Al Copolillo

Racial Differences in Employment Outcome After Traumatic Brain Injury at 1, 2, and 5 Years Postinjury

UNLABELLED Gary KW, Arango-Lasprilla JC, Ketchum JM, Kreutzer JS, Copolillo A, Novack TA, Jha A. Racial differences in employment outcome after traumatic brain injury at 1, 2, and 5 years postinjury. OBJECTIVES To examine racial differences in competitive employment outcomes at 1, 2, and 5 years after traumatic brain injury (TBI) and to determine whether changes in not competitive employment rates over time differ between blacks and whites with TBI after adjusting for demographic and injury characteristics. DESIGN Retrospective cohort study. SETTING Sixteen TBI Model System Centers. PARTICIPANTS Blacks (n=615) and whites (n=1407) with moderate to severe TBI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Employment status dichotomized as competitively employed versus not competitively employed. RESULTS After adjusting for demographic and injury characteristics, repeated-measures logistic regression indicated that (1) the odds of not being competitively employed were significantly greater for blacks than whites regardless of the follow-up year (all P<.001); (2) the odds of not being competitively employed declined significantly over time for each race (P< or =.004); and (3) changes over time in the odds of not being competitively employed versus being competitively employed were not different between blacks and whites (P=.070). In addition, age, discharge FIM and Disability Rating Scale, length of stay in acute and rehabilitation, preinjury employment, sex, education, marital status, and cause of injury were significant predictors of employment status postinjury. CONCLUSIONS Short- and long-term employment is not favorable for people with TBI regardless of race; however, blacks fare worse in employment outcomes compared with whites. Rehabilitation professionals should work to improve return to work for all persons with TBI, with special emphasis on addressing specific needs of blacks.

Differences in employment outcomes 10 years after traumatic brain injury among racial and ethnic minority groups

Employment outcomes of racial and ethnic minority groups with traumatic brain injury (TBI) have not been thoroughly examined in the research literature beyond five years. The objective of this study was to examine differences in employment outcomes 10 years after TBI among racial and ethnic minorities. Using a multi-center, nationwide database, 382 participants (194 minorities and 188 whites) with primarily moderate to severe TBI from 16 TBI Model System Centers were examined. A logistic regression model indicated that the odds of being competitively employed versus not competitively employed at 10 years follow-up were 2.370 times greater for whites as compared to minorities after adjusting for age at injury, pre-injury employment status, cause of injury, and total length of stay (LOS). In addition, the odds of being competitively employed at 10 years follow-up versus not being competitively employed ranged from being 1.485 to 2.553 greater for those who were younger, employed at injury, had shorter total LOS, and non-violent injuries, respectively. This study supports previous research illustrating that compared to whites, employment is less promising for minorities after TBI both short and long term. Recommendations are suggested to help rehabilitation professionals target the specific needs of minorities with TBI in order to address employment disparities through culturally-based interventions and service delivery.

Randomized Controlled Trials in Adult Traumatic Brain Injury: A Review of Compliance to CONSORT Statement

OBJECTIVE To describe the extent to which adherence to Consolidated Standards of Reporting Trials (CONSORT) statement in randomized controlled trials (RCTs) in adult traumatic brain injury (TBI) has improved over time. DATA SOURCES MEDLINE, PsycINFO, and CINAHL databases were searched from inception to September 2013. STUDY SELECTION Primary report of RCTs in adult TBI. The quality of reporting on CONSORT checklist items was examined and compared over time. Study selection was conducted by 2 researchers independently. Any disagreements were solved by discussion. DATA EXTRACTION Two reviewers independently conducted data extraction based on a set of structured data extraction forms. Data regarding the publication years, size, locations, participation centers, intervention types, intervention groups, and CONSORT checklist items were extracted from the including trials. DATA SYNTHESIS Of 105 trials reviewed, 38.1%, 5.7%, and 32.4% investigated drugs, surgical procedures, and rehabilitations as the intervention of interest, respectively. Among reports published between the 2 periods 2002 and 2010 (n=51) and 2011 and September 2013 (n=16), the median sample sizes were 99 and 118; 39.2% and 37.5% of all reports detailed implementation of the randomization process; 60.8% and 43.8% provided information on the method of allocation concealment; 56.9% and 31.3% stated how blinding was achieved; 15.7% and 43.8% reported information regarding trial registration; and only 2.0% and 6.3% stated where the full trial protocol could be accessed, all respectively. CONCLUSIONS Reporting of several important methodological aspects of RCTs conducted in adult TBI populations improved over the years; however, the quality of reporting remains below an acceptable level. The small sample sizes suggest that many RCTs are likely underpowered. Further improvement is recommended in designing and reporting RCTs.

Results from a survey of occupational therapy practitioners in low vision rehabilitation.

The purpose of this study was to provide practitioners working in low vision rehabilitation with a means for comparing service provision, including assessment, intervention, and program evaluation strategies, across a range of treatment facilities in the United States. Occupational therapy practitioners providing low vision services (N = 34) completed an online survey to address: (1) practitioner backgrounds in occupational therapy and low vision, (2) design, type, and location of practice, (3) client diagnoses and demographics, (4) referrals to and from occupational therapy, (5) types of assessments used, (6) types of interventions provided, and (7) follow-up and program evaluation procedures. Descriptive statistics were calculated for all items. Results suggest that practitioners seek adequate continuing education; use a combination of self-designed and standardized assessment procedures, and both remedial and compensatory intervention strategies; frequently refer to other low vision professionals; and provide services primarily to older adults through a medical rehabilitation model.

The Impact of Experience and Heuristics on Everyday Decisions to Use Mobility Devices: The Need for Control in Nine African-American Older Adults

Nine African-American older adults participated in this ualitative research study to examine decision making and problem-solving related to current and potential mobility device use. Focus group and individual narrative interviews were conducted. Results indicated that older adults use their own past experiences, observation of others using or considering use of mobility devices, and rules as heuristics for making decisions about device use. The desire to maintain control of ones physical and social environments guided decisions about using mobility devices. Participants in the study sought ways to manage decreasing capacities for mobility that preserved self-image while altering the environment as little as possible. Therefore, mobility device use was considered a last alternative because it represented a more permanent and drastic environmental alteration than these community-dwelling older adults were prepared to accept. Suggested guidelines for using the results in practice are provided.

Assistive technology and home modification for people with neurovisual deficits

People with neurovisual deficits from acquired brain injuries and other neurological disabilities can benefit from the array of assistive technologies and home modifications available to the larger vision impairment population, especially when symptoms are mild and associated neurological conditions are few. Optics, proper lighting, and magnification to increase the perceived size of both objects and reading material and to improve contrast sensitivity have been shown to be beneficial. Innovative technologies, universally designed for safe independent living and community participation are gradually developing and show promise for addressing the needs of this population. This article highlights technologies that may be useful for people with neurovisual deficits and describes the evidence to support their training and use. The use of various types of eyewear to reduce falls; prisms and telescopic lenses to improve visual attention and minimize the impact of visual field deficits; and technologies to improve computer use, wayfinding, and home safety are discussed. While there remains substantial need for further research and development focusing on the needs of people with vision impairments from neurological conditions, practitioners can use technology with caution to improve functional outcomes.

Effects of Simulated Low Vision on Postural Adjustment to Changes in Center of Mass in Older Adults

ABSTRACT This study examined how instrumental activities of daily living (IADL) performed by older adults under low-vision simulation conditions affect postural adjustments to changes in center of mass (COM). Ten participants with normal vision performed seven activities under two conditions, normal vision, and simulated macular degeneration (MD). Postural adjustment to changes in COM and time to complete activities were recorded. Low vision was compared to normal vision using Wilcoxon signed rank and t tests. Differences between the two conditions were statistically significant for postural adjustments to change in COM and time. Postural adjustments and time to perform IADLs are greater under simulated low vision conditions versus normal vision. These preliminary findings support research with older adults with MD, who may be at risk when making movement transitions like descending or ascending stairs, stepping in and out of a tub, stooping, or reaching from one surface to another.

Teaching/Learning Strategies for Intervention with People with Neurovisual Impairments

This chapter presents teaching/learning strategies that can be used by occupational therapists (OTs) who provide service for people with neurovisual impairments, i.e., vision impairments related to neurological injury and illness. When to consider integrating people with neurovisual impairments into group interventions that primarily include people with adult-onset eye diseases such as macular degeneration and glaucoma is discussed. When it is probably most essential to provide individual intervention is also discussed. There is a focus on self-management and health promotion models to design and plan both group and individual interventions.