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Projects of the TBINDC Registry by Research Center
Long-term Medical Care Utilization and Costs among Traumatic Brain Injury Survivors
Abstract: Examine billing patterns and predictors of health care utilization and costs associated with traumatic brain injury (TBI).

Design: Retrospective cohort study of health care billings.

Participants: 63 persons with TBI were followed over a 19-month period, in state-sponsored Medicaid pogram.

Main Outcome Measures: The relationship of indicators of injury severity and disability to such billings was investigated.

Results: Mean age at time of injury was 33 years. Mean highest Glasgow Coma Scale (GCS) rating immediately post brain injury was 8. A total of $795,635 was billed to Medicaid for 3,950 services and medications used. Motor deficits at discharge from inpatient rehabilitation (FIM Motor Score) showed inverse relationships... more
Investigators: Vangel S, Rapport L, Hanks R, Black K view full
Lead Center: Rehabilitation Institute of Michigan
Severe Penetrating Head Injury: A Follow-up Study
Abstract: This study examines and describes the functional status of persons surviving a severe penetrating head injury, resulting from a gunshot wound (GSW), who require inpatient rehabilitation. Data was collected prospectively at four different time periods: rehabilitation admission and discharge, year 1and year 2 post-injury. Twenty-seven persons were enrolled in the study. Follow-up data were available at years 1 and 2 post-injury for 16 of these study participants. Results indicated functional improvements on the Disability Rating Scale and Functional Independence Measure from rehabilitation admission to discharge. Follow-up data revealed continued improvements on these measures with the greatest improvement in recovery occurring during the... more
Investigators: Wertheimer J, Wood D, Zafonte R, Hanks R view full
Lead Center: Rehabilitation Institute of Michigan
Predictors of Family Functioning and Distress Among Caregivers of Patients with TBI
Abstract: The extent to which patient and caregiver characteristics predicted caregiver psychological distress was examined among 60 pairs of former patients who had sustained a moderate to severe traumatic brain injury (TBI) and their caregivers (N = 120). Time since injury ranged from 4 months to 10 years. The former patients' current neurobehavioral and affective functioning, alcohol use, awareness of deficit, and time since injury, and the caregivers' perceived social support were entered into a standard multiple regression with caregiver psychological distress as the outcome. Results revealed that the predictor model accounted for 34% of the variance in caregiver distress. Neurobehavioral and affective functioning of the patient was the best... more
Investigators: Ergh T, Coleman R, Rapport L, Hanks R view full
Lead Center: Rehabilitation Institute of Michigan
Determinants of Driving Status Following Brain Injury
Abstract: Requirements to safely operate a motor vehicle require a complex interaction of skills (including motor skills, perceptual abilities, and cognitive abilities). TBI patients have a lower rate of relicensure than other impaired groups. Neuropsychological batteries used in the assessment of driving have not focused on higher order cognitive abilities (i.e., executive functioning). 71 adults who sustained moderate to severe brain injuries and their significant others (N = 142) where administered a Neuropsychological test battery, as well as the Patient Competency Rating Scale which was administered to the patient and the caregiver. Contrary to the skepticism regarding the utility of neuropsychological performance in the prediction of driving... more
Investigators: Coleman R, Ergh T, Rapport L, Hanks R, Millis S, Ricker J, Koviak C view full
Lead Center: Rehabilitation Institute of Michigan
Collaborating Centers: Kessler Medical Rehabilitation Research and Education Corporation
Generalizability of the Wechsler Malingering Detection Principle
Abstract: The detection of malingering or incomplete effort on the Wechsler adult scales (WAIS-R & WMS-R) has been successfully replicated using a malingering index, both with simulated malingers and clinical patients with financial incentive. Analysis of these studies suggests that their success derives from examinees' misconception that tasks of immediate attention span are more affected by traumatic brain injury (TBI) than empirical data reveal. We demonstrate this generalization, using the Memory Assessment Scale (MAS), creating a General Memory minus Short Term Memory difference score. Forty-three patients with equivocal TBI involved in injury-related litigation were compared with 45 patients not involved in litigation, with moderate to... more
Investigators: Newman P, Fichtenberg N, Kauder B, Hanks R view full
Lead Center: Rehabilitation Institute of Michigan
Driving after Brain Injury: Barriers, Fitness to Drive, and Community Integration
Abstract: This study examines the resumption of driving a motor vehicle and the extent to which driving influences community integration following TBI. Barriers to resuming driving, the role of significant others, and the relative validities of different assessments of fitness to drive (neuropsychological, driving simulator, and on-road evaluations) will be examined.... more
Investigators: Rapport L, Coleman R, Hanks R, Black K view full
Lead Center: Rehabilitation Institute of Michigan
Social support moderates caregiver life satisfaction following traumatic brain injury.
Abstract: Social support is an important determinant of adjustment following traumatic brain injury (TBI) sustained by a family member. The present study examined the extent to which social support moderates the influence of characteristics of the person with injury on caregiver subjective well-being. Sixty pairs of individuals who had sustained a moderate to severe TBI and their caregivers (N=120) participated. Years postinjury ranged from 0.3 to 9.9 ( M=4.8, SD=2.6). Cognitive, functional, and neurobehavioral functioning of participants with TBI were assessed using neuropsychological tests and rating scales. Caregiver life satisfaction and perceived social support were assessed using self-report questionnaires. Results indicated that time since... more
Investigators: Ergh T, Hanks R, Rapport L, Coleman R view full
Lead Center: Rehabilitation Institute of Michigan
The Reciprocal Relationship of Survivor and Caregiver Emotional Adjustment: Implications for Community Reintegration.
Abstract: The purpose of this study is to identify characteristics of persons with brain injury and their caregivers associated with survivor distress and family dysfunction. We will investigate outcome within the framework of a traditional model, which views caregiver well-being as influenced by stresses associated with caring for a person with TBI, and within the framework of a dynamic systems model, in which the well-being of persons with TBI and their caregivers influence each other in a reciprocal manner. We will examine change in these processes as time from injury increases. A final objective is to identify areas for practical interventions designed to alleviate adverse outcomes experienced by all members of the family affected by TBI. In... more
Investigators: Hanks R, Rapport L, Vangel S, Black K view full
Lead Center: Rehabilitation Institute of Michigan
Peer-Mentoring for Survivors of TBI and their Significant Others: A Model of Social Support
Abstract: This study is a randomized controlled trial of a peer-mentoring program for both survivors and their caregivers. The focus of this study is to determine the efficacy of a peer-mentoring program and to examine the relationship of this mentoring program to three main outcome areas: 1) knowledge and skills regarding access to resources and services; 2) quality of life; and 3) community integration. Moderators of successful peer-mentoring such as injury severity, co-morbid physical disease, education, neuropsychological status of the survivor, coping style, and personality/emotional factors will also be examined. A participatory action framework will be employed for the program, as well as for implementation, dissemination, and evaluation.... more
Investigators: Hanks R, Black K, Wertheimer J, Rapport L, Koviak C, Wood D view full
Lead Center: Rehabilitation Institute of Michigan
Depression after traumatic brain injury: A NIDRR model systems multi-center investigation.
Abstract: Objective: To identify the frequency and manifestations of depression after traumatic brain injury (TBI) and the factors that contribute to developing this mood disorder.

Design: A prospective, nationwide, multicenter study; 17 centers supplied data from medical records and patient responses on a standardized criterion instrument.

Setting: Traumatic Brain Injury Model Systems programs.

Participants: A demographically diverse sample of 666 outpatients with TBI was evaluated 10 to 126 months after injury.

Main Outcome Measures: Depressive symptoms were characterized with the Neurobehavioral Functioning Inventory by using the Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) diagnostic framework. Analysis of... more
Investigators: Seel R, Kreutzer J, Rosenthal M, Hammond F, Corrigan J, Black K view full
Lead Center: Virginia Commonwealth University/Medical College of Virginia
Collaborating Centers: Rehabilitation Institute of Michigan, Kessler Medical Rehabilitation Research and Education Corporation, Carolinas Rehabilitation, Ohio State University
Post-traumatic Depression as a Complication of Violence Induced TBI Versus Non-violence Induced TBI: Implications on treatment, interventions, cost, and long-term outcomes.
Abstract: Depression is a well-established complication of TBI, with reported incidence of less than 10% to 77%. However, previous studies have been limited by small, unrepresentative samples. This study investigates the incidence, time-course, outcome, and measurement of post-traumatic depression in those with TBI who survive and are admitted to acute inpatient rehabilitation.... more
Investigators: Hammond F, Babin P, Grattan K, Norton H, Johnston M, Miller M, Kreutzer J, Black K view full
Lead Center: Carolinas Rehabilitation
Collaborating Centers: Rehabilitation Institute of Michigan, Kessler Medical Rehabilitation Research and Education Corporation, Emory University/Shepherd Center, Virginia Commonwealth University/Medical College of Virginia
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
Blame Attribution in Violent and Non-Violent TBI: Effects on Psychosocial Adjustment
Abstract: Violence is a significant cause of TBI, especially in urban areas. In other populations, violence-related injury has been studied with respect to blame attribution. Previous work suggests that self-blame may be associated with better coping and more favorable outcome compared to blame of other persons. Those with TBI due to violence may therefore be at risk for worse psychological outcomes. In this project we are measuring blame attribution in the acute stages of both violent and non-violent injury and again at 1-year follow-up, along with outcome assessment, to determine the effects of blame attribution on psychosocial outcome. In the first phase of the study we demonstrated that blame attribution is reliable and valid in persons with... more
Investigators: Hart T, Bogner J, Whyte J, Polansky M, Hanks R, Esselman P view full
Lead Center: Moss Rehabilitation Research Institute
Collaborating Centers: Ohio State University, University of Washington, Rehabilitation Institute of Michigan
Effect of blood alcohol level on neurpsych outcome from TBI
Abstract: 1) To resolve contradictory reports in the literature regarding adverse effects of acute blood alcohol level (BAL) on neuropsychological outcome from traumatic brain injury (TBI). 2) 459 adults with nonpenetrating TBI who were inpatients at one of 6 rehabilitation centers in the TBI Model Systems project, whose BAL had been measured at hospital arrival, and who emerged from post-traumatic amnesia (PTA) and underwent neuropsychological testing before rehabilitation discharge. 3)15 neuropsychological tests were administered after resolution of post-traumatic amnesia and at one year post-injury. 4) BAL was classified as 1) negative vs. positive and 2) intoxicated (BAL > 100 mg/dl) vs. non-intoxicated. The effect of BAL on neuropsychological... more
Investigators: Boake C, High Jr. W, Sander A, Kreutzer J, Macciocchi S, Stringer A, Hammond F, Rosenthal M, Bogner J, Hanks R view full
Lead Center: The Institute for Rehabilitation and Research
Collaborating Centers: Emory University/Shepherd Center, Ohio State University, Rehabilitation Institute of Michigan, Carolinas Rehabilitation, Kessler Medical Rehabilitation Research and Education Corporation, Virginia Commonwealth University/Medical College of Virginia
Charges and Lengths of Stay for Acute and Inpatient Rehabilitation Treatment of TBI 1990-1996
Abstract: Acute care daily charges showed almost routine increases, averaging nearly $550 per year. Conversely, lengths of stay generally showed a downward trend, with annual reductions averaging 2.25 days. Between 1990 and 1996, average daily rehabilitation charges increased each year, with the rise averaging $83 or 7%. The rise in daily rehabilitation charges was offset by corresponding decreases in lengths of stay averaging 3.65 days or 8% annually. Increases in daily charges for brain injury rehabilitation care were roughly comparable to those for general medical care prices. However, the rate of change in acute care charges was substantially greater, with annual increases averaging 10% more than national medical care prices... more
Investigators: Kreutzer J, Kolakowsky-Hayner S, Ripley D, Cifu D, Rosenthal M, Bushnik T, Zafonte R, Englander J, High Jr. W view full
Lead Center: Virginia Commonwealth University/Medical College of Virginia
Collaborating Centers: Santa Clara Valley Medical Center, Emory University/Shepherd Center, Rehabilitation Institute of Michigan, Kessler Medical Rehabilitation Research and Education Corporation, The Institute for Rehabilitation and Research
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
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
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
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

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