TBI Model Systems Update

Here, we share “Traumatic Brain Injury as a Chronic Disease: Insights from the United States Traumatic Brain Injury Model Systems Research Program” from Lance Neurology, and “An Umbrella Review of Self-Management Interventions for Health Conditions with Symptom Overlap with Traumatic Brain Injury” from the Journal of Head Trauma Rehabilitation.

The Brain Injury Association of America collaborates with the country’s leading brain injury research centers, such as the TBI Model Systems, to abstract the findings published in professional journals into brief, easy-to-read articles.

Traumatic Brain Injury as a Chronic Disease: Insights from the United States Traumatic Brain Injury Model Systems Research Program

The Question: What have we learned from the Traumatic Brain Injury Model Systems about the long-term effects of traumatic brain injury (TBI)?

The Study: This paper describes lessons learned from the research of the TBI Model Systems of Care.

The Traumatic Brain Injury Model Systems of Care in the US has followed individuals with moderate to severe TBI for over 30 years, providing valuable insights into the functional, cognitive, behavioral, and social effects experienced by these individuals two to 30 years or more post-injury. The information provided can help inform the development of a comprehensive chronic care model to provide ideal services when individuals most need them.

The paper focuses on TBI as a chronic condition rather than a one-time event. The effects of TBI vary across individuals and can change over time. While some individuals show improvement over time, for others TBI can have long-term effects on health and functioning. Sometimes problems worsen over time. Some people who have experienced TBI can develop disability years after the injury, may even require rehospitalization, and have a shorter lifespan compared to the general population.

Findings of these studies indicate that factors such as lower initial function as well as older age at the time of injury are associated with deterioration after recovery. Younger age and greater independence, on the other hand, are linked to risky behaviors like substance misuse and re-injury. Nonmedical factors, such as living conditions and income, can also impact long-term outcomes. Collecting systematic data on long-term outcomes across different areas of health and functioning is necessary worldwide to develop effective models for managing chronic diseases.

While clinical care and research has focused mainly on acute treatment, more attention needs to be given to understanding TBI as a chronic disease. Care models for chronic brain injury should consider long-term outcomes and how needs change over time. Monitoring of common health and functional challenges experienced by people who have had a TBI is critical.

Who may be affected by these findings? Individuals with TBI that required inpatient rehabilitation, family members, care partners, clinicians.

Caveats:The studies reviewed lack a control group that can be used as a comparison. Little is known about the care received after the person leaves the hospital. The participants all received inpatient rehabilitation, and so may not represent individuals who did not receive inpatient rehabilitation. The findings may not apply worldwide due to differences in care systems and access to care.

Bottom Line:The research by the TBI Model Systems of Care indicates that many people with TBI experience difficulties with everyday functioning, thinking and memory, other health conditions, psychological and social functioning. These difficulties can sometimes worsen over time. This information can be used to develop a chronic disease model to better serve people with TBI over their lifetime.

Find this study: Dams-O’Connor K, Juengst SB, Bogner J, Chiaravalloti ND, Corrigan JD, Giacino JT, Harrison-Felix CL, Hoffman JM, Ketchum JM, Lequerica AH, Marwitz JHl, Miller AC, NakaseRichardson R, Rabinowitz AR, Sander AM, Zafonte R, Hammond FM. Traumatic brain injury as a chronic disease: insights from the United States Traumatic Brain Injury Model Systems Research Program. Lance Neurology, 2023; 22(6):517-528.

An Umbrella Review of Self-Management Interventions for Health Conditions with Symptom Overlap with Traumatic Brain Injury

The Question:What can we learn from self-management interventions for other chronic health conditions that can be used by persons who have experienced TBI?

The Study:This research article reviews studies that investigated the effectiveness of self-management training for chronic health conditions that have similar symptoms to traumatic brain injury (TBI). Self-management training shows individuals how to manage their health conditions. They learn how to manage their symptoms, follow treatment recommendations, and engage in healthy behaviors.

The objective of the review is to provide recommendations for self-management interventions for individuals with TBI. The researchers conducted a thorough search of five databases and selected 26 reviews that met their inclusion criteria.

The reviews covered various chronic conditions and outcomes. Some high-quality reviews focused on self-management in individuals with stroke, chronic pain, and psychiatric disorders. The findings suggest that self-management interventions can improve quality of life, hope and confidence in one’s ability to manage their health condition. Self-management interventions can also reduce disability, relapse, and hospitalization rates, as well as improve pain management, psychiatric symptoms, and occupational and social functioning.

However, the reviews did not address how to adapt self-management interventions for individuals with difficulties with thinking or memory. They also did not address how to adapt the interventions for vulnerable populations such as those with low education and older adults. The researchers suggest that adaptations may be necessary to improve use by persons with TBI.

Who may be affected by these findings? Individuals with TBI, family members, care partners, clinicians.

Caveats: Only the seven reviews rated as having moderate or high quality were used for recommendations in this article. Additional information may be available in individual studies or in reviews that did not meet our quality criteria.

Bottom Line: Self-management interventions used for other health conditions could be effective with individuals with TBI, however they may need to be adapted to better fit their needs.

Find this study:: Sander AM, Pappadis MR, Bushnik T, Chiaravalloti ND, Driver S, Hanks R, Lercher K, Neumann D, Rabinowitz A, Seel RT, Weber W, Ralston RK, Corrigan JD, Kroenke K, Hammond FM. An umbrella review of self-management interventions for health conditions with symptom overlap with traumatic brain injury. Journal of Head Trauma Rehabilitation 2023; DOI: 10.1097/HTR.0000000000000863.

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This article originally appeared in Volume 17, Issue 2 of THE Challenge! published in 2023.