Symptoms and Engagement in Anti-social Behavior 10 Years After Mild Traumatic Brain Injury Within a Community Civilian Sample: A Prospective Cohort Study With Age-Sex Matched Control Group.

OBJECTIVE: To determine if there are longer-term effects on symptoms, health status, mood, and behavior 10 years after a mild traumatic brain injury (mTBI). DESIGN: Prospective cohort study. SETTING: Community-based, civilian sample. PARTICIPANTS: Adults aged ≥16 years at follow-up who experienced an mTBI 10 years ago, and an age and sex-matched non-injured control group. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: mTBI cases and controls were asked to complete self-report assessments of functioning (WHO Disability Assessment Schedule Version 2), symptoms (Rivermead Post-Concussion Symptom Questionnaire), health status (100-point scale), alcohol (Alcohol Use Disorders Identification Test) and substance use (Alcohol, Smoking and Substance Involvement Screening Test), and whether they had engaged in any anti-social behaviors over the past 12 months. RESULTS: Data were analyzed for 368 participants (184 mTBI cases and 184 age-sex matched controls). Just over a third of mTBI cases (64, 34.8%) reported that they were still affected by their index mTBI 10 years later. After adjusting for education and ethnicity, the mTBI group had statistically higher overall symptom burden (F=22.32, P<.001, ηp2=0.07) compared with controls. This difference remained after excluding those who experienced a recurrent TBI. The mTBI group were more than 3 times as likely to have engaged in anti-social behavior during the previous 12 months (F=5.89, P=.02). There were no group differences in health status, functioning, or problematic alcohol or substance use 10 years post-injury. CONCLUSIONS: This study provides evidence of potential longer-term associations between mTBI, post-concussion symptoms, and anti-social behavior which warrants further evaluation. Future research should also examine if longer-term effects may be preventable with access to early rehabilitation post-injury.

Executive function in individuals who are compliant and non-compliant with the conditions of a community-based sentence.

Executive function encompasses multiple processes (e.g. regulating emotions, managing behaviours, problem-solving) essential in daily living. A growing body of neuropsychological research shows a relationship between executive dysfunction and criminal behaviour. However, is executive functioning relevant to sentence management? We examined relationships between self-reported executive functioning and community supervision sentence compliance. Sixty-four individuals serving community-based supervision sentences completed the Behavior Rating Inventory of Executive Function-Adult Version, and their compliance data for six months were collected from probation officer notes. The sample's mean scores were significantly higher (i.e. poorer executive functioning) than those for the normative sample. Those who complied with sentence conditions had higher mean scores than those who were non-compliant. Subsequent exploratory analyses showed that those with poorer executive functioning received more probation officer support to comply with sentence conditions. Attention to responsivity issues like executive function problems may help avoid entrapping people in the criminal justice system.

The association between self-reported traumatic brain injury, neuropsychological function, and compliance among people serving community sentences.

BACKGROUND: Traumatic brain injury is overrepresented in incarcerated samples and has been linked to a number of poor correctional outcomes. Despite this, no research has explored the impact of a recent TBI on compliance outcomes for individuals serving community-based. METHOD: We screened for a history of TBI in 106 adults on community sentences and collected compliance (arrests, sentence violations) and related variables (e.g., risk scores, substance use) over 6 months. Sixty-four participants also completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Comprehensive Trail Making Test and Color-Word Inference Test. RESULTS: A TBI in the last year predicted a significantly higher likelihood of arrest, even when controlling for risk of reconviction and current substance use, but was not associated with non-compliance with sentence conditions nor with performance on the neuropsychological tests. In addition, no significant associations were found between performance on neuropsychological tests and measures of non-compliance. CONCLUSIONS: TBI in the last year was an independent predictor of arrest. This result suggests that those with a recent TBI on a community sentence may need additional monitoring or support to reduce the risk of reoffending.

Atypical symptom reporting after mild traumatic brain injury.

OBJECTIVE: Early reporting of atypical symptoms following a mild traumatic brain injury (mTBI) may be an early indicator of poor prognosis. This study aimed to determine the percentage of people reporting atypical symptoms 1-month post-mTBI and explore links to recovery 12 months later in a community-dwelling mTBI sample. METHODS: Adult participants (>16 years) who had experienced a mTBI were identified from a longitudinal incidence study (BIONIC). At 1-month post-injury, 260 participants completed the Rivermead Post-Concussion Symptoms Questionnaire (typical symptoms) plus four atypical symptom items (hemiplegia, difficulty swallowing, digestion problems and difficulties with fine motor tasks). At 12 months post-injury, 73.9% (n = 193) rated their overall recovery on a 100-point scale. An ordinal regression explored the association between atypical symptoms at 1 month and recovery at 12 months post-injury (low = 0-80, moderate = 81-99 and complete recovery = 100), whilst controlling for age, sex, rehabilitation received, ethnicity, mental and physical comorbidities and additional injuries sustained at the time of injury. RESULTS: At 1-month post-injury <1% of participants reported hemiplegia, 5.4% difficulty swallowing, 10% digestion problems and 15.4% difficulties with fine motor tasks. The ordinal regression model revealed atypical symptoms were not significant predictors of self-rated recovery at 12 months. Older age at injury and higher typical symptoms at 1 month were independently associated with poorer recovery at 12 months, p < 0.01. CONCLUSION: Atypical symptoms on initial presentation were not linked to global self-reported recovery at 12 months. Age at injury and typical symptoms are stronger early indicators of longer-term prognosis. Further research is needed to determine if atypical symptoms predict other outcomes following mTBI.

Sex differences in outcomes from mild traumatic brain injury eight years post-injury.

The long-term effects of mild TBI (mTBI) are not well understood, and there is an ongoing debate about whether there are sex differences in outcomes following mTBI. This study examined i) symptom burden and functional outcomes at 8-years post-injury in males and females following mTBI; ii) sex differences in outcomes at 8-years post-injury for those aged <45 years and ≥45 years and; iii) sex differences in outcomes for single and repetitive TBI. Adults (≥16 years at injury) identified as part of a population-based TBI incidence study (BIONIC) who experienced mTBI 8-years ago (N = 151) and a TBI-free sample (N = 151) completed self-report measures of symptoms and symptom burden (Rivermead Post-Concussion Symptom Questionnaire, Hospital Anxiety and Depression Scale, Post-traumatic Stress Disorder Checklist), and functional outcomes (Participation Assessments with Recombined Tools, Work Limitations Questionnaire). The mTBI group reported significantly greater post-concussion symptoms compared to the TBI-free group (F(1,298) = 26.84, p<.01, ηp2 = .08). Females with mTBI were twice as likely to exceed clinical cut-offs for post-concussive (X2 (1)>5.2, p<.05, V>.19) and PTSD symptoms (X2(1) = 6.10, p = .014, V = .20) compared to the other groups, and reported their health had the greatest impact on time-related work demands (F(1,171) = 4.36, p = .04, ηp2 = .03. There was no interaction between sex and age on outcomes. The repetitive mTBI group reported significantly greater post-concussion symptoms (F(1,147) = 9.80, p<.01, ηp2 = .06) compared to the single mTBI group. Twice the proportion of women with repetitive mTBI exceeded the clinical cut-offs for post-concussive (X2(1)>6.90, p<.01, V>.30), anxiety (X2(1)>3.95, p<.05, V>.23) and PTSD symptoms (X2(1)>5.11, p<.02, V>.26) compared with males with repetitive TBI or women with single TBI. Thus, at 8-years post-mTBI, people continued to report a high symptom burden. Women with mTBI, particularly those with a history of repetitive mTBI, had the greatest symptom burden and were most likely to have symptoms of clinical significance. When treating mTBI it is important to assess TBI history, particularly in women. This may help identify those at greatest risk of poor long-term outcomes to direct early treatment and intervention.

The role of prior sleep for divergent thinking in infants.

Higher-order cognitive functions seem particularly vulnerable to disruptions in prior sleep in school-aged children and adult populations. This study tested whether divergent thinking in infants varied as a function of prior sleep. Forty-three infants aged 13-16 months participated in a behavioural assessment of divergent thinking. Length of wakefulness since last sleep was experimentally manipulated. In addition, potential relations between divergent thinking and sleep quantity and quality during the night immediately before the assessment, as well as during three consecutive nights preceding the assessment, were examined using actigraphy recordings in combination with parent diaries. Divergent thinking was not impaired by lack of sleep within the previous 4 h. Divergent thinking was consistently related to night-time sleep quality and quantity prior to the assessment. These results suggest that timing of prior naturally occurring daytime sleep is less relevant for emergent divergent thinking capacity than quality and quantity of preceding night-time sleep.

Parent and Teacher-Reported Child Outcomes Seven Years After Mild Traumatic Brain Injury: A Nested Case Control Study.

Background: Increasing evidence suggests potential lifetime effects following mild traumatic brain injury (TBI) in childhood. Few studies have examined medium-term outcomes among hospitalized and non-hospitalized samples. Study aims were to describe children's behavioral and emotional adjustment, executive function (EF), quality of life, and participation at 7-years following mild TBI using parents' and teachers' reports. Methods: Nested case control study of 86 children (68% male, mean age at assessment = 11.27 years; range 7-17 years) who sustained a mild TBI 7-years previously, identified from a prospective, population-based study. They were compared to 69 children free from TBI (61% male, mean age at assessment = 11.12 years; range 5-17 years). In addition to parent-reported socio-demographic details, parents (mild TBI n = 86, non-TBI n = 69) completed age-appropriate standardized questionnaires about children's health-related quality of life, behavioral and emotional adjustment, EF, and social participation. Parents own mood was assessed using the Hospital Anxiety and Depression Scale. Teachers (mild TBI n = 53, non-TBI n = 42) completed questionnaires about children's behavioral and emotional adjustment, and EF. Results: Parent reports showed median group-level scores for cases were statistically significantly greater than controls for emotional symptoms, conduct problems, hyperactivity/inattention, total behavioral difficulties, inhibitory control, shifting, planning/organizing, and Global Executive Composite (total) EF difficulties (p-values 0.001-0.029). Parent reports of child quality of life and social participation were similar, as were teacher reports of child behavioral and emotional adjustment, and EF (p > 0.05). When examining clinical cut-offs, compared to controls, cases had a higher risk of parent-reported total EF difficulties (odds ratio = 3.00) and, to a lesser extent, total behavior problems (odds ratio = 2.51). Conclusions: As a group, children with a history of mild TBI may be at elevated risk for clinically significant everyday EF difficulties in the medium-term compared to non-TBI controls, as judged by their parents. Further multi-informant longitudinal research is required, following larger samples. Aspects requiring particular attention include pre-injury characteristics, such as sleep disturbances and comorbidities (e.g., headaches), that may act as potential confounders influencing the association between mild TBI and child behavioral problems.

Psychosocial functioning at 4-years after pediatric mild traumatic brain injury.

Objective: Behavioral and emotional difficulties are reported following pediatric mild traumatic brain injury (TBI). But few studies have used a broad conceptual approach to examine children's long-term psychosocial outcomes. This study examines children's psychosocial outcomes at 4-years after mild TBI and associated factors.Methods: Parents of 93 children (<16 years) with mild TBI completed subscales of age-appropriate versions of the Strengths and Difficulties Questionnaire, the Behavior Rating Inventory of Executive Function, the Pediatric Quality of Life Inventory, and the Adolescent Scale of Participation questionnaire at 4-years post-injury.Results: Mean group-level scores were statistically significantly higher for hyperactivity/inattention and lower for emotional functioning than published norms. Levels of participation were greater compared to those observed in normative samples. More than 19% met published criteria for clinically significant hyperactivity/inattention, emotional functioning problems, peer relationship problems, and social functioning difficulties. Lower family socio-economic status and greater parental anxiety and depression were associated with overall psychosocial difficulties.Conclusions: Findings indicate that as a group, children with mild TBI are characterized by elevated rates of behavioral, emotional, and social difficulties at 4-years post-injury. Parent mental health may be an untapped opportunity to support children's psychosocial development following mild TBI, with replication required in larger samples.

Clinician knowledge of driving restrictions following a stroke event.

AIM: To investigate the knowledge and practice of health professionals when advising persons on driving restrictions after a transient ischaemic attack (TIA) or stroke in a tertiary hospital in New Zealand. METHODS: Health professionals working in the area of stroke care across the acute and rehabilitation services in a large tertiary hospital were invited to complete an electronic survey around knowledge of driving restrictions based on the New Zealand Transport Agency (NZTA) guidelines. Knowledge was assessed for both private and commercial vehicle use. The other information gathered included participant profession, level of seniority and experience working in stroke care, previous education around medical-related driving restrictions and how and what driving recommendations were discussed with patients. Knowledge of driving restrictions was established by the number and percentage of correct responses for each condition (single TIA, multiple TIA and stroke with full recovery) relating to the recommended restrictions in both private and commercial vehicle use. RESULTS: Forty-nine participants' surveys were analysed with representation from across all the health professions (24.5% [12/49] doctors, 38.8% [19/49] nurses and 36.7% [18/49] allied health). Only 38.8% reported having had received training around post-stroke driving restrictions. Knowledge around driving restrictions was highest for a single episode TIA for private vehicle use (73.5% [36/49]). For all other categories, fewer than 50% of participants answered correctly, with knowledge of commercial vehicle restrictions being the least accurate. CONCLUSIONS: Many health professionals have discussions with people about driving restrictions following a TIA or stroke. However, there appears to be limited knowledge of all the restrictions for each condition as they relate to either private or commercial vehicle use. Insufficient training and education for clinicians might explain this gap.

Co-driving: Passenger actions and distractions.

Approximately one third of car trips involve one or more passengers and yet we know little about how the presence of a passenger helps or hinders safety and efficiency. To date, research in this area has focused on the possible distractive effects of passengers. Although we know that drivers conversing on a mobile phone is distracting and unsafe, epidemiological studies suggest that driving with a passenger has a lower crash risk than driving alone. This paper describes two studies into how drivers and passengers interact during a journey; a survey regarding the most common actions of passengers and how drivers view their helpfulness, and an on-road study of driver and passenger interactions. The results indicated several areas that drivers felt passenger assistance was quite helpful, but in some cases was exhibited very rarely. The on-road study revealed some interesting gender differences in who offers driving support, and who requests it. By understanding how passengers can contribute to safer journeys we can provide that information to drivers at risk, such as those very early or late in their driving careers.

The role of control in risk perception on rural roads.

Risk perception plays an important role in driver behaviour, particularly for speed choice. Risk perception studies use a range of techniques from on-road data collection to ratings of still photos, however participants' ratings differ depending on the study methodology, possibly due to their perception of control. To explore this we conducted a multiple methods study to investigate drivers' perceptions of risk on rural roads. One group of participants drove (Drivers, n = 13) a 180 km route along rural roads (accompanied by a research assistant) and provided verbal risk ratings at thirteen locations of interest. A second group (Passengers, n = 10) provided ratings at the same points when travelling as a passenger in a vehicle (driven by a research assistant). The third group (Observers, n = 14) were shown videos of the same rural roads (filmed from the drivers' perspective) and also provided risk ratings at the same locations. A week later participants were invited to the laboratory to review the video footage and comment on factors that contributed to the risk ratings. Overall, the Observers gave the highest risk ratings and Drivers the lowest. The Observers also provided twice the number of comments to justify their risk rating compared to the other two groups. The results suggest that control, and on-road experience play a significant role in how perceptions of driving risk are formed and the degree of risk experienced. These findings also bring into question the accuracy of using video-based tasks to assess drivers' risk perception (and speed choice), particularly if the findings are used to inform on-road safety interventions.

Incidence of Sports-Related Traumatic Brain Injury of All Severities: A Systematic Review.

INTRODUCTION: Whilst there are many benefits to participating in sports and recreational activities, there is also a risk of injury including sports-related traumatic brain injury -(SR-TBI). To inform injury prevention initiatives, it is important to explore the burden of SR-TBI at the population level. This review aimed to estimate the incidence of SR-TBI in the general population across injury severities. METHODS: Systematic search of electronic databases using keywords from 1965 until June 2019 facilitated by hand searches of reference lists. Original research reporting on the incidence of SR-TBI, capturing people of all ages in a well-defined population area was included. Studies were excluded if they focused on a specific sport(s) or population group. All studies were required to be published in the English language. Quality of studies was determined as poor, moderate or good based on the standards of reporting of neurological disorders criteria. Data on year(s) of data collection, diagnostic criterion, case ascertainment sources, population denominator and incidence per 100,000 and by age, sex, injury severity and sport were extracted by 2 authors independently using a standard data extraction form. RESULTS: Following review of 11 studies meeting the inclusion criteria, the incidence of SR-TBI within hospital-based studies ranged between 3.5 and 31.5 per 100,000. One community-based study using multiple case ascertainment sources identified a higher incidence of 170 per 100,000. SR-TBI accounted for 1.2-30.3% of all TBIs. One study provided incidence data across a 5-year period suggesting an increasing trend in incidence over time. Males were more at risk than females (66.1-75.6%), and adolescents and young adults had the highest incidence of SR-TBI. CONCLUSION: The primary objective of this review was to provide a summary of descriptive data on SR-TBI epidemiology at the population level. SR-TBI represented up to one-third of all causes of TBI. Trends in incidence by age and sport were challenging to determine due to lack of consistency in reporting as well as the small number of studies overall. Undertaking injury surveillance at all levels of TBI will assist with understanding the nature, mechanism of and surrounding events where injuries occur in sport.

Driving With ADHD: Performance Effects and Environment Demand in Traffic.

Objective: This research investigated the on-road driving performance of individuals with ADHD across a range of road and traffic conditions to determine whether errors were linked to situational complexity and attentional demands. Method: The everyday driving performance of medicated drivers with ADHD, unmedicated drivers with ADHD, and controls was tested in urban, residential, rural, and highway environments using driver license testing procedures. Results: Unmedicated drivers with ADHD displayed fewer safe driving skills and committed more inattentive and impatient driving errors, particularly in low demand highway and rural driving conditions. Medicated drivers' performance was not reliably different than controls. Participants in both ADHD groups were more likely than controls to report risky driving and involvement in crashes. Conclusion: The results demonstrate that situations with low attentional demand are particularly risky for unmedicated ADHD drivers and suggest that focus on these situations may be useful in improving driving outcomes for this population.

The association between health-related quality of life and noise or light sensitivity in survivors of a mild traumatic brain injury.

PURPOSE: Sensory impairment is a common aftereffect of mild traumatic brain injury (TBI); however, their influence upon treatment outcomes and quality of life has yet to be investigated. This study sought to determine the effects of noise and light sensitivity upon the quality of life of individuals diagnosed with a TBI. METHODS: A cross-sectional adult sample obtained from a longitudinal study (n = 293) provided measures of light and noise sensitivity and quality of life 12 months post injury. Sensitivities were taken from the Rivermead Post-concussion Symptoms Questionnaire, while quality of life was estimated using the Short-Form 36 health survey (SF-36). RESULTS: Approximately 42% of participants reported ongoing difficulties with noise and light sensitivity. Additionally, those reporting sensory difficulties also reported lower SF-36 domain and composite scores compared to those reporting no such symptoms. After controlling for known co-factors, hierarchical multiple regression analyses indicated that the combination of light and noise sensitivity explained between 8 and 35% of the variance in SF-36 scores. CONCLUSIONS: Light and noise sensitivity appear to degrade the quality of life of those with a mild TBI. Our findings challenge contemporary rehabilitation practices that tend to sideline sensory complaints and instead focus on the remediation of acute TBI symptoms.

Incidence of stroke and traumatic brain injury in New Zealand: contrasting the BIONIC and ARCOS-IV studies.

AIMS: Traumatic Brain Injury (TBI) and stroke are the main causes of acquired brain injury. The differences in demographic profiles of stroke and TBI suggest that high-quality epidemiological studies of the two be compared. This study examined incidence of stroke and TBI by age and ethnicity in New Zealand. METHODS: Incidence rates are presented by age and ethnicity from two New Zealand population-based epidemiological studies (Brain Injury Outcomes New Zealand In the Community (BIONIC); and Auckland Regional Outcomes of Stroke Studies (ARCOS-IV)). RESULTS: Males and females had similar stroke risk, while males had 2x relative risk of mild TBI and 3x the relative risk of moderate/severe TBI compared to females. More TBI cases (35.6%) were identified through non-medical sources compared to stroke (3%). Incidence of TBI was greater than 5 times that of stroke. New Zealand European/Pakeha had the highest TBI incidence when less than 5 years of age, while Maori had the highest incidence after five years of age. For stroke, Pacific people and Maori had higher incidences until 75-84 years, after which Europeans had higher incidence. CONCLUSIONS: Differences in TBI and stroke incidence suggest targeting prevention very differently for the two groups. Incidence profiles suggest TBI is much more common; and a need to target males and those of Maori ethnicity for TBI prevention.

Longitudinal patterns of behavior, cognition, and quality of life after mild traumatic brain injury in children: BIONIC study findings.

Background: Research following mild traumatic brain injury (mTBI) during childhood predominantly examines recovery up to 12 months post-injury. Objectives: To determine children's longer-term (4 years) patterns and predictors of recovery. Methods: Parents of 196 children (aged 1-15 years) completed the Behaviour Assessment System for Children and Pediatric Quality of Life Inventory at baseline, 1, 6, 12, and 48 months post-injury. Children aged ≥8 years at each assessment completed a computerized neurocognitive testing battery. At 1 month, parents completed the Hospital Anxiety and Depression Scale. Multilevel modeling accounted for repeated measures. Results: Children had significantly fewer child behavior problems, better adaptability, and improved quality of life after 12 months. Concurrent improvements in overall neurocognitive function were no longer significant once adjusted for age, gender, and socio-economic status. From 12 to 48 months, quality of life reduced significantly while child behavior and neurocognition plateaued. Child behavior problems and worse quality of life were associated with parental anxiety and lower socio-economic status. Conclusions: Children's recovery in the year following mTBI appears to plateau from 12 to 48 months, with a concomitant reduction in quality of life. Identification and treatment of parent mental health issues may reduce the exacerbation of negative child outcomes following mTBI.

Social cognition four years after mild-TBI: An age-matched prospective longitudinal cohort study.

OBJECTIVE: To assess longer-term social cognition after mild traumatic brain injury (mTBI) and to identify the sociodemographic and acute factors (mood, cognitive functioning, and symptoms) influencing social cognition. METHOD: Data were extracted for 121 adults who experienced a mTBI and completed the Emotion Evaluation and Social Inference Enriched tests of The Awareness of Social Inference Test (TASIT) 4 years postinjury. To identify early indicators of outcome, responses to the Hospital Anxiety and Depression Scale, Rivermead Post-Concussion Symptom Questionnaire, and CNS Vital Signs neurocognitive assessment conducted 1 month postinjury were also extracted. Social cognition scores were compared to age-matched TASIT norms (N = 121). RESULTS: The mTBI group was significantly less able to interpret what people say and intend than norms, although the effect sizes were small (d = 0.43). There were 24.8% of people 4 years postmTBI and 9.9% of norms who experienced at least mild impairment in social inference. There were no significant differences between the mTBI group and norms for emotion evaluation. Poorer social inference 4 years after mTBI was significantly associated with lower cognitive flexibility and executive function (F = 2.57, df = 13,26, p = .02). Group differences remained after controlling for cognitive functioning (F = 104.59 df = 1,58, p = .001. CONCLUSIONS: These novel results suggest that adults postmTBI may experience social inference difficulties 4 years post-TBI that are not completely explained by cognitive difficulties. Further research is needed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Long-term factor structure of the Rivermead Post-Concussion Symptom Questionnaire in mild traumatic brain injury and normative sample.

BACKGROUND: Previous studies of the Rivermead Post-Concussive Questionnaire(RPQ)'s factor structure were conducted within 1 year post-injury. Post-concussive symptoms may persist, and are common in the general population, so determining if the factor structure in mild-TBI and controls differ is important. This study examined factor structure of the RPQ in adults 4 years post-mild-TBI and in age-/gender-matched controls. METHOD: A total of 232 adults 4 years post-mild-TBI and 232 age-/gender-matched controls completed the RPQ. RESULTS: Both samples produced a three-factor solution (57.98% and 56.44% of variance in the RPQ). Factor 1 for both samples included all RPQ items and accounted for the majority of variance explained (42.6% and 40.7%). After mild-TBI factor 2 included dizziness, vomiting/nausea, irritability, and double vision; whilst in controls it involved headache, dizziness, vomiting/nausea, and slowed thinking. Factor 3 for mild-TBI included vomiting/nausea, blurred vision, slowed thinking, and poor memory; while for controls it was restricted to visual symptoms (blurred vision, light sensitivity, double vision). CONCLUSION: The RPQ factor structure was similar for both groups, although differences were identified in lesser factors. This suggests those with mild-TBI differ minimally from matched controls in the very long term after injury.

Unmoving and unmoved: experiences and consequences of impaired non-verbal expressivity in Parkinson's patients and their spouses.

Purpose: Hypomimia, or facial masking, is a decrease in voluntary control and spontaneous movement of the muscles of the face, which may occur in Parkinson's disease. Little is known about the psychosocial consequences or management of this symptom. The aim of this study was to provide an initial overview of patient & spousal experiences of living with an acquired nonverbal expressive impairment in Parkinson's disease. Method: This qualitative study involved a community sample of individuals with Parkinson's who experienced facial masking, and their close romantic partners. Nine people who had Parkinson's and nine of their spouses or partners participated in separate (individual) semi-structured interviews. Results: A descriptive thematic approach was used to analyze the interview data. Key themes relevant to rehabilitation included the misidentification of masking as negative affect, poor symptom recognition, and unmet health resource needs. Conclusions: The results indicate masking can have an adverse impact on close relationships and psychological well-being. This study presents an initial basis for clinicians working with Parkinson's populations to recognize of the needs of people who experience masking and better support such individuals and their families to live satisfying social and emotional lives. Implications for Rehabilitation People who have Parkinson's and their families are often unaware facial masking is a symptom of Parkinson's disease. Masking may be confused with negative affect and become a barrier to satisfying close relationships. Masking related health resources and support are perceived to be of poor availability and quality. This qualitative study suggests masking be considered as an etiology of interpersonal and psychological difficulties in Parkinson's disease, and encourages better recognition of this unique population's health education needs.

Mind wandering during everyday driving: An on-road study.

This study was an investigation into mind wandering during everyday driving, and its association with crash patterns. We selected a 25 km route on urban roads for analysis of crashes, and an on-road study of mind wandering by a sample of drivers familiar with the route. We analysed reported crashes on the route over a five year period from New Zealand's crash database. For the on-road study a researcher accompanied 25 drivers on the route, asking them what they were thinking about at 15 predetermined road sections. The road sections were selected to include a range of different speed limits and traffic volumes as well as roundabouts, priority intersections and midblocks. Thought samples were categorised as either mind wandering or driving focus, and triggered by the senses, or internally. The frequencies of mind wandering at different road sections on the route were compared to the frequencies of reported crashes along the same route over the preceding five years. Results showed that although all drivers reported mind wandering, it was more likely to be reported at slower, quieter, less complex road sections. Overall, more crashes were reported at priority intersections and midblocks than at roundabouts, but the crash rate (per road section) was higher at roundabouts, where mind wandering was least likely to be reported. These findings suggest that although drivers' minds wander constantly, driving focus is commanded in demanding situations and in response to the actions of other road users. While mind wandering is ubiquitous, drivers are least likely to report mind wandering at locations showing the highest crash rates. More work is needed to test these findings and to provide direction for road safety interventions.