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Objective: Given the high variability in traumatic brain injury (TBI) outcomes and relative lack of examination of the influence of noninjury factors on outcome, this study aimed to examine factors associated with functional outcome at 1 and 2 years after moderate to severe TBI, including both preinjury and injury-related factors., Design: Observational cohort study., Setting: Inpatient hospital recruitment with outpatient follow-up at 1 and 2 years post injury., Participants: Individuals with moderate to severe TBI were recruited prospectively into a Longitudinal Head Injury Outcome Study. Of the eligible 3253 individuals who were eligible, 1899 participants consented to the study (N=1899)., Main Outcome Measure: Functional outcome was measured using the Glasgow Outcome Scale-Extended (GOS-E)., Results: 1476 participants (73.6% males) and 1365 participants (73% males) completed the GOS-E at 1 and 2 years post injury. They had a mean age at injury of 40 years and mean duration of post-traumatic amnesia (PTA) of 26 days. Good recovery, representing return to previous activities on the GOS-E (score 7-8), was present in 31% of participants at 1 year post injury and 33.5% at 2 years post injury. When predictor variables were entered into regression together, good outcome was significantly associated with not being from a culturally and linguistically diverse background and not having preinjury mental health or alcohol treatment, shorter PTA duration, and absence of limb injuries at both 1 and 2 years; higher education was also a significant predictor at 1 year post injury., Conclusions: Alongside consideration of injury severity, understanding and addressing preinjury factors is important to maximize outcomes., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the association of sexuality with sociodemographic (age, sex, education), medical (injury severity, time since injury), physical (fatigue, pain, independence), neuropsychological (memory, attention, executive function), psychological (depression, anxiety, self-esteem), and social participation factors after traumatic brain injury (TBI)., Design: Survey. Individuals with TBI completed measures at a mean average of 2.78 years post injury (range, 1-10.3y)., Setting: All participants were community based at the time of data collection., Participants: Eighty-four individuals with TBI consecutively recruited after discharge from rehabilitation and 88 age-, sex-, and education-matched controls with TBI recruited from the general community., Interventions: Not applicable., Main Outcome Measure: Brain Injury Questionnaire of Sexuality., Results: Individuals with TBI performed significantly worse on sexuality, mood, and self-esteem measures than the control group without TBI, supporting previous findings. Research findings highlighted a range of significant correlations between sociodemographic, physical, neuropsychological, psychological, and social participation factors and sexuality outcomes after TBI. In the multiple regression model, older age, greater depression, and lower self-esteem were significant predictors of poorer sexuality post injury. Further analyses indicated that depression mediated the independent relationships between lower social participation and greater fatigue with a decline in sexuality after TBI., Conclusions: These findings support sexuality changes after TBI as a multidimensional construct, highlighting depression as a key mechanism through which other factors may affect sexual functioning. Further research is needed to target assessment and intervention services for sexuality problems after TBI., (Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the efficacy of adapted cognitive behavioral therapy (CBT) for sleep disturbance and fatigue in individuals with traumatic brain injury (TBI)., Design: Parallel 2-group randomized controlled trial., Setting: Outpatient therapy., Participants: Adults (N=24) with history of TBI and clinically significant sleep and/or fatigue complaints were randomly allocated to an 8-session adapted CBT intervention or a treatment as usual (TAU) condition., Interventions: Cognitive behavior therapy., Main Outcome Measures: The primary outcome was the Pittsburgh Sleep Quality Index (PSQI) posttreatment and at 2-month follow-up. Secondary measures included the Insomnia Severity Index, Fatigue Severity Scale, Brief Fatigue Inventory (BFI), Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale., Results: At follow-up, CBT recipients reported better sleep quality than those receiving TAU (PSQI mean difference, 4.85; 95% confidence interval [CI], 2.56-7.14). Daily fatigue levels were significantly reduced in the CBT group (BFI difference, 1.54; 95% CI, 0.66-2.42). Secondary improvements were significant for depression. Large within-group effect sizes were evident across measures (Hedges g=1.14-1.93), with maintenance of gains 2 months after therapy cessation., Conclusions: Adapted CBT produced greater and sustained improvements in sleep, daily fatigue levels, and depression compared with TAU. These pilot findings suggest that CBT is a promising treatment for sleep disturbance and fatigue after TBI., (Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To characterize self-awareness in older adults undergoing inpatient rehabilitation and explore factors associated with reduced awareness of falls risk., Design: Prospective, cross-sectional design., Setting: Older adult inpatient rehabilitation setting., Participants: Rehabilitation inpatients (N=91; mean age, 77.97±8.04y) and their treating physiotherapist., Interventions: None., Main Outcome Measures: Three aspects of self-awareness (intellectual, emergent, anticipatory) were measured using the Self-Awareness of Falls Risk Measure. Demographic, medical, and cognitive (Mini-Mental State Examination) information were collected. Current ability was measured using the FIM and timed Up and Go test., Results: Of the patients in the sample, 31% to 63% underestimated falls risk and 3% to 10% overestimated falls risk depending on the aspect of awareness measured. Different aspects of reduced self-awareness were correlated with being a man, higher educational attainment, neurologic history, lower cognitive ability, and lower functional ability. Regression analysis indicated that sex (β=-.33, P=.004), education (β=-.30, P=.006), and neurologic history (β=-.22, P=.038) were independently associated with overall self-awareness., Conclusions: The results suggest that a proportion of older adults undergoing inpatient rehabilitation underestimate personal falls risk. Further research is required to investigate the contributors to and effects of reduced self-awareness of falls risk. Greater understanding of these factors will facilitate the development of strategies to increase awareness of falls risk and increase engagement in falls prevention., (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To examine assessment outcomes and factors associated with passing an occupational therapy (OT) on-road driver assessment after traumatic brain injury (TBI)., Design: Retrospective analysis of outcomes of on-road driver assessment completed by persons with TBI over an 8-year period., Setting: Inpatient and outpatient rehabilitation hospital., Participants: A consecutive sample of individuals (N=207) with mild to severe TBI who completed an on-road driver assessment and were assessed at least 3 months postinjury., Intervention: Not applicable., Main Outcome Measure: Outcome of on-road driver assessment., Results: Of the drivers with TBI, 66% (n=137) passed the initial on-road driver assessment (pass group), whereas 34% (n=70) required on-road driver rehabilitation and/or ≥1 on-road assessment (rehabilitation group). After driver rehabilitation, only 3 participants of the group did not resume driving. Participants who were men, had shorter posttraumatic amnesia (PTA) duration, had no physical and/or visual impairment, and had faster reaction times were significantly more likely to be in the pass group. In combination, these variables correctly classified 87.6% of the pass group and 71.2% of the rehabilitation group., Conclusions: PTA duration proved to be a better predictor of driver assessment outcome than Glasgow Coma Scale score. In combination with the presence of physical/visual impairment and slowed reaction times, PTA could assist clinicians to determine referral criteria for OT driver assessment. On-road driver rehabilitation followed by on-road reassessment were associated with a high probability of return to driving after TBI., (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate changes in sleep quality and objectively assessed sleep parameters after traumatic brain injury (TBI) and to investigate the relationship between such changes and mood state and injury characteristics., Design: Survey and laboratory-based nocturnal polysomnography., Setting: Sleep laboratory., Participants: Ten community-based subjects with moderate to very severe TBI and 10 age- and sex-matched controls from the general community., Interventions: Not applicable., Main Outcome Measures: Pittsburgh Sleep Quality Index for self-report sleep quality, nocturnal polysomnography for objective sleep recording, and Hospital Anxiety and Depression Scales., Results: Compared with controls, TBI patients reported significantly poorer sleep quality and higher levels of anxiety and depression. Objective sleep recording showed that TBI patients showed an increase in deep (slow wave) sleep, a reduction in rapid eye movement sleep, and more frequent nighttime awakenings. No significant relationship was observed between these changes in sleep and injury severity or time since injury. Anxiety and depression covaried with the observed changes in sleep., Conclusions: The findings contribute to the growing body of evidence that sleep is involved in the physiologic processes underlying neural recovery. The association between anxiety and depression and the observed changes in sleep in TBI patients warrants further examination to determine whether a causative relationship exists.

Objectives: To explore subjective sleep reports from people in the chronic stages of traumatic brain injury (TBI) and to examine the extent and nature of sleep complaints in this population., Design: Survey., Setting: All participants were community based at the time of data collection., Participants: Sixty-three subjects with TBI consecutively recruited after discharge from rehabilitation and 63 age- and sex-matched controls from the general community., Interventions: Not applicable., Main Outcome Measures: A 7-day self-reported sleep-wake diary assessing sleep and wake times, sleep onset latency, frequency, and duration of nocturnal awakenings and daytime naps; a general sleep questionnaire used to evaluate sleep changes and quality; and the Epworth Sleepiness Scale to measure daytime sleepiness., Results: Group-wise comparisons showed a significantly higher frequency of reported sleep changes after TBI (80%) relative to the control group (23%), supporting previous findings. The TBI group reported more nighttime awakenings and longer sleep onset latency; these changes were more frequently reported by participants with TBI with milder injuries. Increased levels of anxiety and depression were associated with increased reporting of sleep changes., Conclusions: These findings confirm the experience of changes to sleep after TBI and may at least in part account for the reported increased daytime sleepiness in this population. Sleep disturbance should be addressed during rehabilitation. Treatments need to focus on correcting the underlying cause of the sleep problem and to address patients' subjective experiences of their sleep, possibly through education and mood stabilization.