Models of brain injury vocational rehabilitation: The evidence for resource facilitation from efficacy to effectiveness

BACKGROUND: Resource Facilitation (RF) is an intervention developed to improve return to work (RTW) following brain injury. RF is an individualized treatment specializing in connecting patients and caregivers with community-based resources and services to mitigate barriers to return to work. OBJECTIVES: Examine the effectiveness of the RHI RF program for a clinical prospective cohort of participants referred to this program from the State Vocational Rehabilitation agency. METHODS: Participants were 243 participants with data drawn from the two sources: 33 from previous randomized controlled trial (RCT) control groups who did not receive RF and 210 from clinical patients discharged from the RHI RF program. RESULTS: At discharge from RF, a greater proportion of the treatment group obtained employment than the control group [X2 (1)  = 5.39, p = 0.018]. When controlling for baseline level of disability, treatment group significantly predicted employment outcome (Wald = 4.52, p = 0.033) and participants in the treatment group were 2.3 times more likely to return to work than controls. CONCLUSIONS: Previous RCTs have studied the RHI RF model and demonstrated significant efficacy. The findings from the present study are consistent with the employment rates found in the previous RCT's following RF, and also provide initial support for the clinical effectiveness of RF

Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014

Objective To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with TBI or stroke. Data Sources Online Pubmed and print journal searches identified citations for 250 articles published from 2009 through 2014. Study Selection 186 articles were selected for inclusion after initial screening. 50 articles were initially excluded (24 healthy, pediatric or other neurologic diagnoses, 10 non-cognitive interventions, 13 descriptive protocols or studies, 3 non-treatment studies). 15 articles were excluded after complete review (1 other neurologic diagnosis, 2 non-treatment studies, 1 qualitative study, 4 descriptive papers, 7 secondary analyses). 121 studies were fully reviewed. Data Extraction Articles were reviewed by CRTF members according to specific criteria for study design and quality, and classified as providing Class I, Class II, or Class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions). Data Synthesis Of 121 studies, 41 were rated as Class I, 3 as Class Ia, 14 as Class II, and 63 as Class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews. Conclusions CRTF has now evaluated 491 papers (109 Class I or Ia, 68 Class II, and 314 Class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines and 11 Practice Options). Evidence supports Practice Standards for attention deficits after TBI or stroke; visual scanning for neglect after right hemisphere stroke; compensatory strategies for mild memory deficits; language deficits after left hemisphere stroke; social communication deficits after TBI; metacognitive strategy training for deficits in executive functioning; and comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke

Type 3 Functional Response of Mice to Gypsy Moth Pupae: Is It Stabilizing?

We conducted field experiments in 2002 and 2003 to determine whether the functional response of white-footed mice (Peromyscus leucopus ) to gypsy moth (Lymantria dispar ) pupae is decelerating (e.g. type 2) or accelerating (e.g. type 3) at low pupal density. In both experiments, live gypsy moth pupae were deployed in June (prior to the appearance of natural pupae) at densities of approximately 1, 8, and 35 pupae per mouse home range in oak-forest grids in upstate New York and monitored over 10 days for signs of predation. Pupae were deployed 1.5-m high on tree boles in 2002, whereas in 2003 the three density treatments were crossed with a height treatment: ground level vs 1.5-m high. The relationship between daily predation rate (proportion of pupae eaten/day) and pupal density was significantly positive in both years, indicating an accelerating functional response. Daily predation rates on ground-level pupae were substantial in the lowest density treatment, suggesting that dense mouse populations could drive gypsy moths to extinction despite an accelerating functional response. Daily predation rates on elevated pupae increased over several days in the medium and high density treatments, suggesting a lagged shift from ground- to tree-level foraging by mice. Within the high-density treatments, predation rates on pupae showed no apparent relationship with the number of pupae on a tree. Our results disagree qualitatively with simple models of type 3 functional response, in which predation rate of prey approaches zero as prey approach extinction, and support the contention that an accelerating functional response alone may be insufficient to prevent prey extinction

Neuropsychological comparisons of normal, learning disabled and brain damaged children ages five through thirteen

This report is oriented at defining characteristics of children who have problems with school-related skills and abilities (Learning Disabled, N=17) as compared with Brain Damaged children (N=17) and Normals (N=17) as measured by selected measures of the Halstead-Reitan Neuropsychological Test Battery. Also, the Wechsler Intelligence Scale for Children (WISC) and the Wide Range Achievement Test (WRAT) were given to each subject. Subjects were matched for age, sex, and Full Scale Intelligence Quotient as measured by the WISC.It was found that Control children differed significantly on neuropsychological measures when compared to Brain Damaged children. There were no significant differences on the WISC or WRAT. The Learning Disabled children resembled the Brain Damaged children more than they resembled the Control children on several of the neuropsychological measures. No significant lateralized deficits on motor or sensory-motor tasks were found to differentiate between the HV-LP and the LV-HP groups with respect to consistent lateralized deficits on the motor, perceptualmotor, or sensory measures, although both groups were significantly poorer than Controls on some of the sensory measures, particularly perception. of numbers written on the fingertips.Thesis (M.A.

BEHAVIORAL DEFICIT IN VASCULAR DISEASE.

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Neuropsychological comparisons of normal, learning disabled and brain damaged children ages five through thirteen

This report is oriented at defining characteristics of children who have problems with school-related skills and abilities (Learning Disabled, N=17) as compared with Brain Damaged children (N=17) and Normals (N=17) as measured by selected measures of the Halstead-Reitan Neuropsychological Test Battery. Also, the Wechsler Intelligence Scale for Children (WISC) and the Wide Range Achievement Test (WRAT) were given to each subject. Subjects were matched for age, sex, and Full Scale Intelligence Quotient as measured by the WISC.It was found that Control children differed significantly on neuropsychological measures when compared to Brain Damaged children. There were no significant differences on the WISC or WRAT. The Learning Disabled children resembled the Brain Damaged children more than they resembled the Control children on several of the neuropsychological measures. No significant lateralized deficits on motor or sensory-motor tasks were found to differentiate between the HV-LP and the LV-HP groups with respect to consistent lateralized deficits on the motor, perceptualmotor, or sensory measures, although both groups were significantly poorer than Controls on some of the sensory measures, particularly perception. of numbers written on the fingertips.Thesis (M.A.

Mortality Secondary to Unintentional Poisoning after Inpatient Rehabilitation among Individuals with Moderate to Severe Traumatic Brain Injury

Studies have shown reduced life expectancy following moderate-severe traumatic brain injury (TBI) with death from unintentional poisoning (UP) being 11 times higher following TBI than in the general population. The characteristics of those who die of unintentional poisoning are compared with the characteristics of those who die of other causes (OC) in a retrospective cohort who received inpatient rehabilitation following TBI and enrolled in the TBI Model Systems National Database between 1989 and 2017 (n = 15,835 cases with 2,238 deaths recorded). Seventy-eight cases (3.5%) of deaths were the result of UP, 76% were the result of OC, and 20.5% were from an unknown cause. Among the UP deaths, 90% involved drugs (of these, 67% involved narcotic drugs and 14% involved psychostimulants), and 8% involved alcohol. Age-adjusted risk for UP death was associated with: white/non-Hispanic race/ethnicity, living alone, non-institutionalization, pre- and post-injury illicit drug use and alcohol/drug problem use, any alcohol use at last follow-up, better Functional Independence MeasureTM (FIM) scores, history of arrest, moderate disability (vs. severe disability or good recovery), less supervision needed, and greater anxiety. Adults who receive inpatient rehabilitation for TBI who die from UP are distinguishable from those who die of OC. Factors such as pre-injury substance use in the context of functional independence may be regarded as targets for prevention and/or intervention to reduce substance use and substance-related mortality among survivors of moderate-severe TBI. The current findings may have implications for medical care, surveillance, prevention, and health promotion