Bonnie Todis

Rehabilitation and ongoing support after pediatric TBI: twenty years of progress.

This article summarizes major developments of the past 20 years in both acute and chronic management of children with traumatic brain injury. The article begins with brief summaries of developments in acute and rehabilitative medical management and physical rehabilitation. Because long-term cognitive, behavioral, academic, and family issues tend to be dominant after pediatric TBI, more attention is given to these topics. The article ends with a list of general themes that have been identified as critical in providing effective long-term services and supports to children with TBI and their families.

Overcoming the Odds: Qualitative Examination of Resilience among Formerly Incarcerated Adolescents:

Adolescents who have been incarcerated are at extreme risk for poor adult outcomes. However, some former youth offenders become successful, happy adults, presenting a profile of strength and coping known as resilience. This article describes the results of a 5-year qualitative examination of resilience among a group of adolescents transitioning from youth correctional facilities back into their communities. Topics discussed include predelinquent histories, experiences in the correctional system, and postcorrections transition. Currently about half of the respondents are successful—employed, going to school, or raising children. Others are less stable and may be at risk of being rearrested. Internal and situational factors accounting for these differences are discussed. Implications for practice include restructuring post-corrections transition services and improving school-based supports to at-risk youth.

Educating students with TBI: themes and recommendations.

Ten educational consultants and researchers, each with extensive experience working with children with traumatic brain injury (TBI) in school settings, identified seven themes related to serving this population in public schools. These themes are discussed under the headings (1) incidence of TBI and prevalence of persistent educational disability, (2) diversity and central tendencies within the population, (3) assessment, (4) intervention and support in school settings, (5) training and support for educators, (6) intervention and support for families, and (7) systems change and flexibility. For each theme, a set of recommendations is provided, forming an educational research and policy agenda for pediatric TBI.

Redefining success: results of a qualitative study of postsecondary transition outcomes for youth with traumatic brain injury.

ObjectivesIdentify factors that influence postsecondary education outcomes for students with traumatic brain injury (TBI). DesignQualitative longitudinal. ParticipantsThirty-three young adults with TBI, their parents, and knowledgeable others. ResultsStudents with TBI who received transition services that linked them with disability services and support agencies were more likely to complete postsecondary programs. Internal factors such as positive attitude and determination were also associated with success. ConclusionsSurvey items measuring constructs such as “use of accommodations,” “enrolled in special education,” and “high school graduation” mask a range of experiences. Transition supports geared to the postsecondary education goals of students with TBI are needed.

Making electronic mail accessible: Perspectives of people with acquired cognitive impairments, caregivers and professionals

The primary objective of this study was to better understand the technology needs, barriers and strategies of individuals with acquired cognitive impairments (ACI) in order to design and modify technologies with potential for alleviating the diminished independence and social isolation common in this population. The authors hypothesized that (1) higher rates of computer use would be reported by younger, more highly educated individuals with ACI, those with less severe injuries and those with previous computer experience; (2) A low percentage of survey respondents would own their own computers; and (3) People with ACI would experience social isolation and report low frequency of connecting with important people who live far away. A total of 133 individuals with ACI, professionals and care providers completed the survey. To gain more specific information, seven focus groups were conducted with 66 individuals with ACI and 20 care providers. Finally, 10 current email users participated in structured conversations, detailing their strategies for using email. The survey revealed that 80% of subjects with ACI reported owning a computer. Age and education were not predictors of computer use, but individuals whose ACI was the result of more severe injuries were less likely to use computers. As expected, respondents reported that maintaining contact with distant loved ones is problematic. The focus groups and conversations provided more detail about the communication needs of the population and the relative advantages and disadvantages of email compared with telephone and mail. Participants also identified barriers to email use they had encountered or feared they would encounter when using email. A number of accommodations to overcome these barriers were suggested. The results of the survey, focus groups and conversations confirmed the utility of email and other technologies for people with ACI and the need to make these technologies more accessible. The results and suggestions provided by the focus groups and interviews are being used in the design of Think and Link, an email interface for use by individuals with ACI.

Awareness intervention: who needs it?

It is widely accepted that awareness deficits present challenges to recovery and should be addressed as part of rehabilitation programming. Response to awareness intervention is commonly Inferred from measurements that rely on reports by subjects and significant others. This article describes the findings from a pilot study that examined the relationship among a variety of awareness indicators in three individuals with brain damage over a 9-month period. Results suggest a dissociation between behavioral and perceptual indices of awareness. Changes in behavioral indicators of awareness selected by care givers were not related to changes in self- or caregiver ratings. The clinical and research implications of the findings are discussed

The longitudinal effects of accessible email for individuals with severe cognitive impairments

Background: Electronic communication has provided an unprecedented means of networking people for business, educational, and social purposes (eMarketer, 2001; Madden & Rainie, 2003). However, this mainstream form of communication remains largely inaccessible to individuals with severe cognitive-communicative disabilities (Elman, 2001; Lenhart et al., 2003). This report describes the longitudinal effects of using an adapted email interface by individuals with severe cognitive disabilities due to acquired brain injury.Aims: Research questions included: (1) Can people with severe cognitive impairments learn to email independently using an adapted interface? (2) If participants successfully learn to email, what types of supports are needed to maintain long-term use of email? (3) What, if any, are the psychosocial effects of long-term email participation?Methods & Procedures: A combination of qualitative and quantitative approaches was used to address the above questions for four participants with acquired brain injury, one female and three males, ranging in age from 37 to 65 years, all of whom reported significant social isolation due to their cognitive disabilities. Following assessment (e.g., mock email assessment, goal attainment scaling, neuropsychological testing), they were trained to use a simplified email program using an explicit instructional methodology. Weekly email statistic reports and activity logs were generated to measure frequency, efficiency, topic parameters, and satisfaction related to using email.Outcomes & Results: All four participants became independent, satisfied emailers in their home environments and continued to engage in social email after 9 months. The weekly metrics and email logs showed progressive improvements in efficiency, complexity of written expression, and range of topics discussed. All participants endorsed the social benefits of email and achieved the “most successful outcome” possible for several of their individual goals, including learning a new skill, feeling more connected with friends and family, and increasing their list of email partners.Conclusions: This study is one of the first longitudinal reports on the use of assistive technology by people with severe acquired cognitive impairments, and demonstrates the potential of adapted email as a means of increasing their social communication with friends and family. Issues related to the need to decrease the intensity of human support required to establish long-term use of assistive technology are discussed.

A profile of community navigation in adults with chronic cognitive impairments.

Primary objective: This study sought to identify navigation patterns and illuminate the barriers to and possible solutions for independent community travel in people with chronic cognitive impairments as a result of acquired brain injury. Research design: Two investigative methods were used to explore navigation in the population of interest: Study 1 was a field study and study 2 convened a series of focus groups with relevant stakeholders. Methods and procedures: For study 1, each week during a 4 month period, researchers administered a navigational survey and structured interview to a typical case sample of six participants in order to catalogue all trips taken outside the assistive living facility. Study 2 convened six focus groups to access perspectives on navigational issues for individuals with cognitive impairments (CI) from a number of stakeholder groups including individuals with CI, care providers for this population and public transportation workers. Conclusions: The results of both studies were consistent and indicated that community access is severely restricted for individuals with CI. The majority of trips that were taken tended to be routine and assisted. The variety of travel was limited; participants ventured to the same set places with the same people. Participants described barriers accounting for these problems and suggested a number of strategies to minimize problems.

Longitudinal investigation of the post-high school transition experiences of adolescents with traumatic brain injury.

Objective:To describe outcomes for youth with traumatic brain injury (TBI) transitioning from high school to adulthood. Design:Longitudinal design using univariate and multivariate analyses, including survival analysis to predict time to outcomes of interest and longitudinal growth modeling to evaluate factors that predict rates and levels of outcomes over time. Main Outcome Measures:employment, post–secondary education, and independent living status. Participants:Eighty-nine youth and young adults (aged 19–25 years) with TBI (19 mild–moderate TBI and 70 severe TBI). Results:Individuals entering adulthood following childhood TBI experienced fluctuations in rates of employment, enrollment in post–secondary education, and independent living. A higher likelihood of being enrolled in post–secondary education following graduation from high school was associated with being female, later age at injury, and higher socioeconomic status. Overall greater likelihood of employment was associated with higher socioeconomic status, while employment upon high school graduation was associated with more severe injury and lack of rehabilitations services. Greater likelihood of independent living was associated with later age at injury and nonreceipt of rehabilitation services, while shorter time until independent living was associated with less severe injury. Conclusion:Knowledge of how specific factors affect transition outcomes can be used to tailor transition interventions and resources to the needs of students with TBI. Findings related to special education and medical rehabilitation services should be interpreted with caution as the criteria for receipt of both types of services and the links between such services and functional outcomes are unclear.

Validated instructional practices: application to students with traumatic brain injury.

ObjectiveThere is a lack of empirical evidence of effectiveness for instructional interventions for children with traumatic brain injury (TBI). This article addresses this issue by providing an in-depth examination of instructional methodologies validated with other populations of students (with and without disability) and their potential for teaching children with TBI. DesignLiterature review. ConclusionsTwo instructional approaches—Direct Instruction and cognitive strategy intervention—have significant evidence supporting their use with many populations of children, with and without disabilities, and address many of the common needs and learning characteristics of students with TBI, thus showing particular promise for these students. Given the efficacy of these 2 approaches with students with similar learning and behavioral characteristics, the authors recommend establishing and funding a systematic research agenda to test their effectiveness with students with TBI.