Projects of the TBINDC Registry by Researchers Last Name
The Structure of functional and community outcomes following TBI
Abstract: Objectives: To identify the dimensionality of outcomes following serious TBI. To determine whether outcomes are highly multidimensional, or not. To determine which items fit which dimension, what items are redundant, and what items do not “fit”. To determine whether there are anomalous cases of TBI whose outcome cannot be measured using usual methods.

Design: One year follow up data from the National TBI Model Systems database were analyzed. We selected all items indicative of global outcomes, social activities, disability, and handicap or community participation (excluding items indicating highly specific neuropsychological or medical impairment). Data were analyzed using Rasch analysis (WinSteps), an advanced form of... more
Investigators: Johnston M, Shawaryn M, Malec J, Hammond F, Kreutzer J view full
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Lead Center: Kessler Medical Rehabilitation Research and Education Corporation
Factors affecting changes in substance use following TBI
Abstract: The National Head Injury Foundation Task Force concluded in a 1988 summary report that substance abuse is a major etiological factor in 50%-70% of persons who sustain a traumatic brain injury (TBI). It has also been found that the effects of substance abuse on cognition can potentially compromise the recovery and rehabilitation as well as reintegration into family, work, and community of nearly two-thirds of TBI survivors. Some research has found that individuals who abuse substances after TBI are usually abusers prior to injury although the extent of abuse generally declines after injury to a level equal to age cohorts. A more recent study found that there was an increase in quantity and frequency of use over time. Other research has... more
Investigators: Johnston M, Galski T, Cernich A, Alverzo J, Wood K view full
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Lead Center: Kessler Medical Rehabilitation Research and Education Corporation
Information on prognosis to enable timely determination of Medicaid eligibility
Abstract: This small project provides basic technical information on clinically practical and inexpensive predictors of community participation outcomes following TBI. Specifically the literature on the predictive validity of the Glasgow Coma Scale (GCS), duration of unconsciousness, and duration of the post-traumatic confusion and amnesia (commonly labeled duration of post-traumatic amnesia) has been reviewed. The literature is relevant to determining whether a person who is disabled in the first month after TBI will need rehabilitation and still be “disabled” 1 year later – the chief criterion for Medicaid eligibility in NJ and many other states. ... more
Investigators: Johnston M, Cernich A, Nissim E view full
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Lead Center: Kessler Medical Rehabilitation Research and Education Corporation
Relationship of financial resources to rehabilitative treatments and outcomes following TBI
Abstract: Changes in the organization of health care have heightened issues of the cost of rehabilitative care, and their relationships to quality and outcomes to persons served. The provider-dominated system of the past has given way to increased initiative and dominance of payers. Managed care companies frequently enter into risk sharing or other contractual arrangements with rehabilitation programs to which they refer selected individuals. Capitated payment systems entail powerful incentives to deliver less care to persons with disabilities and chronic conditions, who are actuarially likely to require much more care than the average enrollee. Managed care and government cutbacks have decimated rehabilitation in some parts of the country... more
Investigators: Johnston M, Wood K, Collins B, Sebolski M view full
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Lead Center: Kessler Medical Rehabilitation Research and Education Corporation
Value-driven cognitive remediation for persons with TBI
Abstract: While the concept of using patients' stated goals to determine treatment strategies in neuropsy-chological treatment programs is widely accepted in principle, in practice such "holistic" programs often lack the sensitivity or ability to achieve this. This issue becomes acute as the patients' cognitive deficits interact with goal setting process. Treatment designed predominantly from the professional's perspective can be reviewed by the consumer as irrelevant with resultant poor treatment compliance and premature termination of services.
Value-Driven Cognitive Rehabilitation (VCDR) is a proposed clinical intervention which is hypothesized to improve cognitive remediation programs by allowing for a systematic incorporation of... more
Investigators: Carnevale G, Johnston M view full
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Lead Center: Kessler Medical Rehabilitation Research and Education Corporation
Coordinated and adequately funded state streams for rehabilitation of newly injured persons with TBI
Abstract: Traumatic brain injury (TBI) rates are highest among families with the lowest income levels. A paucity of appropriate funding streams for low-income, recently injured TBI patients is reported to cause delays in provision of early postacute rehabilitation or to cause patients to be discharged without receiving rehabilitation. There are also reports of patients remaining in hospitals with minimal care or being returned home, both because of a lack of a discharge site. The purposes of this exploratory study were to: (1) identify model aspects of existing publicly supported and administered programs for postacute individuals with TBI; (2) present results of a survey measuring to what extent state Medicaid programs fund postacute... more
Investigators: Page S, Reynolds W, Johnston M view full
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Lead Center: Kessler Medical Rehabilitation Research and Education Corporation
Natural setting behavior management: an alternative approach to community stabilization following TBI
Abstract: Many people with moderate and severe TBI continue to display significant cognitive and behavioral disruption following acute medical care and formal rehabilitation. Behavioral problems can produce adverse psychosocial, vocational and intra-familial effects that can threaten their community tenure and personal sufficiency. People who remain dependent on families or other and those who experience significant role disruption in post-injury life are especially susceptible to these effects. Research suggests that these disruptive events often occur a year or more post-injury at a time when there is no longer active involvement with rehabilitation programs and professionals who are trained to address these challenges. Caregivers rarely have... more
Investigators: Carnevale G, Anselmi E, Johnston M view full
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Lead Center: Kessler Medical Rehabilitation Research and Education Corporation
Tele-rehabilitation: social support and a test of cognitive rehabilitation on the internet
Abstract: Survivors of traumatic brain injury (TBI) often experience cognitive and physical impairments accompanied by a sense of social isolation. Telemedicine or technologies that deliver therapeutic, and educational resources to consumers and health care professionals from a distance may prove to be valuable resources in providing accessible and affordable health care services. The aims of this study were: 1) to design and build an internet-based, "Virtual Rehabilitation Center" (VRC) that provides rehabilitation, education and support services to brain injury survivors and their families and 2) evaluate the "user-friendliness" of the system in relation to patterns of cognitive impairment. Eight individuals with brain... more
Investigators: Diamond B, Bonilla J, Shreve G, Johnston M view full
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Lead Center: Kessler Medical Rehabilitation Research and Education Corporation
A trial of neuropsychological rehabilitation in mild & moderate TBI
Abstract: Persisting affective, somatic, cognitive and sensory symptoms are often reported by a significant subset of people who sustain mild or moderate TBI. Objective neuropsychological impairments have been documented in survivors of mild and moderate traumatic brain injuries. These difficulties result in substantial handicap, as people are unable to sustain employment or meet demands of daily living.
Integrated neuropsychological rehabilitation programs that address subjective symptoms, objective neuropsychological deficits, and general functional disability following brain injury have been developed across the nation over the last 15 years. Many of these programs integrate cognitive remediation techniques with psychotherapeutic treatment... more
Investigators: Tiersky L, Anselmi E, Carnevale G, DeLuca J, Johnston M view full
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Lead Center: Kessler Medical Rehabilitation Research and Education Corporation
The Prognosis Utility of Pre-Injury, Injury-Related, and Post-Injury Factors in Predicting Outcome in terms of Function, Community Integration, and Quality of Life
Abstract: Abstract: Recovery from TBI involves multiple processes occurring at different times post-injury. Outcome studies have been performed extensively, predominately utilizing the Glasgow Outcome Scale (GOS). The GOS is limited in its measure of outcome by its broad categories; included within a single category may be a wide differential in burden of care, cost, functional level, and social interaction. Studies assessing the relationship of potentially predictive factors to functional outcomes and quality of life are lacking. This study investigates the relationship of premorbid, injury-related and post-injury related factors to function and quality of life.

Primary research hypotheses: 1)Functional outcomes and perceived quality of life at... more
Investigators: Hammond F, Norton H, Phillips V, Johnston M view full
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Lead Center: Charlotte Institute of Rehabilitation
Collaborating Centers: Emory University/Shepherd Center, Kessler Medical Rehabilitation Research and Education Corporation
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
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Lead Center: Charlotte Institute of 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
Factors Influencing Cost of Care and Resource Utilization for Individuals with TBI Participating in Acute Inpatient Rehabilitation: The Relationship to Outcome
Abstract: Difficult decisions regarding the appropriate allocation of services are continually needed in order to control health care costs. In the case of TBI, such decisions must focus on optimizing function and quality of life while minimizing the costs to society and survivors. It is important to demonstrate the efficacy and cost-effectiveness of treatment interventions and service delivery models. Numerous studies have investigated the direct overall cost of acute medical and rehabilitation hospitalization. However, studies regarding the costs and effectiveness of particular treatment strategies utilized in a comprehensive rehabilitation programs and post-acutely are lacking. This study investigates potential predictors of cost... more
Investigators: Hammond F, Grattan K, McDeavitt J, Handy-Williams B, Norton H, Phillips V, Johnston M view full
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Lead Center: Charlotte Institute of Rehabilitation
Collaborating Centers: Emory University/Shepherd Center, Kessler Medical Rehabilitation Research and Education Corporation



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