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Projects of the TBINDC Registry by Research Center
Bladder and Bowel Incontinence after Traumatic Brain Injury: Risk Factors, Prevalence, and Outcome
Abstract: A multicenter study was conducted, reviewing the incidence, risk factors, and outcome of patients with bladder (BdI) and bowel (Bol) incontinence after traumatic brain injury (TBI). Subjects were 587 patients for whom follow-up data at one-year postinjury were available. 77% of patients were incontinent at rehabilitation admission (Bdl 77.3%, Bol 76.7%). The prevalence of incontinence improves to approximately 20% (Bdl 20.3%, Bol 19.2%) by rehabilitation discharge, and 7% (Bdl 7.8%, Bol 6.3%) by one year post-injury. Continent patients were significantly more likely to be living at home at rehabilitation discharge (OR=3.2; [1.8, 5.3]) and at one year post-injury (OR=7.7; [3.9, 15.3])... more
Investigators: Yablon S, Sherer M, Nick T, Ivanhoe C, Fellus J view full
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Lead Center: Methodist Rehabilitation Center
Collaborating Centers: The Institute for Rehabilitation and Research, Kessler Medical Rehabilitation Research and Education Corporation
Pharmacotherapy of Symptoms of the Post-traumatic Confusional State among Neurorehabilitation Admissions with TBI: A Randomized, Double-blind, Placebo-controlled, (Parallel-group)Trial
Abstract: Patients with TBI who require inpatient rehabilitation are frequently confused at the time of admission for rehabilitation. Our investigations of confusion conducted as part of the TBIMSM have clarified the nature of confusion in early recovery after TBI. Early confusion (PTCS) has been found to be a complex syndrome characterized by disorientation, cognitive impairment, restlessness, decreased level of daytime arousal, sleep disturbance, fluctuation of symptoms, and psychotic-type symptoms. PTCS complicates early management of patients with TBI and may contribute to increased risk of injury to patients and hospital staff, increased stress among family members and staff, decreased participation in therapies, increased cost of care, and... more
Investigators: Yablon S, Thompson R, Sherer M view full
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Lead Center: Methodist Rehabilitation Center
Therapeutic Alliance, Impaired Self-awareness, and Functional Outcome after Post-acute TBI Rehabilitation
Abstract: Persons with TBI often have significant neurobehavioral deficits in the post-acute period after completion of inpatient rehabilitation. These deficits limit ability to return to work and independent living and result in low levels of community integration and decreased quality of life. While some persons with TBI continue to have physical impairments, there is consistent evidence that cognitive and behavioral impairments have the greatest impact on long-term outcome. A number of approaches have been developed to address these impairments. Post-acute brain injury rehabilitation programs using a multidisciplinary team to create a therapeutic milieu have been shown to be effective in returning patients to work, decreasing need for... more
Investigators: Sherer M, Thompson R view full
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Lead Center: Methodist Rehabilitation Center
Collaborative Study of Impaired Self-awareness after Traumatic Brain Injury (CSISATBI)
Abstract: The CSISATBI conducted the first large-scale, prospective longitudinal study of impaired self-awareness' (ISA) neural substrates, neuropsychological features, natural history, and relationship to functional and quality-of-life outcomes over the first year following moderate to severe TBI. Extensive data on self-awareness, injury characteristics, neuropsychological status, and various outcomes were collected on 177 persons with TBI. Three papers have already been published and additional papers are in progress. Findings published to this point show that impaired self-awareness is common after TBI and is a significant factor in influencing outcome from TBI. ... more
Investigators: Sherer M, Hart T, Thompson R, Whyte J, Yablon S view full
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Lead Center: Methodist Rehabilitation Center
Collaborating Centers: Moss Rehabilitation Research Institute
Post-traumatic Confusion State after Traumatic Brain Injury
Abstract: The period of motoric agitation/withdrawal, disorientation, attention and memory deficits, mood lability, suspiciousness, and hallucinations that occurs after TBI has been called post-traumatic delirium (PTD) or post-traumatic amnesia (PTA). Recent research has indicated that confusion or attentional disturbance is the defining characteristic of this period rather than memory impairment. Our investigations have confirmed the similarity of this period of recovery to delirium and support the use of the term Post-traumatic Confusional State (PTCS) to describe this period. We have collected data on a substantial number of patients in PTCS. Our investigations have resulted in determination of 7 key symptoms of PTCS and the development of a... more
Investigators: Sherer M, Yablon S, Thompson R view full
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Lead Center: Methodist Rehabilitation Center
Early Cognitive Status and Productivity Outcome Following Traumatic Brain Injury
Abstract: To evaluate the contribution of early cognitive assessment to prediction of productivity outcome after traumatic brain injury (TBI) adjusted for severity of injury, demographic factors, and pre-injury employment status. Design: Inception cohort. Setting: Six inpatient brain injury rehabilitation programs. Participants: 388 adults with TBI whose post-traumatic amnesia resolved prior to discharge from inpatient rehabilitation. Results: Multiple logistic regression analysis revealed that pre-injury productivity status, duration of post-traumatic amnesia, education level, and early cognitive status each made significant, independent contributions to prediction of productivity status at follow-up. Conclusions: Findings support the... more
Investigators: Sherer M, Sander A, Nick T, High Jr. W, Malec J, Rosenthal M view full
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Lead Center: Methodist Rehabilitation Center
Collaborating Centers: The Institute for Rehabilitation and Research, Mayo Medical Center, Kessler Medical Rehabilitation Research and Education Corporation
Feasibility of administration of a brief neuropsychological battery for use during acute inpatient rehabilitation after TBI
Abstract: Previous investigations have studied the association of early neuropsychological test performance with late outcome in patients who were initially evaluated during inpatient rehabilitation. However, in these previous investigations, neuropsychological test findings have been confounded with patient injury severity. Neuropsychological assessment was performed at resolution of PTA and PTA duration is a well-recognized index of injury severity. Clinical experience would suggest that a patient who reaches a given level of neuropsychological functioning at one month post injury will have a better long term outcome than another patient who takes 3 months to reach the same level of neuropsychological functioning. By basing timing of testing... more
Investigators: Kalmar K, Giacino J, Novack T, Sherer M, Nakase-Thompson R, Frol A, Hanks R, Millis S, Gordon W, Ricker J view full
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Lead Center: JFK Johnson Rehabilitation Institute
Collaborating Centers: University of Alabama, Methodist Rehabilitation Center, North Texas Traumatic Brain Injury Model System, Rehabilitation Institute of Michigan, Mount Sinai School of Medicine, University of Pittsburgh
The Effect of Scheduled Telephone Intervention on Outcomes After Traumatic Brain Injury: A Multi-Center Randomized Controlled Trial
Abstract: The University of Washington is the lead center in an innovative, three-site TBI telephone intervention funded by the National Institute on Disability and Rehabilitation Research. The study is being carried out here as well as at two other Model Systems Centers across the country: Moss Rehabilitation Research Institute in Philadelphia, Pennsylvania and Methodist Rehabilitation, in Jackson, Mississippi.

The aim of the study is to evaluate the effect of a low-cost phone intervention for persons with moderate to severe TBI in such areas as community integration and employment at one and two years after injury. Participation in the study will be offered to individuals with TBIs who are receiving inpatient rehabilitation services at... more
Investigators: Bell K, Dikmen S, Temkin N, Fraser R, Brockway J, Hart T, Whyte J, Sherer M view full
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Lead Center: University of Washington
Collaborating Centers: Moss Rehabilitation Research Institute, Methodist Rehabilitation Center
A Multicenter Prospective Randomized Controlled Trial of the Effectiveness of Amantadine Hydrochloride in Promoting Recovery of Function Following Severe Traumatic Brain Injury
Abstract: Severe traumatic brain injury may result in severe disorders of consciousness (DOC), including coma, the vegetative state (VS) and the minimally conscious state (MCS). The longer the duration of impaired consciousness, the worse the ultimate functional prognosis, with only about half of those individuals who remain unconscious for a month post-TBI regaining consciousness within a year. The severe functional disability associated with prolonged DOC places enormous emotional, financial, ethical, and logistical strains on caregivers and major resource demands on society. Numerous treatments have been recommended to hasten the return of consciousness or improve the ultimate level of recovery, including various psychotropic drugs, "coma... more
Investigators: Giacino J, Whyte J, Kalmar K, Yablon S, Sherer M, Bagiella E, Murathe S, Singh V, Long D, Murphy E, Merges B, Eifert B, Mauer P, Katz D, Edelstein M, Novak P, Wright L, Van Wie S, Childs N, Mercer W view full
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Lead Center: JFK Johnson Rehabilitation Institute
Collaborating Centers: Moss Rehabilitation Research Institute, Methodist Rehabilitation Center
Intentional versus Unintentional Traumatic Brain Injury: Risk Factors and Outcomes
Abstract: Purpose: This study examined potential differences between people who have experienced intentional vs unintentional traumatic brain injury (TBI). Subjects: Subjects with unintentional injury (N=194), obtained mostly in crashes, were compared to 44 people with intentional injuries, obtained mostly in assaults, in terms of demographic information, injury factors, and outcome. Setting: Large medical center with acute rehabilitation. Measures: Functional Independence Measure (FIM), Disability Rating Scale (DRS), Community Integration Questionnaire. Results: T-tests did not reveal differences between the groups in age, education, Glasgow Coma Score, total Functional Independence Measure (FIM) scores at rehabilitation admission and... more
Investigators: Novack T, Bush B, Meythaler J, Canupp K, Alderson A view full
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Lead Center: University of Alabama
Collaborating Centers: Methodist Rehabilitation Center
Prediction of Long-Term Family Functioning Based on Pre-Injury Family Environment
Abstract: The current study will seek to characterize the pre-injury family environment of persons with TBI and to determine if the preinjury family environment can predict family members' response to TBI. Information on emotional distress, family systems functioning, social support, and coping styles in the month prior to injury will be obtained from family members within 2 weeks of admission to inpatient rehabilitation. These variables will be used to predict family adjustment at 1 year, after controlling for demographics and injury-related characteristics... more
Investigators: Sander A, Sherer M, Malec J view full
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Lead Center: The Institute for Rehabilitation and Research
Collaborating Centers: Mayo Medical Center, Methodist Rehabilitation Center
Prediction of Long-Term Patient Outcome Based on Pre-Injury Family Environment
Abstract: The purpose of the current study is to determine is the pre-injury family environment is predictive of the outcome of persons with TBI at 1 year after injury. Information on the pre-injury family environment, including emotional distress, coping, family systems functioning, and social support, will be collected within 2 weeks of admission to inpatient rehabilitation. Information on the outcome of persons with injury will be collected at 1 year post-injury. Regression models will be constructed to predict outcome from demographic characteristics, injury characteristics, and the pre-injury family environment.... more
Investigators: Sander A, Sherer M, Malec J view full
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Lead Center: The Institute for Rehabilitation and Research
Collaborating Centers: Mayo Medical Center, Methodist Rehabilitation Center
Prediction of Patients' Progress in Post-Acute Rehabilitation Based on Family Environment at the Time of Admission
Abstract: The purpose of the current study is to determine the relationship of family functioning to patients' ability to complete a post-acute rehabilitation program, and to their outcome following participation in the program. Information on the family systems functioning and caregivers' distress will be collected within 2 weeks of admission to the program. Functional assessment of disability and handicap will take place within 2 weeks of admission and approximately 1 month after discharge. Regression models will be constructed to predict admit to discharge change scores from demographic characteristics, injury characteristics, and the family variables.
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Investigators: Sander A, Sherer M, Malec J view full
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Lead Center: The Institute for Rehabilitation and Research
Collaborating Centers: Mayo Medical Center, Methodist Rehabilitation Center
A Randomized Controlled Family Intervention Trial
Abstract: Family members will be recruited between 1 and 2 years after injury. Family members who agree to participate will be randomly assigned to either a cognitive-behavioral treatment group, a traditional support group, or a no treatment control group. Pre-test and post-test measures will be administered to assess family systems functioning, emotional distress, perceived burden, coping strategies, and satisfaction with social support... more
Investigators: Sander A, Sherer M, Malec J view full
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Lead Center: The Institute for Rehabilitation and Research
Collaborating Centers: Mayo Medical Center, Methodist Rehabilitation Center
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
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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
A Prospective Observational Study of Screening and Prophylaxis for Deep Vein Thrombosis in Survivors of Traumatic Brain Injury During Inpatient Rehabilitation
Abstract: During the period of acute rehabilitation for traumatic brain injury (TBI), the development of deep vein thrombosis (DVT) is a significant complication that increases morbidity and mortality. Pulmonary embolism (PE) is one of the most ominous, and frequently life-threatening, complications that occur during TBI rehabilitation. TBI patients often sustain concomitant multiple trauma and have cumulative risk factors for DVT. Because these TBI patients are usually maintained at bed rest during their acute hospitalization, they are at increased risk for existing DVT to embolize when they enter the rehabilitation setting and resume mobility. Prior to initiating this study, a practice survey was distributed to the 16 rehabilitation centers of... more
Investigators: Carlile M, Diaz-Arrastia R, Mysiw W view full
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Lead Center: North Texas Traumatic Brain Injury Model System
Collaborating Centers: Carolinas Rehabilitation, JFK Johnson Rehabilitation Institute, Mayo Medical Center, Mount Sinai School of Medicine, Santa Clara Valley Medical Center, Methodist Rehabilitation Center, Ohio State University, University of Alabama, University of Pittsburgh


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