Lauren Gillett

Differential pathways of psychological distress in spouses vs. parents of people with severe traumatic brain injury (TBI): multi-group analysis.

Primary objective: A contemporary model of psychological stress based on an amalgamation of Conservation of Resources theory and the McMaster Model of Family Functioning was devised to compare the effects of neurobehavioural impairments on family functioning and psychological distress in spouses and parents caring for relatives with TBI. Method: Participants were 64 spouses and 58 parents. They completed the Neurobehavioral Problem Checklist, Family Assessment Device and the Brief Symptom Inventory. Structural equation modelling (SEM) was used to test the model for the combined (spouses and parents) sample. Multi-group analysis was then employed for examining differences in structural weights for spouses and parents. Main results: SEM supported the model for the combined sample. Multi-group analysis showed for spouses cognitive and behavioural impairments significantly disrupted family functioning, which in turn increased psychological distress. In contrast, cognitive and behavioural impairments did not significantly disrupt family functioning in parents. For parents, however, cognitive impairments increased psychological distress. Furthermore, parents who reported disrupted family functioning also experienced higher levels of psychological distress. The effect of cognitive impairments was statistically more influential on the level of distress in parents when compared to spouses. Conclusions: Understanding these differences can assist in better targeting family support interventions.

An exploratory prospective study of the association between communication skills and employment outcomes after severe traumatic brain injury

Abstract Primary objective: The aim of this pilot study was to explore possible correlations between measures of functional communication skills in the first year post-injury and later employment outcome. Design: A preliminary observational study employing a prospective longitudinal design. Methods: Fourteen adults with traumatic brain injury completed an assessment involving two functional communication measures: an objective test of cognitive communication skills (Functional Assessment of Verbal Reasoning and Executive Strategies, FAVRES) and self-ratings of communication impairment (LaTrobe Communication Questionnaire, LCQ). Follow-up of participants’ employment outcome was conducted 9–18 months after the initial assessment. Results: At follow-up, eight participants had returned to employment (working a similar number of hours to their pre-injury status), five were unemployed and one was lost to follow-up. Employment status at follow-up was strongly correlated with both FAVRES Total Accuracy scores (r = 0.833) and Total Rationale scores (r = 0.837), but there were no correlations with FAVRES Time and Reasoning scores or with the LCQ. Conclusions: The FAVRES shows initial promise as an assessment that may be associated with successful employment outcome following traumatic brain injury. Further research with larger samples is required to provide further information on the prognostic utility of measures such as the FAVRES and the LCQ.

Injury severity, age and pre-injury exercise history predict adherence to a home-based exercise programme in adults with traumatic brain injury

Purpose: To explore factors that may influence exercise adherence in adults with traumatic brain injury (TBI) within the International Classification of Functioning, Disability and Health (ICF) theoretical model. Participants: Thirty participants with TBI who had been randomized to a home-based exercise programme in a recently conducted randomized controlled trial. Methods: Impairments in body functions, environmental factors and personal factors were explored as predictors for exercise adherence. Significant variables were entered into binary logistic regression analyses to determine their combined power to predict exercise adherence. Results: Greater injury severity, older age and a pre-injury exercise history of walking or jogging positively influenced exercise adherence. As a combined set the three predictor variables accurately classified 82% of participants as adherent or non-adherent and were able to explain 49% of the variance (sensitivity = 67%; specificity = 89%). Conclusion: These results demonstrate people with severe injuries are able to exercise independently and suggest that in order to maximize adherence to an exercise programme, clinicians need to consider exercise history when prescribing the type of exercise. The results also provide factors within the ICF theoretical model to investigate in a large-scale study of exercise adherence after TBI.

Efficacy of electronic portable assistive devices for people with acquired brain injury: a systematic review.

A systematic review was conducted to evaluate the efficacy of electronic portable assistive devices (EPADs) for people with acquired brain injury. A systematic database search (OVID, CINAHL) found 541 citations published between 1989 and the end of 2012. A total of 23 reports met the inclusion/exclusion criteria, namely intervention studies (group, n-of-1) testing the efficacy of EPADs as compensatory devices for cognitive impairment for people with acquired brain injury aged 16–65 years. Study quality was rated by the PEDro (Physiotherapy Evidence Database) scale, (randomised controlled trials), the Downes and Black tool (other group intervention studies), and the Single Case Experimental Design tool (single participant studies). Levels of evidence were determined using five levels of classification based on the Spinal Cord Injury Rehabilitation Evidence table. Results found no Level 1 studies (RCTs with PEDro score ≥ 6), four Level 2 studies and 10 Level 3 studies. There was insufficient evidence to recommend any practice standards, but sufficient evidence to recommend the use of electronic reminder systems in supporting the everyday functioning of people with acquired brain injury as a practice guideline. Higher quality studies are required to support a broader range of compensatory roles that EPADs have the potential to play in neurorehabilitation and the long-term support of people with acquired brain injury.

Suicide prevention training outside the mental health service system: evaluation of a state-wide program in Australia for rehabilitation and disability staff in the field of traumatic brain injury

The training needs of staff working in mainstream (i.e., noncrisis) health settings with client groups that have moderate levels of suicide risk have not been extensively addressed. An initiative to train rehabilitation and disability staff working in the field of traumatic brain injury (TBI) is described. A program was adapted from a generic state health department training program, and disseminated by means of established training networks within the brain injury field. Program efficacy was evaluated as the training was provided across the state of Victoria in a series of 1-day workshops. Participants (n = 86) completed two evaluation measures designed for this purpose (objective knowledge test, self-rating of knowledge and skills) on three occasions (pre- and postworkshop, 6-month follow-up). Compared to a control group of rehabilitation and disability workers who did not receive the training (n = 27), the workshop participants made significant gains in objective knowledge and reported skills, and maintained these gains at the 6-month follow-up. The Suicide Interview Response Inventory-2 (Neimeyer & Pfeiffer, 1994) was administered to a subgroup of participants as a validating measure, and correlated significantly with scores from the objective knowledge test. This process may provide a template for developing more fine-grained suicide prevention strategies among other health-related at-risk groups.

Frequency, clinical correlates, and ratings of behavioral changes in primary brain tumor patients: a preliminary investigation.

Purpose Few studies have addressed the specific behavioral changes associated with primary brain tumor (PBT). This paper will report on the frequency and demographic/clinical correlates of such behaviors, and the reliability of rating such behaviors among people with PBT, family informants, and clinicians. The association of behavioral changes and patient functional status will also be discussed. Methods A total of 57 patients with 37 family informants were recruited from two large Australian metropolitan hospitals. Each completed three neuro-behavioral self-report measures; the Emotional and Social Dysfunction Questionnaire, the Frontal Systems Behavior Scale, and the Overt Behavior Scale. Patients also completed a depression symptom measure. Functional status was defined by clinician-rated Karnofsky performance status. Results Patients were on average 52 years old, a median of 4 months (range 1–82) post-diagnosis, with high grade (39%), low grade (22%), or benign tumors (39%). Patients reported frequency rates of 7–40% across various behavioral domains including anger, inappropriate behavior, apathy, inertia, and executive impairment. The presence of epileptic seizures was associated with significantly higher levels of behavioral changes. Notably, behavior did not correlate with tumor grade or treatment modality. There was moderate agreement between patients and relatives on the presence or absence of behavioral changes, and substantial agreement between relative and clinician ratings. Depressed patients did not generally report more changes than non-depressed patients. Increases in the relative and clinician-rated behavior scores were significantly correlated with decreasing functional status in the patient. Conclusion Behavioral changes were a common sequela of both benign and malignant PBT. Larger scale studies are required to confirm these results. The results suggest the importance of including behavior in brain cancer psychosocial assessments and the need to develop interventions to treat these patients and reduce the burden of care on families.

Development and evaluation of information resources for patients, families, and healthcare providers addressing behavioral and cognitive sequelae among adults with a primary brain tumor.

ABSTRACT Behavioral and cognitive changes in patients with primary brain tumor (PBT) are common and may be distressing to patients and their family members. Healthcare professionals report a strong need for information, practical strategies, and training to assist consumers and better address management issues. A literature review by the current project found that 53% of the information resources currently available to consumers and health professionals contained minimal or no information about cognitive/behavioral changes after PBT, and 71% of the resources contained minimal or no information on associated strategies to manage these changes. This project aimed to develop an information resource for patients, carers, and health professionals addressing the behavioral and cognitive sequelae of PBT, including strategies to minimize the disabling impact of such behaviors. In consultation with staff and patient groups, 16 key information topics were identified covering cognitive and communication changes and challenging behaviors including executive impairment, behavioral disturbance, and social/emotional dysfunction. Sixteen fact sheets and 11 additional resource sheets were developed and evaluated according to established consumer communication guidelines. Preliminary data show that these resources have been positively received and well utilized. These sheets are the first of their kind addressing challenging behaviors in the neuro-oncology patient group and are a practical and useful information resource for health professionals working with these patients and their families. The new resource assists in reinforcing interventions provided to individual patients and their relatives who are experiencing difficulties in managing challenging behaviors after PBT.