The impact of female reproductive function on outcomes after traumatic brain injury.

OBJECTIVES: To determine the impact of traumatic brain injury (TBI) on female menstrual and reproductive functioning and to examine the relationships between severity of injury, duration of amenorrhea, and TBI outcomes. DESIGN: Retrospective cohort survey. SETTING: Telephone interview. PARTICIPANTS: Women (N=30; age range, 18-45y), between 1 and 3 years postinjury, who had completed inpatient rehabilitation for TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Data collected included menstrual and reproductive functioning pre- and postinjury, demographic, and injury characteristics. Outcome measures included the Glasgow Outcome Scale-Extended (GOS-E), the Mayo-Portland Adaptability Inventory-4 (MPAI-4), and the Medical Outcome Study 12-Item Short-Form Health Survey, Version 2 (SF-12v2). RESULTS: The median duration of amenorrhea was 61 days (range, 20-344d). Many subjects' menstrual function changed after TBI, reporting a significant increase in skipped menses postinjury (P<.001) and a trend toward more painful menses (P=.061). More severe TBI, as measured by the duration of posttraumatic amnesia, was significantly predictive of a longer duration of amenorrhea (P=.004). Subjects with a shorter duration of amenorrhea scored significantly better on the SF-12 physical component subscale (P=.004), the GOS-E (P=.05), and the MPAI-4 participation subscale (P=.05) after controlling for age, injury severity, and time postinjury. CONCLUSIONS: The severity of TBI was predictive of duration of amenorrhea and a shorter duration of amenorrhea was predictive of better ratings of global outcome, community participation, and health-related quality of life postinjury.

Treatment efficacy of social communication skills training after traumatic brain injury: a randomized treatment and deferred treatment controlled trial.

OBJECTIVE: To evaluate the efficacy of a replicable group treatment program to improve social communication skills after traumatic brain injury (TBI). DESIGN: Randomized treatment and deferred treatment controlled trial, with follow-up at 3, 6, and 9 months post-treatment. SETTING: Community. PARTICIPANTS: Volunteer sample of 52 people with TBI who were at least 1 year postinjury, who received rehabilitation, and who had identified social communication deficits. INTERVENTION: Twelve weekly group sessions (1.5 h each) to improve social communication. MAIN OUTCOME MEASURES: The Profile of Functional Impairment in Communication (PFIC), Social Communication Skills Questionnaire-Adapted (SCSQ-A), Goal Attainment Scale (GAS), Craig Handicap Assessment and Reporting Technique-Short Form social integration and occupation subscales, Community Integration Questionnaire social integration and productivity subscales, and Satisfaction With Life Scale (SWLS). RESULTS: Independent samples t test analysis showed significant treatment effect compared with no treatment on 7 of 10 of the PFIC subscales (P range, .024 to <.001) and the SCSQ-A (P=.005) after the first 12 weeks of the study. After 12 weeks of treatment for all participants, repeated-measures analysis showed significant improvements from baseline on 9 of 10 PFIC subscales (P range, .01-.001), SCSQ-A (P < or = .001), GAS (P < or = .001), and SWLS (P = .011). At 6-month follow-up, scores were significantly better than baseline on 6 of 10 PFIC scales (P range, .01-.001), the SCSQ-A (P < or = .001), GAS (P < or = .001), and SWLS (P < or = .001). CONCLUSIONS: TBI subjects who received social communication skills training had improved communication skills that were maintained on follow-up. Overall life satisfaction for participants was improved.

Social communication skills in persons with post-acute traumatic brain injury: three perspectives.

OBJECTIVE: To describe social communication skills problems identified by individuals with traumatic brain injury (TBI) compared to significant other (SO) and clinician ratings; and associations between these skills and participation outcome measures. DESIGN: Cohort study. METHODS: Sixty individuals with TBI > or = 1 year post-injury were administered measures of social communication, societal participation, social integration and life satisfaction. Clinicians and SOs rated the social communication skills of the subjects. RESULTS: Subjects were able to identify social communication skills problems, associated with lower ratings of community integration and satisfaction with life. Males reported higher scores in social communication and social integration than females. SOs and clinicians identified more social skills problems than subjects. CONCLUSIONS: Persons with TBI experience social communication skills deficits, associated with decreased societal participation and life satisfaction. Further research is needed to determine efficacy of social communication skills treatment and association with improved participation and satisfaction with life.

Magnetic resonance imaging of traumatic brain injury: relationship of T2*SE and T2GE to clinical severity and outcome.

PRIMARY OBJECTIVES: To evaluate (1) the sensitivity of magnetic resonance imaging (MRI) T2* weighted gradient echo (GE) vs T2 weighted spin echo (SE) technology for lesion detection in traumatic brain injury (TBI) and (2) the relationship of lesion patterns to acute clinical severity and 1 year post-injury outcome measures. RESEARCH DESIGN: Comparative analysis. METHODS AND PROCEDURES: Forty-three acute rehabilitation patients with TBI were imaged utilizing T2 SE and T2* GE techniques an average of 26 days post-injury. Acute clinical severity measures, including Glasgow Coma Scale (GCS), time to follow commands (TFC) and post-traumatic amnesia (PTA) were abstracted from medical records. One-year post-injury outcome measures including Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS) and the Craig Handicap Assessment and Reporting Technique--Short Form (CHART-SF) were collected as part of a comprehensive annual follow-up. MAIN OUTCOMES AND RESULTS: In comparison to T2 SE, T2* GE more frequently detected lesions in each of the cortical (p <0.0001), white matter (p <0.001), central grey (p <0.001) and brainstem (p <0.01) regions and in each of the frontal (p <0.0001), temporal (p <0.0001), parietal (p <0.001) and occipital (p <0.0001) lobes. With regards to acute clinical severity measures, T2* GE findings were the best predictors of GCS and the only significant predictors of PTA, while T2 SE findings were better predictors of TFC. For 1 year post-injury outcome measures, multivariate regression models utilizing T2 SE and T2* GE findings in combination were the best predictors of DRS and GOS and T2 SE findings alone were the best predictors of CHART-SF. CONCLUSIONS: This study demonstrates the enhanced sensitivity of T2* GE for detecting haemorrhagic lesions associated with TBI and supports a complimentary role for both T2 SE and T2* GE weighted imaging in characterizing injury severity and predicting longer-term outcomes.

Identifying environmental factors that influence the outcomes of people with traumatic brain injury.

OBJECTIVES: To determine the types of environmental barriers reported by persons with traumatic brain injury (TBI) and to identify the relations between environmental barriers and such components of societal participation as employment, community mobility, social integration, and life satisfaction. DESIGN: Seventy-three persons with TBI who were participating in the TBI Model Systems program at Craig Hospital were surveyed at 1 year, using a new measure of the environment, the Craig Hospital Inventory of Environmental Factors (CHIEF), which rates frequency and impact of 25 barriers. RESULTS: Transportation, the surroundings, government policies, attitudes, and the natural environment were the environmental barriers with the greatest reported impact. Those who were married, older, and unemployed or not in school reported the most barriers overall. Additionally, those reporting a greater impact from environmental barriers also reported lower levels of participation and life satisfaction. CONCLUSIONS: Although environmental barriers affect TBI survivors and play a role in their outcomes, their interplay with other, perhaps as yet unidentified, factors requires continued research. CHIEF may be a valuable tool for understanding the environment's role in the lives of people with TBI, and identifying the general environmental domains where interventions are needed to reduce their negative impact.

Evaluation of the home and community-based services brain injury Medicaid Waiver Programme in Colorado.

PRIMARY OBJECTIVES: To evaluate Colorado's Traumatic Brain Injury (TBI) Waiver programme in terms of functional, community integration and other key psychosocial outcomes. RESEARCH DESIGN: Results of telephone surveys of 66 TBI survivors who had received services through the Colorado Medicaid programme were compared with those of a matched sample not receiving such services. METHODS AND PROCEDURES: Participants were identified by Colorado's Medicaid programme and a control group was randomly selected from the population-based Colorado Traumatic Brain Injury Registry and Follow-up System. Groups were matched on Glasgow Coma Scale score at injury, age, gender,whether inpatient rehabilitation had been received and the number of years post-injury when the follow-up interview was conducted. All participants completed an extensive follow-up interview, which included CHART, the Sickness Impact Profile, the Satisfaction with Life Scale, the SF-12 and questions on symptoms and service use. MAIN OUTCOMES AND RESULTS: For four of the evaluated outcomes-relating to mental health problems (SF-12) and alcohol use-the Medicaid Waiver group had significantly fewer problems than the control group. In eight areas, the Waiver group demonstrated poorer outcomes than the control group. The Waiver group scored significantly lower on most measures of societal participation (measured by CHART), needed more help with IADLS (instrumental activities of daily living) and were less likely to be competitively employed. Additionally, Waiver recipients had significantly more case management, physical therapy and group home services and more second rehabilitation admissions than the control group. No significant differences were found for the remaining 62 outcomes that were evaluated. CONCLUSIONS: Although there were significant differences between the two groups in a few important areas, it is impossible to conclude that any outcome differences--or lack of differences---are attributable to the Waiver programme alone, since many important potential group differences could not be adequately controlled for by the design. Recommendations are offered for future research to address these limitations.