Introduction: Diffuse axonal injury (DAI) is a subtype of traumatic brain injury (TBI) thought to portend poor outcomes, perhaps prompting early withdrawal of life-sustaining therapies. However, large-scale studies are limited. Because DAI can be subtle or invisible on initial head CT imaging, diagnostic delay is common until other causes of encephalopathy are ruled out and MRI can be performed safely. We hypothesized that TBI with DAI would have increased in-hospital mortality compared to comparable TBI without DAI in a large nationwide database.

Methods: This retrospective cohort study included adults from the 2017-2020 American College of Surgeons Trauma Quality Improvement Program admitted with blunt, moderate-severe TBI. Exclusion criteria were bilateral nonreactive pupils. We compared patients with and without DAI and adjusted for age, injury severity score (ISS), presenting hemodynamics, TBI severity, and hospital characteristics. Logistic regression was used for the binary outcomes of inpatient mortality and hospital discharge disposition (proxy for short-term functional status). Linear regression was used for the continuous outcomes of time to intracranial pressure monitor (ICPm) placement and hospital length of stay (LOS).

Results: Of 65,448 patients with moderate-severe TBI (median GCS 8 [interquartile range, IQR 6,10]), 7765 patients (12%) had DAI. DAI patients were significantly younger (median 36 years [25,55] vs. 55 years [32,71]) with higher ISS (33 [26,38] vs. 25 [17,29]), less midline shift (16% vs. 30%), and higher ICPm usage (43% vs. 24%, p<0.01). In multivariable analyses, DAI was associated with lower inpatient mortality (odds ratio [OR] 0.967, 95%CI 0.956-0.978), a 3.2-hour delay in ICPm placement (95%CI 0.1-6.3h), more than 3 days longer LOS (95% CI: 3.33-4.18), and worse short-term functional status (OR 1.06, 1.05-1.07) as measured by hospital discharge disposition.

Conclusion: Previous beliefs about early mortality and withdrawal of life-sustaining care for DAI are challenged by our findings. Further research is needed to clarify reasons for delays in ICPm placement (e.g., diagnostic delay, fatalism, etc.), and to determine if ICPm placement even improves outcomes in DAI. Although DAI prolongs hospitalization and is associated with worse functional status at discharge, the long-term trajectories of recovery remain unknown.

Optimizing acute TBI management determines the potential for recovery and the efficacy of all subsequent interventions. This presentation will discuss the latest advances in physiological assessments, Neurotrauma monitoring and subsequent management strategies following moderate and severe TBI (m/s TBI). Controversies around management paradigms such as the indications for decompressive craniectomies and the timing of cranioplasty to name a few will be discussed. Multidisciplinary knowledge translation from TRACK-TBI and the NASEM report will also be addressed including an action plan aimed at improving long term meaningful outcomes for patients and families. Time for Q and A with an expert panel discussion will be allotted for.

This presentation will review multimodal interdisciplinary strategies with the goal of transforming scientific knowledge into meaningful clinical practice and ultimately providing for “Precision or Personalized TBI Management” . A comprehensive overview of the latest relevant basic science and clinical research following TBI will be presented. We aim for attendees to better understand barriers to knowledge translation following TBI and how to best design research that is easily understandable, implementable and relevant to those patients and families served. Real time multidisciplinary efforts with collaborative public and private partnerships are rapidly advancing our scientific research as a basis for implementing best evidence informed clinical practices and future directions will be reviewed.

Repetitive head impacts and sport-related concussions are significant concerns in contact sports due to their potential adverse effects on brain health. This study investigated the association between head impact exposure (HIE) during varsity football games and short-term changes in cortical excitability of the primary motor cortex (M1) using transcranial magnetic stimulation (TMS). A convenience sample of forty-nine university-level male athletes (median [IQR] age: 23.0 [2.0] years] were recruited. Twenty-nine athletes wore instrumented mouthguards during a football game to measure HIE (head impact group). TMS measurements were conducted 24 hours before and 1-2 hours after the game. Another twenty control football athletes underwent a non-contact training session and underwent identical TMS assessments (control group). For the head impact group, the median [IQR] number of impacts (> 10g) per player during a game was 11.6 [15.0]; the magnitude of each head impact was 18.9 [7.1] g and the cumulative force sustained per player was 234 [312.9] g. TMS results showed that whereas short-interval intracortical inhibition (SICI) ratios increased by 0.054 (± 0.0614 ) in the head impact group in the hours following the game, it decreased by 0.0704 (±0.0352) in the control group within the same time interval following the non-contact training session. A 2X2 mixed ANOVA on SICI ratios showed a significant Time * Group interaction (F(1, 44) = 5.192, p = .028, η2 = 0.106). Neither the main effect of groups (head impact versus control; p = .058) nor the main effect of time (24 hours before sport vs 1-2 hours after sport; p = 0.756) on SICI measures reached statistical significance. The relationship between HIE (i.e., number, magnitude and cumulative forces of impacts) and SICI was also investigated using two-tailed Pearson’s correlations. SICI modulation following the game was found to be unrelated to the mean number of impacts (p˂ .05) as well as to the cumulative forces of impacts across low-magnitude impact ranges (p˂ .05). However, the observed SICI disinhibition following the game was significantly related to the number of high-magnitude head impacts beyond 40g (r(29)=-0.397, p = 0.041) and the cumulative forces beyond 40g (r(29)=-0.468, p = 0.014) after False Discovery Rate corrections for multiple comparisons were applied. Likewise, this SICI disinhibition strongly correlated with the number of head impacts over 60g (r(29)=-0.629, p < 0.001) and cumulative forces over 60g (r(29)=-0.648, p = 0.014). Athletes exposed to subconcussive hits associated to a football game exhibit abnormal M1 corticomotor inhibition function, particularly when recorded impact magnitude ranges above 40g. Given the deleterious effects of decreased inhibition on motor control and balance, systematically tracking head impact forces at each game and practice with contacts could reveal useful for injury prevention in contact sports.

BACKGROUND: Traumatic brain injury (TBI) and problems related to substance use (SU) commonly co-occur in the military and veteran population. Individuals with co-occurring TBI and SU (TBI + SU) are at greater risk for multiple negative outcomes, including death by suicide. Intensive interdisciplinary treatment for TBI can support improvement in symptoms and quality of life, but individuals using substances are often denied access to TBI treatment until they maintain lengthy periods of abstinence.

METHOD: Our interdisciplinary treatment program for military TBI has undertaken efforts to: 1) characterize substance use among those seeking treatment, 2) develop and implement an approach to assessment, integrated treatment, and follow-up support for TBI + SU, and 3) evaluate access and treatment outcomes. We categorized all individuals who inquired about or applied for care within a 26-month period according to level of care accessed or reason for no access. Among 160 participants consented, 101 started intensive outpatient treatment (IOP) for TBI and completed measures related to substance use in addition to assessments for clinical care. This group was divided based on scores on SU-related measures into TBI (n = 59) and TBI + SU (n = 42) groups. Mixed ANOVAs were conducted to determine effects of treatment and group membership on TBI symptoms and consequences related to SU, captured by scores on the Neurobehavioral Symptom Inventory (NSI) and the Short Inventory of Problems - Revised (SIP-R).

RESULTS: An integrated care model of TBI treatment for clients with co-occurring SU was developed by modifying programing and adding resources to help those with TBI + SU safely and effectively participate in interdisciplinary TBI care. There was a significant main effect of treatment (F(1, 100) = 64.37, p < 0.001) on NSI scores, with decreased symptoms at discharge across both groups. Between-group differences were not significant, indicating that groups had similar NSI score reductions with treatment. There was a significant main effect of treatment F(1, 100) = 18.45, p < 0.001 and group membership F(1, 100) = 21.41, p < 0.001 and a group x time interaction F(1, 100) = 9.34, p = 0.003 on SIP-R scores, showing higher SIP-R scores among the TBI + SU group prior to treatment and greater reductions in SIP-R scores for the TBI + SU group with treatment. Among research participants who engaged in IOP treatment during this timeframe (n = 101), four were early discharges, and one of these instances was related to substance use.

CONCLUSIONS: This programming has enabled entry and retention in treatment for many clients with TBI + SU. Initial results related to treatment outcomes are promising, with follow-up data collection ongoing. Lessons from these efforts may inform programming in other interdisciplinary programs treating individuals with TBI + SU.

INTRODUCTION: Homicide is one of the leading causes of maternal mortality in the U.S. and approximately half of these deaths are associated with domestic and intimate partner violence (DV/IPV). With medical advances, maternal obstetric complications have declined in recent years, however maternal mortality continues to increase in part due to violence. Research has shown that DV/IPV increases in both incidence and severity during pregnancy. Understanding that 74% of individual DV/IPV events include injury to the head and neck, including strangulation, it is likely that many women sustain peripartum concussions and abuse induced brain injuries (AIBI). Abuse induced brain Injury often presents with a depressed mood, difficulty concentrating, sleep problems, emotional lability, and/or fatigue, similar to the presentation of peripartum depression (PPD). Given the similarity of clinical symptomatology, are a subset of women with PPD actually suffering from an AIBI? In this review, we explore the association between peripartum depression, domestic violence, and brain injury.

METHODS: A PubMed search was performed from January 2016, the publication date of the U.S. Preventive Services Task Force Recommendation for postpartum depression screening, to July 2022 for keywords prenatal, peripartum, or postpartum depression combined with domestic and/or intimate partner violence. 120 articles met criteria for review to assess available prevalence data and associations between PPD and DV.

RESULTS: The mean prevalence of prenatal, peripartum, and postpartum depression was 25.0%, 17.7%, and 21.1% respectively, with an overall average of 23.5% and range of 5.8-50.5% across all groups. An average of 19.6% women experienced DV/IPV during pregnancy. Of the 98 papers that commented on DV/IPV, 73 (74.5%) found that DV/IPV was strongly associated with PPD. No papers commented on head injury, brain injury, or concussion surrounding pregnancy.

CONCLUSION: Our results show that approximately one in five women experience DV/IPV during pregnancy. While 74% of DV/IPV victims report head injury, to date, no studies have investigated DV/IPV-associated brain injury during the peri- or post-partum period. Given the significant similarities between AIBI and PPD symptoms, there is a critical need for research on the prevalence of peripartum abuse induced brain injury potentially including screening for peripartum brain injury with the current practice of peripartum depression assessment.

Objective: To determine if PRN antipsychotic or benzodiazepine medication administration is increased over the weekends as compared to weekdays.

Design: Retrospective chart review

Setting: Acute inpatient neurorehabilitation hospital

Subjects: Patients admitted for moderate-severe traumatic brain injury and prescribed antipsychotics or benzodiazepines for agitation and/or aggression on an as-needed basis between 1900 Friday evenings and 0700 Monday mornings.

Main Measures: Primary outcome was the comparison of average daily number of administrations and daily medication dose between weekly and weekend PRN antipsychotic or benzodiazepine administration for agitation or aggression.

Results: Fifty-Seven patients with a total of 4,485 PRN administrations were included in the chart review. On the weekdays, benzodiazepine had an average prn dose of 4.3 mg and antipsychotics had an average prn dose of 78.7 mg. The weekend days showed an average prn dose of 3.5 mg and 82.6 mg for benzodiazepine and antipsychotics respectively. Statistically significant differences were found with benzodiazepines where there were larger doses administered on the weekdays when compared to the weekend days on average. No statistical differences were found with the antipsychotic doses.

Conclusion: There was no significant difference found between weekday and weekend administration with prn medications indicated for aggression/agitation to support higher antipsychotic or benzodiazepine use on the weekends. Further research to explore the consequences of and the key components of a deleterious negative "weekend effect" whereby no formal rehabilitative therapies occur on the weekends is warranted for programs treating persons with traumatic brain injury.

Keywords: traumatic brain injury; neurorehabilitation, prn, pro re nata; agitation; aggression

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.

The session will focus on neuromodulatory interventions in the context of recovery following severe brain injury. In particular, we will discuss a global framework for understanding disorders of consciousness following severe brain injury and will then provide an overview of different approaches to intervening highlighting the advantages and disadvantages of each, as well as the current status of the evidence.

Using a case example, content will guide learners in identifying, mitigating, and documenting confounding factors that may invalidate assessment. Presenters will address the many medical and functional confounds that can be present within the DoC population and mask consciousness across settings (acute/ICU and post-acute settings). We will discuss how confounds can impact validity and reliability of assessment and scoring. Content will include recent advances in behavioral measurement such as CRS-R Rasch analysis to detect minimal clinical change and its utility in clinical practice.

Attendees will practice administration of the Coma Recovery Scale-Revise (CRS-R) in small groups rotating through multiple stations that each address crucial considerations of DoC behavioral assessment. Presenters will guide attendees through this hands-on and interactive experience. These small group breakouts will also provide learners an opportunity to network and problem-solve with their clinical peers.

Using a case example, faculty will present novel tools designed specifically for assessment of DoC in the intensive care unit setting, with a focus on the Coma Recovery Scale Revised for Accelerated Standardized Testing (CRSR-FAST). We will review CRSR-FAST administration within an ICU environment, scoring guidelines, approach to application in a medically fragile acute DoC patient, detecting and documenting confounding factors specific to the intensive care unit setting and integration of the CRSR-FAST into medical record systems. We will also compare other measures available for acute assessment of DoC.

There is an array of educational material available to families and caregivers of severe brain injury experiencing Disorders of Consciousness (DoC). However, it is difficult to find information that is accurate and easy to navigate. Families and caregivers experience trauma along a continuum from hospital to community (Cameron and Gignac 2008). The need for caregivers to prepare for changes in role and caring for their loved one evolves over the course of recovery, but often not fully addressed by their clinical care team. This can lead to added stress, ambiguity and compound trauma for family and caregivers. The American Congress of Rehabilitation Medicine (ACRM) Brain Injury Interdisciplinary Special Interest Group: DoC Task Force, Family Education Subcommittee has developed a compendium of shared educational resources. During the last seven years, the committee engaged in an environmental scan of existing family education content from providers and websites that had information specific to DoC. We then developed a structure for delivering information that is simple, easy to read and organized in a way that that families/caregivers can find specific information across the course of recovery all located in a central, accessible location. The organization of content is separated into three sections: Body/Mind, Taking Care of Self and Resources. Focus groups and surveys were completed with 22 families and 16 professionals to validate the overall structure and included content for accuracy and health literacy. Consumer and professional survey responses were analyzed. Results of the family surveys 67-100% of respondents found content was easy to understand, descriptive and prompted end users to further engage with the additional website links embedded into the content. Professional surveys resulted in 100% of respondents approving the overall content included. The final product of family-focused DoC education will be accessible within a Treatment Hub on www.BrainLine.org. This poster will highlight the overall evolution of the project, content, the review process, partnership with BrainLine.org and the funding efforts to build the Treatment Hub and BrainLine. Our objective is to facilitate knowledge translation of this web-based resource to support further dissemination to the family end user experiencing acute and chronic DoC. Implementation to support utilization of this educational resource, by families, will be dependent on expanding knowledge and collaboration with brain injury medicine professionals across the care continuum for persons experiencing DoC.

Cameron JI, Gignac MA. "Timing It Right": a conceptual framework for addressing the support needs of family caregivers to stroke survivors from the hospital to the home. Patient Educ Couns. 2008 Mar;70(3):305-14. doi: 10.1016/j.pec.2007.10.020. Epub 2007 Dec 21. PMID: 18155388.

In 2015, the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) published Best Practices in the Management of Traumatic Brain Injury which provided practice and care recommendations for patients with Traumatic Brain Injury (TBI) served by trauma centers. The purpose of the TBI Best Practice Guidelines (BPG) is to provide ACS verified trauma centers evidence and expert-based recommendations to determine best practices and quality care for TBI to support optimal long-term outcomes and recovery. These 2015 BPGs were developed by a committee consisting of neurotrauma, neurosurgery, neurocritical care and nursing experts and were endorsed by ACS and TQIP.

Since 2015, TBI research, published evidence and clinical care has evolved in multiple domains warranting a re-evaluation of the current TBI BPGs. ACS and TQIP supported an update to the 2015 publication to be congruent with current evidence and recommendations. The revised TBI Best Practice Guidelines builds on the work of the first edition from 2015. The updated 2024 TBI Best Practice Guidelines includes De Novo sections of TBI trauma care that were not included in the previous edition. Recently, ACS has been deliberate in pursuing collaboration with rehabilitation experts as the benefit of early rehabilitation improves outcomes from trauma and TBI patients and lead to the genesis of a focused rehabilitation best practice recommendation section within the new 2024 TBI BPGs as a de Novo section.

A cadre of TBI and rehabilitation experts were assembled to participate in the ACS TBI BPG committee to develop novel rehabilitation recommendations for trauma centers. Rehabilitation experts conducted in-depth review of rehabilitation literature to guide development of robust rehabilitation recommendations that would promote early initiation of rehabilitation within the ICU setting, emphasize the benefits of early rehabilitation for all severities of TBI and support the integration of rehabilitation experts into the core trauma team.

This poster will disseminate the final “key points” that summarize the evidence and expert consensus for rehabilitation best practice after TBI for trauma centers. These key points will be included in the final publication and will be available as open access in January 2024. The six finalized recommendations address rehabilitation for the spectrum of TBI severity and emphasize the importance of rehabilitation specialists as core members of the trauma team.

Disorders of consciousness after severe brain injury encompass conditions of coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state. DoC clinical presentation pose perplexing challenges to medical professionals, researchers, and families alike. The outcome is uncertain in the first weeks to months after a brain injury, with
families and medical providers often making important decisions that require certainty. Prognostication for individuals with these conditions has been the subject of intense scientific investigation that continues to strive for valid prognostic indicators and algorithms for predicting recovery of consciousness. This manuscript aims to provide an overview of the current clinical landscape surrounding prognosis and optimizing recovery in DoC and the current and future research that could improve prognostic accuracy after severe brain injury. Improved understanding of these factors will aid healthcare professionals in providing optimal care, fostering hope, and advocting for ethical practices in the management of individuals with DoC.

There is an array of educational material available to families and caregivers of severe brain injury experiencing Disorders of Consciousness (DoC). However, it is difficult to find information that is accurate and easy to navigate. The need for caregivers to prepare for changes in role and caring for their loved one evolves over the course of recovery, but often not fully addressed by their clinical care team. This can lead to added stress, ambiguity and compound trauma for family and caregivers. The American Congress of Rehabilitation Medicine (ACRM) Brain Injury Interdisciplinary Special Interest Group: DoC Task Force, Family Education Subcommittee has developed a compendium of shared educational resources that have been developed into a website resource in collaboration with BrainLine.org. The objective of this symposium is to facilitate knowledge translation of this web-based resource to support further dissemination to the family end user experiencing acute and chronic DoC. Utilization of this educational resource, by families, will be dependent on expanding knowledge and collaboration with brain injury medicine professionals across the care continuum for persons experiencing DoC.

INTRODUCTION: While traumatic brain injury (TBI) is a recognized cause of postural orthostatic tachycardia syndrome (POTS), the prevalence of POTS among TBI patients is unknown, and the etiology of POTS following TBI is not well understood. POTS is characterized by orthostatic symptoms including dizziness, lightheadedness, fainting, and near syncope, but is also associated with cognitive dysfunction/attention deficits, sleep issues, headache, and anxiety. This collection of symptoms is attributed to dysfunction of the autonomic nervous system and can be seen in a subset of patients following TBI. Without a Tilt Table Test (TTT), POTS symptoms are often considered post-concussive and/or psychological leaving the underlying medical condition undiagnosed, with potential for increased concussion recovery time and decreased quality of life for TBI patients.

OBJECTIVE: The goal of this retrospective case review is to determine the prevalence of POTS in a series of refractory post-concussion symptom patients, 6 months or more post injury, who were evaluated at a single interdisciplinary TBI and Concussion Clinic.

METHODS: A retrospective chart review of 55 consecutive TBI patients evaluated between October 2022 and November 2023 was conducted. The patient’s gender, mechanism of injury, and symptoms associated with POTS were assessed.

RESULTS: Sixty-five percent (36) had orthostatic issues characteristic of POTS including dizziness, lightheadedness, orthostasis, or near syncope. Additional symptoms often associated with POTS were also observed. Eighty nine percent (49) of patients had cognitive dysfunction/attention selectivity issues, 73% (40) had headaches, 67% (37) had anxiety, 56% (31) had sleep issues, 45% (25) had balance issues. Sixty-one percent of the patients with orthostatic symptoms were female.

CONCLUSION: Symptoms associated with POTS were seen in the majority of patients with refractory post concussive symptoms. These findings suggest that patients with refractory post concussive symptoms should be routinely evaluated for POTS. Conversely, given the correlation between TBI and POTS, patients with POTS should be assessed for signs and symptoms of TBI as many in this demographic may have unrecognized brain injury including sports injuries and abuse induced brain injury/strangulation. Further research is warranted on the intersection of TBI and POTS.

BACKGROUND: Acute agitation is a common complication in patients who have sustained traumatic brain injury (TBI) and can be measured using the Agitated Behavior Scale (ABS), a validated tool that drives clinical management. There is no consensus regarding use of as needed agents for pharmacologic management of acute agitation in people with TBI.

OBJECTIVES: The primary objective of this study is to assess the effectiveness of as needed trazodone on reduction of agitation as reflected by lower ABS scores in patients with TBI and to demonstrate consistency in reduction of score across various demographic factors of patients with TBI.

DESIGN: A retrospective chart review was performed of patients admitted to acute inpatient rehabilitation over a 2-year period, who had age > 18 years old and were diagnosed with TBI. Data collected included: demographic information, length of stay, number of trazodone administrations, and pre-/post-trazodone administration ABS scores. Patients were organized into subgroups based on demographic characteristics.

RESULTS: The mean change [CI] in ABS score and total percent change in ABS score for all 128 patients were 8.2 [7.6, 8.8] and 14.6% [13.6%, 15.7%], respectively. For gender, males represented 84.4% (N=108) and females 15.6% (N=20). Mean change and percent change of total ABS based on gender were as follows: males 8.1 [7.4, 8.7] and 14.4% [13.3%, 15.6%], and female 8.7 [7.0, 10.3] and 15.5% [12.5%, 18.4%]. ANOVA showed no significant variance in mean change of ABS based on gender (p=0.51). For race, white represented 52.2% (N=67), black 19.5% (N=25), other 8.6% (N=11), and patients who declined to answer 19.5% (N=25). Mean change and percent change of total ABS based on race were as follows: white 8.3 [7.6, 9.1] and 14.9% [13.5%, 16.3%], black 7.9 [6.3, 9.4] and 14.0% [11.3%, 16.8%], other 8.5 [6.7, 10.2] and 15.1% [12.0%, 18.2%], and declined to answer 8.4 [6.3, 9.6] and 14.2% [11.2%, 17.0%]. ANOVA showed no significant variance based on race (p=0.91). For mechanism of injury, falls represented 46.9% (N=60), motor vehicle collision (MVC) 32.8% (N=42), gunshot wound (GSW) 6.3% (N=8), blunt force trauma (BFT) 9.4% (N=12), and other 4.7% (N=6). Mean change and percent change of total ABS based on mechanism of injury were as follows: falls 8.4 [7.5, 9.3] and 15.0% [13.3%, 16.6%], MVC 7.5 [6.5, 8.4] and 13.4% [11.7%, 15.6%], GSW 7.2 [4.9, 9.4] and 12.8% [8.9%, 16.8%], BFT 10.0 [7.9, 12.2] and 17.9% [14.1%, 21.8%], and other 8.7 [4.8, 12.6] and 15.6% [8.6%, 22.5%]. ANOVA showed no significant variance in mean change of ABS based on mechanism of injury subgroup (p=0.20).

CONCLUSION: Use of as needed trazodone was associated with consistent reduction in ABS scores of people with TBI, independent of subgroup characteristics based on age, gender, race, and mechanism of injury.

Brief overview of the deficits, prevalence, and consequences of these impairments, along with high-level overview of the evidence behind the two interventions.

People with brain injury (BI) often have difficulty recognizing their own emotions (alexithymia) and the emotions of others. The first half of this session will review components of an evidence-based intervention for reducing alexithymia and related emotion dysregulation deficits in individuals with BI. The second half of this interactive session will teach attendees components of, and how to use, a freely available electronic App for treating facial affect recognition deficits that has been recommended as a practice standard in a systematic review by the Cognitive Rehabilitation Task Force of the American Congress of Rehabilitation Medicine.

Building Emotional Self-Awareness Teletherapy (BEST) is an 8-session psychoeducation and interactive intervention that targets problems with alexithymia. This part of the session will provide a detailed review of the treatment sessions, content and exercises. The treatment tool and manual will be made available upon request.

The FACES Intervention is a free electronic App available on Google Play and iTunes. There are seven levels of training, each with multiple exercises, teaching participants to better recognition emotions from facial expressions. Participants will be invited to download the FACES Intervention on their smartphones or tablets. This part of the session will review all components of the App and how to use it clinically with patients with brain injury who have facial affect recognition deficits. The Treatment manual will be emailed to interested participants upon request.

Chronic problems with emotional and behavioral dyscontrol are common after brain injury (BI), and frequently perceived to be more disruptive and distressing than cognitive or physical sequelae. The Process Model of Emotion Regulation (PMER), developed by James Gross, describes core factors (situation, attention, and appraisal) that influence human emotional and behavioral responses, as well as opportunities to regulate these responses. Social cognition can be mapped directly onto the Process Model of Emotion Regulation to understand the roles that social cognitive factors play in emotional and behavioral dyscontrol after BI, and how social cognition can be a treatment target for better emotion and behavioral regulation. This presentation will describe how two often overlooked social cognition deficits fit into the Process Model of Emotion Regulation and contribute to emotional and behavioral problems after brain injury: alexithymia (poor emotional self-awareness) and negative attribution bias (tendency to judge others’ behaviors as intentionally hostile).

INTRODUCTION: While blood transfusions can be lifesaving, they also carry risks including thromboembolic events. This is due to multiple factors including increased blood viscosity, inflammatory response to transfused blood, and changes in the coagulation cascade. Traumatic brain injury (TBI) exhibits a unique coagulopathy, which may predispose patients to both bleeding and clotting complications. Transfusing TBI patients may add an additional layer of complexity to their coagulation profile. Therefore, this study aimed to investigate the relationship between trauma patients with TBI who receive packed red blood cell (pRBC) transfusions and the incidence of venous thromboembolism (VTE) hypothesizing that transfusion of pRBC during the initial resuscitation increases the risk of VTE.

METHODS: The Trauma Quality Improvement Program (TQIP) was queried from 2017-2021 to identify adult (>18 years-old) patients with TBI. Patients receiving pRBC transfusions were compared to those who did not receive pRBC transfusions within 4 hours of presentation. Patients that died or were discharged within 48-hours, and all transferred patients were excluded. Outcomes were compared using bivariate analyses and a multivariable logistic regression analysis to identify predictors of VTE while controlling for age, sex, obesity, vitals on arrival, surgical intervention and fractures to the pelvis, spine, and lower extremities.

RESULTS: Of 422,831 TBI patients, 28,230 (6.7%) received pRBC transfusion. Patients who were transfused were younger (median: 45 vs 61 years old, p< 0.001), but had increased injury severity score ≥ 25 (72.5% vs 20.6%, p< 0.001) and a higher rate of emergent operations (39.4% vs 6.7%, p< 0.001). Transfused patients had higher rates of pelvic fractures (29% vs 4.4%, p< 0.001), spine fractures (50.8% vs 15.7%, p< 0.001), and lower extremity fractures (37% vs 8.6%, p< 0.001). Thrombotic events were more frequently observed in pRBC transfused patients, including cerebrovascular accident (2.7% vs 0.6%, p< 0.001), and VTE (8.1% vs 1.5%, p< 0.001) comprised of deep vein thrombosis (6.4% vs 1.2%, p< 0.001), and pulmonary embolism (2.4% vs 0.4%, p< 0.001). Multivariable regression analysis found undergoing any surgery (OR = 4.78, p<0.001) followed by transfusion of pRBC within 4 hours of presentation (OR = 1.438, p < 0.001) as the strongest predictors of VTE. Additional associated risk factors were ISS ≥ 25 (OR = 1.797, p< 0.001) and male sex (OR = 1.46, p< 0.001).

CONCLUSION: Trauma patients with TBI undergoing pRBC transfusion within 4 hours of arrival had an over 40% increased associated risk of VTE, compared to patients not undergoing transfusion. Providers should be vigilant in assessing the need for transfusions in TBI patients, balancing acute TBI management with thrombotic risks. Increased provider awareness of these findings may foster better patient outcomes by avoiding unnecessary transfusions in this high-risk population.

Background: Communication skills, while often overlooked in the rehabilitation of adults with mild traumatic brain injury (mTBI) are critical to successful community reintegration and re-entry into society. Assessment of language is often challenging in mTBI due to the lack of available sensitive and specific published tools (Duff et al). Recently, the use of story-telling discourse assessment has been explored in mTBI (Norman et al, 2020) but there is limited research on the expected performance of adults who speak a second language. In the US in particular, it is critical for clinical providers to understand the role of second language proficiency in order to accurately assess patients and plan treatment.

Methods: A main concept analysis (MCA) was implemented on “Cinderella” story re-tell samples of thirty-six participants with mTBI to quantify the accuracy and completeness of the story-telling using a well-validated task. The participants were divided into three groups (individuals who learned Spanish before the critical age of seven; individuals who learned Spanish after seven years; individuals who consider themselves monolingual). Relevant concepts based on the story were identified and scaled according to a coding system. Participants were assigned codes based on if key concepts of the story were included in their story-telling discourse and the level of accuracy in their performance.

Results: The final sample included 20 individuals who identified as bilingual before age age seven, seven bilingual individuals who identified as bilingual after age seven and eight monolingual individuals. Preliminary analyses indicated that mean MCA scores for the individuals who identified as bilingual before age seven outperformed the sequential and monolingual individuals, however, statistical significance was not reached. Further linguistic and grammatical analyses are underway to determine if differences at the microlinguistic level exist.

Discussion: The precise measurement of language performance after mTBI is currently elusive, as traditional language tests fail to sufficiently capture linguistic changes specific to mTBI. For individuals who speak one or more languages, assessment is further complicated however, this study is a first step in understanding these differences which in turn can help refine and optimize rehabilitation approaches for individuals from a variety of cultural and language backgrounds.

OBJECTIVE: To determine rates of return to driving following traumatic brain injury (TBI) and explore driving patterns and crash rates pre- and post-injury.

METHOD: Adults (N = 334) with moderate-to-severe TBI enrolled by eight TBI Model System sites. A driving survey was completed during inpatient rehabilitation (for pre-injury information) and at one- and two-years post-injury.

RESULTS: Rates of return to driving were 65% at one-year follow-up and 70% at two-year follow-up. Return to driving was associated with higher levels of family income. Frequency of driving and distance driven were diminished compared to pre-injury as was frequency of driving in risky conditions (heavy traffic, bad weather, at night). Crash rates were 14.9% in the year prior to injury (excluding the crash that resulted in TBI), 9.9% in the first year post-injury, and 6% during the second year post-injury. Post-injury, the odds of a participant having at least one crash was decreased by 40% (95% CI: 15% - 59%) per year (p=0.005). Amongst participants who endorsed crashes in the year prior to their injury, the average number of crashes reported was 1.57 (77 crashes reported by 49 participants). At follow-up, these averages were 1.50 for the 1-year follow-up (i.e., 18 crashes for 12 participants) and 1.33 for the 2-year follow-up (i.e., 12 crashes by 9 participants). Logistic regression examining those who did or did not experience a crash did not reveal any significant findings for Year One. At Year Two the only significant finding was for participants’ time to follow commands. Those with milder injuries were more likely to experience a crash.

CONCLUSION: Consistent with prior reports, this investigation has shown that return to driving is a common occurrence following TBI, although individuals may limit their driving in terms of frequency of driving or total distances driven compared to pre-injury. Also, restriction of driving in particular situations is common. Incidence of crashes in this population is shown to be higher than population-based statistics, but this investigation highlights the critical importance of considering the possibility that, as a group, individuals who sustain a TBI are at higher risk of crash even prior to their injury. Discussion of crash risk needs to be tempered by the finding that 85% of those who returned to driving after injury did not report experiencing any crashes during follow-up interviews. Future work is needed to identify both premorbid and post-injury characteristics that may influence likelihood for adverse events while driving. Such studies will assist in development of screening tools and appropriate regulations to promote appropriate return to driving following TBI.

Using a case example, content will guide learners in identifying common errors in DoC assessment leading to invalid diagnosis and prognosis and provide the tools necessary to mitigate those errors in clinical practice. Key concepts will include optimizing the testing environment, standardizing assessment, understanding the benefit of serial evaluations, and establishing a diagnosis and prognosis. Application of published clinical guidelines regarding assessment of persons with DoC will be reviewed.

Incidences of traumatic brain injury (TBI) are responsible for over one million emergency department visits a year, and rehabilitation costs in the United States may well exceed $100,000, depending on the observed population and injury severity (Dismuke et al., 2015). A national inpatient survey found that the majority of TBI-related hospitalizations for urban (99.6%) and rural (80.3%) residents were located at an urban hospital (Daugherty et al., 2022). When comparing health care costs, individuals living in rural areas experience higher costs yet receive fewer services than urban residents (Graves et al., 2018). Additionally, individuals living in rural areas are at risk for poorer outcomes following TBI due to a lack of accessible resources (e.g., hospital care, neurosurgical interventions, and post discharge rehabilitative services) and must often utilize transportation services to travel to their providers (Brown et al., 2019). The disparities between rural and urban post-TBI care and rehabilitative services are a public health issue, and the overall stress due to lack of accessibility and decreased support can lead to further psychological, cognitive, and physical post-concussive symptoms. For the present study, data was collected from a representative and randomized sample of California residents in collaboration with California Department of Rehabilitation’s TBI Advisory Board and The California State Survey Panel, and from individual assessment packets from 2 out of 12 California Association for Traumatic Brain Injury (CATBI) sites in Northern and Southern California who provide services to improve the independent living and community reintegration for survivors of brain injury. The findings indicate that individuals living in rural counties engage in less community participation than those residing in urban counties. These differences can be explained by how accessible outpatient and rehabilitative services are in an individual’s residence. People with TBIs living in rural areas face many barriers as they reintegrate into their community, especially a lack of knowledge about programs and resources. The disparities between rural and urban post-TBI services and community integration can be diminished by increasing access to transportation and information about resources that are available.

Dr. Christopher Ogunsalu
Dr. Lissa Pinkney
Daniel Ogunsalu
Dr. Arif Saqui

The trigeminal neuralgia is a relatively uncommon condition which affects less than 0.5% of the general population. This condition is characterized by episodic attacks of sharp pains which is almost always unilateral in the region of the face with the fifth cranial nerve (CN V) distribution. This attack is triggered by movements of the facial muscles, cold temperature, touch and are spontaneous in nature and has ill-defined aetiology.

The purpose of this current work is to positively implicate the administration of the COVID-19 vaccine in the pathophysiology of this facial neuralgia which is not unlike Trigeminal neuralgia. It will as such be reasonable to implicate an immunologically mediated biochemical injury to the trigeminal ganglion as the pathway for the expressed pain.

Since Trigeminal neuralgia has existed in the past long before the introduction of COVID-19 vaccination, it may be reasonable that this condition is called a post-traumatic trigeminal neuropathic pain due to biochemical injury to the trigeminal ganglion sequel to an immunological pathway initiated by COVID-19 vaccine. It must as such be a distinct clinic-pathologic entity from trigeminal neuralgia.

Key words: Injury to the trigeminal ganglion; COVID-19 vaccine; Immunological pathway

This course presents the latest evidence-based information on pathophysiology, risk factors, differential diagnosis, and treatment of acute concussion and of persisting post-concussive symptoms (PPCS). Attendees will learn of the latest updates on the approach to sport-related concussion from the 6th International Concussion in Sport Group Conference held in Amsterdam. Attendees will benefit from clinical demonstrations and case reports of specific assessments and treatments for post-concussion vision, vestibular, and cervical injuries as well as how to approach and treat the frequently encountered psychological and cognitive problems after concussion/mTBI.

At the end of this symposium, attendees will be able to: (1) Describe the physiology of concussion and how it informs clinical concussion endophenotypes; (2) Describe risk factors for PPCS; (3) Describe how to develop a differential diagnosis and evidence-based treatments for the symptoms acutely after concussion for PPCS; (4) Describe the latest recommendations for returning concussed students to school and to sport; (5) Identify how to recognize and treat psychiatric, cognitive, cervical spine, vestibular, and vision problems after concussion; and (6) Describe physical examination techniques to aid in the differential diagnosis and treatment of post-concussion vision deficits, vestibular dysfunction, and cervical injuries.

INTRODUCTION: The eTherapy app was created through a collaboration of computer engineering and occupational therapy and developed for patients with orthopedic injuries working on motor re-education. The app uses motion capture technology and a brand of inertia measurement units called Notches to measure a range of motion (ROM) and response time. The Notches are attached to the patient on both sides of a targeted joint and connected through Bluetooth to the mobile device with the app. This study finds novel uses for this app in patients with traumatic brain injuries. Concussion clients can experience long-term symptoms, including visual gaze deficits and changes in reaction time. They can also experience behavior or personality changes, including increased susceptibility to frustration¹.

METHODS: Researchers utilized a case study methodology with an expert opinion process². The eTherapy app was introduced to an occupational therapist (OT) specializing in concussion rehabilitation and demonstrated its current capabilities. Then, researchers conducted a semi-structured interview with the OT about using the app for clients with vision deficits.

RESULTS: In the interview, the therapist reported that the current functioning of the app and its crashes would increase frustration in concussion clients and slow down their progress. Through collaboration with the researchers, a method was developed to assess visual tracking by placing one sensor on the forehead and one on the back of the hand. The therapist also reported that the app's margin of error when measuring ROM should be decreased. With the changes made, the OT believes that the app could be a useful tool for this population³. The app is portable and inexpensive, making it appropriate to use both in-clinic and as part of a home program.

CONCLUSION: Through expert opinion, we determined that if this app is to be utilized in a population with post-concussion visual gaze deficits, it should be further developed. It is viable to continue the development of the app in-clinic or in a home program with a client in this population. The app can calculate data for visual tracking and reaction time to gather objective information in real-time. The app’s final development must be consistent in its utility and function without the application crashing.

References:
1. Scorza KA, Cole W. Current Concepts in Concussion: Initial Evaluation and Management. Fam Physician. 2019;99(7):426-434
2. Bayona-Ore L, Zavala R, Cruz M. Expert opinion process: applications in education. Paper presented at Proceedings of the 10th International Conference on Education Technology and Computers 2018. NY, USA; 2018:172-176. doi: 10.1145/3290511.3290519.
3. Mannino RG, Arconada Alvarez SJ, Greenleaf M, Parsell M, Mwalija C, Lam WA. Navigating the complexities of mobile medical app development from idea to launch, a guide for clinicians and biomedical researchers. BMC Med. 2023;21(1):109. Published 2023 Mar 23. doi:10.1186/s12916-023-02833-7

Supported self-management refers to education and support provided to individuals and their family members to help them live with chronic health conditions. Self-management support includes education to increase awareness and understanding about a disease and one’s role in decision making, management, and health behaviors. Experience with the application of a self-management approach to stroke will be presented and the potential applications for chronic brain injury explored.

Primary care providers (PCP) are essential during the transition from hospital to community, but little is known about whether having a primary care visit will improve post-hospital outcomes among older adults with TBI. Therefore, we examined the predictors of PCP follow-up with an established PCP or any PCP, and its association with 90-day emergency department (ED) use and all-cause hospital readmission, using Cox regression models based on competing risks (death and hospice admission) and censoring (until loss of Medicare coverage, by 90th follow-up day, or by December 31, 2019). The interaction effect of visiting any PCP or established PCP with discharge destination (i.e., home, home health, skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), nursing home, other facility) was also examined. Using 100% Texas Medicare data, we identified 27,480 older patients aged 66 and older hospitalized for TBI from January 1, 2014 and discharged by September 30, 2019, and returned home within 90 days following hospital discharge. Prior to the TBI, about 70% of older patients had an established PCP. By 90 days following discharge home, 79.5% of patients with an established PCP saw their provider, whereas 37% of patients without an established PCP saw any PCP. Patients who were more likely to see any PCP within 90 days after discharge home were female, of Hispanic ethnicity, discharged home from an IRF, or had an established PCP. Patients aged 70-84, of Black race, Medicare/Medicaid dual eligible, with primary TBI diagnosis, and discharged from an IRF were more likely to see their established PCP within 90 days from discharge home. Patients who saw any PCP and were discharged home were less likely to have an ED visit (HR=0.81; CI: 0.76-0.87) and hospital readmission (HR=0.87; CI: 0.81-0.95). Increased likelihood of ED service utilization was found among patients who visited any PCP and were discharged from either a SNF (HR=1.12; CI: 1.02-1.22) or IRF (HR=1.17; CI: 1.06-1.28). Those who visited any PCP and discharged home from an IRF were also more likely to be readmitted (HR=1.16; CI: 1.04-1.30). Patients with a previously established PCP who saw the same PCP and were discharged home following hospitalization were less likely to have an ED visit (HR=0.82; CI: 0.75-0.89) and be readmitted (HR=0.84; CI: 0.77-0.92). Older patients who visited their established PCP and were discharged from an IRF were more likely to have an ED visit (HR=1.16; CI: 1.04-1.29) and be readmitted (HR=1.14; CI: 1.00-1.29, p=0.046). In summary, for older patients with TBI who did not receive post-acute care, having a PCP was associated with better post-hospital outcomes, while those who received post-acute care may need care transition support. The role of continuity of primary care plays in TBI outcomes needs to be further explored.

OBJECTIVES: To examine aggression, executive functioning, and recidivism risk in a sample of incarcerated males with traumatic brain injury (TBI).

METHODS: Cross-sectional study including 89 males with TBI. Data was collected as a baseline assessment for a clinical trial. Participants were recruited within 12 months of anticipated release date.

MEASURES: The Aggression Questionnaire (AQ) total score was used to assess aggression in addition to the verbal and physical aggression subscales. The Behavioral Rating Inventory of Executive Function-Adult Version (BRIEF-A) was used to measure self-regulation. The Level of Service Inventory–Revised (LSI-R) is a structured interview for correctional populations used to predict recidivism risk, adjustment, and institutional misconduct using criminal history, education, employment, finances, relationships, alcohol and drug problems, emotional/personal factors, and attitudes.

RESULTS: The majority of the sample (59%) reported high-very high aggression (T-scores = 60) on the total AQ (mean T-score = 59.93, 95% CI [57.95, 61.91]). 54% of the sample reported high-very high verbal aggression (mean T-score = 56.55, 95% CI [54.58, 58.53]) and 51% reported high-very high physical aggression (mean T-score = 58.89, 95% CI [56.40, 61.39]). Scores on the BRIEF-A were also clinically significant with a mean Global Executive Composite (GEC) T-score of 68.80 (95% CI: [65.95, 71.66]) indicating significant difficulty with executive functioning. The Behavioral Regulation Index (BRI) was also elevated (mean T-score = 69.70, 95% CI [67.07, 72.33]) suggesting increased deficits related to inhibiting impulsive responses and controlling emotions and behavior. The Metacognition Index (MI) was also above average (mean T-score = 66.03, 95% CI [62.90, 69.16]) suggesting impairments related to self-management of tasks and self-monitoring. The sample also showed an increased recidivism risk with a mean LSI-R score of 29.77 (moderate risk), 95% CI [28.26, 31.27] and the majority of the sample (86%) scoring in the moderate or higher risk categories. LSI-R risk scores were significantly correlated with AQ total aggression (r =.404; p<.001) and physical aggression (r=.393; p<.001), but not verbal aggression (r = .081; p=.498). LSI-R scores were also significantly correlated with executive function impairment: GEC (r =.489; p<.0001), BRI (r =.494; p<.0001), and MI (r =.446; p<.0001).

CONCLUSIONS: Aggression and executive dysfunction are common consequences of TBI that are believed to contribute to high incarceration and recidivism rates. The results from this sample suggest that incarcerated individuals with TBI are more likely to display elevated levels of aggression as well as suffer from executive dysfunction. Furthermore, the significant linear relationships between aggression (especially physical) and executive functioning with recidivism risk highlight the need for interventions designed to address and mitigate these deficits in individuals with TBI within the corrections environment as a strategy to potentially reduce recidivism and reincarceration.

INTRODUCTION: Refractory postural instability is among the most challenging conditions, given the complex subsystems integrating into postural control. The rehabilitation of postural dysfunction relies on various assessments and treatment modalities, both low and high-tech, to address deficits in variably weighted sensory or motor subsystem inputs. Dynamic computerized posturography is a reliable, objective metric to assess postural stability in varying testing conditions. These scores are expressed as a percentage of the theoretical limit of stability. There needs to be more information regarding the use of computerized posturography to help direct interventions. This retrospective study aims to determine the efficacy of computerized posturography in informing therapeutic strategies. Specifically, in this cohort, the percentage stability score was used to help guide the rehabilitation mechanism (feedback, feedforward, or efferent copy), as well as the laterality of the treatment application to optimally engage the activity map of the cortico-cerebellar loops underlying motor planning.

METHODS: The subject population with loss of postural control included migraine headaches (23.1%), post-concussion syndrome/traumatic brain injury (37.5%), dizziness/vertigo (21.2%), dysautonomia (2.9%), post-traumatic orthostatic tachycardic syndrome (2.9%), and other brain disorders (12.5%) as the primary diagnoses. The pre-treatment posturography stability scores were compared and the direction of head rotation with the greater stability score dictated the side of individualized Cortical Integrative Therapy (CIT) treatment. Post-treatment posturography stability scores were taken over the intervention course (mean = 3.77 weeks, range 1 day to 20.29 weeks). Analyses considered the laterality of treatment, pre- and post-treatment stability scores, and the primary diagnosis.

RESULTS: The efficacy of the CIT treatment was indicated by over a 10% improvement (P < 0.001) in the mean post-treatment posturography stability score. Treatment ipsilateral to head rotation with the greater stability score produced near-equal results in all head positions. For example, the mean post-CIT treatment stability scores were comparable to the manufacturer's normative data (CDP range of 69.8 to 74.9) for perturbed stability, eyes closed testing conditions. While improvement was observed with all primary diagnoses, the percent of control calculations (post-treatment score ÷ pre-treatment score X 100) indicated that patients with a primary diagnosis of dizziness/vertigo had the greatest improvement in stability scores (nearing 150% of control).

CONCLUSION: The stability score-informed intervention strategy, predicated on posturography results, optimized the efficiency of the motor planning loop. Based upon the level of compromise, the posturography stability scores can direct the laterality of treatment application in real-time. Further study of the use of dynamic posturography can identify its potential role in informing treatment strategies to improve the dysfunctional loop mechanisms.

BACKGROUND: Domestic violence (DV/IPV) is a pressing global issue, affecting 25% of women and 10% of men. In the US alone, 58 million men and women experience DV/IPV within their lifetime. The most common physical assault in DV/IPV events is injury to the head and neck, occurring in 50-80% of altercations. However, there is currently no standardized or routine evaluation of TBI in DV/IPV situations. Debilitating physical, behavioral, and cognitive symptoms can result from such injuries, interfering with the ability to perform daily tasks and increasing the long-term risk of Parkinson’s, Dementia and Chronic Traumatic Encephalopathy (CTE). The purpose of this meta-analysis is to evaluate the prevalence of TBI secondary to DV/IPV.

METHODS: A Pubmed search from September 2014, the publication date of neurosurgical concussion guidelines used for sports, to September 2022 was conducted using keywords domestic violence and/or intimate partner violence in conjunction with concussion, traumatic brain injury, and/or head injury. The resulting primary research articles were then selected based on the following inclusion criteria: participants were ≥ 18 years old, participants had experienced violence by an intimate partner, the screening tool included questions about signs and symptoms of TBI as well as an experience that could cause a TBI, and a TBI diagnosis was not required for inclusion in the study. Data collection was then performed. Inter-reviewer validation and risk of bias assessment were conducted to ensure validity of data collection.

RESULTS: Of the 8,218 publications on domestic and/or intimate partner violence, only 46 (0.6%) included keywords concussion, traumatic brain injury, or head injury. Of those 46, 11 papers were included in this meta-analysis. From these 11 papers, the meta-analysis had a total sample size of 1,498. The prevalence of IPV-related TBI within this aggregated sample was 56.1% (n=841). Two studies with a total of 119 subjects included questions to evaluate the prevalence of multiple TBIs. In this subset, the prevalence of multiple TBIs was 50.4% (n=60). To assess for TBI prevalence, three papers utilized the Brain Injury Severity assessment (BISA), two studies used the HELPS tool, three performed a semi-structured interview, two utilized a modified VA TBI screening tool, and one used a modified Miller Abuse Physical Symptoms and Injury Scale (MAPSAIS).

CONCLUSION: There is a paucity of research into TBI within the DV/IPV population as well as a lack of standardized screening and evaluation. This meta-analysis suggests that more than half of people experiencing DV/IPV have sustained one or more brain injuries. Based on concussion research in sports, prospective studies are needed to optimize the screening, evaluation, and care of concussion and TBI within the DV/IPV population.

BACKGROUND: Rehabilitation for patients after severe acute brain injury (SABI) and subsequent disorders of consciousness (DOC) is a complex balance of restorative strategies and medical management. There is an emerging body of evidence supporting early mobilization and rehabilitation in the acute and subacute phases of rehabilitation after SABI, including the implementation of progressive upright mobilization to support arousal, attention, and hemodynamic stability. 1, 2 Further, new evidence suggests transcutaneous auricular vagus nerve stimulation (taVNS) as a potentially effective, non-invasive neuromodulatory therapy for patients with (DOC) in both acute and chronic stages. 3, 4, 5 Little is known, however, about the safety and feasibility of paired upright mobilization and taVNS interventions in the rehabilitation of patients with chronic DOC. This work reports on the safety and feasibility of robotic enabled upright mobilization with paired taVNS for a patient with chronic DOC following SABI.

METHODS: Patient is a 50 year old male with no significant past medical history prior to diagnosis of SARS- CoV2 infection in June of 2022. Following recovery from acute respiratory symptoms, the patient began to experience new onset fatigue and shortness of breath. Medical examination identified pulmonary emboli. The patient was treated with surgical thrombectomy where he suffered an intraoperative myocardial infarct. He was subsequently diagnosed with a SABI and remains in a minimally conscious state to date. He was seen at the Abilities Research Center Advanced Technology Rehabilitation Program where he underwent 6 weeks of advanced technology physical therapy. Interventions included 2 sessions per week of progressive upright mobilization with robotic assisted-stepping using Erigo (HOCOMA) and paired taVNS (PARASYM). The first 5 weeks consisted of mobilization with Erigo alone, with the addition of paired taVNS during the 6th week. Safety and feasibility were assessed using adverse event reporting. Clinical outcomes were assessed using the Coma Recovery Scale-Revised (CRS-R) and Glasgow Coma Scale (GCS) at baseline and 4 weeks.

RESULTS: The patient participated in 6 weeks of progressive verticalization with the addition of taVNS during the 6th week. No adverse events were reported. The patient tolerated an average of 32.36 (+/-12.14) minutes time on task. The patient tolerated an average tilt angle of 42.75 (+/- 26.66) degrees with a maximum tilt of 74 degrees. At baseline the patient scored 7/15 on GCS and 8/23 on CRS-R. At 4 week reassessment, GCS increased to 9/15. Overall CRS-R score remained 8/23 however motor function subscale score increased and arousal subscale decreased, each by 1 point respectively.

CONCLUSION: These findings suggest that robotic enabled mobilization with paired taVNS, is a feasible and safe intervention for persons with chronic DOC. Future work will continue to investigate short and long term feasibility, safety, and efficacy of the intervention in patients with chronic DOC.

BACKGROUND: Traumatic Brain Injury (TBI) is a serious medical condition well recognized among veterans and athletes, but less is known about TBI as a consequence of physical violence, particularly domestic violence and intimate partner violence (DV/IPV). An estimated 25% of women and 10% of men in the United States experience DV/IPV during their lifetime, with 74% of individual violent events involving injury to the head, neck or face. Half of these events include strangulation causing hypoxic brain injury. Despite a recent study which found that 58% of women entering DV shelters had sustained one or more concussions from DV/IPV, survivors more often engage with mental health professionals (MHPs) for TBI symptoms such as anxiety, depression, and PTSD than with concussion experts. MHPs have an unique opportunity to recognize TBI in clients who have experienced physical violence or abuse, incorporate an understanding of brain injury into their care programs, and refer to TBI experts as appropriate.

OBJECTIVES: The primary objective is to estimate the percentage of MHPs who care for survivors of physical violence in their practice. The secondary objective is to assess among MHPs who care for survivors of physical violence their self-reported comfort and training to recognize signs and symptoms of TBI among their clients.

METHODS: A ten question anonymous online survey tool was vetted, validated, and sent to a cohort of U.S. health care professionals inclusive of MHPs affiliated with DV/IPV organizations. The 5-10 minute survey includes respondent demographics and utilizes standard Likert scales to assess self-reported experience, training and comfort in assessing TBI.

RESULTS: Of an estimated 350 surveys sent out, 102 responses were returned with 74 responses sufficiently completed for inclusion in the analysis. While 89.2% of MHPs reported that their clientele includes individuals who have experienced physical violence, only 16.2% of MHPs responded that they felt very comfortable or extremely comfortable in evaluating clients for TBI. 45.9% of MHPs reported receiving no training in TBI assessment; however, 70.2% reported that they are very interested or extremely interested in further TBI training.

CONCLUSION: While the majority of MHPs reported seeing clients who have experienced physical violence, a population with a high rate of TBI, the results of this study highlight the potential knowledge gap about TBI among MHPs. Given the disparity, it is encouraging that the majority of MHPs reported high interest in further training to recognize the signs and symptoms of brain injury among their clients, suggesting an opportunity to improve trauma-informed mental health services for survivors of DV/IPV.

Behavioral disturbances are some of the most pervasive and persistent phenomena that follow an acquired brain injury (Corrigan, 1985). Rehabilitation sites across the United States struggle to provide services for individuals who consistently engage in challenging behaviors (Ketzmer et. al, 2022). At Craig Hospital, in Englewood, Colorado, Physicians and Board Certified Behavior Analysts (BCBA) are integrating the science of Applied Behavior Analysis (ABA) into the acute inpatient setting. This science, based on human behavior, is reshaping and redefining how clinical staff in this early phase of recovery gain information about patient behaviors, communicate about behavioral needs, and utilize their environments to shape socially appropriate behaviors.
The interdisciplinary teams, in conjunction with the newly added BCBA positions, have created novel systems to collect individualized data around behaviors that most impact the current rehab process. Day-to-day data is facilitated by nursing staff and used by the entire interdisciplinary team to help inform decisions. Data is operationally defined using tools validated through the ABA community. Rehab teams focus on the ability to define behavior prior to trying to measure it for best results. The current site utilizes a 15-minute partial-interval time-sampling template with up to 4 operationally defined behaviors. These individualized systems are used in tandem with reliable and validated assessments such as the Agitated Behavior Scale (ABS) (Corrigan, 1985).
Communication for behavioral needs and escalated events have been a primary focus of this program. Staff have received education, feedback and debriefs for all information provided through our quality improvement system. Most importantly, physicians and BCBAs have focused heavily on creating a language around behavior that allows staff to communicate in a way that is intentional and functional. Staff have been encouraged and engaged with the opportunities to improve the way behavior management flows.
Globally, the focus has been on indicating how the environment shapes patient behavior. Utilizing the building blocks we all know - consistency and structure - ABA fills a crucial gap in rehabilitation implementation that exists within the current structure. Although many team members with insight into behavior do exist, behavior analysts uniquely carry skills that allow them to both intervene and educate on behavioral principles across activities of the day. Our talk will include the process used to determine the effectiveness of medications utilized for behavior management. We will describe how staff are able to also use daily information to determine location, interaction structure and reinforcement for patients. The purpose of the current oral presentation will be to provide clinicians with an overview of the science that they can use in any setting to better manage behavior.

This symposium will assist clinicians in both learning and developing programmatic tools for describing and documenting behavior that occurs as a result of neuroanatomical changes post- brain injury. The ability to effectively treat Brain-Injury Related Behaviors (BIRBs) has limited documentation in the acute phase of recovery (Kretzmer et. al, 2022). Our goal will be to review on-going successful neurobehavioral treatments which include neuro-pharmacological interventions and evidence-based behavior management strategies based in the science of Applied Behavior Analysis (ABA). The group will develop a roadmap to help providers in inpatient rehabilitation facilities develop staff dedicated to behavior management in the care of patients with brain injury. We will outline the adoption of ABA and licensed ABA professionals into the clinical team, the benefits of doing so, and how to overcome potential systematic barriers in place.

This presentation will review the association between brain injury and endocrine abnormalities, including anatomy and pathophysiology, implications for rehabilitation and recovery, and relationships with functional outcomes. Current guidelines and recommendations for screening and treatment will also be discussed.

Cervical spine dysfunction and impairments are an often-overlooked component in the diagnosis and treatment of patients with persistent post concussive symptoms. With some studies showing that as high as 90% of patients with PPCS have cervical spine involvement, it is imperative that a proper screen of the neck be implemented. This session will discuss the current best practices for assessment and interventions of patients suffering from neck pain and headaches after a concussion. Participants will be able to describe common headache types involved in PPCS, differentiate cervical spine involvement from other post-concussive impairments, including vestibular and occulo-motor pathology and identify evidence-based treatment approaches for this patient population.

Vista Centre Brain Injury Services (VCBIS) offer clients with acquired brain injury a day program of social leisure activities with the objective of connecting them with other clients and promoting skill development to encourage self-efficacy in their community. During the COVID-19 pandemic, the VCBIS day program pivoted to virtual and hybrid programming to maintain service to clients. Program staff are now considering the future of these modes of service delivery. Evaluators conducted a needs assessment for the virtual and hybrid day program to determine whether this mode of program delivery would 1) meet clients' needs and 2) be attractive to clients in a way that promotes participation in the program. Evaluators used a mixed methods approach, including a VCBIS record review, surveys of clients (n=28), VCBIS staff (n=3) and alternative service providers (n-6), and client focus groups (n=11). Findings from the evaluation indicated that clients have a similar experience of virtual and in-person programming (i.e., similar levels of enjoyment, interest in activities, social connection, skill development), even if clients generally had a preference for one mode of service delivery over the other due to personal interests and accessibility needs. Contrasting this finding, clients generally perceived hybrid programming less favourably on most measures. Clients rated their enjoyment of hybrid activities (M=2.10, SD=.89) significantly lower than the in-person (M=4.65, SD=.67) and virtual (M=4.19, SD=.87) activities; however, there was no significant difference in enjoyment ratings for in-person and virtual participation. During focus groups, clients frequently reported that they struggled to see or hear others clearly during hybrid programming. Staff and alternative service providers echoed these sentiments in their survey responses, indicating that hybrid programming was often challenging to facilitate due to client lack of interest in the programming and technological barriers. Clients did indicate, however, that participating in hybrid programming was much preferred over missing day programming sessions or having no access to programming at all (e.g., due to weather, COVID). Based on these findings, evaluators recommend that VCBIS: 1) continue to offer a virtual day program; 2) tailor program activities to the mode of service delivery; 3) adopt a flexible approach that allows clients to join virtually in cases where a session would otherwise be missed; and, 4) implement ABI appropriate ongoing client feedback measures.

I arrange ski trips for adults and children, safaris in Africa, surfing in the UK, and camping in Europe. We have captured in pictures on our poster our clients in different environments and facing new challenges, and we have feedback from our clients confirming the benefit they and their families obtain from these experiences. The group holidays increase their confidence and self-esteem, and clients have discussed with me that they gained an insight into their own conditions from the experience and how ‘It was the first time I felt normal’ and, ‘I realised that I could function in a group and enjoy myself’ and are part of the story of how they progressed.

We saw physiotherapy benefits from surfing in the UK and in Africa. We took a brain-damaged, ventilated client skiing in France, showing there are no physical boundaries. We facilitate children’s trips that show us the value of activities with siblings e.g. a child going down an advanced run in contrast to the rest of the family, who are on basic runs! These trips demonstrate that such activities benefit both family and carers.

It is not necessary to go overseas for some clients: similar benefits can be obtained from a surfing holiday in Devon, UK. The safari was a very positive experience, ranging from snorkeling and shark cage diving, to surfing. We saw animals from an accessible open-top vehicle and hippos from a boat, and took a group to a special-needs orphanage, and they raised money for the children and we then took the children to the beach for what was their first outing. It became difficult to tell who were clients, guides, support workers, or family.

Acquired brain injuries (ABI) can result in sequelae across multiple systems and domains that disrupt and impact the individual’s interactions with the environment, thus affecting behavioral relations. The term “neurobehavioral” is used to classify a wide array of challenging excesses and/or deficits of behavior resulting from ABI, that impact or impede an individual’s progress in rehabilitation and recovery, and can ultimately pose safety concerns for the individual and caregivers. This presentation will include a discussion of how evidence-based, behavior analytic principles and practices can be applied at multiple levels of treatment, e.g. to address individual behaviors, in support of interdisciplinary collaboration, and to underpin case conceptualization. Two case studies will be presented to illustrate these areas of application and involvement, including data to highlight and support efficacy.

The first case study calls attention to the significance of the behavioral history of adults with ABI, which may include challenging behaviors pre-injury that can be exacerbated post-injury and complicate treatment planning and programming. The subject of this case study had a pre-injury history of physical and emotional trauma, as well as a diagnosis of borderline personality disorder, that required both inpatient and outpatient treatment. Following an ABI in their late twenties, resulting from a rollover car accident at high speed, pre-injury repertoires and sensitivities were profoundly disrupted and at-risk behavior occurred at high levels across all dimensions and settings during rehabilitation. The principles and practices of behavior analysis helped to inform medication adjustments that proved instrumental in stabilization efforts, and guided the acquisition and generalization of replacement behaviors that established readiness for access to the community and an eventual discharge to home.

The second case study will demonstrate how behavior analysis can play a less direct, but no less valuable role, in the rehabilitation process. A married, middle-aged individual with adult children, working in a management capacity at the time of injury, sustained an ABI in a pedestrian vs. motor vehicle accident. Efforts in acute and post-acute rehabilitation were significantly impacted by sequelae such as confusion, suspiciousness, paranoia and delusionality. This required management of non-reality-based behaviors and close monitoring of medical and behavioral stability, which in the post-acute phase included disrupted sleep, disorientation, irritability, at-risk wandering/mobility, etc. Throughout the rehab process, data collection and analysis supported medication considerations and adjustments. Eventually, following stabilization, behavior analytic input helped to guide systematic efforts to generalize behavior to the community and to establish readiness for a successful return home.

These case presentations represent programming and treatment efforts to address complex neurobehavioral sequelae in an intensive, residential, post-acute rehabilitation setting. Overall, key points of discussion will include data collection, challenging behaviors, specific treatment interventions to promote stabilization and readiness, interdisciplinary collaboration, and medication-related decisions.

Using a case example, content will guide learners in identifying, mitigating, and documenting confounding factors that may invalidate assessment. Presenters will address the many medical and functional confounds that can be present within the DoC population and mask consciousness across settings (acute/ICU and post-acute settings). We will discuss how confounds can impact validity and reliability of assessment and scoring. Content will include recent advances in behavioral measurement such as CRS-R Rasch analysis to detect minimal clinical change and its utility in clinical practice.

This poster aims at presenting the main goals of the Iberian Observatory for Disorders of Consciousness and what the developers intend to do to ensure the success of this international project.

The high rate of misdiagnosis for people with disorders of consciousness (DoC) is well known and widely reported in the literature. Most of these studies have been carried out in countries where there are validated tools for the assessment of DoC (Childs & Mercer, 1996; Andrews et al., 1996; Gill-Thwaites & Munday, 2004; Schnakers et al., 2009; Wang et al., 2020). The JFK Coma Recovery Scale-revised is the gold standard assessment for DoC and has already been translated and validated in many countries. However, there are still countries where there are no translated or validated assessment tools and/or where there is little knowledge among health professionals about this population. Portugal and Spain are among those countries. Thus, it became imperative to create an observatory that would help to organize research in this field and to shed a light on this spectrum of often forgotten population.

The main aim of this Observatory is to contribute to understanding the reality of DoC in Portugal and Spain, to understand the trajectory of patients' general state of health, and above all to give visibility to a spectrum of disorders that are little talked about in both countries. By creating partnerships with health institutions, medical and other health professionals’ societies, research centers, and other stakeholders it is hoped to open a path for high quality standard research.

It is also the Observatory's responsibility to promote international scientific research activities in the area, contribute to the validation of diagnostic tools in Spanish and Portuguese and share knowledge to the community through the organization of short courses as well as by providing support for undergraduate and postgraduate training in this area.

There is a growing body of literature aimed at understanding the assessment and management of chronic pain after moderate to severe traumatic brain injury (M/S-TBI). Multidisciplinary (MDT) pain management is accepted as gold standard for chronic pain, but there is limited evidence to guide clinicians on how to modify general pain management strategies for people with a M/S-TBI. The Be Pain Smart – Online Education Modules (BPS-OEM) are a suite of online modules, providing evidence-based training for clinicians on pain management strategies for people with a M/S-TBI. The modules have utilised optimal adult learning principles within the design to support the learning of pain management strategies and clinical decision making aligned with the BPS clinical reasoning framework. The online delivery allows for maximum accessibility to facilitate the training of clinicians across metropolitan and rural/remote regions. The aim of this study is to evaluate the feasibility and acceptability of the BPS-OEM, particularly examining clinicians’ pain beliefs, confidence and clinical practice when managing pain with people who have a M/S-TBI. A sample of allied health clinicians were recruited via advertisements through the relevant New South Wales (NSW) networks. Data was collected via an online survey with outcome measures targeting clinical practice, knowledge, confidence, pain beliefs and clinical value of the BPS-OEM. Results demonstrated improvement in clinician confidence and pain knowledge, and changes in pain beliefs to be more aligned with MDT pain management approaches. The BPS clinical reasoning framework with an online interactive clinical reasoning tool will be presented with accessibility and usability results presented. The authors will discuss how improvements in clinician confidence and pain knowledge will lead to increased capacity within existing services to assess and manage chronic pain in the TBI population. The added value of additional 6 group mentoring sessions to compliment the BPS-OEM will be reviewed. The BPS-OEM provides training and a clinical reasoning framework to assist clinicians to improve access to and the delivery of appropriate pain management services for people with a M/S-TBI.

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: Blast trauma is unique because of its complex mechanism of injury to the brain and other vital organs due to over pressure air and bleeding from internal organs. Severe loss of blood leading to hemorrhagic shock (HS) results in inadequate supply of oxygen and fuel to the cells for the generation of ATP from the mitochondria for the cell survival. Mitochondria generate ATP for cell survival through the orchestrated action of its electron transport chain enzyme’s activities, mainly through complex I-IV and mitochondrial gatekeeper enzyme” pyruvate dehydrogenase complex. Any damage to these enzymes results in increased oxidative damage to the cells, organ’s dysfunctions and neurological disorders. Although clinical symptoms of metabolic disruption are evident soon after the injury, but actual damage mechanisms at the molecular, cellular and organ system level persists for days to years post injury.

OBJECTIVES: 1) utilize our rapid blood -based dipstick test to monitor the severity of mitochondrial electron transport chain damage in response to blast exposure and HS, and 2) develop mitochondrial targeted therapeutic strategies.

METHOD: Pre-clinical and military relevant rat model with blast exposure accompanied with or without HS and resuscitation was used. The animals underwent three repeated blast injuries of 20PSI at 15 minutes interval. After circulatory variables (MAP and pulse rate) were determined, controlled hemorrhage was induced. Rats were then bled over a 15-minute period to a MAP of 40 mmHg. Blood was collected in pre-heparinized tubes. MAP was sustained at 40 mmHg for 40 minutes by withdrawal or infusion of shed blood. Resuscitation (T60-120) followed by Blood Transfusion (T120-150). After the HS, animals were infused with either hypertonic sodium pyruvate (2M) or osmolality and volume matched control hypertonic saline. Blood collected at T0 (baseline), T60 (after injury), and T180 (end) was analyzed for plasma mitochondrial electron transport enzymes complex I, IV and pyruvate dehydrogenase by our published dipstick test.

RESULTS: Compared with baseline values, a significant decreased activity of complex I, IV and Pyruvate Dehydrogenase Complex (PDH) was noted after blast and HS in all of the animal groups. The animals also had a significantly elevated plasma lactate concentration. Although pyruvate treatment was effective in preventing the loss of these mitochondrial ETC enzyme activities, and also corrected the hyperlactatemia at the end, but it was unable to restore them to the baseline levels, suggesting the need for a combined therapeutic strategy targeted at preventing the mitochondrial damage, inflammatory cascade, antioxidant and cell death mechanisms.

CONCLUSIONS: Serial monitoring and optimization of blood complex I, IV and PDH activity could aid in prognostication and potentially guide in using mitochondrial targeted therapies to reduce the mortality from the severity of combined traumatic injuries associated with hemorrhagic shock.

INTRODUCTION: Traumatic brain injury (TBI) is a known risk factor for delirium, a condition associated with prolonged hospitalization and cognitive deterioration. Although the relationship between TBI and delirium is established, a detailed understanding of specific predictors remains limited. Respiratory disorders can significantly influence the central nervous system, with sequelae such as hypoxia, hypercapnia, and respiratory acidosis causing neurologic dysfunction. Therefore, we hypothesize that lung-associated conditions, stemming either from direct injuries or subsequent surgeries will increase the risk of developing delirium in TBI patients.

METHODS: The 2017-2021 Trauma Quality Improvement Program database was queried for patients with TBI, excluding for those with pre-existing dementia. TBI patients developing delirium were compared to those without delirium. A multivariable logistic regression analysis was performed to determine predictors of delirium.

RESULTS: Among 155,252 TBI patients, 3,244 (2.1%) developed delirium. Delirium-afflicted patients showed elevated rates of lung injury (25.0% vs 13.3%, p<0.001), severe head trauma (Abbreviated Injury Score ≥ 3) (51.4% vs 37.8%, p<0.001), sepsis complications (3.1% vs. 0.5%, p<0.001) and more commonly underwent pulmonary operations (21.8% vs. 6.6%, p<0.001). The strongest associated risk factors for delirium included functional dependence (OR 2.70, CI 2.43-3.00, p<0.001), intubation (OR 2.33, CI 2.13-2.56, p<0.001), concurrent lung injury (OR 1.21, CI 1.20-1.33, p<0.001) and pulmonary surgery (OR 1.64, CI 1.48-1.82, p<0.001).

CONCLUSION: Delirium affected approximately 2% of the national TBI population. Our analysis not only reaffirms known predictors but also emphasizes the critical influence of lung-related conditions on delirium onset. Systemic inflammatory response, frequently instigated by lung injuries, might intensify neurological issues, escalating risk of delirium. Recognizing these risk factors is crucial in refining delirium prediction, prevention, and treatment in the setting of TBI.

In this presentation, the speaker will review measures developed to assess important markers of recovery, including the Kennedy Krieger Institute Scales. Key prognostic markers to consider in this setting will also be reviewed. Lastly, transdisciplinary rehabilitation treatment strategies, including cognitive rehabilitation methods will be discussed.

In this pre-conference session, presenters will discuss pediatric brain injury care across the continuum from intensive care through community living. The first speaker will provide a review of best practices for pediatric brain injury management in the intensive care setting and the general hospital floor. The second speaker will review transdisciplinary rehabilitation assessment and treatment strategies. The third speaker will review coordination among medical and educational teams for community living. Speakers will wrap up the session with case presentations to illustrate pediatric brain injury care across the continuum.

In this final presentation, our presenters will describe one to two cases, highlighting key points in recovery and strategies that optimize long term outcomes.

Over the last several years, best practice guidelines for individuals with disorders of consciousness (DoC) have been published by groups in the United States, Europe, and the United Kingdom. These guidelines have focused almost exclusively on adults with DoC. Evidence informing best practices in assessment and management of pediatric disorders of consciousness is lacking. Published studies include primarily observational studies of small samples at single sites. Additionally, study samples are often heterogeneous in age and etiology injury. Moreover, assessment of young child with DoC is particularly challenging due to their immature nervous systems and limited repertoire of developmental skills. At this time, while published evidence to inform best practices in the assessment and management of pediatric DoC is lacking, foundational literature describing assessment practices, documenting outcomes, and exploring interventions for pediatric DoC is growing. In this session we will review the key literature that constitutes a base for future guidelines related to assessment and management of pediatric DoC and describe assessment and management strategies for pediatric DoC based on the existing literature and expert opinion.

Individuals who sustain hypoxic ischemic brain injury during childhood have high rates of neurobehavioral impairments. There are few studies of long-term follow-up. Additionally, published reports describing outcomes more than one year after brain injury are limited to small single center reports and often combine multiple etiologies of hypoxic ischemic injury. In this session, the speaker will describe the existing literature informing our understanding of functional and neuropsychological outcomes in individuals who sustain hypoxic ischemic injury during childhood. Gap areas and ongoing research endeavors will also be discussed.

Post-acute brain injury rehabilitation has the potential to drive meaningful recovery and support long-term sustainable outcomes when designed correctly. Emphasizing the principles of learning, a program design will consider the clinical model in addition to team structure, cultural norms, and facility design. Individualization of programming matched to the values and goals of the participants facilitates engagement and ties the “tasks” of rehabilitation to the individual’s functional needs. This session will reveal some of the key elements in creating an effective residential rehabilitation model that focuses on recovery of the whole person and re-establishment of a meaningful life path.

This symposium will assist clinicians in both learning and developing programmatic tools for describing and documenting behavior that occurs as a result of neuroanatomical changes post- brain injury. The ability to effectively treat Brain-Injury Related Behaviors (BIRBs) has limited documentation in the acute phase of recovery (Kretzmer et. al, 2022). Our goal will be to review on-going successful neurobehavioral treatments which include neuro-pharmacological interventions and evidence-based behavior management strategies based in the science of Applied Behavior Analysis (ABA). The group will develop a roadmap to help providers in inpatient rehabilitation facilities develop staff dedicated to behavior management in the care of patients with brain injury. We will outline the adoption of ABA and licensed ABA professionals into the clinical team, the benefits of doing so, and how to overcome potential systematic barriers in place.

BACKGROUND: Traumatic Brain Injury (TBI) is a commonly identified condition in athletes, veterans, and car accidents, however, TBI in the domestic violence and intimate partner violence (DV/IPV) population is critically underrecognized. Current literature estimates 74% of these violent events result in mechanical trauma to the head, neck, and face. Additionally, half of these injuries further result in an ischemic brain injury caused by strangulation. Repeated head trauma has been linked to an increased risk of developing multiple sclerosis (MS), predominantly in cohorts of women and children. Approximately 38%-63% of women with MS report prior experiences of abuse, and abuse may lead to earlier onset of illness and higher relapse rates. There are no identified interventional studies that address DV/IPV-induced TBI in the MS population.

OBJECTIVE: The primary objective is to propose abuse-induced brain injury and strangulation as a physiologic risk factor for developing MS.

METHODS: A PubMed search of articles September 2014 to November 2023 using key words multiple sclerosis in conjunction with traumatic brain injury, head injury, concussion, and/or strangulation as well as domestic violence and/or intimate partner violence retrieved ten papers. Articles were reviewed for proposed mechanisms and connections between TBI, MS, and DV/IPV.

RESULTS: While no papers met all inclusion criteria, there is a significant epidemiological overlap between populations at risk of DV/IPV-induced TBI and those who develop MS. There is support in the literature for physiological mechanisms of increased intracranial pressure from venous outflow occlusion with strangulation, paired with the activation of astrocytes, degradation of tight junctions and a loss of blood-brain barrier (BBB) integrity seen with TBI. Disruptions of the BBB from central nervous system (CNS) injury proteins, including S100B, MBP, NSE, GFAP, UCHL-1, and NfL, enter the bloodstream and trigger an immune antibody response. Accumulation of TBI-induced proteins is linked to an increased risk of developing neurological diseases. Serum antibody IgG is released as a secondary immune response following IgM, which the injured CNS is unequipped to defend against following TBI-induced BBB degradation. Similar to ischemic brain injury, 24.8% of ischemic stroke patients have shown elevated oligoclonal IgG bands. Elevated levels of IgG have been established as a risk factor for MS. In TBI, the level of IgG has been associated with the severity and frequency of ischemia and TBI.

CONCLUSION: The literature suggests that TBI and venous outflow obstruction from strangulation may lead to inflammation thus activating the immune system and increasing the likelihood of developing the clinical syndrome of multiple sclerosis. This evidence-based theory highlights the probable link between abuse-induced brain injury and the risk of developing MS. Further research is necessary to establish this relationship and begin education, prevention, and care programs.

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.

In this presentation, the speaker will provide an overview of the session by highlighting key differences in presentation and outcomes of common pediatric brain injury etiologies, summarizing relevant guidelines in brain injury care, and emphasizing the importance of child development in brain injury management. This presenter will also review best practices for pediatric brain injury management in the intensive care setting and the general hospital floor with a focus on delirium assessment and management and approaches to optimize mobilization.

In this pre-conference session, presenters will discuss pediatric brain injury care across the continuum from intensive care through community living. The first speaker will provide a review of best practices for pediatric brain injury management in the intensive care setting and the general hospital floor. The second speaker will review transdisciplinary rehabilitation assessment and treatment strategies. The third speaker will review coordination among medical and educational teams for community living. Speakers will wrap up the session with case presentations to illustrate pediatric brain injury care across the continuum.

This session will introduce pharmacologic treatment strategies for conditions which are common among children with brain injury including cognitive/behavioral and motor sequelae of injury. Medication indications, mechanisms of action, and adverse effects will be reviewed. Relevant evidence from pediatric and adult literature will be discussed and supplemented with case discussion.

This section of the course will focus on strength training, cardiorespiratory fitness training, and cultural arts training to promote community participation after brain injury. Literature on strength training will be discussed with specific emphasis on training that improves walking performance to support community speeds and activity levels. Literature to support cardiorespiratory fitness training throughout the spectrum of recovery and physical activity guidelines after acquired brain injury will be reviewed along with a discussion regarding brain injury recommendations in Healthy People 2030. Emerging opportunities to integrate cultural arts training to improve motor rehabilitation and community participation will be discussed with a focus on practical application.

This course will focus on the clinical translation of novel approaches to optimize motor recovery and function after acquired brain injury. Motor learning principles and current clinical practice guidelines to guide motor rehabilitation after acquired brain injury will be discussed in parallel with innovative technologies to support the application of these principles in individuals across the severity spectrum. Experiential learning will focus on technology currently available to support motor rehabilitation while reinforcing motor learning principles. Appropriate outcome measure selection and implementation will be discussed based on severity level and motor rehabilitation goals.

This presentation will provide an overview of using motor learning principles to facilitate adaptive plasticity after neurologic injury. Neural mechanisms associated with use-dependent learning and the importance and timing of motor rehabilitation will be discussed. An overview of the practical application of motor learning principles including learning considerations associated with errors, contextualization, and advanced training will be reviewed. A general overview of advancements and innovations in technology will be discussed along with the inclusion of TBI in Healthy People 2030 to lay the foundation for the course.

Practical ways to implement and measure intensity during locomotor training.
Practical application of robotic exoskeletons.

This section of the course will focus on current opportunities to promote upper extremity recovery after acquired brain injury. Novel technologies including robotics, vibration, and functional electrical stimulation will be reviewed along with case study presentation of clinical application. The clinical practice guideline to guide upper extremity recovery after brain injury will be discussed along with the challenges and opportunities associated with integration. A review of recommended outcome measures to assess progress will be addressed throughout the severity spectrum. Experiential learning will be facilitated in a lab-based session with advanced technologies.

Practical application of virtual reality.
Practical application of functional electrical stimulation for Upper and lower extremities.

Practical ways to implement and measure intensity during locomotor training.
Practical application of robotic exoskeletons.

This session will focus on current clinical practice guidelines that exist to promote motor recovery after brain injury. The literature used to inform these guidelines will be discussed along with the translation of these guidelines to clinical practice. We will discuss current gaps between research and clinical application and discuss opportunities to bridge these gaps. We will also discuss advancements in technologies and provide examples of using them to improve motor outcomes. Future research opportunities will also be discussed.

INTRODUCTION: Photophobia is a common symptom in traumatic brain injury that can persist months and even years post injury. Currently, there is a lack of scientific guidance as to the best method to treat these patients.

METHODS: We did a retrospective review of patients presenting post-TBI to a neuro-optometric clinic complaining of photophobia and evaluated what types of light sources they found to be most triggering, as well as which treatment option they found to be most alleviating of their symptoms. We then used a spectrophotometer to measure the spectral irradiance and light intensity of the most common triggers (computer, phone, fluorescent lights, indoor incandescent bulbs, and outdoor sunlight), and the change in irradiance and light intensity when using different tinted lenses, reducing screen brightness, and using an anti-glare computer screen.

RESULTS: Direct sunlight has the highest spectral irradiance over 5x that of indoor lighting and electronics. Unlike sunlight, which had a widespread spectral irradiance over all wavelengths, Indoor fluorescent lights and electronics had small, specific peaks of irradiance. Indoor fluorescent light had peaks of irradiance at 435nm, 490nm, 545nm 585nm, 615nm and 710nm, and electronics on full brightness had peaks at 430nm, 450nm, 485nm, 540nm, 585nm, 615nm, 630nm and 650nm and 710nm which were very similar in wavelength but less intense than fluorescent lights. The intensity of the light outside was 60x more intense than fluorescent lights, and 600x more intense than electronics. Patients were variable in their photophobia triggers, with some noting all light sources as triggers, but the majority of patients only reported a profile of specific triggers (ex: fluorescent lights and electronics). Spectrophotometry of 10 different brands of “FL41” tinted lenses revealed that each tint had different spectral profile in reducing light emitted from the computer even though all are marketed as being effective in “blocking blue light.” Online purchased “blue blockers” that were clear with a slight yellow tint and prescription reading glasses with an anti-reflective coating had slight reduction in light transmission at 444-476nm, and 504-536nm, 556-576nm, 628 and 648nm, but the reduction was not as effective as using an anti-glare computer screen or adjusting the brightness of the computer. The most effective tints in reducing spectral irradiance peaks from fluorescent lights included certain but not all FL41 tints, 50% blue and 81% NOIR but that was not what the patient always said was subjectively their preferred tint for comfort.

CONCLUSION: Not all patients post-TBI are photophobic to the same light sources. The most cost effective solution is to turn the brightness down on devices and overhead lighting, and if that is not effective try an FL41, blue or NOIR tint if the patient requires it to return to ADLs.

INTRODUCTION: Patients who suffer from traumatic head injury are at risk of developing traumatic brain injury, traumatic whiplash injury, or both. The majority of these patients present to multiple disciplines of providers including pediatricians, internal medicine, sports medicine, and emergency medicine with nonspecific complaints including headache, dizziness, nausea, brain fog, and anxiety. The majority of these patients self-resolve within 4-6 weeks however approximately 10% will have persistent symptoms for months, years, or indefinitely. Tools like the VOMS (Vestibular Oculomotor Screening Assessment) have been instrumental in screening for visual-vestibular disorders to allow for referral to vestibular physical therapy. However, not all patients fully resolve with standard vestibular physical therapy and may worsen if the etiology is cervical or oculomotor.

METHODS: We present a case series of 15 patients who presented to a transdisciplinary brain injury clinic to be evaluated by neuro-optometry and orthopedic physical therapy after failing vestibular physical therapy post-concussion. The cases have been reviewed with a distinguished national cohort of concussion experts including neuro-optometry, neurosurgery, orthopedic and vestibular physical therapy to propose a novel clinical assessment. Cervical-Oculomotor-Vestibular Assessment (COVA) that could help all providers differentiate cervical, vestibular, and oculomotor dysfunctions to provide more appropriate referrals to rehabilitation specialists and specialty providers.

RESULTS: The subset of patients with refractory or worsening post concussive symptoms following vestibular physical therapy benefit from a clinical assessment based on simple, subjective and objective testing which can be done chairside or bedside based on the nuances of neuro-anatomy and pathophysiology of whiplash vs traumatic brain injury vs traumatic brainstem injury.

CONCLUSION: The cervical, oculomotor, and vestibular systems are intimately connected neuro-anatomically and are often underlying causes of common post-traumatic symptoms like headaches, nausea, dizziness, and brain fog. By varying the methodology of oculomotor testing from current clinical screening assessments, clinicians may be better able to identify the underlying trigger for symptoms, and triage to the appropriate provider and rehabilitation type.

BACKGROUND: Recent studies have shown that concussion may lead to clinical impairment of the oculomotor pathways, and this has led to increasing research in the clinical assessment of post-concussion oculomotor dysfunction and its roles in diagnosis and treatment of concussion.

METHODS: All experimental procedures were approved by the Committee for the Protection of Human Subjects (CPHS), the defined Institutional Review Board (IRB) of University of California, Berkeley, and followed the tenets of the Declaration of Helsinki. Intercollegiate athletes at the University of California, Berkeley were asked to participate in an oculomotor assessment at baseline and after a concussion. All recruited athletes were clinically determined to be free from acute or subacute concussion at the time of the baseline examination by the team physician and diagnosed with a concussion by the same team physician. All post-concussion oculomotor assessments were evaluated 0-5 days post-injury (average of 2.55 days). All baseline and post-concussion eye examinations were conducted by the same optometrist and included a comprehensive clinical test battery to assess fixation, accommodation, vergence, saccades, smooth pursuits, versions, and vestibular-ocular reflex.

RESULTS: A total of nine subjects (age 18-22 years; two female; seven male) were evaluated for this case series. Five of these subjects had a history of a previous concussion, with the number of previous concussions per subject ranging from 1-5, with an average of 2.0. Paired statistical comparisons of baseline versus post-concussion binary measures (fixation, saccades, pursuits, and versions) as well as nineteen continuous function variables (fusional vergence, near point of convergence, near point of accommodation, accommodative facility, and DEM subtest values) did not reveal statistically significant differences among the individual oculomotor metrics, possibly because of limited sensitivity due to the small sample size. When comparing the baseline data to clinical norms, seven of the nine subjects (77.8%) exhibited a pre-existing oculomotor abnormality. Of those seven, all had additional oculomotor abnormalities post-concussion when compared both to clinical norms as well as to their individual baseline assessments.

CONCLUSION: Changes in oculomotor function from baseline data following concussion in this case series provide clinical evidence in support of the hypothesis that concussive injury itself causes oculomotor dysfunction beyond possible pre-existing abnormalities. Without the baseline data in this case series, a number of these subjects would have been misdiagnosed post-concussion with symptoms that were based on pre-existing oculomotor abnormalities, and this could have delayed their return-to-play. Given increased use of oculomotor assessments in concussion diagnosis and management, this case series demonstrates the value of baseline assessments for increasing the accuracy and utility of oculomotor metrics in concussion management decisions.

Oculomotor dysfunctions, including convergence and accommodative disorders, are common in up to 80% of patients with acute concussion and 30-40% with chronic concussion. However, convergence and accommodative disorders are not specific to concussion, and they can also be present from development/non-traumatic origin. While there is a high (20-30%) prevalence of oculomotor dysfunctions in the non-concussed clinical pediatric population, prevalence of oculomotor dysfunctions in collegiate athletes is currently unknown, and this imposes strong limits on conclusions that can be drawn from studies of visual and vestibular-oculomotor dysfunction following suspected concussion. This study collected baseline oculomotor data to assess the presence of vergence and accommodative dysfunctions in collegiate varsity athletes with and without a history of concussion.

METHODS: All experimental procedures were IRB approved. Intercollegiate varsity athletes at the University of California, Berkeley were asked to participate in a comprehensive oculomotor assessment. Athletes were asked about their concussion history and were cleared from prior concussions by the team physician prior to baseline testing. All baseline oculomotor examinations were conducted by the same optometrist.

RESULTS: Baseline data were collected on a total of 179 athletes. Athletes were assigned to groups either with (n=63, 17 females, 45 males) or without (n=116, 32 females, 85 males; control group) a history of a diagnosed concussion. Refractive correction of either glasses or contact lenses were worn by 22.9% (n=41) of the sample. Participants reported whether they had received at least one eye examination with an eyecare provider in their lifetime (52.5%; n=94) and whether they had received an eye examination within the last year (35.75%; n=64).

Baseline binary variables (proportions) were compared using Fisher’s exact test, and continuous variables were compared using the non-parametric Wilcoxon rank sum test. There were no statistically significant differences between groups for any of the oculometric measures. Notably, when compared to clinical norms, there were multiple clinically relevant oculomotor dysfunctions at baseline, including abnormal near cover test (11.2%), reduced fusional divergence at near (15.1%), reduced fusional convergence at near (29.1%), reduced near point of convergence (6.2%), reduced near point of accommodation (13.4%), and reduced accommodative facility (20.1%).

CONCLUSION: There were no statistically significant differences between athletes with or without a history of concussion for convergence or accommodative (dys)functions. Athletes exhibited clinically relevant levels of accommodative and vergence dysfunction at baseline, and 47.5% of the sample had never had a comprehensive eye exam in their lifetime. This lack of information regarding baseline oculomotor function in athletes confounds possible baseline abnormalities with those resulting from suspected concussions. This, in turn, can impact their education, sports performance and pull-from-play and return-to-play decisions.

Patients with disorders of consciousness (DoC) such as the minimally conscious state (MCS) and the unresponsive wakefulness syndrome (UWS) are a challenging population lacking effective treatment options. Among neuromodulation techniques, trans-auricular vagal nerve stimulation (taVNS) may act non-invasively through a bottom-up manner to modulate thalamo-cortical connectivity and promote the recovery of consciousness in the acute phase of severe cerebral damage. In this clinical trial, we aim to characterize the clinical short and long-term effects of taVNS in patients with DoC and determine the phenotype of clinical responders.
Methods: We are conducting the first randomized placebo-controlled double-blind clinical trial assessing the effects of taVNS in 44 acute to sub-acute DoC patients. In this study, patients randomly receive either 5 days of active bilateral vagal stimulation for 45 minutes a day (3mA; 200-300μs current width, 25Hz) or sham stimulation. Behavioural measures (Coma Recovery Scale-Revised, CRS-R) are collected twice at baseline as well as at the end of the treatment. Moreover, patients’ long-term evolution at 3 months after the end of the treatment period is assessed through phone-adapted outcome measures performed with family or caregivers (Glasgow Outcome Scale - Extended, GOS-E; Disability Rating Scale, DRS).

Background: People may experience a myriad of symptoms after mild traumatic brain injury (mTBI), but the relationship between symptoms and objective assessments is poorly characterised. This study sought to investigate the association between symptoms, resting heart rate (HR) and exercise tolerance in individuals following mTBI, with a secondary aim to examine the relationship between symptom-based clinical profiles and recovery.
Methods: Prospective observational study of adults aged 18-65 years who had sustained mTBI within the previous 7 days. Symptoms were assessed using the Post-Concussion Symptom Scale, HR was measured at rest and exercise tolerance assessed using the Buffalo Concussion Bike Test. Symptom burden and symptom-based clinical profiles were examined with respect to exercise tolerance and resting HR.
Findings: Data from 32 participants were assessed (mean age 36.5±12.6 years, 41% female, 5.7±1.1 days since injury). Symptom burden (number of symptoms and symptom severity) was significantly associated with exercise intolerance (p=0.002 and p=0.025, respectively). Physiological and vestibular-ocular clinical profile composite groups were associated with exercise tolerance (p=0.001 and p=0.014 respectively), with individuals who were exercise intolerant having higher mean number of symptoms in each profile compared to those who were exercise tolerant. Mood-related and autonomic clinical profiles were associated with higher resting HR (greater than 80bpm) (p=0.048 and p=0.028 respectively), suggesting altered autonomic response for participants with symptoms relating to this profile. After adjusting for age and mechanism of injury (sport- or non-sport related), having a higher mood-related clinical profile was associated with persisting symptoms at three months post-injury (adjusted odds ratio = 2.08; 95% CI=1.11-3.90; p=0.013).
Interpretation: Symptom-based clinical profiles, in conjunction with objective measures such as resting HR and exercise tolerance, are important components of clinical care for those having 4 sustained mTBI. These results provide preliminary support for the concept that specific symptoms are indicative of autonomic dysfunction following mTBI.

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.