| Summary: | Objective: To examine sleep and wake disorders following traumatic brain injury (TBI) and their impact on recovery of cognition, communication and mood. Research Design: This three-manuscript thesis comprises an introduction to sleep in the context of human function and development. It is followed by a systematic review of the literature pertaining to sleep and wake disorders following TBI, and then explores the relationship between sleep and arousal disturbance and functional recovery of cognitive-communication through a single case study, pre–post intervention. Finally, a larger study longitudinally explores the impact of treatment to optimize sleep and wakefulness on recovery of cognition, communication and mood through objective and subjective measures, pre-post intervention. The thesis concludes with a chapter that addresses the implications of findings for rehabilitation from the perspective of the International Classification of Functioning, Disability and Health (ICF), and a presentation of future research directions for the field Methods: The first manuscript involved a systematic review and rating of the quality of evidence. The second manuscript involved the evaluation of sleep and wakefulness by objective measures, and longitudinally by self-report through the Daily Cognitive-Communication and Sleep Profile (DCCASP, © Wiseman-Hakes 2008, see Appendix S). Cognitive-communication abilities were also measured by the DCCASP. The third manuscript utilized a single case series and cohort design to evaluate sleep and wakefulness, and to examine cognition, communication and mood at baseline and following optimization of sleep and wakefulness. Results: For Manuscript One, 43 articles were reviewed for levels and quality of evidence across 5 domains: epidemiology, pathophysiology, neuropsychological implications, intervention and paediatrics. In Manuscript Two, we showed that there was a statistically and functionally significant relationship between perceived quality of sleep and language processing, attention and memory, seen across the phases of the intervention. In Manuscript Three, we showed that there were statistically and functionally significant improvements across several domains of cognition, communication and mood in response to treatment. Conclusions: Sleep and wake disorders after TBI are pervasive, and can negatively impact rehabilitation and recovery. There is a need for systematic evaluation and intervention for these disorders in all persons with TBI.
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