NeuroRehabilitation - Volume 52, issue 4

Authors: Zasler, Nathan D.

Article Type: Editorial

DOI: 10.3233/NRE-236000

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 519-523, 2023

Authors: McCart, Melissa | Davies, Susan

Article Type: Editorial

DOI: 10.3233/NRE-230002

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 525-527, 2023

Authors: McCart, Melissa | Todis, Bonnie | Gomez, Douglas | Glang, Ann

Article Type: Research Article

Abstract: BACKGROUND: This longitudinal qualitative study tracked students with traumatic brain injury (TBI) from hospital discharge through their return to school and then for an average of four years of school. OBJECTIVE: To better understand the experiences of students and parents in the education system following TBI. METHODS: Participants were parents and educators of 21 students with TBI. Interviews were conducted using open-ended questions and students were observed in the classroom. RESULTS: From these data, three themes were identified: lack of student tracking year to year, lack of educator training, and conflicting views between educators …and parents about students’ needs. These factors ultimately led to parent frustration and eventually conflict and deteriorating relationships between parents and educators. CONCLUSION: The results suggest that improving educator training could positively affect the factors identified and possibly mitigate parent frustration. Show more

Keywords: Low incidence disability, teacher quality, professional development, teacher education, qualitative

DOI: 10.3233/NRE-220209

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 529-537, 2023

Authors: Clasby, Betony | Hughes, Nathan | Clasby, Elizabeth | Catroppa, Cathy

Article Type: Review Article

Abstract: BACKGROUND: Childhood traumatic brain injury (TBI) can result in impairments in learning, cognition, and behaviour; all of which can adversely influence educational outcomes. Schools can play a crucial role in rehabilitation, therefore it is important that evidence-based supports are available in these settings. OBJECTIVE: The aim of this systematic review was to evaluate the effectiveness of school-based supports and interventions available following childhood TBI. METHODS: A comprehensive search strategy involved eight research databases, grey literature, and backward reference searching. RESULTS: The search identified 19 studies, reporting on sixteen distinct interventions, which used a variety …of person-centred and systemic approaches, and typically contained multiple components, including: psychoeducation, behavioural scripts, and attention training. While offering some indication for future directions in intervention, the evidence base for individual interventions was typically limited, and does not take account of cost or issues in sustainability. CONCLUSION: While there appears to be great potential to support students who may otherwise not gain access to services, there is insufficient evidence to guide widespread policy or practice change without further research. Greater collaboration between researchers, clinical practitioners, and educators is necessary to ensure that all interventions developed are robustly evaluated and disseminated. Show more

Keywords: Traumatic brain injury, school, education, intervention, rehabilitation

DOI: 10.3233/NRE-220218

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 539-568, 2023

Authors: Jimenez, Nathalia | Harner, Vern | Oliva, Maria Andrea | Lozano, Lorena | Fuentes, Molly

Article Type: Review Article

Abstract: BACKGROUND: Return to school is key for community re-integration after a traumatic brain injury (TBI). School support facilitates and ensure a successful transition back to school. However, access to school services is not uniform among U.S. children. OBJECTIVE: To describe school services for children with TBI from minoritized backgrounds and highlight population-specific risk factors and facilitators for accessing services. METHODS: Narrative review of the literature including studies on return to school after a mild-complicated, moderate, or severe TBI, among children enrolled in the U.S. school system. We describe receipt of services, enabling and risk factors, and …outcomes, for minority children. RESULTS: There is a gap in knowledge regarding return to school among minoritized children with TBIs. Studies have few participants from racial and ethnic minority backgrounds, or low income or rural communities. Transgender and non-binary youth are not represented in present research efforts. Studies highlight larger barriers to receipt of school services among minority children and additional barriers associated with their minority status. CONCLUSION: Diversity in the U.S pediatric population is increasing. Minoritized populations are at increased risk for TBI and poor outcomes. Research focused on the needs of these populations is required to optimize school return after TBI hospitalization and overall post-discharge care. Show more

Keywords: Traumatic brain injury, children with disability, school based services, medically underserved

DOI: 10.3233/NRE-220210

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 569-583, 2023

Authors: Lundine, Jennifer P. | Hagen, Erika | Davies, Susan

Article Type: Research Article

Abstract: BACKGROUND: Care coordination aligns services and optimizes outcomes for children with traumatic brain injury (TBI), yet numerous obstacles can impede effective care coordination following a TBI. OBJECTIVE: The goal of this work is to identify barriers and facilitators to care coordination from the perspective of individuals who care for young people impacted by TBI (e.g., medical providers, educators, caregivers). METHODS: Twenty-one care providers participated in semi-structured interviews to gather their perspectives on systems of care coordination for youth with TBI and potential areas for improvement. Using reflexive thematic analysis, researchers identified key themes across interviews. …RESULTS: Three themes were identified: 1) gaps in knowledge; 2) poor collaboration and communication between systems and care providers; and 3) inadequate legislative and policy frameworks that fund and support pediatric TBI. Across themes, participants shared their experiences and ideas to improve each of these areas. CONCLUSION: A structured, consistent, and coordinated system of care for pediatric TBI is critical to ensure optimal outcomes. Protocols that emphasize intentional and productive collaboration between healthcare settings and schools and education for all care providers are cornerstones in improving outcomes for children. Top-down action that develops policy and funding initiatives is needed to ensure equitable, consistent access to appropriate healthcare and educational supports. Show more

Keywords: Traumatic brain injury, care coordination, service provision, children, caregiver, communication, family

DOI: 10.3233/NRE-220196

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 585-596, 2023

Authors: McCart, Melissa | Unruh, Deanne | Gomez, Doug | Anderson, Daniel | Gioia, Gerry | Davies, Susan C. | Haarbauer-Krupa, Juliet | Womack, Lindsay S. | Thigpen, Sally | Brown, Linda | Glang, Ann

Article Type: Research Article

Abstract: BACKGROUND: In Oregon in 2019, only 261 students were eligible for special education under the traumatic brain injury (TBI) category. Many students with TBIs are not treated by a medical provider, so the requirement for a medical statement could prevent eligible youth from receiving special education services. OBJECTIVE: This study investigated barriers to using a medical statement to establish special education eligibility for TBI, support for using a guided credible history interview (GCHI), and training needs around GCHI. RESULTS: Among participants, 84% reported difficulty obtaining a medical statement for TBI eligibility determination, and 87% favored the …GCHI as an alternative, though they reported a need for training in TBI and GCHI. CONCLUSION: The results support the use of GCHI to establish special education eligibility for TBI and informed Oregon’s addition of GCHI to TBI special education eligibility determination. Show more

Keywords: Brain injury, concussion, special education, medical statement, policy, school, services

DOI: 10.3233/NRE-220211

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 597-604, 2023

Authors: Gomez, Douglas | Glang, Ann | Haarbauer-Krupa, Juliet | Bull, Rachel | Tucker, Paula | Ratcliffe, Jonathan | Hall, Alex | Gioia, Gerard A. | Jain, Shabnam | Sathian, Usha | Simon, Harold K. | Wright, David

Article Type: Research Article

Abstract: BACKGROUND: For children, the post-concussion return to school process is a critical step towards achieving positive health outcomes. The process requires integration between healthcare professionals, parents, and school personnel. OBJECTIVE: This research team conducted focus groups with stakeholders including parents, education personnel, school nurses, external healthcare providers (nurses) and athletic trainers to identify communication patterns between healthcare providers outside of the school setting and school personnel. METHODS: Data from focus groups were analyzed using a Thematic Analysis approach. Researchers used an inductive (bottom-up) coding process to describe semantic themes and utilized a critical realist epistemology. …RESULTS: We identified four key themes within focus group data: (1) lack of effective communication between hospital and outpatient healthcare providers to school personnel; (2) parents who were strong advocates had improved communication with healthcare professionals and garnered more accommodations for their children; (3) non-school professionals and families were often confused about who the point of contact was at a given school; and (4) differing experiences for athletes vs. non-athletes. CONCLUSION: This study suggests gaps in communication between healthcare and school professionals when children return to school following a concussion. Improving communication between healthcare providers and school staff will require a multi-faceted approach. Show more

Keywords: Qualitative, brain injury, school, healthcare

DOI: 10.3233/NRE-220220

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 605-612, 2023

Authors: Ciccia, Angela | Nagele, Drew | Chen, Zhengyi | Albert, Jeffrey | Eagan-Johnson, Brenda | Vaccaro, Monica | Dart, Libby | Riccardi, Jessica | Lundine, Jennifer

Article Type: Research Article

Abstract: BACKGROUND: Students with traumatic brain injury (TBI) often demonstrate difficulties that impact their successful return to school (RTS). OBJECTIVE: To explore injury severity, age at injury, and time since injury as predictors for performance on measures of cognitive, social and health functioning for students’ participating in a formal RTS cohort at the time of their enrollment in the School Transition After Traumatic Brain Injury (STATBI) research project. METHODS: Outcome measures across cognitive, social, and health domains were analyzed for association with the explanatory variables of interest using quantile regressions and ordinary least squares regression, as appropriate. …RESULTS: Students (N = 91) injured after age 13 showed significantly lower cognitive outcomes than students whose injury occurred earlier. Additionally, students more than one-year post-injury demonstrated poorer social outcome on one measure compared to students whose injury occurred more recently. Health outcomes showed no significant association to any predictors. CONCLUSION: The results of this analysis provide a baseline for a group of students with TBI as they enter a RTS research study. This data can now be paired with longitudinal measures and qualitative data collected simultaneously to gain a deeper understanding of how students with TBI present for RTS. Show more

Keywords: Traumatic brain injury, pediatric, rehabilitation, outcomes

DOI: 10.3233/NRE-220208

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 613-624, 2023

Authors: Bennett, E. | Fletcher, A. | Talbot, E. | Robinson, L.

Article Type: Research Article

Abstract: BACKGROUND: Returning to education (RtE) after an acquired brain injury (ABI) can be stressful for children/young people (CYP) and families. While much can be done to support RtE, there has been limited exploration of the lived experience of parents/carers about what can both help and hinder the process. OBJECTIVE: The aim was to understand more about RtE from parents’ perspectives to inform best practice and facilitate improvements in service delivery. METHODS: A service evaluation explored parent/carer views about the RtE process and the support received from healthcare professionals at a regional centre in the UK. Questionnaires …(n  = 59) were sent to parents of patients treated for an ABI in the last two years. RESULTS: 31 parents (response rate = 51%) completed the survey. Results highlight the many challenges of RtE. Thematic analysis of responses revealed six key themes: Parental mindset and growth; What do they need now?; Specialist support and information; Talk and share; Challenges of new and hidden needs; and Don’t forget them! CONCLUSION: Parents offer crucial insight into the challenges of the RtE process. Their feedback highlights important factors for service development and reminds professionals of the key components of an effective return. Show more

Keywords: Acquired brain injury, return to education, parents, children, young people, ABI, neurorehabilitation

DOI: 10.3233/NRE-220205

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 625-640, 2023

Authors: Avery, Aspen | Takagi-Stewart, Julian | Qiu, Qian | Philipson, Erik B. | Moore, Megan | Kroshus, Emily | Weiner, Bryan J. | Graves, Janessa M. | Glang, Ann | Jinguji, Thomas | Coppel, David B. | Sidhu, Manrita | Vavilala, Monica S.

Article Type: Research Article

Abstract: BACKGROUND: Appropriate concussion care in school is vital for full recovery, but school return-to-learn (RTL) programs are lacking and vary in quality. Establishing student-centered RTL programs may reduce disparities in RTL care. OBJECTIVE: To examine the effect of RISE Bundle (Return to Learn Implementation Bundle for Schools) implementation on high school adoption of a student-centered RTL program. METHODS: A convenience sample of fourteen (4 rural and 10 urban) small and large Washington (WA) State public high schools were enrolled in a stepped-wedge study with baseline, end of study, and monthly measures over the 2021–2022 academic year. …Schools identified an RTL champion who led RISE Bundle implementation in 6-week steps. Concussion knowledge and impact of RTL program on concussion care were examined. RESULTS: Ten schools (71.4%) successfully completed RISE Bundle implementation and established a functional RTL program. Self-reported concussion knowledge from RTL Champions increased post intervention. Establishing RTL programs facilitated provision of tailored accommodations, and perceived variation and inequities in RTL care were reduced. CONCLUSION: RISE Bundle implementation proved feasible, supported the establishment of a functional RTL program, and perceived to reduce disparities in concussion care in rural and urban WA State public high schools of varying sizes. Show more

Keywords: Youth concussion, return to learn, traumatic brain injury

DOI: 10.3233/NRE-220200

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 641-650, 2023

Authors: Ippolito, Christina | Cogliano, Alexandra | Patel, Alexandra | Shear, Sara | Provvidenza, Christine | Wilson, Katherine E. | Reed, Nick

Article Type: Research Article

Abstract: BACKGROUND: Return-to-school processes indicate ‘when’ to initiate activities and ‘what’ activities should be accomplished, but are missing ‘how’ to implement the process. The SCHOOLFirst website provides the ‘how’ through building concussion knowledge, creating a supportive culture, and defining roles. Due to the involvement of pre-service teachers in schools during training and imminent transition to becoming teachers, it is important that pre-service teachers are trained in concussion and can optimally support current and future students. OBJECTIVE: To determine: 1) pre-service teachers’ knowledge and confidence surrounding the return-to-school process before and after using the SCHOOLFirst website; 2) the usability, intended …use and satisfaction of the SCHOOLFirst website from the perspective of pre-service teachers. METHODS: Thirty pre-service teachers completed the demographic survey, knowledge and confidence survey, System Usability Scale, and satisfaction and intended use survey after participating in a workshop. RESULTS: Significant increases in concussion knowledge (Z  = –4.093, p  < 0.001) and confidence in helping students return-to-school (Z  = –4.620, p  < 0.001) were measured after using the SCHOOLFirst website. Participants were satisfied with the SCHOOLFirst website (93.4%) and intend to use it in the future when supporting a student post-concussion (96.4%). CONCLUSION: The SCHOOLFirst website is a valuable tool for pre-service teachers to support students’ return-to-school post-concussion. Show more

Keywords: Educators, teachers, concussion, school, students, return-to-school, return-to-learn

DOI: 10.3233/NRE-220207

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 651-662, 2023

Authors: Amatya, Bhasker | Khan, Fary

Article Type: Other

Abstract: BACKGROUND: Memory disturbance is common in people with multiple sclerosis (pwMS). Currently, a range of memory rehabilitation approaches alone or as a component of cognitive rehabilitation is utilized clinically. OBJECTIVE: To evaluate the effectiveness of memory rehabilitation in improving health outcomes (memory, cognitive function, functional ability, quality of life) in pwMS. METHODS: A summary of the Cochrane Review “Memory rehabilitation for people with multiple sclerosis” by Taylor et al from a rehabilitation perspective. RESULTS: The review included 44 studies (with 2714 participants). The memory rehabilitation approaches varied amongst the included primary studies for memory retraining …techniques (computerized programs, training using internal and external memory aids, etc.). Overall, the risk of bias amongst the included trials was low. The findings suggest high-certainty evidence for a beneficial effect of memory rehabilitation in improving subjective memory at intermediate- (1–6 months) and longer-term (> 6 months); and moderate-certainty evidence at immediate post-intervention. The evidence of the effect of memory rehabilitation on other outcomes showed mixed results. CONCLUSION: The evidence suggests some beneficial effects of memory rehabilitation in improving subjective memory and quality of life in pwMS. However, further evidence is required for the evaluation of memory strategies for other outcomes. Show more

Keywords: Multiple sclerosis, memory, health outcomes, rehabilitation

DOI: 10.3233/NRE-230003

Citation: NeuroRehabilitation, vol. 52, no. 4, pp. 663-666, 2023