Self-report of extent of recovery and barriers to recovery after traumatic brain injury: A longitudinal study

Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98195-6490, USA.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 08/2001; 82(8):1025-30. DOI: 10.1053/apmr.2001.25082
Source: PubMed


To examine the perspective of survivors of traumatic brain injury (TBI) regarding the extent and nature of their recovery over time.
Inception cohort, longitudinal study.
Level I trauma center.
One hundred fifty-seven consecutively hospitalized individuals with TBI (mean age, 36.1 yr; 80% men) with a broad range of injury severity.
Not applicable.
Participants reported the extent of their recovery and barriers to full recovery at 1, 6, and 12 months.
Participants reported a median return to normal at the 3 follow-up times of 65%, 80%, and 85%. After 1 month, self-reported extent of recovery correlated well with performance on the Glasgow Outcome Scale (p <.001 at 6 and 12 mo) and Wechsler Adult Intelligence Scale Performance IQ (p =.001 at 12 mo). The major reported barrier to recovery was physical difficulties, which constituted over half of the concerns at all time periods. Report of physical-related concerns decreased significantly (p =.002) over time whereas cognition-related concerns increased significantly (p =.02).
Brain injury survivors consider themselves to have greater recovery than previously reported by clinicians or family members, consider physical problems a significant factor in their recovery, and appear to become more aware of cognitive impairments over time.

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    • "Interestingly, Seel et al. [20] also reported that mild as well as moderate/severe injury patients rated problems occurring more frequently compared with their family members. Our results are also consistent with reports showing that with increasing time post-injury, self-awareness becomes more accurate [12,13,16,43]. Moreover, most previous reports studied participants two years or less post-injury, whereas the current study, like [13] assessed participants at approximately 10 years post-injury. "
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    ABSTRACT: Traumatic brain injury (TBI) frequently occurs during childhood and adolescence with long-term neuropsychological and behavioral effects. Greater personal awareness of injury is associated with better outcomes. However, personal awareness is often assessed using ratings obtained from family members or significant others. Surprisingly, the accuracy of family-ratings compared with self-ratings has not been well studied in the TBI population. Thus, the purpose of this study was to examine self versus family-ratings of frontal dysfunction and secondly, the association between self/family reported frontal dysfunction and measured executive function outcomes. A total of 60 participants, approximately 10 years post-TBI, comprised 3 groups including; moderate/severe TBI (N=26; mean age 22.9, SD=3.0), mild TBI (N=20; mean age, 21.7, SD=2.7), and control (N=14: mean age, 21.6, SD=3.7). Neuropsychological testing was used to obtain domain scores for executive function and working memory/attention for each participant, and nominated family members and participants with TBI were asked to complete the Frontal Systems Behaviour Scale (FrSBe), consisting of three sub-scales; apathy, disinhibition, and executive dysfunction. Using the FrSBe there was no significant difference between the groups in executive function score, but the moderate/severe and mild groups had significantly lower working memory/attention scores compared with the control group (p<0.05). Repeated measures analysis of variance showed higher self-ratings on all sub-scales compared with family in each group (p<0.05). Scores on executive function and working memory/attention domains correlated with self, but not family reported executive dysfunction. Self-rated executive dysfunction explained 36% of the variance in executive function (p<0.001). While agreement between self-rated and family-rated total FrSBe scores was significant in all groups (p<0.001), our results showed that self-ratings were of higher predictive utility for executive functioning compared with family ratings. Further, at 10 years post-TBI, patients show greater awareness of deficits compared with family who rate consistently closer to the normal functioning range.
    PLoS ONE 10/2013; 8(10):e76916. DOI:10.1371/journal.pone.0076916 · 3.23 Impact Factor
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    • "Subjects had to be 18–65 years old, with one or more mild to moderate TBIs characterized by loss of consciousness due to blast injury that was a minimum of 1 year old and occurred after 9/11/01. They had to have a prior diagnosis of chronic TBI/PCS or TBI/PCS/PTSD by military or civilian specialists, with an absence of acute cardiac arrest or hemorrhagic shock at the time of TBI, Disability Rating Scale score (Rappaport et al., 1982) of 0–3, negative urine toxicology screen for drugs of abuse, negative pregnancy test in females, otherwise good health, and less than 90% on the Percent Back to Normal Rating Scale (PBNRS; Powell et al., 2001). "
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    ABSTRACT: This is a preliminary report on the safety and efficacy of 1.5 ATA hyperbaric oxygen therapy (HBOT) in military subjects with chronic blast-induced mild to moderate traumatic brain injury (TBI)/post-concussion syndrome (PCS) and post-traumatic stress disorder (PTSD). Sixteen military subjects received 40 1.5 ATA/60 min HBOT sessions in 30 days. Symptoms, physical and neurological exams, SPECT brain imaging, and neuropsychological and psychological testing were completed before and within 1 week after treatment. Subjects experienced reversible middle ear barotrauma (5), transient deterioration in symptoms (4), and reversible bronchospasm (1); one subject withdrew. Post-treatment testing demonstrated significant improvement in: symptoms, neurological exam, full-scale IQ (+14.8 points; p<0.001), WMS IV Delayed Memory (p=0.026), WMS-IV Working Memory (p=0.003), Stroop Test (p<0.001), TOVA Impulsivity (p=0.041), TOVA Variability (p=0.045), Grooved Pegboard (p=0.028), PCS symptoms (Rivermead PCSQ: p=0.0002), PTSD symptoms (PCL-M: p<0.001), depression (PHQ-9: p<0.001), anxiety (GAD-7: p=0.007), quality of life (MPQoL: p=0.003), and self-report of percent of normal (p<0.001), SPECT coefficient of variation in all white matter and some gray matter ROIs after the first HBOT, and in half of white matter ROIs after 40 HBOT sessions, and SPECT statistical parametric mapping analysis (diffuse improvements in regional cerebral blood flow after 1 and 40 HBOT sessions). Forty 1.5 ATA HBOT sessions in 1 month was safe in a military cohort with chronic blast-induced PCS and PTSD. Significant improvements occurred in symptoms, abnormal physical exam findings, cognitive testing, and quality-of-life measurements, with concomitant significant improvements in SPECT.
    Journal of neurotrauma 09/2012; 29(1):168-85. DOI:10.1089/neu.2011.1895 · 3.71 Impact Factor
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    • "It used to be interventions concentrated on the restoration of body functions originally with focus on physical dysfunctions. Then followed also a focus on consequences of cognitive dysfunctions, and at the present time, the scope of rehabilitation has expanded to include community based interventions as well, concentrating on long term consequences such as restriction on participation (Mazaux and Richer 1998; Powell, Machamer et al. 2001). "

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