NeuroRehabilitation - Volume 47, issue 1

Authors: Goldberg, Gary | Eapen, Blessen | Kamen, Leonard

Article Type: Editorial

DOI: 10.3233/NRE-200003

Citation: NeuroRehabilitation, vol. 47, no. 1, pp. 1-10, 2020

Authors: Walsh, R. Stephen | Crawley, Lorraine | Dagnall, Neil | Fortune, Dónal G.

Article Type: Case Report

Abstract: BACKGROUND: Stress is common to the experience of TBI. Stressors challenge physical and psychological coping abilities and undermine wellbeing. Brain injury constitutes a specific chronic stressor. An issue that hinders the usefulness of a stress-based approach to brain injury is a lack of semantic clarity attaching to the term stress. A more precise conceptualisation of stress that embraces experienced uncertainty is allostasis. OBJECTIVE: An emerging body of research, collectively identifiable as ‘the social cure’ literature, shows that the groups that people belong to can promote adjustment, coping, and well-being amongst individuals confronted with injuries, illnesses, traumas, and stressors. …The idea is deceptively simple, yet extraordinarily useful: the sense of self that individuals derive from belonging to social groups plays a key role in determining health and well-being. The objective of this research was to apply a social cure perspective to a consideration of an individual’s lived experience of TBI. METHODS: In a novel application of interpretative phenomenological analysis (IPA) this research has investigated one person’s lived experience in a single case study of traumatic brain injury. RESULTS: Paradox, shifting perspectives and self under stress, linked by uncertainty, were the themes identified. CONCLUSIONS: A relational approach must be key to TBI rehabilitation. Show more

Keywords: IPA, TBI, rehabilitation, phenomenology, brain injury, social cure, relational

DOI: 10.3233/NRE-203079

Citation: NeuroRehabilitation, vol. 47, no. 1, pp. 11-24, 2020

Authors: McIntyre, Amanda | Mehta, Swati | Janzen, Shannon | Rice, Danielle | Harnett, Amber | MacKenzie, Heather M. | Vanderlaan, Danielle | Teasell, Robert

Article Type: Research Article

Abstract: OBJECTIVE: The objective of this observational cohort study was to compare coping strategies and personality traits among individuals with acquired brain injury (ABI), based on their level of depression symptoms. METHODS: Participants were recruited from an ABI outpatient clinic in Ontario, Canada. Participants were selected using the following inclusion criteria: 1) diagnosed with an ABI, 2) 18 years of age, and 3) able to read and write in English. Individuals completed the Patient Health Questionnaire 9-item (PHQ-9), Acceptance and Action Questionnaire, Anxiety Sensitivity Index, Adult Dispositional Hope Scale, Big Five Inventory, Brief Coping Orientation of Problems Experienced, and …Rosenberg Self-Esteem Scale. A descriptive analysis was performed for the overall sample, as well as for each subclassification of depression: none (PHQ-9 = 0–4), mild (PHQ-9 = 5–9), moderate (PHQ-9 = 10–14), and severe (PHQ-9 = 15–27). A one-way multivariate analysis of variance, with post hoc Bonferroni-corrected tests, was conducted to assess the impact of depression symptoms on coping strategies and personality traits. RESULTS: A total of 89 individuals (56.2% females) were included with a mean age of 46.6±15.1 years and a mean Glasgow Coma Scale score of 13.2±3.4. Overall, individuals were 3.5±4.3 years post injury. There was a statistically significant interaction effect between depression groups and the combined coping strategy and personality trait variables (F(36,128)=2.959, p  < .001; Wilks’ Λ = .167). Individuals with mild (p  = .045), moderate (p  = .004) and severe (p  < .001) depression symptoms had greater experiential avoidance (EA) than those without depression. Those with severe depression symptoms had significantly greater anxiety sensitivity than those with no (p  < 0.001), mild, (p  = .004) or moderate (p  = .025) depression symptoms. Overall, individuals in the no, mild, and moderate depression groups used emotion-focused strategies primarily, followed by dysfunctional strategies for coping. Conversely, those with severe depression symptoms primarily used dysfunctional strategies, followed by emotion-focused strategies to cope. All depression groups applied problem-based coping strategies infrequently. CONCLUSIONS: The use of passive coping strategies combined with increased EA behaviours among severely depressed individuals with ABI may lead to long-term negative outcomes. Programs that promote problem-based coping and reduce EA behaviours may be beneficial in reducing disability and impaired quality of life associated with depression symptoms in individuals with ABI. Show more

Keywords: Brain injury, depression, coping, anxiety sensitivity, experiential avoidance, dispositional hope, self-esteem

DOI: 10.3233/NRE-203081

Citation: NeuroRehabilitation, vol. 47, no. 1, pp. 25-34, 2020

Authors: McGeary, Cindy | Nabity, Paul | Reed, David | Cobos, Briana | Eapen, Blessen | Pugh, Mary Jo | Jaramillo, Carlos | Potter, Jennifer | Houle, Timothy | Young-McCaughan, Stacey | Peterson, Alan | McGeary, Don

Article Type: Research Article

Abstract: BACKGROUND: Chronic musculoskeletal pain is a complex problem, particularly for individuals with head injury and comorbid psychiatric conditions. The Fear Avoidance Model offers one of the strongest opportunities to conceptualize comorbid traumatic injury and pain, but this model is largely untested. OBJECTIVE: This study tests the Fear Avoidance Model of chronic pain using a sample from a study of polytrauma patients in a large Department of Veterans Affairs facility who participated in a federally-funded study of interdisciplinary chronic pain management. METHODS: The present study comprises a secondary analysis of 93 veterans with chronic pain, head injury, …posttraumatic stress symptoms and a history of persistent opioid use. Standardized measures of Fear Avoidance Model risk factors (e.g., pain catastrophizing, fear avoidance beliefs, anxiety, depression) were examined as cross-sectional predictors of pain-related disability. RESULTS: Secondary data analysis revealed that Fear Avoidance Model factors accounted for almost 40% of the variance in pain-related disability, with pain catastrophizing and depression demonstrating the strongest relationships with disability. A summary variable combining all four factors revealed a 6% increase in disability for each factor that was clinically significant for the sample patients. CONCLUSIONS: This study represents the first attempt to examine a complex, theoretical model of pain in a comorbid pain and TBI sample. Findings revealed a strong relationship between this model and pain-related disability that outperforms pain intensity ratings. This model could be used to guide better treatment for comorbid pain and TBI. Show more

Keywords: Polytrauma, chronic pain, fear avoidance, prediction

DOI: 10.3233/NRE-203084

Citation: NeuroRehabilitation, vol. 47, no. 1, pp. 35-43, 2020

Authors: McIntyre, Amanda | Rice, Danielle | Janzen, Shannon | Mehta, Swati | Harnett, Amber | Caughlin, Sarah | Sequeira, Keith | Teasell, Robert

Article Type: Research Article

Abstract: OBJECTIVES: The objectives of this observational cohort study were to 1) cluster individuals with acquired brain injury (ABI) into subgroups according to their level of anxiety sensitivity (AS) and experiential avoidance (EA), and 2) compare subgroups with respect to anxiety, depression, and quality of life (QoL). METHODS: Individuals were recruited from an ABI outpatient clinic in Ontario, Canada and completed comprehensive psychosocial questionnaires. A two-step cluster analysis was performed to identify unique subgroups based on the clustering variables Anxiety Sensitivity Index (ASI) and Acceptance and Action Questionnaire (AAQ) which measure AS and EA, respectively. Clinical outcome measures were …compared between clusters using multivariate analysis of variance: Generalized Anxiety Disorder 7 item (anxiety); Patient Health Questionnaire-9 (depression), and EQ-5D overall health item (QoL). RESULTS: Among 86 participants included for analysis (mean age 47.1±14.2 years, 54.7% female), three unique clusters were produced. ASI and AAQ were significantly different among all groups (p  < 0.001). Cluster 1 (n  = 26) had the lowest levels of AS and EA whereas Cluster 3 (n  = 24) had the highest levels of AS and EA; Cluster 2 (n  = 36) had moderate levels of AS and EA. There was no significant difference between groups in age, gender, time since injury, or Glasgow Coma Scale scores. Cluster 3 had significantly higher anxiety and depression scores than Cluster 1 and 2 (p  < 0.001 for all). Further, Cluster 2 had significantly higher anxiety and depression scores than Cluster 1 (p  < 0.001 for all). There was no significant difference in EQ-5D scores between Clusters 1 and 2 or Cluster 2 and 3; however, Cluster 3 scored significantly lower on EQ-5D than Cluster 1 (p  = 0.032). CONCLUSIONS: There exists a subgroup of individuals with ABI that have high levels of AS and EA; this was associated with greater symptoms of anxiety and depression, and poorer QoL. Interventions to address AS and EA may improve mood and QoL in this population. Show more

Keywords: Acquired brain injury, anxiety sensitivity, experiential avoidance, anxiety, depression, quality of life

DOI: 10.3233/NRE-203080

Citation: NeuroRehabilitation, vol. 47, no. 1, pp. 45-53, 2020

Authors: Raukola-Lindblom, Marjaana | Elina, Vuorinen | Riitta, Vartiainen

Article Type: Research Article

Abstract: BACKGROUND: Traumatic brain injuries often result in impaired social functioning that may cause uncertainty, isolation, and precipitation of significant stress in social situations. Involvement in directed group treatment helps participants to develop new capabilities for feeling relationally connected, improving verbal and nonverbal communication skills, as well as building the capacity for empathic intersubjectivity. We suggest that group intervention to improve communication and social skills may provide an efficient and effective way for a patient to return to successful social participation. OBJECTIVE: The purpose of this paper is to describe and discuss the principles of a clinical group intervention …for increasing the social participation of persons with traumatic brain injury. METHODS: Since 2000, several intervention periods, each with 10–20 group meetings, including some individual sessions for guidance, have been carried out under our direction in Finland. The intervention periods include education, reflection, and practical experiential exercises and can be multidisciplinary with both speech-language pathologists and neuropsychologists providing oversight and direction. The main goal of the described group interventions is to support community participation and social reintegration. In this article, we describe guiding principles and provide examples of the clinical group interventions drawn from our experience. CONCLUSION: As determined by clinical observations and patient reports, the group intervention for social participation has proven to be beneficial. The participants report gaining more understanding of and insight into social situations, nonverbal and verbal communication, as well as affective interactive experience. Practicing social skills in a group situation is inherently self-motivating and encourages a constructive, positive impetus toward greater social participation. Based on our experience with this approach, it appears that this experiential form of group intervention is an effective bridge between structured cognitive-communication rehabilitation and successful real-life social participation. Show more

Keywords: Communication, social participation, traumatic brain injury, group treatment, rehabilitation

DOI: 10.3233/NRE-203083

Citation: NeuroRehabilitation, vol. 47, no. 1, pp. 55-64, 2020

Authors: Esterov, Dmitry | Lennon, Ryan J. | Bergquist, Thomas | Brown, Allen

Article Type: Research Article

Abstract: BACKGROUND: The Neurobehavioral Symptom Inventory (NSI-22) is a validated self-report measure designed to assess neurobehavioral symptoms (NBS) after mild TBI (MTBI). Psychological and behavioral factors have been shown to be predictors of persistent NBS reporting in veterans; however, there is still a gap in knowledge about these associations in a civilian population presenting for treatment. OBJECTIVE: This study seeks to identify the predictors of increased NBS reporting on the NSI-22 in a treatment-seeking population with MTBI. METHODS: Analysis of 80 treatment seeking participants admitted to an interdisciplinary outpatient rehabilitation program with a diagnosis of MTBI. NSI-22 …was used to measure NBS reporting. Predictor variables identified by univariate analysis were entered into a multivariable regression model, which was adjusted for demographic variables. RESULTS: Higher NSI-22 scores correlated with increased level of depressive complaints (PHQ-9), higher disability (M2PI), lower satisfaction with life (SWLS), prior MTBI, fewer years of education, absence of motor vehicle collision (MVC), and unemployment at time of assessment. When those variables were used in a multivariable linear regression model, PHQ-9, M2PI, years of education, and absence of MVC remained statistically significant. CONCLUSION: Psychological factors and level of societal participation predicted increased NBS as compared with injury severity and time since injury. Show more

Keywords: Traumatic brain injury, TBI, mild traumatic brain injury, MTBI, concussion, post-concussion syndrome, PCS, neurobehavioral symptom inventory, NSI-22, neurobehavioral symptoms

DOI: 10.3233/NRE-203082

Citation: NeuroRehabilitation, vol. 47, no. 1, pp. 65-77, 2020

Authors: Amatya, Bhasker | Khan, Fary

Article Type: Other

Abstract: BACKGROUND: Falls are common and serious health concern in people with multiple sclerosis (MS). Various types of falls prevention interventions are currently investigated in people with MS. OBJECTIVE: To assess the effectiveness of interventions to reduce falls in people with MS. METHODS: To summarize falls prevention interventions from the published Cochrane Review “Interventions for preventing falls in people with multiple sclerosis” conducted by Hayes et al. Best available evidence was discussed from the rehabilitation perspective. RESULTS: Overall 13 RCTs with 839 participants were included. The interventions evaluated included: exercise, education, and functional electrical stimulation …alone or in combination. Majority of the included studies demonstrated high risk of bias. The findings suggest that the evidence was uncertain regarding the effects of evaluated interventions on preventing or reducing falls. CONCLUSIONS: The evidence for any falls prevention interventions in people with MS is sparse and uncertain, and more robust studies are needed. Show more

Keywords: Multiple sclerosis, falls, rehabilitation

DOI: 10.3233/NRE-209005

Citation: NeuroRehabilitation, vol. 47, no. 1, pp. 79-82, 2020