Participation After Multidisciplinary Rehabilitation for Moderate to Severe Traumatic Brain Injury in Adults

Executive function improvement in response to meta-cognitive training in chronic mTBI / PTSD

Objective

We tested Goal Management Training (GMT), which has been recommended as an executive training protocol that may improve the deficits in the complex tasks inherent in life role participation experienced by those with chronic mild traumatic brain injury and post-traumatic stress disease (mTBI/PTSD). We assessed, not only cognitive function, but also life role participation (quality of life).

Methods

We enrolled and treated 14 individuals and administered 10 GMT sessions in-person and provided the use of the Veterans Task Manager (VTM), a Smartphone App, which was designed to serve as a "practice-buddy" device to ensure translation of in-person learning to independent home and community practice of complex tasks. Pre-/post-treatment primary measure was the NIH Examiner, Unstructured Task. Secondary measures were as follows: Tower of London time to complete (cTOL), Community Reintegration of Service Members (CRIS) three subdomains [Extent of Participation; Limitations; Satisfaction of Life Role Participation (Satisfaction)]. We analyzed pre-post-treatment, t-test models to explore change, and generated descriptive statistics to inspect given individual patterns of change across measures.

Results

There was statistically significant improvement for the NIH EXAMINER Unstructured Task (p < .02; effect size = .67) and cTOL (p < .01; effect size = .52. There was a statistically significant improvement for two CRIS subdomains: Extent of Participation (p < .01; effect size = .75; Limitations (p < .05; effect size = .59). Individuals varied in their treatment response, across measures.

Conclusions and Clinical Significance

In Veterans with mTBI/PTSD in response to GMT and the VTM learning support buddy, there was significant improvement in executive cognition processes, sufficiently robust to produce significant improvement in community life role participation. The individual variations support need for precision neurorehabilitation. The positive results occurred in response to treatment advantages afforded by the content of the combined GMT and the employment of the VTM learning support buddy, with advantages including the following: manualized content of the GMT; incremental complex task difficulty; GMT structure and flexibility to incorporate individualized functional goals; and the VTM capability of ensuring translation of in-person instruction to home and community practice, solidifying newly learned executive cognitive processes. Study results support future study, including a potential randomized controlled trial, the manualized GMT and availability of the VTM to ensure future clinical deployment of treatment, as warranted.

The effectiveness of non-invasive brain stimulation on arousal and alertness in patients in coma or persistent vegetative state after traumatic brain injury: Protocol of systematic review and network meta-analysis

BACKGROUND

Traumatic brain injury is a leading cause of death and disability worldwide. The survivors usually suffer from disorders of consciousness, especially coma state and persistent vegetative state. For these patients, there is no standard treatment for them, but non-invasive brain stimulations are considered as relatively more acceptable treatments. However, the knowledge regarding the relative effectiveness and the rank of the effectiveness of the non-invasive brain stimulations is limited. Thus, in this study, we aim to conduct a systematic review and network meta-analysis to evaluate the effect of non-invasive train stimulations on arousal and alertness in patients in a coma or persistent vegetative state after traumatic brain injury.

METHODS AND ANALYSIS

A comprehensive search strategy will be performed in the relevant databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan Fang Data). The random or quasi-random controlled trails focusing on the effectiveness of the non-invasive brain stimulations will be included. The risk of bias for the included studies will be appraised using the Cochrane collaboration tool for assessing risk of bias. The standard pairwise meta-analysis and a Bayesian network meta-analysis will be conducted.

ETHICS AND DISSEMINATION

This research is a systematic review and network meta-analysis. Thus, there is no requirement of ethical approval and patient informed consent.

PROSPERO REGISTRATION NUMBER

CRD42018104945.

Development of a fidelity measure for community integration programmes for people with acquired brain injury

OBJECTIVE

The paper describes development of the Assessment of Community Integration Programme Attributes (ACIPA) measure based on a descriptive community integration framework. The purpose of this measure is to allow evaluation of community integration programmes for adults with acquired brain injury (ABI).

METHODS

The Community Integration Framework (CIF) was used to design a fidelity evaluation measure through consultation with 37 participants from five stakeholder groups (practitioners, researchers, policy-makers, people with ABI and family members of people with ABI) using semi-structured interviews, focus groups, iterative surveys and a multi-attribute utility (MAU) method.

RESULTS

The resultant measure included seven themes and 21 attributes. Each attribute included indicators and probing questions. Weights were assigned to each theme and constituent attributes.

CONCLUSION

Programme evaluation commonly focuses on outcomes, often overlooking analysis of programme processes. Although it requires further psychometric (reliability and validity) development, the Assessment of Community Integration Programme Attributes may be used to assess the relationship between programme processes and specific outcomes and also to inform the development of programmes aiming to enhance community integration for adults with ABI.