Inpatient length of stay moderates the relationship between payer source and functional outcomes in pediatric brain injury.

OBJECTIVE: To examine the extent to which race/ethnicity, length of rehabilitation hospital stay (LOS), and payer source contribute to functional status following inpatient rehabilitation in children with acquired brain injury (ABI). DESIGN: Retrospective cohort study from a pediatric rehabilitation hospital including 485 individuals with ABI. METHODS: Functional Independence Measure for Children (WeeFIM) scores were transformed into age-corrected Developmental Functional Quotients (DFQ) to examine the effects of race/ethnicity, LOS, and payer source (public insurance vs. private) on functional outcomes while controlling for year of admission, admission DFQ, time to rehabilitation, age, and brain injury aetiology. RESULTS: Discharge DFQ scores tended to be lower for children with public insurance as well as those with longer LOS. There was no main effect of race/ethnicity, but a significant interaction effect for payer source×LOS (p < .001) was found. Further breakdown of the interaction showed lower discharge DFQ scores for children with public insurance primarily when LOS exceeded 28 days (p = .001). CONCLUSION: Children with ABI who have both public insurance and LOS beyond 4 weeks tend to have poorer functional outcomes after inpatient rehabilitation. Because all children were receiving services at the same facility, payer source may be functioning as a proxy for other sociodemographic factors.

The Effect of Admission Functional Independence on Early Recovery in Pediatric Traumatic and Nontraumatic Brain Injury.

OBJECTIVE: To examine functional independence at admission as a predictor of outcomes during an initial inpatient hospitalization for a pediatric brain injury. PARTICIPANTS: A total of 531 pediatric inpatients with traumatic (n = 298) or nontraumatic (n = 233) brain injuries. DESIGN: Retrospective analysis of data extracted from the Uniform Data System for Medical Rehabilitation. MAIN MEASURE: The Functional Independence Measure for Children, a measure of self-care, mobility, and cognitive independence. RESULTS: Logistic regression analyses indicated that children with traumatic brain injury showed greater odds of making large functional gains in comparison with children with nontraumatic brain injury. For both groups, children entering rehabilitation with a moderate level of functional independence had the highest probability of making large gains. Children with a nontraumatic brain injury entering treatment with a high level of functioning made greater gains than those entering with low functioning. The opposite trend emerged for children with traumatic injuries. CONCLUSIONS: Level of functioning at admission may be a useful predictor of progress during an inpatient stay for youth with brain injuries. Children with nontraumatic brain injury entering treatment with low functioning are expected to make slower progress during hospitalization.

Problem-solving style and multicultural personality dispositions: a study of construct validity.

This exploratory study examined the relationship between problem-solving styles and multicultural personality dispositions among 91 graduate students enrolled in an urban university located in the northeast United States. Problem-solving style was assessed with the three dimensions of the VIEW: an Assessment of Problem Solving Style. Multicultural personality was assessed with the five-factor Multicultural Personality Questionnaire (MPQ); its factors of Cultural Empathy, Open-mindedness, Social Initiative, and Flexibility correlated significantly with Explorer and External problem-solving styles, as predicted. The Emotional Stability subscale also correlated significantly with scores on Explorer style, suggesting that individuals who prefer "thinking in new directions" in problem solving are more likely to report remaining calm under stressful situations. Collectively, study results provided additional evidence of construct validity for the VIEW.

An investigation of the impact of facial affect recognition impairments in moderate to severe TBI on fatigue, depression, and quality of life.

Individuals with moderate to severe traumatic brain injury (TBI) have been shown to experience significant problems in facial affect recognition (FAR). However, it is not known how these impairments relate to overall functioning and quality of life (QoL) following TBI. The aim of the current study was to test the hypothesis that worse performance on an FAR task would be associated with reduced QoL (related to social and emotional functioning), worse mood, and increased fatigue. Forty-seven individuals with TBI and 27 healthy controls (HCs) completed the facial emotion identification task (FEIT), as well as questionnaires assessing social and emotional QoL, mood, and fatigue. The TBI group performed significantly worse than HCs on the FEIT. A significant relationship between FAR and fatigue and QoL related to social and emotional functioning was documented, but in an unexpected direction: individuals who performed better on the FEIT reported poorer QoL and greater fatigue. Individuals who have better FAR may require increased effort to perform this task, and thus experience greater fatigue and poorer social and emotional QoL.