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Comparison of Informational and Educational Resource Provision for Individuals Living With Traumatic Brain Injury Based on Language, Nativity, and Neighborhood

Wilson, Judith; McGiffin, Jed N; Smith, Michelle; Garduño-Ortega, Olga; Talis, Elina; Zarate, Alejandro; Jenkins, Natalie; Rath, Joseph F; Bushnik, Tamara
OBJECTIVE:To examine a resource provision program for individuals living with moderate-to-severe traumatic brain injury (TBI), using a comparison of the resources provided across social differences of language, nativity, and neighborhood. SETTING/METHODS:The Rusk Rehabilitation TBI Model System (RRTBIMS) collects data longitudinally on individuals from their associated private and public hospitals, located in New York City. PARTICIPANTS/METHODS:A total of 143 individuals with TBI or their family members. DESIGN/METHODS:An observational study of relative frequency of resource provision across variables of language, nativity, and neighborhood, using related-samples nonparametric analyses via Cochran's Q test. MAIN MEASURES/METHODS:Variables examined were language, place of birth, residence classification as medically underserved area/population (MUA), and resource categories. RESULTS:Results indicate that US-born persons with TBI and those living in medically underserved communities are provided more resources than those who are born outside the United States or reside in communities identified as adequately medically served. Language was not found to be a factor. CONCLUSION/CONCLUSIONS:Lessons learned from this research support the development of this resource provision program, as well as guide future programs addressing the gaps in health information resources for groups negatively impacted by social determinants of health (SDoH). An approach with immigrant participants should take steps to elicit questions and requests, or offer resources explicitly. We recommend research looking at what interpreter strategies are most effective and research on SDoH in relation to the dynamic interaction of variables in the neighborhood setting.
PMID: 36730859
ISSN: 1550-509x
CID: 5420432

Societal Participation of People with Traumatic Brain Injury Before and During the COVID-19 Pandemic: A NIDILRR Traumatic Brain Injury Model Systems Study

Venkatesan, Umesh M; Adams, Leah M; Rabinowitz, Amanda R; Agtarap, Stephanie; Bombardier, Charles H; Bushnik, Tamara; Chiaravalloti, Nancy D; Juengst, Shannon B; Katta-Charles, Sheryl; Perrin, Paul B; Pinto, Shanti M; Weintraub, Alan; Whiteneck, Gale G; Hammond, Flora M
OBJECTIVE:To examine the impact of the COVID-19 pandemic on societal participation in people with moderate-to-severe traumatic brain injury (TBI). DESIGN/METHODS:Cross-sectional retrospective cohort. SETTING/METHODS:National TBI Model Systems (TBIMS) centers, United States. PARTICIPANTS/METHODS:TBIMS enrollees (N=7,003), ages 16 and older and 1-30 years post-injury, interviewed either pre-pandemic (PP) or during the pandemic (DP). The sample was primarily male (72.4%) and White (69.5%), with motor vehicle accidents as the most common cause of injury (55.1%). INTERVENTIONS/METHODS:Not applicable. MAIN OUTCOME MEASURE/METHODS:The 3 subscales of the Participation Assessment with Recombined Tools-Objective (PART-O): Out and About (community involvement), Productivity, and Social Relations. RESULTS:Out and About, but not Productivity or Social Relations, scores were appreciably lower among DP participants compared to PP participants (medium effect). Demographic and clinical characteristics showed similar patterns of association with participation domains across PP and DP. When their unique contributions were examined in regression models, age, self-identified race, education level, employment status, marital status, income level, disability severity, and life satisfaction were variably predictive of participation domains, though most effects were small or medium in size. Depression and anxiety symptom severities each showed small zero-order correlations with participation domains across PP and DP, but had negligible effects in regression analyses. CONCLUSIONS:Consistent with the impact of COVID-19 on participation levels in the general population, people with TBI reported less community involvement during the pandemic, potentially compounding existing post-injury challenges to societal integration. The pandemic does not appear to have altered patterns of association between demographic/clinical characteristics and participation. Assessing and addressing barriers to community involvement should be a priority for TBI treatment providers. Longitudinal studies of TBI that consider pandemic-related effects on participation and other societally linked outcomes will help to elucidate the potential longer-term impact the pandemic has on behavioral health in this population.
PMID: 36736808
ISSN: 1532-821x
CID: 5420602

Replicability of proton MR spectroscopic imaging findings in mild traumatic brain injury: Implications for clinical applications

Chen, Anna M; Gerhalter, Teresa; Dehkharghani, Seena; Peralta, Rosemary; Gajdošík, Mia; Gajdošík, Martin; Tordjman, Mickael; Zabludovsky, Julia; Sheriff, Sulaiman; Ahn, Sinyeob; Babb, James S; Bushnik, Tamara; Zarate, Alejandro; Silver, Jonathan M; Im, Brian S; Wall, Stephen P; Madelin, Guillaume; Kirov, Ivan I
PURPOSE/OBJECTIVE:H MRS) offers biomarkers of metabolic damage after mild traumatic brain injury (mTBI), but a lack of replicability studies hampers clinical translation. In a conceptual replication study design, the results reported in four previous publications were used as the hypotheses (H1-H7), specifically: abnormalities in patients are diffuse (H1), confined to white matter (WM) (H2), comprise low N-acetyl-aspartate (NAA) levels and normal choline (Cho), creatine (Cr) and myo-inositol (mI) (H3), and correlate with clinical outcome (H4); additionally, a lack of findings in regional subcortical WM (H5) and deep gray matter (GM) structures (H6), except for higher mI in patients' putamen (H7). METHODS:26 mTBI patients (20 female, age 36.5 ± 12.5 [mean ± standard deviation] years), within two months from injury and 21 age-, sex-, and education-matched healthy controls were scanned at 3 Tesla with 3D echo-planar spectroscopic imaging. To test H1-H3, global analysis using linear regression was used to obtain metabolite levels of GM and WM in each brain lobe. For H4, patients were stratified into non-recovered and recovered subgroups using the Glasgow Outcome Scale Extended. To test H5-H7, regional analysis using spectral averaging estimated metabolite levels in four GM and six WM structures segmented from T1-weighted MRI. The Mann-Whitney U test and weighted least squares analysis of covariance were used to examine mean group differences in metabolite levels between all patients and all controls (H1-H3, H5-H7), and between recovered and non-recovered patients and their respectively matched controls (H4). Replicability was defined as the support or failure to support the null hypotheses in accordance with the content of H1-H7, and was further evaluated using percent differences, coefficients of variation, and effect size (Cohen's d). RESULTS:Patients' occipital lobe WM Cho and Cr levels were 6.0% and 4.6% higher than controls', respectively (Cho, d = 0.37, p = 0.04; Cr, d = 0.63, p = 0.03). The same findings, i.e., higher patients' occipital lobe WM Cho and Cr (both p = 0.01), but with larger percent differences (Cho, 8.6%; Cr, 6.3%) and effect sizes (Cho, d = 0.52; Cr, d = 0.88) were found in the comparison of non-recovered patients to their matched controls. For the lobar WM Cho and Cr comparisons without statistical significance (frontal, parietal, temporal), unidirectional effect sizes were observed (Cho, d = 0.07 - 0.37; Cr, d = 0.27 - 0.63). No differences were found in any metabolite in any lobe in the comparison between recovered patients and their matched controls. In the regional analyses, no differences in metabolite levels were found in any GM or WM region, but all WM regions (posterior, frontal, corona radiata, and the genu, body, and splenium of the corpus callosum) exhibited unidirectional effect sizes for Cho and Cr (Cho, d = 0.03 - 0.34; Cr, d = 0.16 - 0.51). CONCLUSIONS:H MRS biomarkers for mTBI may best be achieved by using high signal-to-noise-ratio single-voxels placed anywhere within WM. The biochemical signature of the injury, however, may differ and therefore absolute levels, rather than ratios may be preferred. Future replication efforts should further test the generalizability of these findings.
PMID: 36724732
ISSN: 2213-1582
CID: 5426722

Perceived care partner burden at 1-year post-injury and associations with emotional awareness, functioning, and empathy after TBI: A TBI model systems study

Klyce, Daniel W; Merced, Kritzianel; Erickson, Alexander; Neumann, Dawn M; Hammond, Flora M; Sander, Angelle M; Bogner, Jennifer A; Bushnik, Tamara; Chung, Joyce S; Finn, Jacob A
BACKGROUND:People with traumatic brain injury (TBI) can lack awareness of their own emotions and often have problems with emotion dysregulation, affective disorders, and empathy deficits. These impairments are known to impact psychosocial behaviors and may contribute to the burden experienced by care partners of individuals with TBI. OBJECTIVE:To examine the associations of emotional awareness, emotional functioning, and empathy among participants with TBI with care partner burden. METHOD/METHODS:This multisite, cross-sectional, observational study used data from 90 dyads (participants with TBI and their care partner) 1-year post-injury. Participants with TBI completed the Difficulty with Emotional Regulation Scale (DERS; Awareness, Clarity, Goals, Impulse, Nonacceptance, and Strategies subscales); PTSD Checklist-Civilian Version; NIH Toolbox Anger-Affect, Hostility and Aggression Subdomains; PHQ-9; GAD-7; and the Interpersonal Reactivity Index (empathic concern and perspective taking subscales). Care partners completed the Zarit Burden Inventory (ZBI) and provided demographic information. RESULTS:Care partners were predominately female (77%), and most were either a spouse/partner (55.2%) or parent (34.4%). In an unadjusted model that included assessments of emotional awareness, emotional functioning, and empathy of the participant with TBI, the DERS-Awareness and NIH-Hostility subscales accounted for a significant amount of variance associated with care partner burden. These findings persisted after adjusting for care partner age, relationship, education, and the functional status of the participant with TBI (β= 0.493 and β= 0.328, respectively). CONCLUSION/CONCLUSIONS:These findings suggest that high levels of hostility and low emotional self-awareness can significantly affect the burden felt by TBI care partners.
PMID: 36617759
ISSN: 1878-6448
CID: 5419012

Brief Report: Cognitive Dependence in Physically Independent Patients at Discharge from Acute Traumatic Brain Injury Rehabilitation

Rath, Joseph F; McGiffin, Jed N; Glubo, Heather; McDermott, Hannah W; Beattie, Aaron; Arutiunov, Caitlyn; Schaefer, Lynn A; Im, Brian; Bushnik, Tamara
OBJECTIVE:To determine the incidence of cognitive dependence in adults who are physically independent at discharge from acute traumatic brain injury (TBI) rehabilitation. DESIGN/METHODS:Analysis of historical clinical and demographic data obtained from inpatient stay. SETTING/METHODS:Inpatient rehabilitation unit in a large, metropolitan university hospital. PARTICIPANTS/METHODS:Adult inpatients with moderate-to-severe TBI (N = 226) who were physically independent at discharge from acute rehabilitation. INTERVENTIONS/METHODS:Not applicable MAIN OUTCOME MEASURES: FIM Motor and Cognitive subscales, discharge destination, and care plan. RESULTS:Approximately 69% (n = 155) of the physically independent inpatients were cognitively dependent at discharge from acute rehabilitation, with the highest proportions of dependence found in the domains of problem solving and memory. Most (82.6%; n =128) of these physically independent, yet cognitively dependent, patients were discharged home. Of those discharged to home, 82% (n = 105) were discharged to the care of family members, and 11% (n = 15) were discharged home alone. Patients from racial-ethnic minority backgrounds were significantly more likely than White patients to be discharged while cognitively dependent. CONCLUSIONS:The majority of physically independent TBI patients were cognitively dependent at the time of discharge from acute inpatient rehabilitation. Further research is needed to understand the impact of cognitive dependence on caregiver stress and strain and the disproportionate burden on racial-ethnic minority patients and families. Given the potential functional and safety limitations imposed by cognitive deficits, healthcare policy and practice should facilitate delivery of cognitive rehabilitation services in acute TBI rehabilitation.
PMID: 35196504
ISSN: 1532-821x
CID: 5163132

Participation importance and satisfaction across the lifespan: A traumatic brain injury model systems study

Juengst, Shannon B; Erler, Kimberly S; Neumann, Dawn; Kew, Chung Lin Novelle; Goldin, Yelena; O'Neil-Pirozzi, Therese M; Rabinowitz, Amanda; Niemeier, Janet; Bushnik, Tamara; Dijkers, Marcel
OBJECTIVE:In rehabilitation research and practice, participation is defined as involvement in life situations and most often measured as frequency of engaging in these life situations. This narrow measurement approach overlooks that individuals perceive importance of and satisfaction with participation in activities in various life areas differently. The purpose of this study was to determine differences in meaningful participation (perceived importance and satisfaction) after moderate to severe traumatic brain injury (TBI) across age groups and to identify predictors of participation satisfaction. METHOD/METHODS:Secondary data analysis of a TBI Model Systems substudy, including the Participation Assessment with Recombined Tools-Subjective (PART-S) that rates participation importance and satisfaction in 11 life areas that we grouped into three domains (i.e., productivity, social relations, out-and-about). We identified differences across age groups (i.e., 16 to 24 years, 25 to 44 years, 45 to 64 years, and 65 + years) and predictors of participation satisfaction. RESULTS:Participation satisfaction in and importance of the 11 life areas varied across age groups. In all age groups, participants rated relationships as being of medium or high importance more often than other life areas. Older adults reported the highest participation satisfaction across life areas, despite having the lowest participation frequency. Consistent predictors of participation satisfaction were cognitive functioning and frequency of participation in the domain examined. CONCLUSION/CONCLUSIONS:Participation importance, satisfaction, and frequency are related, yet distinct, dimensions of participation that should all be measured to adequately evaluate meaningful participation. Future research should explore interventions across the lifespan that target modifiable predictors, like functional cognition and access to frequent participation in important life activities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
PMID: 35834205
ISSN: 1939-1544
CID: 5269332

Organisation of services and systems of care in paediatric spinal cord injury rehabilitation in seven countries: a survey with a descriptive cross-sectional design

Höfers, Wiebke; Jørgensen, Vivien; Sällström, Susanne; Vege, Kristine M; Strøm, Mona; New, Peter W; Bushnik, Tamara; Zakharova, Olga; Krasovsky, Tal; Guttman, Dafna; Ghatasha, Atheer; Genlin, Liu; Yang, Chen; Yu-Xi, Qin; Wahman, Kerstin; Sunnerhagen, Katharina S; Ertzgaard, Per; Sukhov, Renat; Augutis, Marika; Stanghelle, Johan K; Roaldsen, Kirsti S
STUDY DESIGN/METHODS:International multicentre cross-sectional study. OBJECTIVES/OBJECTIVE:To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. SETTING/METHODS:Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age. METHODS:An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. RESULTS:The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. CONCLUSIONS:As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.
PMID: 34802054
ISSN: 1476-5624
CID: 5063202

T1 and T2 quantification using magnetic resonance fingerprinting in mild traumatic brain injury

Gerhalter, Teresa; Cloos, Martijn; Chen, Anna M; Dehkharghani, Seena; Peralta, Rosemary; Babb, James S; Zarate, Alejandro; Bushnik, Tamara; Silver, Jonathan M; Im, Brian S; Wall, Stephen; Baete, Steven; Madelin, Guillaume; Kirov, Ivan I
OBJECTIVES/OBJECTIVE:To assess whether MR fingerprinting (MRF)-based relaxation properties exhibit cross-sectional and prospective correlations with patient outcome and compare the results with those from DTI. METHODS:from MRF were compared in 12 gray and white matter regions with Mann-Whitney tests. Bivariate associations between MR measures and outcome were assessed using the Spearman correlation and logistic regression. RESULTS:, accounted for five of the six MR measures with the highest utility for identification of non-recovered patients at timepoint 2 (AUC > 0.80). CONCLUSION/CONCLUSIONS:, FA, and ADC for predicting 3-month outcome after mTBI. KEY POINTS/CONCLUSIONS:, and FA.
PMID: 34410458
ISSN: 1432-1084
CID: 5006382

Pediatric spinal cord injury rehabilitation: A protocol for an international multicenter project (SINpedSCI)

Roaldsen, Kirsti Skavberg; Jrgensen, Vivien; Höfers, Wiebke; Sällström, Susanne; Augutis, Marika; Ertzgaard, Per; Wahman, Kerstin; Strm, Mona; Vege, Kristine Marie; Srland, Kristine; GenLin, Liu; Qi, Zhang; Yu-Xi, Qin; Yang, Chen; Zakharova, Olga; Trukhankina, Zinaida; Ghatashah, Atheer; Hamdan, Eman; Krasovsky, Tal; Guttman, Dafna; Sunnerhagen, Katharina Stibrant; New, Peter W; Bushnik, Tamara; Sukhov, Renat; Stanghelle, Johan K
PURPOSE/OBJECTIVE:Children and adolescents (<18 years old) who sustain a spinal cord injury (SCI) should ideally be managed in specialized rehabilitation services. This project aims to describe the organization of pediatric SCI in ten rehabilitation units in seven countries and to qualitatively explore psychosocial aspects of adolescents living with SCI. METHODS:A multicenter cross-sectional project is planned, using quantitative (web survey) and qualitative (interview) methods in ten rehabilitation units from Norway, Sweden, United States, Israel, PR China, Russia and Palestine. Individual interviews will be conducted with ≥20 adolescents aged 13-17 years at least 6 months' post rehabilitation. RESULTS:Units involved will be described and compared, according to funding, attachment to an acute SCI unit, catchment area, number of beds, admittance and discharge procedures, availability of services, staff/patient ratio, content and intensity of rehabilitation programs, length of stay, measurement methods, follow-up services, health promotion services, and pediatric SCI prevention acts. The semi-structured interview guide will include experiences from acute care and primary rehabilitation, daily life, school, contact with friends, leisure time activities, peers, physical and psychological health, and the adolescents' plans for the future. CONCLUSION/CONCLUSIONS:Based on the present protocol, this project is likely to provide new insight and knowledge on pediatric SCI rehabilitation and increase the understanding of pediatric SCI in adolescents and their families internationally.
PMID: 34974443
ISSN: 1875-8894
CID: 5097812

The effects of plasticity-based cognitive rehabilitation on resting-state functional connectivity in chronic traumatic brain injury: A pilot study

Lindsey, Hannah M; Lazar, Mariana; Mercuri, Giulia; Rath, Joseph F; Bushnik, Tamara; Flanagan, Steven; Voelbel, Gerald T
BACKGROUND:Traumatic brain injury (TBI) often results in chronic impairments to cognitive function, and these may be related to disrupted functional connectivity (FC) of the brain at rest. OBJECTIVE:To investigate changes in default mode network (DMN) FC in adults with chronic TBI following 40 hours of auditory processing speed training. METHODS:Eleven adults with chronic TBI underwent 40-hours of auditory processing speed training over 13-weeks and seven adults with chronic TBI were assigned to a non-intervention control group. For all participants, resting-state FC and cognitive and self-reported function were measured at baseline and at a follow-up visit 13-weeks later. RESULTS:No significant group differences in cognitive function or resting-state FC were observed at baseline. Following training, the intervention group demonstrated objective and subjective improvements on cognitive measures with moderate-to-large effect sizes. Repeated measures ANCOVAs revealed significant (p <  0.001) group×time interactions, suggesting training-related changes in DMN FC, and semipartial correlations demonstrated that these were associated with changes in cognitive functioning. CONCLUSIONS:Changes in the FC between the DMN and other resting-state networks involved in the maintenance and manipulation of internal information, attention, and sensorimotor functioning may be facilitated through consistent participation in plasticity-based auditory processing speed training in adults with chronic TBI.
PMID: 35404295
ISSN: 1878-6448
CID: 5205092