Lynne C. Davis

Making connections after brain injury: development and evaluation of a social peer-mentoring program for persons with traumatic brain injury.

Objective:To describe the development and implementation of a social peer-mentoring program for persons with traumaticbrain injury (TBI) and to explore whether this program yielded increased social functioning outcomes compared with wait-list (WL)controls. Design:Pilot randomized controlled study. Participants:Community-dwelling individuals with TBI(12 matched with social peer mentors and 18 completing the WL condition). Intervention:Trained social peer mentors (SPMs)were matched to partners with TBI (peer partners (PP)) to foster skill-building in planning of social activities and improvingsocial communication abilities through phone contacts and joint participation in social events within the community over a 3-monthperiod. Measures:Social Activity Interview, Center for Epidemiological Studies Depression Scale, UCLA Loneliness Scale, Satisfaction with Life Scale, 6-Item Interpersonal Support Evaluation List (baseline and postmentoring); weekly social activity data(1-month baseline, continuously collected during 3-month mentoring or WL period); satisfaction survey. Results:Both SPMand PP participants reported high satisfaction with the mentoring program. Statistically significant improvements in perceived socialsupport after mentoring were observed for the mentored group than for WL participants; however, an increase in depressive symptoms wasalso observed. While significant improvements in social activity level and social network size were not found, a trend toward increasedsatisfaction with social life was present for mentored participants. Conclusions:Satisfaction ratings for the SPM programwere uniformly high and selected positive findings encourage further investigation of social mentoring as an intervention to effectimprovements in social integration. Small sample size and reduced “dosage” of mentor interactions were limitations of thispilot study. Benefits of and challenges to implementation of an SPM program are outlined.

Relationship of race/ethnicity and income to community integration following traumatic brain injury: investigation in a non-rehabilitation trauma sample.

The purpose of the current study was to determine the contribution of race/ethnicity and income to community integration at approximately 6 months following traumatic brain injury (TBI). Participants were 151 persons with mild to severe TBI (38% Black; 38% Hispanic; 24% White) recruited from consecutive admissions to the Neurosurgery service of a county Level I trauma center. A large number of participants had low income and low education. Community integration was assessed using the Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique - Short Form (CHART-SF), and Community Integration Measure (CIM). Results of analysis of covariance (ANCOVA) indicated that, after accounting for injury severity, age, education, and income, race/ethnicity contributed significantly to the variance in CIQ Total score, Home Integration Scale, and Productive Activity Scale scores. Blacks had lower CIQ Total scores compared to Whites. Black and Hispanic participants had lower scores than Whites on the Home Integration Scale, and Blacks had lower scores than Whites and Hispanics on the CIQ Productive Activity Scale. Low income ( < or =

Perceptions of communication abilities for persons with traumatic brain injury: Validity of the La Trobe Communication Questionnaire

20,000) was related to lower scores on the CIQ and CHART-SF Social Integration Scales, and scores on the CIM Total, Belonging, and Independent Participation scales. These results indicate that racial/ethnic differences in community integration exist, even after accounting for income. However, income was more predictive than race/ethnicity for certain aspects of community integration, indicating that it should be accounted for in all studies investigating racial/ethnic differences in outcomes.

Preinjury Predictors of Life Satisfaction at 1 Year After Traumatic Brain Injury

Primary objective: To further evaluate the construct validity of the La Trobe Communication Questionnaire (LCQ) and to investigate the extent to which self-ratings of adults with traumatic brain injury compared to ratings made by close others and self-ratings made by non-injured matched controls. Research design: Prospective cohort study. Methods and procedures: Two hundred and seventy-six adults with TBI (121 of which are >1-year post-injury and previously enrolled in TBI Model Systems and 155 of which were consecutively admitted to a Level 1 trauma centre and were at least 6-months post-injury) completed the La Trobe Communication Questionnaire. In addition, for the TBI Model systems sample, 88 friends/family members and 80 non-injured matched controls participated. Main outcomes and results: Principle components analysis with varimax rotation yielded four factors: Initiation/Conversational Flow, Disinhibition/Impulsivity, Conversational Effectiveness and Partner Sensitivity, which were found to have adequate internal consistency. Adequate discriminative validity was obtained in comparing adults with TBI to non-injured matched controls, while no significant differences were found between self-ratings of communication abilities by adults with TBI and those made by close others. Conclusions: Additional support for the LCQ as a useful measure of perceived social communication abilities was obtained. Confirmatory factor analysis with a larger sample of adults with TBI will be a useful step in further development of this tool.

Prognostic Importance of Self-Reported Traits/Problems/Strengths and Environmental Barriers/Facilitators for Predicting Participation Outcomes in Persons With Traumatic Brain Injury: A Systematic Review

OBJECTIVE To investigate the predictive value of preinjury factors for satisfaction with life (SWL) at 1-year posttraumatic brain injury (TBI). DESIGN Secondary analysis of prospective, longitudinal registry using data collected during inpatient rehabilitation and at 1-year post-TBI. SETTING Fifteen specialized brain injury units providing acute rehabilitation care as part of the Traumatic Brain Injury Model Systems (TBIMS) program. PARTICIPANTS Community-dwelling persons (N=444) with moderate to severe TBI aged 16 to 64 years enrolled in the TBIMS program between October 2007 and October 2008 with 1-year follow-up data. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Satisfaction With Life Scale (SWLS). RESULTS Hierarchical stepwise linear regression revealed that injury-related and demographic variables did not contribute significantly to the explained variance in SWLS scores. In contrast, the preinjury functioning (education, productivity/employment) and preinjury condition (psychiatric and substance use problems, severe sensory dysfunction, learning problems, prior TBI) blocks each contributed significantly to the explained variance in SWLS scores. Preinjury functioning accounted for 2.9% of the variance and preinjury conditions for 3.8%. CONCLUSIONS Although their contributions are small, preinjury functioning and preinjury conditions are important to consider in the prediction of SWL post-TBI. Educational level and history of psychiatric and other premorbid difficulties are particularly important for clinicians to consider when implementing or developing interventions for persons with moderate to severe TBI.

Outcome assessment in traumatic brain injury clinical trials and prognostic studies.

OBJECTIVE To conduct a systematic review of the prognostic value of self-reported traits/problems/strengths and environmental barriers/facilitators for participation outcomes in persons with traumatic brain injury (TBI). DATA SOURCES Articles published through August 15, 2013, obtained by conducting electronic searches of PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases and a review of reference lists of reviewed articles. STUDY SELECTION Reviewed articles were written in English and presented findings on adult humans with TBI, participation outcomes, and ≥ 1 self-reported trait/problem/strength (eg, depression, pain, coping style) and/or ≥ 1 environment barrier/facilitator (eg, social support, family functioning, access to services). DATA EXTRACTION Each of the 996 abstracts was examined by 2 reviewers, and those failing to meet all inclusion criteria were excluded. Data were extracted from the 63 retained articles by 2 independent reviewers, who met to resolve any differences in study quality rating or evidence recorded. Study quality was determined using American Academy of Neurology (AAN) criteria. DATA SYNTHESIS Conclusions regarding prognostic importance of self-report and environmental barrier/facilitator variables were made using AAN criteria. Conclusions regarding barrier/facilitator variables indicated that access to transportation, access to services, and participation in social interaction were possibly predictive of employment outcome, whereas living arrangements and social support were possibly not predictive of employment outcome. Conclusions regarding self-report variables indicated that the number of postconcussive symptoms, fatigue, and physical competence were probably predictive of employment and need for supervision, whereas self-efficacy was probably not predictive of employment. Subjective well-being, pain, and social interaction were possibly predictive of employment, whereas coping style was possibly not predictive. CONCLUSIONS Although additional investigation is needed, self-report variables are likely to make important contributions to predicting participation outcomes. Future research should be guided by coherent conceptual models and use a consistent set of assessment instruments to facilitate comparisons between studies.

Factors Associated with Word Memory Test Performance in Persons with Medically Documented Traumatic Brain Injury

Large numbers of investigations have sought to evaluate prediction of outcome after traumatic brain injury (TBI) and the effectiveness of interventions designed to address post-TBI deficits. Unfortunately, failure to attend to key issues in experimental design regarding outcome assessment has limited the utility of these investigations. Increased attention to 5 issues in outcome assessment will increase the evidence base for TBI prognosis and treatment and increase the relevance of findings to end users of research such as other investigators, rehabilitation providers, policy makers, persons with TBI, and family members of persons with TBI. These 5 issues are (1) masking of outcome examiners, (2) retention of study participants, (3) use of surrogate informants to capture data from a wider range of study participants, (4) relevance of study outcomes to stakeholders, and (5) cultural considerations in outcome assessment.

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

Objectives: (1) To examine the rate of poor performance validity in a large, multicenter, prospectively accrued cohort of community dwelling persons with medically documented traumatic brain injury (TBI), (2) to identify factors associated with Word Memory Test (WMT) performance in persons with TBI. Method: This was a prospective cohort, observational study of 491 persons with medically documented TBI. Participants were administered a battery of cognitive tests, questionnaires on emotional distress and post-concussive symptoms, and a performance validity test (WMT). Additional data were collected by interview and review of medical records. Results: One hundred and seventeen participants showed poor performance validity using the standard cutoff. Variable cluster analysis was conducted as a data reduction strategy. Findings revealed that the 10 cognitive tests and questionnaires could be summarized as 4 indices of emotional distress, speed of cognitive processing, verbal memory, and verbal fluency. Regression models revealed that verbal memory, emotional distress, age, and injury severity (time to follow commands) made unique contribution to prediction of poor performance validity. Conclusions: Poor performance validity was common in a research sample of persons with medically documented TBI who were not evaluated in conjunction with litigation, compensation claims, or current report of symptoms. Poor performance validity was associated with poor performance on cognitive tests, greater emotional distress, lower injury severity, and greater age. Many participants expected to have residual deficits based on initial injury severity showed poor performance validity.

Implementation of resource facilitation to assess referral needs and promote access to state vocational rehabilitation services in people with traumatic brain injury

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.

Medical and psychosocial predictors of caregiver distress and perceived burden following traumatic brain injury.

ABSTRACT Resource facilitation (RF) has shown promise for improving return to work (RTW) after traumatic brain injury (TBI), but little is known about the RF needs of people recruited from acute trauma settings. In this descriptive study, we sought to track referral needs, describe problems in accessing state vocational rehabilitation (VR) services, and highlight the role of RF in overcoming these difficulties in 45 adults with complicated mild to severe TBI seeking RTW who were recruited from acute trauma care. Participants received a referral to the state VR agency, along with RF services for up to one year. Case coordinators (CCs) conducted biweekly assessments, provided referrals, and helped address problems in accessing services. On average 4.92 referrals were generated per participant; 91% required referrals. CCs made 44% of referrals, while physicians/other healthcare professionals generated 33% and VR counsellors generated 23%. CCs filled a gap in referring for financial and transportation difficulties. Two case studies illustrate implementation of the RF paradigm. RF provides systematic assessment and referral for services needed to facilitate utilisation of state VR services. Among persons with TBI recruited from acute trauma settings in the US, CCs provide referrals that are often not generated by other sources.