Brain Injury Rehabilitation Program Research Articles

Distinguishing Characteristics of Admissions to Various Types of Posthospital Brain Injury Rehabilitation Programs.

Describe and compare the demographic characteristics and disability profiles of individuals admitted to 6 types of posthospital brain injury rehabilitation (PHBIR) programs. Data from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community Neurorehabilitation, Day Treatment, Outpatient Neurorehabilitation, and Supported Living programs serving individuals with acquired brain injury (ABI). Two thousand twenty-eight individuals with traumatic brain injury (TBI), stroke, or other ABI. Sex, age, time since injury, and Mayo-Portland Adaptability Inventory, 4th edition (MPAI-4). Retrospective analyses of demographic variables and MPAI-4 Total, Index, and subscale Rasch-derived T-scores on admission comparing diagnostic categories and program types within diagnostic categories. Participants with TBI were predominantly male, and those with stroke were generally older. Admissions to more intensive and supervised programs (residential neurobehavioral and residential neurorehabilitation) generally showed greater disability than admissions to home and community programs who were more disabled than participants in day treatment and outpatient programs. Residential neurobehavioral and supported living program participants generally were male and had TBI. Home and community admissions tended to be more delayed than residential neurorehabilitation admissions. The majority of those with other ABI were admitted to outpatient rather than more intensive programs. Additional analyses demonstrated significant differences in MPAI-4 profiles among the various program types. Admissions with TBI, stroke, and other ABI to PHBIR differ in demographic factors and disability profiles. When examined within each diagnostic category, demographic features and disability profiles also distinguish among admissions to the various program types. Results provide insights about decision-making in referral patterns to various types of PHBIR programs, although other factors not available for analysis (eg, participant/family preference, program, and funding availability) likely also contribute to admission patterns.

Headache Management in a Traumatic Brain Injury Rehabilitation Program Targeting Military Special Operation Forces

Headache Management in a Traumatic Brain Injury Rehabilitation Program Targeting Military Special Operation Forces

Rasch Analysis of the Mayo-Portland Adaptability Inventory for Posthospital Brain Injury Rehabilitation.

(1) Reexamine the item structure and reliability of the Mayo-Portland Adaptability Inventory (4th ed; MPAI-4) through Rasch analysis of admission and discharge scores for a large sample of adults with acquired brain injury (ABI) who participated in various types of posthospital brain injury rehabilitation (PHBIR) programs; (2) compare differential item functioning (DIF) for traumatic brain injury (TBI), stroke and other ABI; and (3) explore the viability of more specific subscales in addition to the established indices. Data from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community, Day Treatment, and Outpatient rehabilitation programs serving individuals with ABI. A total of 2154 individuals with TBI, stroke, or other ABI. Retrospective analysis of de-identified admission and discharge data from the Foundation to Advance Brain Rehabilitation (FABR) consortium database. MPAI-4. After adjusting 4 misfitting items and eliminating 20 misfitting persons, the MPAI-4 demonstrated real person reliability/separation = 0.93/3.52 and real item reliability/separation = 1.00/24.02. Independent Rasch analyses by diagnostic category found similar reliabilities and separations. Residual item correlations and principal component analysis of residuals (PCAR) indicated areas of local dependence arranged hierarchically reflecting the full-scale item hierarchy and providing the basis for 3 new subscales of Physical Abilities, Cognitive Abilities, and Autonomy. DIF across diagnostic categories revealed differences in item elevations characteristic of typical patients in each category. Measure means and SDs were very similar across categories. MPAI-4 items demonstrate very good person and item reliabilities for individuals with TBI, stroke, and other ABI at a level that supports individual evaluation. Variations in item calibrations across diagnostic categories reflect the differential characteristics of typical patients within categories. The entire measure provides an overall assessment of common sequalae of ABI, and standard indices used in combination with newly derived subscales provide more specific assessments of rehabilitation needs for treatment planning.

A vocational intervention that enhances return to work after severe acquired brain injury: A pragmatic trial

BackgroundFollowing a severe acquired brain injury, individuals often have low return to work rates. The Vocational Intervention Program (VIP), a partnership of Brain Injury Rehabilitation Program community rehabilitation centres with external vocational rehabilitation providers in New South Wales, Australia, was developed to facilitate a return to competitive employment for working-age people. ObjectivesTo evaluate the efficacy of the VIP partnership model, this intervention was compared to outcomes from a health-based brain injury vocational rehabilitation centre (H-VR) or community brain injury rehabilitation centres (“treatment as usual”; TAU). MethodsA 3-arm non-randomized controlled trial was conducted among the 12 adult rehabilitation centres of the NSW Brain Injury Rehabilitation Program. The VIP arm was delivered by 6 community rehabilitation centres in partnership with 3 external private Vocational Rehabilitation providers. The H-VR arm was delivered by 1 health-based vocational rehabilitation centre and the 5 remaining centres delivered TAU. Competitive employment status (“Yes”/“No”) and clinician ratings of disability and participation were collected pre- and post-intervention, and at 3-month follow-up. Multilevel models were conducted to investigate change over time by treatment arm. ResultsIn total, 148 individuals with severe brain injury were included in the trial: n = 75 (VIP), n = 33 (H-VR) and n = 40 (TAU). Sixty-five people (of 108, 60%) completed the VR intervention. A significant arm-by-time interaction was found, with higher return to work rates from pre- to post-intervention in VIP and H-VR arms compared to TAU (P = 0.0002). Significant arm-by-time interactions also indicated improved work-related participation and independent living skills from pre- to post-intervention in VIP and H-VR compared to the TAU arm (P < 0.05). These improvements were maintained at 3-month follow-up. ConclusionsThe VIP improved return to competitive employment at comparable rates to the specialist H-VR. Larger-scale adoption of the VIP model could provide significant improvements in vocational rehabilition sevices to support people in their return to work following severe brain injury. ANZCTR Trial Registry NumberACTRN12622000769785

Validation of the work-ability support scale in individuals seeking to return to work after severe acquired brain injury

Purpose To assess the reliability and validity of the work-ability support scale (WSS) in a severe traumatic/acquired brain injury (TBI/ABI) population seeking to return to work (RTW). Materials and methods One hundred forty-four clients were enrolled in a vocational rehabilitation (VR) intervention trial through the Brain Injury Rehabilitation Program in New South Wales, Australia. Each client’s primary brain injury clinician and VR provider completed the WSS pre- and post-intervention. Validating measures assessing dysexecutive behavior, disability, participation, and work instability were completed. Several aspects of reliability and validity were evaluated. Results Internal consistency was excellent for Part A (Cronbach’s αs > 0.9) but unacceptably low to questionable for Part B (αs < 0.6). Inter-rater reliability between clinicians and VR providers was generally fair to moderate for Part A (κw < 0.6) and worse for Part B (κw < 0.5), with both slightly improving at post-intervention. Strong support was found for predictive and convergent validity, but not divergent validity. Confirmatory factor analysis indicated a poor fit for Part A, whereas most Part B fit indices met criteria. Conclusions The WSS can play a useful role in assessing return to work (RTW) potential, planning and evaluation after severe TBI/ABI. Training could improve consistency of administration among staff working across health and VR service sectors.

Psychosocial Factors Associated with Prolonged Length of Stay in Acquired Brain Injury Rehabilitation: A Retrospective Cohort Study.

In a climate of rising healthcare costs and increasing pressure to reduce inpatient length of stay, hospitals must balance their role as care providers with that as resource stewards. There is a need to understand what factors are associated with patients staying beyond rehabilitation length of stay targets. The aim of this study was to determine psychosocial patient factors that are identifiable on admission that influence length of stay targets in acquired brain injury rehabilitation. A retrospective case series of 167 inpatients with acquired brain injury was conducted at an urban, academic rehabilitation hospital. A total of 29 factors were used for data analysis. Logistic and multiple linear regression analysis was utilized to determine if any patient factors were associated with patients exceeding their length of stay targets. Premorbid communal living status (e.g. group home) was associated with an odds ratio of 14.67 of exceeding length of stay target. Patients who did not drive prior to their admission had an odds ratio of 2.63 of exceeding their length of stay target. Premorbid communal living and premorbid non-driving status are predictors of patients with acquired brain injuries exceeding target rehabilitation length of stay. These findings may help acquired brain injury rehabilitation programmes plan for the needs of and advocate for patients.

Impact of depression and post-traumatic stress on manual and oculomotor performance in service members with a history of mild TBI

ABSTRACT Objective To determine the impact of depression and post-traumatic stress on an automated oculomotor and manual measure of visual attention, compared to conventional neuropsychological assessment. Setting: Military traumatic brain injury (TBI) rehabilitation program. Participants 188 Active Duty Service Members (ADSM) with a history of mild TBI. Design A cross-sectional and correlational study with data obtained through an IRB-approved data registry study. Main measures: Bethesda Eye & Attention Measure (BEAM); brief neuropsychological battery; self-reported symptom surveys including Neurobehavioral Symptom Inventory (NSI), Patient Health Questionnaire-8 (PHQ-8), and PTSD Checklist-5 (PCL-5). Results Small effect sizes were found for partial correlations between both depression and post-traumatic stress and key BEAM metrics. In contrast, small-to-medium effects sizes were found across all traditional neuropsychological test measures. Conclusion This study illustrates the profile of impairments associated with depression and post-traumatic stress on saccadic eye movements and manual responses to BEAM relative to conventional neuropsychological tests. Results demonstrated that among ADSM seen for mTBI, depression and PTS exert a significant negative impact on measures of processing speed, attention, executive function, and memory across saccadic, manual, and conventional neuropsychological tests. However, the unique psychometric features of each of these assessment approaches may assist in distinguishing the effects of psychiatric comorbidities within this population.

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now?

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What's Changed From 2014 to Now?

What Does It Take to Get Somebody Back to Work after Severe Acquired Brain Injury? Service Actions within the Vocational Intervention Program (VIP 2.0).

Little is known about service actions delivered in the complex intervention of vocational rehabilitation (VR) for people with severe acquired brain injury (ABI). Scale-up of the Vocational Intervention Program (VIP) across the 12 Community teams of the NSW Brain Injury Rehabilitation Program provided an opportunity to analyse the intensity and profile of actions delivered in providing VR programs. Seventy-two participants with severe TBI were supported in returning to either pre-injury employment (FastTrack, FT, n = 27) or new employment (NewTrack, NT, n = 50), delivered by two types of VR providers (Disability Employment Service DES; private providers). VR providers documented their service actions in hours and minutes, using the Case Management Taxonomy, adapted to VR. The NT pathway required significantly higher levels of intervention in comparison to FT (25 h, five minutes vs. 35 h, 30 min, p = 0.048, W = 446). Case coordination was the most frequent service action overall (41.7% of total time for FT, 42.3% for NT). DES providers recorded significantly greater amounts of time undertaking engagement, assessment and planning, and emotional/motivational support actions compared to private providers. Overall duration of the programs were a median of 46 weeks (NT) and 36 weeks (FT), respectively. This study helps illuminate the profile of VR interventions for people with severe TBI.

From the Editors-A Welcome and a THANK YOU!

ON BEHALF OF THE EDITORS and Publisher of the Journal of Head Trauma Rehabilitation (JHTR), I would like to welcome Brad G. Kurowski, MD, MS, as a new Associate Editor. Dr Kurowski brings multiple domains of expertise to the Editorial staff and has an active research portfolio in pediatric traumatic brain injury. He is an Associate Professor at the University of Cincinnati in the Departments of Pediatrics and Neurology & Rehabilitation Medicine. At Cincinnati Children's Medical Center, Dr Kurowski is Co-Director of the Brain Recovery After Injury (BRAIN) Health and Wellness Center and Director of the Brain Injury Rehabilitation Program in the Division of Physical Medicine and Rehabilitation. We are very pleased to have such an accomplished researcher joining the Editorial staff of JHTR. We welcome Dr Kurowski because Dr Bruce Caplan has decided to retire from his role as the Senior Editor of JHTR. I know the other Editors and our Publisher join me in extending a heartfelt “THANK YOU” to Dr Caplan for his decades of service to JHTR. On a recent Editorial Board call, Dr Nat Mayer, former Senior Editor, detailed the substantial history of Dr Caplan's involvement with the journal: In March 1986, Shelly Berrol and Mitch Rosenthal inaugurated JHTR with Dr Caplan as a member of the Editorial Board. Volume 1, Number 1 of JHTR included a book review by Dr Caplan of Barbara Wilson's Clinical Management of Memory Problems. In September 1992, Bruce was formally named as Special Features Editor for Book Reviews. In December 1994, JHTR announced a bimonthly expansion from 4 to 6 issues to include 2 nonthematic issues focusing on clinical research and practice. Dr Caplan was appointed as an Associate Editor managing unsolicited submissions for these two issues. With the untimely passing of Mitch Rosenthal in 2007, Dr Caplan was named a Senior Editor and with Dr Mayer guided JHTR through its transition to a new Editor-in-Chief. To this day, Dr Caplan has continued to serve as a Senior Editor and valued consultant. JHTR is not the only professional journal to have benefited from Dr Caplan's editorial acumen—he was a significant contributor to the Archives of Physical Medicine and Rehabilitation, and served as Editor-in-Chief of Rehabilitation Psychology. He has also served as Editor of a number of preeminent reference texts in rehabilitation and neuropsychology. Dr Caplan's many-faceted expertise is reflected in his Board certification in both Rehabilitation Psychology and Clinical Neuropsychology. It's no wonder he holds Fellow status in the American Psychological Association, the National Academy of Neuropsychology, and the American Congress of Rehabilitation Medicine. Thank you, Dr Caplan for your contribution to JHTR and the entire field of rehabilitation. On a personal note, I cannot thank Bruce enough for the guidance he has provided me in my role as Editor-in-Chief. Whether determining how to handle a specific paper or conceptualizing a policy implied by the decision, Bruce has always been able to balance the scientific needs of the journal with the pragmatic experience of an author or reviewer. Your impact on this journal and our field is immeasurable. John D. Corrigan, PhD Editor-in-Chief

Prism adaptation treatment to address spatial neglect in an intensive rehabilitation program: A randomized pilot and feasibility trial.

Spatial neglect (SN) is a common cognitive disorder after brain injury. Prism adaptation treatment (PAT) is one of the promising interventions for SN albeit inconsistent results from previous studies. We carried out a comparison intervention (PAT vs. Sham) and aimed to evaluate the efficacy of PAT on visuospatial symptoms of SN in an inpatient rehabilitation setting that offered a highly intensive comprehensive brain injury rehabilitation program. A total of 34 patients with moderate-to-severe SN secondary to stroke or traumatic brain injury were randomized to the PAT group and the Sham group (an active control group). Both groups received 10 sessions of treatment, over two weeks, in addition to the rehabilitation therapies provided by their rehabilitation care teams. Outcomes were measured using an ecological instrument (the Catherine Bergego Scale) and paper-and-pencil tests (the Bells Test, the Line Bisection Test and the Scene Copying Test). Patients were assessed at baseline, immediately after treatment, two weeks after treatment, and four weeks after treatment. 23 (67.6%) patients completed treatment and all the assessment sessions and were included in the final analyses using mixed linear modeling. While SN symptoms reduced in both groups, we found no difference between the two groups in the degree of improvement. In addition, the average SN recovery rates were 39.1% and 28.6% in the PAT and Sham groups, respectively, but this discrepancy did not reach statistical significance. Thus, the present study suggests that PAT may contribute little to SN care in the context of a highly intensive inpatient rehabilitation program. Further large-scale investigation is required to uncover the mechanisms underlying PAT and Sham in order to refine the treatment or create new interventions.

Reliability of the Dynavision task in virtual reality to explore visuomotor phenotypes

Daily-life behaviors strongly rely on visuomotor integration, a complex sensorimotor process with obvious plasticity. Visual-perceptive and visual-cognitive functions are degraded by neurological disorders and brain damage, but are improved by vision training, e.g. in athletes. Hence, developing tools to evaluate/improve visuomotor abilities has found echo among psychologists, neurophysiologists, clinicians and sport professionals. Here we implemented the Dynavision visuomotor reaction task in virtual reality (VR) to get a flexible tool to place high demands on visual-perceptive and visual-cognitive processes, and explore individual abilities in visuomotor integration. First, we demonstrated high test–retest reliability for the task in VR among healthy physically-active students (n = 64, 32 females). Second, the capture of head movements thanks to the VR-headset sensors provided new and reliable information on individual visual-perceptual strategies, which added significant value to explore visuomotor phenotypes. A factor analysis of mixed data and hierarchical clustering on principal components points to head movements, video-games practice and ball-tracking sports as critical cues to draw visuomotor phenotypes among our participants. We conclude that the visuomotor task in VR is a reliable, flexible and promising tool. Since VR nowadays can serve e.g. to modulate multisensorial integration by creating visual interoceptive-exteroceptive conflicts, or placing specifically designed cognitive demand, much could be learned on complex integrated visuomotor processes through VR experiments. This offers new perspectives for post brain injury risk evaluation, rehabilitation programs and visual-cognitive training.

The Behavioural Assessment of Self-Structuring (BASS): A Factor Analysis in a Post-Acute Brain Injury Rehabilitation Programme

Research has indicated structure and a client’s ability to self-structure is integral to post-acute brain injury rehabilitation. Self-structuring has previously been theorised to include components referred to as Anchors, Scaffolding, and Strategies. A reliable and validated measure of self-structuring – The Behavioural Assessment of SelfStructuring (BASS) – was used in the current study aimed to identify possible sub-groups of the scale and further explore construct validity. 197 consecutive admissions to the Transitional Rehabilitation Units (TRU) were assessed using the BASS and the results were subjected to a varimax rotation factor analysis. Four factors were revealed, all of which could be related to the theoretical model of self-structuring including Systems (Scaffolding), Routines (Anchors), Awareness and Self-Regulation (both emerging as two sub-divisions of Strategies). Despite orthogonality, all four factors were highly correlated. Only age at brain injury and cause of brain injury showed a significant relationship with Awareness (Strategies), Routines (Anchors), and Systems (Scaffolding). No significant relationship was found for gender, age at admission or length of admission. In conclusion, the findings are consistent with previous research and confirm theoretical models of self-structuring. Further insight has been gained into the complexities of self-structuring as the results propose compelling evidence that the 26-items of the BASS can now be sub-divided into four distinct sub-categories: Awareness, Systems, Routines, and Self-Regulation. Sub-categories can now be utilised to identify individual strengths and areas of weakness within self-structuring. This can inform the adaptation of neurorehabilitation programmes or approaches dependent on client need, and change in scores could be evaluated over time.

Strategy-based reading comprehension therapy during early acquired brain injury rehabilitation: preliminary results

Introduction An evidence-based intervention and service delivery model for early acquired brain injury reading comprehension rehabilitation (involving multiple-strategy, hierarchical reading) was investigated with 3 clients <3 m post onset as part of their brain injury rehabilitation program. Materials and methods A multiple-baseline single case experimental design was used for each participant, with data analysed using Tau-U. Assessments of reading comprehension (impairment and activity level) were performed pre/post intervention, and at follow-up (3–6 months post-treatment). Participants’ perceptions of the intervention and service delivery model were captured via semi-structured interviews. Results All participants demonstrated improved reading comprehension post-intervention on all formal measures. At follow-up, reading comprehension was grossly maintained by 2 participants. The single case experimental design results (Tau-U) showed moderate-large intervention effect sizes for factual and inferential reading comprehension, two participants had significant (p = 0.01) changes. Participants reported overall positive experiences with the intervention. Conclusion The intervention and service delivery model were successfully implemented in clinical practice, and preliminary results show the intervention has clinical promise with an early acquired brain injury population. IMPLICATIONS FOR REHABILITATION Cognitive communication reading comprehension deficits occur following acquired brain injury and impact participation during rehabilitation and in the community. An evidence-based intervention for the early rehabilitation of cognitive communication reading comprehension deficits following acquired brain injury has been developed and trialled in clinical practice with adults <3 months post-acquired brain injury, via a series of single-case experimental designs. Improvements in reading comprehension skill and activity/participation occurred for all participants post-intervention; statistically significant changes occurred for 2 of 3 clients. Early rehabilitation of cognitive communication reading comprehension deficits can be successfully implemented as a component of a multidisciplinary rehabilitation program.

1124 Central Sleep Apnea and Traumatic Brain Injury: A NIDILRR and VA TBI Model System Study

Abstract Introduction Sleep-related breathing disorders are common after TBI. To date, two single site studies have reported divergent findings in post-TBI patients with one reporting predominantly obstructive sleep apnea (OSA, Holcomb et al., 2016) and the other central sleep apnea (CSA, Webster and Bell, 1998). The purpose of this analysis is to explore prevalence, demographics, and injury characteristics of patients with a clinical diagnosis of CSA in a recently-completed multicenter comparative-effectiveness trial during inpatient rehabilitation following moderate to severe TBI. Methods Participants in a six-center diagnostic comparative effectiveness trial underwent Level-1 polysomnography (PSG) during inpatient rehabilitation for TBI. Studies were scored at a centralized scoring center by one of two certified PSG technicians with final interpretation by a board-certified sleep medicine physician. Results 21 of 248 (8.5%) participants evidenced elevated CSA indices &amp;gt;5. Predominant CSA was rare (n=3 [1.2%], age range: 36-59; 100% male; 33-52 days post-TBI). One participant was on opioid, anti-depressant and antiepileptic drugs, one was on an antiepileptic, and another was on an opioid. PAP therapy was not initiated during PSG thus there was no treatment-emergent CSA. All had a central apnea-hypopnea index (AHI) in the moderate to severe range (29-49). Two out of the three had a GCS &amp;lt;8 and one participant had a GCS of 14. Conclusion In this multi-center clinical trial, predominant CSA was rare. The common practice of reducing polypharmacy in order to minimize sedation and optimize mental status in specialized inpatient brain-injury rehabilitation programs may contribute to the low CSA incidence in this cohort. Attention to medication side-effects and their influence on sleep-related breathing should be routinely considered. Support PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015) for DVBIC, NIDILRR (90DPTB0008-03-00; 90DPTB0013-01-00).

Prediction of Functional Outcome in Post-Hospital Brain Injury Rehabilitation

Post-hospital brain injury rehabilitation programs are afforded limited time to reduce chronic disability resulting from acquired brain injury. Therefore, the purpose of this study was to identify deficit areas resulting from acquired brain injury that have the greatest impact on functional outcomes to enable greater efficiency in rehabilitation programming. Study participants were 1717 persons with acquired brain injury treated in residential post-hospital rehabilitation programs. Participants were assessed at admission and discharge on the MPAI-4. Functional status at discharge was evaluated based on T-scores derived from MPAI-4 discharge participation index items: Initiation, self-care and residence. The data base of 1717 was randomly divided into two subsets. Items from admission Abilities Index and select person variables were entered into stepwise multiple regression on subset one and then in a hierarchical multiple regression on subset two. Rash analysis demonstrated satisfactory construct validity and internal consistency of admission and discharge MPAI-4 evaluations (Person reliability > 0.90, Item reliability = 0.99). Both regression analyses revealed that Mobility and Novel Problem Solving accounted for 40% of the variance in functional outcome, p < 0.001. Acquired brain injury results in a myriad of cognitive and physical impairments. Of the many possible deficits, the greatest gains in overall functional outcomes may be achieved by allocating additional treatments aimed at reducing disability in mobility and novel problem solving.

Reduction in Post-concussive Symptom Severity Following Sub-Acute Interdisciplinary Cognitive Rehabilitation

To determine the utility of a structured, interdisciplinary, post-acute brain injury rehabilitation program in addressing persisting symptoms of brain injury.

Participation in competitive employment after severe traumatic brain injury: New employment versus return to previous (pre-injury) employment

ABSTRACTThere is limited literature comparing the clinical and employment characteristics of clients accessing new employment with those resuming previous employment. To address this gap, a multi-centre observational study was conducted of all active clients with severe TBI from the 11 community rehabilitation services (n = 588) of the New South Wales Brain Injury Rehabilitation Program. Demographic, injury, clinical and vocational data were collected by treating clinicians employing a purpose-designed protocol. New employment constituted almost 40% of competitive employment outcomes. Clients accessing new employment were significantly more likely to be younger, single, less educated, with more severe injuries and more likely to be displaying challenging behaviours than those resuming pre-injury work. Kaplan-Meier analyses found time to RTW was significantly longer for new employment. Stability of new employment was significantly poorer with jobs twice as likely to break down compared to previous employment. New employment positions were also more likely to be part-time and unskilled compared to previous employment. The results found that placement into new employment made a substantial contribution to employment outcomes after TBI but requires more intensive and tailored programmes to meet the multiple clinical and workplace challenges.

Investigating the Model of Community-Based Case Management in the New South Wales Brain Injury Rehabilitation Program: A Prospective Multicenter Study.

To investigate a model of community-based case management (CM). New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP). All clinicians (N = 72) providing CM within 14 BIRP community rehabilitation teams. A prospective, multicenter study. A purpose-designed survey. Participants from the 12 adult and 2 pediatric services (8 located in metropolitan areas, 6 in rural areas) completed a 3-part survey investigating their organizational context, clinical approach, and CM interventions. Between-groups analyses explored differences among individual services, as well as differences based on age (adult vs pediatric) and location (metropolitan vs rural). All services provided a direct service model of CM. The underlying principles were uniform across services (more direct than indirect service provision; with more client-related than administrative-related tasks; more holistic than service-led in defining client needs; with decision making equally directed by staff and clients; and undertaking a more comprehensive than minimalist range of tasks). CM interventions included the provision of individual support, family support, advocacy, and community development alongside assessment, monitoring, referral, and liaison tasks. There were little differences in practice based on age or location. The NSW BIRP has drawn upon the results to produce a model of service for CM.

Efficacy of ICT-Based Neurocognitive Rehabilitation Programs for Acquired Brain Injury

Abstract. This systematic review aims to analyze the methods used in the assessment of the efficacy of Neurocognitive Rehabilitation Programs (NRP) based on Information and Communication Technologies in patients with Acquired Brain Injury, namely platforms and online rehabilitation programs. Studies with the main purpose of evaluating the efficacy of those programs were retrieved from multiple literature databases, accordingly to inclusion and exclusion criteria. The inclusion and analysis of the studies followed preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) and Cochrane Collaboration Guidelines. Thirty-one studies were included in this review. Results showed that most studies used a pre-post methodological design, with few studies performing assessment moments during intervention or follow-up. Attention, memory, and executive functions were the cognitive variables considered by a larger number of studies at the assessment of NRP efficacy. Despite that, there is a growing evidence on the inclusion of variables related to everyday functioning in this process, increasing its ecological validity. Concerning the instruments used, the studies presented a large heterogeneity of the instruments and methods used, even for the same assessment purpose, highlighting a lack of consensus regarding assessment protocol. Psychophysiological and neuroimaging techniques are seldom used on this field. This review identifies the main characteristics of the methodology used at the assessment of NRP and potential limitations, providing useful information to guide the practice of the health care professionals in rehabilitation of Acquired Brain Injury. It also suggests new directions for future studies.