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Item Brain Rehabilitation, Advanced Imaging, and Neuroscience (BRAIN): An IUPUI Signature Center Initiative (SCI)(Office of the Vice Chancellor for Research, 2014-04-11) Hammond, Flora; Saykin, Andrew J.; Malec, James; Keiski, MichelleThe Mission of the Indiana Center for Brain Rehabilitation, Advanced Imaging, and Neuroscience (ICBRAIN) is: to develop and disseminate techniques and methodologies for combining advanced neuroimaging, neurogenetics and other neurophysiological measures with precision behavioral measurement to evaluate novel rehabilitation interventions for people with acquired brain injury. Traumatic and other types of acquired brain injury (ABI) affect millions of U.S. citizens each year, many of whom experience persistent disabilities. Over the past decade there has been a notable rise in research activities to address serious gaps in the knowledge base of ABI, including neuroimaging, outcome measurement, and intervention studies to change function. However, brain injury researchers have not yet established solid links between these research agendas. The BRAIN SCI fills this gap in neuroscience by bringing together an interdisciplinary team of clinical researchers to (1) advance basic science and clinical knowledge to the next level of integration, (2) translate the knowledge gained directly into clinical care for improved patient outcomes, and (3) use the newly integrated knowledge to drive the leading edge of translational research. BRAIN research includes the Indiana Traumatic Brain Injury Model System, funded by the National Institute for Disability and Rehabilitation Research (NIDRR), the InterFACE Center for the study of emotions and interpersonal interactions after neurologic injury, and nine other externally funded research projects. BRAIN research ranges from development of a neurogenetic respository and advanced neuroimaging studies to determine critical elements in recovery from brain injury to intervention studies to improve recovery to a multi-national study of an intervention for phantom limb pain. BRAIN research is interdisciplinary. Disciplines currently involved in BRAIN research include physiatry, neuropsychology, neuroradiology, rehabilitation science, biomedical engineering, and psychiatry. The Indiana School of Medicine Neuroscience Center of Excellence provides a home for BRAIN and supports its interdisciplinary Steering Committee. In addition to partnerships with the Neuroscience Center, the Center for Neuroimaging, and the InterFACE Center, BRAIN collaborates with the Rehabilitation Hospital of Indiana, the Stark Neuroscience Institute, and the School of Health and Rehabilitation Sciences. This presentation will describe BRAIN’s mission, vision, organization, partnerships, and ongoing research projects in greater detail.Item Contextualized Treatment in Traumatic Brain Injury Inpatient Rehabilitation: Effects on Outcomes During the First Year after Discharge(Elsevier, 2019) Bogner, Jennifer; Dijkers, Marcel; Hade, Erinn M.; Beaulieu, Cynthia; Montgomery, Erin; Giuffrida, Clare; Timpson, Misti; Peng, Juan; Gilchrist, Kamie; Lash, Aubrey; Hammond, Flora M.; Horn, Susan; Corrigan, John; Physical Medicine and Rehabilitation, School of MedicineObjective To evaluate the effect of providing a greater percentage of therapy as contextualized treatment on acute traumatic brain injury (TBI) rehabilitation outcomes. Design Propensity score methods are applied to the TBI-Practice-Based Evidence (TBI-PBE) database, a database consisting of multi-site, prospective, longitudinal observational data. Setting Acute inpatient rehabilitation. Participants Patients enrolled in the TBI-PBE study (n=1843), aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, receiving their first IRF admission in the US, and consented to follow-up 3 and 9 months post discharge from inpatient rehabilitation. Interventions Not applicable. Main Outcome Measures Participation Assessment with Recombined Tools-Objective- -17, FIMTM Motor and Cognitive scores, Satisfaction with Life Scale and Patient Health Questionnaire-9. Results Increasing the percentage of contextualized treatment during inpatient TBI rehabilitation leads to better outcomes, specifically in regard to community participation. Conclusions Increasing the proportion of treatment provided in the context of real-life activities appears to have a beneficial impact on outcome. Although the effect sizes are small, the results are consistent with other studies supporting functional-based interventions effecting better outcomes. Furthermore, any positive findings, regardless of size or strength, are endorsed as important by consumers (survivors of TBI). While the findings do not imply that decontextualized treatment should not be used, when the therapy goal can be addressed with either approach, the findings suggest that better outcomes may result if the contextualized approach is used.Item Development and external validation of the KIIDS-TBI tool for managing children with mild traumatic brain injury and intracranial injuries(Wiley, 2021-12) Greenberg, Jacob K.; Ahluwalia, Ranbir; Hill, Madelyn; Johnson, Gabbie; Hale, Andrew T.; Belal, Ahmed; Baygani, Shawyon; Olsen, Margaret A.; Foraker, Randi E.; Carpenter, Carpenter; Yan, Yan; Ackerman, Laurie; Noje, Corina; Jackson, Eric; Burns, Erin; Sayama, Christina M.; Selden, Nathan R.; Vachhrajani, Shobhan; Shannon, Chevis N.; Kuppermann, Nathan; Limbrick, David D., Jr.; Neurological Surgery, School of MedicineBackground Clinical decision support (CDS) may improve the postneuroimaging management of children with mild traumatic brain injuries (mTBI) and intracranial injuries. While the CHIIDA score has been proposed for this purpose, a more sensitive risk model may have broader use. Consequently, this study's objectives were to: (1) develop a new risk model with improved sensitivity compared to the CHIIDA model and (2) externally validate the new model and CHIIDA model in a multicenter data set. Methods We analyzed children ≤18 years old with mTBI and intracranial injuries included in the PECARN head injury data set (2004–2006). We used binary recursive partitioning to predict the composite outcome of neurosurgical intervention, intubation for > 24 h due to TBI, or death due to TBI. The new model was externally validated in a separate data set that included children treated at any one of six centers from 2006 to 2019. Results Based on 839 patients from the PECARN data set, a new risk model, the KIIDS-TBI model, was developed that incorporated imaging (e.g., midline shift) and clinical (e.g., Glasgow Coma Scale score) findings. Based on the model-predicted probability of the composite outcome, three cutoffs were evaluated to classify patients as “high risk” for level of care decisions. In the external validation data set consisting of 1,630 patients, the most conservative cutoff (i.e., any predictor present) identified 119 of 119 children with the composite outcome (sensitivity = 100%), but had the lowest specificity (26.3%). The other two decision-making cutoffs had worse sensitivity (94.1%–96.6%) but improved specificity (67.4%–81.3%). The CHIIDA model lacked the most conservative cutoff and otherwise showed the same or slightly worse performance compared to the other two cutoffs. Conclusions The KIIDS-TBI model has high sensitivity and moderate specificity for risk stratifying children with mTBI and intracranial injuries. Use of this CDS tool may help improve the safe, resource-efficient management of this important patient population.Item Empathic Responses to Affective Film Clips Following Brain Injury and the Association with Emotion Recognition Accuracy(Elsevier, 2018) Neumann, Dawn; Zupan, Barbra; Physical Medicine and Rehabilitation, School of MedicineObjective To compare empathic responses to affective film clips in participants with traumatic brain injury (TBI) and Healthy controls (HCs), and examine associations with affect recognition. Design Cross sectional study using a quasi-experimental design. Setting Multi-site study conducted at a post-acute rehabilitation facility in the USA and a University in Canada. Participants A convenience sample of 60 adults with moderate to severe TBI and 60 HCs, frequency matched for age and sex. Average time post-injury was 14 years (range: .5-37) Main Outcome Measures Participants were shown affective film clips and asked to report how the main character in the clip felt and how they personally felt in response to the clip. Empathic responses were operationalized as participants feeling the same emotion they identified the character to be feeling. Results Participants with TBI had lower emotion recognition scores (p=.007) and fewer empathic responses than HCs (67% vs. 79%; p<.001). Participants with TBI accurately identified and empathically responded to characters’ emotions less frequently (65%) than HCs (78%). Participants with TBI had poorer recognition scores and fewer empathic responses to sad and fearful clips compared to HCs. Affect recognition was associated with empathic responses in both groups (p<.001). When participants with TBI accurately recognized characters’ emotions, they had an empathic response 71% of the time, which was more than double their empathic responses for incorrectly identified emotions. Conclusions Participants with TBI were less likely to recognize and respond empathically to others’ expressions of sadness and fear, which has implications for interpersonal interactions and relationships. This is the first study in the TBI population to demonstrate a direct association between an affect stimulus and an empathic response.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 Indiana Center for Brain Rehabilitation, Advanced Imaging, and Neuroscience (ICBRAIN): An IUPUI Signature Center Initiative(Office of the Vice Chancellor for Research, 2012-04-13) Hammond, Flora; Saykin, Andrew J.; Malec, James; Kean, Jacob; Keiski, Michelle; McDonald, Brenna; Neumann, Dawn; Wang, Yang; Yoder, KarmenThe Mission of the Indiana Center for Brain Rehabilitation, Advanced Imaging, and Neuroscience (ICBRAIN) is: to develop and disseminate techniques and methodologies for advanced neuroimaging and precision behavioral measurement to evaluate novel rehabilitation interventions for people with acquired brain injury. Traumatic and other types of acquired brain injury (ABI) affect millions of U.S. citizens each year, many of whom experience persistent disabilities. For example, among the estimated 1.4 million civilians who sustain a traumatic brain injury (TBI) each year, 50,000 die and a minimum of 80,000 sustain injuries of sufficient severity to require extended rehabilitation. The current conflicts in Iraq and Afghanistan have increased awareness and mobilized interest in medical treatment and rehabilitation for returning soldiers with TBI (designated as the “signature injury” of these conflicts). A 2008 study by the RAND corporation based on a random sample of 1,965 veterans estimated that, among 1.64 million returning veterans, approximately 320,000 experienced a probable TBI (19%). Over the past decade there has been a notable rise in research activities to address serious gaps in the knowledge base of ABI, including neuroimaging, outcome measurement, and intervention studies to change function. However, brain injury researchers have not yet established solid links between these research agendas. Such links are crucial for moving the evidence base forward to improve treatment outcomes. ICBRAIN will fill this gap in neuroscience by bringing together an interdisciplinary team of clinical researchers to (1) advance basic science and clinical knowledge to the next level of integration, (2) translate the knowledge gained directly into clinical care for improved patient outcomes, and (3) use the newly integrated knowledge to drive the leading edge of future research. ICBRAIN represents a unique collaboration among established clinical rehabilitation and measurement researchers in PM&R and at RHI and established researchers at the IU Center for Neuroimaging.Item Informational Practices of Postacute Brain Injury Patients During Personal Recovery: Qualitative Study(JMIR, 2019) Masterson, Yamini; Brady, Erin; Miller, Andrew; Human-Centered Computing, School of Informatics and ComputingBackground: The effects of brain injury, structural damage, or the physiological disruption of brain function last far beyond initial clinical treatment. Self-tracking and management technologies have the potential to help individuals experiencing brain injury in their personal recovery—helping them to function at their best despite ongoing symptoms of illness. However, current self-tracking technologies may be unsuited for measuring the interconnected, nonlinear ways in which brain injury manifests. Objective: This study aimed to investigate (1) the current informational practices and sensemaking processes used by postacute brain injury patients during personal recovery and (2) the potential role of quality-of-life instruments in improving patient awareness of brain injury recovery, advocacy, and involvement in care used outside the clinical context. Our objective was to explore the means of improving awareness through reflection that leads to compensatory strategies by anticipating or recognizing the occurrence of a problem caused by impairment. Methods: We conducted a qualitative study and used essentialist or realist thematic analysis to analyze the data collected through semistructured interviews and questionnaires, 2 weeks of structured data collection using brain injury–specific health-related quality of life instrument, quality of life after brain injury (QoLIBRI), and final interviews. Results: Informational practices of people with brain injury involve data collection, data synthesis, and obtaining and applying the insights to their lifestyles. Participants collected data through structured tools such as spreadsheets and wearable devices but switched to unstructured tools such as journals and blogs as changes in overall progress became more qualitative in nature. Although data collection helped participants summarize their progress better, the lack of conceptual understanding made it challenging to know what to monitor or communicate with clinicians. QoLIBRI served as an education tool in this scenario but was inadequate in facilitating reflection and sensemaking. Conclusions: Individuals with postacute brain injury found the lack of conceptual understanding of recovery and tools for making sense of their health data as major impediments for tracking and being aware of their personal recovery. There is an urgent need for a better framework for recovery and a process model for choosing patient-generated health data tools that focus on the holistic nature of recovery and improve the understanding of brain injury for all stakeholders involved throughout recovery.Item Investigation of a New Couples Intervention for Individuals with Brain Injury: A Randomized Controlled Trial(Elsevier, 2018) Backhaus, Samantha; Neumann, Dawn; Parrott, Devan; Hammond, Flora M.; Brownson, Claire; Malec, James; Physical Medicine and Rehabilitation, School of Medicined to (1) examine the efficacy of a treatment to enhance a couple’s relationship after brain injury (BI) particularly in relationship satisfaction and communication; and (2) determine couples’ satisfaction with this type of intervention. Design: Randomized Wait-list Controlled (WC) Trial. Setting: Midwestern outpatient BI rehabilitation center. Intervention: The Couples CARE intervention is a 16 week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition and empathy training, cognitive and dialectical behavioral treatments (CBT, DBT), communication skills training, and Gottman’s theoretical framework for couples. Participants: Forty-four participants (22 persons with BI and their intimate partner) were randomized by couples to the intervention or WC group, with 11 couples in each group. Main Outcome Measures: Dyadic Adjustment Scale (DAS); Quality of Marriage Index (QMI); 4 Horsemen of the Apocalypse communication questionnaire. Measures were completed by the person with BI and their partner at 3 time points: baseline, immediate post-intervention, 3-month follow-up. Results The experimental group showed significant improvement at post-test and follow-up on the DAS and the Horsemen questionnaire compared to baseline and to the WC group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable. Conclusion suggest this intervention can improve couples’ dyadic adjustment and communication after BI. High satisfaction ratings suggest this small group intervention is feasible with couples following BI. Future directions for this intervention are discussed.Item Leveraging Health Information Exchange to Construct a Registry for Traumatic Brain Injury, Spinal Cord Injury and Stroke in Indiana(2018-04-16) Rahurkar, Saurabh; McFarlane, Timothy D.; Wang, Jane; Hoover, Sarah; Hammond, Flora; Kean, Jacob; Dixon, Brian E.; Epidemiology, School of Public HealthTraumatic brain injury (TBI), spinal cord injury (SCI) and stroke are conditions of interest to public health as they can result in long-term outcomes and disabilities. Specialized registries can facilitate public health surveillance, however only 4% of hospitals in the United States actively engage in electronic reporting to these registries. We leveraged electronic claims and clinical data from a health information exchange to create a statewide TBI/SCI/Stroke registry to facilitate the study of long-term outcomes and health services utilization. The registry contains 109,943 TBI patients, 9,027 SCI patients and 117,084 stroke patients with a mean of 3 years of follow-up data after injury. Additionally, the registry contains data on individual patient encounters, prescriptions and clinical variables. The high-dimensional data with large sample sizes may present a valuable informatics resource for injury research as well as public health surveillance.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.