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Introduction: Pain catastrophizing describes helplessness, rumination, and magnification of a pain experience. High pain catastrophizing is an independent risk factor for disability, pain severity, inadequate treatment response, chronicity, and opioid misuse. Interdisciplinary pain programs (IPPs) are beneficial and cost-effective for individuals with chronic pain, but their functional impact on individuals with high pain catastrophizing is not well established. The emerging field of placebo studies suggests that patient-provider relationships, positive treatment expectations, and sociobiologically informed care trigger physiological responses that may enhance therapeutic interventions. Methods: In this retrospective observational cohort study, we compared admission and discharge data for 428 adults with high-impact chronic pain (mean 8.5 years) who completed the Spaulding-Medford Functional Restoration Program (FRP). The interdisciplinary FRP team of physiatrists, behavioral health clinicians, physical therapists, and occupational therapists specializes in evidenced-based conventional rehabilitation, integrative health, and pain psychoeducation via enriched therapeutic encounters, fostering collaboration, validation, trust, self-efficacy, and positive expectations. Clinical outcome measures included the Canadian Occupational Performance Measure (COPM) assessing functional performance (COPM-PS) and satisfaction with function (COPM-SS), the Pain Numeric Rating Scale (NRS), the Pain Catastrophizing Scale (PCS), and the Patient Health Questionnaire-9 (PHQ-9). Results: FRP participants with clinically elevated catastrophizing at baseline (PCS =30, mean PCS 39) achieved statistically significant improvements in function (mean delta -2.09, CHI2 = 15.56, p < 0.001), satisfaction with function (COPM-SS mean delta -2.50, CHI2 = 7.42, p = 0.007), pain (NRS mean delta 2.7), mood (PHQ-9 mean delta 1.87, p = 0.002), and catastrophizing (PCS mean delta 4.16, p < 0.001). Subgroup analysis revealed racial disparities in pain scores, and exploratory analysis showed a trend toward reducing opiate consumption. Discussion: Despite the known association of adverse outcomes with high catastrophizing, FRP participation was associated with increased productive engagement, reduced pain, reduced maladaptive thought processes, and improved mood. Although causation and efficacy cannot be established from a retrospective design, this is the first study to identify functional improvement in patients with high-impact chronic pain and clinically relevant high pain catastrophizing who participate in an IPP combining conventional and complementary rehabilitation with psychoeducation. These enriched therapeutic encounters may enhance the treatment process by promoting trust, empathy, collaboration, and beneficial reframing of patients' experiences, expectations, and goals. [ABSTRACT FROM AUTHOR]

This study evaluated whether a meditation practice incorporating mobile neurofeedback (mNF) offers any advantage over a more traditional form of focused attention (FA) meditation in managing persistent symptoms after traumatic brain injury (TBI) (clinicaltrials.gov NCT02615535). Pilot randomized clinical trial, exploring feasibility of mNF in TBI. Participants included adults with chronic mood and/or cognitive complaints following mild-moderate TBI. Subjects practiced either FA (n = 10) or mNF (n = 10) meditation 12 minutes daily for 6 weeks. Pre-post intervention difference on the Neurobehavioral Symptom Inventory (NSI) was the primary outcome variable. Secondary outcomes included the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), amongst other scales and neurocognitive tests. No significant pre-post between-group differences were found on the NSI (p =.838) nor other assessments. In an exploratory analysis combining FA and mNF data, meditation was associated with significant improvements on the NSI (p =.04), BAI (p =.012) and BDI (p =.037). Meditating with neurofeedback does not appear to provide an advantage over meditating on one's own for chronic post-TBI symptoms. Further research on home-based meditation following TBI, whether self-directed or technologically facilitated, is warranted. [ABSTRACT FROM AUTHOR]

Objective: To create a profile of individuals with traumatic brain injury (TBI) who received inpatient rehabilitation and were discharged to an institutional setting using characteristics measured at rehabilitation discharge. Methods: The Traumatic Brain Injury Model Systems National Database is a prospective, multicenter, longitudinal database for people with moderate to severe TBI. We analyzed data for participants enrolled from January 2002 to June 2012 who had lived in a private residence before TBI. This cross-sectional study used logistic regression analyses to identify sociodemographic factors, lengths of stay, and cognitive and physical functioning levels that differentiated patients discharged to institutional versus private settings. Results: Older age, living alone before TBI, and lower levels of function at rehabilitation discharge (independence in locomotion, bladder management, comprehension, and social interaction) were significantly associated with higher institutionalization rates and provided the best models identifying factors associated with institutionalization. Institutionalization was also associated with decreased independence in bed-chair-wheelchair transfers and increased duration of posttraumatic amnesia. Conclusions: Individuals institutionalized after inpatient rehabilitation for TBI were older, lived alone before injury, had longer posttraumatic amnesia durations, and were less independent in specific functional characteristics. Research evaluating the effect of increasing postdischarge support and improving treatment effectiveness in these functional areas is recommended. [ABSTRACT FROM AUTHOR]

Background: Diffusion tensor imaging (DTI) may have prognostic utility in patients with traumatic brain injury (TBI), but the optimal timing of DTI data acquisition is unknown because of dynamic changes in white matter water diffusion during the acute and subacute stages of TBI. We aimed to characterize the direction and magnitude of early longitudinal changes in white matter fractional anisotropy (FA) and to determine whether acute or subacute FA values correlate more reliably with functional outcomes after TBI.Methods: From a prospective TBI outcomes database, 11 patients who underwent acute (≤7 days) and subacute (8 days to rehabilitation discharge) DTI were retrospectively analyzed. Longitudinal changes in FA were measured in 11 white matter regions susceptible to traumatic axonal injury. Correlations were assessed between acute FA, subacute FA and the disability rating scale (DRS) score, which was ascertained at discharge from inpatient rehabilitation.Results: FA declined from the acute-to-subacute period in the genu of the corpus callosum (0.70 ± 0.02 vs. 0.55 ± 0.11, p < 0.05) and inferior longitudinal fasciculus (0.54+/-0.07 vs. 0.49+/-0.07, p < 0.01). Acute correlations between FA and DRS score were variable: higher FA in the body (R = -0.78, p = 0.02) and splenium (R = -0.83, p = 0.003) of the corpus callosum was associated with better outcomes (i.e. lower DRS scores), whereas higher FA in the genu of the corpus callosum (R = 0.83, p = 0.02) corresponded with worse outcomes (i.e. higher DRS scores). In contrast, in the subacute period higher FA in the splenium correlated with better outcomes (R = -0.63, p < 0.05) and no inverse correlations were observed.Conclusions: White matter FA declined during the acute-to-subacute stages of TBI. Variability in acute FA correlations with outcome suggests that the optimal timing of DTI for TBI prognostication may be in the subacute period. [ABSTRACT FROM AUTHOR]

Primary objective: To determine test-re-test reliability of the Hopkins Verbal Learning Test-Revised (HVLT-R) in a group of individuals with traumatic brain injury (TBI). Research design: Single-group repeated measures design. Methods and procedures: Seventy-five individuals with TBI were administered the HVLT-R twice, with 6-8 weeks between the two test sessions. Main outcomes and results: Test-re-test reliability on HVLT-R scoring parameters ranged from 0.537-0.818, with seven of the eight scoring parameters exhibiting r > 0.6. At re-test, scores did not significantly change on any of the eight HVLT-R scoring parameters. Conclusions: HVLT-R use with individuals with TBI is supported. Test-re-test reliability of total recall and delayed recall sub-scores was particularly high. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) commonly results in residual memory difficulties. Such deficits are amenable to cognitive rehabilitation, but optimal selection of rehabilitation interventions remains a challenge. We hypothesized that diffusion tensor imaging (DTI) could be used to predict which individuals were likely to benefit from a specific memory rehabilitation intervention. Thirty-seven individuals with TBI, of all severities, first underwent DTI scanning, along with 18 matched controls. Participants with TBI then attended a 12-session memory intervention emphasizing internal memory strategies (I-MEMS). Primary outcome measures (HVLT, RBMT) were collected at the time of DTI scanning, and both immediately and one month post-therapy. In contrast to typical neuroimaging analysis, fractional anisotropy (FA) was used to predict long-term outcome scores, adjusting for typical predictors (injury severity, age, education, time since injury, pretest score). FA of the parahippocampal white matter was a significant negative predictor of HVLT, while the anterior corpus callosum, left anterior internal capsule, and right anterior corona radiata were negative predictors of RBMT outcome. The importance of these predictors rivaled those of pretest scores. Thus, FA measures may provide substantial predictive value for other cognitive interventions as well. The reason why higher FA was associated with less successful response to cognitive intervention remains unclear and will require further study. [ABSTRACT FROM AUTHOR]

Primary objective: To determine test–re-test reliability of the VIrtual Planning Test (VIP) in a group of individuals with traumatic brain injury (TBI). Research design: Single-group repeated measures design. Methods and procedures: Seventy-five individuals with TBI were administered the VIP, with 6–8 weeks between the two test sessions. Main outcomes and results: Test–re-test reliability on VIP scoring parameters—as measured by Pearson correlation coefficients—ranged from 0.341–0.855, with five of the seven scoring parameters exhibiting r > 0.6. Conclusions: Based on the findings of the current study, the VIP has overall moderate test–re-test reliability when administered to individuals with TBI. Some VIP scoring parameters, i.e. Total correct/accuracy and Total absence, demonstrated high test–re-test reliability. Others, i.e. Planning time and Total wrong order, demonstrated low test–re-test reliability. [ABSTRACT FROM AUTHOR]

Background: The rehabilitation of the traumatic brain injury (TBI) patient is especially challenging in non-western populations as the phenotypic indicators as well as the neurobehavioral assessments for the survivors of brain injury are limited. Objective: The study screened for the prevalence of anxiety and depressive states among patients with TBI and examined the validity of the Hospital Anxiety and Depression Scale (HADS) to identify TBI patients with comorbid affective dysfunctions, specifically anxiety and depressive disorders, in an Omani population. Methods: Sixty-eight survivors of TBI were screened with the semi-structured, Composite International Diagnostic Interview (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score. Results: The semi-structured interview revealed the prevalence rate of 57.4% for depressive disorder and 50% for anxiety disorder. The sensitivity (53.8%) and specificity 75.9%, gave the best compromise using the cut-off score of 4, suggesting HADS is not a useful screening tool for this particular population. Conclusions: Phenotypic indicators as detected by CIDI revealed that prevalence of affective dysfunctionality is common among this TBI population. Although the HADS is the most widely used screening instrument in other clinical populations, it does not appear to be a reliable resource in identifying depression and anxiety in people with traumatic brain injury in Oman. [ABSTRACT FROM AUTHOR]

Objectives : To conduct a nationwide telephone survey in order to gather data on some of the quantifiable characteristics of home-based community integration programmes available in the US to adults with brain injury. Design : Survey. Methods : The Community Integration Programme Questionnaire (CIPQ) was used to interview 13 home-based community integration programmes. This study then used descriptive statistics to analyse the characteristics of the programmes. Outcome : There was a good deal of variability in client and programmatic characteristics. Conclusions : There is considerable variability in characteristics among home-based community integration programmes. [ABSTRACT FROM AUTHOR]

Primary objective : To explore the relationship between a group of clinicians' own experience, training and confidence with portable electronic memory devices and their use of the same in traumatic brain injury (TBI) rehabilitation. Research design : Survey study. Methods and procedures : Eighty-one TBI clinicians from various disciplines and work settings completed a survey distributed in person or by mail. Main outcomes and results : Twenty-nine respondents (36%) reported using portable electronic memory devices with patients with TBI. Using regression analysis, respondent device training and confidence teaching patients device use were statistically associated with respondents' use of such devices in TBI rehabilitation. Conclusions : Portable electronic memory device use with persons following TBI may be under-utilized. The importance of ongoing clinician training and of maximizing clinician confidence utilizing these devices in TBI rehabilitation is emphasized. The representativeness of the respondent sample is discussed. Specific training strategies and continued research needs are presented. [ABSTRACT FROM AUTHOR]

Presents a differential diagnosis approach to the pharmacological treatment of cognitive, behavioral and affective disorders after traumatic brain injury. Division of the search for etiology into categories including preinjury diagnosis, neuropsychological disorders, sesnsorimotor disorder, medical disorders, adverse effects of medications, reactive mood and anxiety disorders, and sleep disorders.

This cross-sectional study was designed to determine a cutoff score on the Apathy Evaluation Scale (AES) that predicts a clinician's designation of a subject with TBI as apathetic or not. Forty-five outpatients with TBI completed the AES-S, and 37 family members, friends, or significant others filled out the AES-I. Three clinicians prospectively gave their impressions of the presence or absence of apathy and retrospectively chose the degree of apathy on a 7-point subjective rating scale. The data was analysed by logistic regression and Receiver Operating Characteristic (ROC) curve. Sensitivity and specificity were calculated. No cutoff score on the AES-S or AES-I was found to have reasonable sensitivity and specificity with respect to the ability to predict the clinician's designation of a subject as apathetic. The AES requires further study if it is to be used to measure apathy following TBI. [ABSTRACT FROM AUTHOR]

The incidence of depression and its association with subject characteristics in outpatients with traumatic brain injury (TBI) were investigated. Logistic regression was estimated with depressed/not-depressed as the dependent variable in 41 outpatients with TBI who filled out the Beck Depression Inventory-II (BDI-II). Twenty-four of 41 subjects (59%) scored in the depressed categories based on BDI-II scores >13. Fourteen (34%) scored in the moderate or severe depression categories (BDI>19). Logistic regression demonstrated a positive relationship amongst depression and age, female gender, mild TBI, and use of antidepressant and stimulant drugs; and a negative relationship between depression and violent aetiology of injury. ANOVA demonstrated that individuals with mild TBI were significantly older than those with moderate or severe TBI, which might account for the association between depression and age. The implications of these results are discussed. [ABSTRACT FROM AUTHOR]

Presents information on the potential applications of traditional and novel pharmacotherapeutic agents following traumatic brain injury. Discussion of dopamine metabolism and receptors; Concerns regarding the use of levodopa in brain injury population; Advantage of dopamine receptor direct agonists.