Background: Individuals with a history of moderate-severe traumatic brain injury (TBI) experience a significantly higher prevalence of sleep-related problems including insomnia compared to members of the general population. While individuals living with TBI have been shown to benefit from traditional insomnia interventions (e.g., face-to-face [F2F]), such as Cognitive Behavioral Therapy for Insomnia (CBT-I), multiple barriers exist (e.g., cost, insufficient numbers of adequately trained healthcare providers, limited transportation, patient perceptions) that limit access to such F2F evidence-based treatments. Although computerized CBT-I (CCBT-I) has been shown to be efficacious in terms of reducing insomnia symptoms, individuals with moderate-severe TBI may require support to engage in such treatment.

Methods: This is an RCT of a guided CCBT-I intervention for individuals with a history of moderate-severe TBI and insomnia. The primary outcome is self-reported insomnia severity, pre- to post-intervention. Exploratory outcomes include changes in sleep misperception following CCBT-I and describing the nature of guidance needed by the Study Clinician during the intervention.

Results: Data collection is underway, with a notable number of individuals already having completed the trial. With the grant ending (Spring 2024) it is expected that sufficient data will be collected to present feasibility/acceptability data, as well as initial outcome findings.

Conclusion: This study represents an innovative approach to facilitating broader engagement with an accessible and readily available no-cost evidence-based online treatment for insomnia among those with a history of moderate-severe TBI. Findings will provide evidence for the level and nature of support needed to implement guided CCBT-I. Moreover, should results suggest efficacy, this study would provide support for a strategy by which to deliver guided CCBT-I (with support) to individuals with a history of moderate-severe TBI.

Sleep-wake disturbances (SWD) are common following TBI, and often extend into the chronic phase of recovery. Such disturbances in sleep can lead to deficits in executive functioning, attention, and memory consolidation, which may ultimately impact the recovery process. We examined if SWDs following TBI were associated with morbidity during the post-acute period. Particular attention was placed on the impact of sleep architecture on learning and memory. Because women are more likely to report SWDs, we examined sex as a biological variable. We also examined subjective quality of life, depression, and disability levels. Data was retrospectively analyzed for fifty-seven TBI patients that underwent an overnight polysomnography. Medical records were reviewed to determine cognitive and functional status during the period of the sleep evaluation. Consideration was given to medications, as a high number of these are likely to have secondary influences on sleep characteristics. Women showed significantly higher levels of disability and reported more depression and lower quality of life. A sex dependent disruption in sleep architecture was observed, with women having lower percent time in REM sleep. An association between percent of time in REM and better episodic memory scores was found. Melatonin utilization had a positive impact on REM duration. Improvements in understanding the impact of sleep-wake disturbances on post-TBI outcome will aid in defining targeted interventions for this population. Findings from this study support the hypothesis that decreases in REM sleep may contribute to chronic disability and underlie the importance of considering sex differences when addressing sleep.

Chronic pain is a multifaceted health problem which is a recognised concomitant of traumatic brain injury (TBI) that can significantly impact on the achievement of individual goals, social participation, activities of daily living and functional capacity. While the estimated prevalence rate is approximately 50% following moderate to severe TBI, there remains limited research and access to appropriate resources and specialised pain services for this population. The Be Pain Smart (BPS) clinic pilot project was developed to provide specialised pain management consultancy for people with a TBI and/or spinal cord injury (SCI). The BPS clinic provided an interdisciplinary comprehensive pain assessment, pain management plan and support to local clinicians to assist the participants to manage their pain. This state-wide service allowed increased access to pain management healthcare for metropolitan, rural and regional participants. A sample of 40 BPS participants scores on the Patient Reported Outcome Measurement Information System – 29 (PROMIS-29+) and Brief Pain Inventory (BPI) were compared at baseline and follow-up. High rates of referrals were noted throughout the BPS clinic project period. The 40 participants were predominately male (70%), with a mean age of 48.48 years and on average 6.39 years post-injury. On the BPI from baseline to follow-up, on average the participants reported decreased pain scores (worst pain, and average pain) and on pain interference measures including overall pain interference, and more specific areas of pain interference: general activity, mood, walking ability, normal work, relationships with other people, sleep and enjoyment of life. 75% of participants reported a clinically significant improvement on their overall BPI pain interference scores. Participants also reported improved scores on the PROMIS – 29+ including a decrease in pain interference and pain intensity, and a decrease in anxiety, depression, fatigue, and sleep disturbance symptoms. Participants also reported improvement on the participation in social roles and activities domain. Overall, 70% of participants reported a clinically significant improvement on their overall pain interference scores. Consequently, these preliminary results from this pilot study provides burgeoning evidence for the effectiveness of the BPS clinics in reducing pain interference for these two complex cohorts. Access to the BPS clinic reduced the level of interference of pain in the lives of TBI participants which lead to additional improvements in other domains, this emphasises the critical role of an interdisciplinary, patient-centred approach to pain management in this highly complex cohort. The ongoing high referral rate highlights the importance of embedding specialised models of care into existing clinical services to optimise referrals and overall increasing the capacity of the system to manage pain in these populations. In conclusion, a specialised patient-centred, interdisciplinary pain clinic for people with TBI reduced overall pain interference and led to improvements in other key functional domains.

Background: Early rehabilitation is necessary for people with traumatic brain injuries (TBI) to recover, yet 77-88% of people with TBI ever receive rehabilitation. People with TBI who are Hispanic, those without insurance, public insurance, or transportation challenges are even less likely than others to receive rehabilitation. Due to its potential to be mobile and low cost, Virtual reality (VR) is recommended as a rehabilitation option that addresses these challenges. Immersive, interactive VR has improved outcomes for people with TBI including memory and eye tracking.

Methods: This community-based participatory research project included focus groups with people with TBI (N = 12) to design virtual reality scenarios to address common rehabilitative needs. Prospective memory and eye tracking were described as the most common challenges. The authors then developed and assessed the rehabilitative effects of two new virtual reality scenarios using a HTC Vive headset on prospective memory and eye tracking among people with brain injuries (N = 11) randomized to intervention and control groups. The intervention group (n = 6) participated in the 12-minute memory scenario twice a week for 6 weeks. The control group (n = 5) participated in a memory card game for 20 minutes twice a week for 6 weeks and then participated in the memory VR scenario twice a week for 6 weeks. Four participants received 12 sessions of the 6-minute eye tracking scenario.

Results: On an objective memory test, participants in the VR intervention group (66%) improved their memory more often than the memory card control group (0%) after about 12 sessions each. On a PMRQ memory scale, the intervention and control group did not have statistically significant different mean scores after six weeks. Three out of four (75%) of participants improved their eye tracking ability after they completed the eye tracking VR scenario.

Implications: An efficacy study of the two new VR scenarios will be conducted next. Future research should assess the appropriateness of VR for different types of brain injury and co-occurring conditions.

BACKGROUND: Communicating with people with acquired brain injury (ABI) can be challenging given that 75% of people experience social communication impairments (Macdonald, 2017). These difficulties can lead to less successful and less enjoyable interactions with others, including family and health professionals. To address these difficulties, it is internationally recognised best practice that the communication partners of people with a brain injury should receive education about how best to support communication (Togher et al., 2023). This paper presents pilot data for a free communication partner training (CPT) program called interact-ABI-lity.

METHOD: Interact-ABI-lity is a self-guided resource which provides education to family members, friends, and health professionals who interact with a person with an ABI. It was developed via collaborative design and pilot testing (Miao et al., 2022). interact-ABI-lity is a two-hour, web-based CPT program for partners of adults with cognitive-communication disorders, aphasia or dysarthria after ABI. The free, seven-module program is available on desktop, tablet and phone devices as part of the ‘Social Brain Toolkit’. The pilot study entailed the recruitment of two groups: 1. Eleven participants (six support workers, three clinicians, two student health professionals) who were interested in improving their skills, and 2. Five clinicians (two speech pathologists, one occupational therapist, one physiotherapist, one psychologist) with at least four years’ experience working with an ABI caseload. Data collection for group 1 included the number of people who completed the course, their ratings of the likelihood to recommend the course to others and their ratings of their confidence in interacting with people with TBI, and for the clinicians, feedback interviews were also conducted at course completion.

RESULTS: Of the 11 learners in group 1, five fully completed the training, while all participants in group 2 fully completed all modules. Of the five completers, four learners rated their likelihood as 10/10 to recommend the course to others and three reported increased confidence in interacting with people with ABI at the end of the program. Feedback included the need for additional demonstration videos and provision of definitions of the technical language used.

DISCUSSION: interact-ABI-lity may address the need for a short, accessible educational resource about how to communicate with a person with an ABI. The pilot testing process was informative to identify ways to improve interact-ABI-lity. These included building in motivators (e.g., certificate of completion), prioritising development of videos of people with ABI and their family members, and specific additions to the course content (e.g., glossaries of technical terms). Since this pilot study, the program has been updated and the final version will be presented at NABIS. Since launch in Feb 2022, there have been 2280 registrations for interact-ABI-lity, and it is now incorporated into training for assistants, clinicians, and students internationally.