Abstract 1:
Doctor, J.N., Wolfson, A.W., McKnight, P.E., & Burns, SP. (2003). The effect of inaccurate functional independence measure ("FIM") ratings on prospective payment: A study of clinician expertise and FIM rating difficulty as contributing to inaccuracy, Archives of Physical Medicine and Rehabilitation, 84, 46-50.
This study looks at how well rehabilitation psychologists, rehabilitation therapists and nurses (rehab professionals) are able to rate the health of a patient using the Functional Independence Measure (FIM). The FIM is very important because Medicare uses the FIM scores for each patient to figure out how much funding the hospital should receive to treat each patient. Mistakes in rating how well or poorly patients are functioning can prove costly for all parties involved. The researchers on this study wanted to find out what problems there might be when the rehab professionals are using the FIM. One large problem might be that rehab professionals are overconfident in their ability to use the FIM. In order to study this problem, 50 rehab professionals were given practice cases to see how they would rate each patient on the FIM, and how confident they were in their ability to correctly rate each part of the FIM. The results showed considerable overconfidence. With the more experienced rehab professionals and on the easiest questions, the problem of overconfidence was reduced. The researchers recommended that rehab professionals should consult manuals and supporting documents even when they are confident they are correct in their FIM ratings. This in turn should help improve the system of Medicare funding and generally provide enough money for the hospital to keep up good patient care.
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Abstract 2:
Bombardier, CH, Temkin NR, Machamer J, Dikmen SS (2003) The natural history of drinking and alcohol-related problems after traumatic brain injury (TBI), Archives of Physical Medicine and Rehabilitation 84, 185-191.
The goal of this study was to describe the changes in the drinking habits of patients before they have a traumatic brain injury (TBI) up to one year after their TBI. We followed 197 adults hospitalized with a broad range of head injuries, from mild concussions to severe TBI.
We looked primarily at alcohol use and alcohol-related problems. The main results we found were that drinking and alcohol-related problems decrease quite a bit one year after TBI for those who had previous problems with alcohol. However, about one-quarter of the adults in the study reported heavy drinking, serious problems, or both during the first year after TBI. If an adult abused alcohol and had other related problems before the injury, then there was a strong chance that they would have a problem with alcohol abuse and related problems after TBI. We concluded that while drinking and alcohol-related problems decrease after TBI, there appears to be an ongoing need for prevention and treatment efforts. Screening for pre-injury alcohol problems can be used to identify the vast majority of persons who will develop alcohol-related problems within one year after injury.
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Abstract 3:
Kreutzer, J.S., Marwitz, J.H., Walker, W., Sander, A., Sherer, M., Bogner, J., Fraser, R. & Bushnik, T. (2003). Moderating factors in return to work and job stability after traumatic brain injury (TBI), Journal of Head Trauma Rehabilitation, 18(2), 128-138.
The first goal of this study was to identify which factors are most important for for job stability after TBI. The second goal was to develop a way to predict employment patterns after TBI. The study involved 186 participants. All of the people were working pre-injury. All had a severe to moderate brain injury. Information was collected from six NIDRR TBI model system centers. The participants were interviewed about employment at one, two, and three or four years after injury.
The results showed that 34% of the TBI survivors had a job at all three follow-up years. 27% had a job a one or two of the follow-up years. 39% were unemployed at all three follow-up years.
The researchers found that:
- minority individuals were more than twice as likely as non-minority individuals to be unemployed,
- married participants were more than twice as likely to be employed aspeople who were not married,
- individuals with more education were more likely to have a job at all three follow-up years. and
- those who could drive their own vehicle were more than six times as likely to be employed at all three follow-up years than those who had to rely on others for transportation.
The researchers found that age, length of unconsciousness, and the Disability Rating Scale (DRS) score at one year post injury could be used to predict which participants would be employed at follow-up. Based on this information, they could correctly predict the employment status of 79%of people who had jobs at all three follow-up times, 63% of those who had a job at one or two of the follow-up times, and 67% of those who were unemployed at all of the follow-up times.
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Abstract 4:
Temkin N.R., Machamer J.E. & Dikmen S.S. (2003). Correlates of functional status 3-5 years after traumatic brain injury with CT abnormalities, Journal of Neurotrauma, 20(3), 229-242.
This study looked at limitations in everyday life 3 to 5 years after traumatic brain injury. The researchers used the “Functional Status Examination” to learn about day-to day functioning. This test is relatively new and was developed at the University of Washington. The study included 209 adults with brain injury. They all had abnormal CT scans.
The researchers found that people with more problems in everyday living after injury had more severe brain injuries. After injury, it took longer until they could follow simple commands. It also took longer until they could remember things. The people with more problems later on were similar in most ways before the injury. The one difference was that people with more problems later on had more alcohol abuse before the injury. The people with more problems in everyday life were also having more problems with thinking. They were having trouble with memory and concentration. They also said that they were less satisfied with their lives, less a part of their communities, and had more health problems.
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Abstract 5:
Machamer, J.E., Temkin, N.R., & Dikmen, S.S. (2003). Neurobehavioral outcome in violently and non-violently traumatically brain-injured. Journal of Head Trauma Rehabilitation, 18, 387-397.
The goal of this study was to see if there are differences in outcome after brain injury for people injured in a violent manner compared to those injured in a non-violent manner.
The researchers studied 752 adults with brain injury. The participants were divided into two groups. Persons injured in violent circumstances were in one group. Violent circumstances included things like being hit in the head in a fight or getting shot in the head. People injured in non-violent circumstances were in the other group. Non-violent circumstances included car wrecks and falls. The researchers looked at differences between the two groups before injury and one year after injury.
The researchers found that the people who were injured violently were more likely to be non-white, male, and have higher levels of alcohol in their blood in the emergency department. The people who were injured violently were also more likely to have a prior arrest record and prior alcohol problems. In many cases, the pre-injury arrests were also alcohol related. The people who were injured violently had milder head injuries than the ones with non-violent injuries. The outcomes at one year after injury were not different for the two groups when all other factors were taken into account.
It was concluded that the characteristics of the person before the injury and severity of the injury were important to recovery. However, recovery was not related to whether the injury is accidental or caused by violence.
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Abstract 6:
Lew H.L., Dikmen S., Slimp J., Temkin, N., Lee, E.H., Newell, D., & Robinson, L.R. (2003). Use of somatosensory-evoked potentials and cognitive event-related potentials in predicting outcomes of patients with severe traumatic brain injury. American Journal of Physical and Medical Rehabilitation, 82, 53- 61.
In this study researchers looked at ways to predict how much recovery a person will have after a severe traumatic brain injury. The researchers studied two different tests. The tests were given to patients who were in comas after a severe brain injury. Both tests measured the responsiveness of a person's nervous system to input from the environment. First the researchers placed electrodes on the outside of the person's head. The electrodes measured the electrical activity in the brain when something happened in the environment. One test looked at the brain's response when mild electrical stimulation was given to the patient's hands. The other test looked at the brain's response when a series of tones was interrupted by the word “mommy.” The tests were given within 8 days of the injury with the permission of their family. The researchers compared how well the brain responded at that time to the person's recovery later on.
The study showed that one test was better at predicting poor recovery and the other test was better at predicting good recovery. If a person's brain did not respond when the hands were stimulated, by 6 months the person usually was not responding to anything in the environment or had passed away. Even if the person's brain did respond to the electrical stimulation, many still had a poor outcome. However, if a person's brain responded to the word “mommy”, it was more likely that the person would have a favorable outcome.
Many families want to know early on how much their loved one will recover. In the past, it has only been possible to predict more negative outcomes. This study showed that by using both of these tests, it is also possible to foresee more promising outcomes.
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Abstract 7:
Dikmen, S.S., Machamer, J.E., Powell, J.M., & Temkin, N.R. (2003). Outcome 3 to 5 years following traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 84, 1449-1457.
In this study researchers studied people with moderate to severe brain injuries to see how well they were doing 3 to 5 years after their injury. The researchers investigated many different aspects of the participants' lives. They looked at recovery of mental abilities, emotional well-being, level of independence, employment, and how people felt about their quality of life.
Three to five years after their injury, 65% of the people said that they were taking care of their personal needs such as eating, bathing, and toileting as well as they had before the injury. 40% reported recovery of their mental functions to the way it was before the injury. 40% had returned to doing the same main activity such as working, going to school, or taking care of their home and family. 40% were doing the same recreational activities as before.
People with less severe injuries had better recovery of mental functioning and independence. However, injury severity was not related to how people described their emotional well-being or over-all quality of life 3 to 5 years after injury.
The researchers found that the relationship between the injury and how well people were doing 3 to 5 years later was based on two different types of information. One was the kind and amount of injury to the brain. The other was how long it took people to regain consciousness. The researchers suggested using both of these types of information when measuring the severity of a brain injury.
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Abstract 8:
Hoffman, J.M., Doctor, J., Chan, L., Whyte, J., Jha, A., & Dikmen, S.S. (2003). Potential Impact of the New Medicare Prospective Payment System on Traumatic Brain Injury Inpatient Rehabilitation. Archives of Physical Medicine and Rehabilitation, 84,1165-72.
The purpose of this study was to estimate how Medicare's new payment system might affect people with traumatic brain injuries. The new payment system went into effect in January, 2002. In the new payment system, Medicare decides how much money a rehabilitation center will receive for providing care for a patient. The amount of money is determined by several factors including how much difficulty an individual has with their motor and thinking skills following their injury. While this system is for patients on Medicare, it may also affect people with other types of medical insurance as other insurance companies often follow Medicare policies.
The study reviewed data collected from almost two thousand people who went to inpatient rehabilitation after a traumatic brain injury at one of fourteen different rehabilitation hospitals in the United States. The patients had all received inpatient rehabilitation for a brain injury between 1998 and 2001. The researchers looked at how much the rehabilitation centers were paid to provide services for these patients under the old system. The researchers then determined how much the centers would have gotten paid if the new system had been in place.
The study showed that the average cost of inpatient rehabilitation was 16% more than the new system would pay. If this happens under the new payment system, Medicare may not cover the costs of treatment for people with traumatic brain injury. This may lead to shortened lengths of time for inpatient rehabilitation. If inpatient rehabilitation is shorter, rehabilitation centers will either have to help people to get better faster or patients may be discharged when they still need a lot of help.
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Abstract 9:
Bell, K.R., & Williams, F. (2003). Use of botulinum toxin type A and type B for spasticity in upper and lower limbs. Physical Medicine & Rehabilitation Clinics of North America, 14, 821-835.
This paper summarizes the research that has been done on treating limb spasticity with Botulinum toxin injections. There has been more research on using Botulinum toxin to treat spasticity in the arm than in the leg. This research has found that Botulinum toxin is likely to be effective in treating spasticity in the arm and hand. The outcomes when treating leg and foot spasticity are more varied. The larger size of leg muscles makes it more difficult to get good results. This is especially true if the spasticity is over a large area. However, Botulinum toxin may be effective in treating smaller areas of spasticity in the legs and feet, especially if it is combined with other treatments. The authors recommend that each situation be carefully analyzed before Botulinum toxin is used.
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Abstract 10:
Hart, T., Millis, S., Novack, T., Englander, J., Fidler-Sheppard, R., & Bell, K.R. (2003). The relationship between neuropsychologic function and level of caregiver supervision at 1 year after traumatic brain injury. Archives of Physical and Medical Rehabilitation, 84, 221-30.
This study looked at ways to predict how much supervision TBI survivors need 1 year after injury. 563 adults with moderate to severe brain injuries were in the study. The amount of supervision was measured with a questionnaire called the Supervision Rating Scale. This found out how much time a caregiver was with the person with brain injury. 452 of the people did not have physical problems. Researchers looked at the backgrounds of these people to see if pre-injury factors help determine how much care a person will need. This group also took tests to see if mental functioning helps determine how much care a person needs.
The Supervision Rating Scale scores showed that two-thirds of the people did not need supervision at 1 year after injury. However, the researchers were concerned that this test might not have been able to identify people who needed smaller amounts of supervision. For the group without physical problems, the researchers found that the number of years of education was important in predicting how much supervision someone needed. The researchers thought that people with more schooling might have more cognitive capacity to use after the injury. Scoring poorly on a test called Trail Making Part B was also a good predictor. Poor performance on this test indicates difficulty adapting to changes. It appears that people with more education and people with more flexible thinking need less supervision at 1 year after injury.
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Abstract 11:
O'Neill, J.H., Zuger, R.R., Fields, A., Fraser, R., & Pruce, T. (2004). The program without walls: Innovative approach to state agency vocational rehabilitation of persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85, S68-S72.
This study looked at a new vocational rehabilitation approach. The new approach is called Program Without Walls. Forty-two people with traumatic brain injury took part in the study. All of them were vocational rehabilitation clients in New York State. Everyone received an evaluation and individual employment plan. Half of the participants received traditional vocational rehabilitation. They were referred to other agencies for help with getting a job. The other half got help from a team of Program Without Walls consultants. The consultants were recruited, trained, and supervised by a state vocational rehabilitation counselor. The Program Without Walls team had better results. More clients in the new program got jobs. Clients in the new program worked more hours and earned more per week. The new program did not cost more than the traditional approach. It appears that the Program Without Walls approach could help improve vocational outcomes for people with brain injury.
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Abstract 12:
Bell, K.R., Esselman, P., Garner, M.D., Doctor, J., Bombardier, C., Johnson, K., Temkin, N., & Dikmen, S. (2003). The use of a worldwide web-based consultation site to provide support to telephone staff in a traumatic brain injury demonstration project. Journal of Head Trauma Rehabilitation, 18, 504-511.
This paper describes a Web site where experts give advice to general health care providers and telephone care providers about caring for people with brain injury. The University of Washington brain injury team recently developed a Web site like this for a research study. The study was looking at whether telephone follow-up was helpful after people leave the hospital. They found that the Web site was convenient for the telephone staff to use and improved client confidence in their recommendations. It was also an excellent way to train less experienced staff. A similar set-up could be used to improve services for people who do not live close to specialized treatment centers. For example, it could be used to help people who live in rural areas. Local health providers could use the Web site to contact experts and get advice for their patients.
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Abstract 13:
Doctor, J.N., Bleichrodt, H., Miyamoto, J.M., Temkin, N.R., & Dikmen, S. (2004). A new and more robust test of QALYs. Journal of Health Economics, 2, 353-367.
Quality-adjusted life years are a way to measure life expectancy adjusting for quality of life. They are the most important measure of health value in economic studies of healthcare. Quality-adjusted life years include the consequences of illness and treatment. Illness or treatment side-effects decrease the number of quality-adjusted life years. Beneficial treatments increase the number of quality-adjusted years. Previous studies found that the actual values patients place on their lives do not agree well with this measure. We made some changes in how quality-adjusted life years are determined. We then interviewed 48 persons 6 months after a moderate to severe head injury. We found that our new method improved the match between patient values and quality-adjusted life years. We concluded that quality-adjusted life years can be used in medical studies to measure health value.
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Abstract 14:
Powell, J.M., Hunt, E., & Pepping, M. (2004). Collaboration between cognitive science and cognitive rehabilitation. Journal of Head Trauma Rehabilitation, 19, 266-276.
This article talks about the relationship between cognitive science and cognitive rehabilitation. Cognitive scientists develop theories about thinking. Cognitive rehabilitation specialists work with people who are having problems thinking. In the past, the two fields have not collaborated as much as might be expected. We think that improved collaboration would help both fields develop. We discuss barriers to the two fields working together and suggest ways of overcoming those barriers. We explain how this collaboration might help people with brain injury by making research more applicable to real-life situations.
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Abstract 15:
Dikmen, S.S., Bombardier, C.H., Machamer, J., Fann, J.R., & Temkin, N. (2004). Natural history of depression in traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85, 1457-1464.
This study looked at depression after traumatic brain injury. The researchers examined 283 people with moderate to severe brain injuries. At 1 month after injury, 31% of the people had moderate to severe symptoms of depression. At 3 to 5 years, 17% of the people had moderate to severe symptoms of depression. The people who were depressed tended to have less than a high school education. They were less likely to have a steady job prior to the injury. Alcohol abuse before the injury was also associated with depression after the injury. Severity of brain injury was not closely related to depression. The people with depression had typical depression symptoms that are physical, such as headaches and poor sleep. They also expressed more sadness and negative feelings. The researchers concluded that personal factors from before the injury seem to be more important than injury factors in experiencing depression after traumatic brain injury.
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Abstract 16:
Esselman, P.D., Dikmen, S., Bell, K., & Temkin, N. (2004). Access to inpatient rehabilitation after violence related traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85, 1445-1449.
This study compared people whose brain injury resulted from violence with people with non-violent injuries. The study included 1800 people. The researchers found that people who were injured violently were more likely to be male. They came from more diverse racial groups. They were more likely to have an alcohol level above the legal limit. They also had more severe head injuries. The people whose injuries were not violence-related had more injuries to other parts of the body and stayed longer in the acute care hospital. The two groups had equal access to inpatient rehabilitation.
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Abstract 17:
Bell, K.R., Hoffman, J.M., Doctor, J.N., Powell, J.M., Esselman, P., Bombardier, C., & Dikmen, S. (2004). Development of a telephone follow up program for individuals following traumatic brain injury. Journal of Head Trauma Rehabilitation, 19, 502-512.
This article describes a telephone follow program for people with traumatic brain injury. The article explains how the program was developed. It describes its use with 84 people with brain injury and their families. It describes how many phone contacts were made, the concerns the participants had, and what was done to help. This type of telephone program may be especially helpful to people who do not have transportation or do not live close to specialized brain injury clinics.
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Abstract 18:
Bell, K.R., Temkin, N.R., Esselman, P.C., Doctor, J.N., Bombardier, C.H., Fraser, R.T., Hoffman, J.M., Powell, J.M., & Dikmen, S.S. (2005). The effect of a scheduled telephone intervention on outcome after moderate to severe traumatic Brain injury: A randomized trial. Archives of Physical Medicine and Rehabilitation, 86, 851-856.
This study looked at using the telephone to give counseling and education to people with brain injury. 171 people participated. All had been discharged from inpatient rehabilitation. We called half of the people at 7 different times during the first 9 months after discharge. The other half received regular follow-up care. After one year, everyone in the study was evaluated. We found that the people in the telephone group had better overall outcome. They had higher functional status and quality of well-being. We concluded that telephone counseling shows promise as a low-cost, widely available intervention for traumatic brain injury following comprehensive, inpatient treatment.
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Abstract 19:
Doctor, J.N., Castro, J., Temkin, N., Fraser, B., Machamer, J., & Dikmen, S. (2005) Workers’ risk factors for unemployment after traumatic brain injury: A normed comparison. Journal of the International Neuropsychological Society, 11, 747-752.
This study looked at the risk of unemployment one year after a traumatic brain injury (TBI). We studied people who were working before their injury. We compared rates of unemployment to what would be expected for men and women of similar age, education level. Forty-two percent of people with TBI were unemployed one year after injury. In comparison, 9% unemployment would be expected. Persons with less than a high school education had 54% unemployment. Fourteen percent unemployment would be expected for this group. Persons with a college degree had 24% unemployment. Four percent unemployment would be expected for this group. Other risk factors for unemployment included severity of brain injury, early functional outcome, and early cognitive test scores. In conclusion, we found that for workers, risk of unemployment increases after TBI. We also found that employment status depends on several factors.
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Abstract 20:
Powell, J.M., Birk, K., Cummings, E.H., & Ciol, M.A. (2005). The need for adult norms on the Developmental Eye Movement Test (DEM). Journal of Behavioral Optometry, 16, 38-41.
The purpose of this study was to find out how young adults do on the Developmental Eye Movement test. This test was originally developed for use with children. We were interested in finding out more about using the test with adults with brain injury. The Developmental Eye Movement test looks at saccadic eye movements. These are the rapid, jumping movements of the eyes that move the eyes from one area of interest to the next. We gave the test to 50 young adults. The average age of the young adults was 25 years. We compared the performance of the young adults with the test norms for children. The young adults that we tested did better than children typically do. We concluded that further studies should be done to develop standards for using this test with adults.
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Abstract 21:
Hudak, A. M., Caesar, R. R., Frol, A. B., Krueger, K., Harper, C. R., Temkin, N. R., Dikmen, S. S., Carlile, M., Madden, C. & Diaz-Arrastia, R. (2005). Functional outcome scales in traumatic brain injury: A comparison of the Glasgow Outcome Scale (Extended) and the Functional Status Examination. Journal of Neurotrauma, 11, 1319-1326.
This study compared two different tools to measure outcome following traumatic brain injury. One is the Glasgow Outcome Scale-Extended. The other is the Functional Status Examination. 177 people were studied 6 to 12 months after injury. The researchers found that both tools are reliable outcome measures for TBI survivors. They thought that the Functional Status Exam gave a more detailed description of deficits. Differences in how much people had to change their daily activities as a result of head injury were not strongly related to the severity of the initial injury.
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Abstract 22:
Machamer J, Temkin N, Fraser R Doctor J, Dikmen S.(2005). Stability of employment after traumatic brain injury. Journal of the International Neuropsychological Society, 11, 807-816.
This study looked at work stability for people with traumatic brain injury. The study included 165 people. Injuries ranged from complicated mild to severe. The follow-up time was 3 to 5 years after injury. The amount of time people worked after injury was related to several factors. One factor was the severity of the brain injury. Another was people’s cognitive function at 1 month after injury. Other important factors were working at a stable job pre-injury and earnings. The study also looked at factors relating to steady employment once a person had returned to work. The people who were most likely to work without interruption were older, had a higher income before injury, and a pre-injury job with benefits.
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Abstract 23:
Fann, J. R., Bombardier, C. H., Dikmen, S., Esselman, P. Warms, C. A., Pelzer, E., Rau, R., & Temkin, N. (2005). Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. Journal of Head Trauma Rehabilitation, 20, 501-511.
The focus of this study was major depression following traumatic brain injury. The researchers compared two assessments for diagnosing depression. One assessment involves a comprehensive structured interview requiring considerable training to administer. It is called the Structured Clinical Interview for DSM-IV. The other is a short questionnaire. It is called the Patient Health Questionnaire-9 (PHQ-9). 135 people with TBI were included. The study found that the shorter assessment worked well to detect major depression in persons with TBI. The authors concluded that the PHQ is a good screening tool for major depression in persons with traumatic brain injury.
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Abstract 24:
Bombardier, C. H., Fann, J. R., Temkin, N., Esselman, P. C., Pelzer, E., Keough, M, & Dikmen, S. (2006) Posttraumatic stress disorder symptoms during the first six months after traumatic brain injury. The Journal of Neuropsychiatry and Clinical Neurosciences, Fall;18(4):501-8.
The focus of this study was posttraumatic stress disorder symptoms after traumatic brain injury. 124 people were included. Injury severity for people in the study ranged from complicated mild to severe. Ten percent of people had significant symptoms of posttraumatic stress at 1 month after injury. Two percent had significant symptoms at 6 months. Four percent of people met all of the criteria for being diagnosed with posttraumatic stress disorder. Eight-six percent of the people with significant posttraumatic stress symptoms were also depressed, and 29% of this group reported having posttraumatic stress disorder prior to the injury.
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Abstract 25:
Turner, A. P, Kivlahan, D. R., Rimmele, C., & Bombardier, C. H. (2006). Does pre-injury alcohol use or blood alcohol level influence cognitive functioning after traumatic brain injury? Rehabilitation Psychology, 51, 78-86.
This study looked at the impact of alcohol use on injury severity and cognitive function. 124 people were included. People with higher blood alcohol levels at the time of injury had more severe coma scores. Neither pre-injury alcohol use nor blood alcohol levels at the time of injury were related to cognitive function approximately one month after injury.
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Abstract 26:
Pagulayan, K., F., Temkin, N. R., Machamer, J., & Dikmen, S. S. (2006). A longitudinal study of health related quality of life after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 87, 611-618.
This study looked at how people rate their quality of life after brain injury. People were contacted four times. The last contact was three to five years after injury. Each time they were asked questions about their quality of life as related to their health or injury. The questions were from the Sickness Impact Profile. General trauma patients (those with injuries to other body parts, but not the brain) and healthy friends of the people with brain injury were also asked these questions. There were 133 people with brain injury in the study. The severity of injury ranged from complicated mild to severe. There were 111 general trauma patients and 87 healthy friends.
People with brain injury improved considerably in the first 6 months. The most improvement was seen in physical abilities. By one year, the people with brain injury had clear difficulties compared to their healthy friends. The level of difficulties at that time was similar to that of the people with general trauma. Communication, cognition, and emotional function improved less than other areas during the first few years after brain injury.
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Abstract 27 :
Fraser, R., Machamer, J., Dikmen, S., Doctor, J., & Temkin, N. (2006). Return to work in traumatic brain injury (TBI): A perspective on capacity for job complexity. Journal of Vocational Rehabilitation, 25, 141-148..
This study looked at the ability to keep working after brain injury. It included 140 people who were workers at the time of injury. The people who never returned to work had more severe injuries and more problems with thinking. The people who kept working after they returned had several things in common. They were more likely to be female. They were more likely to have fewer alcohol problems. They were also less severely injured and had fewer thinking problems. The people who were not able to keep a job were more likely to have a less complex job than before injury and to be working fewer hours.
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Abstract 28 :
Hoffman, JM, Pagulayan, KF, Zawaideh, N, Dikmen, S, Temkin, N, & Bell, KR. (2007). Understanding Pain After Traumatic Brain Injury and Its Impact on Community Participation. American Journal of Physical Medicine and Rehabilitation, 86(12), 962-969.
This paper examines the prevalence of pain 1 yr after moderate to severe traumatic brain injury (TBI) and identifies predictors from the time of injury. Additionally, factors related to pain at 1 yr after injury are examined along with the impact of pain on community participation. Higher reports of depressive symptoms during inpatient rehabilitation and at 1 yr after injury were significantly related to reports of pain at 1 yr when controlling for demographic and injury characteristics. Being female and nonwhite were also factors related to increased reports of pain. Pain and community participation were significantly related until depression was entered into the model. Depression is a significant factor in the relationship between pain and community participation. Whereas pain was frequently reported 1 yr after injury, injury-related factors were surprisingly unrelated. Further evaluation of the role that depression plays in the relationship between pain and community participation will be important to determine appropriate management of pain and depression and to optimize participation in individuals with TBI.
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Abstract 29 :
Powell, J. M., Temkin, N. R., Machamer, J. M., & Dikmen, S. S. (2007). Gaining insight into patients' perspectives on participation in home management activities following traumatic brain injury. American Journal of Occupational Therapy,61, 269-279.
This study investigated performance of home management activities 1 year after traumatic brain injury (TBI), as reported on the Functional Status Examination. Home management performance of 164 rehabilitation inpatients with moderate to severe TBI was examined in relation to demographics, injury severity, neuropsychological functioning, and living situation. Fifty-nine percent reported more difficulty or more assistance with home management at 1 year. Nonperformance of individual activities before injury ranged from 16% to 76%. Age (p= .001), living situation after injury (p = .002), and neuropsychological function at 1 year (p = .001) were associated with more limited home management performance after injury as compared to premorbid function. Home management is challenging 1 year after TBI, especially for older adults and those with greater cognitive impairments. Accurate preinjury information is needed to determine the nature and extent of subsequent losses, guide treatment planning and interventions, and characterize recovery of function.
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Abstract 30 :
Powell, J. M., Kanny, E. M. & Ciol, M. A. (2008). The state of the occupational therapy workforce: Results of a national study. American Journal of Occupational Therapy, 62, 97-105.
This study determined the current status of the occupational therapy workforce in the United States with a demand-based report using current job data. A 31-question survey was sent to rehabilitation administrators and managers from a proportional random sample of 556 facilities that hire occupational therapy practitioners in 29 states. Data were collected from November 2005 to February 2006 using structured mailing and follow-up procedures. The response rate was 55%. The vacancy rate was 8.9% for occupational therapists and 7.7% for occupational therapy assistants. Forty-five percent of respondents predicted an increase in occupational therapy positions in the next 2 years, and 30% predicted an increase in occupational therapy assistant positions. Sixty-seven percent reported difficulty hiring occupational therapists, and 62% reported difficulty hiring occupational therapy assistants. This study identifies a serious shortage of occupational therapy practitioners at a time when predictions of workforce demands continue to grow.
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Abstract 31 :
Bell, Kathleen R. MD; Hammond, Flora MD; Hart, Tessa PhD; Bickett, Allison K. MS; Temkin, Nancy R. PhD; Dikmen, Sureyya PhD (2008). Participant Recruitment and Retention in Rehabilitation Research. American Journal of Physical Medicine and Rehabilitation, 87(4), 330-338.
Success in clinical research is determined by not only the merit or innovation of the intervention or the precision of measurement, but by the ability to recruit adequate numbers of representative research participants and keep them enrolled within the study until the final outcomes data have been collected. Inadequate participant recruitment and retention has the potential to invalidate even the most carefully constructed and well-controlled study. Low enrollment can reduce the probability that the study will detect differences between control and experimental groups in a treatment trial, and attrition can pose a significant threat to the internal and external validity of any type of study.This paper reviews the challenges of recruitment and retention of participants in clinical rehabilitation research, with an emphasis on special populations such as those with cognitive disabilities. We offer guidelines and strategies to enhance planning and implementation of rehabilitation research methods to optimize the attainment of recruitment goals and preservation of the participant pool through study completion.
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