Sheltering Arms Institute

BackgroundTraumatic brain injury (TBI) is a serious public health problem and is associated with an increased number of health comorbidities.ObjectiveThis study examined: (a) longitudinal trajectories of participation over the 10 years after TBI in a group of Black individuals, and (b) demographic and injury-related predictors of those trajectories.MethodThis study included 1,989 Black individuals in the national TBI Model Systems (TBIMS) Database, who had at least one of each Participation Assessment with Recombined Tools-Objective (PART-O) subscale scores at one or more follow-up time points (1, 2, 5, and 10 years after TBI).ResultsLower PART-O Productivity trajectories were observed among participants who were male (b = -.26, p = .001), were older at the time of injury (b = -.02, p < .001), had a lower education level (b = .06, p < .001), had public insurance coverage (b = .17, p = .009), and had longer posttraumatic amnesia (PTA) duration (b = -.28, p < .001). Lower PART-O Social trajectories emerged among participants who were older at the time of injury (b = -.02, p < .001), did not have a partner at the time of injury (b = .66, p < .001), had public insurance coverage (b = .19, p = .009), and had longer PTA duration (b = -.19, p = .001). Lower PART-O Out and About trajectories emerged among participants who were older at the time of injury (b = -.01, p = .018) and had a lower education level (b = .05, p < .001).ConclusionThe findings highlight the importance of understanding the strengths, risk factors, and unmet needs of this group, many of whom experience decreased community and social engagement after TBI.

Lew, Henry L. MD, PhD; Yu, Jaime MD, MEd; Combs, Dylan MD; Cifu, David X. MD Author Information

ABSTRACT Timely access and continuum of care in older adults with Alzheimer’s Disease and Related Dementia (ADRD) is critical. This is a retrospective study on Medicare fee-for-service beneficiaries with ADRD diagnosis discharged to home with home health care following an episode of acute hospitalization. Our sample included 262,525 patients. White patients in rural areas have significantly higher odds of delay (odds ratio [OR], 1.03; 95% CI, 1.01–1.06). Black patients in urban areas (OR, 1.15; 95% CI, 1.12–1.19) and Hispanic patients in urban areas also were more likely to have a delay (OR, 1.07; 95% CI, 1.03–1.11). Black and Hispanic patients residing in urban areas had a higher likelihood of delay in home healthcare initiation following hospitalization compared to Whites residing in urban areas.

People with traumatic brain injury (TBI) can lack awareness of their own emotions and often have problems with emotion dysregulation, affective disorders, and empathy deficits. These impairments are known to impact psychosocial behaviors and may contribute to the burden experienced by care partners of individuals with TBI. To examine the associations of emotional awareness, emotional functioning, and empathy among participants with TBI with care partner burden. This multisite, cross-sectional, observational study used data from 90 dyads (participants with TBI and their care partner) 1-year post-injury. Participants with TBI completed the Difficulty with Emotional Regulation Scale (DERS; Awareness, Clarity, Goals, Impulse, Nonacceptance, and Strategies subscales); PTSD Checklist-Civilian Version; NIH Toolbox Anger-Affect, Hostility and Aggression Subdomains; PHQ-9; GAD-7; and the Interpersonal Reactivity Index (empathic concern and perspective taking subscales). Care partners completed the Zarit Burden Inventory (ZBI) and provided demographic information. Care partners were predominately female (77%), and most were either a spouse/partner (55.2%) or parent (34.4%). In an unadjusted model that included assessments of emotional awareness, emotional functioning, and empathy of the participant with TBI, the DERS-Awareness and NIH-Hostility subscales accounted for a significant amount of variance associated with care partner burden. These findings persisted after adjusting for care partner age, relationship, education, and the functional status of the participant with TBI (β= 0.493 and β= 0.328, respectively). These findings suggest that high levels of hostility and low emotional self-awareness can significantly affect the burden felt by TBI care partners.

The construct of participation after traumatic brain injury (TBI) can be difficult to operationalize. Psychometric network analysis offers an empirical approach to visualizing and quantifying the associations between activities that comprise participation, elucidating the relations among the construct's components without assuming the presence of a latent common cause and generating a model to inform future measurement methods. The current research applied psychometric network analysis to the Participation Assessment with Recombined Tools-Objective (PART-O) within a sample of service members and veterans (SM/Vs) with a history of TBI at 1 and 2 years ( T1 and T2 ) postinjury. Participants ( N = 663) were SM/Vs with a history of TBI who completed comprehensive inpatient rehabilitation services at a Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC). Five VA PRCs. Cross-sectional, retrospective analysis of data from the VA TBI Model Systems study. PART-O. Network analysis demonstrated that the PART-O structure was generally consistent over time, but some differences emerged. The greatest difference observed was the association between "spending time with friends" and "giving emotional support" to others. This association was more than twice as strong at T2 as at T1 . The "out of the house" item was most central, as demonstrated by dense connections within its own subscale (Out and About) and items in other subscales (ie, Social Relations and Productivity). When examining items connecting the 3 subscales, the items related to giving emotional support, internet use, and getting out of the house emerged as the strongest connectors at T1 , and the internet was the strongest connector at T2 . Providing emotional support to others is associated with greater participation across multiple domains and is an important indicator of recovery. Being out and about, internet use, and engagement in productive activities such as school and work shared strong associations with Social Relations. Network analysis permits visual conceptualization of the dynamic constructs that comprise participation and has the potential to inform approaches to measurement and treatment.