The following is an informal and obviously not exhaustive summary of some aspects of the state of the art in brain injury research. This summary is divided into three areas:
This data will be used in the following ways:
a.) To be shared with residents of Whitemarsh House via a special instructional unit on brain injury. In language accessible to these consumers.
b.) To be shared with Whitemarsh families, stakeholders and the general public via the web site.
c.) To be shared with Whitemarsh staff via targeted in-services and trainings in brain injury.
Aging with Brain Injury
This section draws from the following articles of Felicetti, Trudel, Purdum and Mozzoni:
Felicetti, Thomas PhD “Preface: The Graying of Brain Injury” The Journal of Head Trauma Rehabilitation Volume 23 #3 May-June 2008.
Felicetti, Thomas, PhD “An Update on Activities of the Long-Term Issues Task Force.” IBID
Felicetti, Thomas, PhD, Trudel, Tina, PhD and Purdum, Christina, MA. “Obesity, Overweight and Hypertension in Brain Injury”. Rehab Pro Vol 15, #1 February-March 2007.
Trudel, Tina PhD, Felicetti, Thomas PhD and Mozzoni, Michael PhD “The Graying of Brain Injury; an Overview” Brain Injury Professional Vol 2 #2.
Felicetti, Thomas PhD, Trudel, Tina PhD and Mozzoni Michael PhD “Health, Aging and Brain Injury” Lippincott’s Case Management Vol 10 #5
Please note: These articles, among the early systematic investigations of state of the art in aging and long-term issues in brain injury, were written under the auspices of the long term issues task force of the brain injury division (BI-ISIG) of the American Congress of Rehabilitation Medicine. That work goes on today and is updated by new Chair of the task force Dr. Flora Hammond et al. Dr. Hammond is Medical Director of the Rehabilitation Hospital of Indiana, so please refer to the published works of Dr. Hammond and her colleagues for updated and current state of the art information. Furthermore, please refer to the 2009 fact sheet by Marilyn Lash, MSW Associates on this topic. Also rather current information on the topic can be obtained in the publications of Hibbard, Mary PhD and Gordon Wayne, PhD (Mount Sinai Rehab). Finally, a fact sheet developed by David Krych et al (Remed Recovery Services) is most helpful on this topic and was developed subsequently to the articles by Felicetti, Trudel and Mozzoni. As I summarize the various findings on aging with brain injury, I am drawing freely on the published work of Hammond, Lash, Hibbard, Gordon, Krych et al. Again, this is an informal teaching tool for clients, families, stakeholders and staff of Whitemarsh House and is not intended as a free-standing research paper.
Some Basic Concepts on Aging with Brain Injury
When we present our papers at conferences on this topic to caregivers and families and to individuals with brain injury, we advise at the outset that the challenges of aging with brain injury can seem extremely daunting. But we urge that the consumers not fall into undue pessimism or depression over possible sequelae. To begin with, these are clusters of outcomes post-brain injury that affect sub-groups of individuals. And some people fully recover without the problems addressed here. Virtually no-one exhibits all of these symptoms. Secondly, while the statistical data are valid in the overall brain injury population, facing the potential problems squarely can help prevent more serious issues. Many of the consequences we studied are medical in nature, as that was the essential focus of our research, but our various surveys did tease out some non-medical outcomes as well.
What follows is a partial basic list of consequences for some individuals as they age with brain injury:
Some Causes Of Falling With Brain Injury
We draw this partial summary primarily from the following articles, papers and publications:
Felicetti, Thomas PhD “Falls Prevention at Beechwood” Beechwords Fall, 2009.
Felicetti, Thomas PhD “”Falling in an Aging Brain Injury Population…” Professional Case Management Vol 14 #3 May-June 2009.
I again rely somewhat on my own research for this section because I can obviously speak most accurately to these concepts. However, once again I urge the reader to pursue other and quite current sources as discussed in section 1. Furthermore, the fact sheet developed by Krych and his colleagues is also indispensable here and the fact sheet on falling developed by the American Physical Therapy Association is considered an authoritative classic in the field. These concepts on causation draw from all of these sources, not simply from my own data.
Some Basic Falls Causation with Implications for Falls Prevention:
Optimal Cognitive Interventions in Brain Injury
This summary is drawn largely from:
Cicerone, Keith D, PhD, Langenbahn, Donna M PhD, Braden Cynthia, MA, Malec, James F. PhD, Kalmar Kathleen, PhD, Fraas, Michael PhD, Felicetti, Thomas PhD, Laatsch, Linda PhD, Harley, Preston J, PhD, Berquist, Thomas, PhD, Azulay, Joanne PhD, Cantor, Joshua, PhD, Ashman, Teresa, PhD. “Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 2003-2008.” Archives of Physical Medicine and Rehabilitation Vol 92 #4 April 2011.
It was a privilege to be a very small part of the research team on these data generated by Dr. Cicerone et al. The series of updates on the state of the art in Cognitive Therapy were conducted under the auspices of the Cognitive Task Force of the Brain Injury Division (BI-ISIG) of the American Congress of Rehabilitation Medicine. (ACRM). With the Cognitive Task Force still in operation under the guidance of Dr. Cicerone since my retirement from ACRM activities, there may well be an even more current published update or one may be coming soon.
The research methodology for determining the top classes of studies underpinning state of the art Cognitive interventions, was quite sophisticated and need not be elaborated upon in this summary which only seeks to serve as an accessible teaching tool for Whitemarsh residents, staff, stakeholders and families.
Let it suffice to say that for a then Executive Director of a Post-Acute Rehab Facility like me, without the kind of research staff that is available to those serving in large Rehabilitation Hospitals, this was a great opportunity to work with and learn from, some of the leading brain injury experts and researchers in the field.
In summary, this large meta-analysis found substantial evidence to support interventions for attention, memory, social communication skills, executive functioning, problem-solving and awareness and comprehensive-holistic neuropsychological rehabilitation after Traumatic Brain Injury (TBI). Evidence also supports visuospatial rehab after right hemisphere stroke and interventions for aphasia after left hemisphere stroke.
It is important to consider this data in relation to section 1 and section 2 of this teaching tool. So many of the apparently “dismal” prospects of aging with brain injury and falling with brain injury are cognitive in nature.
For example, the profound loneliness or lack of social capital experienced by some such individuals as they age can be tied to speech impairments and poor communication skills. There is now solid evidence that these are skills that can be re-learned or at least ameliorated to some extent. The same is true for the many implications of memory loss in the graying of brain injury, for judgment issues and for overall planning (Executive Functioning).
And in the propensity for falling with brain injury, we again now have strong evidence for the efficacy of interventions for inattention, hyper-attention, memory (still again), planning ahead, and confusion.
So given this research as a whole, we can see that so many individuals with brain trauma and stroke long after the initial trauma can have increased quality of life and safety, given adequate cognitive therapy by trained professionals.
As said in the previous paragraph, it cannot be repeated enough that this is nothing short of a call for reversal of our thinking on allocation of Government and private rehab dollars. Individuals well post-trauma can benefit from such intervention.
This is a call for extreme public advocacy in the political and social arena.
January 4, 2018