Showing papers by "Jennie Ponsford published in 2014"
TL;DR: Examination of aspects of function, previously shown to be affected following TBI, over a span of 10 years found levels of independence in activities of daily living were high, and as many as 70% of subjects returned to driving, and approximately 40% of patients required more support than before their injury.
Abstract: The deleterious consequences of traumatic brain injury (TBI) impair capacity to return to many avenues of pre-morbid life. However, there has been limited longitudinal research examining outcome beyond five years post-injury. The aim of this study was to examine aspects of function, previously shown to be affected following TBI, over a span of 10 years. One hundred and forty one patients with TBI were assessed at two, five, and 10 years post-injury using the Structured Outcome Questionnaire. Fatigue and balance problems were the most common neurological symptoms, with reported rates decreasing only slightly during the 10-year period. Mobility outcomes were good in more than 75% of patients, with few participants requiring aids for mobility. Changes in cognitive, communication, behavioral, and emotional functions were reported by approximately 60% of the sample at all time points. Levels of independence in activities of daily living were high during the 10-year period, and as many as 70% of subjects returned to driving. Nevertheless, approximately 40% of patients required more support than before their injury. Only half the sample returned to previous leisure activities and fewer than half were employed at each assessment time post-injury. Although marital status remained stable over time, approximately 30% of participants reported difficulties in personal relationships. Older age at injury did not substantially alter the pattern of changes over time, except in employment. Overall, problems that were evident at two years post-injury persisted until 10 years post-injury. The importance of these findings is discussed with reference to rehabilitation programs.
418 citations
TL;DR: There is strong evidence for person-centered treatment of cognitive-communication disorders and use of instructional strategies such as errorless learning, metacognitive strategy training, and group treatment.
Abstract: Summary of participant characteristics andtreatments studied Thisarticleseekstodescribethecurrentevidencebasefor the assessment and management of cognitive com-munication disorders following traumatic brain injury.Tointerpretwhetherthisevidenceappliestoaparticularperson with TBI or a clinician’s current caseload, it isnecessary to examine the characteristics of the partici-pants who were involved in these studies and the natureof the treatments studied. This information is criticallyimportant for clinicians to enable them to make a con-sidered judgment as to whether the findings of existingstudies are relevant to their current caseload. Therefore,we have created an algorithm diagram (see Figure 1)to summarize these characteristics and assist withtranslation of the current research evidence into clinicalpractice. We describe the features of the algorithm here.Social communication training for people with TBIhas been shown to be effective for individuals withchronic injuries, which has been quantified variouslyas more than 6 months postinjury,
203 citations
TL;DR: Intervention programs incorporating metacognitive strategy instruction for planning, problem-solving, and other cognitive-executive impairments have a solid evidence base and new evidence supports the use of strategies to specifically improve reasoning skills.
Abstract: Introduction Traumatic brain injury (TBI) results in complex cognitive (and other) sequelae. Impairments in executive function and self-awareness are among the most characteristic neuropsychological sequelae and can exert a profound effect on resuming previous life roles. An international group of researchers and clinicians (known as INCOG) convened to develop recommendations for interventions to improve impairments in executive functioning and self-awareness after TBI. Methods The team reviewed the available literature and ensured the recommendations were current. To promote implementation, the team developed decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials. The team then prioritized the recommendations for implementation and developed audit criteria to evaluate the adherence to the best practice recommendations. Results Intervention programs incorporating metacognitive strategy instruction for planning, problem-solving, and other cognitive-executive impairments have a solid evidence base. New evidence supports the use of strategies to specifically improve reasoning skills. Substantial support exists for use of direct corrective feedback to improve self-awareness. Conclusions An increasing number of scientifically well-designed studies are available that demonstrate the effectiveness of a variety of interventions for the remediation of impairments in executive function and self-awareness after TBI.
138 citations
TL;DR: The INCOG recommendations for rehabilitation of attention provide up-to-date guidance for clinicians treating people with traumatic brain injury and highlight that metacognitive strategy training focused on functional everyday activities is appropriate.
Abstract: Introduction Traumatic brain injury, due to its diffuse nature and high frequency of injury to frontotemporal and midbrain reticular activating systems, may cause disruption in many aspects of attention: arousal, selective attention, speed of information processing, and strategic control of attention, including sustained attention, shifting and dividing of attention, and working memory. An international team of researchers and clinicians (known as INCOG) convened to develop recommendations for the management of attentional problems. Methods The experts selected recommendations from published guidelines and then reviewed literature to ensure that recommendations were current. Decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials were developed. The team then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to these best practices. Results The recommendations and discussion highlight that metacognitive strategy training focused on functional everyday activities is appropriate. Appropriate use of dual task training, environmental modifications, and cognitive behavioral therapy is also discussed. There is insufficient evidence to support mindfulness meditation and practice on de-contextualized computer-based tasks for attention. Administration of the medication methylphenidate should be considered to improve information-processing speed. Conclusion The INCOG recommendations for rehabilitation of attention provide up-to-date guidance for clinicians treating people with traumatic brain injury.
105 citations
TL;DR: Good evidence is found for the integration of internal and external compensatory memory strategies that are implemented using instructional procedures for rehabilitation for memory impairments and for the efficacy of restorative strategies currently remains weak.
Abstract: Introduction Traumatic brain injury results in complex cognitive sequelae. Impairments in memory are among the most common sequelae resulting in significant functional problems. An international team of researchers and clinicians (known as INCOG) was formed to develop recommendations for the management of impairments in memory. Methods The experts met to select appropriate recommendations and then reviewed available literature to ensure recommendations were current. Decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials were developed. The team then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to the best practice recommendations. Results The recommendations for rehabilitation of memory impairments support the integration of internal and external compensatory strategies implemented using appropriate instructional techniques that consider functional relevance and important patient characteristics. Restorative strategies have regained significant popularity, given broader access to computer technology; however, evidence for efficacy of these techniques remains weak and the choice in using these should be guided by special considerations. Conclusion There is good evidence for the integration of internal and external compensatory memory strategies that are implemented using instructional procedures for rehabilitation for memory impairments. The evidence for the efficacy of restorative strategies currently remains weak.
105 citations
TL;DR: Blue light therapy appears to be effective in alleviating fatigue and daytime sleepiness following TBI and may offer a noninvasive, safe, and nonpharmacological alternative to current treatments.
Abstract: Background. Fatigue is a common, persistent complaint following traumatic brain injury (TBI). Effective treatment is not well established. Objective. The current study aimed to investigate the efficacy of 4 weeks of light therapy for fatigue in patients with TBI. Methods. We undertook a randomized, placebo-controlled study of 4-week, 45 min/morning, home-based treatment with short wavelength (blue) light therapy (max = 465 nm, 84.8 I¼W/cm2, 39.5 lux, 1.74 A� 1014 photons/cm2/s) compared with yellow light therapy (max = 574 nm, 18.5 I¼W/cm2, 68 lux, 1.21 A� 1012 photons/cm2/s) containing less photons in the short wavelength range and a no treatment control group (n = 10 per group) in patients with TBI who self-reported fatigue and/or sleep disturbance. Assessments of fatigue and secondary outcomes (self-reported daytime sleepiness, depression, sleep quality, and sustained attention) were conducted over 10 weeks at baseline (week 2), midway through and at the end of light therapy (weeks 2 and 4), and 4 weeks following cessation of light therapy (week 8). Results. After controlling age, gender, and baseline depression, treatment with high-intensity blue light therapy resulted in reduced fatigue and daytime sleepiness during the treatment phase, with evidence of a trend toward baseline levels 4 weeks after treatment cessation. These changes were not observed with lower-intensity yellow light therapy or no treatment control conditions. There was also no significant treatment effect observed for self-reported depression or psychomotor vigilance performance. Conclusions. Blue light therapy appears to be effective in alleviating fatigue and daytime sleepiness following TBI and may offer a noninvasive, safe, and nonpharmacological alternative to current treatments. © The Author(s) 2013.
100 citations
TL;DR: Cognitive rehabilitation should be offered to select individuals with traumatic brain injury and these guidelines provide assistance to clinicians who want to provide evidence-based care.
Abstract: Introduction Traumatic brain injury results in complex cognitive sequelae. However, clinicians have difficulty implementing the available evidence. An international group of researchers and clinicians (known as INCOG) convened to develop clinical practice guidelines for cognitive rehabilitation posttraumatic brain injury. Methods The Guidelines Adaptation and Development cycle was used to derive the recommendations. Previously published cognitive rehabilitation recommendations were identified and tabulated. An expert panel met to select appropriate recommendations. Afterward, the team enhanced the recommendations by reviewing available literature. To address shortfalls of previous guidelines, the team developed decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials and expert opinion. The team then prioritized the recommendations for implementation and developed audit criteria to evaluate adherence to best practice. Results The team recommends that individuals have detailed assessments of cognition after resolution of posttraumatic amnesia. Cognitive assessment and rehabilitation should be tailored to the patient's neuropsychological profile, premorbid cognitive characteristics, and goals for life activities and participation. Clinical algorithms and audit tools to evaluate current practice are provided. Conclusion Cognitive rehabilitation should be offered to select individuals with traumatic brain injury. These guidelines provide assistance to clinicians who want to provide evidence-based care.
97 citations
TL;DR: The duration of PTA is an important predictor of late outcome after TBI and should be monitored prospectively with a standardized tool and neuroleptic medication should be avoided.
Abstract: Introduction After traumatic brain injury (TBI) and emergence from coma, the majority of people experience posttraumatic amnesia (PTA), characterized by confusion, disorientation, retrograde and anterograde amnesia, poor attention, and sometimes agitation and delusions. An international team of researchers and clinicians developed recommendations for assessment and management of PTA. Methods The experts met to select recommendations, then reviewed literature to ensure they were current. The team then prioritized recommendations for implementation and developed audit criteria to evaluate the adherence to the best practice recommendations. Results Evidence in support of assessment and management strategies during PTA is weak. It is recommended that duration of PTA be assessed prospectively using a validated tool. Consideration should also be given to use of a delirium assessment tool. No cognitive or pharmacological treatments are known to reduce PTA duration. Recommendations for environmental manipulations to reduce agitation during PTA are made. Minimizing use of neuroleptic medication is supported by animal research and 1 retrospective study. Conclusions The duration of PTA is an important predictor of late outcome after TBI and should be monitored prospectively with a standardized tool. Neuroleptic medication should be avoided. There is a significant need for controlled studies evaluating the impact of therapy during PTA.
94 citations
TL;DR: Logistic regression analyses revealed that the attention/working memory, information processing, and executive functions models were significantly associated with anxiety disorder.
Abstract: This study examined the association between cognitive impairment and anxiety disorders following traumatic brain injury (TBI). Sixty-six participants recruited from a rehabilitation hospital completed the Structured Clinical Interview for the DSM–IV (Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition) and cognitive tests at one year post injury. Prevalence of anxiety disorder was 27.3%. Logistic regression analyses revealed that the attention/working memory, information processing, and executive functions models were significantly associated with anxiety disorder. The memory model was not significant. Processing speed emerged as the strongest model associated with anxiety disorder. The role of cognitive impairment in the etiology of anxiety disorders after TBI is discussed, and treatment implications are explored.
65 citations
TL;DR: Self-concept may be lowered following TBI and is associated with negative emotional consequences, and Clinicians may improve the emotional adjustment of survivors of TBI by considering particular dimensions of self-concept for intervention focus.
Abstract: Primary objective: This study examined the multidimensional self-concept, global self-esteem and psychological adjustment of individuals with traumatic brain injury (TBI) as compared with healthy controls.Research design: Group comparison on self-report questionnaires.Methods and procedures: Forty-one individuals who had sustained a TBI were compared with an age- and gender-matched sample of 41 trauma-free control participants on the Rosenberg Self Esteem Scale, the Tennessee Self Concept Scale (second edition) and the Hospital Anxiety and Depression Scales (HADS).Main outcomes and results: Participants with TBI rated significantly lower mean levels of global self-esteem and self-concept on the Rosenberg Self Esteem Scale and Tennessee Self Concept Scale than the control group. Survivors of TBI rated themselves more poorly on a range of self-dimensions, including social, family, academic/work and personal self-concept compared to controls. They also reported higher mean levels of depression and an...
53 citations
TL;DR: A general review of GAS is provided and what the authors found to be the strengths and limitations of using GAS to assess functional improvements in a rehabilitation study are discussed.
Abstract: There is increasing emphasis on the need to identify, work with and evaluate rehabilitation outcomes in ways that are personally relevant to individuals with brain injury, whether this be at a global or individual client level. This paper focuses on the use of one such method, Goal Attainment Scaling (GAS). It provides a general review of GAS and discusses what we found to be the strengths and limitations of using GAS to assess functional improvements in a rehabilitation study. Strengths included enabling the measurement of goal accomplishment on meaningful daily activities, capturing improvement on relevant functional tasks more effectively than broad measures of impairment, and facilitating collaborative goal-setting. Limitations included the time required to identify goals that could be broken down into five GAS outcome levels and defining the five levels, and compromised assessment of goal attainment due to poorly constructed GAS scales. Recommendations for minimising these potential limitations in future applications of GAS are also discussed. They include setting GAS baseline levels consistently across all scales, assigning GAS weights based on the client's ratings of importance, reviewing GAS weightings prior to each measurement phase, and using a suggested checklist to minimise the likelihood of poorly constructed scales.
TL;DR: Although strong associations between diary and actigraphic assessment of sleep duration were observed in both participant groups, agreement between these methods appeared to weaken in patients with TBI, suggesting actigraphy may prove useful to supplement self-report measures of sleep following TBI.
Abstract: The current study examined the use of actigraphy in measurement of sleep following traumatic brain injury (TBI). Twenty-one patients with TBI and self-reported sleep and/or fatigue problems and 21 non-injured controls were studied over seven days using actigraphy and sleep diary reports. Although strong associations between diary and actigraphic assessment of sleep duration were observed in both participant groups, agreement between these methods appeared to weaken in patients with TBI. Associations between sleep diary and actigraphic assessments of sleep disturbance, i.e., wake after sleep onset (WASO) and sleep onset latency (SOL) were not apparent in either group, although weaker agreement between methods for WASO was again observed in patients with TBI. Actigraphy may prove useful to supplement self-report measures of sleep following TBI. More work is required to understand the accuracy of these measures in this population.
TL;DR: The nature and prevalence of sleep disturbances associated with traumatic brain injury and the measures used to assess them and the nature and assessment of fatigue are discussed, followed by a review of evidence regarding causes.
TL;DR: The results support the view of fatigue after TBI as “primary fatigue”—that is, a consequence of the structural brain injury rather than a secondary consequence of depression or daytime sleepiness.
Abstract: OBJECTIVES:: To examine the temporal relation between fatigue, depression, and daytime sleepiness after traumatic brain injury. Fatigue is a frequent and disabling consequence of traumatic brain injury (TBI). However, it is unclear whether fatigue is a primary consequence of the structural brain injury or a secondary consequence of injury-related sequelae such as depression and daytime sleepiness. PARTICIPANTS:: Eighty-eight adults with complicated mild-severe TBI (69% male). MAIN MEASURES:: Fatigue Severity Scale; depression subscale of the Hospital Anxiety and Depression Scale; Epworth Sleepiness scale at baseline and 6-month follow-up. RESULTS:: A cross-lagged path analysis computed within a structural equation modeling framework revealed that fatigue was predictive of depression (β = .20, P .05). CONCLUSIONS:: The results support the view of fatigue after TBI as "primary fatigue"--that is, a consequence of the structural brain injury rather than a secondary consequence of depression or daytime sleepiness. A rehabilitation approach that assists individuals with brain injury in learning to cope with their neuropsychological and physical limitations in everyday life might attenuate their experience with fatigue. Language: en
TL;DR: The findings support identification of individuals at risk of relying on nonproductive coping and poorer psychosocial outcome following TBI and emphasize the need to implement timely interventions to facilitate productive coping and reduce the use of non productive coping in order to maximize favorable long-term psychossocial outcome.
Abstract: OBJECTIVE:: To examine the influence of self-reported preinjury coping on postinjury coping, psychosocial functioning, emotional functioning, and quality of life at 1 year following traumatic brain injury (TBI). SETTING:: Inpatient hospital and community. PARTICIPANTS:: One hundred seventy-four participants with TBI. DESIGN:: Prospective, longitudinal design. Participants were assessed at 5 time points: after emerging from posttraumatic amnesia, and at 6, 12, 24, and 36 months postinjury. MAIN MEASURES:: Coping Scale for Adults-Short Version; Quality of Life Inventory; Sydney Psychosocial Reintegration Scale; Hospital Anxiety and Depression Scale. RESULTS:: High preinjury use of nonproductive coping style predicted high use of nonproductive coping, more anxiety, and lower psychosocial functioning at 1 year postinjury. Increased use of nonproductive coping and decreased use of productive coping predicted poorer psychosocial outcome at 1 year post-TBI. Use of both productive and nonproductive coping decreased in the first 6 to 12 months post-TBI relative to preinjury. Unlike productive coping, nonproductive coping reached preinjury levels within 3 years postinjury. CONCLUSION:: The findings support identification of individuals at risk of relying on nonproductive coping and poorer psychosocial outcome following TBI. In addition, the results emphasize the need to implement timely interventions to facilitate productive coping and reduce the use of nonproductive coping in order to maximize favorable long-term psychosocial outcome.
TL;DR: Future guidelines should address identified limitations by providing implementation information and audit criteria, along with better reporting of guideline development processes and stakeholder engagement.
Abstract: Introduction: Cognitive rehabilitation following traumatic brain injury can aid in optimizing function, independence, and quality of life by addressing impairments in attention, executive function, cognitive communication, and memory. This study aimed to identify and evaluate the methodological quality of clinical practice guidelines for cognitive rehabilitation following traumatic brain injury. Methods: Systematic searching of databases and Web sites was undertaken between January and March 2012 to identify freely available, English language clinical practice guidelines from 2002 onward. Eligible guidelines were evaluated using the validated Appraisal of Guidelines for Research and Evaluation II instrument. Results: The 11 guidelines that met inclusion criteria were independently rated by 4 raters. Results of quality appraisal indicated that guidelines generally employed systematic search and appraisal methods and produced unambiguous, clearly identifiable recommendations. Conversely, only 1 guideline incorporated implementation and audit information, and there was poor reporting of processes for formulating, reviewing, and ensuring currency of recommendations and incorporating patient preferences. Intraclass correlation coefficients for agreement between raters showed high agreement (intraclass correlation coefficient > 0.80) for all guidelines except for 1 (moderate agreement; intraclass correlation coefficient = 0.76). Conclusion: Future guidelines should address identified limitations by providing implementation information and audit criteria, along with better reporting of guideline development processes and stakeholder engagement. Key words: clinical practice guidelines, cognitive rehabilitation, traumatic brain injury
TL;DR: The MFGT experience made a contribution to participants' efforts to find their place in the world after an ABI, enhanced by connection with others within the group, sharing experiences, the development of self and family identity, and the gaining of knowledge and understanding.
Abstract: Acquired brain injuries (ABI) can have a major impact on social participation, causing increased social isolation and emotional distress for people with the injury and their family members. Multifamily Group Therapy (MFGT) provides information, resources, problem-solving strategies and opportunities for social networking for families where one member has an illness. By qualitatively examining the experience of group participation from the perspectives of both individuals with ABI and their family members, the present study aimed to elucidate the processes underlying and factors influencing success of facilitated MFG programmes with families impacted by ABI. Following participation in the 12-week MFGT, 29 individuals with brain injury and 30 caregivers participated in 90-minute, semi-structured focus groups. The overarching theme emerging from the transcripts was that of “Finding One's Place”, with sub-themes of Connectedness, Identity, and Knowledge and Understanding. The MFGT experience made a contributi...
TL;DR: It was concluded that there was little support for the influence of COMT Val(158)Met on cognitive function, or functional outcome measures, in the acute rehabilitation phase after TBI.
Abstract: There is significant variability in long-term outcomes after traumatic brain injury (TBI), making accurate prognosis difficult. In seeking to enhance understanding of outcomes, this study aimed to investigate whether COMT Val158Met allele status was associated with performance on neuropsychological measures of attention and working memory, executive functioning, learning and memory, and speed of information processing in the early rehabilitation phase. The study also aimed to examine whether the COMT polymorphism was associated with longer-term functional outcomes. A total of 223 participants (71.3% male) with moderate-to-severe TBI were recruited as rehabilitation inpatients to participate in a prospective, longitudinal head injury outcome study. The three COMT genotype groups (Val/Val, Val/Met, and Met/Met) were well matched for estimated full-scale IQ, years of education, age at injury, and injury severity. Results showed no significant difference between genotypes on neuropsychological measur...
TL;DR: Return to study was relatively successful; however, this was associated with the experience of fatigue and need for far greater effort, assistance and reduced study hours, and somewhat less overall satisfaction.
Abstract: OBJECTIVE:: To examine the frequency and experience of return to secondary or tertiary study over a 10-year period following traumatic brain injury (TBI). PARTICIPANTS:: A group of 295 students with moderate to severe TBI followed prospectively. SETTING:: Epworth HealthCare TBI outpatient rehabilitation program follow-up clinic 1 to 10 years postinjury. MAIN OUTCOME MEASURES:: Frequency of return to study. Also, for a subset, changes in course enrollment, utilization of additional educational supports, and experience of return to study postinjury. RESULTS:: Of those studying preinjury, 295 attended the follow-up clinic appointments, with 167 (56%) having returned to study. Those who did not return to study had significantly longer posttraumatic amnesia duration. The cross-sectional follow-up revealed that 60.4% were studying at 1 year postinjury, 37.5% at 2 years postinjury, 50.0% at 3 years postinjury, 31.1% at 5 years postinjury, and 2.0% at 10 years postinjury. Many had migrated into employment. A subsample of 95 participants reported on their educational experience. Of those, 28.7% changed their course enrollment from full-time to part-time. While supports such as tuition and special consideration were greatly increased postinjury, students reported the proportion of subjects passed of 79.0%. However, they experienced cognitive difficulties and fatigue and felt less satisfied with their studies. CONCLUSIONS:: Return to study was relatively successful; however, this was associated with the experience of fatigue and need for far greater effort, assistance and reduced study hours, and somewhat less overall satisfaction. Language: en
TL;DR: This trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients who present following mild head injuries (concussion), compared with passive dissemination of these recommendations.
Abstract: Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed. The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following intervention delivery (patient level outcomes). In consenting hospitals, eligible patients will be recruited for a follow-up telephone interview conducted by trained researchers. A cost-effectiveness analysis and process evaluation using mixed-methods will be conducted. Sample size calculations are based on including 30 patients on average per department. Outcome assessors will be blinded to group allocation. Australian New Zealand Clinical Trials Registry ACTRN12612001286831
(date registered 12 December 2012).
TL;DR: Analysis of SADI sub-scales revealed that females had greater awareness in terms of setting more realistic goals early in recovery compared to males, and time post-injury had the strongest influence on the development of awareness.
Abstract: Objective: To examine self-awareness over the first year following traumatic brain injury (TBI) and the association of demographic, biological, cognitive, psychological and social-environmental factors with change in awareness.Research design: Using a longitudinal design the progression of awareness and association of demographic and biopsychosocial factors with its trajectory were analysed using random effects regression.Methods and procedures: Sixty individuals with mainly moderate-to-severe TBI completed assessments at 3, 6 and/or 12 months post-injury. Measures of awareness (Self-Awareness of Deficits Interview; SADI), demographic (age at time of injury and gender), injury severity (post-traumatic amnesia duration), cognitive (Trails Making Test-Part B), psychological (Hospital Anxiety and Depression Scale) and social-environmental (return to pre-injury activities) factors were administered.Main outcomes and results: Awareness improved over the first year post-injury. Analysis of SADI sub-scal...
TL;DR: Initial empirical support of the reliability and validity of the SAFRM for assessment of SA of falls risk in the older inpatient population is provided.
TL;DR: Good psychological adjustment was related to low levels of emotional distress and a small discrepancy between current and aspired functional status and poor functional status had a more minor impact on psychological adjustment in individuals with poor self-awareness than in Individuals with high levels of self- awareness.
Abstract: The aim of the study was to describe the development and predictors of psychological adjustment during community-based traumatic brain injury (TBI) rehabilitation. Forty-two adolescent and adult individuals with TBI (mean age 32 years, 88% male, median post-traumatic amnesia 11 days) participated in a single-group, longitudinal design study. The main measures used were the Reactions to Impairment and Disability Inventory, Adjustment subscale; Sydney Psychosocial Reintegration Scale; Hospital Anxiety and Depression Scale; and Self-awareness of Deficits Interview. At rehabilitation start, individuals differed significantly from each other with respect to their level of psychological adjustment. Individual trajectories of psychological adjustment were highly variable. However, for the sample as a whole, psychological adjustment did not change during the course of rehabilitation (multilevel regression models; p > .05). Good psychological adjustment was related to low levels of emotional distress and a small d...