Amy M. Kemp

Chronic pain is the leading cause of disability worldwide and frequently co-occurs with mild traumatic brain injury among Veterans (mTBI + CP), creating complex treatment challenges and a need for novel, non-pharmacological interventions. This study evaluated a pilot intervention combining intermittent theta burst stimulation (iTBS), a neuromodulatory approach, with the evidence-based LoveYourBrain Yoga program to enhance rehabilitation outcomes. In a six-week open-label trial, ten Veterans with mTBI + CP received weekly iTBS followed by yoga sessions. Pilot quantitative outcomes included quality of life (Traumatic Brain Injury Quality of Life [TBI-QoL]) and functional ability (Mayo Portland Adaptability Inventory-4 [MPAI-4]), assessed pre- and post-intervention, alongside qualitative semi-structured interviews and interdisciplinary clinical notes. Significant improvements were observed in TBI-QoL Fatigue (p = 0.021) and MPAI-4 Grief and Loss (p = 0.016), with clinically meaningful but non-significant gains in Ability and Adjustment. Qualitative findings revealed improved pain management and enhanced self-management, with participants describing better emotional regulation, more effective coping strategies, and stronger social connections. Some benefits were more evident in qualitative data than in standardized measures. These pilot findings suggest that combining iTBS with mind–body therapy may provide complementary tools for pain management and functional recovery in Veterans with mTBI + CP, supporting further investigation of integrated neuromodulation and behavioral interventions.

Background and Objectives: Rural adults (those residing in nonmetropolitan counties) face persistent barriers to brain health assessment that may help prevent or delay cognitive decline. This study reports protocol and pilot feasibility findings from year one of a three-year longitudinal project evaluating Building a Rural Aging and Intervention Network: Factors that Impact Trajectories (BRAIN-FIT), a community-embedded program to improve access to multidomain screening and awareness of modifiable dementia risk factors. Research Design and Methods: Using a mixed-methods design, 119 adults aged 45+ completed a single-day interdisciplinary screening incorporating clinical-standard measures (cardiovascular, physical, lifestyle, social-emotional, sensory, cognitive, and speech-language health), followed by individualized results review. Sixty-three participants completed a four-week post-event behavior change evaluation. Results: BRAIN-FIT, delivered across seven community sites in three cities through 18 events, enrolled 163 adults (aged 46–95; M = 67.5) with socioeconomic and clinical heterogeneity. Engagement was strong: 119 consented to longitudinal participation, 95% completed all stations, and rated the program highly feasible (3.7-4.4/5). Screening identified prevalent modifiable risk factors: elevated cardiometabolic indicators, reduced physical endurance, sleep disturbance, and sensory impairment. Cognitive and language performance remained largely within functional limits, suggesting engagement during a preventive window. Discussion and Implications: Community-embedded multimodal screening appears to be a viable program for identifying actionable brain-health risk prior to substantial decline. By reaching diverse adults outside traditional care pathways, BRAIN-FIT advances a pragmatic population-health approach to dementia prevention. Longitudinal follow-up will evaluate sustained behavior change, strengthen referral integration, and inform hybrid effectiveness–implementation trials to promote healthier aging trajectories.

Acquired brain injury (ABI) may lead to negative functional outcomes even years post injury. Rehabilitation clinicians can help to remediate some of these deficits, however there is a gap in research translation to implementation. While there are many possible ways to address this, one way is to directly engage with individuals and communities. The current work describes our participatory-focused approach to previous research studies in collaboration with Hinds’ Feet Farm and the Unmasking Brain Injury (UBI) project. UBI is a community-based project that fosters agency, education, and social connection for people with ABI. We outline our methods and outputs of participatory dissemination, including creative products and shared platforms, which offers a mode for equitable, survivor-led knowledge generation for research and practice. This work contributes to participatory action research methodology by illustrating how longstanding community art practices can operate as infrastructures for mutual learning, rehabilitation knowledge, and community and scholarship facing products.

Purpose: The purpose of this study was to examine implementation barriers and facilitators related to evidence-based concussion management among school-based speech-language pathologists (SLPs). Using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, we explored how innovation, recipient, context, and facilitation factors influence SLPs' ability to bridge the know–do gap in return-to-learn (RTL) care for students with concussion. Method: We conducted qualitative semistructured interviews with 10 school-based SLPs purposively selected to reflect varying confidence levels regarding concussion management using a framework-informed hybrid deductive–inductive approach. The i-PARIHS framework guided interview development and thematic analysis to identify barriers and facilitators across framework constructs. Results: Implementation barriers and facilitators mapped to all four i-PARIHS constructs. Innovation barriers included limited awareness of RTL protocols (only one of 10 participants knew district protocols) and assessment challenges in establishing baselines and differentiating concussion-related difficulties. Recipient facilitators encompassed professional growth mindset and consultation model preferences, with nine of 10 participants expressing confidence in providing concussion services despite acknowledging knowledge gaps. Context was the primary barrier domain, involving resource constraints including large (up to 150 students) or complex caseloads, high workload demands, and communication gaps between medical and educational settings. Facilitation included peer networks as primary knowledge sources, but limited access to concussion-specific continuing education created barriers. A cross-cutting professional growth mindset demonstrated SLPs' readiness to participate in RTL implementation despite current limitations. Discussion: While SLPs possess strong individual characteristics supporting RTL and concussion care delivery, significant organizational barriers limit evidence-based concussion care delivery. Implementation strategies should leverage SLPs' growth mindset and peer consultation preferences while addressing multilevel contextual barriers through systematic training programs, consultation-based service models, and improved medical-school communication protocols. Supplemental Material: https://doi.org/10.23641/asha.31449640

Implementation science requires pragmatic tools that can assess implementation potential before large-scale testing, yet most existing measures focus on pr

Objective: The purpose of the study was to investigate acceptable and appropriate testing modalities for older adults with and without traumatic brain injuries (TBI) and efficient service delivery models for clinicians. Setting: Two neurocognitive assessments were administered in telehealth settings to older adults with and without TBI. Participants: Forty-two older adults with no more than mild cognitive impairment, 21 with a history of TBI, and 21 without (aged 71.0 ± 4.45 years) were included. All adults with TBI were in chronic stages post-TBI (5-56 years). Design: Participants from a quasi-randomized self-management intervention study were enrolled in 2 visits. The first virtual visit included neurocognitive assessments. Assessment order was randomized, and intervention providers were blinded to the injury status. Main Measures: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) on the QInteractive platform and CNS Vital Signs (CNSVS). Both validated assessments provide a global cognitive score and subscales. Time to administer and qualitative clinical notes on participation, acceptance, and preference (patient and clinician) were also collected. Results: There was a positive correlation between RBANS and CNSVS, r = .710, P < .001, indicating that both assessments produced similar neurocognitive scores. Participants without TBI had higher global neurocognitive scores than participants with TBI across both RBANS ( t = −4.29, P = < .001) and CNSVS ( t = −2.97, P = .002). When examining subscale scores, CNSVS captured more differences in individual subscales than RBANS. The RBANS administration time (34.86 min, SD = 8.4) was longer than CNSVS (31.29 min, SD = 4.79), but did not differ across injury status (RBANS: t = 1.37, P = .179; CNSVS: t = −1.56, P = .127). Patient preference was unremarkable, and older adults were reported to participate well, but clinicians preferred CNSVS. Conclusion: Regardless of the assessment, both were acceptable and appropriate for older adults with and without TBI. However, CNSVS was preferred by clinicians and captured more differences, suggesting an increased sensitivity for evaluating neurocognition.

Purpose :: Person-centered goals represent meaningful and motivating aspirations of patients and help rehabilitation professionals shape treatment plans to meet individual needs. The purpose of this research note is to describe person-centered goals identified among individuals receiving speech-language pathology services after mild traumatic brain injury (mTBI) and to consider how goals might be informed by existing self-report measures and guide treatment planning. Method: Using a retrospective chart review approach, we extracted person-centered goals of patients between the ages of 14 and 65 years who received care from a speech-language pathologist at an outpatient specialty concussion clinic between August 2019 and March 2020. Goals were coded according to impairment, activity, and participation domains; environmental setting; treatment domain; rehabilitative expectation (restorative or compensatory); as well as by alignment with items in a concussion symptom scale. Three reviewers independently coded goals, with discrepancies in ratings resolved through consensus. Data were analyzed descriptively. Results: In total, 59 patient charts met inclusion criteria. Mean patient age was 31.85 ( SD = 17.31). Most goals were at the activity level (46%), followed by participation (32%), and impairment (22%). Return to productivity was central to patient goals, with almost half addressing return to school (49%) and 21% specifying return to work. By domain, goals were primarily cognitive in nature (62%), followed by communication (13%), emotional regulation (13%), or unspecified (12%). Almost all goals were restorative (86%). Just 37% of goals were represented on the symptom scale, as expected, those that were reflected cognitive needs. Conclusion: Person-centered goals are not well captured by standard mTBI symptom scales, thus emphasizing a need for rehabilitation providers to use problem-focused interviewing, motivational interviewing, or other person-centered methods to identify personally relevant and meaningful goals in this population.

Purpose: Effective self-management is key for older adults with and without traumatic brain injury (TBI) to maintain their health, safety, and independence. Self-regulation is one method of promoting self-management. However, it is essential to examine effective methods of self-regulation interventions to maximize the use of such health promotion. Method: Forty-one older adults (19 with TBI; 22 without TBI) participated in an in-person or telepractice health education intervention for fall prevention with 15 speech-language pathology student clinicians. The intervention was a self-regulation strategy, mental contrasting with implementation intentions (MCII), for promoting fall prevention. This mixed methods study explored treatment adherence and evaluated implementation outcomes through acceptability, appropriateness, feasibility, modifications to treatment, and therapist adherence and client participation. Results: All participants demonstrated some behavior change. Participants without TBI evaluated the MCII protocol as more acceptable, F (1, 39) = 5.88, p = .018; appropriate, F (1, 39) = 5.34, p = .023; and feasible, F (1, 39) = 9.56, p = .003, than participants with TBI, although all ratings were perceived as neutral or positive. From clinician data, protocol adherence, F (1, 39) = 1.57, p = .22, and client participation, F (1, 39) = 0.10, p = .92, were similar across injury groups, but participants with TBI required more fidelity-consistent modifications to treatment, F (1, 39) = 6.88, p = .012. There were no differences between settings except that those in telepractice had more client participation, F (1, 39) = 21.02, p < .001. Clinicians felt MCII was equally appropriate for both groups in all settings, acceptability: F (1, 48) = 0.082, p = .78; appropriateness: F (1, 48) = 0.554, p = .46; feasibility: F (1, 48) = 0.197, p = .66. Conclusion: MCII may be a feasible tool to provide health education as it offers enough structure and individualization to be considered appropriate and relevant for older adults, and for novice clinicians to administer and modify as needed based on client needs. Supplemental Material: https://doi.org/10.23641/asha.28074443

Purpose: Speech-language pathologists provide important services to people recovering from mild traumatic brain injury (mTBI), also called concussion, although they may be underutilized in outpatient care. Because health care providers face challenges in selecting assessments to efficiently describe patient needs, the purpose of this study was to describe factors related to patients receiving speech-language pathology services after mTBI, as well as how assessments predict amount of services received. Method: In this retrospective chart review study, demographic factors, injury characteristics, and assessment scores were extracted from medical records of patients aged 14–65 years receiving services for recent (within 6 months) mTBI at an outpatient specialty clinic. The Post-Concussion Symptom Scale (PCSS), Montreal Cognitive Assessment, Standardized Assessment of Concussion, and a newly developed self-report measure of cognitive-communication function—the Cognitive-Communication Referral Indicator for Concussion (CCoRI-C)—were used as dependent variables to predict speech-language pathology service referral. For those referred, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Behavior Rating Inventory of Executive Function (BRIEF) scores were added as dependent variables predicting speech-language pathology dosage. Results: A total of 132 patient charts met inclusion and exclusion criteria. In addition to CCoRI-C and PCSS symptoms, receiving imaging, being injured in a motor vehicle crash, experiencing loss of consciousness, and being of female sex were related to speech-language pathology referrals. Of the 77 patients referred for speech-language pathology care, higher CCoRI-C, PCSS, BRIEF, RBANS total, and RBANS visuospatial scores were associated with recommended speech-language pathology dosage. Only the CCoRI-C, BRIEF–Adult Version (BRIEF-A) Behavioral Regulation, and BRIEF-A Metacognition were associated with actual number of speech-language pathology sessions attended. Conclusions: Cognitive-communication symptoms and executive function may be important to planning speech-language pathology rehabilitative episodes of care for people with mTBI. Future work should continue to evaluate how assessments augment demographic and injury characteristics in decision making for both referral to and use of speech-language pathology services after mTBI.

This study aimed to explore the narratives of people with acquired brain injury (ABI) who participated in the Unmasking Brain Injury project. Through this inquiry, the multifaceted nature of wellbeing after ABI was described in the narratives, which were characterized by identifying facilitators and barriers to overall wellness. A mixed-methods approach was utilized for this study. Narratives from people with ABI (n = 1019) that had been uploaded to a public database were analyzed in three phases: (1) document-level content analysis, (2) communication unit (c-unit) content analysis based on Dimensions of Wellness, and (3) c-unit and full narrative aggregate sentiment analysis. People with ABI used their narratives to share with others and engage in personal reflection. Narratives had c-units related to all areas of wellness, but primarily emotional, spiritual, physical, social, cognitive, and, to a lesser extent, occupational and recreational. Facilitators of wellness included spiritual, social, and recreational health, while barriers to wellness included physical, cognitive, and emotional health. Emotional health was also identified as mixed, emphasizing the challenge of pursuing wellness post-ABI. Narrative storytelling through mask-making can offer an avenue for identifying concrete examples of a person with ABIs' experience, goals, strengths, and weaknesses.