Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury

A special issue of Brain Sciences (ISSN 2076-3425).

Deadline for manuscript submissions: closed (10 May 2026) | Viewed by 3121

Editor


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Guest Editor
1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02115, USA
2. Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
Interests: traumatic brain injury; trauma rehabilitation; intimate partner violence; strangulation and concussion
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Special Issue Information

Dear Colleagues,

We are pleased to invite submissions for a Special Issue dedicated to exploring the critical issue of accessing treatment and rehabilitation for underserved populations who have sustained brain injuries, including women who have experienced partner violence, incarcerated individuals, and people experiencing homelessness. Brain injuries, whether mild or severe, present unique challenges for those already facing social, economic, and systemic barriers to healthcare. This Special Issue aims to bring together interdisciplinary perspectives on the multifaceted barriers to care for these vulnerable groups, such as the lack of resources, stigma, and fragmented healthcare systems. We encourage authors to submit original research, case studies, policy analyses, and theoretical frameworks that examine innovative approaches, challenges, and strategies for improving access to appropriate treatment and rehabilitation. By fostering a broader understanding of these issues, this Special Issue seeks to contribute to the development of more inclusive, equitable, and effective healthcare policies and practices for individuals with brain injuries from marginalized communities.

You may choose our Joint Special Issue in Healthcare.

Dr. Eve M. Valera
Guest Editor

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Keywords

  • TBI
  • brain injury
  • partner violence
  • incarcerated
  • homeless
  • rehabilitation
  • strangulation
  • criminal justice system
  • barriers

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Published Papers (4 papers)

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Research

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11 pages, 268 KB  
Article
Pervasive TBI and Inhibitory Control in a Male New Zealand Prison Population
by Sam Guy, Susan Mahon, James Webb, Makarena Dudley and Alice Theadom
Brain Sci. 2026, 16(6), 637; https://doi.org/10.3390/brainsci16060637 - 15 Jun 2026
Viewed by 346
Abstract
Objective: Traumatic brain injury (TBI) is disproportionately prevalent in incarcerated populations, yet the potential impact on cognitive functioning remains underexplored. This study examined the relationship between TBI history and cognitive performance in a male prison population. Method: Sixty-three participants from Tongariro [...] Read more.
Objective: Traumatic brain injury (TBI) is disproportionately prevalent in incarcerated populations, yet the potential impact on cognitive functioning remains underexplored. This study examined the relationship between TBI history and cognitive performance in a male prison population. Method: Sixty-three participants from Tongariro Prison completed a comprehensive neuropsychological assessment including measures of executive function, memory, processing speed, and perceptual reasoning, with embedded performance validity metrics. TBI history was assessed using the Ohio State University TBI Identification Method (OSU-TBI ID), premorbid function was assessed using the Speed and Capacity of Language Processing (SCOLP) Spot-the-Word task, mood was assessed using the Depression, Anxiety and Stress Scales (DASS-21), and alcohol and substance use were measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Regression analyses explored the relationship between TBI history and cognitive functioning, controlling for premorbid function, mood, alcohol and substance use, and ethnicity. Results: Contrary to hypotheses, TBI frequency and severity were not associated with poorer cognitive performance in this population. However, a self-reported history of pervasive TBI—defined as repeated head impacts over a narrow time frame—was significantly associated with reduced performance on the Color–Word Interference Test (CWIT) inhibition task, indicating links to greater cognitive disinhibition. Conclusions: Findings suggest that experiencing at least one period of pervasive TBI may be associated with an impact on inhibition (but not other aspects of executive functioning) in men in prison. These results underscore the importance of nuanced TBI history assessment and highlight inhibition as a potential target for rehabilitation in incarcerated individuals exposed to repetitive head trauma. Full article
8 pages, 468 KB  
Article
Incidences of Concussion in the United States: A Review of Health Insurance Claims
by Alyssa M. Lickfeld, Elizabeth V. Castro, Ava Ferreira, Jazlyn M. Edwards, Alissa Patel, John J. Leddy and Mohammad N. Haider
Brain Sci. 2026, 16(6), 546; https://doi.org/10.3390/brainsci16060546 - 22 May 2026
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Abstract
Background: Mild traumatic brain injuries (mTBIs) are a significant public health concern in the US. Understanding incidence and demographic patterns is essential for developing targeted prevention and intervention strategies. The most recent study using national healthcare records to examine incidence utilized data [...] Read more.
Background: Mild traumatic brain injuries (mTBIs) are a significant public health concern in the US. Understanding incidence and demographic patterns is essential for developing targeted prevention and intervention strategies. The most recent study using national healthcare records to examine incidence utilized data from 2016, highlighting the need for updated estimates that reflect current trends. Methods: The MarketScan® Database was used for this study which includes person-specific clinical utilization, expenditures, and enrollment across different services. A query for mTBIs (S06.0x.xx) or post-concussion syndrome (F07.89) from January–December 2023 was performed for patients aged 0–64. Patients with the same diagnosis codes for the prior 12 months (i.e., chronic diagnosis), moderate to severe TBIs (S06.2–9), skull fractures (S02.xx), and/or brain hemorrhages (S06.3x) were excluded. Results: Out of 11,737,855 insured members with data in 2023, 43,213 new mTBIs were recorded (incidence rate = 0.37%), with the highest rate in adolescents (incidence rate = 1.27%). From the ages of 0–14 years, males had a higher incidence of concussion, but from 15 to 65 years, females had a higher incidence. Minimal differences were seen between urban and rural zip codes. Conclusions: Concussion incidence in adolescents is higher than other age groups, which may reflect increased participation in sports or heightened vulnerability during development. Males had a higher incidence than females during childhood, but females did later in life. These differences may reflect true disparities in injury risk, variations in reporting patterns, or a combination of both. Further research is warranted to understand the underlying mechanisms and to inform age- and sex-specific prevention efforts. Full article
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19 pages, 762 KB  
Article
Modifiable Barriers to Assessment and Rehabilitation in Justice-Involved Individuals with Self-Reported TBI: The Role of Subjective Sleepiness and Mood
by Sarka Turecka Brown, Maddy Pontius, Jennifer Gallagher, Kim A. Gorgens, Gina Signoracci and Marybeth Lehto
Brain Sci. 2026, 16(5), 520; https://doi.org/10.3390/brainsci16050520 - 13 May 2026
Viewed by 368
Abstract
Background/Objectives: Sleep problems, cognitive deficits, and mood disorders are prevalent in justice-involved populations, especially among individuals with a history of traumatic brain injury (TBI), though the association between these variables remains understudied. This retrospective study examined the relationship between subjective sleepiness and [...] Read more.
Background/Objectives: Sleep problems, cognitive deficits, and mood disorders are prevalent in justice-involved populations, especially among individuals with a history of traumatic brain injury (TBI), though the association between these variables remains understudied. This retrospective study examined the relationship between subjective sleepiness and mood state on neuropsychological functioning in a forensic population with self-reported TBI. Methods: Data were obtained from 419 inmates and probationers with a self-reported history of TBI using the Ohio State University Traumatic Brain Injury Identification Method and Automated Neuropsychological Assessment Metrics (ANAM). Multiple linear regression models examined associations between cognitive performance across domains (i.e., reaction time, learning, attention, processing speed, working memory, delayed memory, and inhibition) and subjective sleepiness and mood states (i.e., depression, anxiety, fatigue, restlessness, anger, happiness, and vigor) measured by self-report scales embedded in the ANAM. Results: Negative mood state was most associated with impaired performance on tests of learning, delayed memory, spatial working memory, and reaction time, as well as global neurocognitive test performance. Subjective sleepiness was predictive of poorer performance on reaction time tasks, while positive mood states were related to better performance on the same task. Regression models were statistically significant (p < 0.05), with subjective sleepiness and mood accounting for approximately 1–5% of the variance in cognitive performance. Conclusions: Subjective sleepiness and mood symptoms are significantly related to cognitive performance among justice-involved individuals with self-reported TBI. While these factors can contribute to the need for rehabilitation, they may also reduce the likelihood of successful engagement. Importantly, both sleepiness and mood are modifiable treatment targets, and adapting interventions to accommodate cognitive inefficiencies can improve engagement and overall treatment benefit. Full article
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Review

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21 pages, 371 KB  
Review
Existing and Potential Therapies for Post-Traumatic Stress Disorder and Persistent Post-Concussion Symptoms in Intimate Partner Violence: A Narrative Review
by Charlotte Copas, Abigail D. Astridge, Jennifer Makovec Knight, Stuart J. McDonald, Sandy R. Shultz and Georgia F. Symons
Brain Sci. 2026, 16(4), 398; https://doi.org/10.3390/brainsci16040398 - 8 Apr 2026
Viewed by 1028
Abstract
Background: Intimate partner violence (IPV) is a pervasive medical concern affecting millions of people worldwide, with the majority being women. IPV is linked to a number of long-term physical and mental health consequences, including brain injuries and associated persistent post-concussion symptoms (PPCS) and [...] Read more.
Background: Intimate partner violence (IPV) is a pervasive medical concern affecting millions of people worldwide, with the majority being women. IPV is linked to a number of long-term physical and mental health consequences, including brain injuries and associated persistent post-concussion symptoms (PPCS) and post-traumatic stress disorder (PTSD). Despite the high prevalence of these conditions, there is sparse literature assessing accessible and effective therapeutic avenues specific to IPV victim-survivors. Methods: This narrative review had two aims: to identify therapeutic studies addressing PTSD and PPCS in women IPV survivors, and to provide a narrative overview of potential therapeutic categories, including psychotherapy, mindfulness and meditation, exercise, and pharmacotherapy. A comprehensive literature search was conducted using PubMed and Google Scholar. Inclusion criteria required full-text, peer-reviewed articles published in English, conducted in women with a history of IPV, reporting treatment outcomes related to PTSD or PPCS. Where no IPV-specific evidence was identified, findings from closely related populations including military veterans, athletes, and general TBI samples were narratively reviewed to inform potential therapeutic implications. Results: Nineteen studies addressing PTSD in women IPV survivors were identified, predominantly utilizing psychotherapeutic or mindfulness and meditation-based interventions. No intervention studies targeting PPCS specifically in IPV survivors were identified. Consequently, results for PPCS are largely extrapolated from adjacent populations. Although potential therapeutic avenues were narratively identified across psychotherapy, mindfulness and meditation, exercise, and pharmacotherapy, IPV-specific evidence remains limited, and validation for PTSD and PPCS in this population is needed before clinical recommendations can be made. Conclusions: While 19 studies identified promising therapeutic options for IPV-related PTSD, no IPV-specific PPCS interventions were identified, and implications for PPCS management remain largely inferential. Validation and integrated trauma-informed approaches addressing the intersection of PTSD and PPCS are needed for this understudied population. Full article
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