The Medical/Research sessions were chosen for their primary focus on medical issuers or research. Other concurrent and poster sessions may also include medical and/or research content.

Download PDF file of PCBIC 2007 Friday Program
Download PDF file of PCBIC 2007 Saturday Program

The Medical/Research sessions were chosen for their primary focus on medical issuers or research. Other concurrent and poster sessions may also include medical and/or research content.

Medical/Research Sessions - Friday, February 16, 2007

Start time 1030
End Time 1125
Session MR1
Psychiatric Illness Following TBI, Diagnosis and Treatment
Presenter(s)
Derryck Smith, MD - Childrens and Women's Hospital - Vancouver,BC

Objective
To identify the major psychiatric illnesses and their treatment following TBI.

Abstract
Psychiatric illness, particularity depression, has an increased incidence following TBI, probably as a direct consequence of damage to the frontal lobes. This damage can also lead to personality changes and attentional problems. This paper will identify the diagnoses and treatment options for these conditions.

Target Audience
Survivors
Service Providers
Medical

Start time 1130
End Time 1200
Session MR2
Delirium After Traumatic Brain Injury: The Results of Implementing of a Pilot Best-Practice Protocol
Presenter(s)
Dimitri Bollegala, - University of Toronto - Toronto,ON
Shree Bhalerao, MD - St. Michael's Hospital & University of Toronto - Toronto,ON

Objective
Participants will follow the development and implementation of an evidence-based, pharmacological/ non-pharmacological best-practice protocol for the treatment of delirium in patients who have undergone traumatic brain injury. Participants will learn of the challenges and benefits associated with implementing a similar protocol in their own practices, which will ultimately help them to improve the detection and treatment of delirium in their patients.

Abstract
Delirium is a medical condition involving a change in the level of consciousness and cognitive function of a patient due to an underlying injury, and it affects an estimated 10 to 30 percent of hospitalized patients with a medical illness, with increased prevalence in the elderly. To address the lack of research into the implementation of an evidence-based best-practice protocol for the treatment of delirium in patients with traumatic brain injuries, this study was undertaken. A pharmacological/ non-pharmacological best-practice protocol for the treatment of delirium was formulated through review of literature, and implemented with the aim of achieving several goals. Among them were the goals of reducing the incidence and severity of delirium in patients with TBI, increasing the detection of delirium in TBI patients by bedside nurses, and uncovering the difficulties in implementing the protocol so that other institutions that implement the same protocol would have foresight as to the problems they may face. The study ran for a two-month period, including a one-month control period to collect baseline data on the presence of delirium in the Neurotrauma Nursing Unit and Neurotrauma ICU of St. Michael's Hospital in Toronto, and a one month period in which the protocol was implemented. Several obstacles were identified in the implementation of the pilot protocol, including staff non-compliance or confusion over administration of the protocol, and an increase in the identification of delirium was noted.

Target Audience
Service Providers
Medical
Research

Start time 1330
End Time 1430
Session MR3
Mild Traumatic Brain Injury (MTBI) - A Review
Presenter(s)
Stephen Anderson, MD - Psychiatrist - Vancouver,BC

Objective
To develop an understanding of the aetiology, diagnosis and prognosis of MTBI.

Abstract
Mild Traumatic Brain Injury(MTBI) is a poorly understood condition. Although the majority of people with MTBI have a good recovery, a small percentage continue to have cognitive impairment and/or physical and emotional symptoms. An overview of research during the past several years will be given. Medical-legal issues will also be discussed with examples given from the BC Supreme Court in which the author was involved. The interaction of psychological factors on cognitive functioning (e.g. depression and pain) will also be reviewed. By the end of the presentation the audience should have a good understanding of this poorly understood disorder.

Target Audience
Service Providers
Medical
Lawyers

Start time 1500
End Time 1530
Session MR4
Finding your way after TBI: Some strategies may work better than others.
Presenter(s)
Sharon Livingstone, BA - University of Victoria - Victoria,BC

Objective
Participants will gain a greater understanding of the reasons why brain injury survivors tend to get lost while trying to go from one place to another, and how survivors might improve their ability to travel independently in their everyday lives. The presentation will describe recent research with brain injury survivors and their performance in video-game-like virtual environments.

Abstract
Traumatic brain injury (TBI) often impairs "wayfinding" (the ability to find one's way around in both familiar and unfamiliar places) but no one is sure why. The research literature indicates that some regions of the brain, like the hippocampus and frontal lobes, are responsible for wayfinding and are also especially vulnerable to TBI. Damage to these areas may impair the survivor's wayfinding by disrupting the brain's ability to process certain types of information. Normally, people use several wayfinding strategies: sometimes they use their sense of direction and sometimes they use landmarks to decide whether to turn or go straight. The former strategy relies on a rich internal (cognitive) map of the environment, whereas the latter depends on a simple sequence of cue-response associations. Our previous research established that TBI disrupts navigation using cognitive maps and now we examine whether it spares navigation using landmarks. To that end, we have tested the ability of TBI survivors to find a place in a game-like virtual environment that either has or does not have landmarks to guide the way to the place. Results to date indicate that TBI survivors who have trouble using cognitive maps can still find a place by using landmarks. We believe that our research will eventually improve assessment and rehabilitation of wayfinding and lead to greater independence for TBI survivors.

Target Audience
Survivors
Family Members
Medical
Research

Start time 1540
End Time 1610
Session MR5
Perception of Quality of Rehabilitation Services - Montreal: an evaluation tool to improve care
Presenter(s)
Bonnie Swaine, PhD - School of Rehabilitation, Université de Montreal - Montreal,Quebec

Objective
Participants will learn about a new questionnaire to assess clients’ perception of the quality of rehabilitation services following head injury (HI) and how this tool may be used to evaluate services and help modify care to better meet clients’ needs.

Abstract
Evaluating the quality of rehabilitation services for persons with head injury (HI) is important to ensure that services meet clients' needs. Objectives: 1) to describe a 61-item questionnaire (administered during an interview) that assesses the perceptions of persons with HI with regards to the quality of rehabilitation services received, and 2) to present data from an ongoing validation study of the tool. Methods and results: Tool development (including back-translation, French to English) will be described as well as data from 334 clients with HI (72.5 % males, GCS = 3 - 15, mean age = 40.5 yrs.) interviewed at different points throughout the continuum of care. Items are grouped under 5 dimensions of care (accessibility, continuity, client-centered, ecological approach, quality of service providers) and scored using a 5-point scale of agreement (1=completely disagree, 5=completely agree). Mean items scores varied from 2.0 to 4.7 and items pertaining to service providers received the highest ratings. Clients value the questionnaire (mean appreciation score = 8.1/10) and generally judge it to be comprehensive, clear and pertinent. They also appreciate the open-ended questions at the end of the interview allowing them to comment on issues not addressed in the tool (e.g. environment and hospital food) but that could be addressed in "in-house" satisfaction questionnaires. Conclusion: The PQRS-Montreal appears to be a promising evaluation tool for service providers and funding providers of HI rehabilitation programs striving to improve the quality of care provided to persons with HI.

Target Audience
Service Providers
Medical
Research

Start time 1615
End Time 1715
Session MR6
Life Time Support in the Community: Where is the evidence?
Presenter(s)
Barbara Baptiste, M Sc - Rehabilitation Management - Toronto,ON

Objective
To review the concept of long-term care planning: the role of community care management and the evidence for long-term service need and use following TBI (in the community) - provide information and data from an international and national perspective.

Abstract
When health and social interventions are provided systematically, diligently and jointly they can strongly reinforce one another. This workshop will provide an overview of the concepts of community support both in Canada and in Taiwan, including differences and similarities of health and social services, within the TBI community. Evolving worldwide perspectives on life time support in the community will be presented and discussed, including World Health Organization (WHO) concepts. Results of evidence-based research on factors associated with care planning will be presented. The use of databases to track life time needs and supports will be presented as part of an evidence-based approach to scientific analysis of life time health and social support needs.

Target Audience
Survivors
Family Members
Service Providers
Medical
Research
Lawyers
Funders

1900 - 2300 Social Reception ~ A Tribute to Our Legends

Medical/Research Sessions - Saturday, February 17, 2007

Start time 1030
End Time 1130
Session MR7
Occupational Disability after Traumatic Brain Injury
Presenter(s)
Tim Dyer, MSc - University of Auckland, New Zealand - Auckland, New Zealand

Objective
Participants will gain an appreciation of the multitude of interacting factors that influence an individual's employment outcome after Traumatic Brain Injury. Participants will be able to apply the Occupational Disability Model of TBI to help identify the facilitors and barriers to vocational outcome and guide clinical decision making.

Abstract
Over twenty years of research has failed to develop a robust predictive model of return to work behaviour after Traumatic Brain Injury (TBI). This research has however focused almost exclusively on the measurement of factors intrinsic to the individual without adequate acknowledgement of the individual in context. The Occupational Disability Model of TBI addresses these short coming by identifying the complex interaction of the individual, their environment and the supports available to them after TBI in return to work behaviour. This model is empirically based, being guided by:

• A systematic review of over 100 journal articles investigating the predictors of employment outcome after TBI.
• Novel qualitative research investigating the perceptions of vocational rehabilitation specialists (n = 9) and individuals with TBI concerning the facilitators and barriers of return to work after TBI (n = 8).

Start time 1130
End Time 1200
Session MR8
Task Analysis as a Quantitative Tool to Evaluate the Efficacy of Inpatient Rehabilitation
Presenter(s)
Diana Velikonja, PhD - Hamilton Health Science and McMaster University - Hamilton, ON

Objective
To determine whether the task analysis methodology is a more sensitive measure of change in the performance of two activities of daily living (showering and dressing) than the Functional Independence Measure, the Bartel index, and the Klein-Bell in an inpatient rehabilitation ABI population.

Abstract
Acquired brain injuries (ABI) can cause physical, cognitive and emotional/behavioural deficits that impact an individual's ability to perform their activities of daily living (ADLs). Standardized ADL assessments used by Occupational Therapists (OT) include the Functional Independence Measure (FIM), Barthel Index (BI), and Klein-Bell ADL Scale (KB), with the FIM and BI being used most widely. Despite having good psychometric properties, the FIM and BI when used in the ABI population show high floor and ceiling effects that reduce their sensitivity to functional changes made during rehabilitation. These measures provide more effective indications of changes in physical status rather changes related to cognitive and behavioural difficulties. The task analysis methodology was adopted in the ABI inpatient rehabilitation unit at Hamilton Health Sciences to improve the assessment of changes in ADL status made during inpatient rehabilitation. The task analysis methodology was applied to various activities of daily living with provisions for graduated stages of independent functioning and the equal weighting of physical and cognitive deficits. The objective of this study was to assess whether the task analysis methodology was more sensitive to functional changes relative to other measures. A repeated measure, within subject design was used with four assessment points as well as the administration of the Disability Rating Scale and the Supervisory Rating Scales as independent measures of functional status. Preliminary results would suggest that the task analysis methodology does provide increased sensitivity to changes in the performance of ADLs with fewer ceiling and floor effects when assessing ABI patients.

Target Audience
Service Providers
Medical

Start time 1330
End Time 1400
Session MR9 ~ Cancelled