Longitudinal Head Injury Outcomes Study

Longitudinal Head Injury Outcomes Study

Longitudinal Head Injury Outcomes Study

Chief Investigator: Professor Jennie Ponsford
Lead Organisation: Monash University
TAC Neurotrauma Funding:
First Round – Sept 2007 – Dec 2010 $1,201,447
Second Round – Jan 2012 – Dec 2014 $1,025,213
Project Start Date: 25 September 2007

Project Summary:

The elucidation of the long-term problems experienced by those who sustain traumatic brain injury owes much to the Longitudinal Head Injury Outcome Project, which has been conducted at Epworth Hospital (formerly Bethesda) since1995. This study has created one of the largest TBI databases worldwide, providing comprehensive information regarding the difficulties experienced by these individuals and their families over long periods of time after injury.

Aims:

The overall objective of the study has been to document long-term outcome between 1 and 20 years following moderate to severe traumatic brain injury, to identify factors influencing outcome, to document the nature, predictors and consequences of psychiatric disturbances and alcohol and drug use following injury, to investigate the specific influence of age, genetic and cultural factors and living in regional Victoria on outcome and to examine the evolution of psychological adjustment and family adjustment over time, as a basis for enhancing rehabilitation programs and ongoing service provision.

Methods:

The study involved the conduct of follow-up interviews and completion of questionnaires documenting neurological, cognitive, behavioural and emotional changes, mobility, independence in activities of daily living, vocational and leisure activities and relationships, alcohol and drug use at 1,2,3,5, 10 and 20 years after injury. Cognitive tests of attention, memory and higher order thinking were completed 1 and 10 years after injury. A subgroup of patients had brain scanning.

Results so far (as at March 2012):

A total of 470 patients were added to the database and 787 follow-ups completed from September 2007-Sept ember2010, bringing the number of patients seen to 1942, with, 1199 having attended at one year, 1104 at two years, 742 at three years, 726 at five years, 309 at ten years, and 53 at twenty years post-injury. The database has been upgraded to a web-based system. The study has identified that problems with balance, fatigue, memory, attention, speed of thinking, planning and irritability as the most common and persistent problems which create difficulties with employment and study and independence in complex activities in the community, as well as social and leisure activities and relationships. The study has established predictors of brain injury severity and functional outcome including return to work, showing that increasing duration of post-injury confusion, increasing age, genetic factors and being from a non-English-speaking background all may be associated with poorer recovery or functional outcome, Anxiety and depression commonly occur in the first two years after injury, more often earlier in people with pre-existing psychiatric problems, but also in those without such a history. People with psychiatric disorders have poorer outcomes. Heavy alcohol and drug use are common pre-injury problems which re-emerge over the first two years after injury. Preventative strategies are to be encouraged. Family members who are in a caregiving role experience significant stress, which does not diminish over many years and has a negative impact on family functioning.

Conclusion:
The study has documented the most significant long-term problems and identified a number of factors which influence outcome following head injury. These findings will form the basis of intervention strategies to improve long-term outcomes in this vulnerable group.

Publications:

PONSFORD J, RUDZKI D, BAILEY K, NG KT. Impact of the Apolipoprotein gene on cognitive impairment and recovery following traumatic brain injury. Neurology. 2007;68(8):619-20.

DRAPER K, PONSFORD J, SCHÖNBERGER M. Psychosocial and Emotional Outcome Following Traumatic Brain Injury. Journal of Head Trauma Rehabilitation. 2007;22(5):278-287.

PONSFORD J, WHELAN R, BAHAR-FUCHS A. Alcohol and drug use following traumatic brain injury: A prospective study. Brain Injury. 2007;21:1385-1392.

SALTAPIDAS H & PONSFORD J. The Influence of Cultural Background on Motivation for and Participation in Rehabilitation and Outcome Following Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 2007;22(2):132-139.

PONSFORD J, DRAPER K, SCHÖNBERGER M. Functional outcome 10 years after traumatic brain injury: Its relationship with demographic, injury severity, cognitive and emotional status. Journal of the International Neuropsychological Society, 2008;14:233-242.

SALTAPIDAS H, PONSFORD J. The influence of cultural background on experiences and beliefs following traumatic brain injury and their association with outcome. Brain Impairment. 2008;9(1):1-13.

PONSFORD J, HILL B, KARAMITSIOS M, BAHAR-FUCHS A. Factors influencing outcome following orthopaedic trauma. Journal of Trauma, Injury Infection and Critical Care. 2008;64(4):1001-1009.

DRAPER K, PONSFORD, J. Cognitive Functioning and Outcome 10 Years Following Traumatic Brain Injury. Neuropsychology. 2008;22(5):618-625.

WHELAN-GOODINSON R, PONSFORD J, SCHÖNBERGER M. The association between psychiatric state and outcome following traumatic brain injury. Journal of Rehabilitation Medicine. 2008;40(10):850-857.

SENATHI-RAJA D, PONSFORD J, SCHONBERGER M. Association of age with long-term psychosocial outcome following traumatic brain injury. Journal of Rehabilitation Medicine. 2009;41(8):666-673.

WHELAN-GOODINSON R, PONSFORD J, SCHÖNBERGER, M. Validity of the Hospital Anxiety and Depression Scale to assess depression and anxiety following traumatic brain injury as compared with the Structured Clinical Interview for DSM-IV. Journal of Affective Disorders. 2009;114(1) 94-102.

DRAPER K, PONSFORD J. Long-term outcome following traumatic brain injury: A comparison of subjective reports by those injured and their relatives. Neuropsychological Rehabilitation. 2009;19(5):645-661.

GOODINSON R, PONSFORD J, JOHNSTON L, GRANT F. Psychiatric disorders following traumatic brain injury: Their nature and frequency. Journal of Head Trauma Rehabilitation. 2009;24(5):324-332.

WHELAN-GOODINSON R, PONSFORD J, SCHÖNBERGER M, JOHNSTON L. Predictors of psychiatric disorders following traumatic brain injury. Journal of Head Trauma Rehabilitation. 2009;24(5):324-332.

SCHÖNBERGER M, PONSFORD J, REUTENS D, BEARE R, O’SULLIVAN R. The relationship between age, injury severity and MRI findings following traumatic brain injury. J Neurotrauma. 2009;26(12):2157-2167.

SCHÖNBERGER M, PONSFORD J. The factor structure of the Hospital Anxiety and Depression Scale in individuals with Traumatic Brain Injury: A Multi-Trait Multi-Method approach. Psychiatry Research. 2010;179(3):342-9.

SENATHI-RAJA D, PONSFORD J, SCHÖNBERGER M. The association of age and time post-injury with long-term emotional outcome following TBI. Journal of Head Trauma Rehabilitation. 2010;25(5):330-338.

SCHÖNBERGER M, PONSFORD J, OLVER J, PONSFORD M. A longitudinal study of family functioning after TBI and relatives’ emotional status. Neuropsychological Rehabilitation. 2010;20(6):813-29.

SENATHI-RAJA D, PONSFORD J, SCHÖNBERGER M. Impact of age and time post-injury on long-term cognitive function after traumatic brain injury. Neuropsychology. 2010;24(3):336-344.

WHELAN-GOODINSON R, PONSFORD,J, SCHÖNBERGER M, JOHNSTON L. Predictors of psychiatric disorders following traumatic brain injury. Journal of Head Trauma Rehabilitation. 2010;25(5):320-329.

PONSFORD J, SCHÖNBERGER M. Long-term family functioning following traumatic brain injury. Journal of the International Neuropsychological Society. 2010;16:306-317.

PONSFORD, J, OLVER J, PONSFORD M, SCHÖNBERGER M. Two-Year Outcome Following Traumatic Brain Injury and Rehabilitation: A Comparison of Patients from Metropolitan Melbourne and Those Residing in Regional Victoria: 2010;11(3)253-261.

GOULD K, PONSFORD J, SCHÖNBERGER M, JOHNSTON L. Predictors and associated factors of psychiatric disorders following traumatic brain injury. Journal of Neurotrauma. 2011;28:1155-1163.

GOULD K, PONSFORD J, SCHÖNBERGER M, JOHNSTON L. The relationship between psychiatric disorders and one-year psychosocial outcome. Journal of Head Trauma Rehabilitation. 2011;26(1)79-89.

SCHÖNBERGER M, PONSFORD J, OLVER J, PONSFORD M, WIRTZ M. Prediction of functional and employment outcome one year after Traumatic Brain Injury: A Structural Equation Modelling approach. Journal of Neurology, Neurosurgery and Psychiatry. 2011; 82(8):936-41.

SCHÖNBERGER M, PONSFORD J, REUTENS D, BEARE R, CLARKE D, O’SULLIVAN R. The relationship between mood disorders and MRI findings following traumatic brain injury. Brain Injury. 2011;25(6):543-50.

GOULD K, PONSFORD J, SCHÖNBERGER M, JOHNSTON L. The Nature, Frequency and Course of Psychiatric Disorders in the First Year after Traumatic Brain Injury, a Prospective Study. Psychological Medicine. 2011;41(10):2099-109.

Presentations:

PONSFORD J, WHELAN-GOODINSON R. Psychiatric disorders following traumatic brain injury. International Neuropsychological Society Conference; 2007 July 4-7, Bilbao, Spain.

PONSFORD J. Psychiatric disorders following traumatic brain injury. BIRT conference: Looking ahead: Innovations in Brain Injury Rehabilitation; 2007 September 26-28, Leeds, UK.

WHELAN-GOODINSON R, PONSFORD J, SCHONBERGER M. Psychiatric Disorders following traumatic brain injury. Allied Health Trauma Symposium, NTRI; 2007 November 7, Melbourne, Australia.

PONSFORD J, DRAPER K. Cognitive functioning and outcome ten years following traumatic brain injury. 35th Annual Meeting of the International Neuropsychological Society; 2007 February 7-10, Portland, Oregon, USA.

WHELAN-GOODINSON R, PONSFORD J, JOHNSTON L, GRANT F. Psychiatric Disorders following traumatic brain injury. World Congress of Psychiatry; 2007 November 25, Melbourne, Australia.

PONSFORD J, DRAPER K, SCHÖNBERGER M. Functional Outcome Ten Years following traumatic brain injury: Its relationship with demographic, injury severity, cognitive and emotional status. Best of Both Worlds: Partnerships in Rehabilitation Conference; 2007 November 14-16, Melbourne, Australia.

GOULD K, PONSFORD J, JOHNSTON L. Psychiatric disorders following traumatic brain injury. The best of both worlds: Partnerships in Rehabilitation Conference; 2007 November 14-16, Melbourne, Australia.

WHELAN-GOODINSON R, PONSFORD J, GRANT F. Psychiatric disorders following traumatic brain injury. 30th Annual Conference of the Australian Society for the Study of Brain Impairment; 2007 May 3-5, Brisbane, Australia.

PONSFORD J, WHELAN R, GOULD K, JOHNSTON L, & SCHÖNBERGER M. Psychiatric disorders following traumatic brain injury. Seventh World Congress on Brain injury; 2008 April 9-11, Lisbon, Portugal.

OLVER JH. The effects of aging on outcome. 5th World Congress of NeuroRehabilitation; 2008 September 24-27, Brasilia, Brazil.

PONSFORD J. Long-term outcome following traumatic brain injury. Trauma Melbourne; 2008 November 21-22, Melbourne, Australia.

SENATHI-RAJA D, PONSFORD J, SCHÖNBERGER M. The influence of age on cognitive and emotional outcome following traumatic brain injury. 5th World Congress for NeuroRehabilitation; 2008 September 24-27, Brasilia, Brazil.

PONSFORD J, WHELAN R, JOHNSTON L. Psychiatric disorders following traumatic brain injury. 5th World Congress for NeuroRehabilitation; 2008, September 24-27, Brasilia, Brazil.

PONSFORD, J. Community-based rehabilitation following traumatic brain injury. Fifteenth Annual Brain Injury Conference; 2008 June 19-20, Minnesota, USA.

PONSFORD, J. Effects of age on long-term functional outcome following traumatic brain injury. 31st Brain Impairment Conference; 2008 May 1-3, Melbourne, Australia.

SCHÖNBERGER M, PONSFORD J, REUTENS D, BEARE R, & O’SULLIVAN R. The relationship between age and MRI findings following traumatic brain injury. 31st Brain Impairment Conference; 2008 May 1-3, Melbourne, Australia.

OLVER J. Medical and psychosocial sequelae in the long term following traumatic brain injury. 1st Asian Oceania Conference of Physical and Rehabilitation Medicine; 2008 May 16-19, Nanjing, China.

PONSFORD J, DRAPER K, & SCHÖNBERGER M. Psychosocial and emotional outcome ten years following traumatic brain injury. 36th Annual Meeting of the International Neuropsychological Society; 2008, February 5-8, Hawaii, USA.

SENATHI-RAJA D, PONSFORD J, & SCHÖNBERGER M. The effect of age on long-term cognitive and emotional outcome following traumatic brain injury. 31st Brain Impairment Conference; 2008 May 1-3, Melbourne, Australia.

PONSFORD J. Psychiatric disorders and alcohol use following traumatic brain injury: Their nature and Management. 32nd Brain Impairment Conference; 2009 May 7-9, Sydney, Australia.

SENATHI-RAJA D, PONSFORD J, SCHÖNBERGER M. The influence of age on functional outcome following traumatic brain injury. 32nd Brain Impairment Conference; 2009 May 7-9, Sydney, Australia.

DAHM J, PONSFORD J, WONG D, SCHÖNBERGER, M. Utility of the Depression Anxiety Stress Scales in assessing depression and anxiety following traumatic brain injury. 44th Annual Meeting of the Australian Psychological Society; 2009 September 30- October 4, Darwin, Australia.

GOULD K, PONSFORD J, JOHNSTON L, & SCHÖNBERGER M. Psychiatric disorders following traumatic brain injury. Sixth Satellite Conference on Neurorehabilitation; 2009 August 2009, Tallinn, Estonia.

SCHÖNBERGER M, PONSFORD J, REUTENS D, BEARE R, & O’SULLIVAN R. The relationship between age, injury severity and MRI findings following traumatic brain injury. Sixth Satellite Conference on Neurorehabilitation; 2009 August 3-4, Tallinn, Estonia.

SCHÖNBERGER M, PONSFORD J. The factor structure of the Hospital Anxiety and Depression Scale. International Neuropsychological society 2009 July 29-August 1, Helsinki, Finland.

PONSFORD J, WILLMOTT C. Rehabilitation of attention following traumatic brain injury: A model for Methylphenidate. Sixth Satellite Conference on Neurorehabilitation; 2009 August 3-4, Tallinn, Estonia.

SCHÖNBERGER M, PONSFORD J, HARRINGTON H, WONG D, MCKAY A, MEALINGS M, LAMBERT S. Psychological adjustment to traumatic brain injury in the early phase of community-based rehabilitation. International Neuropsychological society; 2009 July 29- August , Helsinki, Finland.

OLVER J. Evaluating functional outcomes after the use of botulinum toxin for spasticity post acquired brain injury – an Australian experience. Second Asia-Oceanian Conference of Physical and Rehabilitation Medicine; 2010 April 29-May 2, Taipei, Taiwan.

PONSFORD J. Meaningful long-term outcomes following traumatic brain injury. Trauma 2010; 2010 November 19-21, Melbourne, Australia.

GOULD K, PONSFORD J, JOHNSTON L, SCHÖNBERGER M. The course of psychiatric disorders following traumatic brain injury. Best of Both Worlds Rehabilitation 2010 Conference; 2010 October 6-8, Melbourne, Australia.

PONSFORD J, MCLAREN A, RUDZKI D, BURKE R, SCHÖNBERGER M, OLVER J, PONSFORD M. The relationship between ApoE e4 genetic status and outcome following traumatic brain injury. Best of Both Worlds Rehabilitation 2010 Conference; 2010 October 6-8, Melbourne, Australia.

PONSFORD J, MCLAREN A, RUDZKI D, BURKE R, SCHÖNBERGER M, OLVER J, PONSFORD M. The relationship between ApoE e4 genetic status and outcome following traumatic brain injury. Mid-Year meeting of the International Neuropsychological Society; 2010 June 30-July 3, Krakow, Poland.

SCHÖNBERGER M, PONSFORD J. Prediction of psychosocial outcome one year after traumatic brain injury: A Structural Equation Modelling Approach. 33rd Annual Brain Impairment Conference; 2010 May 6-8, Surfer's Paradise, Australia.

PONSFORD J, MCLAREN A, RUDZKI D, BURKE R, SCHÖNBERGER M, OLVER J, PONSFORD M. The relationship between ApoE e4 genetic status and outcome following traumatic brain injury. 33rd Annual Brain Impairment Conference; 2010 May 6-8, Surfer's Paradise, Australia.

GOULD K, PONSFORD J, JOHNSTON L, SCHÖNBERGER M. The course of psychiatric disorders following traumatic brain injury. Eighth World Congress on Brain Injury; 2010 March 10-14, Washington DC, USA.

PONSFORD J, MCLAREN A, RUDZKI D, BURKE R, SCHÖNBERGER M, OLVER J, PONSFORD M. The relationship between ApoE e4 genetic status and outcome following traumatic brain injury. Eighth World Congress on Brain Injury; 2010 March 10-14, Washington DC, USA.

PONSFORD J. The Nature and treatment of mental health problems following traumatic brain injury. Eighth World Congress on Brain Injury; 2010 March 10-14, Washington DC, USA.

PONSFORD J, MCLAREN A, RUDZKI D, BURKE R, SCHÖNBERGER M, OLVER J, PONSFORD M. The relationship between ApoE e4 genetic status and outcome following traumatic brain injury. Sixth World Congress for Neurorehabilitation; 2010 March 21-25, Vienna, Austria.

OLVER J. Outcomes following traumatic brain injury. 8th Mediterranean Physical & Rehabilitation Medicine Congress; 2010 September 29-October 2, Limassol, Cyprus.