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Brain Sciences
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Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury
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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 4444

Editor

Dr. Eve M. Valera

E-Mail Website
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
Special Issues, Collections and Topics in MDPI journals

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

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

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

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Published Papers (6 papers)

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Research

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21 pages, 1032 KB  
Article
Psychosocial Outcomes of IPV Interventions in Women With and Without Probable IPV-Related Brain Injury
by Brigitta M. Beck, Michelle M. Pebole, Kristiana D. Carrasquillo, Colin T. Mahoney and Katherine M. Iverson
Brain Sci. 2026, 16(8), 836; https://doi.org/10.3390/brainsci16080836 - 6 Aug 2026
Viewed by 260
Abstract
Background: Between 33% and 75% of women who experience intimate partner violence (IPV) sustain an IPV-related traumatic brain injury (TBI). Although IPV-related TBI is associated with adverse psychosocial outcomes, its impact on response to healthcare-based IPV interventions remains unclear. Methods: Using data from [...] Read more.
Background: Between 33% and 75% of women who experience intimate partner violence (IPV) sustain an IPV-related traumatic brain injury (TBI). Although IPV-related TBI is associated with adverse psychosocial outcomes, its impact on response to healthcare-based IPV interventions remains unclear. Methods: Using data from a randomized clinical trial within the Veterans Health Administration, we examined psychosocial outcomes among 60 woman veterans with past-year IPV experiences participating in two brief IPV interventions: Enhanced Care As Usual (ECAU) and Recovering from IPV through Strengths and Empowerment (RISE). Results: At pretreatment, 21 women (35%) reported a history of probable IPV-related TBI. Multilevel modeling revealed no significant main or interaction effects of TBI history for self-efficacy, empowerment, patient activation, depression, physical health symptoms, or resilience. However, there was a significant interaction of time and probable IPV-related TBI history for valued living, such that women with probable IPV-related TBI history demonstrated greater initial gains followed by slight posttreatment decline; F(2, 76.55) = 2.96, p = 0.049. There was also a significant interaction between probable IPV-related TBI history, treatment condition, and pretreatment anxiety symptoms for anxiety symptoms as an outcome, such that women with probable IPV-related TBI history in the RISE condition, who had more severe anxiety symptoms at pretreatment, reported higher anxiety symptoms on average across the study period than women without probable IPV-related TBI history in RISE; F(1, 48) = 5.04, p = 0.029. Furthermore, there was a significant interaction of probable IPV-related TBI history and pretreatment physical health symptoms for physical health symptoms as an outcome, such that women with probable IPV-related TBI histories maintained higher physical symptoms from pretreatment to the last follow-up assessment; F(1, 134) = 8.99, p = 0.004. Conclusions: No evidence of differential treatment response was detected for women with and without probable IPV-related TBI history. Findings related to valued living and anxiety suggest areas where additional support may improve implementation of brief healthcare-based IPV interventions. Full article
(This article belongs to the Special Issue Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury)
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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 597
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
(This article belongs to the Special Issue Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury)
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
Viewed by 791
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
(This article belongs to the Special Issue Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury)
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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 464
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
(This article belongs to the Special Issue Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury)
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Review

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20 pages, 294 KB  
Review
From Recognition Lag to the Treatment Gap in Intimate Partner Violence-Related Brain Injury: The Cognitive Entrapment Prospective Framework
by James V. English
Brain Sci. 2026, 16(8), 863; https://doi.org/10.3390/brainsci16080863 - 15 Aug 2026
Viewed by 210
Abstract
Intimate partner violence-related brain injury is the most recent condition in a 150-year arc in which biological brain injury has been misattributed to psychological or moral causes before formal clinical recognition emerged. Earlier conditions in this pattern were each recognized only after decades [...] Read more.
Intimate partner violence-related brain injury is the most recent condition in a 150-year arc in which biological brain injury has been misattributed to psychological or moral causes before formal clinical recognition emerged. Earlier conditions in this pattern were each recognized only after decades of delay. In each prior case, that delay was constrained by limits in available diagnostic technology. Intimate partner violence-related brain injury is the first condition in which diagnostic technology, including computed tomography, magnetic resonance imaging, diffusion tensor imaging, and neurocognitive assessment, has been continuously available throughout the period of non-recognition. This review identifies three structural barriers that sustain this recognition gap: a diagnostic barrier that leaves the injury without formal criteria, an administrative coding barrier that leaves it absent from ICD architecture, and a population surveillance barrier that leaves it indistinguishable from broader assault categories. Each barrier reinforces the others, limiting visibility, resource allocation, and access to care. Across these conditions, this review argues that deferred recognition reflected an institutional dynamic that shaped which injured populations became clinically legible. Recent neuroimaging and cognitive studies make the biological imperative explicit. A cognitive entrapment framework reframes the reduced capacity to engage the cognitive and material resources leaving requires as injury-driven rather than as ambivalence or motivational deficit. The framework offers a mechanistic account of how brain injury may disrupt the multistep planning that leaving demands. Intimate partner violence-related brain injury is not only underdiagnosed but structurally underserved; correcting the mechanisms of recognition failure is necessary for access to treatment and rehabilitation. Full article
(This article belongs to the Special Issue Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury)
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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 1276
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
(This article belongs to the Special Issue Accessing Treatment and Rehabilitation for Underserved Survivors of Brain Injury)
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