Community reintegration following acquired brain injury

Objective: To evaluate the interventions and strategies used to enable transition from acute care or post-acute rehabilitation to the community following brain injury.

Methods and main outcomes: A systematic review of the literature from 1980-2005 was conducted focusing on ABI rehabilitation. Five major aspects of community reintegration, including: independence and social integration, caregiver burden, satisfaction with quality of life, productivity and return to driving were considered.

Results: With the exception of one, the majority of interventions are supported by only limited evidence, denoting an absence of randomized controlled trials (RCTs) in the literature. Of 38 studies evaluated for this review, only one RCT was found. That RCT provided moderate evidence that behavioural management, coupled with caregiver education, did not help to improve caregiver burden. Conclusions: Further research, using an interventional approach, is required to advance the evidence base of reintegration into the community following brain injury.     

Parental coping following childhood acquired brain injury

Primary objective: To examine parental coping following an acquired brain injury of their child, the relationship between maternal and paternal coping, and the extent to which social support and family environment affect parental coping.

Research design: A cross-sectional design was used.

Methods and procedures: Parents (n = 30) of children with acquired brain injury provided relevant demographic data and completed questionnaires investigating coping, social support and perceptions of family environment.

Main outcomes and results: Perception-focused coping strategies were used most often by parents. Mothers had a more extensive repertoire than fathers, and the relationship between maternal and paternal coping appeared to be complementary. Relationships were found between emotion-focused coping and instrumental support (r = 0.39) and perception-focused coping and family cohesion (r = 0.37).

Conclusions: Recognizing parental coping styles, enhancing the development of positive strategies, and underscoring the importance of social support and the family environment will assist parents to cope positively with their child's acquired brain injury.     

Female body image following acquired brain injury

Primary objective: To investigate body image concerns and psycho-emotional health in females with acquired brain injury (ABI). Research design: Between subjects design. Methods and procedures: Thirteen females with ABI and thirteen matched controls were assessed on a number of variables relating to body image, self-esteem and affect. Main outcomes and results: Indicated that women with ABI had a different profile of body image dissatisfaction than controls and that in some areas it was significantly worse. The women with ABI had significantly lower self-esteem and higher levels of depression than controls and this related to body image. Conclusion: Significant changes in body image and self-concept are potentially damaging to quality of life post-injury and suggest a role for targeted therapeutic work with women with ABI.     

Male body image following acquired brain injury

The purpose of this study was to investigate body image concerns and psycho-emotional health in males with acquired brain injury (ABI). Using a between subjects study of 25 males with ABI and 25 matched controls, variables were analysed using correlations and 2 x 2 analyses of variance (ANOVAs) with head injury and injury type as independent variables. Body image and psycho-emotional health were evaluated using self-report questionnaires. Disability and cognitive impairment were measured using a mixture of self-report, cognitive testing and clinical notes. Results indicated that males with ABI had significantly lower self-esteem and body dissatisfaction on a number of items relating to physical and sexual functioning. There were significant differences in body image between stroke and TBI, but there was no corresponding relationship with psycho-emotional health. These body image differences might be explained by age. The finding that ABI has a negative effect on body image and that this relates to psycho-emotional health should be investigated further, perhaps being included in future rehabilitation strategies.     

Post-traumatic seizure disorder following acquired brain injury

Objective: The present study aimed to evaluate the effectiveness of prophylactic anticonvulsant pharmacological strategies for the prevention of seizure disorders following acquired brain injury (ABI) to provide guidance for clinical practice based on the best available evidence.

Methods and main outcomes: A systematic review of the literature from 1980-2005 was conducted focusing on treatment interventions available for post-traumatic seizures following ABI. The evidence for the efficacy of a given intervention was ranked as strong (supported by at least two randomized controlled trials (RCTs), moderate (supported by a single RCT), or limited (supported by other types of studies in the absence of RCTs).

Results: Based on a previous meta-analysis and the findings of this review, there is strong evidence that prophylactic anticonvulsant therapy decreases the occurrence of early seizures but only within the first week post-injury. Moreover, the evidence indicates that prophylactic anticonvulsant therapy does not decrease the incidence of seizure onset more than one week post-injury. In children, there is moderate evidence that prophylactic phenytoin does not reduce the incidence of early or late seizures. The efficacy of anticonvulsants after the development of seizures has not been specifically studied in ABI.

Conclusions: Prophylactic anti-convulsants are effective in reducing seizures in the first week post-injury in adults. However, they do not reduce the occurrence of seizures after the first week.     

Rehabilitation and outcome following pediatric traumatic brain injury

The long-term outcome for a child who has sustained a traumatic brain injury must be viewed in the context of ongoing development and maturation. Although neuronal plasticity provides the potential for neuronal reorganization in a child's brain, it is the behavioral demands of the environment that allow the child to take advantage of this potential and to maximize recovery. Pediatric rehabilitation is the setting that provides the necessary experiences for stimulating neuronal reorganization following TBI. However, neuronal reorganization has a cost to long-term development. The ultimate long-term impact of a TBI sustained in childhood depends on the child's ability to achieve developmental milestones following injury. Although injury-related and treatment-related factors are critical during the early stages of recovery, patient-related factors such as age-at-injury, developmental achievement at time of injury, maturation, and family involvement and resources impact the later stages of recovery. The process of pediatric rehabilitation following TBI is to provide an enriched, stimulating environment tailored to the needs of the child and based on real-word experiences. Early in the recovery process, pediatric rehabilitation is the setting that maximizes the potential for neuronal reorganization. Early rehabilitation also prepares the family for the child's long-term recovery and developmental needs. Involvement and training of family members early in the recovery process is critical for successful long-term outcome. Family members are the individuals best equipped to ensure treatment compliance and follow through with treatment recommendations, in maintaining treatment gains, and in generalizing treatment effects beyond the medical settings. Despite the life-long ramifications of childhood TBI, pediatric rehabilitation is the necessary step in promoting recovery and successful long-term outcome.     

Psychiatric treatment outcome following traumatic brain injury

The relationship between self-reported history of traumatic brain injury (TBI) and psychiatric treatment outcome was investigated. TBI was hypothesized to be frequent, associated with cognitive deficits on neuropsychological testing, and less amenable to standard psychiatric treatment. Subjects were 42 psychiatric patients with a self-reported history of TBI and 25 psychiatricpatients with no TBI history. Subjects received approximately 2 weeks of inpatient psychiatric treatment. Subjects received neuropsychological testing and completed the Brief Symptom Inventory weekly. TBI was frequent (66% of subjects); multiple injuries were common. Neuropsychological performance was generally average in both groups with few group differences. Subjects, on average, reported significantly decreased psychiatric symtoms on discharge. However, the TBI group appeared to improve less than the control group; group status was a significant predictor of treatment outcome. Implications of results for assessment and treatment of psychiatric disorders in patients with a history of TBI are discussed.     

Psychosocial outcome risk indicator: predicting psychosocial outcome following traumatic brain injury

This study examines the outcome of 29 individuals with traumatic brain injury (TBI) and 23 of their respective significant others, 12 months after discharge from inpatient rehabilitation services, as a means of determining the validity of a measure developed to predict psychosocial outcome. This measure consists of 18 questions that examine 12 factors and requires the rater to make a judgement about the likely impact each factor would have on the individual with TBI and significant other. Results indicate that the social work raters accurately predicted outcome according to the factors contained in the measure. Scores on the measure at discharge were also found to be associated with general psychological distress, anxiety and insomnia, depression, family functioning, and the problems related to emotion and behaviour. Although the sample size was small, there is an indication that the devised measure is useful in predicting outcome and so has clinical value in identifying adults at greatest risk of poor psychosocial outcome after a traumatic brain injury.     

Spatial-temporal characteristics of perceptual organization following acquired brain injury

Objective: To assess characteristics of perceptual organization following brain injury. Research design: A repeated measures between groups design. Methods: Perceptual thresholds were compared between 10 persons with brain injury and 10 demographically matched healthy control subjects. Ten young control subjects were also tested to evaluate effects of normal ageing on these processes. Participants viewed stimuli on a computer monitor in which regularities existed in either the spatial or temporal domain. Psychophysical measurements were made of perceptual thresholds, as well as time required to process stimuli. Results: Relative to age-matched control subjects, patients were impaired on all measures, with greatest deficits in conditions that contained a temporal component. Impairment did not occur with normal ageing. Conclusions: These results reflect cognitive impairment resulting from reduced cortical integrative function as well as reduced information processing speed. Such deficits at this level of processing likely impact subsequent perceptual function, such as object recognition.     

Convergent validity of self-awareness measures and their association with employment outcome in adults following acquired brain injury

PRIMARY OBJECTIVE: To examine the convergent validity of three measures of self-awareness and their correlation with employment status in 38 adults with acquired brain injury. RESEARCH DESIGN: A cross-sectional study examining correlations between standardized measures of self-awareness and employment outcome. METHODS AND PROCEDURES: Self-awareness was assessed using the Self-Awareness of Deficits Interview (SADI), the Self-Regulation Skills Interview (SRSI) and the Awareness Questionnaire (AQ). Employment outcome was classified using a five-point work status rating scale and work items from the Sydney Psychosocial Reintegration Scale (SPRS). MAIN OUTCOMES AND RESULTS: Significant correlations were found between the SADI total score and the AQ discrepancy score and between the total SADI score and the SRSI indices. The work status rating scale was significantly correlated with the SADI and SRSI scores but not the AQ. CONCLUSIONS: The findings support the convergent validity of the three measures of self-awareness and highlight the need to address self-awareness deficits in vocational rehabilitation.     

Self-concept and quality of life following acquired brain injury: a pilot investigation

Objective: To investigate through pilot exploration the relationships between depression, self-concept and perceived quality of life (QoL) in post-acute patients with acquired brain injury (ABI).

Methods: Nineteen patients with ABI were administered the Beck Depression Inventory-II and the Quality of Life Inventory, along with the Tennessee Self-Concept Scale-2 and the Head Injury Semantic Differential Scale, measures of self-concept. The relationships between these measures were explored using correlational analyses.

Results: Ratings of self-concept were correlated with perceived QoL, suggesting that poorer view of self was associated with lower subjective QoL. Additionally, depressive symptoms were associated with lower QoL ratings, consistent with previous research.

Conclusions: These results suggest that intra-personal variables, such as self-concept and depression, impact the perceived QoL of the ABI survivor. Future research exploring the mediating effects of these variables on QoL may clarify this relationship and may aid in developing more effective interventions for these individuals.     

Management of heterotopic ossification and venous thromboembolism following acquired brain injury

Objective: To evaluate the effectiveness of interventional strategies for the common complications of heterotopic ossification (HO) and venous thromboembolism (VTE) following acquired brain injury (ABI).

Methods and main outcomes: A systematic review of the literature from 1980-2005 was conducted focusing on interventions for HO and VTE in the ABI population. Nineteen studies examining a variety of treatment approaches were evaluated.

Results: The majority of interventions are supported by limited evidence, defined as an absence of randomized controlled trials (RCTs). All of the treatment approaches for HO are supported with limited evidence. For VTE, there is moderate evidence, defined as at least one positive RCT, indicating that low-molecular-weight heparin is more effective than low-dose unfractionated heparin in preventing VTE, low-molecular-weight heparin is as effective and safe as unfractionated heparin for the prevention of pulmonary thromboembolism, low-molecular-weight heparin combined with compression stockings is more effective than compression stockings alone for the prevention of VTE and intermittent pneumatic compression devices are as effective as low-molecular-weight heparin for the prevention of VTE.

Conclusions: There are a variety of intervention and prophylactic strategies that have been postulated to treat and reduce the incidence of these complications, with the goal of improving rehabilitation outcomes. It is therefore important to investigate the efficacy of these treatment strategies to provide guidance for clinical practice based on the best available evidence.     

Assessment of family needs following acquired brain injury in Saskatchewan

Primary objective: The objective was to learn what the family members of individuals with acquired brain injury (ABI) perceived as important needs and to what extent these needs are being met.

Methods and procedures: Sixty-six individuals who care for someone with an ABI and who receive service from the Saskatchewan South ABI Outreach Team completed the Family Needs Questionnaire (FNQ).

Main outcomes: An analysis of the importance ratings found that the most important needs were related to health information. Most needs perceived as unmet were related to emotional support.

Conclusions: Caregivers indicated that having honest, accurate comprehensive information regarding the ABI survivor is important. Respondents also indicated that approximately one-half of the needs have gone unmet or only partly met. This study highlights the importance for service providers to assess family needs in order to minimize distress in caregivers, maintenance of the well being of whom is integral in the support of the person with ABI.