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Item Dietary intake and adherence to the 2010 Dietary Guidelines for Americans among individuals with chronic spinal cord injury: a pilot study(Maney Publishing, 2014-11) Lieberman, Jesse; Goff, David; Hammond, Flora; Schreiner, Pamela; Norton, H. James; Dulin, Michael; Zhou, Xia; Steffen, Lyn; Department of Physical Medicine and Rehabilitation, IU School of MedicineOBJECTIVE: To investigate dietary intake and adherence to the 2010 Dietary Guidelines for Americans in individuals with chronic spinal cord injury (SCI) and able-bodied individuals. DESIGN: A pilot study of dietary intake among a sample of individuals with SCI >1 year ago from a single site compared with able-bodied individuals. PARTICIPANTS/METHODS: One hundred black or white adults aged 38-55 years old with SCI >1 year and 100 age-, sex-, and race-matched adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary intake was assessed by the CARDIA dietary history. Linear regression analysis was used to compare dietary intake between the subjects with SCI and those enrolled in the CARDIA study. Further, adherence to the 2010 Dietary Guidelines for dairy, fruits, and vegetables, and whole-grain foods was assessed. RESULTS: Compared with CARDIA participants, participants with SCI consumed fewer daily servings of dairy (2.10 vs. 5.0, P < 0.001), fruit (2.01 vs. 3.64, P = 0.002), and whole grain foods (1.20 vs. 2.44 P = 0.007). For each food group, fewer participants with SCI met the recommended servings compared with the CARDIA participants. Specifically, the participants with SCI and in CARDIA who met the guidelines were, respectively: dairy, 22% vs. 54% (P < 0.001), fruits and vegetables 39% vs. 70% (P = 0.001), and whole-grain foods 8% vs. 69.6% (P = 0.001). CONCLUSIONS: Compared with able-bodied individuals, SCI participants consumed fewer daily servings of fruit, dairy, and whole grain foods than proposed by the 2010 Dietary Guideline recommendations. Nutrition education for this population may be warranted.Item Erratum to: PRISM II: an open-label study to assess effectiveness of dextromethorphan/quinidine for pseudobulbar affect in patients with dementia, stroke or traumatic brain injury(BioMed Central, 2016-09-02) Hammond, Flora M.; Alexander, David N.; Cutler, Andrew J.; D’Amico, Stephen; Doody, Rachelle S.; Sauve, William; Zorowitz, Richard D.; Davis, Charles S.; Shin, Paul; Ledon, Fred; Yonan, Charles; Formella, Andrea E.; Siffert, Joao; Department of Physical Medicine and Rehabilitation, IU School of MedicineItem Exploration of a new tool for assessing emotional inferencing after traumatic brain injury(Taylor and Francis, 2015-05) Zupan, Barbra; Neumann, Dawn; Babbage, Duncan R.; Willer, Barry; Department of Physical Medicine and Rehabilitation, IU School of Medicinebjective: To explore validity of an assessment tool under development—the Emotional Inferencing from Stories Test (EIST). This measure is being designed to assess the ability of people with traumatic brain injury (TBI) to make inferences about the emotional state of others solely from contextual cues. Methods and procedures: Study 1: 25 stories were presented to 40 healthy young adults. From this data, two versions of the EIST (EIST-1; EIST-2) were created. Study 2: Each version was administered to a group of participants with moderate-to-severe TBI—EIST 1 group: 77 participants; EIST-2 group: 126 participants. Participants also completed a facial affect recognition (DANVA2-AF) test. Participants with facial affect recognition impairment returned 2 weeks later and were re-administered both tests. Main outcomes: Participants with TBI scored significantly lower than the healthy group mean for EIST-1, F(1,114) = 68.49, p < 0.001, and EIST-2, F(1,163) = 177.39, p < 0.001. EIST scores in the EIST-2 group were significantly lower than the EIST-1 group, t = 4.47, p < 0.001. DANVA2-AF scores significantly correlated with EIST scores, EIST-1: r = 0.50, p < 0.001; EIST-2: r = 0.31, p < 0.001. Test–re-test reliability scores for the EIST were adequate. Conclusions: Both versions of the EIST were found to be sensitive to deficits in emotional inferencing. After further development, the EIST may provide clinicians valuable information for intervention planning.Item Factors associated with remission of post-traumatic brain injury fatigue in the years following traumatic brain injury (TBI): a TBI model systems module study(Taylor & Francis, 2016) Lequerica, Anthony; Botticello, Amanda L.; Lengenfelder, Jean; Chiaravalloti, Nancy; Bushnik, Tamara; Dijkers, Marcel P.; Hammond, Flora M.; Kolakowsky-Hayner, Stephanie A.; Rosenthal, Joseph; Department of Physical Medicine and Rehabilitation, IU School of MedicinePost-traumatic brain injury fatigue (PTBIF) is a major problem in the years after traumatic brain injury (TBI), yet little is known about its persistence and resolution. The objective of the study was to identify factors related to PTBIF remission and resolution. TBI Model System registrants at five centres participated in interviews at either one and two years post-injury (Y1-2 Cohort), or two and five years post-injury (Y2-5 Cohort). Characteristics of participants with PTBIF remission were compared to those with PTBIF persistence. Variables studied included the presence of and changes in disability, sleep dysfunction, mood, and community participation. The Functional Independence Measure did not differ significantly between groups or over time. In the Y1-2 Cohort the Fatigue Resolved group scored significantly better on the Disability Rating Scale and Pittsburgh Sleep Quality Index. In the Y2-5 Cohort the Fatigue Resolved group scored significantly higher on a measure of community participation. It was concluded that fewer than half of the sample in each cohort experienced a remission of PTBIF between time points. Persistence of PTBIF 1–2 years post-injury is associated with disability, sleep disturbance, and depression while persistence of fatigue beyond 2 years post-injury appears to be related to participation level, underscoring the potential impact of effective surveillance, assessment, and treatment of this condition in optimising life after TBI. Differences in fatigue progression may point to the presence of different types of PTBIF.Item Long-term survival after traumatic brain injury: a population-based analysis controlled for nonhead trauma(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2014-01) Brown, Allen W.; Leibson, Cynthia L.; Mandrekar, Jay; Ransom, Jeanine E.; Malec, James F.; Department of Physical Medicine and Rehabilitation, IU School of MedicineOBJECTIVE: To examine the contribution of co-occurring nonhead injuries to hazard of death after traumatic brain injury (TBI). PARTICIPANTS: A random sample of Olmsted County, Minnesota, residents with confirmed TBI from 1987 through 1999 was identified. DESIGN: Each case was assigned an age- and sex-matched, non-TBI "regular control" from the population. For "special cases" with accompanying nonhead injuries, 2 matched "special controls" with nonhead injuries of similar severity were assigned. MEASURES: Vital status was followed from baseline (ie, injury date for cases, comparable dates for controls) through 2008. Cases were compared first with regular controls and second with regular or special controls, depending on case type. RESULTS: In total, 1257 cases were identified (including 221 special cases). For both cases versus regular controls and cases versus regular or special controls, the hazard ratio was increased from baseline to 6 months (10.82 [2.86-40.89] and 7.13 [3.10-16.39], respectively) and from baseline through study end (2.92 [1.74-4.91] and 1.48 [1.09-2.02], respectively). Among 6-month survivors, the hazard ratio was increased for cases versus regular controls (1.43 [1.06-2.15]) but not for cases versus regular or special controls (1.05 [0.80-1.38]). CONCLUSIONS: Among 6-month survivors, accounting for nonhead injuries resulted in a nonsignificant effect of TBI on long-term mortality.Item Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study(Liebert, 2015-12) Greenwald, Brian D.; Hammond, Flora M.; Harrison-Felix, Cynthia; Nakase-Richardson, Risa; Howe, Laura L. S.; Kreider, Scott; Department of Physical Medicine and Rehabilitation, IU School of MedicineSevere traumatic brain injury (TBI) has been associated with increased mortality. This study characterizes long-term mortality, life expectancy, causes of death, and risk factors for death among patients admitted within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS) who lack command following at the time of admission for inpatient TBI rehabilitation. Of the 8084 persons enrolled from 1988 and 2009, 387 from 20 centers met study criteria. Individuals with moderate to severe TBI who received inpatient rehabilitation were 2.2 times more likely to die than individuals in the U.S. general population of similar age, gender, and race, with an average life expectancy (LE) reduction of 6.6 years. The subset of individuals who were unable to follow commands on admission to rehabilitation was 6.9 times more likely to die, with an average LE reduction of 12.2 years. Relative to the U.S. general population matched for age, gender, and race/ethnicity, these non–command following individuals were more than four times more likely to die of circulatory conditions, 44 times more likely to die of pneumonia, and 38 times more likely to die of aspiration pneumonia. The subset of individuals with TBI who are unable to follow commands upon admission to inpatient rehabilitation are at a significantly increased risk of death when compared with the U.S. general population and compared with all individuals with moderate to severe TBI receiving inpatient rehabilitation. Respiratory causes of death predominate, compared with the general population.Item Neurobiological mechanisms associated with facial affect recognition deficits after traumatic brain injury(Springer, 2015-06) Neumann, Dawn; McDonald, Brenna C.; West, John; Keiski, Michelle A.; Wang, Yang; Department of Physical Medicine and Rehabilitation, IU School of MedicineThe neurobiological mechanisms that underlie facial affect recognition deficits after traumatic brain injury (TBI) have not yet been identified. Using functional magnetic resonance imaging (fMRI), study aims were to 1) determine if there are differences in brain activation during facial affect processing in people with TBI who have facial affect recognition impairments (TBI-I) relative to people with TBI and healthy controls who do not have facial affect recognition impairments (TBI-N and HC, respectively); and 2) identify relationships between neural activity and facial affect recognition performance. A facial affect recognition screening task performed outside the scanner was used to determine group classification; TBI patients who performed greater than one standard deviation below normal performance scores were classified as TBI-I, while TBI patients with normal scores were classified as TBI-N. An fMRI facial recognition paradigm was then performed within the 3T environment. Results from 35 participants are reported (TBI-I = 11, TBI-N = 12, and HC = 12). For the fMRI task, TBI-I and TBI-N groups scored significantly lower than the HC group. Blood oxygenation level-dependent (BOLD) signals for facial affect recognition compared to a baseline condition of viewing a scrambled face, revealed lower neural activation in the right fusiform gyrus (FG) in the TBI-I group than the HC group. Right fusiform gyrus activity correlated with accuracy on the facial affect recognition tasks (both within and outside the scanner). Decreased FG activity suggests facial affect recognition deficits after TBI may be the result of impaired holistic face processing. Future directions and clinical implications are discussed.Item Perspective training to treat anger problems after brain injury: Two case studies(IOS, 2016-07) Winegardner, Jill; Keohane, Clare; Prince, Leyla; Neumann, Dawn; Department of Physical Medicine and Rehabilitation, IU School of MedicineBACKGROUND: People with acquired brain injury (ABI) often show increased anger and aggression. Anger has been linked to attributions of hostile intent. The more intentional and hostile the judgments of other’s behaviours are, the angrier the responses tend to be. Some people with ABI tend to make harsher attributions than healthy controls (negative attribution bias). Poor perspective-taking may distort assessment of others’ intentions, thereby contributing to this bias and subsequent anger responses. OBJECTIVE: Examine changes in anger and perspective-taking after a Perspectives Group in two participants with ABI. METHODS: This study is a case report exploring observational changes in anger, hostility, verbal and physical aggression and perspective-taking in two males with ABI and severe emotion dysregulation. Participants and their spouses also provided qualitative feedback through a semi-structured interview following perspectives training. The six-week “Perspectives Group” used hypothetical and real-life situations to teach participants to consider the perspectives of others when determining their intentions. RESULTS: Both participants showed post-treatment declines in aggression. Although only minimal changes occurred on the perspective-taking measure, spouses described important behavioural changes in their partners that indicated both decreased aggression and better perspective taking. CONCLUSIONS: These preliminary findings support further investigation of perspectives training for reducing anger after ABI.Item Preliminary Evaluation of a Measure for Reliable Assessment of Need for Constant Visual Observation in Adults with Traumatic Brain Injury(Taylor & Francis, 2016) Moessner, Anne; Malec, James F.; Beveridge, Scott; Reddy, Cara Camiolo; Huffman, Tracy; Marton, Julia; Department of Physical Medicine and Rehabilitation, IU School of MedicinePrimary objective: To develop and provide initial validation of a measure for accurately determining the need for Constant Visual Observation (CVO) in patients with traumatic brain injury (TBI) admitted to inpatient rehabilitation. Research design: Rating scale development and evaluation through Rasch analysis and assessment of concurrent validity. Methods and procedures: One hundred and thirty-four individuals with moderate–severe TBI were studied in seven inpatient brain rehabilitation units associated with the National Institute for Disability, Independent Living and Rehabilitation Research (NIDILRR) TBI Model System. Participants were rated on the preliminary version of the CVO Needs Assessment scale (CVONA) and, by independent raters, on the Levels of Risk (LoR) and Supervision Rating Scale (SRS) at four time points during inpatient rehabilitation: admission, Days 2–3, Days 5–6 and Days 8–9. Outcomes and results: After pruning misfitting items, the CVONA showed satisfactory internal consistency (Person Reliability = 0.85–0.88) across time points. With reference to the LoR and SRS, low false negative rates (sensitivity > 90%) were associated with moderate-to-high false positive rates (29–56%). Conclusions: The CVONA may be a useful objective metric to complement clinical judgement regarding the need for CVO; however, further prospective study is desirable to further assess its utility in identifying at-risk patients, reducing adverse events and decreasing CVO costs.Item Prevalence of suicidal behaviour following traumatic brain injury: Longitudinal follow-up data from the NIDRR Traumatic Brain Injury Model Systems(Taylor & Francis, 2016) Fisher, Lauren B.; Pedrelli, Paola; Iverson, Grant L.; Bergquist, Thomas F.; Bombardier, Charles H.; Hammond, Flora M.; Hart, Tessa; Ketchum, Jessica M.; Giacino, Joseph; Zafonte, Ross; Department of Physical Medicine and Rehabilitation, IU School of MedicineObjective: This study utilized the Traumatic Brain Injury Model Systems (TBIMS) National Database to examine the prevalence of depression and suicidal behaviour in a large cohort of patients who sustained moderate-to-severe TBI. Method: Participants presented to a TBIMS acute care hospital within 72 hours of injury and received acute care and comprehensive rehabilitation in a TBIMS designated brain injury inpatient rehabilitation programme. Depression and suicidal ideation were measured with the Patient Health Questionnaire (PHQ-9). Self-reported suicide attempts during the past year were recorded at each follow-up examination, at 1, 2, 3, 10, 15 and 20 years post-injury. Results: Throughout the 20 years of follow-up, rates of depression ranged from 24.8–28.1%, suicidal ideation ranged from 7.0–10.1% and suicide attempts (past year) ranged from 0.8–1.7%. Participants who endorsed depression and/or suicidal behaviour at year 1 demonstrated consistently elevated rates of depression and suicidal behaviour 5 years after TBI. Conclusion: Compared to the general population, individuals with TBI are at greater risk for depression and suicidal behaviour many years after TBI. The significant psychiatric symptoms evidenced by individuals with TBI highlight the need for routine screening and mental health treatment in this population.