Janet P. Niemeier

Acute cognitive and neurobehavioural intervention for individuals with acquired brain injury: Preliminary outcome data

The present study provides a rationale for and detailed description of a structured curriculum for a cognitive and neurobehavioural group intervention for patients in an acute inpatient brain injury rehabilitation setting. Preliminary outcome data are provided for 29 patients with acquired brain injuries who attended the group during inpatient rehabilitation. The group was held during three 30-minute sessions per week. Prior to discharge, patients completed a Learning Assessment, which assessed their level of knowledge about the material covered during the course. Patients received a mean score of 85.54 on the Learning Assessment. High scores on the Learning Assessment correlated significantly with discharge Disability Rating Scale total and Social Interaction FIM scores. Age, level of education, race, sex, and length of stay did not significantly impact these results. Results suggest that patients with acquired brain injuries benefit from acute cognitive and neurobehavioural intervention and are capable of learning compensatory strategies, even in the acute stages of recovery. This learning may help improve functional status, especially skills needed for psychosocial adjustment.

Toward improved rehabilitation services for ethnically diverse survivors of traumatic brain injury.

Traumatic brain injury is an important public health problem in the United States, especially for individuals from racial and ethnic minorities. The first part of this article provides a synthesis of findings and discussions of cultural issues in the rehabilitation, medical, and psychological scientific literature highlighting the needs and challenges of our diverse population of minority traumatic brain injury survivors in the United States. The second part offers practical recommendations for rehabilitation professionals who desire to improve the healthcare and health outcomes of these individuals. Through an examination of research, guidelines, and resources, we justify the importance of cultural sensitivity in everyday provider interactions with minority clients and their families.

Gender Differences in Awareness and Outcomes During Acute Traumatic Brain Injury Recovery

BACKGROUND Recent literature on traumatic brain injury (TBI), though mixed when reporting outcomes, seems collectively to suggest possible gender advantage for women in postinjury recovery, especially in executive functions. Hormonal neuroprotection, through female reproductive hormones, is often proposed as an underlying factor in these results. We explored potential gender differences in an aspect of executive functions, self-awareness (SA), which is often impaired after TBI, limits patient effort in critical rehabilitation, and increases caregiver burden. METHODS Within a prospective survey, repeated-measures design, 121 patients with moderate or severe TBI undergoing acute rehabilitation in a Level 1 trauma center, a family member or caregiver informant, and a treating clinician were asked to complete the Patient Competency Rating Scale (PCRS) and the Frontal Systems Behavior Scale (FrSBe) at admission and discharge. RESULTS Although overall, women and men with TBI showed generally similar levels of SA, women had significantly better awareness of their injury-related deficits at acute rehabilitation discharge, even when controlling for age, education, and injury severity. CONCLUSIONS Mixed findings in this study mirror the pattern of results that dominate the published literature on gender and TBI. Gender differences in executive dysfunction may not be as large or robust as some researchers argue. In addition, complex interplays of socialization, gender-role expectations, naturally occurring male and female ability differences, and differences in access to postinjury rehabilitation are understudied potential moderators.

Factor structure, reliability, and validity of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury population

OBJECTIVE This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury (TBI) population across indices of factor structure, reliability, and validity. METHOD Data were collected from 101 individuals undergoing acute rehabilitation for moderate and severe TBI both upon emergence from posttraumatic amnesia and at hospital discharge, as well as from their family members or caregivers. RESULTS Four separate confirmatory factor analyses (CFAs) suggested that the FrSBes three-factor/three-subscale solution did not fit the data well, and follow-up CFAs employing a one-factor structure similarly yielded poor fit indices. Four exploratory factor analyses (EFAs) failed to produce factor solutions consistent with each other or that resembled the factor solution retained in the EFA during the FrSBes initial construction. The FrSBe had sufficiently high internal consistency at the total-score and subscale-score levels, good convergent validity with other indices of TBI functioning, and good test-retest reliability in the family administration of the measure, but not in the patient administration. CONCLUSIONS The FrSBe is an appropriate measure for use in an inpatient TBI population when using the total score and the family administration, though its subscales and patient administration warrant more rigorous examination.

Are there cognitive and neurobehavioural correlates of hormonal neuroprotection for women after TBI

This study examined possible cognitive correlates of hormonal neuroprotection following traumatic brain injury (TBI) using archival neuropsychological findings for 1563 individuals undergoing acute TBI rehabilitation between 1989 and 2002. Presumed age of menopause was based on the STRAW (Stages of Reproductive Aging) staging system (Soules, 2005; Soules et al., 2001) and general linear model (GLM) analysis of performance on neuropsychological testing by participants across gender and age groups (25–34, 35–44, 45–54, and 55–64) was performed. Hypotheses were (1) women with TBI in the oldest age group would have lower scores on neuropsychological tests and functional outcome measures than women in the younger groups, and (2) men in the oldest age group would have higher scores than women of the same age group. Analyses revealed that oldest females had significantly worse Trails B and SDMT written and oral scores than the youngest females. In addition, oldest females had significantly better Trails B, Rey AVLT and SDMT written scores than the oldest males. Possible cohort exposure to hormone replacement therapy, unknown hormonal status at time of testing, and sample-specific injury characteristics may have contributed to these findings.

Does history of substance use disorder predict acute traumatic brain injury rehabilitation outcomes

BACKGROUND/OBJECTIVE The study explored whether premorbid substance use disorder (SUD) predicts acute traumatic brain injury (TBI) outcomes. METHODS 143 participants with moderate (34.2%) and severe (65.8%) TBI were enrolled at two Level 1 trauma center inpatient brain injury rehabilitation units. Acute outcomes were measured with the Disability Rating Scale (DRS), the FIMTM; self and informant ratings of the Patient Competency Rating Scale (PCRS); self and family rating of the Frontal Systems Behavioral Scale (FrSBe), and the Neurobehavioral Rating Scale-Revised (NRS-R). RESULTS Hierarchical linear modeling revealed that SUD history significantly predicted trajectories of PCRS clinician ratings, PCRS self-family and PCRS self-clinician discrepancy scores, and more negative FrSBE family ratings. These findings indicate comparatively greater post-injury executive functions (EF) impairments, particularly self-awareness (SA) of injury-related deficits, for those with SUD history. No significant SUD*time interaction effect was found for FIM or NRS-R scores. CONCLUSIONS SUD history and TBI are associated with impaired SA and EF but their co-occurrence is not a consistent predictor of acute post-injury functional outcomes. Pre-morbid patient characteristics and rater expectations and biases may moderate associations between SA and recovery after TBI.

Turning Data Into Information Opportunities To Advance Rehabilitation Quality, Research And Policy

Attention to health care quality and safety has increased dramatically. The internal focus of an organization is not without influence from external policy and research findings. Compared with other specialties, efforts to align and advance rehabilitation research, practice, and policy using electronic health record data are in the early stages. This special communication defines quality, applies the dimensions of quality to rehabilitation, and illustrates the feasibility and utility of electronic health record data for research on rehabilitation care quality and outcomes. Using data generated at the point of care provides the greatest opportunity for improving the quality of health care, producing generalizable evidence to inform policy and practice, and ultimately benefiting the health of the populations served.