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4 The Role of Cognition and Self-Awareness on Driving Patterns After Moderate-to-Severe Traumatic Brain Injury
- Christina A DiBlasio, Thomas A Novack, Laura E Dreer, Michael Crowe, Despina Stavrinos, Lisa Rapport, Thomas Watanabe, Candice Tefertiller, Charles Bombardier, Thomas Bergquist, Jennifer Marwitz, Robert Brunner, Yelena Goldin, Richard E Kennedy
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 116-117
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Objective:
Return to driving after moderate-to-severe traumatic brain injury (TBI) is often a key step in recovery to regain independence. Survivors are often eager to resume driving and may do so despite having residual cognitive limitations from their injury. A better understanding is needed of how cognition and self-awareness impact survivors’ driving after injury. This study examined the influence of cognition and self-awareness on driving patterns following moderate-to-severe TBI.
Participants and Methods:Participants were 350 adults aged 19-87 years (mean age = 46 years; 70% male) with history of moderate-to-severe TBI, who resumed driving and were enrolled in the TBI Model System. Cross-sectional data were obtained ranging 1-30 years post injury, including questions on driving practices, the Brief Test of Adult Cognition by Telephone (BTACT), and the Functional Independence Measure (FIM). Self-awareness of cognitive function was measured via the discrepancy between dichotomized ratings (intact versus impaired) of objective cognitive testing (BTACT) and self-reported cognitive function (FIM Cognition subscale). Driving patterns included frequency (driving 'more than once a week’ versus 'once a week or less') and restricted driving behavior (total number of driving situations the survivor described as restricted, ranging 0-15). Regression analyses were conducted to examine the relationships between cognition, self-awareness, and each driving outcome (frequency and restriction), followed by causal mediation analyses to examine the mediating effect of self-awareness. Demographics (age, sex, education), injury characteristics (time since injury, injury severity, history of seizures in past year), and medical/social factors (family income, motor function, urban-rural classification) were included in the models as covariates.
Results:Thirty-nine percent of survivors had impaired self-awareness, 88% of survivors drove numerous times per week, and the average survivor reported limited driving in 6 situations (out of 15 total situations). Cognition was inversely related to impaired self-awareness (OR = 0.03, p < 0.001) and inversely related to restricted driving behavior (b = -0.79, p < 0.001). Motor function was positively related to impaired self-awareness (OR = 1.28, p < 0.01). Cognition was not related to driving frequency, and self-awareness did not mediate the relationships between cognition and driving patterns (all p > 0.05).
Conclusions:Most survivors who drive after their injury are driving frequently, but the situations they drive in differ based on their cognitive ability. Impaired self-awareness of cognitive deficits is common after TBI, and self-awareness of cognitive function does not affect driving patterns. Future research needs to focus on how cognition affects nuanced aspects of driving behavior after injury (i.e., types of situations survivors drive in).
2418 Post-traumatic stress symptoms in caregivers of pediatric hydrocephalus population
- Kathrin Zimmerman, Alexandra Cutillo, Laura Dreer, Anastasia Arynchyna, Brandon G. Rocque
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 86
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OBJECTIVES/SPECIFIC AIMS: The goal of this study is to characterize traumatic events and post-traumatic stress symptom severity experienced by caregivers of children with hydrocephalus. Results will eventually be evaluated and compared with demographic and medical characteristics. This study is part of a larger research project that aims to (1) determine the prevalence and risk factors for post-traumatic stress symptoms in pediatric hydrocephalus patients and their caregivers; (2) develop a targeted intervention to mitigate its effects and pilot test the intervention. METHODS/STUDY POPULATION: Caregivers of children with hydrocephalus that have received surgical treatment (CSF shunt or ETV/CPC) were enrolled during routine follow up visit in a pediatric neurosurgery clinic. Caregivers completed the PTSD Checklist for DSM-5 (PCL-5), a 20-item self-report measure that assesses the presence and severity of post-traumatic stress disorder (PTSD) symptoms. RESULTS/ANTICIPATED RESULTS: Participant responses (n=56) revealed that 57.14% of caregivers indicated that their most traumatic event was directly related to their child’s medical condition. In total, 23.21% of caregivers did not specify their most traumatic event and 1.79% of caregivers indicated that they had never experienced a traumatic event. Median Total Symptom Severity Score was 11 (mean: 15.32±14.92), and scores ranged from 0 to 67; 32.14% of caregivers scored 19 or greater, and 16.07% of caregivers scored 33 or greater, a value suggestive of a provisional diagnosis of PTSD. Severity scores by DSM-V clusters were as follows: cluster B—intrusion symptoms (mean: 4.91±4.77, median: 4, range: 0–20), cluster C—avoidance symptoms (mean: 1.27±1.87, median: 0.5, range: 0–8), cluster D—negative alterations in cognition and mood (mean: 4.86±6.07, median: 2, range: 0–22), and cluster E—alterations in arousal and reactivity (mean: 4.29±4.07, median: 3, range: 0–17). DISCUSSION/SIGNIFICANCE OF IMPACT: Preliminary results from this study indicate that post-traumatic stress symptoms are prevalent among caregivers of children with hydrocephalus. These results suggest that psychosocial issues such as PTSS may be a significant problem in need of treatment, that is not traditionally addressed as part of routine care for families of children with hydrocephalus. Characterizing post-traumatic stress symptoms in this population sets the foundation for the development of screening and treatment protocols for post-traumatic stress symptoms in caregivers of children with hydrocephalus. This study is the first step towards fundamentally improving routine clinical care and quality of life for patients with hydrocephalus and their caregivers by understanding and addressing the effects of traumatic stress.
2466: Communication frequency and content between parents of concussed youth and systems of care
- Sarah Terry, Molly Cox, Alexandra Linley, Jilian O’Neill, Laura Dreer
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- Journal:
- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, p. 80
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OBJECTIVES/SPECIFIC AIMS: To characterize parent communication frequency and content between systems of care (medical, school, and sports/recreation) of concussed youth who are in prolonged recovery. METHODS/STUDY POPULATION: In this ongoing study, 16 concussed youth (average age=14.9 years, SD=1.5; 31.2% female and 68.8% male) and their parent study partner (average age=44.3 years, SD=4.3; 87.3% female and 12.5% male) have been enrolled to date from sports medicine clinics. Demographic information was obtained during the initial clinic intake session. Weekly phone calls were also conducted with the parent and child until the child was considered asymptomatic (ie, reporting no symptoms on the SCAT3), to collect data on communication with the school, sport/recreation, and medical systems throughout the recovery process. For the purpose of this study, we evaluated communication patterns of those parents who had a child in prolonged recovery (ie, symptomatic 14 d or more post-concussion injury). Communication variables included frequency (ie, number of times a parent contacted or attempted to contact a system of care) and content or topic discussed during the contact event. RESULTS/ANTICIPATED RESULTS: Of the 16 enrolled participants to date, 68.8% (n=11) experienced concussion related symptoms 14 days postinjury (M=22.2, SD=4.6) at the time of their 2 week follow-up call and were thus considered to be in prolonged recovery. Of those 11, 81.8% (n=9) of parents reported communicating with the school system at some point between the initial clinic intake session and the 2 week follow-up phone call. The frequency of communication for this period ranged between 0 and 10 instances of contact (M=2.5, SD=2.9). Of the 11 prolonged cases, 8 participants were members of sports teams. Sixty-three percent (n=5) of those parents with a child on a sports team communicated with a coach while none of the parents contacted a team athletic trainer. The frequency of communication with the coach ranged from 0 to 8 (M=1.5, SD=2.5) over the course of 2 weeks from enrollment. With regards to the medical system, the majority of parents (72.7%, n=8) communicated at least once with a medical professional during the same time period. The frequency of communication with the medical system ranged from 0 to 8 (M=2.2, SD=2.6) points of contact. Themes that arose for communicating with the school system included informing school personnel of academic accommodations prescribed by the physician, explaining absences, and concerns about missed academic work and grades. The content of communication with the sports system (ie, coach) pertained to return-to-play issues as well as progress updates on recovery. Themes for communication with the medical system were centered on scheduling appointments, attending follow-up medical appointments, and starting return-to-play protocols. DISCUSSION/SIGNIFICANCE OF IMPACT: Parents of concussed youth who were still in prolonged recovery, for the most part, appear engaged in communicating with multiple systems of care. However, a subset of parents did not participate in contact with these systems. Further discussion of these findings will highlight areas for improvement in concussion management as well as strategies parents can utilize to advocate for their child in terms of return-to-learn and recovery.
Disability
- from Psychology, health and illness
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- By Timothy R. Elliott, Texas A&M University, Laura Dreer, University of Alabama at Birmingham
- Edited by Susan Ayers, University of Sussex, Andrew Baum, University of Pittsburgh, Chris McManus, Stanton Newman, Kenneth Wallston, John Weinman, Robert West
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- Book:
- Cambridge Handbook of Psychology, Health and Medicine
- Published online:
- 18 December 2014
- Print publication:
- 23 August 2007, pp 80-84
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Summary
Disability has traditionally been defined by prevailing medical and legal systems across cultures. Less apparent have been social and technological contributions that substantially determine the experience of disability. The many and multidisciplinary definitions of disability in clinical, legal and academic life inadvertently compromise efforts to develop, sponsor and enact effective policy and service for persons who live with disabling conditions (Walkup, 2000).
Theoretical models of disability
The most pervasive definitions of disability have been provided by disciplines associated with healthcare delivery. Contemporary perspectives have evolved in response to the increase of chronic health conditions across societies generally, and from criticisms of the medical model that recognize the broader policy, psychological and socio-economic issues associated with the management of disabling conditions over time and throughout communities.
Medical model of disability
The medical model of disability is the traditional and predominant model. Essentially, healthcare services which flow from this model assume a ‘find it and fix it’ perspective: health problems are diagnosed and specialized services are prescribed to cure the problem (Kaplan, 2002). This perspective is most effective in the detection and treatment of acute health problems; so effective, in fact, that this model has guided the development and status of medical training, facilities and specialties. The medical model is also responsible for the rapid and effective response to the acute needs of persons with physical disabilities and other chronic health conditions, and the first initiatives to address issues of improved care, survival and quality of life can be attributed to professions who embraced the medical model.