Telephone Problem-Solving Treatment Improves Sleep Quality in Service Members With Combat-Related Mild Traumatic Brain Injury: Results From a Randomized Clinical Trial.

OBJECTIVE: Evaluate sleep quality, its correlates, and the effect of telephone-based problem-solving treatment (PST) in active duty postdeployment service members with mild traumatic brain injury (mTBI) SETTING:: Randomized clinical trial. PARTICIPANTS: Active duty service members with combat-related mTBI. STUDY DESIGN: Education-only (EO) and PST groups (N = 178 each) received printed study materials and 12 educational brochures. The PST group additionally received up to 12 PST telephone calls addressing participant-selected issues. Outcomes were evaluated postintervention (6 months) and at 12 months. MAIN MEASURE: Pittsburgh Sleep Quality Index. RESULTS: Sleep quality was manifestly poor in both groups at baseline (Pittsburgh Sleep Quality Index = 12.5 ± 4). Overall sleep quality was significantly different between the PST and EO groups at 6 months (P = .003) but not at 12 months. Longitudinally, PST significantly improved sleep quality at 6 months (P = .001) but not over the follow-up. Low sleep quality was associated with concussion symptoms, pain, depression, and posttraumatic stress disorder at all time points (P < .0001). CONCLUSIONS: Sleep disorders, common in postdeployment service members with mTBI, are strongly associated with the presence of pain, posttraumatic stress disorder, and depression. Telephone-based PST may be an effective therapeutic approach for reducing sleep disorders in this population. Research should focus on maintenance of treatment gains.

Student selection process: a follow-up study.

This is a follow-up study of the 20 junior students admitted into an occupational therapy educational program under a selection process described in a previous article in AJOT in 1974. It reports the outcome resulting from the use of the selection process and t test findings between the upper ten ranked students and the remaining lower ranked students. Academic achievements and employment patterns of the 19 students completing the program are presented.

Anger management training for brain injured patients and their family members.

Anger dyscontrol is a common occurrence after brain injury. The anger problems of brain injured persons create a burden for their caretakers who most frequently are their family members. Two single-case design studies are presented that demonstrate the efficacy of behavioral interventions for the control of anger problems in brain injured adults. Anger control was accomplished by training the patients in skills to control their own anger, and teaching family members behavior modification principles. In each case, the patient was taught to implement a self-talk method to decrease tension during the escalation period of an anger episode and to execute a time-out when aware of increased anger. Family members were trained in ways to monitor such problems and to identify antecedents to an outburst. They were given feedback and suggestions to modify their communication style with the patient so as to reduce patient irritability, and were taught ways to use a verbal cue to remind the patient to use pretrained self-control methods. Patients and family members were also asked to increase the number of pleasant events in which they engaged as a general means to decrease the patients' anger outbursts. These cases showed evidence that the treatment program reduced the frequency of anger outbursts and, in one case, increased the social participation by the patient immediately after treatment and at one-month and three-month follow-up assessments. The importance of having key family members involved in anger management training for brain injured patients is underscored, particularly when cognitive impairment limits patients' ability to benefit from and to retain the content of psychotherapy.

Acute back pain: a control-group comparison of behavioral vs traditional management methods.

Back-pain patients with onset in the preceding 1-10 days and comparable on a back examination were randomly assigned to traditional management (A regimen) and behavioral treatment methods (B regimen). Patients were compared at 6 weeks and 9-12 months on a set of "Sick/Well" scores derived from patient reported vocational status (V), health-care utilization (HCU), claimed impairment (CI), and pain drawings (D) and on two measures of activity level. No differences were found at 6 weeks, but at 9-12 months, A-group S's were more "sick." No A/B differences were found on activity-level measures. Group A S's showed significant increases in claimed impairment from preonset to follow-up, whereas Group B S's had returned at follow-up to preonset levels.

Wheelchair transfer training for right cerebral dysfunctions: an interdisciplinary approach.

A 44-year-old patient with cerebrovascular accident and resulting total occlusion of the right internal carotid artery and severe cognitive impairments was seen as an inpatient. Impulsivity, general inattention, left side neglect, decreased concentration and visual-spatial-perceptual difficulties were clinically evident. A conventional approach to training this patient in wheelchair transfer skills met with little success. An individualized training program based on the patient's specific cognitive strengths and deficits was developed. The major elements of the program were (a) careful observation of task performance, (b) task analysis of the skill to be taught, (c) utilization of the patient's learning strengths to guide performance, (d) small step hierarchical programming to meet the desired goal, (e) intense repetition of the skill and (f) data collection procedures to monitor change and program adjustments. Six weeks after the program was implemented the patient was able to complete safe transfers, and was discharged home. At follow-up, two weeks after discharge, inconsistency in transfers was noted; the written program was immediately reestablished, and the patient continued safe wheelchair transfers at every subsequent check. This study suggests that treatment outcome in patients with right hemisphere damage may not be as bleak as has been previously suggested. A treatment strategy that includes an optimal utilization of a patient's verbal skills to cue and monitor performance and judgment, along with systematic data collection to guide program modifications, can lead to a more successful rehabilitation outcome.

Measuring functional impairment associated with pain: psychometric analysis of an exploratory scoring protocol for activity pattern indicators.

Behavioral science theorists who study pain have advocated the development of measures designed to assess aspects of behavior. Recently, Diller , Fordyce , Jacobs, and Brown developed a 64-item self-report activity measure. Assessment of functional impairment associated with pain is a potentially appropriate application for the Activity Pattern Indicators (API). The API provides a description of actual functioning; frequency of behavior is the unit of measurement. Currently, no agreed upon scoring protocol is available for this measure. We propose to design, in accordance with measurement theory, a psychometrically sound yet practical scoring protocol. The API data presented allow an acceptable degree of reliability and sensitivity to group differences. Results of the present study support continued psychometric exploration of: the current scoring protocol, alternative scoring protocols, and the Activity Pattern Indicators.