Severe ABI Research Articles

15 Examining Unmet Needs in a Brain Injury Sample, Consisting of Various Races/Ethnicities, Referred to Resource Facilitation

Objective:To investigate differences of the perceived unmet needs in a post-acute brain injury sample when referred to Resource Facilitation (RF) among various race/ethnic groups.Participants and Methods:The methodology utilizied within this study consisted of a retrospective chart review, which was sourced from a clinical database serving chronic outpatients in the Midwest region. The main outcome measure was the Service of Unmet Needs & Service Use (SUNSU). The sample consisted of N = 455 subjects, which included a small sample size of Hispanics (N=7). Therefore, African American and Hispanic groups were combined for a total minority sample (N=84). Clinical disorders included within the study was an ABI from either stroke, anoxic injury, ruptured aneurysm, or tumor resection surgery. Eligibility criteria included participants’ admission into a RF program, a vocational goal, and a diagnosis of a moderate to severe TBI or other ABI. Lastly, key sociodemographic features included age, race, ethnicity, education, and sex.Results:Significant differences were found between ethnic groups (white non-Hispanics and minority group) in terms of years of education (p=<.01). White non-Hispanics had higher education (M=13.39, SD=2.23), reported significantly more rural addresses (40.2%, p=<.01), and had private insurance coverage more frequently than the minority group (33.7%, p=<.01). The full model was statistically significant, R2=.077 = F(4,450) = 9.387, p<.0001; adjusted R2 = .069. The addition of ethnicity led to a statistically significant increase in R2 of .019, F(1,450) =9.025, p<.0005.Conclusions:Ethnicity was found to be a predictive factor for greater unmet needs even after controlling for insurance, employment status, and urbanicity. It is currently unknown RF’s success rate in providing culturally competent services to different racial/ethnic groups, which consider factors such as primary language spoken, immigration status, and additional ethnocultural factors that could deter accurate reporting of unmet needs by minoritized groups. Future studies should investigate barriers in referring and meeting eligibility for this program and analyze post-treatment data to determine if the impact of racial, geographic, and insurance disparities is mitigated with RF treatment.

Unequal neurorehabilitation trajectories – a longitudinal case study combining field structures with social Class–Based Capital Conversion

ABSTRACT Inequalities in illness, service provision, and outcomes are well documented in the Nordic universal welfare state. The ways in which inequalities are produced during illness recovery trajectories remain largely unknown. Long-term brain injury rehabilitation in this context provides a window into veiled aspects of inequality and the underlying mechanisms. We examine inequality empirically by combing framing field structures with the classed abilities of families to mobilise capital after a severe acquired brain injury (severe ABI). Using a Bourdieuan theoretical framework, informed by the concepts of field, doxa, cultural health capital (CHC), and rehabilitation capital (RC), we designed a longitudinal case study encompassing professional records, observations, and interviews that tracked and analysed subjects' trajectories. We found that families’ consistent accumulation and conversion of capital was crucial after a severe ABI because of the multifaceted rehabilitation process involving many different field specific agendas and doxas. This study supplements previous concepts (CHC and RC) developed in a health care context by including other rehabilitation contexts. These disparities in forms of capital amongst social classes result in winners and losers and were reflected in the rehabilitation trajectories of the young adults, characterised by continuity on one extreme and broken trajectories on the other.

Development of a generic version of the multiple errands test for severe acquired brain injuries

Background Impairment of executive functions is a frequent and disabling consequence of brain injury. In 1991, Shallice and Burgess elaborated the Multiple Errand Test (MET) to assess everyday troubles associated with this impairment. Objective Our first aim was to create a generic version of MET (MET-G) readily adaptable to different settings and for retesting. The second aim was to validate the revised version to detect executive impairment in individuals with severe ABI. Methods An inter-professional team of experts in neurorehabilitation created a revised version of MET. Twenty-one patients with sABI (severe Acquired Brain Injury) and a control group of 20 neurologically healthy subjects, took part in the testing of MET-G. Results MET-G clearly distinguished people with sABI from healthy controls based on Total error score, task completion, and rule breaking. The test showed good inter-rater reliability and internal consistency. Conclusions The new, generic version of MET was able to differentiate adults with sABI from controls and proved to be a good tool for evaluating executive functions in these patients in daily-life contexts. Indications on how to adapt the test to different contexts and different scoring modalities are provided.

Exploring the use of the Cognitive Orientation to daily Occupational Performance approach (CO-OP) with children with executive functions deficits after severe acquired brain injury: A single case experimental design study.

to assess whether the use of CO-OP could be of interest in children with EF deficits after ABI, to improve their occupational performance, their executive functioning in everyday life and their cognitive processes constituting EF. This was a single case experimental study with multiple baselines across individuals and behaviors. We included 2 children at least 6 months after severe ABI. The children received 14 individual sessions of the CO-OP intervention. Each child set 3 goals by using the Canadian Occupational Performance Measure; 2 goals were trained and the third was a control goal. The achievement of the goals was measured by using repeated measures of Goal Attainment Scales (GASs). Ecological assessments of EF included the Children's Cooking Task and parent and teacher ratings of the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire. both children improved their performance on both trained goals (and, to a lesser extent, on untrained goals). We found significant improvement on tests of EF and on the BRIEF questionnaire, reflecting executive functioning in everyday life, at home and at school. these results are encouraging and suggest the feasibility and effectiveness of CO-OP for children with EF deficits after ABI. They should be replicated in a larger number of cases. ClinicalTrials.gov (NCT04718688).

Acquired brain injuries: neurophysiology in early prognosis and rehabilitation pathway

Despite advances in intensive care medicine and neurosurgical procedures, the mortality and long-term disability rates for serious traumatic and non-traumatic brain injuries remain high. With improvements in intensive care, the most common proximate cause of death in comatose patients following acquired brain injury is represented the withdrawal of life-sustaining therapies (ABI). This procedure, however, raises serious ethical concerns, as current approaches in the prediction of consciousness recovery and functional independence lack accuracy. The prediction of neurological outcome after severe ABI at the individual patient level is variable and challenging. Current prognostication models applied in severe traumatic brain injury and the post-cardiac arrest population perform reasonably well in predicting the neurological outcomes in low- and high-severity patients but do not allow for accurate outcome predictions in patients with intermediate severity. The current review highlights new clinical and instrumental prognostication develop-ments, with a particular focus on the prediction of consciousness recovery. In particular, recent research has leveraged neurophysiological techniques (electroencephalogram and somatosensory evoked potentials) to build a strategy for recovery prediction. In addition, we underline the relevance of instrumental motor assessments because motor impairment may affect the reliable evaluation of the effective consciousness level or may hamper patients’ complete functional recovery.

Multichannel mixture models for time-series analysis and classification of engagement with multiple health services: An application to psychology and physiotherapy utilization patterns after traffic accidents

BackgroundMotor vehicle accidents (MVA) represent a significant burden on health systems globally. Tens of thousands of people are injured in Australia every year and may experience significant disability. Associated economic costs are substantial. There is little literature on the health service utilization patterns of MVA patients. To fill this gap, this study has been designed to investigate temporal patterns of psychology and physiotherapy service utilization following transport-related injuries. MethodDe-identified compensation data was provided by the Australian Transport Accident Commission. Utilization of physiotherapy and psychology services was analysed. The datasets contained 788 psychology and 3115 physiotherapy claimants and 22,522 and 118,453 episodes of service utilization, respectively. 582 claimants used both services, and their data were preprocessed to generate multidimensional time series. Time series clustering was applied using a mixture of hidden Markov models to identify the main distinct patterns of service utilization. Combinations of hidden states and clusters were evaluated and optimized using the Bayesian information criterion and interpretability. Cluster membership was further investigated using static covariates and multinomial logistic regression, and classified using high-performing classifiers (extreme gradient boosting machine, random forest and support vector machine) with 5-fold cross-validation. ResultsFour clusters of claimants were obtained from the clustering of the time series of service utilization. Service volumes and costs increased progressively from clusters 1 to 4. Membership of cluster 1 was positively associated with nerve damage and negatively associated with severe ABI and spinal injuries. Cluster 3 was positively associated with severe ABI, brain/head injury and psychiatric injury. Cluster 4 was positively associated with internal injuries. The classifiers were capable of classifying cluster membership with moderate to strong performance (AUC: 0.62–0.96). ConclusionThe available time series of post-accident psychology and physiotherapy service utilization were coalesced into four clusters that were clearly distinct in terms of patterns of utilization. In addition, pre-treatment covariates allowed prediction of a claimant's post-accident service utilization with reasonable accuracy. Such results can be useful for a range of decision-making processes, including the design of interventions aimed at improving claimant care and recovery.

Early rehabilitation: benefits in patients with severe acquired brain injury.

Establish the best time to start rehabilitation by means of scientific evidence. Observational study in patients with a diagnosis of Severe Brain Injury who received intensive inpatient rehabilitation after acute care. 1470 subjects enrolled: 651 with Traumatic Brain Injury (TBI) and 819 with Non-TBI. Male gender was prevalent in the population study, but sex distribution was not different among groups, with a prevalence of male gender in both populations. This project involved 29 rehabilitation facilities for Severe ABI. The registry was an electronic database, remained active only during the period of data collection. The patients were divided into three different categories according to the time interval from brain injury to inpatient rehabilitation admission and demographic and clinical data were collected. Etiology, time interval from injury to inpatient rehabilitation, disability severity, the presence of tracheostomy at admission to the rehabilitation facility, rehabilitation length of stay and transfer back to acute care wards because of medical, surgical or neurosurgical complications. The interval from brain injury to rehabilitation facilities admission increases along with age, brain injury severity according to DRS scores, the presence of a tracheal tube and the percentage of transfers back to acute care wards from rehabilitation facilities, because of medical, surgical or neurosurgical complications. The better recovery and more positive outcomes, reported as resulting from early rehabilitation, may be due more to less severity of brain injury and fewer complications in the acute and post-acute phase than to when the rehabilitation starts.

Analysis of a Comprehensive Dysphagia Protocol for Adults with TBI in a Post-Acute Rehab

To investigate swallowing outcomes in adults with moderate to severe ABI over a 5 year period using a Comprehensive Dysphagia Protocol.

Anxiety related to discharge from inpatient neurorehabilitation: Exploring the role of self-efficacy and internal health control beliefs

The study aimed to determine the prevalence of anxiety related to discharge, among a group of 42 participants who were likely to have sustained an at least moderate to severe ABI and who were due to be discharged home following a period of inpatient neurorehabilitation. Differential relationships between psychological factors (self-efficacy and internal health control beliefs) were examined, alongside the relative influence of demographic and clinical characteristics on discharge anxiety. Data were obtained via self-report measures and retrospective reviews of participant's inpatient medical records. While relatively few participants (n = 6; 14%) reported markedly elevated trait-anxiety, almost half the sample (n = 19; 45%) reported clinically significant levels of transient state-anxiety. Notably, state-anxiety was strongly associated with discharge anxiety. Multivariate analyses revealed that age, self-efficacy and internal health control beliefs made independent contributions to self-reported discharge anxiety, with perceived self-efficacy alone explaining 69% of the variance and mediating the effects of age and internal health control beliefs. None of the other demographic or clinical characteristics examined was significantly associated with discharge anxiety. While causality cannot be inferred, findings suggest that anxiety related to discharge from rehabilitation might be best predicted by poor perceptions of self-efficacy. Implications for clinical practice and future research are discussed.

Awareness assessment during cognitive rehabilitation in children with severe ABI: A pilot study

Awareness assessment during cognitive rehabilitation in children with severe ABI: A pilot study

Comparing memory and meta-memory abilities between children with acquired brain injury and healthy peers.

This study compared visual memory and meta-memory abilities of children with ABI to that of healthy peers. Participants included 16 children (aged 13.55 ± 3.29 years) with moderate or severe ABI and 16 healthy children (aged 12.44 ± 3.24 years) with typical development. Children completed the Contextual Memory Test for Children (CMT-CH). The study group showed significantly lower immediate and delayed recall abilities. While the controls used the context for better memorizing, most of the children with ABI used rehearsals. In both groups better delayed recall correlated with the use of a more efficient strategy. Meta-memory should be an integral part of the assessment for children with ABI. Therapists should enhance child's self-awareness to his/her abilities and encourage the use of strategies (e.g. context) for memorizing in daily life.

Assessing preferences of individuals with acquired brain injury using alternative stimulus modalities

Primary objective: To extend previous research on alternative stimulus preference assessment (SPA) modalities to individuals with severe ABI by evaluating the effects of pictorial, verbal and tangible item presentation.Research design: Paired-stimulus procedure used for SPA sessions with the order of modalities counterbalanced across participants. Reinforcer assessments (RAs) were experimentally evaluated using an alternating treatments design. A progressive-ratio procedure was used for reinforcer assessment (RA) sessions.Methods and procedures: Six adults with severe ABI. The Assessment of Basic Learning Abilities was conducted to assess discrimination skills; the Reinforcer Assessment for Individuals with Severe Disabilities structured interview was administered to identify items for subsequent evaluations. Three SPA sessions—one of each stimulus modality—were conducted with each participant. Subsequent RAs were conducted using the stimuli ranked as the most highly preferred for each participant.Main outcomes and results: Each modality identified a different food item with the highest selection percentage for three participants, while three participants had highly consistent SPA results. Subsequent RAs demonstrated that all modalities made valid predictions of foods that would function as reinforcers for programming.Conclusions: Use of the different direct-observation methods to identify reinforcers for reductive and skill acquisition programming would likely be a useful addition to rehabilitation settings.

A randomised controlled trial evaluating a brief intervention for deficits in recognising emotional prosody following severe ABI

Many adults with acquired brain injuries, including traumatic brain injuries (TBI) have impaired emotion perception. Impaired perception of emotion in voice can occur independently to facial expression and represents a specific target for remediation. No research to date has addressed this. The current study used a randomised controlled trial to examine the efficacy of a short treatment (three x two-hour sessions) for improving the ability to recognise emotional prosody for people with acquired brain injury, mostly TBI. Ten participants were allocated to treatment and 10 to waitlist. All participants remained involved for the duration of the study in the groups to which they were allocated. There were no significant treatment effects for group, but analyses of individual performances indicated that six of the treated participants made demonstrable improvements on objective measures of prosody recognition. The reasons why some participants showed improvements while others did not, was not obvious. Improvements on objective lab-based measures did not generalise to relative reports of improvements in everyday communicative ability. Nor was there clear evidence of long-term effects. In conclusion, treatment of emotional prosody was effective in the short-term for half of the participants. Further research is required to determine what conditions are required to optimise generalisability and longer-term gains.

Moving from aged care facilities to community-based accommodation: Outcomes and environmental factors

Objective: Nearly 3500 people under 60 years of age are living in residential aged care in Australia, a situation which is generally recognized as incompatible with optimum quality of life. The objective of the current study is to explore the transition experiences of young people with acquired brain injury who have lived in aged care facilities and moved into community-based settings.Research design: Grounded theory, qualitative design.Methods and procedures: Semi-structured interviews were conducted with seven individuals with very severe ABI, seven family caregivers and two disability support workers. Each interview was recorded and transcribed verbatim.Results: Participants identified a range of positive outcomes that resulted from the transition from aged care settings to community living environments including increased independence in everyday activities, improved well-being and a greater degree of social inclusion. Participants also identified environmental factors that they deemed as crucial to facilitating positive outcomes.Conclusions: People with very severe ABI have the potential to increase their level of independence in community-based accommodation settings; a potential that is not fostered in most aged care environments. The findings inform the outcome variables and environmental factors that should be measured in studies of transition from aged care to the community.

Persons with acquired brain injury: a disabled diaspora.

1 The risk of ABI is greatest between the mid-teen years and mid-twenties, and again in the elderly, with males at particular risk. The commonest causes are transport-related injuries, followed by falls which are more frequent in older age groups. 3 Residual deficits in cases of mild, moderate and severe ABI have been estimated at 10%, 67% and 100% respectively. 4 Psychiatric sequelae are common and may develop several years after the initial injury. A 30 year follow-up study of 60 ABI patients found a lifetime prevalence of 26.7% for DSM- IV major depression. 5 Kreutzer et al found a prevalence rate for DSM-IV major depression of 42% at 2.5 years post-injury. 6 Anatomical regions implicated in the aetiology of psychosis, such as the temporal lobes, prefrontal cortex and hippocam- pus, are particularly vulnerable to acquired injury, and ABI has been estimated to account for 1-17% of all cases of schizo- phrenia. 7