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Poster 6: Pediatric Interventions in Acquired Brain Injury Rehabilitation
E10
CONGRESS ANNUAL CONFERENCE ABSTRACTS
clients living in the community. Generic services are able to maintain clients in the community but they may experience some decline in functioning and health status. Key Words: Brain injuries; Rehabilitation. Poster 4 Effectiveness of Acute and Postacute Manualized Interventions Following Brain Injury. Janet Niemeier (Virginia Commonwealth University School of Medicine, Richmond, VA), Jeffrey Kreutzer. Disclosure: None declared. Objective: To test the hypothesis that participation in comprehensive, manualized, neurobehavioral, and cognitive interventions (NCI) addressing recovery stage-related challenges will improve outcomes for both inpatients and outpatients with brain injury compared with controls receiving standard program interventions (SPI). Design: Prospective, controlled studies. Settings: Inpatient brain injury rehabilitation unit; outpatient, work-focused clubhouses. Participants: 72 acute and 59 postacute subjects with brain injury assigned to either the NCI (n⫽51 acute, n⫽35 postacute) or SPI (n⫽21, n⫽24) groups. Interventions: 10-session manualized intervention for the NCI inpatient group; 20-session vocational protocol for the NCI outpatient group. Main Outcome Measures: Learning assessment, FIM instrument, and Neurobehavioral Rating Scale (NBRS) for inpatients; staff ratings of effort and employment status for outpatients. Results: NCI inpatient learning assessment means significantly (P⬍.01) increased over time and NBRS scores significantly decreased (P⬍.01) compared with the SPI group. FIM scores did not differ. Significantly (P⬍.05) more NCI outpatient group participants obtained and kept volunteer or competitive jobs than controls. Conclusions: Manualized treatment interventions can improve outcomes for patients in both acute and postacute phases of brain injury rehabilitation. Key Words: Brain injuries; Rehabilitation; Treatment outcome.
Poster 6 Pediatric Interventions in Acquired Brain Injury Rehabilitation. Anna McCormick (University of Ottawa, Ottawa, ON), Vithya Gnanakumar, David Collins, Margaret Weiser, Shawn Marshall, Linh Tu, Jo-Anne Aubut, Robert Teasell. Disclosure: Supported by the Ontario Neurotrauma Foundation and the Rick Hansen Man in Motion Research Fund. Objective: To review the interventions available to remediate deficits related to a moderate-to-severe acquired brain injury within the pediatric population. Data Source: The following databases were used in this search: PubMed, CINAHL, PsycINFO, Embase, ERIC, and Child Development and Adolescent Studies. Data Selection: To be included in this review, articles had to meet the following criteria: study population of 3 or more participants, 50% of the study population was diagnosed with a moderate or severe acquired or traumatic brain injury, and an intervention was examined. Data Extraction: Data extracted included demographic information, inclusion and exclusion criteria, the description of the intervention, and the study results. Data Synthesis: Articles were scored for quality using either the Downs and Black or PEDro evaluation tools. A level of evidence using a modified Sackett scale was assigned to each intervention. Conclusions: Areas investigated in the review include: acute interventions, behavioral and cognitive therapies, communication, familysupported interventions, community-based interventions, social integration, and pharmacologic interventions. Even though the efficacy of several interventions was assessed, we concluded that future research should include a more in-depth examination of the various impairments and difficulties associated with an acquired or traumatic brain injury in the pediatric population. Key Words: Brain injuries; Pediatrics; Rehabilitation; Review [publication type].
Poster 5 An Update of the Systematic Review of the Rehabilitation of Moderateto-Severe Acquired Brain Injuries. Nora Cullen (Toronto Rehabilitation Institute, Toronto, ON), Mark Bayley, Robert Teasell, Shawn Marshall, Maureen Hildritch, Corbin Lippert, Penny WelchWest, Pat McCabe, Margaret Weiser, Connie Ferrie, Laura Rees, Anna McCormick, Linh Tu, Jo-Anne Aubut. Disclosure: Supported by the Ontario Neurotrauma Foundation. Objective: To conduct a systematic review of the rehabilitation literature of moderate-to-severe acquired brain injuries from traumatic and nontraumatic causes. Data Source: The following databases were searched for articles relating to the interventions used to assist people with acquired brain injuries: Medline and PubMed, CINAHL, Embase, and PsycINFO. Study Selection: The review included randomized controlled trials (RCTs), non-RCTs, cohort, case-control, case series, as well as pre-post- and postinterventional studies related to intervention strategies used to help those with acquired brain injuries recover. Data Extraction: Data extracted included demographic information, inclusion and exclusion criteria, the description of the intervention, and the study results. Data Synthesis: Articles were scored for quality, using either the Downs and Black or the PEDro evaluation tools. A level of evidence using a modified Sackett scale was assigned to each intervention. Conclusions: Despite the large body of literature addressing acquired brain injury rehabilitation interventions, only 28% were found to be RCTs and less than half of those selected were considered strong evidence. Therefore, strong levels of evidence were limited or not possible for most areas of acquired brain injury rehabilitation. From the high proportion of interventional studies found, there appears to be a need to improve the methodologic quality of acquired brain injury rehabilitation research. Key Words: Brain injuries; Evidence-based medicine; Rehabilitation.
Poster 7 Relationship Between Coping and Problem-Solving Strategies and Psychologic Adjustment in Survivors of Brain Injury and Their Caregivers. Samantha Backhaus (Rehabilitation Hospital of Indiana, Indianapolis, IN), Summer Ibarra, Lance Trexler, Daniel Klyce. Disclosure: None declared. Objective: To analyze the relationship of coping and problemsolving styles with psychologic distress among survivors of brain injury and their caregivers who are participating in a treatment study. Design: Correlational study. Setting: Postacute rehabilitation clinic. Participants: 20 brain injury survivors and 20 caregivers. Interventions: Not applicable. Main Outcome Measures: Brief Symptom Inventory⫺18, Coping Inventory for Stressful Situations, and Social Problem Solving Inventory⫺Revised. Results: Regression analyses revealed that for survivors, higher levels of psychologic distress were weakly associated with emotion-oriented coping (F⫽4.83, P⫽.041) and more strongly associated with avoidant problem-solving (F⫽17.51, P⫽.001). In contrast, for caregivers, distress was strongly and negatively correlated with task-oriented coping (F⫽10.81, P⫽.002) and positively associated with emotion-oriented coping (F⫽12.57, P⫽.002) and a negative problem-solving orientation (F⫽23.32, P⬍.001). Conclusions: As predicted, based on the coping literature, adaptive coping styles and problem-solving strategies are related to positive psychologic adjustment in caregivers. This relationship was not as clear for survivors for whom an avoidant problem-solving style was more strongly associated with psychologic distress than coping style. These findings suggest that other moderator variables (such as neurocognitive and behavioral dysfunction), may influence the relationship between coping and problem-solving strategies and psychologic adjustment for survivors. Key Words: Brain injuries; Rehabilitation.
Arch Phys Med Rehabil Vol 89, October 2008
CONGRESS ANNUAL CONFERENCE ABSTRACTS
clients living in the community. Generic services are able to maintain clients in the community but they may experience some decline in functioning and health status. Key Words: Brain injuries; Rehabilitation. Poster 4 Effectiveness of Acute and Postacute Manualized Interventions Following Brain Injury. Janet Niemeier (Virginia Commonwealth University School of Medicine, Richmond, VA), Jeffrey Kreutzer. Disclosure: None declared. Objective: To test the hypothesis that participation in comprehensive, manualized, neurobehavioral, and cognitive interventions (NCI) addressing recovery stage-related challenges will improve outcomes for both inpatients and outpatients with brain injury compared with controls receiving standard program interventions (SPI). Design: Prospective, controlled studies. Settings: Inpatient brain injury rehabilitation unit; outpatient, work-focused clubhouses. Participants: 72 acute and 59 postacute subjects with brain injury assigned to either the NCI (n⫽51 acute, n⫽35 postacute) or SPI (n⫽21, n⫽24) groups. Interventions: 10-session manualized intervention for the NCI inpatient group; 20-session vocational protocol for the NCI outpatient group. Main Outcome Measures: Learning assessment, FIM instrument, and Neurobehavioral Rating Scale (NBRS) for inpatients; staff ratings of effort and employment status for outpatients. Results: NCI inpatient learning assessment means significantly (P⬍.01) increased over time and NBRS scores significantly decreased (P⬍.01) compared with the SPI group. FIM scores did not differ. Significantly (P⬍.05) more NCI outpatient group participants obtained and kept volunteer or competitive jobs than controls. Conclusions: Manualized treatment interventions can improve outcomes for patients in both acute and postacute phases of brain injury rehabilitation. Key Words: Brain injuries; Rehabilitation; Treatment outcome.
Poster 6 Pediatric Interventions in Acquired Brain Injury Rehabilitation. Anna McCormick (University of Ottawa, Ottawa, ON), Vithya Gnanakumar, David Collins, Margaret Weiser, Shawn Marshall, Linh Tu, Jo-Anne Aubut, Robert Teasell. Disclosure: Supported by the Ontario Neurotrauma Foundation and the Rick Hansen Man in Motion Research Fund. Objective: To review the interventions available to remediate deficits related to a moderate-to-severe acquired brain injury within the pediatric population. Data Source: The following databases were used in this search: PubMed, CINAHL, PsycINFO, Embase, ERIC, and Child Development and Adolescent Studies. Data Selection: To be included in this review, articles had to meet the following criteria: study population of 3 or more participants, 50% of the study population was diagnosed with a moderate or severe acquired or traumatic brain injury, and an intervention was examined. Data Extraction: Data extracted included demographic information, inclusion and exclusion criteria, the description of the intervention, and the study results. Data Synthesis: Articles were scored for quality using either the Downs and Black or PEDro evaluation tools. A level of evidence using a modified Sackett scale was assigned to each intervention. Conclusions: Areas investigated in the review include: acute interventions, behavioral and cognitive therapies, communication, familysupported interventions, community-based interventions, social integration, and pharmacologic interventions. Even though the efficacy of several interventions was assessed, we concluded that future research should include a more in-depth examination of the various impairments and difficulties associated with an acquired or traumatic brain injury in the pediatric population. Key Words: Brain injuries; Pediatrics; Rehabilitation; Review [publication type].
Poster 5 An Update of the Systematic Review of the Rehabilitation of Moderateto-Severe Acquired Brain Injuries. Nora Cullen (Toronto Rehabilitation Institute, Toronto, ON), Mark Bayley, Robert Teasell, Shawn Marshall, Maureen Hildritch, Corbin Lippert, Penny WelchWest, Pat McCabe, Margaret Weiser, Connie Ferrie, Laura Rees, Anna McCormick, Linh Tu, Jo-Anne Aubut. Disclosure: Supported by the Ontario Neurotrauma Foundation. Objective: To conduct a systematic review of the rehabilitation literature of moderate-to-severe acquired brain injuries from traumatic and nontraumatic causes. Data Source: The following databases were searched for articles relating to the interventions used to assist people with acquired brain injuries: Medline and PubMed, CINAHL, Embase, and PsycINFO. Study Selection: The review included randomized controlled trials (RCTs), non-RCTs, cohort, case-control, case series, as well as pre-post- and postinterventional studies related to intervention strategies used to help those with acquired brain injuries recover. Data Extraction: Data extracted included demographic information, inclusion and exclusion criteria, the description of the intervention, and the study results. Data Synthesis: Articles were scored for quality, using either the Downs and Black or the PEDro evaluation tools. A level of evidence using a modified Sackett scale was assigned to each intervention. Conclusions: Despite the large body of literature addressing acquired brain injury rehabilitation interventions, only 28% were found to be RCTs and less than half of those selected were considered strong evidence. Therefore, strong levels of evidence were limited or not possible for most areas of acquired brain injury rehabilitation. From the high proportion of interventional studies found, there appears to be a need to improve the methodologic quality of acquired brain injury rehabilitation research. Key Words: Brain injuries; Evidence-based medicine; Rehabilitation.
Poster 7 Relationship Between Coping and Problem-Solving Strategies and Psychologic Adjustment in Survivors of Brain Injury and Their Caregivers. Samantha Backhaus (Rehabilitation Hospital of Indiana, Indianapolis, IN), Summer Ibarra, Lance Trexler, Daniel Klyce. Disclosure: None declared. Objective: To analyze the relationship of coping and problemsolving styles with psychologic distress among survivors of brain injury and their caregivers who are participating in a treatment study. Design: Correlational study. Setting: Postacute rehabilitation clinic. Participants: 20 brain injury survivors and 20 caregivers. Interventions: Not applicable. Main Outcome Measures: Brief Symptom Inventory⫺18, Coping Inventory for Stressful Situations, and Social Problem Solving Inventory⫺Revised. Results: Regression analyses revealed that for survivors, higher levels of psychologic distress were weakly associated with emotion-oriented coping (F⫽4.83, P⫽.041) and more strongly associated with avoidant problem-solving (F⫽17.51, P⫽.001). In contrast, for caregivers, distress was strongly and negatively correlated with task-oriented coping (F⫽10.81, P⫽.002) and positively associated with emotion-oriented coping (F⫽12.57, P⫽.002) and a negative problem-solving orientation (F⫽23.32, P⬍.001). Conclusions: As predicted, based on the coping literature, adaptive coping styles and problem-solving strategies are related to positive psychologic adjustment in caregivers. This relationship was not as clear for survivors for whom an avoidant problem-solving style was more strongly associated with psychologic distress than coping style. These findings suggest that other moderator variables (such as neurocognitive and behavioral dysfunction), may influence the relationship between coping and problem-solving strategies and psychologic adjustment for survivors. Key Words: Brain injuries; Rehabilitation.
Arch Phys Med Rehabil Vol 89, October 2008