- Email: [email protected]
Poster 16
2005 ACADEMY ANNUAL ASSEMBLY ABSTRACTS
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Poster 12 Chronic 5-HT1A Receptor Agonist Treatments and Environmental Enrichment After Experimental Traumatic Brain Injury Positively Impact Functional Outcome. Anthony E. Kline, PhD (University of Pittsburgh, Pittsburgh, PA); Amy K. Wagner, MD; C. Edward Dixon, PhD; Ross D. Zafonte, DO, e-mail: [email protected]. Disclosure: None. Objective: To evaluate chronic 5-HT1A receptor agonist treatments coupled with environmental enrichment (EE) on motor and cognitive outcome after experimental traumatic brain injury (TBI). Design: Randomized controlled study. Setting: Experimental research laboratory. Animals: 55 adult male Sprague-Dawley rats. Intervention: Isoflurane anesthetized rats received a controlled cortical impact (CCI) or sham injury and then were assigned to 4 TBI (VEH⫹EE, VEH⫹STD [standard environment], 8-OH-DPAT⫹EE, buspirone⫹EE) and 2 sham (VEH⫹EE, VEH⫹STD) groups. The 5-HT1A receptor agonists, 8-OH-DPAT (0.1mg/kg) and buspirone (0.3mg/kg), or saline vehicle (VEH; 1mL/kg) were administered (ip) 24 hr after surgery and every day thereafter for 20 days. Function was assessed by established motor (beam balance/walk) and cognitive (spatial learning/memory) tests on postoperative days 1 to 5 and 14 to 18, respectively. Main Outcome Measures: Latency (in seconds) to maintain beam balance, traverse a narrow elevated beam, and to locate a submerged platform in a Morris water maze. Results: Both 8-OH-DPAT and buspirone facilitated motor performance versus VEH (P⬍.05) in the TBI EE groups, but did not differ from one another (P⬎.05). Moreover, all TBI EE groups differed from the TBI VEH-treated standard condition group (P⬍.05). Additionally, all TBI EE groups displayed an accelerated rate of recovery in the water maze task versus the TBI/VEH⫹STD group (P⬍.05), but did not significantly differ from one another. No differences were observed among the sham-treated groups in either task. Conclusions: These data indicate that chronic administration of 5-HT1A receptor agonists coupled with EE improve functional outcome after experimental TBI. Key Words: Functional outcome; Morris water maze; Rehabilitation; Recovery; Brain injuries.
Poster 15 Cerebrospinal Fluid Dopamine Levels and Associations With Functional and Neuropsychologic Outcome After Severe Traumatic Brain Injury. Amy K. Wagner, MD (University of Pittsburgh, Pittsburgh, PA); Dianxu Ren, MS; Ava M. Puccio, MSN; Ross D. Zafonte, DO; Sue R. Beers, PhD; C. Edward Dixon, PhD, e-mail: [email protected]. Disclosure: None. Objective: To determine whether elevated dopamine levels in cerebral spinal fluid (CSF) may result in secondary injury after traumatic brain injury (TBI) and adversely affect outcome. Design: Historical cohort study utilizing multivariate regression analysis for repeated measures of outcome to analyze the relationship between average CSF dopamine levels collected during the first 5 days after injury and several measures of functional and neuropsychologic outcome 3 to 24 months after severe TBI. Setting: Level I trauma center. Participants: 91 subjects with severe TBI. Interventions: Not applicable. Main Outcome Measures: Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), Trail-Making Test (TMT), Wisconsin Card Sort Test (WCST), Neurobehavioral Rating Scale (NRS), and FIM cognitive scores were evaluated 3 to 24 months after injury. Results: Both low and high dopamine levels at the time of injury were independently associated with better recovery based GOS, TMT-A, TMT-B, WCST, NRS, and FIM cognitive scores (P⬍.05 for all comparisons) Conclusions: CSF dopamine levels may be reflective of injury type and location and other intrinsic factors that impact postinjury CSF dopamine levels, including gender and dopamine transporter genotype. We speculate that although high dopamine levels may contribute to early oxidative injury, high dopamine levels may also reflect better chronic dopaminergic tone post-TBI. Low dopamine levels acutely after TBI may cause less oxidative injury post-TBI, also positively impacting outcome. Future work should focus on relationships between early CSF dopamine concentration and chronic dopamine system function post-TBI. Key Words: Dopamine; Treatment outcome; Rehabilitation; Brain injuries.
Poster 13 Preliminary Evaluation of a Short-Form Beck Depression Inventory–10 for Use in Patients With Brain Injury. Lynne Turner-Stokes, DM, FRCP (King’s College London, Middlesex, United Kingdom); Margot Kalmus; Frances Clegg, e-mail: Lynne.turner-Stokes@ dial.pipex.com. Disclosure: None. Aim: To identify a short-form of the Beck Depression Inventory (BDI-II) providing specific and responsive evaluation of depression in patients following acquired brain injury, which minimizes confounds arising from brain injury itself. Design: Cohort analysis of consecutive patients in an integrated care pathway (ICP) for treatment of depression. Setting: Inpatient neurorehabilitation unit. Participants: Of 193 consecutive patients with acquired brain injury, 82 screened positive for depression and were subsequently reassessed after treatment (mean interval ⫾ SD, 5.1⫾3.3wk; mean age, 43.7⫾13.8y). Median time since injury 4.4 (IQR, 4.0 – 6.9) months. Intervention: Antidepressants and counseling according to the ICP. Main Outcome Measures: BDI-II, BDIFastScreen, and DSM-IV. Results: Previous factor analyses subdivided BDI items into “cognitive” (self-denigration/affective) and “somatic” (physical function) items. Analysis of individual item change scores in this cohort yielded a shortlist of 10 cognitive items that changed significantly during treatment (Wilcoxon, P⬍.02): Self-denigration: guilt, worthlessness, failure, punishment, and self-dislike. Affective: crying, indecision, suicidal thoughts, irritability, and agitation. The list included only 3/7 BDI-FastScreen items. In a stepwise multiple regression, the short-form BDI-10, entered first, explained 72% of variance in change of total BDI. A physical function subscale explained a further 14%, and the BDI-FastScreen an additional 8%. All 3 factors had highly significant effects (P⬍.001). Returning to the baseline sample, the area under the curve in a receiver operating characteristic analysis of BDI-10 compared with DSM-IV category was .58 (95% CI, .50 –.67). A cutoff score of 5 predicted “cases of depression” according to DSM-IV criteria with 83% sensitivity, 90% specificity, 89% positive predictive value (PPV), and 84% negative predictive value (NPV). This compared favorably with the BDI-FastScreen (88% sensitivity, 63% specificity, 62% PPV, 72% NPV). Conclusions: This preliminary evaluation identifies a possible short-form BDI-I0 for use following acquired brain injury, which avoids confounding items of physical function and appears to be more specific than the BDI-FastScreen for predicting depression in this context. Key Words: Assessment; Brain injuries; Depression; Rehabilitation.
Poster 16 Chronic Risperidone Treatment After Experimental Traumatic Brain Injury Negatively Impacts Functional Outcome. Ross D. Zafonte, DO; C. Edward Dixon, PhD; Anthony E. Kline, PhD (University of Pittsburgh, Pittsburgh, PA), e-mail: [email protected]. Disclosure: None. Objective: To evaluate the effects of chronic risperidone treatment on motor and cognitive function after experimental traumatic brain injury (TBI). Design: Randomized controlled study. Setting: Experimental research laboratory. Animals: 65 adult male Sprague-Dawley rats. Intervention: Isoflurane anesthetized rats received a controlled cortical impact (CCI) or sham injury and then were assigned to 5 TBI (risperidone .045, .45, or 4.5mg/kg, haloperiodol 0.5mg/kg, or vehicle 1mL/kg; n⫽10 per group) or 3 sham (risperidone 4.5, haloperiodol 0.5, or vehicle; n⫽5 per group) groups. Treatments were administered (ip) 24 hours after surgery and every day thereafter for 20 days. Function was assessed by established motor (beam balance, walk) and cognitive (spatial learning, memory) tests on postoperative days 1 to 5 and 14 to 18, respectively. Main Outcome Measures: Latency (in seconds) to maintain beam balance, traverse a narrow elevated beam, and to locate a submerged platform in a Morris water maze. Results: The high dose of RIS (4.5mg/kg) delayed motor and cognitive recovery relative to vehicle treatment. No differences were observed in either task after haloperiodol versus vehicle. The medium (.45mg/kg) and high doses of RIS differed from the low dose (.045mg/kg) on motor, but not cognitive function. Last, risperidone (4.5mg/kg) and haloperiodol slowed swim speed in both the TBI and sham groups versus vehicle. Conclusions: These data indicate that chronic high-dose administration of the atypical antipsychotic RIS delays motor and cognitive recovery after CCI injury in rats. The mechanism(s) for the detrimental effects of risperidone after TBI remain to be determined. Key Words: Functional outcome; Morris water maze; Rehabilitation; Brain injuries.
Poster 14 Regional Changes in Norepinephrine Transporter Expression After Experimental TBI. Xiangbai Chen, MD, PhD; Amy K. Wagner, MD (University of Pittsburgh, Pittsburgh, PA); Youming Li, MS; Ross D. Zafonte, DO; C. Edward Dixon, PhD, e-mail: [email protected]. Disclosure: None. Objective: To examine frontal cortical and striatal norepinephrine transporter (NET) expression after controlled cortical impact (CCI) injury. Design: Prospective naturalistic study with comparison group. Setting: Experimental research laboratory. Animals: 24 adult male Sprague-Dawley rats. Intervention: Isoflurane anesthetized rats received a CCI or sham injury and were euthanized either 1 or 4 weeks after surgery. Main Outcome Measures: Striatal and frontal cortical NET expression 1 and 4 weeks after CCI. Results: Compared with sham, NET expression was increased in ipsilateral frontal cortex at both 1 (173% vs 100%, P⫽.03) and 4 weeks after traumatic brain injury (TBI) (150% vs 100%, P⬍.01). There were no significant changes in NET expression in the contralateral frontal cortex. There was a trend for increased NET expression in contralateral striatum at 1 week post-TBI (120% vs 100%, P⫽.15). However, there were significant increases in contralateral striatal NET expression at 4 weeks postinjury (124% vs 100%, P⫽.02). There were no significant changes in NET expression in the ipsilateral striatum. Conclusions: These results suggest regional and chronic postinjury changes in NET expression post-TBI. Future work should focus on the relationship of NET expression to postinjury norepinephrine as well as determining the value of NET as a therapeutic target after TBI. Key Words: Norepinephrine transporter; Rehabilitation; Recovery; Brain injury.
Poster 17 An Online Problem-Solving Intervention to Improve Child and Parent Adaptation Following Pediatric Brain Injury. Shari L. Wade, PhD (Cincinnati Children’s Hospital Medical Center, Cincinnati, OH); Joanne Carrey, MA, e-mail: [email protected]. Disclosure: None. Objective: To examine the efficacy of an online family problem-solving (OFPS) intervention for improving caregiver and child function following pediatric traumatic brain injury (TBI). Design: Randomized clinical trial. Setting: Families’ homes. Participants: 40 families of children with moderate to severe TBI randomly assigned to OFPS intervention (n⫽20) or usual care (UC; n⫽20). Intervention: All families received a computer, printer, and high-speed Internet access to information and resources on TBI. Families in the OFPS group also received a web camera. The OFPS intervention alternated between self-guided Web-based interactive sessions (n range, 7–11) and therapist-guided synchronous videoconference sessions (n range, 7–11). The intervention emphasized collective problem identification, strategy development, implementation, and monitoring as well as communication skills and antecedent behavior management. All school-age or older family members were encouraged to participate and the web pages cycled through participating family members to solicit responses from each individual. Main Outcome Measures: Parental psychologic distress (Symptom Checklist–90), depression (Center for Epidemiology Scale for Depression), and anxiety (Anxiety Inventory) and child behavior (Child Behavior Checklist) and social competence (Home and Community Social Behavior Scale). Results: Parents in the OFPS group reported significantly less global distress (M⫽52.11 vs M⫽58.37, P⫽.02), depression (M⫽9.45 vs M⫽18.15; P⫽.01), and anxiety (M⫽9.20 vs M⫽14.05, P⫽.04) than parents in the UC condition at follow-up after controlling for baseline symptoms. There was also a trend toward greater improvements in child behavior (M⫽47.67 vs M⫽56.06) and social competence (M⫽52.80 vs M⫽45.50); however, these differences did not achieve statistical significance. Conclusions: These findings suggest that an online problem-solving intervention can be successfully used to improve both parent and child adaptation following pediatric TBI. Key Words: Brain injuries; Coping skills; Rehabilitation.
Arch Phys Med Rehabil Vol 86, September 2005
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Poster 12 Chronic 5-HT1A Receptor Agonist Treatments and Environmental Enrichment After Experimental Traumatic Brain Injury Positively Impact Functional Outcome. Anthony E. Kline, PhD (University of Pittsburgh, Pittsburgh, PA); Amy K. Wagner, MD; C. Edward Dixon, PhD; Ross D. Zafonte, DO, e-mail: [email protected]. Disclosure: None. Objective: To evaluate chronic 5-HT1A receptor agonist treatments coupled with environmental enrichment (EE) on motor and cognitive outcome after experimental traumatic brain injury (TBI). Design: Randomized controlled study. Setting: Experimental research laboratory. Animals: 55 adult male Sprague-Dawley rats. Intervention: Isoflurane anesthetized rats received a controlled cortical impact (CCI) or sham injury and then were assigned to 4 TBI (VEH⫹EE, VEH⫹STD [standard environment], 8-OH-DPAT⫹EE, buspirone⫹EE) and 2 sham (VEH⫹EE, VEH⫹STD) groups. The 5-HT1A receptor agonists, 8-OH-DPAT (0.1mg/kg) and buspirone (0.3mg/kg), or saline vehicle (VEH; 1mL/kg) were administered (ip) 24 hr after surgery and every day thereafter for 20 days. Function was assessed by established motor (beam balance/walk) and cognitive (spatial learning/memory) tests on postoperative days 1 to 5 and 14 to 18, respectively. Main Outcome Measures: Latency (in seconds) to maintain beam balance, traverse a narrow elevated beam, and to locate a submerged platform in a Morris water maze. Results: Both 8-OH-DPAT and buspirone facilitated motor performance versus VEH (P⬍.05) in the TBI EE groups, but did not differ from one another (P⬎.05). Moreover, all TBI EE groups differed from the TBI VEH-treated standard condition group (P⬍.05). Additionally, all TBI EE groups displayed an accelerated rate of recovery in the water maze task versus the TBI/VEH⫹STD group (P⬍.05), but did not significantly differ from one another. No differences were observed among the sham-treated groups in either task. Conclusions: These data indicate that chronic administration of 5-HT1A receptor agonists coupled with EE improve functional outcome after experimental TBI. Key Words: Functional outcome; Morris water maze; Rehabilitation; Recovery; Brain injuries.
Poster 15 Cerebrospinal Fluid Dopamine Levels and Associations With Functional and Neuropsychologic Outcome After Severe Traumatic Brain Injury. Amy K. Wagner, MD (University of Pittsburgh, Pittsburgh, PA); Dianxu Ren, MS; Ava M. Puccio, MSN; Ross D. Zafonte, DO; Sue R. Beers, PhD; C. Edward Dixon, PhD, e-mail: [email protected]. Disclosure: None. Objective: To determine whether elevated dopamine levels in cerebral spinal fluid (CSF) may result in secondary injury after traumatic brain injury (TBI) and adversely affect outcome. Design: Historical cohort study utilizing multivariate regression analysis for repeated measures of outcome to analyze the relationship between average CSF dopamine levels collected during the first 5 days after injury and several measures of functional and neuropsychologic outcome 3 to 24 months after severe TBI. Setting: Level I trauma center. Participants: 91 subjects with severe TBI. Interventions: Not applicable. Main Outcome Measures: Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), Trail-Making Test (TMT), Wisconsin Card Sort Test (WCST), Neurobehavioral Rating Scale (NRS), and FIM cognitive scores were evaluated 3 to 24 months after injury. Results: Both low and high dopamine levels at the time of injury were independently associated with better recovery based GOS, TMT-A, TMT-B, WCST, NRS, and FIM cognitive scores (P⬍.05 for all comparisons) Conclusions: CSF dopamine levels may be reflective of injury type and location and other intrinsic factors that impact postinjury CSF dopamine levels, including gender and dopamine transporter genotype. We speculate that although high dopamine levels may contribute to early oxidative injury, high dopamine levels may also reflect better chronic dopaminergic tone post-TBI. Low dopamine levels acutely after TBI may cause less oxidative injury post-TBI, also positively impacting outcome. Future work should focus on relationships between early CSF dopamine concentration and chronic dopamine system function post-TBI. Key Words: Dopamine; Treatment outcome; Rehabilitation; Brain injuries.
Poster 13 Preliminary Evaluation of a Short-Form Beck Depression Inventory–10 for Use in Patients With Brain Injury. Lynne Turner-Stokes, DM, FRCP (King’s College London, Middlesex, United Kingdom); Margot Kalmus; Frances Clegg, e-mail: Lynne.turner-Stokes@ dial.pipex.com. Disclosure: None. Aim: To identify a short-form of the Beck Depression Inventory (BDI-II) providing specific and responsive evaluation of depression in patients following acquired brain injury, which minimizes confounds arising from brain injury itself. Design: Cohort analysis of consecutive patients in an integrated care pathway (ICP) for treatment of depression. Setting: Inpatient neurorehabilitation unit. Participants: Of 193 consecutive patients with acquired brain injury, 82 screened positive for depression and were subsequently reassessed after treatment (mean interval ⫾ SD, 5.1⫾3.3wk; mean age, 43.7⫾13.8y). Median time since injury 4.4 (IQR, 4.0 – 6.9) months. Intervention: Antidepressants and counseling according to the ICP. Main Outcome Measures: BDI-II, BDIFastScreen, and DSM-IV. Results: Previous factor analyses subdivided BDI items into “cognitive” (self-denigration/affective) and “somatic” (physical function) items. Analysis of individual item change scores in this cohort yielded a shortlist of 10 cognitive items that changed significantly during treatment (Wilcoxon, P⬍.02): Self-denigration: guilt, worthlessness, failure, punishment, and self-dislike. Affective: crying, indecision, suicidal thoughts, irritability, and agitation. The list included only 3/7 BDI-FastScreen items. In a stepwise multiple regression, the short-form BDI-10, entered first, explained 72% of variance in change of total BDI. A physical function subscale explained a further 14%, and the BDI-FastScreen an additional 8%. All 3 factors had highly significant effects (P⬍.001). Returning to the baseline sample, the area under the curve in a receiver operating characteristic analysis of BDI-10 compared with DSM-IV category was .58 (95% CI, .50 –.67). A cutoff score of 5 predicted “cases of depression” according to DSM-IV criteria with 83% sensitivity, 90% specificity, 89% positive predictive value (PPV), and 84% negative predictive value (NPV). This compared favorably with the BDI-FastScreen (88% sensitivity, 63% specificity, 62% PPV, 72% NPV). Conclusions: This preliminary evaluation identifies a possible short-form BDI-I0 for use following acquired brain injury, which avoids confounding items of physical function and appears to be more specific than the BDI-FastScreen for predicting depression in this context. Key Words: Assessment; Brain injuries; Depression; Rehabilitation.
Poster 16 Chronic Risperidone Treatment After Experimental Traumatic Brain Injury Negatively Impacts Functional Outcome. Ross D. Zafonte, DO; C. Edward Dixon, PhD; Anthony E. Kline, PhD (University of Pittsburgh, Pittsburgh, PA), e-mail: [email protected]. Disclosure: None. Objective: To evaluate the effects of chronic risperidone treatment on motor and cognitive function after experimental traumatic brain injury (TBI). Design: Randomized controlled study. Setting: Experimental research laboratory. Animals: 65 adult male Sprague-Dawley rats. Intervention: Isoflurane anesthetized rats received a controlled cortical impact (CCI) or sham injury and then were assigned to 5 TBI (risperidone .045, .45, or 4.5mg/kg, haloperiodol 0.5mg/kg, or vehicle 1mL/kg; n⫽10 per group) or 3 sham (risperidone 4.5, haloperiodol 0.5, or vehicle; n⫽5 per group) groups. Treatments were administered (ip) 24 hours after surgery and every day thereafter for 20 days. Function was assessed by established motor (beam balance, walk) and cognitive (spatial learning, memory) tests on postoperative days 1 to 5 and 14 to 18, respectively. Main Outcome Measures: Latency (in seconds) to maintain beam balance, traverse a narrow elevated beam, and to locate a submerged platform in a Morris water maze. Results: The high dose of RIS (4.5mg/kg) delayed motor and cognitive recovery relative to vehicle treatment. No differences were observed in either task after haloperiodol versus vehicle. The medium (.45mg/kg) and high doses of RIS differed from the low dose (.045mg/kg) on motor, but not cognitive function. Last, risperidone (4.5mg/kg) and haloperiodol slowed swim speed in both the TBI and sham groups versus vehicle. Conclusions: These data indicate that chronic high-dose administration of the atypical antipsychotic RIS delays motor and cognitive recovery after CCI injury in rats. The mechanism(s) for the detrimental effects of risperidone after TBI remain to be determined. Key Words: Functional outcome; Morris water maze; Rehabilitation; Brain injuries.
Poster 14 Regional Changes in Norepinephrine Transporter Expression After Experimental TBI. Xiangbai Chen, MD, PhD; Amy K. Wagner, MD (University of Pittsburgh, Pittsburgh, PA); Youming Li, MS; Ross D. Zafonte, DO; C. Edward Dixon, PhD, e-mail: [email protected]. Disclosure: None. Objective: To examine frontal cortical and striatal norepinephrine transporter (NET) expression after controlled cortical impact (CCI) injury. Design: Prospective naturalistic study with comparison group. Setting: Experimental research laboratory. Animals: 24 adult male Sprague-Dawley rats. Intervention: Isoflurane anesthetized rats received a CCI or sham injury and were euthanized either 1 or 4 weeks after surgery. Main Outcome Measures: Striatal and frontal cortical NET expression 1 and 4 weeks after CCI. Results: Compared with sham, NET expression was increased in ipsilateral frontal cortex at both 1 (173% vs 100%, P⫽.03) and 4 weeks after traumatic brain injury (TBI) (150% vs 100%, P⬍.01). There were no significant changes in NET expression in the contralateral frontal cortex. There was a trend for increased NET expression in contralateral striatum at 1 week post-TBI (120% vs 100%, P⫽.15). However, there were significant increases in contralateral striatal NET expression at 4 weeks postinjury (124% vs 100%, P⫽.02). There were no significant changes in NET expression in the ipsilateral striatum. Conclusions: These results suggest regional and chronic postinjury changes in NET expression post-TBI. Future work should focus on the relationship of NET expression to postinjury norepinephrine as well as determining the value of NET as a therapeutic target after TBI. Key Words: Norepinephrine transporter; Rehabilitation; Recovery; Brain injury.
Poster 17 An Online Problem-Solving Intervention to Improve Child and Parent Adaptation Following Pediatric Brain Injury. Shari L. Wade, PhD (Cincinnati Children’s Hospital Medical Center, Cincinnati, OH); Joanne Carrey, MA, e-mail: [email protected]. Disclosure: None. Objective: To examine the efficacy of an online family problem-solving (OFPS) intervention for improving caregiver and child function following pediatric traumatic brain injury (TBI). Design: Randomized clinical trial. Setting: Families’ homes. Participants: 40 families of children with moderate to severe TBI randomly assigned to OFPS intervention (n⫽20) or usual care (UC; n⫽20). Intervention: All families received a computer, printer, and high-speed Internet access to information and resources on TBI. Families in the OFPS group also received a web camera. The OFPS intervention alternated between self-guided Web-based interactive sessions (n range, 7–11) and therapist-guided synchronous videoconference sessions (n range, 7–11). The intervention emphasized collective problem identification, strategy development, implementation, and monitoring as well as communication skills and antecedent behavior management. All school-age or older family members were encouraged to participate and the web pages cycled through participating family members to solicit responses from each individual. Main Outcome Measures: Parental psychologic distress (Symptom Checklist–90), depression (Center for Epidemiology Scale for Depression), and anxiety (Anxiety Inventory) and child behavior (Child Behavior Checklist) and social competence (Home and Community Social Behavior Scale). Results: Parents in the OFPS group reported significantly less global distress (M⫽52.11 vs M⫽58.37, P⫽.02), depression (M⫽9.45 vs M⫽18.15; P⫽.01), and anxiety (M⫽9.20 vs M⫽14.05, P⫽.04) than parents in the UC condition at follow-up after controlling for baseline symptoms. There was also a trend toward greater improvements in child behavior (M⫽47.67 vs M⫽56.06) and social competence (M⫽52.80 vs M⫽45.50); however, these differences did not achieve statistical significance. Conclusions: These findings suggest that an online problem-solving intervention can be successfully used to improve both parent and child adaptation following pediatric TBI. Key Words: Brain injuries; Coping skills; Rehabilitation.
Arch Phys Med Rehabil Vol 86, September 2005