Showing papers by "Jennie Ponsford published in 2015"
TL;DR: World Health Organization Disability Assessment Schedule 2.0 is a clinically acceptable, valid, reliable, and responsive instrument for measuring postoperative disability in a diverse surgical population and its use as an endpoint in future perioperative studies can provide outcome data that are meaningful to clinicians and patients alike.
Abstract: Background:Survival and freedom from disability are arguably the most important patient-centered outcomes after surgery, but it is unclear how postoperative disability should be measured. The authors thus evaluated the World Health Organization Disability Assessment Schedule 2.0 in a surgical popula
161 citations
TL;DR: The results revealed that family caregivers adopted a broader definition of challenging behaviour than that used by professionals and these behaviours impacted on the community integration of the individual with TBI, most notably leading to poor social relationships.
Abstract: Primary objective: Family caregivers play an important role in managing challenging behaviours after TBI. The aims of this study were to understand how family caregivers of individuals with TBI perceive challenging behaviours and their impact on the TBI individual’s community integration and family functioning.Research design: A qualitative research design was employed to capture the lived experience of family caregivers of individuals with TBI.Methods and procedures: Face-to-face interviews were conducted on six female family caregivers of individuals with severe TBI (sustained an average of 17 years earlier) and long-standing challenging behaviours.Main outcomes and results: The results revealed that family caregivers adopted a broader definition of challenging behaviour than that used by professionals and these behaviours impacted on the community integration of the individual with TBI, most notably leading to poor social relationships. Challenging behaviours were viewed as a key source of dist...
73 citations
TL;DR: Significantly greater instability in employment was reported by individuals who were machinery operators or laborers before injury, had a longer duration of posttraumatic amnesia, reported more cognitive difficulties, and were less mobile 1 year following their injury.
Abstract: Objective To examine the stability of employment between 1 and 3 years following traumatic brain injury (TBI) and to identify the variables associated with continued employment throughout this time span. Participants This study included 236 individuals with predominantly moderate to very severe TBI, who had received rehabilitation in the context of a no-fault accident compensation system. Participants were eligible for the current study if they were employed before injury and reported their employment status at 1, 2, and 3 years following their injury as part of a longitudinal head injury outcome study. Results Only 44% of participants remained employed at each of the 3 years following TBI. There was also substantial transition into and out of employment across the 3 years. Significantly greater instability in employment was reported by individuals who were machinery operators or laborers before injury, had a longer duration of posttraumatic amnesia, reported more cognitive difficulties, and were less mobile 1 year following their injury. Conclusion A number of important factors determine the likelihood of achieving stability in employment following TBI. Findings from the current study support the continued need to identify ways in which physical as well as cognitive changes contribute to employment following TBI. Further examination is needed to identify possible compensatory strategies or job modifications to maximize the likelihood of job retention.
65 citations
TL;DR: The hypothesis that fatigue after TBI is a cause, not a consequence, of anxiety, depression, and daytime sleepiness, which, in turn, may exacerbate fatigue by affecting cognitive functioning is supported.
Abstract: OBJECTIVE:: Fatigue is one of the most frequent sequelae of traumatic brain injury (TBI), although its causes are poorly understood. This study investigated the interrelationships between fatigue and sleepiness, vigilance performance, depression, and anxiety, using a structural equation modeling approach. METHODS:: Seventy-two participants with moderate to severe TBI (78% males) were recruited a median of 305 days postinjury. They completed the Fatigue Severity Scale, a vigilance task, the Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale. A model of the interrelationships between the study variables was developed, tested, and modified with path analysis. RESULTS:: The modified model had a good overall fit (χ2 = 1.3, P =.54; comparative fit index = 1.0; root-mean square error of approximation = 0.0; standardized root-mean square residual = 0.02). Most paths in this model were significant (P CONCLUSIONS:: This model confirms the complexity of fatigue experience. It supports the hypothesis that fatigue after TBI is a cause, not a consequence, of anxiety, depression, and daytime sleepiness, which, in turn (especially depression), may exacerbate fatigue by affecting cognitive functioning. These findings suggest that to alleviate fatigue, it is important to address each of these factors. However, the findings need to be confirmed with a longitudinal research design. Language: en
53 citations
TL;DR: In this paper, the authors evaluated the World Health Organization Disability Assessment Schedule 2.0 in a surgical popula and found that survival and freedom from disability are arguably the most important patient-centered outcomes after surgery.
Abstract: Background:Survival and freedom from disability are arguably the most important patient-centered outcomes after surgery, but it is unclear how postoperative disability should be measured. The authors thus evaluated the World Health Organization Disability Assessment Schedule 2.0 in a surgical popula
52 citations
TL;DR: Comparing self-reported outcomes at 5-10 years post-injury for those with TBI, TOI, and uninjured controls has implications for managing risks associated with these injury groups and tailoring rehabilitation to improve long-term outcomes.
Abstract: Objective Whilst it has been well-demonstrated that traumatic brain injury (TBI) results in long-term cognitive, behavioural and emotional difficulties, less is understood about how these outcomes differ from those following traumatic orthopaedic injury (TOI). The aim of this study was to compare self-reported outcomes at 5–10 years post-injury for those with TBI, TOI, and uninjured controls. It was hypothesised that participants with TBI would have greater cognitive difficulties; participants with TOI and TBI would have similar functional and physical outcomes, both being poorer than controls; and participants with TBI would have poorer psychosocial outcomes than those with TOI. Participants and methods Eighty-eight individuals with complicated mild to severe TBI and 96 with TOI recruited during inpatient rehabilitation were followed up 5–10 years post-injury, together with 48 controls followed over a similar period. Self-report measures of global functioning (GOS-E), quality of life (SF-36), psychological wellbeing (SCL-90-R, HADS, PCL-S), psychosocial difficulties (SIP), cognitive difficulties (SF-36 COG), pain (BPI), and fatigue (FSS) were administered. Results Outcomes for individuals with TBI and TOI differed significantly from controls, with poorer global functioning, and greater psychological distress and interference from pain. Only participants with TBI reported greater cognitive difficulties and anxiety than controls, and were less likely to be employed or in a relationship. Participants with TBI reported greater anxiety, PTSD, psychological distress and psychosocial difficulties than those with TOI. Conclusions Both TOI and TBI cause long-term disability, interference from pain, and psychological distress. However, cognitive impairments, unemployment, lack of long-term relationships, anxiety and PTSD are more substantial long-term problems following TBI. Findings from this study have implications for managing risks associated with these injury groups and tailoring rehabilitation to improve long-term outcomes.
48 citations
TL;DR: While slowed speed of information processing was pervasive across tasks after TBI, residual difficulties in response inhibition remained after controlling for slowness, which suggests impaired strategic control.
Abstract: Introduction: Slowed information processing speed has consistently been documented after traumatic brain injury (TBI). Debate continues as to whether deficits in strategic control are proportionate to, or remain after controlling for, reduced speed of processing. The study aim was to investigate the association of speed of processing and strategic control of attention with working memory, selective attention, response inhibition, and mental flexibility task performance after TBI using traditional and novel clinical measures. Method: Twenty-five individuals with complicated mild to severe TBI (post-traumatic amnesia duration, M = 39.52 days, SD = 38.34; worst Glasgow Coma Scale score, M = 7.33, SD = 4.35; time post-injury, M = 392.64 days, SD = 537.19) and 25 matched healthy controls completed assessment of attentional and executive functioning. Measures included the Symbol Digit Modalities Test (SDMT), the computerized Selective Attention Task (SAT), the Ruff 2&7 Selective Attention Test (2&7), the visual...
48 citations
TL;DR: The process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention in managing mild traumatic brain injury in the emergency department is described.
Abstract: Despite the availability of evidence-based guidelines for the management of mild traumatic brain injury in the emergency department (ED), variations in practice exist. Interventions designed to implement recommended behaviours can reduce this variation. Using theory to inform intervention development is advocated; however, there is no consensus on how to select or apply theory. Integrative theoretical frameworks, based on syntheses of theories and theoretical constructs relevant to implementation, have the potential to assist in the intervention development process. This paper describes the process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention. A stepped approach was followed: (i) identification of locally applicable and actionable evidence-based recommendations as targets for change, (ii) selection and use of two theoretical frameworks for identifying barriers to and enablers of change (Theoretical Domains Framework and Model of Diffusion of Innovations in Service Organisations) and (iii) identification and operationalisation of intervention components (behaviour change techniques and modes of delivery) to address the barriers and enhance the enablers, informed by theory, evidence and feasibility/acceptability considerations. We illustrate this process in relation to one recommendation, prospective assessment of post-traumatic amnesia (PTA) by ED staff using a validated tool. Four recommendations for managing mild traumatic brain injury were targeted with the intervention. The intervention targeting the PTA recommendation consisted of 14 behaviour change techniques and addressed 6 theoretical domains and 5 organisational domains. The mode of delivery was informed by six Cochrane reviews. It was delivered via five intervention components : (i) local stakeholder meetings, (ii) identification of local opinion leader teams, (iii) a train-the-trainer workshop for appointed local opinion leaders, (iv) local training workshops for delivery by trained local opinion leaders and (v) provision of tools and materials to prompt recommended behaviours. Two theoretical frameworks were used in a complementary manner to inform intervention development in managing mild traumatic brain injury in the ED. The effectiveness and cost-effectiveness of the developed intervention is being evaluated in a cluster randomised trial, part of the Neurotrauma Evidence Translation (NET) program.
44 citations
TL;DR: This study highlights the limitations of using discrepancy scores to measure awareness, as ratings of injury-related changes are influenced by the mood of the individual with TBI and the close other, as well as by injury severity.
Abstract: OBJECTIVE:: To examine self-awareness and injury-related, emotional and demographic factors across acute/subacute (3-12 months), medium-term (24-60 months), and long-term (120-240 months) time periods after traumatic brain injury (TBI), because unawareness of injury-related changes can affect engagement in rehabilitation and functional outcomes. PARTICIPANTS:: A total of 168 individuals with mild to severe TBI and 105 of their close others. MAIN OUTCOMES MEASURES:: Awareness Questionnaire (AQ) and Hospital Anxiety and Depression Scale. DESIGN:: Cross-sectional study. RESULTS:: There were no significant differences in awareness as a function of time postinjury, except for the AQ motor/sensory domain wherein individuals with TBI at longer time periods displayed increased awareness of deficits than those at earlier time periods. Greater patient-other AQ discrepancy scores (interpreted as lower patient awareness) were associated with longer posttraumatic amnesia duration in the individual with TBI and also with increased self-reported depressive symptoms in the close others. Conversely, smaller AQ discrepancy scores (interpreted as better awareness) were associated with increased self-reported depressive symptoms by the individuals with TBI. CONCLUSION:: This study highlights the limitations of using discrepancy scores to measure awareness, as ratings of injury-related changes are influenced by the mood of the individual with TBI and the close other, as well as by injury severity. Language: en
37 citations
TL;DR: In this paper, the authors investigated the trajectory and predictors of employment over a period of 10 years following traumatic brain injury and traumatic orthopaedic injury and found that individuals with traumatic brain injuries were less likely to be competitively employed during the period up to 10 years post-injury compared with individuals with TBI, although there was evidence of increasing employment participation during that time.
Abstract: OBJECTIVE: To investigate the trajectory and predictors of employment over a period of 10 years following traumatic brain injury and traumatic orthopaedic injury. DESIGN: Prospective follow-up at 1, 2, 5 and 10 years post-injury. PARTICIPANTS: Seventy-nine individuals with traumatic brain injury and 79 with traumatic orthopaedic injury recruited from Epworth HealthCare in Melbourne, Australia during inpatient rehabilitation. METHODS: Information was obtained from medical files and self-report questionnaires. RESULTS: Individuals with traumatic brain injury were less likely to be competitively employed during the period up to 10 years post-injury compared with individuals with traumatic orthopaedic injury, although there was evidence of increasing employment participation during that time. More severe traumatic brain injury, older age, pre-injury psychological treatment, and studying or having a blue-collar occupation at time of injury were associated with poorer employment outcomes. Individuals with traumatic brain injury had spent less time with their current employer and were less likely to have increased responsibility since the injury than those with traumatic orthopaedic injury. At least half of each group reported difficulty at work due to fatigue. CONCLUSION: Given the potential for gains in employment participation over an extended time-frame, there may be benefit in ongoing access to individualized vocational rehabilitation. Particular areas of focus would include managing fatigue and psychiatric disorders, and exploring supported occupational activity for all levels of injury severity. Language: en
34 citations
TL;DR: The current healthcare system would appear to be ill-equipped to meet the needs of TBI survivors in Botswana, and understanding of cultural responses and approaches to brain injuries in the country will improve understanding of improved practice.
Abstract: Whilst the consequences of traumatic brain injury (TBI) are understood in Western countries, it is not known how cultural background and beliefs affect response and outcome following TBI in low and middle income countries. This study aimed to explore the experiences of TBI in Botswana. Participants included 21 individuals with moderate to severe TBI (68% males, mean age 35.2 years), 18 caregivers and 25 healthcare workers. Qualitative semi-structured interviews were transcribed, translated and thematically coded. Thematic analysis indicated several themes: Injury-related changes, attributions and beliefs about the cause of the injury, family reactions, attitudes, and resources. Participants described the common injury-related effects of TBI. Many participants attributed their injury to supernatural causes. Immediate family members of participants with TBI expressed a sense of love and devotion towards the injured person. Communication was characterised by inadequate information given to those injured and ...
TL;DR: The results of this project have the potential to inform clinical decisions and public health policy, which can reduce the burden of non-fatal injury and improve the lives of people living with the consequences of severe injury.
Abstract: Background Traumatic injury is a leading contributor to the overall global burden of disease. However, there is a worldwide shortage of population data to inform understanding of non-fatal injury burden. An improved understanding of the pattern of recovery following trauma is needed to better estimate the burden of injury, guide provision of rehabilitation services and care to injured people, and inform guidelines for the monitoring and evaluation of disability outcomes. Objective To provide a comprehensive overview of patient outcomes and experiences in the first 5 years after serious injury. Design This is a population-based, nested prospective cohort study using quantitative data methods, supplemented by a qualitative study of a seriously injured participant sample. Participants All 2547 paediatric and adult major trauma patients captured by the Victorian State Trauma Registry with a date of injury from 1 July 2011 to 30 June 2012 who survived to hospital discharge and did not opt-off from the registry. Analysis To analyse the quantitative data and identify factors that predict poor or good outcome, whether there is change over time, differences in rates of recovery and change between key participant subgroups, multilevel mixed effects regression models will be fitted. To analyse the qualitative data, thematic analysis will be used to identify important themes and the relationships between themes. Contribution to the field The results of this project have the potential to inform clinical decisions and public health policy, which can reduce the burden of non-fatal injury and improve the lives of people living with the consequences of severe injury.
TL;DR: It is suggested that a proportion of older adults undergoing inpatient rehabilitation underestimate personal falls risk, and greater understanding of these factors will facilitate the development of strategies to increase awareness of falls risk and increase engagement in falls prevention.
TL;DR: Premorbid lifestyle factors exerted a greater influence on mortality following TBI, compared with injury-related factors, and this risk was especially prominent for younger individuals, who died primarily due to external causes.
Abstract: The aim of this study was to examine the rate and causes of mortality following mild to severe traumatic brain injury (TBI) rehabilitation and to develop a multivariate prognostic model of mortality. We conducted a cohort study of 3341 individuals with mild to severe TBI followed-up from a post-acute inpatient rehabilitation center. Rate of death and survival between one and 26 years following injury were examined using standardized mortality ratios (SMRs) and prognostic models developed using Cox regression. A mortality rate of 9.3% was observed and an overall SMR of 1.04 (95% confidence interval [CI]=1.04–1.05). A statistically significant elevated SMR of 1.20 (95% CI=1.06–1.37) was observed for males, and both males and females had an elevated risk of death from external causes. Females also were found to have a significantly elevated SMR of 5.02 (95% CI=1.36–12.80) for intentional self-harm. Individuals ages 15-44 had a two-fold increase in mortality, compared with the general population. The...
TL;DR: This study has provided a comprehensive analysis of factors predicting various types of costs following TBI, with the combination of injury-related and demographic variables predicting 23-44% of costs.
Abstract: Objective The ability to predict costs following a traumatic brain injury (TBI) would assist in planning treatment and support services by healthcare providers, insurers and other agencies. The objective of the current study was to develop predictive models of hospital, medical, paramedical, and long-term care (LTC) costs for the first 10 years following a TBI. Methods The sample comprised 798 participants with TBI, the majority of whom were male and aged between 15 and 34 at time of injury. Costing information was obtained for hospital, medical, paramedical, and LTC costs up to 10 years postinjury. Demographic and injury-severity variables were collected at the time of admission to the rehabilitation hospital. Results Duration of PTA was the most important single predictor for each cost type. The final models predicted 44% of hospital costs, 26% of medical costs, 23% of paramedical costs, and 34% of LTC costs. Greater costs were incurred, depending on cost type, for individuals with longer PTA duration, obtaining a limb or chest injury, a lower GCS score, older age at injury, not being married or defacto prior to injury, living in metropolitan areas, and those reporting premorbid excessive or problem alcohol use. Conclusions This study has provided a comprehensive analysis of factors predicting various types of costs following TBI, with the combination of injury-related and demographic variables predicting 23-44% of costs. PTA duration was the strongest predictor across all cost categories. These factors may be used for the planning and case management of individuals following TBI.
TL;DR: Even after a significant brain injury, some individuals show sustained improved QoL, and factors such as lack of ‘good old days’ bias and increased value placed on family may have important clinical utility.
Abstract: Purpose: Most studies of quality-of-life (QoL) after traumatic brain injury (TBI) reveal a largely negative picture, yet some survivors show positive changes (PC). Understanding PC in QoL may assist clinicians in facilitating post-injury adjustment. This study aimed to prospectively explore changes in QoL from pre- to post-injury, identify those with PC and examine predictive and associated factors.Methods: Ninety-five participants, recruited from consecutive admissions to a rehabilitation hospital, were prospectively assessed at least once over the first 4 years post-injury. Measures of QoL, psychiatric disorders, coping style and psychosocial outcome were administered at each assessment.Results: Participants’ mean QoL was in the average range pre-injury and at follow-up. A third demonstrated PC post-injury, which tended to remain stable. PC participants tended to rate their relatives as of greater importance than other participants, but did not rate their health as high. Group membership was not...
TL;DR: On-road driver rehabilitation followed by on-road reassessment were associated with a high probability of return to driving after TBI and PTA duration proved to be a better predictor of driver assessment outcome than Glasgow Coma Scale score.
TL;DR: There is ongoing detrimental influence of orthopaedic injuries on global functioning for individuals with TBI, suggesting a potential benefit in greater clinical attention to these injuries, and PTA continues to influence outcomes 10 years following TBI.
Abstract: Objective: The aim of this study was to prospectively investigate predictors of global functioning and employment 10 years following traumatic brain injury (TBI) compared with orthopaedic trauma.Research design: Prospective cohort.Methods: Ninety-seven individuals with complicated mild-to-severe TBI and 91 with traumatic orthopaedic injury were followed-up at 10 years post-injury. Global functioning (GOS-E) and employment status were recorded.Results: Groups did not differ on global functioning or employment status. Post-TBI, shorter PTA and less severe orthopaedic injuries were associated with better global functioning; and shorter PTA and younger age were associated with employment. Following traumatic orthopaedic injury, younger age was associated with employment, but not after excluding individuals no longer in the labour force.Conclusions: In this sample, demographic factors and injury severity contribute to long-term outcomes following TBI, but not orthopaedic trauma. PTA continues to influe...
TL;DR: PTA duration and behavioural sequelae were the strongest predictors of productivity in those studying prior to injury, with PTA duration of more than 80 days reducing the probability of being productive at 1 year to 50%.
Abstract: Primary objective: This prospective longitudinal study aimed to identify rates and predictors of productivity outcomes (educational or vocational) at 1 year post-injury in young people studying prior to sustaining a traumatic brain injury (TBI).Methods and procedures: A total of n = 145 with complicated mild–severe injuries, studying at secondary (45.2%) or tertiary (54.8%) levels pre-injury, participated. Mean age at injury = 18.6 years (SD = 3.29) and mean duration of PTA = 21.9 days (SD = 27.18). Pre-injury demographic (gender, age, level of study, living situation), injury related (severity, physical injuries) and concurrent post-injury (independence in ADLs and self-reported cognitive, behavioural, emotional sequelae) predictors were entered into logistic regressions.Main outcomes: Of those participants categorized as ‘productive’ (79.3%), 60% were studying, with 40% employed. Participants with longer PTA and those with reduced initiative and self-centredness were less likely to be ‘productiv...
TL;DR: Both the AUDIT and the DAST are suitable measures for assessing substance use following TBI and may serve as future screening standards in TBI research.
Abstract: OBJECTIVE:: To examine the validity of the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test (DAST)-2 widely recommended rating scales-in a traumatic brain injury (TBI) population at 24 months following injury. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders was used as the gold standard criterion. SETTING:: TBI rehabilitation program at Epworth Hospital, Victoria, Australia. PARTICIPANTS:: A total of 113 individuals, 87 males and 26 females, with complicated mild to severe TBI. DESIGN:: Prospective study documenting substance use following TBI. MAIN MEASURES:: AUDIT, DAST, and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. RESULTS:: In individuals with TBI, a cutoff score of 11 on the AUDIT may be the most appropriate indicator of an alcohol use disorder whereas a cutoff score of 6 on the DAST may be the most appropriate indicator of drug use disorder. Both screening measures demonstrated excellent diagnostic accuracy at 24 months following injury. CONCLUSION:: The optimal cutoff score for the AUDIT may need to be elevated for use following TBI. Nevertheless, both the AUDIT and the DAST are suitable measures for assessing substance use following TBI. Given the importance of uniformity in postinjury assessment, the AUDIT and the DAST may serve as future screening standards in TBI research. Language: en
TL;DR: The pattern of results suggested that PFTBI patients share deficits with their brain-injured, and psychotic, counterparts, and that these are exacerbated by their dual-diagnosis.
Abstract: Verbal fluency in patients with psychosis following traumatic brain injury (PFTBI) has been reported as comparable to healthy participants. This finding is counterintuitive given the prominent fluency impairments demonstrated post-traumatic brain injury (TBI) and in psychotic disorders, e.g. schizophrenia. We investigated phonemic (executive) fluency (3 letters: 'F' 'A' and 'S'), and semantic fluency (1 category: fruits and/or vegetables) in four matched groups; PFTBI (N=10), TBI (N=10), schizophrenia (N=23), and healthy controls (N=23). Words produced (minus perseverations and errors), and clustering and switching scores were compared for the two fluency types across the groups. The results confirmed that PFTBI patients do show impaired fluency, aligned with existing evidence in TBI and schizophrenia. PFTBI patients produced the least amount of words on the phonemic fluency ('A') trial and total score, and demonstrated reduced switching on both phonemic and semantic tasks. No significant differences in clustering performance were found. Importantly, the pattern of results suggested that PFTBI patients share deficits with their brain-injured (primarily executive), and psychotic (executive and semantic), counterparts, and that these are exacerbated by their dual-diagnosis. These findings add to a very limited literature by providing novel evidence of the nature of fluency impairments in dually-diagnosed PFTBI.
TL;DR: Novel evidence of substantially impaired executive function across four task types in PFTBI is presented and it is suggested that TBI and psychosis have an additive influence on executive function deficits.
Abstract: Introduction: Executive dysfunction is well established in patients with traumatic brain injury and in schizophrenia (SCZ). However, assessments of executive function in psychosis following traumatic brain injury (PFTBI) are limited and inconsistent, and often do not reflect the deficits demonstrated in patients with traumatic brain injury (TBI) or SCZ. We sought to determine the extent of executive dysfunction in PFTBI relative to three comparison cohorts. Method: Measures of executive function were administered to dually diagnosed patients with PFTBI (n = 10) including tests of mental inhibition and switching, processing speed, and attention: the Stroop Task, Trail Making Test (TMT), and the Attention subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Demographically comparable patients with TBI (n = 10), SCZ (n = 23), and healthy controls (n = 23) underwent an identical battery. Results: Significant executive dysfunction was evident in patients with PFTBI on all ...
TL;DR: The traditional view of PTA recovering in the order of person, place, time, and memory does not adequately describe the profile of recovery on the Westmead Post-Traumatic Amnesia Scale.
Abstract: Objective Prospective monitoring of posttraumatic amnesia (PTA) is recommended following moderate to severe traumatic brain injury (TBI). However, few studies have examined the typical order in which items recover on PTA scales. Different methods have been used to define recovery, and the order reported is not consistent across the literature. The purpose of this study was to improve understanding of the progression of PTA by reporting the duration to recovery of items and categories on the Westmead Post-Traumatic Amnesia Scale (WPTAS) according to different criteria. Method A retrospective analysis was conducted of 66 patients with TBI who were administered the WPTAS during hospital admission. The duration to recovery of items and categories was determined according to 3 criteria: first correct, correct 3 times in a row, and consistently correct. Results On the basis of the sample mean, date of birth (DOB), year, age, place, month, day, name, and memory for the 3 pictures recovered in this order according to all 3 criteria. However, the significance of differences between items and the order of recovery of categories depended on the criterion adopted. Although DOB recovered first in 74% of cases and the 3 pictures last in 63% of cases, there was a high degree of individual variability in the precise sequence of recovery. Conclusions The traditional view of PTA recovering in the order of person, place, time, and memory does not adequately describe the profile of recovery on the WPTAS. Considering the recovery of individual items is necessary to understand and account for individuals differences in the order of recovery.
TL;DR: The high rates of feedback by close-others but low acceptance/acknowledgement of that feedback by individuals with TBI suggests that clinicians may need to work in partnership with close- others to facilitate supportive relationships for effective delivery of feedback.
Abstract: This study examined the relationship between the nature of feedback provided by close-others and self-awareness in individuals with traumatic brain injury (TBI). Using a cross-sectional design, 69 individuals with mild-to-severe TBI and their close-others completed the Awareness Questionnaire, Hospital Anxiety and Depression Scale, Trail Making Test–Part B and Feedback about Cognitive Difficulties Questionnaire, between 3 months and 20 years post-injury. Results showed cognitive and/or behavioural issues post-injury were identified in 97% of individuals with TBI and over 80% of these were provided with feedback by close-others at least sometimes after making errors. Close-others reported two main reasons for not providing feedback about problems: (1) not wanting to hurt the feelings of the injured individual and (2) pointing out errors would be detrimental to the injured individual's rehabilitation. Whilst nearly 60% of the individuals with TBI were reported to detect an error once they received feedback,...