TRAUMATIC BRAIN INJURY 1997

1. AUTHOR	Hillier-S-L, Metzer-J.
INSTITUTION	School of Psychology, University of South Australia.
TITLE	Awareness and perceptions of outcomes after traumatic brain injury.
SOURCE	Brain-Inj 1997 Jul, VOL: 11 (7), P: 525-36, ISSN: 0269-9052.
ABSTRACT	Awareness or insight has been identified as a major factor in successful rehabilitation after traumatic brain injury (TBI). Anecdotal evidence suggests people with TBI are more likely to be aware of residual physical disabilities, perhaps focusing on these to the exclusion of other issues in the psychosocial and cognitive domains, for example. To investigate this more accurately, recovery and outcome questionnaires were administered to people with TBI and their nominated significant others, and, as appropriate, an assessment of their level of functioning was also recorded. Two- and three-way analyses (t-tests, Kendall's and Wilcoxon's) comparing these perceptions were then conducted. The results indicated a high level of agreement for basic demographic data and broad outcomes. It was found the subjects reported a lower rate of physical impairment and disability than the significant other or the author, suggesting that, as a group, they do not fixate on physical issues. Other areas of difference were found, such as a tendency for the significant other to perceive the subject as being more dependent in mobility and self-care tasks, possibly because of their close involvement. Also the author reported more impairments, using clinical language and assessment that did not necessarily have meaning or significance for the other groups. There was also evidence to support the notion that there is an inherent hierarchy of needs ranging from the lower-order, physiological or survival skills through to higher-order, self- actualizing areas. Because of the differing awareness and perceptions, care must be taken in service provision to identify the personal needs and values of each individual involved. Author.
2. AUTHOR	Seel-R-T, Kreutzer-J-S, Sander-A-M.
INSTITUTION	Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
TITLE	Concordance of patients' and family members' ratings of neurobehavioral functioning after traumatic brain injury.
SOURCE	Arch-Phys-Med-Rehabil 1997 Nov, VOL: 78 (11), P: 1254-9, ISSN: 0003-9993.
ABSTRACT	OBJECTIVE: To examine differences in family and patient evaluation of neurobehavioral functioning in adults with traumatic brain injury (TBI). DESIGN: Differences were examined by conducting 70 paired sample t tests on scale items and 6 paired sample t tests on scale scores from a neurobehavioral inventory. SETTING: Medical center outpatient clinic. PARTICIPANTS: Three hundred one consecutive adult patients with TBI and 301 informants, primarily family members, completed the neurobehavioral inventory. MAIN OUTCOME MEASURE: Neurobehavioral Functioning Inventory (NFI) comprised of six scales with items describing symptoms and daily living problems. RESULTS: Paired to test analyses of the six scales indicated that patients reported a significantly greater level of communication problems than did their matched family members. No differences were found for the other five scales. Paired t test analyses of the 70 scale items revealed significant differences in patient and family ratings for only 13 items. In all 13 instances, patients reported greater levels of dysfunction than were reported by their family members. Analysis of variance (ANOVA) indicated a main effect of injury severity for only the Communication and Memory/Attention scales. CONCLUSIONS: Findings indicate general agreement between family members and patients regarding patients' everyday problems. Results do not support contentions that patients tend to underestimate difficulties. Agreement levels appear related to injury severity, item specificity, and item content. More research is needed to identify other variables relating to agreement levels, including age, injury severity, and amount of contact between patients and family members. Author.
3. AUTHOR	Sander-A-M, Seel-R-T, Kreutzer-J-S, Hall-K-M, High-W-M-Jr, Rosenthal- M.
INSTITUTION	Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond 23298-0542, USA.
TITLE	Agreement between persons with traumatic brain injury and their relatives regarding psychosocial outcome using the Community Integration Questionnaire.
SOURCE	Arch-Phys-Med-Rehabil 1997 Apr, VOL: 78 (4), P: 353-7, ISSN: 0003-9993.
ABSTRACT	OBJECTIVE: To extend psychometric research on the Community Integration Questionnaire (CIQ) by comparing patients' reports with those of family members. DESIGN: Reports on community integration were obtained from family members and patients 1 year after brain injury. Kappa reliability coefficients were used to examine agreement for individual items on the questionnaire. Total scores for the three CIQ scales were compared between groups using independent samples t tests. SETTING: Outpatient clinics affiliated with the four NIDRR traumatic brain injury Model System rehabilitation centers. PARTICIPANTS: CIQ data were obtained for 259 adult patients with traumatic brain injury. For 122 cases, patients and family members provided corresponding data. In 101 cases, only self-reported data were available. In 36 cases, information was provided solely by family members. All patients received inpatient rehabilitation and were at least 16 years of age. The full range of brain injury severity was represented. MAIN OUTCOME MEASURE: The 15-item CIQ, comprised of three scales, Home Integration, Productive Activity, and Social Integration. RESULTS: Analysis of kappa values found "moderate " to "almost perfect" agreement levels for all 15 items. Almost- perfect ratings were found for three of the four items on the Productive Activity Scale. Comparisons were made between scale scores derived from patients and families. The Home Integration scale showed differences, with patient scores higher than those reported by family members (t = 3.51, p < .01). However, the difference in scores was attributable to small discrepancies on two items and was not considered clinically meaningful. The Total CIQ score also showed a difference, with patients reporting significantly higher levels of integration relative to family members (t = 2.30, p < .05). This difference was also attributable to discrepancies on two items of the Home Integration Scale. CONCLUSIONS: The results have important implications for researchers who may be limited to one source of data. The hypothesis that patients and family members have very different perspectives of patients' community activities was not supported. Rather, similar ratings of individual activities were given with two exceptions, meal preparation and housekeeping. More research is needed to delineate relationships between agreement ratings and outcome categories. Author.
4. AUTHOR	Kelly-M-P, Johnson-C-T, Knoller-N, Drubach-D-A, Winslow-M-M.
INSTITUTION	University of Maryland School of Medicine, Baltimore, USA.
TITLE	Substance abuse, traumatic brain injury and neuropsychological outcome.
SOURCE	Brain-Inj 1997 Jun, VOL: 11 (6), P: 391-402, ISSN: 0269-9052.
ABSTRACT	The neuropsychological performance of 119 patients with severe closed traumatic brain injury (TBI) who had received toxicology screens at the time of trauma centre admission was examined. Three groups were created: normal screen, positive alcohol screen, or positive abused drugs screen (with or without the presence of alcohol). The admitting Glasgow Coma Scale (GCS) score was significantly lower in the positive alcohol screen group than the normal screen group, while the three groups did not differ in length of post-traumatic amnesia (PTA) or years of education. Neuropsychological assessment was conducted during inpatient rehabilitation, following resolution of PTA. Normal screen patients obtained significantly better scores than the abused- drugs patients on the Full Scale IQ (FIQ) and Verbal IQ (VIQ) indices of the Wechsler Adult Intelligence Scale-Revised and the Verbal Memory, General Memory, Attention-Concentration, and Delayed Recall indices of the Wechsler Memory Scale-Revised. Normal screen patients also scored significantly higher than positive alcohol screen patients on FIQ and VIQ indices and all five indices from the Wechsler Memory Scale-Revised. These data suggest the existence of an additive effect of substance abuse on neuropsychological outcome in TBI. Findings have potential implications for both acute management and rehabilitation of TBI. Author.
5. AUTHOR	Baguley-I-J, Felmingham-K-L, Lahz-S, Gordan-E, Lazzaro-I, Schotte-D- E.
INSTITUTION	Brain Injury Rehabilitation Service, Westmead Hospital, Australia.
TITLE	Alcohol abuse and traumatic brain injury: effect on event-related potentials.
SOURCE	Arch-Phys-Med-Rehabil 1997 Nov, VOL: 78 (11), P: 1248-53, ISSN: 0003-9993.
ABSTRACT	OBJECTIVE: To examine the individual and combined impact that traumatic brain injury (TBI) and heavy social use of alcohol have on electrophysiologic correlates of working memory and evaluation of task-relevant information. DESIGN: Case-control study. SETTING: University hospital brain injury rehabilitation unit. PARTICIPANTS: Forty male volunteers divided into four groups on the basis of their history of TBI and alcohol intake. Subjects with TBI had experienced a severe closed head injury at least 1 year before testing. MAIN OUTCOME MEASURE: Event-related potentials (ERPs) and neuropsychometric tests. RESULTS: Groups showed no significant differences in average age or neuropsychological tests. TBI groups did not differ in time postinjury or on severity measures. Alcohol use measures were significantly greater in the two alcohol groups. N200 latency and P300 amplitude were impaired in heavy social drinkers and in nondrinking subjects with TBI relative to controls, but were significantly impaired in subjects with TBI who were also heavy social drinkers. CONCLUSION: The results indicate that although alcohol use and TBI independently produce mile alterations in some aspects of late ERP components, the ERP changes are significantly greater when alcohol use and TBI are combined. This study provides evidence that heavy social drinking after TBI has a measurable impact on electrophysiologic correlates of cognition. Author.
6. AUTHOR	Sander-A-M, Witol-A-D, Kreutzer-J-S.
INSTITUTION	Department of Rehabilitation Medicine, Medical College of Virginia, Richmond 23298-0542, USA.
TITLE	Alcohol use after traumatic brain injury: concordance of patients' and relatives' reports.
SOURCE	Arch-Phys-Med-Rehabil 1997 Feb, VOL: 78 (2), P: 138-42, ISSN: 0003-9993.
ABSTRACT	OBJECTIVE: To investigate bias and concurrent validity of patients' alcohol use reports by examining concordance with relatives' reports. DESIGN: Using a quasiexperimental static group comparison design, alcohol use was examined at 1 year after injury. Chi-square analyses, t tests, and a Fisher exact probability test were conducted to investigate the relationship between patients' and caregivers' reports on measures of alcohol use. SETTING: Medical center outpatient clinic. PARTICIPANTS: 175 adult patients with traumatic brain injury and 175 family informants. Inclusion criteria were: patient older than 18 years of age and completion of self-report and family member versions of questionnaires. The full range of brain injury severity was represented. MAIN OUTCOME MEASURES: Quantity- Frequency-Variability Index (QFVI; Cahalan and Cisin, 1968); Brief Michigan Alcohol Screening Test (B-MAST; Porkorny et al, 1972). RESULTS: A high rate of concordance, typically greater than 90%, was noted between patients' and relatives' reports on each of the alcohol use measures. Chi-square analyses revealed no significant differences (p > .05) between patients' and relatives' reports for the QFVI or the B-MAST. Inspection of the data found lesser rates of agreement for persons with severe injuries. Chi-square analyses revealed no differences based on family members' relationship to patients or whether they lived together or apart. However, a Fisher exact probability test (p < .03) for the QFVI indicated higher agreement rates for spouses relative to parents. CONCLUSIONS: The results do not support the hypothesis that patients underreport drinking and that their reports are inconsistent with those of caregivers. The high levels of concordance are consistent with those found in similar research studies involving alcoholic populations. Results suggest that patients' reports should be given higher credibility and should not be routinely dismissed in favor of information provided by families. However, more caution is necessary when collecting information from persons with severe injury. Author.
7. AUTHOR	Bombardier-C-H, Ehde-D, Kilmer-J.
INSTITUTION	Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA.
TITLE	Readiness to change alcohol drinking habits after traumatic brain injury.
SOURCE	Arch-Phys-Med-Rehabil 1997 Jun, VOL: 78 (6), P: 592-6, ISSN: 0003-9993.
ABSTRACT	OBJECTIVE: To describe how motivated are persons with recent traumatic brain injury (TBI) to change their alcohol drinking habits and what factors affect their motivation. DESIGN: Survey. SETTING: Acute inpatient rehabilitation program. PATIENTS: Subjects were 50 patients with recent TBI during inpatient rehabilitation. MAIN OUTCOME MEASURES: Readiness to Change (RTC) questionnaire, Michigan Alcoholism Screening Test (MAST), and alcohol use questions. RESULTS: Subjects were 36 years old; 86% were men. Eighty-four percent fell in the contemplation or action phases. Comparisons with a separate medical patient sample suggested that TBI may be associated with greater contemplation of change and greater readiness to take action to change alcohol use. Multivariate analyses indicated that within the TBI sample a positive history of alcoholism, alcohol involved in the accident, and higher daily consumption were associated with greater readiness to change (especially contemplation scores). CONCLUSIONS: Soon after TBI, drinkers frequently contemplate changing their alcohol use. This situation may represent an underutilized window of opportunity to reduce postinjury alcohol use and abuse. Motivational interviewing techniques seem well suited to facilitate change during this period. Author.
8. AUTHOR	Corrigan-J-D, Bogner-J-A, Mysiw-W-J, Clinchot-D, Fugate-L.
INSTITUTION	Department of Physical Medicine and Rehabilitation, Ohio State University, Columous, USA.
TITLE	Systematic bias in outcome studies of persons with traumatic brain injury.
SOURCE	Arch-Phys-Med-Rehabil 1997 Feb, VOL: 78 (2), P: 132-7, ISSN: 0003-9993.
ABSTRACT	OBJECTIVE: (1) Examine systematic biases created by subjects lost at 1-year follow-up in samples of persons with traumatic brain injury; (2) identify potential threats to generalization of outcomes data. DESIGN: A consecutive sample of admissions to acute rehabilitation studied 1 year following discharge. SETTING: An inpatient brain injury rehabilitation unit in a large, academic medical center. SUBJECTS: Eighty-eight patients with primary diagnosis of traumatic brain injury. MAIN OUTCOME MEASURES: Subjects were considered lost to follow-up when phone calls, mail, clinic visits, and assistance from family failed to allow contact 1 year after discharge from acute rehabilitation. Potential effects of the biased follow-up sample were examined for seven suboptimal outcomes. RESULTS: A total of 38.6% of subjects were lost to follow-up. Subjects intoxicated at time of injury and those with history of substance abuse were more-likely to be lost. Among subjects followed, the likelihood of working or being in school 1 year after discharge was significantly less for those intoxicated at time of injury and those with a history of substance abuse. CONCLUSIONS: Systematic bias in longitudinal studies may result from subjects with substance use problems being lost to follow-up. Population estimates for return to work or school will be overestimated if those lost who have substance use problems resemble those followed. Author.
9. AUTHOR	Wood-R-L, Yurdakul-L-K.
INSTITUTION	Brain Injury Rehabilitation Trust, Milton Keynes, UK.
TITLE	Change in relationship status following traumatic brain injury.
SOURCE	Brain-Inj 1997 Jul, VOL: 11 (7), P: 491-501, ISSN: 0269-9052.
ABSTRACT	Previous studies have highlighted the burden placed on family members and close partners of individuals who have sustained traumatic brain injury. This burden of stress has been attributed to the neurobehavioural sequelae of such injuries. However, the extent to which brain injury affects marriages and close relationships has never been statistically evaluated. This study looked at 131 adults with traumatic brain injury in order to determine the incidence of divorce/separation; 49 per cent of our sample reported that they had divorced or separated from their partners during a 5-8-year period following brain injury. Factors which may predict the outcome of relationships include severity of injury (as determined by length of post-traumatic amnesia), length of relationship, and time since injury. The influence of these factors in determining the risk of relationship breakdown is discussed. Author.

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