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Community Integration Following Traumatic Brain Injury1
Abstract
Community integration is the assumption or resumption of culturally and developmentally appropriate social roles following disability. This article describes characteristics of a model system of professional and social services required to address the long-term, community integration of individuals who have experienced traumatic brain injury (TBI). Emphasis is given to defining the goals and values of a model system rather than the structure itself. Goals are defined from the point of view of the individual who has incurred a TBI, the professional providing rehabilitation services, and the society in which they both function. Optimal quality of life is described as the attainment of desirable outcomes from all three perspectives. Common barriers to optimal quality of life are discussed in relation to six salient dimensions of life activities. Values of a model system are drawn from recently delineated principles of community-based services. Implications for the structure of a model system built on these goals and values are suggested.
... As the literature reports, various authors (e.g., Martin & Cobigo, 2011;McColl et al., 1998;Parvaneh & Cocks, 2012;Wong & Solomon, 2002) characterize CI using different elements and domains. For example, Wilier et al. (1994) define CI as the ability to successfully perform roles within community settings, while Corrigan (1994) describes CI as the meaningful engagement of individuals with disabilities in social roles deemed culturally and developmentally appropriate. Still, there is agreement that participation in meaningful daily activities and interpersonal relationships are core components of the CI framework across different interpretations and definitions (e.g., McColl, 2007;Parvaneh & Cocks, 2012). ...
... Future research could study both models (Figures 2.1 and 2.2) using a longitudinal design and resort to longitudinal mediation analysis (e.g., simple mediation, two-mediator serial mediation). Secondly, the CI 95 variable in this study encompassed three dimensions (i.e., home and family life, activities outside the home and interpersonal relationships, and participation in electronic social networking), in line with the definitions proposed in the literature (e.g., Corrigan, 1994;McColl, 2007;Parvaneh & Cocks, 2012;Wilier et al., 1994). Nevertheless, recognizing that the literature around the construct of CI remains inconsistent and conceptually unclear (Amado et al., 2013;Overmars-Marx et al., 2014;Petros et al., 2021;Simplican et al., 2015), future studies could consider exploring the effect of SU, SD, and EA on CI following a distinct theoretical background and encompassing other dimensions (e.g., participation in healthcare). ...
Self-determination (SD) is considered one of the most relevant constructs in the field of disability,
particularly in developmental disabilities (DD). Among others, SD has been shown to have a positive
impact on variables in different life spheres of people with disabilities, like school life, transition from
school to post-school education and job market, socio-emotional, and quality of life. Within the
contemporary Causal Agency Theory, SD is defined as a dispositional characteristic manifested as acting
as the causal agent in one's own life, comprising three essential characteristics: action-control beliefs,
volitional action, agentic action. Despite the advances in international research into the SD of people with
DD, the Portuguese context lacks assessment tools and interventions to promote SD in line with the state of-the-art as well as research relating SD with other variables. The current thesis aimed (1) to provide
researchers and professionals with a valid and reliable assessment tool to evaluate SD in adults with and
without DD; and (2) to examine the relationships between SD and various contextual factors that can
serve as predictors of SD, as well as potential outcomes associated with SD in Portuguese adults with
DD. Specifically, three cross-sectional studies were carried out to (i) describe the process of translation
and adaptation of the Self-Determination Inventory: Adult Report Portuguese, as well as study the
psychometric properties of this instrument in adults with and without DD; (ii) examine the direct and
indirect relationship, through the educational attainment, of SD and community integration of adult people
with DD, and examine the influence of being supported in decision-making in the former relationship;
and, finally, (iii) study the impact of three personal and environmental factors on the three essential
characteristics of SD in the adult population with cerebral palsy. The current work presents itself as a
pioneer work in the field of SD in disability in Portugal, more specifically in DD in adulthood, contributing
to aligning Portuguese research with the international context. Both practice and research will be provided
with specific guidelines aimed at the effective promotion of SD in the population with DD.
... Domiciliary and community integration dimensions are also important goals following a stroke [5,19], with social support playing a significant role [20,21]. Community reintegration is described as "the assumption/resumption of a culturally and developmentally appropriate social roles" and the "full inclusion and participation in the physical and psychosocial environment", essentially returning to "preinjury roles and activities" [22]. ...
... Each domain is scored both individually (home integration -10 points, social integration -12 points and productive activity -7 points) and as a total score (from 0 to 29 points), where a higher score indicates better integration. The CIQ is a valid and reliable instrument for assessing participation and community integration in brain acquired injury [22,24] and specifically after stroke [40,41]. ...
Purpose
To assess the association between professional reintegration and mental health, quality of life (QoL) and community reintegration of stroke survivors.
Methods
Using a cross-sectional study design, a structured questionnaire was administered to previously working stroke survivors, 18–24 months post-stroke. Data on sociodemographic characteristics, professional reintegration (prevalence of return to work (RTW), period of RTW, job placement, function at work, reintegration support, association of stroke with work and number of working hours), mental health (Hospital Anxiety and Depression Questionnaire), QoL (Stroke Specific Quality of Life Scale) and community integration (Community Integration Questionnaire) were reported by 553 stroke survivors.
Results
Twenty months after stroke, 313 (56.6%; 95%CI 52.4–60.8) stroke survivors had return to work. RTW was positively associated with both global and sub-domains scores of Community Integration Questionnaire (CIQ) (global CIQ β = 3.50; 95%CI 3.30–3.79) and with depressive symptomatology (β = 0.63; 95%CI 0.20–1.46) measured by the Hospital Anxiety and Depression Scale. No significant differences were found regarding QoL, according to RTW status. For those who RTW, no significant associations were found between any of the professional reintegration determinants assessed and mental health, QoL and community integration scores.
Conclusions
RTW seems to be associated to better community integration after stroke, but appears to be negatively associated to stroke survivor’s mental health, namely considering depression symptoms. Future studies should explore the barriers to stroke survivors’ RTW and the challenges and strategies used to overcome them, to allow the development of professional reintegration policies.
... Much of the current research is based in hospital and rehabilitative contexts, with a distinct lack of community-based programs [18,22,23]. Within rehabilitative contexts, the therapeutic focus is largely placed on physical strength and functioning, including sexual functioning, while sexuality and relationships feature only incidentally or within a deficitbased approach to sexual behavior [10,[24][25][26]. We note the positive example provided by the American Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation which includes formal requirements for programs and rehabilitation to address meaningful relationships and sexuality related concerns when certifying as a specialized brain injury program [27]. ...
... Research on sexual functioning after an ABI widely accepts that sex drive, and genital functioning can involve a period of adjustment [10,26]. Studies now suggest that up to 75% of people with ABI in rehabilitation experience sexual problems, including feeling comfortable in their sexual expression and perceived satisfaction of sexual experiences [29]. ...
This literature review presents a critical appraisal of the dominant approaches toward the sexuality and relationships of people with acquired brain injury. In particular, we sought to identify and review existing programs focusing on sexuality and relationships which use an educational and/or peer–peer approach. A systematic and comprehensive search of the EBSCOHOST database was conducted within an unlimited time-frame to yield the highest number of relevant results possible, along with hand-searching of key journals and databases. Reports, papers and webpages, documents commonly referred to as ‘grey literature’ that are not published in peer-reviewed journals, were also hand searched as a part of this review. The database search yielded 862 results, 14 of which were found to be relevant to our research interests. All of the sexuality education programs identified in this review were experienced positively by participants, families, caregivers, and professionals working with people with acquired brain injury. No peer–peer sexuality and relationships programs were identified. However, we found strong support for the use of peer–peer approaches in other programs for people with acquired brain injury. This literature review provides strong support for the development peer–peer sexuality and relationships programs for people with acquired brain injury. However, any future programs would have to overcome the limitations of existing sexuality and relationships programs.
... In deciding on the components of a minimal data set, the tri-partite model of outcomes was adopted (initially employed in psychotherapy [4], adapted to TBI [5]) which focuses on the needs of the individual, society and the health provider. A basic contention of the model is that the interests of the individual, society and professional are based on independent value systems; and, to prioritize one over the other requires criteria that may be common to one or two, but are not likely shared by all three. ...
... Adding post-discharge predictors such as social outcomes to pre-morbid and acute variables can increase the ability to predict community re-entry [30,31]. In 1994, Corrigan [5] defined community reintegration as the assumption and resumption of the culturally and developmentally appropriate roles after TBI. Corrigan identified six critical areas for community re-entry that included: ...
Efforts to establish a minimal data set for the period of community integration after traumatic brain injury (TBI) have been the focus of a working group of leading researchers, clinicians and advocates attending the Galveston Brain Injury Symposium in 2001 and 2002. The purpose of the data set is to increase the consistency and interpretability of TBI research and programme evaluation by providing a common set of measures to document key aspects of community integration. It is intended to be sensitive to intervention, comprehensive, reflect satisfaction and outcome and promote future treatment/therapy. In deciding on the components of a minimal data set, the tri-partite model of outcomes was adopted (initially employed in psychotherapy, adapted to TBI) which focuses on the needs of the individual, society and the health provider. Scales are recommended for the respective components of the model.
... Further, the natural progression from direct language translations should also include culturally relevant and ecological measures of concussion among diverse communities. This may include community integration, or the inclusion of culturally appropriate social roles following injury; a paradigm that has been well established in traumatic brain injury research (53,54). Moreover, there are limitations in the availability of concussion education materials across different languages. ...
Objective:
The aim of this study was to investigate the association between academic adjustments and recovery from sport-related concussions (SRCs) in collegiate athletes.
Materials and methods:
A retrospective medical chart review was performed between the 2015-2016 and 2019-2020 sport seasons at 11 Long-term Impact of Military-relevant Brain Injury Consortium Military and Tactical Athlete Research Study (LIMBIC MATARS) sites. Days between injury and symptom resolution, and injury and return to sport (dependent variables) for collegiate athletes who did or did not receive academic adjustments (independent variable) were analyzed using Mann-Whitney U tests.
Results:
The number of days between date of injury and symptom-resolution between those who did (median = 9 [interquartile range = 5,16]) and did not have (7[3,12]) academic adjustments were statistically different (z=-2.76, p < 0.01, r=-0.17). However, no differences were observed between days to return to sport among those who did (14[10,22]) and did not (13[8,20]) receive assigned academic adjustments (z= -1.66, p = 0.10, r= -.10).
Conclusions:
Recovery trajectories were similar between athletes diagnosed with a SRC who did or did not receive academic adjustments.. Our findings suggest academic adjustments supported recovery for those who needed academic adjustments. Clinicians and healthcare professionals should assist and support collegiate athletes after SRCs on an individual basis, including academic adjustments when appropriate based on patient presentation.
... Further, the natural progression from direct language translations should also include culturally relevant and ecological measures of concussion among diverse communities. This may include community integration, or the inclusion of culturally appropriate social roles following injury; a paradigm that has been well established in traumatic brain injury research (53,54). Moreover, there are limitations in the availability of concussion education materials across different languages. ...
Objective:
The purpose of this study was to characterize the associations of international student status and native language on time (in days) with the date of injury to (i) diagnosis, (ii) symptom resolution, and (iii) return to sport.
Methods:
Utilizing data from a cross-sectional cohort of 1,044 concussion cases from LIMBIC MATARS member institutions (n = 11) in the US, we conducted two, matched case-control designs. Cases were divided into two groups: (i) international (n = 32) or domestic students (n = 32) and (ii) English as an Additional Language (EAL) speakers (n = 18) or Native English language speakers (n = 18). Both groups were individually matched to their respective controls based on gender, age, sport, and preexisting health conditions.
Results:
There were no significant differences in days from injury to diagnosis (p = 0.94), symptom resolution (p = 0.64), or return to sport (p = 0.15) between international and domestic athletes. EAL speakers experienced symptom resolution approximately 7.5 days sooner (Md = 4.50; IQR = 4.00, 8.00) than Native English language speakers (Md = 12.00; IQR = 7.00, 21.00, p = 0.01).
Conclusions:
Our findings suggest that native language is associated with symptom resolution in collegiate athletes. Healthcare professionals should consider barriers related to native language that may impact symptom reporting and the overall injury experience of diverse collegiate athletes.
... Community integration is the engagement of an individual following a disability in social roles that are culturally and developmentally appropriate. 1 Community integration is described as the ultimate goal of rehabilitation interventions. 2,3 The reason is that successful community integration is often synonymous with physical accessibility, sufficient and satisfactory opportunities for social participation, a network of reciprocal social relations, a sense of belonging to one's environment and fewer identity issues. ...
Objectives
This systematic review documents the content and the quality of the psychometric evidence concerning the utilization of the Community Integration Questionnaire for individuals living with a disability other than a traumatic brain injury.
Data sources
Medline, Embase, CINAHL, OTseeker and PsycINFO (searched from inception to June 2019).
Review methods
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for conducting and reporting this review. Studies that investigated at least one psychometric property of the Community Integration Questionnaire for individuals living with a disability other than traumatic brain injury were included. Data extraction and critical methodological appraisal of the articles (MacDermid checklist, COnsensus-based Standards for the selection of health Measurement INstruments checklist) were independently performed and validated by the first two authors.
Results
Ten studies representing 3000 individuals met the inclusion criteria. Five populations were documented. There are positive and trustable data regarding internal consistency for adults living with multiple sclerosis, spinal cord injury or burns and in mixed samples (α = 0.71–0.84). Construct validity is fairly documented for adults living with multiple sclerosis or aphasia and in mixed samples. Test–retest reliably is acceptable for adults living with multiple sclerosis (intraclass correlation coefficient = 0.91–0.97) as well as responsiveness (area under the receiver operating characteristic curve = 0.81). Other psychometric properties could not be demonstrated sufficiently solid.
Conclusion
Many psychometric properties of the Community Integration Questionnaire are still poorly evaluated for adults living with a disability other than a traumatic brain injury. However, promising data have been documented in each population included in this review.
... Beyond focusing on reducing medical secondary complications, positive self-management behavior can be important for facilitating social participation and improving overall wellbeing as individuals transition from rehabilitation into the community [34]. Challenges experienced by individuals with SCI reintegrating back into the community are partly attributable to limited opportunities for meaningful social participation, including leisure pursuits [35]. A study found that for individuals with SCI, injured at least 10 years prior, participation in sport and recreational activities decreases from 84% pre-injury to 47% postinjury [36]. ...
With decreasing inpatient rehabilitation lengths of stay, there may be a greater risk of spinal cord injury (SCI) populations being discharged into the community without the self-management skills needed to prevent secondary complications. Recent advancements in mobile health has made mobile apps a feasible method of delivering population-based, self-management interventions to address SCI-specific secondary complications. The objective of this study is to describe stakeholder perspectives on the development of a functional mobile app to facilitate self-management skills needed to prevent secondary complications following recent SCI during inpatient rehabilitation. A user-centered design approach was used that involved an evolving mobile app and the collection of prospective qualitative data. Stakeholders from three groups were enrolled in the study: individuals admitted for rehabilitation following SCI (n = 20) and informal (n = 7) and formal (n = 48) caregivers. Iterative feedback was gathered from rehabilitation inpatients during ongoing interactions and via post-discharge exit questionnaires, from informal caregivers via one-on-one interviews, and from formal caregivers via series of focus groups at various phases throughout the design process. Three main themes emerged from the analysis: (1) being individualized and user friendly (i.e., developing an app that is simple and easy to use to facilitate universal uptake), (2) targeting goals to promote self-management (i.e., adopting self-management skills relative to personal goals and confidence), and (3) increasing participation and support-seeking to facilitate lifestyle change (i.e., encouraging leisure activities to facilitate community integration). Key stakeholder perspectives contributed to the development of a self-management mobile app that will be evaluated in future research.
... The overall community integration at 20-year follow-up did not differ from the general population (Corrigan, 1994), suggesting successful long-term community reintegration (Wood & Rutterford, 2006). Age and gender had no impact on community reintegration. ...
Objectives
The study describes functional outcomes and health‐related quality of life (HRQL) in patients with traumatic brain injury (TBI) 20 years postinjury.
Materials and Methods
Forty‐four survivors who acquired moderate and severe TBI during 1995–1996 were followed 10 and 20 years postinjury. Outcomes were Glasgow Outcome Scale Extended (GOSE), Community Integration Questionnaire (CIQ), and SF‐36 questionnaire (SF‐36). Multiple regressions were performed to examine the relationship between follow‐up measurements, controlling for baseline demographics and injury severity.
Results
There were no significant differences in baseline age and civil status between moderate and severe TBI, but patients with severe injury had significantly lower employment rates (p = 0.05). Mean age at 20‐years follow‐up was 50.8 (SD 11.4) years, and 73% were males. Most patients showed good recovery (52%) or moderate disability (43%). Disability levels remained stable between and within severity groups from 10 to 20 years. Community integration including social integration improved from 10 to 20 years (p = 0.01 and p = 0.005, respectively). HRQL remained stable, except for subscales Bodily Pain and Role Emotional (p = 0.02 and p = 0.06). Depression at 10 years and females were associated with poorer mental health, while productive activity at 10 years indicated better physical and mental health at 20 years postinjury, respectively.
Conclusions
Functional limitations persist even decades after moderate and severe TBI, with poorer prognosis for females and persons who were depressed at the 10‐year follow‐up. Development and evaluation of targeted long‐term follow‐up programs and access to rehabilitation services for these groups should be highlighted. Improved community integration despite stable functional limitations draws attention to long‐term adaptation to adversity and illness.
... To address these issues, the interprofessional team initiated the development of a specialized service to help persons with SCI successfully participate in their physical and psychosocial environment. Specifically, the service would provide a structured platform to enable people with SCI to reflect on their experiences living with the injury and acquire the necessary skills and knowledge to engage (or resume) in appropriate social roles, statuses, activities, and productive behaviours in "natural" community settings [17,18]. With support from the organization, inkind contributions (e.g., provision of space, clinical release time to develop the service, etc.) were provided to staff to establish and deliver a time-specific pilot project to promote better outcomes in the community for outpatients with SCI. ...
... 16 One of the more formal definitions reported in the literature views community integration as individuals' ability to resume their social roles, as appropriate within their cultural and developmental context, after sustaining a TBI. 17 Numerous studies have documented decreased community integration among individuals with TBI in key life domains such as employment, 18,19 leisure activities, 7,12,20 ability to live independently, 7,12 and ability to drive. 7, 21 Corrigan and colleagues found that community integration, as assessed by the Community Integration Questionnaire (CIQ), was relatively stable over the first five years after TBI. ...
The aims of this study were to assess the trajectories of community integration in individuals with traumatic brain injury (TBI) through 1, 2, and 5 years post-injury and to examine whether those trajectories could be predicted by demographic and injury characteristics. A longitudinal cohort study was conducted with 105 individuals with moderate-to-severe TBI admitted to a Trauma Referral Centre in 2005-2007. Demographics and injury-related factors were extracted from medical records. At the 1-, 2- and 5-year follow-ups, community integration was measured by the Community Integration Questionnaire (CIQ). A hierarchical linear model (HLM) examined whether longitudinal trajectories of community integration could be predicted by: time, sex, age, relationship status, education, employment status, occupation, acute Glasgow Coma Scale score, cause of injury, days in posttraumatic amnesia (PTA), CT Marshall Score, and injury severity score. CIQ scores improved across the three time points (p < .001). Additionally, higher trajectories of community integration were predicted by being single at the time of injury (p < .001), higher level of education (p = .006), employment (p < .001), and a shorter length of PTA (p < .001). In a follow-up HLM with interaction terms, time*PTA was statistically significant (p < .001), suggesting that participants with longer PTA increased in community integration more rapidly than those with shorter PTA. The longitudinal course of community integration described in this study may help rehabilitation professionals to plan more extensive follow-ups and targeted rehabilitation programs in the early stage of recovery for patients with specific demographic and injury characteristics.
... To address these issues, the interprofessional team initiated the development of a specialized service to help persons with SCI successfully participate in their physical and psychosocial environment. Specifically, the service would provide a structured platform to enable people with SCI to reflect on their experiences living with the injury and acquire the necessary skills and knowledge to engage (or resume) in appropriate social roles, statuses, activities, and productive behaviours in "natural" community settings [17,18]. With support from the organization, inkind contributions (e.g., provision of space, clinical release time to develop the service, etc.) were provided to staff to establish and deliver a time-specific pilot project to promote better outcomes in the community for outpatients with SCI. ...
Objective. To evaluate the effectiveness of a community reintegration outpatient (CROP) service for promoting well-being and
community participation following spinal cord injury (SCI).
Participants. Community-dwelling adults (N = 14) with traumatic and nontraumatic SCI. Interventions. The CROP service is a 12-week (1 × week; 120 minutes) interprofessional closed therapeutic education service. Main Outcome Measure(s). Moorong Self-Efficacy Scale (MSES); Impact on Participation and Autonomy (IPA); Positive Affect and Negative Affect Scale (PANAS); Coping Inventory of Stressful Situations (CISS); World Health Organization Quality of Life (WHOQOL-BREF); semistructured qualitative interviews. Methods. Twenty-one participants were recruited from two subsequent CROP services, with only 14 persons completing all data assessments.
Data were collected at baseline (week 0), at exit (week 12), and at a three-month follow-up. Semistructured interviews were conducted at exit. Results. Self-efficacy (MSES) and positive affect (PANAS) improved from baseline to exit (P < .05), but the changes were not maintained at follow-up. Qualitative analysis identified four major themes related to therapeutic benefits: (1) role of self; (2) knowledge acquisition; (3) skill application; and (4) group processes. Conclusions. Participation in a therapeutic education service has the potential to improve well-being in persons with SCI, but there is a need to identify strategies to maintain long-term gains.
... The task of defining and assessing community integration is complex and there does not "seem to be a single, universally accepted definition for this construct" (Salter, Foley, Jutai, Bayley, & Teasell, 2008, p. 820). According to Corrigan (1994), community integration is defined as "the assumption or resumption of culturally and developmentally appropriate social roles following disability" (as cited in Sander et al., 2010, p. 123). Community reintegration is the process of adjustment in social and workrelated activities after sustaining a life-changing and disabling event. ...
Purpose: The purpose of the study was to measure predictors of community reintegration and empirically test the resiliency model of family stress, adjustment, and adaptation in persons with traumatic brain injury (TBI). The study also aimed to measure family needs by surveying
caregiving family members through the use of the Family Needs Questionnaire (FNQ). Primary caregivers of those with TBI were surveyed using a convenience sample accessed through the Brain Injury Association of Florida.
Methods: Participants were asked to complete a multiple-choice
questionnaire in exchange for a gift card. The questionnaire comprises demographic questions and five standardized instruments (Family Crisis Oriented Personal Evaluation Scales, Family Inventory of Resources for Management, Family Coping Coherence Index, FNQ, and Community Integration Questionnaire).
Results:
Results of the study validate the resiliency model and place emphasis on family coherence as the strongest predictor within the model. Results similarly support the importance of all other factors of family resiliency and addressing needs of the family specific to TBI.
Conclusion:
In closing, the article provides recommendations for counselors working with families with members with TBI.
... The task of defining and assessing community integration is complex and there does not "seem to be a single, universally accepted definition for this construct" (Salter, Foley, Jutai, Bayley, & Teasell, 2008, p. 820). According to Corrigan (1994), community integration is defined as "the assumption or resumption of culturally and developmentally appropriate social roles following disability" (as cited in Sander et al., 2010, p. 123). Community reintegration is the process of adjustment in social and workrelated activities after sustaining a life-changing and disabling event. ...
Purpose: The purpose of the study was to measure predictors of community
reintegration and empirically test the resiliency model of family stress, adjustment,
and adaptation in persons with traumatic brain injury (TBI). The study also aimed
to measure family needs by surveying caregiving family members through the use of
the Family Needs Questionnaire (FNQ). Primary caregivers of those with TBI were
surveyed using a convenience sample accessed through the Brain Injury Association of
Florida.
Methods: Participants were asked to complete a multiple-choice questionnaire in
exchange for a gift card. The questionnaire comprises demographic questions and five
standardized instruments (Family Crisis Oriented Personal Evaluation Scales, Family
Inventory of Resources for Management, Family Coping Coherence Index, FNQ, and
Community Integration Questionnaire).
Results: Results of the study validate the resiliency model and place emphasis on
family coherence as the strongest predictor within the model. Results similarly support
the importance of all other factors of family resiliency and addressing needs of the
family specific to TBI.
Conclusion: In closing, the article provides recommendations for counselors working
with families with members with TBI.
... Community reintegration following TBI is a dynamic and multidimensional process including assumption or resumption of culturally and developmentally appropriate social roles following disability (Corrigan, 1994;Salter, Foley, Juati, Bayley, & Teasell, 2008;Sander et al., 2010). Successful community reintegration is a primary rehabilitative goal for persons with TBI (Resnik, Bradford, Glynn, Jette, Hernandez, & Wills, 2012;Salter et al., 2008;Sander, et al., 2010;Sperry, 2009;Willer, Rosenthal, Kreutzer, Gordon, & Rempel, 1993) and has implications in the field of mental health counseling (Sperry, 2009). ...
Traumatic Brain Injury (TBl) is complex and unique, encompassing a myriad of challenges for the person with the injury, rehabilitation counselors, and the survivor's family and friends. The challenges can affect work and family reintegration. Sustaining a TBI can result in familial strain as it affects the role and function of the individual with TBI in the family. Manifestations can include financial, psychological, and caregiver-related stress. Since individual andfamily coping mechanisms interrelate, it is important for rehabilitation counselors to appreciate theoretical constructs offamily resiliency. This article explores the rehabilitation counselor's need to assess the connectedness of family resiliency and community reintegration outcomes in persons with TBl; it also underscores the importance of evaluating family-inclusive rehabilitative interventions.
... 53). Corrigan (1994) identified community integration as the "assumption or resumption of culturally and developmentally appropriate social roles" (p. 110). ...
Community integration is one of the most important as well as most frequently identified goals of rehabilitation and habilitation for people with disabilities. Although rehabilitation professionals have identified community integration as an important goal, the role of community leisure service providers in this process has not been as clear. This article offers the core ideas associated with community integration. In addition, using Duck's (1994) theoretical model of social relationships, this paper presents how social relationships are developed in order to engage in social support. Further, this paper demonstrates how leisure could be used to facilitate development of meaningful relationships. Such information can clarify the professional's role in providing community integration services.
... In the pathomechanism of such disorders in post-TBI adolescents, the most important role is played by frontal lobe injuries [3,7,9]. Frontal lobe areas are injured quite often as a result of damage related to the mechanism of the brain injury itself, especially in the case of motor vehicle accidents [10–12]. Although scientific neuropsychological studies of this phenomenon have been conducted for dozens of years [13] the brain mechanisms are not yet fully understood [14]. ...
The aim of this research was to evaluate the effectiveness of the post-accessive Conduct Disorder Therapy Program administered within the "Academy of Life" in the reduction of behavioural disorder in adolescents following traumatic brain injury (TBI).
100 adolescents from Gdansk and adjacent areas, psychiatrically diagnosed with "frontal lobe syndrome" following a TBI, were examined. Group A included 50 participants examined and treated at the Reintegration and Training Center of the Foundation for Persons with Brain Dysfunctions. Group B comprised 50 people matched for age and sex, under treatment at the Gdansk Center for Neuropsychological Studies, Gdansk-Południe Non-Public Health Care Center. Group A used the above therapy programme, while group B did not. The studies included an analysis of documentation, neuro-imaging (CT or MRI), clinical interviews, the Mini-Mental State Examination and the Frontal Behavioural Inventory.
The therapy program had a significant impact on conduct disorders, the most visible differences being within neurological disorders and the least visible within cognitive disorders. It also influenced the social reintegration of adolescents following TBI, as demonstrated by the greater increase in the percentage of participants from group A returning to school and hobbies practised before the accident.
The results indicate that the evaluated therapy program is effective in reducing behavioral disorders in adolescents following brain injury, and their reintegration into society.
... 17 fere with normal motor function, and can cause discomfort; however, reflex hyperexcitability is also purported to have beneficial effects, including the prevention of muscle wasting and deep vein thrombosis. 22 Theories have been proposed that offer different possible neurophysiological and mechanical mechanisms for the potential positive effects of casting on reflex hyperexcitability and mechanical changes. These mechanisms include the stretch imposed by the cast, the warmth provided by the enclosed structure, and the stability provided by the external structure. ...
Many controversies exist regarding the practicality, the theoretical premises, and the supporting evidence for the use of casts in the management of joint hypomobility and hypertonia (ie, increase in joint resistance to passive movement resulting from hyperactivity of the stretch reflex and/or changes in the muscles and connective tissues). The purpose of this review was to determine current best practice for the use of casting in the rehabilitation of adults with brain injury. A systematic review was undertaken to find studies that quantified the effectiveness of casting in adults with brain injury. Thirteen articles that presented experimental or case report evidence on casting were analyzed using Sackett's levels of evidence and were examined for scientific rigor. A grade B recommendation is given for the use of casting to increase passive range of motion or to prevent its loss, and implications for further research are provided.
Purpose:
Traumatic brain injury (TBI) is a chronic disease process and a public health concern that disproportionately impacts Black populations. While there is an abundance of literature on race and TBI outcomes, there is a lack of scholarship that addresses racism within rehabilitation care, and it remains untheorized. This article aims to illuminate how racism becomes institutionalized in the scientific scholarship that can potentially inform rehabilitation care for persons with TBI and what the implications are, particularly for Black populations.
Material and methods:
Applying Bacchi's What's the Problem Represented to be approach, the writings of critical race theory (CRT) are used to examine the research about race and TBI rehabilitation comparable to CRT in other disciplines, including education and legal scholarship.
Results:
A CRT examination illustrates that racism is institutionalized in the research about race and TBI rehabilitation through colourblind ideologies, meritocracy, reinforcement of a deficit perspective, and intersections of race and the property functions of whiteness. A conceptual framework for understanding institutional racism in TBI rehabilitation scholarship is presented.
Conclusions:
The findings from this article speak to the future of TBI rehabilitation research for Black populations, the potential for an anti-racist agenda, and implications for research and practice.
Objectives:
The objective of this study was to understand the relative contribution of acute motor versus cognitive functioning on community integration 1 year after moderate-severe traumatic brain injury (TBI).
Methods:
Secondary data analysis of 779 participants in the TBI Model Systems National Database who experienced a moderate-severe TBI requiring inpatient rehabilitation. Participants were categorized into four groups: low motor/low cognition, low motor/high cognition, high motor/low cognition, or high motor/high cognition. Community integration outcomes measured 1 year post-TBI included the Participation Assessment with Recombined Tools-Objective (PART-O), driving status, Supervision Rating Scale, residence, re-injury, and employment status.
Results:
Participants with both high motor/high cognition had higher scores on the PART-O total score (p < 0.001), living independently (p = 0.023), living in a private residence (p = 0.002), and being employed (p = 0.026) at 1 year. Participants with high motor/high cognition and high motor/low cognition had higher odds of driving (p = 0.001 and p = 0.034, respectively) when compared to low motor/low cognition. All groups relative to the low motor/low cognition group had higher odds of being re-injured.
Discussion and conclusions:
High motor and high cognitive function at rehabilitation are associated with favorable community integration outcomes 1 year post-injury, though greater participation afforded by high function may confer elevated risk of re-injury.
Traumatic brain injury (TBI) is commonly associated with problems in social functioning. There have been very few studies conducted to elucidate the specific contribution of cognitive deficits to these problems. Previous studies have suggested that executive impairment might be related to poor social decision-making. This study aimed to examine whether TBI was related to problems with the interpretation of social information and to what extent any problems were associated with executive impairment. The performance of seventeen TBI non-aphasic participants was compared to seventeen healthy control group participants matched in age, sex and NART IQ on neuropsychological tests of executive function, theory-of-mind-type social comprehension tasks and three real- life-type social tasks involving the interpretation of social information. The social interpretation tasks consisted of a pragmatic judgment task, a social skill judgment task and a conversation judgment task. The first two tasks presented a series of short written social interactions between pairs of characters. It was necessary to rate alternative verbal responses made by one character, which varied in their degree of context appropriateness and skill. The third task involved judging the manner and para-linguistic features of characters in an audible conversation. The TBI group performed more poorly on the pragmatic judgment and social skill judgment tasks. They demonstrated poor inferential sensitivity by failing to differentiate adequately between alternative responses. They were also significantly impaired on the measures of attention, executive function and theory-of-mind-type social comprehension, compared to the Control group. It was argued that difficulty appreciating the appropriateness and skilfulness of responses reflected poor inhibitory control resulting from deficits in executive functioning. Despite a lack of correlational evidence to support an executive explanation, this was considered more plausible to an account in terms of selective theory of mind impairment. TBI group performance on the conversation judgment task was generally similar to the Control group. They judged the manner of the characters as accurately as the Control group. However, they appeared less sensitive to the presence of para-linguistic features. It was speculated that this might have been due to poor attention or difficulties retaining and retrieving information. Overall, the findings suggest that there is a need for further research examining the interpretation of social information in TBI patients. The implications for rehabilitation were discussed.
Rehabilitation studies have recently demonstrated that the amount of time spent training is one of the most important factors in one’s ability to regain motor control. The methods employed need to be effective, but individuals need to spend significant amounts of time retraining. One of the most effective ways to enable more training time is for rehabilitation to occur in one’s home so individuals have adequate access to it and there is no cost associated with traveling to the clinic. There are several challenges that need to be overcome to make home rehabilitation more common; for example adapting the methods from the clinical setting to the home setting, ensuring safety, and providing motivation. This chapter outlines existing technologies for upper and lower limb rehabilitation and how they could be adapted for use in one’s home. Although many types of disabilities would benefit from home-based rehabilitation, this discussion will focus on traumatic brain injuries, specifically stroke related. Many of the methods that could be used at home for stroke would also have application for helping in other circumstances.
Clinical approaches based on the principles of behaviour modification and behaviour therapy have evolved into an experimental literature that demonstrates the benefit and efficacy of these approaches in mental illness, mental retardation, autism, and special education. Significant advantages of these learning-based therapies have reduced reliance on traditional psychodynamic models. Indeed, over the past 30 years, behavioural services have not only become a cornerstone of clinical psychology but have led to the development of new models of care for a host of other disorders and problems. This paper summarizes the historical perspectives and new directions in the field of behaviour analysis and therapy. Focusing on applications to paediatric medicine, we will trace the development of behavioural applications in this field and explore new extensions of the behavioural paradigm. By way of review of one of the newest areas of endeavour for behavioural medicine, traumatic brain injuries, we suggest future directions for the growth of behavioural approaches.
Bogner JA, Corrigan JD, Mysiw WJ, Clinchot D, Fugate L. A comparison of substance abuse and violence in the prediction of long-term rehabilitation outcomes after traumatic brain injury. Arch Phys Med Rehabil 2001;82:571-7. Objective: To 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 1 year postdischarge from rehabilitation. Setting: Specialized TBI acute rehabilitation unit. Participants: Three hundred fifty-one individuals consecutively admitted for rehabilitation. Interventions: Gathered data from patients' medical records (including etiology of injury, initial Glasgow Coma Scale scores, and FIM™ instrument scores at discharge), demographic details, and history of substance abuse; phone and mail survey data from individuals (Satisfaction with Life Scale [SWLS]; Community Integration Questionnaire [CIQ]). Main Outcome Measures: CIQ and SWLS; relative contributions of injury etiology, demographic and injury-related dependent variables, and substance abuse history to predictive model. Results: Almost 80% of persons with injuries from violence-related causes had a history of substance abuse. Substance abuse was found to contribute to the prediction of life satisfacton 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 after TBI, and to increase prevention efforts to limit the effects of such a history. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
In this study of 78 people living in the community 1 to 7 years after spinal cord injury, community integration and reported coping strategies were investigated for their association with life satisfaction. Community integration was measured in terms of objective and subjective handicap in social roles. Objective handicap, defined by the Craig Handicap Assessment and Reporting Technique (CHART), and subjective handicap, defined by the Perceived Handicap Questionnaire (PHQ), were hypothesized to show an inverse relationship with life satisfaction, as measured by the Life Satisfaction Index-Z (LSI-Z). It was hypothesized that each measure of handicap would provide unique explanation of variability in life satisfaction. Furthermore, it was hypothesized that differences in participants' use of coping strategies, measured via an abbreviated version of the Ways of Coping Questionnaire (abbrWOC), would be associated with differences in their reported handicap and life satisfaction. Participants' use of coping strategies was hyothesized to provide a unique explanation of their life satisfaction, even when considered together with the two measures of handicap. The study's hypotheses were partially supported. Objective and subjective measures of handicap were correlated with each and with life satisfaction. However, only perceived handicap provided a unique explanation of life satisfaction in a multivariate context. Two of the eight assessed coping strategies were associated with life satisfaction, but only one, escape-avoidance coping, remained significant when assessed in conjunction with handicap. These results are discussed in relation to a contemporary theory regarding the effects of individual characteristics and handicap on quality of life and directions for future study are discussed.
Objective
To provide biomedical researchers and clinicians with information regarding
and recommendations for effective rehabilitation measures for persons who
have experienced a traumatic brain injury (TBI).Participants
A nonfederal, nonadvocate, 16-member panel representing the fields of
neuropsychology, neurology, psychiatry, behavioral medicine, family medicine,
pediatrics, physical medicine and rehabilitation, speech and hearing, occupational
therapy, nursing, epidemiology, biostatistics, and the public. In addition,
31 experts from these same fields presented data to the panel and a conference
audience of 883 members of the public. The conference consisted of (1) presentations
by investigators working in areas relevant to the consensus questions during
a 2-day public session; (2) questions and statements from conference attendees
during open discussions that were part of the public session; and (3) closed
deliberations by the panel during the remainder of the second day and part
of the third. Primary sponsors of the conference were the National Institute
of Child Health and Human Development and the National Institutes of Health
Office of Medical Applications of Research.Evidence
The literature was searched through MEDLINE for articles from January
1988 through August 1998 and an extensive bibliography of 2563 references
was provided to the panel and the conference audience. Experts prepared abstracts
for their conference presentations with relevant citations from the literature.
The panel prepared a compendium of evidence, including a patient contribution
and reports from federal agencies. Scientific evidence was given precedence
over clinical anecdotal experience.Consensus Process
The panel, answering predefined questions, developed their conclusions
based on the scientific evidence presented during the open forum (October
26-28, 1998) and in the scientific literature. The panel composed a draft
statement that was read in its entirety and circulated to the experts and
the audience for comment. Thereafter, the panel resolved conflicting recommendations
and released a revised statement at the end of the conference. The panel finalized
the revisions within a few weeks after the conference. The draft statement
was made available on the Internet immediately following its release at the
conference and was updated with the panel's final revisions.Conclusions
Traumatic brain injury results principally from vehicular incidents,
falls, acts of violence, and sports injuries and is more than twice as likely
to occur in men as in women. The estimated incidence rate is 100 per 100,000
persons, with 52,000 annual deaths. The highest incidence is among persons
aged 15 to 24 years and 75 years or older, with a less striking peak in incidence
in children aged 5 years or younger. Since TBI may result in lifelong impairment
of physical, cognitive, and psychosocial functioning and prevalence is estimated
at 2.5 million to 6.5 million individuals, TBI is a disorder of major public
health significance. Mild TBI is significantly underdiagnosed and the likely
societal burden is therefore even greater. Given the large toll of TBI and
absence of a cure, prevention is of paramount importance. However, the focus
of this conference was the evaluation of rehabilitative measures for the cognitive
and behavioral consequences of TBI. Evidence supports the use of certain cognitive
and behavioral rehabilitation strategies for individuals with TBI. This research
needs to be replicated in larger, more definitive clinical trials and, thus,
funding for research on TBI needs to be increased.
Objective: Examine longitudinal changes in attribution of blame to self and others, and concern over cause of injury, in both intentional (violence-related) and unintentional (accidental) traumatic brain injury (TBI); investigate the relation of these factors to subjective well-being outcomes at 1 year post-TBI. Study Design: Prospective, multicenter, observational study with longitudinal component. Participants: 99 men with unintentional TBI and 25 men with intentional TBI who sustained moderate to severe injuries, received inpatient rehabilitation, and provided data in both acute rehabilitation and 1-year follow-up. Measures: Blame Attribution Questionnaire, General Health Questionnaire-30, Neurobehavioral Functioning Inventory-Revised Depression Scale, Satisfaction With Life Scale, community participation measures. Results: At both time points, participants with intentional TBI blamed others more while those with unintentional TBI blamed themselves more (trend). Other-blame at 1 year predicted depression but not life satisfaction. Self-blame was not a significant predictor of depression or life satisfaction. Increasing concern over cause/blame for injury from acute rehabilitation to follow-up was associated with high levels of emotional distress. Conclusion: Blame attribution issues may be markers of TBI-related emotional distress regardless of injury etiology, particularly when others are blamed for the injury and/or concerns over cause of injury do not resolve over time. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective: Describe the pre- and postinjury patterns of alcohol and other drug use among persons who have incurred traumatic brain injury (TBI). Injury-related characteristics and negative consequences are also reported, as well as preliminary outcomes of treatment.
Design: Descriptive analysis of a consecutive sample of persons referred during an 18-month period to a treatment program for substance abuse after TBI.
Setting: A community-based demonstration project affiliated with an acute rehabilitation hospital in a large midwestern academic medical center.
Patients: The first 211 persons screened by the program, including all 97 receiving comprehensive assessments and 68 who dropped out prior to assessment. Preliminary outcomes were based on the first 37 clients monitored 6 months after entering into treatment.
Intervention: Screening for appropriateness of referral; comprehensive, holistic assessment; and resource and service coordination provided by an interdisciplinary staff that facilitates treatment by local providers.
Main Outcome Measures: Alcohol use measured by the Quantity-Frequency-Variability Index, completed by client and significant other; productivity measured by the Employability Rating Scale; multiple sociodemographic indicators.
Results: More than 60% of injuries were use related; this included 71% of assaults. Alcohol was the preferred drug for 83%, and more than half used some marijuana. Prior to injury, the study sample consumed significantly greater amounts of alcohol than national averages; after injury, consumption was consistent with national averages. Approximately 20% of individuals who abstained or were light drinkers before injury showed high volume use after injury.
Conclusions: There are multiple reasons why the harmful effects of alcohol and other drug use after TBI are underestimated, including cultural acceptance of beer and the subtle sequelae of marijuana use. It is recommended that the extent of use of same-aged peers not be used as the criterion for acceptable use by persons who have experienced TBI. Further study is needed regarding the utility of assessment devices, the effectiveness of referrals made during rehabilitation, and the efficacy of intervention techniques.
(C) Williams & Wilkins 1995. All Rights Reserved.
The Community Integration Questionnaire (CIQ) was developed as a measure of reassumption of roles, responsibilities, and relationships by persons with traumatic brain injury (TBI). In this article, data from a number of studies relevant to the CIQ's psychometric qualities (reliability, sensitivity, validity, and subscore and total score distributions) are summarized, and its scope, content validity, metric, norms, and age and gender effects on scores are discussed. Recommendations are made for the use of the CIQ, and for research needed to improve the utility of the current measure as well as to develop a better one.
(C) Williams & Wilkins 1997. All Rights Reserved.
Children who have suffered traumatic brain injury (TBI) or have neurological impairments due to disease, toxins, or genetic makeup present challenges that are best addressed by coordinated treatment and support activities among all their caregivers. Such systematic approaches to treatment, rehabilitation, teaching, and parenting are both complex to describe and difficult to create and maintain. The goal of this chapter is to focus on one of the key systems that affects children’s learning and behavioral adjustments: the interface between schools and families. Other Handbook authors have described specialized consultation to teachers needed to support their efficacy with children. This chapter offers information that psychologists can share with educators to inoculate educators to the unique stresses that families endure. Further, a particular approach to shared needs identification, goal setting, and problem solving is described so that educators and families can form a supportive team that enhances students’ success. Finally, some of the other activities that school and families can share, such as advocacy and family education and counseling, are explored. The etiology of a learner’s neurological challenge is sometimes relevant to highlight given the different influences on recovery and on family functioning. Often, however, the educator is dealing with a child and family in need of help and support, wherein the etiology of the difficulty is unimportant. For this reason, we use the term “affected child” to refer to a child with neurological difficulties from any cause. If etiology does moderate intervention or outcomes, it is described specifically.
Introduction:
Adults sustain significant, often irreversible impairments following brain injury. The process they go through coming to terms with these impairments can seriously interfere with their readiness to engage in rehabilitation.
Aim:
This study aimed to look beyond the development of self-awareness and insight in order to explore the concept of readiness as it relates to clients' experiences of engaging with therapy.
Method:
Sixteen in-depth interviews were conducted with 14 adults with a moderate-severe traumatic brain injury (TBI) and nine of their significant others. These participants were asked to speak about the continuum of care they experienced and the factors that effected their engagement with care.
Results:
The results of this study indicated that participants believed their ability to engage in therapy was related to the degree to which they were aware of and accepted their impairments and motivated to engage in rehabilitation. Participants reported that the rate and degree to which they developed awareness varied according to the type of impairments they experienced (i.e. physical vs cognitive). Participants also stated that one way to augment their awareness was to compare their new vs old selves and to compare their recovery to those of others with a similar impairment. Finally, participants reported that it was important to be able to access services when they had accepted their impairment and were ready to engage in therapy.
Conclusion:
The clinical implications for considering the degree of awareness of impairments and readiness for engagement in care of an adult with a moderate-severe TBI are discussed in relation to future services planning.
As triumphant as the survivor, family, and neuro-rehabilitation team may be on the day of a successful discharge, it is premature
to forecast continued growth or even stability at a later date. Numerous studies suggest ongoing challenges experienced by
both survivors and caregivers, which can persist years after the injury, and long after rehabilitation ends, as is illustrated
by the case of LV, below.
To evaluate the contribution of social communication abilities and affective/behavioral functioning to social integration outcomes for persons with traumatic brain injury (TBI).
Prospective cohort study.
A total of 184 adults with TBI (72.8% men) evaluated at least 6 months postdischarge from acute care or inpatient rehabilitation hospitals and after living at least 3 months in the community postdischarge (Mean = 7.84 months postinjury).
La Trobe Communication Questionnaire (LCQ), Assessment of Interpersonal Problem-Solving Skills(AIPSS), Affective Behavioral subscale From the Problem Checklist of the Head Injury Family Interview (AB-HIFI), Craig Handicap Assessment and Reporting Technique-Short Form Social Integration subscale (CHART-SF-SI), Community Integration Questionnaire Social Integration subscale (CIQ-SI).
Social communication measures (LCQ, AIPSS) and self-reported behavioral functioning (AB-HIFI) contributed significantly to concurrently measured social integration outcomes after controlling for demographic and injury-related variables. Separate hierarchical multiple regression analyses revealed that social communication and behavioral variables accounted for 11.3% of variance in CIQ-SI and 16.3% of variance in CHART-SF-SI.
Social communication abilities and affective/behavioral functioning make a substantial contribution to social integration outcomes after TBI. The implications of such evidence for clinical assessment and intervention are discussed.
Full community integration, or participation in society, is the ultimate goal of rehabilitation and of research conducted in the field of rehabilitation for persons with traumatic brain injury (TBI). Community integration has been traditionally defined by 3 main areas: employment or other productive activity, independent living, and social activity. However, these have not always received equal weighting and attention in clinical or research efforts. Significant gaps remain in our understanding of factors that impact community integration and in our ability to intervene to improve participation for persons with TBI. This article describes 3 main challenges for researchers and rehabilitation professionals. First, a comprehensive meaning of community integration is needed, which includes the viewpoints and preferences of persons with TBI. Second, cultural competence in measurement and intervention is needed. Third, a thorough assessment of environmental factors impacting participation is needed and should be incorporated into research and treatment planning.
Despite the importance of community integration to individuals with traumatic brain injury, it is assessed relatively infrequently. The present paper provides a review of current approaches to the assessment of community integration, including evaluation of psychometric and administrative properties reported in the literature.
Based on results from existing systematic reviews, the Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique (CHART), Reintegration to Normal Living Index (RNLI), Sydney Psychosocial Reintegration Scale (SPRS) and Community Integration Measure (CIM) were included in the present study. Descriptive details are provided along with results of psychometric evaluations and discussion of the strengths and limitations associated with each instrument.
The instruments reviewed all provide assessment of three core elements of community integration: relationships with others, independence in one's own living situation and meaningful activities. Within the context of available information, the CIQ and RNLI appear the most reliable and valid, objective and subjective assessments of community reintegration, respectively. Caution is recommended in use of these tools by proxy raters. Unfortunately, with the exception of the CIQ and RNLI, evaluation of measurement characteristics and clinical usefulness is lacking. To promote an informed process of selection of tools, further evaluation is recommended.
This article describes a pilot programme initiated in 1991 to address the problems of substance abuse among persons who have experienced traumatic brain injury (TBI). The model of treatment is community-based, using an interdisciplinary staff with expertise in TBI, vocational rehabilitation, and substance abuse treatment, to support and enhance existing services in the client's own community. The primary method of intervention is resource and service coordination. Six principles that serve as the underpinnings of the model are described, as are core and supplemental services and staffing patterns. Innovative components of the programme include the theoretical model of changing addictive behaviours used to guide treatment, and the development of community teams to facilitate a coordinated and integrated approach. The programme has relatively low start-up costs and can serve both urban and rural populations. Clinical experience and initial programme evaluation results suggest that substance abuse and vocational rehabilitation goals can be effectively attained using this model of service delivery.
Replicate and extend studies of the construct validity of the Functional Independence Measure (FIM) for persons with traumatic brain injury (TBI).
A cross-sectional study of admissions to acute rehabilitation evaluated 6 months to 5 years after discharge.
An inpatient brain injury rehabilitation unit in a large, academic medical center.
Ninety-five patients with primary diagnosis of TBI stratified by time postdischarge.
Prediction of (1) average daily minutes of assistance and (2) supervision required in comparison to the Sickness Impact Profile (SIP) and SF-36.
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.
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.
To examine the extent to which outcomes from traumatic brain injury differ as a function of time and can be predicted at discharge from inpatient rehabilitation.
Survey method employing cross-sectional analyses.
An inpatient brain injury rehabilitation unit in a large midwestern academic medical center.
Ninety-five adults with traumatic brain injuries, 6 months to 5 years after inpatient rehabilitation, stratified by time postdischarge.
Functional Independence Measure (FIM), 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.
Substance abuse, need for supervision, life satisfaction, and selected subscales of the CIQ and CHART differed over the period 6 months to 5 years after discharge. Approximately 75% of the variance in current FIM scores, and 40% to 50% of CHART, CIQ, and SIP total scores, could be predicted at time of discharge.
Outcomes over the first 5 years after discharge were dynamic, with most change being improvement, at least after the first 2 years. Important aspects of outcome could not be predicted based on premorbid characteristics, injury severity, and initial functional abilities.
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.
To 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.
Longitudinal study of outcomes 1 year postdischarge from rehabilitation.
Specialized TBI acute rehabilitation unit.
Three hundred fifty-one individuals consecutively admitted for rehabilitation.
Gathered data from patients' medical records (including etiology of injury, initial Glasgow Coma Scale scores, and FIMtrade mark instrument scores at discharge), demographic details, and history of substance abuse; phone and mail survey data from individuals (Satisfaction with Life Scale [SWLS]; Community Integration Questionnaire [CIQ]).
CIQ and SWLS; relative contributions of injury etiology, demographic and injury-related dependent variables, and substance abuse history to predictive model.
Almost 80% of persons with injuries from violence-related causes had a history of substance abuse. Substance abuse was found to contribute to the prediction of life satisfacton and productivity, while violent etiology was not a significant contributor to predictive models.
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 after TBI, and to increase prevention efforts to limit the effects of such a history.
Evaluate changes in community integration for survivors of traumatic brain injury (TBI) who participated in a post-acute rehabilitation programme.
Cohort, prospective study investigating change from admission to post-discharge.Participants: Individuals, the majority of whom were diagnosed with severe TBI, were placed into one of two groups as follows: (1). admitted for treatment less than 1 year post-injury (L1Y) or (2). admitted for treatment between 1-5 years post-injury (G1Y).
The Community Integration Questionnaire (CIQ).
Both groups showed significant improvements from admission to follow-up; however, some CIQ findings were more pronounced for the L1Y group. Reliable change (RC) methodology was used to assess individual change. Results of this approach were consistent with group results, but tempered the perception of degree of change.
Findings cannot simply be attributed to neurological recovery and individual factors are important to examine when assessing change.
(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.
Telephone survey 1 year after injury of a prospective cohort of all people hospitalized with TBI in the state of Colorado during 2000.
Self-reported need for assistance in 13 areas of functioning.
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.
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.
To determine whether there is a latent structure among measures used to evaluate rehabilitation outcomes for persons with traumatic brain injury and if the construct of participation is discernible within this structure.
Exploratory factor analyses of 2 cross-sectional cohorts of rehabilitation patients who sustained a traumatic brain injury up to 5 years prior to assessment.
Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique (CHART), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Satisfaction With Life Scale (SWLS).
Both factor analyses suggested a latent structure composed of 3 factors that were interpreted as representing the Activities and Participation dimensions of the World Health Organization's International Classification of Functioning, Disability and Health (ICF), and a third representing Subjective Well-Being. Low to moderate correlations were found between factors.
The World Health Organization's ICF excludes subjective well-being; however the factor analyses indicate that it is a distinct domain not incorporated into Activities and Participation. The SF-36, CIQ, and CHART can, in combination, evaluate all 3 domains, but not alone. The SF-36 appears to be sensitive to the affective, but not the cognitive, aspect of Subjective Well-Being. A measure of life satisfaction would be a useful supplement to traditional measures of rehabilitation outcome.
To examine instrument reliability, validity, factor structure, and conceptual underpinnings of the Community Integration Measure (CIM) with the Community Integration Questionnaire Revised (CIQ-R) and the Satisfaction with Life Scale (SWLS).
A replication study.
Community living.
Ninety-one participants: 51 individuals with a brain injury, and 40 without brain injury.
Internal consistency, criterion validity, construct validity, discriminant validity factor structure.
CIM items produced standardized alphas ranging from 0.72 to 0.83. Significant positive correlations were found among the CIM and both the CIQ-R and SWLS, with the CIM performing better with the SWLS than did the CIQ-R. The CIM discriminated between subject samples as well as by living arrangement. The factor loading solution revealed a three-factor model that explained 63.72 percent of the variance.
The CIM shows good promise for capturing an individual's perception of community integration. The factor structure supports the original Model of Community Integration. Further research is needed to examine the influence of objective items on the CIM and Model of Community Integration.
ResearchGate has not been able to resolve any references for this publication.