Insomnia in Workers with Delayed Recovery from Mild Traumatic Brain Injury

Research Posters Participants: 33 patients originally admitted to a Level I trauma center; all participants then completed inpatient rehabilitation in the same hospital system, followed by a 3-month telephonic follow-up. Interventions: N/A. Main Outcome Measure(s): Patients were divided into BMI categories based on admission data. Acute care data (e.g., demographic and injuryrelated) was collected from patient charts and hospital trauma registry. Rehabilitation data (e.g., Functional Independence Measures) was collected from eRehab and the patient charts. Health outcomes included depression and post-traumatic stress disorder screens, pain levels, and return to work status. Kruskal-Wallis and Fisher’s tests compared outcomes across BMI categories. Results: 12 participants were classified as being of normal weight, 11 overweight, and 10 obese. A significantly greater number of overweight patients had more severe injuries in the acute care setting. Individuals who were overweight were significantly more likely to have a positive depression screen at baseline (pZ.0011). Differences in FIM efficiency during rehabilitation approached significance (pZ.0551). While no differences were found in inpatient rehabilitation or 3-month outcomes, results did indicate that individuals who were overweight or obese experienced length of stays two days longer than their normal weight individuals. Conclusions: As the number of individuals considered overweight or obese now includes over two-thirds of Americans, it is critical to examine the characteristics of this population and identify strategies to achieve best outcomes. Further research to determine the relationship between BMI after traumatic injury and outcomes after inpatient rehabilitation is needed. Key Words: Trauma, Body Weight, Obesity Disclosure(s): Stanley Seeger Surgical Fund & Ginger Murchison of the Baylor Healthcare System Foundation. Research Poster 4890 Veterans with Severe TBI Complicated by Disorder of Consciousness: Caregiver Stress and Needs Assessment Johanna Tran (James A Haley Veterans’ Hospital), Steven Scott, Kristina M. Martinez Objective(s): Identify needs of caregivers of Veterans with severe traumatic brain injury complicated by chronic disorder of consciousness. Design: Cross-sectional study with qualitative data collection methods. Setting: James A. Haley Veterans’ Hospital, Tampa, Florida. Participants: Five caregivers of Veterans with severe traumatic brain injury complicated by chronic disorder of consciousness. Privacy officer approval obtained due to lack of need for IRB approved protocol. Interventions: One hour long focus group targeting caregiver needs. Main Outcome Measure(s): None. Results: Significantly stressful challenges common to all caregivers of patients with severe traumatic brain injury complicated by chronic disorder of consciousness were identified as follows:(1) Complexity of arranging health care schedule, (2) Social isolation once discharged from hospital, (3) Disparity in perceived function of the patient between parents and health care providers based on evaluation environment, (4) Inadequate provision of equipment to allow continued high level therapy activities in the home setting, (5) Perception that community care providers lack adequate education and experience in treating patients with this diagnosis as well as a common belief among providers that only custodial care is appropriate, (6) Lack of adequate respite services, (7) Fear of inadequate care provision in the caregiver’s absence. Conclusions: (1) Caregivers of patients with severe traumatic brain injury complicated by chronic disorder of consciousness experience very high levels of caregiver stress, (2) Important identified caregiver stressors included generalized lack of high quality community resources for care of this patient population, general expectation amongst most providers that this patient population requires only custodial care, social isolation, and

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e13 lack of suitable respite care, (3) Caregivers reported continued functional improvement of their loved ones and hope for the future, (4) Further study is needed to confirm these findings and define interventions to decrease caregiver stress. Key Words: Brain Injuries, Caregivers, Family, Veterans Disclosure(s): Kristina M. Martinez is a contractor with the Defense and Veterans Brain Injury Center (DVBIC), James A. Haley Veterans’ Hospital, Tampa, FL USA. Johanna Tran (PMRS), Steven G. Scott (PMRS), and Samuel L. Phillips (CINDRR) are employees of the Department of Veterans Affairs at the James A. Haley Veterans’ Hospital (Tampa, FL) and are affiliated with the Department of Medicine at the University of South Florida (Tampa, FL). Financial disclosures e none. This research was supported by grants from the U.S. Department of Veterans Affairs, Ubisense PLC and Defense and Veterans Brain Injury Center (DVBIC) through the US Army Medical Research and Materiel Command (USAMRMC) under General Dynamics Information Technology (GDIT) (Award Ref: W91YTZ-13-C0015). This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital. The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official position, policy or decision of the Departments of Defense or Veterans Affairs, or any other federal agency, unless so designated by other official documentation. Research Poster 4891 Insomnia in Workers with Delayed Recovery from Mild Traumatic Brain Injury Tatyana Mollayeva (University of Toronto, GDRS/Neuroscience; Toronto Rehab-University Health Network), Shirin Mollayeva, Colin M. Shapiro, J. David Cassidy, Angela Colantonio Objective(s): To evaluate the prevalence of insomnia among Ontario workers with delayed recovery from mild TBI, and its relationship with sociodemographic, TBI- and claim-related, behavioral, and clinical factors. Design: Cross-sectional study with blinded comparison. Data were collected through medical chart review and self-report questionnaire. Setting: Outpatient clinic serving injured workers in a large rehabilitation hospital. Participants: Eligibility criteria were being 18 years of age at the time of injury; injured at work; had a documented force blow to the head, and were assessed by a transdisciplinary team at the Toronto Rehabilitation Institute between May 2012 and May 2014. Of 178 individuals invited to participate, 110 consented; upon assessment, 94 had a diagnosis of mild TBI. A comparison group (nZ294) was drawn from a retrospective chart review of consecutive individuals referred to the same clinic. Interventions: N/A. Main Outcome Measure(s): Questionnaire comprised of standardized measures of mental and physical health, pain, and sleep. Results: Of the 94 participants diagnosed with mTBI, clinical insomnia was reported by 69.2%. Insomnia was significantly associated with certain sociodemographic, claim-related, behavioral, and clinical variables. Conclusions: Insomnia is common in persons with delayed recovery from mTBI, and it is significantly associated with potentially modifiable clinical and nonclinical variables. Care of persons with brain injury requires greater attention with regard to the diagnosis and management of insomnia and associated disorders. Key Words: Brain Injuries, Sleep Initiation and Maintenance Disorders, Rehabilitation, Diagnostic Techniques and Procedures, Brain Concussion Disclosure(s): None Disclosed. Research Poster 4894 Referral Needs Demonstrated During Resource Facilitation for Persons with Employment as a Goal Following TBI Lynne Davis (Brain Injury Research Center, TIRR Memorial Hermann), Angelle M. Sander, Jay Ashley Bogaards, Monique Renae Pappadis