Providing Care for Comorbid Mental Health Conditions in the Polytrauma System of Care.

OBJECTIVE: To summarize challenges and best practices relevant to providing care for mental health comorbidities in veterans and service members (V/SM) treated in the Polytrauma System of Care (PSC) and to review themes that emerged during a May 2017 meeting of rehabilitation professionals on this topic. Management of comorbid mental health conditions remains a critical issue within the PSC, given the high rate of these comorbidities and the impact of mental health conditions on treatment planning and outcomes. DESIGN: To identify the challenges of concomitantly treating TBI-related symptoms and mental health comorbidities in V/SM treated within the PSC, describe specialty programs within the Veterans Health Administration designed to treat these comorbid conditions, and report on the themes and recommendations identified by rehabilitation professionals at the 2017 meeting. CONCLUSION: To further develop mental health treatment within the PSC, the following recommendations were made: (1) continued support for family members as critical members of the rehabilitation team; (2) adding measures and mechanisms to monitor mental health within the PSC; and (3) exploration of modern technologies to enhance care of existing polytrauma clients and to better prepare to serve clients with all types of acquired brain injury.

Neuropsychology of COVID-19: Anticipated cognitive and mental health outcomes.

OBJECTIVE: Discuss anticipated patterns of cognitive and emotional dysfunction, prognostic indicators, and treatment considerations based on review of (a) neuroinvasive properties of prior human coronaviruses and (b) extensively researched disorders which share similar neurological mechanisms. METHOD: A web-based comprehensive search of peer-reviewed journals was conducted based on a variety of key terms (and variants of) including coronavirus, neuroinvasion, cognitive dysfunction, viral pandemics, respiratory illness, critical illness, and metabolic disease. Articles were chosen based on relevance to the current topic and ability to provide unique thematic information. Historical articles were included if these added scientific merit to recent literature. Review of information in widely disseminated news articles was followed-up with direct review of cited scientific literature. Databases searched included Google Scholar, PubMed, and Ovid Medline. RESULTS: Based on neuroinvasive properties of prior coronaviruses and existing research on similar neurophysiological conditions with detrimental cognitive effects, COVID-19-especially those with severe symptoms-are at risk for cognitive decline and significant psychiatric/behavioral sequela. CONCLUSIONS: There are few studies examining cognitive outcomes in COVID-19. This review argues that neuropsychological sequelae are to be expected in patients with COVID-19. Considerations for clinicians working with this unique population are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial.

PURPOSE: To compare coping effectiveness training (CET) with supportive group therapy (SGT) for anxiety, depression, and adjustment to injury in an acute spinal cord injury/dysfunction (SCI/D) rehabilitation population. CET was shown to result in decreased anxiety and depression symptoms when compared to historical no-treatment control groups (Kennedy, Duff, Evans, & Beedie, 2003; King & Kennedy, 1999). The present study sought to extend those findings with a comparison of CET to an alternative active therapy condition, SGT. RESEARCH METHOD: Participants (N = 40) entering a hospital-based program were assigned to treatment condition using block randomization. Questionnaire mood measures were completed at program admission, program discharge, and 3-month postdischarge follow-up. Adjustment to disability was assessed at follow-up only. Analyses of variance tested for group differences in anxiety, depression, and adjustment to injury. RESULTS: Both groups reported reductions in mood symptoms with no differences between treatment conditions. However, similar reductions were obtained after fewer sessions of CET. Symptoms of depression increased in both groups following hospital discharge. CONCLUSIONS: Clinical and research implications, including innovative interventions during the period after discharge, are discussed.

Role of executive functioning in verbal and visual memory.

G. Tremont, S. Halpert, D. J. Javorsky, and R. A. Stern (2000) found that individuals with executive dysfunction were more impaired on less structured versus more structured verbal memory tasks. In the present study, the authors investigated the relationship between executive functions and memory in patients with a history of traumatic brain injury by examining the effect of executive functioning on more structured and less structured verbal and visual memory tasks at baseline and 1-year follow-up. Matched subgroups controlled for differences in severity of neuropsychological impairment unrelated to specific executive functions. The G. Tremont et al. (2000) findings were not replicated. Results showed that when acuteness and severity of injury were controlled, executive impairment played no significant role in performance on either more or less structured memory tasks. However, regardless of structure, executive functions played a role in visual memory performance, suggesting that visual memory may be a more fluid ability than verbal memory.

Polytrauma transitional rehabilitation programs: Comprehensive rehabilitation for community integration after brain injury.

When the U.S. Congress passed the Veterans Health Programs Improvement Act of 2004 and the Consolidated Appropriations Act in 2005, Veterans Affairs (VA) traumatic brain injury centers responded by establishing and developing the polytrauma rehabilitation centers and polytrauma transitional rehabilitation programs (PTRPs) across 4 sites in Minneapolis, Minnesota, Palo Alto, California, Richmond, Virginia, and Tampa, Florida, in 2007. The 5th PTRP was opened in 2011 in San Antonio, Texas. This article presents the context of establishing these programs within a VA system, describes aspects of programmatic design, and shares characteristics and outcomes of individuals served by the first 4 national centers. PTRPs provide specialized, interdisciplinary brain injury rehabilitation to active-duty service members and veterans with complex rehabilitation needs. A total of 286 individuals participated in the first 4 PTRPs during the first 3 years. Admission and discharge data were collected as part of routine care, and data review focused on describing the demographic, injury, and neurobehavioral functioning outcomes across 4 sites. Mayo-Portland Adaptability Inventory Abilities, Adjustment, and Participation subscales and total scale T-scores served as primary functioning outcome measures. Mean scores are presented. Statistical analysis found a significant change in total scale T-score from admission to discharge, consistent with improved patient functional ability. Challenges associated with the development and implementation of programs are discussed. Elements of programming may be applicable for other health care organizations that seek to improve rehabilitation care delivery.

Identifying retrieval problems using the California Verbal Learning Test.

Wilde, Boake, and Sherer (1995) examined the discrepancy between Long Delayed Free Recall (LDFR) and Recognition Discriminability (RD)--the California Verbal Learning Test (CVLT) index thought to indicate the presence of memory retrieval problems--and found little evidence to recommend its use in traumatic brain injury (TBI). The present investigation re-examined this index from the perspective of a continuum of retrieval deficit severity. CVLT performance was examined in 122 TBI patients, and 2 retrieval deficit indicators of varying severity were evaluated. Memory-impaired control groups were matched with retrieval deficit groups on initial acquisition and demographic characteristics. Individuals with a LDFR/RD discrepancy did not show predicted differences on other CVLT indices of retrieval problems, similar to the findings of Wilde et al. (1995). In contrast, individuals with a consistent discrepancy between free recall and semantic cued recall (Short and Long Delay) had greater improvement with recognition cueing and made fewer intrusive errors than controls. Individuals who benefited from semantic cues (where retrieval of the target word is still required) also benefited from recognition cues (where retrieval demands are minimal). Evidence supported the existence of a continuum of retrieval deficit severity. An LDFR/RD discrepancy without performance improvement from semantic cueing appears to indicate a more severe retrieval deficit, whereas performance improvement from both recognition and semantic cueing indicates less severe retrieval deficits.

Demographic, medical, and psychiatric factors in work and marital status after mild head injury.

OBJECTIVE: To explore factors associated with long-term outcomes of work and marital status in individuals who had experienced a mild head injury (MHI), as well as those who had not. DESIGN: Population-based study using logistical regression analyses to investigate the impact of preinjury characteristics on work and marital status. PARTICIPANTS: Two groups of Vietnam-era Army veterans: 626 who had experienced a MHI an average of 8 years before examination, and 3,896 who had not. MAIN OUTCOME MEASURES: Demographic characteristics, concurrent medical conditions, early life psychiatric problems, loss of consciousness (LOC), and interactions among these variables were used to predict current work and marital status. RESULTS: Multiple variables were associated with work and marital status in the sample with MHI, accounting for approximately 23% and 17% of the variance in these two outcome variables, respectively. In contrast, the same factors accounted for significantly less variance in outcome in the sample without a head injury-13.3% and 9.4% for work and marital status, respectively. CONCLUSIONS: These findings suggest a more potent role for and increased vulnerability to the influence of demographic, medical, and psychiatric factors on outcomes after a MHI. That is, MHI itself moderates the influence of preinjury characteristics on work and marital status. In addition, in those who had a MHI, moderator relationships were found between education and LOC for both work and marital status. Similarly, complex moderator relationships among race, region of residence, and LOC were found for both work and marital status outcomes.