Review of Clinical neuropsychology of intervention.

Reviews the book, Clinical neuropsycbology of intervention by Barbara Uzzell and Yigal Gross. Doctors Uzzell and Gross have performed a great service for the field of Neuropsychology by editing the volume which they entitle Clinical Neuropsychology of Intervention. They have succeeded in making the book a depiction of the state of the art of neuropsychological rehabilitation in 1986. The contributions, of uniformly high quality, are by individuals who are experienced in service delivery to the brain injured. The contributions reflect both an underlying concern with psychological theory and with principles of neuropsychology and reflect an effort by each author to analyze and codify his/her own experience so as to present it systematically to the reader. These efforts are all successful—some to such a degree that those chapters constitute superb, self-contained treatments of their topics. Surely, this coherence of approach and the high quality of the result have to reflect the skillful editing by Doctors Uzzell and Gross. The reviewer recommends this book as obligatory reading for anyone involved in the evaluation or treatment of brain damaged patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Brain injury casebook: Methods for re-integration to home, school, and community.

Reviews the book, Brain injury casebook: Methods for re-integration to home, school, and community by Dorrie Rapp (1986). Any professional who has been part of the difficult process of helping a brain injured individual re-integrate into life will undoubtedly find Dr. Rapp's book useful and timely. Recent head injury seminars have begun to focus directly upon the myriad of problems facing the traumatically brain injured when he or she begins to deal with life after traditional rehabilitation. Through the use of actual and often poignant case studies, Dr. Rapp illustrates the flexibility, creativity, and persistence necessary when working with the traumatically brain injured and their families. As we begin to grasp the complexity of re-integration for the traumatically brain injured individual, more documentation of the comprehensiveness of the problem needs to be published. Professionals working with the brain injured will find both support and new ideas from reading Dr. Rapp's book. The only criticism is that it does not delve into vocational issues which, by far, comprise a large portion of reintegration problems. However, professionals, care providers, brain injured individuals, families, schools, funding agencies, and employers can all obtain an excellent overview of the complexity of successful re-integration following traumatic brain injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Rehabilitation with brain injury survivors: An empowerment approach.

Reviews the book, Rehabilitation with brain injury survivors: An empowerment approach by Christiane C. O'Hara and Minnie Harrell (see record 1991-97522-000). The authors' goal is stated as being a treatment/evaluation manual for traumatic brain injury (TBI) survivors that corrects the frequent failures of traditional rehabilitation models, and describes an integrated, wholistic approach that can be implemented across settings and used by clients and treatment staff of all disciplines. The manual is published in a loose-leaf notebook format that has been adopted by rehabilitation workshop sponsors and publishers of computer software manuals. It contains five chapters: (1) Introduction; (2) Evaluation; (3) Case Management and Treatment Planning; (4) Cognition; and (5) Emotions/Behavior. Of the 491 pages contained therein, there are 140 pages of text. The remaining pages provide a series of forms and checklists that are to be used for assessment, treatment, and program administration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Current topics in rehabilitation psychology.

Reviews the book, Current topics in rehabilitation psychology edited by Charles J. Golden (1984). Every few years an edited volume of chapters on rehabilitation psychology is published. The latest contribution, Current Topics in Rehabilitation Psychology, edited by Charles Golden, is written for students, professionals, and educated lay people who want to learn about some of the recent advances in the field. Golden makes clear, and quite correctly so, that the volume is not a comprehensive coverage of all the areas of research, training, and service that are in the domain of rehabilitation psychology. Instead, after two chapters giving an overview of the field, several specific areas are addressed. They include management of chronic pain, cognitive retraining in brain damaged patients, rehabilitation and aging, adjustment of people with spinal cord injury, vocational training of people with severe developmental disabilities, biofeedback, and the role of personality in attitudes toward those with physical disabilities. The book would have profited greatly from more careful editing. Although the quality of writing varies from author to author, the grammatical errors, misspellings, and garbled sentences are uniformly so numerous that they sometimes distract the reader from the valuable content of the chapters. Nevertheless, the book is worthwhile as one that gives an overview of several specific topics and supplies rich bibliographies to those wishing to learn more. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religion and spirituality in rehabilitation outcomes among individuals with traumatic brain injury.

Objective: The long-term consequences of traumatic brain injury affect millions of Americans, many of whom report using religion and spirituality to cope. Little research, however, has investigated how various elements of the religious and spiritual belief systems affect rehabilitation outcomes. The present study sought to assess the use of specifically defined elements of religion and spirituality as psychosocial resources in a sample of traumatically brain injured adults. Participants: The sample included 88 adults with brain injury from 1 to 20 years post injury and their knowledgeable significant others (SOs). The majority of the participants with brain injury were male (76%), African American (75%) and Christian (76%). Measures: Participants subjectively reported on their religious/spiritual beliefs and psychosocial resources as well as their current physical and psychological status. Significant others reported objective rehabilitation outcomes. Analyses: Hierarchical multiple regression analyses were used to determine the proportion of variance in outcomes accounted for by demographic, injury related, psychosocial and religious/spiritual variables. Results: The results indicate that religious well-being (a sense of connection to a higher power) was a unique predictor for life satisfaction, distress and functional ability whereas public religious practice and existential well-being were not. Conclusions: The findings of this project indicate that specific facets of religious and spiritual belief systems do play direct and unique roles in predicting rehabilitation outcomes whereas religious activity does not. Notably, a self-reported individual connection to a higher power was an extremely robust predictor of both subjective and objective outcome. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mitchell Rosenthal (1949-2007).

Mitchell Rosenthal, a central figure in the emergence of traumatic brain injury (TBI) rehabilitation and the professionalization of rehabilitation psychology, died unexpectedly on May 31, 2007, at the age of 58 from complications following cardiac surgery. Rosenthal was a major figure in the development and evolution of the Traumatic Brain Injury Model Systems program and the Traumatic Brain Injury Rehabilitation and Research Centers. From 1999 to 2004, he was the principal investigator for the TBI National Database Center funded by the National Institute on Disability and Rehabilitation Research. Rosenthal's leadership roles in rehabilitation psychology were many and significant. He was a founding member of the American Board of Rehabilitation Psychology and served on the Board of Trustees of the American Board of Professional Psychology at his death. His advocacy for rehabilitation psychology was evident throughout his career. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Behavioral assessment and rehabilitation of the traumatically brain-damaged.

Reviews the book, Behavioral assessment and rehabilitation of the traumatically brain-damaged by Barry A. Edelstein and Eugene T. Couture (1984). Over the last decade or so, advances in assessment and management within clinical neuropsychology have had a profound impact on rehabilitation psychology. Barry Edelstein and Eugene Couture have edited this book out of a "long-standing interest in the retraining of traumatically brain-damaged adults and the management of their behavior by family members." The editors want to provide a reference that moves from standard neuropsychological assessment to issues of retraining of skill deficits. They hope that this volume will be useful to clinical psychologists, clinical neuropsychologists, rehabilitation medicine specialists, physical therapists, speech pathologists, and other rehabilitation disciplines involved in the treatment and rehabilitation of the traumatically brain-damaged. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of causal attributions in public misconceptions about brain injury.

Objective: Social psychological theories such as attribution theory have been applied to conditions such as depression and physical disability, but not to traumatic brain injury (TBI). The goal of this paper is to show that that attribution theory and related concepts help to explain the public's misconceptions about TBI and other challenges faced by clinicians and families of persons with TBI. Results: Research shows that misconceptions about brain injury occur because people misattribute the actions of persons with brain injury. These misattributions reflect two features: (a) the absence of visible markers of the injury, and (b) the tendency to compare persons with TBI with their peers rather than their own preinjury performance. These two processes lead to the opposite pattern to the stigma that occurs with visible disabilities: specifically, a failure among members of the public to recognize that problematic behaviors may result from the injury. This analysis suggests several therapeutic strategies for managing public misconceptions in ways that enhance coping and recovery. Conclusion: Clarifying the attribution processes that underpin misconceptions about brain injury provides a framework for enhancing rehabilitation and addressing these misconceptions effectively. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Explanatory Style and Perception of Recovery in Symptomatic Mild Traumatic Brain Injury.

Objective: To examine perception of injury and explanatory style in symptomatic mild traumatic brain injury (MTBI). Study Design: Cross-sectional comparisons. Setting: Outpatient brain injury rehabilitation clinic. Participants: Twenty-two adults with MTBI and 11 with moderate/severe traumatic brain injury (TBI). Measures: Questionnaires addressing self-perception of injury severity and recovery and explanatory style. Results: MTBI patients reported greater injury severity and poorer cognitive recovery and rated their brain injury as affecting more areas of life than the moderate/severe TBI group. Pessimistic explanatory style was associated with poorer perceived recovery. Conclusions: The results provide a stimulus for future research on self-perception and explanatory style as significant psychological variables and should be considered as relevant for interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Head injury rehabilitation: Children and adolescents.

Reviews the book, Head injury rehabilitation: Children and adolescents by Mark Yivisaker. This book is intended to be a practical guide for professionals seeking concrete guidance in the difficult and frustrating search for effective treatment strategies for head injured patients. While maintaining a commitment to scholarship, the authors of the treatment chapters of this textbook have taken as their primary responsibility the clear presentation of a treatment philosophy as well as specific principles and techniques of remediation" (p. xvii). It is clear that the contributors of this volume, most of whom work together at the Rehabilitation Institute of Pittsburgh, labored long and hard to accomplish this goal and, as a result, they have produced a lucid and thorough volume. This book provides a very helpful and coherent account of pediatric head injury rehabilitation. No important topics are overlooked and, although some crucial areas are given fairly short shrift, the coverage is quite within the stated purpose of the work and the task that the authors set for themselves. I think that this book will prove to be a useful manual for neophytes to the head injury rehabilitation field, and to many parents of head injured children. It certainly should be required reading for all who choose to prepare themselves for professional work with head injured children. One final point: although not explicitly stated, the enormous investment of time and effort required by the head injured child and his or her family reflects a capacity that arises more from the heart than from the mind. This commitment can only come from a well-integrated and devoted team of professionals such as the group who authored this book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to "Programming for occupational outcomes following traumatic brain injury".

Responds to an article Programming for occupational outcomes following traumatic brain injury by William J. Haffey and Frank D. Lewis (see record 1990-02644-001). The dramatic upsurge in attention paid in the past 10 years to the rehabilitation of persons with traumatic brain injury (TBI) has resulted in an accelerating proliferation of treatment programs purporting to apply specialized techniques that will "remediate" the cognitive and behavioral deficits of this population, with implicit or explicit promises of functional gain. Specifically, given the epidemiologic realities of the TBI population, returning to work is a major goal of the rehabilitation process. With the movement of TBI rehabilitation programs out of academic medical centers and into the private sector, increasing numbers of zealous professionals are ready to apply a variety of treatment approaches, thousands of families are eager to find the "best" program, and more and more nervous insurers are both mandated and requested to pay for expensive treatments that hold out the promise of return to work. Unfortunately, the field of TBI rehabilitation has been more eager to provide services than critically evaluate the effectiveness of those services. The first major contribution of the Haffey and Lewis article is to call attention both to the paucity of posttreatment vocational outcome studies, and to emphasize the need to evaluate the success of various models of vocational rehabilitation. The second major contribution of the Haffey and Lewis article is their offering of a concrete example of one approach to systematic programming for vocational outcomes. Our experience is that vocational potential—and therefore reasonable goals—only emerge as the product of a process that involves testing the client's capacities not just cognitively and behaviorally, but also his or her capacity to conform to a series of messages and procedures that will determine the viability of any given vocational plan. Readers should take from the concrete programming suggestions in this article the laudable objective of making vocational goals, obstacles, and critical events specific and public, but beware of mechanically applying the approach without appreciating the complex subtleties in enabling a brain-injured person to become a productive worker. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response to "Care continuum in traumatic brain injury rehabilitation".

Comments on the original article "Care continuum in traumatic brain injury rehabilitation," by J. M. Uomoto and A. McLean (see record 1990-02670-001). As someone working within the insurance industry with the responsibility for purchasing services for TBI patients, I think that the TBI care continuum, as presented by Uomoto and McLean, represents a sensible response to a critical need. It does not offer, however, any specific information on what is effective and simply restates what has already been recognized by many in the insurance industry: head trauma rehabilitation is long, complex, multidisciplinary, intensely individualistic, and enormously expensive. The insurance industry is aware that a continuum care approach is necessary. Clearly, no one can dispute that treatment has to be ongoing and multifaceted to address a disability that has such a colossal medical, social, vocational, and psychological impact. In addition, the need for acute hospitalization, acute rehabilitation, and a protective environment to provide care and address basic needs is readily accepted. The problem for the insurance industry is what constitutes effective treatment beyond the acute phase of trauma stabilization and maintenance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advanced regression methods for single-case designs: Studying propranolol in the treatment for agitation associated with traumatic brain injury.

Objective: The use of single-case designs in intervention research is discussed. Regression methods for analyzing data from these designs are considered, and an innovative use of logistic regression to analyze data from a double-blind, randomized clinical trial of propranolol for agitation among persons with traumatic brain injury (TBI) is used. Method: Double-blind, randomized clinical trial performed in an outpatient rehabilitation setting. Participants: Nine men and 4 women with TBI. Results: Logistic models indicated that propranolol was not associated with less agitation for most participants (Φ=-.135; 90% exact confidence interval was -.03     

Injury severity and outcome: A meta-analysis of prospective studies on TBI outcome.

Objective: The recent movement to apply evidenced-based approaches to medical and rehabilitation care has increased the importance of approximating outcomes as early in the recovery process as possible. The relationship between injury severity and outcome following traumatic brain injury (TBI), however, has remained unclear due to the variety of predictor and criterion variables used throughout the literature. Method: A meta-analysis of eligible prospective studies that assessed the bivariate association between injury severity and outcome at 1-year postinjury was conducted. Results: Twenty-six studies met the inclusion criteria (total N = 21,050 patients). Injury severity was a significant predictor of outcome at 1-year postinjury (r = .257). Homogeneity testing by means of the Q test, Q(n), indicated that injury severity measurement, Q(68) = 1140.76, p     

Comparison of functional outcomes and treatment cost between a computer-based cognitive rehabilitation teletherapy program and a face-to-face rehabilitation program.

The authors compared outcomes of 19 participants who received computer-based cognitive teletherapy rehabilitation with 20 participants who received face-to-face speech-language rehabilitation. The study compared outcomes from 2 "real-word" treatment programs provided by an outpatient rehabilitation center. A total of 39 participants with moderate to severe closed head traumatic brain injuries and a minimum of 1 year following injury were analyzed. Outcome measures included clinical indicators of independent living status, return to work or school, and independent driving. Cost measures included the total cost of the treatment and a measure of service costs per hour. Time since injury was a covariate, and an analysis of covariance revealed no differences between groups in independent living, driving status, return to work or school, or total treatment costs. The computer-based teletherapy cognitive rehabilitation program provided similar functional outcomes as face-to-face speech-language therapy at a similar total cost. (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)     

Telehealth Brain Injury Training for Rural Behavioral Health Generalists: Supporting and Enhancing Rural Service Delivery Networks.

Rural psychologists are frontline primary behavioral health care providers for nearly 60 million Americans, but they face limited access to peer consultation and continuing education. This article describes a program that matched 70 rehabilitation inpatients who had new brain injury with rural clinicians from patients' home communities. Neuropsychologists provided one-on-one training for clinicians through telehealth video teleconferencing. Clinicians showed gains in brain injury knowledge, and clients rated trained providers higher than untrained providers. Families seeking brain injury services can connect with these trained rural providers through a Web site, which receives more than 800 hits per month. Telehealth offers potential for rural clinicians to receive support, reduce professional isolation, gain working knowledge of specialty conditions, and deliver high-quality services for their rural clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group psychotherapy focusing on self-concept change following acquired brain injury: A pilot investigation.

Objective: The current study explored the effectiveness of a group therapy intervention that was focused specifically on self-concept changes following acquired brain injury (ABI). Method: Eighteen individuals in the postacute phase of recovery underwent a 6-week group therapy intervention and were administered a self-concept measure before and after the intervention. Results: Group members showed a significant increase (improvement) in self-concept ratings at the end of the group intervention. Conclusions: Although the results of this study suggest that this intervention may be helpful in improving self-concept following ABI, further exploration is clearly warranted. Future research is needed to investigate the impact of self-concept on emotional adjustment, participation in rehabilitation activities, and functional outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Harnessing Brain Plasticity through Behavioral Techniques to Produce New Treatments in Neurorehabilitation.

Basic behavioral neuroscience research with monkeys has given rise to an efficacious new approach to the rehabilitation of movement after stroke, cerebral palsy, traumatic brain injury, and other types of neurological injury in humans termed Constraint-Induced Movement therapy or CI therapy. For the upper extremity, the treatment involves intensive training of the more affected arm by "shaping," the application of a number of other behavioral techniques, and prolonged constraint of use of the less affected arm. CI therapy has been shown to produce large changes in the organization and function of the brain. This result points to the fact that behavior can have a profound effect on the nervous system that is greater than is generally recognized, and harnessing this brain plasticity by behavioral means has promise for the development of new treatments in the field of rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crisis intervention training program: Influence on staff attitudes in a postacute residential brain injury rehabilitation setting.

Purpose/Objective: Acquired brain injury produces a host of behavioral changes, and specialized training in proper management of these behaviors is essential to resolve crises and calm aggressive clients. This study was conducted to determine whether crisis intervention training was effective in increasing staff comfort with difficult client behaviors in a residential rehabilitation program for individuals with postacute acquired brain injury and whether changes would be maintained over time. Research Method/ Design: Twenty-five rehabilitation staff members participated in Nonviolent Crisis Intervention training and completed the Rehabilitation Situations Inventory before training, immediately following completion of the program, and 1 month later. Results: Immediately following completion of the program, participants reported increased comfort when faced with client behaviors related to motivation and adherence, sexuality, and aggression and when interacting with other staff and client families. Changes in comfort level with sexual situations, aggression, and staff/staff interactions were maintained 1 month post training. Conclusions/Implications: These results suggest that crisis intervention training is effective in increasing levels of staff comfort with difficult situations commonly experienced in the rehabilitation setting and the changes are maintained following training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)