At least 3 million Americans sustain a mild traumatic brain injury (mTBI) each year, and 1 in 5 have symptoms that persist beyond 1 month. Standards of mTBI care have evolved rapidly, with numerous ...expert consensus statements and clinical practice guidelines published in the last 5 years. This Special Communication synthesizes recent expert consensus statements and evidenced-based clinical practice guidelines for civilians, athletes, military, and pediatric populations for clinicians practicing outside of specialty mTBI clinics, including primary care providers. The article offers guidance on key clinical decisions in mTBI care and highlights priority interventions that can be initiated in primary care to prevent chronicity.
Objective: To characterize how mentorship has been perceived, received, and practiced by individuals in the field of rehabilitation psychology across the career lifespan. Method: Current members of ...the American Psychological Association Division 22 (Rehabilitation Psychology) were invited to complete an electronic survey via REDCap assessing individual experiences and perspectives on mentorship. Thematic analysis was used to identify key constructs and themes. Results: 39 participants (n = 25 mentors) completed the survey with valid responses. Participants spanned the career lifespan, ranging from predoctoral trainees to late-senior psychologists. Mentorship was generally perceived as helpful for both mentors and mentees. Several important qualities of mentors (e.g., availability, communication skills, self-disclosure, and emotional support) and mentees (e.g., flexibility, motivation, and openness to feedback) were identified. Among both groups, mentorship was viewed as especially beneficial for obtaining American Board of Professional Psychology (ABPP) board certification, which may reflect an aspect of mentoring unique to Division 22. Existing gaps in mentorship and key areas for improvement were also identified; access to mid- to late-career mentorship emerged as a notable gap in mentorship. Increased program structure, networking opportunities, and research mentorship were also identified as possible areas of growth. Conclusions: This study provides meaningful insights into mentorship within the field of rehabilitation psychology. Our findings demonstrate the value of mentorship across the career lifespan, and the beneficial role of mentorship in obtaining ABPP board certification. In addition, we identify key areas of growth that can inform and improve mentorship within the field.
Impact and ImplicationsThe results provide valuable insights into the perspectives of mentors and mentees regarding their views on mentorship, and can help mentors and mentees identify areas in need of improvement and guide them in fostering effective mentoring relationships. This study identifies the importance of mentorship across the career lifespan, wherein mentorship for individuals who are advanced in their careers is identified as being equally important, although not necessarily as available, as early career mentorship. APA mentoring programs should offer mentor-mentee matches specifically geared toward mid- to late-career psychologists.
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Objective: Develop and validate the Behavioral Assessment Screening Tool for Adolescents with brain injury.
Setting: Concussion clinics
Participants: Adolescents with mild traumatic brain injury ...3 months after initial concussion clinic visit (n = 138).
Design: Assessment development and validation (cross-sectional cohort) study
Main Measures: Behavioral Assessment Screening Tool - Adolescent
Results: Expert panel members added or modified items specific to adolescents to the original Behavioral Assessment Screening Tool for adults. The Content Validity Index was 97.2%. Exploratory factor analysis of the Behavioral Assessment Screening Tool - Adolescent reduced the initial 70 items to 46 primary items with a 3-factor solution: Negative Affect & Fatigue, Executive & Social Function, and Risk Behaviors. Internal consistency reliabilities ranged from good to excellent for all factors (Cronbach's α =.80-.95). We retained four secondary maladaptive coping items (from an initial six), though these require further modification and testing (Cronbach's α =.67).
Conclusion: The Behavioral Assessment Screening Tool for Adolescents, a measure of neurobehavioral symptoms after mild traumatic brain injury in adolescents, has a multidimensional factor structure with evidence of good internal consistency reliabilities. Future work will further evaluate its convergent and discriminant validity and employ item response theory analyses for validation in a new sample of adolescents with concussion.
Preliminary evaluation of the efficacy of a Web-based group intervention (Online EmReg) to improve emotion regulation (ER) in individuals with traumatic brain injury (TBI).
Pre-/post-within-subject ...design with baseline, end-of-treatment, and 12-week follow-up assessments.
Ninety-one individuals with TBI and deficits in ER.
Twenty-four sessions of training in ER skills delivered by group videoconference.
Difficulties in Emotion Regulation Scale (DERS), Positive Affect Negative Affect Schedule (PANAS), Satisfaction With Life Scale (SWLS), Problem Solving Inventory (PSI), Social Problem Solving Inventory-Revised: Short Form (SPSI-R:S), and Dysexecutive Questionnaire (DEX).
Significant changes with large effect sizes were found for the DERS at the 12-week follow-up assessment. Significant and moderate changes were found on the SWLS, DEX, PSI, and subscales of the PANAS and SPSI-R:S.
Online EmReg appears to be a promising method of delivering a group intervention to improve ER following TBI.
As part of an initiative led by the Brain Injury Special Interest Group Mild Traumatic Brain Injury (TBI) Task Force of the American Congress of Rehabilitation Medicine (ACRM) to update the 1993 ACRM ...definition of mild TBI, the present study aimed to characterize current expert opinion on diagnostic considerations.
Cross-sectional web-based survey.
Not applicable.
An international, interdisciplinary group of clinician-scientists (N=31) with expertise in mild TBI completed the survey by invitation between May and July 2019 (100% completion rate).
Not applicable.
Ratings of agreement with statements related to the diagnosis of mild TBI and ratings of the importance of various clinical signs, symptoms, test findings, and contextual factors for increasing the likelihood that the individual sustained a mild TBI, on a scale ranging from 1 (“not at all important”) to 10 (“extremely important”).
Men (n=25; 81%) and Americans (n=21; 68%) were over-represented in the sample. The survey revealed areas of expert agreement (eg, acute symptoms are diagnostically useful) and disagreement (eg, whether mild TBI with abnormal structural neuroimaging should be considered the same diagnostic entity as “concussion”). Observable signs were generally rated as more diagnostically important than subjective symptoms (Wilcoxon signed ranks test, Z=3.77; P<.001; r=0.68). Diagnostic importance ratings for individual symptoms varied widely, with some common postconcussion symptoms (eg, fatigue) rated as unhelpful (<75% of respondents indicated at least 5 out of 10 importance). Certain acute test findings (eg, cognitive and balance impairments) and contextual factors (eg, absence of confounds) were consistently rated as highly important for increasing the likelihood of a mild TBI diagnosis (≥75% of respondents indicated at least 7 out of 10).
The expert survey findings identified several potential revisions to consider when updating the ACRM mild TBI definition, including preferentially weighing observable signs in a probabilistic framework, incorporating symptoms and test findings, and adding differential diagnosis considerations.
To ascertain patient and caregiver satisfaction with an individualized case management intervention to improve transition from inpatient rehabilitation care to the community after traumatic brain ...injury (TBI).
Participants from 6 National Institute on Disability, Independent Living, and Rehabilitation Research-funded TBI Model Systems sites in the United States.
Adult, English-speaking patients with TBI who had moderate-to-severe TBI and were discharged from a TBI Model Systems site and who were in the intervention arm of the Brain Injury Rehabilitation: Improving the Transition Experience pragmatic clinical trial, as well as their caregivers.
A survey of participants in the intervention arm, which included an individualized case management program administered by a TBI Care Manager (TCM) who facilitated resource connection, education, and support.
Satisfaction with intervention was measured through Likert-scaled and open-ended questions. The survey was administered verbally through telephone, audio-recorded, and transcribed. Descriptive statistics were calculated for categorical variables, and content analysis was conducted for open-ended responses.
Patient and caregiver participants were satisfied with the intervention and highlighted the benefits of the interpersonal and practical support provided by the TCM. Participants identified the need for a more intensive intervention and clear expectations of the TCM role, as well as gaps in available medical and rehabilitation services in the community, as areas for improvement.
Patients with TBI and their caregivers reported satisfaction with the individualized case management program in supporting their transition from inpatient rehabilitation to the community. Further research is needed to understand the impact on outcomes.
The current prospective, multi-center, longitudinal cohort study examined how veterans/service members (V/SM) changed in their irritability, anger, and aggression (IAA) scores from admission to ...discharge in post-acute rehabilitation settings. The goals were to identify trajectory subgroups, and explore if there were different predictors of the subgroups. V/SM (
= 346) from five Veterans Affairs TBI Model Systems Polytrauma Rehabilitation Centers participated. The sample was mostly men (92%) and identified as white (69%), black (13%), and other races (18%). Median age was 28 years, and 78% had sustained a severe TBI. Staff rated IAA at admission and discharge using the Mayo-Portland Adaptability Inventory-4 item#15. Four IAA trajectory subgroups were identified: (1) no IAA at admission or discharge (
= 89, 25.72%), (2) resolved IAA (
= 61, 17.63%), (3) delayed onset IAA (
= 31, 8.96%), and (4) persistent IAA (
= 165, 47.69%). Greater post-traumatic stress disorder (PTSD) symptoms were the only consistent predictor of belonging to all the subgroups who had IAA compared with the no IAA subgroup. We conclude that IAA had different trajectories after a TBI. The majority of V/SM had persistent impairment from IAA, a quarter of the sample had no impairment from IAA, and fewer participants had resolving or worsening IAA. Findings emphasize the importance of educating providers and family of the different ways and times that IAA can manifest after TBI. Timely diagnosis and treatment of PTSD symptoms during and after rehabilitation are critical treatment targets.
To examine the breadth of education or training on the consequences of traumatic brain injury (TBI) for children and adolescents with TBI and their families/caregivers.
Systematic scoping review of ...literature published through July 2018 using eight databases and education, training, instruction, and pediatric search terms. Only studies including pediatric participants (age <18) with TBI or their families/caregivers were included. Six independent reviewers worked in pairs to review abstracts and full-text articles independently, and abstracted data using a REDCap database.
Forty-two unique studies were included in the review. Based on TBI injury severity, 24 studies included persons with mild TBI (mTBI) and 18 studies focused on moderate/severe TBI. Six studies targeted the education or training provided to children or adolescents with TBI. TBI education was provided primarily in the emergency department or outpatient/community setting. Most studies described TBI education as the main topic of the study or intervention. Educational topics varied, such as managing TBI-related symptoms and behaviors, when to seek care, family issues, and returning to work, school, or play.
The results of this scoping review may guide future research and intervention development to promote the recovery of children and adolescents with TBI.
To identify early predictors of US high school and college graduation after moderate-to-severe traumatic brain injury (TBI).
Inpatient rehabilitation and community.
TBI Model Systems participants, ...aged 16 to 24 years, enrolled as high school or college students at time of injury.
Prospective cohort study.
Successful graduation was defined as having a diploma (high school) or an associate/bachelor's degree (college) at 1-, 2-, or 5-year follow-up. Predictors were sex, race/ethnicity, urbanicity, preinjury substance abuse, primary rehabilitation payer, and functional independence at inpatient rehabilitation discharge.
We descriptively characterized differences between those who did and did not graduate high school and college within the first 5 years postinjury and identified early predictors of successful high school and college graduation using 2 binomial logistic regressions.
Of those with known graduation status, 81.2% of high school and 41.8% of college students successfully graduated. Graduates in both groups were more often White than Black and had more functional independence at discharge. Among high school students, preinjury substance abuse was also a risk factor for not graduating, as was identifying as Hispanic or "other" race.
Sociodemographic factors and disability influence graduation outcomes, requiring structural, institutional, and personal interventions for success.
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