Denise Krch

Early predictors of employment outcomes 1 year post traumatic brain injury in a population of Hispanic individuals

OBJECTIVE To determine which demographic, injury, and rehabilitation factors are associated with employment rates in Hispanic individuals 1 year post traumatic brain injury (TBI). DESIGN Retrospective study. SETTING Longitudinal dataset of the TBI Model Systems National Database. PARTICIPANTS 418 Hispanic individuals with TBI hospitalized between 1990 and 2009 having year 1 follow-up data (18-55 years and not retired at injury). MAIN OUTCOME MEASURE Competitive employment status 1 year post-injury (yes/no). RESULTS A multiple logistic regression model indicated that pre-injury employment status, pre-injury level of education, etiology, days of posttraumatic amnesia (PTA), associated spinal cord injury, Functional Independence Measure (FIM) motor at rehabilitation discharge, and length of stay in rehabilitation were significant predictors of competitive employment post-injury, controlling for the effects of each other (all p-values ≤ 0.014). Increases in the odds of not being employed post-injury were associated with not being employed pre-injury, having lower levels of education pre-injury, etiologies due to violence or falls, increased PTA, an associated spinal cord injury, lower FIM motor scores, and greater lengths of stay in rehabilitation. CONCLUSIONS The first year post-TBI is critical for recovery and gainful employment, particularly for Hispanic individuals. Early identification of factors influencing successful gainful employment and expeditious implementation of services to ameliorate these issues are paramount in improving employment outcomes for Hispanic individuals with TBI.

Health-related quality of life of individuals with traumatic brain injury in Barranquilla, Colombia.

Objective: To assess health-related quality of life (HRQoL) of individuals with traumatic brain injury (TBI) in Barranquilla, Colombia. Participants/methods: Thirty-one individuals with TBI and 61 healthy controls completed the SF-36, a self-report HRQoL measure composed of eight component areas: physical health problems, pain, role limitations due to physical problems or due to emotional problems, emotional well-being, social functioning, energy/fatigue and general health perceptions. Results: The samples were statistically similar with respect to age, gender and education and statistically different with respect to depression, SES, social support and cognition. Compared to healthy controls, individuals with TBI had significantly lower means on all SF-36 sub-scales. However, after adjusting for depression, SES, social support and cognitive performance, significant differences remained on three of the SF-36 sub-scales. Specifically, individuals with TBI had lower adjusted means on Role-Physical (p-value < 0.005), Role-Emotional (p-value < 0.005) and Bodily Pain (p-value < 0.05). Conclusion: Even after controlling for depression, SES, social support and cognitive performance, individuals with TBI living in Barranquilla Colombia report having poorer quality of life across various domains, including Role-Physical, Role-Emotional and Bodily Pain. These findings suggest the need for rehabilitation health professionals to develop and implement culturally-appropriate interventions to improve quality of life in Colombian individuals with TBI.

Racial and Ethnic Disparities in Employment Outcomes for Persons With Traumatic Brain Injury: A Longitudinal Investigation 1-5 Years After Injury

To determine whether differences exist in employment rates between whites, blacks, and Hispanics with traumatic brain injury (TBI) at 1, 2, or 5 years after injury; to determine whether changes occur in postinjury employment rates over time for whites, blacks, and Hispanics; and to determine whether changes in postinjury employment rates over time are different for whites, blacks, and Hispanics.

Does slowed processing speed account for executive deficits in multiple sclerosis? Evidence from neuropsychological performance and structural neuroimaging.

OBJECTIVE Executive deficits and slow processing speed (PS) are observed in persons with multiple sclerosis (MS). The question of whether executive deficits can be explained by slow PS was examined with neuropsychological measures and a neurostructural measure (brain atrophy). METHOD Fifty MS patients were compared with 28 healthy controls (HCs) on tasks of executive functioning with and without a PS element (e.g., Trail Making Test and Wisconsin Card Sorting Test). RESULTS The MS group performed worse than HCs on speeded tasks of executive function. However, after controlling for speed, group differences on executive tasks disappeared. There were also no group differences on executive tasks with no PS demands. The effect of disease progression on executive task performance was assessed in the MS group. Higher atrophy in MS participants was associated with greater deficits on speeded executive tasks, but this association disappeared when controlling for PS. There was no association between atrophy and performance on nonspeeded executive tasks. CONCLUSIONS Our results support the notion that executive deficits in MS may be explained by slow PS. These findings highlight the role of slowed PS as a primary impairment underlying other cognitive functions. Disentangling the relative contribution of PS to executive function is an important step toward the development of appropriate rehabilitation strategies for persons with MS.

Characteristics associated with satisfaction with life 1 year post traumatic brain injury in a population of Hispanic individuals.

OBJECTIVE To determine which demographic, injury, rehabilitation, and follow-up characteristics are associated with satisfaction with life in a population of Hispanic individuals 1 year post-traumatic brain injury (TBI). DESIGN Retrospective study. SETTING Longitudinal dataset of the TBI Model Systems National Database. PARTICIPANTS 291 Hispanic adults with TBIs occurring between 1999 and 2008 having year 1 follow-up data. MAIN OUTCOME MEASURE Satisfaction with Life Scale (SWLS) measured 1 year post-TBI. RESULTS The relationships between SWLS 1 year post-injury and a variety of demographic, injury, rehabilitation, and follow-up characteristics were modeled using generalized linear models. The final multivariable model explained 25.2% of variability in SWLS (F (7, 261)=12.6, p < 0.001) and included quadratic effects for both age at injury and FIM cognitive scores 1 year post-injury, as well as effects for associated SCI and employment status 1 year post-injury (all p-values ≤ 0.036). In general, higher age, no associated SCI, not being unemployed at 1 year post-injury, and very high or very low FIM cognitive scores were associated with greater SWLS scores 1 year post-injury. CONCLUSIONS These results suggest a variety of demographic, injury, and follow-up characteristics are related with SWLS 1 year post-TBI in Hispanic individuals. Focusing rehabilitation efforts on improving cognition and vocational skills may improve SWLS in Hispanics 1 year post-TBI.

Issues of cultural diversity in acquired brain injury (ABI) rehabilitation

INTRODUCTION With the general population in the United States becoming increasingly diverse, it is important for rehabilitation professionals to develop the capacity to provide culturally sensitive treatment. This is especially relevant when working with minority populations who have a higher risk for brain injury and poorer rehabilitation outcomes. OBJECTIVES This article presents a number of clinical vignettes to illustrate how cultural factors can influence behavior in patients recovering from brain injury, as well as rehabilitation staff. The main objectives are to raise awareness among clinicians and stimulate research ideas by highlighting some real world examples of situations where a specialized, patient-centered approach needs to consider factors of cultural diversity. CONCLUSION Because ones own world view impacts the way we see the world and interpret behavior, it is important to understand ones own ethnocentrism when dealing with a diverse population of patients with brain injury where behavioral sequelae are often expected. Being able to see behavior after brain injury with an open mind and taking into account cultural and contextual factors is an important step in developing culturally competent rehabilitation practices.

Subjective memory in multiple sclerosis is associated with initial-trial learning performance.

Subjective reports of memory functioning are often included as part of neuropsychological evaluations. However, information from subjective measures often conflicts with formal testing results. The current study explored the relationships among self-reported memory functioning and objective learning and memory measures. Sixty-four multiple sclerosis (MS) patients completed a self-report memory questionnaire (Memory Functioning Questionnaire, MFQ) and objective measures of learning and memory (California Verbal Learning Test-II, CVLT-II; Open-Trial Selective Reminding Test, OT-SRT; and Prose Memory, PM). Significant positive correlations were found between self-reported memory functioning and recall following initial exposure to material: OT-SRT Trial 1 (r = .42; p = .001); CVLT-II Trial 1 (r = .39; p = .002): PM Immediate Recall (r = .28; p = .028). Subjective memory was unrelated to recall performance on subsequent learning trials, aggregate learning scores, or delayed free recall. Results suggest that self-reported memory functioning in MS patients may be specifically related to single-trial learning.

The effect of cognitive impairment on self-generation in Hispanics with TBI.

The objective of this study was to determine the moderating effect of cognitive impairment (CI) on the usefulness of the generation effect to improve learning and memory in Hispanics with traumatic brain injury (TBI). Sixty-one Hispanic individuals with TBI (29 without CI, 22 with mild to moderate CI, and 10 with severe CI) and 44 healthy controls (HC) were required to remember the last word in each of 32 sentences. Target words were presented in a self-generated and provided condition. Recall and recognition were examined immediately, after 30 minutes, and at one week. Individuals remembered and recalled significantly more words in the generated condition than the provided condition, regardless of group or time. The self-generation technique equally benefitted all participants regardless of TBI status or degree of CI. Future cognitive rehabilitation programs designed to improve short-term recall and recognition in Hispanic individuals with TBI should include the self-generation technique. Further research into the longer-term effects of the generation effects is warranted.

Pilot results from a virtual reality executive function task

Impairments in executive functions (EF) negatively impact the capacity for independent living, damaging personal autonomy, and diminishing quality of life. Virtual environments offer an ecologically valid way to evaluate a persons ability to carry out tasks that depend on EFs. The purpose of this pilot study was to evaluate the feasibility of a virtual reality office task, the Assessim Office (AO), in persons with Multiple Sclerosis and Traumatic Brain Injury, to evaluate performance of patient groups relative to each other and to healthy controls on the AO, and to explore the relationship between patients performance on AO tasks and neuropsychological measures of EF.

The Multidimensional Influence of Acculturation on Digit Symbol-Coding and Wisconsin Card Sorting Test in Hispanics

Objective: The purpose of the current study was to evaluate the relative contribution of acculturation to two tests of nonverbal test performance in Hispanics. Method: This study compared 40 Hispanic and 20 non-Hispanic whites on Digit Symbol-Coding (DSC) and the Wisconsin Card Sorting Test (WCST) and evaluated the relative contribution of the various acculturation components to cognitive test performance in the Hispanic group. Results: Hispanics performed significantly worse on DSC and WCST relative to non-Hispanic whites. Multiple regressions conducted within the Hispanic group revealed that language use uniquely accounted for 11.0% of the variance on the DSC, 18.8% of the variance on WCST categories completed, and 13.0% of the variance in perseverative errors on the WCST. Additionally, years of education in the United States uniquely accounted for 14.9% of the variance in DSC. Conclusions: The significant impact of acculturation on DSC and WCST lends support that nonverbal cognitive tests are not necessarily culture free. The differential contribution of acculturation proxies highlights the importance of considering these separate components when interpreting performance on neuropsychological tests in clinical and research settings. Factors, such as the country where education was received, may in fact be more meaningful information than the years of education of education attained. Thus, acculturation should be considered an important factor in any cognitive evaluation of culturally diverse individuals.