R2: Development and Evaluation of an Innovative Program to Improve Outcomes in Persons at Risk Following Mild or Complicated Mild Traumatic Brain Injury

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CENTER DIRECTOR
Walter M. High, Ph.D.
713- 666-9550

DIRECTOR OF RESEARCH
Angelle Sander, Ph.D.
713- 666-9550

DIRECTOR OF TRAINING
Karen A. Hart, Ph.D.
713-797-5946

Principal Investigator: Walter M. High, Ph.D.

Co-Investigators: H. Julia Hannay, Ph.D., Margaret Struchen, Ph.D., Angelle Sander, Ph.D., Charles Contant, Ph.D., Claudia Robertson, M.D., Alex Valadka, M.D., Gerard Francisco, M.D., Cindy Ivanhoe, M.D.

Specific Aims: 

• To determine whether providing early education concerning the effects of mild TBI is more effective than the current standard of care in improving outcome at 3 months post injury. 
• To determine whether an intensive treatment program is more effective than the standard of care or early education in improving outcome 3 months following a complicated mild TBI.
• To develop and test prognostic indicators of rehabilitation outcomes for persons with mild TBI.

Sample:  168 persons, age 18 years or greater, with mild TBI (Glasgow Coma Scale (GCS) score of 13 to 15 and no neurological abnormalities) and 207 persons with complicated mild TBI (GCS 13 to 15, but abnormalities evident on neuroimaging or on neurological exam); subjects recruited from the acute care facility of a county hospital that serves the indigent and uninsured members of the community, as well as some patients with insurance; the county hospital population is approximately 1/3 Caucasian, 1/3 Hispanic, and 1/3 African-American.

Design:  Assessment of pre-injury risk factors and of neuropsychological performance will be conducted within 1 week of injury.  Persons with uncomplicated mild injury will be randomly assigned to a standard of care group or to a single session cognitive-behavioral educational intervention.  Persons with complicated mild injury will be assigned to either a standard of care group, a single-session cognitive-behavioral educational intervention, or a four-session in-home treatment program.  Outcome will be assessed at 3 months following the baseline assessment. 

Predictor Variables:  Demographic variables (age, gender, race. education, marital status, vocational history); acute injury variables (injury severity, CT/MRI results, associated trauma); pre-injury history (substance use, medical history, neurological history, psychiatric history, pre-existing disabilities, social/leisure activities); presence of injury-related litigation or workman’s compensation; neuropsychological test performance at 1 week post-injury; pre-injury psychological functioning (depressive symptoms, symptoms of Posttraumatic Stress Disorder; stress and coping, anger, pain, substance use, personality); family resources; treatment group.

Primary Outcome Measures:  New York Head Injury Family Interview Problem Checklist; SF-36; Community Integration Questionnaire; Brief Symptom Inventory; Disability Rating Scale; Glasgow Outcome Scale; # of days until return to productive activity

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