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Projects of the TBINDC Registry by Research Center
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
Community Outcomes Following Traumatic Brain Injury: Impact of Race and Pre-Injury Status
Abstract: Objective: To investigate the contribution of pre-injury differences and potential biases in outcome measurement in explaining outcome differences between white and African-American persons with moderate
and severe traumatic brain injury (TBI).

Design: Prospective, two group longitudinal study with retrospective self-assessment of pre-injury status.

Setting: Inpatient and outpatient TBI rehabilitation program.

Participants: 94 persons with moderate and severe TBI (55 white, 39
African-American) who provided data on both pre-injury status and 1-year outcome.

Measures: Community Integration Questionnaire, Aggression and Depression subscales of Neurobehavioral Functioning Inventory-Revised,
Satisfaction With Life Scale, other... more
Investigators: Hart T, Whyte J, Polansky M, Kersey-Matusiak G, Fidler-Sheppard R view full
Lead Center: Moss Rehabilitation Research Institute
Comparing electronic and paper strategies for enhancing goal-related behavior after TBI using self-cueing: A randomized controlled trial.
Abstract: The ability to formulate and carry out goals and intentions is impaired in TBI due to characteristic difficulties with memory, attention and executive function. Difficulties inhibiting socially inappropriate or unsafe behaviors may also interfere with the attainment of personal goals and increase the affected person.s dependence on others. The current study extends a line of research in which use of hand-held electronic devices was shown to enhance memory for therapy goals at the verbal level. The current project, which incorporated extensive consumer input in the planning process, uses Goal Attainment Scaling and objective behavioral monitoring to assess the efficacy of the electronic strategy compared to traditional paper-and-pencil... more
Investigators: Hart T, DiPasquale M, Whyte J view full
Lead Center: Moss Rehabilitation Research Institute
Efficacy of a Low-Dose Targeted Injection of Botulinum Toxin in Treatment of Elbow Flexor Hypertonia after TBI
Abstract: Botulinum toxin is used to treat hypertonia following TBI. Both cost and limits on the total number of units that may be used in a given treatment period, may make it difficult to treat all of the involved areas that are clinically indicated. The current injection technique involves injecting the toxin into quadrants of the involved muscle. This study explores whether injection guided by electromyographic search for a muscle's motor points might provide greater benefit from a smaller dose, thus allowing more comprehensive treatment from a given dose. Patients with TBI and hypertonia producing elbow flexion are randomized to receive a fixed dose of botulinum toxin into the biceps and/or brachioradialis by either the traditional technique or... more
Investigators: Mayer N, Whyte J, Esquenazi A view full
Lead Center: Moss Rehabilitation Research Institute
Internet Strategies for Facilitating Social Integration After TBI: Resources and Potentials
Abstract: This is a 2-part project. In Part 1, Clubhouse members with TBI worked using a Participatory Action strategy to compile annotated lists and ratings of websites relevant to TBI consumer needs. In Part 2, 80 persons with moderate to severe TBI were interviewed in depth as to their interest in, use of, and problems associated with internet resources, as well as their wishes for training or facilitation in using the internet. Results of this partly qualitative, partly quantitative investigation are currently being prepared for publication.... more
Investigators: Vaccaro M, Hart T, Whyte J view full
Lead Center: Moss Rehabilitation Research Institute
Validation of the Moss Attention Rating Scale (MARS)
Abstract: Previous research has suggested that the MARS represents a unitary dimension, and that inter-rater agreement between occupational and physical therapists is good. This projects seeks to extend these findings by examining inter-rater agreement among additional rehabilitation therapy disciplines. In addition, the MARS will be validated by examining its correlation with a set of neuropsychological measures sensitive to attention, by assessing change in scores between inpatient rehabilitation admission and discharge, and by assessing its responsiveness to methylphenidate treatment.... more
Investigators: Whyte J, Hart T view full
Lead Center: Moss Rehabilitation Research Institute
Characterizing and testing the relative efficacy of vocational rehabilitation interventions after TBI - Phase 1: Characterizing and measuring variations in vocational treatments across the TBIMS
Abstract: The ability to work is important to many persons with TBI for maximizing financial independence, achieving social re-integration and maintaining quality of life. Vocational re-entry is frequently addressed in post-acute rehabilitation of TBI, but employment remains a goal that is difficult to attain. We need ways of evaluating what the most critical elements of the treatment are, or at what intensity or duration they must be delivered. The objectives of Phase 1 are: (1) to develop definitions for content and process parameters for characterizing specific vocational interventions for TBI; (2) to use these definitions to survey the types and variations in vocational services across the TBIMS; (3) to develop testable hypotheses about... more
Investigators: Hart T, Dijkers M, Fraser R, Bogner J, Cicerone K, Malec J view full
Lead Center: Moss Rehabilitation Research Institute
Collaborating Centers: Mayo Medical Center, Kessler Medical Rehabilitation Research and Education Corporation, Ohio State University, University of Washington, Mount Sinai School of Medicine
Impact of service availability on functional outcome: qualitative analysis of transition points in the model system of care
Abstract: The impact of third party payers on health care service delivery, especially with the rapid growth of managed care in the 1990s, is a subject of regular comment and lament among providers as insurers continue to ratchet down reimbursable charges. For TBI, insurance companies increasingly question the value of certain kinds of treatment, e.g. cognitive remediation. Decisions about treatment for individuals with TBI are being made by insurers as well as, or instead of, clinicians to a greater extent than ever before.Studying the impact of variations in service availability is exceedingly difficult, since those who receive a given service typically differ from those who do not (e.g., in premorbid employment, education, and other factors that... more
Investigators: Burke J, Hart T, Fitzpatrick-DeSalme E, Whyte J view full
Lead Center: Moss Rehabilitation Research Institute
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
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
Lead Center: University of Washington
Collaborating Centers: Moss Rehabilitation Research Institute, 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
Lead Center: Methodist Rehabilitation Center
Collaborating Centers: Moss Rehabilitation Research Institute
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
Lead Center: JFK Johnson Rehabilitation Institute
Collaborating Centers: Moss Rehabilitation Research Institute, Methodist Rehabilitation Center
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
Development of Participation Measures for People with Traumatic Brain Injury
Abstract: There is no general agreement in the field regarding a reliable and valid objective measure of community participation after TBI. This study will use a multi-center, prospective, cohort design to evaluate participation items pooled from four currently used tools: the Craig Handicap Assessment and Reporting Technique Short Form (CHART-SF); the Community Integration Questionnaire Version 2 (CIQ-2); the Participation Objective-Participation Subjective (PO-PS) section of the Living Life After TBI (LLATBI); and the Mayo-Portland Participation Index (M2PI). The primary objectives of this study are to: 1) evaluate internal consistency, concurrent validity, and item/scale structure of current measures of community participation after TBI; and 2)... more
Investigators: Whiteneck G, Bushnik T, Cicerone K, Corrigan J, Bogner J, Dijkers M, Gordon W, Hart T, Malec J, Novack T view full
Lead Center: Craig Hospital
Collaborating Centers: University of Alabama, Santa Clara Valley Medical Center, Mayo Medical Center, Kessler Medical Rehabilitation Research and Education Corporation, Mount Sinai School of Medicine, Ohio State University, Moss Rehabilitation Research Institute
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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