Marie M. Cavallo

Problems and changes after traumatic brain injury : differing perceptions within and between families

This study is an attempt to characterize subgroups of families based on differing perceptions of problems and changes after traumatic brain injury. The Problem Checklist of the NYU Head Injury Family Interview was administered to 34 people with head injuries (PHI), and a significant other (SO) of each, between 1 and 3 years post-injury. Families were found to differ systematically in their responses and could be divided into three groups: High Agreement group (HAF), where there was high agreement between the PHI and the SO regarding problems and changes; High Disagreement--PHI endorsing more problems than the SO (HD-PHI); and High Disagreement--SO endorsing more problems than the PHI (HD-SO). No differences were found between these groups in age, sex, duration of coma, time since injury, educational achievement of the PHI, or the SOs relationship to the PHI. However, the HD-PHI group tended to have a higher return-to-work rate, the SOs in the HAF group reported the highest rates of subjective burden, and groups were found to differ in types of items endorsed by the PHI v. the SOs. Implications of findings are discussed regarding reliability of reporting problems, awareness issues in return to work and subjective burden of family members, and methodological and treatment issues.

Heart rate variability biofeedback, executive functioning and chronic brain injury

Primary objective: To determine if individuals with brain injury can modify heart rate variability (HRV) through biofeedback and, if so, enhance its pattern to improve emotional regulation and problem-solving ability. Design: A quasi-experimental design with repeated measures was employed. Thirteen individuals aged 23–63 years with severe brain injury (13–40 years post-onset) participating in a community-based programme were enrolled. Main outcomes: Response-to-treatment was measured with HRV indices, Behavior Rating Inventory of Executive Function (BRIEF-A-Informant) and attention/problem-solving tests. Results: At post-treatment, HRV indices (Low Frequency/High Frequency [LF/HF] and coherence ratio) increased significantly. Increased LF/HF values during the second-half of a 10-minute session were associated with higher attention scores. Participants who scored better (by scoring lower) in informant ratings at pre-treatment had highest HRV scores at post-treatment. Accordingly, at post-treatment, families’ ratings of participants’ emotional control correlated with HRV indices; staffs’ ratings of participants’ working memory correlated with participants’ HRV indices. Self-ratings of the BRIEF-A Task Monitoring scale at post-treatment correlated with family ratings at pre-treatment and post-treatment. Conclusions: Results demonstrate an association between regulation of emotions/cognition and HRV training. Individuals with severe, chronic brain injury can modify HRV through biofeedback. Future research should evaluate the efficacy of this approach for modifying behavioural problems.

Traumatic brain injury in families from culturally diverse populations

ABSTRACT:This article presents information regarding the epidemiology of traumatic brain injury (TBI) in culturally diverse populations and factors that must be considered when providing services to these persons and their families (eg, language, level of acculturation, family values). Issues of assessment and treatment are also discussed. Recommendations for education and training of rehabilitation professionals and for providing effective clinical interventions to culturally diverse people with TBI and their families are provided.

Heart Rate Variability Biofeedback, Self-Regulation, and Severe Brain Injury

This article describes a study using heart rate variability (HRV) biofeedback to treat emotional dysregulation in 13 individuals with severe chronic brain injury. Measures included HRV indices, tests of attention and problem solving, and informant reports of behavioral regulation. Results demonstrated that individuals with severe brain injury were able to learn HRV biofeedback and increase coherence between the parasympathetic and sympathetic nervous systems. Individuals who attained the greatest coherence were rated as being able to best regulate their emotions and behavior.

Problem solving, biofeedback, and severe brain injury: The moderating role of positive affect.

Objective: To examine how positive affect influences ability to benefit from heart rate variability (HRV) biofeedback treatment for individuals with severe brain injury. Method: Secondary data analysis of a nonrandomized experimental study that assessed the efficacy of biofeedback treatment for executive dysfunction in 13 individuals with chronic severe brain injury. Results: Bivariate correlations between the predictors (levels of HRV and positive affect) and the outcome (change in Category Test errors) showed large effect sizes for higher levels of HRV coherence (r = −.495, p = .085) but not for positive affect (r = .069, p = .824). Although positive affect had a negligible effect on Category Test improvements by itself, positive affect played a moderating role that complemented the effect of HRV coherence. HRV coherence had a stronger effect on Category Test performance among those participants who demonstrated higher positive affect. A regression model was fit that included main effects for HRV coherence and positive affect, as well as their interaction. The interaction term was significant in a 1-tailed test (b = −3.902, SE = 1.914, p = .072). Conclusions: Participants who had the most positive emotions made the most gains in the HRV biofeedback training and performed better posttreatment on a test designed to measure problem-solving ability. Results indicate that positive affect can improve cognition, specifically mental flexibility and abstract thinking. Addressing factors that shape negative affect such as irrational beliefs and self-doubt is an important target for therapeutic intervention even in those with severe, chronic deficits.