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Objective: This study aimed to investigate the association between white matter tracts and multiple aspects of attention and working memory deficits in a relatively acute traumatic brain injury (TBI) sample., Method: Neuropsychological measures of attention and working memory were administered to 20 participants with complicated mild-to-very severe TBI and 20 control participants. Tract-based spatial statistics was used to assess fractional anisotropy (FA) and mean diffusivity (MD) of white matter tracts for 15 TBI participants and 20 controls., Results: When compared to controls, participants with TBI were found to have lower FA (p < 0.001) and higher MD (p < 0.001) values in the majority of white matter tracts. TBI participants were also slower to complete tasks including Trail Making Test, Hayling, computerized Selective Attention Task, n-back and Symbol Digit Modalities Test (p < 0.001), when compared to controls. When controlling for age and estimated premorbid intelligence, slowed information processing speed following TBI was found to be associated with FA values in the corpus callosum, superior longitudinal fasciculus, cingulum, inferior fronto-occipital fasciculi, corona radiata and cerebral white matter., Conclusion: The results highlight the widespread damage associated with TBI, as well as the impact of these alterations on information processing speed.

Primary Objective: Behaviours of Concern (BoC) following traumatic brain injury (TBI) have a significant negative impact on the daily functioning and quality of life for the individual and their family. However, there has been limited research examining the nature and severity of BoC beyond the acute recovery period, including the perspective of the individual with TBI as well as close others (COs)., Methods and Procedure: Eighty-nine individuals with predominantly severe TBI, at a mean of 11.4 years' post-injury, were identified through a no-fault accident compensation system database. Structured interviews were completed with 65 individuals with TBI, and 62 COs. Current BoC were documented using the Overt Behaviour Scale (OBS)., Main Outcomes and Results: 70.5% of participants exhibited BoC on the OBS, with an average of 3 behaviours. Verbal aggression and socially inappropriate behaviour were the most common BoC. Self-report of behaviour change was endorsed by 81% of the sample. There was generally poor concordance between the perspectives of the individual with the TBI and their CO., Conclusion: Severe BoC, across multiple behaviour types, may be evident many years following predominantly severe TBI. There is a need to provide long-term behaviour support for these individuals.

Background: A minority of patients with mild traumatic brain injury (mTBI) experience a persistent symptom complex also known as post-concussion syndrome. Explanations for this syndrome are still lacking., Objective: To investigate if the fear avoidance model, including catastrophizing thoughts and fear avoidance behaviour, poses a possible biopsychosocial explanation for lingering symptoms and delay in recovery after traumatic brain injury (TBI) with special focus on mTBI., Design: Cross-sectional study., Participants: 48 patients with TBI, of which 31 patients with mTBI, had persistent symptoms (mean time since injury 48.2 months); 92% of the entire sample fulfilled the criteria for post-concussion syndrome., Outcome Variables: catastrophizing, fear-avoidance, depression and post-concussion symptoms., Results: High levels of catastrophizing were found in 10% and high levels of fear avoidance behaviour were found in 35%. Catastrophizing, fear avoidance behaviour, depressive symptoms and post-concussion symptoms correlated significantly with each other (p < 0.05)., Conclusion: The fear-avoidance model proposes a possible explanation for persistent symptoms. Validation and normative data are needed for suitable measures of catastrophizing and fear avoidance of post-concussion symptoms after TBI. Longitudinal prospective cohort studies are needed to establish its causal and explanatory nature.

Primary Objective: This prospective longitudinal study aimed to identify rates and predictors of productivity outcomes (educational or vocational) at 1 year post-injury in young people studying prior to sustaining a traumatic brain injury (TBI)., Methods and Procedures: A total of n = 145 with complicated mild-severe injuries, studying at secondary (45.2%) or tertiary (54.8%) levels pre-injury, participated. Mean age at injury = 18.6 years (SD = 3.29) and mean duration of PTA = 21.9 days (SD = 27.18). Pre-injury demographic (gender, age, level of study, living situation), injury related (severity, physical injuries) and concurrent post-injury (independence in ADLs and self-reported cognitive, behavioural, emotional sequelae) predictors were entered into logistic regressions., Main Outcomes: Of those participants categorized as 'productive' (79.3%), 60% were studying, with 40% employed. Participants with longer PTA and those with reduced initiative and self-centredness were less likely to be 'productive'. The overall relationship between PTA and productivity appeared to be linear in nature, with PTA duration of more than 80 days, reducing the probability of being productive at 1 year to 50%., Conclusions: PTA duration and behavioural sequelae were the strongest predictors of productivity in those studying prior to injury. Allied health supports should be targeted towards reducing the impact of and compensating for barriers such as reduced initiative in order to maximize productive outcomes in this group.

Purpose: Most studies of quality-of-life (QoL) after traumatic brain injury (TBI) reveal a largely negative picture, yet some survivors show positive changes (PC). Understanding PC in QoL may assist clinicians in facilitating post-injury adjustment. This study aimed to prospectively explore changes in QoL from pre- to post-injury, identify those with PC and examine predictive and associated factors., Methods: Ninety-five participants, recruited from consecutive admissions to a rehabilitation hospital, were prospectively assessed at least once over the first 4 years post-injury. Measures of QoL, psychiatric disorders, coping style and psychosocial outcome were administered at each assessment., Results: Participants' mean QoL was in the average range pre-injury and at follow-up. A third demonstrated PC post-injury, which tended to remain stable. PC participants tended to rate their relatives as of greater importance than other participants, but did not rate their health as high. Group membership was not predicted by pre-injury demographic or injury factors, but it was significantly associated with psychosocial and functional outcome., Conclusions: Even after a significant brain injury, some individuals show sustained improved QoL. Factors such as lack of 'good old days' bias and increased value placed on family may have important clinical utility.

Objective: To examine self-awareness over the first year following traumatic brain injury (TBI) and the association of demographic, biological, cognitive, psychological and social-environmental factors with change in awareness., Research Design: Using a longitudinal design the progression of awareness and association of demographic and biopsychosocial factors with its trajectory were analysed using random effects regression., Methods and Procedures: Sixty individuals with mainly moderate-to-severe TBI completed assessments at 3, 6 and/or 12 months post-injury. Measures of awareness (Self-Awareness of Deficits Interview; SADI), demographic (age at time of injury and gender), injury severity (post-traumatic amnesia duration), cognitive (Trails Making Test-Part B), psychological (Hospital Anxiety and Depression Scale) and social-environmental (return to pre-injury activities) factors were administered., Main Outcomes and Results: Awareness improved over the first year post-injury. Analysis of SADI sub-scales revealed that females had greater awareness in terms of setting more realistic goals early in recovery compared to males. Models including demographic, biological, cognitive, psychological and social-environmental factors did not contribute significantly to prediction of awareness on the SADI above the influence of time., Conclusions: Time post-injury had the strongest influence on the development of awareness. This understanding may be important in determining the optimal timing of rehabilitative intervention.

This study examined long-term outcome in traumatically brain-injured individuals following discharge from a comprehensive rehabilitation programme. Of 254 traumatic brain injury (TBI) patients reviewed at 2 years, 103 have been followed up at 5 years using a structured interview format detailing neurological symptoms, mobility, independence in ADL, productivity status, relationship issues, communication and the presence of cognitive, behavioural and emotional changes. Visual difficulties, headache and fatigue were persistent in a significant number of patients. Between 2 and 5 years there was increased independence in personal, domestic and community ADL and the use of transport. Ten more patients had returned to driving. On the other hand there was a slightly higher incidence of cognitive, behavioural and emotional changes reported at 5 years. Thirty-two per cent of those working at 2 years were not employed at 5 years. Many students had also become unemployed. These findings suggest the need for intermittent lifelong intervention following TBI. Systems of rehabilitation need to be adapted to provide this.

The present study used a multivariate approach to investigate which of a range of variables relating to demographic factors, injury severity and degree of disability on admission to rehabilitation were the best predictors of employment status 2 years after traumatic brain injury (TBI). Subjects were 74 TBI patients who had been working prior to injury, had undergone rehabilitation at Bethesda Hospital and attended a review clinic 2 years after injury. A cross-validation sample consisted of a further 50 such subjects. Following preliminary analysis four input variables were selected: age under or over 40 at time of injury, Glasgow Coma Scale score on acute hospital admission, duration of post-traumatic amnesia and total score on the Disability Rating Scale (DRS) on admission to rehabilitation. Stepwise discriminant function analysis resulted in a discriminant function consisting of three variables--total score on the Disability Rating Scale, Glasgow Coma Scale Score and age--which correctly classified 74% of grouped cases. A second analysis using the original discriminant function correctly classified 68% of the cross-validation sample. Chi-square analysis showed no significant difference between these results, thus confirming these variables, in combination, as predictors of employment status 2 years after TBI.

A group of 175 traumatic brain injury (TBI) patients who had undergone intensive rehabilitation at Bethesda Hospital attended a follow-up interview 2 years after injury. The majority of patients had suffered severe TBI. Outcome was documented in ten areas: medical/physical, mobility, activities of daily living (ADLs) accommodation, marital status, leisure and recreation, employment/study, communication, cognition and behaviour. Whilst most patients were physically independent and competent in personal and domestic activities of daily living, a third of the group were still reliant on assistance with community skills and transport, and more than half of those who previously had a job, were not working at 2 years post-injury. Around two-thirds of the sample reported cognitive, behavioural and emotional changes. There is clearly a need for ongoing community-based support and assistance in dealing with practical difficulties and psychological problems as they are experienced after return to the community.