Psychobiological Treatment Response to a Two-Week Posttraumatic Stress Disorder and Mild Traumatic Brain Injury Integrated Treatment Program: A Case Report

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) demonstrate high prevalence and comorbidity among post-9/11 veterans. Veterans with this comorbidity often present with multiple co-occurring healthcare needs and increased clinical complexity. The current case report describes the clinical presentation of a veteran with mild TBI and PTSD, both before, during, and after treatment within a multidisciplinary 2-week intensive outpatient program involving prolonged exposure, evidence-based PTSD treatment, and Cognitive Symptom Management and Rehabilitation Therapy, evidence-based treatment for postconcussive symptoms. Mr. A was a 25-year-old White, transgender male who presented with a complex mental health history. At intake, presenting complaints included anxiety, panic attacks, nightmares, and depression secondary to military sexual trauma, as well as reported cognitive difficulties secondary to a concussion. He met current criteria for PTSD as well as panic disorder with agoraphobia. Head injury history consisted of a motor vehicle collision with less than 30 seconds loss of consciousness, brief posttraumatic amnesia, and alterations of consciousness. Mr. A demonstrated habituation during individual exposure sessions as assessed via skin conductance during imaginal exposures and decreased subjective ratings during in vivo exposures, as well as a decrease in trauma-potentiated startle response to trauma cues. Posttreatment data indicates significant reduction in neurobehavioral, posttraumatic stress, and depression symptoms and significant improvement in subjective cognitive functioning. The current findings support the feasibility and efficacy of short-term integrated treatment for complex clinical presentations and the need for larger scale research investigating combined PTSD and TBI intervention.     

The effects of video feedback on running form

Correct running form is important for injury prevention; as such, correct form promotes continued engagement in running as a long-term form of exercise. Researchers have shown video feedback to be an effective strategy to improve athletic form for a variety of sports, but it has not been evaluated in any behavior analytic research as a method for improving running form. The purpose of this study is to evaluate the effectiveness of video feedback to improve running form for regular runners. During baseline, each participant was video recorded while running without any feedback (verbal or video). During intervention, the researcher recorded the participant, then showed them the video and provided feedback on correct or incorrect form, according to a 9-step task analysis. Results show that all three participants achieved 100% correct steps on the task analysis when video feedback was used to maintain their form during follow-up.     

Traumatic Brain Injury in School-Age Children Academic and Social Outcome

School-aged children with a traumatic brain injury (TBI) require extraordinary effort and energy from individuals in their school, home, and community. The purpose of this study was to examine the academic, behavioral, and social outcomes of a cohort of children and adolescents following TBI. A comprehensive assessment of cognitive functioning, achievement, and adaptive behavior was administered to 43 school-aged children 2 years after their TBI. Premorbid functioning for each participant was obtained from state-mandated test scores assessed prior to the TBI. The predictive utility of premorbid functioning, TBI severity, and age at injury were examined. Findings revealed that premorbid functions were significant predictors of reading and spelling achievement and adaptive functioning. Severity of injury was predictive of adaptive functioning. Implications of findings include program development, reintegration into school, and educating parents and teachers.     

Reducing risk of head injury in youth soccer: An extension of behavioral skills training for heading

Recently, concerns regarding sport-related concussions have increased within the research literature, the media, and popular culture. One potential source of soccer-related concussions involves the purposeful striking of the ball with one's head (i.e., heading). There is currently limited research on an effective teaching method to improve safe heading technique. In the current study, Behavior Skills Training (BST) was evaluated as a method to teach correct heading techniques to youth soccer players. BST increased the percentage of correct steps for each player based on a task analysis of heading. Based on social validity questionnaires administered to players and the coach, BST was rated as an acceptable form of training. After the final training session, experienced coaches rated each player as having improved from baseline to training.     

Traumatic Brain Injury Outcome in Older Adults: A Critical Review of the Literature

This paper is a critical overview of the literature on older adults' outcome after traumatic brain injury (TBI). Eighteen outcome studies were reviewed. Results indicated that older patients demonstrated an increased risk for negative outcome following TBI when compared to younger patients with similar injury severity. Poorer outcome was characterized by higher mortality rates, decreased likelihood of returning to preinjury living arrangement, and declines in cognitive and affective functioning. In the studies reviewed, discharge destination, global outcome scales, and standardized neuropsychological tests were the primary measures of outcome from elderly TBI. Conceptual and methodological difficulties including variability in the definition of and inadequate measures of recovery from elderly TBI, inadequate control groups, and poor follow-up were discussed. Recommendations for future outcome research to increase uniformity in defining recovery in order to enhance comparability between studies and to tailor cognitive rehabilitation to the special needs of the older TBI patient were provided.     

DECREASING CHILDREN'S RISK TAKING ON THE PLAYGROUND

Playground mishaps are some of the most common sources of injury and are the leading killer of children. The present study used a multiple baseline design across three classrooms (N = 379 children). With minimal teaching and rewards, children decreased and maintained decreased risky playground behaviors on slides. Floor effects on climbers prevented the demonstration of similar effects. The decreases seen in risky slide behavior are discussed within the context of preventive safety training for playground injuries.     

Proximal and distal effects of play on child compliance with a brain-injured parent.

Individuals with brain injury may experience severe cognitive and other impairments. For brain‐injured parents, such deficits may be associated with child behavior problems, including noncompliance. We assessed the effects of a play period conducted by a brain‐injured father on the compliance of his son, who had become uncooperative with his father after the injury. The child consistently demonstrated improved compliance during proximal and distal compliance sessions that followed father‐son play periods.     

Psychopathy and behavioral correlates of victim injury in serious juvenile offenders

The study examines delinquent behavior and psychopathy and assesses their relationship to victim injury in a population of 168 incarcerated juvenile delinquent males with lengthy histories of criminal and violent behavior. A series of multiple regressions found that 17% of the variance associated with level of victim injury was accounted for by a model that included the three-factor model of the Psychopathy Checklist: Youth Version [Forth, Kosson, and Hare, 2003], criminal versatility, and age of onset of criminal offending. Notably, anger and DSM-IV symptoms of conduct disorder were not related to level of victim injury. The results of this study support an escalation hypothesis where individuals with earlier onset to criminal behavior and greater criminal versatility escalate to more severe violence. The current results demonstrate the importance of integrating established theories of juvenile delinquency when explaining severe violence in youth.     

Modeling the Ecological Validity of Neurocognitive Assessment in Adults with Acquired Brain Injury

Neuropsychologists are increasingly asked to make judgments regarding treatment options and rehabilitation strategies in addition to evaluating the degree and scope of neuropsychological impairment following acquired brain injuries. The capacity to make informed clinical decisions relies upon research investigating the relationships between neuropsychological and psychosocial status (i.e., ecological validity). Unfortunately, much of this research employs exploratory analyses, an approach that can lead to theoretical ambiguity and ad-hoc interpretations. The current availability and accessibility of analytical tools, like structural equation modeling (SEM), however, permits the testing of specific hypotheses regarding ecological validity and promotes a-priori theory development. In the current study, a theory-driven model of the ecological validity of a neurocognitive assessment was tested against data obtained from individuals with acquired brain injury using SEM. The results provide confirmatory evidence for the ecological validity of neurocognitive constructs and empirical support for a theory-driven analytical approach to ecological validity research.     

Preliminary evaluation of a parent training program to prevent gun play

Recent research has shown that behavioral skills training with in situ training is an effective strategy to teach children the safety skills needed if they ever encounter an unattended firearm. The current study evaluated the use of parents as trainers to increase the efficiency of training. The success of parent training on their children's safety skills was evaluated in a multiple baseline across participants design. The results showed that the training was effective for 3 of the 4 children.