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Juengst SB, Wright B, DeMello A, Vos L, Biney F, Novelo LL, Williams M. Neurobehavioral Symptom Profiles for the Behavioral Assessment Screening Tool in Chronic Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00144. [PMID: 38652671 DOI: 10.1097/htr.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To identify neurobehavioral symptom profiles among persons with chronic traumatic brain injury (TBI) using the Behavioral Assessment Screening Tool (BAST) and to consider participant characteristics that differ between profile groups. SETTING Community. PARTICIPANTS Participants (n = 615) were English-speaking adults (≥18) and had a self-reported history of at least one TBI of any severity. DESIGN Secondary analysis of cross-sectional data. MAIN MEASURES The BAST measures neurobehavioral symptoms in the domains of Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, and Substance Misuse. RESULTS Using latent profile analysis (LPA), we identified 3 different neurobehavioral profiles. Overall symptom frequency and differences in the pattern of symptom frequency across domains differentiated the profile groups. Average domain scores differed significantly across the profiles (P < .001) for all domains except Fatigue (P = .076). Those in profile 3 (High-Risk group) reported the most frequent symptoms across all domains (similar Negative Affect frequency as profile 1). Substance Misuse was especially high in this group. Compared to profile 2 (High Negative Affect group), participants in profile 1 (Moderate-Risk group) endorsed significantly more frequent (and more variable) symptoms across all BAST domains, particularly Impulsivity and Substance Misuse. Participants in profile 2 endorsed the least frequent symptoms across all domains. Demographic comparison showed that groups differed based on gender, age, and injury severity (mild vs moderate-severe), with profile 3 composed of the most men and the most persons in early adulthood, and profile 2 composed of the most women and those with mild TBI. CONCLUSIONS We differentiated 3 neurobehavioral symptom profiles among persons with chronic TBI and determined differences in sociodemographic factors between the groups. Future research should focus on validating these profiles in another sample of individuals with chronic TBI. Characterizing persons according to multidimensional symptom profiles could allow for more tailored approaches to predict and prevent long-term negative outcomes.
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Affiliation(s)
- Shannon B Juengst
- Author Affiliations: TIRR Memorial Hermann (Dr Juengst), Houston, TX; Department of Physical Medicine & Rehabilitation (Dr Juengst), Department of Biostatistics and Data Science (Dr Novelo), University of Texas Health Sciences Center at Houston, Houston, TX; Department of Physical Medicine & Rehabilitation (Drs Juengst and Wright), University of Texas Southwestern Medical Center, Dallas, TX; School of Nursing (Dr DeMello), University of Texas Medical Branch, Galveston, TX; Spectrum Health Medical Group, Neurosciences (Dr Vos), Grand Rapids, MI; Department of Physical Medicine & Rehabilitation (Dr Biney), University of Alabama at Birmingham, Birmingham, AL; and Department of Psychology (Dr Williams), University of Houston, Houston, TX
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Juengst SB, Wright B, Vos L, Perna R, Williams M, Dudek E, DeMello A, Taiwo Z, Novelo LL. Emotional, Behavioral, and Cognitive Symptom Associations With Community Participation in Chronic Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:E83-E94. [PMID: 37582176 PMCID: PMC10864677 DOI: 10.1097/htr.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVES To determine the association between self-reported emotional and cognitive symptoms and participation outcomes in chronic traumatic brain injury (TBI) and to explore the relative contribution of self-reported versus performance-based cognition to participation outcomes. SETTING Community. PARTICIPANTS Community-dwelling adults ( n = 135) with a lifetime history of mild to severe TBI. DESIGN Secondary analysis of a cross-sectional study on neurobehavioral symptoms in chronic TBI. MAIN MEASURES Behavioral Assessment Screening Tool (BAST) (Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, Substance Abuse subscales) measured self-reported neurobehavioral symptoms; Participation Assessment with Recombined Tools (Productivity, Social Relations, and Out and About) measured self-reported participation outcomes; and Brief Test of Adult Cognition by Telephone (BTACT) measured performance-based cognition (Episodic Memory and Executive Function summary scores) in a subsample ( n = 40). RESULTS The BAST Executive Dysfunction was significantly associated with less frequent participation and had the strongest effect on participation in all participation domains. No other BAST subscales were associated with participation, after adjusting for all subscale scores and age, with the exception of BAST Impulsivity, which was associated with more frequent Social Relationships. Exploratory analysis in the sample including the BTACT revealed that, after accounting for subjective Executive Dysfunction using the BAST, performance-based Executive Function was associated with Productivity and Working Memory was associated with Social Relations, but neither was associated with being Out and About; the BAST Executive Dysfunction remained significant in all models even after including BTACT scores. CONCLUSIONS Self-reported Executive Dysfunction contributed to participation outcomes after mild to severe TBI in community-dwelling adults, whereas self-reported emotional and fatigue symptoms did not. Performance-based cognition measures may capture different variability in participation after injury.
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Affiliation(s)
- Shannon B Juengst
- Author Affiliations: TIRR Memorial Hermann, Houston, Texas (Drs Juengst, Perna, and Taiwo); Departments of Physical Medicine & Rehabilitation (Dr Juengst) and Biostatistics and Data Science (Dr Novelo), The University of Texas Health Science Center at Houston; Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas (Drs Juengst and Wright); Spectrum Health Medical Group, Neurosciences, Grand Rapids, Michigan (Dr Vos); Department of Psychology, University of Houston, Houston, Texas (Dr Williams and Ms Dudek); School of Nursing, The University of Texas Medical Branch, Galveston (Dr DeMello); and Department of Neurology, Section of Neuropsychology, Baylor College of Medicine, Houston, Texas (Dr Taiwo)
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Juengst S, Grattan E, Wright B, Terhorst L. Rasch analysis of the Behavioral Assessment Screening Tool (BAST) in chronic traumatic brain injury. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2021; 8:231-246. [PMID: 34926129 PMCID: PMC8673913 DOI: 10.1007/s40737-021-00218-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/10/2021] [Indexed: 06/14/2023]
Abstract
The Behavioral Assessment Screening Tool (BAST) measures neurobehavioral symptoms in adults with traumatic brain injury (TBI). Exploratory Factor Analyses established five subscales: Negative Affect, Fatigue, Executive Function, Impulsivity, and Substance Abuse. In the current study, we assessed all the subscales except Substance Abuse using Rasch analysis following the Rasch Reporting Guidelines in Rehabilitation Research (RULER) framework. RULER identifies unidimensionality and fit statistics, item hierarchies, targeting, and symptom severity strata as areas of interest for Rasch analysis. The BAST displayed good unidimensionality with only one item from the Impulsivity scale exhibiting potential item misfit (MnSQ 1.40). However, removing this item resulted in a lower average domain measure (1.42 to -1.49) and higher standard error (0.34 to 0.43) so the item was retained. Items for each of the four subscales also ranged in difficulty (i.e. endorsement of symptom frequency) with more severe symptoms being endorsed in the Fatigue subscale and more mild symptoms being endorsed in the Impulsivity subscale. Though Negative Affect and Executive Function displayed appropriate targeting, the Fatigue and Impulsivity Subscales had larger average domain values (1.35 and -1.42) meaning that more items may need to be added to these subscales to capture differences across a wider range of symptom severity. The BAST displayed excellent reliability via item and person separation indices and distinct strata for each of the four subscales. Future work should use Rasch analysis in a larger, more representative sample, include more items for the Fatigue and Impulsivity subscale, and include the Substance Abuse subscale.
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Affiliation(s)
- Shannon Juengst
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX
- Department of Applied Clinical Research, UT Southwestern Medical Center, Dallas, TX
| | - Emily Grattan
- Department of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Brittany Wright
- Department of Applied Clinical Research, UT Southwestern Medical Center, Dallas, TX
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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Klyce DW, West SJ, Perrin PB, Agtarap SD, Finn JA, Juengst S, Dams-O'Connor K, Eagye CB, Vargas TA, Chung JS, Bombardier CH. Network Analysis of Neurobehavioral and Posttraumatic Stress Disorder Symptoms One Year after Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study. J Neurotrauma 2021; 38:3332-3340. [PMID: 34652955 DOI: 10.1089/neu.2021.0200] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Traumatic brain injury (TBI) is often experienced under stressful circumstances that can lead to both symptoms of posttraumatic stress disorder (PTSD) and neurobehavioral symptoms of brain injury. There is considerable symptom overlap in the behavioral expression of these conditions. Psychometric network analysis is a useful approach to investigate the role of specific symptoms in connecting these two disorders and is thus well-suited to explore their interrelatedness. This study applied network analysis to examine the associations among PTSD and TBI symptoms in a sample of Service Members and Veterans (SM/Vs) with a history of TBI one year after injury. Responses to the Neurobehavioral Symptom Inventory (NSI) and PTSC Checklist-Civilian version (PCL-C) were obtained from participants who completed comprehensive inpatient rehabilitation services at five VA polytrauma rehabilitation centers. Participants (N = 612) were 93.1% male with an average age of 36.98 years at injury. The analysis produced a stable network. Within the NSI symptom groups, the frustration symptom was an important bridge between the affective and cognitive TBI symptoms. The PCL-C nodes formed their own small cluster with hyperarousal yielding connections with the affective, cognitive, and somatic symptom groups. Consistent with this observation, the hyperarousal node had the second strongest bridge centrality in the network. Hyperarousal appears to play a key role in holding together this network of distress and thus represents a prime target for intervention among individuals with elevated symptoms of PTSD and a history of TBI. Network analysis offers an empirical approach to visualizing and quantifying the associations among symptoms. The identification of symptoms that are central to connecting multiple conditions can inform diagnostic precision and treatment selection.
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Affiliation(s)
- Daniel Wesley Klyce
- Richmond VAMC, 20125, 1201 Broad Rock Blvd, Richmond, Virginia, United States, 23249.,Sheltering Arms Institute, 559078, Richmond, United States, 23233-7632;
| | - Samuel J West
- Virginia Commonwealth University, 6889, Department of Psychology, Richmond, Virginia, United States;
| | - Paul B Perrin
- Virginia Commonwealth University, Department of Psychology, Richmond, United States;
| | | | - Jacob A Finn
- Minneapolis VA Health Care System, 20040, Minneapolis, Minnesota, United States.,University of Minnesota Department of Psychiatry, 172737, Minneapolis, Minnesota, United States;
| | - Shannon Juengst
- University of Texas Southwestern, Physical Medicine & Rehabilitation; Rehabilitation Counseling, 5323 Harry Hines Blvd, Dallas, Texas, United States, 75390-9055;
| | - Kristen Dams-O'Connor
- Icahn School of Medicine at Mount Sinai, 5925, Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, New York, United States, 10029; kristen.dams-o'
| | - C B Eagye
- Craig Hospital, 20588, Research Department, Englewood, Colorado, United States;
| | | | - Joyce S Chung
- Veterans Affairs Palo Alto Health Care System, Polytrauma, Palo Alto, California, United States;
| | - Charles H Bombardier
- University of Washington, Rehabilitation Medicine, Box 359612, Harborview Medical Center, 325 9th Avenue, Seattle, Washington, United States, 98104;
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Osborne C, Wong A, Vo W, Juengst S. Psychometric analysis of the behavioral assessment screening tool (BAST) in adults with stroke. Top Stroke Rehabil 2021; 29:321-330. [PMID: 33678137 DOI: 10.1080/10749357.2021.1895495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to examine the initial psychometric properties of the Behavioral Assessment Screening Tool (BAST), a self-reported measure of neurobehavioral symptoms, in adults with stroke. METHODS We assessed subscale and item-level reliabilities of the five BAST subscales in 75 community-dwelling adults with stroke. We further assessed the known-groups validity of the BAST to differentiate individuals with and without self-reported lifetime stroke history (n = 47 with stroke and n = 1843 neurologically healthy controls). RESULTS Cronbach's alpha coefficients of all subscales were >0.7, demonstrating acceptable to good internal consistency reliabilities, and corrected item-total correlations were all >.30 demonstrating good item-level reliabilities. ROC curves demonstrated strong known-groups validity of the negative affect, executive function, and fatigue subscales for classifying stroke versus healthy controls (AUC = .669-.758, p < .001). CONCLUSION The BAST demonstrates good initial psychometric properties as a screening tool to identify neurobehavioral symptoms in community-dwelling adults with stroke. Future work will add stroke-specific items, further assess the validity of the BAST, and employ item response theory or Rasch analyses to identify highly discriminative items for potential smart device-based ecological momentary assessments.
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Affiliation(s)
- Candice Osborne
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, USA
| | - Alex Wong
- Program in Occupational Therapy and Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - Willa Vo
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, USA
| | - Shannon Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, USA
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Meltzer KJ, Juengst SB. Associations between frequent pain or headaches and neurobehavioral symptoms by gender and TBI severity. Brain Inj 2021; 35:41-47. [PMID: 33395320 PMCID: PMC7933051 DOI: 10.1080/02699052.2020.1857438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/14/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
Objective: To investigate differences in frequent pain or headaches and associated neurobehavioral symptoms among men, women, and transgender individuals with and without a history of traumatic brain injury (TBI).Setting: CommunityParticipants: English and Spanish-speaking adults (n = 2,862) with and without self-reported TBIDesign: Cross-sectional studyMain Measures: Behavioral Assessment Screening Tool (BAST) subscales for Negative Affect, Substance Abuse, Executive Function, Fatigue, Impulsivity, and one item for experiencing "frequent pain or headache."Results: Women reported more pain than men. Women with a mild TBI (mTBI) more often reported frequent headaches/pain than woman in general or those with mTBI alone. Women reporting frequent headache/pain reported more negative affect and fatigue than men with comparable TBI history. Individuals identifying as transgender/other without TBI had higher negative affect and fatigue than both men and women without TBI. Individuals with mTBI and frequent headache/pain reported more executive function problems than those with mTBI without headache/pain. Pain and moderate/severe TBI were associated with more executive function problems in men and women, but more so for women.Conclusion: Results suggest frequent headache/pain may differ between genders, particularly after mTBI. Pain, fatigue, executive function, and negative affect may be especially important in women's recovery from TBI.
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Affiliation(s)
- Karen J Meltzer
- Department of Clinical Rehabilitation Counseling, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shannon B Juengst
- Department of Clinical Rehabilitation Counseling, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
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B Juengst S, Kajankova M, Wright B, Terhorst L. Factor analysis of the adolescent version of the behavioural assessment screening tool (BAST-A) in adolescents with concussion. Brain Inj 2020; 35:130-137. [PMID: 33372810 DOI: 10.1080/02699052.2020.1857838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Develop and validate the Behavioral Assessment Screening Tool for Adolescents with brain injury.Setting: Concussion clinicsParticipants: Adolescents with mild traumatic brain injury 3 months after initial concussion clinic visit (n = 138).Design: Assessment development and validation (cross-sectional cohort) studyMain Measures: Behavioral Assessment Screening Tool - AdolescentResults: Expert panel members added or modified items specific to adolescents to the original Behavioral Assessment Screening Tool for adults. The Content Validity Index was 97.2%. Exploratory factor analysis of the Behavioral Assessment Screening Tool - Adolescent reduced the initial 70 items to 46 primary items with a 3-factor solution: Negative Affect & Fatigue, Executive & Social Function, and Risk Behaviors. Internal consistency reliabilities ranged from good to excellent for all factors (Cronbach's α =.80-.95). We retained four secondary maladaptive coping items (from an initial six), though these require further modification and testing (Cronbach's α =.67).Conclusion: The Behavioral Assessment Screening Tool for Adolescents, a measure of neurobehavioral symptoms after mild traumatic brain injury in adolescents, has a multidimensional factor structure with evidence of good internal consistency reliabilities. Future work will further evaluate its convergent and discriminant validity and employ item response theory analyses for validation in a new sample of adolescents with concussion.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Maria Kajankova
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brittany Wright
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Fakhoury M, Shakkour Z, Kobeissy F, Lawand N. Depression following traumatic brain injury: a comprehensive overview. Rev Neurosci 2020; 32:289-303. [PMID: 33661587 DOI: 10.1515/revneuro-2020-0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/21/2020] [Indexed: 12/19/2022]
Abstract
Traumatic brain injury (TBI) represents a major health concern affecting the neuropsychological health; TBI is accompanied by drastic long-term adverse complications that can influence many aspects of the life of affected individuals. A substantial number of studies have shown that mood disorders, particularly depression, are the most frequent complications encountered in individuals with TBI. Post-traumatic depression (P-TD) is present in approximately 30% of individuals with TBI, with the majority of individuals experiencing symptoms of depression during the first year following head injury. To date, the mechanisms of P-TD are far from being fully understood, and effective treatments that completely halt this condition are still lacking. The aim of this review is to outline the current state of knowledge on the prevalence and risk factors of P-TD, to discuss the accompanying brain changes at the anatomical, molecular and functional levels, and to discuss current approaches used for the treatment of P-TD.
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Affiliation(s)
- Marc Fakhoury
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Zaynab Shakkour
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nada Lawand
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Neurology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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McIntyre A, Mehta S, Janzen S, Rice D, Harnett A, MacKenzie HM, Vanderlaan D, Teasell R. Coping strategies and personality traits among individuals with brain injury and depressive symptoms. NeuroRehabilitation 2020; 47:25-34. [DOI: 10.3233/nre-203081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Swati Mehta
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Shannon Janzen
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Danielle Rice
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Amber Harnett
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Heather M. MacKenzie
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Danielle Vanderlaan
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Robert Teasell
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
- St. Joseph’s Health Care, Parkwood Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Juengst SB, Nabasny A, Terhorst L. Neurobehavioral Symptoms in Community-Dwelling Adults With and Without Chronic Traumatic Brain Injury: Differences by Age, Gender, Education, and Health Condition. Front Neurol 2019; 10:1210. [PMID: 31849805 PMCID: PMC6879460 DOI: 10.3389/fneur.2019.01210] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Neurobehavioral symptoms after Traumatic Brain Injury (TBI) are prevalent, persist for many years, and negatively affect long-term health, function, and quality of life. Symptoms may differ based on age, gender, education, race, ethnicity, and injury severity. To better understand neurobehavioral functioning after TBI, we need a comprehensive picture of emotional, cognitive, and behavioral symptoms in the context of personal factors that may affect these symptoms. We also need to understand the extent to which these symptoms are specific to TBI, shared across other neurological conditions, or attributable to factors outside of the injury itself. We collected neurobehavioral symptoms via the self-reported Behavioral Assessment Screening Tool (BAST) in a National Cohort of English (n = 2,511) and Spanish speaking (n = 350) community-dwelling adults with and without chronic TBI and other neurological and mental health conditions. The primary focus of the present study was to comprehensively describe neurobehavioral symptoms in adults with and without TBI, broken down by gender and health conditions and then further by age group or educational attainment. As expected, participants with TBI reported more symptoms than Healthy Controls. Regardless of condition, women reported more fatigue, while men reported more substance abuse and impulsivity. Hispanic participants reported more neurobehavioral symptoms than non-Hispanic participants did across health conditions, though primarily Spanish-speakers reported fewer symptoms than English-speakers, suggesting that level of acculturation may contribute to symptom reporting. These data provide a comprehensive characterization of neurobehavioral symptoms in adults with TBI and adults without TBI (healthy controls, adults with other neurological conditions, and adults with mental health conditions).
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Andrew Nabasny
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, United States
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Patel UK, Anwar A, Saleem S, Malik P, Rasul B, Patel K, Yao R, Seshadri A, Yousufuddin M, Arumaithurai K. Artificial intelligence as an emerging technology in the current care of neurological disorders. J Neurol 2019; 268:1623-1642. [PMID: 31451912 DOI: 10.1007/s00415-019-09518-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Artificial intelligence (AI) has influenced all aspects of human life and neurology is no exception to this growing trend. The aim of this paper is to guide medical practitioners on the relevant aspects of artificial intelligence, i.e., machine learning, and deep learning, to review the development of technological advancement equipped with AI, and to elucidate how machine learning can revolutionize the management of neurological diseases. This review focuses on unsupervised aspects of machine learning, and how these aspects could be applied to precision neurology to improve patient outcomes. We have mentioned various forms of available AI, prior research, outcomes, benefits and limitations of AI, effective accessibility and future of AI, keeping the current burden of neurological disorders in mind. DISCUSSION The smart device system to monitor tremors and to recognize its phenotypes for better outcomes of deep brain stimulation, applications evaluating fine motor functions, AI integrated electroencephalogram learning to diagnose epilepsy and psychological non-epileptic seizure, predict outcome of seizure surgeries, recognize patterns of autonomic instability to prevent sudden unexpected death in epilepsy (SUDEP), identify the pattern of complex algorithm in neuroimaging classifying cognitive impairment, differentiating and classifying concussion phenotypes, smartwatches monitoring atrial fibrillation to prevent strokes, and prediction of prognosis in dementia are unique examples of experimental utilizations of AI in the field of neurology. Though there are obvious limitations of AI, the general consensus among several nationwide studies is that this new technology has the ability to improve the prognosis of neurological disorders and as a result should become a staple in the medical community. CONCLUSION AI not only helps to analyze medical data in disease prevention, diagnosis, patient monitoring, and development of new protocols, but can also assist clinicians in dealing with voluminous data in a more accurate and efficient manner.
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Affiliation(s)
- Urvish K Patel
- Department of Neurology and Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.
| | - Arsalan Anwar
- Department of Neurology, UH Cleveland Medical Center, Cleveland, OH, USA
| | - Sidra Saleem
- Department of Neurology, University of Toledo, Toledo, OH, USA
| | - Preeti Malik
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bakhtiar Rasul
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karan Patel
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Yao
- Department of Biomedical Informatics, Arizona State University and Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Ashok Seshadri
- Department of Psychiatry, Mayo Clinic Health System, Rochester, MN, USA
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Williams MW, Rapport LJ, Hanks RA, Parker HA. Engagement in rehabilitation therapy and functional outcomes among individuals with acquired brain injuries. Disabil Rehabil 2019; 43:33-41. [PMID: 31099267 DOI: 10.1080/09638288.2019.1613682] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purpose : The purpose was to examine the role of therapy engagement as a potential mediator for the relationship between neuropsychological performance and functional outcomes. Materials and method : Participants were 94 adults with medically documented ABI recruited from three outpatient rehabilitation clinics at the start of occupational therapy. Participants (57% men) ranged from 18 to 82 in age, with the majority (81%) having completed 12 or more years of education. They completed a comprehensive neuropsychological assessment at baseline. Separately, occupational therapists (OTs) assessed functional independence and disability at baseline and follow up. The OTs also rated the participants' therapy engagement. Results : Therapy engagement predicted functional outcomes and mediated the relationship between neuropsychological performance and outcomes. Moreover, therapy engagement accounted for unique variance in functional outcome, even after accounting for education, comorbid health conditions, emotional distress, apathy, and baseline functional ability. Conclusions : Engagement in therapy is a crucial patient characteristic in successful rehabilitation outcome. Cognitive deficits associated with ABI undermine full engagement in rehabilitation therapy, which in turn diminishes potential gains made in therapy and functional recovery. Neuropsychological assessment can enhance rehabilitation outcomes by identifying characteristics that underlie therapy engagement, which can ultimately be used to maximize the effectiveness of individualized treatment plans. Implications for rehabilitation Neuropsychological assessment can identify cognitive abilities that are strongly related to functional outcomes during occupational therapy for acquired brain injury. Therapy engagement is an important pathway by which neuropsychological impairment predicts functional outcomes after acquired brain injuries.
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Affiliation(s)
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA.,Rehabilitation Institute of Michigan, Detroit, MI, USA
| | - Hillary A Parker
- Department of Psychology, Wayne State University, Detroit, MI, USA
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Mitrushina M, Tomaszewski R. The effect of subjective perception of cognition on emotional functioning in adults with long-term neurological and neuropsychiatric disorders. Disabil Rehabil 2019; 42:3135-3141. [PMID: 31006289 DOI: 10.1080/09638288.2019.1585490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To examine effects of subjective perception and objective status of cognition on emotional functioning in a sample of adults with long-term neurological and neuropsychiatric disorders.Method: N = 65. Subjective measures were derived from the self-ratings on the Problem Checklist (PCL) from the HI-FI; the objective status was represented by combined externally standardised scores on neuropsychological tests across three cognitive domains: verbal memory, executive functioning, and psychomotor speed.Results: No relationship was found between self-ratings of cognitive competence and performance on neuropsychological tests. Based on the results of the multiple regression analysis, approximately 40% of the variability in emotional functioning was explained by self-perceived cognitive and physical competence, while the addition of objective measures of cognition increased predictive capacity by only 1.3%. The awareness scores were calculated as the difference between objective performance scores and self-ratings of cognition. Overall, the sample demonstrated a tendency towards low awareness of cognitive deficits. Patients who overestimated cognitive deficits self-rated emotional functioning at a significantly lower level, while those with average or low awareness of deficits were equally emotionally content.Conclusions: Self-perception of competence, rather than objective level of functioning influence emotional well-being and quality of life in individuals with long-term disabilities in our study.IMPLICATIONS FOR REHABILITATIONCognitive deficits are common consequences of neurological dysfunction.This study shows that self-perception of cognitive competence, rather than objective level of cognitive functioning has critical influence on emotional well-being and perceived quality of life.An addition of psychotherapeutic intervention directed at alleviation of self-perception bias is likely to improve emotional well-being and enhance efficiency of rehabilitation efforts in patients with long-term disabilities due to neurological disorders.Based on our findings, patients with long-term disabilities could benefit from psychotherapy to improve their self-perception and quality of life.
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Affiliation(s)
- Maura Mitrushina
- Department of Psychology, California State University, Northridge, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Robert Tomaszewski
- Department of Psychology, California State University, Northridge, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Visscher RMS, Feddermann-Demont N, Romano F, Straumann D, Bertolini G. Artificial intelligence for understanding concussion: Retrospective cluster analysis on the balance and vestibular diagnostic data of concussion patients. PLoS One 2019; 14:e0214525. [PMID: 30939164 PMCID: PMC6445465 DOI: 10.1371/journal.pone.0214525] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/14/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES We propose a bottom-up, machine-learning approach, for the objective vestibular and balance diagnostic data of concussion patients, to provide insight into the differences in patients' phenotypes, independent of existing diagnoses (unsupervised learning). METHODS Diagnostic data from a battery of validated balance and vestibular assessments were extracted from the database of the Swiss Concussion Center. The desired number of clusters within the patient database was estimated using Calinski-Harabasz criteria. Complex (self-organizing map, SOM) and standard (k-means) clustering tools were used, and the formed clusters were compared. RESULTS A total of 96 patients (81.3% male, age (median [IQR]): 25.0[10.8]) who were expected to suffer from sports-related concussion or post-concussive syndrome (52[140] days between diagnostic testing and the concussive episode) were included. The cluster evaluation indicated dividing the data into two groups. Only the SOM gave a stable clustering outcome, dividing the patients in group-1 (n = 38) and group-2 (n = 58). A large significant difference was found for the caloric summary score for the maximal speed of the slow phase, where group-1 scored 30.7% lower than group-2 (27.6[18.2] vs. 51.0[31.0]). Group-1 also scored significantly lower on the sensory organisation test composite score (69.0[22.3] vs. 79.0[10.5]) and higher on the visual acuity (-0.03[0.33] vs. -0.14[0.12]) and dynamic visual acuity (0.38[0.84] vs. 0.20[0.20]) tests. The importance of caloric, SOT and DVA, was supported by the PCA outcomes. Group-1 tended to report headaches, blurred vision and balance problems more frequently than group-2 (>10% difference). CONCLUSION The SOM divided the data into one group with prominent vestibular disorders and another with no clear vestibular or balance problems, suggesting that artificial intelligence might help improve the diagnostic process.
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Affiliation(s)
- Rosa M. S. Visscher
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nina Feddermann-Demont
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Fausto Romano
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Dominik Straumann
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Giovanni Bertolini
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
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15
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Juengst SB, Terhorst L, Kew CL, Wagner AK. Variability in daily self-reported emotional symptoms and fatigue measured over eight weeks in community dwelling individuals with traumatic brain injury. Brain Inj 2019; 33:567-573. [PMID: 30836017 DOI: 10.1080/02699052.2019.1584333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate within-person variability in daily self-reported emotional and fatigue symptoms and factors associated with high within-person variability among individuals with chronic traumatic brain injury (TBI). DESIGN This was a prospective descriptive pilot study of n = 18 adults with chronic TBI (2-27 years post-injury) who owned and could independently use an Apple or Android device. METHODS Participants completed daily assessments for 8 weeks via smartphone. Outcome measures included the Positive and Negative Affect Schedule, Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, and a 7-point fatigue rating. We examined within-person variability over time using individual Multilevel Linear Models. We categorized within-person variability as High or Low based on individual standard deviations in relationship to sample standard deviation. RESULTS Significant temporal within-person variability occurred for all measures. High variability was associated with more symptom reporting versus Low variability, and variability was associated with sex (High variability: 88% women; Low variability 90% men). CONCLUSIONS Symptom measurement at a single time point among adults with chronic TBI may not capture day-to-day symptom fluctuation and may misidentify individuals in need of intervention. Assessing symptom profiles over time to capture temporal and individual variability may provide a more ecologically valid measure for managing long-term symptoms after TBI.
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Affiliation(s)
- Shannon B Juengst
- a Department Physical Medicine and Rehabilitation , University of Texas Southwestern Medical Center , Dallas , TX , USA.,b Department Rehabilitation Counseling , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Lauren Terhorst
- c Department of Occupational Therapy , University of Pittsburgh , Pittsburgh , PA , USA.,d Clinical and Translational Science Institute, University of Pittsburgh , Pittsburgh , PA , USA
| | - Chung Lin Kew
- a Department Physical Medicine and Rehabilitation , University of Texas Southwestern Medical Center , Dallas , TX , USA.,b Department Rehabilitation Counseling , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Amy K Wagner
- e Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA.,f Center for Neuroscience, University of Pittsburgh , Pittsburgh , PA , USA.,g Safar Center for Resuscitation, University of Pittsburgh , Pittsburgh , PA , USA
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16
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Osborne CL, Kauvar DS, Juengst SB. Linking the behavioral assessment screening tool to the international classification of functioning, disability, and health as a novel indicator of content validity. Disabil Rehabil 2019; 42:1775-1782. [PMID: 30656977 DOI: 10.1080/09638288.2018.1539128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To use the International Classification of Functioning, Disability, and Health (ICF) to classify and describe the concepts of the Behavioral Assessment Screening Tool (BAST), a measure of behavioral disruptions after traumatic brain injury (TBI).Methods: Meaningful concepts in the BAST were linked to the International Classification of Functioning to (1) further explore the validity of the conceptual model of behavior; (2) demonstrate ICF linking as a novel indicator of the content validity; (3) identify International Classification of Functioning concepts that characterize behavior; (4) determine the comprehensiveness of the BAST.Results: The body functions component and the activities and participation component were most frequently addressed in the BAST. The majority of the TBI Core Set categories were included in the BAST and the manifest and latent coders agreed 85% of the time.Conclusions: Linking BAST concepts to the International Classification of Functioning demonstrated the BAST's content validity and comprehensiveness. This approach provides a model for how ICF coding could be used to assess content validity.Implications for RehabilitationICF coding can be used to assess content validity and refine rehabilitation measures.The Behavioral Assessment Screening Tool can be used for clinical and research purposes to assess behavior as it relates to a wide range of ICF TBI Core Set categories.
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Affiliation(s)
- Candice L Osborne
- Department of Physical Medicine and Rehabilitation, University of Texas Southwest Medical Center, Dallas, TX, USA
| | - David S Kauvar
- Department of Surgery, San Antonio Military Medical Center, San Antonio, TX, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwest Medical Center, Dallas, TX, USA
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17
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Juengst SB, Terhorst L, Wagner AK. Factor structure of the Behavioral Assessment Screening Tool (BAST) in traumatic brain injury. Disabil Rehabil 2018; 42:255-260. [PMID: 30451025 DOI: 10.1080/09638288.2018.1496487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: Establish the factor structure of the Behavioral Assessment Screening Tool (BAST), a self-reported emotional/behavioral symptom measure for adults with traumatic brain injury (TBI).Setting: Community.Participants: Community-dwelling adults with moderate-severe TBI (n = 162; n = 110).Design: Assessment development (cohort study).Main measures: Behavioral Assessment Screening Tool.Results: The original BAST included 61 items (55 primary, six secondary), an Environmental Context checklist including recent major life events, and three open-ended questions about other relevant factors. Two rounds of pilot testing and exploratory factor analysis of the BAST (n = 162; n = 110) reduced the total items to 37 primary items and six secondary coping items. The final BAST had a five-factor solution with communalities ranging from 0.323 to 0.771. Internal consistency reliabilities ranged from acceptable to excellent for all factors (Cronbach's α = 0.76-0.90). The items related to coping, given only to those endorsing stress, had a two-factor solution with communalities ranging from 0.224 to 0.605, but demonstrated acceptable to poor internal consistency (Cronbach's α = 0.46-0.68). Participants rated ease of use and overall satisfaction with completing the scale as high, with mean scores of 6.42 and 6.22 out of 7, respectively.Conclusions: The BAST, a measure of behavioral and emotional symptoms after TBI, has a multidimensional factor structure with evidence of good internal consistency reliability. Future work will evaluate the convergent, discriminant, and discriminative validity of the BAST and employ item response theory analyses to further develop a short version for mobile health assessment.Implications for RehabilitationLong-term monitoring of behavioral and emotional symptoms after traumatic brain injury could improve clinical management and reduce negative participation and quality of life outcomes.The Behavioral Assessment Screening Tool demonstrates reliability for use among adults with chronic traumatic brain injury, through its factor structure and internal consistency reliabilities, to measure chronic behavioral and emotional symptoms.The Behavioral Assessment Screening Tool is a screening tool to identify potential behavioral and emotional problems that individuals with chronic traumatic brain injury may be experiencing; it could be implemented in a proactive, rather than reactive, system for long-term monitoring of these symptoms to improve early identification of clinical disorders.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, USA.,Department of Rehabilitation Counseling, University of Texas Southwestern, Dallas, TX, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.,Safar Center for Resuscitation, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Barrash J, Stuss DT, Aksan N, Anderson SW, Jones RD, Manzel K, Tranel D. "Frontal lobe syndrome"? Subtypes of acquired personality disturbances in patients with focal brain damage. Cortex 2018; 106:65-80. [PMID: 29883878 PMCID: PMC6120760 DOI: 10.1016/j.cortex.2018.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/29/2018] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
Abstract
Conceptualizations of the nature of acquired personality disturbances after brain damage, especially to prefrontal cortex, have progressed from clinical observations of a large, disparate set of disturbances to theories concerning neuroanatomically-based subgroups with prefrontal damage. However, hypothesized subtypes have not yet been studied systematically. Based on our previous investigations of acquired personality disturbances, we hypothesized five subtypes of acquired personality disturbances: Executive Disturbances, Disturbed Social Behavior, Emotional Dysregulation, Hypo-emotionality/De-Energization, and Distress, as well as an undisturbed group. Subtypes were investigated in 194 adults with chronic, stable, focal lesions located in various aspects of prefrontal lobes and elsewhere in the brain, using two different cluster analysis techniques applied to ratings on the Iowa Scales of Personality Change. One technique was a hypothesis-driven approach; the other was a set of strictly empirical analyses to assess the robustness of clusters found in the first analysis. The hypothesis-driven analysis largely supported the hypothesized set of subtypes. However, in contrast to the hypothesis, it suggested that disturbed social behavior and emotional dysregulation are not two distinct subtypes, but two aspects of one multifaceted type of disturbance. Additionally, the so-labeled "executive disturbances" group also showed disturbances in other domains. Results from the second (empirical) set of cluster analyses were consistent with findings from the hypothesis-driven cluster analysis. Overall, findings across the two cluster analyses indicated four subtypes of acquired personality disturbances: (1) executive disturbances in association with generalized disturbance, (2) dysregulation of emotions and behavior, (3) hypo-emotionality and de-energization, and (4) distress/anxiety. These findings show strong correspondence with subtypes suggested by prominent models of prefrontal systems based on neuroanatomically-defined circuits. Clarification of distinctive subtypes of acquired personality disturbances is a step toward enhancing our ability to tailor rehabilitative interventions for patients with prefrontal brain injuries.
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Affiliation(s)
- Joseph Barrash
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Donald T Stuss
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Rotman Research Institute of Baycrest, Toronto, Ontario, Canada
| | - Nazan Aksan
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Steven W Anderson
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Robert D Jones
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kenneth Manzel
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Daniel Tranel
- Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
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19
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Juengst SB, Terhorst L, Dicianno BE, Niemeier JP, Wagner AK. Development and content validity of the behavioral assessment screening tool (BAST β). Disabil Rehabil 2018; 41:1200-1206. [PMID: 29303003 DOI: 10.1080/09638288.2017.1423403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Develop and establish the content validity of the Behavioral Assessment Screening Tool (BASTβ), a self-reported measure of behavioral and emotional symptoms after traumatic brain injury. METHODS This was an assessment development study, including two focus groups of individuals with traumatic brain injury (n = 11) and their family members (n = 10) and an expert panel evaluation of content validity by experts in traumatic brain injury rehabilitation (n = 7). We developed and assessed the Content Validity Index of the BASTβ. RESULTS The BASTβ initial items (n = 77) corresponded with an established conceptual model of behavioral dysregulation after traumatic brain injury. After expert panel evaluation and focus group feedback, the final BASTβ included 66 items (60 primary, 6 branching logic) rated on a three-level ordinal scale (Never, Sometimes, Always) with reference to the past two weeks, and an Environmental Context checklist including recent major life events (n = 23) and four open-ended questions about environmental factors. The BASTβ had a high Content Validity Index of 89.3%. CONCLUSION The BASTβ is a theoretically grounded, multidimensional self-reported assessment of behavioral dysregulation after traumatic brain injury, with good content validity. Future translation into mobile health modalities could improve effectiveness and efficiency of long-term symptom monitoring post-traumatic brain injury. Future work will establish and validate the factor structure, internal consistency reliabilities and other validities of the BAST. Implications for Rehabilitation Behavioral problems after traumatic brain injury is one of the strongest contributing factors to poor mood and community integration outcomes after injury. Behavior is complex and multidimensional, making it a challenge to measure and to monitor long term. The Behavioral Assessment Screening Tool (BAST) is a patient-oriented outcome assessment developed in collaboration with individuals with traumatic brain injury, their care partners, and experts in the field of traumatic brain injury rehabilitation to be relevant and accessible for adults with traumatic brain injuries. The BAST is a long-term monitoring and screening tool for community-dwelling adults with traumatic brain injuries, to improve identification and management of behavioral and emotional sequelae.
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Affiliation(s)
- Shannon B Juengst
- a Department of Physical Medicine and Rehabilitation , University of Texas Southwestern , Dallas , TX , USA.,b Department of Rehabilitation Counseling , University of Texas Southwestern , Dallas , TX , USA
| | - Lauren Terhorst
- c Department of Occupational Therapy , University of Pittsburgh , Pittsburgh , PA , USA.,d Clinical and Translational Science Institute , University of Pittsburgh , Pittsburgh , PA , USA
| | - Brad E Dicianno
- e Department of Physical Medicine and Rehabilitation , University of Pittsburgh , Pittsburgh , PA , USA.,f Department of Rehabilitation Science and Technology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Janet P Niemeier
- g Department of Physical Medicine and Rehabilitation , Carolinas Medical Center , Charlotte , SC , USA
| | - Amy K Wagner
- f Department of Rehabilitation Science and Technology , University of Pittsburgh , Pittsburgh , PA , USA.,h Center for Neuroscience , University of Pittsburgh , Pittsburgh , PA , USA.,i Safar Center for Resuscitation , University of Pittsburgh , Pittsburgh , PA , USA
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20
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Juengst SB, Kumar RG, Wagner AK. A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges. Psychol Res Behav Manag 2017; 10:175-186. [PMID: 28652833 PMCID: PMC5476717 DOI: 10.2147/prbm.s113264] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine and Rehabilitation
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation
- Department of Neuroscience
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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21
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Juengst SB, Myrga JM, Fann JR, Wagner AK. Cross-Lagged Panel Analysis of Depression and Behavioral Dysfunction in the First Year After Moderate-to-Severe Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2017; 29:260-266. [PMID: 28294709 PMCID: PMC5533513 DOI: 10.1176/appi.neuropsych.16100217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Timely treatment of depression and behavioral dysfunction after moderate-to-severe traumatic brain injury (TBI) could improve health, function, and quality of life. The authors hypothesized that 6-month depression would be the stronger contributor to later depression and behavioral dysfunction in a sample of 88 adults with moderate-to-severe TBI. A structural equation modeling cross-lagged panel analysis, adjusting for all 6-month predictors, revealed that 6-month depression had a stronger relationship to 12-month depression (βstand=0.55, p=0.002) and behavioral dysfunction (βstand=0.41, p=0.004) than did 6-month behavioral dysfunction (βstand=0.17, p=0.270, βstand=0.30, p=0.035). Depression may be in the developmental pathway to behavioral dysfunction, triggering a cycle of reciprocal causality.
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Affiliation(s)
- Shannon B Juengst
- From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh (S.B.J., J.M.M., A.K.W.); and the Departments of Psychiatry and Behavioral Sciences, Rehabilitation Medicine, and Epidemiology, University of Washington, Seattle (J.R.F.)
| | - John M Myrga
- From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh (S.B.J., J.M.M., A.K.W.); and the Departments of Psychiatry and Behavioral Sciences, Rehabilitation Medicine, and Epidemiology, University of Washington, Seattle (J.R.F.)
| | - Jesse R Fann
- From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh (S.B.J., J.M.M., A.K.W.); and the Departments of Psychiatry and Behavioral Sciences, Rehabilitation Medicine, and Epidemiology, University of Washington, Seattle (J.R.F.)
| | - Amy K Wagner
- From the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh (S.B.J., J.M.M., A.K.W.); and the Departments of Psychiatry and Behavioral Sciences, Rehabilitation Medicine, and Epidemiology, University of Washington, Seattle (J.R.F.)
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