Provision of resource facilitation services for individuals with acquired brain injury across the United States: results of a 2018 resource facilitator provider survey.

OBJECTIVE: Resource Facilitation is a lesser-known service line within the field of brain injury rehabilitation and has been described as similar to case management, care coordination, and neuronavigation. The purpose of this project was to evaluate current Resource Facilitation programs and provide a comprehensive summary of program characteristics to work toward a common definition of Resource Facilitation services and inform future program development and evaluation frameworks. MATERIALS AND METHODS: An online survey was sent to all known Resource Facilitation programs in the US (N = 70). DATA COLLECTION: Completed through Survey Monkey including information related to program history, structure, population served, and outcomes measurement. STATISTICALANALYSIS: Descriptive statistical analyses were applied. RESULTS: Twenty-four of the 70 programs completed the survey, resulting in a 34% completion rate. This snapshot of the current definitions and activities demonstrated high variability across programs regarding structure, funding, eligibility, and data collection. Only 33% of programs reported having a program evaluation system. CONCLUSIONS: This project provided a comprehensive summary of Resource Facilitation program characteristics and associated outcome metrics. The findings may be used to begin the formulation of a common definition of Resource Facilitation services, a program evaluation framework, and aid in establishing a common data set across programs.

Comparison of a Cognitive-Behavioral Coping Skills Group to a Peer Support Group in a Brain Injury Population.

OBJECTIVE: To compare the efficacy of 2 group treatments for persons with brain injury (BI) and their caregivers in promoting perceived self-efficacy (PSE) and emotional and neurobehavioral functioning. DESIGN: Randomized controlled trial. SETTING: Outpatient BI rehabilitation. PARTICIPANTS: Subjects (N=38), including 19 with BI and 19 caregivers, participated in a BI coping skills group or a support group. INTERVENTIONS: BI coping skills is a manualized cognitive-behavioral treatment (CBT). CBT was compared with a structurally equivalent support group. MAIN OUTCOME MEASURES: Brain Injury Coping Skills Questionnaire (PSE), Brief Symptom Inventory-18 ([BSI-18]; emotional distress), and Frontal Systems Behavior Scale (neurobehavioral functions). RESULTS: There were no significant differences between survivors and caregivers on the Brain Injury Coping Skills Questionnaire and BSI-18; therefore, groups were combined during final analyses. Frontal Systems Behavior Scale caregiver data were used for analysis. Both groups showed significantly improved PSE between baseline and follow-up on repeated-measures analysis of variance, with the CBT group showing greater stabilization of change. There was no significant group by time interaction on measures of neurobehavioral functions, but the CBT group showed significant improvements at 3-month follow-up. No significant effects were found on the BSI-18. CONCLUSIONS: To our knowledge, no studies to date have been published comparing a CBT intervention with a support group in a BI population with caregiver participation. This study showed that given equivalent group structure, individuals with BI and caregivers may benefit from either type of intervention in enhancing PSE or maintaining emotional stability. However, there was a trend for individuals who received CBT to maintain the effects of improved PSE, whereas support group participants showed a trend for decline. This study offers a new conceptualization that with certain group dynamics and support, individuals with BI and caregivers may benefit similarly from either a support group or CBT intervention. However, because our sample did not include individuals in clinically significant emotional distress, we cannot rule out the possibility that those with more significant challenges in PSE or emotional functions may show greater benefits with a CBT group.

Brain injury coping skills group: a preventative intervention for patients with brain injury and their caregivers.

OBJECTIVE: To determine whether training in coping strategies will improve psychologic functioning and self-efficacy in survivors of brain injury (BI) and caregivers. DESIGN: Randomized controlled pilot study with measurements at baseline, postintervention, and 3-month follow-up. SETTING: Postacute rehabilitation clinic. PARTICIPANTS: Survivors of BI (n=20) and caregivers (n=20). INTERVENTIONS: The Brain Injury Coping Skills Group is a 12-session, manualized, cognitive-behavioral treatment (CBT) group providing psychoeducation, support, and coping skills training. Effects of this preventative intervention were examined on emotional functioning and perceived self-efficacy (PSE). MAIN OUTCOME MEASURES: Brief Symptom Inventory-18 (BSI-18) and Brain Injury Coping Skills Questionnaire. RESULTS: Analyses revealed that the Brain Injury Coping Skills group showed significantly improved PSE compared with the control group immediately posttreatment (F=14.16; P=.001) and maintained this over time. PSE assessed posttreatment predicted global distress at 3-month follow-up across groups (rho=-.46). No differences between treatment and control groups were apparent on the BSI-18 posttreatment. However, the control group showed increased emotional distress at 3-month follow-up while the Brain Injury Coping Skills group remained stable over time. CONCLUSIONS: Few CBT studies have included survivors of BI and caregivers together in group treatment or included a control group. No prior studies have examined the role of PSE specifically. Prior intervention studies show inconsistent effects on emotional functioning, raising questions regarding the role of intervening variables. This study offers a new conceptualization that PSE may moderate longer-term emotional adjustment after brain injury. Results indicate that PSE is an important and modifiable factor in helping persons better adjust to BI.

The development and evaluation of a web-based programme to support problem-solving skills following brain injury.

BACKGROUND AND AIM: Cognitive impairments following brain injury, including difficulty with problem solving, can pose significant barriers to successful community reintegration. Problem-solving strategy training is well-supported in the cognitive rehabilitation literature. However, limitations in insurance reimbursement have resulted in fewer services to train such skills to mastery and to support generalization of those skills into everyday environments. The purpose of this project was to develop and evaluate an integrated, web-based programme, ProSolv, which uses a small number of coaching sessions to support problem solving in everyday life following brain injury. METHOD: We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study. RESULTS: Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions. CONCLUSIONS: Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury. Implications for Rehabilitation People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts. Research supports problem solving skills training following brain injury. Assistive technology for cognition (smartphones, selected apps) offers a means of supporting problem solving for this population. This project demonstrated the feasibility of a web-based programme to address this need.

Is the montreal cognitive assessment superior to the mini-mental state examination in detecting subtle cognitive impairment among middle-aged outpatient U.S. Military veterans?

The Montreal Cognitive Assessment (MoCA) is a relatively newly designed test that was developed as a tool to screen patients with mild cognitive problems that are not typically detected by the Mini-Mental State Exam (MMSE). While early research suggests that the MoCA is more sensitive to subtle cognitive impairment than the MMSE, there is concern about potential decreased specificity when using the MoCA. The aim of the present study was to examine the comparative utility of using the MoCA and the MMSE to detect subtle cognitive impairment among a group of 82 middle-aged U.S. military veterans referred for outpatient neuropsychological testing. Using receiver operating characteristic analyses, the MoCA was shown to be a better predictor of subtle cognitive impairment on neuropsychological testing than the MMSE. When using an adjusted cutoff, the MoCA was shown to be more sensitive (i.e., 0.72 vs. 0.52) and nearly as specific as the MMSE (0.75 vs. 0.77).