Treatment for depression following mild traumatic brain injury in adults: A meta-analysis

Primary objective: Development of depression after TBI is linked to poorer outcomes. The aim of this manuscript is to review evidence for the effectiveness of current treatments. Research design: Two meta-analyses were undertaken to examine the effectiveness of both pharmacological and non-pharmacological interventions for depression after mild TBI Method and procedures: PubMed, Medline, PsychInfo, Web of Science and Digital Dissertations were searched and 13 studies located. Meta Analyst Beta 3.13 was used to conduct analyses of pre- vs post-effects then to examine treatment group vs control group effects. Main outcomes and results: Studies using a pre–post design produced an overall effect size of 1.89 (95% CI = 1.20–2.58, p < 0.001), suggesting that treatments were effective; however, the overall effect for controlled trials was 0.46 (95% CI = −0.44–1.36, p < 0.001), which favoured the control rather than treatment groups. Conclusions: This study highlights the need for additional large well-controlled trials of effective treatments for depression post-TBI

Further validation of the New Zealand test of adult reading (NZART) as a measure of premorbid IQ in a New Zealand sample

Premorbid IQ estimates are used to determine decline in cognitive functioning following trauma or illness. This study aimed to: 1) further validate the New Zealand Adult Reading Test (NZART) in a New Zealand population and compare its performance to the UK developed National Adult Reading Test, and 2) develop regression formulae for the NZART to estimate Wechsler Adult Intelligence Scale-IV (WAIS–IV) IQ scores. The 67 participants (53 females; 16 Māori), aged 16 to 90 years old (mean age = 46.07, SD 23.21) completed the WASI-IV, the NART and the NZART. The NZART predicted Verbal Comprehension Index (VCI) scores slightly better than the NART (r =.63 vs. r = .62) and explained 33% of the variance in FSIQ scores. Reasons for developing regression formulae for the NZART are discussed, regression formulas for the NZART based on the WAIS–IV are included and suggestions of alternate ways of determining premorbid IQ are made

Computerised tomography indices of raised intracranial pressure and traumatic brain injury severity in a New Zealand sample

After traumatic brain injury (TBI) complex cellular and biochemical processes occur¹ including changes in blood flow and oxygenation of the brain; cerebral swelling; and raised intracranial pressure (ICP).² This can dramatically worsen the damage³ and contributes to mortality

Attention deficits after incident stroke in the acute period: Frequency across types of attention and relationships to patient characteristics and functional outcomes

Background: Attention deficits are common post stroke and result in poorer functional outcomes. This study examined the frequency of attention deficits after incident stroke and their correlates. Method: Attention of 94 stroke survivors was assessed using the Bells test, Trails Making Test A/B, 2.4- and 2.0-second trials of the Paced Auditory Serial Addition Test (PASAT), and Integrated Auditory Visual Continuous Performance Test (IVA-CPT) within 3 weeks post stroke. Wider functioning was assessed using the Medical Short Form-36 (SF-36) Physical and Mental Component Summary scores (PCS and MCS), London Handicap Scale, Modified Rankin Scale, General Health Questionnaire-28, and Cognitive Failures Questionnaire (CFQ). Results: Most participants were impaired or very impaired on the IVA-CPT (z scores > 3 SDs below normative mean) but not other attention measures. Functional independence and cognitive screening test (Mini-Mental State Examination) performance were significantly related to IVA-CPT, Trails A/B, and Bells tests but not PASAT. Better performance across the Bells test was related to better SF-36 PCS, whereas Trails A and the PASAT were related to SF-36 MCS. Better CFQ naming was related to Trails B, whereas worse CFQ memory was related to better PASAT performance. Conclusion: Attention deficits are common post stroke, though frequency varies widely across the forms of attention assessed, with tests of neglect and speeded attention tasks being linked to quality of life. This variability of performance and linking to wider outcomes suggests the need for comprehensive assessment of attention and that attention is a viable target for rehabilitative efforts

Reliable Individual Change in Post Concussive Symptoms in the Year Following Mild Traumatic Brain Injury: Data From the Longitudinal, Population-based Brain Injury Incidence and Outcomes New Zealand in the Community (Bionic) Study

Objective: Post concussive syndromes (PCS) is common after mild-TBI, yet are not well studied on a population level. This study examined PCS symptoms, including reliable change over time in a population-based sample up to one year post-TBI. Methods: Prospective follow-up of 527 adults (≥16 years) with mild TBI (mTBI) and assessment data (Rivermead Post concussion Questionnaire; RPQ) at baseline, 1, 6, and/or 12-months post-TBI. Change in mean scores and clinically significant change across RPQ items for each person was calculated between assessment time points using a reliable change index (RCI). Results: While prevalence of all symptoms reduced over time, >30% of participants reported fatigue, slowed thinking, and forgetfulness 12-months postinjury. Using the RCI, <12% of individuals improved from baseline to 1-month, 50% from 1 to 6-months, and 4.2% from 6 to 12-months. Conclusions: Improvements in PCS post-mTBI were most obvious between 1 and 6-months, suggesting lengthy recovery trajectory. A third of patients experience residual cognitive problems 12-months following a mTBI, and while many individuals improve post-TBI, a large proportion remain stable or worsen

Communication and behavioral assessment of persons with developmental disabilities

Communication affects many areas of daily life. Therefore, support programs to assist persons with developmental disabilities should identify individuals who would especially benefit from communication training. Forty individuals with developmental disabilities were assessed on Vineland Adaptive Behavioral Scales (VABS) (Sparrow, Balia, &Cicchetti, 1984), the Assessment of Basic Learning Abilities (ABLA) test (Kerr, Meyerson, & Flora, 1977), and a Communication Status Survey developed for this study. ABLA level was correlated with all VABS scales except gross motor skills and maladaptive behaviors. These correlations validate the use of the ABLA as a measure of cognitive ability. Ability to use formal communication modes (speech, sign language, symbols) was significantly (p= 0.001) related to ABLA level. Examination of individual cases suggested that the ABLA may be predictive of the ability to acquire formal communication. All persons able to pass ABLA level 2 or higher who had received previous communication training had some formal communication ability. In contrast, five individuals who were able to pass ABLA level 2 or 3 and lacked formal communication had not received communication training. The importance of formal communication is confirmed since persons without formal communication were unable to provide information about immediate and external environments or request clarification. Training in formal communication may be of benefit in allowing clients to perform these skills

Model of posttraumatic stress reactions to sexual abuse in females / by Suzanne L. Barker-Collo.

Sexual abuse is identified by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV, APA, 1994) as a possible precipitator of Posttraumatic Stress Disorder (PTSD). An estimated 50% of sexual abuse survivors will develop PTSD (Kiser, Heston, Millsap, & Pruitt, 1991; O’Neil & Gupta, 1991). Therefore, while exposure to a traumatic stressor such as sexual abuse is necessary in the development of PTSD, it is not sufficient A number of models have been proposed that attempt to describe the process of coping and symptom development associated with PTSD, and to account for individual differences in this process. One such model is Joseph, Williams, and Yule’s (1995) integrative cognitive-behavioural model of response to traumatic stress (see Figure I). The present stucfy evaluated Joseph, et al.’s (1995) model when applied to a sample of 122 female sexual abuse survivors from across Ontario, Canada. Participants completed survey packages which included measures for each of the variables presented in Joseph et al ’s (1995) model. The variable Event Stimuli was measured using the Sexual Experiences Survey (Koss & Orso, 1982; see Appendix A). Personality was measured using Neuroticism items of the NEO-PIR (Costa & McCrae, 1992; see Appendix C). Appraisal of the abuse was measured using a modified version of the Attributional Style Questionnaire (Peterson, Semmel, Baqrer, Abramson, Metalsky, & Seligman, 1982; see Appendix D). Coping and Crisis Support were measured using the Coping Responses Inventory (Moos, 1993; see Appendix E) and the Crisis Support Scale (Joseph, Andrews, Williams, & Yule, 1992; see Appendix F), respectively. Symptom outcomes, as indicated by the model variables Event Cognitions and Emotional States, were assessed by specified items of the Trauma Symptom Checklist- 40 (Elliott & Briere, 1991; see Appendix G). This study makes three main empirical contributions. First, MANOVA results indicate that response to abuse was significantly influenced by ethnicity, age at which abuse first occurred, and the type of mental health services currently being received. Caucasian individuals rated themselves lower on use of problem-focused coping strategies, vulnerability, impulsiveness, and self-blame than individuals of Native American ancestry. Those 15 years of age or less when first abused rated themselves higher on anxiety and lower on social supports while those in older age groups rated themselves in the opposite direction, individuals currently in counselling or on a waiting list rated themselves lower on anxiety, depression, and vulnerability. Conversely, those currently in support groups rated themselves as higher on depression, anxiety, and vulnerability. Those currently in both counselling and a support group and those receiving no clinical services scored moderately on the three variables. Second, path analysis indicated that Joseph et al.’s (1995) model did not fit the data X[superscript 2](9) = 24.81, p .4 (see Figure 7). As hypothesized, one modification that improved the fit of the model was the addition of a path from characteristics of the abuse to engagement of social support In the modified model, the sign of the path from crisis support to appraisals indicated that increased levels of crisis support were associated with maladaptive appraisals (i.e., self-blame). This relationship is opposite to that proposed by Joseph et al. (1995), where increased crisis support is proposed to lead to more adaptive appraisals, but is consistent with the second hypothesized modification to the model. When examined as a single construct, coping strategies was not found to significantly influence any other variables in the model. Finally, relationships between coping, appraisal, neuroticism and symptom subscales were evaluated. Individuals who coped through cognitive avoidance, emotional discharge, acceptance/resignation, and logical analysis following abuse reported more event cognitions, negative emotional states, sexual problems, and somatic complaints. Increased sexual and somatic complaints, negative emotional states, and event cognitions were accompanied by decreased depression, self-consciousness, anxiety, vulnerability, and impulsiveness, in contrast those who engaged in less cognitive avoidance, sought less support from others and engaged in less problem solving behaviours reported fewer sexual or somatic complaints. Reduced symptomatology (i.e., event cognitions, negative emotional states, somatic symptoms) was also associated with increased trait levels of anxiety, depression, and vulnerability and decreased impulsiveness. Implications of the findings for assessment and therapeutic interventions and for future research were explored

Development of the Standards of Reporting of Neurological Disorders (Strond) Checklist: A Guideline for the Reporting of Incidence and Prevalence Studies in Neuroepidemiology

Background: Incidence and prevalence studies of neurologic disorders play an important role in assessing the burden of disease and planning services. However, the assessment of disease estimates is hindered by problems in reporting for such studies. Despite a growth in published reports, existing guidelines relate to analytical rather than descriptive epidemiologic studies. There are also no user-friendly tools (e.g., checklists) available for authors, editors, and peer reviewers to facilitate best practice in reporting of descriptive epidemiologic studies for most neurologic disorders. Objective: The Standards of Reporting of Neurological Disorders (STROND) is a guideline that consists of recommendations and a checklist to facilitate better reporting of published incidence and prevalence studies of neurologic disorders. Methods: A review of previously developed guidance was used to produce a list of items required for incidence and prevalence studies in neurology. A 3-round Delphi technique was used to identify the “basic minimum items” important for reporting, as well as some additional “ideal reporting items.” An e-consultation process was then used in order to gauge opinion by external neuroepidemiologic experts on the appropriateness of the items included in the checklist. Findings: Of 38 candidate items, 15 items and accompanying recommendations were developed along with a user-friendly checklist. Conclusions: The introduction and use of the STROND checklist should lead to more consistent, transparent, and contextualized reporting of descriptive neuroepidemiologic studies resulting in more applicable and comparable findings and ultimately support better health care decisions

Reducing recurrent stroke: methodology of the motivational interviewing in stroke (MIST) randomized clinical trial

Recurrent stroke is prevalent in both developed and developing countries, contributing significantly to disability and death. Recurrent stroke rates can be reduced by adequate risk factor management. However, adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor, leading to a large number of preventable recurrent strokes. Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke