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Rehabilitation of attention following traumatic brain injury: A model for methylphenidate
Abstracts Trauma Melbourne 2009 / Injury 41S (2010) S27–S48
ORAL-INVITED BREAKOUT 5-4 Rehabilitation of attention following traumatic brain injury: A model for methylphenidate C. Willmott 1,2,∗ , J. Ponsford 1,2,3 , C. Hocking 1 , M. Schönberger 1,2 1
School, of Psychology, Psychiatry & Psychological Medicine, Monash University, Clayton, Victoria, Australia 2 Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia 3 National Trauma Research Institute, Melbourne, Victoria, Australia Introduction: Traumatic brain injury (TBI) results in disabling impairments of attention and speed of information processing. Methylphenidate (MP) primarily acts upon dopaminergic and noradrenergic neurotransmitter systems which mediate attentional processes, and are disrupted by TBI. Previous treatment studies with MP (Ritalin® ) in this population have been conducted many years post-injury and findings have been mixed. This study investigated the efficacy of MP in the amelioration of attention deficits during the acute rehabilitation phase. Methods: Forty participants with moderate–severe TBI sustained on average 68 days previously, were recruited into a randomised, crossover, repeated measures, double-blind, placebo controlled trial. MP was administered at a dose of 0.3 mg/kg bd over two weeks. Neuropsychological measures included standardized clinical tests and experimental reaction time (RT) measures. The Rating Scale of Attentional Behaviour was completed by therapists. Results: The drug was well tolerated in this population. MP significantly increased speed of information processing on the Symbol Digit Modalities Task, Ruff 2 & 7 Selective Attention Test, three out of four conditions of a visuo-spatial choice RT task, and a selective attention RT task. There was less of an effect on executive control over attention. Whilst therapist ratings of attentional behaviour indicated improvement with MP, findings were not significant. Discussion: This is the largest randomized, placebo controlled study of the efficacy of MP in the early rehabilitation phase. The pharmacological augmentation of attention following TBI with MP acts primarily on speed of information processing. Further large scale clinical trials over longer timeframes are warranted. doi:10.1016/j.injury.2010.01.058 ORAL-INVITED
of studies involving a small number of individuals with mild or moderate TBI. This study aims to develop and evaluate a CBT-based anxiety treatment program adapted for a community sample with moderate–severe TBI. It also aims to evaluate the application of Motivational Interviewing as preparatory intervention, focusing on increasing motivation to change and engagement in treatment. Methods: Participants with moderate to severe TBI, aged 18 years and over, are being randomly assigned to three treatment conditions, to evaluate the relative effectiveness of (1) CBT with 3 additional sessions of MI (MI + CBT) as compared with (2) CBT only and (3) treatment as usual (Control). Assessment includes a structured clinical interview to determine psychiatric diagnoses; self-report measures of anxiety, depression, psychosocial functioning and coping style; and measures of premorbid intellectual functioning, memory and executive functions. Results: The study is in progress. Preliminary outcome data and observations from individual case studies will be presented at the conference. Discussion and conclusion: The study results will inform clinical practice by providing evidence about relative effectiveness of interventions for individuals with TBI who suffer from anxiety. doi:10.1016/j.injury.2010.01.059 ORAL-INVITED BREAKOUT 5-6 Trauma survivor perspective S. Reid Melbourne, Victoria, Australia Susan Reid’s life changed dramatically on June 14, 1995 when the car she was driving was involved in a serious accident. She relives that moment every day. Susan and her youngest son, Kirby, were able to walk away from the crash. Her eldest son, Blair, aged nine at the time, sustained a traumatic brain injury and is confined to a wheelchair. Her mother died two years later from complications arising from the injuries. The journey for the Reid family has been a long and hard one. Despite this, Blair remains remarkably positive and is dedicated to his rehabilitation. He is an inspiration to his mother. Susan will speak about the challenges of dealing with the guilt of the crash, the changes for the family, and her role as principal carer for Blair who is now 24.
BREAKOUT 5-5 The use of motivational interviewing and cognitive behaviour therapy to treat anxiety disorders following traumatic brain injury M.-Y. Hsieh 1 , J. Ponsford 1,2,3 , D. Wong 1 , M. Schonberger 1,2 1
School of Psychology, Psychiatry and Psychological Medicine Monash University, Melbourne, Victoria, Australia 2 Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Victoria, Australia 3 National Trauma Research Institute, Melbourne, Victoria, Australia Introduction: Recent Australian studies show that approximately 38% of individuals with moderate–severe TBI develop anxiety disorders within the first 5 years post-injury, and that the presence of anxiety significantly affects psychosocial outcomes. Although psychological interventions such as cognitive behaviour therapy (CBT) are the preferred choice of treatment, CBT’s efficacy in treating anxiety disorders has been demonstrated in an only handful
S45
doi:10.1016/j.injury.2010.01.060 ORAL-INVITED BREAKOUT 6-1 Spinal cord injury and physical activity M.P. Galea 1,2 1 2
The University of Melbourne, Melbourne, Victoria, Australia Austin Health, Heidelberg, Victoria, Australia
The current paradigm for rehabilitation after spinal cord injury (SCI) is based on expectations regarding functional outcomes predicted by the initial level of injury and severity of impairment. Recent observations that a significant proportion of patients with clinically complete lesions may retain some physiological continuity across the injury site, and that inactivity following SCI may further exacerbate the neurological impairment caused by paralysis, challenge the current rehabilitation paradigm. In animal
ORAL-INVITED BREAKOUT 5-4 Rehabilitation of attention following traumatic brain injury: A model for methylphenidate C. Willmott 1,2,∗ , J. Ponsford 1,2,3 , C. Hocking 1 , M. Schönberger 1,2 1
School, of Psychology, Psychiatry & Psychological Medicine, Monash University, Clayton, Victoria, Australia 2 Monash Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia 3 National Trauma Research Institute, Melbourne, Victoria, Australia Introduction: Traumatic brain injury (TBI) results in disabling impairments of attention and speed of information processing. Methylphenidate (MP) primarily acts upon dopaminergic and noradrenergic neurotransmitter systems which mediate attentional processes, and are disrupted by TBI. Previous treatment studies with MP (Ritalin® ) in this population have been conducted many years post-injury and findings have been mixed. This study investigated the efficacy of MP in the amelioration of attention deficits during the acute rehabilitation phase. Methods: Forty participants with moderate–severe TBI sustained on average 68 days previously, were recruited into a randomised, crossover, repeated measures, double-blind, placebo controlled trial. MP was administered at a dose of 0.3 mg/kg bd over two weeks. Neuropsychological measures included standardized clinical tests and experimental reaction time (RT) measures. The Rating Scale of Attentional Behaviour was completed by therapists. Results: The drug was well tolerated in this population. MP significantly increased speed of information processing on the Symbol Digit Modalities Task, Ruff 2 & 7 Selective Attention Test, three out of four conditions of a visuo-spatial choice RT task, and a selective attention RT task. There was less of an effect on executive control over attention. Whilst therapist ratings of attentional behaviour indicated improvement with MP, findings were not significant. Discussion: This is the largest randomized, placebo controlled study of the efficacy of MP in the early rehabilitation phase. The pharmacological augmentation of attention following TBI with MP acts primarily on speed of information processing. Further large scale clinical trials over longer timeframes are warranted. doi:10.1016/j.injury.2010.01.058 ORAL-INVITED
of studies involving a small number of individuals with mild or moderate TBI. This study aims to develop and evaluate a CBT-based anxiety treatment program adapted for a community sample with moderate–severe TBI. It also aims to evaluate the application of Motivational Interviewing as preparatory intervention, focusing on increasing motivation to change and engagement in treatment. Methods: Participants with moderate to severe TBI, aged 18 years and over, are being randomly assigned to three treatment conditions, to evaluate the relative effectiveness of (1) CBT with 3 additional sessions of MI (MI + CBT) as compared with (2) CBT only and (3) treatment as usual (Control). Assessment includes a structured clinical interview to determine psychiatric diagnoses; self-report measures of anxiety, depression, psychosocial functioning and coping style; and measures of premorbid intellectual functioning, memory and executive functions. Results: The study is in progress. Preliminary outcome data and observations from individual case studies will be presented at the conference. Discussion and conclusion: The study results will inform clinical practice by providing evidence about relative effectiveness of interventions for individuals with TBI who suffer from anxiety. doi:10.1016/j.injury.2010.01.059 ORAL-INVITED BREAKOUT 5-6 Trauma survivor perspective S. Reid Melbourne, Victoria, Australia Susan Reid’s life changed dramatically on June 14, 1995 when the car she was driving was involved in a serious accident. She relives that moment every day. Susan and her youngest son, Kirby, were able to walk away from the crash. Her eldest son, Blair, aged nine at the time, sustained a traumatic brain injury and is confined to a wheelchair. Her mother died two years later from complications arising from the injuries. The journey for the Reid family has been a long and hard one. Despite this, Blair remains remarkably positive and is dedicated to his rehabilitation. He is an inspiration to his mother. Susan will speak about the challenges of dealing with the guilt of the crash, the changes for the family, and her role as principal carer for Blair who is now 24.
BREAKOUT 5-5 The use of motivational interviewing and cognitive behaviour therapy to treat anxiety disorders following traumatic brain injury M.-Y. Hsieh 1 , J. Ponsford 1,2,3 , D. Wong 1 , M. Schonberger 1,2 1
School of Psychology, Psychiatry and Psychological Medicine Monash University, Melbourne, Victoria, Australia 2 Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Victoria, Australia 3 National Trauma Research Institute, Melbourne, Victoria, Australia Introduction: Recent Australian studies show that approximately 38% of individuals with moderate–severe TBI develop anxiety disorders within the first 5 years post-injury, and that the presence of anxiety significantly affects psychosocial outcomes. Although psychological interventions such as cognitive behaviour therapy (CBT) are the preferred choice of treatment, CBT’s efficacy in treating anxiety disorders has been demonstrated in an only handful
S45
doi:10.1016/j.injury.2010.01.060 ORAL-INVITED BREAKOUT 6-1 Spinal cord injury and physical activity M.P. Galea 1,2 1 2
The University of Melbourne, Melbourne, Victoria, Australia Austin Health, Heidelberg, Victoria, Australia
The current paradigm for rehabilitation after spinal cord injury (SCI) is based on expectations regarding functional outcomes predicted by the initial level of injury and severity of impairment. Recent observations that a significant proportion of patients with clinically complete lesions may retain some physiological continuity across the injury site, and that inactivity following SCI may further exacerbate the neurological impairment caused by paralysis, challenge the current rehabilitation paradigm. In animal