Assessment of veteran and caregiver knowledge about mild traumatic brain injury in a VA Medical Center

Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury

A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where "psychoeducation" was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation-the Rehabilitation Treatment Specification System-can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.

Informal carer's knowledge of traumatic brain injury questionnaire: Initial development and validation

Aim

To develop and psychometrically test the instrument for measuring the knowledge of traumatic brain injury of informal carers.

Design

Instrument development.

Method

Focus group discussions were conducted among informal carers and healthcare specialists in March 2017. The content validity was determined by the mean of the item content validity index. A reliability test was performed by the Kuder‐Richardson 20 and Pearson's correlation coefficient among 40 informal carers of patients with a traumatic brain injury in the rehabilitation medicine department of a tertiary hospital from August–September 2017.

Results

The final 34‐item questionnaire covers the nature of traumatic brain injury, the consequences of traumatic brain injury, the rehabilitation process, and the role of the caregiver. The item content means ranged from 0.8–1.00, and the difficulty of knowledge items ranged from 0.18–0.98. The internal consistency reliability and correlation coefficient were 0.70 and 0.84, respectively.

Psychological Symptoms and Rates of Performance Validity Improve Following Trauma-Focused Treatment in Veterans with PTSD and History of Mild-to-Moderate TBI

OBJECTIVE

Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.

METHOD

Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).

RESULTS

Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.

CONCLUSION

Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.

New Zealand Caregiver Knowledge of Paediatric Traumatic Brain Injury

Background:

Traumatic brain injury (TBI) is common among children. However, their caregivers’ knowledge and understanding of symptoms may influence how the injury is managed.

Primary objective:

To investigate the knowledge of New Zealand (NZ) parents about TBI and concussion.

Method and procedures:

Parents (n = 205) of children aged 5–13 years completed a pen-and-paper or online survey containing questions examining their knowledge of TBI terminology, TBI symptoms and knowledge about concussion management.

Main outcomes and results:

A high proportion (61%) of parents did not think that a concussion was the same as a brain injury. Loss of consciousness (LOC) was the most endorsed symptom of TBI. However, 69% of participants were aware that TBI could occur without LOC. On average, parents correctly identified 19.5 (67.3%) of the 29 symptoms of TBI, but also identified 2.0 (11.9%) of the 17 distractor symptoms as being TBI related. Demographic factors and experience of TBI/concussion were associated with TBI symptom identification accuracy and concussion knowledge.

Conclusions:

Further education of parents is needed to ensure they recognise the signs and symptoms of concussion/mild TBI so that they can make informed decisions on how best to manage their child’s injury.

Cognition among community-dwelling individuals with spinal cord injury

PURPOSE/OBJECTIVE

To compare the cognitive profiles of a well-characterized sample of adults with and without spinal cord injury (SCI) using the NIH Toolbox Cognition Battery NIHTB-CB. Research Method/Design: Participants were 156 community-dwelling individuals with SCI recruited from 3 academic medical centers, and 156 individuals without SCI selected from the NIHTB-CB normative database (N = 312). The main outcome measures were the demographically adjusted NIHTB-CB subtest and composite scores.

RESULTS

Individuals with and without SCI performed equivalently on the NIHTB-CB crystallized composite score, suggesting comparable premorbid functioning. Individuals with SCI produced lower scores on the NIHTB-CB fluid composite score by an average of 4.5 T-score points (Cohen's d = 0.50; a medium effect size). As a group, individuals with SCI had the most difficulty on tests of processing speed and executive functions, and some difficulty on a test of episodic memory, although effect sizes were small. These differences remained even after accounting for fine motor speed and dexterity. Individuals with tetraplegia produced lower scores than individuals with paraplegia on tests of processing speed and executive functioning.

CONCLUSION/IMPLICATIONS

Community-dwelling individuals with SCI are at elevated risk of mild cognitive difficulties, particularly on tasks that rely on processing speed and executive functions. The NIHTB-CB is relatively brief, samples important cognitive domains, has good normative data, and is appropriate for some individuals with SCI (those who have functional use of one hand). The battery has standardized accommodations for individuals with minor motor limitations, but timed tests are inaccessible for individuals who are unable to perform rapid button presses. (PsycINFO Database Record

Unique Aspects of Traumatic Brain Injury in Military and Veteran Populations

Traumatic brain injury (TBI), in particular mild TBI (mTBI), is a relatively common injury experienced by service members across both deployed and nondeployed environments. Although many of the principles and practices used by civilian health care providers for identifying and treating this injury apply to military settings, there are unique factors that impact mTBI-related care in service members and Veterans. This article reviews several of these factors, including the epidemiology of TBI in the military/Veteran population, the influence of military culture on this condition, and identification and treatment of mTBI in the war zone.

[Brain injury knowledge in family members of neurosurgical patients]

BACKGROUND AND OBJECTIVES

Several studies have shown misconceptions about brain injury in different populations. The aim of this study was to assess the knowledge and perceptions about brain injury of family members of neurosurgical patients in our hospital.

MATERIAL AND METHODS

The participants (n=81) were relatives of patients admitted to the neurosurgery department between February and August 2016. They voluntarily completed a 19-item true-false format survey about brain injury based on a translation of other questionnaires used in previous studies from other countries (USA, Canada, UK, Ireland and New Zealand). Also, some sociodemographic data were collected (age, sex, education level and the patient's pathology). Data analysis was developed through graphical modelling with a regularisation parameter plotted on a network representing the association of the items of the questionnaire from the response pattern of participants.

RESULTS

Data analysis showed two conceptual areas with a high rate of wrong answers: behaviour and management of patients, and expectations about acquired brain injury recovery.

CONCLUSIONS

The results obtained in this study would enable us to objectify misconceptions about acquired brain injury in patients' relatives attended in the neurosurgery department. This lack of knowledge could be a great obstacle in patients' recovery process. Therefore, we suggest placing the emphasis on the provision of information on brain injury to patients' families, especially with regard to its symptoms and course of development.

Towards Measuring Community Understanding of Traumatic Brain Injury: The Structure and Potential Utility of the Head Injury Knowledge Scale

Background and aims: International research has shown the public hold various misconceptions about traumatic brain injury (TBI). Yet, relatively little has been done towards developing appropriate measures of public knowledge of TBI. The Head Injury Knowledge Scale (HIKS, Ono, Ownsworth, & Walters, 2011) is a newly developed measure of misconceptions and expectations about the effects of TBI. Additional investigation of its psychometric properties appeared warranted. The aims of this further preliminary study were to examine the factor structure of the HIKS and the relationship between psychosocial variables and factor scores.

Method: A convenience sample comprising 167 adults, of whom 65% were females, responded to an online survey including the HIKS. The two-factor HIKS structure was tested using confirmatory factor analyses and the relationships between psychosocial variables and the HIKS factors were investigated.

Results: A good fit was found for the structure of the HIKS. All items loaded adequately onto the HIKS Over-generalisation and Minimisation factors and their internal consistencies were good. Significant differences between gender groups and for level of education were observed on the HIKS Over-generalisation scale, suggesting various groups in the community may have differing levels of knowledge of TBI.

Conclusion: This study confirmed the robustness of the HIKS factor structure. The HIKS is likely to be an important measure of community understanding of TBI in future research.

Misconceptions and Misattributions About Traumatic Brain Injury: An Integrated Conceptual Framework

The objective of the present narrative review was to provide a conceptual framework to address common misconceptions in the field of traumatic brain injury (TBI) and enhance clinical and research practices. This framework is based on review of the literature on TBI knowledge and beliefs. The comprehensive search of the literature included seminal and current texts as well as relevant articles on TBI knowledge and education, misconceptions, and misattributions. Reviewed materials ranged from 1970 to 2013 and were obtained from PubMed and PubMed Central online research databases. Research findings from the reviewed literature were integrated with existing social and cognitive psychological concepts to develop a framework that includes: (1) the identification antecedents of TBI-related misconceptions and misattribution; (2) understanding of how inaccurate beliefs form and persist as the result of pre- and postinjury cognitive operations such as informational cascades and attribution biases; and (3) a discussion of ways in which these beliefs can result in consequences in all domains of a survivor's life, including physical and mental health, stigma, and discrimination. This framework is intended to serve as a first stage of development of a model that will improve treatment endeavors and service delivery to individuals with TBI and their families.