e72 Brain Injury

results were found for high-risk alcohol use (time, p<.001; severity X

time, pZ.022) and drug use (time, p<.001; severity X time, pZ.016).

The proportion of participants using drug pre-injury was greater in

moderate-severe than in mild TBI, but there was no difference in post-

injury use.

Conclusions: Substance use declined in the early months following

TBI but increased before the end of the first year. This was espe-

cially true for alcohol use in participants with mild injury. Given that

substance use may alter recovery, prevention strategies need to be

reinforced, even more so for individuals not getting inpatient

rehabilitation.

Key Words: Alcohol Drinking, Traumatic Brain Injury, Drugs of Abuse,

Substance-Related Disorders

Disclosure(s): None Disclosed.

Poster 218

Predictors of Post-Traumatic Amnesia Rehabilitation Outcomes

Sonja Blum (NYU), Liat Rabinowitz

Objective: To examine the predictive value of variables known at initial

assessment of patients in post-traumatic amnesia (PTA) on outcome of

acute inpatient rehabilitation.

Design: Retrospective study.

Setting: Acute inpatient rehabilitation at NYU medical center-Rusk

Rehabilitation.

Participants: Forty patients with traumatic brain injury who were in PTA

at admission to acute inpatient rehabilitation (29 male, 11 female; age

range 18-91; location of lesions: diffuse axonal injury 7.5% of subjects,

frontal lobe 91.9%, temporal lobe 59.5%, parietal 29.7% and occipi-

tal 8.1%).

Interventions: Not applicable.Main Outcome Measure(s): GOAT score, length of PTA, FIM, FAM,

requirement for neuroleptics (as correlate of behavioral disturbance).

Results: Initial GOAT score is predictive of length of PTA (inversely

related; pZ0.031). PTA length correlated negatively with discharge FIM

(pZ0.013) and FAM (pZ0.034). Almost all patients in PTA had a frontal

lobe lesion. Neither initial GOAT score nor length of PTA predicted

whether patients had a significant behavioral disturbance requiring neu-

roleptics at discharge from acute rehabilitation (14 patients discharged on

neuroleptics, 25 not, data missing 1).

Conclusions: A detailed examination of variables known at initial pre-

sentation to acute rehabilitation may be helpful in predicting outcomes of

acute rehabilitation. Initial GOAT score may be helpful in predicting PTA

length. From our small dataset we have some hints that looking at location

of lesion and requirements for neuroleptics may also be helpful in prog-

nosticating patient trajectories. Future studies on larger patient population

will be needed to confirm their utility in predicting outcomes of acute

rehabilitation.

Key Words: traumatic brain injury, post-traumatic amnesia, frontal

lobe, GOAT

Disclosure(s): None disclosed.

Poster 219

Self-Reports for Individuals with Severe Brain Injury

Sonya Kim (Rusk Institute of Rehabilitation Medicine),Joseph F. Rath, Vance Zemon, Marie M. Cavallo, Ana Sostre,Frederick W. Foley

Objective: To examine the usefulness of various self-reports of cognitive

impairment in individuals with severe chronic brain injury.

Design: Analysis of existing dataset.

Setting: Structured day program (SDP).

Participants: Fourteen individuals attending a SDP aged 23-63yrs.

(MdnZ44y/IQRZ22); time-post-onset 13-40yrs. (MdnZ22.5y/

IQRZ16.5); Halstead-Reitan-Impairment Index (MdnZ1/IQRZ.10)d0-

.3, normal; .4, borderline; .5-1.0, impaired.

Interventions: Community-based activities.

Main Outcome Measure(s): z-score of Problem Solving Inventory scales

(PSI), approach-avoidance (AA), problem-solving confidence (PSC), per-

sonal control (PC); Raw score of Problem-Solving-Checklist (PCL, �2

indicates problem is endorsed), affective/behavioral (A/B) and cognitive

(Cog) scales; Tscore of Behavioral Rating Inventory of Executive Func-

tions InventoryeAdult version: global executive functions composite

(GEC) (�65, impaired).

Results: PSI-AA scale was nearly -2SD below the mean. However, the

remaining self-reports fell in the unimpaired range:BRIEF-A-GEC

(MdnZ55.5/IQRZ31.75); PCL A/B(MdnZ .39/IQRZ.36), Cog (MdnZ.45/IQRZ.84); PSI-AA (MdnZ -1.87/IQRZ.88), PSI-PSC (MdnZ -.67/

IQRZ1.77), PSI-PC (MdnZ -.01/IQRZ.98). The PSI has been success-

fully usedin a number of studies where the patients using this instrument

were able to demonstrate awareness and meaningfully communicate their

core difficulties in solving problems (Rath et al., 2003; 2011; Heppner

et al., 2004).

Conclusions: These results indicate that self-report measures that ask in-

dividuals to assess their perceptions of their problem-solving could be

more useful than self-reports of actual problem-solving skills, such that

certain attitudes are likely more influential on the individual’s success in

solving problems. Future work could use PSI-AA as an outcome measure

for this population in a problem-solving-treatment study to see whether the

PSI-AA score changes in accordance with improved problem-

solving abilities.

Key Words: Self-reports, chronic brain injury, cognition

Disclosure(s): None Disclosed.

Poster 220

Characteristics of Community-based Treatment For Individuals WithBrain Injury

Sonya Kim (Rusk Institute of Rehabilitation Medicine),Marie M. Cavallo, Vance Zemon, Joseph F. Rath, Ana Sostre,Frederick W. Foley

Objective: To determine common characteristics of community-based

treatment programs (CBP) for individuals with brain injury.

Design: A search of peer-reviewed articles limited to the terms: commu-

nity-based rehabilitation/treatment and brain injury, followed by a com-

plementary data analysis of a CBP.

Setting: Community-based structured day program.

Participants: Fourteen individuals attending a CBP aged 23-63yrs

(MdnZ44/IQRZ22); time-post-onset 13-40yrs (MdnZ22.5/IQRZ16.5);

time enrolled in the CBP: 5mos-14.25yrs. (MdnZ5.88yrs/IQRZ7.67);

Halstead-Reitan-Impairment-Index (MdnZ1, IQRZ.10)d0-.3/normal, .4/

borderline, .5-1.0/impaired.

Interventions: Community-based activities.

Main Outcome Measure(s): Problem Solving Inventory, approach-

avoidance-scale/PSI-AA; Problem Solving Checklist/PCL, �2 indicates

problem is endorsed, affective/behavioral (A/B) andcognitive (Cog) scales;

Satisfaction with Life Scale/SWLS, 35Zhighly satisfied to 5Zextremely

dissatisfied; Rosenberg Self-esteem Scale/RSES, 10Zlow-self-esteem to

40Zhigh-self-esteem.

Results: Apart from taking place outside a clinic, no consensus of what

constituted “community-based treatment” emerged. In this specific CBP,

all participants were determined by severity of brain injury, time-post-

onset, high life satisfaction, healthy self-esteem, and no complaints of

impairment, except appraising their problem-solving ability as weak:

SWLS (MdnZ25, IQRZ10.75), RSES (MdnZ31/IQRZ7.25), PCL-A/B

(MdnZ.39/IQRZ.36), PCL-Cog (MdnZ.45/IQRZ.84); PSI-AA (MdnZ-1.87/IQRZ.88).

Conclusions: Participants attended this CBP for up to 14yrs, making one

characteristic of a CBP the potential lengthiness of its care. Taken together

with the participants’ relatively negative self-appraisal of problem-solving

ability, this characteristic could suggest a need for the reconceptualization

of the meaning of “rehabilitation outcomes,” where the appropriateness of

“discharge” [from treatment] is questioned.Future studies could examine

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