Journal of Head Trauma Rehabilitation最新文献

{"title":"Bypassing Striatal Learning Mechanisms Using Delayed Feedback to Circumvent Learning Deficits in Traumatic Brain Injury.","authors":"Ekaterina Dobryakova, Tien T Tong, Olesya Iosipchuk, Anthony Lequerica, Veronica Schneider, Nancy Chiaravalloti, Joshua Sandry","doi":"10.1097/HTR.0000000000000947","DOIUrl":"10.1097/HTR.0000000000000947","url":null,"abstract":"<p><strong>Objective: </strong>Feedback facilitates learning by guiding and modifying behaviors through an action-outcome contingency. As the majority of existing studies have focused on the immediate presentation of feedback, the impact of delayed feedback on learning is understudied. Prior work demonstrated that learning from immediate and delayed feedback employed distinct brain regions in healthy individuals, and compared to healthy individuals, individuals with traumatic brain injury (TBI) are impaired in learning from immediate feedback. The goal of the current investigation was to assess the effects of delayed vs immediate feedback on learning in individuals with TBI and examine brain networks associated with delayed and immediate feedback processing.</p><p><strong>Setting: </strong>Nonprofit research organization.</p><p><strong>Participants: </strong>Twenty-eight individuals with moderate-to-severe TBI.</p><p><strong>Design: </strong>Participants completed a paired-associate word learning task while undergoing magnetic resonance imaging. During the task, feedback was presented either immediately, after a delay, or not at all (control condition).</p><p><strong>Main measures: </strong>Learning performance accuracy, confidence ratings, post-task questionnaire, and blood oxygen level-dependent signal.</p><p><strong>Results: </strong>Behavioral data showed that delayed feedback resulted in better learning performance than immediate feedback and no feedback. In addition, participants reported higher confidence in their performance during delayed feedback trials. During delayed vs immediate feedback processing, greater activation was observed in the superior parietal and angular gyrus. Activation in these areas has been previously associated with successful retrieval and greater memory confidence.</p><p><strong>Conclusion: </strong>The observed results might be explained by delayed feedback processing circumventing the striatal dopaminergic regions responsible for learning from immediate feedback that are impaired in TBI. In addition, delayed feedback evokes less of an affective reaction than immediate feedback, which likely benefited memory performance. Indeed, compared to delayed feedback, positive or negative immediate feedback was more likely to be rated as rewarding or punishing, respectively. The findings have significant implications for TBI rehabilitation and suggest that delaying feedback during rehabilitation might recruit brain regions that lead to better functional outcomes.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E129-E138"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationships Between Neighborhood Disadvantage, Race/Ethnicity, and Neurobehavioral Symptoms Among Veterans With Mild Traumatic Brain Injury.","authors":"Adam R Kinney, Nazanin H Bahraini, Alexandra L Schneider, Xiang-Dong Yan, Jeri E Forster, Ryan Holliday, Lisa A Brenner","doi":"10.1097/HTR.0000000000001016","DOIUrl":"10.1097/HTR.0000000000001016","url":null,"abstract":"<p><strong>Objective: </strong>To examine the relationship between neighborhood disadvantage and severity of vestibular, sensory, mood-behavioral, and cognitive neurobehavioral symptoms among Veterans with a mild traumatic brain injury (mTBI); and whether Veterans in underrepresented racial/ethnic groups with high neighborhood disadvantage experience the most severe symptoms.</p><p><strong>Setting: </strong>Outpatient Veterans Health Administration (VHA).</p><p><strong>Participants: </strong>Veterans with the following data available in the electronic health record (2014-2020): (1) clinician-confirmed mTBI and complete neurobehavioral symptom inventory (NSI) as part of their comprehensive traumatic brain injury evaluation (CTBIE) and (2) area deprivation index (ADI) scores assessing neighborhood disadvantage from the same quarter as their CTBIE.</p><p><strong>Design: </strong>Retrospective cohort study. Latent variable regression was used to examine unique and interactive relationships between neighborhood disadvantage, race/ethnicity, and neurobehavioral symptoms.</p><p><strong>Main measures: </strong>NSI and ADI national percentile rank.</p><p><strong>Results: </strong>The study included 58 698 eligible Veterans. Relative to Veterans in the first quintile of ADI national percentile rank, representing those with the least neighborhood disadvantage, Veterans in the ADI quintiles indicating greater neighborhood disadvantage reported more severe vestibular, sensory, mood-behavioral, and cognitive symptoms. The strongest associations between neighborhood disadvantage and neurobehavioral symptoms were observed within the sensory ( β = 0.07-0.16) and mood-behavioral domains ( β = 0.06-0.15). Statistical interactions indicated that the association between underrepresented racial/ethnic group status (vs. identifying as white, non-Hispanic) and the severity of neurobehavioral symptoms did not differ among those with severe neighborhood disadvantage versus those without.</p><p><strong>Conclusion: </strong>Veterans with mTBI living in more disadvantaged neighborhoods reported more severe neurobehavioral symptoms relative to those in the most advantaged neighborhoods, with the strongest relationships detected within the sensory and mood-behavioral domains. While neighborhood disadvantage and underrepresented race/ethnicity were both independently associated with symptoms, these factors did not interact to produce more severe symptoms. Findings suggest that addressing factors driving socioeconomic disadvantage may assist in mitigating symptoms in this population.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"65-75"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Home Neighborhood Tree Canopy Coverage on Mental Health Outcomes: A Traumatic Brain Injury Model Systems Investigation.","authors":"Shannon B Juengst, Raj G Kumar, Alexandra Holland, Achituv Cohen, Trisalyn A Nelson, John D Corrigan, Angelle M Sander, Paul B Perrin, Umesh M Venkatesan, Amanda Rabinowitz, Simon Driver, Kristin Wilmoth, Candace Tefertiller","doi":"10.1097/HTR.0000000000001031","DOIUrl":"10.1097/HTR.0000000000001031","url":null,"abstract":"<p><strong>Objective: </strong>Explore the relationship between tree canopy coverage (TCC) in one's home neighborhood and mental health outcomes, and how these relationships differ by home neighborhood factors, among persons with traumatic brain injury (TBI) in the United States.</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>Enrolled in the TBI Model Systems National Database with completed follow-up interview after January 1, 2017.</p><p><strong>Design: </strong>Secondary analysis of cross-sectional data.</p><p><strong>Main measures: </strong>Neighborhood (census tract) Percent TCC, depressive (Patient Health Questionnaire-9) and anxiety (General Anxiety Disorder-7) symptoms (scores ≥10 on each measure), personal/demographic (age, sex, education, homebound status), and neighborhood factors (type, socioeconomic disadvantage).</p><p><strong>Results: </strong>Separate negative binomial regression models were constructed for the 2 mental health outcomes (depression and anxiety symptoms). Covariates in final models were age, sex, neighborhood type, Functional Independence Measure (FIM) total (concurrent), driving status, homebound status, and neighborhood-level socioeconomic disadvantage. The interaction between Percent TCC and neighborhood type (but not homebound status) was significant for depression and anxiety symptoms. The nature of the significant interaction was such that, for both mental health outcomes, those living in rural neighborhoods with higher Percent TCC were more likely to have moderate to severe mental health symptoms. However, this effect was attenuated after adding neighborhood level socioeconomic disadvantage, suggesting that part of the effect may be due to socioeconomic characteristics of rural versus other neighborhoods.</p><p><strong>Conclusions: </strong>After adjusting for SDoH, the direct effect of TCC on mental health after TBI was small and opposite the direction hypothesized (higher TCC associated with poorer mental health), particularly for those living in rural neighborhoods potentially more likely to experience socioeconomic disadvantage. Our findings highlight the importance of evaluating interactions between different aspects of the social (eg, SDoH), natural (eg, greenspace), and built (eg, neighborhood type) environment to provide a comprehensive understanding of factors affecting health after TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"107-116"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the Association Between Traumatic Brain Injury and Discontinuation of Medications for Opioid Use Disorder in a Commercially Insured Adult Population.","authors":"Jake R Morgan, Sharon Reif, Maureen T Stewart, Marc R Larochelle, Rachel Sayko Adams","doi":"10.1097/HTR.0000000000000964","DOIUrl":"10.1097/HTR.0000000000000964","url":null,"abstract":"<p><strong>Objective: </strong>Extending prior research that has found that people with traumatic brain injury (TBI) experience worse substance use treatment outcomes, we examined whether history of TBI was associated with discontinuation of medication to treat opioid use disorder (MOUD), an indicator of receiving evidence-based treatment.</p><p><strong>Setting: </strong>We used MarketScan claims data to capture inpatient, outpatient, and retail pharmacy utilization from large employers in all 50 states from 2016 to 2019.</p><p><strong>Participants: </strong>We identified adults aged 18 to 64 initiating non-methadone MOUD (ie, buprenorphine, injectable naltrexone, and oral naltrexone) in 2016-2019. The exposure was whether an individual had a TBI diagnosis in the 2 years before initiating MOUD. During this period, there were 709 individuals with TBI who were then matched with 709 individuals without TBI.</p><p><strong>Design: </strong>We created a retrospective cohort of matched individuals with and without TBI and used quasi-experimental methods to identify the association between TBI status and MOUD use. We estimated propensity scores by TBI status and created a 1:1 matched cohort of people with and without TBI who initiated MOUD. We used a Cox proportional hazards model to identify the association between TBI and MOUD discontinuation.</p><p><strong>Main measure: </strong>The outcome was discontinuation of MOUD (ie, a gap of 14 days or more of MOUD).</p><p><strong>Results: </strong>Among those initiating MOUD, the majority were under 26 years of age, male, and living in an urban setting. Nearly 60% of individuals discontinued medication by 6 months. Adults with TBI had an elevated risk of MOUD discontinuation (hazard ratio [HR] 1.13; 95% confidence interval [CI], 1.01-1.27) compared to those without TBI. Additionally, initiating oral naltrexone was associated with a higher risk of discontinuation (HR 1.63; 95% CI, 1.40-1.90).</p><p><strong>Conclusion: </strong>We found evidence of reduced MOUD retention among people with TBI. Differences in MOUD retention may reflect health care inequities, as there are no medical contraindications to using MOUD for people with TBI or other disabilities.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E111-E120"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contextual Determinants of Health Disparities in Utilization of Community-Based Rehabilitation Services Among Medicare Fee-for-Service Beneficiaries With Traumatic Brain Injury.","authors":"Chinedu Onwudebe, Caitlin R Aguirre, Ioannis Malagaris, Yong-Fang Kuo, Monique R Pappadis","doi":"10.1097/HTR.0000000000001026","DOIUrl":"10.1097/HTR.0000000000001026","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between contextual social determinants of health (SDoH) and receipt of first outpatient or home health (HH) rehabilitation visit after hospital discharge among older adults with traumatic brain injury (TBI) in Texas.</p><p><strong>Setting: </strong>Community following hospital discharge.</p><p><strong>Participants: </strong>19 117 patients aged 66 and older hospitalized for a TBI from January 1, 2014, and discharged up to December 31, 2018, who returned home within 90 days from discharge.</p><p><strong>Design: </strong>Retrospective cohort study using 100% Texas Medicare claims data.</p><p><strong>Main measures: </strong>Contextual-level SDoH (eg, neighborhood ethno-racial identity make-up, socioeconomic position, and residential context) from the 2022 American Community Survey (zip-code level) and the 2023 County Health Rankings; HH and Outpatient Rehabilitation Services (eg, physical therapy, occupational therapy, speech/language therapy, and behavioral health [eg, psychology, neuropsychology, social work]). Fine-Gray competing risk models were conducted.</p><p><strong>Results: </strong>Patients living in areas with higher median household incomes (Hazard ratio, HR = 0.92; 95% Confidence Interval, 95% CI: 0.87-0.97) and higher unemployment rate (HR = 0.98; 95% CI: 0.97-0.99) had decreased likelihood of having a HH visit upon return to community; those with higher uninsured rates (HR = 0.78; 95% CI: 0.70-0.87) and in rural areas (HR = 0.83; 95% CI: 0.76-0.92) had decreased likelihood of having an outpatient visit. In contrast, Food Environment Index (HR = 1.08; 95% CI: 1.05-1.11) increased the likelihood of having a HH visit while a higher percentage with severe housing problems (HR = 1.34; 95% CI: 1.22-1.46) increased the likelihood of an outpatient visit. When treating either outpatient or HH visits as a competing event, contextual-level SDoH was associated with a decreased likelihood of an outpatient visit but an increased likelihood of a HH visit.</p><p><strong>Conclusions: </strong>Disparities exist in access to rehabilitation following community discharge, based on contextual-level SDoH, indicating the need to improve access to rehabilitation services for persons with TBI living in communities with greater social needs.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":"40 2","pages":"76-85"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12118153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The TBI Model Systems Neighborhood Socioeconomic Disadvantage Index (TBIMS-NSDI): Development and Comparison to Individual Socioeconomic Characteristics.","authors":"Raj G Kumar, Andrew Delgado, John D Corrigan, C B Eagye, Gale G Whiteneck, Shannon B Juengst, Librada Callender, Jennifer A Bogner, Shanti M Pinto, Amanda R Rabinowitz, Paul B Perrin, Umesh M Venkatesan, Amanda L Botticello, Anthony H Lequerica, Shameeke Taylor, Ross D Zafonte, Kristen Dams-O'Connor","doi":"10.1097/HTR.0000000000000968","DOIUrl":"10.1097/HTR.0000000000000968","url":null,"abstract":"<p><strong>Objective: </strong>To create a census-based composite neighborhood socioeconomic deprivation index (NSDI) from geocoded residential addresses and to quantify how NSDI aligns with individual-level socioeconomic factors among people with traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>People enrolled in the TBI Model Systems National Database (TBIMS NDB).</p><p><strong>Design: </strong>Secondary analysis of a longitudinal cohort study.</p><p><strong>Main measures: </strong>The TBIMS-NSDI was calculated at the census tract level for the United States population based on a principal components analysis of eight census tract-level variables from the American Community Survey. Individual socioeconomic characteristics from the TBIMS NDB were personal household income, education (years), and unemployment status. Neighborhood:Individual NSDI residuals represent the difference between predicted neighborhood disadvantage based on individual socioeconomic characteristics versus observed neighborhood disadvantage based on the TBIMS-NSDI .</p><p><strong>Results: </strong>A single principal component was found to encompass the eight socioeconomic neighborhood-level variables. It was normally distributed across follow-up years 2, 5, and 10 post-injury in the TBIMS NDB. In all years, the TBIMS-NDSI was significantly associated with individual-level measures of household income and education but not unemployment status. Males, persons of Black and Hispanic background, Medicaid recipients, persons with TBI caused by violence, and those living in urban areas, as well as in the Northeast or Southern regions of the United States, were more likely to have greater neighborhood disadvantage than predicted based on their individual socioeconomic characteristics.</p><p><strong>Conclusions: </strong>The TBIMS-NSDI provides a neighborhood-level indicator of socioeconomic disadvantage, an important social determinant of outcomes from TBI. The Neighborhood:Individual NSDI residual adds another dimension to the TBIMS-NSDI by summarizing how a person's socioeconomic status aligns with their neighborhood socioeconomics. Future studies should evaluate how both measures affect TBI recovery and life quality. Research studying neighborhood socioeconomic disadvantage may improve our understanding of how systemic adversity influences outcomes after TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"86-96"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental Factors and Traumatic Brain Injury.","authors":"Raj G Kumar, Shannon B Juengst","doi":"10.1097/HTR.0000000000001035","DOIUrl":"10.1097/HTR.0000000000001035","url":null,"abstract":"","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":"40 2","pages":"53-56"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decisional Needs of Veterans With Mild Traumatic Brain Injury Initiating Treatment for Insomnia Disorder and Obstructive Sleep Apnea.","authors":"Adam R Kinney, Lisa A Brenner, Morgan Nance, Joseph Mignogna, Audrey D Cobb, Jeri E Forster, Christi S Ulmer, Risa Nakase-Richardson, Nazanin H Bahraini","doi":"10.1097/HTR.0000000000000978","DOIUrl":"10.1097/HTR.0000000000000978","url":null,"abstract":"<p><strong>Objective: </strong>We sought to elicit key informant (KI) perspectives regarding decisional needs of Veterans with mild traumatic brain injury (mTBI) who are initiating insomnia disorder and obstructive sleep apnea (OSA) treatment within the Veterans Health Administration (VHA) Polytrauma/TBI System of Care (PSC). Specifically, we sought to understand: (1) information regarding treatment options that Veterans with mTBI require in order to make an informed decision; and (2) values used to guide decision-making (ie, personally meaningful aspects of the decision used to compare treatment options).</p><p><strong>Setting: </strong>Nationwide VHA PSC sites.</p><p><strong>Participants: </strong>Clinicians included VHA providers and policymakers involved in the management of mTBI and/or sleep disorders in the VHA PSC ( n = 29). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or OSA within the past year ( n = 20).</p><p><strong>Design: </strong>Semi-structured interviews with the 49 KIs were recorded and transcribed verbatim. Themes were identified using a descriptive and interpretive approach to qualitative analysis.</p><p><strong>Main measures: </strong>Not applicable.</p><p><strong>Results: </strong>Informational needs identified by both KI groups included information regarding outcomes and downsides of treatment, accessible delivery, treatment candidates, description of diagnosis, and level of commitment. Values used to guide decision-making for both insomnia disorder and OSA treatment included benefits, downsides, and availability of treatments. Values used to decide on insomnia treatments alone included time commitment, intrinsic management of sleep, beliefs regarding mental health treatment, and time course of benefit. Values used to decide on OSA treatment alone included intrusiveness of the treatment, appearance, and impact on bed partners.</p><p><strong>Conclusions: </strong>The current study revealed the decisional needs of Veterans with mTBI who are initiating sleep disorder treatment. Findings can inform the development of decision aids and other efforts aimed at promoting patient-centered management of comorbid mTBI and sleep disorders, thereby improving care quality and clinical outcomes.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E144-E153"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Integration Challenges of Men and Women After Traumatic Brain Injury: A Reflexive Thematic Analysis of Lived Experiences Through a Gender Lens.","authors":"Lulu Lian, Rachael Coupland, Thaisa Tylinski Sant'Ana, Angela Colantonio, Tatyana Mollayeva","doi":"10.1097/HTR.0000000000000994","DOIUrl":"10.1097/HTR.0000000000000994","url":null,"abstract":"<p><strong>Objective: </strong>To investigate community integration (CI) challenges following traumatic brain injury (TBI) through a gender lens.</p><p><strong>Setting: </strong>Rehabilitation research-teaching hospital.</p><p><strong>Participants: </strong>Adult participants (22 men and 20 women) with a primary diagnosis of mild or moderate-severe TBI, in the acute or chronic stages after injury, were recruited using purposive sampling.</p><p><strong>Design: </strong>Qualitative study. Data were collected through semistructured interviews, and thematic analysis was used to identify themes of CI challenges.</p><p><strong>Results: </strong>Three overarching themes emerged: (1) lack of a \" graduated home plan \": difficulty enacting gendered roles and responsibilities at home, (2) \" Something that I cannot handle \": mismatch between occupational demands and abilities, and (3) \" Slipping away \": disrupted connections with self and others. Men consistently voiced struggles with and inability to fulfill household tasks, whereas women detailed ways of adapting domestic responsibilities because of postinjury limitations. Productivity challenges resonated with a substantial number of participants, and a gendered pattern was observed: More women reported an inability, whereas more men reported a limited ability to meet occupational demands. Both genders conveyed disruptions in recreational and leisure activities, although women predominantly discussed challenges relating to social activities and men a tendency to avoid social situations because of anticipated stigma and/or shame. Across all themes, a pervasive sense of diminished community contributions and disrupted identities was observed.</p><p><strong>Conclusion: </strong>The incongruence between preinjury roles and responsibilities and postinjury abilities resulted in difficulties across multiple CI domains for the study participants and did not go unnoticed by them. It is important for health care professionals to assist patients in addressing gendered challenges at home, work, and in the social circle for a smoother transition back into the community.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E163-E174"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood Deprivation and Recovery Following Traumatic Brain Injury Among Older Adults.","authors":"Jennifer S Albrecht, Jennifer Kirk, Kathleen A Ryan, Jason R Falvey","doi":"10.1097/HTR.0000000000001007","DOIUrl":"10.1097/HTR.0000000000001007","url":null,"abstract":"<p><strong>Objective: </strong>Understanding the extent to which neighborhood impacts recovery following traumatic brain injury (TBI) among older adults could spur targeting of rehabilitation and other services to those living in more disadvantaged areas. The objective of the present study was to determine the extent to which neighborhood disadvantage influences recovery following TBI among older adults.</p><p><p>Setting and Participants: Community-dwelling Medicare beneficiaries aged ≥65 years hospitalized with TBI 2010-2018.</p><p><strong>Design and main measures: </strong>In this retrospective cohort study, the Area Deprivation Index (ADI) was used to assess neighborhood deprivation by linking it to 9-digit beneficiary zip codes. We used national-level rankings to divide the cohort into the top 10% (highest neighborhood disadvantage), middle 11-90%, and bottom 10% (lowest neighborhood disadvantage). Recovery was operationalized as days at home, calculated by subtracting days spent in a care environment or deceased from monthly follow-up over the year post-TBI.</p><p><strong>Results: </strong>Among 13,747 Medicare beneficiaries with TBI, 1713 (12.7%) were in the lowest decile of ADI rankings and 1030 (7.6%) were in the highest decile of ADI rankings. Following covariate adjustment, beneficiaries in neighborhoods with greatest disadvantage [rate ratio (RtR) 0.96; 95% confidence interval (CI) 0.94, 0.98] and beneficiaries in middle ADI percentiles (RtR 0.98; 95% CI 0.97, 0.99) had fewer days at home per month compared to beneficiaries in neighborhoods with lowest disadvantage.</p><p><strong>Conclusion: </strong>This study provides evidence that neighborhood is associated with recovery from TBI among older adults and highlights days at home as a recovery metric that is responsive to differences in neighborhood disadvantage.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"57-64"},"PeriodicalIF":2.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}