Michael Oddy

Return to work following moderate-to-severe traumatic brain injury

Primary objective: To investigate the role of cognitive functioning, fatigue, mood and behaviour in return to work (RTW) following moderate-to-severe traumatic brain injury. Design and methods: Between-groups comparisons were conducted with 20 participants who had RTW and 13 who had not. Participants were well matched for age, pre-morbid intellectual functioning, years of education, injury severity and time since injury. Outcomes and results: The unemployed group reported significantly higher levels of fatigue and depression and significantly more problems on self-report questionnaires. A significantly higher proportion of this group was seeking compensation. No significant differences were obtained on neuropsychological measures of cognitive functioning. Conclusions: Mood, fatigue and behavioural problems may impede a persons ability to RTW. Subjective measures may be more superior to objective measures in predicting RTW. The litigation process may affect peoples motivation to RTW.

Intervention with families following brain injury: Evidence-based practice

The literature on brain injury and the family is examined to provide an evidence base for family intervention. In the absence of methodologically sound studies which evaluate the efficacy of family intervention, current practice should be based on the findings of studies that have investigated how families adapt and the difficulties they face in this process. The implications of this literature should be considered at all stages in the rehabilitation process and in all forms of contact with the family.

Cost-benefits associated with social outcome from neurobehavioural rehabilitation

Primary objective: To carry out a clinical and cost-outcome evaluation of a neurobehavioural post-acute rehabilitation programme in the UK. Research design: The study was a multi-centre prospective cohort study of adults with acquired brain injury admitted for residential rehabilitation. Comprehensive data were collected on type of residence, amount and type of care, functional independence, engagement in constructive occupation and participation in social roles. Procedures: Data were gathered on admission relating to individuals’ levels of care and functioning, both pre-morbidly and at the time of admission (pre-rehabilitation). Additional information about functioning was collected upon discharge (post-rehabilitation). Follow-up data was collated in person, by telephone or by post after an average of 18 months by a researcher who was blind to the rehabilitation outcomes. The data were analysed in terms of clinical outcomes and support costs. Savings in costs of care or support were calculated on the basis of difference between pre-rehabilitation and follow-up support costs minus the costs of rehabilitation. Results: Significant gains were evident at discharge and follow-up in virtually all indices of social outcome. Improvements were recorded in type of accommodation, levels of care, functional ability, productive occupation and performance of social roles. Patients admitted within 1 year of injury made the most progress, but improvements were made regardless of time since injury. Patients continued to benefit from rehabilitation well beyond the period when most natural recovery would take place. Economic calculations suggested that the initial costs of rehabilitation are generally offset by savings in care costs within 2 years. Sensitivity analysis on estimated savings in care costs yielded projected lifetime savings of between £1.1–0.8 M for persons admitted for rehabilitation within 12 months of injury, £0.7–£0.5 M within 2 years of injury and £0.5–0.36 M for admissions after 2 years. Conclusions: Specialist rehabilitation for neurobehavioural disability produces comprehensive and sustainable improvements in the life of individuals with brain injury. The initial costs associated with neurobehavioural rehabilitation are offset by savings in costs of support in the medium and longer term.

The prevalence of traumatic brain injury in the homeless community in a UK city

Primary objective: The main aim of the study was to investigate the prevalence of traumatic brain injury in a sample of homeless individuals. Research design: The researchers employed a cross-sectional survey design and contacted 12 organizations providing services for homeless individuals across a city in the UK. Methods and procedures: The sample included 100 homeless participants (75 males and 25 females) who met the inclusion criteria. A matched control group (n = 100) of individuals who were not homeless was also recruited. A questionnaire was administered to all participants to elicit information relating to history of possible traumatic brain injury. Main outcomes and results: Results indicated that a significantly higher number of homeless participants (48%) reported a history of traumatic brain injury than control participants (21%). Of those homeless participants, 90% indicated they had sustained their first traumatic brain injury before they were homeless. Conclusions: These findings suggest that rates of traumatic brain injury are much higher among the homeless population than in the general population and that sustaining a traumatic brain injury may be a risk factor for homelessness.

The association between neuropsychological performance and self-reported traumatic brain injury in a sample of adult male prisoners in the UK.

This study employed a correlational and group comparison design to investigate whether self-report of traumatic brain injury (TBI) in a sample of male prisoners screened using the Brain Injury Screening Index (BISI) was associated with impaired cognitive performance on standardised questionnaires and neuropsychological tests. A total of 139 male prisoners who reported having suffered a TBI in the BISI were interviewed, and completed further questionnaires and neuropsychological assessments. Their results were compared to 50 prisoners who had no reported history of TBI. The results of the screening questionnaire correlated with responses in a follow-up interview, with self-report questionnaires of neurobehavioural disorder (.31 to .50) and neuropsychological measures (−.24 to −.45). The “TBI Index”, an indicator summarising the number and severity of self-reported injuries in a single score, also correlated well with scores on formal neuropsychological tests (–.20 to –.42). Self-report of traumatic brain injury among prisoners is consistently associated with measurable neuropsychological and neurobehavioural disability. The implications of these findings for current practice in identifying and referring individuals to specialist services are considered.

The development of a measure of emotional regulation following acquired brain injury

Disturbances in emotional regulation following acquired brain injury have been found to be both prevalent and particularly disabling. Despite this, relatively little attention has been given to identifying characteristics of such deficits in a systematic way. We therefore describe the development of a new questionnaire measure of disturbances in emotional regulation that may occur following acquired brain injury. The measure demonstrates excellent psychometric properties, including high test–retest (.95) and split half (.96) reliability, high internal consistency (.96), and good concurrent validity (r = .64–.82). The questionnaire measures characteristics that are distinguishable from measures of cognitive ability and from other tests of affect. There was moderate overlap between self-report and relative versions of the questionnaire. Results suggest that the relative version has the stronger predictive value. The potential uses of the measure in relation to theory and practice are discussed.

The clinical and cost-benefits of investing in neurobehavioural rehabilitation: a multi-centre study.

Abstract Primary objective: The aim of this study was to investigate the cost-benefits of a residential post-acute neurobehavioural rehabilitation programme and its effects on care needs and social participation of adults with acquired brain injury. Research design: Retrospective multi-centre design. Methods and procedures: Data on occupation, adaptability and level of support required were collected at admission, discharge and 6-months follow-up. Cost analysis was performed on cost estimates based on level of support. Main outcomes and results: Significant gains were observed in all areas of functioning, with individuals progressing towards higher levels of independence and more participation in society upon discharge. Conclusions: Cost-benefits of up to £1.13 million were demonstrated for individuals admitted to rehabilitation within a year of sustaining a brain injury and of up to £0.86 million for those admitted more than 1 year after injury. Functional gains and reductions in levels of care required upon discharge were maintained 6 months later. These results demonstrate that post-acute neurobehavioural rehabilitation can have a positive impact on the lives of individuals with brain injury and that the associated costs are off-set by significant savings in the longer-term.

Post-injury personality in the prediction of outcome following severe acquired brain injury

Primary objective: The aim of the study was to examine the utility of five measures of non-cognitive neurobehavioural (NCNB) changes that often occur following acquired brain injury, in predicting outcome (measured in terms of participation and social adaptation) at 1-year follow-up. Research design: The study employed a longitudinal, correlational design. Methods and procedures: Multiple regression was employed to investigate the value of five new NCNB measures of social perception, emotional regulation, motivation, impulsivity and disinhibition in the prediction of outcome as measured by the Mayo-Portland Adaptability Inventory (MPAI). Main outcomes and results: Two NCNB measures (motivation and emotional regulation) were found to significantly predict outcome at 1-year follow-up, accounting for 53% of the variance in MPAI total scores. Conclusions: These measures provide a method of quantifying the extent of NCNB changes following brain injury. The predictive value of the measures indicates that they may represent a useful tool which could aid clinicians in identifying early-on those whose symptoms are likely to persist and who may require ongoing intervention. This could facilitate the planning of rehabilitation programmes.

Efficacy of rehabilitation for functional skills more than 10 years after extremely severe brain injury

Purpose: To determine whether gains in personal independence can be achieved in individuals 10 or more years after very severe acquired brain injury. Method: Four individuals in a continuing (slow stream) rehabilitation centre were assessed by an occupational therapist (OT) and programmes were designed to help the individual enhance personal independence. Support staff were trained to implement these programmes under the guidance of the OT. Methods described by Giles, Ridley, Dill, and Frye (1997) were used. Pre- and post-training measures were taken as well as follow up measures to assess the durability of such changes. Results: The results demonstrate that it is possible to achieve clinically significant improvements in personal independence many years after very severe acquired brain injury. Conclusions: The findings of this study suggest that personally and clinically significant goals can be achieved 10 or more years after brain injury and there should be continuing effort to improve the circumstances of individuals with acquired brain injury. Such gains can be achieved through consistent application of such programmes by support workers working under the supervision of an occupational therapist.

The development of a measure of motivational changes following acquired brain injury

Motivational deficits following acquired brain injury have been found to be both prevalent and particularly disabling. Despite this, relatively little attention has been given to such deficits. The development of self and informant versions of a new questionnaire measure of the changes in motivation that may occur following acquired brain injury is described. The measure demonstrates excellent psychometric properties including high test–retest (r = .90) and split-half reliability (.94), high internal consistency (Cronbachs alpha = .94), and good concurrent validity. The study also demonstrates that the questionnaire is measuring a different domain to cognitive tests and tests of affect, but one that is predictive of brain injury outcome. There was moderate overlap between self-report and relative versions of the questionnaire (r = .41) but results suggest that the relative version has the stronger predictive value. The potential uses of the measure in relation to theory and practice are discussed.