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Projects of the TBINDC Registry by Research Center
Brain injury severity as measured by the Glasgow Coma Scale & its influence on outcome as measured by Disability Rating Scale at acute rehabilitation discharge and long term follow-up after severe TBI
Abstract: This study will compare outcomes among those with severe injuries to determine how they differ at discharge from rehabilitation and at 1, 5 and 10 years after injury. The data from the model system national database will be reviewed to determine how the patterns and ultimate recovery differ by Glasgow Coma Scale (GCS) score. Severity of injury will be measured by GCS scores in the emergency room. Outcome will be measured by the Disability Rating Scale (DRS).... more
Investigators: Burke D, Hammond F, Rosenthal M, Glenn M, Meythaler J, Jacob L view full
Lead Center: Spaulding Rehabilitation Hospital
Collaborating Centers: Carolinas Rehabilitation, University of Alabama
Depression Following TBI
Abstract: 41 outpatients with TBI filled out the Beck Depression Inventory-II (BDI-II). 24 of 41 subjects (59%) scored in the depressed categories based on BDI-II scores >13. 14 (34%) scored in the moderate or severe depression categories (BDI>19). Logistic regression demonstrated a positive relationship among depression and age, female gender, and mild TBI; and a negative relationship between depression and violent etiology 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... more
Investigators: Glenn M, Burke D, O'Neil-Pirozzi T, Goldstein R, Jacob L view full
Lead Center: Spaulding Rehabilitation Hospital
Responsiveness of the Community Integration Questionnaire (CIQ) and the Supervision Rating Scale (SRS)
Abstract: It is unknown whether the CIQ (or the SRS) is sensitive to change in S.s. This study planned to use data from other studies, where the CIQ (and/or the SRS) is collected both before and after CI-related interventions, to assess whether these instruments are responsive to change. The study was never initiated due to lack of sufficient available data.... more
Investigators: Goldstein R, Hammond F view full
Lead Center: Spaulding Rehabilitation Hospital
Collaborating Centers: Carolinas Rehabilitation
Sleep wake cycles of those with brain injury
Abstract: This study involved a retrospective review of medical records to determine the severity of sleep disturbance among individuals with brain injury. Data on 17 patients was recorded hourly for a two-week period by staff as to the wakefulness of the patients. In addition, demographic data and FIM scores were collected. Results indicated that the 17 patients experienced interrupted sleep during 71% of the night. This was true of 66% of the patients with traumatic brain injury and 92% of the patients with anoxic brain injury. 100% of the women had a sleep disturbance compared with 64% of the men. Patients who were 60+ years of age had interrupted sleep 90% of the time compared with those who were less than 25 years of age (70%). FIM scores... more
Investigators: Burke D, Shah M, Schneider J, Ahanger B, Al-Adawi S view full
Lead Center: Spaulding Rehabilitation Hospital
The use of modafinil to treat attention deficits and underarousal following traumatic brain injury
Abstract: The goals of this pilot study were to 1) examine various aaspects of attention before and after treatment with modafinil and 2) to determine if there were any trends towards benefit using this pharmalogic treatment, while familiarizing the investigators with attention-based measurement tools including computerized assessments. Four subjects with traumatic brain injury were studied. The number of subjects was too small to determine whether any trends existed.... more
Investigators: Knight R, Glenn M, Deters T, Goldstein R, Selleck E view full
Lead Center: Spaulding Rehabilitation Hospital
Palmtop computers as memory aids in a residential community integration program following TBI
Abstract: This project examined the effectiveness of palmtop computers providing alarm cues in improving compliance on prospective memory tasks among TBI clients in supervised living settings. Using a three-month ABA design, subjects were monitored in terms of the number of staff cues that had to be provided to them prior to their initiating target tasks including medication dosage initiation (3 times daily), daily schedule review, and laying out the next day's clothing. In the initial and final Phase A months, subjects were monitored for the number of staff cues required for initiating target tasks under baseline conditions in which no memory aid was provided.

In Phase B, subjects were provided a palmtop computer with alarmed reminders for... more
Investigators: Dowds M, McGrath N, Jacob L, Goldstein R view full
Lead Center: Spaulding Rehabilitation Hospital
Useful Field of View
Abstract: Useful field of view (UFOV) has been an effective assessment tool of attention for driving safety. This study compared the findings of the UFOV Test with those of conventional neuropsychologic tests to determine the utility of the UFOV Test as a measure of attention in an acute rehabilitation inpatient population with brain injury. Results indicated that the UFOV subtest UF2 correlated strongly with two other UFOV subtests, UF1 and UF3. Also, the UF2 subtest correlated strongly with neuropsychological paper-pencil tests of visual attention. The UF2 subtests predicted 52% of Functional Independence Measure(FIM) change and 60% of inpatient length of stay (LOS) variance second only to FIM admission scores, which predicted 75% and 80% of FIM... more
Investigators: Calvanio R view full
Lead Center: Spaulding Rehabilitation Hospital
Subacute changes in metabolism following TBI
Abstract: Objectives: 1) to determine whether patients with recent TBI entering a rehabilitation facility are dehydrated, malnourished, and/or have an increased resting metabolic rate; 2) to determine whether resting metabolic rate is associated with severity of TBI; 3)to determine the duration of metabolic changes seen in BI patients admitted to a rehabilitation facility. Patient Population: Patients admitted to the inpatient TBI unit at SRH for treatment of head trauma. Methods: Patients had their caloric expenditure measured three times: once upon admission, and two times during their first week of stay. Resting energy expenditure data will be obtained using a portable metabolic unit (Cosmed, K4b2, Rome, Italy). Results: Data was collected on 21... more
Investigators: Burke D view full
Lead Center: Spaulding Rehabilitation Hospital
Effectiveness of palmtop computers as prospective memory aids following traumatic brain injury
Abstract: In prior open trials, palmtop computers with scheduling software providing alarmed reminders have proven helpful to substantial
numbers of clients as memory aids to compensate for prospective memory
impairment following traumatic brain injury. The present study undertook a controlled examination of the hypothesis that palmtop computer-based memory aids would prove more effective in enhancing prospective memory task performance than would other conditions.

Subjects (independently functioning outpatients who had sustained traumatic brain injury) were enrolled for a 6-week study in which they were assigned twice daily phone-in times for five work days each week. They were instructed to make their calls to a date- and time-stamped... more
Investigators: Boone K, Dowds M, Sanders R, Goldstein R view full
Lead Center: Spaulding Rehabilitation Hospital
Regional Cerebral Activation on fMRI as a Predictor of Outcome Following Traumatic Brain Injury
Abstract: Using functional magnetic resonance imaging (fMRI), this TBIMS project is studying memory rehabilitation in the traumatic brain injury (TBI) population. The study includes both cross-sectional and longitudinal components. The cross-sectional component is assessing regional cerebral activity during word list memorization between subjects with TBI and matched healthy controls. The longitudinal component is assessing the ability of fMRI to predict outcome among persons with TBI from
a custom-designed memory rehabilitation program.... more
Investigators: Strangman G, O'Neil-Pirozzi T, Burke D, Cristina D, Goldstein R, Katz D, Rauch S, Savage C, Glenn M view full
Lead Center: Spaulding Rehabilitation Hospital
Outcomes of Patients with Both Spinal Cord Injury and Traumatic Brain Injury
Abstract: This study will evaluate the outcomes of people who have both spinal cord injury (SCI) and traumatic brain injury (TBI). The TBI Model Systems (TBIMS) National Database includes spinal cord injury as a variable. A number of centers hold both SCI and TBIMS grants from NIDRR, allowing for the identification of subjects that are enrolled in both. Level of injury and ASIA classification can therefore be obtained from the SCI Model Systems database, while severity of TBI can be determined from the TBI Model Systems database. Thus, the influence of severity of SCI and TBI, as well as other known predictors as age, education, and employment can be assessed with respect to outcome variables such as FIM, DRS, CHART, CHIEF, and CIQ.

The analysis... more
Investigators: Glenn M, Williams S, Karpakjian C, Richards S, Bushnik T, Goldstein R, Harrison-Felix C, Hanks R, Hammond F, Bell K, High Jr. W view full
Lead Center: Spaulding Rehabilitation Hospital
Characteristics of community integration programs: Development of measurement tools and determination of national variability among programs
Abstract: We developed the Community Integration Program Questionnaire, a tool designed to quantify some of the tangible characteristics of community integration programs for people with brain injuries. We then surveyed 49 facility-based outpatient, 30 residential, and 13 home-based programs. There were dramatic differences among programs with respect to staffing, client characteristics, and programmatic qualities. Using cluster and matching analysis, it was determined that overlap among programs with respect to characteristics was such that it would take a large number of client subjects per site to study the effect of program characteristics on outcomes of clients.... more
Investigators: Glenn M view full
Lead Center: Spaulding Rehabilitation Hospital
Validation of the Designation "Apathetic" on the Apathy Evaluation Scale
Abstract: 45 outpatients with TBI completed the AES-S. 37 family members, friends, or significant others filled out the AES-I. Three clinicians prospectively gave a blind impression of the presence or absence of apathy and retrospectively described his/her perception of the subjectÂ’s apathy on a seven-point subjective rating scale. 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... more
Investigators: Glenn M, Burke D, O'Neil-Pirozzi T, Goldstein R, Kettell J view full
Lead Center: Spaulding Rehabilitation Hospital
Efficacy of Individual Versus Individual and Group Outpatient Therapies
Abstract: This study investigated the efficacy of a post-acute TBI rehabilitation program that included a community group component. Using a pseudo-randomization process, 30 subjects participated in individual SLP therapy or individual SLP and community group therapies and were followed for one year post-discharge. Data analysis revealed the following: 1. No statistically significant cognitive-linguistic differences between groups pre-intervention; 2. No statistically significant differences in test performance pre-intervention; 3. Subjects who received individual and group interventions had significantly better cognitive-linguistic test performance on Woodcock-Johnson Analysis-Synthesis 12 months post--intervention; 4. Satisfaction was... more
Investigators: O'Neil-Pirozzi T, Drane-Fleming K, Sanders R view full
Lead Center: Spaulding Rehabilitation Hospital
The development of a scale for the measurement of apathy following brain injury
Abstract: The investigators sought to develop a valid and reliable scale to measure apathy following brain injury. They adapted a number of apathy items from other scales, made up new items, including confounder items, categorized the items into domains, and interviewed therapists regarding the comprehensibility of the items. The next steps will be factor analysis, pilot administration by therapists, and then validity and reliability studies.... more
Investigators: Glenn M, Burke D, O'Neil-Pirozzi T, Goldstein R, Jacob L, Selleck E view full
Lead Center: Spaulding Rehabilitation Hospital
Auditory-Perceptual Attributes of Dysarthric Speech as a Predictive Tool for Successful Use of Voice Recognition Software for Computer Access
Abstract: Voice recognition software is considered a viable option for adaptive computer access for people with disabilities. People with dysarthria, however, often have difficulty using this technology. This study identified specific voice qualities and analyzed their effect on performance of voice recognition software. Results indicated a strong correlation between intelligibility of dysarthric speech and successful use of DragonDictate voice recognition software. The correlation held for three variables within the study: AIDS Word Test, AIDS Sentence Test, and Kent Word List. The strongest correlation was seen using the Kent Word List. A correlation between level of education and successful use of voice recognition was also found, with a... more
Investigators: Dellea P view full
Lead Center: Spaulding Rehabilitation Hospital
Clinical Supervision of Clients with Traumatic Brain Injury in Host Home Community Placements Using Video Teleconferencing
Abstract: This project examined the use of video teleconferencing technology in the supervision of persons with traumatic brain injury enrolled in a community reintegration program utilizing host home placement following inpatient rehabilitation. Using a three-month A-B-A design, weekly video teleconferencing supervision meetings with the client's clinical case coordinator were substituted for in-person supervision visits during intervention Phase B. Weekly ratings of ommunication effectiveness, impact on working relationships, and overall satisfaction were completed by clients, their clinical case coordinator, and their resident host home "mentor" throughout the three months.

In a single case study of a 41-year old aphasic man three years... more
Investigators: McGrath N, Dowds Jr. M, Goldstein R view full
Lead Center: Spaulding Rehabilitation Hospital
Family Members' and Caregivers' Emotional Well Being
Abstract: Objectives for this collaborative project include: (1) to examine the frequency and magnitude of emotional distress and depressive symptoms and the level of life satisfaction of family members and non-family caregivers as compared to clinical and non-clinical populations, and (2) to identify the relationships between caregivers' well-being and survivors' injury severity and level of functioning. Six TBI Model System centers are collecting data from family members, significant others, and friends of individuals in the National Database at either 1, 2, or 5 year follow-up. Data is collected from each caregiver only once. Measures include the Neurobehavioral Functioning Inventory (NFI) Depression subscale, the Brief Symptom Inventory-18... more
Investigators: Kreutzer J, Marwitz J, Rapport L, Koviak C, Hammond F, Morita C, Hart T, Selleck E, Glenn M, Harrison-Felix C view full
Lead Center: Virginia Commonwealth University/Medical College of Virginia
Collaborating Centers: Spaulding Rehabilitation Hospital, Rehabilitation Institute of Michigan, Carolinas Rehabilitation, Moss Rehabilitation Research Institute, Craig Hospital
A double-blind, placebo-controlled trial exploring the efficacy of nortriptyline and amantadine in the management of post-traumatic agitation
Abstract: Objective: Test the efficacy of two medications, amantadine and nortriptyline, to control agitation.

Subjects: Persons receiving rehabilitation for TBI who met all inclusion and exclusion criteria.

Design: Double-blind, randomized, placebo-controlled clinical trial. Both agitation and cognition were monitored during the trial.

Current status: Data collection has been completed.... more
Investigators: Mysiw W, Fugate L, Bogner J, Glenn M view full
Lead Center: Ohio State University
Collaborating Centers: Spaulding Rehabilitation Hospital
Serial Casting Versus Ultrasound with Weight Bearing for the Treatment of Equinovarus Contractures in the Individual with Acute TBI: Comparison of Efficacy and Cost
Abstract: Plantar flexion contractures are a common complication of TBI. Multiple treatment methods are available for increasing joint range of motion (ROM). Serial casting and ultrasound combined with a static stretch are two conservative methods of treatment for plantar flexion contractures known to increase dorsiflexion ROM. However, studies have not compared the effectiveness and cost of serial casting versus ultrasound/static stretch in increasing dorsiflexion ROM. This is a randomized, controlled study comparing the efficacy and cost associated with these two methods... more
Investigators: Hammond F, Lang E, LaBarbera J, Bucklew S, Norton H, Burke D, Flanagan S, Rupright J view full
Lead Center: Carolinas Rehabilitation
Collaborating Centers: Spaulding Rehabilitation Hospital, University of Missouri
Improving Prediction of Long-Term Functional Outcomes Through Case Mix Adjustment
Abstract: The effectiveness of rehabilitation interventions is ultimately judged based on functional outcomes produced, and in this endeavor, one must be able to adjust for individual factors that affect prognosis, or case mix. We will use several approaches to develop case mix adjustment models for one-year follow-up outcomes. If the different methodologies suggest similar models, this will increase the confidence with which they can be employed. If not, it will be useful to understand variations in the models as a way to explore the structure of relationships between predictors and outcomes and the usefulness of the modeling approaches themselves.... more
Investigators: Segal M, Whyte J, Goodman P, Hauck W, Goldstein R, Polansky M view full
Lead Center: Moss Rehabilitation Research Institute
Collaborating Centers: Spaulding Rehabilitation Hospital
Mortality and Life Expectancy After TBI Rehabilitation
Abstract: Abstract from Project Phase I - Objective: To investigate mortality, life expectancy, risk factors for death, and causes of death in individuals with traumatic brain injury (TBI). Methods: Retrospective cohort study utilizing data from the TBI Model Systems National Database, the Social Security Death Index and death certificates. Participants: 2,178 individuals with TBI completing inpatient rehabilitation in one of 15 National Institute on Disability and Rehabilitation Research-funded TBI Model Systems of care between 1988 and 2001. Results: Individuals with TBI were twice as likely to die compared to individuals in the general population of similar age, gender and race, resulting in an estimated average life expectancy reduction of 7... more
Investigators: Harrison-Felix C, Whiteneck G, Devivo M, Hammond F, Jha A view full
Lead Center: Craig Hospital
Collaborating Centers: Carolinas Rehabilitation, Emory University/Shepherd Center, Mayo Medical Center, Ohio State University, University of Alabama, Oregon Health Sciences University, University of Missouri, Moss Rehabilitation Research Institute, Rehabilitation Institute of Michigan, Spaulding Rehabilitation Hospital, Virginia Commonwealth University/Medical College of Virginia, Santa Clara Valley Medical Center, University of Washington
A Collaborative National Information Center on Outcome Measurement in Brain Injury
Abstract: In order to better serve the rehabilitation community, the Center on Outcome Measurement in Brain Injury (COMBI) website and newsletter are proposed. The COMBI provides information on measures in a format that is easily accessed and understood, free of charge, objective, and comprehensive. Each measure will have online syllabi, training and testing materials (including the measure's rating form), information on scale properties, a reference listing of published studies using the measure, and a section for "Frequently Asked Questions."... more
Investigators: Bushnik T, Wright J, Mellick D, Harrison-Felix C, Boake C, Sander A, Malec J, Sherer M, Thompson R, Novack T, Dijkers M, Bogner J, Corrigan J, Hammond F, Kreutzer J, Marwitz J, Millis S, O'Neil-Pirozzi T view full
Lead Center: Santa Clara Valley Medical Center
Collaborating Centers: Craig Hospital, The Institute for Rehabilitation and Research, Mayo Medical Center, Methodist Rehabilitation Center, University of Alabama, Rehabilitation Institute of Michigan, Ohio State University, Carolinas Rehabilitation, Virginia Commonwealth University/Medical College of Virginia, Moss Rehabilitation Research Institute, Kessler Medical Rehabilitation Research and Education Corporation, Spaulding Rehabilitation Hospital, Mount Sinai School of Medicine

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