Article Abstracts
Ashley, M. and Persel, C. (1999). Traumatic Brain Injury Recovery Rates in Post-Acute Rehabilitation: Spontaneous Recovery or Treatment?. Journal of Rehabilitation Outcomes Measurement, 3(4), 15-21. [order reprint]
The purpose of this study was to investigate rates of recovery following traumatic brain injury, its relationship to chronicity (time-from-injury), and spontaneous recovery. Subjects were divided into three chronicity groups (<6 months; 6-18 months; >18 months) for analysis. Results indicated that the groups were equivilant on admission rating scale scores. At discharge, the shortest chronicity group was significantly less disabled, more independent, and less costly to rehabilitate than other groups. Significant improvement past spontaneous recovery time spans was also demonstrated. The findings suggest a relationship between chronicity and rate of recovery, as well as rehabilitation outcome apart from spontaneous recovery.
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Ashley, M., Schultz, J., Bryan, V., Krych, D. and Hays, D. (1997). Justification of Postacute Traumatic Brain Injury Rehabilitation Using Net Present Value Techniques: A Case Study. Journal of Rehabilitation Outcomes Measurement, 1(5), 33-41. [order reprint]
Current developments in managed care have had a substantial impact on traumatic brain injury (TBI) rehabilitation services. Some recent studies have questioned whether the trend toward shorter lengths of stay and reduced program costs will result in true lifetime cost savings. The purpose of this study wsa to examine the cost effectiveness of postacute TBI rehabilitation utilizing the financial measures of Total Lifetime Savings (TLS) and the more sophisticated Net Present Value (NPV). Results indicated that NPV techniques allow for an evaluation of rehabilitation proposals from a quantitative perspective, giving appropriate consideration to rehabilitation costs and long-term savings.
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Persel, C.S., Persel, C.H., Ashley, M.J. and Krych, D.K. (1997). The Use of Noncontingent Reinforcement and Contingent Restraint to Reduce Physical Aggression and Self-Injurious Behavior in a Traumatically Brain Injured Adult. Brain Injury, 11(10), 751-760. [order reprint]
Many different intervention programmes for reducing undesirable behavior with people with traumatic brain injury (TBI) have been investigated in recent years. The purpose of this study was to examine the potential of using noncontingent (NCR) in combination with contingent restraint to reduce severe behaviour. The subject (E.L.) was a 40-year-old male with TBI admitted to a rehabilitation long-term care programme. E.L. had a history of physical aggression (PA) and self-injurious behaviour (SIB). Assessment conditions included a descriptive analysis, response scatterplot and Self-Injury Trauma (SIT) Scale. Attention was identified as the maintaining positive reinforcement for PA and SIB. Treatment conditions were compared using a reversal (ABAB) design. Attention (NCR) was delivered on a fixed-time schedule that was not dependent on the subject's behaviour. Contingent restraint was applied when E.L. exhibited PA or SIB that was dangerous to himself or others. During treatment, PA occurred over 4 times less often and SIB over 2.5 times less often. Results demonstrated that PA and SIB were sensitive to NCR. NCR can be an effective procedure for reducing severe behaviour maintained by socially-mediated positive reinforcement.
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Ashley, M.J., Persel, C.S., Clark, M.C. and Krych, D.K. (1997). Long-Term Follow-Up of Post-Acute Traumatic Brain Injury Rehabilitation: A Statistical Analysis to Test for Stability and Predictability of Outcome. Brain Injury, 11(9), 677-690. [order reprint]
A high percentage of the estimated 500,000 traumatic brain injuries (TBI) in the US every year occur with young people who will face many years of neurobehavioral and economic consequences. This study examined the long-term stability of outcome after post-acute TBI rehabilitation and possible predictors of long-term outcome based on a 127-item survey of 332 clients up to 14 years post-discharge. Correlational, factor, and mulitple regression analysis indicated positive long-term outcome stability following rehabilitation with the exception of vocational status, which decreased over the same time period. A number of possible explanations for this occupational anomaly are suggested. Rating scale scores and latency-to-rehabilitation proved to be better predictors of long-term outcome than demographic data.
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Ashley, M.J., Persel, C.S. and Krych, D.K. (1997). Long-Term Follow-Up of Postacute Traumatic Brain Injury Rehabilitation: An Assessment of Functional and Behavioral Measures of Daily Living. Journal of Rehabilitation Outcomes Measurement, 1(4), 40-47. [order reprint]
One of the most important questions facing the field of traumatic brain injury (TBI) rehabiliation today concerns the long-term outcome of persons with TBI. The purpose of this study was to examine the effects of postacute TBI rehabilitation over a period of time extending to 15 years postdischarge. A 127-item questionnaire was utilized to survey 332 persons who had completed postacute TBI rehabilitation. Results indicated that many of the gains achieved in rehabilitation remained stable through the time of follow-up. Vocational status was one of the measures found to be unstable at follow-up.
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Little A.J., Templer D.I., Persel C.S. and Ashley M.J. (1996). Feasibility of the Neuropsychological Spectrum in Prediction of Outcome Following Head Injury. Journal of Clinical Psychology, 52(4), 455-460. [no reprints available at this time]
This study provided further substantiation of the neuropsychological spectrum conceptualization (Templer, Campodonico, Trent, Spencer, & Hartlage, to appear;Templer, Spencer, & Hartlage, 1993; Templer, Campodonico, Trent, & Spencer, 1991). Two hundred and two traumatic brain injury patients were administered the Wechsler Adult Intelligence Scale-Revised, the Luria-Nebraska Neuropsychological Battery, the Wisconsin Card Sorting Test, the Booklet Category Test, and Trails A and B. The correlations between neuropsychological and intellectual tests were significantly lower than the correlations within intelligence tests and within neuropsychological tests. Neuropsychological tests predicted outcome better than intelligence tests. This was interpreted in terms of outcome for severely brain-damaged patients being more dependent upon basic neuropsychological functioning than on abstract thinking ability.
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Ashley, M.J., Persel, C.S., Lehr, R.P., Feldman, B. and Krych, D.K. (1994). Post-Acute Rehabilitation Outcome: Relationship to Case-Management Techniques and Strategy. Journal of Insurance Medicine, 26(3), 348-354. [view or download] Requires Adobe Acrobat Reader. Free download here.
Successful outcome for the traumatically brain-injured (TBI) patient is dependent on both a productive clinical therapy program and an effective case-management strategy by the carrier. This retrospective study focuses on identifying those case-management techniques which contributed to improvement in the disability, living and occupational status of patients in a post-acute rehabilitation program. Statistical analysis indicated a positive relationship between two case-management factors and improved patient outcome. Additional analysis demonstrated predictive qualities of specific admission data for patient program cost. A review of these case-management techniques and their impact on discharge disability, living and occupational status will be discussed.
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Ashley, M.J., Persel, C.S. and Krych, D.K. (1993). Changes in Reimbursement Climate: Relationship Among Outcome, Cost and Payor Type in the Postacute Rehabilitation Environment. The Journal of Head Trauma Rehabilitation, 8(4), 30-47. [no reprints available at this time]
A number of investigations have been published that examine the efficacy of postacute rehabilitation for patients who have sustained traumatic brain injuries (TBIs). These studies have generally indicated that this level of care is effective in improving overall levels of independence for this patient population. In light of these findings, however, payors and families are requesting justification for perceived high program costs. This retrospective study investigated the outcomes of patients admitted to a postacute TBI rehabilitation facility and analyzed the relationship of these outcomes to the changing economic and reimbursement climate. Results from the study suggest that while costs of patient treatment decreased slightly over the years, greater disability reduction and improvements in living status were achieved by treatment in the latter years of this study. These findings are discussed in relation to previous research with regard to long-term versus short-term cost savings for the catastrophic TBI patient. Differences between payor types for disability reduction and living status, together with differences in program cost and length, were observed. These data suggest an association between rehabilitation effort and outcome.
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Ashley, M.J. and Krych, D.K. (1990). Considerations in the Purchase of Post-Acute Rehabilitative Services for the Head Injured. Journal of Insurance Medicine, 22(3), 230-234. [view or download] Requires Adobe Acrobat Reader. Free download here.
Rehabilitation for the traumatically brain-injured patient has undergone tremendous growth and change in the last ten years. Innovative treatment techniques and treatment environments have developed, outpacing the consumer's ability to monitor efficacy. This paper provides discussions of numerous parameters which may impact the operation and efficacy of post-acute rehabiliation programs for the traumatically brain-injured patient.
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Ashley, M.J., Krych, D.K. and Lehr, R.P. (1990). Cost/Benefit Analysis for Post-Acute Rehabilitation of the Traumatically Brain-Injured Adult. Journal of Insurance Medicine, 22(2), 156-161. [view or download] Requires Adobe Acrobat Reader. Free download here.
Outcome studies related to the post-acute rehabilitation of the traumatically brain injured (TBI) have focused on quality-of-life issues. There has been little attention paid to cost/benefit relationships. Two-hundred-eighteen patients were rated at admission and discharge on the Disability Rating Scale (DRS) and on a living status scale. Costs of care in different living status settings (private living quarters with professional help, long-term care facility, psychiatric hospital, etc.) were obtained and analyzed by the two scales to demonstrate the cost/benefit relationships. The study showed a statistically significant benefit and cost savings, over time, for those patients receiving post-acute rehabiliation. These benefits are in addition to improved quality-of-life benefits. In the last ten to twelve years, rehabilitation has seen the introduction and maturation of an entirely new subspecialty: head-injury rehabilitation. Major emphasis has been placed on improving acute medical care for and rehabilitative management of the traumatically brain injured (TBI) patient. Perhaps of equal importance has been the developments of post-acute rehabilitation programs for these patients.
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