This article describes Posttraumatic Stress Disorder (PTSD) symptomatology in 69 sixth-grade youths who resided within 100 miles of Oklahoma City at the time of the 1995 bombing of the Alfred P. Murrah Federal Building. These youths neither had any direct physical exposure nor personally knew anyone killed or injured in the explosion. A survey conducted two years after the bombing assessed exposure, PTSD symptoms, and functioning. PTSD symptom frequency was measured with the Impact of Event Scale--Revised. Our BCD criteria for defining PTSD caseness was modeled after DSM-IV B, C, and D criteria requiring one reexperiencing, three avoidance/numbing, and two arousal symptoms for diagnosis. Those who met our BCD criteria had significantly higher PTSD symptom scores than those who did not. Both increased mean PTSD symptom score and meeting our caseness definition were associated with increased functioning difficulties. Media exposure and indirect interpersonal exposure (having a friend who knew someone killed or injured) were significant predictors of symptomatology. These findings suggest that children geographically distant from disaster who have not directly experienced an interpersonal loss report PTSD symptoms and functional impairment associated with increased media exposure and indirect loss.

The effects of traumatic loss on children who reported a friend or acquaintance killed in the 1995 Oklahoma City bombing of a federal office building were examined. Twenty-seven children who lost a friend or acquaintance and 27 demographically matched controls were assessed eight to ten months after the bombing. All but three of the children continued to experience posttraumatic stress symptoms. Those who lost a friend watched significantly more bombing-related television coverage than those without losses. Those who lost a friend had significantly more posttraumatic stress symptoms at the time of the assessment than those who lost an acquaintance. Parents and those working with children should be alert to the impact of loss even when it involves nonrelatives.

Advances in the design and delivery of trauma care and acute medical management have increased the number of survivors of traumatic brain injury (TBI), producing societal consequences and medical challenges. Although access to health care for rural patients remains a critical challenge, teletherapy may represent a viable means for the delivery of therapeutic services to such patients. A case study is presented in which teletherapy was successfully utilized to improve the functional outcomes, both physical and cognitive, of a patient with a severe TBI. A physical therapist from a metropolitan rehabilitation center employed teletherapy to provide Neuro Developmental Treatment for a patient and to mentor staff in a nursing home located over 100 miles from the metro area. The patient, who participated in 48 physical teletherapy sessions over a 24-week period, demonstrated improvements in physical functioning and neuropsychological status. During the course of therapy, goals were adjusted upward to match the patient's improvements. This case study provides confirmatory evidence that teletherapy represents an effective and efficient means for providing rehabilitation services for patients in rural communities, as well as for facilitating mentoring relationships between seasoned professionals and trainees located in rural settings.

The authors compared outcomes of 19 participants who received computer-based cognitive teletherapy rehabilitation with 20 participants who received face-to-face speech-language rehabilitation. The study compared outcomes from 2 "real-word" treatment programs provided by an outpatient rehabilitation center. A total of 39 participants with moderate to severe closed head traumatic brain injuries and a minimum of 1 year following injury were analyzed. Outcome measures included clinical indicators of independent living status, return to work or school, and independent driving. Cost measures included the total cost of the treatment and a measure of service costs per hour. Time since injury was a covariate, and an analysis of covariance revealed no differences between groups in independent living, driving status, return to work or school, or total treatment costs. The computer-based teletherapy cognitive rehabilitation program provided similar functional outcomes as face-to-face speech-language therapy at a similar total cost.

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