Biomedical subjects

J D Corrigan

Publications and source records attributed to J D Corrigan.

At least 19 recordsLinked to original sources

PubMed2001

A comparison of substance abuse and violence in the prediction of long-term rehabilitation outcomes after traumatic brain injury.

OBJECTIVE: To determine the relative contributions of substance abuse history and violent etiology to the prediction of outcomes for individuals who sustained a traumatic brain injury (TBI) requiring inpatient rehabilitation. DESIGN: Longitudinal study of outcomes 1 year postdischarge from rehabilitation. SETTING: Specialized TBI acute rehabilitation unit. PARTICIPANTS: Three hundred fifty-one individuals consecutively admitted for rehabilitation. INTERVENTIONS: Gathered data from patients' medical records (including etiology of injury, initial Glasgow Coma Scale scores, and FIMtrade mark instrument scores at discharge), demographic details, and history of substance abuse; phone and mail survey data from individuals (Satisfaction with Life Scale [SWLS]; Community Integration Questionnaire [CIQ]). MAIN OUTCOME MEASURES: CIQ and SWLS; relative contributions of injury etiology, demographic and injury-related dependent variables, and substance abuse history to predictive model. RESULTS: Almost 80% of persons with injuries from violence-related causes had a history of substance abuse. Substance abuse was found to contribute to the prediction of life satisfacton and productivity, while violent etiology was not a significant contributor to predictive models. CONCLUSION: Substance abuse history proved to be a strong predictor of long-term outcomes, while violent etiology of injury was less influential. The results of this study emphasize the need to include substance abuse history in all studies of outcomes after TBI, and to increase prevention efforts to limit the effects of such a history.

Adolescent↗

PubMed2001

The utility of the Substance Abuse Subtle Screening Inventory-3 for use with individuals with brain injury.

The utility of the Substance Abuse Subtle Screening Inventory (SASSI-3) for the use with individuals with traumatic brain injuries (TBI) was investigated. The SASSI-3 was administered to 78 subjects prior to discharge from inpatient rehabilitation. The SASSI-3 diagnosis of chemical dependency was compared with the diagnosis of staff psychologists. Lower accuracy, sensitivity, and specificity were found in SASSI-3 diagnosis for the subjects with brain injury, as compared to a normative sample of persons with disabilities participating in a vocational rehabilitation programme. When a diagnosis of 'dependence or abuse' was used, accuracy of the SASSI-3 increased. Comparison of diagnosis based on SASSI-3 versus Blood Alcohol Level (BAL) at the time of injury showed comparable accuracy; however, BAL was found to have higher specificity. For dependence or abuse, BAL continued to be more specific than the SASSI-3; however, the SASSI-3 was more sensitive. Based on these findings, a clinical approach to screening using both BAL and the SASSI-3 is discussed.

Adolescent↗

PubMed2001

Conducting statewide needs assessments for persons with traumatic brain injury.

The Traumatic Brain Injury Act of 1996 (Public Law 104-166) gave new authority to the Health Resources and Services Administration (HRSA) in the United States Department of Health and Human Services (DHHS) to establish a grant program for states to assist in addressing the needs of persons with traumatic brain injury (TBI). The resulting State Demonstration Grant Program has made available two categories of grants: planning and implementation. Planning grants are awarded to assist states in building infrastructure through the development of four core components. One of the core components is a statewide needs and resource assessment encompassing the full spectrum of services, from initial acute treatment through rehabilitation and long-term community supports. In 1999, assessments completed in 11 states were subjected to a comparative analysis to identify trends across states and to extract salient issues for the State Demonstration Grant Program. This article summarizes the context of the HRSA-funded needs assessments and contrasts the methods of needs assessment utilized. Over-arching issues are discussed, including exemplary qualitative and quantitative methods, and the diversity of theoretical models employed in designing assessments and interpreting findings. Several limitations in approaches were also identified, including shortcomings of convenience samples for conducting mail surveys and the unlikely validity of using a needs and resource discrepancy approach to identify gaps in services.

Brain Injuries↗

PubMed2001

Long-term recovery course after traumatic brain injury: a comparison of the functional independence measure and disability rating scale.

OBJECTIVES: To study group changes over time after traumatic brain injury (TBI). DESIGN: Prospective cohort. SETTING AND PARTICIPANTS: TBI Model System Database with 1160 subjects using cohort with complete data. MAIN OUTCOME MEASURES: Functional Independence Measure (FIM) and Disability Rating Scale (DRS) at rehabilitation discharge and annually after injury. RESULTS: Statistically significant differences existed between FIM-total, FIM-Motor, FIM-Cognitive subscales, and DRS at rehabilitation discharge and year 1. Comparisons of year-to-year intervals, years 1 and 3, 1 and 5, and 3 and 5, revealed no statistically significant differences except between years 1 and 3 and 1 and 5 with DRS, and years 1 and 5 with FIM. Including only those more dependent at year 1 revealed statistically significant differences between years 1 and 2 and 1 and 5 on FIM-Cognitive and DRS, but not the FIM-Motor. The proportion of change for FIM and DRS items from year 1 to years 2 and 5 revealed DRS Level of Functioning and Employability items accounted for most DRS change, whereas FIM change was more spread across its components. CONCLUSIONS: DRS is more sensitive to changes during a shorter time period than FIM and seems to be more appropriate for detecting long-term deficits. However, research studies aimed at detecting meaningful changes year to year after TBI may need to use other tools or consider changes among individuals instead of group changes. DRS Level of Function and Employability Items represent complex functions expected to recover later than the more basic DRS items. Sole use of these two DRS items might provide an efficient means of measuring long-term recovery when resources are limited, whereas expansion of these two items might allow greater sensitivity and detail.

Activities of Daily Living↗

PubMed2001

Life satisfaction after traumatic brain injury.

OBJECTIVE: To investigate correlates of life satisfaction after traumatic brain injury (TBI). DESIGN: Prospective, longitudinal study of patients with TBI studied 1 and 2 years after injury. SETTING: A specialized inpatient TBI rehabilitation unit in a midwestern academic medical center. SUBJECTS: Two hundred eighteen consecutive patients admitted for rehabilitation, at least 14 years of age, with a primary diagnosis of TBI, consented to participate, and interviewed 1 and/or 2 years after injury (112 interviewed both years, 58 at year 1 only, 48 at year 2 only). MAIN OUTCOME MEASURES: Satisfaction With Life Scale. RESULTS: Stepwise multiple regressions accounted for statistically significant, but small, proportions of variance. Not having a preinjury history of substance abuse and having gainful employment at the time of follow-up were associated with higher life satisfaction both 1 and 2 years after injury. Motor independence at rehabilitation discharge was also associated at 1 year. Current social integration and the absence of depressed mood were associated at 2 years. Life satisfaction was relatively stable between years. Change that did occur was associated with marital status and depressed mood 2 years after injury. CONCLUSIONS: Life satisfaction after TBI seems to be related to attaining healthy and productive lifestyles. Future research should investigate other factors that affect life satisfaction to increase prediction and appreciate all influences on subjective well being after TBI.

Activities of Daily Living↗

PubMed2001

Role of agitation in prediction of outcomes after traumatic brain injury.

OBJECTIVE: To determine the role of agitation in the prediction of traumatic brain injury rehabilitation outcomes. DESIGN: A longitudinal study of 340 consecutive patients admitted to an acute traumatic brain injury rehabilitation unit was conducted. Outcomes under study included rehabilitation length of stay, discharge destination, functional independence at discharge (FIM instrument), productivity at 1-yr follow-up, and life satisfaction at 1-yr follow-up (Satisfaction with Life Scale). RESULTS: Univariate analyses suggested that the presence of agitation in rehabilitation is predictive of a longer length of stay and decreased functional independence in the cognitive realm at discharge. In addition, individuals who exhibit agitation at any time during rehabilitation are less likely to be discharged to a private residence. However, multivariate analyses indicated that cognitive functioning at admission to rehabilitation (FIM cognitive) mediates the relationship between the presence of agitation and length of rehabilitation, as well as between agitation and FIM cognitive at discharge. Similar results were found when discharge residence was the dependent variable; however, agitation also contributed some unique variance to the prediction. Lower cognitive functioning at admission to rehabilitation was associated with the occurrence of agitation during rehabilitation, longer length of stay, lower cognitive functioning at discharge, and a decreased likelihood that an individual would be discharged to a private residence. CONCLUSIONS: The results of the multivariate analyses support the contention that agitation and cognition are intimately related, with the long-term effects of the former being at least partially driven by the latter. These findings support the importance of systematically monitoring both agitation and cognition when applying interventions to reduce agitation.

Activities of Daily Living↗

PubMed2000

Rating scale analysis of the Agitated Behavior Scale.

OBJECTIVE: Evaluate the measurement properties of the Agitated Behavior Scale (ABS) using rating scale analysis. SAMPLES: Sample 1: 900 observations of 100 individuals with traumatic brain injury; Sample 2: 204 observations of 102 persons with dementia; Sample 3: 241 observations of 6 individuals with anoxia. RESULTS: The calibration indicated that the rating scale was used as intended. The hierarchies of item difficulty were similar across samples. Person and item separation values were within the acceptable range for the TBI sample. Generally, the items work well together, however 3 items misfit the measurement model moderately. CONCLUSIONS: Agitation as measured by the ABS is best represented as a unitary construct. Results provide additional support for the reliability and validity of the ABS.

Brain Injuries↗

PubMed1999

Reliability of the Agitated Behavior Scale.

OBJECTIVE: The objective of this study was to investigate the interrater reliability of the Agitated Behavior Scale. DESIGN: Ratings made by research assistants and nursing staff were compared. PARTICIPANTS AND SETTING: Forty-five persons with brain injury and 23 persons with progressive dementia were studied at an acute rehabilitation unit and a long-term-care facility. RESULTS: Ratings of persons with brain injury by research assistants yielded a correlation coefficient for the Total score of.920. The correlation coefficients for the factors Disinhibition, Aggression, and Lability were.902,.909, and.726, respectively. Lower coefficients were obtained when the ratings of the research assistants and nursing staff were correlated; these ranged from.364 to.604. The ratings by research assistants of long-term-care facility residents yielded coefficients ranging from.860 to.906 for the Total and factor scores. CONCLUSION: This study shows that the Agitated Behavior Scale is a reliable instrument for measuring agitation in persons with traumatic brain injury, as well as with long-term-care facility residents experiencing dementia.

Brain Injuries↗

PubMed1998

Outcomes in the first 5 years after traumatic brain injury.

OBJECTIVE: To examine the extent to which outcomes from traumatic brain injury differ as a function of time and can be predicted at discharge from inpatient rehabilitation. DESIGN: Survey method employing cross-sectional analyses. SETTING: An inpatient brain injury rehabilitation unit in a large midwestern academic medical center. SUBJECTS: Ninety-five adults with traumatic brain injuries, 6 months to 5 years after inpatient rehabilitation, stratified by time postdischarge. MAIN OUTCOME MEASURES: Functional Independence Measure (FIM), Sickness Impact Profile (SIP), Medical Outcomes Survey SF-36, Community Integration Questionnaire (CIQ), Craig Handicap Assessment and Reporting Technique (CHART), Brief Symptom Inventory (BSI), Satisfaction With Life Scale (SWLS), and indices of current psychosocial functioning. RESULTS: Substance abuse, need for supervision, life satisfaction, and selected subscales of the CIQ and CHART differed over the period 6 months to 5 years after discharge. Approximately 75% of the variance in current FIM scores, and 40% to 50% of CHART, CIQ, and SIP total scores, could be predicted at time of discharge. CONCLUSIONS: Outcomes over the first 5 years after discharge were dynamic, with most change being improvement, at least after the first 2 years. Important aspects of outcome could not be predicted based on premorbid characteristics, injury severity, and initial functional abilities.

Activities of Daily Living↗

PubMed1998

Primary caregivers of persons with brain injury: life change 1 year after injury.

The impact of a traumatic brain injury on the family of the injured person is just beginning to be explored. In the current study, 61 primary caregivers were contacted at 1 year following injury. They completed the Relative and Friend Support Index, Social Support Index, Trauma Complaints List and the Life Change Question. The majority of caregivers indicated at least mild negative life change following the brain injury. Greater social support was correlated with less life change and greater injury severity was correlated with negative life change. Neither of these relationships was found to be significant at the 0.05 level. A significant positive correlation was found between caregivers' perception of deficits and the degree of negative life change. Perceived deficits accounted for the greatest amount of variance in life change followed by relative and friend support when all variables were entered into a stepwise regression. Further analyses indicated that the most significant factor of the Trauma Complaints List in predicting life change may be problems with cognition, which accounted for a significant amount of the variance in life change. Implications for counselling and further research regarding caregivers of persons with brain injury are discussed.

Adolescent↗

PubMed1997

Validity of the functional independence measure for persons with traumatic brain injury.

OBJECTIVE: Replicate and extend studies of the construct validity of the Functional Independence Measure (FIM) for persons with traumatic brain injury (TBI). DESIGN: A cross-sectional study of admissions to acute rehabilitation evaluated 6 months to 5 years after discharge. SETTING: An inpatient brain injury rehabilitation unit in a large, academic medical center. SUBJECTS: Ninety-five patients with primary diagnosis of TBI stratified by time postdischarge. MAIN OUTCOME MEASURES: Prediction of (1) average daily minutes of assistance and (2) supervision required in comparison to the Sickness Impact Profile (SIP) and SF-36. RESULTS: The FIM was highly predictive of minutes of assistance (83% accuracy), supervision (82% accuracy), and the need for either type of assistance (78% accuracy). Prediction was only minimally improved by measures of neurobehavioral impairment. The accuracy of the FIM was superior to the SIP and SF-36. CONCLUSIONS: Results provided substantial support for the validity of the FIM as a measure of functional independence for persons with TBI. The importance of supervision as a type of assistance required after TBI was evident, with the FIM highly predictive of this need, as well.

Activities of Daily Living↗

PubMed1997

Systematic bias in outcome studies of persons with traumatic brain injury.

OBJECTIVE: (1) Examine systematic biases created by subjects lost at 1-year follow-up in samples of persons with traumatic brain injury; (2) identify potential threats to generalization of outcomes data. DESIGN: A consecutive sample of admissions to acute rehabilitation studied 1 year following discharge. SETTING: An inpatient brain injury rehabilitation unit in a large, academic medical center. SUBJECTS: Eighty-eight patients with primary diagnosis of traumatic brain injury. MAIN OUTCOME MEASURES: Subjects were considered lost to follow-up when phone calls, mail, clinic visits, and assistance from family failed to allow contact 1 year after discharge from acute rehabilitation. Potential effects of the biased follow-up sample were examined for seven suboptimal outcomes. RESULTS: A total of 38.6% of subjects were lost to follow-up. Subjects intoxicated at time of injury and those with history of substance abuse were more-likely to be lost. Among subjects followed, the likelihood of working or being in school 1 year after discharge was significantly less for those intoxicated at time of injury and those with a history of substance abuse. CONCLUSIONS: Systematic bias in longitudinal studies may result from subjects with substance use problems being lost to follow-up. Population estimates for return to work or school will be overestimated if those lost who have substance use problems resemble those followed.

Adolescent↗

PubMed1996

Predicting functional independence from neuropsychological tests following traumatic brain injury.

The relationship between impairment, measured by the Halstead-Reitan Neuropsychological Test Battery (HRNTB), and disability, measured by the Functional Independence Measure (FIM), was investigated in 164 subjects completing acute, inpatient rehabilitation following traumatic brain injury. Exploratory factor analysis of the FIM supported a two-factor model of disability, with 13 items loading on a motor disability factor and five items loading on a cognitive disability factor. HRNTB findings and injury-related variables were predictive of motor disability, as five variables accounted for 39-44% of the variance in FIM Motor scores. Contrary to expectations, the relationship with cognitive disability was comparable to, but did not exceed, that for motor disability, as only 29-40% of the variance in FIM Cognitive scores was accounted for. The WAIS-R Comprehension subtest was the single best predictor of cognitive disability, accounting for 20% of variance, and suggesting that the FIM Cognitive subscale is measuring social-cognitive ability, as intended by its authors. Results are discussed in terms of the relationships among impairment and disability, including the need to further scrutinize the operationalization of these constructs as they relate to cognitive functions.

Activities of Daily Living↗

PubMed1995

Substance abuse as a mediating factor in outcome from traumatic brain injury.

A review of recent research addressed two questions: how common are problems of substance abuse in traumatic brain injury (TBI), and to what extent does alcohol and other drug use mediate outcome? Studies showed alcohol intoxication present in one third to one half of hospitalizations; data for other drug intoxication were not available. Nearly two thirds of rehabilitation patients may have a history of substance abuse that preceded their injuries. Intoxication was related to acute complications, longer hospital stays, and poorer discharge status; however, these relationships may have been caused by colinearity with history. History of substance abuse showed the same morbidity, and was further associated with higher mortality rates, poorer neuropsychological outcome, and greater likelihood of repeat injuries and late deterioration. The effect of history may be caused by subgroups with more severe substance abuse problems. Implications for rehabilitation are discussed, including the potential negative impact of untreated substance abuse on the ability to document efficacy of rehabilitation efforts.

Alcoholic Intoxication↗

PubMed1995

A programme of intervention for substance abuse following traumatic brain injury.

This article describes a pilot programme initiated in 1991 to address the problems of substance abuse among persons who have experienced traumatic brain injury (TBI). The model of treatment is community-based, using an interdisciplinary staff with expertise in TBI, vocational rehabilitation, and substance abuse treatment, to support and enhance existing services in the client's own community. The primary method of intervention is resource and service coordination. Six principles that serve as the underpinnings of the model are described, as are core and supplemental services and staffing patterns. Innovative components of the programme include the theoretical model of changing addictive behaviours used to guide treatment, and the development of community teams to facilitate a coordinated and integrated approach. The programme has relatively low start-up costs and can serve both urban and rural populations. Clinical experience and initial programme evaluation results suggest that substance abuse and vocational rehabilitation goals can be effectively attained using this model of service delivery.

Brain Damage, Chronic↗

PubMed1994

The relationship between cognition and functional independence in adults with traumatic brain injury.

This study investigates the relationship between cognitive impairment, as measured by Orientation Group Monitoring System (OGMS) scores, and disability as measured by Functional Independence Measure (FIM) scores in a sample of 122 persons with traumatic brain injury admitted to an inpatient rehabilitation unit. The relationships between Aggregate OGMS and FIM Total, FIM Motor, and FIM Cognitive scores were significant (rho = .49, p < .001; .40, p < .001; and .64 p < .001 respectively). Lower cognition was related to greater disability; with this relationship stronger for FIM Cognitive versus FIM Motor scores. Consistent with prior research, time to rehabilitation was significantly related to FIM Total (rho = -.42 p < .001) at admission to rehabilitation, with shorter time to rehabilitation related to greater functional independence. Stepwise regression indicated that the Aggregate OGMS score contributed 24%, and time to rehabilitation 5% unique variance to FIM Total score. These results support previous findings of distinct cognitive and motor subscales of the FIM, and suggest the importance of cognitive impairment to both.

Activities of Daily Living↗

PubMed1994

Factor structure of the Agitated Behavior Scale.

The Agitated Behavior Scale (ABS; Corrigan, 1989) is a 14-item scale developed to monitor agitation during the acute phase of recovery from acquired brain injury. While previous studies have supported the reliability, internal consistency, and concurrent validity of the ABS, the current study was designed to investigate its underlying factor structure, as well as to determine systematic effects of time-of-day on the occurrence of agitation. Subjects were 212 patients with traumatic or other recently acquired brain injury who exhibited agitation during their treatment on a specialized brain-injury unit of an acute rehabilitation hospital. Confirmatory factor analysis revealed that agitation is best represented by one general construct with three underlying factors: Aggression, Disinhibition, and Lability. Analysis of agitation by nursing shift in which ratings were made confirmed that overall level was lowest during the night shift; however, the relationship between time-of-day and underlying factors deviated from this pattern. Results are discussed in terms of the necessity for objective measurement, definition of the construct of agitation, and time-of-day issues in sampling agitated behavior.

Adolescent↗

PubMed1994

Whatever it takes: a model for community-based services.

The Whatever It Takes model is presented as an extension of the medical/rehabilitation model. It is not presented as an alternative to the rehabilitation model, although it does represent an opposition to the manner in which the model is typically implemented in community-based programmes for individuals with acquired brain injury. After brain injury, medical complications persist and a strictly anti-medical model in a community-based programme is unwise. On the other hand, community-based programmes that attempt to treat the individual, or provide rehabilitation services, in the absence of careful consideration of environmental barriers or the need for natural supports, are not likely to meet the long-term community reintegration needs of the individual, and may be unjustly using up finite resources. There are numerous complications associated with living with the effects of acquired brain injury. There also is considerable complexity associated with a health-care system and reimbursement system that emphasize acute care. Given these complexities, and the strong probability that a cure for brain injury is not likely to be found within the next decade, even the most learned professionals in brain injury are likely to say that practical solutions are needed for the present. Most notable is the late Dr Sheldon Berroll, who provided so much leadership to the field, but when asked about solving the day-to-day problems for an individual, would often respond: 'Do whatever it takes'. This advice was not presented in desperation, but rather as practical guidance. We have attempted to describe the whatever it takes approach, and to provide some guidelines for its implementation in community integration programmes.

Activities of Daily Living↗