Gary Seale

Comparison of the Community Integration Questionnaire, the Craig Handicap Assessment and Reporting Technique, and the Disability Rating Scale in traumatic brain injury.

Objective:To examine the concurrent validity of the Community Integration Questionnaire (CIQ) in assessing outcomes in traumatic brain injury (TBI) by comparing it with two widely used and well-validated measurements of rehabilitation outcome. Design:A retrospective relational study of the concurrent validity of the CIQ, Craig Handicap Assessment and Reporting Technique (CHART), and Disability Rating Scale (DRS). Setting:A postacute rehabilitation facility. Participants:Seventy patients with a medical diagnosis of TBI admitted between April 1996 and October 1998 participated in the study. Results:CIQ and CHART provide ratings that are similar in several areas to those provided by the DRS. Correlation (r) among total scores and subscales for all three instruments ranged from 0.021 to 0.671 (P < .01). Correlation between CIQ and CHART is stronger than that between CIQ and DRS or between CHART and DRS, and the correlation between CHART and DRS is stronger than that between CIQ and DRS. Conclusion:The CIQ appears to be the most appropriate instrument in quantifying rehabilitation outcome in patients with TBI at the participatory (handicap) level. The findings of this study can help clinicians gain a greater understanding of the nature, redundancy, and gaps among functional outcome measures. Monitoring outcomes can also help clinicians better understand the effectiveness of interventions.

Change in positive emotion and recovery of functional status following stroke.

OBJECTIVES To investigate change in positive emotion over a 3-month follow-up period and determine whether this change is associated with recovery of functional status in persons with stroke. DESIGN A longitudinal study using information from the Stroke Recovery in Underserved Patients (SRUP) database. Positive emotion and functional status were assessed within 72 hours of discharge from an in-patient medical rehabilitation facility and at 3-month follow-up using established measurement instruments. PARTICIPANTS The study included 840 adults 55 years old or older with a first-time stroke and admitted to one of eleven in-patient medical rehabilitation facilities in the United States. RESULTS The mean age was 72.9 (SD = 9.52) years, 78.6% were non-Hispanic white and 51.7% were women. The average length of stay was 20.2 (SD =10.1) days and the most prevalent type of stroke was ischemic (75.0%). Positive emotion increased for 35.6% of the sample, decreased for 29.2%, and 35.2% reported no change. Increases in positive emotion change score compared to no change (b = -3.2, SE = 1.5, p = .032) or a decline (b = -8.9, SE = 1.4, p = or <.001) was significantly associated with improved functional status at the 3-month follow-up after adjusting for sociodemographic and clinical variables as well as depressive symptoms. CONCLUSION Positive emotion is a dynamic process and can change over time. In persons with stroke, increases in positive emotion over a 3-month period was significantly associated with an increasing likelihood of recovery of functional status compared to no change or a decline in positive emotion. Understanding factors that influence both increases and decreases in positive emotion has implications for stroke rehabilitation programming and quality of life post-hospital discharge.

Ecological validity of the neuropsychological assessment battery screening module in post-acute brain injury rehabilitation.

Primary objective: To assess the ecological validity of the Screening Module of the Neuropsychological Assessment Battery (NAB-SM) using the Functional Independence Measure (FIM). Method: Seventy individuals with moderate-to-severe traumatic brain injury at a residential post-acute rehabilitation facility were administered the FIM instrument and the NAB-SM upon admission. Hierarchical regression analysis was used to examine the relationship between the variables from these two assessment measures. Results: Hierarchical models revealed that (1) the NAB-SM Total score was significantly associated with the FIM instrument Total score as well as the Motor and Cognition sub-scale scores, above and beyond the contribution of demographic variables, (2) the NAB-SM Language, Memory and Spatial domain scores were significantly associated with of the FIM instrument Cognition sub-scale score and (3) the NAB-SM Spatial domain score was significantly associated with of the FIM instrument Total and Motor sub-scale scores. Conclusions: The current findings support previous research and provide strong evidence for the ecological validity of the NAB-SM with regard to functional abilities as assessed by the FIM instrument.

Interdisciplinary meetings: investigating the collaboration between persons with brain injury and treatment teams.

The purpose of this study was to gain an understanding of the collaboration that occurs in interdisciplinary team meetings (ITMs) at a post-acute brain injury rehabilitation centre. A qualitative descriptive case study was chosen for its interpretative and naturalistic approach. The study included participant observation of 51 meetings, five interviews, document review of charts and memos, and inductive analyses. Four themes emerged: (1) the ITM transformation ritual (the meetings themselves); (2) the ITM shapers (the case managers); (3) the ITM collaborators (the professional interdisciplinary team members); and (4) the ritual ghosts (surprisingly, the clients). Several patterns of interactions were documented, including subservient clients, lengthy meetings, and client transformation. These findings are discussed within the context of client-centred practice. The results indicate that inclusion of the client in interdisciplinary meetings does not necessarily lead to collaboration. Clinical implications and future research are discussed.

The role of positive affect on social participation following stroke

Purpose: To examine the association between positive affect and social participation in adults with first-time stroke after in-patient medical rehabilitation. Methods: A prospective cohort design using information from the Stroke Recovery in Underserved Populations database (SRUP) for the years 2005–2006. Data were collected at discharge from in-patient medical rehabilitation and 3 months post-discharge. Participants were aged 50 and older with first-time stroke (n = 605) and admitted to 1 of 11 in-patient medical rehabilitation facilities across the United States. Primary measures included a positive affect scale and a home and community social participation instrument. Results: The mean age was 71.6 years, 50.3% were women, and 56.5% were married. Results of cumulative logit models showed each 1 point increase in positive affect was significantly associated with a 17% odds of higher social participation (OR: 1.17, 95% CI 1.10, 1.25), after adjusting for demographics, clinical characteristics, and negative affect. Conclusions: High positive affect at discharge from in-patient medical rehabilitation was associated with higher levels of social participation 3 months post-discharge. The significant association between higher positive affect and higher levels of social participation adds to accumulating evidence linking positive affect with beneficial physical and psychological outcomes after an acute event such as stroke. Implications for Rehabilitation This study shows positive affect associated with greater social participation 3 months post-discharge from in-patient medical rehabilitation. Positive affect may be a critical factor in the recovery trajectory of the stroke patient. The assessment of positive affect during in-patient medical rehabilitation may identify those at risk for poor social participation post-discharge and may lead to the design of innovative interventions aimed at the re-integration of stroke individuals into the community.

Recovery of Functional Status After Stroke in a Tri-Ethnic Population

To examine recovery of functional status for white, black, and Hispanic patients who have had a stroke from the time of admission to inpatient medical rehabilitation to 12 months after discharge.

Psychiatric Disease and Post-Acute Traumatic Brain Injury

Psychiatric disorders are common following traumatic brain injury (TBI) and can include depression, anxiety, and psychosis, as well as other maladaptive behaviors and personality changes. The epidemiologic data of psychiatric disorders post-TBI vary widely, although the incidence and prevalence rates typically are higher than in the general population. Although the experience of psychiatric symptoms may be temporary and may resolve in the acute period, many patients with TBI can experience psychopathology that is persistent or that develops in the post-acute period. Long-term psychiatric disorder, along with cognitive and physical sequelae and greater risk for substance use disorders, can pose a number of life-long challenges for patients and their caregivers, as they can interfere with participation in rehabilitation as well as limit functional independence in the community. The current review of the literature considers the common psychiatric problems affecting individuals with TBI in the post-acute period, including personality changes, psychosis, executive dysfunction, depression, anxiety, and substance misuse. Although treatment considerations (pharmacological and nonpharmacological) are referred to, an extensive description of such protocols is beyond the scope of the current review. The impact of persistent psychiatric symptoms on perceived caregiver burden and distress is also discussed.

Positive affect and pain ratings in persons with stroke.

OBJECTIVE To examine the association between positive affect at discharge from inpatient medical rehabilitation and pain ratings 3 months postdischarge in persons with stroke aged 50 or older. DESIGN A longitudinal study using information from the Stroke Recovery in Underserved Population (SRUP) data base. A 4-item positive affect scale and an 11-point visual analog pain scale were collected at discharge and at 3 months postdischarge. PARTICIPANTS The study included 917 adults aged 50 and older with first-time stroke admitted to one of eleven inpatient medical rehabilitation facilities across the United States. RESULTS The mean age of the sample was 71 years, 51.0% were women, and 51.6% were married. One third of the sample reported pain and the mean positive affect score was 9.2 (range 0-12). Cumulative logit models showed higher positive affect scores at discharge were significantly associated with lower pain ratings (OR: 0.87, 95% CI 0.81, 0.92) at 3-month follow-up after adjusting for discharge pain ratings, negative affect, and demographic and clinical characteristics. CONCLUSION High positive affect at discharge from inpatient medical rehabilitation was associated with lower pain ratings 3 months post discharge after controlling for pain and negative affect at discharge and clinical and demographic characteristics. The identification of links between positive affect and pain may contribute to a better understanding of functional recovery processes poststroke and the planning of therapeutic programs directed at the positive psychological strengths in elderly persons with stroke.