Posts Tagged research in focus

[WEB SITE] A Brief Program May Help People Build Resilience After a Traumatic Brain Injury – National Rehabilitation Information Center


study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

A traumatic brain injury (TBI) is lasting brain damage resulting from an external force, such as a fall or a car accident. People with TBI may have challenges managing stress, thinking and remembering things, or communicating with others. Resilience is the ability to adapt positively to traumatic events and being resilient can help people manage these challenges and adjust to life changes after a TBI. Past research has found that people can become more resilient by learning and practicing coping skills.

In a recent NIDILRR-funded study, researchers tested a new program called the Resilience and Adjustment Intervention (RAI). The RAI program is designed to help build resilience for people with TBI. They wanted to find out if the program would lead to higher resilience, fewer emotional challenges, or lower stress for people with TBI. They also wanted to find out if the benefits of the program could last over a 3-month period.

Researchers at the Virginia Commonwealth University Traumatic Brain Injury Model System Center enrolled 160 people with TBI in a study. The participants were adults over the age of 18, and all had their TBI for at least three months before beginning the study. The participants were randomly divided into two groups: an experimental group who participated in the RAI Program and a comparison group who did not receive any services during the study (but were given the opportunity to receive the intervention after the study was complete).

Each participant in the experimental group had 7 one-hour sessions with a therapist in an outpatient clinic over a five-week period. Participants were also given worksheets and reading materials to complete at home between sessions and were asked to discuss these materials with family and friends. Each session covered a different topic related to resilience and TBI as follows:

  1. Learning about common life changes after a TBI;
  2. Discussing how to take an active role in TBI recovery;
  3. Goal setting and defining success in a flexible way;
  4. Learning how to solve problems and overcome challenges;
  5. Managing stress and difficult emotions;
  6. Communication skills, building relationships, and talking to others about TBI; and
  7. Having a positive outlook on life and overcoming negative thinking.

The participants in both the experimental and comparison groups completed questionnaires at the beginning of the study and either after the final session (experimental group) or about five weeks after starting the study (comparison group). The participants in the experimental group completed the questionnaires a third time about three months after the end of the program. The questionnaire included questions asking how often the participants felt resilient (e.g., “coping with stress can strengthen me”); how they rated themselves on problem-solving and communication skills; and how much they experienced emotional challenges (such as anxiety or depression) or feelings of being stressed or overwhelmed.

The researchers found that the participants in the experimental group reported feeling more resilient, improving their communication and problem-solving skills, and feeling fewer emotional challenges and less stress at the end of the study than at the beginning of the study. For example, the participants’ resilience scores increased by an average of 35%, and their stress scores decreased by an average of 33%. These improvements were maintained three months after the end of the study. In contrast, the participants in the comparison group showed only very small changes in their resilience, skills, emotional challenges, and stress levels.

The authors noted that resilience may play a key role in helping people adjust to challenges after a TBI. Although the stresses of having a TBI can challenge resilience, people can improve their resilience by learning and practicing specific skills. The participants in this study showed improvements in their emotional health and problem-solving skills after only seven brief sessions. Future research may be useful to explore other ways for people with TBI to build their resilience, including long-distance or group-based programs.

To Learn More

The Model Systems Knowledge Translation Center (MSKTC) develops and curates TBI resources from the Model Systems, including factsheets, video modules, and the innovative TBI InfoComics series. offers a wealth of resources on TBI for survivors, family members and caregivers, military personnel, and professionals, including articles from researchers, survivors, and supportive organizations. These include:

For professionals who work with individuals with TBI, the Resilience and Adjustment Intervention (RAI) is available through the National Resource Center for TBI. Learn more about its development and frequently asked questions, including how to receive training on using the RAI with clients with TBI.

To Learn More About This Study

Kreutzer, J.S., Marwitz, J.H., Sima, A.P., Mills, A., Hsu, N.H. & Lukow II, H.R., (2018) Efficacy of the resilience and adjustment intervention after traumatic brain injury: A randomized controlled trial. Brain Injury, 32(8), 963-971. This article is available from the NARIC collection under accession number J79743.

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[Study] A New Online Program May Help People with TBI Build Emotion Regulation Skills – NARIC

A traumatic brain injury (TBI) is lasting brain damage from an external force, such as a fall or a car accident. People with TBI may have challenges with emotion regulation (ER), the process of recognizing and controlling their feelings or their reactions to feelings. Previous research has shown that a structured group therapy program can help people with TBI develop and practice ER skills in real-life situations. However, some people with TBI may not be able to get to a clinic to receive group therapy, or they may not be able to afford it. Internet-based therapy programs may offer a convenient alternative for these individuals to receive the therapy they need. In a recent NIDILRR-funded study, researchers tested an Internet-based program to teach ER skills to people with TBI through group videoconferencing. The researchers wanted to find out whether people who participated in the program experienced less difficulties with ER after the program than before, and whether they experienced improvements in mood or quality of life. They also wanted to find out what the participants thought of the online program format.

Researchers at the New York Traumatic Brain Injury Model System Center enrolled 91 adults with TBI in a study. The participants came from 33 U.S. states and 5 countries. They had experienced their TBI at least six months prior to starting the program, with a group average of five years of living with TBI. All of the participants reported multiple challenges with ER.

All of the participants were enrolled in the experimental program, called Online EmReg, which was adapted from a face-to-face group therapy program. Online EmReg consists of 24 one-hour videoconference sessions, held twice a week for 12 weeks. A small group of 4-5 participants attend each session, which is led by a trained facilitator. The participants and facilitator use the GotoMeeting platform to communicate and share information. During the first 8 sessions, the participants learn about the basics of ER, how ER can be impacted by TBI, and some specific strategies or tools for managing their emotions. The participants also set specific goals for improvements during the program, such as learning to feel calmer under pressure or being more patient with themselves and others. During the final 16 program sessions, the participants practice their skills in individual and group exercises.

To find out how the program impacted ER, the researchers gave online questionnaires to the participants 4 weeks before the program started, immediately after the program ended, and again 12 weeks after the program ended. Each questionnaire included a 36-question scale called the Difficulties with Emotion Regulation Scale (DERS), where the participants reported how often they encounter various challenges with ER, such as losing control of impulses or having trouble identifying their feelings, on a scale from 1 (almost never) to 5 (almost always). The participants also completed additional scales rating their current positive and negative emotions, overall satisfaction with their lives, and the extent to which they experienced challenges with other mental activities such as problem-solving, planning, and decision-making. To find out what the participants thought of the program, the participants answered questions regarding their satisfaction with the program and the extent to which they felt they achieved their goals for the program. Each participant was also interviewed by phone after the program ended to obtain more detailed feedback.

The researchers found that the participants reported less frequent challenges with ER after the program started than before. Their total scores on the DERS decreased by an average of 10% between the beginning and end of the program, and these scores decreased by another 4% during the 12 weeks after the program ended, for a total decrease of 14% by the end of the follow-up period. The participants also reported an 18%  decrease in negative emotions, a 17% improvement in overall satisfaction with their lives, and a 65% improvement in planning and decision-making scores, and an 11% improvement in problem-solving scores between the beginning and end of the program. The participants’ overall satisfaction with their lives increased by another 14% during the 12 weeks after the end of the program, for a total increase of 31%.

The researchers also found that most of the participants were satisfied with the program and found it helpful. When asked to rate their improvement in ER skills during the program, 49% of the participants reported a large improvement, another 41% reported a moderate improvement, and only 10% reported little or no improvement. During the interviews after the program had ended, nearly all of the participants said that they felt the program was relevant to their goals. The participants said that the program was a good learning experience, that they enjoyed the connections with others, and that it was convenient to participate from their homes.

The authors noted that, because there was no comparison group for this study, it is unclear whether or not the improvements were a direct result of the program or if the participants’ skills simply improved over time. In the future, randomized experiments may be useful in establishing the impact of the Online EmReg program compared with usual care for people with TBI. They also noted that the participants in this study had access to the high-speed Internet and equipment necessary to use videoconferencing, which may not be available to people with lower incomes or those who live in rural areas. These individuals might face more challenges to participating in this type of program.

The authors noted that Internet-based programs such as Online EmReg may benefit diverse groups of people with TBI, particularly those who live far away from a medical center or who may not be able to travel for regular appointments. The program can also be implemented at low cost since videoconferencing platforms such as GoToMeeting may be free for participants to use. In this study, the participants were very satisfied with the Online EmReg program, and reported improvements in ER as well as more general life satisfaction and well-being. These improvements were maintained over time after the program was over, suggesting that the participants may have continued to practice and apply their newfound skills in their everyday lives. These findings may show a promise for researchers and rehabilitation professionals to consider developing similar programs for people with TBI to practice coping skills and exchange support with one another.

To Learn More

The authors continue to study the impact of Online EmReg with a new NIDILRR-funded randomized controlled trial as part of the 2017-2022 New York TBI Model System Center. To learn more about the current study and how to participate, contact the Brain Injury Research Center at

The Model Systems Knowledge Translation Center (MKSTC) has many information resources for people living with TBI, including:

Tessa Hart, PhD, director of the NIDILRR-funded Moss TBI Model System Center, discussed recent research in ER and TBI in a blog post at Moss Rehabilitation Hospital

People living with TBI and their families can find a wealth of information and support resources, including local groups and organizations, from the Brain Injury Association of America and from

To Learn More About this Study

Tsaousides, T., Spielman, L., Kajankova, M., Guetta, G., Gordon, W., and Dams-O’Connor, K. (2017) Improving emotional regulation following Web-based group intervention for individuals with traumatic brain injury. Journal of Head Trauma Rehabilitation, 32(5) 354-365. This article is available from the NARIC collection under accession number J77071.

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via National Rehabilitation Information Center | Information for Independence

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[WEB SITE] A New Assistive Glove Can Help People Regain Hand Function After a Stroke – NARIC

About 800,000 Americans have a stroke each year, according to the Centers for Disease Control and Prevention. A stroke occurs when a blood vessel in the brain becomes blocked or bursts, causing brain damage. Sometimes, stroke can lead to long-lasting difficulties with moving one hand or arm due to both muscle weakness and spasms. Therapies are available to help people regain hand mobility after a stroke, but these therapies may not work for people with severely limited hand movement. Research shows that, even with therapy, some people can stall in their recovery (plateau) around three months after experiencing a stroke. A recent NIDILRR-funded study tested a new portable assistive glove to see if it could help people move beyond that plateau and regain hand strength and mobility after a stroke.

Researchers from the Rehabilitation Research and Training Center on Enhancing the Functional and Employment Outcomes of Individuals Who Experience a Stroke tested a new therapy device called the X-Glove. The X-Glove is a modified sports glove with cables running through the back of the glove along the fingers. The cables apply an external source to aid or resist finger movements through a battery-powered system. The glove can be set to one of two modes: passive stretching mode and active training mode. In the passive stretching mode, the glove bends and straightens the user’s finger joints in a repeating cycle. This passive movement provides finger stretching that helps loosen the muscles and reduce spasms. In the active training mode, the glove provides individualized constant tension that maintains the finger joints toward a straight position. The user then bends his or her finger against the tension to build finger strength.

The researchers tested the glove with 13 stroke survivors who were receiving rehabilitation services in a day program, including physical, speech, and occupational therapy. The participants were at least 40 years old and had a stroke in the past 2-6 months. Most had severe limitations in their hand function. The participants completed an additional 15 occupational therapy sessions, 3 per week for 5 weeks, using the X-Glove.

An occupational therapist assists a patient with therapy exercises using the X-glove. The patient is wearing the glove on his right hand and grasping a telephone handset.

Photo: A therapy session with the X-glove.

At the beginning of each session, the participants completed 30 minutes of passive finger stretching with the glove set in the passive stretching mode to help loosen the muscles and reduce spasms. Then they practiced using their hand to complete meaningful tasks for 60 minutes with the glove set in the active training mode to help build strength and skills, while the glove provided resistance. For example, participants practiced grasping, holding, and lifting small objects in their affected hand while pushing against the tension applied by the glove. To find out if the task practice with the X-Glove improved hand function, the researchers first measured participants’ hand mobility and strength three times, once per week over 3 weeks, before the participants started working with the glove. The researchers then took measurements after the participants’ ninth occupational therapy session with the glove, at the end of the fifteenth session, and again one month after the sessions ended.

Although the participants showed little or no improvement in hand strength or function over the course of 3 weeks before working with the glove, they did improve significantly with the help of the X-Glove. For example, the researchers found that participants’ grip was strengthened by about 35% and maintained the strength one month after the treatment ended. The participants also did better on functional tests, such as moving blocks or pouring water from glass to glass. According to the authors, participants showed improvement within the first half of the treatment, and continued to improve throughout the treatment sessions. They suggested that participants could have improved more with more time using the X-Glove.

According to the authors, these findings indicated that with devices like the X-glove, improvements in hand function are possible even for people with severe hand impairment after a stroke. Incorporating both passive stretching of and active practice with the hand during occupational therapy using a device like the X-Glove may help push past the therapy plateau if implemented soon after a stroke. For future research, the authors recommended randomized controlled trials to test the X-Glove with stroke patients in inpatient and outpatient rehabilitation settings, as well as studies with longer treatment and follow-up periods.

To Learn More

The prototype X-Glove and other hand rehabilitation technology are under development at the Rehabilitation Institute of Chicago’s Hand Rehabilitation Laboratory:

To see the X-Glove and other hand rehabilitation technology in action, check out this Prezi from the Hand Rehabilitation Laboratory

Flint Rehabilitation developed the Music Glove, another hand rehabilitation device that was tested under a NIDILRR grant and shown to improve hand function post-stroke:

The American Stroke Association and the National Stroke Association both offer resources for stroke recovery:

To Learn More About This Study

Fischer, H.C., Triandafilou, K.M., Thielbar, K.O., Ochoa, J.M., Lazzaro, E.D.C., Pacholski, K.A., & Kamper, D.G. (2016) Use of a portable assistive glove to facilitate rehabilitation in stroke survivors with severe hand impairment. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 24(3), 344-351. This article is available from the NARIC collection under Accession Number J73926

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Source: National Rehabilitation Information Center | Information for Independence

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