Cognitive, social, and health functioning of children with TBI engaged in a formal support program.

BACKGROUND: Students with traumatic brain injury (TBI) often demonstrate difficulties that impact their successful return to school (RTS). OBJECTIVE: To explore injury severity, age at injury, and time since injury as predictors for performance on measures of cognitive, social and health functioning for students' participating in a formal RTS cohort at the time of their enrollment in the School Transition After Traumatic Brain Injury (STATBI) research project. METHODS: Outcome measures across cognitive, social, and health domains were analyzed for association with the explanatory variables of interest using quantile regressions and ordinary least squares regression, as appropriate. RESULTS: Students (N = 91) injured after age 13 showed significantly lower cognitive outcomes than students whose injury occurred earlier. Additionally, students more than one-year post-injury demonstrated poorer social outcome on one measure compared to students whose injury occurred more recently. Health outcomes showed no significant association to any predictors. CONCLUSION: The results of this analysis provide a baseline for a group of students with TBI as they enter a RTS research study. This data can now be paired with longitudinal measures and qualitative data collected simultaneously to gain a deeper understanding of how students with TBI present for RTS.

Factors impacting educational outcomes for students with traumatic brain injury in BrainSTEPS.

Purpose: To describe child pre-injury and injury factors impacting post-injury educational outcomes for students with traumatic brain injury (TBI) participating in a state-wide, school-based, school re-entry consultation program, BrainSTEPS in Pennsylvania.Method: Retrospective analysis of a BrainSTEPS annual follow-up survey.Result: A total of 296 parent surveys were completed. Analysis revealed a significant difference between levels of severity of TBI and current educational placement (p < 0.001), receipt of current therapy (p < 0.05) and need for additional consult (p < 0.05). Severity of TBI was not related to other examined educational outcome variables (i.e. school performance, current symptoms). History of TBI, symptoms and treatment were not found to be associated with educational outcomes.Conclusion: These results both support findings from previous studies, and extend previous work by highlighting ongoing needs, including continued, individualised support, of children who sustain a moderate-severe TBI during childhood, and are currently in the chronic stages of injury, with consideration of pre- and post- injury factors. Programs such as BrainSTEPS provide identification of educational needs and provide needed services and supports for children with TBI. Sensitive, validated measures are needed to further understand the role of pre-injury and injury factors on educational outcomes, particularly in programs like BrainSTEPS.

Predictors of Treatment Response to a Psychoeducational Intervention for Anger in Chronic Moderate-Severe Traumatic Brain Injury.

OBJECTIVE: The investigators examined predictors of treatment response to anger self-management training (ASMT) among patients with chronic moderate-severe traumatic brain injury (TBI). METHODS: A multicenter randomized clinical trial comprising 90 participants with moderate-severe TBI was conducted. Fifty-four participants who were randomly assigned to receive active treatment and provided complete data were included in the current secondary analysis. Model averaging was used to examine the relative importance and significance of pretreatment variables for predicting change during treatment. Dependent variables were pre- to posttreatment changes in trait anger (TA) and anger expression-out (AX-O) subscale scores of the State-Trait Anger Expression Inventory-Revised. Predictors included demographic, injury-related, and neuropsychological variables, including both objective and self-reported measures of executive function, as well as readiness to change and participation of a significant other in treatment. RESULTS: Change in both dependent variables was predicted by higher baseline anger. Greater change in TA was additionally predicted by White race, higher education, shorter posttraumatic amnesia, and worse self-reported (but not objectively measured) executive dysfunction; the latter predictor may have indicated better self-awareness. Greater change in AX-O was additionally predicted by better episodic memory and, paradoxically, lower readiness to change. CONCLUSIONS: Further research should focus on adapting psychoeducational anger treatments to better serve the diverse populations affected by moderate-severe TBI. These findings suggest that providing memory aids to support the use of learned strategies after treatment cessation would be beneficial. Further research should also examine the construct of readiness to change and specific aspects of executive function that may affect treatment response in psychoeducational treatments. These findings were derived from only one model of anger intervention, and the relevance to other treatment approaches cannot be assumed.

Development of RehaBot-A Conversational Agent for Promoting Rewarding Activities in Users With Traumatic Brain Injury.

OBJECTIVE: In this article, we describe the development and preliminary testing of RehaBot-a chatbot that users communicate with via text messaging designed to augment behavioral activation (BA) treatment of reducing depression and increasing participation in individuals with moderate to severe traumatic brain injury (TBI). SETTING: Outpatient brain injury rehabilitation facility. PARTICIPANTS: Outpatient brain injury clinicians and individuals with moderate to severe TBI. DESIGN: Focus groups, software demonstration trials, and single-case experiments with an A-B-A design. MAIN MEASURES: System Usability Scale (SUS) and self-reported completed target activities. RESULTS: Focus group feedback guided the development of a flexible system to be used in conjunction with face-to-face therapy, designed to provide reminders, encouragement, and supportive feedback. Two of 3 participants completed all 6 RehaBot tasks independently. One completed 4 tasks independently and a fifth with assistance. Average SUS score in demonstration trials was 76.77 (SD = 21.19). In 4 single-case experiments, participants completed their highest proportion of planned activities in the RehaBot phase and the lowest proportion of planned activities in the reversal phase. They all interacted with RehaBot daily, exchanging an average of 225 messages over the 1-week period, and average SUS score was 95 (SD = 4.74). Their open-ended feedback revealed that participants found RehaBot enjoyable and easy to use. They felt it was a helpful memory aid and promoted better adherence to planned activities by providing accountability and positive reinforcement. CONCLUSIONS: This article presents a chatbot development process heavily involving consumer input, which may serve as a model for future development efforts. Our findings provide preliminary evidence suggesting that RehaBot is usable and may promote better adherence to planned target activities. However, future research is needed to establish usability and efficacy of RehaBot and to explore applications of chatbots to other domains of TBI rehabilitation.

Psychoeducational Interventions for Problematic Anger in Chronic Moderate to Severe Traumatic Brain Injury: A Study of Treatment Enactment.

OBJECTIVES: Treatment enactment, a final stage of treatment implementation, refers to patients' application of skills and concepts from treatment sessions into everyday life situations. We examined treatment enactment in a two-arm, multicenter trial comparing two psychoeducational treatments for persons with chronic moderate to severe traumatic brain injury and problematic anger. METHODS: Seventy-one of 90 participants from the parent trial underwent a telephone enactment interview at least 2 months (median 97 days, range 64-586 days) after cessation of treatment. Enactment, quantified as average frequency of use across seven core treatment components, was compared across treatment arms: anger self-management training (ASMT) and personal readjustment and education (PRE), a structurally equivalent control. Components were also rated for helpfulness when used. Predictors of, and barriers to, enactment were explored. RESULTS: More than 80% of participants reported remembering all seven treatment components when queried using a recognition format. Enactment was equivalent across treatments. Most used/most helpful components concerned normalizing anger and general anger management strategies (ASMT), and normalizing traumatic brain injury-related changes while providing hope for improvement (PRE). Higher baseline executive function and IQ were predictive of better enactment, as well as better episodic memory (trend). Poor memory was cited by many participants as a barrier to enactment, as was the reaction of other people to attempted use of strategies. CONCLUSIONS: Treatment enactment is a neglected component of implementation in neuropsychological clinical trials, but is important both to measure and to help participants achieve sustained carryover of core treatment ingredients and learned material to everyday life.

Promoting mental health in traumatic brain injury using single-session Behavioural Activation and SMS messaging: A randomized controlled trial.

We compared two treatments for depression and/ or anxiety in chronic moderate to severe traumatic brain injury (TBI) (Clinicaltrials.gov NCT02061553). Fifty-nine participants were randomized 2:1 to a single session of Behavioural Activation followed by 8 weeks of daily SMS (text) messages in the form of implementation intentions supporting individualized goals for increased rewarding/ meaningful activities (INT), or a single (attention control) session focused on the importance of motivation followed by 8 weeks of motivational SMS messages (MOT). Both conditions resulted in modestly improved emotional status. The INT condition led to more exposure to environmental reward and greater productivity. Gains in both conditions were of questionable clinical significance but suggested different mechanisms of action, which should be confirmed by further research. The delivery of frequent text messages proved to be a very feasible means of supporting treatment in this population.

Self-Report of Outpatient Therapy Dose at 6 and 12 Months After Severe Traumatic Brain Injury.

OBJECTIVE: Determine agreement between self-reported dose and dose reflected in administrative records of outpatient physical, occupational, and speech therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported health care utilization in this population. DESIGN: Secondary analysis of survey used in a larger study; participants were queried about therapy doses using a structured interview, either alone or assisted by relatives if they so chose, with responses compared to administrative records. SETTING: Rehabilitation center providing outpatient TBI therapies. PARTICIPANTS: Sixty-five people with severe TBI living in the community provided 6-month data (N=65); 54 provided 12-month data. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Degree of agreement with administrative records of scheduled and billed therapy appointments, measured using intraclass correlation coefficients (ICCs), with linear regression used to predict accuracy from demographic variables and cognitive status. RESULTS: ICCs were in the moderate range at 6 months, but were more variable, with some in the poor range, at 12 months. Agreement was higher for scheduled than for billed (attended) appointments. Assisted and unassisted patients provided comparable agreement with records. No demographic factors were associated with accuracy, but lower cognitive FIM scores, as hypothesized, tended to predict lower agreement at 6 months. CONCLUSIONS: People with severe TBI can provide reasonable estimates of commonly prescribed outpatient therapy doses at 6 months postinjury. Accuracy may be improved by inviting patients to request assistance from relatives and by asking them to consider attended (vs scheduled) sessions.

Behavioral Activation Augmented With Mobile Technology for Depression and Anxiety in Chronic Moderate-Severe Traumatic Brain Injury: Protocol for a Randomized Controlled Trial.

OBJECTIVE: To describe and provide the rationale for a randomized controlled trial for depression or anxiety after moderate to severe traumatic brain injury (TBI), which will test 2 treatments based on behavioral activation (BA), a promising model to promote both positive mood and increased activity in this population. DESIGN: Randomized controlled trial with masked outcome assessment. SETTING: Outpatient catchment area of 1 TBI treatment center. PARTICIPANTS: Community-dwelling persons (N=60) with moderate-severe TBI at least 6 months prior to enrollment and greater than mild depression or anxiety. INTERVENTIONS: Participants will be randomized 2:1 into an 8-session treatment, behavioral activation with technology, consisting of 6 face-to-face sessions and 2 via phone, with mood and activity monitoring conducted via ecological momentary assessment on a smartphone; or a single session incorporating BA principles followed by 8 weeks of activity reminders in the form of implementation intentions, delivered as text messages. MAIN OUTCOME MEASURES: Brief Symptom Inventory-18 (primary outcome); Environmental Reward Observation Scale, Behavioral Activation for Depression Scale, Participation Assessment with Recombined Tools-Objective, Diener Satisfaction With Life Scale, Quality of Life after Brain Injury scale, Patient Global Impression of Change. Outcomes are measured midway through intervention, after treatment cessation (primary outcome), and at 2-month follow-up. A treatment enactment interview is administered after the follow-up to ascertain to what extent participants continue to engage in activities and use strategies promoted during trial participation. RESULTS: N/A. CONCLUSIONS: N/A.

Examining a Statewide Educational Consulting Program for Pediatric Brain Injury.

This study describes characteristics of students with acquired brain injury enrolled in a statewide educational consultation program and the program's support activities. Utilizing deidentified data from a statewide brain injury school consultation program, descriptive analyses of demographic and injury characteristics, including medical diagnosis (concussion/mild traumatic brain injury [TBI], moderate-severe TBI, and non-TBI), referral characteristics, educational placement, and the types of program activities were undertaken. 70% of students were referred for concussions/mild TBI and students were infrequently referred by medical professionals. Most students with concussion/mild TBI experienced recreational injuries (59%), while students with moderate/severe TBI commonly experienced road traffic injuries (48%). The greatest proportion of program team members' time was spent in consultation with school personnel (24%), communication with families (20%), and communication with school personnel (16%). Results suggest that the program addresses important communication and coordination needs among families, medical professionals, and educators and identifies opportunities to enhance program utilization.

Anger Self-Management Training for Chronic Moderate to Severe Traumatic Brain Injury: Results of a Randomized Controlled Trial.

OBJECTIVE: To test efficacy of 8-session, 1:1 treatment, anger self-management training (ASMT), for chronic moderate to severe traumatic brain injury (TBI). SETTING: Three US outpatient treatment facilities. PARTICIPANTS: Ninety people with TBI and elevated self-reported anger; 76 significant others (SOs) provided collateral data. DESIGN: Multicenter randomized controlled trial with 2:1 randomization to ASMT or structurally equivalent comparison treatment, personal readjustment and education (PRE). Primary outcome assessment 1 week posttreatment; 8-week follow-up. PRIMARY OUTCOME: Response to treatment defined as 1 or more standard deviation change in self-reported anger. SECONDARY OUTCOMES: SO-rated anger, emotional and behavioral status, satisfaction with life, timing of treatment response, participant and SO-rated global change, and treatment satisfaction. MAIN MEASURES: State-Trait Anger Expression Inventory-Revised Trait Anger (TA) and Anger Expression-Out (AX-O) subscales; Brief Anger-Aggression Questionnaire (BAAQ); Likert-type ratings of treatment satisfaction, global changes in anger and well-being. RESULTS: After treatment, ASMT response rate (68%) exceeded that of PRE (47%) on TA but not AX-O or BAAQ; this finding persisted at 8-week follow-up. No significant between-group differences in SO-reported response rates, emotional/behavioral status, or life satisfaction. ASMT participants were more satisfied with treatment and rated global change in anger as significantly better; SO ratings of global change in both anger and well-being were superior for ASMT. CONCLUSION: ASMT was efficacious and persistent for some aspects of problematic anger. More research is needed to determine optimal dose and essential ingredients of behavioral treatment for anger after TBI.

Goal intention reminding in traumatic brain injury: A feasibility study using implementation intentions and text messaging.

OBJECTIVE: To examine feasibility of participant-created implementation intentions, delivered as text message reminders, to enhance goal-related activity in persons with chronic, moderate/severe traumatic brain injury (TBI). DESIGN: Pilot randomized controlled trial on effects of 8 weeks receiving goal-related implementation intentions (GI) compared to control condition, educational review regarding goals (GR). PARTICIPANTS: Eight persons with moderate/severe TBI nearing discharge from intensive outpatient brain injury treatment. MEASURES: Neuropsychological tests to characterize cognitive status; Participation with Recombined Tools-Objective (PART-O) assessing community activity, social relations and productivity; Brief Symptom Inventory-18 (BSI-18) assessing depression, anxiety and overall distress; Goal Attainment Scales (GAS). PART-O, BSI-18 and GAS were completed at baseline and 8 weeks; significant others provided ratings on PART-O and GAS. RESULTS: Participants replied to SMS messages at high rates. Statistically significant group × time interactions with medium-to-large effect sizes favouring the GI group were observed on PART-O community activity and social relations. Neither BSI-18 nor GAS revealed differences or trends by group. Qualitative results suggested overall acceptance and success of SMS reminders. CONCLUSIONS: Given positive preliminary findings, implementation intentions delivered by text holds promise as a simple, low-cost intervention to help people with moderate/severe TBI to implement goal-relevant behaviours.

How Do Intensity and Duration of Rehabilitation Services Affect Outcomes From Severe Traumatic Brain Injury? A Natural Experiment Comparing Health Care Delivery Systems in 2 Developed Nations.

OBJECTIVE: To determine the effects of inpatient and outpatient treatment intensity on functional and emotional well-being outcomes at 1 year after severe traumatic brain injury (TBI). DESIGN: Prospective, quasiexperimental study comparing outcomes in a U.S. TBI treatment center with those in a Denmark (DK) center providing significantly greater intensity and duration of rehabilitation. SETTING: Inpatient and outpatient TBI rehabilitation. PARTICIPANTS: Persons with severe TBI (N=274). INTERVENTIONS: Inpatient rehabilitation interventions were counted daily by discipline. Outpatient treatments were estimated per discipline using a structured interview administered to patients, caregivers, or both, at 12 months. MAIN OUTCOME MEASURES: FIM, Glasgow Outcome Scale-Extended, Disability Rating Scale, Participation Assessment with Recombined Tools-Objective, Perceived Quality of Life, Medical Outcomes Study 12-Item Short-Form Health Survey, Brief Symptom Inventory-18-item version. RESULTS: Despite identical inclusion criteria, patient severity on admission was greater at the DK site. After adjustment for patient/injury characteristics, there were no site differences in either functional or emotional outcome at 12 months. Significantly more inpatient plus outpatient treatment was administered to DK patients than to those in the U.S. For functional but not emotional treatments, more severely impaired patients received higher doses. One-year outcomes were predicted by admission severity, age, employment, and other baseline characteristics. CONCLUSIONS: Contrary to expectation, DK patients who received significantly more rehabilitation services during the year after severe TBI did not differ in outcome from their less intensively treated U.S. counterparts, after adjusting for initial severity. The negative association of functional treatment dose with extent of early disability suggests that dose was driven by unmeasured factors reflecting need for services. Improved measures of injury-related factors driving treatment allocation are needed to model the independent effects of treatment on outcomes.

Anger self-management in chronic traumatic brain injury: protocol for a psycho-educational treatment with a structurally equivalent control and an evaluation of treatment enactment.

Anger and irritability are important and persistent clinical problems following traumatic brain injury (TBI). Treatment options include medications, behavioral modification, and psychotherapies, but some are impractical and none have proven efficacy with this population. We describe a randomized multi-center clinical trial testing a novel, one-on-one, 8-session psychoeducational treatment program, Anger Self-Management Training (ASMT), designed specifically for people with TBI who have significant cognitive impairment. The trial is notable for its use of a structurally equivalent comparison treatment, called Personal Readjustment and Education (PRE), which was created for the study and is intended to maximize equipoise for both participants and treaters. Fidelity assessment is conducted in real time and used in therapist supervision sessions. The primary outcome is change in self-reported anger on validated measures from pre-treatment to 1 week after the final session. Secondary outcomes include participant anger as reported by a significant other; emotional distress in domains other than anger/irritability; behavioral functioning; and quality of life. An interim assessment after the 4th session will allow examination of the trajectory of any observed treatment effects, and a follow-up assessment 2 months after the end of intervention will allow examination of persistence of effects. A treatment enactment phase, in which participants are interviewed several months after the last therapy session, is designed to provide qualitative data on whether and to what extent the principles and techniques learned in treatment are still carried out in daily life.

Anger self-management training for people with traumatic brain injury: a preliminary investigation.

OBJECTIVE: : To examine the feasibility and gather preliminary data on the efficacy of a fully manualized, 8-session, psychoeducational treatment for irritability and anger after traumatic brain injury (TBI), called anger self-management training (ASMT). PARTICIPANTS: : A total of 10 persons with moderate to severe, chronic TBI with significant cognitive impairment and elevated levels of anger and irritability participated in the study; 8 had significant others (SOs) who participated in portions of the treatment and provided pre- and posttreatment measures; 1 SO provided only data. MAIN OUTCOME MEASURE: : Two subscales of the State-Trait Anger Expression Scale-Revised and Brief Anger-Aggression Questionnaire. DESIGN: : Pre- to posttreatment pilot study. RESULTS: : There was significant improvement on all 3 measures of self-reported anger, with large effect sizes (>1.0), and on 1 of 3 SO-reported scales. Qualitative feedback from participants was positive and dropout rate was low (1 of 11). CONCLUSIONS: : The treatment model represented by the ASMT appears worthy of further study in persons with TBI who have both problematic anger and cognitive impairment.

Professional development in TBI for educators: the importance of context.

Effective instructional and behavioral support strategies implemented by trained educators can help mitigate the academic and behavioral challenges associated with childhood brain injury. However, the training provided by university teacher preparation programs is clearly inadequate, a problem that cuts across the professions that work with school-aged students. Educators need training in methods validated for students with traumatic brain injury (TBI) and in adapting strategies validated for students with other disabilities. Almost 10 years after Ylvisaker and colleagues proposed a research and professional development agenda in the area of teacher training, students with TBI continue to be underserved and underidentified for educational supports. Effective staff development practices for educators must include training in evidence-based interventions, supervised practice with new skills, and continued mentoring, feedback, and consultation in the school setting. Two models currently in use-the TBI Consulting Team and BrainSTARS models-incorporate those features. Preliminary evidence suggests that these models help teachers feel more prepared and knowledgeable in working with students with TBI. Given the urgent needs of students with TBI, validating these promising practices should be a high priority for the field of pediatric brain injury.

The effects of bromocriptine on attention deficits after traumatic brain injury: a placebo-controlled pilot study.

OBJECTIVE: To evaluate the effects of bromocriptine on a variety of aspects of attention, ranging from laboratory-based impairment measures to caregiver ratings and work productivity, in individuals after traumatic brain injury. DESIGN: Twelve adults with moderate to severe traumatic brain injury and attention complaints in the postacute phase of recovery were enrolled in a 6-wk double-blind, placebo-controlled, crossover study of bromocriptine, titrated to a dose of 5 mg twice a day. A wide range of attentional measures was administered weekly, including computerized and paper-and-pencil tests of attention, videotaped records of individual work in a distracting environment, real-time observational scoring of attentiveness in a classroom environment, and caregiver and clinician ratings of attentiveness. Data from these 12 participants were used to identify attentional dimensions suggestive of a treatment effect for independent replication. RESULTS: The effects of bromocriptine on 13 previously identified attentional factors and 13 individual performance scores were assessed via the Wilcoxon signed ranks test, using a relaxed probability cutoff of 0.20 to select those to be studied in a larger replication sample. Only two factor scores and one individual score met the cutoff, and all of these showed trends toward worse performance on bromocriptine than on placebo. A more detailed investigation of bromocriptine's effect on divided attention was also conducted, but the previously reported finding of a beneficial effect on this domain was not replicated. Blood pressure was marginally lower on bromocriptine than on placebo. In view of the lack of cognitive benefit and the fact that several participants experienced possible or probable drug side effects, we did not pursue a larger replication at this drug dose. CONCLUSIONS: Bromocriptine in a dose of 5 mg, given twice a day to individuals with attentional complaints after TBI, does not seem to enhance attentional skills, and it may be associated with an excess of adverse events. It is not clear whether intermittent dosing or lower doses might confer benefit.

Internet use and interest among individuals with traumatic brain injury: A consumer survey.

PURPOSE: To examine experiences among individuals in the USA with traumatic brain injury (TBI) regarding their access to and use of the Internet, problems encountered, and desire for improved Internet access and skills. METHOD: An in-depth survey was administered as a semi-structured interview to 80 individuals at least 3 months post moderate to severe TBI. RESULTS: Two-thirds of respondents reported having a computer at home, but only half had access to the Internet. Fewer than half were Internet users, as compared to 60% users in the USA population at the time of the survey. However, Internet activities engaged in by users in this sample were comparable to those of the overall population. There was a strong interest in using the Internet among non-users. Most respondents expressed a strong desire for coaching or other training to enhance or develop Internet skills. Reported reasons for Internet non-use in this sample were lack of access and knowledge, versus lack of interest as in the general population. CONCLUSIONS: The high interest in using and learning more about the Internet supports the development of interventions to mprove Internet skills for people with TBI.

Executive function as a predictor of inattentive behavior after traumatic brain injury.

Emerging evidence from recent studies using laboratory and naturalistic attention tasks suggests that individuals with traumatic brain injury (TBI) may have a deficit mainly in strategic control of attention. In the present study, we tested the hypothesis that inattentive behavior after TBI could be predicted by performance on psychometric measures of executive function. A group of 37 individuals with moderate to severe TBI were assessed with previously validated naturalistic measures of attention. A battery of neuropsychological tests was also administered to assess various aspects of executive function. Seven measures of executive function and 10 variables reflecting inattentive behavior were combined to form 1 executive and 3 inattentive behavior (IB) composite scores. Three predictors (executive composite, current disability scores, and age) were associated, at the univariate level, with one of the IB composites reflecting frequency and duration of off-task episodes. A stepwise multiple regression procedure indicated that the executive composite was the only significant predictor of the IB composite. Additional post-hoc regression analyses suggested that the relationship was not likely to be mediated by processing speed. The current study supports the hypothesis that executive function, measured by commonly used neuropsychological tests, significantly predicts certain aspects of inattentive behavior in real-world tasks after TBI.

Executive function and self-awareness of "real-world" behavior and attention deficits following traumatic brain injury.

OBJECTIVE: To investigate the relationship between executive function and awareness of real-world behavioral and attentional dysfunction in persons with moderate and severe traumatic brain injury (TBI) and uninjured controls. DESIGN: Observational 2-group study. PARTICIPANTS: Thirty-six persons with moderate to severe TBI and residual cognitive deficits, recruited from therapy programs and the community, and 30 uninjured control participants of similar age, education, gender, and race. MEASURES: Eight clinical measures of executive function were combined in a composite score, the Executive Composite (EC). Awareness of behavioral and attentional lapses in everyday life was estimated using Self and Significant Other (SO) ratings on the Dysexecutive (DEX) Questionnaire and the Cognitive Failures Questionnaire (CFQ). RESULTS: Participants with TBI scored significantly worse on the EC than control participants and exhibited impaired self-awareness (ISA) compared to controls. Control participants agreed closely with their SOs on both the DEX and CFQ scales, whereas the SOs of TBI participants reported significantly greater degrees of difficulty on both scales than was endorsed by participants with TBI. Low-EC scorers within the TBI group had significantly worse ISA than controls, lending support to the hypothesis that executive function is related to ISA in chronic, moderate to severe TBI. Executive function and discrepancy scores demonstrated a modest but statistically significant association across the sample. CONCLUSION: Although executive function was associated with ISA in this sample, further research is needed to determine whether executive function deficits contribute in a causal fashion to ISA, and which of the cognitive operations within executive function are responsible for supporting self-awareness.

Portable electronic devices as memory and organizational aids after traumatic brain injury: a consumer survey study.

OBJECTIVE: To ascertain consumer experiences and attitudes regarding the use of portable electronic devices as memory and organizational aids after traumatic brain injury (TBI). DESIGN: Survey study. SETTING: Post-acute TBI rehabilitation programs, research registries. PARTICIPANTS: Eighty persons with moderate to severe TBI interviewed a median of 3.7 years postinjury. OUTCOME MEASURE: Survey administered in structured interview format, analyzed both quantitatively and qualitatively. RESULTS: Two thirds of participants reported regular use of computers, but fewer than one third had experience with hand-held computers or similar devices. Interest in using portable devices for everyday memory and organizational tasks was higher than the expressed need for improvement in participants' current strategies. Respondents expressed reliable preferences for key device features, including simplicity of use, technical support, and long-lasting battery power. Preferred functions included keeping track of money spent, remembering things to do, and remembering what other people say. CONCLUSION: Portable electronic devices are acceptable or desirable by consumers with moderate to severe TBI for use as compensatory aids.