Online Problem-Solving Therapy After Traumatic Brain Injury: A Randomized Controlled Trial

Wade, Shari L.; Kurowski, Brad G.; Kirkwood, Michael W.; Zhang, Nanhua; Cassedy, Amy; Brown, Tanya M.; Nielsen, Britt A.; Stancin, Terry; Taylor, H. Gerry

doi:10.1542/peds.2014-1386

Cited by 71 publications

(67 citation statements)

References 38 publications

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“…problem-solving and emotional dysregulation) noted minimal behavioural changes immediately post-intervention [58, 93,98,100,104,105,107]. However there was high participant satisfaction with using tele-practice [93] and greater changes observed in outcome at follow-up [58, 98,100,104,105,107].…”

Section: Telerehabilitationmentioning

confidence: 99%

“…Indeed, telerehabilitation for MANUSCRIPT ACCEPTED -BRAIN INJURY: 02 FEBRUARY 2017 17 people with TBI featured in 38 of the included papers (see Table 2), comprising 2 systematic reviews [39,79], 22 group comparison trials [23][24][25]30,35,52,58,74,77,82,84,[98][99][100][104][105][106][108][109][110][111]113], 9 case series [28,50,80,83,93,97,101,102,107] Importantly, no statistically significant differences were found between the tele-practice and face-to-face intervention delivery methods [39,79].…”

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confidence: 99%

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Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

et al. 2017

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distinct from motor speech impairments or primary language impairments (e.g. aphasia), in that the impairments arise from the diffuse axonal injuries which occur in frontal and prefrontal areas of the brain [6]. These impairments can be defined as any aspect of communication that result from underlying deficits in cognition [4,5,7].Communication difficulties after a TBI can affect how a person hears, listens, understands, speaks, reads, writes, and how they engage in conversation and social communication [5]. The underlying deficits of cognition that affect these communicative functions can include slowed information processing; impaired working memory and attention; disorientation and disorganisation; executive function problems including rigidity, poor conceptualization, planning, and problem solving; and poor self-control or selfregulation of cognition or behaviour [4,5]. As a result of these changes in cognitivecommunicative processes, people with TBI have been described as 'overtalkative, inefficient, tangential or drifting from topic to topic, or lacking in language output. ' [4] (p.354). These cognitive-communication impairments can restrict a person's ability to communicate, live independently, return to work or education, participate in society, and build or maintain relationships after their TBI [8].The International Cognitive (INCOG) guidelines for the management of a person's cognitive rehabilitation following TBI highlight that assessment of cognitive-communication skills should incorporate performance in everyday social activities [4]. Adolescents and young adults, the group most at risk of TBI, use digital and online communication MANUSCRIPT ACCEPTED -BRAIN INJURY: 02 FEBRUARY 2017 4 technologies from a young age [9] and, following TBI, involvement in social, academic, and societal situations may be reduced with difficulties using technology and social media [5]. As a result, people with cognitive-communication impairments resulting from a TBI face challenges in accessing information independently and engaging effectively in social networks [8]. However, little is known about how people with cognitive-communication impairments after TBI use and experience digital communication and the internet.Furthermore, clinical guidelines for the assessment of cognitive-communication skills following a TBI do not provide guidance on the use of social media, or of assistive technologies (AT) to support cognitive-communication rehabilitation [4,5].In order to review the existing literature on technology it is essential to consider which types of technology appear in relation to TBI and cognitive-communication. In this study, we considered three major categories of technology: (i) Assistive Technology (AT), being 'any item, piece of equipment, or product, whether it is acquired commercially, includes technology such as email, the internet, and mobile phones [13] which enable users to access, store, transmit, and manipulate information [14]. The multiple purposes of the different types of technology selected ...

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Section: Telerehabilitationmentioning

confidence: 99%

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confidence: 99%

Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

et al. 2017

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“…Parent-and teen-reported time spent on the websites did not differ significantly by group. 18 Within the CAPS group, 35% of parents were single (n = 23), 23% (n = 15) were married with only one parent participating, and 41% (n = 27) were married with both parents participating. Among participants assigned to CAPS, 32 were attending high school and 33 were attending middle school at baseline.…”

Section: Participantsmentioning

confidence: 97%

Long-Term Behavioral Outcomes after a Randomized, Clinical Trial of Counselor-Assisted Problem Solving for Adolescents with Complicated Mild-to-Severe Traumatic Brain Injury

Wade

Taylor

Cassedy

et al. 2015

Journal of Neurotrauma

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Family problem-solving therapy (FPST) has been shown to reduce behavior problems after pediatric traumatic brain injury (TBI). It is unclear whether treatment gains are maintained. We sought to evaluate the maintenance of improvements in behavior problems after a Web-based counselor-assisted FPST (CAPS) intervention compared to an Internet resource comparison (IRC) intervention provided to adolescents within the initial year post-TBI. We hypothesized that family socioeconomic status, child educational status, and baseline levels of symptoms would moderate the efficacy of the treatment over time. Participants included 132 adolescents ages 12-17 years who sustained a complicated mild-to-severe TBI 1-6 months before study enrollment. Primary outcomes were the Child Behavior Checklist Internalizing and Externalizing Totals. Mixed-models analyses, using random intercepts and slopes, were conducted to examine group differences over time. There was a significant group · time · grade interaction (F (1,304) = 4.42; p = 0.03) for internalizing problems, with high school-age participants in CAPS reporting significantly lower symptoms at 18 months postbaseline than those in the IRC. Post-hoc analyses to elucidate the nature of effects on internalizing problems revealed significant group · time · grade interactions for the anxious/depressed ( p = 0.03) and somatic complaints subscales ( p = 0.04). Results also indicated significant improvement over time for CAPS participants who reported elevated externalizing behavior problems at baseline (F (1, 310) = 7.17; p = 0.008). Findings suggest that CAPS may lead to long-term improvements in behavior problems among older adolescents and those with pretreatment symptoms.

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“…For example, we found that both child’s age and family SES moderated treatment effects, with older adolescents and families of lower SES benefiting more from the online problem-solving treatments. 4,5 Furthermore, it is sometimes difficult to determine if cognitive and behavioral problems that developed post TBI are directly related to the injury or if the problems would have developed later regardless of the brain injury (e.g., Attention Deficit Hyperactivity Disorder). Developmental and age considerations may significantly impact decisions around trial design, recruitment/enrollment, outcome selection, and interpretation of findings.…”

Section: Developmental and Age Considerationsmentioning

confidence: 99%

“…Our single study with a narrower time-window post injury (1–7 months) revealed some initial treatment effects but others that emerged over the course of 12 month follow-up. 4,15 Our experiences suggest that the timing of intervention matters, with early versus late intervention having different sets of challenges. Intervention development, delivery, and assessment must account for timing of intervention delivery (early versus late recovery) to maximize the relevance and benefit for families.…”

Section: Timing Of Intervention Deliverymentioning

confidence: 99%

Behavioral Clinical Trials in Moderate to Severe Pediatric Traumatic Brain Injury: Challenges, Potential Solutions, and Lessons Learned

Wade

Kurowski²

2017

Journal of Head Trauma Rehabilitation

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The purpose of this commentary is to outline the challenges encountered when conducting clinical trials of interventions for pediatric traumatic brain injury (TBI) and share potential solutions for surmounting these issues. This commentary grows out of our experience implementing 8 randomized clinical trials (RCTs) of family-centered interventions to reduce child behavior problems and caregiver/parent distress following pediatric brain injury. These studies, involving more than 600 participants from 8 clinical centers, support the feasibility of conducting RCTs with children who have sustained TBIs while highlighting potential challenges and threats to validity. The challenges of behavioral trials for pediatric TBI are apparent but not insurmountable. Careful consideration of the clinical trial issues outlined in this commentary can inform design choices and analyses when planning a clinical trial. It is critically important that investigators share their failures as well their successes to move the field of pediatric TBI intervention research forward.

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Online Problem-Solving Therapy After Traumatic Brain Injury: A Randomized Controlled Trial

Cited by 71 publications

References 38 publications

Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

Long-Term Behavioral Outcomes after a Randomized, Clinical Trial of Counselor-Assisted Problem Solving for Adolescents with Complicated Mild-to-Severe Traumatic Brain Injury

Behavioral Clinical Trials in Moderate to Severe Pediatric Traumatic Brain Injury: Challenges, Potential Solutions, and Lessons Learned

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