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Lifetime History of Brain Injury among Collegiate Athletes
Research Posters development of a psychotherapeutic intervention geared towards specific factors that contribute to post-TBI mood disturbance. By focusing specifically on these factors, this targeted approach will greatly improve upon current treatment efforts. Key Words: TBI (traumatic brain injury), Depression, Anxiety Disclosure(s): None Disclosed. Research Poster 3848 Performance Validity and Post-Concussive Symptoms in a Pediatric and Young Adult Sample Subramani Seetharama (Hartford Hospital HealthCare), Timothy Belliveau, Jennifer Renee Cromer, Jason Cromer, David W. Lovejoy Objective(s): To investigate the relationship between self-reported postconcussive symptoms and cognitive test validity among youth. Design: Analysis of an archival dataset. Setting: Hospital-affiliated, multi-site, concussion clinics. Participants: A convenience sample of 162 subjects (Mean age Z 15.5 years) evaluated after concussion (Mean post-injury days Z 21.0). Interventions: N/A. Main Outcome Measure(s): Post-Concussion Symptom Scale (PCSS), Patient Reported Outcomes Measurement Information System (PROMIS: Anxiety and Depression), Cogstate Brief Battery (CBB: including embedded effort indices), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Balance Error Scoring System (BESS). Results: Subjects with one or more atypical CBB embedded effort indices reported a broader profile of post-concussive symptoms than those with fully acceptable performance (p Z 0.011), and had worse processing speed (p Z 0.012), working memory (p < 0.001), learning (p Z 0.002), and impulse control (p Z 0.049). CBB embedded effort indices were positively correlated with self-reported post-concussive symptoms (PCSS: r Z 0.354, p < 0.001; ImPACT: r Z 0.235, p Z 0.035) and negatively correlated with working memory (r Z 0.665; p < 0.001), learning (r Z 0.501, p < 0.001), impulse control (r Z 0.339, p Z 0.002), and verbal memory (r Z 0.275, p Z 0.012). Among subjects with fully valid CBB test scores, report of post-concussive symptoms were positively correlated with anxiety symptoms (PCSS: r Z 0.479, p < 0.001; ImPACT: r Z .433; p Z 0.002). Conclusions: These findings highlight the utility of embedded validity measures for ensuring accurate interpretation of cognitive test results. Elevations on validity indices combined with elevations on psychological measures suggest non-neurological contributing factors, and may identify opportunities for early behavioral intervention to decrease the risk for an atypical course of persistent symptoms. Key Words: Pediatric, Concussion, Validity Disclosure(s): Dr. Jason A. Cromer is employed as the Director of Clinical Science by Cogstate, Inc., publisher of the Cogstate Brief Battery. Research Poster 3849 Lifetime History of Brain Injury among Collegiate Athletes Erica Kaplan (Mount Sinai), Lisa Spielman, Wayne Gordon, Robin Wellington, Karla Therese Sy, Kristen Dams-O’Connor Objective(s): (1) To examine self-reported traumatic brain injury (TBI) history in collegiate athletes as measured by a single item indicator and a comprehensive screening measure. (2) To evaluate the impact of TBI history on self-reported symptoms and cognitive performance in male and female athletes. Design: Cross-sectional. Setting: Urban, NCAA Division I university. Participants: Collegiate athletes (NZ127) assessed prior to the 2013 athletic season. Interventions: N/A. Main Outcome Measure(s): (1) Brain Injury Screening Questionnaire (BISQ), a comprehensive self-report measure of brain injury history and
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e77 subjective symptoms. (2) Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), which assesses concussion history using a single-item indicator and provides a computer-based assessment of cognitive functioning. Results: 1. On the ImPACT, 41 athletes (32% of the total sample, 66% female) reported a history of concussion. 2. Of the 86 athletes that reported no concussion history on the ImPACT, 24 athletes (28%) endorsed 1 blow to the head on the BISQ. On the BISQ, 62 athletes (49% of the total sample) reported 1 blow to the head. 3. Males with 1 blow to the head reported significantly more mood symptoms than males without blows to the head (t Z 2.2, p<.05). Conclusions: When collegiate athletes were asked to self-report lifetime history of blows to the head, a comprehensive screening tool yields significantly more reported injuries than a single-item indicator. While a higher percentage of females reported a history of brain injury, the relationship between prior brain injury and mood was only significant for males. Given the importance of TBI history in predicting recovery from future TBIs, results support the importance of comprehensive concussion screenings for male and female athletes. Key Words: Brain concussion, Athletes, Screening Disclosure(s): None Disclosed.
Research Poster 3851 Integrating Opportunities for Family Involvement into a Manualized Goal Self-Management Intervention for Veterans with mTBI Samantha Cichon (Well-Being Literacy, Multimedia Education & Psychosocial Research Program (WeLL) at the DC VAMC and MedStar Health), Ellen Kathleen Danford, Manon M. Schladen, Dwan Bruner, Alexander Libin, Joel Scholten Objective(s): To analyze narratives produced by interviews and a focus group with Veterans with mild traumatic brain injury (mTBI) in order to identify family related themes to inform the development of a manualized goal self-management intervention for Veterans with executive dysfunction due to mTBI. Design: Qualitative analysis of semi-structured interviews and a focus group. Setting: DC VA Medical Center TBI/Polytrauma Outpatient Clinic. Participants: Nine Veterans with mTBI, 7 male and 2 female. Interventions: N/A. Main Outcome Measure(s): Summary of family-related themes reported by Veterans. Results: Qualitative analysis of the narratives revealed three key themes: the centrality of family members to the rehabilitation process, family members as an extension of the Veterans’ self-awareness, and the impact of mTBI on family relationships. Veterans reflected on the active role family members and caregivers had played in their successful rehabilitation. They discussed the ability of family members and close friends to provide valuable information that may go unnoticed by clinicians and even the Veterans themselves. Veterans also described how their residual mTBI symptoms have affected their family dynamic resulting in strained relationships with family members and others. Conclusions: Veterans’ family members or caregivers are often essential facilitators of the rehabilitation process following a TBI who may actively increase Veterans’ self-efficacy and self-reliance. All family-related themes revealed in the analysis of the narratives were successfully integrated into the manualized goal management intervention. Family members and caregivers will be invited to participate, at the Veteran’s discretion, in assessment sessions prior to the manualized intervention to capture their valuable observations. They are also invited to attend the goal-setting sessions to gain information about the Veteran’s goals and learn skills that family members may utilize as caregivers to support relationship-repairing goals. Key Words: Military family, Professional-Family relations, Brain injuries, Veterans, Executive function Disclosure(s): None Disclosed.
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e77 subjective symptoms. (2) Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), which assesses concussion history using a single-item indicator and provides a computer-based assessment of cognitive functioning. Results: 1. On the ImPACT, 41 athletes (32% of the total sample, 66% female) reported a history of concussion. 2. Of the 86 athletes that reported no concussion history on the ImPACT, 24 athletes (28%) endorsed 1 blow to the head on the BISQ. On the BISQ, 62 athletes (49% of the total sample) reported 1 blow to the head. 3. Males with 1 blow to the head reported significantly more mood symptoms than males without blows to the head (t Z 2.2, p<.05). Conclusions: When collegiate athletes were asked to self-report lifetime history of blows to the head, a comprehensive screening tool yields significantly more reported injuries than a single-item indicator. While a higher percentage of females reported a history of brain injury, the relationship between prior brain injury and mood was only significant for males. Given the importance of TBI history in predicting recovery from future TBIs, results support the importance of comprehensive concussion screenings for male and female athletes. Key Words: Brain concussion, Athletes, Screening Disclosure(s): None Disclosed.
Research Poster 3851 Integrating Opportunities for Family Involvement into a Manualized Goal Self-Management Intervention for Veterans with mTBI Samantha Cichon (Well-Being Literacy, Multimedia Education & Psychosocial Research Program (WeLL) at the DC VAMC and MedStar Health), Ellen Kathleen Danford, Manon M. Schladen, Dwan Bruner, Alexander Libin, Joel Scholten Objective(s): To analyze narratives produced by interviews and a focus group with Veterans with mild traumatic brain injury (mTBI) in order to identify family related themes to inform the development of a manualized goal self-management intervention for Veterans with executive dysfunction due to mTBI. Design: Qualitative analysis of semi-structured interviews and a focus group. Setting: DC VA Medical Center TBI/Polytrauma Outpatient Clinic. Participants: Nine Veterans with mTBI, 7 male and 2 female. Interventions: N/A. Main Outcome Measure(s): Summary of family-related themes reported by Veterans. Results: Qualitative analysis of the narratives revealed three key themes: the centrality of family members to the rehabilitation process, family members as an extension of the Veterans’ self-awareness, and the impact of mTBI on family relationships. Veterans reflected on the active role family members and caregivers had played in their successful rehabilitation. They discussed the ability of family members and close friends to provide valuable information that may go unnoticed by clinicians and even the Veterans themselves. Veterans also described how their residual mTBI symptoms have affected their family dynamic resulting in strained relationships with family members and others. Conclusions: Veterans’ family members or caregivers are often essential facilitators of the rehabilitation process following a TBI who may actively increase Veterans’ self-efficacy and self-reliance. All family-related themes revealed in the analysis of the narratives were successfully integrated into the manualized goal management intervention. Family members and caregivers will be invited to participate, at the Veteran’s discretion, in assessment sessions prior to the manualized intervention to capture their valuable observations. They are also invited to attend the goal-setting sessions to gain information about the Veteran’s goals and learn skills that family members may utilize as caregivers to support relationship-repairing goals. Key Words: Military family, Professional-Family relations, Brain injuries, Veterans, Executive function Disclosure(s): None Disclosed.