Mitchell Rosenthal

Assessment of community integration following rehabilitation for traumatic brain injury

Community integration is defined as integration into a home-like setting, integration into a social network, and integration into productive activities such as employment, school, or volunteer work. For the purpose of evaluating outcomes for individuals with traumatic brain injury (TBI) who are prov

Long-term Neuropsychological Outcome After Traumatic Brain Injury

Objective:To describe neuropsychological outcome 5 years after injury in persons with traumatic brain injury (TBI) who received inpatient medical rehabilitation. To determine the magnitude and pattern neuropsychological recovery from 1 year to 5 years after injury. Design:Longitudinal cohort study with inclusion based on the availability of neuropsychological data at 1 year and 5 years after injury. Setting:National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems of Care. Participants:One hundred eighty-two persons with complicated mild to severe traumatic brain injury. Primary Outcome Measures:Digits Forward and Backward, Logical Memory I and II, Token Test, Controlled Oral Word Association Test, Symbol Digit Modalities Test, Trail Making Test, Rey Auditory Verbal Learning Test, Visual Form Discrimination, Block Design, Wisconsin Card Sorting Test, and Grooved Pegboard. Results:Significant variability in outcome was found 5 years after TBI, ranging from no measurable impairment to severe impairment on neuropsychological tests. Improvement from 1 year after injury to 5 years was also variable. Using the Reliable Change Index, 22.2% improved, 15.2% declined, and 62.6% were unchanged on test measures. Conclusions:Neuropsychological recovery after TBI is not uniform across individuals and neuropsychological domains. For a subset of persons with moderate to severe TBI, neuropsychological recovery may continue several years after injury with substantial recovery. For other persons, measurable impairment remains 5 years after injury. Improvement was most apparent on measures of cognitive speed, visuoconstruction, and verbal memory.

Handbook of rehabilitation psychology

Spinal Cord Injury, J. Scott Richards et al Limb Amputation, Bruce Rybarczyk et al Traumatic Brain Injury, Mitchell Rosenthal and Joseph Ricker Stroke, Bruce Caplan and Steve Moelter Geriatric Issues, Peter A. Lichtenberg and Susan E. MacNeill Neuromuscular and Musculoskeletal Disorders in Children, Dennis C. Harper and David B. Peterson Brain Injuries, David R. Patterson and Greg R. Ford Multiple Sclerosis, Gerald M. Devins and Zachary Shnek Chronic Pain, Daniel M. Doleys Hearing and Vision Loss, Robert Q. Pollard, Jr. et al Psychiatric Rehabilitation, Gary R. Bond and Sandra G. Resnik Functional Status and Quality of Life Measures, Allen Heinemann Assessment of Psychopathology and Personality in Persons with Disabilities, Cynthia L. Padnitz et al Evaluating Outcomes Research - Statistical Concerns and Clinical Relevance, Mary J. McAweeney Neuropsychological Assessment, Tim Conway and Bruce Crosson Forensic Psychological Evaluation in Rehabilitation, Brick Johnstone et al Patients with Brain Tumors, Marc W. Haut et al Paediatric Neuropsychology, Janet E. Farmer and Laura Muhlenbruck Alcohol and Traumatic Disability, Charles H. Bombardier Postacute Brain Injury Rehabilitation, James F. Malec and Jennie L. Ponsford Neuroimaging and Rehabilitation Outcome, Erin Bigler Rehabilitation Based on Behavioural Neuroscience, Edward Taub and Gitendra Uswatte Disability and Vocational Behaviour, Edna Mora Symanski Injury Prevention, Frank A. Fee and Dawn A. Bouman Social Support and Adjustment to Disability, Kathleen Chwalisz and Alan Vaux Caregiving in Chronic Disease and Disability, Richard Shewchuk and Timothy R. Elliott Social Psychological Issues in Disability and Rehabilitation, Dana S. Dunn The Disability and Rehabilitation Experience - an African American Example, Faye Z. Belgrave and S. Lisbeth Jarama Prospective Payment Systems, Kristopher J. Hagglund et al Education in Rehabilitation and Healthcare Psychology - Principles and Strategies for Unfiying Subspecialty Training, Robert L. Glueckauf Ethics in Rehabilitation Psychology - Historical Foundations, Basic Principles and Contemporary Issues Stephanie L. Hanson et al Drawing New Horizons for Rehabilitation Psychology, Timothy R. Elliott and Robert G. Frank.

Depression following traumatic brain injury

OBJECTIVE Review the existing literature on the incidence, neurobiological and psychosocial correlates, and methods of assessment and treatment of depression following traumatic brain injury (TBI). DATA SOURCES Computerized database searches of the English-language literature from Index Medicus, Psychological Abstracts, Excerpta Medica, and Cumulative Index of Nursing and Allied Health Literature. STUDY SELECTION Given the relatively small number of publications specifically related to TBI and depression, all studies appearing in the peer-reviewed literature were included in the review. In addition, studies examining depression and other neurologic diseases (eg, stroke) were also reviewed as to the potential applicability of the theoretical model or methodology used. CONCLUSIONS Depression occurs with sufficient frequency to be considered a significant consequence after TBI. Depression can impede the achievement of optimal functional outcome, whether in the acute or chronic stages of recovery. It appears that a combination of neuroanatomic, neurochemical, and psychosocial factors is responsible for the onset and maintenance of depression. Its treatment is typically psychopharmacologic, with best results obtained from nontricyclic antidepressants. These results have not been confirmed in double-blind clinical trials, however. Future research should use comprehensive, integrative models of depression that include demographic, biologic, and psychosocial factors; enhanced functional neuroimaging techniques; controlled studies of psychopharmacologic and other interventions; and prospective designs with long-term follow-up.

The community integration questionnaire revisited: An assessment of factor structure and validity

OBJECTIVE To investigate the factor structure and concurrent validity of the Community Integration Questionnaire (CIQ), using a large sample of persons with traumatic brain injury (TBI). DESIGN Principal components analysis with varimax rotation was performed on CIQ items completed through interview with patients at 1 year after injury. Correlational analyses compared CIQ scores to scores on other widely used outcome measures. SETTING Outpatient clinics affiliated with four TBI Model System rehabilitation centers funded by the National Institute on Disability and Rehabilitation Research. PARTICIPANTS Three hundred twelve patients with medically documented TBI who were enrolled in the TBI Model Systems Project. The majority of patients were Caucasian males with severe TBI. MAIN OUTCOME MEASURES CIQ; Functional Independence Measure (FIM); Functional Assessment Measure (FAM); Disability Rating Scale (DRS). RESULTS Three factors emerged: Home Competency, Social Integration, and Productive Activity. The financial management item was moved from Social Integration to Home Competency, and the travel item was moved from Productive Activity to Social Integration. Each CIQ scale score showed significant correlations in the expected direction with the FIM+FAM and DRS items. CONCLUSIONS The results provide further evidence for the validity of the CIQ and improve the scoring system. The factor structure is clinically and theoretically meaningful. The subscale and total scores show significant relationships with other widely used measures of outcome. Future research should focus on increasing the range of questions, accounting for changes from preinjury functioning, and obtaining normative data on the new factors.

A multicenter longitudinal investigation of return to work and community integration following traumatic brain injury.

Objectives:To characterize changes in employment status and community integration following traumatic brain injury and to investigate relationships among outcome, sociodemographic, and injury-related variables. Design:Longitudinal analyses of employment (n=42) and community Integration (n=53) were conducted, with data examined at three follow-up periods. Chi-square (x2) and analysis of variance (ANOVA) were used to investigate the relationship between employment, time since injury, and demographic and injury-related variables. Repeated measures ANOVA and multiple regression analyses were utilized to investigate similar relationships for the community integration sample. Setting:Outpatient clinics affiliated with the TBI Model Systems programs. Participants:Patients with traumatic brain injury who received acute medical care at a Level I Trauma Center and received inpaticnt rehabilitation. Mean age of subjects was 33.9 years. The full range of injury severity was represented. Main Outcome Measures:Employment status determined through structured interview and scores on the Community Integration Questionnaire. Results:Less than 40% of persons employed before injury were employed at any follow-up interval. Fewer persons were employed at year 2 than at year 1 and years 3 or 4. Seventy-five percent of persons employed at year 1 were also employed at year 3 or 4. Fifty percent of persons unemployed at year 1 were either employed or otherwise productively engaged at year 3 or 4. Unemployed persons had longer acute hospital stays than employed persons at all follow-up intervals. Conclusions:Till has an adverse, long-term impact on employment and productivity. Findings highlight the need for postacute rehabilitation programs with particular emphasis on vocational rehabilitation. Uncertainties remain about the impact of brain injury on socialization and home activity patterns, partly because of limitations in measurement of community integration

Predictors of caregiver burden following traumatic brain injury

Primary objective : To investigate the relationship of demographic characteristics of the caregiver (i.e. race, age, household income, education) to caregiver burden, family needs, family functioning and social support to assess the predictors of caregiver burden. Research design : Information was obtained through mailed surveys and follow-up phone interviews. Methods and procedures : Participants were 24 African American and 21 White caregivers of individuals with traumatic brain injury who were at least 1-year post-injury. Measures administered included the Head Injury Family Interview, Family Needs Questionnaire, Family Assessment Device and the NON, a measure of social support. Main outcomes and results : Regression analyses revealed that importance of needs and percentage of needs met accounted for a significant amount of the variance in predicting affective/behavioural, cognitive and physical/dependency burden. Conclusions : Rehabilitation professionals need to provide support that includes ongoing assessment of needs and provides a resource for steering caregivers to potential sources for meeting those needs.

Impact of Minority Status on Functional Outcome and Community Integration Following Traumatic Brain Injury

Objective:To determine whether minority status affected short-term and 1-year functional outcome and community integration for patients with traumatic brain injury (TBI) in the TBI Model Systems National Data Base. Design:Prospective study, consecutive sample. Setting:Four tertiary care rehabilitation centers. Patients:Five hundred and eighty-six patients with TBI admitted to one of four TBI Model Systems programs from February 1989 through June 1995. Inclusion criteria for the study included evidence of a TBI, admission to the system hospital emergency department within 8 hours of injury, 19 years of age or older, and acute care and inpatlent rehabilitation within the system hospitals. Information was collected for demographics such as race, age, gender, education, employment status, marital status, and data related to the injury such as injury severity, etiology of injury, and payer source. Over half of the sample was white (53.4%) with the 46.6% of minorities composed of blacks (37.2%), Hispanics (7.3%), and Asians (2.0%). Main Outcome Measures:Functional outcome was measured with the Functional Independence Measure (FIM), Disability Rating Scale (DRS), and Community Integration Questionnaire (CIQ). The FIM and DRS were measured at inpatient rehabilitation admission, discharge, and 1 year post injury. The CIQ total score and subscale scores for Home Integration, Social Integration, and Productivity were obtained at 1-year post injury. It was hypothesized that minority status would not predict functional outcome after acute rehabilitation but would predict functional outcome and community integration at 1 year post injury. Results:There were no significant differences between whites and minorities for DRS and FIM scores at acute rehabilitation discharge. There were also no significant differences between whites and minorities on FIM scores 1 year post injury, but there were significant differences between whites and minorities on the Social Integration and Productivity subscales and total score of the CIQ. Multiple regression indicated that minority status predicted functional outcome for CIQ total score (r=-.28) and two subscales, Social Integration (=-.28) and Productivity ( r= -.23) even after controlling for etiology, severity of injury, age, gender, and functional status at rehabilitation discharge. Conclusions:Although minority status does not negatively impact recovery of basic mobility and daily living skills, it may impact long-term outcome related to community integration as measured by productivity and social integration. Greater outreach and access to postdischargc services and support may be needed to optimize community integration outcomes. Further studies are needed to determine how best to serve the needs of this segment of the population with TBI

A model systems database for traumatic brain injury.

This article describes the development and characteristics of the database that supports the research and demonstration aspects of the traumatic brain injury (TBI) model systems project sponsored by the National Institute on Disability and Rehabilitation Research. Criteria for inclusion of patients

Return to work after rehabilitation following traumatic brain injury

The relationship of medical variables and discharge functional status to vocational and educational outcomes was examined in 79 closed head-injured patients who were consecutively admitted to an inpatient rehabilitation hospital during a two-year period. A follow-up study, conducted after hospital discharge (median, 16.5 months), found that 66% (n = 52) of the patients had returned to work or school, while 34% (n = 27) did not. Patients were divided into return and non-return to work groups. Traditional variables included age, severity of brain-damage as characterized by CT head scan, duration of post-traumatic amnesia, duration of coma, length of stay and acute inpatient rehabilitation program. Discharge functional scores were analysed by t-tests and chi-square analysis. Results suggest that traditional factors of younger age, shorter length of coma, minimal CT head scan findings and shorter length of stay were significant contributors to educational/vocational outcome. Their significance was enhanced by discharge functional profile measurement of medical, physical and psychological/neuropsychological integrity. Those functional measures not significant were in social, vocational, recreational and communication areas. These factors may continue to improve over a longer period of time and should be tracked in the post-acute rehabilitation phase for their significance in return to work/school.