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Background Memory impairments commonly afflict individuals with MS. While evidence-based cognitive rehabilitation treatments are available in English, the lack of such interventions in Spanish is an important barrier to care for Hispanics with MS. There is class I evidence that the modified Story Memory Technique (mSMT) improves learning in English. This intervention has been translated and adapted into Spanish. Objective To examine the preliminary efficacy of the Spanish mSMT to improve learning in Mexicans with MS. Methods Twenty individuals with relapsing-remitting MS were randomized to treatment (n = 10) or placebo control (n = 10) groups. The Spanish mSMT is a 10-session intervention that teaches imagery and context to facilitate learning. The control condition was matched to the treatment condition in treatment duration, and stimulus content and presentation. Participants completed baseline and post-treatment neuropsychological assessments. Results Individuals who received the Spanish mSMT showed significant improvements in learning and life satisfaction relative to the control group. Also observed were a near-moderate effect size on perceived memory complaints and a moderate-to-large effect size on the family's perception of the patient's competency. Conclusions The Spanish mSMT showed preliminary efficacy in improving learning deficits in Mexicans with MS, and such improvements may extend to other domains.

BACKGROUND: With structured interviews being an established method for assessing one’s exposure to traumatic brain injury across their lifetime, effective assessment tools are needed to serve the large population of Spanish speakers in the U.S. and abroad. OBJECTIVE: To obtain preliminary evidence of validity for a Spanish version of a web-based, structured interview designed to assess lifetime exposure to TBI. METHODS: A sample of 720 Spanish-speaking individuals between the ages of 18 through 65 from the continental U.S. (34.3%), South America (30.8%), the Caribbean (12.6%), Spain (12.4%), and Mexico and Central America (9.9%) completed an online survey containing the Ohio State University Traumatic Brain Injury Identification Method (Self-Administered-Brief; OSU TBI-ID SAB), Neurobehavioral Symptom Inventory, and PROMIS Cognitive Concerns Scale. RESULTS: Indices of severity of worst TBI, time since most recent TBI, and multiple injuries demonstrated expected relationships with neurobehavioral symptoms such that greater symptom reporting was observed among those who had more severe injuries, more recent injuries, and multiple injuries over a period of time. CONCLUSIONS: Findings provide preliminary evidence of validity for three of the indices derived from OSU TBI-ID SAB among Spanish-speaking individuals. Further study is needed to assess other aspects of this instrument to pave the way for further epidemiological studies involving lifetime exposure to TBI among Spanish-speaking individuals across the U.S., Spain, and Latin America.

Background Identification and management of comorbidities in TBI has become an increasing focus for optimizing TBI outcomes. Recent meta-analyses highlight sleep disturbance and sleep disorders following TBI (Mathias & Alvaro, 2012). Improving the recognition and treatment of sleep disorders in TBI should be a central focus of rehabilitation. The Traumatic Brain Injury Model System (TBIMS) has created an infrastructure allowing multi-center investigations into sleep dysfunction in those who have had a moderate to severe TBI and received inpatient rehabilitation. Objective This paper will describe the 1) infrastructure used to advance sleep dysfunction/disorders research following TBI, 2) preliminary findings from these studies, and 3) repository of data which can be accessed for secondary analyses by investigators outside of the TBIMS infrastructure. Methods Two internal mechanisms allow investigators at TBIMS sites to collaborate on projects of shared interest: Research Modules and Special Interest Groups (SIG). Results To date, five studies have resulted from the TBIMS collaborative process focusing on insomnia, circadian disruption, and sleep apnea. Conclusions Future directions for the SIG include continued development of available knowledge and understanding of the multidimensional factors that contribute to TBI-related sleep disturbance, optimal assessment tools, effectiveness of available treatments, and treatment compliance in this population.

BACKGROUND: Sleep disturbances are common following traumatic brain injury (TBI). The Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of sleep quality that has been used in numerous populations. Although this measure has been used in TBI research, there are few studies examining the psychometric properties in this population. OBJECTIVE: The current study examined the factor structure of the PSQI in a sample of persons with TBI and tested the one, two, and three factor models derived from previous studies in other populations. METHODS: A telephone interview was conducted with 243 individuals who had sustained a TBI. All participants were approximately one year post-injury. Factor analyses were conducted (exploratory and confirmatory) to examine the factor structure of the PSQI. RESULTS: Results confirm the fit of models previously tested in the literature but also reveal an alternative conceptualization of sleep containing both qualitative and quantitative factors. CONCLUSIONS: While the 3-factor model best fits the data in this TBI sample, the use of a 2-factor model is acceptable and may be more clinically relevant due to the grouping of time-related variables that could provide important information with regard to circadian rhythm disorders. Language: en

INTRODUCTION: With the general population in the United States becoming increasingly diverse, it is important for rehabilitation professionals to develop the capacity to provide culturally sensitive treatment. This is especially relevant when working with minority populations who have a higher risk for brain injury and poorer rehabilitation outcomes. OBJECTIVES: This article presents a number of clinical vignettes to illustrate how cultural factors can influence behavior in patients recovering from brain injury, as well as rehabilitation staff. The main objectives are to raise awareness among clinicians and stimulate research ideas by highlighting some real world examples of situations where a specialized, patient-centered approach needs to consider factors of cultural diversity. CONCLUSION: Because one's own world view impacts the way we see the world and interpret behavior, it is important to understand one's own ethnocentrism when dealing with a diverse population of patients with brain injury where behavioral sequelae are often expected. Being able to see behavior after brain injury with an open mind and taking into account cultural and contextual factors is an important step in developing culturally competent rehabilitation practices. Language: en

OBJECTIVE To determine which demographic, injury, rehabilitation, and follow-up characteristics are associated with satisfaction with life in a population of Hispanic individuals 1 year post-traumatic brain injury (TBI). DESIGN Retrospective study. SETTING Longitudinal dataset of the TBI Model Systems National Database. PARTICIPANTS 291 Hispanic adults with TBIs occurring between 1999 and 2008 having year 1 follow-up data. MAIN OUTCOME MEASURE Satisfaction with Life Scale (SWLS) measured 1 year post-TBI. RESULTS The relationships between SWLS 1 year post-injury and a variety of demographic, injury, rehabilitation, and follow-up characteristics were modeled using generalized linear models. The final multivariable model explained 25.2% of variability in SWLS (F (7, 261)=12.6, p < 0.001) and included quadratic effects for both age at injury and FIM cognitive scores 1 year post-injury, as well as effects for associated SCI and employment status 1 year post-injury (all p-values ≤ 0.036). In general, higher age, no associated SCI, not being unemployed at 1 year post-injury, and very high or very low FIM cognitive scores were associated with greater SWLS scores 1 year post-injury. CONCLUSIONS These results suggest a variety of demographic, injury, and follow-up characteristics are related with SWLS 1 year post-TBI in Hispanic individuals. Focusing rehabilitation efforts on improving cognition and vocational skills may improve SWLS in Hispanics 1 year post-TBI.

Objective: To determine which demographic, injury, and rehabilitation factors are associated with employment rates in Hispanic individuals 1 year post traumatic brain injury (TBI). Design: Retrospective study. Setting: Longitudinal dataset of the TBI Model Systems National Database. Participants: 418 Hispanic individuals with TBI hospitalized between 1990 and 2009 having year 1 follow-up data (18-55 years and not retired at injury). Main outcome measure: Competitive employment status 1 year post-injury (yes/no). Results: A multiple logistic regression model indicated that pre-injury employment status, pre-injury level of education, etiology, days of posttraumatic amnesia (PTA), associated spinal cord injury, Functional Independence Measure (FIM) motor at rehabilitation discharge, and length of stay in rehabilitation were significant predictors of competitive employment post-injury, controlling for the effects of each other (all p-values ⩽ 0.014). Increases in the odds of not being employed post-injury were associated with not being employed pre-injury, having lower levels of education pre-injury, etiologies due to violence or falls, increased PTA, an associated spinal cord injury, lower FIM motor scores, and greater lengths of stay in rehabilitation. Conclusions: The first year post-TBI is critical for recovery and gainful employment, particularly for Hispanic individuals. Early identification of factors influencing successful gainful employment and expeditious implementation of services to ameliorate these issues are paramount in improving employment outcomes for Hispanic individuals with TBI. Language: en