Functional Outcomes/Traumatic Brain Injury

The Research Institute established an agenda with the help of Mary Segal, PhD, (Adjunct Scientist at Moss Rehabilitation Research Institute) in which we explore factors underlying functional recovery and life satisfaction after discharge from rehabilitation. Scientists need the prediction and explanation of functional outcomes for reimbursement for services to develop appropriate levels of care.  Results from this research can assist healthcare providers to improve outcomes by suggesting new and more effective clinical interventions.

Clinical scientists at MRRI are studying the outcomes of Traumatic Brain Injury (TBI) through the TBI Model System program: 

Moss Traumatic Brain Injury (TBI) - Model System of Care (with sub-projects listed below)

T. Hart, PhD, Principal Investigator

J. Whyte, MD, PhD, Co-Principal Investigator

Comparing electronic and paper strategies for enhancing goal-related behavior after TBI using self-cueing: A randomized controlled trial.

T. Hart, PhD, Principal Investigator

Monica Vaccaro, MS, Co-Investigator

J. Whyte, MD, PhD, Co-Investigator

The ability to formulate and carry out goals and intentions is impaired in TBI due to characteristic difficulties with memory, attention and executive function.  Difficulties inhibiting socially inappropriate or unsafe behaviors may also interfere with the attainment of personal goals and increase the affected person's dependence on others.  The current study extends a line of research in which use of hand-held electronic devices was shown to enhance memory for therapy goals a the verbal level.  The current project, which incorporated extensive consumer input in the planning process, uses Goal Attainment Scaling (GAS) to assess the efficacy of an electronic strategy for goal attainment compared to traditional paper-and-pencil strategies. 

Validation of Moss Attention Rating Scale (MARS)

J. Whyte, MD, PhD, Principal Investigator

T. Hart, PhD, Co-Principal Investigator

The Moss Attention Rating Scale (MARS) is a quantitative, observational measure of disordered attention that may be used with patients who are unable to complete psychometric measures. Previous research has suggested that the MARS is composed of 3 inter-correlated factors (Initiation, Restlessness/Distractibility, and Sustained Attention) within a unitary dimension of disordered attention.  Inter-rater agreement between occupational and physical therapists is good.  -  This project seeks to extend these findings by examining inter-rater agreement among additional rehabilitation therapy disciplines.  In addition, the MARS will be validated by examining its correlation with a set of neuropsychological measures sensitive to attention, by assessing change in scores between inpatient rehabilitation admission and discharge, and by assessing its responsiveness to methylphenidate treatment.

Efficacy of a low-dose targeted injection of botulinum toxin in treatment of elbow flexor hypertonia after TBI

N. Mayer, MD, Principal Investigator

A. Esquenazi, MD, Co-Principal Investigator

J. Whyte, MD, PhD, Co-Investigator

This research is studying whether botulinum toxin, which treats Traumatic Brain Injury related spasticity can be administered more effectively.  We know that botulinum toxin can alleviate muscle spasticity; however, patients with TBI tend to have many spastic muscles - all requiring individual treatment.  As a result, we quickly reach the maximum level of medication that can be given according to establishes standards of practice.  This research is studying ways to deliver this medication more efficiently so less botulinum toxin is required for each individual muscle. 

Improving prediction of long-term functional outcomes through case mix adjustment

M. Segal, PhD, Principal Investigator, University of Pennsylvania

J. Whyte, MD, PhD, Co-Investigator

The effectiveness of rehabilitation interventions is ultimately judged based on functional outcomes produced, and in this endeavor, one must be able to adjust for individual factors that affect prognosis, or case mix.  This study will use several approaches to develop case mix adjustment models for one-year follow-up outcomes.  If the different methodologies suggest similar models, this will increase the confidence with which they can be employed.  If not, it will be useful to understand variations in the models as a way to explore the structure of relationships between predictors and outcomes and the usefulness of the modeling approaches themselves. 

Efficacy of Internet strategies for facilitating social integration after TBI

M. Vaccaro, MS, Principal Investigator

T. Hart, PhD, Co-Investigator

J. Whyte, MD, PhD,, Co-Investigator

This study is a 2-part project.  In part 1,  individuals with TBI work using a Participatory Action strategy to compile annotated lists and ratings of websites relevant to TBI consumer needs.  In

Part 2, 80 persons with moderate to severe TBI were interviewed in depth about their interest in, use of, and problems associated with internet resources, as well as, their wishes for training or facilitation in using the Internet. People who had used the Internet both before and after TBI expressed different training needs compared to those who had only attempted Internet use after injury.  There was a high degree of interest in both groups in using the Internet for TBI-related activities.

Community Outcomes Following Traumatic Brain Injury:  Impact of  Race and Pre-Injury Status

T. Hart, PhD, Principal Investigator

J. Whyte, MD, PhD, Co-Principal Investigator

G. Kersey-Matusiak, Co-Investigator

This study investigates the contribution of pre-injury differences and potential biases in outcome measurement in explaining outcome differences between white and African-American persons with moderate and severe traumatic brain injury (TBI). 

Blame attribution in violent and accidental TBI

T. Hart, PhD, Principal Investigator

Violence is a significant cause of TBI, especially in urban areas.  In other populations, violence-related (intentional)  injury has been studied with respect to blame attribution.  Previous work suggests that self-blame may be associated with better coping and more favorable outcome compared to blame of other persons.  Those with TBI due to violence may therefore be at risk for worse psychological outcomes. In this project we are measuring blame attribution in the acute stages of both intentional and unintentional injury and again a 1-year follow-up, along with outcome assessment, to determine the effects of blame attribution on psychosocial outcome.