hollingsworth, Holly, Jerousek, SaraNodevopsadmin
2017Development of the life impact burn recovery evaluation (LIBRE) profile: Assessing burn survivors' social participationJournalJ76048Quality of Life ResearchArticle describes the development and evaluation of the Life Impact Burn Recovery Evaluation (LIBRE) Profile, a patient-reported multidimensional assessment for understanding the social participation after burn injuries. One hundred ninety-two questions representing multiple social participation areas were administered to 601 burn survivors. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to identify the underlying structure of the data. Using item response theory methods, a Graded Response Model was applied for each identified sub-domain. The resultant multidimensional LIBRE Profile can be administered via computerized adaptive testing (CAT) or fixed short forms. The study sample was 54.7 percent women with a mean age of 44.6 years. The average time since burn injury was 15.4 years and the average total body surface area burned was 40 percent. The CFA indicated acceptable fit statistics. The six unidimensional scales were named: relationships with family and friends, social interactions, social activities, work and employment, romantic relationships, and sexual relationships. The marginal reliability of the full item bank and CATs ranged from 0.84 to 0.93, with ceiling effects less than 15 percent for all scales. Finding suggest that the LIBRE Profile is a promising new measure of social participation following a burn injury that enables burn survivors and their care providers to measure social participation.Kazis, Lewis E., Marino, Molly, Ni, Pengsheng, Bori, Marina S., Amaya, Flor, Dore, Emily, Ryan, Colleen M., Schneider, Jeff C., Shie, Vivian, Acton, Amy, Jette, Alan M.Nodevopsadmin
2016Duration of posttraumatic amnesia predicts neuropsychological and global outcome in complicated mild traumatic brain injuryJournalJ74877Journal of Head Trauma Rehabilitation316E1-E9Study examined the effects of posttraumatic amnesia (PTA) duration on neuropsychological and global recovery from 1 to 6 months after complicated mild traumatic brain injury (cmTBI). A total of 330 persons with cmTBI, defined as Glasgow Coma Scale (GCS) score of 13 to 15 in emergency department, with well-defined abnormalities on neuroimaging, were enrolled within 24 hours of injury with follow-up at 1, 3, and 6 months. Outcome measures included the Glasgow Outcome Scale-Extended (GOS-E), California Verbal Learning Test II, and Controlled Oral Word Association Test. Duration of PTA was retrospectively measured with structured interview at 30 days after injury. Results showed that, despite all having a GCS score of 13 to 15, a quarter of the sample had a PTA duration of greater than 7 days and half had a PTA duration of 1 of 7 days. Both cognitive performance and GOS-E outcomes were strongly associated with time since injury and PTA duration, with those with PTA duration of greater than 1 week showing residual moderate disability at 6-month assessment. The findings reinforce importance of careful measurement of duration of PTA to refine outcome prediction and allocation of resources to those with cmTBI. Future research would benefit from standardization in computed tomographic criteria and use of severity indices beyond the GCS to characterize cmTBI.Hart, Tessa, Novack, Thomas A., Temkin, Nancy, Barber, Jason, Dikmen, Sureyya S., Diaz-Arrastia, Ramon, Ricker, Joseph, Hesdorffer, Dale C., Jallo, Jack, Hsu, Nancy H., Zafonte, RossSpaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2014Evaluation of the short-term executive plus intervention for executive dysfunction after traumatic brain injury: A randomized controlled trial with minimizationJournalJ67771Archives of Physical Medicine and Rehabilitation9519-JanStudy evaluated the efficacy of the Short-Term Executive Plus (STEP) cognitive rehabilitation program for improving executive dysfunction, attention, and emotional regulation after traumatic brain injury (TBI). The goal of STEP is to teach a core set of metacognitive skills that can be applied across a wide range of real-life activities. The treatments included in STEP are problem solving training, emotional regulation training, attention training, and use of cognitive supports. Ninety-eight participants with TBI and executive dysfunction were randomly to immediately start the STEP program (12 weeks of group training in problem solving and emotional regulation and individual sessions of attention and compensatory strategies training) or to the waitlist. Factor analysis was used to create a composite executive function measure using the Problem Solving Inventory (PSI), Frontal Systems Behavior Scale (FSBS), Behavioral Assessment of the Dysexecutive Syndrome, and Self-Awareness of Deficits Interview. Emotional regulation was assessed with the Difficulties in Emotion Regulation Scale. The primary attention measure was the Attention Rating and Monitoring Scale. Secondary measures included neuropsychological measures of executive function, attention, and memory and measures of affective distress, self-efficacy, social participation, and quality of life (QOL). Intention-to-treat mixed-effects analyses revealed significant treatment effects for the composite executive function measure and the FSBS and PSI. No between-group differences were found on the neuropsychological measures or on measures of attention, emotional regulation, self-awareness, affective distress, self-efficacy, participation, or QOL. Results suggest that the STEP program is efficacious in improving self-reported post-TBI executive function and problem solving.Cantor, Joshua, Ashman, Teresa, Dams-O'Conor, Kristen, Dijkers, Marcel P., Gordon, Wayne, Spielman, Lisa, Tsaousides, Theodore, Allen, Hafina, Nguyen, Michael, Oswald, JenniferNew York Traumatic Brain Injury Model SystemYesdevopsadmin
2016Effects of an employer-based intervention on employment outcomes for youth with significant support needs due to autismJournalJ74348AutismStudy implemented an employer-based intervention for high school youth with autism spectrum disorder (ASD) to learn job skills and acquire employment. The intervention modified a program titled Project SEARCH and incorporated the use of applied behavior analysis to develop Project SEARCH plus Autism Spectrum Disorder Supports (PS-ASD). A randomized clinical trial compared the implementation of PS-ASD with high school special education services as usual. Participants were 49 students between the ages of 18 and 21 years, diagnosed with an ASD, eligible for supported employment, and able to demonstrate independent self-care. At 3 months after graduation, 90 percent of the treatment group acquired competitive, part-time employment earning $9.53 to $10.66 per hour. Furthermore, 87 percent of those individuals maintained employment at 12 months post-graduation. The control group’s employment outcomes were 6 percent acquiring employment by 3 months post-graduation and 12 percent acquiring employment by 12 months post-graduation. The positive employment outcomes generated by the treatment group provide evidence that youth with ASD can gain and maintain competitive employment. Additionally, there is evidence that they are able to advance within that time toward more weekly hours worked, while they also displayed increasing independence in the work setting.Wehman, Paul, Schall, Carol M., McDonough, Jennifer, Graham, Carolyn, Brooke, Valerie, Riehle, J. Erin, Brooke, Alissa, Ham, Whitney, Lau, Stephanie, Allen, Jacklyn, Avellone, LaurenNodevopsadmin
2015Employment interventions for individuals with ASD: The relative efficacy of supported employment wth or without prior project SEARCH trainingJournalJ73204Journal of Autism and Developmental Disorders (JADD)45123990-4001Study compared the outcomes associated with implementation of supported employment (SE) with and without prior Project SEARCH with autism spectrum disorder (ASD) Supports (PS-ASD) on wages earned, time spent in intervention, and job retention. The SE intervention uses a four-step process to assist job seekers in achieving stability in competitive employment: job seeker profile, job development, job site training, and long-term support (LTS) services. PS-ASD is a school-to-work transition program in which youth with ASD in their last year of high school are embedded in a large community business to teach them job skills. Upon the acquisition of a job or the completion of the program, the student then transitions to adult services and receives SE until they achieve stability on the job and enter into LTS services. Clinical records were reviewed for 45 adults with ASD who received SE from the same agency. Twenty-five individuals received prior intervention through PS-ASD while the other 20 individuals received SE only. The individuals in the PS-ASD group differed from the individuals in the SE-only group only in that they received a very specific vocational training intervention in their last year of high school. The data collected included the number of hours of intervention, length of time in the job, and wages earned. Results suggest that SE resulted in competitive employment for both groups. Individuals who received PS-ASD required fewer hours of intervention. Additionally, individuals in the PS-ASD group achieved a mean higher wage and had higher retention rates than their peers who received SE only.Schall, Carol M., Wehman, Paul, Brooke, Valerie, Graham, Carolyn, McDonough, Jennifer, Brooke, Alissa, Ham, Whitney, Rounds, Rachael, Lau, Stephanie, Allen, JaclynNodevopsadmin
2014Development of a measure of knowledge use by stakeholders in rehabilitation technologyJournalJ69927SAGE Open Medicine2http://smo.sagepub.com/content/2/2050312114554331.full.pdf+htmlArticle describes the development of the Level of Knowledge Use Survey (LOKUS) instrument, a web-based measure of self-reported knowledge use. The LOKUS was developed in the context of assessing effectiveness of knowledge communication strategies in rehabilitation technology. It was validated on samples representing five stakeholder types: researchers, manufacturers, clinician–practitioners, knowledge brokers, and consumers. Its structure is broadly based on Rogers’ stages of innovation adoption. Its item generation was initially guided by Hall et al’s Levels of Use framework. Item selection was based on content validity indices computed from expert ratings. Five representative stakeholders established usability of the web version. The version included 47 items (content validity index for individual items >0.78; content validity index for a scale or set of items >0.90) in self-reporting format. Psychometrics were then established for the version. Analyses of data from small (69 subjects) and large (215 subjects) samples using the LOKUS suggested a conceptual model of four levels of knowledge use: Non-awareness, Awareness, Interest, and Use. The levels covered eight dimensions and six user action categories. The sequential nature of levels was inconclusive due to low cell frequencies. The LOKUS showed adequate content validity and excellent test–retest reliability. It also demonstrated good construct validity for differentiating among new knowledge outputs and among stakeholder types. It showed strong responsiveness to change between baseline and follow-up testing. The LOKUS instrument is valid and reliable for measuring uptake of innovations across diffuse stakeholders of rehabilitation technologies and therefore also for tracking changes in knowledge use.Stone, Vathsala I., Nobrega, Amanda R., Lane, Joseph P., Tomita, Machiko R., Usiak, Douglas J., Lockett, Michelle M.Nodevopsadmin
2017Evaluating the effectiveness of Facebook to impact the knowledge of evidence-based employment practices by individuals with traumatic brain injury: A knowledge translation random control studyJournalJ77612Work: A Journal of Prevention, Assessment, and Rehabilitation58173-81Study compared the effect of a knowledge translation (KT) strategy using a secret Facebook group, on the knowledge of evidence-based employment research by individuals with traumatic brain injury (TBI). Sixty individuals with TBI were recruited through clubhouse programs in the state where the researchers resided as well as through support groups nationally for individuals with TBI, and were randomly assigned to one of two groups. Both groups received information on evidence-based employment practices for individuals with TBI over a three month period. One group received the information via participation in a secret Facebook group while the comparison group received information as an “e-news” email blast. The email blast was considered the “business as usual” approach to delivering information on employment evidence-based practices. Participants were assessed before and after the intervention with a Likert-scale instrument designed to measure knowledge of evidenced-based employment information for TBI. Both groups gained a significant amount of knowledge between baseline and post-intervention. However, there were no significant differences between groups in knowledge gained at post-intervention. While the study did not identify the most effective means of delivering information to individuals with TBI, it does provide some guidance for future KT research.Inge, Katherine J., Graham, Carolyn W., McLaughlin, James W., Erickson, Doug, Wehman, Paul, Seward, Hannah E.Nodevopsadmin
2016Diffusion tensor imaging in acute-to-subacute traumatic brain injury: A longitudinal analysisJournalJ75739BMC Neurology162https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707723/Study investigated the direction and magnitude of early longitudinal changes in white matter fractional anisotropy (FA) in patients with traumatic brain injury (TBI) and determined whether acute or subacute FA values correlate more reliably with functional outcomes after TBI. From a prospective TBI outcomes database, 11 patients who underwent acute (≤7 days) and subacute (8 days to rehabilitation discharge) diffusion tensor imaging (DTI) were retrospectively analyzed. Longitudinal changes in FA were measured in 11 white matter regions susceptible to traumatic axonal injury. Correlations were assessed between acute FA, subacute FA and the disability rating scale (DRS) score, which was ascertained at discharge from inpatient rehabilitation. Results indicated that FA declined from the acute-to-subacute period in the genu of the corpus callosum (0.70 vs. 0.55) and inferior longitudinal fasciculus (0.54 vs. 0.49). Acute correlations between FA and DRS score were variable: higher FA in the body (−0.78) and splenium (−0.83) of the corpus callosum was associated with better outcomes (i.e. lower DRS scores), whereas higher FA in the genu of the corpus callosum corresponded with worse outcomes (i.e. higher DRS scores). In contrast, in the subacute period higher FA in the splenium correlated with better outcomes and no inverse correlations were observed. In this study, white matter FA declined during the acute-to-subacute stages of TBI. Variability in acute FA correlations with outcome suggests that the optimal timing of DTI for TBI prognostication may be in the subacute period.Edlow, Brian L., Copen, William A., Izzy, Saef, Bakhadirov, Khamid, van der Kouwe, Andre, Glenn, Mel B., Greenberg, Steven M., Greer, David M., Wu, OnaSpaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2014Effect of supported employment on vocational rehabilitation outcomes of transition-age youth with intellectual and developmental disabilities: A case control studyJournalJ69377Intellectual and Developmental Disabilities524296-310Study examined the effect of supported employment intervention on the employment outcomes of transition-age youth with intellectual and developmental disabilities (IDD) served by the public vocational rehabilitation (VR) system using a case-control study design. Data for this study were extracted from the Rehabilitation Services Administration Case Service Report (RSA-911) database for fiscal year 2009. The sample included 23,298 youth with IDD aged between 16 and 25 years old at the time of application. The classification and regression tree method was used to estimate propensity scores and to adjust for selection bias on the basis of all prominent covariates relevant to the dependent variable (competitive employment). Results yielded six homogeneous subgroups, and receipt of supported employment was found to increase the employment rates across all of the groups. The effect of supported employment was especially strong for youth who were Social Security beneficiaries, special education students, and individuals with intellectual disabilities or autism who were high school graduates. These findings suggest that supported employment is an effective service for enhancing the VR outcomes of young adults and provides valuable information for policy makers, healthcare providers, rehabilitation counselors, and educators.Wehman, Paul, Chan, Fong, Ditchman, Nicole, Kang, Hyun-JuNodevopsadmin
2015Efficacy of venlafaxine XR for the treatment of pain in patients with spinal cord injury and major depression: A randomized, controlled trialJournalJ71255Archives of Physical Medicine and Rehabilitation964680-689Study investigated the efficacy of venlafaxine XR for the treatment of pain (secondary aim) in individuals with spinal cord injury (SCI) enrolled in a randomized controlled trial on the efficacy of venlafaxine XR for major depressive disorder (MDD) (primary aim). It also tested the hypothesis that venlafaxine XR would be effective for both neuropathic and nociceptive pain. A total of 123 adults with SCI and major depression who also reported pain were randomly assigned to 12 weeks of active treatment (venlafaxine XR) or inactive placebo using a flexible titration schedule. Outcome measures included a 0-to-10 numeric rating scale for pain intensity, and pain interference items of the Brief Pain Inventory. Results indicated that the effect of venlafaxine XR on neuropathic pain was similar to that of placebo. However, venlafaxine XR resulted in statistically significant and clinically meaningful reductions in nociceptive pain site intensity and interference even after controlling for anxiety, depression, and multiple pain sites within the same individual. For those who achieved a minimally effective dose of venlafaxine XR, some additional evidence of effectiveness was noted for those with mixed (both neuropathic and nociceptive) pain sites. Findings suggest that venlafaxine XR could complement current medications and procedures for treating pain after SCI and MDD that has nociceptive features. Its usefulness for treating central neuropathic pain is likely to be limited. Research is needed to replicate these findings and determine whether the antinociceptive effect of venlafaxine XR generalizes to people with SCI pain without MDD.Richards, J. Scott, Bombardier, Charles H., Wilson, Catherine S., Chiodo, Anthony E., Brooks, Larry, Tate, Denise G., Temkin, Nancy R., Barber, Jason K., Heinemann, Allen W., McCullumsmith, Cheryl, Fann, Jesse R.Nodevopsadmin
2015Environmental barriers and supports to everyday participation: A qualitative insider perspective from people with disabilitiesJournalJ71244Archives of Physical Medicine and Rehabilitation964578-588Study identified and described environmental factors that influence participation of people with disabilities. Data were obtained through constant comparative, qualitative analyses of transcripts from 36 focus groups across 5 research projects conducted with 201 community-dwelling people with diverse disabilities (primarily spinal cord injury, traumatic brain injury, and stroke) from 8 states. Results revealed 8 major categories of environmental factors that influence participation: built, natural, transportation, assistive technology, information and technology access, social support and societal attitudes, systems and policies, and economics. Participants described these environmental factors as facilitators and/or barriers, enabling and/or disabling participation in different participation contexts. The authors developed a conceptual framework to describe how environmental factors influence the participation of people with disabilities, and a transactional model showing the influence of environmental factors on participation at the micro (individual), mesa (community), and macro (societal) levels. The results have implications for assessing environmental facilitators and barriers to participation within rehabilitation and community settings, evaluating outcomes of environmental interventions, and effecting system and policy changes to target environmental barriers that may result in societal participation disparities versus opportunities.Hammel, Joy, Magasi, Susan, Heinemann, Allen W., Gray, David B., Stark, Susan, Kisala, Pamela, Carlozzi, Noelle E., Tulsky, David, Garcia, Sofia F., Hahn, Elizabeth A.Nodevopsadmin
2015Development of self-report measures of social attitudes that act as environmental barriers and facilitators for people with disabilitiesJournalJ71246Archives of Physical Medicine and Rehabilitation964596-603Article describes the development of new self-report measures of social attitudes that act as environmental facilitators or barriers to the participation of people with disabilities in society. A mixed-methods approach included a literature review; item classification, selection, and writing; cognitive interviews and field testing of participants with spinal cord injury (SCI), traumatic brain injury (TBI), or stroke; and rating scale analysis to evaluate initial psychometric properties. An interdisciplinary team of experts classified 710 existing social environment items into content areas and wrote 32 new items. Additional qualitative item review included item refinement and winnowing of the pool prior to cognitive interviews and field testing of 82 items. Nine individuals with SCI, TBI, or stroke participated in cognitive interviews; 305 community residents with those same conditions participated in field testing. Field test data indicated that the pool satisfies a 1-parameter item response theory measurement model and would be appropriate for development into a calibrated item bank. The qualitative item review process supported a social environment conceptual framework that includes both social support and social attitudes and developed a new social attitudes self-report item pool. Calibration testing of that pool is underway with a larger sample to develop a social attitudes item bank for people with disabilities.Garcia, Sofia F., Hahn, Elizabeth A., Magasi, Susan, Lai, Jin-Shei, Semik, Patrick, Hammel, Joy, Heinemann, Allen W.Nodevopsadmin
2015Dual diagnosis of traumatic brain injury and alcohol use disorder: Characterizing clinical and neurobiological underpinningsJournalJ75716Current Addiction Reports24273-284https://link.springer.com/article/10.1007/s40429-015-0078-3Article reviews the evidence that presents the clinical picture of co-occurring traumatic brain injury (TBI) and alcohol use disorder (AUD), including the overlapping cognitive dysfunction and underlying neurobiological alterations. Recent evidence indicates that TBI can increase the risk of developing AUD. TBI and AUD share common symptoms including cognitive dysfunction. Therefore, it is of interest to better understand how reward-mediated behaviors central to alcohol addiction, such as alcohol craving, may interact with the cognitive dysfunction of TBI both at the behavioral and neurobiological level. A neuroimaging case series is used to illustrate how neural activation to alcohol cues may provide insight into the unique brain state of co-occurring mild TBI and AUD. Treatment implications for TBI and AUD and their co-occurrence are also discussed. Finally, the authors provide an overview of potential treatments for the co-occurrence of TBI and AUD.Herrold, Amy A., Sander, Angelle M., Wilson, Kimberlee V., Scimeca, Lauren M., Cobia, Derin J., Breiter, Hans C.Texas TBI Model System of TIRRYesdevopsadmin
2016Evaluation of a physical activity behavior change program for individuals with a brain injuryJournalJ75251Archives of Physical Medicine and Rehabilitation979 (Supplement 3)S194-S200Study investigated the effectiveness of a physical activity intervention for use within a comprehensive outpatient rehabilitation program for individuals with brain injury. Forty-seven individuals with a brain injury were enrolled in either the intervention group or control group. The intervention consisted of an 8-week informational and social/behavioral program that focused on enabling individuals to become independently active. The control group completed the standard of care typically available to patients in comprehensive outpatient rehabilitation. Assessments completed pre- and post-intervention and at 3-month follow-up included physical activity as the primary outcome and exercise self-efficacy and rehabilitation outcomes as secondary outcomes. Outcome measures included the Behavioral Risk Factor Surveillance Survey self-report physical activity items, Exercise Self-Efficacy Scale, and Mayo-Portland Adaptability Inventory-4. The intervention group reported significantly greater weekly activity, self-efficacy, and rehabilitation outcomes at the completion of the program as well as at the 3-month follow-up when compared with the control group. Significantly, individuals in the experimental group reported increasing their weekly activity from 45 minutes preprogram to 72 minutes post-program, and 67 minutes at 3-month follow-up. Findings suggest that the intervention may be effective in increasing the physical activity behaviors of individuals engaged in a comprehensive outpatient rehabilitation program after brain injury.Driver, Simon, Woolsey, AnneNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2016Effectiveness of group wheelchair skills training for people with spinal cord injury: A randomized controlled trialJournalJ74706Archives of Physical Medicine and Rehabilitation97101777-1784, 1784.e1-1784.e3Study assessed the effectiveness of group wheelchair skills training to elicit improvements in wheelchair skills for people with spinal cord injury (SCI). Participants were recruited from 4 SCI Model Systems Centers. A total of 114 manual wheelchair users with SCI were randomly assigned to six 90-minute group Wheelchair Skills Training Program (WSTP) classes or two 1-hour active control sessions with 6 to 10 people per group. Baseline (t1) and 1-month follow-up (t2) measures included the Wheelchair Skills Test Questionnaire (WST-Q) for capacity and performance and Goal Attainment Scale (GAS) score. Follow-up was completed by 79 participants (36 WSTP and 43 active control). No differences were found between missing and complete cases. Many users were highly skilled at baseline with a WST-Q capacity interquartile range of 77 to 97 percent. There were no differences between groups at baseline in WST-Q measures or demographics. Compared with the active control group, the WSTP group improved in WST-Q capacity advanced score but not in WST-Q capacity or WST-Q performance total scores. The average GAS score (0 percent at t1) for the WSTP group at t2 was 65.6 percent. Higher GAS scores and WST-Q capacity scores were found for those who attended more classes and had lower baseline skills. Findings suggest that group training can improve advanced wheelchair skills capacity and facilitate achievement of individually set goals. Lower skill levels at baseline and increased attendance were correlated with greater improvement.Worobey, Lynn A., Kirby, R. Lee, Heinemann, Allen W., Krobot, Emily A., Dyson-Hudson, Trevor A., Cowna, Rachel E., Pedersen, Jessica P., Shea, Mary, Boninger, Michael L.Nodevopsadmin
2016Employment for adults with autism spectrum disorders: A retrospective review of a customized employment approachJournalJ75655Research in Developmental Disabilities53-5461-72A retrospective records review examined the services provided and outcomes achieved for 64 individuals with autism spectrum disorders (ASD) who were referred for supported employment services by a state vocational rehabilitation services agency. Employment specialists engaged in situational assessment, discovery, job development, customized job descriptions, on-site training and support, positive behavioral supports, and job retention techniques. The employment specialists were responsible for tracking their actual time spent working directly with or for the jobseeker with ASD. All vocational rehabilitation clients with ASD served during this time successfully secured competitive integrated employment (CIE), and maintained their employment with ongoing supports, with intensity of support time decreasing over time. Results showed that using supported employment with significant use of customized employment, 63 of the 64 individuals (98.4 percent) successfully secured CIE in 72 unique employment positions. Of the majority of the individuals who secured employment, 50 individuals (77 percent) indicated that they had never worked before and additional 12 (18 percent) reported having short intermittent histories of employment. Despite this lack of employment experience, in all cases the jobseeker directed the job search and ultimately the job selection. This study shows how customized employment can capitalize on the strengths of job seekers with ASD while also meeting the needs of the business.Wehman, Paul, Brooke, Valerie, Brooke, Alissa M., Ham, Whitney, Schall, Carol, McDonough, Jennifer, Lau, Stephanie, Seward, Hannah, Avellone, LaurenNodevopsadmin
2017Developing the WorkingWell mobile app to promote job tenure for individuals with serious mental illnessesJournalJ75562Psychiatric Rehabilitation Journal (formerly Psychosocial Rehabilitation Journal)403276-282Study engaged individuals living with serious mental illnesses (SMI) as key stakeholders in user experience design and the development of the WorkingWell mobile app to enhance on-the-job follow-along support. To inform app development, focus groups were conducted in 3 agencies providing individual placement and support (IPS) services to examine consumers’ perspectives on supported employment, challenges in sustaining employment, and their preferences for technology-based solutions for coping on the job. Qualitative data were coded thematically in a multistep, collaborate approach to ensure trustworthiness. Survey data were collected to describe participants and their current experience with and interest in using technology; these data were analyzed descriptively. A total of 25 IPS consumers reported work challenges related to interpersonal relationships and social situations; job characteristics, tasks, and expectations; illness- and treatment-related issues; lifestyle/wellness and conditions apart from work; and motivation. The majority owned mobile phones, felt comfortable using technology, and could see how technology-based tools could help sustain employment. Participants highlighted the potential benefits of technology-based supports for work challenges, and underscored the potential for independence and empowerment as a consequence. Study findings suggest the value of a WorkingWell mobile app that is innovative, easy to access, self-directed, and individually tailored to enhance IPS follow-along support. The WorkingWell app, if proven effective, will provide an empowering set of tools designed with input from individuals with SMI, and integrated into a single, accessible interface.Nicholson, Joanne, Carpenter-Song, Elizabeth A., MacPherson, Lynn H., Tauscher, Justin S., Burns, T. Chris, Lord, Sarah E.Nodevopsadmin
2015Evaluating Siebens domain management model for inpatient rehabilitation to increase functional dependence and discharge rate to home in geriatric patientsJournalJ71935Archives of Physical Medicine and Rehabilitation9671310-1318Study evaluated the use of the Siebens Domain Management Model (SDMM) during geriatric inpatient rehabilitation (IR) to increase functional independence and dispositions to home in geriatric (aged 75 years or older). The SDMM involved weekly adjustments of IR care focused on potential barriers to discharge home. The preintervention group (2010) involved 429 geriatric patients who were on average admitted to IR 8.2 days after the onset of acute care hospitalization. The postintervention group (2012) included 524 geriatric patients who were on average admitted to IR 5.5 days after acute care. A comparison was made between the 2010 preintervention group and 2012 postintervention group discharge Functional Independence Measure (FIM) efficiency scores, length of stay (LOS), and rates of discharge to home/community, acute care, and long-term care (LTC). Preintervention and postintervention group admission FIM scores were similar, but the preintervention group had on average 2.6 days greater LOS during IR and greater time to onset of IR from acute care. Preintervention FIM efficiency was 2.1, whereas postintervention FIM efficiency was 2.76. There were significantly more discharges to the community in the postintervention group (74.4 percent) than the preintervention group (58.5 percent). There were significantly fewer patients discharged to LTC in the postintervention group. Findings suggest that the use of the SDMM during IR in geriatric patients is associated with increased functional independence and discharges to home/community and reduced institutionalization.Kushner, David S., Peters, Kenneth M., Johnson-Greene, DougSouth Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2015Differences in quality of life outcomes among depressed spinal cord injury trial participantsJournalJ70683Archives of Physical Medicine and Rehabilitation962340-349Study examined differences in quality of life (QOL) outcomes among individuals with spinal cord injury (SCI) who previously participated in a randomized controlled trial (RCT) of an antidepressant to treat major depressive disorder (MDD). Of the 133 subjects who were participated in the Project to Improve Symptoms and Mood after Spinal Cord Injury RCT, 124 participated in this study. QOL was assessed at baseline and 12-week follow-up using the Satisfaction with Life Scale and the physical and mental component summary scores of the Medical Outcomes Study 12-Item Short-Form Health Survey. Multivariable analyses were conducted, controlling for demographic, neurologic, and participatory factors and perceived functional limitations. Results indicated that a reduction in depressive symptoms over the course of a 12-week trial was predictive of increased QOL, which was measured as life satisfaction and mental well-being, within the context of other explanatory factors. However, reduction in symptoms did not explain differences in physical well-being among those with MDD. Perceived functional disability explained all 3 indices of QOL. The findings support the association of QOL to the reduction of depression symptoms among trial participants. This association differs depending on how QOL is defined and measured, with stronger relations observed with life satisfaction and mental well-being among those diagnosed with MDD. The lack of association between depression and physical well-being may be explained by participants’ subjective interpretation of physical well-being after SCI and their expectations and perceptions of improved physical health-related QOL based on the use of assistive technology.Tate, Denise G., Forchheimer, Martin, Bombardier, Charles H., Heinemann, Allen W., Neumann, Holly D., Fann, Jesse R.Nodevopsadmin
2015Effect of obesity on motor functional outcome of rehabilitating traumatic brain injury patientsJournalJ72052American Journal of Physical Medicine and Rehabilitation848627-632Study examined the association between obesity and functional motor outcome of patients undergoing inpatient rehabilitation after traumatic brain injury (TBI). Data were obtained from the medical records of 761 subjects enrolled in the TBI Model Systems program who were admitted from January 2010 to September 2013. Inclusion criteria consisted of age of 18 years or older and an abnormal Functional Independence Measure (FIM) motor score. Body mass index (BMI) was used to determine obesity in the study population. Patients with a body mass index of 30 kilograms per meter squared or greater were considered obese. A total of 372 subjects met the criteria for inclusion in the study. Of these, 54 (13.2 percent) were obese. Both obese and non-obese patients showed similar improvement in FIM motor score (mean 30.4 for the obese patients, and 27.3 for the non-obese patients). The mean FIM motor scores at discharge for the obese and non-obese patients were 63.0 and 62.3, respectively. The findings suggest that obesity had no adverse impact on motor functional outcomes of the TBI patients who underwent inpatient rehabilitation. Therefore, obesity should not be considered an obstacle in inpatient rehabilitation after TBI, if patients are able to participate in necessary therapy.Le, David, Shafi, Shahid, Gwirtz, Patricia, Bennett, Monica, Reeves, Rustin, Callender, Librada, Dunklin, Cynthia, Cleveland, SamanthaNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2015Efficacy of the brain injury family intervention: Impact on family membersJournalJ72025Journal of Head Trauma Rehabilitation304249-260Study evaluated the effectiveness of the Brain Injury Family Intervention (BIFI) for family caregivers of individuals with acquired brain injury. The BIFI was designed as a whole-family approach to addressing needs, emphasizing education, skill building, and psychological support. The manualized treatment focused on highly relevant topics (e.g., common injury effects, coping with loss and change, communication, and stress management) and was composed of five 2-hour sessions with outcome measurement pretreatment, posttreatment, and at 3 months follow-up. Outcome measures included the Family Needs Questionnaire, the Service Obstacles Scale, and the Zarit Burden Interview. Of the 108 families enrolled in the treatment group, 80 completed the intervention program and the baseline and posttreatment assessments. Of the 46 families in the control group, 29 completed the baseline assessment and 24 completed all assessments. Treatment group caregivers showed an increase in met needs, greater satisfaction with services, and reduced burden relative to pretesting, whereas controls did not. Between-group differences for Professional Support needs were identified. This study provides evidence that a curriculum-based education, skill-building, and support intervention can benefit caregivers for up to 3 months. Additional research is needed to determine the longer-term benefits of intervention and the efficacy of alternative delivery methods (e.g., via telephone and the Internet).Kreutzer, Jeffrey S., Marwitz, Jennifer H., Sima, Adam P., Godwin, Emilie E.Virginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2015Enteral nutrition for patients with traumatic brain injury in the rehabilitation setting: Associations with patient preinjury and injury characteristics and outcomesJournalJ72088Archives of Physical Medicine and Rehabilitation968, Supplement 3S245-S255Study examined the association of enteral nutrition (EN) with patient preinjury and injury characteristics and outcomes for patients receiving inpatient rehabilitation after traumatic brain injury (TBI). Participants were 1,701 patients admitted to 1 of 9 rehabilitation centers participating in a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. Outcome variables examined to assess the association with EN were discharge Functional Independence Measure (FIM) motor and cognitive scores, weight loss during rehabilitation, length of stay, and various infections (aspiration pneumonia, pneumonia, urinary tract infections, and sepsis). The results indicated that there were many significant differences in preinjury and injury characteristics between patients who received EN and patients who did not. After matching patients with a propensity score of greater than 40 percent for the likely use of EN, patients receiving EN with either a standard or a high-protein formula (more than 20 percent of calories coming from protein) for more than 25 percent of their rehabilitation stay had higher FIM motor and cognitive scores at rehabilitation discharge and less weight loss than did patients with similar characteristics not receiving EN.Horn, Susan D., Kinikini, Merin, Moore, Linda W., Hammond, Flora M., Brandstater, Murray E., Smout, Randall J., Barrett, Ryan S.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2015Development of mHealth system for supporting self-management and remote consultation of skincareJournalJ75557BMC Medical Informatics and Decision Making15114http://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-015-0237-4Article describes the development of a mobile health (mHealth) system for supporting self-care and management of skin problems called SkinCare as part of an mHealth suite called iMHere (interactive Mobile Health and Rehabilitation). The SkinCare system is one component of a more comprehensive system to support a wellness program for individuals with spina bifida. The SkinCare system consists of the SkinCare app, a clinician portal, and a two-way communication protocol connecting the two. The SkinCare app requires three main functions: (1) self-care task schedule and reminders; (2) skin condition monitoring and communications that include imaging, information about the skin problem, and consultation with clinician; and (3) secure two-way messaging between the patient and clinician (wellness coordinator). The SkinCare app has several features that include reminders to perform daily skin checks as well as the ability to report skin breakdown and injury, which uses a combination of skin images and descriptions. The data is sent to the portal where clinicians can monitor patients’ conditions. Using the two-way communication, clinicians can receive pictures of the skin conditions, track progress in healing over time, and provide instructions for how to best care for the wound. This study shows the feasibility of a long-term implementation of skincare mHealth systems to support self-care and two-way interactions between patients and clinicians.Parmanto, Bambang, Pramana, Gede, Yu, Daihua X., Dicianno, Brad E.Nodevopsadmin
2016Does participation in higher education make a difference in life outcomes for students with intellectual disability?JournalJ74046Journal of Vocational Rehabilitation443295-298Article discusses higher education and outcomes related to employment, health, relationships and medications for students with intellectual disabilities. Students who had completed at least two semesters of college in Kentucky were surveyed about life outcomes using the National Core Indicators Adult Consumer Survey. Findings on health, medications, employment, and relationships are reported. Participation in higher education can positively impact life outcomes across a variety of domains. This research represents a first step in utilizing a nationally recognized instrument that takes a holistic view of outcomes for adults with intellectual and developmental disabilities to assess impact of participation in higher education. While the results are promising, further studies using larger samples are needed.Butler, Laura N., Sheppard-Jones, Kathy, Whaley, Barry, Harrison, Beth, Osness, MichelleNodevopsadmin
2015Evaluating use of the Siebens domain management model during inpatient rehabilitation to increase functional independence and discharge rate to home in stroke patientsJournalJ74456PM & R74354-364Study evaluated the use of the Siebens Domain Management Model (SDMM) during stroke inpatient rehabilitation (IR) to increase functional independence and rate of discharge to home. The SDMM involved weekly adjustments of IR care focused on potential barriers to discharge home including medical/surgical issues, cognitive/emotional coping issues, physical function, and living environment/community re-entry needs. This study entailed a comparison of pre-intervention and post-intervention participant outcome metrics for the purpose of assessing the use of SDMM in stroke IR. The pre-intervention group included 154 patients with ischemic/hemorrhagic strokes who were, on average, admitted to an IR facility 9.1 days after receiving acute care in 2010. The post-intervention group included 151 patients with ischemic/hemorrhagic strokes who were, on average, admitted to IR 7.3 days after receiving acute care in 2012. Results showed that pre-intervention Functional Independence Measure (FIM) score change during IR length of stay (FIM-LOS efficiency) was 1.44 and post-intervention FIM-LOS efficiency of 2.24, which was significant. Comparison of the 2012 Uniform Data System for Medical Rehabilitation (UDSMR) national FIM-LOS efficiency score (1.72) to the post-intervention score of 2.24 also reached significance. In the pre-intervention group, 57.8 percent were discharged to home/community, 14.9 percent to long-term care (LTC), and 27.3 percent back to acute care whereas in the post-intervention group, 81.2 percent were discharged to home/community, 9.4 percent to LTC, and 9.4 percent back to acute care. Comparison of 2010 to 2012 facility data then showed a 23.4 percent increase in discharge to the community compared with an increase of 5.8 percent for the UDSMR 2010 to 2012 data, representing a community discharge rate that is 4 times greater for the post-intervention group. Findings suggest that use of the SDMM during stroke IR may convey improvement in functional independence and is associated with an increased discharge rate to home/community and a reduction in institutionalization and acute-care transfers.Kushner, David S., Peters, Kenneth M., Johnson-Greene, DougSouth Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2017Effectiveness of an educational intervention on reducing misconceptions among ethnic minorities with complicated mild to severe traumatic brain injuryJournalJ75831Archives of Physical Medicine and Rehabilitation984751-758Study evaluated the effectiveness of an educational intervention designed to improve knowledge about traumatic brain injury (TBI) among Blacks and Latinos with complicated mild, moderate, or severe TBI. Participants were 52 adults with complicated mild-to-severe TBI (mean age, 37.71 years); 25 participants were Black and 27 were Hispanic/Latino. Of the Hispanic/Latino participants, 18 (66.7 percent) were not born in the United States and 12 (44.4 percent) spoke Spanish as their primary language. Twenty-seven individuals were randomized to a single-session educational intervention with written materials provided in English or Spanish, while the remaining 25 comprised the wait-list control group. The 40-item Common Misconceptions about Traumatic Brain Injury Questionnaire (CM-TBI) was administered at baseline and 1-month follow-up. After controlling for ethnic and language differences, results showed a significant between-group main effect and a significant time-group interaction for the CM-TBI was noted. The intervention group showed a decrease in TBI misconception percentages, whereas the wait-list control group maintained similar percentages. At 1-month follow-up, the wait-list control group reported more misconceptions than did the intervention group. The findings demonstrate that an educational intervention developed to address the recovery process, common symptoms, and ways to handle the symptoms shows promise as a tool to decrease TBI misconceptions among individuals from ethnically and educationally diverse backgrounds.Pappadis, Monique R., Sander, Angelle M., Lukaszewska, Beata, Struchen, Margaret A., Leung, Patrick, Smith, Dennis W.Texas TBI Model System of TIRRYesdevopsadmin
2015Employment and economic self-sufficiency: 2015 national goals for research, policy, and practiceJournalJ73055Inclusion34227-232Article presents the consensus-based recommendations identified by the Employment and Economic Self-Sufficiency Strand of the National Goals 2015 Conference. The recommendations provide direction on research goals to advance policy and practice related to improving employment and economic self-sufficiency of people with intellectual and developmental disabilities. A discussion of the implications of the findings is also provided, including the need for advocacy to advance the goals.Nord, Derek, Barkoff, Allison, Butterworth, John, Carlson, Dawn, Cimera, Robert, Fabian, Ellen, Grossi, Teresa, Hall, Allison, Lucus, Jonathan, Nye-Lengerman, Kelly, Gower, Wendy S., Tyree, Milton, Von Schrader, Sarah, Wohl, AllisonNodevopsadmin
2018Epidemiology of comorbid conditions among adults 50 years and older with traumatic brain injuryJournalJ77719Journal of Head Trauma Rehabilitation33115-24Study determined the comorbidities and complications that most commonly co-occur in adults aged 50 years and older with traumatic brain injury (TBI). Data were obtained from 2,134 adults 50 years of age or older with moderate/severe TBI enrolled in the TBI-Model Systems (TBI-MS) study from 2007 to 2014. International Classification of Disease–9th Revision codes, collapsed into 45 comorbidity categories, were used to classify comorbid conditions for each participant. Comorbidity prevalence estimates and trend analyses were conducted by age strata (50-54, 55-64, 65-74, 75-84, ≥85 years). A dimension reduction method, Treelet Transform, classified clusters of comorbidities that tended to co-occur. The results indicated that the 3 most commonly occurring comorbid categories were hypertensive disease (52.6 per 100 persons), other diseases of the respiratory system (51.8 per 100 persons), and fluid component imbalances (43.7 per 100 persons). Treelet Transform classified 3 clusters of comorbid codes: (1) acute medical diseases/infections, (2) chronic conditions, and (3) substance abuse disorders. This study provides valuable insight into comorbid conditions that co-occur among adults aged 50 years and older with TBI and provides a foundation for future studies to explore how specific comorbidities affect TBI recovery.Kumar, Raj G., Juengst, Shannon B., Wang, Zhensheng, Dams-O'Connor, Kristen, Dikmen, Sureyya S., O'Neil-Pirozzi, Therese M., Dahdah, Marie N., Hammond, Flora M., Felix, Elizabeth R., Arenth, Patricia M., Wagner, Amy K.New York Traumatic Brain Injury Model System, University of Pittsburgh Model Center for Traumatic Brain Injury , North Texas Traumatic Brain Injury Model System, South Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2015Diabetes increases financial burden of individuals with traumatic spinal cord injury (TSCI)JournalJ71152Spinal Cord (formerly Paraplegia)532135-138Study estimated the association of diabetes comorbidity with family income in individuals with traumatic spinal cord injury (TSCI). A total number of 1,408 individuals identified with TSCI were surveyed regarding family income as well as clinical and demographic factors. Due to income being reported in censored intervals rather than individual dollar values, interval regression was used to estimate models of the association of family income with diabetes. Approximately 12 percent of individuals with TSCI reported being diagnosed with diabetes. The most frequent family income interval in this sample was Dismuke, C. E., Egede, L. E., Saunders, L., Krause, J. S.Nodevopsadmin
2015Effect of intrathecal baclofen bolus injection on ankle muscle activation during gait in patients with acquired brain injuryJournalJ70718Neurorehabilitation and Neural Repair292163-173Study examined activation of medial gastrocnemius (MG) and tibialis anterior (TA) muscles during gait before and after intrathecal baclofen (ITB) bolus injection in patients with resting hypertonia after acquired brain injury. Eight patients with hemorrhagic stroke and 11 patients with traumatic brain injury were assessed before and at 2, 4, and 6 hours after a 50-μg ITB injection via lumbar puncture. Measures included the lower-extremity Ashworth score, temporospatial gait parameters, characteristics of the linear relationship between electromyogram (EMG) and lengthening velocity (LV) in MG during stance, and the duration and magnitude of TA-MG coactivation. Results showed that temporospatial gait parameters did not significantly differ across the evaluation points. However, the Ashworth score, frequency and gain of significant positive EMG-LV slope, and duration of TA-MG coactivation significantly decreased in the more-affected leg after ITB bolus. EMG changes were not significantly different between patients who did and did not increase gait speed after the injection. The timing of the largest decrease in the Ashworth score and the largest decrease in EMG parameters coincided in 36 percent of cases, on average. Findings suggest that ITB bolus injection reduces the activation of ankle muscles during gait without affecting the pattern of coactivation or the overall gait performance. The authors conclude that the analysis of ankle-muscle activation during gait better characterizes the response to ITB bolus injection than gait kinematics.Chow, John W., Yablon, Stuart A., Stokic, Dobrivoje S.Nodevopsadmin
2015Exploring caregivers' knowledge of and receptivity toward novel diagnostic tests and treatments for persons with post-traumatic disorders of consciousnessJournalJ73324NeuroRehabilitation371117-130Study analyzed data from family caregivers of individuals with post-traumatic disorders of consciousness (DOC) regarding their knowledge of and attitudes toward novel tests and treatments (NTT). Data were gathered through focus groups conducted with 17 caregivers recruited from within one Traumatic Brain Injury Model System center; 7 were from the acute unit and 10 were from the subacute unit. Supplemental survey data explored their knowledge of DOC. While attitudes toward NTT were generally favorable, 2 main themes emerged that influenced willingness to pursue NTT: patient and caregiver-specific factors, and the acquisition/use of information to guide decision-making. While survey data suggested a lack of knowledge about NTT, qualitative data revealed that this was better explained by different standards for knowledge, i.e., anecdotal versus empirical information. Findings could facilitate the discussion between healthcare providers and caregivers regarding medical decision-making as well as provide suggestions for how to increase the likelihood of caregivers being willing to enroll their family members in clinical trials of NTT.Smart, Colette M., Giacino, Joseph T.Spaulding-Harvard Traumatic Brain Injury Model System, JFK Johnson Rehabilitation Institute Traumatic Brain Injury Model System, JFK Johnson Rehabilitation InstituteYesdevopsadmin
2015Effects of patient preinjury and injury characteristics on acute rehabilitation outcomes for traumatic brain injuryJournalJ72085Archives of Physical Medicine and Rehabilitation968, Supplement 3S209-S221, S221.e1-S221.e6Study investigated the influence of patient and injury characteristics on outcomes at inpatient rehabilitation discharge and 9 months after discharge for patients with traumatic brain injury (TBI). Data were obtained from 2,130 patients admitted to 10 acute inpatient rehabilitation centers as part of a comparative effectiveness study in which patient characteristics, environmental factors, and interventions were evaluated to identify factors associated with key TBI inpatient rehabilitation outcomes. Participants were divided into 5 subgroups based on rehabilitation admission Functional Independence Measure (FIM) cognitive score. Rehabilitation length of stay, discharge to home, and FIM motor and cognitive scores at discharge and 9 months after discharge were analyzed. Results indicated that severity indices increased the explained variation in outcomes beyond that accounted for by patient characteristics. FIM motor scores were generally the most predictable. Higher functioning subgroups had more predictable outcomes then subgroups with lower cognitive function at admission. Age at injury, time from injury to rehabilitation admission, and functional independence at rehabilitation admission were the most consistent predictors across all outcomes and subgroups. The findings from previous studies of the relations among patient and injury characteristics and rehabilitation outcomes were largely replicated. Discharge outcomes were most strongly associated with injury severity characteristics, whereas predictors of functional independence at 9 months postdischarge included both patient and injury characteristics.Corrigan, John D., Horn, Susan D., Barrett, Ryan S., Smout, Randall J., Bogner, Jennifer, Hammond, Flora M., Brandstater, Murray E.Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2015Enhancing rigor and practice of scoping reviews in social policy research: Considerations from a worked example on the American with Disabilities ActJournalJ71553Work: A Journal of Prevention, Assessment, and Rehabilitation502323-334Article explores the challenges, benefits, and procedures for conducting rigorous exploratory scoping reviews of diverse evidence in informing disability and rehabilitation research and practice. This journal published an article by Rumrill, Fitzgerald, and Merchant in 2010 explaining the utility of and process for conducting reviews of intervention-based research. There is still need to consider how to apply such rigor when conducting more exploratory reviews of heterogeneous research. This article expands upon Rumrill, Fitzgerald and Merchant’s framework and considers its application to more heterogeneous evidence on the impact of social policy. A worked example of a scoping review of the Americans with Disabilities Act is provided with a procedural framework for conducting scoping reviews on the effects of a social policy. The need for more nuanced techniques for enhancing rigor became apparent during the review process. There are multiple methodological steps that can enhance the utility of exploratory scoping reviews. The potential of systematic consideration during the exploratory review process is shown as a viable method to enhance the rigor in reviewing diverse bodies of evidence.Harris, Sarah P., Gould, Robert, Fujiura, GlennNodevopsadmin
2014Development of a traumatic brain injury model system within the department of veterans affairs polytrauma system of careJournalJ69041Journal of Head Trauma Rehabilitation293E1-E7Article describes the development of a Traumatic Brain Injury (TBI) Model Systems (TBIMS) program within the Department of Veterans Affairs (VA) Polytrauma System of Care. In 2008, the Department of In 2008, the VA Polytrauma Rehabilitation Centers partnered with the National Institute on Disability and Rehabilitation Research (NIDRR) to establish a Model Systems program of research that would closely emulate the civilian TBIMS program established in 1987. Enrollment criteria and data collection/data quality efforts for the newly established VA sites are reviewed. Data collection has moved forward and program-specific modifications have been implemented. The VA TBIMS program is established and growing, with many projects underway and a strong working relationship with the NIDRR TBIMS programs.Lamberty, Greg J., Nakase-Richardson, Risa, Farrell-Carnahan, Leah, McGarity, Suzanne, Bidelspach, Douglas, Harrison-Felix, Cindy, Cifu, David X.Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2014Disorders of consciousness after acquired brain injury: The state of the scienceJournalJ68867Nature Reviews Neurology1099-114Article provides an overview of the clinical management of patients with prolonged disorders of consciousness after acquired brain injury. The authors review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. The article concludes with a provocative discussion of bioethical and medico-legal issues that are unique to this population and that have a profound impact on care.Giacino, Joseph T., Fins, Joseph J., Laureys, Steven, Schiff, Nicholas D.Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2016Evaluating the Siebens model in geriatric-stroke inpatient rehabilitation to reduce institutionalization and acute-care readmissionsJournalJ76322Journal of Stroke and Cerebrovascular Diseases252317-326Study investigated differences between older stroke patients treated with the Siebens Domain Management Model (SDMM) and older patients not treated with the SDMM. The SDMM provides a patient management plan to provide a standard structure for all weekly multi-disciplinary conferences to assess patient problems, progress, and barriers to discharge to home. Overall, researchers found that the SDMM method is helpful for older stroke patients. Patients using the SDMM stayed in the hospital for less time, were sent back to their home and community more often, had less complications resulting in transfers back to an acute-care hospital, and had higher cognitive and motor functioning scores compared to both the national average and the pre-SDMM group.Kushner, David S., Peters, Kenneth M., Johnson-Greene, DougSouth Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2014Effectiveness of amantadine hydrochloride in the reduction of chronic traumatic brain injury irritability and aggressionJournalJ69857Journal of Head Trauma Rehabilitation295391-399Study tested the a priori hypothesis that amantadine reduces irritability (primary hypothesis) and aggression (secondary hypothesis) among individuals with chronic traumatic brain injury (TBI). A total of 76 individuals greater than 6 months post-TBI were randomly assigned to receive 100 milligrams of amantadine hydrochloride twice a day or an equivalent placebo for 28 days. Symptoms of irritability and aggression were measured before and after treatment using the Neuropsychiatric Inventory Irritability (NPI-I) and Aggression (NPI-A) domains, as well as the NPI-Distress for these domains. In the amantadine group, 80.56 percent improved at least 3 points on the NPI-I, compared with 44.44 percent in the group that received placebo. Mean change in NPI-I was -4.3 in the amantadine group and -2.6 in the placebo group. When excluding individuals with minimal to no baseline aggression, mean change in NPI-A was -4.56 in the amantadine group and -2.46 in the placebo group. Mean changes in NPI-I and NPI-A Distress were not statistically significant between the amantadine and placebo groups. Adverse event occurrence did not differ between the 2 groups. Findings suggest that 100 milligrams of amantadine every morning and at noon appears an effective and safe means of reducing frequency and severity of irritability and aggression among individuals with TBI and sufficient creatinine clearance.Hammond, Flora M., Bickett, Allison K., Norton, James H., Pershad, RashmiIndiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2014Emotional and behavioral dyscontrol after traumatic brain injuryJournalJ71276Psychiatric Clinics of North America37131-53Article provides clinicians with practical guidance on the evaluation and management of emotional and behavioral dyscontrol following traumatic brain injury (TBI). Methods of assessing emotional and behavioral dyscontrol are described briefly, and the importance of considering the differential diagnoses for these clinical phenomena is highlighted. Emotional dyscontrol is a common consequence of moderate or severe TBI and includes pathologic laughing and crying (also known as pseudobulbar affect or emotional incontinence), affective lability, and irritability. These problems are common in the early period following mild TBI, after which they resolve in most people. Among the most challenging forms of posttraumatic behavioral dyscontrol are disinhibition and aggression. These problems tend to be more common, chronic, disruptive, and challenging to manage among persons with moderate and severe TBI. Emotional and behavioral dyscontrol frequently co-occur with other posttraumatic neuropsychiatric disturbances, the treatment of which may concurrently reduce the frequency and severity of dyscontrol symptoms. When emotional and/or behavioral dyscontrol require symptom-specific treatments, a combination of non-pharmacologic (i.e., psychological, behavioral, environmental) and pharmacologic approaches is usually required. Properly administered, these interventions may provide persons with TBI and their families with substantial relief from these problems and their effects on daily functioning and quality of life.Arciniegas, David B., Wortzel, Hal S.Texas TBI Model System of TIRRYesdevopsadmin
2015Epidemiology of adults receiving acute inpatient rehabilitation for a primary diagnosis of traumatic brain injury in the United StatesJournalJ71202Journal of Head Trauma Rehabilitation302122-135Study examined the overall and by-age characteristics of patients aged 16 years and older undergoing acute inpatient rehabilitation for a primary diagnosis of traumatic brain injury (TBI) in the United States between 2001 and 2010. Data were obtained from the TBI Model Systems National Database. The incidence of TBI by age group found the largest proportion of cases to be aged 80 years and older. Injuries resulted predominantly from falls and motor vehicle crashes; however, injuries to the youngest individuals were largely from motor vehicle crashes with decreasing rates as age increased, while injuries due to falls rose as age increased, with the oldest age groups most likely to incur a TBI. Age distributions demonstrated high pre-injury alcohol and substance misuse among individuals younger than 50 years with decreasing misuse as age increased. Of the total population, 49.2 percent were retired, 31.1 percent employed, 14.1 percent not working, and 5.6 percent students. Trends by age showed that younger individuals were more likely to be students or employed, with employment status peaking for those aged 30 to 39 years, and declining to 3.2 percent for those aged 80 years and older. The trend of living alone between pre- and post-rehabilitation showed the least amount of change for those aged 16 to 19 years, with steadily increasing changes as age increased. Similar trends were seen for residence changes pre- and post-rehabilitation, with the youngest most likely to return to living at a private residence, and a gradual decrease in return to living at a private residence as age increased. Functional Independence Measure scores demonstrated that younger individuals had lower scores at admission and higher scores at rehabilitation discharge.Cuthbert, Jeffrey P., Harrison-Felix, Cynthia, Corrigan, John D., Kreider, Scott, Bell, Jeneita M., Coronado, Victor G., Whiteneck, Gale G.Ohio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2016Development of the telehealth usability questionnaire (TUQ)JournalJ74983International Journal of Telerehabilitation8110-Marhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985278/Article describes the development and reliability assessment of the Telehealth Usability Questionnaire (TUQ), developed to evaluate the usability of telehealth implementation and services. Specifically, this article addresses: (1) the need for a new measure of telehealth usability, (2) the development of the TUQ, (3) intended uses for the TUQ, and (4) the reliability of the TUQ. Analyses indicate that the TUQ is a solid, robust, and versatile measure that can be used to measure the quality of the computer-based user interface and the quality of the telehealth interaction and services.Parmanto, Bambang, Lewis Jr., Allen N., Graham, Kristin M, Bertolet, Marnie H.Nodevopsadmin
2017Educational and vocational issues in traumatic brain injuryJournalJ75966Physical Medicine and Rehabilitation Clinics of North America282351-362Article describes some of the current issues related to return to school and employment for individuals with traumatic brain injury (TBI). A strong, collaborative partnership between an individual’s care team and key stakeholders is essential for a smooth transition back to school or work. Ways to improve current practices and ensure more timely and appropriate educational and employment supports for people with TBI are discussed. Some recommendations on areas for future research are also offered.Wehman, Paul H., Targett, Pamela S., Avellone, Lauren E.Virginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2015Examining the efficacy of the modified story memory technique (mSMT) in persons with TBI using functional magnetic imaging (fMRI): The TBI-MEM trialJournalJ72026Journal of Head Trauma Rehabilitation304261-269Study examined changes in cerebral activation on functional magnetic resonance imaging (fMRI) following modified Story Memory Technique (mSMT) treatment in people with traumatic brain injury (TBI). The mSMT consists of 10 sessions during which 2 skills are taught to facilitate new learning: (1) visualization (sessions 1-4) and (2) context formation (sessions 5-8). The final 2 sessions (9 and 10) focus on applying the newly learned technique to daily life. Eighteen individuals with TBI were randomly assigned to treatment or placebo groups. Participants in the placebo group underwent memory exercises at the same frequency and duration as the treatment group but were not exposed to the critical ingredients of training in visualization and context formation. Baseline and follow-up fMRI data was collected during a list-learning task. Significant differences in cerebral activation from before to after treatment were noted in regions belonging to the default mode network and executive control network in the treatment group only. Results are interpreted in light of these networks. Activation differences between the groups likely reflect increased use of strategies taught during treatment. This study demonstrates a significant change in cerebral activation resulting from the mSMT in individuals with TBI. The findings are consistent with previous work in multiple sclerosis. Behavioral interventions can show significant changes in the brain, validating clinical utility.Chiaravalloti, Nancy D., Dobryakova, Ekaterina, Wylie, Glenn R., DeLuca, JohnNorthern New Jersey Traumatic Brain Injury System Yesdevopsadmin
2016Can cognitive behavioral therapy for insomnia also treat fatigue, pain, and mood symptoms in individuals with traumatic brain injury? -- A multiple case reportJournalJ74145NeuroRehabilitation38159-69http://content.iospress.com/journals/neurorehabilitation/38/1Article reviews the use of Cognitive Behavioral Therapy for Insomnia (CBT-I) for three participants with traumatic brain injuries (TBI) of different severities. CBT-I is a manualized treatment that effectively treats insomnia with secondary effects on cognition, mood, and pain in various populations. Pre- and post-treatment assessments of insomnia, fatigue, depression, anxiety, and pain were conducted. Mood was further assessed at follow-up. Minimal clinically important difference (MCID) scores derived from the research literature were used to establish clinically meaningful symptom improvement on self-report questionnaires. The reduction in insomnia severity scores for all three participants were not large enough to be considered a clinically significant improvement following CBT-I, although trends toward improvement were observed. However, all participants showed clinically significant reductions in anxiety at post-treatment; the effects persisted for 2 participants at follow-up. Reductions in depression symptoms were observed for 2 participants at post-treatment, and treatment effects persisted for 1 participant at follow-up. One participant endorsed clinically significant improvements in fatigue and pain severity. The authors conclude that CBT-I may provide secondary benefits for symptoms commonly experienced by individuals with TBI, especially mood disturbances.Lu, William, Krellman, Jason W., Dijkers, Marcel P.New York Traumatic Brain Injury Model SystemYesdevopsadmin
2015Defining the treatment targets and active ingredients of rehabilitation: Implications for rehabilitation psychologyJournalJ71977Rehabilitation Psychology602126-135Article describes a framework by which rehabilitation interventions, including those delivered by rehabilitation psychologists, can be defined according to the treatment theories underlying them. The authors argue that the tripartite structure of a treatment theory (the targets, active ingredients, and mechanisms of action) may be specified, often in hypothesized form, for each treatment component used to effect desired changes for each patient. Targets are specific, measurable aspects of patient functioning in which change is desired; active ingredients are specific, measurable actions performed by a clinician to effect these changes; and mechanisms of action are the often invisible and inferred ways in which ingredients work to cause the desired effects. To illustrate these concepts, the authors present how they might be applied in 2 areas of treatment that frequently involve rehabilitation psychologists: management of memory disorders and interventions for chronic pain. This type of systematic approach to defining and, ultimately, measuring the quality and quantity (dose) of specific treatments stands to enhance research, practice, and training in rehabilitation as well as communication across the treatment team and other stakeholders in the process and outcomes of rehabilitation.Hart, Tessa, Ehde, Dawn M.Nodevopsadmin
2017Characteristics of firearm brain injury survivors in the traumatic brain injury model systems (TBIMS) national database: A comparison of assault and self-inflicted injury survivorsJournalJ76501Archives of Physical Medicine and RehabilitationStudy compared subgroups of survivors with assault-related versus self-inflicted traumatic brain injuries (TBIs) via firearms at the time of inpatient rehabilitation and at 1-, 2-, and 5-year follow-up. A secondary analysis was conducted of data from the Traumatic Brain Injury Model Systems National Database (TBIMS NDB), a multicenter, longitudinal cohort study. Participants were 399 Individuals aged 16 years and older (310 via assault, 89 via self-inflicted injury) with a primary diagnosis of TBI caused by firearm injury enrolled in the TBIMS NDB. Measures included: Disability Rating Scale, Glasgow Outcome Scale-Extended, sociodemographic variables (sex, age, race, marital status), injury-related/acute care information (posttraumatic amnesia, loss of consciousness, time from injury to acute hospital discharge), and mental health variables (substance use history, psychiatric hospitalizations, suicide history, incarcerations). Individuals who survived TBI secondary to a firearm injury differed by injury mechanism (assault vs self-inflicted) on critical demographic, injury-related/acute care, and mental health variables at inpatient rehabilitation and across long-term recovery. Groups differed in terms of geographic area, age, ethnicity, education, marital status, admission Glasgow Coma Scale score, and alcohol abuse, suicide attempts, and psychiatric hospitalizations at various time points. These findings have implications for prevention and for rehabilitation planning (e.g., by incorporating training with coping strategies and implementation of addictions-related services) for firearm-related TBI, based on subtype of injury.Bertisch, Hilary, Krellman, Jason W., Bergquist, Thomas F., Dreer, Laura E., Ellois, Valerie, Bushnik, TamaraMayo Clinic Traumatic Brain Injury Model System , New York Traumatic Brain Injury Model System, UAB Traumatic Brain Injury Model System, Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue HospitalYesdevopsadmin
2014Comorbidity of pain and depression among persons with traumatic brain injuryJournalJ69086Archives of Physical Medicine and Rehabilitation9561100-1105Study examined the prevalence of pain, depression, and comorbid pain and depression among 158 individuals with moderate to severe traumatic brain injury (TBI) during inpatient rehabilitation and at 1-year follow-up. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9); pain was assessed with a numerical rating scale from 0 (no pain) to 10 (worst pain). Participants who reported average pain ≥4 were classified as having pain, and participants with PHQ-9 scores ≥10 were classified as depressed. Both pain and depression were more prevalent at baseline assessment (pain: 70 percent; depression: 31 percent) than at year 1 (pain: 34 percent; depression: 22 percent). Comorbid pain and depression declined from 27 percent at baseline to 18 percent at year 1. Pain was significantly associated with depression at baseline (relative risk: 2.62) and at year 1 (relative risk: 7.98). The results indicate that pain and depression are common and frequently co-occur in people with TBI. Although the frequency of both conditions declined over the first year after injury, the strength of their association increased. Findings suggest that it is essential to be aware of potential comorbidity throughout the course of recovery from TBI.Sullivan-Singh, Sarah J., Sawyer, Kathryn, Ehde, Dawn M., Bell, Kathleen R., Temkin, Nancy, Dikmen, Sureyya, Williams, Rhonda M., Hoffman, Jeanne M.University of Washington Traumatic Brain Injury Model SystemYesdevopsadmin
2015Behavioral, psychological, educational, and vocational interventions to facilitate employment outcomes for cancer survivors: A systematic reviewJournalJ70490Campbell Systematic Reviews115http://www.campbellcollaboration.org/lib/project/225/This literature review focused on identifying interventions with behavioral, psychological, educational, or vocational content that aim to facilitate cancer survivors’ employment outcomes. Studies with a research design of randomized controlled trial (RCT) or quasi-experimental study (QED) were included. A combination of electronic search techniques, hand searches, and examination of the grey literature produced a total of 20,249 citations. Twelve studies (8 RCTs and 4 QEDs) evaluating the effects of psychosocially-related interventions on the employment of 2,151 cancer survivors met the inclusion criteria. The results of the studies were synthesized in a random-effects meta-analysis using odds ratio (OR) effect sizes. For RCTs, the weighted mean effect size for employment status was OR = 1.44, favoring the intervention groups. The mean OR of 1.44 translates to an employment rate of about 68 percent for intervention participants compared to a baseline 60 percent for comparison-group participants. For QEDs, the weighted mean effect size for employment status was OR = 2.18, also favoring the intervention groups. The mean OR of 2.18 translates to an employment rate of about 77 percent for intervention participants, compared to the baseline rate of 60 percent for the comparison-group participants. There was no evidence of an effect on the number of hours worked or number of sick leave days. The assessment of the risk of bias was high, and conclusions about the effectiveness of the included interventions should be interpreted with caution. Overall, the results provide promising evidence that the included interventions may improve employment status for cancer survivors.Fong, Carlton J., Murphy, Kathleen M., Westbrook, John D., Markle, Minda M.Nodevopsadmin
2015Concussion treatment after combat trauma: Development of a telephone based, problem solving intervention for service membersJournalJ75715Contemporary Clinical Trials4054-62Article describes the protocol for a randomized clinical trial of a telephone-mediated program for military service members who sustain mild traumatic brain injuries during a combat deployment. The 12-session program combines problem-solving training with embedded modules targeting depression, anxiety, insomnia, and headache. The rationale and development of this behavioral intervention for implementation with individuals with multiple co-morbidities is described along with the proposed analysis of results. In particular, details are provided regarding the creation of a treatment that is manualized yet flexible enough to address a wide variety of problems and symptoms within a standard framework. The methods involved in enrolling and retaining an often hard-to-study population are also highlighted.Bell, Kathleen R., Brockway, Jo Ann, Fann, Jesse R., Cole, Wesley R., St. De Lore, Jef, Bush, Nigel, Lang, Ariel J., Hart, Tessa, Warren, Michael, Dikmen, Sureyya, Temkin, Nancy, Jain, Sonia, Raman, Rema, Stein, Murrary B.North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2017Cerebrospinal fluid cortisol mediates brain-derived neurotrophic factor relationships to mortality after severe TBI: A prospective cohort studyJournalJ78243Frontiers in Molecular Science1044https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343043/Study investigated the relationship between cerebrospinal fluid (CSF) cortisol and brain-derived neurotrophic factor (BDNF) as gene- and age-dependent biomarkers to predict mortality in 117 patients sampled within 6 days after severe traumatic brain injury (TBI). Researchers also determined associations between CSF cortisol and BDNF with 6-month mortality. BDNF variants, rs6265 and rs7124442, were used to create a gene risk score (GRS) in reference to previously published hypothesized risk for mortality in younger patients (Munoz, Miranda J., Kumar, Raj G., Oh, Byung-Mo, Conley, Yvette P., Wang, Zhensheng, Failla, Michelle D., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2017Design of mobile health tools to promote goal achievement in self-management tasksJournalJ77126JMIR mHealth and uHealth54e103http://mhealth.jmir.org/2017/7/e103/Study qualitatively analyzed data from a wellness program for patients with spina bifida (SB) and spinal cord injury (SCI) in order to generate software requirements for a goal-setting module within an existing mobile health (mHealth) system. The study also determined what educational content might be necessary to integrate into the system. A total of 750 goals were identified from 50 patients (37 with SB and 13 with SCI) enrolled in a wellness program. These goals were qualitatively analyzed in order to operationalize a set of software requirements for the mHealth goal-setting module and identify important educational content. Of the 750 total wellness goals, 669 (89 percent) were achieved. Furthermore, 20 out of 50 participants (40 percent) achieved all of their goals, and 42 participants (84 percent) achieved at least 13 out of 15 goals (87 percent). Individuals with SB and females achieved fewer goals than those with SCI and males. Temporality and type of goal were associated with likelihood that the goal would be achieved. Nearly all (98.6 percent) of the fact-finding goals were achieved. There was no significant difference in achievement based on goal theme. Checklists, data tracking, and fact-finding tools were identified as three functionalities that could support goal-setting and achievement in an mHealth system. Based on the qualitative analysis, a list of software requirements for a goal-setting module was generated, and a prototype was developed. Targets for educational content were also generated.Dicianno, Brad E., Henderson, Geoffrey, Parmanto, BambangNodevopsadmin
2015Cognitive contributions to differences in learning after moderate to severe traumatic brain injuryJournalJ74079Journal of Clinical and Experimental Neuropsychology37101074-1085Study investigated the contribution of executive functioning and other cognitive processes to verbal learning after moderate to severe traumatic brain injury (TBI). It wash hypothesized that adults with TBI who have verbal learning deficits would perform worse on executive measures than adults who are able to learn. Participants were 51 community-dwelling adult volunteers (ages 18–59) with moderate and severe TBI. Injury severity was determined by Glasgow Coma Scale score ≤12 and corroborating information from medical records. Group membership (TBI-learners or TBI-nonlearners) was determined by a learning criterion of perfect recall on 2 consecutive trials within 15 trials on the open-trial Selective Reminding Test. All participants completed a comprehensive neuropsychological test battery. Group differences were examined using independent-samples t tests, and logistic regression was used to determine significant predictors of learning ability. Results showed that the TBI-learner group performed better than the TBI-nonlearner group most consistently on tasks of executive control and working memory. The results of a logistic regression showed that working memory capacity was the most significant predictor of learning ability after TBI. The findings suggest that working memory significantly influences the ability to learn verbal information after TBI. The documented relationship between working memory and learning will guide the development of more efficacious treatments to rehabilitate learning and memory deficits after TBI.Chiou, Kathy S., Sandry, Joshua, Chiaravalloti, Nancy D.Northern New Jersey Traumatic Brain Injury System Yesdevopsadmin
2015Availability of state-based obesity surveillance data on high school students with disabilities in the United StatesJournalJ74375Maternal and Child Health Journal1951152-1161Study assessed the availability of public health surveillance data on obesity among American children with disabilities in state-based surveillance programs. Researchers reviewed annual cross-sectional datasets in state-level surveillance programs for high school students, implemented 2001-2011, for the inclusion of weight and height and disability screening questions. When datasets included a disability screen, its content and consistency of use across years were examined. Fifty-four surveillance programs with 261 annual datasets containing obesity data were identified. Twelve surveillance programs in 11 states included a disability screening question that could be used to extract obesity data for high school students with disabilities, leaving the other 39 states with no state-level obesity data for students with disabilities. A total of 43 annual datasets (16.5 percent of the available datasets) could be used to estimate the obesity status of students with disabilities. The frequency of use of disability questions varied across states, and the content of the questions often changed across years and within a state. Findings indicated that state surveillance programs rarely contained questions that could be used to identify high school students with disabilities. This limits the availability of data that can be used to monitor obesity and related health statuses among this population in the majority of states.Yamaki, Kiyoshi, Lowry, Brienne D., Buscaj, Emilie, Zisko, Leigh, Rimmer, James H.Nodevopsadmin
2014Competitive employment for youth with autism spectrum disorders: Early results from a randomized clinical trialJournalJ71126Journal of Autism and Developmental Disorders (JADD)443487-500Article presents the preliminary results of a randomized clinical trial of a modified Project SEARCH model on the employment outcomes for youth with autism spectrum disorders (ASD) between the ages of 18-21 years of age. Project SEARCH is a 9-month internships model where youth with development disabilities in their last year of high school are embedded in a large community business. In this study, additional components were added to the model to meet the learning and behavioral needs of youth with ASD. This model provided very promising results in that the employment outcomes for youth in the treatment group were much higher in non-traditional jobs with higher than minimum wage incomes than for youth in the control condition. Specifically, 21 out of 24 (87.5 percent) treatment group participants acquired employment while 1 of 16 (6.25 percent) of control group participants acquired employment.Wehman, Paul H., Schall, Carol M., McDonough, Jennifer, Kregel, John, Brooke, Valerie, Molinelli, Alissa, Ham, Whitney, Graham, Carolyn W., Riehle, J. Erin, Collins, Holly T., Thiss, WestonNodevopsadmin
2015Bridging the persistent gap between R&D and application: A historical review of government efforts in the field of assistive technologyJournalJ71562911-19http://www.atia.org/i4a/pages/index.cfmArticle explains why the government funds university-based academics to perform technological product and service improvement tasks normally performed by corporate manufacturers and suppliers in order to develop assistive technology devices and services for people with disabilities. This approach leaves a gap between the specific project outputs (academic papers, patent claims), and their transformation into products, services and related outcomes capable of delivering beneficial socio-economic impacts. In an attempt to bridge the gap, the National Institute on Disability and Rehabilitation Research (NIDRR) has invested additional resources over the past 25 years in a series of projects tasked with generating models, methods, and metrics regarding the transformation of research-based discoveries into beneficial devices and services. For example, the currently funded Center on Knowledge Translation for Technology Transfer (KT4TT) has now created and documented an evidence-based framework for planning, implementing, and managing projects meant intending to generate technology-based outputs in the form of prototype devices intended for transfer to the commercial marketplace through established corporations or through start-up enterprises.Lane, Joseph P.Nodevopsadmin
2014Crowdsourcing accessibility: Human-powered access technologiesJournalJ73942Foundations and Trends in Human-Computer Interaction84273-372This article outlines the growth of online human support, describes a number of projects utilizing the paradigm of human-powered access technologies, and presents a set of challenges and opportunities for this work going forward. People with disabilities have always engaged the people around them in order to circumvent inaccessible situations, allowing them to live more independently and get things done in their everyday lives. Increasing connectivity is allowing this approach to be extended to wherever and whenever it is needed. Technology can leverage this human work force to accomplish tasks beyond the capabilities of computers, increasing how accessible the world is for people with disabilities.Brady, Erin, Bigham, Jeffrey P.Nodevopsadmin
2017Characteristics and concerns of caregivers of adults with traumatic brain injuryJournalJ75310Journal of Head Trauma Rehabilitation321E33-E41Study examined the characteristics and concerns of caregivers of adults with traumatic brain injury (TBI) in the first few months after the TBI survivor was discharged to the community. Data were collected during a randomized controlled trial involving 153 caregiver-survivor pairs, with 77 randomized to the treatment group and 76 to the control group. The telephone-based intervention combined education and mentored problem-solving for participants in the treatment group. Participants in the control group received usual care. Data regarding caregiver demographics, caregiver-survivor relationship characteristics, caregiver activity changes, and concerns targeted by caregivers for education and problem-solving via biweekly phone calls were examined. Seventy-one caregivers in the treatment group participated in at least 1 call in which a concern was targeted and addressed as part of the intervention procedures. Thirty-nine percent of caregivers were spouses and 35 percent were parents. Sixty-five percent lived in the same house as the survivor preinjury with 86 percent in touch daily to several times per week. Concerns targeted by more than one-third of caregivers related to managing their emotional adjustment, strategies for getting things done, managing survivor emotions and behaviors, and engaging in healthful habits. Findings show that caregivers of TBI survivors targeted personal concerns relating to their own emotional adjustment and participation as well as concerns relating to symptoms and recovery of the TBI survivor.Powell, Janet M., Wise, Elizabeth K., Brockway, Jo Ann, Fraser, Robert, Temkin, Nancy, Bell, Kathleen R.University of Washington Traumatic Brain Injury Model System, North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2014Comorbidity and insurance as predictors of disability after traumatic brain injuryJournalJ70235Archives of Physical Medicine and Rehabilitation95122396-2401Study examined the unique contribution of self-reported medical comorbidity and insurance type on disability after traumatic brain injury (TBI). Data were obtained from 70 adults with mild-complicated to severe TBI enrolled in the Southeastern Michigan Traumatic Brain Injury System, which is part of the National Institute on Disability and Rehabilitation Research-funded Traumatic Brain Injury Model Systems project. Self-reported medical comorbidities were measured using the Modified Cumulative Illness Rating Scale, while insurance type was classified as commercial or government-funded; disability was measured using the Disability Rating Scale. Two models were run using multiple linear regression, and the best-fitting model was selected on the basis of Bayesian information criterion. The full model, which included self-reported medical comorbidity and insurance type, was significantly better fitting than the reduced model. Participants with a longer duration of posttraumatic amnesia, more self-reported medical comorbidities, and government insurance were more likely to have higher levels of disability. Meanwhile, individual organ systems were not predictive of disability. The cumulative effect of self-reported medical comorbidities and type of insurance coverage predict disability above and beyond well-known prognostic variables. Early assessment of medical complications and improving services provided by government-funded insurance may enhance quality of life and reduce long-term health care costs.Gardizi, Elmar, Hanks, Robin A., Millis, Scott R., Figueroa, Maritza J.Nodevopsadmin
2016Behavioral inhibition and activation systems in traumatic brain injuryJournalJ74912Rehabilitation Psychology614397-407Gray’s theory of behavioral inhibition system and behavioral activation system (BIS/BAS) offers a neurobiologic view of personality that may be especially relevant to neurobehavioral change associated with traumatic brain injury (TBI). This study examined theoretical and psychometric issues of using the BIS/BAS scale among adults with TBI as well as BIS/BAS personality correlates of TBI. Eighty-one adults with complicated mild to severe TBI and 76 of their significant others (SOs) participated. Measures included the BIS/BAS scale, Positive and Negative Affect Schedule, and Awareness Questionnaire. Among adults with TBI, BIS/BAS internal consistency reliabilities were similar to those found in normative samples of adults without TBI. The TBI group endorsed significantly higher BAS than did the SO group, and injury severity was positively correlated to BAS. The SO group showed expected patterns of correlation between personality and affect; positive affect was associated with BAS, and negative affect with BIS. In contrast, in the TBI group, BAS was positively correlated to both positive and negative affect. Impaired awareness of abilities moderated the intensity of relationships between BIS/BAS and affect. TBI was associated with relatively intensified BAS (approach behavior) but not BIS (avoidance behavior). The observed pattern is consistent with the neurobiology of TBI-related personality change and with theory regarding the independence of the BIS and BAS systems. The BIS/BAS scale shows promise as a personality measure in TBI.Wong, Christina G., Rapport, Lisa J., Meachen, Sarah-Jane, Hanks, Robin A., Lumley, Mark A.Southeastern Michigan Traumatic Brain Injury SystemYesdevopsadmin
2017Concussion knowledge among rehabilitation staffJournalJ75917Baylor University Medical Proceedings30133-37https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242107/Study developed, administered, and analyzed the results of a survey assessing knowledge about concussion diagnosis, treatment, and expected recovery among rehabilitation staff across inpatient and outpatient rehabilitation settings along with sports care clinics. The questions were structured to reflect key areas of concussion knowledge targeted in a prior consensus statement. The survey was completed by 561 rehabilitation professionals across a wide range of disciplines in a nationwide rehabilitation hospital system. A large portion of the respondents were physical therapists and athletic trainers. Common misperceptions about concussion requiring loss of consciousness, contact to the head, and symptom onset immediately after concussion were not endorsed by most participants. The vast majority of staff provided responses consistent with the current concussion literature regarding concussion diagnosis and symptom presentation immediately after concussion. Greater variability was seen for items assessing beliefs about the typical recovery from concussion, best care practices, and long-term effects from concussion. Factors such as profession, years of experience, and work with concussion or traumatic brain injury were not consistently related to better performance on the survey. Prior concussion-focused education/training was related to better survey performance. This survey highlights the pressing need to educate frontline health providers regarding concussion recovery and best care practices.Salisbury, David, Kolessar, Michael, Callendar, Librada, Bennett, MonicaNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2014Cerebrospinal fluid cortisol and progesterone profiles and outcomes prognostication after severe traumatic brain injuryJournalJ73540Journal of Neurotrauma318699-712http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967414/Study evaluated cerebrospinal fluid (CSF) progesterone and cortisol levels over the first week after severe traumatic brain injury (TBI), examined the relationships between CSF and serum profiles, and assessed the utility of these hormones as predictors of long-term outcomes. One hundred thirty adults with severe TBI were evaluated. Serum samples and CSF samples were collected for 6 days post-injury, analyzed for cortisol and progesterone, and compared with 13 healthy controls. Hormone data were linked with clinical data, including Glasgow Outcome Scale scores at 6 and 12 months. Group based trajectory analysis was used to develop temporal hormone profiles delineating distinct subpopulations. Compared with controls, CSF cortisol levels were significantly and persistently elevated during the first week after TBI, and high CSF cortisol levels were associated with poor outcome. As a precursor to cortisol, progesterone mediated these effects. Serum and CSF levels for both cortisol and progesterone were strongly correlated after TBI relative to controls, possibly because of blood–brain barrier disruption. After the first few days post-injury, CSF progesterone levels declined to normal levels whereas cortisol levels remained elevated, possibly because of the different transport mechanisms that regulate cortisol and progesterone levels in the brain. These findings, when taken together, may help shed light on why corticosteroid trials have previously failed and why progesterone treatment after TBI may be beneficial.Santarsieri, Martina, Niyonkuru, Christian, McCullough, Emily H., Dobbs, Julie A., Dixon, C. Edward, Berga, Sarah L., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2016Design and focus group evaluation of a bed-integrated weight measurement system for wheelchair usersJournalJ78046Assistive Technology284193-201Article describes the design, development, and testing of the Embedded Scale, or E-Scale, which is a bed-integrated bodyweight measuring system that allows wheelchair users to measure and track their weight. The E-Scale team followed a standard product development approach to build the prototype of the passive bodyweight measurement system. The E-Scale is a combination of sensor pods that are placed under the feet of a wheelchair user’s bed that connects to a bedside unit that displays weight and sends data for tracking purposes to a user’s phone. Bench testing results indicate that the performance of the prototype is on par with commercially available wheelchair scales (capacity = 1,200 lbs, accuracy = 1.73 lbs, and precision = ± 0.35 lbs over one-fourth rated capacity). Focus groups were conducted with 20 veterans who use wheelchairs for mobility to gather feedback about the design, which was very positive. Results suggest the E-Scale technology is feasible and may provide a valuable tool to help wheelchair users manage their weight.Mhatre, Anand, Duvall, Jonathan, Ding, Dan, Cooper, Rory, Pearlman, JonNodevopsadmin
2014Clinical preventive service use disparities among subgroups of people with disabilities: A scoping reviewJournalJ70151Disability and Health Journal74373-393This scoping review of the literature was conducted to identify relevant studies on disparities in receipt of clinical preventive services (CPS) among subgroups of individuals with disabilities. Access to CPS, which includes routinely offered screenings, diagnostic tests, physician counseling, and immunizations, is of critical importance because receipt of these services prevent disease or detect diseases in early stages. Electronic and manual literature searches were conducted for years 2000 to 2009. Review for inclusion/exclusion and data analysis occurred in 2010 and 2011. In 2012, the review was updated to cover abstracts published in 2010 and 2011. Identified abstracts, and then full-text articles of included abstracts, were reviewed according to inclusion/exclusion criteria by multiple reviewers. For articles meeting all criteria, two reviewers performed independent data extraction. A gap analysis was performed to identify areas of concentration and gaps in the literature. Twenty-seven articles met inclusion criteria for this review. Studies varied substantially in sample composition and research methods. CPS examined most often were cervical cancer screening (14 studies) and mammography (13 studies). Potential disparity factors studied most often were disability factors (i.e., disabling condition in 12 studies, disability severity in 10 studies). Stratification of CPS by disparity factors revealed substantial gaps in the literature. The literature gaps point to a need for high-quality research on access disparities among subgroups of individuals with disabilities.Peterson-Besse, Jana J., O'Brien, Megan S., Walsh, Emily S., Monroe-Gulick, Amalia, White, Glen, Drum, Charles E.Nodevopsadmin
2014Atomoxetine for attention deficits following traumatic brain injury: Results from a randomized controlled trialJournalJ70037Brain Injury28121514-1522Study investigated whether atomoxetine, a selective norepinephrine re-uptake inhibitor with a primary indication for attention, would improve attention impairment following traumatic brain injury (TBI). Fifty-five adults with a history of a single moderate-to-severe TBI for at least 1 year and self-reported complaints of attention difficulties received 40 milligrams of atomoxetine or a placebo twice a day for 2 weeks. Outcome measures included the Cognitive Drug Research (CDR) Computerized Cognitive Assessment System, the Stroop Color and Word Test, the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale, and the Neurobehavioural Functioning Inventory. Atomoxetine was well-tolerated by the subject sample. The use of atomoxetine by individuals with reported attention difficulty following TBI did not significantly improve scores on measures of attention, the CDR Power of Attention domain, or the Stroop Interference score. In addition, no significant relationship was found between atomoxetine use and self-reported symptoms of attention or depression. Atomoxetine did not significantly improve performance on measures of attention among individuals post-TBI with difficulties with attention. This study follows a trend of other pharmacological studies not demonstrating significant results among those with a history of TBI. Various possibilities are discussed, including the need for a more sophisticated system of classification of TBI.Ripley, David L., Morey, Clare E., Gerber, Don, Harrison-Felix, Cynthia, Brenner, Lisa A., Pretz, Christopher R., Cusick, Chris, Wesnes, KeithRocky Mountain Regional Brain Injury SystemYesdevopsadmin
2017Comparison of the VA and NIDILRR TBI model system cohortsJournalJ76520Journal of Head Trauma Rehabilitation324221-233Study compared participants in the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Traumatic Brain Injury Model System (TBIMS) and the Department of Veterans Affairs (VA) TBIMS. The level of comparability between these 2 databases will help inform generalizability of findings across cohorts. Setting: Inpatient comprehensive interdisciplinary rehabilitation facilities. The analytic sample included 550 VA and 5270 NIDILRR participants who were enrolled in TBIMS between August 2009 and July 2015. The VA and NIDILRR cohorts were compared across demographic, premorbid status, injury characteristics, and rehabilitation outcome variables for the full sample and across motor vehicle-related, fall-related, and violent-related TBI etiologies. Overall, violent injury mechanisms were more common in the VA cohort, many of which were deployment related, while falls were more common in the NIDILRR cohort. The VA and NIDILRR TBIMS participants differed on 76 percent of comparisons, with unique differences shown across TBI etiology subgroups. The VA cohort was more educated, more likely to be employed at the time of injury, utilized mental health services premorbidly, and experienced greater traumatic brain injury severity. As expected, acute and rehabilitation lengths of stay were longer in the VA with no differences in death rate found between cohorts. A substantial number of NIDILRR enrollees had a history of military service (13 percent) warranting further focused study. The TBIMS participant data collected across cohorts can be used to help evidence-informed policy for the civilian and military-related healthcare systems. The significant baseline differences between the NIDILRR and VA TBIMS participants warrant caution when comparing rehabilitation outcomes.Nakase-Richardson, Risa, Stevens, Lillian F., Tang, Xinhy, Lamberty, Greg J., Sherer, Mark, Walker, William C., Pugh, Mary J., Eapen, Blessen C., Finn, Jacob A., Saylors, Mimi, Dillahunt-Aspillaga, Christina, Adams, Rachel S., Garofano, Jeffrey S.Texas TBI Model System of TIRR, Mayo Clinic Traumatic Brain Injury Model System Yesdevopsadmin
2014Bridging the ICT and ICT-AT digital divide for work: Lessons from the United StatesJournalJ71541Proceedings of the First Entelis Seminar: Bologna, Itally; November 26-27, 2014http://www.entelis.net/sites/all/files/entelis_fullpaper_samantraja_bridgingict_0.pdfArticle presents findings from two surveys on consumers’ experiences with obtaining information and communication technology (ICT) and ICT-based assistive technology (ICT-AT) for employment through the vocational rehabilitation system as well as through their employers in the United States. It explores the role of ICT and ICT-AT in workplace productivity, performance, and growth. It also explores the nature and impact of training and education on assistive technology for effective use. The results from these different cohorts offer important lessons in developing strategies to overcome the digital divide and allow meaningful access to ICT and ICT-AT for successful employment outcomes in today’s technology-based workplace.Raja, Samant, Adya, Meera, Killeen, Mary, Scherer, MarciaNodevopsadmin
2017Cross-validation of a classification system for persons with traumatic brain injury in the posthospital periodJournalJ77073Journal of Head Trauma Rehabilitation325E17-E25Study identified groupings of community-dwelling individuals with traumatic brain injury (TBI) in a cohort recruited in Australia, and compared groupings from the Australian cohort to groupings previously developed for a cohort from the United States (US). A total of 170 participants with TBI from Australia and 504 participants with TBI from the US were administered an extensive battery of cognitive tests and questionnaires. The cognitive tests included the Wechsler Letter-Number Sequencing and Coding subtests, the Rey Auditory Verbal Learning Test, the Trail Making Test, the Word Memory Test, and the Verbal Fluency test. Questionnaires included 9 scales from the TBI Quality-of-Life system, the Neurobehavioral Symptom Inventory, the Economic Quality of Life Scale, and the Family Assessment Device General Functioning Scale. Cluster analysis of the Australian cohort was conducted to derive a 5-group solution allowing comparison with the US data. Agreement between group assignments based on the Australian cluster analysis and reassignment of the Australian sample based on the US means was assessed using Cohen’s kappa coefficient of agreement. Results showed that agreement in classification for the 2 samples was only moderate, with 63.5 percent correctly classified and Cohen’s kappa = 0.53. A post hoc analysis placing all persons showing poor performance validity in the same group improved classification to 73 percent and Cohen’s kappa= 0.65 indicating substantial agreement.Sherer, Mark, Ponsford, Jennie, Hicks, Amelia, Leon-Novelo, Luis, Ngan, Esther, Sander, Angelle M.Texas TBI Model System of TIRRYesdevopsadmin
2016Changes in pain and quality of life in depressed individuals with spinal cord injury: Does type of pain matter?JournalJ73837Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)395535-543Study examined the association of neuropathic and nociceptive pain severity with interference with quality of life (QoL) in people with spinal cord injury (SCI) who underwent a randomized controlled 12-week trial of an antidepressant to treat depression. A secondary objective was to assess the effect of changes in pain on mobility and physical independence. Of the 133 participants who were randomized into the trial, 108 provided pain severity and interference ratings through follow-up. QOL was measured using the Satisfaction with Life Scale and the physical and mental component summary scores of the 12-Item Short-Form Health Survey. Secondary outcome measures included the mobility and physical independence subscales of the Craig Handicap Assessment and Reporting Technique. Results revealed relationships between lower baseline nociceptive pain interference and higher satisfaction with life and mental health-related QoL at 12 weeks. Similarly, lower neuropathic pain interference was associated with change in physical independence, but unrelated to mobility. Few associations were found between pain and QoL. Findings suggest that pain interference over time may be differentially related to QoL outcomes based on the type of pain following SCI, but overall, there were no extensive relationships between pain and QoL in this sample of depressed individuals with SCI.Richardson, Elizabeth J., Brooks, Larry G., Richards, J. Scott, Bombardier, Charles H., Barber, Jason, Tate, Denise, Forchheimer, Martin B., Fann, Jesse R.Nodevopsadmin
2017Community reintegration problems among veterans and active duty service members with traumatic brain injuryJournalJ75306Journal of Head Trauma Rehabilitation32134-45Study investigated community reintegration problems among veterans and military service members with mild versus moderate/severe traumatic brain injury (TBI) at 1 year post injury and identified unique predictors that may contribute to these difficulties. Participants were 154 inpatients enrolled in the Department of Veterans Affairs TBI Model Systems Program with available injury severity data and 1-year post-injury outcome data. Community reintegration outcomes included independent driving, employability, and general community participation. Additional measures assessed depression, posttraumatic stress, and cognitive and motor functioning. In the mild-TBI group, posttraumatic stress disorder and depressive symptoms were associated with lower levels of various community reintegration outcomes. In the moderate/severe-TBI group, cognition and motor skills were significantly associated with lower levels of community participation, independent driving, and employability. These findings highlight the ongoing rehabilitation needs of individuals with TBI, specifically evidence-based mental healthcare, in comprehensive rehabilitation programs consistent with a chronic disease management model.McGarity, Suzanne, Barnett, Scott D., Lamberty, Greg, Kretzmer, Tracy, Powell-Cope, Gail, Patel, Nitin, Nakase-Richardson, RisaNational Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2014Bedside evaluationsJournalJ72350In M. Sherer and A.M. Sander (eds.), Handbook on the Neuropsychology of Traumatic Brain Injury, Clinical Handbooks in Neuropsychology, Springer Science+Business Media, LLC49-75This chapter discusses the issues associated with traumatic brain injury that can be addressed with bedside evaluations. These issues include level of consciousness, posttraumatic confusion, language functioning, overall cognitive functioning, and emotional distress. Brief assessments of these issues that can be completed at bedside and are amenable to repeated administration to track clinical course can make several contributions to clinical management. These contributions include: feedback to family members regarding patient status, feedback to the patient to improve self-awareness and facilitate active participation in therapies, feedback to caregivers to inform approaches to treatment, documentation of the course of recovery and detection of unexpected worsening, assessment of effects of medication and other interventions, determination of decision-making capacity, determination of safety judgment, and others.Sherer, Mark, Giacino, Joseph T., Doiron, Matthew J., LaRussa, Allison, Taylor, Sabrina R.Texas TBI Model System of TIRR, Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2017Conceptual model and cluster analysis of behavioral symptoms in two cohorts of adults with traumatic brain injuriesJournalJ78563Journal of Clinical and Experimental Neuropsychology396513-524Study developed and tested a conceptual model that is specific to behavioral symptoms after traumatic brain injury (TBI), to serve as a basis for better assessment and treatment. Data were collected from two cohorts of adults with moderate-to-severe TBI: 79 adults with data collected at 6 months post-injury and 62 adults with data collected more than 6 months post-injury. Model-based cluster analyses was conducted to explore the face validity of the conceptual model by evaluating how participants clustered with regard to emotional, cognitive, and frontal behavioral symptoms. In each cohort, unique clusters of participants emerged that differed significantly with regard to emotional state, cognition, and behavior. Those 6-months post-injury clustered along a general continuum of symptom severity in emotional and behavioral symptom domains, from no impairment to severe impairment. Clusters in the chronic cohort (>6 months) demonstrated a more complex pattern of symptoms; the most severe behavioral symptoms occurred in the context of severe emotional symptoms, even in the absence of cognitive impairment. However, problematic behavioral symptoms were also present in the context of severe cognitive impairment, even in the absence of emotional symptoms. Emotional, cognitive, and behavioral characteristics were represented as expected, based on the proposed conceptual model of behavior. This conceptual model provides the basis for evaluating behavioral changes after moderate-to-severe TBI and identifying modifiable targets and relevant subpopulations for behavioral intervention, with the goal of improved evidence-based personalized medicine for this population.Juengst, Shannon B., Switzer, Galen, Oh, Byung M., Arenth, Patricia M., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2015Cautionary case: Low Glasgow coma scale scores, brainstem involvement, decompressive craniectomy, full recovery, and one more reason for advocacy/collaborationJournalJ70736American Journal of Physical Medicine and Rehabilitation942154-158Case study of a 21-yr-old premed college student with severe traumatic brain injury (TBI) describes an exceptional outcome that may have been facilitated by decompressive craniectomy (DC), while highlighting need for caution in development of potentially overly restrictive presurgical selection criteria. Presurgical selection criteria for DC treatment of severe TBI remain controversial. Proposed criteria to improve outcomes include high admission Glasgow Coma Scale (GCS) scores (≥7) and exclusion of patients having brainstem involvement. The patient, who initially had a GCS score of 3, left fixed dilated pupil, and brainstem signs, had emergency DC following a motor vehicle crash. Nine years after the trauma, she was employed full time as a physician, and only residual symptom, an occasional headache, remained. The authors conclude that caution is necessary in the development of DC presurgical selection guidelines, as this case had excellent long-term functional outcome that may have been facilitated by DC despite initial low GCS scores and signs of brainstem involvement. Also, this case highlights one more reason for multispecialty physician advocacy, collaboration, and comparative effectiveness research.Kushner, David S.South Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2014Describing what we do: A qualitative study of clinicians' perspectives on classifying rehabilitation interventionsJournalJ67522Archives of Physical Medicine and Rehabilitation951 (Supplement 1)S55-S65Study explored clinical thought processes about treatment classification and description, and identified desired characteristics of and challenges to be addressed by a future rehabilitation treatment taxonomy. Eight-four clinicians from 7 disciplines involved in data collection for practice-based evidence studies of spinal cord injury and traumatic brain injury rehabilitation provided feedback. A summary of themes reported by clinicians was determined by content analysis of focus group and individual interview transcripts. The multifaceted nature of rehabilitation treatment was identified as a major challenge to the process of classifying interventions. Simultaneous delivery of multiple interventions, performance of integrated tasks that challenge multiple body systems, and conversation-based treatments were reported to be difficult to classify. Clinicians reported that treatment classifications that make reference to goals of treatment were clinically intuitive, but they also reported difficulties when attempting to classify activities that could address multiple goals. These rehabilitation practitioners considered the setting in which treatment occurs, equipment used, assistance or cueing provided, type of treatment participants, and specific tasks performed to be important descriptors of their interventions. They recommended creating a classification system that can be applied at greater or lesser levels of detail depending on the purpose for which it is being used.Zanca, Jeanne M., Dijkers, Marcel P.Nodevopsadmin
2015Clinical management of the minimally conscious stateJournalJ71536In J. Grafman and A. M. Salazar (Eds.), Handbook of Clinical Neurology, New York : Elsevier395-410This chapter provides an overview of the clinical aspects of the minimally conscious state (MCS), a condition defined to distinguish patients who retain at least one behavioral sign of consciousness from those who appear to be completely unconscious. The authors begin by outlining the diagnostic criteria for MCS, emphasizing the clinical features that differentiate this condition from related disorders. This is followed by a review of existing approaches to assessment with special attention to factors that confound diagnostic accuracy. The next section provides a critical review of available treatment options for this population, and identifies gaps in the existing evidence base. The chapter concludes with practice-based recommendations for clinical management of MCS.Rosenbaum, Amy M., Giacino, Joseph T.Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2015Comparison of FIM™ communication ratings for English versus non-English speakers in the traumatic brain injury model systems (TBIMS) national databaseJournalJ72817Brain Injury29121445-1451Study examined the effect of primary language on rehabilitation admission and discharge FIM™ communication ratings in individuals with moderate-to-severe traumatic brain injury (TBI) who underwent a comprehensive rehabilitation program. A secondary data analysis was conducted of rehabilitation admission and discharge FIM™ communication ratings for 2,795 individuals hospitalized at a TBI Model Systems center between 2007 and 2012. Despite the fact that no significant disparities existed at admission, individuals who spoke no English were rated worse on functional communication outcomes at discharge compared to individuals whose primary language was English. These findings may reflect systematic bias in FIM™ communication ratings of non-English-speaking individuals with TBI and/or TBI-induced communication difficulties in non-English-speaking individuals. Clinical and research implications are discussed.Lequerica, Anthony, Krch, Denise, Lengenfelder, Jean, Chiaravalloti, Nancy, Arango-Lasprilla, Juan C., Hammond, Flora M., O'Neil-Pirozzi, Therese M., Perrin, Paul B., Sander, Angelle M.National Data and Statistical Center for the TBI Model Systems, Texas TBI Model System of TIRR, Northern New Jersey Traumatic Brain Injury System , Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2016Brain-derived neurotrophic factor (BDNF) in traumatic brain injury-related mortality: Interrelationships between genetics and acute systemic and central nervous system BDNF profilesJournalJ72859Neurorehabilitation and Neural Repair30183-93Study evaluated brain-derived neurotrophic factor (BDNF) levels, interactions with BDNF genetic variation, and mortality associations across the first year following traumatic brain injury (TBI). Cerebrospinal fluid (CSF) and serum BDNF were assessed prospectively during the first week following severe TBI in 203 subjects and in 10 control subjects. Age, BDNF genotype, and BDNF levels were assessed as mortality/outcome predictors. CSF BDNF levels tended to be higher post-TBI versus controls and were associated with time until death. In contrast, serum BDNF levels were reduced post-TBI versus controls. Both gene-by-BDNF serum and gene-by-age interactions were mortality predictors post-TBI in the same multivariate model. CSF and serum BDNF tended to be negatively correlated post-TBI. Both CSF and serum BDNF demonstrated significant predictive capacity when assessing mortality over a 1-year recovery period, in addition to genetic risk, suggesting BDNF levels as a novel and informative TBI biomarker. The findings support further work exploring BDNF pathophysiology as a contributing factor to mortality following TBI. Understanding BDNF signaling in neuronal survival, plasticity, and autonomic function may inform treatment.Failla, Michelle D., Conley, Yvette P., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2017Cross-lagged panel analysis of depression and behavioral dysfunction in the first year after moderate-to-severe traumatic brain injuryJournalJ76050Journal of Neuropsychiatry and Clinical NeurosciencesStudy examined the temporal relationships between depression and behavioral dysfunction in the first year after moderate-to-severe traumatic brain injury (TBI). The authors hypothesized that 6-month depression would be the stronger contributor to 12-month depression and behavioral dysfunction in a sample of 88 adults with moderate-to-severe TBI. A structural equation modeling cross-lagged panel analysis revealed that 6-month depression had strong effects on both 12-month depression and behavioral dysfunction. This findings suggests that once an individual has clinically significant depressive symptoms after TBI, these symptoms can continue to self-perpetuate and lead to behavioral dysfunction.Juengst, Shannon B., Myrga, John M., Fann, Jesse R., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2014Changes in cognition and continence as predictors of rehabilitation outcomes in individuals with severe traumatic brain injuryJournalJ70620Journal of Rehabilitation Research and Development (JRRD) (formerly the Bulletin of Prosthetics Research)5171057-1068Study examined postacute changes in bowel and bladder continence and cognition after severe traumatic brain injury (TBI) in patients with long-term functional recovery to full independence. This case series included 9 patients initially admitted to inpatient rehabilitation (IR) with severe TBI who had returned to prior responsibilities and functional independence by 8 to 15 months. Patients had initial Glasgow Coma Scale scores of 3 to 6, posttraumatic amnesia durations of 18 to 70 days, time-to-follow-commands of 16 to 56 days, initial abnormal brain computed tomography scans, and initial pupil abnormalities. IR Functional Independence Measure (FIM) cognitive and sphincter score improvements were compared with national TBI FIM data on 16,638 patients from the Uniform Data Systems for Medical Rehabilitation (UDSMR) for 2010. All patients had IR improvements in cognitive and sphincter FIM scores approximately twice the national 2010 UDSMR data. All patients had combined IR discharge sphincter FIM scores that were 12 or greater, indicating independence to modified independence with bowel and bladder function with no incontinence. Five of the 9 participants (55 percent) were admitted to IR with sphincter FIM scores of 11 to 12, indicating recovery of continence during acute care. These findings suggest potential usefulness of IR cognitive FIM score changes and of the recovery of bowel and bladder continence for predicting favorable functional outcomes following severe TBI.Kushner, David S., Johnson-Greene, DougSouth Florida Traumatic Brain Injury Model SystemYesdevopsadmin
2015Developing an item bank to measure economic quality of life for individuals with disabilitiesJournalJ71247Archives of Physical Medicine and Rehabilitation964604-614Study developed and evaluated the psychometric properties of an item set measuring economic quality of life (QOL) for use by individuals with disabilities. A mixed-methods approach included a literature review; semi-structured interviews and focus group discussions with individuals with spinal cord injury (SCI), traumatic brain injury (TBI), or stroke; cognitive interviews and field testing; and rating scale analysis to evaluate initial psychometric properties. Sixty-four individuals with disabilities completed individual interviews, 172 participated in focus groups, and 15 completed cognitive interviews. From these activities, an item pool of 37 items was developed and administered to a sample of 305 individuals who sustained SCI, TBI, or stroke. Confirmatory factor analysis showed acceptable fit indices for the 37 items. However, 3 items demonstrated local item dependence. Dropping 9 items improved fit and obviated local dependence. Rasch analysis of the remaining 28 items yielded a person reliability of .92, suggesting that these items discriminate about 4 economic QOL levels. Preliminary confirmatory factor analysis and Rasch analysis results support the psychometric properties of this new patient-reported measure. It fills a gap in health-related QOL measurement by describing the economic barriers and facilitators of community participation.Tulsky, David S., Kisala, Pamela A., Lain, Jin-Shei, Carlozzi, Noelle, Hammel, Joy, Heinemann, Allen W.Nodevopsadmin
2014Communities of practice to improve employment outcomes: A needs assessmentJournalJ70882Journal of Occupational Rehabilitation244597-604Study conducted four focus groups with human resource (HR) professionals and vocational rehabilitation professionals to fully assess the need for a community of practice (CoP) to help improve employment outcomes for people with disabilities. CoPs offer a promising strategy to improve communication among various professionals committed to advancing employment outcomes for people with disabilities. CoPs also provide a tool for professionals to share knowledge and resources related to the Americans with Disabilities Act and job accommodations. Coding and memoing were the two data analysis strategies employed in this study. Results indicate a strong interest in developing a CoP to assist with employment concerns for people with disabilities. HR professionals reported a need for current, relevant information on this topic, and the participants outlined guidelines for developing the CoP and building useful content areas.Bezyak, Jill L., Yan, Min-Chi, Kang, Hyun-Ju, Burke, Jana, Chan, FongNodevopsadmin
2014Barriers to accessible health care for Medicaid eligible people with disabilities: A comparative analysisJournalJ70202Journal of Disability Policy Studies253154-163Study examined perceived barriers to healthcare access for people with disabilities (PWD) from the perspective of 360 healthcare providers and 540 Medicaid eligible PWD. Results indicated major variations in provider and PWD perceptions about barriers to care. PWD and providers both perceived transportation issues as the highest-ranked barriers and physical access issues as the lowest-ranked barriers. Multivariate results indicated that PWD reported barriers when communicating with providers, although providers did not consider communication as a major barrier. Among PWD, those with multiple types of disabilities were more likely to experience barriers when communicating with providers compared with other PWD. In addition, providers considered insurance a barrier to care, although this was not the perception of PWD. Particularly in the era of healthcare reform, policy responses to these findings should address the specific needs of people with different types of disabling conditions rather than assuming all PWD face similar challenges in accessing and utilizing health care.McDoom, M. Maya, Koppelman, Elisa, Drainoni, Mari-LynnNodevopsadmin
2016COMT and ANKKI genetics interact with depression to influence behavior following severe TBI: An initial assessmentJournalJ77947Neurorehabilitation and Neural Repair3010920-930Study assessed associations of functional polymorphisms in the ankyrin repeat and kinase domain (ANKK1; Taq1a) and catechol-O-methyltransferase (COMT; Val158Met) genes with behavioral dysfunction following traumatic brain injury (TBI). Ninety survivors of severe TBI recruited from a level 1 trauma center were evaluated. The Frontal Systems Behavior Scale, a self- or family report questionnaire evaluating behavior associated with frontal lobe dysfunction, was completed 6 and 12 months postinjury. Depression was measured concurrently with the Patient Health Questionnaire-9. Study participants were genotyped for Val158Met and Taq1a polymorphisms. No statistically significant behavioral differences were observed by Taq1a or Val158Met genotype alone. At 12 months, among those with depression, Met homozygotes (Val158Met) self-reported worse behavior than Val carriers, and A2 homozygotes (Taq1a) self-reported worse behavior than A1 carriers in bivariable analysis. Multivariable models suggest an interaction between depression and genetic variation with behavior at 12 months post-TBI, and descriptive analysis suggests that carriage of both risk alleles may contribute to worse behavioral performance than carriage of either risk allele alone. Findings demonstrate that in the context of depression, Val158Met and Taq1a polymorphisms are individually associated with behavioral dysfunction 12 months following severe TBI, with preliminary evidence suggesting cumulative, or perhaps epistatic, effects of COMT and ANKK1 on behavioral dysfunction.Myrga, John M., Juengst, Shannon B., Failla, Michelle D., Conley, Yvette P., Arenth, Patricia M., Grace, Anthony A., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2016Cardiometabolic syndrome in people with spinal cord injury/disease: Guideline-derived and nonguideline risk components in a pooled sampleJournalJ74698Archives of Physical Medicine and Rehabilitation97101696-1705Study assessed cardiometabolic syndrome (CMS) risk definitions in spinal cord injury/disease (SCI/D). Baseline data from participants in 7 clinical studies were pooled; not all variables were collected in all studies; therefore, participant numbers varied from 119 to 389. The pooled sample included men and women with chronic paraplegia and tetraplegia (American Spinal Injury Association Impairment Scale [AIS] grades A-D). The prevalence of CMS was computed using the American Heart Association/National Heart, Lung, and Blood Institute guideline (CMS diagnosis as sum of risks ≥3 method) for the following risk components: overweight/obesity, insulin resistance, hypertension, and dyslipidemia. This prevalence was compared with the risk calculated from 2 routinely used nonguideline CMS risk assessments: (1) key cut scores identifying insulin resistance derived from the homeostatic model 2 (HOMA2) method or quantitative insulin sensitivity check index (QUICKI), and (2) a cardioendocrine risk ratio based on an inflammation (C-reactive protein [CRP])-adjusted total cholesterol/high-density lipoprotein cholesterol ratio. After adjustment for multiple comparisons, injury level and AIS grade were unrelated to CMS or risk factors. Thirteen percent of the participants had CMS when using the sum of risks method and 32.1 percent had CMS using the HOMA2/QUICKI model. Overweight/obesity and (pre)hypertension were highly prevalent, with risk for overweight/obesity being significantly associated with CMS diagnosis. Insulin resistance was significantly associated with CMS when using the HOMA2/QUICKI model. Seventy-six percent of the subjects were at moderate-to-high risk from elevated CRP, which was significantly associated with CMS determination. As expected, guideline-derived CMS risk factors were prevalent in individuals with SCI/D. Overweight/obesity, hypertension, and elevated CRP were common in SCI/D and, because they may compound risks associated with CMS, should be considered population-specific risk determinants.Nash, Mark S., Tractenberg, Rochelle E., Mendez, Armando J., David, Maya, Ljungberg, Inger H., Tinsley, Emily A., Burns-Drecq, Patricia A., Betancourt, Luisa F., Groah, Suzanne L.Nodevopsadmin
2017Depressive symptomatology after spinal cord injury: A multi-center investigation of multiple racial-ethnic groupsJournalJ78075Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)40185-92Study examined racial-ethnic differences in depressive symptomatology after spinal cord injury (SCI) and investigated the relationship of multiple additional factors to depressive symptoms, including health behaviors, employment, fatigue, and pain interference. Data were collected from 1,063 participants identified from outpatient records of 3 specialty hospitals in different regions of the United States (Southeastern, Mountain, and Western) with oversampling of racial-ethnic minority groups. Depressive symptomatology was measured by the Older Adult Health and Mood Questionnaire (OAHMQ). Participant demographic and injury characteristics were measured as statistical controls, as well as other variables including health behavior factors, depression/stress relief medication usage, fatigue, and pain interference. The multivariate analyses were developed using ordinary least squares regression models and logistic regression models. Employment was protective for depressive symptomatology, whereas fatigue, pain interference, and binge drinking were risk factors for higher OAHMQ scores. Although there were no bivariate racial-ethnic differences in depressive symptoms, fatigue and pain interference had suppression effects on the relationship between race-ethnicity and depressive symptomatology. After controlling for fatigue and pain interference, Hispanic participants had significantly lower OAHMQ scores and lower odds of probable major depression than non-Hispanic Whites and Blacks. Findings suggest that fatigue and pain interference are associated with both race-ethnicity and depressive symptomatology. Assuming the same level of fatigue and pain interference, Hispanics will have a lower risk of depressive symptoms than non-Hispanic Whites and Blacks.Cao, Yue, Li, Chao, Gregory, Anne, Charlifue, Susan, Krause, James S.Nodevopsadmin
2015Chronic inflammation after severe traumatic brain injury: Characterization and associations with outcome at 6 and 12 months postinjuryJournalJ72833Journal of Head Trauma Rehabilitation306369-381Study examined associations between chronic inflammatory profiles and outcome 6 to 12 months following severe traumatic brain injury (TBI). Blood was collected in 2-week intervals from 87 adults with severe TBI and 7 healthy controls. Serum cytokines (interleukin [IL]-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, tumor necrosis factor α) were measured at 2 weeks to 3 months, 4- to 6-month averages, and 6- and 12-month levels. The primary outcomes were 6- and 12-month Glasgow Outcome Scale (GOS) scores. Serum levels of IL-1β, IL-6, IL-8, IL-10, and tumor necrosis factor α were elevated over 3 months following TBI. Multivariate analysis showed that increased cytokine load score was associated with a 1.21 and 1.18 (increase in odds of unfavorable GOS score at 6 and 12 months, respectively. Also, elevated IL-6/IL-10 ratios were associated with increased odds of unfavorable outcomes at 6 months (adjusted odds ratio = 1.76). Findings suggest that TBI can be viewed as a condition with a persistent inflammatory state. The subacute cytokine load score classifies individuals at risk for unfavorable outcomes following injury. Higher proinflammatory burden with IL-6, relative to the anti-inflammatory marker IL-10, is significantly associated with outcome. Further research should examine whether inflammatory genes and other inflammatory biomarkers affect risk for unfavorable outcomes and TBI complications.Kumar, Raj G., Boles, Jennifer A., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2014Comparative effectiveness of traumatic brain injury rehabilitation: Differential outcomes across TBI model systems centersJournalJ69864Journal of Head Trauma Rehabilitation295451-459Study compared the functional outcomes of 6,975 patients with traumatic brain injury (TBI) admitted to 21 Traumatic Brain Injury Model System (TBIMS) rehabilitation centers from 1999 to 2008. Patient outcomes were measured using the Functional Independence Measure and the Disability Rating Scale at discharge and at 1 year follow-up. In addition, the Glasgow Outcome Scale-Extended was also assessed at 1 year. Analysis of the data indicated that there were large differences in patient characteristics across these centers (demographics, TBI severity, and functional deficits at admission to rehabilitation). However, even after taking those factors into account, there were significant differences in functional outcomes of patients treated at different TBIMS centers. The authors conclude that these findings may be related to differences in institutional structures, resources, and clinical practices between centers.Dahdah, Marie N., Barisa, Mark T., Schmidt, Kathryn, Barnes, Sunni A., Dubiel, Rosemary, Dunklin, Cynthia, Harper, Caryn, Callender, Librada, Wilson, Amy, Diaz-Arrastia, Ramon, Shafi, ShahidNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2015Brain-computer interface for assessing consciousness in severely brain-injured patientsJournalJ72347In A.O. Rossetti and S. Laureys (Eds.), Clinical Neurophysiology in Disorders of Consciousness: Brain Function Monitoring in the ICU and Beyond, Springer-Verlag Wien133-148This chapter reviews studies on brain-computer interface (BCI) applications in patients with disorders of consciousness. BCIs are tools that allow overcoming motor disability in patients with brain injury, allowing them to communicate with the environment. This system is based on cerebral activity that can be measured using techniques such as electroencephalography, functional magnetic resonance imaging, implanted electrodes, or functional near-infrared spectroscopy. The authors highlight the main challenges that will need to be overcome in future research and offer suggestions from studies conducted in healthy controls and motor-disabled patients that may be applied to the severely brain-injured population.Chatelle, Camille, Lesenfants, Damien, Guller, Yelena, Laureys, Steven, Noirhomme, QuentinSpaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2014Contributions of treatment theory and enablement theory to rehabilitation research and practiceJournalJ67518Archives of Physical Medicine and Rehabilitation951 (Supplement 1)S17-S23Article defines 2 broad classes of theory relevant to rehabilitation research and practice and explores their distinct but complementary contributions to research and clinical practice. These theory classes are referred to as treatment theories (theories about how to effect change in clinical targets) and enablement theories (theories about how changes in a proximal clinical target will influence distal clinical aims). Treatment theories provide the tools for inducing clinical change but do not specify how far reaching the ultimate impact of the change will be. Enablement theories model the impact of changes on other areas of function but provide no insight as to how treatment can create functional change. Treatment theories are more critical in the early stages of treatment development, whereas enablement theories become increasingly relevant in specifying the clinical significance and practical effectiveness of more mature treatments. Understanding the differences in the questions these classes of theory address and how to combine their insights is crucial for effective research development and clinical practice.Whyte, JohnNodevopsadmin
2018Changes in alcohol use after the onset of spinal cord injuryJournalJ76509Journal of Spinal Cord Medicine (JSCM) (formerly Journal of the American Paraplegia Society)412230-237Study examined the rate of alcohol consumption and binge drinking among recently injured individuals with spinal cord injury (SCI), compared these rates to data from the general population, and identified changes in alcohol use over time. Self-reported assessments were completed during inpatient rehabilitation and at follow-up approximately 17 months later. Five hundred sixty-six inpatients completed the baseline measure. After eliminating those under age 18, there were 524 participants at baseline. Of the 410 participants approached for follow-up, 201 of those responded. The two primary outcomes were the number of days consuming 5 or more drinks (binge drinking) and the number of days consuming any alcoholic beverages within the 30 days prior to the assessment. Comparison data for the general population were taken from the Behavioral Risk Factor Surveillance System. At SCI onset, the prevalence of alcohol use, particularly binge drinking, was substantially higher than the general population (SCI = 44.9 percent; general population = 13 percent). Alcohol consumption dropped from pre-to post injury. Compared to 69.7 percent at baseline, 51.2 percent reported having at least one drink in the past 30 days of follow-up. There was also a dramatic decrease in binge drinking from 42.9 percent at SCI onset to 17.4 percent at follow-up. The study shows that alcohol use and binge drinking in people with SCI are elevated over the general population at the time of injury. Drinking patterns reflect a decrease following injury but remain slightly elevated, signifying a need for interventions to minimize long-term health consequences.Davis, Janice F., Cao, Yue, Krause, James S.Nodevopsadmin
2016Detection and interpretation of impossible and improbable coma recovery scale-revised scoresJournalJ73921Archives of Physical Medicine and Rehabilitation9781295-1300, e.1-e.4Study determined the frequency with which specific Coma Recovery Scale-Revised (CRS-R) subscale scores co-occur as a means of providing clinicians and researchers with an empirical method of assessing CRS-R data quality. Participants were 1,190 hospital inpatients diagnosed with disorders of consciousness: coma: 76, vegetative state: 464, minimally conscious state: 586, emerged from minimally conscious state:64; 794 men; mean age, 43 years; traumatic etiology: 747; mean time postinjury, 162 days. The participants’ CRS-R subscale scores were analyzed to identify impossible and improbable subscore combinations as a means of detecting inaccurate and unusual scores. Impossible subscore combinations were based on violations of CRS-R scoring guidelines. To determine improbable subscore combinations, researchers relied on the Mahalanobis distance, which detects outliers within a distribution of scores. Subscore pairs that were not observed at all in the database were also considered improbable. Of the 1,190 CRS-R profiles analyzed, 4.7 percent were excluded because they met scoring criteria for impossible co-occurrence. Among the 1137 remaining profiles, 12.2 percent of possible subscore combinations were classified as improbable. Clinicians and researchers should take steps to ensure the accuracy of CRS-R scores. To minimize the risk of diagnostic error and erroneous research findings, 9 impossible and 36 improbable CRS-R subscore combinations were identified. The presence of any one of these subscore combinations should trigger additional data quality review.Chatelle, Camille, Bodien, Yelena G., Carlowicz, Cecilia, Wannez, Sarah, Charland-Verville, Vanessa, Gosseries, Olivia, Laureys, Steven, Seel, Ron T., Giacino, Joseph T.Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2014Coma recovery scale-revised: Evidentiary support for hierarchical grading of level of consciousnessJournalJ70227Archives of Physical Medicine and Rehabilitation95122335-2341Study examined the construct validity of the subscales of the Coma Recovery Scale-Revised (CRS-R) in measuring the neurobehavioral pattern of recovery of consciousness. Item response theory (IRT) and factor analyses were applied to CRS-R subscales scores collected from 180 rehabilitation inpatients with posttraumatic disturbance in consciousness who participated in a double-blinded, randomized, controlled drug trial. The CRS-R was found to fit factor analytic models adhering to the assumptions of unidimensionality and monotonicity. In addition, subscales were mutually independent based on residual correlations. Nonparametric IRT reaffirmed the finding of monotonicity. A highly constrained confirmatory factor analysis model, which imposed equal factor loadings on all items, was found to fit the data well and was used to estimate a 1-parameter IRT model. The CRS-R adhered to the 4 critical scaling criteria of unidimensionality, monotonicity, mutual independence, and equivalent loadings of all items. These results support the hierarchical structure of the CRS-R and suggest that it is an effective tool for establishing diagnosis and monitoring recovery of consciousness after severe traumatic brain injury.Gerrard, Paul, Zafonte, Ross, Giacino, Joseph T.Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2015Barriers for parents with disabilities traveling with children on ADA complementary paratransitJournalJ71910Journal of Public Transportation183124-142Study examined paratransit policies that impact parents with disabilities who travel with young children. Under the Americans with Disabilities Act (ADA), transit agencies are required to provide ADA complementary paratransit services to individuals whose disability prevents them from using fixed-route bus or rail. Ninety-two transit agencies from across the United States completed a survey of their policies and procedures that impact parents with disabilities traveling with minor children. Results indicate that certain policies make it difficult for parents to use paratransit. These policies include limiting the number of children who can accompany a parent, lack of access to chain rides (i.e., no scheduled waits), lack of driver assistance with car seats, not providing car seats, not allowing storage of car seats on vehicles, and fares for adults and children that make regular use of paratransit cost prohibitive, particularly for parents on a fixed income. These policies have serious consequences for parents to obtain and maintain employment, meet their children’s educational, childcare, and medical needs, and, in some cases, even retain custody of their children. Recommendations are provided for agencies to consider implementing to make paratransit systems more accessible to parents with disabilities.Jacob, Jean, Kirshbaum, Megan, Preston, PaulNodevopsadmin
2014Components of traumatic brain injury severity indicesJournalJ70825Journal of Neurotrauma31111000-1007Study investigated whether there are underlying dimensions common among traditional traumatic brain injury (TBI) severity indices and, if so, the extent to which they are interchangeable when predicting short-term outcomes. The sample consisted of 77,470 adult cases reported to the National Trauma Data Bank from 2007 to 2010, with a diagnosis of TBI. There were no interventions. Severity indices used were the emergency department Glasgow Coma Scale total score and each of the subscales for eye opening, verbal response, and motor response; the worst Abbreviated Injury Scale severity score for the head; and the worst Barell index type. Prediction models were computed for acute care length of stay (days), intensive care unit length of stay (days), hospital discharge status (alive or dead), and, if alive, discharge disposition (home versus institutional). Multiple correspondence analysis (MCA) indicated a two-dimensional relationship among items of severity indexes. The primary dimension reflected overall injury severity. The second dimension seemed to capture volitional behavior without the capability for cogent responding. Together, they defined two vectors around which most of the items clustered. A scale that took advantage of the order of items along these vectors proved to be the most consistent index for predicting short-term health outcomes. MCA provided useful insight into the relationships among components of traditional TBI severity indices. The two-vector pattern may reflect the impact of injury on different cortical and subcortical networks. Results are discussed in terms of score substitution and the ability to impute missing values.Corrigan, John D., Kreider, Scott, Cuthbert, Jeffrey P., Whyte, John, Dams-O'Connor, Kristen, Faul, Mark, Harrison-Felix, Cynthia, Whiteneck, Gale, Pretz, Christopher R.National Data and Statistical Center for the TBI Model Systems, Texas TBI Model System of TIRR, Mayo Clinic Traumatic Brain Injury Model System Yesdevopsadmin
2017Acute ischemic stroke after moderate to severe traumatic brain injury: Incidence and impact on outcomeJournalJ78511Stroke4871802-1809Study assessed the frequency of acute ischemic stroke (AIS) acutely after traumatic brain injury (TBI) in a large, multi-year, multicenter cohort of TBI patients. Data from 22 acute inpatient brain injury rehabilitation centers and their referring acute-care hospitals in the Traumatic Brain Injury Model Systems (TBIMS) National Database (NDB) were analyzed. Outcome measures were AIS incidence, duration of posttraumatic amnesia, Functional Independence Measure, and Disability Rating Scale, at rehabilitation discharge. Between October 1, 2007, and March 31, 2015, a total of 6488 patients with moderate-to-severe TBI were enrolled in the TBIMS NDB. One hundred fifty-nine (2.5 percent) patients had a concurrent AIS, and among these, median age was 40 years. AIS was associated with intracranial mass effect and carotid or vertebral artery dissection. High-velocity events more commonly caused TBI with dissection. AIS predicted poorer outcome by all measures, accounting for a 13.3-point reduction in Functional Independence Measure total score, a 1.9-point increase in Disability Rating Scale, and an 18.3-day increase in posttraumatic amnesia duration. Results indicate that ischemic stroke is observed acutely in 2.5 percent of moderate-to-severe TBI survivors and predicts worse functional and cognitive outcome. Half of TBI patients with AIS were aged ≤40 years, and AIS patients more often had cervical dissection. Vigilance for AIS is warranted acutely after TBI, particularly after high-velocity events.Kowalski, Robert G., Haarbauer-Krupa, Juliet K., Bell, Jeneita M., Corrigan, John D., Hammond, Flora M., Torbey, Michel T., Hofmann, Melissa C., Dams-O'Connor, Kristen, Miller, A. Cate, Whiteneck, Gale G.National Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2016A dopamine pathway gene risk score for cognitive recovery following traumatic brain injury: Methodological considerations, preliminary findings, and interactions with sexJournalJ75672Journal of Head Trauma Rehabilitation315E15-E29Study investigated sexual dimorphism within the dopamine (DA) gene pathway that may influence cognitive outcomes following traumatic brain injury (TBI). Dopamine is critical for attention, memory, and planning, and DA deficiencies lead to cognitive deficits. Participants were 193 adult survivors of severe TBI recruited from a level 1 trauma center. Risk allele assignments were made for multiple DA pathway genes using a sex-specific stratified approach. Genetic risk alleles, and their impacts on cognition, were assessed at 6 and 12 months postinjury using unweighted, semi-weighted, and weighted gene risk score (GRS) approaches. A cognitive composite score was generated from 8 standardized neuropsychological tests targeting multiple cognitive domains. A significant sex-by-gene interaction was observed at 6 and 12 months for ANKK1 rs1800497 and COMT rs4680; DRD2 rs6279 and VMAT rs363226 genotypes were independently associated with cognition at 6 months, with trends for a sex-by-gene interaction at 12 months. All GRS methods were significant predictors of cognitive performance in multivariable models. Weighted GRS multivariate models captured the greatest variance in cognition, significantly increasing the variance captured from the base prediction models. Result suggest that a sex-specific DA-pathway GRS may be a valuable tool when predicting cognitive recovery post-TBI. Future work should validate these findings and explore how DA-pathway genetics may guide therapeutic intervention.Myrga, John M., Failla, Michelle D., Ricker, Joseph H., Dixon, C. Edward, Conley, Yvette P., Arenth, Patricia M., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2016An exploratory study of inclusive worksite wellness: Considering employees with disabilitiesJournalJ73096Disability and Health Journal91100-107Study identified factors that facilitate and impede participation in worksite wellness offerings by individuals with disabilities. A total of 87 participants completed the Access to Worksite Wellness Services to Employees with Disabilities. Results suggest that the decision to participate in worksite wellness programs is influenced by several individual, social, and organizational factors including perceptions of the impact of one’s disability on health, the health habits of coworkers, and an organizational commitment to employee well-being. Study participants also indicated the importance of affordability, convenient times, and interest in the wellness activities being offered, as influencing participation decisions. These findings suggest that individual, social, and organizational factors all contribute to the decision to participate and suggest that social support from colleagues as well as easily obtained and understandable program information from the employer, may be especially useful in engaging employees with disabilities in wellness programs.Cook, LaWanda H., Foley, John T., Semeah, Luz M.Nodevopsadmin
2015Assessing vocational rehabilitation professionals' competencies in Taiwan: A multi-trait scaling analysisJournalJ73788Rehabilitation Counseling Bulletin (RCB)Study assessed the validity of the Taiwanese version of the Systems Approach to Placement: Self-Assessment for Students and Counselors (SAP-SASC), designed to identify critical areas of knowledge, skills, and competencies possessed by practicing vocational rehabilitation (VR) professionals. Rehabilitation counselor skills, knowledge, and training are significant predictors of quality of employment outcome. In the past decade, VR and placement-related work settings in Taiwan have gone through a tremendous amount of change to reflect changing policies, types of disabilities, and global factors. VR professionals’ competencies also need to be addressed to keep pace with this transformation. A total of 116 participants completed the instrument. The participants represent: (1) rehabilitation counseling master’s students from National Changhua University of Education, National Kaohsiung Normal University, and National Taiwan Normal University; and (2) job coaches, VR case managers, and other VR professionals from the Council of Labor Affairs in Taichung, Changhua, Nantou, and Taipei counties. Multi-trait scaling analysis revealed eight components of VR professionals’ competence: client, health, education, family, social, employer, placement, and funding. The respondents expressed the highest level of competence in providing job seeking and social skills training, addressing job modification needs, performing job analysis, and referring clients of community-based support services. The finding demonstrate that the Taiwanese SAP-SASC is a reliable measure of rehabilitation professionals’ competence in Taiwan.Dutta, Alo, Kundu, Madan M., Chan, Fong, Wang, Ming H., Huang, I-Chun, Fleming, Kayla, Bezyak, JillNodevopsadmin
2015A review of the effectiveness of neuroimaging modalities for the detection of traumatic brain injuryJournalJ75743Journal of Neurotrauma32221693-1721https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651019/In 2011, the Department of Defense (DoD) prepared a congressional report summarizing the effectiveness of seven neuroimaging modalities for the detection of traumatic brain injury (TBI). The report included computed tomography (CT), magnetic resonance imaging (MRI), transcranial Doppler (TCD), positron emission tomography, single photon emission computed tomography, electrophysiologic techniques (magnetoencephalography and electroencephalography), and functional near-infrared spectroscopy. For this report, neuroimaging experts identified the most relevant peer-reviewed publications and assessed the quality of the literature for each of these imaging technique in the clinical and research settings. Although CT, MRI, and TCD were determined to be the most useful modalities in the clinical setting, no single imaging modality proved sufficient for all patients due to the heterogeneity of TBI. All imaging modalities reviewed demonstrated the potential to emerge as part of future clinical care. This article describes and updates the results of the DoD report and also expands on the use of angiography in patients with TBI.Amyot, Franck, Arciniegas, David B., Brazaitis, Michael P., Curley, Kenneth C., Diaz-Arrastia, Ramon, Gandjbakhche, Amir, Herscovitch, Peter, Hinds II, Sidney R., Manley, Geoffrey T., Pacifico, Anthony, Razumovsky, Alexander, Riley, Jason, Salzer, Wanda, Shih, Robert, Smirniotopoulos, James G., Stocker, DerekTexas TBI Model System of TIRRYesdevopsadmin
2015Accessibility of mHealth self-care apps for individuals with spina bifidaJournalJ73700Perspectives in Health Information Management1219-Janhttp://perspectives.ahima.org/accessibility-of-mhealth-self-care-apps-for-individuals-with-spina-bifida/Study explored the accessibility of mobile health (mHealth) system’s software applications (apps) for individuals with spina bifida (SB), focusing on the user interface and navigation, which might affect users’ performance and satisfaction with the system. An innovative mHealth system called iMHere (Internet Mobile Health and Rehabilitation) was developed to support self-care and adherence to self-care regimens for individuals with SB and other complex conditions who are vulnerable to secondary complications. The iMHere system consists of smartphone apps, a clinician portal, and two-way communication connecting the two to support self-management and service delivery. A web-based portal provides clinicians with the ability to monitor individuals’ conditions and send treatment plans to individuals via smartphones. The iMHere apps on smartphones allow individuals to set up reminders according to their preferences, respond to alerts, and report symptoms. Six participants performed tasks related to self-care at home in a lab environment. Though all of the participants were satisfied with the iMHere apps and would use them again in the future, their needs and preferences to access and use iMHere apps differed. Personalization that provides the ability for a participant to modify the appearance of content, such as the size of the icons and the color of text, could be an ideal solution to address potential issues and barriers to accessibility. The importance of personalization and potential strategies for accessibility are discussed.Yu, Daihua X., Parmanto, Bambang, Dicianno, Brad E., Pramana, GedeNodevopsadmin
2016Alcohol abuse after traumatic brain injury: Experimental and clinical evidenceJournalJ76087Neuroscience and Biobehavioral Reviews6289-99Article reviews the existing clinical and animal evidence indicating that traumatic brain injuries (TBIs), particularly those that occur early in development, increase the lifelong propensity for alcohol abuse and discusses the potential underlying neurobiological mechanisms. Substance abuse is a major problem in this vulnerable patient population and a greater understanding of the underlying biology has the potential to greatly improve outcomes. The evidence for modulation of drinking behavior after TBI and the costs of problem drinking after TBI from both a biomedical and economic perspective is examined. The authors also review the existing animal models of drinking after brain injury and consider the potential underlying psychosocial and neurobiological mediators of this phenomenon. In particular, the potential interactions among TBI, neuroinflammation, and alcohol abuse are highlighted. Brain injury survivors, particularly those injured early in life are very likely to abuse drugs and alcohol later in life. Alcohol abuse following TBI is associated with poorer rehabilitation outcomes and greatly increased chances of suffering future head trauma. Thus, substance abuse among people with brain injury reduces the chances for positive long-term outcomes and greatly increases the societal costs.Weil, Zachary M., Corrigan, John D., Karelina, KateOhio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2016A new framework and practice center for adapting, translating, and scaling evidence-based health/wellness programs for people with disabilitiesJournalJ75654Journal of Neurologic Physical Therapy402107-114Article describes a knowledge-to-practice framework that will support therapists and other rehabilitation professionals in building and maintaining a database of successful health/wellness guidelines, recommendations, and adaptations to promote community health inclusion for people with disabilities. The framework was developed in the National Center on Health, Physical Activity and Disability (NCHPAD) to systematically build and advance the evidence base of health/wellness programs, practices, and services applicable to people with newly acquired and existing disabilities. The NCHPAD Knowledge Adaptation, Translation, and Scale-up (N-KATS) framework has 4 sequencing strategies: Knowledge Adaptation (strategy 1), Dissemination and Training (strategy 2), Implementation Facilitation (strategy 3), and Update and Maintenance (strategy 4).The N-KATS framework supports the role of rehabilitation professionals as knowledge brokers, facilitators, and users in a collaborative, dynamic structure that will grow and be sustained over time through the NCHPAD.Rimmer, James H., Vanderbom, Kerri A., Graham, Ian D.Nodevopsadmin
2016Another look at the PART-O using the traumatic brain injury model systems national database: Scoring to optimize psychometricsJournalJ73154Archives of Physical Medicine and Rehabilitation972211-217Study used Rasch analysis to develop an approach to scoring the Participation Assessment with Recombined Tools-Objective (PART-O) that would result in a unidimensional parametric equivalent measure. Data from 469 individuals selected randomly from participants who completed 1-year follow-up in the Traumatic Brain Injury Model Systems were used in Rasch model development. The model was subsequently tested on data from additional random samples of similar size at 1-, 2-, 5-, 10-, and >15-year follow-ups. After combining items for productivity and social interaction, the initial analysis at 1-year follow-up indicated relatively good fit to the Rasch model (person reliability = .80) but also suggested item misfit and that the 0-to-5 scale used for most items did not consistently show clear separation between rating levels. Reducing item rating scales to 3 levels (except combined and dichotomous items) resolved these issues and demonstrated good item level discrimination, fit, and person reliability (.81), with no evidence of multidimensionality. These results were replicated in analyses at each additional follow-up period. Modifications to item scoring for the PART-O resulted in a unidimensional parametric equivalent measure that addresses previous concerns about competing item relations, and it fit the Rasch model consistently across follow-up periods. The person-item map shows a progression toward greater community participation from solitary and dyadic activities, such as leaving the house and having a friend through social and productivity activities, to group activities with others who share interests or beliefs.Malec, James F., Whiteneck, Gale G., Bogner, Jennifer A.Rocky Mountain Regional Brain Injury System, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, Ohio Regional Traumatic Brain Injury Model System Yesdevopsadmin
2014A systematic framework to classify physical activity research for individuals with spina bifidaJournalJ67626Disability and Health Journal7136-41Study used the Behavioral Epidemiological Framework (BEF) to systematically classify physical activity (PA) studies for people with spina bifida (SB) to examine the current state of research in this area. The BEF classifies research into one of five phases: phase 1 research links behaviors to health, phase 2 includes research focused on developing methods for measuring behavior, phase 3 research identifies factors that influence behavior, phase 4 research evaluates interventions to change the behavior, and phase 5 studies translates research into practice. An audit of the literature was conducted using search engines and keywords related to PA and SB. Inter-rater reliability was established between the research team coding articles based on established inclusion criteria. Finally, literature was categorized into one of the five phases. Seventy-seven articles met the inclusion criteria and were categorized. Forty-three percent of the articles were categorized in phase 1, 21 percent in phase 2, 32 percent in phase 3, 4 percent in phase 4, and zero in phase 5. Results indicated that the majority of articles are in phase 1, indicating that PA and SB research is still in early stages of development. Future research needs to move beyond phase 1 to examine factors that affect PA behaviors and ways to increase PA behaviors in the SB population.Vanderbom, Kerri A., Driver, Simon, Nery-Hurwit, MaraNodevopsadmin
2015Acute inflammatory biomarker profiles predict depression risk following moderate to severe brain injuryJournalJ71790Journal of Head Trauma Rehabilitation303207-218Study investigated whether acute inflammation profiles predict posttraumatic depression (PTD) risk 6 and 12 months after moderate-to-severe traumatic brain injury (TBI). A total of 41 participants had acute cerebrospinal fluid (CSF) inflammatory biomarker values, and 50 participants had acute serum inflammatory biomarker values. Outcome variables included the Patient Health Questionnaire and inflammatory biomarkers: interleukin (IL)-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, tumor necrosis factor α, soluble vascular adhesion molecule (sVCAM-1), soluble intracellular adhesion molecule (sICAM-1), and soluble Fas (sFAS). Higher levels of acute CSF cytokine surface markers (sVCAM-1, sICAM-1, and sFAS) in an inflammatory biomarker risk (IBR) score were associated with a 3.920-fold increase in the odds of developing PTD at 6 months. Having sICAM-1, sVCAM-1, or sFAS above the 75th percentile had a positive predictive value of 85.7 percent for PTD risk at 6 months. An IBR score including inflammatory biomarkers IL-7 and IL-8 showed a trending association with 12-month PTD risk. Acute CSF IBR scores show promise for identifying individuals with TBI at risk for PTD. Further research should assess acute CSF inflammatory biomarkers’ relationships to chronic inflammation as a mechanism of PTD and should explore anti-inflammatory treatments for PTD, as well as prevention and screening protocols, and link inflammatory biomarkers to symptom tracking.Juengst, Shannon B., Kumar, Raj G., Failla, Michelle D., Goyal, Akash, Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2016A conceptual model of irritability following traumatic brain injury: A qualitative, participatory research studyJournalJ73359Journal of Head Trauma Rehabilitation312E1-E11Study examined the experience (thoughts and feelings) of irritability from the perspectives of multiple people living with or affected by traumatic brain injury (TBI), and developed a conceptual model of TBI irritability. Forty-four stakeholders (individuals with a history of TBI, family members, community professionals, healthcare providers, and researchers) were divided into 5 focus groups. Each group met 10 times to discuss the experience of irritability following TBI. Data were coded using grounded theory to develop themes, metacodes, and theories. A conceptual model emerged in which irritability has 5 dimensions: (1) affective (related to moods and feelings); (2) behavioral (especially in areas of self-regulation, impulse control, and time management); (3) cognitive-perceptual (self-talk and ways of seeing the world); (4) relational issues (interpersonal and family dynamics); and (5) environmental (including environmental stimuli, change, disruptions in routine, and cultural expectations). This multidimensional model provides a framework for assessment, treatment, and future research aimed at better understanding irritability, as well as the development of assessment tools and treatment interventions.Hammond, Flora M., Davis, Christine, Cook, James R., Philbrick, Peggy, Hirsch, Mark A.Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBIYesdevopsadmin
2016Ambiguous loss and emotional recovery after traumatic brain injuryJournalJ76577Journal of Family Theory and Review83386-397Article explores the application of ambiguous loss theory as it relates to traumatic brain injury (TBI), to better understand and enhance families’ emotional adjustment. Ambiguous loss is a theoretical framework that helps account for the drastic impact of TBI on family well-being. The authors present a brief overview of TBI, review the literature examining ambiguous loss in families after TBI, discuss the relevance of ambiguous loss to family treatment, and explore existing, empirically supported family intervention strategies that incorporate ambiguous loss theory.Kreutzer, Jeffrey S., Marwitz, Jennifer h.Virginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2015Assessing the roles of national organizations in research-based knowledge creation, engagement and translation: Comparative results across three assistive technology application areasJournalJ715659154-97http://www.atia.org/i4a/pages/index.cfmArticle describes the application of knowledge value mapping (KVM) techniques to facilitate knowledge translation in the field of assistive technology (AT). Specifically, this study used the KVM technique to explore the extent to which national organizations are willing and able to communicate research findings to the targeted stakeholder groups, and therefore serve as conduits for knowledge translation strategies. It expounded upon a prior analysis conducted in augmentative and alternative communication to two additional AT application areas: recreational access and wheeled mobility. The objective was to determine the extent to which the original findings can be generalized. Results indicate that: (1) findings from the initial study are, in fact, generalizable to various AT fields of application; (2) national organizations are an appropriate channel for translating and disseminating new research-based knowledge to diverse stakeholders; and (3) national organizations engage with knowledge mechanisms at different levels and in different capacities. These results suggest that researchers should identify organizations representing the stakeholder groups most relevant to their own area of study, and then conduct the KVM process with those organizations to identify the best approach to knowledge translation.Nobrega, Amanda R., Lane, joseph P., Flagg, Jennifer L., Stone, Vasthala I., Lockett, Michelle M., Oddo, Christine, Leahy, James A., Usiak, Douglas J.Nodevopsadmin
2014A rehabilomics framework for personalized and translational rehabilitation research and care for individuals with disabilities: Perspectives and considerations for spinal cord injuryJournalJ69850Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)375493-502Article introduces the Rehabilomics framework, a translational model that provides an “-omics” overlay to the scientific study of rehabilitation processes and multidimensional outcomes. Despite many people having similar clinical presentation, demographic factors, and clinical care, outcome can differ for those sustaining significant injury such as spinal cord injury (SCI) and traumatic brain injury. This variability may be attributable to innate (including genetic, transcriptomic proteomic, epigenetic) biological variation that individuals bring to recovery and their unique response to their care and environment. Technologies collectively called “-omics” enable simultaneous measurement of an enormous number of biomolecules that can capture many potential biological contributors to heterogeneity of injury/disease course and outcome. Due to the nature of injury and complex disease, and its associations with impairment, disability, and recovery, rehabilitation does not lend itself to a singular “protocolized” plan of therapy. Yet, by nature and by necessity, rehabilitation medicine operates as a functional model of personalized care. Rehabilomics research provides novel opportunities to evaluate the neurobiology of complex injury or chronic disease and can be used to examine methods and treatments for person-centered care among populations with disabilities. Examples for application in SCI and other neurorehabilitation populations are discussed.Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2017Accessibility needs and challenges of a mHealth system for patients with dexterity impairmentsJournalJ76308Disability and Rehabilitation: Assistive Technology12156-64Study identified the accessibility needs and preferences of individuals with dexterity impairments when using the mobile health (mHealth) system called iMHere (interactive Mobile Health and Rehabilitation. Nine participants with various levels of dexterity abilities were asked to perform tasks after a one-week field trial to evaluate their performance when using iMHere apps on smartphones for self-care. The time for a participant to complete each task, the number of possible errors a participant made and the number of errors a participant was able to self-correct were recorded and analyzed. The Telehealth Usability Questionnaire was collected to rate participants' experiences. A statistically significant negative correlation was identified between participants' dexterity levels and their error ratios by using a Pearson product-moment correlation. Approximately 51 percent of errors detected were self-corrected without any help, but other errors called for resolution from a researcher. Due to the diversity of the participants' dexterity impairments, their needs and preferences differ one from another. Personalized design may be the key to approaching these challenges in improving accessibility.Yu, Daihua X., Parmanto, Bambang, Dicianno, Brad E., Watzlaf, Valerie J., Seelman, Katherine D.Nodevopsadmin
2014Adverse events in cardiovascular-related training programs in people with spinal cord injury: A systematic reviewJournalJ68720Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)376672-692Study examined the type and frequencies of adverse events (AEs) associated with cardiovascular-related exercise training in adults with spinal cord injury (SCI). Literature searches were conducted in PubMed, CINAHL, PsycINFO, and EMBASE databases for peer-reviewed studies published in English from 1970 to 2011. Studies that evaluated training protocols consisting of repeated sessions over at least 4 weeks to maintain or improve cardiovascular health, included volitional exercise modalities and functional electrical stimulation (FES)-enhanced exercise modalities, and included a specific statement about AEs were selected. From a total of 144 studies that appeared to meet the inclusion criteria, after further screening, 38 studies were included in the review. Quality of evidence was evaluated using established procedures. In the studies reviewed, there were no serious AEs reported. There were no common AEs reported across most types of interventions, except for musculoskeletal AEs related to FES walking. There were few AEs in volitional exercise studies. There is no evidence to suggest that cardiovascular exercise performed according to guidelines and established safety precautions is harmful for people with SCI. To improve the strength of these conclusions, future publications should include definition of AEs, information about pre-intervention screening, and statements of the nature and extent of AEs.Warms, Catherine A., Backus, Deborah , Rajan, Suparna, Bombardier, Charles H., Schomer, Katherine G., Burns, Stephen P.Nodevopsadmin
2016A need for an augmented review when reviewing rehabilitation researchJournalJ74541Disability and Health Journal94559-566This commentary suggests that there is a need for additional strategies for performing systematic reviews (SRs) to improve translation of findings into practice and to influence health policy. SRs critically appraise research methodology and determine level of evidence of research findings. The standard type of SR identifies randomized controlled trials (RCTs) as providing the most valid data and highest level of evidence. RCTs are not among the most frequently used research design in disability and health research. RCTs usually measure impairments for the primary research outcome rather than improved function, participation or societal integration. It forces a choice between ‘‘validity’’ and ‘‘utility/relevance.’’ Other approaches have effectively been used to assess the validity of alternative research designs, whose outcomes focus on function and patient-reported outcomes. The authors propose that utilizing existing evaluation tools that measure knowledge, dissemination and utility of findings, may help improve the translation of findings into practice and health policy.Gerber, Lynn H., Nava, Andrew, Garfinkel, Steven, Goel, Divya, Weinstein, Ali A., Cai, CindyNodevopsadmin
2016An RCT to treat learning impairment in traumatic brain injury: The TBI-MEM trialJournalJ74083Neurorehabilitation and Neural Repair306593-550Study examined the efficacy of the modified Story Memory Technique (mSMT) to improve learning and memory in participants with traumatic brain injury (TBI). The mSMT is a behavioral intervention that teaches context and imagery to facilitate learning within 10 sessions over 5 weeks. A total of 69 participants with moderate-severe TBI (35 in the treatment group and 34 in the placebo control group) completed this double-blind, placebo-controlled randomized clinical trial (RCT). A baseline neuropsychological assessment was administered, including questionnaires assessing everyday memory. Repeat assessments were conducted immediately posttreatment and 6 months following treatment. Participants in the treatment group were randomly assigned to a booster session or a non-booster session group after completion of treatment with the mSMT to examine the efficacy of monthly booster sessions in facilitating the treatment effect over time. Results showed that the treatment group demonstrated significant improvement on a prose memory task relative to the placebo group posttreatment. Similar results were noted on objective measures of everyday memory, specifically prospective memory, and family report of disinhibition in daily life. The findings suggest that the mSMT is effective for improving learning and memory in TBI.Chiaravalloti, Nancy D., Sandry, Joshua, Moore, Nancy B., DeLuca, JohnNorthern New Jersey Traumatic Brain Injury System Yesdevopsadmin
2014A state comparison of vocational rehabilitation support of youth with intellectual disabilities' participation in postsecondary educationJournalJ68679Journal of Vocational Rehabilitation403185-194Study examined the role of vocational rehabilitation (VR) programs in promoting participation in postsecondary education for individuals with intellectual disabilities (ID). A secondary data analysis was conducted using the Rehabilitation Services Administration’s 911 dataset. Researchers compared the participation rate and postsecondary education outcomes of youth with ID and other disabilities who exited the VR program between 2006 and 2010 and determined if any trends related to the participation rate were apparent in different states. Results indicated that: (1) youth with ID were substantially less likely to participate in postsecondary education while in the VR system compared to youth with other disabilities, (2) their participation varied substantially across states, and (3) participation remained static, nationally, between 2006 and 2010, despite positive trends in several state VR programs. Overall, this study showed that state VR programs play an important role in assisting youth with ID to participate in postsecondary education, although to a lesser extent than youth with other disabilities.Grigal, Meg, Migliore, Alberto, Hart, DebraNodevopsadmin
2015Acute CSF interleukin-6 trajectories after TBI: Associations with neuroinflammation, polytrauma, and outcomeJournalJ73537Brain, Behavior, and Immunity45253-262Study investigated the contribution of polytrauma to inflammatory profiles that occur with traumatic brain injury (TBI). Interleukin-6 (IL-6) is a pro-inflammatory cytokine known to be elevated after trauma, and a major contributor to the inflammatory response following TBI. Serial cerebrospinal fluid (CSF) samples were used to generate temporal acute IL-6 trajectory (TRAJ) profiles in a prospective cohort of 114 adults with severe TBI. Analysis examined the impact of injury type (isolated TBI versus TBI + polytrauma) on IL-6 profiles, and how IL-6 profiles impact sub-acute (2 weeks–3 months) serum inflammatory marker load and long-term global outcome 6–12 months post-injury. There were two distinct acute CSF IL-6 profiles, a high and low TRAJ group. Individuals in the high TRAJ had increased odds of unfavorable Glasgow Outcome Scale (GOS) scores at 6 months. Individuals in the high TRAJ also had higher mean acute CSF inflammatory load compared to individuals in the low TRAJ. The two groups did not differ with respect acute serum profiles; however, individuals in the high CSF IL-6 TRAJ also had higher mean sub-acute serum IL-1b and IL-6 levels compared with the low TRAJ group. Lastly, injury type was associated with IL-6 TRAJ group. Specifically, there was 70 percent concordance between those with TBI + polytrauma and the low TRAJ; in contrast, isolated TBI was similarly distributed between TRAJ groups. These data provide evidence that sustained, elevated levels of CSF IL-6 are associated with an increased inflammatory load, and these increases are associated with increased odds for unfavorable global outcomes in the first year following TBI.Kumar, R. G., Diamond, M. L., Boles, J. A., Berger, R. P., Tisherman, S. A., Kochanek, P. M., Wagner, Amy K.University of Pittsburgh Model Center for Traumatic Brain Injury Yesdevopsadmin
2015Amantadine effect on perceptions of irritability after traumatic brain injury: Results of the amantadine irritability multisite studyJournalJ71539Journal of Neurotrauma32161230-1238Study examined the effect of amantadine on irritability in people in the post-acute period after traumatic brain injury (TBI). One hundred sixty-eight subjects with irritability 6 or more months post-TBI were enrolled in a parallel-group, randomized, double-blind, placebo-controlled trial receiving either 100 milligrams of amantadine every morning and noon or equivalent placebo for 60 days. Subjects were assessed at baseline and days 28 and 60 of treatment using observer-rated and participant-rated Neuropsychiatric Inventory (NPI-I) Most Problematic item (primary outcome), NPI Most Aberrant item, and NPI-I Distress Scores, as well as physician-rated Clinical Global Impressions (CGI) scale. Observer ratings between the two groups were not statistically significantly different at day 28 or 60; however, observers rated the majority in both groups as having improved at both intervals. Participant ratings for day 60 demonstrated improvements in both groups with greater improvement in the amantadine group on NPI-I Most Problematic and NPI-I Distress. CGI demonstrated greater improvement for amantadine than the placebo group. Adverse event occurrence did not differ between the two groups. This study of amantadine twice daily to reduce irritability was not positive from the observer perspective, although there are indications of improvement at day 60 from the perspective of patients with TBI and clinicians that may warrant further investigation.Hammond, Flora M., Sherer, Mark, Malec, James F., Zafonte, Ross D., Whitney, Marybeth, Bell, Kathleen, Dikmen, Sureyya, Bogner, Jennifer, Mysiw, Jerry, Pershan, RashmiTexas TBI Model System of TIRR, Indiana University School of Medicine / Rehabilitation Hospital of Indiana TBI, North Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2017Application of virtual environments in a multi-disciplinary day neurorehabilitation program to improve executive functioning using the Stroop taskJournalJ78119NeuroRehabilitation414721-734Study examined whether immersive virtual reality (VR) treatment interventions improve executive dysfunction in patients with brain injury and whether performance is stronger on a VR version of the Stroop than traditional Stroop formats. Fifteen patients with brain injury admitted to day neurorehabilitation completed the VR intervention sessions twice per week for a 4-week period (8 total sessions). This intervention consisted of 2 Stroop conditions across all 8 sessions: word reading and color naming. Outcome measures included: reaction time, inhibition, and accuracy indices on the VR Stroop, Automated Neuropsychological Assessment Metrics (ANAM) Stroop, Delis-Kaplan Executive Function System Stroop, Golden Stroop, and Woodcock-Johnson, 3rd Edition: Pair Cancellation subtest. Participants demonstrated significantly reduced response time on the word-reading condition of VR Stroop and non-significantly reduced response time on the interference condition. Non-significant improvements in accuracy and inhibition were demonstrated on the color-naming condition of VR Stroop. Significantly improved accuracy under time pressure was found for the ANAM, after VR intervention. Results suggest that implementation of immersive VR interventions during neurorehabilitation is effective in improving specific executive functions and information processing speed in brain-injured patients during the subacute period.Dahdah, Marie N., Bennett, Monica, Prajapati, Purvi, Parsons, Thomas D., Sullivan, Erin, Driver, SimonNorth Texas Traumatic Brain Injury Model SystemYesdevopsadmin
2015A randomized practical behavioural trial of curriculum-based advocacy training for individuals with traumatic brain injury and their familiesJournalJ72861Brain Injury2913-141530-1538Study examined whether a curriculum-based advocacy training program improves advocacy behavior when compared to a matched group engaged in self-directed advocacy activities. Adults with moderate-to-severe TBI and their family members were recruited in Minnesota (4 years), Iowa and Wisconsin (each 3 years) and randomized into a curriculum-based or self-directed advocacy training group. Both groups met on the same day, at separate locations in the same city, once per month for 4 consecutive months. Pre–post written and video testimony were rated using the Advocacy Behavior Rating Scale (ABRS). Mean ABRS scores increased after intervention in both groups, but there was no significant difference in this increase between groups. When groups were combined, a significant improvement in mean ABRS scores was observed. This community-based randomized practical behavioral trial showed that curriculum-based advocacy training was not superior to a self-directed approach in improving ABRS scores. However, when groups were combined and intervention type was not considered, a significant improvement in advocacy skills was observed for both verbal and written expression of an advocacy message. These findings suggest that bringing together like-minded motivated individuals is more important than program structure or content in changing advocacy behavior.Brown, Allen W., Moessner, Anne M., Bergquist, Thomas F., Kendall, Kathryn S., Diehl, Nancy N., Mandrekar, JayMayo Clinic Traumatic Brain Injury Model System Yesdevopsadmin
2016ABLE accounts: A down payment on freedomJournalJ73568Inclusion4121-29Article examined the Achieving a Better Life Experience Act (ABLE), which was signed into law by President Obama on December 19, 2014. The act amends Section 529 of the Internal Revenue Code to allow use of tax-free savings accounts for eligible individuals with disabilities. ABLE accounts are exempt as a resource from means-tested eligibility requirements for public benefits such as Social Security Income and Medicaid. The ABLE program represents transformative policy change that will open new pathways to advance independence and economic self-sufficiency for individuals with significant disabilities. The authors describe key elements of the law and discuss the potential effect of ABLE on future disability policy and program development.Morris, Michael, Rodriguez, Christopher, Blanck, PeterNodevopsadmin
2015ADA at 25 and people with cognitive disabilities: From voice to actionJournalJ73672Inclusion3246-54This article introduces a two-part special journal issue that examines the Americans with Disabilities Act (ADA) at its 25th anniversary. The journal articles reflect on the past 25 years, examine present opportunities and challenges, and consider the future to ensure continued action toward the civil and human rights of individuals with cognitive and other disabilities for inclusion and active citizenship. They examine an array of groundbreaking substantive issues as well as legal cases on the interpretation of the ADA.Blanck, PeterNodevopsadmin
2016A multidimensional Rasch analysis of the functional independence measure based on the national institute on disability, independent living, and rehabilitation research traumatic brain injury model systems national databaseJournalJ78468Journal of Neurotrauma33141358-1362Study examined the psychometric properties of the Functional Independence Measure (FIM) using data from the Traumatic Brain Injury Model Systems (TBIMS) National Database (NDB), and demonstrated that the FIM comprises three subscales representing cognitive, self-care, and mobility domains. The TBIMS NDB is a longitudinal database that captures demographic and outcome information on individuals with moderate-to-severe traumatic brain injury (TBI) across the United States. TBIMS clinicians collect FIM data at admission and discharge from rehabilitation, and certified data collectors record scores by telephone interview 1, 2, and 5 years post-discharge and every 5 years thereafter. The FIM assesses problem solving; memory; expression; comprehension; social interaction; eating; grooming; bathing; dressing-upper body; dressing-lower body; toileting; bowel management; bladder management; transfers to bed, chair, or wheelchair; transfers to toilet; transfers to shower/tub; locomotion; and stair climbing. These subscales were analyzed simultaneously using a multivariate Rasch model in combination with a time dependent concurrent calibration scheme with the goal of creating a raw score-to-logit transformation that can be used to improve the accuracy of parametric statistical analyses. The bowel and bladder function items were removed because of misfit with the motor and cognitive items. Some motor items exhibited step disorder, which was addressed by collapsing Categories 1-3 for Toileting, Stairs, Locomotion, Tub/Shower Transfers; Categories 1 and 2 for Toilet and Bed Transfers; and Categories 2 and 3 for Grooming. The strong correlations among the resulting three subscales (cognitive, self-care, and mobility) suggest they should be modeled together. Coefficient alpha of 0.98 indicates high internal consistency.Pretz, Christopher R., Kean, Jacob, Heinemann, Allen W., Kozlowski, Allan J., Bode, Rita K., Gebhardt, EvelineNational Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2014An introduction to analyzing dichotomous outcomes in a longitudinal setting: A NIDRR traumatic brain injury model systems communicationJournalJ70865Journal of Head Trauma Rehabilitation295E65-E71Article describes 2 statistical methods used for assessing change over time and demonstrates the effectiveness of each approach in analyzing data in the National Institute on Disability and Rehabilitation Research (NIDRR)-funded Traumatic Brain Injury Model Systems National Database. Specifically, the intent of this article is to familiarize the rehabilitation community with the application of generalized estimating equations and generalized linear mixed models as used in longitudinal studies focusing on investigation of dichotomous responses. Similarities and differences between the 2 methods are discussed. In addition, to reinforce the ideas and concepts embodied in each approach, examples based on data from the Rocky Mountain Regional Brain Injury System are used to highlight each method.Pretz, Christopher R., Ketchum, Jessica M., Cuthbert, Jeffrey P.National Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2016Asthma and asthma-related health care utilization among people without disabilities and people with physical disabilitiesJournalJ74548Disability and Health Journal94646-654Study examined whether differences in the prevalence of asthma, asthma flare, and asthma-related measures of healthcare quality, utilization, and cost exist among people with physical limitations (PL) and without any limitations. Data from the 2004-2010 Medical Expenditure Panel Survey were pooled to compare outcomes for working-age adults with PL to those with no limitations. Results indicated that people with PL had higher rates of asthma (13.8 versus 5.9 percent) and recent asthma flare (52.6 versus 39.6 percent) than people without limitations. There were no differences in health care quality, utilization or cost between people with PL and people without limitations in multivariate analyses. The findings suggest that although there are no differences in asthma-related quality or utilization of health care, people with PL have poorer asthma control than people without limitations. Research is needed to determine what factors (e.g., focus on other acute ailments, perceptions that asthma control cannot improve) are related to this outcome.Stransky, Michelle L., McGrath, Robert, Reichard, Amanda, McClain, Monica, Phillips, Kimberly G., Houtenville, Andrew, Drum, Charles E.Nodevopsadmin
2014A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part two: Research and outcomesJournalJ71297Prosthetics and Orthotics International385343-362This literature review analyzed the outcomes and conclusions of research studies to produce an evidence base for determining factors that may lead to successful provision of orthoses and prostheses in resource-limited environments. A total of 431 articles were included in a scoping review of all information published from 2000 to 2010 related to orthotic and prosthetic provision in resource-limited environments. Measured outcomes reported in all types of articles and analyzed conclusions from research studies were extracted. Reported outcomes included durability, cost, satisfaction, use/nonuse of device, amount of utilization, walking speed, discomfort, pain, fit, misalignment, capacity for service provision, number of devices produced or delivered, and number of graduates from training programs. The results indicate that there are many gaps in the evidence base, notably in measuring inclusion, participation, and quality of life for orthosis and prosthesis users in resource-limited environments. There is a paucity of reported outcomes for orthotics. Valid, reliable, and standard methods of data collection and reporting are needed to advance the field and enhance the evidence base.Ikeda, Andrea J., Grabowski, Alena M., Lindsley, Alida, Sadeghi-Demneh, Ebrahim, Reisinger, Kim D.Nodevopsadmin
2015Activities and interim outcomes of a multi-site development project to promote cognitive support technology use and employment success among postsecondary students with traumatic brain injuriesJournalJ73336NeuroRehabilitation373449-458Article describes the activities and interim outcomes of a multi-site development project called Project Career, designed to promote cognitive support technology (CST) use and employment success for college and university students with traumatic brain injuries (TBIs). Fifty-six students with TBI have participated to date (April 30, 2015) across three implementation sites in Massachusetts, Ohio, and West Virginia, with 25 of these participants being military veterans. Descriptive analyses provide information regarding the participants, the barriers they face due to their TBI in obtaining a post-secondary education, and the impact services provided by Project Career have had to date in ameliorating those difficulties. Inferential statistical analyses provide preliminary results regarding program effectiveness. Preliminary results indicate the program is encouraging students to use CST strategies in the form of iPads and cognitive enhancement applications (also known as apps). Significant results indicate participants are more positive, independent, and social; participants have a more positive attitude toward technology after six months in the program; and participants reported significantly improved experiences with technology during their first six months in the program.Hendricks, Deborah J., Sampson, Elaine, Rumrill, Phillip, Leopold, Anne, Elias, Eileen, Jacobs, Karen, Nardone, Amanda, Scherer, Marcia, Stauffer, CallistaNodevopsadmin
2014Allegation of ethnic minorities from 1993-2008: An equal employment opportunity commission (EEOC) studyJournalJ73910Work: A Journal of Prevention, Assessment, and Rehabilitation472267-279Study investigated the relationship among race, disability, and workplace discrimination under Title I of the Americans with Disabilities Act (ADA). Although Title I prohibits employment discrimination against people with disabilities, significant economic disparities still exist between those with and without disabilities for multiple reasons. Logistic regression was used to model the merit closure rate for each ethnic group from 1993 to 2008 using 318,587 charging parties from the Equal Employment Opportunity Commission (EEOC) database. This model was used to determine whether: (1) the proportion of allegations of ADA Title I workplace discrimination closed with merit at any year between 1993 and 2008 differs among Whites, African Americans, Hispanics, and Asians; (2) there was a change over time from 1993 to 2008 in merit closure rate within each race/ethnicity group; and (3) changes over time between 1993 and 2008 in the merit closure rate differ among the race/ethnicity groups. All ethnic groups exhibited significant changes over time in the merit closure rate. There were significant differences in the closure rates among the race/ethnicity groups specifically at closure years 1995–2000, 2002, 2003, and 2006. Finally, there was evidence that the trends in merit closure rates over time differed significantly among the race/ethnicity groups.Arango-Lasprilla, Juan C., Ketchum, Jessica M., Hurley, Jessica, Getachew, Almaz M., Gary, Kelli W.Nodevopsadmin
2014Application and clinical utility of the Glasgow coma scale over time: A study employing the NIDRR traumatic brain injury model systems databaseJournalJ69858Journal of Head Trauma Rehabilitation295400-406Study examined possible changes in Glasgow Coma Scale (GCS) scores related to changes in emergency management, such as intubation and chemical paralysis, and the potential impact on outcome prediction. The GCS is the most commonly used index of traumatic brain injury (TBI) severity. Participants were 1,228 patients enrolled in the Traumatic Brain Injury Model Systems national database, a multicenter longitudinal study of TBI funded by the National Institute on Disability and Rehabilitation Research (NIDRR). GCS scores were assessed in the emergency department (GCS scores for intubated, but not paralyzed, patients were estimated with a formula using 2 of the 3 GCS components). The Functional Independence Measure (FIM) was assessed at rehabilitation admission. Linear regression evaluated the ability of GCS to predict FIM. Analyses revealed that the rate of intubation prior to GCS scoring averaged 43 percent and did not increase across time. However, a clear increase over time was observed in the use of paralytics or heavy sedatives, with 27 percent of patients receiving this intervention in the most recent epoch. Estimated GCS scores classified 69 percent of intubated patients as severely brain injured and 8 percent as mildly injured. The GCS accounted for a modest, yet consistent, amount of variability in FIM scores during most epochs. There is no evidence for declining predictive utility of the GCS over time.Barker, Marie D., Whyte, John, Pretz, Christopher R., Sherer, Mark, Temkin, Nancy, Hammond, Flora M., Saad, Zabedah, Novack, ThomasMoss Traumatic Brain Injury Model System, Carolinas Traumatic Brain Injury Rehabilitation and Research System, UAB Traumatic Brain Injury Model System, Texas TBI Model System of TIRRYesdevopsadmin
2016A randomised control trial of walking to ameliorate brain injury fatigue: A NIDRR TBI model system centre-based studyJournalJ75369Neuropsychological RehabilitationStudy evaluated the impact of a graduated physical activity program on fatigue after traumatic brain injury (TBI). Using a prospective randomized single-blind crossover design, 123 individuals with TBI, over the age of 18, were enrolled. Interventions included a home-based walking program utilizing a pedometer to track daily number of steps at increasing increments accompanied by tapered coaching calls over a 12-week period. Nutritional counseling with the same schedule of coaching calls served as the control condition. Main outcome measures included: the Global Fatigue Index (GFI), the Barrow Neurological Institute (BNI) Fatigue Scale Total and Overall severity index scores, and the Multidimensional Fatigue Inventory (MFI) General Fatigue, Physical Fatigue, Reduced Activity, Reduced Motivation, Mental Fatigue subscales. Step counts improved over time regardless of group assignment. The walking intervention led to a decrease in GFI, BNI Total, and MFI General scores. Participants reported less fatigue at the end of the active part of the intervention (24 weeks) and after a wash-out period (36 weeks) as measured by the BNI Overall score. The results suggest that walking can be used as an efficient and cost-effective tool to improve fatigue in persons who have sustained a TBI.Kolakowsky-Hayner, Stephanie A., Bellon, Kimberly, Toad, Ketra, Bushnik, Tamara, Wright, Jerry, Isaac, Linda, Englander, JeffreyNorthern California Traumatic Brain Injury Model SystemYesdevopsadmin
2015A validation study for using iterative proportional fitting to weight the traumatic brain injury model systems national database: An NIDRR-sponsored studyJournalJ71262Archives of Physical Medicine and Rehabilitation964742-745Study examined whether iterative proportional fitting (IPF) has the desired effect of aligning estimates and parameters when weighting data from the National Institute on Disability and Rehabilitation Research (NIDRR)-funded Traumatic Brian Injury Model Systems (TBIMS) national database. IPF, also known as raking, was first proposed in the 1940s as a method of estimating individual cell probabilities in a contingency table using fixed marginal row and column totals as constraints. The TBIMS has adopted IPF so that weights generated on the basis of known parameters can be used in analyses with the expectation that results are more representative of all late teens and adults receiving inpatient rehabilitation for a primary diagnosis of traumatic brain injury (TBI). These parameters include age at injury, race, sex, marital status, rehabilitation length of stay, payer source, and motor and cognitive Functional Independence Measure scores. This study demonstrates the utility of applying IPF to weight the TBIMS national database so that results of ensuing statistical analyses better reflect those in the United States who are 16 years and older with a primary diagnosis of TBI and are receiving inpatient rehabilitation. In general, IPF aligns population estimates on the basis of weighted TBIMS data and known population parameters. It is reasonable to assume that IPF has the same effect on unknown variables. This provides confidence to researchers wishing to use IPF for making population projections in analyses.Pretz, Christopher R., Cuthbert, Jeffrey P., Whiteneck, Gale G.National Data and Statistical Center for the TBI Model SystemsYesdevopsadmin
2016Acute trauma factor associations with suicidality across the first 5 years after traumatic brain injuryJournalJ74414Archives of Physical Medicine and Rehabilitation9781301-1308Study examined whether severity of head and extracranial injuries (ECI) is associated with suicidal ideation (SI) or suicide attempt (SA) after traumatic brain injury (TBI). Factors associated with SI and SA were assessed using data collected 1, 2, and 5 years post-TBI from 3,575 participants from 15 TBI Model System centers, linked with outcomes from the National Trauma Data Bank. SI was measured via the Patient Health Questionnaire 9 (question 9). SA in the last year was assessed via interview. ECI was measured by the Injury Severity Scale and categorized as none, mild, moderate, or severe. Results indicated that there were 293 (8.2 percent) participants who had SI without SA and 109 (3.0 percent) who had SA at least once in the first 5 years after injury. Random effects logit modeling showed a higher likelihood of SI when ECI was severe. Drug use at time of injury was also associated with SI. Severity of ECI was not associated with SA. This study showed that severe ECI carried a nearly 3-fold increase in the odds of SI after TBI, but it was not related to SA. Head injury severity and less severe ECI were not associated with SI or SA. These findings warrant additional work to identify factors associated with severe ECI that make individuals more susceptible to SI after TBI.Kesinger, Matthew R., Juengst, Shannon B., Bertisch, Hillary, Niemeier, Janet P., Krellman, Jason W., Pugh, Mary Jo, Kumar, Raj G., Sperry, Jason L., Arenth, Patricia M., Fann, Jesse R., Wagner, Amy K.New York Traumatic Brain Injury Model System, University of Pittsburgh Model Center for Traumatic Brain Injury , Rusk Rehabilitation TBIMS at NYU Langone Health and Bellevue HospitalYesdevopsadmin
2015A home-based walking study to ameliorate perceived stress and depressive symptoms in people with a traumatic brain injuryJournalJ71238Brain Injury293313-319Study explored whether a 12-week home-based walking program can decrease perceived stress and depressive symptoms in people with traumatic brain injury (TBI). Sixty-nine participants with a TBI were randomly assigned to complete a 12-week walking intervention or a nutrition education program. The walking intervention utilized pedometers to track the amount of steps each participant walked daily. With the assistance of an assigned coach, weekly goals were given with the intent of increasing the amount of walking that the participant was initially completing. The nutrition control group was created to offset the impact of the coaching calls. Measurement of perceived stress and depressive symptoms was performed using the Perceived Stress Scale and Center for Epidemiological Studies-Depression, respectively. These measures were collected at three time points: baseline and following each 12-week intervention. The results indicated that both perceived stress and depression symptoms significantly improved following the walking intervention. While limitations existed with the study, it is evident that walking can be used as an efficient and cost-effective tool to manage perceived stress and depressive symptoms in people who have sustained a TBI.Bellon, Kimberly, Kolakowsky-Hayner, Stephanie, Wright, Jerry, Huie, Henry, Toda, Ketra, Bushnik, Tamara, Englander, JeffreyRusk Rehabilitation TBIMS at NYU Langone Health and Bellevue Hospital, Northern California Traumatic Brain Injury Model SystemYesdevopsadmin
2014An ideal model of an assistive technology assessment and delivery processJournalJ69441Technology and Disability26127-38Article presents some aspects of the Assistive Technology Assessment (ATA) process model compatible with the Position Paper 2012 by the Association for the Advancement of Assistive Technology in Europe and the European Assistive Technology Information Network. Three aspects of the ATA process are discussed in light of three topics of the Position Paper: (1) the dimensions and the measures of the User eXperience (UX) evaluation modelled in the ATA process as a way to verify the efficient and the evidence-based practices of an AT service delivery center; (2) the relevance of the presence of the psychologist in the multidisciplinary team of an AT service delivery center as necessary for a complete person-centered assistive solution empowering users to make their own choices; and (3) the new profession of the psychotechnologist, who explores user’s needs by seeking a proper assistive solution, leading the multidisciplinary team to observe critical issues and problems. This article sets forth a concept and approach that emphasize the personal factors of the individual consumer and UX as key to positively impacting a successful outcome and AT solution.Federici, Stefano, Scherer, Marcia J., Borsci, SimoneNodevopsadmin
2016Assessment of the relationship of spiritual well-being to depression and quality of life for persons with spinal cord injuryJournalJ73828Disability and RehabilitationStudy examined the associations among spiritual well-being, demographic characteristics, quality of life (QOL) and depressive symptoms following spinal cord injury (SCI). It was hypothesized that QOL and depressed mood would both be explained by extent of spiritual well-being, and meaning-focused spirituality would have a stronger impact than faith-focused spirituality. A total of 204 individuals with SCI who were screened as part of a randomized control trial of venlafaxine XR for major depressive disorder (MDD) completed the following measures: Patient Health Questionniare-9 (PHQ-9) assessed depression, the Functional Assessment of Chronic Illness Therapies-Spiritual (FACIT-Sp) assessed spiritual well-being, the Quality of Life in Neurological Disorders: Positive Affect and Well-Being Short Form (PAWB) scale assessed QOL, and the Positive and Negative Affect Schedule (PANAS) assessed affect. Results indicated that approximately 26 percent had major depression. Bivariate correlations of scores on PAWB and PANAS and FACIT-Sp showed that all four scales had strong associations with those on PAWB. As hypothesized, both the Meaning and Peace (M&P) and Faith scales of the FACIT-Sp were significant predictors of QOL, though only the M&P scale was an independently significant predictor of likely MDD. The findings suggest that spirituality, as measured by the FACIT-Sp, is strongly associated with QOL and likelihood of MDD. Assessment of spirituality should be included along with more traditional psychological measurements to better inform treatment.Wilson, Catherine S., Forchheimer, Martin, Heinemann, Allen W., Warren, Anne M., McCullumsmith, CherylNodevopsadmin
2015A scholarship of practice revisited: Creating community-engaged occupational therapy practitioners, educators, and scholarsJournalJ72646Occupational Therapy in Health Care294352-369Article proposes a revised community-engaged Scholarship of Practice (SOP) model, reviews the evidence justifying the need for such a model, and presents strategies to effectively create community-engaged practitioners, educators, and career scientists within occupational therapy. Changing societal issues and trends in health disparities, health policy and practice, and research and evidence-based practice point to the need for a revised SOP model that emphasizes the creation of engaged scholars and practitioners. The authors argue that policies affecting people with disabilities, current emphasis on addressing health disparities, and the wide use of a participatory approach to research, all call for a closer, interactive, and dynamic relationship among scholars, practitioners, and communities. In the proposed new model, complex contextual factors such as social, cultural, economic, policy, and global issues play a critical role in promoting or limiting participation and health. The authors present examples of strategies used to promote a community-engaged SOP and translate knowledge back to communities for action and systems change to affect the lives of people with disabilities and the communities in which they live and participate.Hammel, Joy, Magasi, Susan, Mirza, Mansha P., Preissner, Katharine, Peterson, Elizabeth, Suarez-Balcazar, YolandaNodevopsadmin
2015Accuracy of self-reported length of coma and posttraumatic amnesia in persons with medically verified traumatic brain injuryJournalJ71251Archives of Physical Medicine and Rehabilitation964652-658Study examined the accuracy of self-reported length of coma and posttraumatic amnesia (PTA) in patients with medically verified traumatic brain injury (TBI) and identified factors that affect self-report of length of coma and PTA duration. A total of 242 individuals with medically verified TBI were identified from a registry of persons who had previously participated in TBI-related research. Review of medical records revealed that the mean medically documented length of coma and PTA duration was 6.9 and 19.2 days, respectively, and the mean self-reported length of coma and PTA duration was 16.7 and 106 days, respectively. The average discrepancy between self-report and medical record for length of coma and PTA duration was 8.2 and 64 days, respectively. Multivariable regression models revealed that time since injury, performance on cognitive tests, and medical record values were associated with self-reported values for both length of coma and PTA duration. In this study, people with medically verified TBI showed poor accuracy in their self-report of length of coma and PTA duration. Discrepancies were large enough to affect injury severity classification. The findings suggest that caution should be exercised when considering self-report of length of coma and PTA duration.Sherer, Mark, Sander, Angelle M., Maestas, Kacey L., Pastorek, Nicholas J., Nick, Todd G., Li, JingyunTexas TBI Model System of TIRR, New York Traumatic Brain Injury Model SystemYesdevopsadmin
2015Aligning policy and practice in science, technology and innovation to deliver the intended socio-economic results: The case of assistive technologyJournalJ73951International Journal of Transitions and Innovations Systems44-Mar221-248Article recommends that science, technology and innovation policies intending to address socio-economic problems, properly align their chosen implementation system to the intended solution's requirements. Society typically relies on the industrial sector to supply product and service innovations through the free market system. In cases of free market failure representing national interests governments may apply alternative innovation systems. The procurement contract system delivers tangible products meeting pre-determined performance criteria (e.g., military weapons; orphan drugs). The exploratory grant system delivers conceptual discoveries advancing the state of science (e.g., scholarly publications). The field of assistive technology exemplifies those social problems requiring technology-based solutions, for which governments around the globe consistently and inappropriately apply the exploratory grant system. The example reflects a broader government bias towards applied scientific research by the academic sector, at the expense of delivering practical solutions through engineering development and industrial production by the private sector.Lane, Joseph P.Nodevopsadmin
2018Antispasmodic medications may be associated with reduced recovery during inpatient rehabilitation after traumatic spinal cord injuryJournalJ78585Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)41163-71Study investigated whether antispasmodic medications are associated with neurological and functional outcomes during the first year after traumatic spinal cord injury (SCI). A retrospective analysis was conducted of data collected prospectively from six inpatient SCI rehabilitation centers. Baseline-adjusted outcomes at discharge and one-year follow-up were compared using analysis of covariance between patients who received antispasmodic medication on at least 5 days during inpatient rehabilitation and patients who did not. Outcome measures included the Rasch-transformed motor subscore of the Functional Independence Measure (FIM) and the International Standards for Neurological Classification of Spinal Cord Injury motor scores, grade, and level. Of 1,259 included patients, 59.8, 35.4, and 4.8 percent were injured at the cervical, thoracic, and lumbosacral levels, respectively; 65.6 percent had motor complete injury. Rasch-transformed motor FIM score at admission averaged 23.3. Total motor score averaged 39.2. Six hundred eighty-five patients (54.4 percent) received one or more antispasmodic medications on at least 5 days. After controlling for demographic and injury variables at admission, Rasch-transformed motor FIM scores at discharge were significantly lower in patients receiving antispasmodic medications than in those who did not. This trend persisted in secondary analyses for cervical, thoracic, and lumbosacral subgroups. Multivariate regression showed that receiving antispasmodic medication significantly contributed to discharge motor FIM outcome. At one-year follow-up, no outcomes significantly differed between patients ON or OFF antispasmodics. Findings suggest antispasmodic medications may be associated with decreased functional recovery at discharge from inpatient traumatic SCI rehabilitation. Randomized prospective studies are needed to directly evaluate the effects of antispasmodic medication on recovery. Theriault, Eric R., Huang, Vincent, Whiteneck, Gale, Dijkers, Marcel P., Harel, Noam Y.Nodevopsadmin
2017A qualitative study examining methods of accessing and identifying research relevant to clinical practice among rehabilitation cliniciansJournalJ77473Journal of Multidisciplinary Healthcare10429-435https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722016/Study examined the utilization of evidence-based practice (EBP) among rehabilitation clinicians. Specifically, it examined how various rehabilitative clinicians including physical therapists, occupational therapists, rehabilitation counselors, and physiatrists are gaining access to literature and whether they are able to implement the available research into practice. Twenty-one clinicians were interviewed by telephone. Participants responded to open-ended questions about their current health information sources and implementation of EBP. A qualitative analysis of the responses was performed using NVivo. There were similarities found with respect to the information-seeking behaviors and translation of research across the different clinician types. Lack of time was reported to be a barrier for both access to literature and implementation of research across all clinician types. The majority of clinicians who reported having difficulty with utilizing the published literature indicated that the literature was not applicable to their practice, the research was not specific enough to be put into practice, or the research found was too outdated to be relevant. In addition, having a supportive work environment aided in the search and utilization of research through providing resources central to assisting clinicians in gaining access to health information. This study identified several barriers that affect EBP for rehabilitation clinicians. The findings suggest the need for researchers to ensure that their work is applicable and specific to clinical practice for implementation to occur.Patel, Drasti, Koehmstedt, Christine, Jones, Rebecca, Coffey, Nathan T., Cai, Xinsheng, Garfinkel, Steven, Shaewitz, Dahlia M., Weinstein, Ali A.Nodevopsadmin
2016A telehealth approach to caregiver self-management following traumatic brain injury: A randomized controlled trialJournalJ74090Journal of Head Trauma Rehabilitation313180-190Study examined whether a telephone-based, individualized education and mentored problem-solving intervention would improve outcomes for caregivers of people with traumatic brain injury (TBI). One hundred fifty-three caregivers (mean age 49.7 years; 82 percent female; 54 percent spouses/partners, 35 percent parents) of adults with moderate-to-severe TBI who received acute and/or rehabilitation care at a level I trauma center were randomized to intervention or control groups. The individualized education and mentored problem-solving intervention focused on caregivers’ primary concerns delivered via up to 10 telephone calls at 2-week intervals. The control group received usual care. Eighty-two percent of participants were evaluated at 6-month follow-up using the Composite of Bakas Caregiving Outcomes Scale (BCOS) and the Brief Symptom Inventory. Secondary measures included the Brief COPE. Results indicate that caregivers in the intervention group scored higher on the BCOS-BSI composite, with more active coping and less emotional venting as measured by the Brief COPE. This study demonstrated that an individualized education and mentored problem-solving approach delivered via telephone in the first few months following community discharge of the TBI survivor resulted in better caregiver outcomes than usual care. Consideration should be given to using this approach to augment the limited support typically offered to caregiversPowell, Janet M., Fraser, Robert, Brockway, Jo Ann, Temkin, Nancy , Bell, Kathleen R.University of Washington Traumatic Brain Injury Model SystemYesdevopsadmin
2016A call to action: Building a translational inclusion team science in physical activity, nutrition, and obesity management for children with disabilitiesJournalJ75559Frontiers in Public Health4164https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979202/Article addresses the need for health promotion programs for children with disabilities. The growing evidence base of childhood obesity prevention and treatment programs do not adequately consider how to adapt these programs for children with disabilities. The authors propose a Call to Action for health researchers who conduct studies focused on the general population (i.e., without a disability) to work closely with disability researchers to adapt their programs (e.g., obesity management, increased physical activity, and caregiver training in diet and nutrition) to be relevant to both groups. This approach is referred to as inclusion team science. The hope for this Call to Action is that there will be greater synergy between researchers who have high levels of expertise in a specialty area of health (but little or no knowledge of how to adapt their program for children with disabilities) to work more closely with researchers who have a high level of expertise in adapting evidence-based health promotion recommendations and strategies for children with disabilities. Together, these two areas of expertise will lead to inclusive physical activity and nutrition programs for all children. Rimmer, James H., Vanderbom, Kerri A.Nodevopsadmin
2018"Going the extra mile": Disclosure, accommodation, and stigma management among working women with disabilitiesJournalJ78290Deviant BehaviorStudy examined women’s experiences of disability disclosure and accommodation in the workplace. Seven focus groups were conducted with 42 women with disabilities. The findings revealed that women with disabilities face intentional and unintentional structural discrimination and must weigh the pros and cons of disclosure and navigate devaluation threats in pursuing workplace accommodations. Concerns related to prejudice and both interpersonal and structural forms of discrimination infused the whole of the data and stigma management techniques emerged as a primary theme. “Going the extra mile” emerged as a stigma management technique which was prevalent among women with higher social capital. Moloney, Mairead E., Brown, Robyn L., Ciciurkaite, Gabriele, Foley, Susan M.Nodevopsadmin
2016A community living management program for people with disabilities who have moved out of nursing homes: A pilot studyJournalJ73491Disability and Rehabilitation388754-760Article describes implementation and evaluation of the Stepping Stones program, a community living management program designed to assist people with disabilities to gain community living skills after moving out of nursing homes. Thirteen people with diverse disabilities participated in the 10-week Stepping Stones program. The participants attended two sessions a day every week, over a 5-week period. Interviewer-administered surveys were used at baseline and 1 week post-intervention to evaluate the impact of the program. Focus group interviews were conducted at 1 week after the intervention. Analyses of quantitative data demonstrated improved self-efficacy in community living management skills, with medium-to-high effect sizes. Participants reported improved sense of empowerment and confidence in finding resources and managing community living. They also reported high satisfaction with the program. Preliminary findings suggest that the Stepping Stones program is beneficial to the target group. This study indicates that application of social learning and self-efficacy theories is effective to empower and enable people with disabilities to manage their lives in the community. The Stepping Stones program may be provided as a risk-management intervention after individuals’ transition into the community.Lee, Danbi, Hammel, Joy, Wilson, TomYesdevopsadmin
2015A brief overview of the coma recovery scale-revised: Updates from the COMBIJournalJ71204Journal of Head Trauma Rehabilitation302143-145Article provides an update from the Center for Outcome Measurement in Brain Injury (COMBI). The Coma Recovery Scale (CRS) was developed to detect subtle differences in neurobehavioral function and monitor recovery in patients with disorders of consciousness, particularly coma, vegetative state (VS), and minimally conscious states (MCS). This scale was revised in 2004 and is presently named the Coma Recovery Scale–Revised (CRS-R). The revised version consists of 23 hierarchically organized items subdivided into 6 subscales. These subscales assess audition, receptive and expressive language, visuoperception, communication ability, motor functions, and arousal level. Using the CRS-R allows clinicians to more easily provide a differential diagnosis, establish prognosis, gauge functional outcome, more effectively plan treatment, and accurately assess a patient’s response to treatment. The CRS-R is the only standardized neurobehavioral assessment instrument that directly incorporates all of the diagnostic criteria required to distinguish VS from MCS, as well as MCS from emergence from MCS.McDonnell, Emily, Giacino, Joseph T., Kolakowsky-Hayner, Stephanie A.Spaulding-Harvard Traumatic Brain Injury Model SystemYesdevopsadmin
2014A randomized controlled trial of venlafaxine XR for major depressive disorder after spinal cord injury: Methods and lessons learnedJournalJ69170Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)373247-263Article describes the rationale, design, methods, and lessons learned in conducting a multi-site, double-blind, randomized controlled trial of venlafaxine XR to treat major depressive disorder (MDD) or dysthymia in people with spinal cord injury (SCI). Across 6 participating SCI centers throughout the United States, 2,536 subjects were screened and 133 were enrolled into a twelve-week trial of venlafaxine XR versus placebo using a flexible titration schedule. Subjects were block randomized and stratified by site, lifetime history of substance dependence, and prior history of MDD. The primary outcome was improvement in depression severity at 12 weeks. The secondary outcome was improvement in pain. The authors describe common methodological and operational challenges conducting multi-site trials and how they were addressed them. Challenges included study organization and decision making, staff training, obtaining human subjects approval, standardization of measurement and treatment, data and safety monitoring, subject screening and recruitment, unblinding and continuity of care, database management, and data analysis. The methodological and operational challenges faced and the lessons learned may provide useful information for researchers who aim to conduct clinical trials, especially in the area of medical treatment of depression in people with SCI.Bombardier, Charles H., Fann, Jesse R., Wilson, Catherine S., Heinemann, Allen W., Richards, J. Scott, Warren, Anne M., Brooks, Larry, Warms, Catherine A., Temkin, Nancy R., Tate, Denise G.Nodevopsadmin
2010Relationship of pre-injury family environment to community integration in adults with traumatic brain injuryJA Journal of the International Neuropsychological Society16 e77Swartwout M.D., Sander A.M., Clark A.N., Sherer M., Nakase-Richardson R., Malec J.F., Moessner A.Texas Model Spinal Cord Injury SystemYesdevopsadmin
2009Relationship of perceived attitudinal barriers and community integration to psychosocial adjustment to disability in persons with traumatic brain injuryJA Archives of Physical Medicine and Rehabilitation9010e19Pappadis M.R., Sander A.M., Struchen M.A.Texas Model Spinal Cord Injury SystemYesdevopsadmin
2009Racial/ethnic disparities in outcomes after central nervous system injuryJAJ55858NeuroRehabilitation2413-JanArango J.Virginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2009Validity of the Acceptance of Disability Scale for persons with traumatic brain injury in an ethnically diverse sampleJA Archives of Physical Medicine and Rehabilitation9010e21Pappadis M.R., Sander A.M., Struchen M.A.Texas Model Spinal Cord Injury SystemYesdevopsadmin
2009Self-Inflicted Traumatic Brain Injury: Patient Characteristics and OutcomesJAJ57785Brain Injury2313-14991-998Objective: To characterize the population of those receiving inpatient rehabilitation who sustained a traumatic brain injury (TBI) secondary to a suicide attempt and identify differences between such individuals and a demographically-matched control group (n¼230) of those whose TBIs were of an unintentional aetiology. Method: Analysed cases were identified from the TBI Model Systems National Database. Based on ICD-9-CM external cause-of-injury codes, 79 participants incurred a TBI secondary to a suicide attempt. An approximate 1 : 3 matched casecontrol (age, gender, race, injury year) design was chosen to make statistical comparisons. Results: Those who sustained a TBI secondary to a suicide attempt had greater pre-existing psychiatric and psychosocial problems (substance use problems (p¼0.01) prior suicide attempt ( p50.0001), psychiatric hospitalization ( p¼0.014) and non-productive activity (p¼0.014)), required more resources during acute and rehabilitative hospitalizations (i.e. charges per day; p¼0.024, p¼0.047) and had greater disability at the time of discharge, even after controlling for injury severity (p¼0.022). Conclusion: Individuals who sustained TBIs secondary to a suicide attempt had increased pre-injury psychiatric and psychosocial problems and poorer outcomes at discharge than those who incurred unintentional injuries. For these individuals, acute and rehabilitation charges per day were higher and could not be accounted for by injury severity.Brenner L.A., Carlson N.E., Harrison-Felix C., Ashman T., Hammond F.M., Hirschberg R.E.Carolinas Traumatic Brain Injury Rehabilitation and Research SystemYesdevopsadmin
2009Neurorehabilitation in traumatic brain injury: Does it make a difference?JA Mount Sinai Journal of Medicine762182-189Greenwald, B.D., & Rigg, J.L.New York Traumatic Brain Injury Model SystemYesdevopsadmin
2009Mortality Over Four Decades Following Traumatic Brain Injury Rehabilitation: A Retrospective Cohort StudyJAJ57188Archives of Physical Medicine and Rehabilitation9091506-1513Objective: To investigate mortality, life expectancy, risk factors for death. and causes of death in persons with traumatic brain injury (TBI) Design: Retrospective Cohort study. Setting: Used data from an inpatient rehabilitation facility,the Social Security Death Index, death certificates, and the u.s. population age-race-sex-specific and cause-specific mortality rates. Part!cipants: Persons with TBI (N= 1678) surviving to their first anniversary of injury admitted to rehabilitation from an acute care hospital within 1 year of injury between 1961 and 2002. Interventions: Not applicable, Main Outcome Measures: Vital status. standardized mortality ratio. life expectancy, cause of death. . Results: Persons with TBI were 1 .5 times more likely to dIe than persons in the general population of similar age, sex, and race, resulting in an estimated average life expectancy reduction of 4 years. Within tbe TBI population. the strongest independent risk factors for death after I year post injury were being older. being male, having less education. baving a longer hospitalization, having an earlier year of injury) and being in a vegetative state at rehabilitation ctischarge. After 1 year postinjury persons with TBI were 49 times more likely to die of aspiration pneumonia, 22 times more likely to die of seizures, 4 times more likely to die ofpneulTIonia, 3 times more likely to commit suicide. and 2.5 times more likely to die of digestive conditions than persons in the general population of similar age, sex, and race. Conclusions: This study demonstrated life expectancy after TBf rehabilitation is reduced and associated with specific risk factors and causes of death. Key Words: Brain injuries; Cause of death; Life expectancy; Mortality: Rehabilitation. © 2009 by the American Congress of Rehabilitation MedicineHarrison-Felix C., Whiteneck G.G., Jha A., DeVivo M.L., Hammond F.M., Hart D.M.Carolinas Traumatic Brain Injury Rehabilitation and Research SystemYesdevopsadmin
2010Mortality after discharge from acute care hospitalization with traumatic brain injury: a population-based studyJAJ58111ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION91120-29Study examined long-term mortality after acute hospitalization for traumatic brain injury (TBI) among patients from diverse races, ethnicities, and socioeconomic conditions. Data were collected for 18,998 Colorado residents with TBI discharged alive from acute hospitalization between 1998 and 2003. Vital status at the end of the study period and statewide population mortality rates were used to calculate all-cause and cause-specific standardized mortality ratios (SMRs) and life expectancy compared with population mortality rates. The influence of demographics, injury severity, and comorbid conditions on time until death was investigated using age-stratified Cox proportional hazards modeling. Results indicated that patients with TBI carried about 2.5 times the risk of death compared with the general population. Life expectancy reduction averaged 6 years. SMRs were largest for deaths caused by mental/behavioral and neurologic conditions and were smaller but significantly higher than 1.0 for an array of other causes. Injury severity and older age increased mortality among young people (age under 20 years). However, risk factors for mortality among adults age 20 and older involved multiple domains of demographics (metropolitan residence), injury-related measures (falls versus vehicular incidents), and comorbidity (3 or more comorbid health conditions versus none).Ventura T, Harrison-Felix C, Carlson N, Diguiseppi C, Gabella B, Brown A, Devivo M, Whiteneck G.Mayo Clinic Traumatic Brain Injury Model System Yesdevopsadmin
2010Race, Ethnicity, and Neurobehavioral Outcomes One Year After Traumatic Brain InjuryJA Brain Injury24 310Arango J., Ketchum, J., Carr, C., Powell, J., Kreutzer, J., Lim C., Hammond F., Drew A.Virginia Commonwealth Traumatic Brain Injury Model SystemYesdevopsadmin
2009Methodological quality of research on cognitive rehabilitation after traumatic brain injuryJAJ57359Archives of Physical Medicine and Rehabilitation9011 SupplS52-S59Objective: To evaluate the methodological quality of research on cognitive rehabilitation after traumatic brain injury (TBI). Data Sources: Secondary analysis of studies identified in prior systematic reviews of cognitive rehabilitation. Study Selection: Randomized controlled trials (RCTs) and observational studies involving exclusively or primarily participants with TBI. Data Extraction: Criteria for evaluating methodological quality were adapted from plior reviews of rehabilitation research.These criteria were modified to be relevant to cogrutive rehabilitation research. Sixteen criteria for evaluating the quality of RCTs were applied: 8 relating to the internal validity of studies, 5 descriptive critelia, and 3 statistical criteria. Twelve of these criteria were used to evaluate non-RCT observational studies. Data Synthesis: Thirty·two RCTs and 21 observational studies were independently reviewed and rated by 2 of theauthors. Initial agreement between raters for individual studies ranged from 57% to 100%. Interrater reliabilities based on the kappa statistic indicated moderate to substantial agreement. Conclusions: Several high·quality RCTs support the effectiveness of interventions for attention, communication skills, and executive functioning after TBI. Several high·quality observational studies support the effectiveness of comprehensive holistic rehabilitation after TBI, including improvements in participation outcomes. The proposed criteria appears useful for evaluating the quality of research on cogmtlve rehabllitatlonand improving the desi