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Objective: To examine motor vehicle crash frequency and risk factors following moderate-to-severe traumatic brain injury (TBI). Setting: Eight TBI Model Systems sites. Participants: Adults (N = 438) with TBI who required inpatient acute rehabilitation. Design: Cross-sectional, observational design. Main Measures: Driving survey completed at phone follow-up 1 to 30 years after injury. Results: TBI participants reported 1.5 to 2.5 times the frequency of crashes noted in the general population depending on the time frame queried, even when accounting for unreported crashes. Most reported having no crashes; for those who experienced a crash, half of them reported a single incident. Based on logistic regression, age at survey, years since injury, and perception of driving skills were significantly associated with crashes. Conclusion: Compared with national statistics, crash risk is higher following TBI based on self-report. Older age and less time since resuming driving were associated with lower crash risk. When driving was resumed was not associated with crash risk. These results do not justify restricting people from driving after TBI, given that the most who resumed driving did not report experiencing any crashes. However, there is a need to identify and address factors that increase crash risk after TBI. [ABSTRACT FROM AUTHOR]

Objective: To assess the interrelations of neuropsychological tests and rating scales with in vivo behavioral observation of impulsive behavior, accounting for the mode of expression (verbal or motor). Design: Cross-sectional, correlational. Setting: An urban, inpatient rehabilitation facility in the Midwestern United States. Participants: Forty patients who were hospitalized in the traumatic brain injury unit. Main outcome measures: Impulsivity Rating Scale and Agitated Behavior Scale (completed by rehabilitation therapists), Barratt Impulsivity Scale (patient self-report), neuropsychological tests, and in vivo behavioral observation of impulsivity using a structured checklist during rehabilitation therapy. Results: Relations of impulsivity rating scales and performance tests to in vivo behavior dissociated. Verbal impulsivity was best assessed by rating scales and was largely unrelated to performance measures of impulsivity, whereas motor impulsivity was best assessed by performance tests and was unrelated to rating scales. Performance tests also had poor specificity, showing equally strong associations with tests of other neuropsychological domains. Conclusions: Impulsivity is a multidimensional construct that should be assessed in a variety of ways. Using either rating scales or neuropsychological tests alone will not likely yield a comprehensive representation of TBI patients' impulsive behaviors. In vivo observation in the clinical setting showed strong ability to identify impulsivity in the presence of global deficits. [ABSTRACT FROM AUTHOR]

Objective: To examine the nature of agitation in patients with brain injury and quantify the relation between agitation and patient progress in rehabilitation. Design: Cross-sectional, correlational. Setting: Urban, inpatient rehabilitation facility in the midwestern United States. Participants: Sixty-nine patients with acquired brain injury admitted to an acute rehabilitation hospital. Main Outcome Measures: Therapy Engagement using the Rehabilitation Therapy Engagement Scale; Functional Status using the Functional Independence Measure. Results: Agitated behavior was inversely associated with engagement in rehabilitation therapy even after controlling for injury severity. Engagement in therapy mediated the relation between agitated behavior and progress in rehabilitation as assessed using a Functional Independence Measure efficiency ratio. Conclusions: Progress in acute brain injury rehabilitation appears to be meaningfully influenced by the complex interplay among injury severity, agitation, and engagement. The findings are consistent with a theoretical model, suggesting that agitated patients make less progress in rehabilitation not only because of greater injury severity but also because agitation disrupts engagement in rehabilitation therapies. Multiple clinical purposes may be better served by measuring behavioral excess on a continuum than in a dichotomous fashion. [ABSTRACT FROM AUTHOR]

Objective: Compare white and African American caregivers of people with moderate to severe traumatic brain injury (TBI) regarding caregiving patterns, emotional function and life satisfaction, and preferred supports. Design: Prospective, observational study; 1, 2, or 5 years post-TBI. Setting: Six TBI model systems. Participants: Two hundred fifty-six caregivers (195 white and 61 African American). Measures: Brief Symptom Inventory-18, Satisfaction With Life Scale. Results: Races differed as to kinship patterns, with more white caregivers including spouses and more African Americans including ‘other relatives.’ African Americans spent significantly more time in direct caregiving, and reported more depression. African American TBI survivors were significantly more disabled than whites, which appeared to account for emotional function differences. Whites were more likely to use professional services for emotional support. Conclusion: Across races, TBI caregiver emotional health is affected by the functional level of the survivor. African American caregivers may be at risk for worse emotional consequences due to worse survivor outcomes, yet may underutilize professional services. [ABSTRACT FROM AUTHOR]

Objective: To examine the relations among driving status, perceptions of barriers to the resumption of driving, and community integration outcomes after traumatic brain injury (TBI). Design: Correlational research using logistic and multiple regression analyses, analyses of variance, and covariance. Participants: Fifty-one survivors of TBI, 6 months to 10 years postinjury. Main outcome measures: Driving status postinjury, Community Integration Measure, and Craig Hospital Assessment and Reporting Technique. Results: Perceptions of barriers to driving provided unique information in predicting subjective and objective indices of community integration, even after accounting for other potentially pertinent variables (eg, injury severity, social support, negative affectivity, and use of alternative transportation). Moreover, survivors who had not resumed driving showed poorer community integration than did those who had resumed driving. Social barriers such as directives against driving from significant others accounted for the most variance in survivor driving status. Decisions to cease driving were more common among those with no formal driving evaluation than among survivors who had been evaluated. Conclusions: Significant others have substantial influence on post-TBI driving outcome. The findings highlight the importance of independent driving to community integration, as well as psychoeducation of survivors and their families. [ABSTRACT FROM AUTHOR]

Objective: To examine the relation between sleep disturbance and neurocognitive ability among persons with traumatic brain injury (TBI). Design: Correlational research evaluating demographic and neuropsychological predictors of sleep disturbance using multiple regression analysis and analysis of variance. Participants: Eighty-seven patients with mild to severe TBI admitted to a comprehensive outpatient neurorehabilitation program. Main Outcome Measures: Sleep disturbance assessed using the Pittsburgh Sleep Quality Index. Results: Hierarchical regression analysis revealed that performance on selected measures of cognitive functioning significantly improved prediction of sleep disturbance, accounting for 14% of variance beyond that accounted for by injury severity and gender. The total model accounted for 31% of the variance in Pittsburgh Sleep Quality Index scores. Patients with mild TBI reported more sleep disturbance (P < .01) than did patients with severe TBI. Conclusions: Sleep disturbance among patients with TBI may be associated with a particular constellation of neuropsychological abilities. These issues are discussed in relation to prior findings that indicate the involvement of additional neuropsychiatric factors associated with sleep disturbance in mild TBI. [ABSTRACT FROM AUTHOR]

Presents a study to examine predictors of family dysfunction and caregiver distress among 60 pairs of persons who sustained a traumatic brain injury and their caregivers. Design; Results; Conclusion that rehabilitation professionals should stress the importance of caregivers and families of persons with TBI seeking and obtaining adequate social support.

Objective: To examine billing patterns and predictors of healthcare utilization and costs associated with traumatic brain injury., Design: Retrospective cohort study of healthcare billings for 63 survivors of traumatic brain injury, over a 19-mo period, using a state-sponsored Medicaid program. The relationship of indicators of injury severity and disability to billings and payments was investigated. Mean age at time of injury was 33 yrs. Mean highest Glasgow Coma Scale rating immediately after brain injury was 8., Results: A total of 795,635 US dollars was billed to Medicaid for 3,950 services and medications used. A total of 281,897 US dollars was paid for these billings out of the Medicaid account studied. Billings were used for statistical analyses, as they were considered the most stable indicator of cost. Motor deficits at discharge from inpatient rehabilitation (FIM motor score) showed inverse relationships to total billings (rho = -0.42, P < 0.001), subcategories of billings reflecting equipment and supplies (rho = -.26, P = 0.020), and outpatient billings (rho = -0.27, P = 0.015). Change in FIM motor scores during inpatient rehabilitation was inversely associated with billings (rho = -0.40). Change in FIM motor scores provided unique information in predicting utilization after accounting for demographic characteristics and severity of injury., Conclusions: Motor disability and improvement during inpatient rehabilitation were significant predictors of billings after traumatic brain injury. Initial severity of brain injury was not a significant factor in utilization.