Purpose: This study examined the extent to which resilience is associated with well-being outcomes after traumatic brain injury, and whether those relationships are independent of global personality ...traits, such as affectivity.
Materials and methods: Sixty-seven adults with complicated-mild to severe traumatic brain injury participated. Measures included the Connor-Davidson Resilience Scale, Modified Cumulative Illness Rating Scale, Disability Rating Scale, SF-12 Health Survey, Satisfaction with Life Scale, and Community Integration Measure.
Results: Objective physical health and disability showed modest relation to resilience, indicating that adverse health conditions and disability decreased with increasing resilience. The three measures of subjective well-being showed modest-to-strong positive relation to resilience. These correlations between resilience and well-being generally remained significant after accounting for negative and positive affectivity. Results also suggest that the influence of resilience on well-being has a threshold effect: a greater influence on outcome among people with low or inadequate resilience than among people with average or high resilience.
Conclusion: The experience of brain injury does not diminish the positive influence resilience may have on long-term well-being. Resilience may function as a buffer to trauma even in the challenging context of cognitive insult. Routine assessment of resilience might be beneficial to the rehabilitation team.
Implications for rehabilitation
Resilience is positively associated with subjective and objective well-being among adults with moderate-to-severe traumatic brain injury, and it appears to function among adults with traumatic brain injury similarly to adults without cognitive disabilities.
Resilience overlaps with overarching trait personality constructs such as affectivity; yet, it has unique characteristics and unique value in understanding well-being.
The adverse effects of low resilience show stronger influence on well-being than do the positive effects of high resilience.
Routine assessment of resilience might be beneficial to the rehabilitation team in understanding patients and their families, especially in discharge planning, where beliefs about personal capabilities to rebound from adversity shape likely future behavior.
To investigate the extent to which neuropsychologic and functional outcome after complicated mild traumatic brain injury (TBI) parallels that of moderate TBI recovery.
A longitudinal study comparing ...neuropsychologic and functional status of persons with complicated mild TBI and moderate TBI at discharge from inpatient rehabilitation and at 1 year postinjury.
Rehabilitation hospital with a Traumatic Brain Injury Model System.
Persons with complicated mild TBI (n=102), each with an intracranial brain lesion documented through neuroimaging and a highest Glasgow Coma Scale (GCS) score in the emergency department between 13 and 15, and 127 persons with moderate TBI.
Not applicable.
FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Wechsler Memory Scale logical memory I and II, Rey Auditory Verbal Learning Test, Trail-Making Test, Controlled Oral Word Association Test, Symbol Digit Modalities Test, Wisconsin Card Sorting Test, and block design.
Few differences in neuropsychologic performance existed between the TBI groups. Less severely impaired information processing speed and verbal learning were seen in the complicated mild TBI group at rehabilitation discharge and 1 year postinjury. Despite overall improvement across cognitive domains within the complicated mild TBI group, some degree of impairment remained at 1 year postinjury on those measures that had identified participants as impaired soon after injury. No differences on functional ability measures were found between the TBI groups at either time period postinjury, with both groups exhibiting incomplete recovery of functional status at the 1-year follow-up.
When classifying severity of TBI based on GCS scores, consideration of a moderate injury designation should be given to persons with an intracranial bleed and a GCS score between 13 and 15.
Pain acceptance is a robust predictor of adjustment to chronic pain; however, the dynamics of pain acceptance in daily life are largely unexamined. Furthermore, research on pain acceptance in those ...with pain and physical disability is needed. To examine pain acceptance in daily life, we collected 7 days of ecological momentary assessments of pain intensity and pain interference (5 times per day) with continuous accelerometry (physical activity) in 128 individuals with chronic pain and spinal cord injury. Multilevel modeling revealed that pain acceptance significantly moderated the momentary association between pain intensity and pain interference; those with higher pain acceptance experienced a blunted increase in interference when pain was high. Pain acceptance also moderated the association between pain intensity and physical activity; high pain acceptance was associated with an increase and low pain acceptance with a decrease in physical activity in the context of high pain. The activities engagement component of pain acceptance was a slightly more robust driver of these interaction effects; whereas activities engagement significantly moderated the association between momentary pain and pain interference as well as physical activity, pain willingness exerted a significant moderating effect on the momentary association between pain intensity and pain interference only. These findings suggest that both components contribute to the decoupling effects of pain acceptance. Task persistence did not show the same moderating effects, indicating that pain acceptance may be unique from other types of behavioral pain coping in its ability to decouple expected associations between pain intensity, pain interference, and physical activity.
In the daily lives of individuals with chronic pain and spinal cord injury, pain acceptance buffered expected increases in pain interference and decreases in physical activity in the context of high pain. These findings can inform further development of models of chronic pain adjustment and of more efficient, effective treatment approaches.
Purpose/Objective: To explore the extent to which Acceptance and Commitment Therapy (ACT) core processes are related to depressive symptoms and pain interference in a sample of individuals with ...spinal cord injury (SCI). Research Method/Design: 159 individuals with an SCI completed self-report surveys of 6 core processes of ACT and of 2 quality-of-life indicators (Spinal Cord Injury-Quality of Life SCI-QOL Depressive Symptoms and Pain Interference). Hierarchical linear regressions were used to analyze the amount of variance in depressive symptom and pain interference accounted for by ACT as a comprehensive construct and each individual ACT component. Data were collected specifically to examine these research questions. Results: Analyses revealed that ACT as a unified construct accounted for a significant amount of variance in both criterion variables (range ΔR2 = .29-.56; all ps < .001). Pursuit of Values and Emotional Acceptance were significant independent predictors of depressive symptoms; Self-as-Context and Emotional Acceptance were significant independent predictors of pain interference. Conclusions/Implications: Overall, these results demonstrate that ACT core processes account for moderate to large amounts of the variance in indicators of depressive symptoms and pain interference for individuals who have an SCI. Pursuit of values and acceptance had the greatest associations with depressive symptoms, whereas self as context and acceptance had the greatest associations with reported pain interference. These results highlight the potential for ACT core processes to be targeted in a treatment context.
Impact and ImplicationsAcceptance and Commitment Therapy (ACT) has been shown to be an appropriate framework for understanding experiences and maximizing value-consistent behavior in many populations, with an emerging literature in neurological rehabilitation. This study demonstrates the relevance of the core tenets of ACT for understanding quality of life outcomes, including depression and pain interference, in persons with SCI. Emphasizing behavioral pursuit of values and maximizing acceptance of difficult emotions may be the most meaningful treatment targets for managing depression in individuals with an SCI, while emphasizing self-as-context may be particularly relevant for minimizing pain interference.
Purpose
: The purpose was to examine the role of therapy engagement as a potential mediator for the relationship between neuropsychological performance and functional outcomes.
Materials and method
: ...Participants were 94 adults with medically documented ABI recruited from three outpatient rehabilitation clinics at the start of occupational therapy. Participants (57% men) ranged from 18 to 82 in age, with the majority (81%) having completed 12 or more years of education. They completed a comprehensive neuropsychological assessment at baseline. Separately, occupational therapists (OTs) assessed functional independence and disability at baseline and follow up. The OTs also rated the participants' therapy engagement.
Results
: Therapy engagement predicted functional outcomes and mediated the relationship between neuropsychological performance and outcomes. Moreover, therapy engagement accounted for unique variance in functional outcome, even after accounting for education, comorbid health conditions, emotional distress, apathy, and baseline functional ability.
Conclusions
: Engagement in therapy is a crucial patient characteristic in successful rehabilitation outcome. Cognitive deficits associated with ABI undermine full engagement in rehabilitation therapy, which in turn diminishes potential gains made in therapy and functional recovery. Neuropsychological assessment can enhance rehabilitation outcomes by identifying characteristics that underlie therapy engagement, which can ultimately be used to maximize the effectiveness of individualized treatment plans.
Implications for rehabilitation
Neuropsychological assessment can identify cognitive abilities that are strongly related to functional outcomes during occupational therapy for acquired brain injury.
Therapy engagement is an important pathway by which neuropsychological impairment predicts functional outcomes after acquired brain injuries.
To examine the efficacy of a peer-mentoring program for persons with traumatic brain injury (TBI) and their significant others, and to determine the relationship of this mentoring program to 3 main ...outcomes: (1) emotional well-being; (2) post-TBI quality of life; and (3) community integration.
Randomized controlled trial.
Midwestern rehabilitation hospital.
Persons with TBI (n=96) and significant others/caregivers (n=62).
Persons with TBI and friends/caregivers who knew the person prior to their injury were randomly assigned to a treatment (mentored) or no-treatment (no mentoring) control group immediately prior to discharge from the rehabilitation unit and were mentored for up to 2 years.
Peer Mentoring Questionnaire; Brief Symptom Inventory-18; Family Assessment Device; Coping Inventory for Stressful Situations; Short Michigan Alcohol Screening Test; Medical Outcomes Study 12-Item Short-Form Health Survey; and Community Integration Measure.
Eighty-eight percent of individuals who were involved in the mentoring program reported positive experiences. t tests revealed that among persons with TBI, individuals who received mentoring had significantly better behavioral control and less chaos in the living environment (P=.04), lower alcohol use (P=.01), less emotion-focused (P=.04) and avoidance coping (P=.03), and good physical quality of life (P=.04) compared with those who did not receive mentoring. Among significant others, mentored individuals demonstrated greater community integration (P=.03) than the nonmentored control group.
Mentoring can be an effective way to benefit mood and healthy coping after TBI, and it can help to prevent maladaptive behaviors, such as substance abuse and behavioral dyscontrol, in the living situation.
To examine resumption of driving after traumatic brain injury (TBI) and its relation to community integration.
Cross-sectional cohort study; survey and cognitive data.
Inpatient rehabilitation ...hospital of the Traumatic Brain Injury Model Systems and community.
Persons (N=261) ranging from 3 months to 15 years postinjury.
Not applicable.
Barriers to Driving Questionnaire, Driver Survey, Community Integration Measure, and Craig Hospital Assessment and Reporting Technique.
Forty-four percent of survivors had resumed driving; of nondrivers, 48% reported a strong desire to resume driving. Nondriver survivors who sought to resume driving generally rated themselves as currently fit to drive, viewed themselves as having physical and cognitive profiles like those of survivor drivers, and reported their greatest barriers to driving as social and resource related. However, cognitive functioning was similar to nondriver survivors who did not seek to resume driving and significantly worse than survivors who were currently driving. Nondrivers showed poorer community integration than did drivers, even after accounting for injury severity, social support, negative affectivity, and use of alternative transportation. Use of alternative transportation was common among nondrivers, but it was unrelated to community integration outcomes. Cognitive functioning moderated risk of adverse incident: among survivors with low cognitive functioning and high self-estimates of driving ability, which is indicative of unawareness of deficit, adverse incidents showed positive relation to amount of driving and inverse relation to cognitive functioning.
Driving status has unique and independent association with post-TBI community integration. Additional research is needed to evaluate transportation barriers that undermine full engagement in community living after TBI and to determine which barriers to driving reflect valid risk to survivors and the public.
Purpose Research studies that measure health-related quality of life (HRQOL) in both children and adults and longitudinal studies that follow children into adulthood need measures that can be ...compared across these age groups. This study links the PROMIS pediatric and adult emotional distress measures using data from participants with diverse health conditions and disabilities. Methods Analyses were conducted and compared in two separate samples to confirm the stability of results. One sample (n = 874) included individuals aged 14-20 years with special health care needs and who require health services. The other sample (n = 641) included individuals aged 14-25 years who have a physical or cognitive disability. Participants completed both PROMIS pediatric and adult measures. Item response theory-based scores were linked using the linear approximation to calibrated projection. Results The estimated latent-variable correlation between pediatric and adult PROMIS measures ranged from 0.87 to 0.94. Regression coefficients β₀ (intercept) and β₁ (slope), and mean squared error are provided to transform scores from the pediatric to the adult measures, and vice versa. Conclusions This study used a relatively new linking method, calibrated projection, to link PROMIS pediatric and adult measure scores, thus expanding the use of PROMIS measures to research that includes both populations.
Pupillometry provides information about physiological and psychological processes related to cognitive load, familiarity, and deception, and it is outside of conscious control. This study examined ...pupillary dilation patterns during a performance validity test (PVT) among adults with true and feigned impairment of traumatic brain injury (TBI).
Participants were 214 adults in three groups: adults with bona fide moderate to severe TBI (TBI; n = 51), healthy comparisons instructed to perform their best (HC; n = 72), and healthy adults instructed and incentivized to simulate cognitive impairment due to TBI (SIM; n = 91). The Recognition Memory Test (RMT) was administered in the context of a comprehensive neuropsychological battery. Three pupillary indices were evaluated. Two pure pupil dilation (PD) indices assessed a simple measure of baseline arousal (PD-Baseline) and a nuanced measure of dynamic engagement (PD-Range). A pupillary-behavioral index was also evaluated. Dilation-response inconsistency (DRI) captured the frequency with which examinees displayed a pupillary familiarity response to the correct answer but selected the unfamiliar stimulus (incorrect answer).
All three indices differed significantly among the groups, with medium-to-large effect sizes. PD-Baseline appeared sensitive to oculomotor dysfunction due to TBI; adults with TBI displayed significantly lower chronic arousal as compared to the two groups of healthy adults (SIM, HC). Dynamic engagement (PD-Range) yielded a hierarchical structure such that SIM were more dynamically engaged than TBI followed by HC. As predicted, simulators engaged in DRI significantly more frequently than other groups. Moreover, subgroup analyses indicated that DRI differed significantly for simulators who scored in the invalid range on the RMT (n = 45) versus adults with genuine TBI who scored invalidly (n = 15).
The findings support continued research on the application of pupillometry to performance validity assessment: Overall, the findings highlight the promise of biometric indices in multimethod assessments of performance validity.
Objective: Chronic Traumatic Encephalopathy (CTE) has received significant media coverage as a major health concern for collision sport athletes and combat veterans. This survey study investigated ...neuropsychologists' perspectives of CTE.Methods: Neuropsychologists (N = 325) were contacted via electronic advertisement posted to popular neuropsychology professional listservs and completed a survey regarding their perspectives of: the proposed sequelae of repeated concussions, the strength of the CTE research base, and its media coverage.Results: Most respondents (91%) were at least somewhat familiar with the concept of CTE. Moderate uncertainty was reported (i.e. up to 30%) regarding the effects of repeated concussions. Most felt the research in support of CTE was unreliable (80%) and weak regarding claims that repeated concussions cause CTE (91%), independently cause behavioral/emotional/cognitive dysfunction (86%), or increase the risk for neurodegeneration (79%). Respondents agreed patients are concerned about CTE (92%), concerns are influenced by the media (96%) that presents a biased/alarmist view of CTE (96%), and patient recovery is influenced by their CTE beliefs (82%).Conclusions: There was strong agreement that the media presents an alarmist/biased view of CTE that influences patients concerns and outcomes following concussion. This presentation is incongruent with the perceptions of surveyed neuropsychologists who find the research in support of CTE to be weak and unreliable. More research is needed to determine the potential effects of repeated (sub)concussive events. As public knowledge will continue to be influenced by the media and health care professionals, future research should explore CTE perceptions across other health care disciplines.
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