Attribution of blame in accidental and violence-related traumatic brain injury.

Objective: To study reliability and validity of blame attribution following acute moderate to severe traumatic brain injury (TBI) caused by violence versus accident. Study Design: Prospective study with test-retest component, comparing groups with violent versus accidental injuries as determined by self-report and chart review. Participants: Fifty-seven persons in acute rehabilitation for moderate to severe TBI. Measure: Eight-item Blame Attribution Questionnaire. Results: Blame attribution was reliable, even for participants with severe TBI. Violence and accident groups apportioned different amounts of blame to other people; concern with cause of injury and degree of self-blame showed less striking differences. Conclusions: Blame of others, which may increase risk of adverse psychological outcome, is strongest in those with violence-related TBI. Self-blame is not as strongly related to external circumstances and could signal a constructive coping mechanism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions of responsibility in father-daughter incest in relation to gender, socio-economic status, ethnicity, and experiential differences in participants

One hundred and fifty-seven state college undergraduates (84 females and 73 males) answered the Jackson Incest Blame Scale [JIBS] modified to include mother-blaming after reading one of four vignettes about father-daughter incest in high or low SES White or Black families. Responses about incest prevalence (created for this study) in families with different ethnic and SES backgrounds varied with gender and SES of participants. Gender differences include blame of offender, situation, victim, and mother on the modified JIBS. Parents blamed the offender more than non-parents. Participants who knew an incest survivor disagreed significantly more with victim-blaming statements than those who did not know a survivor of incest.     

Spirituality, quality of life, and functional recovery after medical rehabilitation.

Objectives: To explore (a) how spiritual well-being (WB), emotional WB, life satisfaction, and functional status change during and after rehabilitation; (b) the relationships among these variables over time; and (c) associations with demographic and clinical characteristics. Study Design: Longitudinal assessment across 3 time points. Participants and Setting: 155 adults admitted to a freestanding rehabilitation hospital. Main Outcome Measures: Spiritual Well-Being Scale, Life Satisfaction Questionnaire, Short-Form Health Survey, and the Functional Independence MeasureTM. Results: Emotional WB increased during rehabilitation, whereas life satisfaction and spiritual WB did not change; however, substantial subgroups of individuals experienced changes in life satisfaction and spiritual WB over time. Measures of spiritual WB, emotional WB, and life satisfaction were moderately correlated within and across time points. Persons making smaller functional gains during inpatient rehabilitation were least likely to experience increased emotional WB. Although African Americans as a group reported greater spiritual WB than other racial-ethnic groups on admission, they were least likely to increase in emotional WB over time.… (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)     

Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationshipto outcome

The purpose of this study was to investigate the relationship between self-awareness, emotional distress, motivation, and outcome in adults with severe traumatic brain injury. A sample of 55 patients were selected from 120 consecutive patients with severe traumatic brain injury admitted to the rehabilitation unit of a large metropolitan public hospital. Subjects received multidisciplinary inpatient rehabilitation and different types of outpatient rehabilitation and community-based services according to availability and need. Measures used in the cluster analysis were the Patient Competency Rating Scale, Self-Awareness of Deficits Interview, Head Injury Behavior Scale, Change Assessment Questionnaire, the Beck Depression Inventory, and Beck Anxiety Inventory; outcome measures were the Disability Rating Scale, Community Integration Questionnaire, and Sickness Impact Profile. A three-cluster solution was selected, with groups labeled as high self-awareness (n = 23), low self-awareness (n = 23), and good recovery (n = 8). The high self-awareness cluster had significantly higher levels of self-awareness, motivation, and emotional distress than the low self-awareness cluster but did not differ significantly in outcome. Self-awareness after brain injury is associated with greater motivation to change behavior and higher levels of depression and anxiety; however, it was not clear that this heightened motivation actually led to any improvement in outcome. Rehabilitation timing and approach may need to be tailored to match the individual's level of self-awareness, motivation, and emotional distress.     

Irrational schematic beliefs and psychological distress in caregivers of people with traumatic brain injury.

Objective: To investigate the relation between irrational schematic beliefs and psychological distress in caregivers of persons with traumatic brain injury (TBI). Design: Cross-sectional mail survey. Participants: One hundred sixteen caregivers of persons with TBI living in the Australian states of Victoria and Queensland who were members of community support groups and brain injury associations. Measures: The Irrational Beliefs Inventory, Brief Symptom Inventory, income satisfaction, degree of personality and behavior change in the TBI individual, and injury severity. Results: Hierarchical regression analyses showed that after controlling for the effects of characteristics of the caregiving situation and the individual with TBI, greater adherence to irrational beliefs was related to higher levels of global psychological distress. Specifically, irrational beliefs related to Worrying were associated with all areas of psychological distress. Conclusion: Results support the cognitive theory proposal that irrational beliefs play an important role in the adaptation to TBI caregiving. Findings suggest the inclusion of cognitive therapy strategies in interventions for caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family satisfaction predicts life satisfaction trajectories over the first 5 years after traumatic brain injury.

Objectives: Examined the influence of functional impairment, stable marital status, and family satisfaction on life satisfaction trajectories for 609 individuals (435 men, 174 women) over the first 5 years after traumatic brain injury (TBI). Measures: Participants completed the Family Satisfaction Scale (FSS), Functional Independence Measure (FIM), and the Life Satisfaction Index (LSI) at years 1, 2, 4, and 5 after sustaining a TBI. Results: Trajectory modeling revealed that higher family satisfaction was associated with increases in life satisfaction for individuals with less functional impairment. Stable marital status was not significantly associated with life satisfaction trajectories. Implications: Family satisfaction appears to have pronounced beneficial effects on life satisfaction for persons with less functional impairment after TBI regardless of marital status. In contrast, a stable marriage appears to have no apparent benefits to self-reported life satisfaction over the first 5 years post-TBI. Theoretical and clinical implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Initial disturbances of consciousness and resultant impaired awareness in Spanish patients with traumatic brain injury

The purpose of this prospective, between-subjects study was to look at impaired awareness cross-culturally in patients with traumatic brain injury (TBI) and to relate impaired awareness after injury to the initial estimates of disturbed consciousness at time of injury. The study was conducted in community and inpatient and outpatient rehabilitation centers in Barcelona and Madrid. Participants were 30 persons with primarily moderate to severe TBI who could complete a written questionnaire concerning their functioning and 28 age- and gender-matched controls. A Spanish translation of the Patient Competency Rating Scale (PCRS) was administered to each participant. Relatives or significant others also completed this scale on each participant using the relative's version (PCRS-R). Difference scores, obtained by subtracting PCRS-R from PCRS-P (PCRS-P minus PCRS-R), were used as a marker of impaired awareness. Individuals with TBI were rated (by self and significant others) as being less competent than controls. Forty percent of Spanish patients with TBI who suffered severe injuries tended to overestimate their behavioral competencies. The PCRS-P minus the PCRS-R difference scores tended to correlate with admitting Glasgow Coma Scale (GCS) scores and retrospective estimates of posttraumatic amnesia (PTA). Initial disturbances of consciousness, one measure of severity of brain injury, appeared to relate to later measures of impaired self-awareness in Spanish patients with TBI. Non-brain-injured controls did not tend to report levels of competency that differed from their relatives' reports.     

Social Problem-Solving Abilities and Psychological Adjustment of Persons in Low Vision Rehabilitation.

Objective: Tested the relations of social problem-solving abilities to distress, depression, and well-being and impairment reported by persons participating in a low vision rehabilitation program. Study Design: Correlational and multiple regression analyses. Setting: Outpatient low vision rehabilitation clinic. Participants: 25 men (M = 73.88 years old, SD = 11.94 years) and 29 women (M = 68.79 years old, SD = 17.25 years) participating in a comprehensive admitting examination. Main Outcome Measures: Emotional distress specific to the condition, depressive behavior, satisfaction with life, and functional ability. Results: A negative problem orientation significantly predicted depression and emotional distress; rational problem-solving skills predicted life satisfaction. Conclusions: A negative problem orientation toward problem solving predicts poor emotional adjustment reported by persons with low vision, and proactive problem-solving skills appear to promote optimal adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fatigue following traumatic brain injury: Frequency, characteristics, and associated factors.

Objectives: To document the frequency, characteristics, and factors associated with fatigue following traumatic brain injury (TBI). Design: Survey methodology and multivariate statistical design. Setting: Rehabilitation center and community. Participants: 452 participants aged 16 years and over with minor to severe TBI who answered a questionnaire measuring diverse aspects of fatigue as well as different dimensions of psychological distress, pain, and sleep quality. Measures: Proportion of participants reporting being significantly fatigued. Validated measures of fatigue, sleep quality, and psychological distress. Results of a logistic regression analysis. Results: Significant fatigue was reported by 68.5% of participants. Mental fatigue was the most prominent type of fatigue, followed by physical fatigue. Fatigue was present even several years following the accident and had many perceived impacts on day-to-day function. Factors associated with fatigue were a shorter time since injury; being on long-term disability leave; and higher levels of sleep problems, cognitive disturbances, and anxiety. Conclusion: Fatigue is a prevalent problem after TBI that requires more clinical and scientific attention because it probably has important repercussions on the quality of rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The enigma of "hidden" traumatic brain injury

OBJECTIVE: To examine individuals with "hidden" traumatic brain injury (TBI), defined in this study as those who sustained a blow to the head, with altered mental status, and experienced a substantial number of the cognitive, behavioral, and emotional sequelae typically associated with brain injury but did not make the causal connection between the injury and its consequences. DESIGN: Comparison of four groups of individuals matched for age, gender, years of education, and duration of loss of consciousness. SETTING: This study of hidden TBI followed the identification of 143 individuals who, within a larger study of people with TBI who live in the community, identified themselves as "nondisabled" (they were to be part of the comparison sample) but who had experienced a blow to the head that left them at minimum dazed and confused. PARTICIPANTS: 21 of these 143 individuals also reported large numbers of symptoms (eg, headaches, memory problems) associated with TBI. This group (Hidden TBI-High Symptoms group) was compared to three other matched samples: one with known TBI (Known Mild TBI group) and one with no disability (No Disability group) (both of which were drawn from the larger study), and one group of individuals who identified themselves as having no disability but who had experienced a blow to the head that resulted in a few symptoms (Head Trauma-Low Symptoms group). MAIN OUTCOME MEASURES: All study participants were administered an interview that incorporated several existing instruments documenting levels of reported symptoms, emotional well-being/distress, and vocational/social handicaps. RESULTS: The Hidden TBI-High Symptoms group was found to be similar to the Known Mild TBI group in terms of the number and types of symptoms experienced, whereas the Head Trauma-Low Symptoms group was similar in this respect to the No Disability group. The two former groups also evidenced high levels of emotional distress, whereas the two latter groups did not. However, on measures of handicap, the Hidden TBI-High Symptoms and Head Trauma-Low Symptoms groups were similar to the No Disability group and dissimilar from the Known Mild TBI group in that the last group experienced vocational handicap, in particular, whereas the other groups did not. Conclusions: We conclude that hidden TBI occurs at a nontrivial level (7% of our nondisabled sample). Also, individuals with hidden TBI (with persistent symptoms), unlike those with known mild TBI, are likely to experience emotional distress but not vocational handicap following injury.     

Potential of and problems with new measures of psychometric intelligence after traumatic brain injury.

Objective: Examination of the concurrent and criterion validities of the General Ability Measure for Adults (GAMA) and the Wechsler Adult Intelligence Scale–Third Edition (WAIS–III) in patients with traumatic brain injury (TBI). Study Design: Correlational methods and multivariate analyses of variance. Setting: Regional rehabilitation center. Participants: Prospective series of consecutive rehabilitation referrals, including 60 adults with TBI and no confounding premorbid histories. Main Outcome Measures: GAMA and WAIS–III IQ and factor index scores were obtained within 1 year after injury and were compared with each other and with measures of injury severity. Results: GAMA and WAIS–III summary IQ scores demonstrated substantial covariance (supporting concurrent validity), but neither was sufficiently sensitive to injury severity. The WAIS–III Processing Speed (PS) index was the only measure that clearly demonstrated criterion validity. Conclusions: GAMA and WAIS–III summary IQ scores measure similar abilities but may not be sensitive to degree of injury severity in individuals with TBI. In contrast, the WAIS–III PS index appears to have promise in the evaluation of sequelae of TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and functional outcome following traumatic brain injury.

Objective: To investigate pre- to postinjury personality change in relation to outcomes following traumatic brain injury (TBI). Design: Prospective analysis of personality ratings, depression, and outcome using multiple regression analyses. Participants: Cohort of 3 clinical trauma groups (mild TBI, moderate-severe TBI, orthopedic injury) and their significant others (SO). Outcome Measures: Independent Living Scale, Vocational Independence Scale, and Mayo-Portland Adaptability Inventory, 1-2 years postinjury. Predictor Variables: Posttraumatic amnesia (PTA); patient and SO NEO Personality Inventory-Revised ratings of preinjury personality taken at 1-2 months postinjury. Results: Personality function was normal for all groups (regardless of rating source) and stable over time. Neuroticism, and specifically depression, accounted for small proportions of variance in functional outcome, beyond PTA. Conclusions: There is little empirical evidence for significant personality disturbance or change up to 2 years post-TBI. Personality and depression contribute modestly to functional outcomes. Results support a distinction between "personality change" and behavior change following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sentencing strategies and justice: Effects of punishment philosophy on sentencing decisions.

Examined the cognitive processes underlying sentencing decisions made by college students in a judicial decision-making experiment. Ss were asked to follow 1 of 3 punishment strategies (retribution, rehabilitation, or deterrence). In addition, the type of crime and the physical attractiveness of the offender were systematically varied. Length of recommended prison term, Ss' judgments of seriousness of the crime, likelihood of recidivism, and blame attributed to offender and victim were examined. The pattern of strategy effects on prison term recommendations was generally consistent with that found in other studies involving real judges in their actual cases. Deterrence group sentences were the most severe for all crimes, whereas the rehabilitation group sentences were the least severe for serious crimes only. The rehabilitation group Ss consistently blamed the victim of the crime more than did the other groups. This finding is discussed with respect to belief in a just world and defensive attribution. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cost-effectiveness of the diagnosis of renal artery stenosis

Variables were studied which predict at the acute stage the functional and occupational long-term outcome for patients with traumatic brain injury (TBI). Glasgow Coma Scale (GCS) score on hospital admission, length of coma (LOC) and duration of post-traumatic amnesia (PTA) were studied in a group of 508 TBI rehabilitation patients, age 0.8-71, mean age 19, followed up between five and over 20 years, mean of 12 years. Information from hospital charts and all data available before and after the injury were gathered and reviewed. The study was carried out among a consecutive sample of Finnish patients with TBI referred to a rehabilitation programme at the out-patient neurological clinic of Kauniala Hospital, which specializes in brain injuries in Finland. The patients came from various hospital districts in the country for an evaluation of their educational and vocational problems. Main outcome measures were functional outcome, as measured by the Glasgow Outcome Scale (GOS) at the end of follow-up, and post-injury occupational outcome. The patients' reemployment on the open job marklet, subsidized employment or inability to work was noted. The GCS score on hospital admission correlated clearly with the functional outcome of the patients at the end of follow-up. Length of coma and duration of post-traumatic amnesia correlated specifically with the patient's work history after the brain injury and with functional outcome measured by the GOS. Outcomes varied among age groups and seemed to be affected by age at injury. Accordingly, the extent of recovery and quality of life for rehabilitation patients with TBI can be estimated early on by prognostic factors reflecting injury severity in the acute phase. The results suggest that the GCS score, LOC and duration of PTA all have a strong predictive value in assessing functional or occupational outcome for TBI patients.     

Positive psychological variables in the prediction of life satisfaction after spinal cord injury.

Objective: To examine relationships between select positive psychological variables and life satisfaction in persons with spinal cord injury during acute rehabilitation and 3 months after discharge. Design: Prospective observational design; correlational and regression analyses. Eighty-seven adults who were participating in in-patient, acute rehabilitation for spinal cord injury in two metropolitan hospitals completed the following measures: Benefit finding Scale, Hope Scale, Brief Symptom Inventory, COPE, Positive and Negative Affect Schedule, and Satisfaction with Life Scale. Results: Hypothesized relationships of hope and positive affect (facilitator variables) with greater life satisfaction during the initial acute rehabilitation period were supported. Facilitators, as measured at baseline, accounted for a significant amount of variance in life satisfaction above and beyond barrier variables (depression, negative affect, and avoidant coping) both during the acute rehabilitation phase (R2 change = .20, p R2 change = .09, p     

The associations among self-awareness, emotional well-being, and employment outcome following acquired brain injury: A 12-month longitudinal study.

Objective: To investigate self-awareness and emotional well-being according to change in employment outcome in people with acquired brain injury (ABI). Design: A 12-month longitudinal study. Participants and Setting: Fifty adults with ABI attending outpatient rehabilitation (n = 17) or vocational rehabilitation services (n = 33). Time since injury ranged from 6 months to 12 years (M = 4.3 years, SD = 4.1). Main Outcome Measures: Self Awareness of Deficits Interview, Self-Regulation Skills Interview, Hospital Anxiety Depression Scale, and employment outcome (stable employment, improved employment, and stable unemployment). Results: At the initial assessment, level of awareness for the improved employment group was significantly lower than that for the stable employment group (p = .017), whereas no between-groups differences were found at the 12-month follow-up assessment. Employment outcome was not significantly associated with changes in self-monitoring or emotional well-being (p = .017). Demographic and injury-related variables were generally not related to employment outcome. Conclusions: The findings empirically support the theoretical view that an increase in self-awareness is associated with improved employment status, although the direction of this relation is unclear. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are the subjective complaints of traumatically brain injured patients reliable?

The present study was designed to compare the subjective complaints of 50 traumatically brain injured (TBI) patients with the observations of their significant others. The complaints of the TBI patients and their significant others were contrasted according to the severity of the TBI and the type of complaint (physical, cognitive/behavioural and emotional). While no differences were found in physical complaints, the cognitive/behavioural and emotional complaints of TBI patients, regardless of the severity of the initial TBI, were significantly under-reported in comparison to the observations of their significant others. The data suggests that while this finding was most likely due to the TBI patients' poor awareness, it was unlikely to be the result of psychological denial since all of these individuals were evaluated in the context of being a plaintiff in personal injury litigation or a claimant in a Workers' Compensation claim. The data suggests that the cerebral trauma these patients sustained played a major role in their ability to recognize their cognitive, behavioural and emotional symptoms. Finally, the data suggests that clinicians should obtain information about the TBI patients' cognitive/behavioural and emotional functioning from their significant others, rather than rely entirely on the TBI patients' subjective assessment of these problems.     

Deep venous thrombosis: incidence on admission to a brain injury rehabilitation program

OBJECTIVE: To determine the incidence of deep venous thrombosis (DVT) in brain injured individuals at time of admission to a brain injury (BI) rehabilitation program. DESIGN: Prospective study, sequential case series. SETTING: University tertiary care BI rehabilitation center. DATA SET: Eighty-two traumatic brain injury (TBI) and 71 atraumatic brain injury (ABI) patients were consecutively admitted to our BI unit over a 12-month period and screened within 24 hours of admission for a lower extremity DVT with color flow duplex Doppler ultrasonography. All patients had been prophylaxed with either subcutaneous heparin anticoagulation therapy or intermittent compression devices, and all patients were within 2 months of the original BI. MAIN OUTCOME MEASURES: Evidence of intrinsic venous occlusion by duplex Doppler. RESULTS: DVTs were detected and treated prior to rehabilitation admission in three patients (2%), and these persisted at rehabilitation admission. New DVTs were detected at time of rehabilitation admission in 17 patients (11%). All were occult DVTs; none of the 17 patients had clinical findings indicative of acute DVT. No significant differences were noted in the TBI group when age, highest 24-hour Glasgow Coma Scale score, length of acute hospitalization, type of DVT prophylaxis, or presence of an extremity fracture were compared for individuals with and without DVT. No significant differences were noted in the ABI group when age, length of acute hospitalization, and type of DVT prophylaxis were compared for individuals with and without DVT. CONCLUSION: The overall incidence of DVTs was 13% and the incidence of occult DVT was 11%. Individuals with TBI had an overall incidence of DVTs of 20% and an occult DVT incidence of 18%. Individuals with ABI had an overall incidence of DVT's of 6% and an occult DVT incidence of 4%. These findings indicate the importance of baseline screening for DVT in this patient population.