Reducing disability in patients with traumatic brain injuries via a transdisciplinary biopsychosocial therapeutic community model occupational medicine program. 

  • Coauthors: Powell AC, Dawson G, Anbar T.
  • Presented at: American Society of Pain & Neuroscience (ASPN) Conference; Jul 17-20, 2025
  • Location: Miami Beach, FL.

Overall Findings

In a population of patients with brain injuries and severe pain-related disabilities at program initiation, increased program participation was associated with significantly decreased disability, significantly enhanced ability to perform activities of daily living, and significantly reduced depression.

Introduction

Patients with traumatic brain injuries (TBI) frequently experience chronic pain. [1, 2] Chronic pain may cause disability, as it can impede patients’ abilities to perform activities of daily living. [3] As both psychosocial and physical factors may hamper TBI recovery, a transdisciplinary occupational medicine program helps patients with deficits due to TBI reduce their degree of disability using a biopsychosocial therapeutic community approach. This approach may improve patients’ health along multiple dimensions concurrently, addressing issues such as disability, anxiety, depression, and pain catastrophizing.

Objectives

To assess whether increased program participation was associated with reduced disability at program completion in a population of patients being treated for TBIs and experiencing severe pain-related disabilities at program initiation. Additionally, to assess whether increased program participation by this population reduced anxiety, depression, and pain catastrophizing.

Methods

Data came from a brain injury treatment program. Patients were excluded if they did not start care from January 1, 2021 to September 30, 2024, or lacked a severe disability due to pain (Oswestry Disability Questionnaire [ODQ]>40) at program initiation. Data included treatment duration, demographics, location, as well as scores from the following scales at treatment initiation and completion: Oswestry Disability Questionnaire (ODQ), Activities of Daily Living (ADL), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI), and Pain Catastrophizing Scale (PCS). A series of multivariable linear regressions were run, with change in scale scores serving as the dependent variables, program participation hours (log-transformed, base 2) serving as the independent variable, and age, gender, treatment location, first responder status, as well as initial scores on all the scales serving as control variables.

Results

A total of 187 patients were included in the sample after exclusion criteria were applied. Patients participated in the program for between 60.0 and 450.0 hours, with a median participation of 180.0 hours (IQR: 143.5-258.0, mean: 199.0, s.d.: 77.1). Patients had a mean ODQ of 54.8 (s.d.: 10.6) at initiation and 42.7 (s.d.: 17.5) at completion. Multivariable linear regression models found that doubling hours of program participation was significantly associated with improvements on the ODQ (-4.05; p=0.03), ADL (2.07; p<0.01), and BDI (-3.04 p=0.01) scales. While there was not a significant association with improvements on the BAI (-2.46, p=0.07) and PCS (-1.93; p=0.25) scales, the associations were directionally suggestive of a potential relationship between participation and improved health.

Conclusion

In a population of patients with brain injuries and severe pain-related disabilities at program initiation, increased program participation was associated with significantly decreased disability, significantly enhanced ability to perform activities of daily living, and significantly reduced depression.

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References

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Spring Superfoods for Health & Healing

Arugula

Arugula is packed with vitamins A, K, and folate, and it’s a great way to reduce inflammation while hydrating your body. Add it to your salads, bowls, or smoothies for a fresh, peppery kick that supports your health with every bite.

Artichokes

Artichokes are rich in folic acid, vitamin C, and B vitamins, making them perfect for detoxification and boosting metabolism. Keep it simple—boil them, dip in garlic-infused olive oil, and enjoy the health benefits they bring.

Asparagus

Asparagus is a powerhouse of vitamin K and antioxidants. It nourishes your heart and bones while also helping to prevent cancer. Sauté it with garlic and extra virgin olive oil for a nutrient-dense side dish that embodies the freshness of spring.

Beets

Beets help with circulation, detoxification, and stamina—making them an ideal choice for recovery. Roast them, juice them, or spiralize them to enjoy their earthy sweetness and health benefits in any meal.

Carrots

Carrots are packed with vitamin A and antioxidants, which support healthy skin, hair, and nails. Enjoy them raw, chopped into salads, or spiralized for a healthy pasta alternative—there’s no wrong way to eat them.

Mint

Mint is more than just a refreshing herb. It helps soothe digestion, reduce allergy symptoms, and act as a natural decongestant. Add it to your water or smoothies, or use it as a garnish to enhance your dishes with a burst of freshness.

Peas

Peas are an excellent anti-inflammatory food, full of vitamins, minerals, and protein. They’re perfect for tossing into stir-fries, salads, or soups, or even enjoying as a simple snack.

Strawberries

Strawberries are packed with antioxidants that help balance blood sugar and support your immune system. Fresh, frozen, or drizzled with dark chocolate, they’re the perfect treat to satisfy your cravings while nourishing your body.

Spring Onions

These vibrant onions are full of polyphenols and flavonoids, which fight oxidative stress and support disease prevention. Use them raw in salads or caramelized as a side dish—either way, they’ll add flavor and health benefits to your meal.

Radishes

Radishes are fantastic detoxifiers, cleansing the stomach and liver while also supporting hydration and skin health. Slice them thin for a refreshing salad, roast them for a savory twist, or add them to your favorite quinoa dish.

By adding these seasonal spring foods to your meals, you’re not just eating—you’re nourishing your body with the nutrients it needs to heal and thrive. Eating fresh, local produce is one of the simplest ways to support your health and recovery. Head to your local farmer’s market and experience the true taste of spring—your body will thank you!

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A Full Spectrum of Whole Foods To Boost Your Health This Fall

As the fall season brings cooler weather and holiday celebrations, it’s the perfect time to focus on the wide variety of nutrient-rich whole foods available. Health and prevention thrive on a diverse diet, emphasizing plant-based ingredients, fruits, vegetables, seeds, nuts, and legumes. Whether preparing holiday dishes or everyday meals, these foods can be easily integrated into your diet for long-term health benefits.

Seasonal Stars: Elevating Holiday Dishes with Fall’s Freshest Vegetables
  • Pumpkin and Winter Squash: Rich in beta-carotene, fiber, and vitamin A, pumpkins and squashes like butternut and acorn are ideal for soups, casseroles, and even desserts. Their nutrients support eye health, immune function, and digestive wellness.
  • Brussels Sprouts: Packed with vitamin C, vitamin K, and fiber, Brussels sprouts are an excellent side dish during the holidays. Roasted with olive oil and herbs, they provide a delicious, nutrient-dense option that supports immune function and bone health.
  • Sweet Potatoes: These are a holiday favorite, often featured in dishes like sweet potato casserole. For a healthier option, try roasting them hasselback-style with olive oil, sage, garlic and a sprinkling of sea salt. Rich in beta-carotene, fiber, and potassium, sweet potatoes contribute to heart health and provide a steady source of energy.
Nuts, Seeds, and Legumes: Essential for a Plant-Based Diet
  • Walnuts and Almonds: These nuts are nutrient powerhouses, offering omega-3 fatty acids, protein, and antioxidants. They’re perfect for adding crunch to salads or baking in holiday cookies​.
  • Pumpkin Seeds: A byproduct of pumpkin use, these seeds are rich in magnesium, zinc, and healthy fats, making them a great addition to salads, bread, or even roasted on their own​.
  • Legumes (Lentils, Chickpeas, Beans): High in fiber, protein, and essential vitamins, legumes are a great plant-based protein option for soups, stews, and side dishes. Including these in holiday meals ensures a filling, nutritious boost​.
Incorporating a Variety of Fruits:
  • Pears and Apples: Pears and apples provide fiber, antioxidants, and a range of vitamins. They’re perfect for desserts or salads, supporting heart health and digestion.
  • Cranberries: A seasonal favorite, cranberries can be used in sauces, baked goods, or salads. They’re rich in antioxidants and known for supporting urinary tract health.

You can support long-term health and wellness by incorporating a variety of nutrient-rich vegetables, fruits, seeds, nuts, and legumes into your holiday meals and daily diet. Whether you’re roasting Brussels sprouts, baking sweet potatoes, or adding walnuts and cranberries to a festive dish, these foods will enhance your seasonal recipes and provide essential nutrients for a balanced, heart-healthy diet. This fall, celebrate the season by nourishing your body with nature’s most wholesome ingredients and enjoy the benefits they bring all year.

View References

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Embrace the Rainbow For More Phytonutrients!

Summer presents a prime opportunity for embracing healthier eating habits, especially beneficial for those managing chronic pain. This season offers an abundance of vibrant fruits and vegetables rich in phytonutrients—natural compounds known for their antioxidant properties, which support overall health and help reduce inflammation. Let’s embark on a delicious journey towards better health and function!

“Eating the rainbow” entails consuming a diverse array of colorful produce, each color group offering unique health benefits:

  • Red Fruits and Vegetables: Rich in lycopene, a carotenoid known for its potent anti-inflammatory effects (Smith et al., 2019).
    • Examples: Strawberries, tomatoes, cherries, red bell peppers.
  • Orange and Yellow Fruits and Vegetables: A source of beta-cryptoxanthin, a precursor to Vitamin A and a powerful antioxidant that also supports cell-cell communication (Burri BJ., Adams & White, 2020).
    • Examples: Carrots, sweet potatoes, oranges, mangoes.
  • Green Fruits and Vegetables: Rich in sulforaphane, isothiocyanates, and indoles, compounds that aid in reducing inflammation (Brown & Green, 2017).
    • Examples: Spinach, kale, broccoli, avocados.
  • Blue and Purple Fruits and Vegetables: Contains protective flavonoids called anthocyanins, which reduce inflammation and promote healthy cellular metabolism (Jones et al., 2016).
    • Examples: Blueberries, blackberries, grapes, plums.
  • White and Brown Fruits and Vegetables: Contain allicin, an organosulfur compound known for its protective anti-inflammatory properties that can help manage pain (Miller & Smith, 2018).
    • Examples: Onions, garlic, mushrooms.

Fun and Flavorful Self-Management

Eating an abundance of colorful fruits and vegetables supports sustainable pain management and enhances the microbiome to improve gut-brain health and function. The compounds contained in these foods are known for their protective anti-inflammatory properties and support innate antioxidant defenses, which are crucial for health and sustained function (Smith et al., 2019; Adams & White, 2020; Brown & Green, 2017; Jones et al., 2016). Research demonstrates a strong connection between gut health and brain function, suggesting that a diet rich in these phytonutrients improves cognitive function and mood regulation (Miller & Smith, 2018). These foods promote physical well-being and a healthy gut-brain axis, enhancing overall health and vitality.

The abundant availability of these foods during summer invites experimentation to improve nutrient intake that can help manage chronic pain while enjoying delicious meals. Incorporate them into various recipes and meal combinations to maximize health benefits and flavor.

Try Chef Denise’s Watermelon Ceviche

References
  1. Adams, L., & White, J. (2020). Beta-cryptoxanthin and inflammation. The American Journal of Clinical Nutrition, 78(3), 517S-523S. doi:10.1093/ajcn/78.3.517S
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  6. Smith, E., et al. (2019). Lycopene and inflammation. Journal of Nutrition, 135(6), 143–148. doi:10.1093/jn/135.6.143