Effectiveness of attention rehabilitation after an acquired brain injury: A meta-analysis.

The efficacy of attention rehabilitation after an acquired brain injury was examined meta-analytically. Thirty studies with a total of 359 participants met the authors' selection criteria. Studies were categorized according to whether training efficacy was evaluated by comparing pre- and posttraining scores only or included a control condition as well. Performance improved significantly (using the d+ statistic) after training in pre-post only studies but not in pre-post with control studies. Further analyses showed that specific-skills training significantly improved performance of tasks requiring attention but that the cognitive-retraining methods included in the meta-analysis did not significantly affect outcomes. These findings demonstrate that acquired deficits of attention are treatable using specific-skills training. Implications of these results for rehabilitation theory and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diller lecture: Impaired awareness, finger tapping, and rehabilitation outcome after brain injury.

Speed of finger tapping after traumatic brain injury has been related to the problem of impaired self-awareness as well as to rehabilitation outcome. This article summarizes selected literature that documents the potentially rich information this simple task can provide. It supports Leonard Diller's emphasis on using developmentally sensitive tasks that allow for simple inferences to be applied to issues of diagnosis and rehabilitation after brain injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in orientation during acute rehabilitation after traumatic brain injury.

Objective: To examine the profile of scores on a measure of orientation in a sample of patients with traumatic brain injury (TBI) during acute rehabilitation as a means of (a) assessing the extent of neural compromise, (b) assessing recovery of functioning, and (c) determining the relative difficulty of different indicators of orientation. Design: Repeated measures. Setting: Acute rehabilitation hospital. Participants: Forty-three patients with severe TBI interviewed daily throughout rehabilitation. Measures: The Orientation Log (O-Log) is a 10-item measure of orientation to place, time, and situation. Items are scored 0–3 on the basis of whether they are recalled spontaneously (3), with cueing (2), via recognition (1), or not at all (0). Results: O-Log score was correlated with severity of TBI. Return of orientation followed a consistent trajectory, with initial gains preceding a plateau effect. Patients had relatively more difficulty orienting to hospital name and date than to year, month, and city. Conclusions: The O-Log is sensitive to the severity of TBI. Progress in orientation, on average, occurs at a similar rate across patients, including those who present as severely disoriented, although those with severe disorientation may not achieve orientation by rehabilitation discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties of the rehabilitation therapy engagement scale when used among individuals with acquired brain injury.

Objective: To examine the properties of the Rehabilitation Therapy Engagement Scale (RTES), a new scale developed to assess patient engagement in physical and occupational therapies in the acute rehabilitation setting quantitatively. Design: Psychometric analysis to test the reliability and validity of the RTES in a Midwestern acute rehabilitation facility. Participants: 75 individuals with acquired brain injury admitted to an acute rehabilitation program in a Midwestern urban setting. Main Outcome Measures: Physical therapists (PTs) and occupational therapists (OTs) completed a rating scale designed to measure each patient's level of engagement, or involvement, in therapy. Functional status at admission and discharge was measured with the Motor and Cognition scales of the Functional Independence Measure (FIM; J. M. Linacre, A. W. Heinemann, B. D. Wright, C. V. Granger, B. B. Hamilton, 1994). Results: The RTES showed high internal consistency in both physical therapy and occupational therapy settings, as well as significant correlation across those settings (r = .56, p = .001). Conclusions: The RTES appears to be a reliable and relatively unidimensional measure to identify and describe issues affecting patient engagement in rehabilitation therapies. Additional research is suggested to better understand and define the construct of engagement and to provide additional evidence of convergent and discriminant validity in the RTES. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in learning and memory after pediatric traumatic brain injury.

Thirty boys and 30 girls who sustained a traumatic brain injury (TBI) were evaluated within 1 year postinjury with the California Verbal Learning Test--Children's Version (CVLT-C; D. C. Delis, J. H. Kramer, E. Kaplan, & B. A. Ober, 1994). Boys had statistically significantly lower performance on the CVLT-C than girls in the absence of statistically significant group differences on various demographic and neurological variables. Although the effect size for this difference was modest (η=.09), gender accounted for a statistically significant amount of the variance (5%) in CVLT-C scores in addition to effects of injury severity and age. It is concluded that male gender is associated with an increased risk for retrieval deficits after pediatric TBI, possibly because of reduced speed or efficiency of information processing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychological effects of employment after traumatic brain injury: Objective and subjective indicators.

Objectives: This study examines the effects of objective (level of engagement) and subjective (discrepancy between importance of work and the degree to which work needs are met) indicators of employment on self-reported psychological well-being, quality of life (QoL), and depression for individuals with traumatic brain injury (TBI). Design: Cross-sectional. Setting: Community-based research and training center. Participants: 317 individuals with self-reported TBI under the age of 65 were included in analysis. Main Outcome Measures: Living Life After Traumatic Brain Injury (LLATBI; 1998), Flanagan Scale of Needs (J. C. Flanagan, 1982), Beck Depression Inventory-II (BDI-II; A. T. Beck, R. Steer, & G. Brown, 1996). Results: Only 21% of the present sample experienced similar levels of pre- and postinjury employment. Multiple regressions revealed significant relationships between demographic, objective, and subjective employment indicators and perceived QoL and depression. In addition, significant increments in QoL and depression variance were accounted for by subjective indicators of employment per se. Conclusions: Subjective indicators are additional important measures when assessing the rehabilitation needs and planning treatment for individuals with TBI, as they contribute to further improvements in their QoL and mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive rehabilitation following acquired brain injury: A meta-analytic re-examination of Cicerone et al.'s (2000, 2005) systematic reviews.

The present study provides a meta-analysis of cognitive rehabilitation literature (K = 115, N = 2,014) that was originally reviewed by K. D. Cicerone et al. (2000, 2005) for the purpose of providing evidence-based practice guidelines for persons with acquired brain injury. The analysis yielded a small treatment effect size (ES = .30, d+ statistic) directly attributable to cognitive rehabilitation. A larger treatment effect (ES = .71) was found for single-group pretest to posttest outcomes; however, modest improvement was observed for nontreatment control groups as well (ES = .41). Correction for this effect, which was not attributable to cognitive treatments, resulted in the small, but significant, overall estimate. Treatment effects were moderated by cognitive domain treated, time postinjury, type of brain injury, and age. The meta-analysis revealed sufficient evidence for the effectiveness of attention training after traumatic brain injury and of language and visuospatial training for aphasia and neglect syndromes after stroke. Results provide important quantitative documentation of effective treatments, complementing recent systematic reviews. Findings also highlight gaps in the scientific evidence supporting cognitive rehabilitation, thereby indicating future research directions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traumatic brain injury, polytrauma, and pain: Challenges and treatment strategies for the polytrauma rehabilitation.

Problem: Chronic pain conditions are common sequelae of traumatic brain injury (TBI). Unfortunately, the incidence of TBI among personnel deployed for Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) is significant, and there is growing evidence that ongoing pain, particularly headaches, will be a primary concern for these individuals. Objective: This article synthesizes empirical data from civilian and veteran populations and clinical experience with OEF/OIF personnel with polytrauma to provide recommendations for the assessment and treatment of chronic pain among those with TBI. Conclusions: The available data signal the need for the incorporation of early and aggressive pain management strategies into existing treatment models. Challenges to providing effective pain management for OEF/OIF veterans are numerous and include comorbid cognitive, medical, and emotional impairments that complicate readjustment to civilian life. It is likely that the problem of polytrauma pain and associated comorbid conditions such as posttraumatic stress disorder and postconcussive syndrome will require the development of integrated approaches to clinical care which bridge traditional subspecialty divisions. A proposed model of treatment is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Material-specific memory in traumatic brain injury: Differential effects during acquisition, recall, and retention.

Material-specific memory refers to the ability to learn and recall new episodic information on the basis of the nature of the stimulus material (e.g., verbal vs. nonverbal-visuospatial). Structural equation modeling was used to analyze data from a sample of patients with traumatic brain injury to compare 3 models of memory functioning: material-specific, material-specific plus general, and general (non-material-specific). The models were examined separately for acquisition, delayed free recall, and retention aspects of memory. Results suggest that, at least in a population with traumatic brain injury, the acquisition of new information takes place in a material-specific memory fashion, delayed free recall involves both material-specific and general (non-material-specific) memory components, but retention relies primarily on general (non-material-specific) memory processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance of administrators, professionals, and paraprofessionals during community-based brain injury rehabilitation training

OBJECTIVE: Two related studies that evaluated the impact of a continuing education program about community-based rehabilitation on the performance of administrators, professionals, and paraprofessionals are presented. One study contained a second part that examined whether differences between pre-course test performance and post-course test performance might be accounted for by practice effects. DESIGN: Factorial mixed model designs. SETTING: University classroom. PARTICIPANTS: Three hundred and eight professionals, administrators, and paraprofessionals from a variety of community-based rehabilitation programs. INTERVENTION: The 4-day graduate-level course focused on three content areas: brain and behavior relationships, behavioral and cognitive intervention strategies, and a rehabilitation philosophy that emphasizes individual client rights. MAIN OUTCOME MEASURE: An examination completed before and immediately after taking the course. RESULTS: Professionals and administrators perform better than paraprofessionals when tested at the beginning and end of the training. However, the absolute differences among these groups were not substantial. In addition, the rate of learning course content was the same for administrators, paraprofessionals, and professionals. CONCLUSIONS: The results support the usefulness of training for all levels of staff and suggest that all levels of staff benefit in an equal fashion.     

Peer group training of pragmatic skills in adolescents with acquired brain injury

OBJECTIVE: To empirically evaluate a method of treating adolescents with cognitive communication disorders, including pragmatic deficits, secondary to acquired brain injury (ABI) in a group setting by objectively measuring outcomes before treatment and immediately after treatment and at 6 months posttreatment. DESIGN: A before-after trial with follow-up in a consecutive sample, with no control group. SETTING: Inpatient and outpatient pediatric rehabilitation center. SUBJECTS: Adolescents who demonstrated pragmatic deficits and scored a rating of 3 or less on each subdomain of the Rehabilitation Institute of Chicago Rating Scale of Pragmatic Communication Skills (RICE-RSPCS) were eligible for the study. Eight subjects were recruited into the study, and two subjects were lost to follow-up. Thus, six of the eight completed the study. MAIN OUTCOME MEASURES: RICE-RSPCS, Communication Performance Scale (CPS). Results: Clinically relevant and statistically significant (P <.01) changes occurred during the treatment and were maintained at follow-up for the four RICE-RSPCS subscales and the CPS. CONCLUSION: These results suggest that the potential and often typical long-term pragmatic and subsequent social difficulties associated with ABI can possibly be lessened through effective intervention.     

Traumatic brain injury and memory: The role of hippocampal atrophy.

In traumatically brain-injured (TBI) patients (n?=?83), memory performance was examined on the Warrington Recognition Memory Test, Rey-Osterrieth Complex Figure, and the Logical Memory and Visual Reproduction subtests of the Wechsler Memory Scale-Revised in relationship to time postinjury and structural changes based on MRI volumetry, including hippocampus volume. Significant trauma-induced changes were observed, including hippocampal atrophy. Structure-function relationships generally became significant only after 90 days postinjury. Memory tended to relate more to the degree of hippocampal atrophy, particularly left hippocampus, than to nonspecific indicators such as the temporal horns or the ventricle-to-brain ratio. A stronger relationship with left versus right hippocampus was evident for measures of verbal and supposedly nonverbal memory. These results are discussed with regard to the role the hippocampus may play in a neural system of memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Molecular biology of opioid receptors: recent advances

Endogenous opioid peptides and opiates like morphine produce their pharmacological effects through the membrane bound opioid receptors. These receptors belong to a superfamily of G-protein-coupled receptors, all of which possess seven membrane-spanning regions. Structure-activity relationship studies of opioids opened up new avenues for the pharmacological characterization of the opioid receptors. As a further advancement in this direction, molecular cloning has led to the identification of three different types of opioid receptors -- OP1 (delta), OP2 (kappa) and OP3 (mu) -- thereby supporting the results of earlier pharmacological studies which postulated their existence. The three opioid receptors are highly homologous. Consequent to the development of highly specific and selective agonists and antagonists, it was proposed that the three types of opioid receptors could be further categorized into different subtypes. However, the molecular biology data generated so far do not support the presence of the various subtypes of the three well-characterized opioid receptors. Recent strides towards the advancement of our knowledge relating to the molecular biology of these receptors have been reviewed in this article.     

Bring it up in milieu: Toward effective traumatic brain injury rehabilitation interaction.

Reviews the emotional and motivational problems faced by the rehabilitation therapist dealing with traumatic brain injury (TBI) patients and describes a neuropsychologically oriented method to help rehabilitation team members improve their effectiveness in returning post-TBI patients to work. A clinical vignette describing the use of milieu therapy is presented. Topics that rehabilitation team members need to be taught about cognitive and personality problems of TBI patients are discussed, focusing on teaching staff to give feedback in milieu. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of return to work following traumatic brain injury: Intellectual, memory, and demographic variables.

Objective: To identify predictors of return to work for individuals with traumatic brain injury (TBI). Study Design: Data gathered from a retrospective chart review that included predictor variables (demographic, intellectual, and memory) and an outcome variable (employment status 1 year postprogram) were entered into a logistical regression analysis. Setting: A Commission for Accreditation of Rehabilitation Facilities-accredited outpatient brain injury program. Participants: Forty-three adults with TBI who completed the brain injury program. Main Outcome Measure: Employment status at 1 -year follow-up. Results: Individuals with higher scores on measures of Performance IQ and Verbal Memory were more likely to return to work. Conclusions: When the effects of many demographic variables are controlled for, intelligence and memory variables can provide valuable information to patients, families, and service providers (e.g., rehabilitation centers) with regard to returning to work after TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anosognosia and denial: Their relationship to coping and depression in acquired brain injury.

Objective: To evaluate relations among denial, anosognosia, coping strategies, and depression in persons with brain injury. Study Design: Correlational. Setting: A Midwest residential, post-acute brain injury rehabilitation center. Participants: Twenty-seven adults with brain injury. Measures: Clinician's Rating Scale for Evaluating Impaired Self-Awareness and Denial of Disability After Brain Injury, COPE, Beck Depression Inventory-I. Results: Denial and anosognosia were related and co-occurred. Use of process coping strategies was associated with greater use of problem-focused coping strategies. Higher levels of denial were associated with greater use of avoidant coping strategies, and greater use of these coping strategies was related to higher levels of depression. Conclusions: Individuals primarily in denial and individuals primarily anosognosic differ in the coping strategies they institute. Avoidant coping strategies are used more frequently by individuals in denial, and use of these strategies is associated with higher levels of clinical depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dental hypersensitivity: recent advances in diagnosis and treatment

Perirenal extravasation of urine with an intact renal parenchyma and with dye visualized in the ureter was seen on an excretory urogram (IVP) and computed tomographic (CT) scan in two patients (bilateral in one) with multiple injuries following blunt trauma. Expectant management with no invasive procedures resulted in disappearance of the extravasation within 3 to 5 days. Traumatic rupture of a calyceal fornix is thought to be the cause of the extravasation similar to the perirenal extravasation seen with renal colic from a ureteral calculus.     

Traumatic brain injury in children and adolescents: psychiatric disorders at two years

OBJECTIVE: To extend findings regarding predictive factors of psychiatric outcome from the first to the second year after traumatic brain injury (TBI) in children and adolescents. METHOD: Subjects were children aged 6 to 14 years at the time they were hospitalized after TBI. The study used a prospective follow-up design. Assessments of preinjury psychiatric, behavioral, adaptive functioning, family functioning and family psychiatric history status were conducted. Severity of injury was assessed by standard clinical scales and neuroimaging was analyzed. The outcome measure was the presence of a psychiatric disorder, not present before the injury ("novel"), during the second year after TBI. RESULTS: Fifty subjects enrolled, and the analyses focused on 42 subjects followed at 24 months. Severity of injury, preinjury family function, and preinjury lifetime psychiatric history predicted the development of a "novel" psychiatric disorder present in the second year. CONCLUSION: These data suggest that there are children, identifiable through clinical assessment, at increased risk for "novel" psychiatric disorders in the second year after TBI.     

Rehabilitation after traumatic brain injury in adults

PURPOSE: Traumatic brain injury (TBI) stands as a major public health problem and one of the most important challenges for neurological rehabilitation. This review discusses advances that have occurred in the past 10 years in rehabilitation after severe TBI in adults. METHOD: First, theoretical concepts, goals of rehabilitation and organization of resources are reviewed. Then specific questions that arise in the rehabilitation of severe TBI patients are considered. RESULTS: Three phases are distinguished in post-traumatic evolution. Acute rehabilitation takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications, and to provide sensory stimulations with the hope of accelerating arousal. Secondly subacute (generally inpatient) rehabilitation is designed to facilitate and accelerate recovery of impairments, and to compensate for disabilities. Motility, cognition, behaviour, personality and affect should be simultaneously addressed in an holistic approach. Physical as well as psychological independence and self-awareness are the major goals to emphasize. A third, post-acute rehabilitation phase includes outpatient therapy for achieving physical, domestic and social independence, reduction of handicaps and re-entry into the community. CONCLUSIONS: Problems with returning home, obtaining financial independence, driving, returning to work, participating in social relationships and leisure activities, and the importance of psychosocial adjustment and self-acceptance, are outlined. Questions about economic aspects and rehabilitation in the future are addressed.