[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Cognitive rehabilitation following traumatic brain injury can aid in optimizing function, independence, and quality of life by addressing impairments in attention, executive function, cognitive communication, and memory. This study aimed to identify and evaluate the methodological quality of clinical practice guidelines for cognitive rehabilitation following traumatic brain injury. METHODS: Systematic searching of databases and Web sites was undertaken between January and March 2012 to identify freely available, English language clinical practice guidelines from 2002 onward. Eligible guidelines were evaluated using the validated Appraisal of Guidelines for Research and Evaluation II instrument. RESULTS: The 11 guidelines that met inclusion criteria were independently rated by 4 raters. Results of quality appraisal indicated that guidelines generally employed systematic search and appraisal methods and produced unambiguous, clearly identifiable recommendations. Conversely, only 1 guideline incorporated implementation and audit information, and there was poor reporting of processes for formulating, reviewing, and ensuring currency of recommendations and incorporating patient preferences. Intraclass correlation coefficients for agreement between raters showed high agreement (intraclass correlation coefficient > 0.80) for all guidelines except for 1 (moderate agreement; intraclass correlation coefficient = 0.76). CONCLUSION: Future guidelines should address identified limitations by providing implementation information and audit criteria, along with better reporting of guideline development processes and stakeholder engagement.
Journal of Head Trauma Rehabilitation 07/2014; 29(4):277 - 289. · 4.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury results in complex cognitive sequelae. Impairments in memory are among the most common sequelae resulting in significant functional problems. An international team of researchers and clinicians (known as INCOG) was formed to develop recommendations for the management of impairments in memory.
The Journal of head trauma rehabilitation. 07/2014; 29(4):369-386.
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury (TBI) results in complex cognitive (and other) sequelae. Impairments in executive function and self-awareness are among the most characteristic neuropsychological sequelae and can exert a profound effect on resuming previous life roles. An international group of researchers and clinicians (known as INCOG) convened to develop recommendations for interventions to improve impairments in executive functioning and self-awareness after TBI.
The Journal of head trauma rehabilitation. 07/2014; 29(4):338-352.
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury results in complex cognitive sequelae. However, clinicians have difficulty implementing the available evidence. An international group of researchers and clinicians (known as INCOG) convened to develop clinical practice guidelines for cognitive rehabilitation posttraumatic brain injury.
The Journal of head trauma rehabilitation. 07/2014; 29(4):290-306.
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury, due to its diffuse nature and high frequency of injury to frontotemporal and midbrain reticular activating systems, may cause disruption in many aspects of attention: arousal, selective attention, speed of information processing, and strategic control of attention, including sustained attention, shifting and dividing of attention, and working memory. An international team of researchers and clinicians (known as INCOG) convened to develop recommendations for the management of attentional problems.
The Journal of head trauma rehabilitation. 07/2014; 29(4):321-337.
[Show abstract][Hide abstract] ABSTRACT: After traumatic brain injury (TBI) and emergence from coma, the majority of people experience posttraumatic amnesia (PTA), characterized by confusion, disorientation, retrograde and anterograde amnesia, poor attention, and sometimes agitation and delusions. An international team of researchers and clinicians developed recommendations for assessment and management of PTA.
The Journal of head trauma rehabilitation. 07/2014; 29(4):307-320.
[Show abstract][Hide abstract] ABSTRACT: Published reports describing interventions featuring a single participant are common in neurorehabilitation. Yet, not all such reports use rigorous single-case methodology and there is mounting evidence to suggest that the design, conduct and report of single-case research in the behavioural sciences (including neurorehabilitation) needs improvement. The first part of this article describes resources that will guide the improved design, conduct and critical appraisal of single-case research, including recently published standards in the field of special education and the Risk of Bias in N-of-1 Trials (RoBiNT) Scale for evaluating internal and external validity of designs using a single participant. The second part of the article reports on work currently in progress in developing a reporting guideline in the CONSORT tradition specifically for single-case experimental designs in the behavioural sciences, entitled the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE). It is anticipated that adoption and use of these resources by authors, reviewers and journal editors will improve the reporting and, potentially, the quality of the single-case literature.
[Show abstract][Hide abstract] ABSTRACT: Abstract Background: A large literature documents psychosocial difficulties affecting participation in everyday activities following acquired brain injury (ABI). This study examined executive, behavioural and emotional contributions to psychosocial outcome in children with ABI. Method: Participants with ABI (n = 35; aged 7-18 years) were recruited from a rehabilitation department. Psychosocial functioning was assessed using the Sydney Psychosocial Reintegration Scale for Children (SPRS-C). Executive, emotional and behavioural variables were examined using self and parent-report measures. Results: Thirty-eight per cent of the sample was classified as having good psychosocial functioning, with 54% classified as limited and 8% as poor. The sample was dichotomized on executive, behavioural and emotional functioning comparing those with and without difficulties. Participants classified without behavioural difficulties had better functioning on SPRS-C compared to those with difficulties (p < 0.01). In contrast, for executive and emotional functioning, hardly any SPRS-C variable showed significant group differences. Of the total group, 15-21% had elevated levels on emotional outcome measures. This was, however, dependent on age, with 22-44% of the older sample reporting elevated levels on at least one emotional variable compared to 4-16% of the younger sample. Discussion: The pattern of results highlight the contribution of behavioural functioning to psychosocial outcome post-childhood ABI.
[Show abstract][Hide abstract] ABSTRACT: Objective:To determine the effectiveness of personal digital assistant devices on achievement of memory and organization goals in patients with poor memory after acquired brain injury.Design:Assessor blinded randomized controlled trial.Setting:Specialist brain injury rehabilitation hospital (inpatients and outpatients).Participants:Adults with acquired brain impairments (85% traumatic brain injury; aged ≥17 years) who were assessed as having functional memory impairment on the Rivermead Behavioural Memory Test (General Memory Index).Interventions:Training and support to use a personal digital assistant for eight weeks to compensate for memory failures by an occupational therapist. The control intervention was standard rehabilitation, including use of non-electronic memory aids.Main outcome measures:Goal Attainment Scale which assessed achievement of participants' daily memory functioning goals and caregiver perception of memory functioning; and General Frequency of Forgetting subscale of the Memory Functioning Questionnaire administered at baseline (pre-randomization) and post intervention (eight weeks later).Results:Forty-two participants with memory impairment were recruited. Use of a personal digital assistant led to greater achievement of functional memory goals (mean difference 1.6 (95% confidence interval (CI) 1.0 to 2.2), P = 0.0001) and improvement on the General Frequency of Forgetting subscale (mean difference 12.5 (95% CI 2.0 to 22.9), P = 0.021).Conclusions:Occupational therapy training in the use of a handheld computer improved patients' daily memory function more than standard rehabilitation.
[Show abstract][Hide abstract] ABSTRACT: Poor skills generalization poses a major barrier to successful outcomes of rehabilitation after traumatic brain injury (TBI). Error-based learning (EBL) is a relatively new intervention approach that aims to promote skills generalization by teaching people internal self-regulation skills, or how to anticipate, monitor and correct their own errors. This paper describes the protocol of a study that aims to compare the efficacy of EBL and errorless learning (ELL) for improving error self-regulation, behavioral competency, awareness of deficits and long-term outcomes after TBI.Methods and design: This randomized, controlled trial (RCT) has two arms (EBL and ELL); each arm entails 8 x 2 h training sessions conducted within the participants' homes. The first four sessions involve a meal preparation activity, and the final four sessions incorporate a multitasking errand activity. Based on a sample size estimate, 135 participants with severe TBI will be randomized into either the EBL or ELL condition. The primary outcome measure assesses error self-regulation skills on a task related to but distinct from training. Secondary outcomes include measures of self-monitoring and self-regulation, behavioral competency, awareness of deficits, role participation and supportive care needs. Assessments will be conducted at pre-intervention, post-intervention, and at 6-months post-intervention.
This study seeks to determine the efficacy and long-term impact of EBL for training internal self-regulation strategies following severe TBI. In doing so, the study will advance theoretical understanding of the role of errors in task learning and skills generalization. EBL has the potential to reduce the length and costs of rehabilitation and lifestyle support because the techniques could enhance generalization success and lifelong application of strategies after TBI.Trial registration: ACTRN12613000585729.
[Show abstract][Hide abstract] ABSTRACT: Recent literature suggests a revival of interest in single-case methodology (e.g., the randomised n-of-1 trial is now considered Level 1 evidence for treatment decision purposes by the Oxford Centre for Evidence-Based Medicine). Consequently, the availability of tools to critically appraise single-case reports is of great importance. We report on a major revision of our method quality instrument, the Single-Case Experimental Design Scale. Three changes resulted in a radically revised instrument, now entitled the Risk of Bias in N-of-1 Trials (RoBiNT) Scale: (i) item content was revised and increased to 15 items, (ii) two subscales were developed for internal validity (IV; 7 items) and external validity and interpretation (EVI; 8 items), and (iii) the scoring system was changed from a 2-point to 3-point scale to accommodate currently accepted standards. Psychometric evaluation indicated that the RoBiNT Scale showed evidence of construct (discriminative) validity. Inter-rater reliability was excellent, for pairs of both experienced and trained novice raters. Intraclass correlation coefficients of summary scores for individual (experienced) raters: ICCTotalScore = .90, ICCIVSubscale = .88, ICCEVISubscale = .87; individual (novice) raters: ICCTotalScore = .88, ICCIVSubscale = .87, ICCEVISubscale = .93; consensus ratings between experienced and novice raters (ICCTotalScore = .95, ICCIVSubscale = .93, ICCEVISubscale = .93. The RoBiNT Scale thus shows sound psychometric properties and provides a comprehensive yet efficient examination of important features of single-case methodology.
[Show abstract][Hide abstract] ABSTRACT: Objective: To determine effectiveness of communication training for partners of people with severe traumatic brain injury. Design: Three arm non-randomized controlled trial comparing communication partner training (JOINT) with individual treatment (TBI SOLO) and a waitlist control group with 6 month follow-up. Participants: Forty-four outpatients with severe chronic traumatic brain injuries were recruited. Intervention: Ten-week conversational skills treatment program encompassing weekly group and individual sessions for both treatment groups. The JOINT condition focused on both the partner and the person with traumatic brain injury while the TBI SOLO condition focused on the individual with TBI only. Main outcome measures: Primary outcomes were blind ratings of the person with traumatic brain injury's level of participation during conversation on the Measure of Participation in Communication Adapted Kagan scales. Results: Communication partner training improved conversational performance relative to training the person with traumatic brain injury alone and a waitlist control group on the primary outcome measures. Results were maintained at six months post-training. Conclusion: Training communication partners of people with chronic severe traumatic brain injury was more efficacious than training the person with traumatic brain injury alone. The Adapted Kagan scales proved to be a robust and sensitive outcome measure for a conversational skills training program.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 06/2013; · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: It was hypothesized that, for people with severe traumatic injuries, no association between long term health status and receiving financial compensation would be detected. Design: Two prospective cohort studies. Subjects: A group of people with severe traumatic brain injury (n = 132) and a group of people with traumatic spinal cord injury (n = 58). Methods: Health status and functioning were measured at baseline and at 5 years follow-up for both injury groups. Results per group were compared between those who received compensation and those who were non-compensable. Results: In the brain injury cohort those receiving financial compensation showed a significantly worse Disability Rating Scale score after 5 years compared to the non-receiving group (p = 0.01). Financial compensation was a modest predictor for being disabled (scores ≥ 4) after 5 years (Exp (B) = 2.47, 95% confidence interval 1.03 to 5.93). In the spinal cord injury cohort those receiving financial compensation scored significantly lower with the Short-Form 36 General Health Survey/Physical Component Summarise scores after 5 years than those who did not (p = 0.04). Again, receiving financial compensation had a modest predictive value for the Short-Form 36/Physical Component Summarise scores after 5 years (B = -4.72, SE = 2.16, 95% confidence interval -9.05 to -0.38). Conclusion: Financial compensation may have a small negative association with recovery, even for people with severe traumatic injury.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 03/2013; · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injuries (TBI) in children and adolescents can impair social cognition and communication skills but there are few assessment tools suitable for adolescents. The Awareness of Social Inference Test (TASIT) uses professionally enacted audiovisual vignettes of everyday conversational exchanges and is a valid measure of social perception disorders in adults. This study examined its utility for assessing impairments in social cognition in a group of 16 adolescents with TBI, compared to a group of 16 typically developing (TD) adolescents. Adolescents with TBI were, on average, no different to their TD peers on TASIT 1 (emotion recognition) and TASIT 3 (recognizing lies and sarcasm when provided with additional cues) but performed more poorly on TASIT 2 which required them to interpret sarcastic and sincere conversational exchanges with few cues other than the demeanor of the speakers. Within the TBI group, poor performance on TASIT correlated to both relative and self-reported communication difficulties at home. It also correlated with IQ, face recognition and severity of injury as indexed by duration of post-traumatic amnesia. Overall, this study suggests TASIT is a valid measure for adolescents although it raised questions as to how effective normative data is for comparing performance in social cognition during childhood and adolescence. (JINS, 2013, 19, 1-11).
Journal of the International Neuropsychological Society 02/2013; · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Good assessment is an essential component of effective patient management. Yet the sheer volume of available assessment instruments presents a barrier for the clinician or researcher to (a) be knowledgeable about suitable measures and (b) keep up-to-date with new measures that are published. In order to create a resource of currently-used measures, we conducted a systematic review of assessment tools used in the research literature on traumatic brain injury (TBI).
We used two electronic databases (Medline and PsycINFO) to identify full-length, English-language articles published between 2000 and 2012 in which outcome in adults with TBI was assessed with behavioural tests or questionnaires.
The searches yielded 5,735 articles and after deletion of duplicates (n = 1,383) and articles not meeting selection criteria (n = 1,759), 2,593 articles were further examined. The articles contained 910 behavioural instruments, with a final set of 728 unique instruments. Each instrument was classified against the International Classification of Functioning, Disability and Health (ICF). Half of the instruments (n = 370, 50.8%) evaluated the mental functions domain of the ICF body functions component, with a substantially smaller proportion (n = 64, 8.8%) examining specific motor-sensory and other body functions. Instruments also covered domains of activities/participation (n = 109, 15.0%), environmental factors (n = 22, 3.0%) and personal factors (n = 36, 4.9%). A substantial number of scales (n = 93, 12.8%) were multidimensional across the body function domains (n = 32), as well as the functioning and disability part of the ICF (n = 60). The remaining 5% of instruments addressed concepts not covered by the ICF, including quality of life (n = 19, 2.6%) and rehabilitation process tools (such as therapeutic alliance). The 728 instruments were listed and more than 70 of the most common, spread across 20 domains, were highlighted.
These data provide a comprehensive and up-to-date resource that gives the researcher or clinician a very large selection of assessment instruments covering the major areas of function pertinent to TBI.
[Show abstract][Hide abstract] ABSTRACT: Many adults with acquired brain injuries, including traumatic brain injuries (TBI) have impaired emotion perception. Impaired perception of emotion in voice can occur independently to facial expression and represents a specific target for remediation. No research to date has addressed this. The current study used a randomised controlled trial to examine the efficacy of a short treatment (three x two-hour sessions) for improving the ability to recognise emotional prosody for people with acquired brain injury, mostly TBI. Ten participants were allocated to treatment and 10 to waitlist. All participants remained involved for the duration of the study in the groups to which they were allocated. There were no significant treatment effects for group, but analyses of individual performances indicated that six of the treated participants made demonstrable improvements on objective measures of prosody recognition. The reasons why some participants showed improvements while others did not, was not obvious. Improvements on objective lab-based measures did not generalise to relative reports of improvements in everyday communicative ability. Nor was there clear evidence of long-term effects. In conclusion, treatment of emotional prosody was effective in the short-term for half of the participants. Further research is required to determine what conditions are required to optimise generalisability and longer-term gains.
[Show abstract][Hide abstract] ABSTRACT: There are many challenges in incorporating an evidence-based approach into clinical practice and a large literature exists on various barriers and facilitators. Within this context, we have developed a framework to advocate an empirical approach to therapeutic interventions, using our Model to Assess Treatment Effect (MATE). The MATE is designed to characterise how an intervention is delivered to an individual patient/client. It is organised hierarchically into seven levels, from low levels of capacity to demonstrate treatment effect (e.g., Level 1: treatment commenced without pre-intervention assessment) to high levels where cause–effect relationships can be established between the intervention and the behaviour being treated (e.g., Level 6: implementation of a well-designed single-case experimental design). Consequently, the MATE captures all levels of clinical intervention and can be applied readily to an individual patient, as well as an entire clinical setting. In this paper, we present a decision tree in the form of a detailed flow-chart which assists the clinician to classify treatment delivery on the MATE. We believe that the MATE has the capacity not only to document current clinical practice, but also to provide a model whereby future treatments can be planned and implemented with greater scientific rigour and hence accountability in relation to treatment outcomes.
[Show abstract][Hide abstract] ABSTRACT: A paucity of studies have evaluated the biopsychosocial factors contributing to quality of life (QoL) in adults with a primary brain tumor (BT). Our objective was to investigate (i) the effects of radiotherapy on the psychosocial (ie, posttraumatic stress symptoms [PTSS]) and cognitive functioning of adults with a primary BT, assessed preradiotherapy [T1] and postradiotherapy [T2], and (ii) predictors of PTSS and QoL postradiotherapy. Seventy adults with a BT were assessed at T1, and 67 patients were reassessed 3.5 months postradiotherapy. At each assessment, participants completed measures of PTSS, mood, QoL, and quality of social support and neurocognitive tests focusing on memory and executive functioning. Minimal differences in functioning were found between patients according to BT type (benign [n = 45] vs malignant [n = 25]) and tumor laterality (left vs right hemisphere), with 2 exceptions. Individuals with a left hemisphere benign BT experienced greater distress at T1, which declined at T2, whereas individuals with a left hemisphere malignant BT reported poorer social support at T2. The full sample performed poorly on tests of executive functioning, and 17% reported clinically elevated PTSS at T1, which reduced to 13% at T2. Younger age (<65 y), reduced QoL, and elevated anger symptoms at T1 predicted PTSS at T2, whilst having a benign BT, low PTSS, and depressive symptoms at T1 were predictive of improved QoL at T2. Findings highlight the importance of screening for psychosocial and cognitive disturbances in BT patients undergoing treatment to identify those at risk for acute and more prolonged problems.
[Show abstract][Hide abstract] ABSTRACT: Severe traumatic brain injury (TBI) is the most common cause of brain injury in the Western world and leads to physical, cognitive and emotional deficits that reduce independence. Changes to psychosocial function are the most disruptive, resulting in vocational difficulties, family stress and deteriorating relationships, and are a major target for remediation. But rehabilitation is expensive and its evidence base is limited. Thus, new collaborative initiatives are needed. This article details the development of ‘Moving Ahead’, a model for a Centre of Research Excellence (CRE) for Traumatic Brain Injury Rehabilitation. This CRE offers several major innovations. First, it provides an integrated, multi-faceted approach to addressing psychosocial difficulties embracing different clinical standpoints (e.g., psychological, speech pathology, occupational therapy) and levels of investigation (e.g., basic science to community function) across the lifespan. It is based upon a close relationship with clinicians to ensure transfer of research to practice and, conversely, to ensure that research is clinically meaningful. It provides an integrated platform with which to support and train new researchers in the field via scholarships, postdoctoral fellowships, websites, meetings, mentoring and across-site training, and thus build workforce capacity for individuals with TBI and their families. It has input from the international community to contextualise research more broadly and ensure scientific rigour. Finally, it provides collaboration across sites to facilitate research and data collection.