Mayo-Portland Adaptability Inventory Research Articles

Rehabilitation and multiple limb amputations: A clinical report of patients injured in combat.

This clinical report describes the outpatient rehabilitation program for patients with multiple limb amputations enrolled in the Comprehensive Combat and Complex Casualty Care facility at the Naval Medical Center San Diego. Injury-specific data for 29 of these patients wounded by blast weaponry in Afghanistan in 2010 or 2011 were captured by the Expeditionary Medical Encounter Database at the Naval Health Research Center and were reviewed for this report. Their median Injury Severity Score was 27 (N = 29; range, 11-54). Patients averaged seven moderate to serious injuries (Abbreviated Injury Scale scores ≥2), including multiple injuries to lower limbs and injuries to the torso and/or upper limbs. All patients received care from numerous clinics, particularly physical therapy during the first 6 mo postinjury. Clinic use generally declined after the first 6 mo with the exception of prosthetic devices and repairs. The clinical team implemented the Mayo-Portland Adaptability Inventory, 4th Revision (MPAI-4) to assess functioning at outpatient program initiation and discharge (n = 23). At program discharge, most patients had improved scores for the MPAI-4 items assessing mobility, pain, and transportation, but not employment. Case reports described rehabilitation for two patients with triple amputations and illustrated multispecialty care and contrasting solutions for limb prostheses.

Post-Inpatient Brain Injury Rehabilitation Outcomes: Report from the National OutcomeInfo Database.

This study examined outcomes for intensive residential and outpatient/community-based post-inpatient brain injury rehabilitation (PBIR) programs compared with supported living programs. The goal of supported living programs was stable functioning (no change). Data were obtained for a large cohort of adults with acquired brain injury (ABI) from the OutcomeInfo national database, a web-based database system developed through National Institutes of Health (NIH) Small Business Technology Transfer (STTR) funding for monitoring progress and outcomes in PBIR programs primarily with the Mayo-Portland Adaptability Inventory (MPAI-4). Rasch-derived MPAI-4 measures for cases from 2008 to 2014 from 9 provider organizations offering programs in 23 facilities throughout the United States were examined. Controlling for age at injury, time in program, and time since injury on admission (chronicity), both intensive residential (n = 205) and outpatient/community-based (n = 2781) programs resulted in significant (approximately 1 standard deviation [SD]) functional improvement on the MPAI-4 Total Score compared with supported living (n = 101) programs (F = 18.184, p < 0.001). Intensive outpatient/community-based programs showed greater improvements on MPAI-4 Ability (F = 14.135, p < 0.001), Adjustment (F = 12.939, p < 0.001), and Participation (F = 16.679, p < 0.001) indices than supported living programs; whereas, intensive residential programs showed improvement primarily in Adjustment and Participation. Age at injury and time in program had small effects on outcome; the effect of chronicity was small to moderate. Examination of more chronic cases (>1 year post-injury) showed significant, but smaller (approximately 0.5 SD) change on the MPAI-4 relative to supported living programs (F = 17.562, p < 0.001). Results indicate that intensive residential and outpatient/community-based PIBR programs result in substantial positive functional changes moderated by chronicity.

Usefulness of the rivermead postconcussion symptoms questionnaire and the trail-making test for outcome prediction in patients with mild traumatic brain injury

ABSTRACTThe aim of the study was to determine if the Rivermead Postconcussion Symptoms Questionnaire (RPQ) is a better tool for outcome prediction than an objective neuropsychological assessment following mild traumatic brain injury (mTBI). The study included 47 patients with mTBI referred to an outpatient rehabilitation clinic. The RPQ and a brief neuropsychological battery were performed in the first few days following the trauma. The outcome measure used was the Mayo-Portland Adaptability Inventory-4 (MPAI-4) which was completed within the first 3 months. The only variable associated with results on the MPAI-4 was the RPQ score (p < .001). The predictive outcome model including age, education, and the results of the Trail-Making Test-Parts A and B (TMT) had a pseudo-R2 of .02. When the RPQ score was added, the pseudo-R2 climbed to .19. This model indicates that the usefulness of the RPQ score and the TMT in predicting moderate-to-severe limitations, while controlling for confounders, is substantial as suggested by a significant increase in the model chi-square value, delta (1df) = 6.517, p < .001. The RPQ and the TMT provide clinicians with a brief and reliable tool for predicting outcome functioning and can help target the need for further intervention and rehabilitation following mTBI.

Replication of a Prospective Randomized Controlled Trial of Resource Facilitation to Improve Return to Work and School After Brain Injury

ObjectiveTo determine the extent to which previous findings on the effectiveness of resource facilitation to impact return to work and school could be replicated. DesignRandomized controlled trial. SettingOutpatient rehabilitation clinic. ParticipantsOutpatients with acquired brain injury (N=44). InterventionFifteen months of resource facilitation services. Main Outcome MeasuresA revised version of the Vocational Independence Scale and the Mayo-Portland Adaptability Inventory-4 Participation Index. ResultsParticipants randomized to the resource facilitation group demonstrated a significant advantage in terms of rate and timing of return to productive community-based work relative to control participants. When examining only return to competitive work (and not return to school), 69% of the resource facilitation group was able to return compared with 50% of the control participants. Analyses of measures of participation in household and community activities revealed that both groups improved significantly over the 15-month study period, but no significant advantage for either group was demonstrated. ConclusionsThis study replicates the positive impact of resource facilitation in improving productive community-based activity, including competitive employment and volunteering in the community.

Successful outcomes following neurorehabilitation in military traumatic brain injury patients in the United Kingdom.

The Defence Medical Rehabilitation Centre Headley Court is the UK military rehabilitation unit. A pilot study identified the Mayo-Portland Adaptability Inventory-4 (MPAI-4) as the most appropriate rehabilitation outcome measure in young military patients with acquired brain injury. MPAI-4 scores were prospectively recorded for patients on admission and discharge. At 4 months, independent living and employment status were recorded. Inclusion criteria were all new admissions with traumatic brain injury (TBI). Before injury, all patients were fully employed and lived independently. In a 3-year period from April 2011, there were 91 TBI patients with complete admission-discharge episodes: by US Department of Defense criteria, 21 were mild, 35 were moderate, and 35 were severe. There was a significant positive relationship between TBI severity and MPAI-4 score on admission (χ = 12.77, df = 2, p = 0.0017).Median age was 27 years, and median duration of admission was 63 days. Employment and independent living status were available for 79 patients at 4 months. Seventy-three patients (92%) were in community-based employment, with 64 (81%) employed in a competitive or transitional work; 6 (8%) were unemployed or in sheltered work. Sixty-nine (87%) were living independently, and 10 (13%) were living with support in their own home, with no one requiring institutional care.Complete MPAI-4 scores were available for 79 patients. There were statistically and clinically significant improvements in MPAI-4 scores between admission and discharge for the overall group: median admission T score was 40.0 (95% confidence interval, 36.0-42.0) and on discharge was 31.0 (95% confidence interval, 27.0-36.0), a nine-point change (Z = 6.53, p < 0.0001). These improvements with rehabilitation were sustained when patients were subdivided by TBI severity or MPAI-4 limitations. This study demonstrates significant functional improvements in military TBI patients following intensive inpatient multidisciplinary rehabilitation, which includes substantial vocational rehabilitation. At 4 months, 92% were employed, and 87% were living independently. Therapeutic study, level V; prognostic/epidemiologic study, level IV.

Utility of the Community Integration Questionnaire in a sample of adults with neurological and neuropsychiatric disorders receiving prevocational training

Purpose: To investigate utility of the Community Integration Questionnaire (CIQ) in a mixed sample of adults with neurological and neuropsychiatric disorders. Method: Cross-sectional, interview-based study. Participants were community-dwelling adults with disabilities resulting from neurological and neuropsychiatric disorders (N = 54), who participated in a pre-vocational readiness and social skills training program. Psychometric properties of the Community Integration Questionnaire (CIQ) were assessed and validated against Mayo-Portland Adaptability Inventory (MPAI) and The Problem Checklist from the New York University Head Injury Family Interview (PCL). Results: Based on the revised scoring procedures, psychometric properties of the CIQ Home Competency scale were excellent, followed by the Total score and Social Integration scale. Productive Activity scale had low content validity and a weak association with the total score. Convergent and discriminant validity of the CIQ were demonstrated by correlation patterns with MPAI scales in the expected direction. Significant relationship was found with PCL Physical/Dependency scale. Significant associations were found with sex, living status, and record of subsequent employment. Conclusions: The results provide support for the use of the CIQ as a measure of participation in individuals with neurological and neuropsychiatric diagnoses and resulting disabilities.Implications for RehabilitationAn important goal of rehabilitation and training programs for individuals with dysfunction of the central nervous system is to promote their participation in social, vocational, and domestic activities.The Community Integration Questionnaire (CIQ) is a brief and efficient instrument for measuring these participation domains.This study demonstrated good psychometric properties and high utility of the CIQ in a sample of 54 individuals participating in a prevocational training program.

Neurologic continuum of care: Evidence-based model of a post-hospital system of care.

There is increasing need for a well-organized continuum of post-hospital rehabilitative care to reduce long term disability resulting from acquired brain injury. This study examined the effectiveness of four levels of post-hospital care (active neurorehabilitation, neurobehavioral intensive, day treatment, and supported living) and the functional variables most important to their success. Participants were 1276 adults with acquired brain injury who were being treated in one of the four program levels. A Repeated Measures MANOVA was used to evaluate change from admission to discharge on the Mayo Portland Adaptability Inventory-4 T-scores. Regression analyses were used to identify predictors of outcome. Statistical improvement on the MPAI-4 was observed at each program level. Self-care and Initiation were the strongest predictors of outcome. The results support the effectiveness of a continuum of care for acquired brain injury individuals beyond hospitalization and acute in-hospital rehabilitation. It is particularly noteworthy that reduction in disability was achieved for all levels of programming even with participants whose onset to admission exceeded 7 years post-injury.

Outcome prediction in home- and community-based brain injury rehabilitation using the Mayo-Portland Adaptability Inventory

The objective of the study was to develop statistical formulas to predict levels of community participation on discharge from post-hospital brain injury rehabilitation using retrospective data analysis. Data were collected from seven geographically distinct programmes in a home- and community-based brain injury rehabilitation provider network. Participants were 642 individuals with post-traumatic brain injury. Interventions consisted of home- and community-based brain injury rehabilitation. The main outcome measure was the Mayo-Portland Adaptability Inventory (MPAI-4) Participation Index. Linear discriminant models using admission MPAI-4 Participation Index score and log chronicity correctly predicted excellent (no to minimal participation limitations), very good (very mild participation limitations), good (mild participation limitations), and limited (significant participation limitations) outcome levels at discharge. Predicting broad outcome categories for post-hospital rehabilitation programmes based on admission assessment data appears feasible and valid. Equations to provide patients and families with probability statements on admission about expected levels of outcome are provided. It is unknown to what degree these prediction equations can be reliably applied and valid in other settings.

Sentinel Events During the Transition From Hospital to Home: A Longitudinal Study of Women With Traumatic Brain Injury

ObjectiveTo describe the occurrence of sentinel events and their influence on community integration of women with traumatic brain injury (TBI) transitioning from hospital to home. Design: A longitudinal study was completed with data collected before and at 1, 3, and 6 months after hospital discharge. SettingBrain injury rehabilitation unit and acute neuroscience ward. ParticipantsWomen (N=25) with severe TBI (aged between 17 and 50 years; duration of posttraumatic amnesia ranged from 1 to 123d). Sixteen family caregivers also participated. InterventionsNot applicable. Main Outcome MeasuresCommunity integration was measured using the Mayo-Portland Adaptability Inventory. Depression, anxiety, and stress were measured using the Depression Anxiety Stress Scale. The Sentinel Events Questionnaire was used to record life events that potentially influence the transition process. ResultsMost women (>16 at each time point) experienced mild to moderate impairments in psychosocial integration. A third of the sample reported symptoms of depression (n=8), anxiety (n=9), and stress (n=7) that exceeded clinical cutoff levels on at least 1 occasion. At 6 months, 3 women reported clinically significant depression and anxiety (12%) and 2 reported significant stress levels (8%). Positive sentinel events such as return to meaningful occupation were common (n=14). Negative sentinel events were also quite common. For example, reduced access to therapy, reported by 10 women, was associated with poorer participation levels. ConclusionsThese findings suggest that the presence of sentinel events influences the transition experiences of women with TBI in this sample. Rehabilitation should consider the occurrence and impact of sentinel events because this may facilitate successful transitions.

Clinician Versus Veteran Ratings on the Mayo-Portland Participation Index in Veterans With a History of Mild Traumatic Brain Injury

The Department of Veterans Affairs is encouraging administration of the Mayo-Portland Adaptability Inventory-4 Participation Index (M2PI) to identify long-term psychosocial outcomes of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans with a history of traumatic brain injury (TBI). To evaluate clinician and Veteran interrater reliability and how response validity influences M2PI item ratings. A total of 122 OEF/OIF/OND Veterans who reported a history consistent with mild TBI during deployment and were referred for neuropsychological evaluation following Comprehensive TBI Evaluation. Interrater reliability study. M2PI; Minnesota Multiphasic Personality Inventory-2 Symptom Validity Scale (FBS). Veterans reported greater perceived restrictions than clinicians across all M2PI items and total score. Interrater correlations ranged from rs = 0.27 (residence) to rs = 0.58 (money management) across items, with a total score correlation of rs = 0.60. When response bias was indicated, both Veterans and clinicians reported greater participation restrictions than those reported by Veterans without evidenced response bias. Low interrater correlation is consistent with previous findings. As ratings of clinicians and Veterans should not be interpreted as equivalent, documenting the rater's identity is important for interpretation. Using objective indicators of functional outcome may assist clinician raters, particularly when self-report may be biased.

Outcome Prediction in Home- and Community-Based Brain Injury Rehabilitation using the Mayo-Portland Adaptability Inventory

Outcome Prediction in Home- and Community-Based Brain Injury Rehabilitation using the Mayo-Portland Adaptability Inventory

C-70 * Brain Injury Rehabilitation and Cognitive Therapy: A Program Evaluation of Outcomes

Objective: This study sought to examine the effects of the implementation of cognitive therapy program changes on patient outcomes in a post-acute care inpatient facility for brain injury rehabilitation. These changes include the implementation of a new cognitive therapy program, facilitated by licensed clinicians, that assesses and treats neurocognitive deficits in patients with brain injuries by using empirically supported techniques and individualized approaches in rehabilitation. Method: Data were collected on 548 residents at an inpatient post-acute care brain injury rehabilitation facility. The outcomes were evaluated using the Mayo-Portland Adaptability Inventory (MPAI) and the Level of Observation Tool (LOOT). The data were collected for two years prior to the implementation of the new program and for 2 years afterwards, between 2010–2013. The information was collected from persons with both traumatic and acquired brain injuries. Results: Measures of ability on the MPAI were significant (p < 0.05) and level of supervision required according to the LOOT approached significance (p = 0.053). These results were for the entire sample and TBI's, right and left CVA's, hypoxia/encephalopathy will be looked at separately. Conclusion(s): These findings show support for cognitive therapy in post-acute brain injury rehabilitation when treatment is facilitated by trained professionals who use empirically supported interventions and address deficits through individualized treatment planning approaches. The implementation of these changes has resulted in significant reduction in the level of care a patient requires post-treatment, as reflected by the improved patient outcomes in terms of their ability as reflected in the MPAI. NEUROPSYCHOLOGICAL DOMAINS: ATTENTION

Ecological Validity of Performance Validity Testing

Performance validity tests (PVTs) have been shown to relate to neuropsychological performance, but no studies have looked at the ecological validity of these measures. Data from 131 veterans with a history of mild traumatic brain injury from a multicenter Veterans Administration consortium were examined to determine the relation between scores on a self-report version of the Mayo-Portland Adaptability Inventory Participation Index, a measure of community participation, and the Word Memory Test, a PVT. A restricted regression model, including education, age, history of loss of consciousness, cognitive measures, and a measure of symptom validity test performance, was not significantly associated with self-reported community reintegration. Adding PVT results to the restricted model, however, did significantly improve the prediction of community reintegration as PVT failure was associated with lower self-reported community participation. The results of this study indicate that PVTs may also serve as an indicator of patients' functioning in the community.

The Effect of Environmental Barriers on Community Integration for Individuals With Moderate to Severe Traumatic Brain Injury

To describe environmental barriers endorsed by individuals with traumatic brain injury during the first 6 months after discharge and determine their effect on community integration. Prospective longitudinal study with data collected at predischarge and at 1, 3, and 6 months postdischarge. One hundred thirty-five individuals with a diagnosis of traumatic brain injury discharged from a large metropolitan hospital to a home/community environment. Sydney Psychosocial Reintegration Scale; Craig Hospital Inventory of Environmental Factors; and Mayo-Portland Adaptability Inventory-4. Multiple regression analyses indicated that environmental barriers arising during the transition from hospital to home had a negative association with community integration outcomes. Physical barriers were most commonly endorsed, but attitudinal barriers were significantly correlated with relationship changes. Environmental barriers should be addressed in rehabilitation and considered in policy development for people with traumatic brain injury. Future research on the measurement of environmental barriers is recommended.

Variability in quality of life 13 years after traumatic brain injury in childhood.

With the aim of describing variability in the long-term outcome of quality of life after neurosurgically treated pediatric traumatic brain injury, mostly self-reports of 21 individuals with mild or moderate/severe injury were gathered using Mayo-Portland Adaptability Inventory in telephone interviews 13 years aftyer injury. A majority of the participants reported brain injury-related problems. The median outcome on Mayo-Portland Adaptability Inventory was mild to moderate limitations. The variation within the moderate/severe group varied between relatively good outcome and moderate/severe limitations. Concentration, irritability, fatigue, and transportation were reported as the most problematic areas, whereas self-care was reported as well functioning. Societal participation appeared to be the best functional domain in this Swedish study. Examples of individual reports of the life-situation at various outcome levels were provided. Variability in outcome is large within severity groups, and research may gain by addressing both outcomes of the individuals and groups. Objective questions of outcome should be accompanied by questions of actual functioning in everyday life. To ensure long-term support for quality of life for those with remaining dysfunction after pediatric traumatic brain injury, healthcare systems should implement systematic routines for referral to rehabilitation and support.

A comparison of participation outcome measures and the International Classification of Functioning, Disability and Health Core Sets for traumatic brain injury

To compare the contents of participation outcome measures in traumatic brain injury with the International Classification of Functioning, Disability and Health (ICF) Core Sets for traumatic brain injury. A systematic search with an independent review process selected relevant articles to identify outcome measures in participation in traumatic brain injury. Instruments used in two or more studies were linked to the ICF categories, which identified categories in participation for comparison with the ICF Core Sets for traumatic brain injury. Selected articles (n = 101) identified participation instruments used in two or more studies (n = 9): Community Integration Questionnaire, Craig Handicap Assessment and Reporting Technique, Mayo-Portland Adaptability Inventory-4 Participation Index, Sydney Psychosocial Reintegration Scale Version-2, Participation Assessment with Recombined Tool-Objective, Community Integration Measure, Participation Objective Participation Subjective, Community Integration Questionnaire-2, and Quality of Community Integration Questionnaire. Each instrument was linked to 4-35 unique second-level ICF categories, of which 39-100% related to participation. Instruments addressed 86-100% and 50-100% of the participation categories in the Comprehensive and Brief ICF Core Sets for traumatic brain injury, respectively. Participation measures in traumatic brain injury were compared with the ICF Core Sets for traumatic brain injury. The ICF Core Sets for traumatic brain injury could contribute to the development and selection of participation measures.

Cognitive function after cardiac arrest and temperature management; rationale and description of a sub-study in the Target Temperature Management trial

BackgroundMild to moderate cognitive impairment is common amongst long-term survivors of cardiac arrest. In the Target Temperature Management trial (TTM-trial) comatose survivors were randomized to 33°C or 36°C temperature control for 24 hours after cardiac arrest and the effects on survival and neurological outcome assessed. This protocol describes a sub-study of the TTM-trial investigating cognitive dysfunction and its consequences for patients’ and relatives’ daily life.Methods/DesignSub-study sites in five European countries included surviving TTM patients 180 days after cardiac arrest. In addition to the instruments for neurological function used in the main trial, sub-study patients were specifically tested for difficulties with memory (Rivermead Behavioural Memory Test), attention (Symbol Digit Modalities Test) and executive function (Frontal Assessment Battery). Cognitive impairments will be related to the patients’ degree of participation in society (Mayo-Portland Adaptability Inventory-4), health related quality of life (Short Form Questionnaire–36v2©), and the caregivers’ situation (Zarit Burden Interview©). The two intervention groups (33°C and 36°C) will be compared with a group of myocardial infarction controls.DiscussionThis large international sub-study of a randomized controlled trial will focus on mild to moderate cognitive impairment and its consequences for cardiac arrest survivors and their caregivers. By using an additional battery of tests we may be able to detect more subtle differences in cognitive function between the two intervention groups than identified in the main study. The results of the study could be used to develop a relevant screening model for cognitive dysfunction after cardiac arrest.Trial registrationClinicalTrials.gov: NCT01946932.

Utility of the Mayo-Portland Adaptability Inventory-4 for Self-Reported Outcomes in a Military Sample With Traumatic Brain Injury

ObjectiveTo investigate the psychometric properties of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) obtained by self-report in a large sample of active duty military personnel with traumatic brain injury (TBI). DesignConsecutive cohort who completed the MPAI-4 as a part of a larger battery of clinical outcome measures at the time of intake to an outpatient brain injury clinic. SettingMedical center. ParticipantsConsecutively referred sample of active duty military personnel (N=404) who suffered predominantly mild (n=355), but also moderate (n=37) and severe (n=12), TBI. InterventionsNot applicable. Main Outcome MeasureMPAI-4 ResultsInitial factor analysis suggested 2 salient dimensions. In subsequent analysis, the ratio of the first and second eigenvalues (6.84:1) and parallel analysis indicated sufficient unidimensionality in 26 retained items. Iterative Rasch analysis resulted in the rescaling of the measure and the removal of 5 additional items for poor fit. The items of the final 21-item Mayo-Portland Adaptability Inventory-military were locally independent, demonstrated monotonically increasing responses, adequately fit the item response model, and permitted the identification of nearly 5 statistically distinct levels of disability in the study population. Slight mistargeting of the population resulted in the global outcome, as measured by the Mayo-Portland Adaptability Inventory-military, tending to be less reflective of very mild levels of disability. ConclusionsThese data collected in a relatively large sample of active duty service members with TBI provide insight into the ability of patients to self-report functional impairment and the distinct effects of military deployment on outcome, providing important guidance for the meaningful measurement of outcome in this population.

Occupation-Based Strategy Training for Adults With Traumatic Brain Injury: A Pilot Study

ObjectiveTo evaluate, before undertaking a larger trial, feasibility of the study processes to determine the effectiveness of occupation-based strategy training for producing changes on trained real-world behaviors, and to determine whether far transfer of training effects to measures of real-world impact, including participation in everyday life, could be achieved. DesignPartially randomized controlled trial with pre- and postintervention assessments done by assessors masked to the treatment arm. SettingTesting occurred at a research institute, interventions at participants' homes. ParticipantsPeople (N=13) with chronic traumatic brain injury (TBI), 7 in the experimental group (mean age, 42.6y; mean time post-TBI, 9.8y; 4 men) and 6 in the control arm (mean age, 40.5y; mean time post-TBI, 10.8y; 3 men), were assessed immediately before and after the intervention phase. InterventionOccupation-based strategy training, an adapted version of the Cognitive Orientation to daily Occupational Performance (CO-OP), was provided in two 1-hour sessions per week for 10 weeks. Main Outcome MeasuresCanadian Occupational Performance Measure, Dysexecutive Questionnaire, Mayo-Portland Adaptability Inventory-4 Participation Index, and Assessment of Motor and Process Skills. ResultsThe study processes (testing and intervention) were acceptable to all participants. Evidence of far transfer was found as the experimental group improved significantly more than the control group on performance and satisfaction with performance ratings on untrained goals (P<.05), and reported increased levels of participation (P<.01). ConclusionsFindings must be interpreted with caution since the sample is small and comparisons are made with a no-treatment control. Nevertheless, they suggest that the training is feasible and a larger trial warranted.

Telerehabilitation for addressing executive dysfunction after traumatic brain injury

Primary objective: To investigate the feasibility of implementing the Cognitive Orientation to daily Occupational Performance approach (CO-OP) in a telerehabilitation format and to examine its impact on community integration and executive dysfunction for adults with traumatic brain injury (TBI).Research design: A pilot series of three case studies with 3-month follow-up was conducted.Methods and procedures: Three adults (all males, >10 years post-TBI) and their significant others were recruited. The CO-OP intervention, a meta-cognitive approach, was delivered through videoconferencing via Internet to train three of five participant-identified goals. Two goals were not trained to allow examination of transfer. Outcome measures included the Canadian Occupational Performance Measure, the Mayo-Portland Adaptability Inventory-4 Participation Index, and the Dysexecutive Questionnaire. Descriptive statistical analysis was used.Main outcomes and results: The CO-OP approach administered in a telerehabilitation format was found to be feasible. All participants indicated self-reported improvement in both trained and untrained goals. Trends toward fewer symptoms of executive dysfunction and greater community integration were demonstrated. All participants expressed satisfaction with the Internet delivery method.Conclusions: Telerehabilitation shows promise as a way to deliver the CO-OP approach and may help promote community integration of individuals living with TBI. Further study is warranted.