Cognition and Other Predictors of Functional Disability Among Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder.

Background: Limitations in everyday functioning are frequently reported by veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). Multiple factors are associated with functional disability among veterans, including depression, poor social support, cognition, and substance use. However, the degree to which these factors, particularly cognitive capacities, contribute to functional limitations remains unclear.

Diagnostic Accuracy of the Veteran Affairs' Traumatic Brain Injury Screen.

Objective: To comprehensively estimate the diagnostic accuracy and reliability of the Department of Veterans Affairs (VA) Traumatic Brain Injury (TBI) Clinical Reminder Screen (TCRS).

Design: Cross-sectional, prospective, observational study using the Standards for Reporting of Diagnostic Accuracy criteria.

Setting: Three VA Polytrauma Network Sites.

Evaluating the performance of the Montreal Cognitive Assessment in early stage Parkinson's disease.

Introduction: Mild cognitive impairment is common in Parkinson's disease, even in the early stages, and can be a risk for developing dementia. To properly track development and progression of cognitive impairment, reliable measurement tools are necessary. The Montreal Cognitive Assessment is currently used as a global cognitive screening tool and has been recommended as an abbreviated diagnostic tool to measure mild cognitive impairment in the context of global cognitive function.

Perceived health, caregiver burden, and quality of life in women partners providing care to Veterans with traumatic brain injury.

Families of Veterans with traumatic brain injury (TBI) are often faced with providing long-term informal care to their loved one. However, little is known about how their perceived health and caregiving burden contribute to their quality of life (QOL). The purpose of this descriptive study was to describe perceived health, somatic symptoms, caregiver burden, and perceived QOL and to identify the extent to which these variables are associated with QOL in female partners/spouses of Veterans with TBI.

Algorithm for Symptom Attribution and Classification Following Possible Mild Traumatic Brain Injury.

Objective: To present a heuristic model of a symptom attribution and classification algorithm (SACA) for mild traumatic brain injury (mTBI).

Setting: VA Polytrauma sites.

Participants: 422 Veterans.

Responsiveness, Minimal Detectable Change, and Minimally Clinically Important Differences for the Disorders of Consciousness Scale.

Objectives: To determine the responsiveness, minimal detectable change (MDC95), and minimally clinically important difference (MCID) of the Disorders of Consciousness Scale (DOCS-25) in patients with severe traumatic brain injury (TBI) and to report the percentages of patients' change scores exceeding MDC and MCID after 3 weeks of inpatient rehabilitation.

Setting: Post-acute rehabilitation hospitals.

Participants: One hundred seventy-two patients with severe TBI.

Exploring the Relationship Between Mild Traumatic Brain Injury Exposure and the Presence and Severity of Postconcussive Symptoms Among Veterans Deployed to Iraq and Afghanistan.

Objective: The aim of this study was to describe the association between mild traumatic brain injury (mTBI) and persisting postconcussive symptoms according to symptom category, number, and severity.

Design: The study design was observational.

Participants: The study sample comprised veterans (≥18 years of age) deployed in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) conflicts who had not received any treatment for mTBI in the 30 days preceding study enrollment.

Placebo-Controlled Trial of Familiar Auditory Sensory Training for Acute Severe Traumatic Brain Injury: A Preliminary Report.

Background: Sensory stimulation is often provided to persons incurring severe traumatic brain injury (TBI), but therapeutic effects are unclear.

Objective: This preliminary study investigated neurobehavioral and neurophysiological effects related to sensory stimulation on global neurobehavioral functioning, arousal, and awareness.

Methods: A double-blind randomized placebo-controlled trial where 15 participants in states of disordered consciousness (DOC), an average of 70 days after TBI, were provided either the Familiar Auditory Sensory Training (FAST) or Placebo of silence.

Prescribing multiple neurostimulants during rehabilitation for severe brain injury.

Background: Despite a lack of clear evidence, multiple neurostimulants are commonly provided after severe brain injury (BI). The purpose of this study is to determine if the number of neurostimulants received during rehabilitation was associated with recovery of full consciousness or improved neurobehavioral function after severe BI.

Method: Data from 115 participants were extracted from a neurobehavioral observational study database for this exploratory, retrospective analysis.

He Looks Normal But … Challenges of Family Caregivers of Veterans Diagnosed with a Traumatic Brain Injury.

Purpose: To describe the experience of family caregivers providing care to veterans with traumatic brain injury (TBI).

Design/methods: Using a qualitative design, interviews were conducted with a purposeful sample of women caregivers. Data were analyzed using content analysis procedures.

Transcranial magnetic stimulation: potential treatment for co-occurring alcohol, traumatic brain injury and posttraumatic stress disorders.

Alcohol use disorder (AUD), mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD) commonly co-occur (AUD + mTBI + PTSD). These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms.

Psychometric properties of the disorders of consciousness scale.

Objective: To provide evidence for psychometric properties of the Disorders of Consciousness Scale (DOCS).

Design: Prospective observational cohort.

Settings: Seven rehabilitation facilities.

Alcohol use and craving among Veterans with mental health disorders and mild traumatic brain injury.

Mental health disorders (MHDs), mild traumatic brain injury (mTBI), and alcohol use disorder (AUD) are endemic among recent Veterans, resulting in a population with heterogeneous, co-occurring conditions. While alcohol craving negatively affects rehabilitation and leads to relapse, no studies have examined alcohol craving among Veterans with co-occurring MHDs and mTBI. The purpose of this preliminary cohort study is to describe alcohol craving in a convenience sample of Iraq and Afghanistan Veterans (n = 48), including those exposed to traumatic events and experiencing active symptoms.

Predicting levels of independence with expressing needs and ideas 1 year after severe brain injury.

Purpose/objective: Severe brain injury (BI) is a catastrophic event often evolving into a complex chronic and severely disabling condition making activity participation possible only with sustained caregiving. One aspect of building sustainable caregiving is early provision of information about expected outcomes germane to patients and their caregivers. An analysis was conducted to determine whether 2 levels of independence with expressing needs and ideas 1-year after severe BI could be predicted using variables available early after injury.

Caregiving experiences and health conditions of women veteran and non-veteran caregivers.

Background: Unique experiences, for example, trauma, of women veteran caregivers may create differences in the caregiving experience and may be associated with health concerns. We examined caregiving factors and health concerns in women veteran caregivers compared to non-veteran women (civilian) caregivers, and identified variables associated with being a woman veteran caregiver.

Methods: We conducted secondary data analyses using data from a multistate survey to examine sociodemographics, the caregiver experience (relationship to recipient, duration as caregiver, hours of care provided, area help is needed, and greatest difficulty faced as a caregiver); emotional support; life satisfaction; lifestyle behaviors; general, physical, and mental health; and chronic conditions in women informal caregivers.

Medical comorbidities in disorders of consciousness patients and their association with functional outcomes.

Objective: To identify, for patients in states of seriously impaired consciousness, comorbid conditions present during inpatient rehabilitation and their association with function at 1 year.

Design: Abstracted data from a prospective cross-sectional observational study with data collection occurring January 1996 through December 2007.

Setting: Four inpatient rehabilitation facilities in metropolitan areas.

Burnout and coping strategies of polytrauma team members caring for veterans with traumatic brain injury.

Objective: The aims of this national study were to (1) examine the extent of job burnout among VA Polytrauma team members engaged in the diagnosis and treatment of traumatic brain injury (TBI); and (2) identify their coping strategies for dealing with job-related stress.

Design: A cross-sectional sample of 233 VA Polytrauma team members completed the Maslach Burnout Inventory (MBI) and identified strategies for coping with work stress as part of an online survey.

Results: VA Polytrauma team members experience moderate levels of emotional exhaustion, but low levels of depersonalization and high levels of personal accomplishment.

Preliminary framework for Familiar Auditory Sensory Training (FAST) provided during coma recovery.

Since there remains a need to examine the nature of the neural effect and therapeutic efficacy/effectiveness of sensory stimulation provided to persons in states of seriously impaired consciousness, a passive sensory stimulation intervention, referred to as the Familiar Auditory Sensory Training (FAST) protocol, was developed for examination in an ongoing, double-blind, randomized clinical trial (RCT). The FAST protocol is described in this article according to the preliminary framework, which is a synthesis of knowledge regarding principles of plasticity and capabilities of the human brain to automatically and covertly process sensory input. Feasibility issues considered during the development of the intervention are also described.

Sex differences in perceived life satisfaction and functional status one year after severe traumatic brain injury.

Aims: The primary aim of this study was to describe and compare perceived life satisfaction and perceived functional motor and cognitive status 1 year after severe traumatic brain injury (TBI) in males and females, adjusting for demographics and severity of injury.

Methods: Data of 297 participants were abstracted from the National Institute on Disability Rehabilitation and Research (NIDRR)-funded Traumatic Brain Injury Model Systems (TBIMS). Participants were aged 16-50, enrolled in the TBIMS study between the years 1998 and 2008, diagnosed with severe TBI (defined as having an initial Glasgow Coma Scale [GCS] score between 3 and 8), and with perceived life satisfaction and functional status data available at 1 year postinjury.

Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research.

Objectives: To conduct a systematic review of behavioral assessment scales for disorders of consciousness (DOC); provide evidence-based recommendations for clinical use based on their content validity, reliability, diagnostic validity, and ability to predict functional outcomes; and provide research recommendations on DOC scale development and validation.

Data Sources: Articles published through March 31, 2009, using MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Biomedical Reference Collection, and PsycINFO. Thirteen primary terms that defined DOC were paired with 30 secondary terms that defined aspects of measurement.

Predictive value of the Disorders of Consciousness Scale (DOCS).

Objective: To examine the predictive validity of measures of neurobehavioral change derived from the Disorders of Consciousness Scale (DOCS) for predicting return to consciousness 4, 8, and 12 months after severe brain injury (BI).

Design: Prospective observational predictive validity study

Setting: Inpatient rehabilitation hospitals and postrehabilitation residence

Participants: A total of 113 persons with a mean age of 38 +/- 17.8 years who were unconscious for >28 days consecutively after severe BI; 73% (83/113) with traumatic BI and 27% (30/113) with other BI.

Repetitive transcranial magnetic stimulation-associated neurobehavioral gains during coma recovery.

Background: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method to induce changes in cortical neural excitability. This report presents findings from the first participant of a safety and efficacy study that examined a therapeutic rTMS protocol for persons with severe traumatic brain injury (TBI).

Objective: The primary hypothesis was that there will be no adverse events related to the provision of a 6-week rTMS protocol for persons with severe TBI who remain, at best, in a minimally conscious state for longer than 3 months.

Transcranial magnetic stimulation: a possible treatment for TBI.

The purpose of this article is to outline the principles of transcranial magnetic stimulation (TMS), to summarize the existing use of TMS as a prognostic indicator and as a therapeutic device in clinical populations, and to highlight the potential of repetitive TMS (rTMS) as an intervention for traumatic brain injury. TMS is a painless method to stimulate the human brain. Repeated applications of TMS can influence brain plasticity and cortical reorganization through stimulation-induced alterations in neuronal excitability.