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Wittine LM, Ketchum JM, Silva MA, Hammond FM, Chung JS, Loyo K, Lezama J, Nakase-Richardson R. Mortality Among Veterans Following Traumatic Brain Injury: A Veterans Administration Traumatic Brain Injury Model System Study. J Neurotrauma 2024. [PMID: 38959125 DOI: 10.1089/neu.2024.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Few studies have examined long-term mortality following traumatic brain injury (TBI) in a military population. This is a secondary analysis of a prospective, longitudinal study that examines long-term mortality (up to 10 years) post-TBI, including analyses of life expectancy, causes of death, and risk factors for death in service members and veterans (SM/V) who survived the acute TBI and inpatient rehabilitation. Among 922 participants in the study, the mortality rate was 8.3% following discharge from inpatient rehabilitation. The mean age of death was 54.5 years, with death occurring on average 3.2 years after injury, and with an average 7-year life expectancy reduction. SM/V with TBI were nearly four times more likely to die compared with the U.S. general population. Leading causes of death were external causes of injury, circulatory disease, and respiratory disorders. Also notable were deaths due to late effects of TBI itself and suicide. Falls were a significant mechanism of injury for those who died. Those who died were also more likely to be older at injury, unemployed, non-active duty status, not currently married, and had longer post-traumatic amnesia, longer rehabilitation stays, worse independence and disability scores at rehabilitation discharge, and a history of mental health issues before injury. These findings indicate that higher disability and less social supportive infrastructure are associated with higher mortality. Our investigation into the vulnerabilities underlying premature mortality and into the major causes of death may help target future prevention, surveillance, and monitoring interventions.
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Affiliation(s)
- Lara M Wittine
- Department of Internal Medicine, James A. Haley Veterans Administration Hospital, Tampa, Florida, USA
- AdventHealth-Tampa, Pioneer Neurohealth, Tampa, Florida, USA
| | | | - Marc A Silva
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, Florida, USA
- Department of Internal Medicine, University of South Florida, Tampa, FL
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joyce S Chung
- Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Karina Loyo
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, Florida, USA
| | - Jose Lezama
- Department of Internal Medicine, James A. Haley Veterans Administration Hospital, Tampa, Florida, USA
- Department of Internal Medicine, University of South Florida, Tampa, FL
| | - Risa Nakase-Richardson
- Craig Hospital, Englewood, Colorado, USA
- Department of Internal Medicine, University of South Florida, Tampa, FL
- Research Service, James A. Haley Veterans Administration Hospital, Tampa, Florida, USA
- Defense Health Agency Traumatic Brain Injury Center of Excellence, University of South Florida, Tampa, Florida, USA
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O'Neil-Pirozzi TM, Sevigny M, Pinto SM, Hammond FM, Juengst SB. 10-year variability in high and low life satisfaction trajectories post-traumatic brain injury: a TBI model systems study. Brain Inj 2024; 38:796-806. [PMID: 38682889 DOI: 10.1080/02699052.2024.2347567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE To determine how life satisfaction changes across the first 10 years following traumatic brain injury (TBI). METHODS Participants included 1,941 individuals from the TBI Model Systems database with life satisfaction data at 1-, 5-, and 10-years post-TBI. Based on Satisfaction With Life Scale scores, individuals were characterized as having one of the five 10-year life satisfaction trajectories: 'Stable High,' 'Stable Low,' 'Increased to High,' 'Decreased to Low,' and 'Unstable.' These were analyzed for group differences in demographics and psychosocial and functional outcomes. RESULTS Sixty percent participants had 'Stable High' or 'Increasing to High' trajectories. Approximately 25% had "Stable Low' or 'Decreasing to Low' trajectories, and approximately 15% had unstable trajectories. Higher life satisfaction trajectories were associated with the best psychosocial and functional outcomes whereas lower trajectories were associated with the worst psychosocial and functional outcomes. Trajectories were indistinguishable based on demographics. CONCLUSION Life satisfaction over the first 10 years following TBI is dynamic, with most individuals reporting high life satisfaction by 10 years post-TBI. Examination of psychosocial and functional factors related to life satisfaction trajectories may inform community-based intervention recommendations, resources, and supports to maximize long-term satisfaction with life.
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Affiliation(s)
- Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts, USA
| | - Mitch Sevigny
- Research Department, Craig Hospital, Denver, Colorado
| | - Shanti M Pinto
- Department of Physical Medicine and Rehabilitation; O'Donnell Brain Institute Clinical Neuroscience Scholar, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Flora M Hammond
- Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine; Rehabilitation Hospital of Indiana, Indianapolis, Indiana
| | - Shannon B Juengst
- Brain Injury Research Center, TIRR Memorial Hermann; Department of Physical Medicine & Rehabilitation, UT Health Sciences Center at Houston, Houston, Texas
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Klyce DW, Perrin PB, Ketchum JM, Finn JA, Juengst SB, Gary KW, Fisher LB, Pasipanodya E, Niemeier JP, Vargas TA, Campbell TA. Suicide Attempts and Ideation Among Veterans/Service Members and Non-Veterans Over 5 Years Following Traumatic Brain Injury: A Combined NIDILRR and VA TBI Model Systems Study. J Head Trauma Rehabil 2024; 39:183-195. [PMID: 37773598 PMCID: PMC10978550 DOI: 10.1097/htr.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
OBJECTIVE This study compared rates of suicide attempt (SA) and suicidal ideation (SI) during the first 5 years after traumatic brain injury (TBI) among veterans and service members (V/SMs) in the Veterans Affairs (VA) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Model Systems National Databases to each other and to non-veterans (non-Vs) in the NIDILRR database. SETTING Twenty-one NIDILRR and 5 VA TBI Model Systems (TBIMS) inpatient rehabilitation facilities in the United States. PARTICIPANTS Participants with TBI were discharged from rehabilitation alive, had a known military status recorded (either non-V or history of military service), and successful 1-, 2-, and/or 5-year follow-up interviews completed between 2009 and 2021. The year 1 cohort included 8737 unique participants (8347 with SA data and 3987 with SI data); the year 2 (7628 participants) and year 5 (4837 participants) cohorts both had similar demographic characteristics to the year 1 cohort. DESIGN Longitudinal design with data collected across TBIMS centers at 1, 2, and 5 years post-injury. MAIN OUTCOMES AND MEASURES History of SA in past year and SI in past 2 weeks assessed by the Patient Health Questionnaire-9 (PHQ-9). Patient demographics, injury characteristics, and rehabilitation outcomes were also assessed. RESULTS Full sample rates of SA were 1.9%, 1.5%, and 1.6%, and rates of SI were 9.6%, 10.1%, and 8.7% (respectively at years 1, 2, and 5). There were significant differences among groups based on demographic, injury-related, mental/behavioral health, and functional outcome variables. Characteristics predicting SA/SI related to mental health history, substance use, younger age, lower functional independence, and greater levels of disability. CONCLUSIONS Compared with participants with TBI in the NIDILRR system, higher rates of SI among V/SMs with TBI in the VA system appear associated with risk factors observed within this group, including mental/behavioral health characteristics and overall levels of disability.
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Affiliation(s)
- Daniel W Klyce
- Mental Health Service, Central Virginia Veterans Affairs VA Health Care System, Richmond (Drs Klyce, Perrin, and Campbell and Ms Vargas); Departments of Physical Medicine and Rehabilitation (Dr Klyce), Rehabilitation Counseling (Dr Gary), and Psychology (Ms Vargas),Virginia Commonwealth University, Richmond; Rehabilitation Psychology Service, Sheltering Arms Institute, Richmond, Virginia (Dr Klyce); School of Data Science, University of Virginia, and Department of Psychology, University of Virginia, Charlottesville (Dr Perrin); Department of Research, Craig Hospital, Englewood, Colorado (Dr Ketchum); Rehabilitation and Extended Care Service, Minneapolis VA Health Care System, and Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Dr Finn); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, and Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston (Dr Juengst); Department of Psychiatry, Massachusetts General Hospital, Boston, and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts (Dr Fisher); Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California (Dr Pasipanodya); and Department of Psychology, University of Alabama, Birmingham, and Ackerson and Associates, Vestavia Hills, Alabama (Dr Niemeier)
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Skop KM, Bajor L, Sevigny M, Swank C, Tallavajhula S, Nakase-Richardson R, Miles SR. Exploring the relationship between sleep apnea and vestibular symptoms following traumatic brain injury. PM R 2023; 15:1524-1535. [PMID: 37490363 DOI: 10.1002/pmrj.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/09/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a complex health problem in military veterans and service members (V/SM) that often involves comorbid vestibular impairment. Sleep apnea is another comorbidity that may exacerbate, and/or be exacerbated by, vestibular dysfunction. OBJECTIVE To examine the relationship between sleep apnea and vestibular symptoms in V/SM diagnosed with TBI of any severity. DESIGN Multicenter cohort study; cross-sectional sample. SETTING In-patient TBI rehabilitation units within five Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS V/SM with a diagnosis of TBI (N = 630) enrolled in the VA TBI Model Systems study. INTERVENTION Not applicable. METHODS A multivariable regression model was used to evaluate the association between sleep apnea and vestibular symptom severity while controlling for relevant covariates, for example, posttraumatic stress disorder (PTSD). MAIN OUTCOME MEASURES Lifetime history of sleep apnea was determined via best source reporting. Vestibular disturbances were measured with the 3-item Vestibular subscale of the Neurobehavioral Symptom Inventory (NSI). RESULTS One third (30.6%) of the sample had a self-reported sleep apnea diagnosis. Initial analysis showed that participants who had sleep apnea had more severe vestibular symptoms (M = 3.84, SD = 2.86) than those without sleep apnea (M = 2.88, SD = 2.67, p < .001). However, when the data was analyzed via a multiple regression model, sleep apnea no longer reached the threshold of significance as a factor associated with vestibular symptoms. PTSD severity was shown to be significantly associated with vestibular symptoms within this sample (p < .001). CONCLUSION Analysis of these data revealed a relationship between sleep apnea and vestibular symptoms in V/SM with TBI. The significance of this relationship was affected when PTSD symptoms were factored into a multivariable regression model. However, given that the mechanisms and directionality of these relationships are not yet well understood, we assert that in terms of clinical relevance, providers should emphasize screening for each of the three studied comorbidities (sleep apnea, vestibular symptoms, and PTSD).
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Affiliation(s)
- Karen M Skop
- Physical Medicine and Rehabilitation Services, Department of Physical Therapy, James A Haley Veterans' Hospital, Tampa, Florida, USA
- Morsani College of Medicine, University of South Florida, School of Physical Therapy, Tampa, Florida, USA
| | - Laura Bajor
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital, Tampa, Florida, USA
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Harvard South Shore Psychiatry Training Program, Brockton, Massachusetts, USA
| | - Mitch Sevigny
- Research Department, Craig Hospital, Englewood, Colorado, USA
| | - Chad Swank
- Baylor Scott & White Research Institute for Rehabilitation, Dallas, Texas, USA
- Baylor Scott White Research Institute, Dallas, Texas, USA
| | - Sudha Tallavajhula
- University of Texas McGovern Medical School, Houston, Texas, USA
- TIRR Memorial Hermann Neurological Sleep Disorders Center, Houston, Texas, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences and Defense and Veterans' Brain Injury Center, James A. Haley Veterans' Hospital, Tampa, Florida, USA
- Morsani College of Medicine, Pulmonary and Sleep Medicine Division, University of South Florida, Tampa, Florida, USA
| | - Shannon R Miles
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital, Tampa, Florida, USA
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Chung JS, Jouk A, Licona NP, Terry JH, Harris OA. In her own words: a phenomenological analysis of stories told by female service members and veterans after traumatic brain injury. Disabil Rehabil 2023; 45:4086-4093. [PMID: 36398683 DOI: 10.1080/09638288.2022.2146766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Given the majority of Service Members and Veterans (SMV) who have sustained a traumatic brain injury (TBI) are male, the female experience with TBI has not been captured in the general understanding of TBI. To improve understanding of the experience of female SMV after TBI utilizing a qualitative phenomenological approach on stories as told by female SMV. MATERIALS AND METHODS Ten female SMV participated in storytelling workshops and created video stories documenting their personal experience with TBI. Workshops were hosted by the VA Palo Alto Health Care System Polytrauma System of Care (VAPAHCS PSC). A grounded thematic analysis was conducted on the video stories. RESULTS Three common content themes emerged from all the stories: (1) negative psychological and emotional impacts of TBI, (2) acceptance and healing process associated with recovery, and (3) military contexts. Negative psychological and emotional impacts included intrapersonal impacts such as negative emotions, suicidal ideation, and dealing with cognitive and physical challenges, and interpersonal impacts in relationships and loss of independence. Notably, all the stories acknowledged an acceptance and healing process, characterized by several subthemes including motivational factors, TBI education, spirituality, and advocacy work. Lastly, each story mentioned military context, highlighting the unique experience within this population. CONCLUSIONS This phenomenological examination adds evidence-based understanding to the experience after TBI among female SMV. Each story uncovered nuanced and multifaceted issues that women experience in their TBI recovery. Our findings provide context to guide future intervention on the care, support, and TBI recovery for the female SMV population.
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Affiliation(s)
- Joyce S Chung
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexandra Jouk
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Nytzia P Licona
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
- University of Illinois Chicago, Palo Alto, CA, USA
| | - Jennifer H Terry
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Odette A Harris
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford University, Stanford, CA, USA
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O'Neil-Pirozzi TM, Sevigny M, Pinto SM, Hammond FM, Juengst SB. Early Factors Predictive of Extreme High and Low Life Satisfaction 10 Years Post-Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:448-457. [PMID: 36854110 PMCID: PMC10460820 DOI: 10.1097/htr.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To identify demographic, injury-related, and 1-year postinjury clinical and functional predictors of high and low life satisfaction at 10 years after moderate to severe traumatic brain injury (TBI) using an extreme phenotyping approach. SETTING Multicenter longitudinal database study. PARTICIPANTS A total of 3040 people from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Model Systems database with life satisfaction data at 10 years post-TBI. DESIGN Multicenter, cross-sectional, observational design. MAIN MEASURES Satisfaction With Life Scale (outcome), Glasgow Coma Scale, Disability Rating Scale, Functional Independence Measure, Participation Assessment with Recombined Tools-Objective, Patient Health Questionnaire-9, and General Anxiety Disorder-7 (standardized predictors). RESULTS Greater cognitive and motor independence, more frequent community participation, and less depressive symptoms 1 year post-moderate to severe TBI predicted extreme high life satisfaction 10 years later. Non-Hispanic White and Hispanic individuals were significantly more likely than Black individuals to have extreme high life satisfaction 10 years post-TBI. CONCLUSIONS Extreme phenotyping analysis complements existing knowledge regarding life satisfaction post-moderate to severe TBI. From a chronic disease management perspective, future studies are needed to examine the feasibility and impact of early postinjury medical and rehabilitative interventions targeting cognitive and motor function, community participation, and mood on the maintenance/enhancement of long-term life satisfaction post-TBI.
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Affiliation(s)
- Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (Dr O'Neil-Pirozzi); Research Department, Craig Hospital, Denver, Colorado (Mr Sevigny); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas (Dr Pinto); Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Juengst); and Department of Physical Medicine and Rehabilitation, UT Houston Health Sciences Center, Houston, Texas (Dr Juengst)
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Hamilton JA, Ketchum JM, Hammond FM, Peterson MD, Zasler ND, Eapen BC, Adamson MM, Galhorta PP, Harris O, Nakase-Richardson R. Comparison of veterans affairs and NIDILRR traumatic brain injury model systems participants with disorders of consciousness. Brain Inj 2023; 37:282-292. [PMID: 36539996 DOI: 10.1080/02699052.2022.2158226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To characterize demographic, pre-injury, and outcome data within the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and Veterans Affairs (VA) Traumatic Brain Injury Model Systems (TBIMS) cohorts with severe traumatic brain injury (TBI) with no command-following ability at time of admission to acute rehabilitation. DESIGN Retrospective cohort. SETTING NIDILRR and VA TBI Model Systems (TBIMS) centers. PARTICIPANTS 396 NIDILRR and 72 VA participants without command-following ability who experienced TBI with subsequent Disorder of Consciousness (DoC). MAIN OUTCOME MEASURE Pre-injury and injury characteristics, rehabilitation outcomes, and 1-year self-reported outcomes. RESULTS VA TBIMS cohort included individuals who were active duty or had military service before their injury. The VA cohort were more likely to be re-hospitalized at 1-year follow-up or residing in a long-term care or rehab setting. The NIDILRR TBIMS cohort had higher FIM and DRS scores at rehabilitation discharge, while the VA participants saw longer lengths of stay and higher numbers of "violent" injury types. CONCLUSIONS This study allows for a better understanding of the comparability between VA and NIDILRR DoC cohorts providing guidance on how veteran and civilian samples might be merged in future TBIMS studies to explore predictors of recovery from a DoC.
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Affiliation(s)
| | | | - Flora M Hammond
- Department Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Carolinas Rehabilitation, 4141 Shore Drive 46254, Indianapolis, Indiana
| | | | - Nathan D Zasler
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Blessen C Eapen
- Division of Physical Medicine and Rehabilitation, Physical Medicine and Rehabilitation Service, VA Greater Los Angeles Health Care System, Los Angeles, California
| | - Maheen Mausoof Adamson
- Department of Neurosurgery, Rehabilitation Service, VA Palo Alto Health Care System, Palo Alto, California
| | - Pawan P Galhorta
- VA Palo Alto Health Care System, Palo Alto, CA, Program Director, Polytrauma Rehabilitation Center
| | - Odette Harris
- Department of Neurosurgery, Director, Brain Injury, Stanford University School of Medicine
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences, James A. Haley Veterans Hospital, Defense Health Agency TBI Center of Excellence at James A. Haley Veterans Hospital, Tampa, Florida
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Barriers and Facilitators to Accessing Rehabilitation Health Care: A Veterans Affairs Traumatic Brain Injury Model Systems Qualitative Study. Arch Phys Med Rehabil 2023; 104:380-389. [PMID: 36265532 DOI: 10.1016/j.apmr.2022.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare barriers and facilitators to accessing health care services among service members and veterans (SMVs) by traumatic brain injury (TBI) severity groups. DESIGN Qualitative descriptive study guided by an access to health care services conceptual framework. SETTING Five Veterans Affairs (VA) polytrauma rehabilitation centers. PARTICIPANTS SMVs (N=55, including 10 caregivers as proxies) ≥2 years post-TBI recruited from the VA TBI Model Systems and grouped by TBI severity (mild/moderate, severe). MAIN OUTCOME MEASURES Barriers and facilitators accessing care. RESULTS The main facilitators included ease of communicating with providers to help SMVs identify and utilize appropriate health care, family advocates who promoted engagement in health care, ability to use government and community facilities, and online resources or equipment. Distance to services was uniformly identified as a main barrier for both patient groups. However, facilitators and barriers to health care access differed by TBI severity. SMVs with severe TBI highlighted the role of nonprofit organizations in promoting health care engagement and the availability of VA specialty residential programs in meeting health care needs. Having unrecognized health care needs in chronic stages and communication difficulties with providers were more commonplace for those with greater TBI severity and affected quality of care. Those with mild/moderate TBI highlighted challenges associated with paying for services in the community and scheduling of services. CONCLUSIONS Barriers and facilitators exist across multiple dimensions of a health care access framework and vary by TBI severity. Results suggest possible mechanistic links between health care access and SMV health outcomes. Findings support current policy and practice efforts to facilitate health care access for SMVs with TBI but highlight the need for tailored approaches for those with greater disability.
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Venkatesan UM, Rabinowitz AR, Bernier RA, Soto JA, Hillary FG. Effects of Perceived Discrimination on Behavioral Health Outcomes in People Aging With Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:191-200. [PMID: 36731038 DOI: 10.1097/htr.0000000000000815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate major and everyday experiences of discrimination (MED and EED, respectively) in relation to behavioral health outcomes in people with traumatic brain injury (PwTBI). SETTING Outpatient research laboratory. PARTICIPANTS Adults, 50 years or older, with a chronic (1+ year) history of moderate or severe TBI ( N = 118). DESIGN Cross-sectional observational study. MAIN MEASURES MED and EED (primary measures of interest) and behavioral health outcomes: global cognition, psychological symptoms, neurobehavioral symptoms, societal participation, and health-related quality of life (HRQoL). In participants with available geodata ( N = 28), neighborhood socioeconomic deprivation (ND) was examined as a potential contributor to MED, EED, and measured outcomes. RESULTS EED and MED were significantly associated with psychological symptoms, neurobehavioral symptoms, and HRQoL after correction for multiple comparisons. Counter to expectations, EED were related to higher societal participation. MED and EED were unrelated to cognition. When MED and EED were entered together in hierarchical regressions, only EED made significant contributions beyond demographic and injury-related covariates to each outcome. Sensitivity analyses revealed that most of these relationships were not solely accounted for by disability-related discrimination. ND showed negligible associations with discrimination but moderate effect sizes for cognition and participation. Race was not significantly related to discrimination and was not a significant predictor in regression models but was strongly associated with ND. CONCLUSION The current data provide preliminary support for perceived discrimination as an important factor in neurobehavioral and psychosocial health, but not cognitive performance, after TBI. These relationships appear to be driven by daily experiences of discriminatory treatment versus single major instances of injustice. Measured outcomes may also reflect socioeconomic challenges and structural discrimination faced by diverse PwTBI, although more work in this area is urgently needed. Multiple sources of marginalization and disenfranchisement and their functional effects should be considered in TBI rehabilitation and outcome monitoring.
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Affiliation(s)
- Umesh M Venkatesan
- Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Drs Venkatesan and Rabinowitz); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Drs Venkatesan and Rabinowitz); Department of Neurosciences, UC San Diego School of Medicine, La Jolla, California (Dr Bernier); Department of Psychology, Pennsylvania State University, University Park (Drs Soto and Hillary); and Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania (Dr Hillary)
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Silva MA, Miles SR, O'Neil-Pirozzi TM, Arciniegas DB, Klocksieben F, Dismuke-Greer CE, Walker WC, Nakase-Richardson R. Alternative Structure Models of the Traumatic Brain Injury Rehabilitation Needs Survey: A Veterans Affairs TBI Model Systems Study. Arch Phys Med Rehabil 2023:S0003-9993(23)00048-5. [PMID: 36736804 DOI: 10.1016/j.apmr.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To explore the factor structure of the Rehabilitation Needs Survey (RNS). DESIGN Secondary analysis of observational cohort study who were 5-years post-traumatic brain injury (TBI). SETTING Five Inpatient Rehabilitation Facilities. PARTICIPANTS Veterans enrolled in the TBI Model Systems longitudinal study who completed the RNS at 5-year follow-up (N=378). MAIN OUTCOME MEASURE(S) RNS. RESULTS RNS factor structure was examined with exploratory factor analysis (EFA) with oblique rotation. Analyses returned 2- and 3-factor solutions with Cronbach alphas ranging from 0.715 to 0.905 and corrected item-total correlations that ranged from 0.279 to 0.732. The 2-factor solution accounted for 61.7% of the variance with ≥3 exclusively loading items on each factor with acceptable internal consistency metrics and was selected as the most parsimonious and clinically applicable model. Ad hoc analysis found the RNS structure per the EFA corresponded with elements of the International Classification of Functioning, Disability and Health (ICF) conceptual framework. All factors had adequate internal consistency (α≥0.70) and 20 of the 21 demonstrated good discrimination (corrected item-total correlations≥0.40). CONCLUSIONS The 2-factor solution of the RNS appears to be a useful model for enhancing its clinical interpretability. Although there were cross-loading items, they refer to complex rehabilitation needs that are likely influenced by multiple factors. Alternatively, there are items that may require alteration and redundant items that should be considered for elimination.
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Affiliation(s)
- Marc A Silva
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL; Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL; Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL.
| | - Shannon R Miles
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL; Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
| | - David B Arciniegas
- Marcus Institute for Brain Health, University of Colorado-Anschutz Medical Campus, Aurora, CO; Department of Psychiatry & Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM
| | - Farina Klocksieben
- Research Methodology and Biostatistics Core, Office of Research, University of South Florida, Tampa, FL
| | - Clara E Dismuke-Greer
- Health Economics Resource Center (HERC), Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Menlo Park, CA
| | - William C Walker
- Department of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University, Richmond, VA; PM&R Service, Richmond Veterans Affairs Medical Center, Central Virginia VA Health Care System, Richmond, VA
| | - Risa Nakase-Richardson
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL; Division of Pulmonary and Sleep Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL; Defense Health Agency Traumatic Brain Injury Center of Excellence at James A. Haley Veterans Hospital, Tampa, FL
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The Power of Perception: Beliefs About Memory Ability Uniquely Contribute to Memory Performance and Quality of Life in Adults Aging with Traumatic Brain Injury. J Int Neuropsychol Soc 2023; 29:159-171. [PMID: 35225201 DOI: 10.1017/s1355617722000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Personal beliefs about memory ability, which comprise memory self-efficacy (MSE), can influence memory performance in healthy older adults. Self-efficacy theory also predicts that MSE biases self-perceptions of functioning more globally, potentially impacting daily activity beyond cognitive performance. People with traumatic brain injury (PwTBI) frequently report debilitating memory problems long after acute recovery, but little is known about how MSE affects health outcomes in this population. We examined demographic and clinical correlates of MSE, as well as its relationship to memory test performance and health-related quality of life (QOL), in older adults with chronic moderate-to-severe TBI (msTBI). METHOD One hundred fourteen adults, aged 50+ and at least 1 year post-msTBI, underwent neuropsychological testing to assess their memory functioning. Participants also self-reported levels of psychological distress, MSE (Cognitive Confidence subscale of the Metacognitions Questionnaire), and health-related QOL (Quality of Life after Brain Injury questionnaire). RESULTS Demographic and injury-related predictors showed weak correlations with MSE. Although the relationship between MSE and general psychological distress was robust, only the former significantly predicted memory performance. Bivariate analyses revealed significant relationships between MSE and five out of the six QOL domains assessed. Multivariate linear regression revealed a significant impact of MSE on overall QOL independent of demographic and clinical variables. CONCLUSIONS Our findings support a unique role for MSE in both the objective cognitive performance and subjective health of PwTBI. Increased focus on self-perceptions of ability and their impact on measured outcomes is an important step towards personalized rehabilitation for adults with chronic msTBI.
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Turner SM, Kiser SA, Gipson BJ, Martin EMM, Smith JM. Surveying the Landscape: A Review of Longitudinal TBI Studies in Service Member and Veteran Populations. J Neurotrauma 2023. [PMID: 36394952 DOI: 10.1089/neu.2022.0237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Traumatic brain injury (TBI) is known to be a signature wound of the post-9/11 conflicts. In response, the U.S. Department of Defense (DOD) and other federal organizations have directed significant investments toward TBI research on characterizing injury populations and understanding long-term outcomes. To address legislative requirements and research gaps, several observational, longitudinal TBI studies were initiated as an effective means of investigating TBI clinical management, outcomes, and recovery. This review synthesizes the landscape (i.e., requirements and gaps, infrastructure, geography, timelines, TBI severity definitions, military and injury populations of interest, and measures) of DOD-funded longitudinal TBI studies being conducted in service member and veteran (SMV) populations. Based on the landscape described here, we present recommended actions and solutions that would allow a consolidated and cooperative future state of longitudinal TBI research, optimized continued investments, and advances in the state of the science without redundancy.
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Affiliation(s)
- Stephanie M Turner
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Seth A Kiser
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Brooke J Gipson
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Elisabeth M Moy Martin
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - Johanna M Smith
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
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O'Neil-Pirozzi TM, Pinto SM, Sevigny M, Hammond FM, Juengst SB, Bombardier CH. Factors Associated With High and Low Life Satisfaction 10 Years After Traumatic Brain Injury. Arch Phys Med Rehabil 2022; 103:2164-2173. [PMID: 35202582 PMCID: PMC9484051 DOI: 10.1016/j.apmr.2022.01.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify correlates of life satisfaction at 10 years after moderate to severe traumatic brain injury (TBI) using an extreme phenotyping approach. DESIGN Effect sizes were calculated in this observational cohort study to estimate relationships of 10-year postinjury extremely high, extremely low, and moderate life satisfaction with (1) pre-injury demographics, injury-related factors, and functional characteristics at inpatient rehabilitation admission and discharge; and (2) postinjury demographics and clinical and functional measures at 10 years postinjury. SETTING Multicenter longitudinal database study. PARTICIPANTS People identified from the National Institute on Disability, Independent Living, and Rehabilitation Research TBI Database with life satisfaction data at 10 years post TBI (N=4800). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Satisfaction With Life Scale. RESULTS Although few pre-injury factors or clinical and functional factors shortly after injury were associated with 10-year life satisfaction groups, the following 10-year postinjury factors were associated with extremely high vs extremely low life satisfaction group membership: greater independent functioning, less disability, more frequent community participation, being employed, and having fewer depressive and anxiety symptoms. Those with extremely high life satisfaction were distinctly different from those with moderate and extremely low satisfaction. Extremely high life satisfaction was underrepresented among non-Hispanic Black persons relative to non-Hispanic White persons. Relationships between life satisfaction and independent functioning, disability, and participation were attenuated among non-Hispanic Black persons. CONCLUSIONS Extreme phenotyping analysis complements existing knowledge regarding life satisfaction after moderate to severe TBI and may inform acute and postacute clinical service delivery by comparing extremely high and extremely low life satisfaction subgroups. Findings suggest little association among personal, clinical, and functional characteristics early post TBI and life satisfaction 10 years later. Contemporaneous correlates of extremely high life satisfaction exist at 10 years post TBI, although the positive relationship of these variables to life satisfaction may be attenuated for non-Hispanic Black persons.
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Affiliation(s)
- Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Department of Communication Sciences and Disorders, Northeastern University, Boston, MA.
| | - Shanti M Pinto
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC
| | | | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN; Department of Applied Clinical Research, UT Southwestern Medical Center, Dallas, TX
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
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14
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Garcia A, Kretzmer TS, Dams-O'Connor K, Miles SR, Bajor L, Tang X, Belanger HG, Merritt BP, Eapen B, McKenzie-Hartman T, Silva MA. Health Conditions Among Special Operations Forces Versus Conventional Military Service Members: A VA TBI Model Systems Study. J Head Trauma Rehabil 2022; 37:E292-E298. [PMID: 34698680 DOI: 10.1097/htr.0000000000000737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine traumatic brain injury (TBI) characteristics and comorbid medical profiles of Special Operations Forces (SOF) Active Duty Service Member/Veterans (ADSM/Vs) and contrast them with conventional military personnel. SETTING The 5 Veterans Affairs (VA) Polytrauma Rehabilitation Centers. PARTICIPANTS A subset of participants in the VA TBI Model Systems multicenter longitudinal study with known SOF status. These included 157 participants who identified as SOF personnel (average age = 41.8 years; 96% male, 81% active duty), and 365 who identified as Conventional Forces personnel (average age = 37.4 years; 92% male, 30% active duty). DESIGN Retrospective analysis of prospective cohort, cross-sectional. MAIN MEASURES The Health Comorbidities Interview. RESULTS SOF personnel were more likely to have deployed to a combat zone, had more years of active duty service, and were more likely active duty at time of TBI. SOF personnel were more likely to have had mild TBI (vs moderate/severe) and their TBI caused by violent mechanism. SOF personnel had a higher number of comorbidities, with more diagnoses of chronic pain, osteoarthritis, hyperlipidemia, hip fractures, and obstructive sleep apnea. CONCLUSION SOF personnel are at a higher risk for multimorbidity after TBI. Current rehabilitation practices should incorporate early screening and treatment of common conditions in this population, while future practices may benefit from a focus on prevention.
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Affiliation(s)
- Amanda Garcia
- Mental Health and Behavioral Sciences Section (MHBSS) (Drs Garcia, Kretzmer, Miles, Bajor, and Silva) and Physical Medicine & Rehabilitation Service (Dr Merritt), James A. Haley Veterans' Hospital, Tampa, Florida; Traumatic Brain Injury Center of Excellence (TBI CoE), Tampa, Florida (Dr Garcia); Departments of Neurology (Dr Dams-O'Connor) and Rehabilitation and Human Performance (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York City, New York; Departments of Psychiatry and Behavioral Neurosciences (Drs Miles, Bajor, Belanger, and Silva), Internal Medicine (Dr Silva), and Psychology (Dr Silva), University of South Florida, Tampa, Florida; Harvard Medical School, Boston, Massachusetts (Dr Bajor); Tampa VA Research and Education Foundation, Inc, Temple Terrace, Florida (Dr Tang); United States Special Operations Command (USSOCOM), Tampa, Florida (Dr Belanger); St Michael's Inc, Woodbridge, Virginia (Dr Belanger); VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Eapen); National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland (Dr McKenzie-Hartman); and F. Edward Hébert School of Medicine (SOM), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland (Dr McKenzie-Hartman)
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15
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Klyce DW, West SJ, Perrin PB, Agtarap SD, Finn JA, Juengst S, Dams-O'Connor K, Eagye CB, Vargas TA, Chung JS, Bombardier CH. Network Analysis of Neurobehavioral and Posttraumatic Stress Disorder Symptoms One Year after Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study. J Neurotrauma 2021; 38:3332-3340. [PMID: 34652955 DOI: 10.1089/neu.2021.0200] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Traumatic brain injury (TBI) is often experienced under stressful circumstances that can lead to both symptoms of posttraumatic stress disorder (PTSD) and neurobehavioral symptoms of brain injury. There is considerable symptom overlap in the behavioral expression of these conditions. Psychometric network analysis is a useful approach to investigate the role of specific symptoms in connecting these two disorders and is thus well-suited to explore their interrelatedness. This study applied network analysis to examine the associations among PTSD and TBI symptoms in a sample of Service Members and Veterans (SM/Vs) with a history of TBI one year after injury. Responses to the Neurobehavioral Symptom Inventory (NSI) and PTSC Checklist-Civilian version (PCL-C) were obtained from participants who completed comprehensive inpatient rehabilitation services at five VA polytrauma rehabilitation centers. Participants (N = 612) were 93.1% male with an average age of 36.98 years at injury. The analysis produced a stable network. Within the NSI symptom groups, the frustration symptom was an important bridge between the affective and cognitive TBI symptoms. The PCL-C nodes formed their own small cluster with hyperarousal yielding connections with the affective, cognitive, and somatic symptom groups. Consistent with this observation, the hyperarousal node had the second strongest bridge centrality in the network. Hyperarousal appears to play a key role in holding together this network of distress and thus represents a prime target for intervention among individuals with elevated symptoms of PTSD and a history of TBI. Network analysis offers an empirical approach to visualizing and quantifying the associations among symptoms. The identification of symptoms that are central to connecting multiple conditions can inform diagnostic precision and treatment selection.
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Affiliation(s)
- Daniel Wesley Klyce
- Richmond VAMC, 20125, 1201 Broad Rock Blvd, Richmond, Virginia, United States, 23249.,Sheltering Arms Institute, 559078, Richmond, United States, 23233-7632;
| | - Samuel J West
- Virginia Commonwealth University, 6889, Department of Psychology, Richmond, Virginia, United States;
| | - Paul B Perrin
- Virginia Commonwealth University, Department of Psychology, Richmond, United States;
| | | | - Jacob A Finn
- Minneapolis VA Health Care System, 20040, Minneapolis, Minnesota, United States.,University of Minnesota Department of Psychiatry, 172737, Minneapolis, Minnesota, United States;
| | - Shannon Juengst
- University of Texas Southwestern, Physical Medicine & Rehabilitation; Rehabilitation Counseling, 5323 Harry Hines Blvd, Dallas, Texas, United States, 75390-9055;
| | - Kristen Dams-O'Connor
- Icahn School of Medicine at Mount Sinai, 5925, Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, New York, United States, 10029; kristen.dams-o'
| | - C B Eagye
- Craig Hospital, 20588, Research Department, Englewood, Colorado, United States;
| | | | - Joyce S Chung
- Veterans Affairs Palo Alto Health Care System, Polytrauma, Palo Alto, California, United States;
| | - Charles H Bombardier
- University of Washington, Rehabilitation Medicine, Box 359612, Harborview Medical Center, 325 9th Avenue, Seattle, Washington, United States, 98104;
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16
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Garcia A, Miles SR, Reljic T, Silva MA, Dams-O'Connor K, Belanger HG, Bajor L, Richardson R. Neurobehavioral Symptoms in U.S. Special Operations Forces in Rehabilitation After Traumatic Brain Injury: A TBI Model Systems Study. Mil Med 2021; 187:1412-1421. [PMID: 34591087 DOI: 10.1093/milmed/usab347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/26/2021] [Accepted: 08/10/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Special Operations Forces (SOF) personnel are at increased risk for traumatic brain injury (TBI), when compared with conventional forces (CF). Prior studies of TBI in military samples have not typically investigated SOF vs. CF as specific subgroups, despite documented differences in premorbid resilience and post-injury comorbidity burden. The aim of the current study was to compare SOF vs. CF on the presence of neurobehavioral symptoms after TBI, as well as factors influencing perception of symptom intensity. MATERIALS AND METHODS This study conducted an analysis of the prospective veterans affairs (VA) TBI Model Systems Cohort, which includes service members and veterans (SM/V) who received inpatient rehabilitation for TBI at one of the five VA Polytrauma Rehabilitation Centers. Of those with known SOF status (N = 342), 129 participants identified as SOF (average age = 43 years, 98% male) and 213 identified as CF (average age = 38.7 years, 91% male). SOF vs. CF were compared on demographics, injury characteristics, and psychological and behavioral health symptoms. These variables were then used to predict neurobehavioral symptom severity in univariable and multivariable analyses. RESULTS SOF personnel reported significantly greater posttraumatic stress disorder (PTSD) symptoms but less alcohol and drug use than the CF. SOF also reported greater neurobehavioral symptoms. When examining those with TBIs of all severities, SOF status was not associated with neurobehavioral symptom severity, while race, mechanism of TBI, and PTSD symptoms were. When examining only those with mTBI, SOF status was associated with lower neurobehavioral symptoms, while PTSD severity, white race, and certain mechanisms of injury were associated with greater neurobehavioral symptoms. CONCLUSIONS Among those receiving inpatient treatment for TBI, SOF SM/V reported higher neurobehavioral and symptom severity. PTSD was the strongest predictor of neurobehavioral symptoms and should be considered an important treatment target in both SOF and CF with co-morbid PTSD/TBI. A proactive human performance approach towards identification and treatment of psychological and neurobehavioral symptoms is recommended for SOF.
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Affiliation(s)
- Amanda Garcia
- Traumatic Brain Injury Center of Excellence, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA
| | - Shannon R Miles
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA
| | - Tea Reljic
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Marc A Silva
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA.,Department of Psychology, University of South Florida, Tampa, FL 33620, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine, New York, NY 10029, USA.,Department of Neurology, Icahn School of Medicine, New York, NY 10029, USA
| | - Heather G Belanger
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.,United States Special Operations Command (USSOCOM), MacDill AFB, FL 33621, USA.,St Michael's Inc., Woodbridge, VA 22192, USA
| | - Laura Bajor
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.,Harvard South Shore Psychiatry Residency Program, Brockton, MA 02301, USA
| | - Risa Richardson
- Traumatic Brain Injury Center of Excellence, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL 33612, USA.,Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
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17
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Kanser R, O'Rourke J, Silva MA. Performance validity testing via telehealth and failure rate in veterans with moderate-to-severe traumatic brain injury: A veterans affairs TBI model systems study. NeuroRehabilitation 2021; 49:169-177. [PMID: 34397429 DOI: 10.3233/nre-218019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to increased utilization of teleneuropsychology (TeleNP) services. Unfortunately, investigations of performance validity tests (PVT) delivered via TeleNP are sparse. OBJECTIVE The purpose of this study was to examine the specificity of the Reliable Digit Span (RDS) and 21-item test administered via telephoneMETHOD:Participants were 51 veterans with moderate-to-severe traumatic brain injury (TBI). All participants completed the RDS and 21-item test in the context of a larger TeleNP battery. Specificity rates were examined across multiple cutoffs for both PVTs. RESULTS Consistent with research employing traditional face-to-face neuropsychological evaluations, both PVTs maintained adequate specificity (i.e., > 90%) across previously established cutoffs. Specifically, defining performance invalidity as RDS < 7 or 21-item test forced choice total correct < 11 led to < 10%false positive classification errors. CONCLUSIONS Findings add to the limited body of research examining and provide preliminary support for the use of the RDS and 21-item test in TeleNP via telephone. Both measures maintained adequate specificity in veterans with moderate-to-severe TBI. Future investigations including clinical or experimental "feigners" in a counter-balanced cross-over design (i.e., face-to-face vs. TeleNP) are recommended.
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Affiliation(s)
- Robert Kanser
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Justin O'Rourke
- Polytrauma Section, Audie L. Murphy Memorial Veterans' Hospital, San Antonio, TX, USA
| | - Marc A Silva
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
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18
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Cognitive Reserve in Individuals Aging With Traumatic Brain Injury: Independent and Interactive Effects on Cognitive Functioning. J Head Trauma Rehabil 2021; 37:E196-E205. [PMID: 34145164 DOI: 10.1097/htr.0000000000000697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the influence of 2 temporal factors-age and injury chronicity-on the relationship between cognitive reserve (CR) and cognitive functioning in older adults with chronic traumatic brain injury (TBI). SETTING Outpatient research laboratory. PARTICIPANTS Adults, 50 years or older, with a 1- to 45-year history of moderate or severe TBI (N = 108). DESIGN Cross-sectional observational study. MAIN MEASURES CR was estimated using demographically corrected performance on a word-reading test (an approximation of premorbid IQ). Injury chronicity was operationalized as number of years since the date of injury. Composite cognitive scores were computed from performances on neuropsychological tests of processing speed, executive functioning, and memory. RESULTS CR was positively and significantly related to all cognitive performances independent of age, injury chronicity, and injury severity. Greater injury chronicity significantly attenuated the effect of CR on processing speed such that individuals more distal from their injury date evidenced a weaker positive relationship between CR and performance. CONCLUSION Temporal factors may modify associations between CR and cognition. Findings suggest that the protective effects of CR are temporally delimited, potentially contending with declines in brain reserve. The prognostic value of traditional outcome determinants should be considered in the context of injury chronicity.
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Mahoney EJ, Silva MA, Reljic T, Dams-O'Connor K, Hammond FM, Monden KR, Chung JS, Dillahunt-Aspillaga C, Nakase-Richardson R. Rehabilitation Needs at 5 Years Post-Traumatic Brain Injury: A VA TBI Model Systems Study. J Head Trauma Rehabil 2021; 36:175-185. [PMID: 33201036 DOI: 10.1097/htr.0000000000000629] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe rehabilitation needs and factors associated with unmet needs at 5 years post-traumatic brain injury (TBI). SETTING Five Veterans Affairs (VA) polytrauma rehabilitation centers (PRCs). PARTICIPANTS VA TBI Model Systems participants (N = 283; 96% male, 75%, 57% severe TBI). DESIGN Prospective observational cohort. MAIN MEASURES Rehabilitation Needs Survey (21-item survey that assesses cognitive, emotional, social, and functional needs); Craig Hospital Inventory of Environmental Factors (25-item survey of potential environmental barriers). RESULTS Participants endorsed a mean of 8 (SD: 6.2) ongoing and 3 (SD: 4.7) unmet rehabilitation needs at 5 years post-TBI. Approximately 65% of participants reported at least 1 rehabilitation need that remained unmet. The number and nature of needs differed across TBI severity groups. In unadjusted and adjusted linear regression models, Black race and environmental barriers (Craig Hospital Inventory of Environmental Factors total score) were predictive of unmet needs (P < .001). Those with greater unmet needs reported the physical environment (54%-63%), informational sources (54%), social attitudes (55%), healthcare access (40%), public policy (32%-37%), transportation availability (33%), and in-home assistance (32%) as the most frequent environmental barriers at 5 years post-TBI. CONCLUSION Veterans and Service Members continue to have rehabilitation needs at 5 years post-TBI. Veterans Affairs programs to address ongoing needs and policy to support them are needed.
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Affiliation(s)
- Elaine J Mahoney
- Mental Health and Behavioral Sciences (MHBS) (Drs Mahoney, Silva, and Nakase-Richardson) and Defense and Veterans Brain Injury Center (DVBIC) (Drs Silva and Nakase-Richardson), James A. Haley Veterans' Hospital, Tampa, Florida; Departments of Psychiatry and Behavioral Neurosciences (Dr Silva), Psychology (Dr Silva), Child & Family Studies (Dr Dillahunt-Aspillaga), and Internal Medicine, Division of Pulmonary and Sleep Medicine (Dr Nakase-Richardson), University of South Florida, Tampa; Morsani College of Medicine, University of South Florida, Tampa (Ms Reljic); Departments of Rehabilitation Medicine (Dr Dams-O'Connor) and Neurology (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis (Dr Hammond); Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Research Department, Craig Hospital, Englewood, Colorado (Dr Monden); Department of Rehabilitation Medicine, University of Minnesota, Minneapolis (Dr Monden); VA Palo Alto Health Care System, Palo Alto, California (Dr Chung); and Research Service, James A. Haley Veterans' Hospital, Tampa, Florida (Dr Dillahunt-Aspillaga)
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20
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Silva MA, Finn JA, Dillahunt-Aspillaga C, Cotner BA, Stevens LF, Nakase-Richardson R. Development of the traumatic brain injury Rehabilitation Needs Survey: a Veterans Affairs TBI Model Systems study. Disabil Rehabil 2021; 44:4474-4484. [PMID: 33756089 DOI: 10.1080/09638288.2021.1900930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the development of the Rehabilitation Needs Survey (RNS) for persons in the chronic phase of traumatic brain injury (TBI) recovery. MATERIALS AND METHODS RNS items were generated following a literature review (January - March 2015) on the topic of rehabilitation needs and revised via consensus from an expert panel of TBI clinicians and researchers. The RNS was added to the VA TBI Model Systems longitudinal study; data collection occurred between 2015-2019. Needs were classified as current (if endorsed) or absent; if current, needs were classified as unmet if no help was received. Need frequency and association with rehabilitation outcomes were presented. RESULTS Eight studies examined rehabilitation needs and formed the initial item pool of 42 needs. This was reduced to form the 21-item RNS which was administered at year 1 (n = 260) and year 2 (n = 297) post-TBI. Number of needs endorsed was 8-9, and number of unmet needs was 1-2, on average. Number of needs was correlated with functional status, neurobehavioral symptoms, and mental health symptoms (p < 0.05) suggesting support for convergent validity of the RNS. CONCLUSION The RNS is a new measure of rehabilitation needs following TBI. Further investigation into its psychometrics and clinical utility is recommended.Implications for rehabilitationVeterans and Service Members with traumatic brain injury across the severity spectrum have ongoing rehabilitation needs during the chronic phase of recovery.The Rehabilitation Needs Survey is a standardized measure of rehabilitation needs following traumatic brain injury.Identification of unmet rehabilitation needs is important for raising awareness of service gaps and providing justification for resource allocation.
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Affiliation(s)
- Marc A Silva
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Jacob A Finn
- Extended Care and Rehabilitation (EC&R) Patient Service Line, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Bridget A Cotner
- Research Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Lillian F Stevens
- Mental Health Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,TBI Center of Excellence (TBICoE), James A. Haley Veterans' Hospital, Tampa, FL, USA
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21
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Tso S, Saha A, Cusimano MD. The Traumatic Brain Injury Model Systems National Database: A Review of Published Research. Neurotrauma Rep 2021; 2:149-164. [PMID: 34223550 PMCID: PMC8240866 DOI: 10.1089/neur.2020.0047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The Traumatic Brain Injury Model Systems (TBIMS) is the largest longitudinal TBI data set in the world. Our study reviews the works using TBIMS data for analysis in the last 5 years. A search (2015–2020) was conducted across PubMed, EMBASE, and Google Scholar for studies that used the National Institute on Disability, Independent Living and Rehabilitation Research NIDILRR/VA-TBIMS data. Search terms were as follows: [“TBIMS” national database] within PubMed and Google Scholar, and [“TBIMS” AND national AND database] on EMBASE. Data sources, study foci (in terms of data processing and outcomes), study outcomes, and follow-up information usage were collected to categorize the studies included in this review. Variable usage in terms of TBIMS' form-based variable groups and limitations from each study were also noted. Assessment was made on how TBIMS' objectives were met by the studies. Of the 74 articles reviewed, 23 used TBIMS along with other data sets. Fifty-four studies focused on specific outcome measures only, 6 assessed data aspects as a major focus, and 13 explored both. Sample sizes of the included studies ranged from 11 to 15,835. Forty-two of the 60 longitudinal studies assessed follow-up from 1 to 5 years, and 15 studies used 10 to 25 years of the same. Prominent variable groups as outcome measures were “Employment,” “FIM,” “DRS,” “PART-O,” “Satisfaction with Life,” “PHQ-9,” and “GOS-E.” Limited numbers of studies were published regarding tobacco consumption, the Brief Test of Adult Cognition by Telephone (BTACT), the Supervision Rating Scale (SRS), general health, and comorbidities as variables of interest. Generalizability was the most significant limitation mentioned by the studies. The TBIMS is a rich resource for large-sample longitudinal analyses of various TBI outcomes. Future efforts should focus on under-utilized variables and improving generalizability by validation of results across large-scale TBI data sets to better understand the heterogeneity of TBI.
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Affiliation(s)
- Samantha Tso
- Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ashirbani Saha
- Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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22
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McGeary DD, Penzien DB, Resick PA, McGeary CA, Jaramillo CA, Eapen BC, Young-McCaughan S, Nabity PS, Moring JC, Houle TT, Keane TM, Peterson AL. Study design for a randomized clinical trial of cognitive-behavioral therapy for posttraumatic headache. Contemp Clin Trials Commun 2021; 21:100699. [PMID: 33490706 PMCID: PMC7806520 DOI: 10.1016/j.conctc.2021.100699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/06/2020] [Accepted: 01/01/2021] [Indexed: 11/29/2022] Open
Abstract
Posttraumatic headache (PTH) is a common debilitating condition arising from head injury and is highly prevalent among military service members and veterans with traumatic brain injury (TBI). Diagnosis and treatment for PTH is still evolving, and surprisingly little is known about the putative mechanisms that drive these headaches. This manuscript describes the design of a randomized clinical trial of two nonpharmacological (i.e., behavioral) interventions for posttraumatic headache. Design of this trial required careful consideration of PTH diagnosis and inclusion criteria, which was challenging due to the lack of standard clinical characteristics in PTH unique from other types of headaches. The treatments under study differed in clinical focus and dose (i.e., number of treatment sessions), but the trial was designed to balance the treatments as well as possible. Finally, while the primary endpoints for pain research can vary from assessments of pain intensity to objective and subjective functional measures, this trial of PTH interventions chose carefully to establish clinically relevant endpoints and to maximize the opportunity to detect significant differences between groups with two primary outcomes. All these issues are discussed in this manuscript.
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Key Words
- AUDIT, Alcohol Use Disorders Identification Test-Self Report
- B-IPF, Brief Inventory of Psychosocial Functioning
- CAP, Consortium to Alleviate PTSD
- CAPS-5, Clinician-Administered PTSD Scale for DSM-5
- CBT, cognitive-behavioral therapy
- CCBT, clinic-based cognitive-behavioral therapy intervention for headache
- CEQ, Credibility and Expectancy Questionnaire
- CGRP, calcitonin gene-related peptide
- CPRS, Computerized Patient Record System
- CPT, Cognitive Processing Therapy
- CRIS, Community Reintegration of Injured Service Members
- DRRI-2-D, Deployment Risk and Resilience Inventory-2-Deployment Environment
- DRRI-2-P, Deployment Risk and Resilience Inventory-Postbattle Experiences
- DSI-SS, Depressive Symptom Index-Suicide Subscale
- DoD, U.S. Department of Defense
- GAD-7, Generalized Anxiety Disorder Screener
- GLM, general linear mixed
- HIPAA, Health Insurance Portability and Accountability Act
- HIT-6, Headache Impact Test
- HMSE, Headache Management Self-Efficacy Scale
- HSLC, Headache-Specific Locus of Control Scale
- Headache
- ICHD-2, International Classification of Headache Disorders, 2nd Edition
- ICHD-3, International Classification of Headache Disorders, 3rd Edition
- IRB, institutional review board
- ISI, Insomnia Severity Index
- ITT, intent to treat
- LEC-5, Life Events Checklist for DSM-5
- NIH, National Institutes of Health
- NSI, Neurobehavioral Symptom Inventory
- OSU TBI-ID-SF, Ohio State University TBI Identification Method-Interview Form
- PCL-5, PTSD Checklist for DSM-5
- PHQ-15, Patient Health Questionnaire-15
- PHQ-9, Patient Health Questionnaire-9 Item
- PP, per protocol
- PRC, Polytrauma Rehabilitation Center
- PROMIS, Patient-Reported Outcomes Measurement Information System
- PTCI, Posttraumatic Cognitions Inventory
- PTH, posttraumatic headache
- PTHA Study, posttraumatic headache and PTSD study
- PTSD
- PTSD, posttraumatic stress disorder
- Polymorbidity
- QDS, Quick Drinking Screen
- RSES, Response to Stressful Experiences Scale
- SDIH-R, Structured Diagnostic Interview for Headache-Revised, Brief Version
- SITBI, Self-Injurious Thoughts and Behaviors Interview – Short Form
- STOP, Snoring, Tired, Observed, Blood Pressure
- TAU, treatment as usual
- TBI, traumatic brain injury
- Traumatic brain injury
- VA, U.S. Department of Veterans Affairs
- VHCS, Veterans Health Care System
- VR-12, Veterans RAND 12-Item Health Survey
- Veterans
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Affiliation(s)
- Donald D. McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Donald B. Penzien
- Departments of Psychiatry and Behavioral Medicine & Neurology, Wake Forest University, Winston-Salem, NC, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Cindy A. McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Carlos A. Jaramillo
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Blessen C. Eapen
- Greater Los Angeles Veterans Health Care System, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, PM&R, Los Angeles, CA, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Paul S. Nabity
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - John C. Moring
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Timothy T. Houle
- Department of Anaesthesia, Massachusetts General Hospital, Boston, MA, USA
| | - Terence M. Keane
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA
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Miles SR, Hammond FM, Neumann D, Silva MA, Tang X, Kajankova M, Dillahunt-Aspillaga C, Nakase-Richardson R. Evolution of Irritability, Anger, and Aggression after Traumatic Brain Injury: Identifying and Predicting Subgroups. J Neurotrauma 2021; 38:1827-1833. [PMID: 33470179 DOI: 10.1089/neu.2020.7451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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 (n = 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 (n = 89, 25.72%), (2) resolved IAA (n = 61, 17.63%), (3) delayed onset IAA (n = 31, 8.96%), and (4) persistent IAA (n = 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.
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Affiliation(s)
- Shannon R Miles
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Dawn Neumann
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Marc A Silva
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Internal Medicine Pulmonary and Sleep Medicine Division, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Xinyu Tang
- Tampa VA Research and Education Foundation, Inc., Tampa, Florida, USA
| | - Maria Kajankova
- Department of Rehabilitation and Human Performance, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Dillahunt-Aspillaga
- Rehabilitation and Mental Health Counseling Program, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, Florida, USA.,Department of Internal Medicine Pulmonary and Sleep Medicine Division, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,TBI Center of Excellence, James A. Haley Veterans' Hospital, Tampa, Florida, USA
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24
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Gallant C, Good D. Alcohol misuse and traumatic brain injury: a review of the potential roles of dopaminergic dysfunction and physiological underarousal post-injury. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:501-511. [PMID: 31561716 DOI: 10.1080/23279095.2019.1670181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although many researchers have demonstrated an increase in alcohol use following traumatic brain injury (TBI), there is also a body of research indicating that alcohol misuse predisposes one to injury and precedes TBI. Accordingly, various mechanisms have been proposed (e.g., self-medication, dampened levels of arousal, dopaminergic dysfunction, etc.) and variable results have emerged. This paper reviews the empirical evidence, for and against, TBI as a risk factor for alcohol misuse. In particular, this paper focuses on the brain-behavior relationships involved and examines the roles of physiological underarousal and dopaminergic dysfunction in the development of alcohol misuse after injury. Alcohol misuse impedes community reintegration among TBI survivors and creates additional rehabilitative challenges. Thus, in order to inform and improve treatment outcomes among this vulnerable population, a deeper understanding of the neural mechanisms implicated is needed.
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Affiliation(s)
- Caitlyn Gallant
- Department of Psychology, Brock University, St. Catharines, ON, Canada
| | - Dawn Good
- Department of Psychology, Brock University, St. Catharines, ON, Canada.,Centre for Neuroscience, Brock University, St. Catharines, ON, Canada
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Polytrauma Transitional Rehabilitation in the Veterans Administration: Implementing the Principles of Person-Centered, Participation-Oriented Rehabilitation. J Head Trauma Rehabil 2019; 34:135-140. [PMID: 31058755 DOI: 10.1097/htr.0000000000000456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review principles of person-centered, participation-oriented (PCPO) rehabilitation and introduce their implementation in Veterans Administration (VA) Polytrauma Transitional Rehabilitation Programs (PTRPs). BACKGROUND Post-hospital rehabilitation for individuals with acquired brain injury (ABI) has evolved toward PCPO rehabilitation, an approach that makes participation goals identified by the person served and his or her significant others the primary focus of rehabilitation. Goals to reduce impairments and increase activities contribute to the achievement of primary participation goals. Research, primarily in the nonveteran population, confirms the effectiveness of PCPO rehabilitation. OVERVIEW In the civilian sector, PCPO programs are generally provided locally or regionally in outpatient or community settings to individuals with moderate-severe ABI associated with other traumatic injuries and comorbidities. Because of the geographical dispersion of veterans, the VA provides these services in residential centers serving larger geographical areas. The group of veterans served more often has sustained milder traumatic ABI associated with neuropsychiatric comorbidities, particularly posttraumatic stress disorder and depression. Measuring progress and outcome is important to establish a feedback loop for process improvement. VA PTRPs use state-of-the-science standardized outcome measures and methods for identifying successful cases, that is, the minimal clinically important difference. Vocational reintegration is an important element of PCPO rehabilitation. Articles in this special section detail the development and effectiveness of PTRPs.
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