The work of a research team led by principal investigator Mark Sherer, PhD, ABPP, FACRM, has resulted in the development of a web-based resource created to help clinicians working with persons with traumatic brain injury (TBI) develop case conceptualizations and consider treatment options. Practitioners can access TBI ACTION (Traumatic Brain Injury Assessment Conceptualization Therapeutic Intervention Options Narrative) at http://tbiaction.tbindsc.org.
“The typical TBI ACTION user is a psychologist or neuropsychologist who conducts cognitive testing in a rehabilitation setting,” says Dr. Sherer, senior scientist and associate vice president for research at TIRR Memorial Hermann and a clinical professor of physical medicine and rehabilitation at Baylor College of Medicine and at McGovern Medical School at UTHealth. “Once clinicians have the results of a client’s cognitive processing, memory and verbal fluency tests, they can enter the scores on the website. There are 12 questionnaires on the site, which can be completed by the client in 30 to 40 minutes. An algorithm combines the test and questionnaire scores to describe the dimensions that represent key indicators of recovery from TBI, including cognitive processing speed, verbal fluency, self-reported cognitive symptoms, independence and self-esteem, resilience, emotional distress, post-concussive symptoms, physical symptoms, physical functioning and economic and family support.”1
The website grew out of a research project funded by the 2010 Rehabilitation Research and Training Center grant on Developing Strategies to Foster Community Integration and Participation for Individuals with Traumatic Brain Injury. The $4.2 million grant awarded to researchers at TIRR Memorial Hermann by the National Institute on Disability and Rehabilitation Research funded three research projects and five training projects. Among them was Dr. Sherer’s study, “Development and Validation of a Classification System of Symptoms and Characteristics to Guide Treatment Assignments for Persons with TBI Living in the Community.” The ultimate aim of the study was the creation of a web-based classification system that can be used to recommend the type of treatment most likely to provide the greatest benefit to persons with TBI. Participants for the study were recruited from three centers following discharge from neurosurgery and inpatient rehabilitation programs: TIRR Memorial Hermann, Rehabilitation Institute of Michigan at Wayne State University, and Spain Rehabilitation Center at the University of Alabama at Birmingham.
After identifying the dimensions, the researchers conducted a cluster analysis to determine the number of groups they could derive from a large cohort of 504 people with TBI. Five groups emerged.2 In May 2014, they assembled a consensus group of 17 experts from around the country and Australia at the Galveston Brain Injury Conference to review draft descriptions of the five groups and develop lists of therapeutic options. The experts’insights form the basis of the website, which allows practitioners to apply data gained from research directly to their clinical practice.
Dr. Sherer views the website as an assist to clinical judgment. “Clinicians can use the website to get a description of their client, treatment options, the average profile of group members and an individual profile of their client, allowing them to compare the characteristics of their client to people assigned to the group,” he says. “Each client is an individual who won’t necessarily fit precisely into any of the five groups. In the end, clinicians have to use their judgment in applying the information available on the website.”
Use of the website is free, secure and HIPAA compliant. “Clinicians have a good idea of what’s going on with their clients,” he says. “The site allows them to compare their own measures with those of a team of expert researchers. We hope the information we’ve provided will spur some new ways of thinking that ultimately will improve outcomes for people with TBI.”
1Sherer M, Sander AM, Nick TG, Melguizo MS, Tulsky DS, Kisala P, Hanks R, Novack TA. Key Dimensions of Impairment, Self-Report, and Environmental Supports in Persons with Traumatic Brain Injury. Rehabilitation Psychology 2015 May;60(2):138-46.
2Sherer M, Nick TG, Sander AM, Melguizo M, Hanks R, Novack TA, Tulsky D, Kisala P, Luo C, Tang X. Groupings of Persons with Traumatic Brain Injury: A New Approach to Classifying Traumatic Brain Injury in the Post-Acute Period. Journal of Head Trauma Rehabilitation. 2015 Dec 24. [Epub ahead of print]