Relationships of self-awareness and facial affect recognition to social communication ability in persons with traumatic brain injury.

Traumatic brain injury (TBI) can cause changes to the injured person's physical ability, cognitive functioning, and social interactions. Since these attributes largely determine a person's concept of who they are, TBI poses a threat to sense of self. Due to the importance of social communication skills for community integration, impairment of these skills is a particular threat to sense of self. The present investigation sought to explore characteristics that influence social communication abilities. We hypothesized that both ability to interpret facial affect and self-awareness would be associated with communication ability. We also expected that facial affect recognition would influence self-awareness and that the effect of facial affect recognition on social communication would be partially mediated by self-awareness. For this prospective cohort study, participants were 77 individuals with documented TBI. Of these, 65% were male and 83% sustained severe injuries. The hypothesized association of facial affect recognition with social communication was demonstrated with path analysis as was the effect of facial affect recognition on self-awareness. However, the effect of facial affect recognition on social communication was not mediated by self-awareness. In addition, social communication was associated with employment, social integration, and loneliness. Findings highlighted the importance of social communication after TBI.

Soy diferente: a qualitative study on the perceptions of recovery following traumatic brain injury among Spanish-speaking U.S. immigrants.

PURPOSE: To explore the impact of traumatic brain injury (TBI) on the quality of life (QoL) and self-concept of Spanish-speaking U.S. Hispanic immigrants with TBI. MATERIALS AND METHODS: A prospective, qualitative study conducted in a county level I trauma center and community. Semi-structured interviews on QoL and self-concept following TBI were conducted with 24 Spanish-speaking U.S. Hispanic immigrants with TBI living in the community at least 6 months following injury. RESULTS: Perceived facilitators of QoL included faith, hopefulness in recovery, empathy for others, and support from others. Perceived barriers to QoL mentioned were symptoms/consequences of injury, employment/financial changes, loss of independence, fear/uncertainty, stigma/shame, lack of medical care, and decreased social integration. Participants described their self-concept after TBI as either a maintained self or loss of self. Those who viewed themselves differently reported physical and emotional changes, gender role conflict, loss of self-worth, and total loss due to the TBI. CONCLUSIONS: Spanish-speaking U.S. Hispanic immigrants held a strong faith and positive outlook after TBI in spite of the significant barriers to recovery. A need exists for programs to support creatively the recovery of Spanish-speaking U.S. Hispanic immigrants with limited access to care and resources.IMPLICATIONS FOR REHABILITATIONSpanish-speaking U.S. Hispanic immigrants may experience significant barriers to care following traumatic brain injury (TBI), such as access to rehabilitation services and follow-up care.Rehabilitation professionals should consider the importance of faith and encourage positive thinking and social support when working with Spanish-speaking U.S. Hispanic immigrants on how to cope with TBI-related challenges.Access to Spanish-speaking rehabilitation professionals, translators and Spanish language educational materials could help reduce language-related barriers to recovery among Spanish-speaking U.S. immigrants with TBI.Rehabilitation facilities should develop partnerships with community-based organizations serving the uninsured or underinsured to address the access to rehabilitation and medical needs of Spanish-speaking U.S. immigrants with TBI.

Effectiveness of an Educational Intervention on Reducing Misconceptions Among Ethnic Minorities With Complicated Mild to Severe Traumatic Brain Injury.

OBJECTIVE: To evaluate the effectiveness of an educational intervention designed to reduce traumatic brain injury (TBI)-related misconceptions among blacks and Latinos with complicated mild to severe TBI. DESIGN: Randomized controlled trial with masked 1-month follow-up. SETTING: Community. PARTICIPANTS: Persons (N=52) with complicated mild to severe TBI (mean best day 1 Glasgow Coma Scale score, 11.27±3.89) were randomly recruited from 141 eligible participants (mean age, 37.71±13.88y; age range, 19-66y; mean months postinjury, 24.69±11.50); 25 participants (48.1%) of participants were black and 27 (51.9%) were Hispanic/Latino. Of the Hispanic/Latino participants, 18 (66.7%) were non-U.S. born and 12 (44.4%) spoke Spanish as their primary language. Twenty-seven individuals were randomized to the educational intervention group and 25 were randomized to the wait-list control group. INTERVENTIONS: Single-session educational intervention with written materials provided in English or Spanish. MAIN OUTCOME MEASURES: Forty-item Common Misconceptions about Traumatic Brain Injury Questionnaire administered at baseline and 1-month follow-up. RESULTS: After controlling for ethnic and language differences, a significant between-group main effect (P=.010) and a significant time-group interaction for the Common Misconceptions about Traumatic Brain Injury Questionnaire were noted (Wilks Λ=.89; F1,46=6.00; P=.02). The intervention group showed a decrease in TBI misconception percentages, whereas the wait-list control group maintained similar percentages. At 1-month follow-up, the wait-list control group reported more misconceptions than did the intervention group (P=.019). CONCLUSIONS: An educational intervention developed to address the recovery process, common symptoms, and ways to handle the symptoms provides promise as a tool to decrease TBI misconceptions among persons from ethnically and educationally diverse backgrounds. The effects of therapist characteristics and the client-therapist relation on outcomes should be further explored.

Impact of pre-injury family functioning and resources on self-reported post-concussive symptoms and functional outcomes in persons with mild TBI.

OBJECTIVE: This study investigates the contribution of pre-injury family functioning and resources on self-reported post-concussive symptoms and functional outcomes in persons with mild TBI (mTBI). DESIGN: Participants with uncomplicated or complicated mTBIs were recruited from consecutive admissions to the emergency department of a level 1 trauma centre. Patients completed baseline assessments within 2 weeks of injury and an outcomes assessment at 3 months post-injury. METHODS AND PROCEDURES: One hundred and sixty-six adults with mTBI were included. Baseline measures of pre-injury history, family functioning and resources were obtained. Functional status assessments and self-reported measures of health, common TBI symptoms and psychological problems were administered at 3-months post-injury. RESULTS: Data reduction of outcome measures using principle components analysis revealed two factors: self-reported post-concussive symptoms and current functional/participation status, explaining 60.53% of the variance. Family resources (ß = -0.239, t(150) = -2.84, p = 0.005) and age (ß = -0.170, t(150) = -2.19, p = 0.030), but not family functioning, were significant predictors of self-reported post-concussive symptoms at follow-up, R2 = 0.051, F(5, 150) = 4.09, p = 0.002. Neither family resources nor functioning predicted current functional/participation status. CONCLUSIONS: Fewer family resources and younger age were associated with increased self-reported post-concussive symptoms. Fewer resources may be a potential risk factor to heightened perception of post-concussive symptoms. Providing low-cost counselling or resource facilitation services may improve outcomes for those with limited resources after mTBI.

Sex-Based Differences in Perceived Pragmatic Communication Ability of Adults With Traumatic Brain Injury.

OBJECTIVE: To identify sex-based differences in self-reported and close other-reported perceptions of communication behaviors in adults with traumatic brain injury (TBI). DESIGN: Between-groups comparison of questionnaire data from men and women with TBI and their close others. SETTING: University academic department. PARTICIPANTS: Adults with medically documented TBI (n=160) and adults without TBI (n=81; control group) (N=241). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: La Trobe Communication Questionnaire, a standardized measure of communication problems in everyday life. RESULTS: Participants with TBI endorsed more communication problems than controls (P<.001). There were no significant differences in self-ratings (P=.20) or in the ratings of close others (P=.09) in communication behaviors of men with TBI compared with women with TBI. There was no difference between the self-ratings of women with TBI and their close others (P=.59). However, men with TBI significantly underreported communication problems compared with reports of close others (P<.001). CONCLUSIONS: Women with TBI might be more accurate than men with TBI in recognizing their own pragmatic communication problems.

Preinjury coping, emotional functioning, and quality of life following uncomplicated and complicated mild traumatic brain injury.

OBJECTIVE: To identify preinjury coping profiles among adults with uncomplicated mild traumatic brain injury (mTBI) and complicated mTBI and to determine whether preinjury coping profiles contribute to the prediction of emotional functioning and quality of life (QOL) 3 months post-mTBI. PARTICIPANTS: One hundred eighty-seven persons with medically documented mTBI (uncomplicated mTBI, n = 89; complicated mTBI, n = 98) were recruited from the emergency center of a level I trauma center and followed in community 3 months post-mTBI. MEASURES: The Ways of Coping Questionnaire was administered within 2 weeks of injury. Cluster analysis was used to group participants on basis of their preinjury use of problem-focused and avoidant coping strategies. The Brief Symptom Inventory and the 36-item Short-Form Health Survey were administered 3 months postinjury. RESULTS: Cluster analysis distinguished 3 distinct preinjury coping profiles that were differentially associated with outcomes. Participants who used avoidant coping showed the worse emotional functioning and QOL outcomes, although this cluster also reported high usage of problem-focused strategies. Preinjury coping profiles explained a significant proportion of the variance in depression, anxiety, and mental health QOL at 3 months postinjury beyond that accounted for by demographic characteristics and mTBI severity. CONCLUSIONS: Cluster analysis holds practical value in illustrating the pattern of coping strategies used by person with uncomplicated and complicated mTBI. It appears worthwhile to address coping in future trials of interventions that are aimed at improving emotional functioning after mTBI.

Examining the contribution of social communication abilities and affective/behavioral functioning to social integration outcomes for adults with traumatic brain injury.

OBJECTIVE: To evaluate the contribution of social communication abilities and affective/behavioral functioning to social integration outcomes for persons with traumatic brain injury (TBI). DESIGN: Prospective cohort study. PARTICIPANTS: A total of 184 adults with TBI (72.8% men) evaluated at least 6 months postdischarge from acute care or inpatient rehabilitation hospitals and after living at least 3 months in the community postdischarge (Mean = 7.84 months postinjury). MEASURES: La Trobe Communication Questionnaire (LCQ), Assessment of Interpersonal Problem-Solving Skills(AIPSS), Affective Behavioral subscale From the Problem Checklist of the Head Injury Family Interview (AB-HIFI), Craig Handicap Assessment and Reporting Technique-Short Form Social Integration subscale (CHART-SF-SI), Community Integration Questionnaire Social Integration subscale (CIQ-SI). RESULTS: Social communication measures (LCQ, AIPSS) and self-reported behavioral functioning (AB-HIFI) contributed significantly to concurrently measured social integration outcomes after controlling for demographic and injury-related variables. Separate hierarchical multiple regression analyses revealed that social communication and behavioral variables accounted for 11.3% of variance in CIQ-SI and 16.3% of variance in CHART-SF-SI. CONCLUSIONS: Social communication abilities and affective/behavioral functioning make a substantial contribution to social integration outcomes after TBI. The implications of such evidence for clinical assessment and intervention are discussed.

Making connections after brain injury: development and evaluation of a social peer-mentoring program for persons with traumatic brain injury.

OBJECTIVE: To describe the development and implementation of a social peer-mentoring program for persons with traumatic brain injury (TBI) and to explore whether this program yielded increased social functioning outcomes compared with wait-list (WL)controls. DESIGN: Pilot randomized controlled study. PARTICIPANTS: Community-dwelling individuals with TBI(12 matched with social peer mentors and 18 completing the WL condition). INTERVENTION: Trained social peer mentors (SPMs)were matched to partners with TBI (peer partners (PP)) to foster skill-building in planning of social activities and improving social communication abilities through phone contacts and joint participation in social events within the community over a 3-month period. MEASURES: Social Activity Interview, Center for Epidemiological Studies Depression Scale, UCLA Loneliness Scale, Satisfaction with Life Scale, 6-Item Interpersonal Support Evaluation List (baseline and postmentoring); weekly social activity data(1-month baseline, continuously collected during 3-month mentoring or WL period); satisfaction survey. RESULTS: Both SPM and PP participants reported high satisfaction with the mentoring program. Statistically significant improvements in perceived social support after mentoring were observed for the mentored group than for WL participants; however, an increase in depressive symptoms was also observed. While significant improvements in social activity level and social network size were not found, a trend toward increased satisfaction with social life was present for mentored participants. CONCLUSIONS: Satisfaction ratings for the SPM program were uniformly high and selected positive findings encourage further investigation of social mentoring as an intervention to effect improvements in social integration. Small sample size and reduced "dosage" of mentor interactions were limitations of this pilot study. Benefits of and challenges to implementation of an SPM program are outlined.

Exploring experiences of intimacy from the viewpoint of individuals with traumatic brain injury and their partners.

OBJECTIVE: To explore qualitatively the experience of intimacy from the viewpoint of persons with traumatic brain injury (TBI) and their intimate partners. DESIGN: Qualitative interview study. SETTING: Outpatient community. PARTICIPANTS: Eighteen persons with TBI and their intimate partners at a mean length of 4.78 years postinjury. MAIN MEASURES: Open-ended, semistructured, in-depth interviews regarding participants' experience of intimacy, factors impacting intimacy, and need for services. RESULTS: Factors that were perceived as helping relationships remain strong included unconditional commitment, spending time together, open communication, a strong preinjury relationship, bonding through surviving the injury together, social support, family bonds, spirituality, experience with overcoming hardship, and coping skills. Factors that were perceived as barriers to intimacy included injury-related changes, emotional reactions to changes, sexual difficulties, role conflict and strain, family issues, social isolation, and communication issues. CONCLUSIONS AND IMPLICATIONS: Education regarding the impact of TBI on intimacy should be integrated into rehabilitation. Health professionals should be sensitized as to the needs that persons with TBI and their partners have regarding intimacy and how to make appropriate referrals to assist them.

Common misconceptions about traumatic brain injury among ethnic minorities with TBI.

OBJECTIVE: To investigate common TBI misconceptions among ethnic minorities with TBI. DESIGN: Cross-sectional study. SETTING: Level I trauma center. PARTICIPANTS: Fifty-eight persons with TBI (28 black and 30 Hispanic) discharged from the neurosurgery unit and living in the community. MAIN MEASURE: Forty-item Common Misconceptions about Traumatic Brain Injury Questionnaire (CM-TBI). RESULTS: Participants displayed misconceptions about approximately one-third of the 40 items, most regarding amnesia and recovery. Fewer misconceptions were found in the brain damage/injury and sequelae categories. A greater percentage of TBI misconceptions was associated with having lower education, actively practicing religion, being Spanish-speaking and non-US born. After controlling for education and actively practicing religion, Spanish-speaking Hispanics reported a greater percentage of misconceptions than English-speaking Hispanics and blacks. CONCLUSIONS AND IMPLICATIONS: Understanding common TBI misconceptions can assist rehabilitation staff in tailoring education programs for racial/ethnic minorities including those who are Spanish-speaking. Educational attainment and cultural factors should be considered when developing educational interventions for persons with TBI from diverse backgrounds. Inaccurate information regarding TBI, especially the recovery process, may hinder treatment planning by rehabilitation professionals and may result in disappointment and the setting of unrealistic goals for persons with injury and their families.

Perceptions of community integration in an ethnically diverse sample.

OBJECTIVE: To investigate the meaning of community integration in an ethnically diverse sample. DESIGN: Prospective study using mixed qualitative and quantitative methods. SETTING: County level I trauma center. PARTICIPANTS: Fifty-eight blacks, 57 Hispanics, and 52 whites with traumatic brain injury living in the community 6 months postinjury. MAIN MEASURES: Open-ended interview questions and a questionnaire assessing perceived importance of community integration activities. RESULTS: Resulting themes indicated that feeling part of the community was related to type and quality of community relationships, perceived safety and security, active involvement, feeling included and respected, and familiarity with the community. Themes regarding barriers included the following: environmental and social barriers; injury-related cognitive and physical changes; dissimilarities to others; relocation; and financial issues. Blacks and Hispanics placed more emphasis on domestic activities than did whites. CONCLUSIONS AND IMPLICATIONS: Feeling integrated into the community relates to aspects of the environment as much as to involvement in specific activities. Environmental barriers can be just as important as injury-related changes. Different racial/ethnic groups place different value on participation activities. The results emphasize the importance of assessing subjective aspects of community integration, individualizing rehabilitation goals, and intervening in the environment to facilitate participation.

Medical and psychosocial predictors of caregiver distress and perceived burden following traumatic brain injury.

OBJECTIVE: To determine whether caregivers' medical and psychiatric histories, coping style, and social support predict global distress and perceived burden. DESIGN: Correlational, cohort study. PARTICIPANTS: A total of 114 caregivers of persons with moderate to severe traumatic brain injury, assessed 1 year postinjury. MEASURES: Ratings of caregivers' medical and psychiatric history; Disability Rating Scale; Ways of Coping Questionnaire; Multidimensional Scale of Perceived Social Support; Brief Symptom Inventory; and Modified Caregiver Appraisal Scale. RESULTS: Caregivers' medical and psychiatric histories predicted global distress, after accounting for education, sex, income, and relationship, as well as disability of the person with injury. Increased use of escape-avoidance as a coping strategy was related to increased distress. Perceived burden was predicted by disability in the person with injury, use of escape-avoidance, and perceived social support. CONCLUSIONS: Caregivers' preinjury functioning is more predictive of global distress, whereas the functioning of the person with injury is more predictive of injury-related burden. Caregivers' medical and psychiatric histories are important considerations when targeting interventions; global stress management strategies may be as important as assisting with injury-related issues.

Relationship of race/ethnicity and income to community integration following traumatic brain injury: investigation in a non-rehabilitation trauma sample.

The purpose of the current study was to determine the contribution of race/ethnicity and income to community integration at approximately 6 months following traumatic brain injury (TBI). Participants were 151 persons with mild to severe TBI (38% Black; 38% Hispanic; 24% White) recruited from consecutive admissions to the Neurosurgery service of a county Level I trauma center. A large number of participants had low income and low education. Community integration was assessed using the Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique - Short Form (CHART-SF), and Community Integration Measure (CIM). Results of analysis of covariance (ANCOVA) indicated that, after accounting for injury severity, age, education, and income, race/ethnicity contributed significantly to the variance in CIQ Total score, Home Integration Scale, and Productive Activity Scale scores. Blacks had lower CIQ Total scores compared to Whites. Black and Hispanic participants had lower scores than Whites on the Home Integration Scale, and Blacks had lower scores than Whites and Hispanics on the CIQ Productive Activity Scale. Low income ( < or = $20,000) was related to lower scores on the CIQ and CHART-SF Social Integration Scales, and scores on the CIM Total, Belonging, and Independent Participation scales. These results indicate that racial/ethnic differences in community integration exist, even after accounting for income. However, income was more predictive than race/ethnicity for certain aspects of community integration, indicating that it should be accounted for in all studies investigating racial/ethnic differences in outcomes.

Perceptions of communication abilities for persons with traumatic brain injury: validity of the La Trobe Communication Questionnaire.

PRIMARY OBJECTIVE: To further evaluate the construct validity of the La Trobe Communication Questionnaire (LCQ) and to investigate the extent to which self-ratings of adults with traumatic brain injury compared to ratings made by close others and self-ratings made by non-injured matched controls. RESEARCH DESIGN: Prospective cohort study. METHODS AND PROCEDURES: Two hundred and seventy-six adults with TBI (121 of which are >1-year post-injury and previously enrolled in TBI Model Systems and 155 of which were consecutively admitted to a Level 1 trauma centre and were at least 6-months post-injury) completed the La Trobe Communication Questionnaire. In addition, for the TBI Model systems sample, 88 friends/family members and 80 non-injured matched controls participated. MAIN OUTCOMES AND RESULTS: Principle components analysis with varimax rotation yielded four factors: Initiation/Conversational Flow, Disinhibition/Impulsivity, Conversational Effectiveness and Partner Sensitivity, which were found to have adequate internal consistency. Adequate discriminative validity was obtained in comparing adults with TBI to non-injured matched controls, while no significant differences were found between self-ratings of communication abilities by adults with TBI and those made by close others. CONCLUSIONS: Additional support for the LCQ as a useful measure of perceived social communication abilities was obtained. Confirmatory factor analysis with a larger sample of adults with TBI will be a useful step in further development of this tool.

Relation of executive functioning and social communication measures to functional outcomes following traumatic brain injury.

Neuropsychologists are increasingly asked to provide recommendations regarding functional abilities based on test results, particularly within the rehabilitation setting. Yet, the empirical basis for making such recommendations is limited. The current study examines relationships between executive functioning and social communication measures and concurrently measured occupational and social integration outcomes. Participants were 121 individuals with traumatic brain injury (TBI) recruited from participants in a longitudinal study of outcome following TBI who had all received comprehensive brain injury rehabilitation. As part of a larger study designed to evaluate social communication abilities following TBI, participants completed measures of executive functioning, affect perception, perceived communication ability, and functional outcome. After adjusting for age, education, and performance on executive functioning measures, social communication performance accounted for a unique 5.6% of the variance in occupational outcomes and 7.9% of variance in social integration outcomes. Executive functioning performance accounted for a unique 13.3% of the variance in occupational functioning and 16.0% of explained variance in social integration. These results provide evidence of the value of executive functioning and social communication measures in the prediction of functional outcomes. Additionally, such results provide preliminary support for the addition of social communication measures to assessment of TBI in neuropsychological practice.

Relationship of race/ethnicity to caregivers' coping, appraisals, and distress after traumatic brain injury.

The objective of the current study was to determine the relationship between race/ethnicity and caregivers' coping, appraisals of the caregiving role, and distress after traumatic brain injury (TBI). Participants were 195 caregivers (75% white; 25% black/Hispanic) of persons with TBI who were admitted to comprehensive inpatient rehabilitation at one of three participating centers and were followed up at 1 year after injury. Caregivers completed interview and self-report questionnaires, including the Ways of Coping Questionnaire, Caregiver Appraisal Scale, and Brief Symptom Inventory. Compared to whites, blacks/Hispanics reported lower levels of education, lower annual household income, and were more likely to be caring for an extended family member. After adjusting for relationship to the person with injury, age, education and income, race/ethnicity significantly predicted caregivers' use of the coping strategies distancing and accepting responsibility. Blacks/Hispanics made greater use of these strategies compared to whites. Blacks/Hispanics also showed more traditional beliefs regarding the caregiving role. Race/ethnicity was not predictive of distress. However, an interaction was noted between race/ethnicity and caregiver ideology. For Blacks/Hispanics, more traditional ideology was associated with increased distress. Future research using a larger sample of non-whites and including measures of acculturation is warranted.

Early versus later admission to postacute rehabilitation: impact on functional outcome after traumatic brain injury.

OBJECTIVE: To examine the impact of participation in a postacute community reentry program on functional outcome after traumatic brain injury (TBI). DESIGN: Cohort, nonrandomized, intervention study. Pretest-posttest, follow-up design. SETTING: Nonprofit outpatient community reentry program affiliated with an inpatient rehabilitation hospital. PARTICIPANTS: Three groups of persons with moderate to severe TBI differing in length of time between injury and admission. The first group entered postacute rehabilitation within 6 months of injury (n=115); the second group, between 6 and 12 months (n=23); and the third group, greater than 12 months (n=29). INTERVENTIONS: Persons with TBI participated in a postacute community reentry program (average, 4.3mo) that emphasized (1) teaching compensatory strategies to address residual cognitive deficits; (2) arranging environmental supports to maximize functioning; (3) counseling and education to address personal and family adjustment and to improve accurate self-awareness; and (4) transition from simulated activities in the clinic to productive activities in the community. MAIN OUTCOME MEASURES: Disability Rating Scale, Supervision Rating Scale, and the Community Integration Questionnaire. RESULTS: All groups showed improvements between admission and discharge on measures of overall disability, independence, home competency, and productivity, and these gains were maintained at follow-up. For the group beginning postacute rehabilitation the earliest (<6mo postinjury) independence continued to improve after discharge. Community integration total score and home competency also continued to improve even after discharge. CONCLUSIONS: The results point toward the effectiveness of postacute rehabilitation in improving functional outcome after TBI even for persons who have reached stable neurologic recovery at 12 or more months postinjury.

Relationship between neuropsychological test performance and productivity at 1-year following traumatic brain injury.

While there has been strong evidence for the ability of neuropsychological performance at resolution of posttraumatic amnesia to predict later productivity, there has been less conclusive evidence for the relationship of neuropsychological test scores to concurrent productivity status. The purpose of the current study was to evaluate the relationship of neuropsychological test performance at 1 year post-injury to productivity assessed at the same time point. Participants were 518 persons with medically documented TBI who were enrolled in the TBI Model Systems Research and Demonstration Project. Stepwise logistic regression was utilized to determine the contributions of neuropsychological test scores to productivity after accounting for demographic characteristics, injury severity, and pre-injury productivity. Missing neuropsychological test scores were accounted for in the model. Variables that remained in the model and accounted for a significant proportion of the variance included age, duration of impaired consciousness, pre-injury productivity, and scores on measures of GOAT, Logical Memory II, and Trail Making Test, part B. The results indicate that neuropsychological test performance provides important information regarding the ability of persons with injury to return to productive activities. The results also indicate that inability to complete neuropsychological tests at 1 year post-injury is associated with non-productive activity.

Post-acute brain injury rehabilitation for patients with stroke.

PRIMARY OBJECTIVE: Conduct an investigation of post-acute brain injury rehabilitation (PABIR) for persons with stroke. RESEARCH DESIGN: Pre-post-treatment observation study. METHODS AND PROCEDURES: Demographic and medical data for 127 persons with stroke admitted for PABIR at a median interval of 87 days post-stroke were abstracted from medical records. Participants' levels of independence and productivity were assessed at admission and discharge. Follow-up data were available for 90 participants at a median interval of 346 days post-discharge. EXPERIMENTAL INTERVENTIONS: Not applicable. MAIN OUTCOMES AND RESULTS: Participants showed improvements in productivity and independence level from admission to discharge and these gains were maintained at follow-up. Predictors of productivity at discharge were gender and level of independence at admission (Model R(2) = 0.28). Predictors of independence at discharge were similar (Model R(2) = 0.37). CONCLUSION: While this investigation has limitations, findings suggest that PABIR is beneficial for some persons with strokes.