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Hudak A, Sabini R, Moen M, Rothman D. Acute Management of Moderate to Severe Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2024; 35:479-492. [PMID: 38945645 DOI: 10.1016/j.pmr.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The focus of this article is on the acute management of traumatic brain injury. The article focuses on the classification of traumatic brain injury, general acute management of traumatic brain injury, the role of the physiatrist on this team, and lastly, behavioral and family considerations in the acute care setting. The article includes a focus on physiologic systems, strategies for the management of various aspects of brain injury, and consideration of factors associated with the continuum of care. Overall, the article reviews this critical period of brain injury recovery and provides a primer for the physiatrist.
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Affiliation(s)
- Anne Hudak
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 223 E. Marshall Street Box 980677, Richmond, VA 23284-0667, USA; Central Virginia Veterans Affairs Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249-4915, USA
| | - Rosanna Sabini
- Department of Physical Medicine & Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, South Shore University Hospital, Bay Shore, NY 11706, USA
| | - Makinna Moen
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 223 E. Marshall Street Box 980677, Richmond, VA 23284-0667, USA
| | - David Rothman
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 223 E. Marshall Street Box 980677, Richmond, VA 23284-0667, USA.
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Worthen-Chaudhari L, Schnell PM, Hackney ME, Lustberg MB. Partnered dance evokes greater intrinsic motivation than home exercise as therapeutic activity for chemotherapy-induced deficits: secondary results of a randomized, controlled clinical trial. Front Psychol 2024; 15:1383143. [PMID: 38962217 PMCID: PMC11220256 DOI: 10.3389/fpsyg.2024.1383143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Dance has been proposed to support superior intrinsic motivation over non-dance forms of therapeutic physical activity. However, this hypothesis has yet to be evaluated empirically, particularly among populations living with neuropathology such as survivors of cancer with neurologic complications from chemotherapy treatment. Questions about motivation are relevant to clinical outcomes because motivation mediates neuroplasticity. We conducted this secondary analysis of a randomized-controlled study to begin to investigate the relationships between personal motivation and neurophysiologic effects of dance-based intervention for healthy aging among populations with neurologic complications of cancer. Methods We measured motivation using the Intrinsic Motivation Inventory, a validated patient-reported outcome from the psychological approach of Self Determination Theory. We assessed intrinsic motivation, extrinsic motivation, and satisfaction with intervention within a randomized controlled trial of dance versus exercise designed to alleviate symptoms of chemotherapy-induced impairment. Fifty-two survivors of breast cancer with chemotherapy-induced neuropathy diagnosis and associated sensorimotor functional deficits were randomized (1:1) to 8 weeks of partnered dance or home exercise, performed biweekly (NCT05114005; R21-AG068831). Results While satisfaction did not differ between interventions, intrinsic motivation was higher among participants randomized to dance than those randomized to exercise (p < 0.0001 at all timepoints: 2 weeks, 4 weeks, 6 weeks, and 8 weeks of intervention), as was extrinsic motivation at 2 weeks (p = 0.04) and 8 weeks (p = 0.01). Discussion These data provide evidence that social dance is more motivating than the type of home exercise generally recommended as therapeutic physical activity. The results inform directions for future study of the effect of dance-based therapeutics on embodied agency, neuroplastic changes, and clinically-relevant neuropathic improvement.
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Affiliation(s)
- Lise Worthen-Chaudhari
- NeuroArtsRx Laboratory, Department of Physical Medicine and Rehabilitation, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Patrick M. Schnell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Madeleine E. Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, GA, United States
- Center for Visual and Neurocognitive Rehabilitation, United States Department of Veterans Affairs, Atlanta, GA, United States
| | - Maryam B. Lustberg
- Center for Breast Cancer, Yale Cancer Center, Yale University, New Haven, CT, United States
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3
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Levac DE. Individual and contextual factors influencing children's effort in pediatric rehabilitation interventions. Dev Med Child Neurol 2024; 66:23-31. [PMID: 37082901 DOI: 10.1111/dmcn.15609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 04/22/2023]
Abstract
Rehabilitation clinicians strive to encourage children's sustained effort within challenging practice conditions. Effort influences intervention success, yet it is rarely defined or measured. Effort can be conflated with individual factors, such as motivation and engagement, that might influence it. Contextual factors that likely impact children's effort, such as practice conditions and therapeutic interactions, are generally under-described. Defining, describing, and measuring effort and its influencers is necessary to enhance understanding of differences in rehabilitation intervention outcomes across individuals and contexts and to support the development of personalized precision rehabilitation approaches. This narrative review describes effort conceptualization in rehabilitation, particularly in relation to intensity, engagement, and participation nomenclature. The review outlines individual and contextual factors that may influence children's effort in rehabilitation and describes potential next steps for effort description and measurement. Subsequent work should aim to identify factors that can be targeted in clinical practice to promote and sustain children's effort in the rehabilitation process, thereby individualizing interventions and potentially improving their effectiveness. WHAT THIS PAPER ADDS: Effort as it relates to rehabilitation is confusingly described and infrequently measured. Engagement, involvement, intensity, and participation are terms alluding to effort. Child-specific and therapy-specific factors, alone and in combination, may influence children's effort. Clearer conceptualization of effort and the factors that influence it will support personalization of interventions. Better measurement will enhance knowledge about relationships between effort and therapeutic outcomes.
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Affiliation(s)
- Danielle E Levac
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada
- CHU Sainte-Justine Research Center, Montreal, Canada
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Rich TL, Truty T, Muschler K, Gravely A, Marth LA, Barrett B, Mortimer D, Hansen AH. Virtual Reality Game Selection for Traumatic Brain Injury Rehabilitation: A Therapist's Wish List for Game Developers. Games Health J 2023; 12:445-449. [PMID: 37498203 DOI: 10.1089/g4h.2022.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
This project explored the selection process of commercially available virtual reality (VR) games for traumatic brain injury rehabilitation. Occupational therapy practitioners (OTPs) developed a classification framework that they used to evaluate VR games. The classification framework focused on movements required to effectively play the game, cognitive demand, position for game play, ease in menu navigation, and perceived therapeutic applications. OTPs used the ratings to aid in game selection and identified relevant game examples that allowed customizable settings and basic navigation with a game focus on functional activities. The OTPs and the research team identified the need for further work on accessibility and adaptability of game features (e.g., difficulty and limb usage) allowing for more individualization to optimize outcomes of VR-enhanced rehabilitation. The classification framework was useful in evaluating the potential therapeutic benefit of commercially available VR games. However, trial of the game by clinicians prior to use was still warranted.
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Affiliation(s)
- Tonya L Rich
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
- University of Minnesota, Division of Rehabilitation Medicine, Minneapolis, Minnesota, USA
| | - Timothy Truty
- Minneapolis VA Health Care System, Research Service Line, Minneapolis, Minnesota, USA
| | - Katherine Muschler
- Minneapolis VA Health Care System, Research Service Line, Minneapolis, Minnesota, USA
| | - Amy Gravely
- Minneapolis VA Health Care System, Research Service Line, Minneapolis, Minnesota, USA
| | - Lindsay A Marth
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
| | - Benjamin Barrett
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
| | - Diane Mortimer
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
- University of Minnesota, Division of Rehabilitation Medicine, Minneapolis, Minnesota, USA
| | - Andrew H Hansen
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
- University of Minnesota, Division of Rehabilitation Medicine, Minneapolis, Minnesota, USA
- University of Minnesota, Department of Biomedical Engineering, Minneapolis, Minnesota, USA
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Anders DM, Logan DM, Shelton JA, Walters GJ, Perry S, Carter KD, Malec JF. An Observational Cohort Study of the Role of Level of Effort in Post-Acute Brain Injury Rehabilitation. Arch Phys Med Rehabil 2023; 104:211-217. [PMID: 35934046 DOI: 10.1016/j.apmr.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the role of participant level of effort (LoE) on outcome in post-acute brain injury rehabilitation with the hypothesis that greater effort is associated with more positive outcomes. DESIGN Observational cohort study. SETTING Comprehensive integrated rehabilitation program for brain injury within a skilled nursing facility. PARTICIPANTS Consecutive admissions with acquired brain injury (N=101). INTERVENTIONS Individualized interdisciplinary brain injury rehabilitation; therapist rating of participant LoE with Acquired Brain Injury LoE Scale (ABI-LoES) during physical therapy, occupational therapy, and speech and language pathology sessions. MAIN OUTCOME MEASURES Mayo-Portland Adaptability Inventory, fourth edition (MPAI-4); Supervision Rating Scale (SRS). RESULTS Linear regression showed that discharge MPAI-4 Total T scores were significantly associated with mean ABI-LoES rating, admission MPAI-4 Total T scores, age at admission, and days from injury but not with standard deviation of ABI-LoES rating, sex, injury type, length of stay, or treatment before or during the COVID-19 pandemic. Discharge SRS scores were significantly associated with mean ABI-LoES rating, admission SRS scores, and age. A 1-unit increase in mean ABI-LoES rating was associated with 5.1-unit lower discharge MPAI-4 Total T scores and 1.5 lower discharge SRS scores, after controlling for other variables. Logistic regression showed that the odds of achieving a minimal clinically important difference on the MPAI-4 were 8.34 times higher with each 1-unit increase in mean ABI-LoES rating after controlling for other variables. Admission MPAI-4 was negatively associated with mean ABI-LoES rating (β=-0.07, t=-8.85, P<.0001). CONCLUSIONS After controlling for nonmodifiable variables, average ABI-LoES rating is positively associated with outcome. Initial level of disability is negatively associated with mean ABI-LoES rating.
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Affiliation(s)
| | | | | | | | - Sarah Perry
- Department of Biostatistics, The University of Iowa, Iowa City, IA
| | - Knute D Carter
- Department of Biostatistics, The University of Iowa, Iowa City, IA
| | - James F Malec
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
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van der Veen R, Oosterlaan J, Bos M, van Dooren M, Düdükçü I, van Iperen A, Kooiman L, Nicolas K, Peerdeman S, Königs M. Measurement Feedback System for Intensive Neurorehabilitation after Severe Acquired Brain Injury. J Med Syst 2022; 46:24. [PMID: 35377012 PMCID: PMC8979932 DOI: 10.1007/s10916-022-01809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/23/2022] [Indexed: 11/01/2022]
Abstract
AbstractOutcome of acquired brain injury (ABI) and the potential for neurorehabilitation are subject to distinct heterogeneity between patients. Limited knowledge of the complex constellation of determinants at play interferes with the possibility to deploy precision medicine in neurorehabilitation. Measurement Feedback Systems (MFS) structure clinical data collection and deliver the measurement results as feedback to clinicians, thereby facilitating progress monitoring, promoting balanced patient-centered discussion and shared decision making. Accumulation of clinical data in the MFS also enables data-driven precision rehabilitation medicine. This article describes the development and implementation of a MFS for neurorehabilitation after ABI. The MFS consists of specialized measurement tracks which are developed together with representatives of each discipline in the multidisciplinary team. The MFS is built into a digital platform that automatically distributes measurements among clinicians, at predetermined time points during the inpatient treatment, outpatient treatment and follow-up. The results of all measurements are visualized in individual patient dashboards that are accessible for all clinicians involved in treatment. Since step-wise implementation, 124 patients have been registered on the MFS platform so far, providing an average of more than 200 new measurements per week. Currently, more than 15,000 clinical measurements are captured in the MFS. The current overall completion rate of measurements is 86,4%. This study shows that structured clinical assessment and feedback is feasible in the context of neurorehabilitation after severe ABI. The future directions are discussed for MFS data in our Health Intelligence Program, which aims at periodic care evaluation and the transition of neurorehabilitation care towards precision medicine.
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Phyland RK, Ponsford JL, Carrier SL, Hicks AJ, McKay A. Agitated Behaviors following Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prevalence by Post-Traumatic Amnesia Status, Hospital Setting, and Agitated Behavior Type. J Neurotrauma 2021; 38:3047-3067. [PMID: 34435884 DOI: 10.1089/neu.2021.0257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Agitation is a common behavioral problem following traumatic brain injury (TBI); however, the precise proportion of patients who experience agitation in the early stages of recovery is unknown. The aim of this systematic review and meta-analysis was to evaluate the prevalence of agitation in TBI patients undergoing inpatient care, and whether this prevalence differed by post-traumatic amnesia (PTA) status and setting (acute and rehabilitation). We also aimed to describe the prevalence of sub-types of agitated behavior (disinhibited, aggressive, and emotionally labile). We searched five databases and one clinical trials register, with additional review of websites and key journals to identify any relevant records up to July 2020. We included studies describing the proportion of hospitalized TBI patients age 16 years or older demonstrating agitated behavior. We included comparative studies with and without concurrent controls, randomized controlled trials, pseudo-randomized controlled trials, and case series. Methodological quality was critically appraised using a Joanna Briggs Institute checklist. Sixteen studies met eligibility criteria, with a total of 5592 participants. The pooled prevalence of agitation was 31.73% (95% confidence interval [CI], 25.25%-39.00%) during inpatient care (acute and rehabilitation), 32.23% (95% CI, 27.13%-37.80%) during rehabilitative care and 44.06% (95% CI, 36.15%-52.28%) for inpatients in PTA specifically. Disinhibited behaviors were the most common. There was substantial heterogeneity between studies. Additional high-quality research featuring large samples, frequent and long-term measurement of agitation, use of validated scales, and consideration of variables such as PTA status will further improve estimates of agitation prevalence following TBI.
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Affiliation(s)
- Ruby K Phyland
- Monash Epworth Rehabilitation Research Center, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jennie L Ponsford
- Monash Epworth Rehabilitation Research Center, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sarah L Carrier
- Monash Epworth Rehabilitation Research Center, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Amelia J Hicks
- Monash Epworth Rehabilitation Research Center, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Adam McKay
- Monash Epworth Rehabilitation Research Center, Melbourne, Victoria, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Division of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
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8
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Cao D, Chu N, Yu H, Sun M. Role of comprehensive nursing care in improving the prognosis and mood of patients with secondary cerebral infarction after craniocerebral injury. Am J Transl Res 2021; 13:7342-7348. [PMID: 34306503 PMCID: PMC8290807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the application value of comprehensive nursing in improving prognosis and relieving bad moods of patients with secondary cerebral infarction after craniocerebral injury. METHODS Patients with cerebral infarction secondary to craniocerebral injury in our hospital from January 2017 to October 2019 were selected as the study subjects. According to the random number table method, they were randomly divided into the control group and the observation group, with 40 patients in each group. The control group was given routine nursing care and the observation group was given comprehensive nursing care. The prognosis, the changes of mood before and after nursing, nursing satisfaction, quality of life after nursing, and complications were compared between the two groups. RESULTS After the implementation of nursing, the good prognosis rate of the observation group was 90.00% (36/40), significantly higher than that of the control group 60.00% (24/40) (P<0.05); the HAMA and HDRS scores of the observation group were significantly better than that of the control group, and the nursing satisfaction rate was higher than that of the control group (P<0.05). The total score of quality of life in the observation group was significantly higher than that in the control group, and the incidence of complications was significantly lower than that in the control group (P<0.05). CONCLUSION Comprehensive nursing care for patients with secondary cerebral infarction after craniocerebral injury can effectively improve prognosis and relieve bad moods, reduce the incidence of complications and improve nursing satisfaction, so as to improve the quality of life of patients.
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Affiliation(s)
- Deyan Cao
- The Second Hospital of Shandong UniversityNo. 247 Beiyuan Avenue, Jinan 250033, Shandong Province, China
| | - Nina Chu
- Department of Nursing, Penglai TCM HospitalPenglai 250033, Shandong Province, China
| | - Hongyan Yu
- Department of Outpatient, Wucheng County Peoples HospitalDezhou 250033, Shandong Province, China
| | - Meihua Sun
- The Second Hospital of Shandong UniversityNo. 247 Beiyuan Avenue, Jinan 250033, Shandong Province, China
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9
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Rehabilitation of social cognition impairment after traumatic brain injury: a systematic review. NEUROLOGÍA (ENGLISH EDITION) 2020; 37:767-780. [DOI: 10.1016/j.nrleng.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
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Factors Affecting Participation in Physical Therapy During Posttraumatic Amnesia. Arch Phys Med Rehabil 2020; 102:378-385. [PMID: 32745545 DOI: 10.1016/j.apmr.2020.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/16/2020] [Accepted: 06/30/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To examine the effect of agitation, cognitive impairment, fatigue, and pain on physical therapy participation and outcomes during posttraumatic amnesia (PTA) after traumatic brain injury (TBI). DESIGN Prospective longitudinal study. SETTING Inpatient rehabilitation hospital. PARTICIPANTS Participants (N=77) with moderate-to-severe TBI who were deemed to be experiencing PTA using the Westmead Post-Traumatic Amnesia Scale. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The Pittsburgh Rehabilitation Participation Scale and time in therapy (min) were recorded twice daily after routine physical therapy sessions during PTA. The FIM-motor (select items related to physical therapy) score rated on admission and after emergence from PTA was used to calculate FIM-motor change. RESULTS Agitation was associated with lower participation in therapy. The presence of agitation and pain both predicted lower FIM-motor change at emergence from PTA. Higher levels of cognitive impairment and fatigue were also associated with lower participation and less time in therapy. CONCLUSIONS The presence of agitation, fatigue, pain, and cognitive impairment impede rehabilitation success during PTA. This study strengthens the case for implementing environmental and behavioral recommendations, such as conducting therapy earlier in the day within a familiar space (ie, on the ward) and tailoring session duration to patient needs. This is with the aim of minimizing fatigue, agitation, and pain, while promoting cognitive recovery and arousal during PTA to maximize physical gains. Further research is warranted to examine the factors associated with rehabilitation success across other therapeutic disciplines.
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Krese K, Ingraham B, O'Brien MK, Mummidisetty CK, McNulty M, Srdanovic N, Kocherginsky M, Ripley D. The impact of a yoga-based physical therapy group for individuals with traumatic brain injury: results from a pilot study. Brain Inj 2020; 34:1118-1126. [PMID: 32530717 DOI: 10.1080/02699052.2020.1776394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare the impacts of yoga-based physical therapy versus a seated rest within the context of standard rehabilitation practice on sleep, heart rate variability (HRV), anxiety, and fatigue during acute traumatic brain injury (TBI) rehabilitation. METHODS Eleven individuals participated in this crossover study involving the following interventions in a randomized order: group yoga-based physical therapy (YPT), conventional physical therapy (CPT), and group seated rest in a relaxing environment (SR). HRV and self-reported anxiety and fatigue were measured immediately before and after each group, and sleep after each condition and at baseline. Data was analyzed using generalized linear mixed models with repeated measures. RESULTS The interaction between time and treatment was statistically significant (p = .0203). For the SR treatment, wake after sleep onset (WASO) rate was reduced from 14.99 to 10.60 (IRR = 0.71; p = .006). Time and treatment were not found to be statistically significantly associated with any of the secondary outcomes. CONCLUSION Yoga-based physical therapy is feasible and safe in the inpatient rehabilitation setting following TBI. Sleep quality improved following the addition of a one-hour seated rest in a relaxing environment to a standard rehabilitation daily schedule, suggesting that structured rest time may be beneficial to sleep hygiene during inpatient rehabilitation following TBI. ClinicalTrials.Gov Registration Number: NCT03701594.
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Affiliation(s)
- Kelly Krese
- Brain Innovation Center, Shirley Ryan AbilityLab , Chicago, Illinois, USA
| | - Benjamin Ingraham
- Brain Innovation Center, Shirley Ryan AbilityLab , Chicago, Illinois, USA.,Division of Physical Medicine and Rehabilitation, University of Utah , Salt Lake City, Utah, USA
| | - Megan K O'Brien
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab , Chicago, Illinois, USA
| | - Chaithanya K Mummidisetty
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab , Chicago, Illinois, USA
| | - Mary McNulty
- Brain Innovation Center, Shirley Ryan AbilityLab , Chicago, Illinois, USA.,Department of Occupational Therapy, Midwestern University , Glendale, Arizona, USA
| | - Nina Srdanovic
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
| | - Masha Kocherginsky
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
| | - David Ripley
- Brain Innovation Center, Shirley Ryan AbilityLab , Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
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12
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Hammond FM, Baker-Sparr CA, Dahdah MN, Dams-O'Connor K, Dreer LE, O'Neil-Pirozzi TM, Novack TA. Predictors of 1-Year Global Outcomes After Traumatic Brain Injury Among Older Adults: A NIDILRR Traumatic Brain Injury Model Systems Study. J Aging Health 2020; 31:68S-96S. [PMID: 31718413 DOI: 10.1177/0898264318819197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: To assess predictors of global function and driving status among older adults (50 years and older) who survived 1 year following inpatient rehabilitation for moderate-to-severe traumatic brain injury (TBI). Methods: Functional status at 1-year post-TBI was determined for 1,845 individuals. The relationship age category to function was studied using associations and predictive modeling. Results: The final model accounted for 34% variance in Glasgow Outcome Scale-Extended (GOS-E) among 60- to 69-year-olds and 70- to 79-year-olds, and 25% variance in 50- to 59-year-olds and 80+-year-olds. FIM Motor at rehabilitation discharge made the greatest contribution to GOS-E variance across all age groups. Inpatient rehabilitation discharge to nursing home or adult home and rehospitalization were associated with a one-level decrease in GOS-E. Alcohol use predicted lower GOS-E among the 70- to 79-year-olds. Gender, ethnicity, and rehospitalizations were negatively associated driving. Discussion: Rehabilitation approaches to older adults with TBI may help maximize function and, thereby, improve later outcomes and decrease rehospitlaizations. Such strategies may include longer and more intensive acute rehabilitation with greater patient engagement and enhanced transitions of care.
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Affiliation(s)
- Flora M Hammond
- Indiana University School of Medicine, Indianapolis, USA.,Rehabilitation Hospital of Indianapolis, IN, USA
| | | | - Marie N Dahdah
- North Texas Traumatic Brain Injury Model System, Dallas, TX, USA
| | | | | | - Therese M O'Neil-Pirozzi
- Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Northeastern University, Boston, MA, USA
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13
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Munsell M, De Oliveira E, Saxena S, Godlove J, Kiran S. Closing the Digital Divide in Speech, Language, and Cognitive Therapy: Cohort Study of the Factors Associated With Technology Usage for Rehabilitation. J Med Internet Res 2020; 22:e16286. [PMID: 32044752 PMCID: PMC7055773 DOI: 10.2196/16286] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/29/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND For stroke, traumatic brain injury (TBI), and other neurologic conditions associated with speech-language disorders, speech and language therapy is the standard of care for promoting recovery. However, barriers such as clinician time constraints and insurance reimbursement can inhibit a patient's ability to receive the support needed to optimize functional gain. Although digital rehabilitation has the potential to increase access to therapy by allowing patients to practice at home, the clinical and demographic characteristics that impact a patient's level of engagement with technology-based therapy are currently unknown. OBJECTIVE This study aimed to evaluate whether the level of engagement with digital therapy differs by various patient characteristics, including age, gender, diagnosis, time from disease onset, and geographic location (urban vs rural). METHODS Data for patients with stroke or TBI that initiated the use of Constant Therapy, a remotely delivered, cloud-based rehabilitation program for patients with speech-language disorders, were retrospectively analyzed. Only data from therapeutic sessions completed at home were included. The following three activity metrics were evaluated: (1) the number of active weeks of therapy, (2) the average number of active therapy days per week, and (3) the total number of therapeutic sessions completed during the first 20 weeks of program access. An active day or week was defined as having at least one completed therapeutic session. Separate multiple linear regression models were performed with each activity measure as the dependent variable and all available patient demographics as model covariates. RESULTS Data for 2850 patients with stroke or TBI were analyzed, with the average patient completing 8.6 weeks of therapy at a frequency of 1.5 days per week. Contrary to known barriers to technological adoption, older patients were more active during their first 20 weeks of program access, with those aged 51 to 70 years completing 5.01 more sessions than patients aged 50 years or younger (P=.04). Similarly, patients living in a rural area, who face greater barriers to clinic access, were more digitally engaged than their urban counterparts, with rural patients completing 11.54 more (P=.001) sessions during their first 20 weeks of access, after controlling for other model covariates. CONCLUSIONS An evaluation of real-world data demonstrated that patients with stroke and TBI use digital therapy frequently for cognitive and language rehabilitation at home. Usage was higher in areas with limited access to clinical services and was unaffected by typical barriers to technological adoption, such as age. These findings will help guide the direction of future research in digital rehabilitation therapy, including the impact of demographics on recovery outcomes and the design of large, randomized controlled trials.
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Affiliation(s)
| | | | | | | | - Swathi Kiran
- The Learning Corp, Newton, MA, United States.,Aphasia Research Laboratory, Speech Language and Hearing Sciences, Boston University, Boston, MA, United States
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Bartur G, Joubran K, Peleg-Shani S, Vatine JJ, Shahaf G. A pilot study on the electrophysiological monitoring of patient's engagement in post-stroke physical rehabilitation. Disabil Rehabil Assist Technol 2019; 15:471-479. [PMID: 31684777 DOI: 10.1080/17483107.2019.1680749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: This study discusses the feasibility of an electrophysiological monitor for patient engagement during rehabilitation sessions. While patient engagement has a significant clinical role, it is not obvious how its real-time monitoring could be used.Objective: We designed this study to provide further support for the feasibility of such a tool based on the Brain Engagement Index (BEI), and to discuss clinical usefulness and its evaluation.Methods: The study involved 30 patients during post-stroke rehabilitation. Each patient underwent two sessions with BEI monitoring. In one session the therapist received real-time feedback from the monitor and in the other he did not. The BEI was compared to video-based evaluation of temporary functional change from the session start to its end and with a rater-based evaluation of the level of engagement evoked by the exercises in the session.Results: Irrespective of whether feedback is used, there is association between BEI and temporary functional change as well as with evaluated engagement. Furthermore, the contribution of the BEI monitor to rehabilitation may be demonstrated.Conclusions: It would be challenging to establish directly the monitor's contribution in large-scale studies. Nevertheless, it might be sufficient to demonstrate that the monitor provides important information regarding patient engagement.Implication for RehabilitationThis work presents an easy-to-use electrophysiological index for monitoring patient engagement in real-time.Enhanced engagement is of utmost importance for effective rehabilitation.The ability to identify in real-time barriers to engagement is expected to be of great contributive value.
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Affiliation(s)
- Gadi Bartur
- Rehabilitative Psychobiology Laboratory, Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel Aviv, Israel.,Department of Rehabilitation, Reuth Rehabilitation Hospital, Tel Aviv, Israel
| | - Katherin Joubran
- Department of Rehabilitation, Reuth Rehabilitation Hospital, Tel Aviv, Israel.,Rehabilitation and Motor Control of Walking Laboratory, Department of Physiotherapy, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sara Peleg-Shani
- Department of Rehabilitation, Reuth Rehabilitation Hospital, Tel Aviv, Israel
| | - Jean-Jacques Vatine
- Department of Rehabilitation, Reuth Rehabilitation Hospital, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Goded Shahaf
- Rehabilitative Psychobiology Laboratory, Reuth Research and Development Institute, Reuth Rehabilitation Hospital, Tel Aviv, Israel.,BrainMARC LTD, Yokneam, Israel
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15
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Zarshenas S, Colantonio A, Horn SD, Jaglal S, Jacob B, Cullen N. Occupational and Physical Therapy Activities and Level of Effort in Patients With Traumatic Brain Injury: Association With Functional Outcomes. PM R 2019; 12:339-348. [PMID: 31600430 DOI: 10.1002/pmrj.12260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/17/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although some attention has been given to the association of functional outcomes with rehabilitation intensity, the evidence is still sparse in this field. OBJECTIVE To investigate the effect of inpatient rehabilitation (IR) on discharge cognitive and motor function and the association of time spent in occupational and physical therapy and level of effort with cognitive and motor function in patients with traumatic brain injury (TBI). DESIGN Secondary analysis of TBI-Practice Based Evidence dataset. SETTINGS Inpatient rehabilitation. PARTICIPANTS One hundred forty-nine patients with TBI who were consecutively admitted for IR between 2008 and 2011 in Ontario, Canada. INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENTS Admission and discharge Functional Independence Measure-Rasch Cognitive and Motor Scores. RESULTS Patients showed significant improvement in cognitive and motor function from admission to discharge (P < .0001). After controlling for confounding factors, discharge FIM-Rasch cognitive and motor scores were not associated with either level of effort or time spent in physical therapy activities. Discharge motor, but not cognitive function, was associated with more time spent in the complex (β = 0.20, confidence interval [CI] 0.005, 0.05) and less time spent in simple OT activities (β = -0.13, CI -0.13, -0.01). CONCLUSION This study provides valuable information for clinicians about the effectiveness of IR on the improvement of motor and cognitive outcomes and the importance of considering the amount of time spent in activities based on their level of complexity rather than the total time of therapy to improve motor outcomes in this population. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sareh Zarshenas
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Susan D Horn
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake, UT
| | - Susan Jaglal
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
| | - Binu Jacob
- University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
| | - Nora Cullen
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,University Health Network, Toronto Rehabilitation Institute, University Centre, Toronto, Canada
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16
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Beaulieu CL, Peng J, Hade EM, Corrigan JD, Seel RT, Dijkers MP, Hammond FM, Horn SD, Timpson ML, Swan M, Bogner J. Level of Effort and 3 Hour Rule Compliance. Arch Phys Med Rehabil 2019; 100:1827-1836. [DOI: 10.1016/j.apmr.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 01/07/2023]
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17
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Comparative Effectiveness of Inpatient Rehabilitation Interventions for Traumatic Brain Injury: Introduction. Arch Phys Med Rehabil 2019; 100:1986-1989. [PMID: 31561814 DOI: 10.1016/j.apmr.2019.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 11/22/2022]
Abstract
The Comparative Effectiveness of Inpatient Rehabilitation Interventions for Traumatic Brain Injury (TBI-CER) project used causal inference methods as an alternative to randomized controlled trials to evaluate rehabilitation practices. The TBI practice-based evidence dataset afforded the opportunity to compare the outcomes of different rehabilitation approaches while controlling for a large set of potential confounders using propensity score methods (PSMs). PSMs rely on 4 assumptions: positivity, exchangeability, consistency, and correct specification of the propensity score model. When these assumptions are met, PSMs provide a transparent means for evaluating potential causal relations between interventions and outcomes using observational data. In combination, the series of studies resulting from the TBI-CER project suggested that the content and approach used in treatment have a stronger effect on outcomes than the amount of time spent in treatment. Further, engagement of the patient and family in treatment is key to optimizing outcomes up to 9 months postdischarge from rehabilitation.
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18
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Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients With Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100:1274-1282. [DOI: 10.1016/j.apmr.2018.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023]
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19
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Yamanaka S, Goldman RD, Goto T, Hayashi H. Multiple intubation attempts in the emergency department and in-hospital mortality: A retrospective observational study. Am J Emerg Med 2019; 38:768-773. [PMID: 31255428 DOI: 10.1016/j.ajem.2019.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Multiple intubation attempts in the Emergency Department (ED) have been associated with adverse events, but no study examined the influence of multiple intubation attempts on survival during hospitalization. Our aim was to compare one or more intubation attempts in the ED with risk of morbidity and mortality during hospitalization. METHODS We conducted a single center retrospective analysis of all patients undergoing emergency intubation in the ED and then admission to the hospital, during September 2010 to April 2016. The primary exposure was multiple intubation attempts. The primary outcome was mortality during hospitalization after intubation in the ED. RESULTS Of 181 patients, 63 (35%) required two or more attempts. We found no significant difference in mortality (p = 0.11), discharge from the hospital (p = 0.45), length of stay in hospital (p = 0.34), intensive care unit (ICU) (p = 0.32), ED (p = 0.81) or intubation period (p = 0.64), between one or more intubation attempts. After adjustment for the number of intubation trials, age, sex, intubation methods, first intubator training level and diagnostic category, use of medications during intubation was the only independent prognostic variable for hospital death (adjusted OR 0.21, 95%CI 0.1-0.45, p < 0.01). Number of trials to achieve successful intubation was not associated with discharge disposition (OR 0.77 95%CI 0.24-2.46, p = 0.66). Age (OR 0.95, 95%CI 0.93-0.98, p < 0.01) and brain injury as a diagnostic category (OR 0.15 95%CI 0.04-0.56, p < 0.01) were independent prognostic variables. CONCLUSIONS We found multiple intubation attempts were not associated with increased mortality and morbidity during hospitalization.
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Affiliation(s)
- Syunsuke Yamanaka
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan.
| | - Ran D Goldman
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Tadahiro Goto
- Graduate School of Medical Sciences, University of Fukui, Japan
| | - Hiroyuki Hayashi
- Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan.
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20
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Rodríguez-Rajo P, Leno Colorado D, Enseñat-Cantallops A, García-Molina A. Rehabilitation of social cognition impairment after traumatic brain injury: A systematic review. Neurologia 2018; 37:S0213-4853(18)30202-0. [PMID: 30553571 DOI: 10.1016/j.nrl.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/26/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Many studies have described the presence of difficulty processing and generating social behaviour in patients who have suffered a traumatic brain injury (TBI). These difficulties in social cognition (SC) deteriorate personal relationships in the family, at work, or in the community. However, therapeutic programmes aiming to improve SC continue to be an outstanding issue in clinical practice. We performed a systematic review of the existing literature on the recovery of SC in patients with TBI, assessing the methodological quality of the included studies and the therapeutic effectiveness of the rehabilitation strategies used. DEVELOPMENT We performed a bibliographic search of papers published before June 2018 in the Medline/PubMed, Google Scholar, PsycINFO, and ClinicalTrials.gov databases. Of the 198 potentially relevant articles, 10 met our eligibility criteria. Two of the authors independently and blindly assessed the methodological quality of these studies using the PEDro scale. CONCLUSIONS The articles included in this systematic review essentially studied the effect of different interventions aimed at the rehabilitation of SC in patients with chronic TBIs. The analysis showed adequate methodological quality and an acceptable level of evidence. Future research should analyse the effect of these interventions in patients with TBIs in the sub- and post-acute phases.
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Affiliation(s)
- P Rodríguez-Rajo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España.
| | - D Leno Colorado
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España
| | - A Enseñat-Cantallops
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España
| | - A García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España
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21
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Agitated Behavior and Activities of Daily Living Retraining During Posttraumatic Amnesia. J Head Trauma Rehabil 2018; 33:317-325. [DOI: 10.1097/htr.0000000000000363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Lamontagne ME, Gagnon C, Allaire AS, Noreau L. A Scoping Review of Clinical Practice Improvement Methodology Use in Rehabilitation. Rehabil Process Outcome 2016. [DOI: 10.4137/rpo.s20360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Context The Clinical Practice Improvement (CPI) approach is a methodological and quality improvement approach that has emerged and is gaining in popularity. However, there is no systematic description of its use or the determinants of its practice in rehabilitation settings. Method We performed a scoping review of the use of CPI methodology in rehabilitation settings. Results A total of 103 articles were reviewed. We found evidence of 13 initiatives involving CPI with six different populations. A total of 335 citations of determinants were found, with 68.7% related to CPI itself. Little information was found about what type of external and internal environment, individual characteristics and implementation process might facilitate or hinder the use of CPI. Conclusion Given the growing popularity of this methodological approach, CPI initiatives would gain from increasing knowledge of the determinants of its success and incorporating them in future implementation.
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Affiliation(s)
- Marie-Eve Lamontagne
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, L'Institut de réadaptation en déficience physique de Québec, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Cynthia Gagnon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Neuromuscular Clinic, Centre de réadaptation en déficience physique de Jonquière, Centre de santé et de services sociaux de Jonquière, Jonquière, QC, Canada
| | - Anne-Sophie Allaire
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, L'Institut de réadaptation en déficience physique de Québec, Québec, QC, Canada
| | - Luc Noreau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, L'Institut de réadaptation en déficience physique de Québec, Québec, QC, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
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23
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Horn SD, Corrigan JD, Beaulieu CL, Bogner J, Barrett RS, Giuffrida CG, Ryser DK, Cooper K, Carroll DM, Deutscher D. Traumatic Brain Injury Patient, Injury, Therapy, and Ancillary Treatments Associated With Outcomes at Discharge and 9 Months Postdischarge. Arch Phys Med Rehabil 2015; 96:S304-29. [PMID: 26212406 PMCID: PMC4517296 DOI: 10.1016/j.apmr.2014.11.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/28/2014] [Accepted: 11/20/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine associations of patient and injury characteristics, inpatient rehabilitation therapy activities, and neurotropic medications with outcomes at discharge and 9 months postdischarge for patients with traumatic brain injury (TBI). DESIGN Prospective, longitudinal observational study. SETTING Inpatient rehabilitation centers. PARTICIPANTS Consecutive patients (N=2130) enrolled between 2008 and 2011, admitted for inpatient rehabilitation after an index TBI injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Rehabilitation length of stay, discharge to home, and FIM at discharge and 9 months postdischarge. RESULTS The admission FIM cognitive score was used to create 5 relatively homogeneous subgroups for subsequent analysis of treatment outcomes. Within each subgroup, significant associations were found between outcomes and patient and injury characteristics, time spent in therapy activities, and medications used. Patient and injury characteristics explained on average 35.7% of the variation in discharge outcomes and 22.3% in 9-month outcomes. Adding time spent and level of effort in therapy activities and percentage of stay using specific medications explained approximately 20% more variation for discharge outcomes and 12.9% for 9-month outcomes. After patient, injury, and treatment characteristics were used to predict outcomes, center differences added only approximately 1.9% additional variance explained. CONCLUSIONS At discharge, greater effort during therapy sessions, time spent in more complex therapy activities, and use of specific medications were associated with better outcomes for patients in all admission FIM cognitive subgroups. At 9 months postdischarge, similar but less pervasive associations were observed for therapy activities, but not classes of medications. Further research is warranted to examine more specific combinations of therapy activities and medications that are associated with better outcomes.
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Affiliation(s)
- Susan D Horn
- Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT.
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH
| | | | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH
| | - Ryan S Barrett
- Institute for Clinical Outcomes Research, International Severity Information Systems, Salt Lake City, UT
| | | | - David K Ryser
- Neuro Specialty Rehabilitation Unit, Intermountain Medical Center, Salt Lake City, UT
| | - Kelli Cooper
- Neuro Specialty Rehabilitation Unit, Intermountain Medical Center, Salt Lake City, UT
| | - Deborah M Carroll
- Neuro Specialty Rehabilitation Unit, Intermountain Medical Center, Salt Lake City, UT
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