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Articles Written by OVC Professionals
Corrigan, J. D., Bogner, J., Lamb-Hart, G., Heinemann, A. W. & Moore, D. (2004). Increasing substance abuse treatment compliance for persons with traumatic brain Injury. Psychology of Addictive Behaviors, in press.
Corrigan, J. D. & Bogner, J. (2004). Latent factors in measures of rehabilitation outcomes after TBI. Journal of Head Trauma Rehabilitation, in press.
Corrigan, J. D., Whiteneck, G. & Melnick, D. (2004). Perceived needs following traumatic brain injury. Journal of Head Trauma Rehabilitation, 19, 205-16.
Objectives: (1) Provide population-based estimates of perceived needs following traumatic brain injury (TBI) and the prevalence of unmet needs 1 year postinjury; (2) identify relations among needs that define unique clusters of individuals; and (3) identify risk factors for experiencing selected needs. Design: Telephone survey 1 year after injury of a prospective cohort of all people hospitalized with TBI in the state of Colorado during 2000. Measures: Self-reported need for assistance in 13 areas of functioning. Results: A total of 58.8% of persons hospitalized with TBI experienced at least 1 need during the year following injury; 40.2% will experience at least 1 unmet need 1 year after injury. Most frequently experienced needs were "improving your memory, solving problems better" (34.1%), "managing stress, emotional upsets" (27.9%), and "managing your money, paying bills" (23.3%). Cluster analysis revealed 8 distinctive groupings of subjects. If a need existed, those least likely to be met involved cognitive abilities, employment, and alcohol and/or drug use. Conclusions: Results were consistent with findings from previous assessments of need for services based on surveys of convenience samples; however, the prevalence of unmet needs 1 year after injury may be higher than previously suspected. More post-hospital services addressing cognitive and emotional problems appear needed. Risk factors for experiencing needs suggest potential avenues for clinical intervention.
Heinemann, A.W., Corrigan, J.D. & Moore, D. (2004). Case management for traumatic brain injury survivors with alcohol problems. Rehabilitation Psychology, 49, 156-66.
Objective: To evaluate a community-based approach to substance abuse using comprehensive case management for persons with traumatic brain injury (TBI). Setting: Two programs that provide case management services (n=217); a comparison group was recruited that did not receive case management (n=102). Intervention: Comprehensive case management. Main Outcome Measures: Self-reported substance use, community integration, employment status, health-related quality of life. Results: For those receiving case management, employment at recruitment and early referral were associated with employment 9 months later. Community integration and physical well-being increased for both groups. Earlier program referral was associated with larger gains in physical well-being, employment, and community integration. Conclusions: Case management appears to have beneficial effects for adults with TBI and substance abuse problems in terms of life and family satisfaction as well as to have potential cost savings.
Hammond, F. M., Grattan, K. D., Sasser, H., Corrigan, J. D., Rosenthal, M., Bushnik, T. & Shull, W. (2004). Five years after traumatic brain injury: A study of individual outcomes and pre-dictors of change in function. NeuroRehabiliation, 19, 25-35.
The article studies functional changes between one and five years after traumatic brain injury (TBI). Prospective cohort. TBI Model Systems National Database subjects using cohort with complete one and five year data (n = 301). Disability Rating Scale (DRS) Level of Functioning and Employability Items. On Level of Functioning, 53 (18%) individuals improved, 228 (76%) stayed the same, and 20 (7%) worsened by more than one point from Year 1 to Year 5. On Employability, 50 (17%) individuals improved, 237 (79%) stayed the same, and 14 (5%) worsened by greater than one point. Level of Functioning improvement was predicted by FIM-super(TM) Motor, FIM-super(TM)-Cognitive, Rey Auditory Verbal Learning Test, Symbol Digit Modalities Test (written and oral), and Wechsler Adult Intelligence Scale-Revised Block Design, and worsening predicted by Symbol Digit Modalities Test (written and oral). Improvement in Employability was predicted by race, while Glasgow Coma Scale Eye Opening was predictive of worsening. Although the majority did not demonstrate meaningful change on the DRS items from year 1 to 5, some individuals made dramatic gains and a minority declined.
Hart, T., Bogner, J. A., Whyte, J. & Polansky, M. (2003). Attribution of blame in accidental and violence-related traumatic brain injury. Rehabilitation Psychology, 48, 86-92.
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.
Kadyan, V., Colachis, S. C., DePalma, M. J., Samderson, J. D. & Mysiw, W. J. (2003). Early recognition of neuroleptic malignant syndrome during traumatic bain injury rehabilitation. Brain Injury, 17, 631-37.
Neuroleptic malignant syndrome is a rare disorder that manifests with hyperthermia, muscle rigidity and autonomic instability. Presented is a case series of individuals with traumatic brain injury and agitation who, when treated with neuroleptics, developed neuroleptic malignant syndrome. Although the incidence of this syndrome is rare, it is associated with significant morbidity and mortality. The onset of symptoms inconsistent with the patient's current level of recovery should alert the clinician to consider other possible diagnosis and failure to distinguish the features of neuroleptic malignant syndrome from post-traumatic agitation will delay appropriate intervention for this potentially life-threatening disorder.
Kreutzer, J. S., Marwitz, J. H., Walker, W., Sander, A., Sherer, M., Bogner, J., Fraser, B. & Bushnik, T. (2003). Moderating factors in return to work and job stability after traumatic brain injury. Journal of Head Trauma Rehabilitation, 18, 128-38.
Objective: To examine job stability moderating variables and develop a postinjury work stability prediction model. Design: Multicenter analysis of individuals with traumatic brain injury (TBI) who returned for follow-up at 1, 2, and 3, or 4 years postinjury, were of working age (between 18 and 62 years of age at injury), and were working preinjury. Setting: Six National Institute on Disability and Rehabilitation Research TBI Model System centers for coordinated acute and rehabilitation care. Participants: A total of 186 adults with TBI were included in the study. Main Outcome Measures: Job stability was categorized as stably employed (employed at all 3 follow-up intervals); unstably employed (employed at one or two of all three follow-up intervals); and unemployed (unemployed at all three follow-up intervals). Results: After injury, 34% were stably employed, 27% were unstably employed, and 39% were unemployed at all three follow-up intervals. Minority group members, people who did not complete high school, and unmarried people were more likely to be unemployed. Driving independence was highly influential and significantly related to employment stability. A discriminant function analysis, which included age, length of unconsciousness and Disability Rating Scale scores at 1 year postinjury, accurately predicted job stability groupings. Conclusion: Data analysis provided evidence that employment stability is predictable with a combination of functional, demographic, and injury severity variables. Identification of people at risk for poor employment outcomes early on can facilitate rehabilitation planning and intervention.
Seel, R. T. & Kreutzer, J. S. (2003). Depression assessment after traumatic brain injury: an empirically based classification method. Archives of Physical Medicine and Rehabilitation, 84, 177-84.
Objectives: To describe the patterns of depression in patients with traumatic brain injury (TBI), to evaluate the psychometric properties of the Neurobehavioral Functioning Inventory (NFI) Depression Scale, and to classify empirically NFI Depression Scale scores. Design: Depressive symptoms were characterized by using the NFI Depression Scale, the Beck Depression Inventory (BDI), and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Depression Scale. Setting: An outpatient clinic within a Traumatic Brain Injury Model Systems center. Participants: A demographically diverse sample of 172 outpatients with TBI, evaluated between 1996 and 2000. Interventions: Not applicable. Main Outcome Measures: The NFI, BDI, and MMPI-2 Depression Scale. The Cronbach alpha, analysis of variance, Pearson correlations, and canonical discriminant function analysis were used to examine the psychometric properties of the NFI Depression Scale. Results: Patients with TBI most frequently reported problems with frustration (81%), restlessness (73%), rumination (69%), boredom (66%), and sadness (66%) with the NFI Depression Scale. The percentages of patients classified as depressed with the BDI and the NFI Depression Scale were 37% and 30%, respectively. The Cronbach alpha for the NFI Depression Scale was.93, indicating a high degree of internal consistency. As hypothesized, NFI Depression Scale scores correlated highly with BDI (r=.765) and MMPI-2 Depression Scale T scores (r=.752). The NFI Depression Scale did not correlate significantly with the MMPI-2 Hypomania Scale, thus showing discriminant validity. Normal and clinically depressed BDI scores were most likely to be accurately predicted by the NFI Depression Scale, with 81% and 87% of grouped cases, respectively, correctly classified. Normal and depressed MMPI-2 Depression Scale scores were accurately predicted by the NFI Depression Scale, with 75% and 83% of grouped cases correctly classified, respectively. Patients' NFI Depression Scale scores were mapped to the corresponding BDI categories, and 3 NFI score classifications emerged: minimally depressed (13-28), borderline depressed (29-42), and clinically depressed (43-65). Conclusions: Our study provided further evidence that screening for depression should be a standard component of TBI assessment protocols. Between 30% and 38% of patients with TBI were classified as depressed with the NFI Depression Scale and the BDI, respectively. Our findings also provided empirical evidence that the NFI Depression Scale is a useful tool for classifying postinjury depression.
Doninger, N. A., Heinemann, A. W., Bode, R. K., Sokol, K., Corrigan, J. D. & Moore, D. (2003). Predicting community integration following traumatic brain injury with health and cognitive status measures. Rehabilitation Psychology, 48, 67-76
Objective: To examine measurement properties of the Community Integration Questionnaire (CIQ) and the Short-Form Health Survey (SF-36) and assess the contributions of cognitive functioning and health to community integration. Design: Rating scale analyses and regression analysis data on basic cognitive functioning and health collected from 289 individuals with traumatic brain injury. Results: Person reliabilities indicated substantial measurement error. Ceiling effects weakened the model (adjusted R2 =.143) specifying the contributions of age, gender, cognitive functioning, and health to community integration. Conclusions: Poor measurement properties and definitional problems associated with community integration weakened the results. The extent to which potential familial and environmental characteristics contributing to role fulfillment change across time requires further research.
Corrigan, J.D., Wolfe, M., Mysiw, W.J., Jackson, R.D., & Bogner, J.A. (2003) Early identification of mild traumatic brain injury in female victims of domestic violence. American journal of obstetrics and gynecology, 188, 71-6.
Objective: Explore the inter-relationship between domestic violence and traumatic brain injury. A clinically relevant relationship is suggested by recent outcome data which reveal that traumatic brain injury survivors who are victims of assault more prone to a suboptimal outcome. Also, recovery after traumatic brain injury is worse among women in most studied outcome measures. Design: Screenings for a possible secondary mild traumatic brain injury were conducted. Participants and setting: Women who presented to three metropolitan emergency departments for health issues associated with domestic violence. Results: Although screens were administered to only 30% of potential respondents, a positive loss of consciousness was reported in 30% of the respondents and 67% of women reported residual problems that were potentially brain injury related. Conclusion: These data argue for greater vigilance in screening domestic violence victims for mild traumatic brain injury as earlier identification and treatment of any postconcussive syndrome symptoms appears to diminish their impact on outcome.
Corrigan, J.D., Harrison-Felix, C., Bogner, J., Dijkers, M., Sendroy, M., Whiteneck, G., Kreutzer, J. (2003). Systematic bias in traumatic brain injury outcome studies because of loss to follow-up. Archives of Physical Medicine and Rehabilitation, 84, 153-60.
Objective: This study sought to identify potential sources of selection bias created by subjects lost to follow-up in longitudinal studies of traumatic brain injury (TBI). Design: Differences in demographic characteristics, premorbid status, injury-related indicators, and initial hospital course were compared between subjects lost to and found using bivariate and multivariate analyses for one- and two-year post-injury follow-ups. Setting: Three prospective, longitudinal datasets were utilized--two based on admissions to acute rehabilitation and one of acute hospitalizations; one single center, one multi-center, and the third using a statewide incidence surveillance system. Subjects: Adolescents and adults hospitalized with a diagnosis of TBI who had consented to participate in research. Main Outcome Measures: Subjects were considered lost when no information was collected from the person with TBI, or only limited information could be obtained from a proxy, by in-person, telephone or mailed questionnaire for any reason, including refused, expired, no response to contact, and unable to be interviewed. Results: Loss to follow-up rates were highly consistent across all three datasets, ranging from 40.4% to 42.3% in the first year. Variables most frequently associated with loss to follow-up were cause of injury, blood alcohol level at acute hospital admission, functional status during inpatient rehabilitation, payer source for hospitalizations, and racial/ethnic group. Conclusions: The consistency of lost to follow-up rates suggests that difficulties finding subjects are to some degree inherent in either the population or the methodology. However, the fact that so many cases are lost, and that the loss is selective, may seriously affect the conclusions that can be drawn from this research. The level of attrition should be of concern to all researchers with a stake in long-term outcome research, and an incentive to improve our methods.
Bogner, J.A., Corrigan, J.D., Fugate, L.P., Mysiw, W.J., & Clinchot D. (2001). Role of agitation in prediction of outcomes after traumatic brain injury. American Journal of Physical Medicine and Rehabilitation / Association of Academic Psychiatrists, 80, 636-44.
Objective: Determine the role of agitation in the prediction of TBI rehabilitation outcomes. Design: A longitudinal study of 340 consecutive patients admitted to an acute TBI rehabilitation unit was conducted. Main Outcome Measures: Outcomes under study included rehabilitation length of stay, discharge destination, functional independence at discharge (Functional Independence Measure, FIM), productivity at one year follow-up, and life satisfaction at one year follow-up (Satisfaction with Life Scale, SWLS). Results: Univariate analyses suggested that the presence of agitation in rehabilitation is predictive of a longer length of stay and decreased functional independence in the cognitive realm at discharge. In addition, individuals who exhibit agitation at any time during rehabilitation are less likely to be discharged to a private residence. However, multivariate analyses indicated that cognitive functioning at admission to rehabilitation (FIM Cognitive) mediates the relationship between the presence of agitation and length of rehabilitation, as well as between agitation and FIM Cognitive at discharge. Similar results were found when discharge residence was the dependent variable, however agitation also contributed some unique variance to the prediction. Lower cognitive functioning at admission to rehabilitation was associated with the occurrence of agitation during rehabilitation, longer length of stay, lower cognitive functioning at discharge, and a decreased likelihood that an individual would be discharged to a private residence. Conclusions: The results of the multivariate analyses support the contention that agitation and cognition are intimately related, with the long-term effects of the former being at least partially driven by the latter. These findings support the importance of systematically monitoring both agitation and cognition when applying interventions to reduce agitation.
Arenth P.A., Bogner J.A., Corrigan J.D., & Schmidt L. (2001). The utility of the Substance Abuse Subtle Screening Inventory-3 for use with individuals with brain injury. Brain Injury, 15, 499-510.
Objective: Investigate the utility of the Substance Abuse Subtle Screening Inventory (SASSI-3), for use with individuals with brain injuries. Setting and participants: The SASSI-3 was administered to 83 subjects prior to discharge from inpatient rehabilitation. Design: The validity of the SASSI-3 diagnosis of chemical dependency was analyzed through comparison with the diagnoses of a psychologist. Results: Lower accuracy, sensitivity, and specificity were found in SASSI-3 diagnosis for the subjects with brain injury, as compared to the normative sample. When a diagnosis of 'dependence or abuse' was used, the rates of the normative sample continued to be higher than the rates of the study sample. Comparison of diagnoses based on SASSI-3 versus Blood Alcohol Level (BAL) at the time of injury showed comparable accuracy, however BAL was found to have higher specificity rate. For dependence or abuse, the SASSI-3 was more sensitive and BALs were more specific. Conclusions: Given that the literature suggests that up to 60% of brain injuries are substance related, it appears certain that the search for substance dependence/abuse screening instruments for prevention and treatment after injury is of vital importance. Overall the SASSI-3 appears to show promise for use with persons with brain injury, although it did not yield the high accuracy, sensitivity and specificity rates found with the normative sample. Several suggestions for further consideration are discussed.
Bogner, J.A., Corrigan, J.D., Mysiw, W.J., Clinchot, D., & Fugate, L.P. (2001). A comparison of substance abuse and violence in the prediction of long-term rehabilitation outcomes after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 82, 571-7.
Objective: Determine the relative contributions of substance abuse history and violent etiology to the prediction of outcomes for individuals who sustained a traumatic brain injury (TBI) requiring inpatient rehabilitation. Design: Longitudinal study of outcomes one year after discharge from rehabilitation. Setting: Specialized TBI acute rehabilitation unit. Participants: Three hundred fifty-one individuals consecutively admitted for rehabilitation. Main Outcome Measures: Community Integration Questionnaire (CIQ), Satisfaction with Life Scale (SWLS). Results: Almost 80% of persons with injuries due to violence-related causes had a history of substance abuse. Substance abuse was found to contribute to the prediction of life satisfaction and productivity, while violent etiology was not a significant contributor to predictive models. Conclusion: Substance abuse history proved to be a strong predictor of long-term outcomes, while violent etiology of injury was less influential. The results of this study emphasize the need to include substance abuse history in all studies of outcomes following TBI, and to increase prevention efforts in order to limit the effects of such a history.
Corrigan, J.D., Bogner, J.A., Mysiw, W.J., Clinchot, D., Fugate L. (2001). Life satisfaction after traumatic brain injury. Journal of Head Trauma Rehabilitation, 16, 543-55.
Objective: To investigate predictors of life satisfaction following traumatic brain injury (TBI). Design: Prospective, longitudinal study of patients with TBI followed at one and two years post-injury. Setting: A specialized inpatient, TBI rehabilitation unit in a Midwestern academic medical center. Subjects: 218 consecutive patients admitted for rehabilitation, at least 14 years of age, a primary diagnosis of TBI, consented to participate, and interviewed at follow-up. Main Outcome Measures: Satisfaction With Life Scale. Results: Stepwise multiple regressions predicted statistically significant, but small proportions of variance. Not having a pre-injury history of substance abuse and having gainful employment at time of follow-up were associated with higher life satisfaction both one and two years post-injury. Motor independence at rehabilitation discharge was also predictive at one year. Current social integration and the absence of depressed mood were predictive at two years. Life satisfaction was relatively stable between years, with marital status and depressed mood at two years post-injury predictive of what change did occur. Conclusions: Life satisfaction following TBI appears to be related to attaining healthy and productive lifestyles. Future research should investigate other potential mediating factors of life satisfaction in order to increase prediction and appreciate all influences on subjective well-being following TBI.
Corrigan, J. D. (2001). Conducting statewide needs assessments for persons with traumatic brain injury. The Journal of head trauma rehabilitation, 16, 1-19.
The Traumatic Brain Injury Act of 1996 (Public Law 104-166) gave new authority to the Health Resources and Services Administration (HRSA) in the United States Department of Health and Human Services (DHHS) to establish a grant program for states to assist in addressing the needs of persons with traumatic brain injury (TBI). The resulting State Demonstration Grant Program has made available two categories of grants: planning and implementation. Planning grants are awarded to assist states in building infrastructure through the development of four core components. One of the core components is a statewide needs and resource assessment encompassing the full spectrum of services, from initial acute treatment through rehabilitation and long-term community supports. In 1999, assessments completed in 11 states were subjected to a comparative analysis to identify trends across states and to extract salient issues for the State Demonstration Grant Program. This article summarizes the context of the HRSA-funded needs assessments and contrasts the methods of needs assessment utilized. Over-arching issues are discussed, including exemplary qualitative and quantitative methods, and the diversity of theoretical models employed in designing assessments and interpreting findings. Several limitations in approaches were also identified, including shortcomings of convenience samples for conducting mail surveys and the unlikely validity of using a needs and resource discrepancy approach to identify gaps in services.
Wallace, C.A. & Bogner, J.A. (2000). Awareness of deficits: emotional implications for persons with brain injury and their significant others. Brain Injury, 14, 549-62.
Objective: Investigate the relationships between emotional distress and differing perceptions of the extent of deficits. Participants: 50 individuals with brain injury and their family members or close friends. Main Outcome Measures: Patient Competency Rating Scale, Beck Anxiety Inventory, Beck Depression Inventory. Results: Fifty-four percent of persons with brain injury and 39% of family members reported symptoms suggestive of experiencing mild or greater anxiety, while 40% of persons with brain injury and 34% of family members reported symptoms suggestive of mild or greater depression. Significant relationships were not found between the emotional distress of family members and difference scores. Moderate relationships were found between difference scores and the emotional distress of the individual with brain injury. Conclusions: Efforts to improve awareness of deficits in order to maximize the benefits of rehabilitation should be balanced with a recognition of the possible increase in emotional distress. Counseling to address issues of adjustment, motivation, and awareness of deficits is an important component of the rehabilitation process.
Bogner J.A., Bode R.K., Corrigan J.D., & Heinemen A.W. (2000). Rating scale analysis of the Agitated Behavior Scale. Journal of Head Trauma Rehabilitation, 15, 656-69.
Objective: Investigate
psychometric properties of the Agitated Behavior Scale (ABS). Design:
Rating scale analysis provided measures of reliability and validity. Samples:
Sample 1: 900 observations of 100 individuals with traumatic brain
injury; Sample 2: 204 observations of 102 persons with dementia; Sample
3: 241 observations of 6 individuals with anoxia. Results:
The calibration indicated that the rating scale was being used as intended.
The majority of the items work well together in defining milder versus
more severe examples of agitation. There is a clear hierarchy of item
difficulty which is relatively stable across samples of different diagnostic
groups and nursing shifts, even when the distributions are skewed. Person
separation, or internal consistency, was satisfactory with a distribution
without extreme skew, as is item separation. The dementia and anoxia samples
were skewed, resulting in lower person and item separation values. Conclusions:
The rating scale analysis supported previous findings regarding the psychometric
properties of the Agitated Behavior Scale, and suggested additional avenues
for further refinement and expanded application.
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Bogner, J.A., Corrigan, J.D., Stange, M., & Rabold, D. (1999). Reliability of the Agitated Behavior Scale. Journal of Head Trauma Rehabilitation, 14, 91-6.
Objective: Investigate the inter-rater reliability of the Agitated Behavior Scale. Design: Ratings by research assistants and nursing staff were compared. Setting: An acute rehabilitation unit and a long-term care facility. Participants: Forty-five persons with brain injury and 23 persons with progressive dementia. Results: Ratings of persons with brain injury by research assistants yielded a correlation coefficient for the Total score of .920. The correlation coefficients for the factors Disinhibition, Aggression, and Lability were .902, .909, and .726, respectively. Lower coefficients were obtained when the ratings of the research assistants and nursing staff were correlated, ranging from .364 to .604, however ratings were based on observations over different time periods. The ratings by research assistants of long-term care facility residents yielded coefficients ranging from .860 to .906 for the Total and factor scores. Conclusions: The Agitated Behavior Scale is a reliable instrument for measuring agitation in persons with traumatic brain injury, as well as with long-term care facility residents experiencing dementia.
Corrigan, J.D., Smith-Knapp, K., and Granger, C.V. (1998). Outcomes in the first five years following traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 79(3), 298-305.
Objectives: This study examined the extent to which outcomes from traumatic brain injury (1) differ as a function of time and (2) can be predicted at discharge from inpatient rehabilitation. Design: A cross-sectional design, with survey data, was employed. Participants: Subjects included 95 adults with traumatic brain injuries, six months to five years following inpatient rehabilitation, stratified by time post-discharge. Main Outcome Measures: Functional Independence Measure (FIMSM), Sickness Impact Profile (SIP), Medical Outcomes Survey SF-36, Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique (CHART), Brief Symptom Inventory (BSI), Satisfaction With Life Scale (SWLS), and indices of current psychosocial functioning. Results: Substance abuse, need for supervision, life satisfaction and selected subscales of the CIQ and CHART differed over the period 6 months to five years post-discharge. Approximately 75% of the variance in current FIM scores could be predicted at time of discharge; 40% to 50% of CHART, CIQ and SIP total scores. Conclusions: Outcomes over the first five years post-discharge were dynamic, with most change being improvement, at least after the first two years. Important aspects of outcome could not be predicted based on premorbid characteristics, injury severity, and initial functional abilities.
Wallace, C., Bogner , J.A., Corrigan, J.D., Fugate, L.P., Clinchot, D., & Mysiw, W.J. (1998). Primary caregivers of persons with traumatic brain injury. Brain Injury, 12, 483-93.
Objective: Examine adjustment of family members. Participants: Close family members of 61 individuals with TBI were contacted at 1 year following rehabilitation discharge. Main Outcome Measures: Relative and Friend Support Index, Social Support Index, and the Trauma Complaints List, and the Life Change Question. Results: The majority of family members reported at least mild negative impact on their life circumstances. Family members who reported greater impact also perceived more deficits in the individual with brain injury and reported fewer sources of social support. Conclusions: Implications for rehabilitation and research directions are discussed.
Clinchot, D., Bogner, J.A., Mysiw, W.J., Fugate, L.P., & Corrigan, J.D. (1998). Defining sleep disturbance after brain injury. Archives of Physical Medicine and Rehabilitation, 77, 291-5.
Objective: This study attempts to define and to correlate the incidence and type of sleep disturbances that occur after brain injury. Design: Prospective, longitudinal study. Participants: Eighty-six persons who had sustained a TBI and who were successfully contacted for follow-up one year after discharge from inpatient rehabilitation. Results: Fifty percent of subjects had difficulty sleeping at one year follow-up. Sixty-four percent described waking up too early, 25% described sleeping more than usual, and 45% described problems falling asleep. Eighty percent of subjects reporting sleep problems also reported problems with fatigue. Sleep difficulties were found to be more likely for individuals with milder injuries, both in regard to initial depth of coma as well as immediate memory scores upon discharge from inpatient rehabilitation. Older individuals and females were also more likely to experience sleep difficulties. Conclusions: This study provides support for the significance of sleep disturbance following brain injury and underscores the relationship between sleep difficulties and perceptions of fatigue.
Bogner, J.A., Corrigan, J.D., Spafford, D.E., and Lamb-Hart, G. (1997). Integrating substance abuse treatment and vocational rehabilitation after traumatic brain injury. Journal of Head Trauma Rehabilitation, 12, 57-71.
Objective: Describe and evaluate a resource and service coordination model for integrating community-based substance abuse treatment and vocational rehabilitation was described and evaluated. Design: Retrospective analysis of archival data. Participants and setting: 72 clients who received services from a resource and service coordination program for persons with TBI and a history of substance abuse. Inclusion criteria specified that potential subjects had to have received a comprehensive assessment, agreed to a treatment plan, and had been monitored for at least one year following initiation of the plan. Main Outcome Measures: Quantity-Frequency-Variability Index, General Health and History Questionnaire, Addiction Severity Index, and the Employability Rating Scale. Results: Pre-/post-comparisons showed significantly better vocational status and greater likelihood of abstinence from alcohol and other drugs following the intervention. An investigation of a priori hypotheses regarding mediating variables was limited by sample size and selection biases. Time post-injury was not associated with outcomes, though a trend was evident for decreased substance use among those referred within three months post-injury. The engagement of a community team was associated with decreased substance use but not greater productivity. Conclusions: Results are discussed in terms of possible ingredients for replication of this approach in other settings.
Corrigan, J.D., Bogner, J.A., Mysiw, W.J., Clinchot, D., & Fugate, L.P. (1997). Systematic Bias in Outcome Studies of Persons with Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation, 78, 132-7.
Objectives: 1)Examine systematic biases created by subjects lost at 1-year follow-up in samples of persons with TBI and 2)Identify potential threats to generalization of outcomes data. Design: Longitudinal study participants who were lost to follow-up were compared to those found in regard to demographic and injury-related characteristics. Participants: Subjects included 88 patients with a primary diagnosis of traumatic brain injury who had received acute inpatient rehabilitation. Subjects were considered to be lost to follow-up when phone calls, mail, clinic visits, and assistance from family failed to allow contact 1 year after discharge from acute rehabilitation. Main Outcome Measures: Potential effects of a biased follow-up sample were examined for six suboptimal outcomes: fatigue, seizure disorder, visual problems, not living independently, not working or in school, and social isolation (Community Integration Questionnaire). Results: A total of 38.6% of subjects were lost to follow-up. Subjects intoxicated at time of injury and those with a history of substance abuse were more likely to be lost. Among subjects followed, the likelihood of working or being in school 1 year after discharge was significantly less for those intoxicated at time of injury and those with a history of substance abuse. Conclusions: Systematic bias in longitudinal studies may result from subjects with substance use problems being lost to follow-up. Population estimates for return to work or school will be overestimated if those lost who have substance use problems resemble those followed.
Fugate, L. P., Spacek, L. A., Kresty, L. A., Levy, C. E, Johnson, J. C. & Mysiw, W. J. (1997) Definition of agitation following traumatic brain injury: I. A survey of the Brain Injury Special Interest Group of the American Academy of Physical Medicine and Rehabilitation.
Archives of Physical Medicine and Rehabilitation, 78, 917-23.
Objective: To determine national patterns of defining agitation after traumatic brain injury (TBI) by physiatrists with expressed interest in treating TBI survivors. Design: A random sample of 70% of the members of the Brain Injury Special Interest Group (SIG) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) were surveyed by telephone. Results: The 129 members who responded yielded an 82% response rate. Respondents rated 18 characteristics from established rating scales on a 5-point scale according to each characteristic's relation to its clinical definition of agitation. Physical aggression, explosive anger, increased psychomotor activity, impulsivity, verbal aggression, disorganized thinking, perceptual disturbances, and reduced ability to maintain or appropriately shift attention were rated by at least 50% of the sample as very important or essential to agitation. Delirium, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), has been proposed as a standard definition of agitation. The degree to which all characteristics from the 3rd revised edition of the DSM (DSM-IIIR), considered together, were perceived to relate to agitation predicted 24% of the degree to which the term "delirium" was perceived to relate to agitation (Canonical correlation r = .48, p = .0002). Physicians' ratings of individual delirium characteristics from the DSM-IIIR were examined to determine if a sufficient number were similarly ranked to fulfill the diagnostic criteria for delirium. A significant number of physicians rated diagnostic criteria for delirium in one direction, yet did not rank the term "delirium" accordingly (McNemar's p = .04). Conclusions: There is considerable variation among physiatrists in their rating of characteristics that define agitation. Many define agitation during the acute recovery phase as posttraumatic amnesia plus an excess of behavior such as aggression, disinhibition, and/or emotional lability. Less support was given to defining agitation by the DSM-IIIR or DSM-IV diagnostic criteria for delirium. Delirium appears related to, but is not sufficient for, a diagnosis of agitation.
Fugate, L.P., Spacek, B.A., Kresty, L.P., Levy,
C., Johnson, J.C., & Mysiw, W.J. (1997). Measurement and treatment
of agitation following traumatic brain injury: II. A survey of the Brain
Injury Special Interest Group of the American Academy of Physical Medicine
and Rehabilitation, Archives of Physical Medicine and Rehabilitation,
78, 917-23.
Objective: The objective
of this study was to determine national patterns of measuring and treating
agitation after TBI by specializing physiatrists.
Design: Phone surveys were conducted with a random sample of 70%
of the members of the Brain Injury Special Interest Group of the American
Academy of Physical Medicine and Rehabilitation. The survey instrument
was designed to determine the most common pharmacologic interventions
for agitation used by general physiatrists and those specializing in TBI
rehabilitation. Data were also collected on the manner in which participants
measured agitation and judged treatment efficacy. Results:
Eighty-two percent of the sample agreed to participate. The five most
frequently prescribed medications by specialists included carbamazepine,
tricyclic antidepressants, trazodone, amantadine, and beta-blockers. General
physiatrists tended to prescribe carbamazepine, beta-blockers, haloperidol,
TCAs, and benzodiazepines. Prescription of sedating drugs did not appear
to be correlated with injury acuity. Conclusions:
The breadth of pharmacologic agents identified in this survey probably
reflects the lack of research specific to the pathophysiology of post-traumatic
agitation.
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Mysiw, W.J. & Sandel, M.E. (1997). The agitated brain injured patient, part 2: pathophysiology and treatment. Archives of Physical Medicine and Rehabilitation, 78, 213-20.
Objective: Describe potential mechanisms for post-traumatic agitation and common intervention strategies. Results: Various pharmacologic agents are reviewed in regard to potential effectiveness and side effects. Conclusions: The intent of the 2 part series is advocate for the use of a consistent definition of agitation, to encourage proper assessment and monitoring strategies, and to recommend that intervention decisions be based on at least a theoretical understanding of the relationship between specific target behaviors and probable brain-behavior relationships.
Corrigan, J. D., Smith-Knapp, K & Granger, C. V. (1997). Validity of the functional independence measure for persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 78, 828-34.
Objective: Replicate and extend studies of the construct validity of the Functional Independence Measure (FIM) for persons with traumatic brain injury (TBI). Design: A cross-sectional study of admissions to acute rehabilitation evaluated 6 months to 5 years after discharge. Setting: An inpatient brain injury rehabilitation unit in a large, academic medical center. Subjects: Ninety-five patients with primary diagnosis of TBI stratified by time postdischarge. Main Outcome Measures: Prediction of (1) average daily minutes of assistance and (2) supervision required in comparison to the Sickness Impact Profile (SIP) and SF-36. Results: The FIM was highly predictive of minutes of assistance (83% accuracy), supervision (82% accuracy), and the need for either type of assistance (78% accuracy). Prediction was only minimally improved by measures of neurobehavioral impairment. The accuracy of the FIM was superior to the SIP and SF-36. Conclusions: Results provided substantial support for the validity of the FIM as a measure of functional independence for persons with TBI. The importance of supervision as a type of assistance required after TBI was evident, with the FIM highly predictive of this need, as well.