Thinking Outside the Box: Maximizing Vocational Outcomes Post-Traumatic Brain Injury through Rehabilitation Counseling and Recreation/Leisure Activities

2015 ◽  
Vol 46 (4) ◽  
pp. 37-44
Author(s):  
Leah Cox Thomas ◽  
Eileen J. Burker ◽  
Kelly A. Kazukauskas
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Rehabilitation Counseling ◽  
Leisure Activities ◽  
Rehabilitation Counselors ◽  
Post Injury ◽  
Rehabilitation Programs ◽  
Vocational Outcomes ◽  
Post Traumatic ◽  
Employment Programs

Traumatic brain injury (TBI) is a disability that is becoming more common and post-injury many individuals with TBI have difficulty returning to employment for extended periods of time. Despite the success of traditional vocational rehabilitation programs, many individuals still struggle to maintain long-term employment. The purpose of this paper is to suggest the use of recreation and leisure activities (RLA) as a complementary treatment modality that can be utilized in conjunction with traditional employment programs to maximize vocational outcomes and increase overall life satisfaction. Benefits and barriers to RLA participation are discussed as well as specific attributes necessary for participation in both vocational pursuits and RLA. Recommendations for rehabilitation counselors are also provided.

Differences Between Elapsed Time to Employment and Employer Selection in Vocational Outcome Following Severe Traumatic Brain Injury

1995 ◽  
Vol 26 (4) ◽  
pp. 17-20 ◽  
Author(s):  
Robert J. Fabiano ◽  
Nancy Crewe ◽  
David A. Goran
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Neuropsychological Testing ◽  
Hourly Wage ◽  
Post Injury ◽  
Severe Injuries ◽  
Telephone Interviews ◽  
Rehabilitation Programs ◽  
Vocational Outcome ◽  
Acute Rehabilitation

Information from medical records and telephone interviews were collected on 94 patients who had enrolled in three post-acute rehabilitation programs for the treatment of traumatic brain injury. Those patients who performed better on neuropsychological testing returned to work sooner (within two years post-injury), had less severe injuries, and were more likely to return to the same employer post-injury. Furthermore, those patients who returned to work with the same employer were more likely to be employed and earned a greater hourly wage than those who returned to a new employer.

scholarly journals A pilot study exploring pupil response measurement in mild traumatic brain injury

2015 ◽  
Vol 42 (S1) ◽  
pp. S40-S40
Author(s):  
W Ting ◽  
J Topolovec-Vranic ◽  
M McGowan ◽  
MD Cusimano
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Healthy Controls ◽  
Response Dynamics ◽  
Post Injury ◽  
Response Measurement ◽  
Pupil Response ◽  
Post Traumatic ◽  
Traumatic Symptoms

Background: Pupillometry, the measurement of pupil response dynamics via the pupillary light reflex, is seldom used in the assessment of mild traumatic brain injury (mTBI). We hypothesized that there would be quantifiable differences in detailed pupil response measurements in patients with acute and chronic mTBI. Methods: We conducted 49 bilateral pupillometry measurements, in acute mTBI patients at 1-week (N=11), 2-4w (N=9), and 3-7mo post-injury (N=3); 14 patients with persistent post-traumatic symptoms (PTS) once, and healthy controls across a first visit (N=7) and second visit 2-4w later (N=5). Results: The percentage of left pupil diameter change was significantly greater in the acute mTBI group at second visit (mean=36.3% (2.96)), compared to controls at second visit (mean=31.6% (4.39)) (F=5.87, p=0.0321). We did not identify significant differences between acute mTBI patients and controls at first visit, PTS patients versus controls, and within the acute mTBI group across three longitudinal visits. Conclusion: While these preliminary data suggest that pupillometry under these conditions does not distinguish between patients who had a recent mTBI or those with PTS and healthy controls, further research is warranted investigating pupil behavior and its clinical utility in mTBI.

Addressing the Sexual Concerns of Persons With Traumatic Brain Injury in Rehabilitation Settings: A Framework for Action

2001 ◽  
Vol 2 (2) ◽  
pp. 97-108 ◽  
Author(s):  
Grahame Simpson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
World Health Organisation ◽  
World Health ◽  
Post Injury ◽  
Rehabilitation Programs ◽  
Human Functioning ◽  
Sexual Concerns ◽  
Organisational Structures

AbstractTraumatic brain injury (TBI) impacts upon people's sexuality with 50% to 60% of persons reporting some level of disruption post-injury. However, only small proportions of patients/family members report that rehabilitation health professionals made inquiries about whether they had any sexual concerns. Rehabilitation programs have a responsibility to meet the challenge of addressing this important area of human functioning. An agency framework is described that provides a non-threatening, structured way for services to conceptualise, introduce or upgrade sexuality services in a manner that can be maintained over the long term. The framework contains an underlying philosophy of sexuality, five proposed modalities of service provision and detail of the underlying organisational structures that are required to provide sexuality services with consistency and effectiveness over the long term. Finally, organisational strategies that can be employed to implement the framework are discussed as well as suggestions about the sequencing of such strategies. By using the framework, rehabilitation services can put sexuality back onto their treatment agenda, as they seek to restore patients/clients with TBI to the “highest level of adaptation attainable” (World Health Organisation, 1996, p. 1) in all areas of their lives.

scholarly journals The Functional Status Examination in Mild Traumatic Brain Injury: A TRACK-TBI Sub-Study

2019 ◽  
Vol 34 (7) ◽  
pp. 1165-1174
Author(s):  
Evan Zahniser ◽  
Nancy R Temkin ◽  
Joan Machamer ◽  
Jason Barber ◽  
Geoffrey T Manley ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Status ◽  
Emotional Health ◽  
Functional Limitations ◽  
Well Being ◽  
Functional Impairments ◽  
Post Injury ◽  
Post Traumatic ◽  
Leisure And Recreation

Abstract Objective The Functional Status Examination (FSE) is a comprehensive measure of functional status post-traumatic brain injury (TBI) that has primarily been used in studies of moderate-to-severe TBI. The present observational study examines functional status using the FSE among patients who sustained mild TBIs (mTBIs; defined as Glasgow Coma Scale [GCS] = 13–15 at admission) seen in a Level 1 trauma center. Study aims included examining the course of functional status following mTBI, as well as exploring relationships of the FSE and other relevant constructs among those with GCS = 13–15. Method Participants were assessed at 2 weeks (n = 112), 3 months (n = 113), 6 months (n = 106), and 12 months (n = 88) post-injury for changes in functional status resulting both (a) from all injuries and (b) from TBI only. Results Among seven domains of day-to-day functioning, participants generally experienced the greatest disruption in their primary activity (work or school) and in leisure and recreation. Subjects’ overall functional status tended to improve over time, with sharpest increases in functionality occurring in the first 3 months post-injury. However, some subjects continued to report functional limitations even at 12 months post-injury. Functional status was largely unrelated to neurocognitive functioning, but related strongly to post-traumatic symptoms, life satisfaction, and emotional well-being, particularly at 3 months post-injury and beyond. Conclusion Findings indicate that functional impairments related to mTBI may be more likely to persist than widely believed, with those who experience lingering functional deficits at particular risk for emotional health difficulties.

Duration of post-traumatic amnesia is uniquely associated with memory functioning in chronic moderate-to-severe traumatic brain injury

2021 ◽  
pp. 1-13
Author(s):  
Umesh M. Venkatesan ◽  
Amanda R. Rabinowitz ◽  
Stephanie J. Wolfert ◽  
Frank G. Hillary
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Memory Performance ◽  
Acute Injury ◽  
Post Injury ◽  
Memory Processing ◽  
Memory Functioning ◽  
Traumatic Amnesia ◽  
Post Traumatic ◽  
With Memory

BACKGROUND: Disrupted memory circuitry may contribute to post-traumatic amnesia (PTA) after traumatic brain injury (TBI). It is unclear whether duration of PTA (doPTA) uniquely impacts memory functioning in the chronic post-injury stage. OBJECTIVE: To examine the relationship between doPTA and memory functioning, independent of other cognitive abilities, in chronic moderate-to-severe TBI. METHODS: Participants were 82 individuals (median chronicity = 10.5 years) with available doPTA estimates and neuropsychological data. Composite memory, processing speed (PS), and executive functioning (EF) performance scores, as well as data on subjective memory (SM) beliefs, were extracted. DoPTA-memory associations were evaluated via linear modeling of doPTA with memory performance and clinical memory status (impaired/unimpaired), controlling for PS, EF and demographic covariates. Interrelationships between doPTA, objective memory functioning, and SM were assessed. RESULTS: DoPTA was significantly related to memory performance, even after covariate adjustment. Impairment in memory, but not PS or EF, was associated with a history of longer doPTA. SM was associated with memory performance, but unrelated to doPTA. CONCLUSIONS: Findings suggest a specific association between doPTA—an acute injury phenomenon—and chronic memory deficits after TBI. Prospective studies are needed to understand how underlying mechanisms of PTA shape distinct outcome trajectories, particularly functional abilities related to memory processing.

Rates of symptom reporting following traumatic brain injury

2010 ◽  
Vol 16 (3) ◽  
pp. 401-411 ◽  
Author(s):  
SUREYYA DIKMEN ◽  
JOAN MACHAMER ◽  
JESSE R. FANN ◽  
NANCY R. TEMKIN
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Symptom Reporting ◽  
Psychiatric History ◽  
Post Injury ◽  
Post Traumatic ◽  
Severity Levels ◽  
Traumatic Symptoms

AbstractThis study examines rates of reporting of new or worse post-traumatic symptoms for patients with a broad range of injury severity at 1 month and 1 year after traumatic brain injury (TBI), as compared with those whose injury spared the head, and assesses variables related to symptom reporting at 1 year post-injury. Seven hundred thirty two TBI subjects and 120 general trauma comparison (TC) subjects provided new or worse symptom information at 1 month and/or 1 year post-injury. Symptom reporting at 1 year post-injury was compared in subgroups based on basic demographics, preexisting conditions, and severity of brain injury. The TBI group reported significantly more symptoms at 1 month and 1 year after injury than TCs (each p < .001). Although symptom endorsement declined from 1 month to 1 year, 53% of people with TBI and 24% of TC continued to report 3 or more symptoms at 1 year post-injury. Symptom reporting in the TBI group was significantly related to age, gender, preinjury alcohol abuse, pre-injury psychiatric history, and severity of TBI. Symptom reporting is common following a traumatic injury and continues to be experienced by a substantial number of TBI subjects of all severity levels at 1 year post-injury. (JINS, 2010, 16, 401–411.)

scholarly journals Differential Expression Patterns of TDP-43 in Single Moderate versus Repetitive Mild Traumatic Brain Injury in Mice

2021 ◽  
Vol 22 (22) ◽  
pp. 12211
Author(s):  
Tamara Janković ◽  
Petra Dolenec ◽  
Jelena Rajič Bumber ◽  
Nika Gržeta ◽  
Jasna Kriz ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Expression Patterns ◽  
Brain Trauma ◽  
Post Injury ◽  
Postsynaptic Protein ◽  
Fluid Percussion Injury ◽  
Post Traumatic ◽  
Nuclear Levels ◽  
The Brain

Traumatic brain injury (TBI) is a disabling disorder and a major cause of death and disability in the world. Both single and repetitive traumas affect the brain acutely but can also lead to chronic neurodegenerative changes. Clinical studies have shown some dissimilarities in transactive response DNA binding protein 43 (TDP-43) expression patterns following single versus repetitive TBI. We explored the acute cortical post-traumatic changes of TDP-43 using the lateral fluid percussion injury (LFPI) model of single moderate TBI in adult male mice and investigated the association of TDP-43 with post-traumatic neuroinflammation and synaptic plasticity. In the ipsilateral cortices of animals following LFPI, we found changes in the cytoplasmic and nuclear levels of TDP-43 and the decreased expression of postsynaptic protein 95 within the first 3 d post-injury. Subacute pathological changes of TDP-43 in the hippocampi of animals following LFPI and in mice exposed to repetitive mild TBI (rmTBI) were studied. Changes in the hippocampal TDP-43 expression patterns at 14 d following different brain trauma procedures showed pathological alterations only after single moderate, but not following rmTBI. Hippocampal LFPI-induced TDP-43 pathology was not accompanied by the microglial reaction, contrary to the findings after rmTBI, suggesting that different types of brain trauma may cause diverse pathophysiological changes in the brain, specifically related to the TDP-43 protein as well as to the microglial reaction. Taken together, our findings may contribute to a better understanding of the pathophysiological events following brain trauma.

scholarly journals 513 Understanding the Role of HMGB1 Post-Traumatic Brain Injury - The Complex Interplay Between Neuro-Inflammation and Neurogenesis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Marei ◽  
S Manivannan ◽  
O Elalfy ◽  
M Zaben
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Current Evidence ◽  
Post Injury ◽  
Term Survival ◽  
Positive Effects ◽  
Pubmed Database ◽  
Post Traumatic

Abstract Introduction Traumatic brain injury (TBI) is a global public health burden. Although neurogenesis occurs post-injury, achieving long term survival of newly generated neurons remains elusive. High Mobility Group Box protein 1 (HMGB1) is a pivotal cytokine in hosting the neuro-inflammatory response to injury, but also mediates neurogenesis during physiological development. In this review, we examine current evidence for post-traumatic neurogenesis and HMGB1 as a therapeutic target. Method PubMed database was evaluated with the following search terms: HMGB1, isoforms, neurogenesis, traumatic brain injury, Toll-like receptor, receptor for advanced glycation end-products. Results Multiple studies support the existence of neurogenesis post-injury both in vitro and in vivo. Different HMGB1 target receptors mediate different functions of HMGB1, though these are not mutually exclusive in the context of injury. Interaction with RAGE is responsible for developmental neurogenesis, whilst TLR-4 mediates the innate immune response. Though different HMGB1 isoforms are recognised, specific effects post-injury remains unexplored. In vivo animal studies demonstrate positive effects of HMGB1 antagonism post-TBI, but long-term outcomes remain unclear. Conclusions Modulating HMGB1 may enhance post-TBI recovery, but a mechanistic understanding of its effects on neurogenesis is fundamental to avoid negating potentially beneficial effects.

A-97 Headache before and after Mild Traumatic Brain Injury: Acute-to-Subacute Outcomes in Patients with no Headache, Pre-Existing Headache, and Post-Traumatic Headache

2021 ◽  
Vol 36 (6) ◽  
pp. 1145-1145
Author(s):  
Justin E Karr ◽  
Michael W Williams ◽  
Grant L Iverson ◽  
Sheng-Jean Huang ◽  
Chi-Cheng Yang
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Neuropsychological Tests ◽  
Neuropsychological Test ◽  
Future Research ◽  
Cognitive Symptoms ◽  
Post Injury ◽  
Before And After ◽  
Post Traumatic

Abstract Objective Patients who experience a mild traumatic brain injury (MTBI) may have a headache condition preceding injury, develop a post-traumatic headache after injury, or experience headache neither before nor after injury. This study examined whether MTBI patients with no headache, pre-existing headache, and post-traumatic headache differed in acute-to-subacute outcomes. Method Patients with MTBI were recruited from an outpatient neurosurgery clinic in Taipei, Taiwan after emergency department referral (N = 291; 40.2% men; M = 37.9 ± 13.9 years-old; Mdn = 7 days-since-injury, range = 0–21), completing neuropsychological tests of attention, memory, and verbal fluency and questionnaires evaluating depression, anxiety, and post-concussion symptoms. Participants with no headache (reported neither pre- or post-injury), pre-existing headache (reported pre-injury headache, of whom some reported worsened post-injury headache), and post-traumatic headache (denied pre-injury headache, reported post-injury headache) were compared using non-parametric ANCOVA, controlling for gender and days-since-injury. Results Neuropsychological test performances did not differ between headache groups. Participants with pre-injury headache and post-traumatic headache had greater change in self-reported physical (F = 25.52, p &lt; 0.011, η2 = 0.15) and cognitive symptoms (F = 3.74, p = 0.025, η2 = 0.03) than participants with no headache. Participants with pre-injury headache reported worse post-injury anxiety symptoms than participants with post-traumatic headache (F = 12.02, p &lt; 0.011, η2 = 0.08). Conclusion(s) Participants with pre-injury and post-traumatic headache did not differ in outcome within 21 days of injury but had worse self-reported physical and cognitive symptoms than participants with no headache. Most participants with pre-injury headache experienced worsened headache following MTBI (53.7%). Future research is needed to assess whether more specific headache subtypes are differentially associated with MTBI outcome.

scholarly journals A Multiscale Model of Traumatic Brain Injury Suggests Possible Mechanisms of Post-Traumatic Psychosis

2021 ◽  
Author(s):  
Dalton A R Sakthivadivel
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Traumatic Injury ◽  
Multiscale Model ◽  
Cortical Activation ◽  
Post Injury ◽  
Regulation Of Activity ◽  
Post Traumatic ◽  
And Function ◽  
The Brain

AbstractTraumatic brain injury is a devastating injury to the brain that can have permanent or fatal effects, leading to life-long deficits or death. Among these effects is psychosis and schizophrenia, sometimes reported in the population of TBI sufferers. Here we evaluate a possible mechanism of post-traumatic psychosis, shedding light on the anomalous nature of psychosis as over-activity and brain injury as destruction. Using a multiscale model of the brain to relate molecular pathology to connectomic and macroscopic features of the brain, we identify cell lysis and membrane deformation as a possible mechanism for psychosis after injury. We also evaluate the reorganisation of functional networks and cortical activation post-injury, and find the features of a simulated brain under traumatic injury correlate with recorded results on the schizophrenic functional connectome. This provides a possible mechanism for post-traumatic psychosis, as well as a proof-of-principle of advanced multiscale modelling methods in computational psychiatry and neuromedicine. It also elaborates on the relationship between structure and function in the brain, information processing, and the delicate regulation of activity in healthy brains.

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