Archive for category TBI

[ARTICLE] Pituitary dysfunction following traumatic brain injury: clinical perspectives – Full Text


Traumatic brain injury (TBI) is a well recognized public health problem worldwide. TBI has previously been considered as a rare cause of hypopituitarism, but an increased prevalence of neuroendocrine dysfunction in patients with TBI has been reported during the last 15 years in most of the retrospective and prospective studies. Based on data in the current literature, approximately 15%–20% of TBI patients develop chronic hypopituitarism, which clearly suggests that TBI-induced hypopituitarism is frequent in contrast with previous assumptions. This review summarizes the current data on TBI-induced hypopituitarism and briefly discusses some clinical perspectives on post-traumatic anterior pituitary hormone deficiency.


Traumatic brain injury (TBI) could be defined as a change in brain function or other evidence of brain pathology caused by external forces,1 and is a well recognized public health problem worldwide. A substantial number of people with TBI are seen in emergency departments; the great majority, approximately 235,000 each year, are hospitalized because of non-fatal TBI and nearly 50,000 die according to reports from the USA. Further, the overall annual incidence of TBI in the USA has been reported to be 506 per 100,000 population.2 The severity ratio of hospitalized TBI patients was reported to be approximately 22:1.5:1 for mild to moderate to severe cases, respectively.3 Thus, there is no doubt that TBI is one of the most common causes of mortality and long-term disability among young adults. The main causes of TBI are road traffic accidents (the leading cause, accounting for 50% of all cases), falls, violence-related incidents, sports-related head trauma (hockey, soccer, football), combative sports (boxing and kickboxing) characterized by chronic repetitive head trauma, and war-related accidents, including blast injuries.47

Although TBI has previously been considered as a rare cause of hypopituitarism, an increased prevalence of neuroendocrine dysfunction in patients with TBI has been reported during the last 15 years in most of the retrospective and prospective studies.818 This review summarizes the current data on TBI-induced hypopituitarism and briefly discusses some clinical perspectives on post-traumatic anterior pituitary hormone deficiency.[…]


Continue —> Pituitary dysfunction following traumatic brain injury: clinical perspectives


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[WEB SITE] Traumatic Brain Injury Rehabilitation at Florida Institute for Neurologic Rehabilitation

A Specialized Approach to NeuroRehabilitation & Traumatic Brain Injury Rehabilitation

The Florida Institute for Neurologic Rehabilitation, (FINR) has developed a comprehensive brain injury rehabilitation continuum of care offering specialized inpatient evaluation and treatment for both children and adults. Through a pre-admission evaluation and medical records review, FINR develops individualized treatment programs. As a leader in traumatic brain injury rehabilitation (TBI)neurorehabilitation, and neuropsychiatric disorders, our continuum of care delivers clinically relevant and cost effective services with unparalleled continuity of care. The distinct programs in our continuum are designed for individuals with a wide range of complex medical, neurorehabilitation, neurobehavioral, and neuropsychiatric care needs.

Potential traumatic brain injury rehabilitation clients, family members, funders, referral sources, and other concerned parties are encouraged to tour our facilities in order to make informed placement decisions. If our team of expert staff can assist in scheduling a tour or providing educational resources and information, please give us a call at 1-888-TBI-FINR (888-824-3467).



via Traumatic Brain Injury Rehabilitation at Florida Institute for Neurologic Rehabilitation

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[ARTICLE] Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review – Full Text


Guidelines aim to improve the quality of medical care and reduce treatment variation. The extent to which guidelines are adhered to in the field of traumatic brain injury (TBI) is unknown. The objectives of this systematic review were to (1) quantify adherence to guidelines in adult patients with TBI, (2) examine factors influencing adherence, and (3) study associations of adherence to clinical guidelines and outcome. We searched EMBASE, MEDLINE, Cochrane Central, PubMed, Web of Science, PsycINFO, SCOPUS, CINAHL, and grey literature in October 2014. We included studies of evidence-based (inter)national guidelines that examined the acute treatment of adult patients with TBI. Methodological quality was assessed using the Research Triangle Institute item bank and Quality in Prognostic Studies Risk of Bias Assessment Instrument. Twenty-two retrospective and prospective observational cohort studies, reported in 25 publications, were included, describing adherence to 13 guideline recommendations. Guideline adherence varied considerably between studies (range 18–100%) and was higher in guideline recommendations based on strong evidence compared with those based on lower evidence, and lower in recommendations of relatively more invasive procedures such as craniotomy. A number of patient-related factors, including age, Glasgow Coma Scale, and intracranial pathology, were associated with greater guideline adherence. Guideline adherence to Brain Trauma Foundation guidelines seemed to be associated with lower mortality. Guideline adherence in TBI is suboptimal, and wide variation exists between studies. Guideline adherence may be improved through the development of strong evidence for guidelines. Further research specifying hospital and management characteristics that explain variation in guideline adherence is warranted.


Traumatic brain injury (TBI) is a major public health concern affecting approximately 150–300 per 100,000 persons annually in Europe.1 The World Health Organization has predicted that TBI will be one of the leading causes of death and disability worldwide by the year 2020.2

The care for patients with TBI is often complex and multidisciplinary. Guidelines, protocols, and care pathways have been developed to improve quality of care, to reduce variation in practice, and to ensure that evidence-based care is optimally implemented.3

A 2013 systematic review4 found that the use of protocols in the management of severe TBI in the intensive care unit (ICU) led to improved patient outcomes. The findings, however, were based on observational studies that did not report on adherence rates. Without an understanding of adherence rates, the improved outcomes stated in the review cannot be directly attributed to the use of protocols.

Guideline adherence can be defined as the proportion of patients treated according to a guideline recommendation, which often represents evidence-based or best practice care. Previous studies have found that guideline adherence in medicine is generally low5–7 and varies widely across centers,7,8 medical condition,9 types of guideline,10,11 and time period.8,10 As a result, many patients do not receive evidence-based care, while others receive unnecessary care that may even be harmful.5To date, no systematic review of the literature about guideline adherence in TBI has been conducted.

The aim of this systematic review was to provide a comprehensive overview of professionals’ adherence to guidelines in adult patients with TBI. The objectives were threefold:

  • 1. To quantify adherence to guidelines in adult patients with TBI.

  • 2. To explore factors influencing adherence to TBI guidelines in those studies reporting on adherence.

  • 3. To examine the association between adherence to guidelines and outcome in patients with TBI in those studies reporting on adherence.

Continue —> Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review | Journal of Neurotrauma

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[ARTICLE] Internet and Social Media Use After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems Study – Full Text

Objectives: To characterize Internet and social media use among adults with moderate to severe traumatic brain injury (TBI) and to compare demographic and socioeconomic factors associated with Internet use between those with and without TBI.

Setting: Ten Traumatic Brain Injury Model Systems centers.

Participants: Persons with moderate to severe TBI (N = 337) enrolled in the TBI Model Systems National Database and eligible for follow-up from April 1, 2014, to March 31, 2015.

Design: Prospective cross-sectional observational cohort study.

Main Measures: Internet usage survey.

Results: The proportion of Internet users with TBI was high (74%) but significantly lower than those in the general population (84%). Smartphones were the most prevalent means of Internet access for persons with TBI. The majority of Internet users with TBI had a profile account on a social networking site (79%), with more than half of the sample reporting multiplatform use of 2 or more social networking sites.

Conclusion: Despite the prevalence of Internet use among persons with TBI, technological disparities remain in comparison with the general population. The extent of social media use among persons with TBI demonstrates the potential of these platforms for social engagement and other purposes. However, further research examining the quality of online activities and identifying potential risk factors of problematic use is recommended.

THE INTERNET AND SOCIAL MEDIA are dominant forces in our lives in this Age of Information. Time spent on the Internet continues to grow steadily in the United States and worldwide, with mobile technology and social media driving much of the expansion.1 , 2 Social media tools, including social networking sites (SNSs) (eg, Facebook), blogs (eg, Tumblr), online content communities (eg, YouTube), and online forums (eg, Google Hangouts), encourage multidimensional communication where users can exchange information, connect to resources, and create social networks based on common interests.3 Such platforms can facilitate opportunities that would otherwise be limited by various barriers. Not only have the Internet and social media transformed the ways that we seek and gather information but they also appear to be changing the perception of communication and of what constitutes social support. For example, among college students, large and seemingly impersonal networks of Facebook friends are associated with greater perceived social support than smaller ones and expressing one’s feelings to such large networks may serve important needs for an evolving type of intimacy.4

People with disabilities may encounter obstacles to keeping up with these social trends and enjoying their advantages. A Pew survey5 in 2011 revealed that Americans with disabilities are less likely to use the Internet than their able-bodied counterparts (54% vs 81%). This remained true even after controlling for factors such as lower income, lower education, and older age. Moreover, people with disabilities were less likely to use online access methods such as broadband service and mobile devices, both of which are advantageous for seeking work, finding health information, and communicating remotely with others. Lack of experience with these technologies creates a vicious cycle, as less experience predicts less favorable outcome in studies using Web-based platforms to help mitigate the effects of disability.6 All of these trends are unfortunate, considering that the Internet and social media may be seen as electronic curb cuts7—resources to help offset the reduced mobility and social isolation that affect many people with disabilities.

Reduced social network size and loneliness are particularly common for persons with traumatic brain injury (TBI).8–11 Social networking through the Internet has the potential to alleviate this isolation. However, cognitive impairments typical after TBI9 , 11 (eg, impaired memory, attention, and organization) may pose an obstacle to learning and utilizing rapidly changing technology. There have been recent studies exploring the use of mobile technology to help people with acquired brain injury compensate for cognitive impairments12–14 and caregivers for such individuals to utilize online resources for support.15 , 16 A few studies have attempted to directly teach Internet access17 or use of social media18 to people with TBI. Others have surveyed people with TBI on their habitual use of the Internet19 or Facebook.20 Such studies quickly become outdated and difficult to generalize as new technologies and online trends emerge. As a result, there is an ongoing need for updated information regarding the use of online technology after TBI that can guide future efforts to narrow the “disability divide,”21 encourage Internet-based social participation, and develop online interventions to facilitate these novel forms of interaction.

In this study, we interviewed a large cohort of people at least 1 year after moderate or severe TBI to examine the current level of online activity among these individuals. Our aims were (1) to examine various aspects of Internet use among adults with TBI, particularly focusing on activities involving communication and social participation through social media platforms; and (2) to compare certain online activities, as well as demographic and socioeconomic factors associated with Internet use, between those with and without TBI, the latter based on published surveys of the general population.22 […]

Continue —>  Internet and Social Media Use After Traumatic Brain Injury:… : The Journal of Head Trauma Rehabilitation


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[Abstract] Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research – The Lancet Neurology

First page of article

A concerted effort to tackle the global health problem posed by traumatic brain injury (TBI) is long overdue. TBI is a public health challenge of vast, but insufficiently recognised, proportions. Worldwide, more than 50 million people have a TBI each year, and it is estimated that about half the world’s population will have one or more TBIs over their lifetime. TBI is the leading cause of mortality in young adults and a major cause of death and disability across all ages in all countries, with a disproportionate burden of disability and death occurring in low-income and middle-income countries (LMICs).

This article is available free of charge. Simply login to access the full article, or register for free if you do not yet have a username and password.

via Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research – The Lancet Neurology

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[Abstract] Interventions for managing skeletal muscle spasticity following traumatic brain injury – Cochrane Systematic Review



Skeletal muscle spasticity is a major physical complication resulting from traumatic brain injury (TBI), which can lead to muscle contracture, joint stiffness, reduced range of movement, broken skin and pain. Treatments for spasticity include a range of pharmacological and non-pharmacological interventions, often used in combination. Management of spasticity following TBI varies from other clinical populations because of the added complexity of behavioural and cognitive issues associated with TBI.


To assess the effects of interventions for managing skeletal muscle spasticity in people with TBI.

Search methods

In June 2017, we searched key databases including the Cochrane Injuries Group Specialised Register, CENTRAL, MEDLINE (Ovid), Embase (Ovid) and others, in addition to clinical trials registries and the reference lists of included studies.

Selection criteria

We included randomised controlled trials (RCTs) and cross-over RCTs evaluating any intervention for the management of spasticity in TBI. Only studies where at least 50% of participants had a TBI (or for whom separate data for participants with TBI were available) were included. The primary outcomes were spasticity and adverse effects. Secondary outcome measures were classified according to the World Health Organization International Classification of Functioning, Disability and Health including body functions (sensory, pain, neuromusculoskeletal and movement-related functions) and activities and participation (general tasks and demands; mobility; self-care; domestic life; major life areas; community, social and civic life).

Data collection and analysis

We used standard methodological procedures expected by Cochrane. Data were synthesised narratively; meta-analysis was precluded due to the paucity and heterogeneity of data.

Main results

We included nine studies in this review which involved 134 participants with TBI. Only five studies reported between-group differences, yielding outcome data for 105 participants with TBI. These five studies assessed the effects of a range of pharmacological (baclofen, botulinum toxin A) and non-pharmacological (casting, physiotherapy, splints, tilt table standing and electrical stimulation) interventions, often in combination. The studies which tested the effect of baclofen and tizanidine did not report their results adequately. Where outcome data were available, spasticity and adverse events were reported, in addition to some secondary outcome measures.

Of the five studies with results, three were funded by governments, charities or health services and two were funded by a pharmaceutical or medical technology company. The four studies without useable results were funded by pharmaceutical or medical technology companies.

It was difficult to draw conclusions about the effectiveness of these interventions due to poor reporting, small study size and the fact that participants with TBI were usually only a proportion of the overall total. Meta-analysis was not feasible due to the paucity of data and heterogeneity of interventions and comparator groups. Some studies concluded that the intervention they tested had beneficial effects on spasticity, and others found no difference between certain treatments. The most common adverse event was minor skin damage in people who received casting. We believe it would be misleading to provide any further description of study results given the quality of the evidence was very low for all outcomes.

Authors’ conclusions

The very low quality and limited amount of evidence about the management of spasticity in people with TBI means that we are uncertain about the effectiveness or harms of these interventions. Well-designed and adequately powered studies using functional outcome measures to test the interventions used in clinical practice are needed.

Plain language summary

Treatments for spasticity (overactive muscle contractions) following brain injury

Review question

We reviewed the evidence about the effect of treatments (drug and non-drug) for spasticity following a brain injury caused by a blow to the head (traumatic brain injury (TBI)).


Many people with TBI experience muscle spasticity, when their muscles contract or tighten involuntarily. This can impact on a person’s ability to carry out daily activities causing pain, stiffness and broken skin. There are many treatments used to manage spasticity, including medicines, casting, splints and stretches. Often, these treatments are used in combination.

Study characteristics

We included nine studies in this review which involved 134 participants with TBI. Only five studies, including 105 people provided usable results. These studies tested the effects of a range of treatments, including medicines (baclofen or botulinum toxin A), casting, physiotherapy, splints, a table that moves people from the lying position to standing and electrical stimulation (where electrical impulses are delivered to the muscles). Studies inadequately reporting results had tested the effect of medicines (baclofen or tizanidine).

Study funding sources

Of the five studies with results, three were funded by governments, charities or health services and two were funded by a drug manufacturer and medical technology company. The other four studies without useable results were funded by drug manufacturer or medical technology companies.

Key results

This evidence is current to June 2017.

Interpreting the results of the studies was difficult because of a lack of information and concerns about the quality of the evidence. For spasticity, some studies concluded that the treatment they tested made an improvement, and others found no difference between treatments. The most common side effect was minor skin damage in people who received casting. We believe it would be misleading to provide any further description of study results given the quality of the evidence was very low for all measurements.

Quality of the evidence

The quality of this evidence was very low; we only had five studies with results and none of the studies were large or comparable with one another. We also had concerns about how they were conducted or analysed. Because of this, we cannot draw any firm conclusions about the benefits and harms of different treatments for spasticity in people with TBI.

via Interventions for managing skeletal muscle spasticity following traumatic brain injury – Synnot – 2017 – The Cochrane Library – Wiley Online Library

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[WEB SITE] Brain Injury — Important Facts and Implications for Social Work Practice

Brain Injury — Important Facts and Implications for Social Work Practice
By Jennifer Fleming, MA, LPC, CBIS; Natasha McVey, MSS, LCSW, CBIS; Madeleine Shusterman, LCSW, CBIS; and Eli DeHope, PhD, LCSW, BCD

Roberta is a bright, high-energy, fun-loving, career-oriented woman in her early 30s who worked as a pharmaceutical sales representative. Roberta’s ability to multitask and think quickly and her dedication to working long hours put her on the fast track to project leader of the sales team.

On one winter day while traveling to see a client, Roberta’s car slid on a patch of ice, went off the road, and crashed into a ditch. Roberta sustained minor physical injuries and a bad concussion. She did not lose consciousness. Her family and coworkers believed, as did Roberta, that while this was a serious accident, she would recover fully. The expectation was that she would be back to her usual, highly productive self in a matter of weeks.

After several months of ongoing headaches, fatigue, difficulty concentrating, and decreased motivation to return to work, her family started to wonder what was wrong with Roberta. Why didn’t she just get over the accident and go back to her life? Why was she so unmotivated? What her family didn’t understand was that Roberta’s symptoms were related to her concussion and that Roberta had actually sustained a brain injury.

Brain injury refers to the death of brain cells and the disruption of neural pathways that can change the way a person thinks, feels, and/or actsA brain injury can be caused by an outside force, such as a bump, blow, or jolt to the head related to an accident, fall, or violence, or to a change in air pressure, such as a blast injury. Brain injuries can also result from neurologic diseases, lack of oxygen to the brain, or penetrating wounds like gunshots (Rutland-Brown, Langlois, Thomas, & Xi, 2006).

Brain injury is increasingly recognized as a health concern with lifelong implications; however, it continues to be referred to as the “silent epidemic,” perhaps because awareness about brain injury, although improving, continues to be limited. It is estimated that an average of 1.7 million individuals sustain brain injuries each year (Coronado et al., 2011), which translates to about one person every 23 seconds. Brain injuries are most likely to occur in the very young (under the age of 5), followed by adolescents (ages 15 to 19) and adults over the age of 75 (Coronado et al.). Brain injury has a higher prevalence than HIV, breast cancer, and multiple sclerosis combined. Brain injury is also frequently undiagnosed and underreported (Leibson et al., 2011).

Brain Injury Sequelae
Because the brain is responsible for many functions, once an individual experiences a brain injury, his or her life is often drastically affected. A person with a brain injury can have a range of medical, cognitive, emotional/behavioral, and psychosocial issues. The sequelae listed in this chart are common challenges associated with brain injury; however, this list is not exhaustive:

Clearly, brain injury can impact all aspects of a person’s life. An individual’s identity in his or her family, friendships, and workplace are often affected. Alarmingly, it is estimated that 60% of people with brain injuries are never able to return to their prior employment (van Velzen, van Bennekom, Edelaar, Sluiter, & Frings-Dresen, 2009). Many lose their friendships and spouse or partner. People with a brain injury often experience and report social isolation, feelings of loneliness, and loss of friendships as a primary problem (Temkin, Corrigan, Dikmen, & Machamer, 2009) as well as an inability to participate in their hobbies and leisure activities.

Similarly, family members of these patients often experience significant stress, including the development of significant psychological symptoms as well as the loss of social support (Vangel, Rapport, & Hanks, 2011). Social workers can play a vital role in helping individuals and their families to accept and learn how to adapt to the inevitable changes that result from brain injury.

Making an Impact
All social workers should be equipped to recognize and refer individuals who might be struggling with a brain injury. Knowing who is at risk and what to look for is an important first step.

Recognizing At-Risk Populations and Symptoms
Individuals who have been involved in violence, dangerous occupations or hobbies, or who were athletes, veterans, or substance abusers should be considered as possibly having suffered a brain injury. Via case review, social workers should look for a history of loss/alteration of consciousness or significant events such as falls, motor vehicle accidents, and hospitalizations.

While a history of coma indicates the likelihood of a brain injury and the potential for long-term impairment, short losses of consciousness, or alterations, can also indicate the presence of a brain injury.

There is no medical test that can predict a person’s prognosis based on a specific injury. It is important to understand that even if an MRI or CT scan does not reveal any physical brain changes, the injury may still affect the person. The social worker should take into consideration a client’s history, as there may have been instances of head trauma not documented in the person’s medical record, as well as look for possible symptoms of brain injury.

Screening Questions
If a brain injury is suspected, social workers can ask several questions during an interview that may shed light on the person’s history of head trauma. These questions include the following:

• Have you ever been hit in the head?

• Have you ever lost consciousness?

• Have you ever had a concussion?

• Do you, or did you ever, play contact sports?

• Have you ever been in a car accident?

• Have you ever been in a physical fight or a victim of violence?

• Are you a veteran? Were you ever injured in service?

If an event with the potential to cause head trauma is found, social workers should follow up with questions about the immediate effect of the trauma, including amnesia, disorientation, or confusion, and then with questions about its impact on functioning in the following weeks, months, and even years. The Ohio Valley Center for Brain Injury Prevention and Rehabilitation, in conjunction with BrainLine, has developed a screening tool available at

Helpful Referrals
Brain injury rehabilitation services are highly specialized. Knowing where quality rehabilitation services are located in your community is most important for referring clients appropriately. The majority of physicians have little or no experience with brain injury and its short- and long-term impact. So identifying a physiatrist, a rehabilitation doctor, and a neurologist who do have experience treating those with brain injuries can greatly improve an individual’s overall medical care. Major trauma centers and rehabilitation facilities in urban areas are a good place to start.

Each state has a Brain Injury Association, organized by the umbrella organization Brain Injury Association of America ( These organizations often have online resources that contain provider information, family support services, and general brain injury education.

Children with brain injuries can qualify for specialized services until the age of 21 through their school districts with an individualized education plan. This information is imperative for school social workers to know so they can educate parents, teachers, coaches, colleagues, and students. They can also advocate for needed services and make necessary referrals.

School social workers should also be aware of the special situation concussions can pose for students and schools. While a child can completely recover from a concussion, it is often recommended that a child’s return to school be gradual, following a period of complete rest at home. Social workers can play a critical role in gathering information from family and physicians and ensuring that all school staff are aware of medical recommendations about concussion management and restrictions (e.g., recess, physical education, sports). The Centers for Disease Control and Prevention has many valuable resources on concussion, including free tool kits and checklists (

Finally, social workers should be aware of the adjunct resources in their community that clients may need to access, including assistance with transportation, housing, legal problems, education and/or employment, attendant care, assistive technology, and financial support.

Quick Tips for Working With Individuals With Brain Injury
• Provide simple written information, including summaries of what you are doing and what is next.

• Have a family member present in sessions.

• Speak simply and ask direct questions.

• Avoid long, complicated discussions.

• Check the client’s understanding of the information presented, making sure to allow time for processing.

• Offer breaks.

• Provide appointment reminders.

• Be careful with humor and your personal space.

Additional resources are provided in the table below:

Resources on Brain Injury provides resources for preventing, treating, and living with brain injury
Brain Injury Association of America: a website with links to state affiliates and their resources; also a great source of information on current advocacy efforts in this area
Centers for Disease Control and Prevention – Traumatic Brain Injury: extensive resource on brain injury (mild to severe), including fact sheets, tip cards, and other practical tools
Systematic Approach to Social Work Practice: Working With Clients With Traumatic Brain Injuries: a downloadable 132-page manual completed with support from the National Institute on Disability and Rehabilitation Research
Defense and Veterans Brain Injury Center: provides both information and resources on brain injury in the military for veterans, military families, and other interested parties


Final Thoughts
With brain injury becoming more common, especially with more veterans returning home from war, it is important for social workers to understand this condition and know the best means for helping their clients get the treatment they need to successfully function from day to day. Doing so will prove beneficial not only for the client but for family and friends as well.

— Jennifer Fleming, MA, LPC, CBIS, is a day program specialist at ReMed in Paoli, PA.

— Natasha McVey, MSS, LCSW, CBIS,is a rehabilitation case manager atReMed.

— Madeleine Shusterman, LCSW, CBIS, is a clinical specialist at ReMed.

— Eli DeHope, PhD, LCSW, BCD, is a professor of undergraduate social work at West Chester University of Pennsylvania.


Coronado, V. G., Xu, L., Basavaraju, S. V., McGuire, L. C., Wald, M. W., Faul, M. D., et al. (2011). Surveillance for traumatic brain injury-related deaths—United States, 1997-2007. MMWR Surveill Summ, 60(5), 1-32.

Rutland-Brown, W., Langlois, J. A., Thomas, K. E., & Xi Y. L. (2006). Incident of traumatic brain injury in the United States, 2003. Journal of Head Trauma and Rehabilitiation, 21(6), 544-548.

Leibson, C. L., Brown, A.W., Ransom, J. E., Diehl, N. N., Perkins, P. K., Mandekar, J. et al. (2011). Incidence of traumatic brain injury across the full disease spectrum: A population-based medical record review study. Epidemiology22(6), 836-844.

Temkin, N. R., Corrigan, J. D., Dikmen, S. S., & Machamer, J. (2009). Social functioning after traumatic brain injury. Journal of Head Trauma Rehabilitation, 24(6), 460-467.

Vangel, S. J., Rapport, L. J., & Hanks, R. A. (2011). Effects of family and caregiver psychosocial functioning on outcomes of persons with traumatic brain injury. Journal of Head Trauma Rehabilitation, 26(1), 20-29.

van Velzen, J. M., van Bennekom, C. A., Edelaar, M. J., Sluiter, J. K. & Frings-Dresen, M. H. (2009). How many people return to work after acquired brain injury?: A systematic review. Brain Injury, 23(6), 473-488.

via Brain Injury — Important Facts and Implications for Social Work Practice


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“Brain injury can last a lifetime, but it doesn’t have to cost a lifetime.”
– Anonymous person with a brain injury

Living with a brain injury can require a range of resources, strategies and supports. The range of possible supports can be tremendous. This page hopes to offer links to articles and information about the supports and resources that are available to people with brain injury and their families to assist them.

Below is a list of common issues that can arise, with links to publications and/or other website with useful information. If you know of additional information or resources, or find something missing, please feel free to contact us to let us know.  Also look in the BIAA Marketplace for additional resources, including personal accounts, webinars and more.

Alternative Medicines
Challenge Issue on Alternative Medicine
National Insitutes of Health Alternative Medicine Information
Brain Injury Association Caregiver Webinar on Alternative Medicine

Assistive Technology
Assistive Technology Tip Card
Assistive Technology Checklist for PDA’s
Resources for Finding and Funding AT Devices
Family Caregivers article on Assistive Technology
    What Are Your Options to Pay for Assistive Devices?

Behavioral Challenges
Road to Rehabilitation Part 4 – Behavior and Brain Injury
Cognition and Behavior
Behavioral Guidelines
Emotional Issues After Brain Injury

Caregiver/Family Stress
    Family Caregiver Alliance
Brain Injury is a Family Affair
Caregiver Planning Tool
Family News and Views Letting Go
Tips for Dealing with Stress
Changes, Choices, Challenges- A Guide for Families to Brain Injury Rehabilitation
Impact of Brain Injury on the Family and How They Can Help

Children and Brain Injury
    See the Children’s Page
Challenge Issue on Children and Brain Injury
Return to School After Brain Injury

Cognition and Memory
     Road to Rehabilitation Part 3- Cognition and Memory
Family News and Views: Cognition is the Key
Family News and Views Neuropsychological Assessment
Organizing Daily Life After Brain Injury
Cognitive Problems After Brain Injury
Brain Injury Association Cognitive Stimulation Resource Guide

College/Return to School
Young Adults with Brain Injury and College
Life After High School
Return to School After Brain Injury
TBI Model Systems Research: Return to Work After Brain Injury

     Depression and Brain Injury
Overcoming Loneliness
Depression After Brain Injury
TBI Model Systems Research: Depression and Brain Injury

    Driving After Brain Injury
Return to Driving After Brain Injury

Employment After Brain Injury
    Challenge Winter 2011 Issue Return to Work

Falls and Brain Injury

Fatigue and Brain Injury

Financial Issues
    Financial Resources for Students with Brain Injury
College Funding Information for Students with a Disability

    Road to Rehabilitation #2- Headaches
Headaches After Brain Injury

    Navigating The Insurance Maze After Brain Injury

Legal Issues
Guide to Selecting Legal Representation
Legal Glossary
Brain Injury Association webinar on Special Needs Trusts

Road to Rehabilitation #6 – Medications and Brain Injury
Brain Injury Association Webinar on Medication and Brain Injury

Road to Rehabilitation #1- Pain

Research/Clinical Trials
Guide to Participating in Clinical Trials
Abstracts of TBI Model Systems Research
Knowledge Translation Center of TBI Model Systems
    THE Challenge! newsletter issue on research (summer 2009)

Seizures and Brain Injury
Epilepsy Information

Severe Brain Injury
    Facts About Severe Brain Injury
A Physician Talks About Severe Brain Injury
Facts About the Vegetative and Minimally Conscious States After Brain Injury

Family News and Views Sexuality and Brain Injury
Sexuality and Brain Injury

Sleep disturbances after brain injury
Brain Injury Association webinar on Sleep and Brain Injury

Spasticity Alliance: An Educational Website About Spasticity
Spasticity After Brain Injury

    Road to Rehabilitation #5- Speech and Communication
Challenge Spring 2011 issue on Communication

Substance Abuse
Substance Abuse and Brain Injury
Substance Abuse Information from the Ohio Valley Center
TBI Model Systems Research: Substance Abuse and Brain Injury
Model Systems Knowledge Translation Center presentation on Substance Abuse and Brain Injury

Taste and Smell
Taste and Smell issues after brain injury
Taste and Smell Disorders
    Taste and Smell Information

Vestibular Fact Sheet

    Vision and Brain Injury
Vision issues post injury


Source: Brain Injury Resources

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[WEB SITE] TBI Basics – BrainLine

A TBI can happen to anyone, whether it happens while playing sports, at work, or just slipping on an icy sidewalk. Injuries can range from “mild” to “severe”, with a majority of cases being concussions or mild TBI. The good news is that most cases are treatable and there are several ways to help prevent injury.

What You’ll Find Here

You Are Not Alone

You Are Not Alone

See how others are navigating their post-TBI lives. Check out personal stories and “life after TBI” blogs, or join the conversation with our Facebook community.

Source: TBI Basics | BrainLine

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[Dissertation] Perceived Self-Efficacy in Individuals with Moderate-to-Severe Brain Injury: The Effects of Rehabilitation Outcomes and Depression – Full Text PDF


Brain injury represents a major public health issue in the United States, accounting for a largely underestimated figure of 2.5 million cases in 2010. The pervasive effects of this chronic medical condition contribute to a growing economic burden, as the physical, cognitive, behavioral, and emotional sequelae of brain injury demand long-term care for those with moderate-to-severe brain injuries. The Centers for Disease Control and Prevention recently proposed new recommendations for improvements in monitoring the incidence of and research on brain injury. The goals of this public health initiative are to better inform health service delivery and ultimately improve quality of life for those affected, as well as their loved ones.
In addition to improved quality of life, community reintegration is a primary goal
of brain injury rehabilitation. Engagement in rehabilitation is largely dependent upon an individual’s level of impairment, as well as other personal factors. For example, research examining the relationship between targeted interventions and community participation has established support for the protective effects of self-efficacy, or personal belief in one’s abilities to achieve a desired goal. Additional research on the importance of selfefficacy to psychological health has provided further support for the protective effects of this construct against depression and anxiety. Therefore, further research into the relationship between rehabilitation outcomes, psychological health, and self-efficacy is necessary to inform recommendations for improving health service delivery and quality of life for this vulnerable population.

The aim of the present study is to examine factors that may be related to self
efficacy in persons with moderate-to-severe brain injury who receive treatment at along term post acute brain injury program. The implications of this research include baseline assessment of self-efficacy in this sample that could potentially inform future staff training and overall clinical practice geared towards cultivating self-efficacy in persons with brain injury. The primary limitations of this study are its small sample size and constrained external validity. Despite these limitations, more research is necessary to understand the role of psychological protective factors in brain injury rehabilitation and to inform strategies for improved health service delivery and increased quality of life.

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