A program evaluation of a healthy lifestyle intervention adapted for individuals with brain injury.

Repetitive mild traumatic brain injuries in children of abuse

XV. Steroids

Defense and Veterans Brain Injury Center: The First 25 Years

Weight gain and inactivity are common problems for individuals living with a traumatic brain injury (TBI). Yet, interventions to support a healthy lifestyle specific to individuals with TBI are lacking. The purpose of this study was to complete a program evaluation of a 12-month evidence-based healthy lifestyle intervention adapted for people with a TBI. Eighteen participants completed a brief interview after the yearlong intervention to determine their perceptions of the program effectiveness as well as barriers and facilitators in making lifestyle changes. Participants reported staff, tracking of dietary and activity behavior, and in-person meetings as most helpful aspects. Lack of motivation and difficulty preparing healthy meals were the primary barriers to a healthy lifestyle. Qualitative data revealed five themes that influenced healthy behaviors, including (1) self-regulation, (2) environmental resources, (3) knowledge of health behaviors, (4) TBI-related impairment and comorbidities, and (5) social support. Results suggest that future iterations of the healthy lifestyle intervention should emphasize self-regulation activities; require tracking of dietary and activity behaviors across 12 months; provide concurrent support for individual motivation issues; provide prepared meals; utilize web-based, telephonic, or hybrid approaches to delivery; further simplify the curriculum and learning tools; and include caregivers and peer accountability partners. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Inflicted Childhood Neurotrauma: New Insight into The Detection, Pathobiology, Prevention, and Treatment of Our Youngest Patients with Traumatic Brain Injury

Medical Therapies for Concussion

Abstracts from The 34(th) Annual National Neurotrauma Symposium June 26-29, 2016 Lexington, Kentucky.

You have accessThe ASHA LeaderFeature1 Nov 2010Pediatric Traumatic Brain InjuryWhere Do We Go From Here? Roberta DePompeiCCC-SLP/A Roberta DePompei Google Scholar More articles by this author , CCC-SLP/A https://doi.org/10.1044/leader.FTR2.15132010.16 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In “She is a beautiful 4-year-old. She was in the hospital for several months and has a severe brain injury. She can’t speak and has difficulty maintaining balance for sitting. She is more like a 2-year-old than a 4-year-old. We know there are many challenges before us in getting all the services she will need throughout her life.” —Jessica’s parents, who found their daughter comatose in her crib at the age of 3 weeks, injured while in the care of her nanny. “I have headaches and can’t concentrate in school. I am a little impatient with my friends, and they don’t call like they used to. Maybe I am just over-stressed with sports and schoolwork?” —Kiesha, 17, a varsity volleyball player, one year after sustaining a concussion when she hit her head on the gym floor and was returned to play in that game against the recommendation of the athletic trainer. “Our son is now 11 and has begun to do poorly in school. We can’t figure out what is bothering him. He was a great student until third grade, but he just can’t keep up anymore. His friends are a little on the wild side and influence him to do bad things. He is physically fine. Maybe he should play sports and get rid of some of this energy.” —Matthew’s parents, discussing academic and behavioral changes in their son, who was hit by a car when he was 8 years old. Matthew was unconscious for 24 hours, hospitalized for three days, and discharged home with no further recommendations. “I served in Iraq. I was injured in a blast and have been home for 11 months. I was discharged and tried working at my old job as a manager at a local pizza shop. But I just could not take the chaos and noise there. I am now enrolled in a local university. Keeping organized for classes, recalling assignments, and listening to lectures is really difficult. Maybe I need counseling for post-traumatic stress disorder. But I was told I only have a minor leg injury and really don’t qualify for any service-related assistance. There doesn’t seem to be anyone here in the community who knows what I should do.” —Marvin, a 21-year-old who was injured in Iraq and now is considering dropping out of college. These quotes—from real families and individuals dealing with traumatic brain injury (TBI)—illustrate the spectrum of traumatic brain injuries and the resulting complexities. The families’ words also convey frustrations that can result from a lack of awareness about TBI and its implications for children, adolescents, and young adults, as brain development continues into their 20s. Some common factors in these experiences are relevant to speech-language pathologists who may be called upon to treat communication difficulties in children and adolescents with TBI: The effects of a TBI in childhood are not fully realized right away and, in fact, new challenges can emerge after the individual has become an adult. The full scope of cognitive-communicative issues that results from a TBI often are not recognized in school and community environments, and sometimes, not even at home. There is a lack of recognition of the full scope of cognitive and communication issues and their impact on lifelong learning and living; as a result, there are significant gaps in the available research, especially with respect to evidence-based methods that are likely to improve outcomes for this population. Considerable information exists based on expert opinion about how practitioners and caregivers can support cognition and communication throughout development, but this information is not widely disseminated. Although professionals often discuss and present on these concerns, positive strides have been made in the past decade and sufficient information exists to guide young TBI patients, their families, and the clinicians who treat them. These advances include increased information about cognitive communication after TBI, research on post-TBI developmental issues, and resources for best practice. Immediate Effects Cognitive communication is the ability to use language and underlying skills such as attention, memory, self-awareness, organization, and problem-solving skills to communicate effectively. Cognitive communication combines thinking skills with language. Language skills may appear to have returned after brain injury, particularly in nonstressful situations. However, when the child most needs to communicate at home, in school, and in the community, the spontaneous and unpredictable nature of communication demands can result in decreased language performance. Changes are most likely to be seen at school under the pressures of time, grades, assignments, the struggle to keep up with curricular requirements, and social pragmatic interactions (DePompei & Blosser, 2003). The entire spectrum of TBI—from mild through severe injuries—can have an effect on cognitive-communication issues and the complex academic learning and social interactions that can be involved. A history of a mild brain injury is considered a significant factor that may preclude an athlete from returning to play and may necessitate academic accommodations. The effects of moderate injuries typically are better understood as causing academic struggles as well as an inability to develop adequate social skills. Individuals with severe injuries uniformly receive specialized accommodations in school and community environments within the special education category of TBI. Strategic learning is essential for success at all educational and social levels and often does not develop properly in students with TBI. Strategic learning, an important function that underlies the brain’s capacity to learn, is the ability to extract important information while inhibiting the unimportant features of that information. When a student is presented with a new learning task, the student’s ability to identify meaningful information, generalize or abstract this information, and store it for future use may be impaired. Thus, this student may store details related to less important information and be unable to recall the gist of the new learning task efficiently or successfully. Language and cognitive communicative difficulties are often at the root of these problems and treatment is usually indicated (Blosser & DePompei, 2003; Chapman et al., 1999). Receptive language skills also may be affected and the student may appear not to hear well. In many circumstances, a hearing assessment reveals normal hearing but delayed auditory-processing capacities. The student who may have difficulty processing what is said or written may ask for multiple repetitions, have poor vocabulary recognition, and have difficulty following instructions or remembering what was said. Certain situations such as blast trauma, however, can result in impaired hearing acuity. Therefore, a hearing assessment to rule out or identify a hearing loss should be completed when any receptive language skill is questioned. Long-term Challenges Developmental stages and challenges after TBI can be overlooked because of the erroneous belief that a child who “looks okay” must “be okay.” Therefore, if an educational, behavioral, or social problem emerges several years after an injury, the link between observed problems and a past TBI often is overlooked (Chapman et al., 1999; Yeates & Taylor, 2006; Turkstra et al., 2008). Unlike TBI in an adult, an injury to a child’s brain affects an organ that is still developing. It is often believed that an immature brain may be more plastic or resilient, allowing children to “bounce back” more easily after a TBI. However, recent research demonstrates that the younger a child at the time of injury, the greater the possibility of long-term developmental challenges (Yeates & Taylor, 2006; Turkstra et al., 2008; Babikian & Asarnow, 2009; Hawley et al., 2004). The full impact of an injury to a young brain can become evident over time as the brain fails to mature at the same rate as the child’s physical growth and development. Young children’s cognitive impairments may not be obvious immediately following an injury, but become apparent as the child gets older and faces increasing expectations for new learning and independent, socially appropriate behavior. For example, Chapman, Gamino, and Cook (2009) state that many youths who have experienced a TBI recover to near-normal levels in early-developing, basic cognitive functions such as memory and vocabulary acquisition. However, youths with TBI often are found to have decreased academic and social performance that worsens through adolescence; specific reasons for this performance decline are unclear. Chapman (2006) and Gamino et al. (2009) indicated that TBI in childhood can be followed by a significant decrease in cognitive, social, or behavioral skills at the time of injury and also by a later “stall” (possibly years later) during which failure to develop cognitive, behavioral, or social skills affects learning and the ability to maintain friends and jobs. Figure 1 [PDF] outlines these potential times—immediate and delayed—for loss of learning and social development. Most efforts in rehabilitation focus on the initial dip; few supports are provided for developmental complications—the “stall”—that can occur years later. Given this delay in TBI effects, a student’s cognitive-communication skill development should be followed in the schools and community until high school graduation. These periodic checks are essential to determine if the student’s language learning is sufficient in all developmental stages. The sidebar on p. 18 offers a suggested starting place for following the cognitive-communicative development of these students. Resources and Supports In the past several years, many organizations, materials, and websites have disseminated information about children and TBI. These resources include: Newspapers and magazines. The general public’s interest in pediatric TBI has increased with articles and YouTube videos about concussion and sports injuries. Information about returning military personnel and TBI also has increased public awareness about the cognitive-communicative issues that can alter a person’s ability to perform in school and the community. Journals. Recent issues of Brain Injury Professional, Journal of Head Trauma Rehabilitation, and Neurorehabilitation have focused on pediatrics. National agencies and organizations. ASHA, the Brain Injury Association of America, the National Institute on Disability Rehabilitation Research, and the U.S. Health Resources and Services Administration are advocating for the needs of this population, providing information and materials and offering training opportunities. Websites. See the sidebar on p. 20 for a list of sites that provide significant amounts of information, training, and intervention materials for pediatric TBI. Colleagues. Many professionals share their research and clinical work. Of special interest to SLPs is the website created by the late Mark Ylvisaker, which includes tutorials about underlying processes and methods for analysis, diagnosis, and treatment of cognitive-communicative challenges. National Plan An additional contribution was made by the Sarah Jane Brain Foundation. In January 2009, this foundation brought together 50 researchers, clinicians, and family members and issued a challenge to develop a national plan of care for children, adolescents, and young adults with brain injuries. Within one month, a national Pediatric Acquired Brain Injury Plan (PABI Plan) was created. The PABI Plan outlines seven categories of care for treating brain injuries in children, adolescents, and young adults: Prevention Acute Phase Mild TBI Assessment and Treatment Reintegration and Long-term Care Adult Transition Rural/Telehealth Virtual Center, which provides a family registry and a central location for information and materials about pediatric TBI The extent and scope of the PABI Plan are ambitious, but several benefits have emerged. PABI offers a comprehensive plan that represents best practices and is endorsed by key researchers and clinicians. The major issues and an aggressive plan to address each one are clearly outlined. As a part of the Successful Outcomes plan, each state has a designated lead center that acts as a model and collaborator in the state and communicates with national partners. States can support the plan because each has a stake in the plan’s development, implementation, and benefits. Ideas for funding through federal and state grants are outlined in this document, which can serve to direct and justify future research initiatives. Finally, any organization or agency can use part of this plan to implement its own programs for this population. Successful Treatment The four children and young adults with TBI introduced in the beginning of this article—Jessica, Kiesha, Matthew, and Marvin—were each referred to SLPs who helped them develop cognitive-communicative skills that support them in school and in the community. Jessicareceives multiple therapies in school and has an Individualized Education Program (IEP) that addresses her cognitive-communication challenges. Her SLP reports that she now uses an augmentative and alternative communication device to communicate essential feelings and needs. Kieshawas referred to a neurologist who diagnosed mild seizure activity and prescribed medication. She receives social-pragmatic language intervention from her SLP, and qualifies for services on a 504 plan (for students who need accommodations, but not specialized instruction). She is considering attending a two-year college this fall. Supports to help her achieve success should be provided by the college’s accessibility office and its speech and hearing center. Matthewwas identified for a full assessment and was found to have cognitive-communication challenges based in problems with attention, memory, organization, and expressive language. His IEP includes placement in a regular-education classroom. Marvinwas identified as having cognitive-communication problems with memory, organization, and planning. He is continuing his education at the university with classroom accommodations and supports from the speech and hearing center. These youngsters received appropriate services, in part because evidence-based information is now available, agencies now advocate for this population and provide well-designed educational materials, and more research is available for professionals who are helping them overcome the short- and long-term effects of TBI. Cognitive-Communicative Checklist This list can be used to monitor the cognitive-communicative and language skills of a child with TBI. This list is not all-inclusive and should be modified according to the needs of an individual student. These indications can appear immediately after a TBI or years later, and need to be monitored throughout the student’s academic career. Receptive skills: Can the child understand what is said or written? Becomes confused by lots of spoken or written information Needs information repeated Does not follow conversations Recalls instructions inconsistently Has difficulty understanding spoken words Recalls or understands what has been read with difficulty Expressive skills: Can the child express ideas? Uses limited vocabulary Does not use new vocabulary Uses rude or immature language Retells the same story repeatedly Talks about unrelated topics Talks quickly or non-stop Cognitive-communication skills: Can the child produce and use organized language? Has difficulty expressing thoughts Becomes easily sidetracked Rambles in conversation or writing Provides short answers to questions Leaves out details in a response Loses topic focus and drops out of conversations Loses interest in TV or a movie Does not catch jokes or puns Takes what is said literally Has difficulty with reasoning or idea analysis Needs extra time to understand Isn’t sure how to use new words in conversation or writing Online Resources The following websites offer information on TBI for clinicians, parents, students, teachers, athletic coaches, and others who work with children and young adults: ASHA BrainLine Brain Injury Association of America Brain Injury Partners: Navigating the School System Centers for Disease Control and Prevention Defense and Veteran Brain Injury Center Exceptional Educational Services Lash & Associates Publishing/Training, Inc. LEARNet, Brain Injury Association of New York State Project BRAIN The Sarah Jane Brain Project Academy of Neurologic Communication Disorders and Sciences: Evidence-Based TBI Practice Guidelines References Babikian T., & Asarnow R. (2009). Neurocognitive outcomes and recovery after pediatric TBI: Meta-analysis of the literature.Neuropsychology, 23(3), 283–296. Google Scholar Blosser J. L., & DePompei R. (2003). Pediatric traumatic brain injury: Proactive intervention. New York: Delmar. Google Scholar Chapman S. B. (2006). Neurocognitive stall: A paradox in long term recovery from pediatric brain injury.Brain Injury Professional, 3(4), 10–13. Google Scholar Chapman S. B., Gamino J. F., Cook L. G., Hanten G., Li X., & Levin H. S. (2009).Impaired discourse gist and working memory in children after brain injury.Brain and Language, 97, 178–188. Google Scholar Chapman S. B., Nasits J., Challas J. D., & Billinger A. P. (1999). Long-term recovery in pediatric head injury: Overcoming the hurdles.Advances in Speech Language Pathology, 191, 19–30. Google Scholar DePompei R., & Blosser J. (2003). Communication: How communication changes over time. Wake Forest, NC: LA Publishing/Training. Google Scholar Gamino J. F., Chapman S.B., & Cook L. G. (2009). Strategic learning in youth with traumatic brain injury: Evidence for stall in higher-order cognition.Topics in Language Disorders, 24(3), 1–12. Google Scholar Hawley C., Ward A. B., Magnay A., & Mychalkiw W. (2004). Return to school after brain injury.Archives of Disease in Childhood, 89, 136–142. Google Scholar Turkstra L. S., Williams W. H., Tonks J., & Frampton I. (2008). Measuring social cognition in adolescents: Implications for students with TBI returning to school.NeuroRehabilitation, 23(6), 501–509. CrossrefMedlineGoogle Scholar Yeates K. O., & Taylor G. H. (2006). Behavior problems in school and their educational correlates among children with traumatic brain injury.Exceptionality, 14(3), 141–154. Google Scholar Author Notes Roberta DePompei, CCC-SLP/A, is a distinguished professor and director of the School of Speech-Language Pathology and Audiology at the University of Akron. She is a former co-chair of the Brain Injury Association of America’s Task Force for Children and Adolescents. Her research interests include TBI and resultant cognitive-communication disorders. Contact her at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 15Issue 13November 2010 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2010 Metrics Downloaded 3,053 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2010 American Speech-Language-Hearing AssociationLoading ...

Neurological deficits in the homeless: a downward spiral

The Neuroendocrine Effects of Traumatic Brain Injury

Neuroendocrine dysfunction after traumatic brain injury (TBI) is under-diagnosed, under-treated, and may adversely affect the rate of recovery. Single or multiple pituitary-target hormone disruption occurs in up to two-thirds of persons with TBI, most commonly affecting the gonadal and growth hormone axes. The time course of decline in and recovery of pituitary function in relation to cognitive dysfunction and rehabilitation progress are not well described. This article reviews the clinical spectrum of neuroendocrine deficits after TBI and their underlying mechanisms. Future studies of the effects of hormonal replacement on recovery are recommended.

To investigate associations of lifetime history of traumatic brain injury (TBI) with prescription opioid use and misuse among noninstitutionalized adults. Ohio Behavioral Risk Factor Surveillance System (BRFSS) participants in the 2018 cohort who completed the prescription opioid and lifetime history of TBI modules (n = 3448). Secondary analyses of a statewide population-based cross-sectional survey. Self-report of a lifetime history of TBI using an adaptation of the Ohio State University TBI-Identification Method. Self-report of past year: (1) prescription pain medication use (ie, prescription opioid use); and (2) prescription opioid misuse, defined as using opioids more frequently or in higher doses than prescribed and/or using a prescription opioid not prescribed to the respondent. In total, 22.8% of adults in the sample screened positive for a lifetime history of TBI. A quarter (25.5%) reported past year prescription opioid use, and 3.1% met criteria for prescription opioid misuse. A lifetime history of TBI was associated with increased odds of both past year prescription opioid use (adjusted odds ratio [AOR] = 1.52; 95% CI, 1.27-1.83; P < .01) and prescription opioid misuse (AOR = 1.65; 95% CI, 1.08-2.52; P < .05), controlling for sex, age, race/ethnicity, and marital status. Results from this study support the "perfect storm" hypothesis-that persons with a history of TBI are at an increased risk for exposure to prescription opioids and advancing to prescription opioid misuse compared with those without a history of TBI. Routine screening for a lifetime history of TBI may help target efforts to prevent opioid misuse among adults.

Background: Groups are an integral part of everyday life. Some groups are chosen by participants whereas membership in other groups may not be an active choice. The benefits of participation in groups are widely documented, and perhaps most commonly cited are Yalomrs eleven curative factors of group therapy, examples of which include the instillation of hope and imparting of knowledge.n Groups have long been used therapeutically and are increasingly used as a context for delivery of rehabilitation interventions. Following a traumatic brain injury (TBI), rehabilitation is recommended to maximise recovery and the use of groups in TBI rehabilitation programmes is common practice, particularly in occupational therapy. TBI results in a complex variety of impairments that can interfere with an individualrs ability to participate in their life roles and activities. Therefore, groups in TBI rehabilitation may pose some unique challenges for facilitators. Currently there is limited research evidence to guide clinicians in the facilitation of groups with this population group. In addition, there is limited literature investigating key stakeholderrs perspectives of group participation in TBI rehabilitation. The purpose of this thesis is to explore processes and perspectives of participation in inpatient occupational therapy groups in TBI rehabilitation.Objectives: The aims were 1) to scope the current state of evidence regarding the use of groups in rehabilitation following TBI; 2) to explore the perspectives of patients with TBI about participation in inpatient occupational therapy groups; 3) to investigate the perspectives of clinicians from multiple rehabilitation settings about facilitation of groups with patients following TBI; and 4) to explore the nature of interactions in inpatient occupational therapy groups in TBI rehabilitation.Method: A mixed methods approach was used. The primary components of the thesis were a scoping review, focus groups with clinician participants, questionnaires and individual interviews with patient participants, and video-recordings of inpatient occupational therapy groups. A total of 46 rehabilitation inpatients recruited from the occupational therapy groups programme at the hospital participated in the study, with fifteen completing individual interviews. Twenty-two clinicians and four student clinicians who worked in inpatient occupational therapy teams in brain injury, spinal cord injury and geriatric rehabilitation settings from one hospital participated in the study. The thesis explored the experiences and perspectives of participants and was guided by a phenomenological approach. The method of qualitative analysis for focus groups was framework analysis. Thematic content analysis was utilised to analyse interview data. Descriptive statistics were used to analyse questionnaire data. Qualitative analysis guided by qualitative description was used to analyse video data.Results: The scoping review concluded that existing research about the use of groups in TBI rehabilitation consisted mostly of pre-post intervention studies that addressed specific cognitive impairments with outpatient participants. Most studies identified significant positive changes on targeted outcome measures, suggesting group interventions were effective. The findings from patient interviews and questionnaires indicated that participation in inpatient groups helped patients to learn because they felt comfortable and experienced a sense of normality.n Patients highlighted that they learned by doing activities, observing others and sharing experiences, which was particularly valuable coming from peers.n They also made practical recommendations for facilitation of groups including achieving the right mix of participants. From the perspectives of clinicians, a recurring theme that emerged was that of achieving a good fit of participants in groups. Clinicians across the three rehabilitation settings also highlighted the need for structured group formats and pre-group planning in TBI rehabilitation compared to other settings. Clinician skill and confidence particularly for managing cognitive impairments, as well as opportunities for peer support and learning were emphasised by clinicians. Video analysis of inpatient occupational therapy groups in TBI rehabilitation demonstrated that these groups were activity-based and rehabilitation-focused, and highlighted that interactions occurred predominantly between clinicians and individual participants. Clinicians were observed to use a number of strategies to encourage interaction including activity choice, physical positioning of group members, and knowledge of group participants.Conclusion: This series of studies has contributed new information to the existing body of evidence about rehabilitation following TBI, specifically regarding the use of groups. The importance of stakeholder perspectives has been highlighted, and overall participation in inpatient occupational therapy groups in TBI rehabilitation was perceived as positive by both patients and clinicians. Practical implications for facilitation of groups were identified by patients. Clinicians emphasised the importance of facilitator skills and described strategies they utilised, particularly in planning groups. They were also observed to utilise a number of strategies to encourage interactions during group facilitation. Further exploration of the nature of interactions occurring in occupational therapy TBI rehabilitation groups would enable wider understanding of what strategies facilitate peer interaction successfully in the context of these activity-based groups. The findings of these studies have been translated into a tool for use in clinical practice to guide clinicians in the facilitation of occupational therapy groups in TBI rehabilitation.n

Does donor cause of death affect the outcome of lung transplantation?

Neuropsychiatric Complications of Traumatic Brain Injury: A Critical Review of the Literature (A Report by the ANPA Committee on Research)