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Postol N, Barton J, Wakely L, Bivard A, Spratt NJ, Marquez J. "Are we there yet?" expectations and experiences with lower limb robotic exoskeletons: a qualitative evaluation of the therapist perspective. Disabil Rehabil 2024; 46:1023-1030. [PMID: 36861846 DOI: 10.1080/09638288.2023.2183992] [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] [Received: 09/28/2022] [Revised: 02/11/2023] [Accepted: 02/18/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Lower limb robotic exoskeletons can assist movement, however, clinical uptake in neurorehabilitation is limited. The views and experiences of clinicians are pivotal to the successful clinical implementation of emerging technologies. This study investigates therapist perspectives of the clinical use and future role of this technology in neurorehabilitation. METHODS Australian and New Zealand-based therapists with lower limb exoskeleton experience were recruited to complete an online survey and semi-structured interview. Survey data were transposed into tables and interviews transcribed verbatim. Qualitative data collection and analysis were guided by qualitative content analysis and interview data were thematically analysed. RESULTS Five participants revealed that the use of exoskeletons to deliver therapy involves the interplay of human elements - experiences and perspectives of use, and mechanical elements - the device itself. Two overarching themes emerged: the "journey", with subthemes of clinical reasoning and user experience; and the "vehicle" with design features and cost as subthemes, to explore the question "Are we there yet?" CONCLUSION Therapists expressed positive and negative perspectives from their experiences with exoskeletons, giving suggestions for design features, marketing input, and cost to enhance future use. Therapists are optimistic that this journey will see lower limb exoskeletons integral to rehabilitation service delivery.
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Affiliation(s)
- Nicola Postol
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
- Centre for Brain and Mental Health, Hunter Medical Research Institute, New Lambton, Australia
| | - Julia Barton
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
| | - Luke Wakely
- Department of Rural Health, University of Newcastle, Callghan, Australia
- Hunter New England Local Health District, New Lambton, Australia
| | - Andrew Bivard
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
- Centre for Brain and Mental Health, Hunter Medical Research Institute, New Lambton, Australia
- University of Melbourne, School of Medicine, Dentistry and Public Health, Melbourne, Australia
| | - Neil J Spratt
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
- Centre for Brain and Mental Health, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Local Health District, New Lambton, Australia
| | - Jodie Marquez
- University of Newcastle, College of Health, Medicine and Wellbeing, Callghan, Australia
- Centre for Brain and Mental Health, Hunter Medical Research Institute, New Lambton, Australia
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McCormick S, Jarvis JM, Terhorst L, Richardson A, Kaseman L, Kesbhat A, Yepuri Y, Beyene E, VonVille H, Bendixen R, Treble-Barna A. Patient-report and caregiver-report measures of rehabilitation service use following acquired brain injury: a systematic review. BMJ Open 2024; 14:e076537. [PMID: 38382949 PMCID: PMC10882343 DOI: 10.1136/bmjopen-2023-076537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE To review patient-report/caregiver-report measures of rehabilitation service use following acquired brain injury (ABI). DATA SOURCES Medline, APA PsycINFO, Embase and CINAHL were searched on November 2021 and November 2022. Authors were contacted if measures were not included in manuscripts/appendices. STUDY SELECTION Included articles were empirical research or a research protocol, available in English and described measures of patient report/caregiver report of rehabilitation service use post-ABI via quantitative or qualitative methods. Two reviewers independently screened 5290 records using DistillerSR. Discrepancies were resolved by team adjudication. DATA EXTRACTION Data extraction was piloted with high levels of agreement (k=.94). Data were extracted by a single member with team meetings to seek guidance as needed. Data included administration characteristics (reporter, mode of administration, recall period), psychometric evidence and dimensions assessed (types of services, setting, frequency, duration, intensity, qualitative aspects). DATA SYNTHESIS One hundred and fifty-two measures were identified from 85 quantitative, 56 qualitative and 3 psychometric studies. Psychometric properties were reported for four measures, all of which focused on satisfaction. Most measures inquired about the type of rehabilitation services used, with more than half assessing functional (eg, physical therapy) and behavioural health rehabilitation services, but fewer than half assessing community and academic reintegration (eg, special education, vocational rehabilitation) or cognitive (eg, neuropsychology) services. Fewer than half assessed qualitative aspects (eg, satisfaction). Recall periods ranged from 1 month to 'since the ABI event' or focused on current use. Of measures that could be accessed (n=71), many included a limited checklist of types of services used. Very few measures assessed setting, frequency, intensity or duration. CONCLUSIONS Despite widespread interest, the vast majority of measures have not been validated and are limited in scope. Use of gold-standard psychometric methods to develop and validate a comprehensive patient-report/caregiver-report measure of rehabilitation service use would have wide-ranging implications for improving rehabilitation research in ABI.
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Affiliation(s)
- Sophie McCormick
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessica M Jarvis
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, SHRS Data Center, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amanda Richardson
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Kaseman
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aboli Kesbhat
- College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Yamini Yepuri
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Beyene
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Helena VonVille
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roxanna Bendixen
- Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amery Treble-Barna
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Bompani N, Bertella L, Barbieri V, Scarabel L, Scarpina F, Perucca L, Rossi P. The predictive role of fatigue and neuropsychological components on functional outcomes in COVID-19 after a multidisciplinary rehabilitation program. J Int Med Res 2023; 51:3000605221148435. [PMID: 36650909 PMCID: PMC9869216 DOI: 10.1177/03000605221148435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To verify the impact of altered cognitive functioning and higher levels of mental fatigue, both reported after coronavirus disease 2019 (COVID-19), on rehabilitation treatment outcomes. METHODS In this real-practice retrospective pre-post intervention cohort study, cognitive functioning, measured through standardized neuropsychological measures, and individual levels of fatigue, depression and anxiety symptoms, were evaluated at admission to a rehabilitation program in individuals who had been hospitalized for COVID-19. The rehabilitation program effectiveness was measured through the Functional Independence Measure. RESULTS Among the patient sample (n = 66), 87.88% reported experiencing high levels of fatigue at admission, while 16.67% reported depressive symptoms, and 22.73% reported anxiety symptoms. After rehabilitation, the sample displayed a significant decrease in the level of disability, in both the motor and cognitive subscales. Neuropsychological and psychological functioning did not play a predictive role. The 45 patients who received mechanical ventilation during intensive care, representing 68.18% of the sample, benefited more from rehabilitation treatment. CONCLUSIONS The results support the importance of an early rehabilitation program after COVID-19 infection, independent of the initial neuropsychological and psychological functioning. Respiratory assistance may represent a crucial factor for short-term neuropsychological disease after-effects. Future studies on the long-term neuropsychological effect of COVID-19 infection on individual levels of disability are necessary.
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Affiliation(s)
- Nicole Bompani
- Clinica Hildebrand, Centro di Riabilitazione, Brissago, Switzerland,IRCCS Istituto Auxologico Italiano, U.O. di Riabilitazione Neuromotoria di Auxologico ‘Capitanio’, Milan, Italy
| | - Laura Bertella
- Clinica Hildebrand, Centro di Riabilitazione, Brissago, Switzerland,Laura Bertella, Clinica Hildebrand, Centro di Riabilitazione Brissago, Via Crodolo 18, 6614 Brissago, Switzerland.
| | | | - Luca Scarabel
- Clinica Hildebrand, Centro di Riabilitazione, Brissago, Switzerland,Clinica di Riabilitazione dell’Ente Ospedaliero Cantonale, sede di Novaggio e sede di Fado, Switzerland
| | - Federica Scarpina
- ‘Rita Levi Montalcini’ Department of Neurosciences, University of Turin, Italy,IRCCS Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Laura Perucca
- IRCCS Istituto Auxologico Italiano, U.O. di Riabilitazione Neuromotoria di Auxologico ‘Capitanio’, Milan, Italy,Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Paolo Rossi
- Clinica Hildebrand, Centro di Riabilitazione, Brissago, Switzerland
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Xie C, Hu J, Cheng Y, Yao Z. Researches on cognitive sequelae of burn injury: Current status and advances. Front Neurosci 2022; 16:1026152. [PMID: 36408414 PMCID: PMC9672468 DOI: 10.3389/fnins.2022.1026152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/20/2022] [Indexed: 09/29/2023] Open
Abstract
Burn injury is a devastating disease with high incidence of disability and mortality. The cognitive dysfunctions, such as memory defect, are the main neurological sequelae influencing the life quality of burn-injured patients. The post-burn cognitive dysfunctions are related to the primary peripheral factors and the secondary cerebral inflammation, resulting in the destruction of blood-brain barrier (BBB), as is shown on Computed Tomography (CT) and magnetic resonance imaging examinations. As part of the neurovascular unit, BBB is vital to the nutrition and homeostasis of the central nervous system (CNS) and undergoes myriad alterations after burn injury, causing post-burn cognitive defects. The diagnosis and treatment of cognitive dysfunctions as burn injury sequelae are of great importance. In this review, we address the major manifestations and interventions of post-burn cognitive defects, as well as the mechanisms involved in memory defect, including neuroinflammation, destruction of BBB, and hormone imbalance.
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Affiliation(s)
- Chenchen Xie
- Department of Neurology, Affiliated Hospital and Clinical Medical College of Chengdu University, Chengdu, China
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Hu
- Department of Neurology, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yong Cheng
- Department of Neurology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Zhongxiang Yao
- Department of Physiology, Army Medical University, Chongqing, China
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5
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Rath JF, McGiffin JN, Glubo H, McDermott HW, Beattie A, Arutiunov C, Schaefer LA, Im B, Bushnik T. Cognitive Dependence in Physically Independent Patients at Discharge From Acute Traumatic Brain Injury Rehabilitation. Arch Phys Med Rehabil 2022; 103:1866-1869. [PMID: 35196504 PMCID: PMC9391527 DOI: 10.1016/j.apmr.2022.01.160] [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] [Received: 08/03/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the incidence of cognitive dependence in adults who are physically independent at discharge from acute traumatic brain injury (TBI) rehabilitation. DESIGN Analysis of historical clinical and demographic data obtained from inpatient stay. SETTING Inpatient rehabilitation unit in a large, metropolitan university hospital. PARTICIPANTS Adult inpatients with moderate to severe TBI (N=226) who were physically independent at discharge from acute rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM Motor and Cognitive subscales, discharge destination, and care plan. RESULTS Approximately 69% (n=155) of the physically independent inpatients were cognitively dependent at discharge from acute rehabilitation, with the highest proportions of dependence found in the domains of problem solving and memory. Most (82.6%; n=128) of these physically independent, yet cognitively dependent, patients were discharged home. Of those discharged home, 82% (n=105) were discharged to the care of family members, and 11% (n=15) were discharged home alone. Patients from racial and ethnic minority backgrounds were significantly more likely than White patients to be discharged while cognitively dependent. CONCLUSIONS The majority of physically independent patients with TBI were cognitively dependent at the time of discharge from acute inpatient rehabilitation. Further research is needed to understand the effect of cognitive dependence on caregiver stress and strain and the disproportionate burden on racial and ethnic minority patients and families. Given the potential functional and safety limitations imposed by cognitive deficits, health care policy and practice should facilitate delivery of cognitive rehabilitation services in acute TBI rehabilitation.
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Affiliation(s)
- Joseph F Rath
- Rusk Rehabilitation, NYU Langone Health, New York, NY.
| | | | - Heather Glubo
- Rusk Rehabilitation, NYU Langone Health, New York, NY
| | | | - Aaron Beattie
- Rusk Rehabilitation, NYU Langone Health, New York, NY
| | | | | | - Brian Im
- NYU Grossman School of Medicine, New York, NY
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Vaughan M, McMullen T, Palmer L, Kwon S, Ingber MJ. The Change in Mobility Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and the Risk Adjustment Model. Arch Phys Med Rehabil 2022; 103:1096-1104. [DOI: 10.1016/j.apmr.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
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Deutsch A, McMullen T, Vaughan M, Palmer L, Kwon S, Ingber MJ. The Change in Self-Care Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and Risk-Adjustment Model. Arch Phys Med Rehabil 2022; 103:1085-1095. [DOI: 10.1016/j.apmr.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
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Nunes I, Silva Nunes MV. The influence of cognitive reserve in the protection of the cognitive status after an acquired brain injury: A systematic review. J Clin Exp Neuropsychol 2022; 43:839-860. [PMID: 35014599 DOI: 10.1080/13803395.2021.2014788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cognitive Reserve (CR) hypothesis was introduced to account for the variability in cognitive performance of patients with similar degrees of brain injury or pathology. The individual variability of CR is modulated by the interaction of innate capacities and exposures throughout life, which can act as protectors against neuropathology's clinical effects. Individuals with higher CR appear to have better cognitive performance after a brain injury. The present review aimed to identify and map the scientific evidence available in literature regarding CR's influence in protecting the cognitive status after an Acquired Brain Injury (ABI). METHOD A systematic review was performed for published studies until October 2020 in PubMed, Scopus, and CINAHL electronic databases. Studies regarding CR's influence in protecting the cognitive status after an ABI were included in this review. The Newcastle-Ottawa Scale was used to assess risk of bias in the included studies. This systematic review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42021236594. RESULTS Twenty-one studies published between 2003 and 2020 were selected and analyzed. The literature analysis showed that CR has a positive effect on cognitive status after an ABI. Various proxies were used to estimate CR, including estimated premorbid IQ, education, occupation attainment, socioeconomic status, leisure activities, bilingualism, and social integration. CR proxies constitute a set of variables that may have a significant influence on cognitive status. Higher CR levels were associated with lower cognitive impairment after an ABI. CONCLUSIONS Although more research is necessary for a complete understanding of CR's impact on cognition, the synthesis of these studies confirmed that there is evidence on the beneficial impact of CR on cognitive status after an ABI. These findings support CR's cognitive status role following an ABI and may provide additional information for prognosis and rehabilitation plans.
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Affiliation(s)
- Inês Nunes
- Health Sciences Institute, Portuguese Catholic University, Lisbon, Portugal.,Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Maria Vânia Silva Nunes
- Health Sciences Institute, Portuguese Catholic University, Lisbon, Portugal.,Centre for Interdisciplinary Research in Health, Lisbon, Portugal
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9
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Vuong V, Patterson KK, Cole LP, Henechowicz TL, Sheridan C, Green REA, Thaut MH. Relationship Between Cognition and Gait at 2- and 12-Months Post-Traumatic Brain Injury. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:726452. [PMID: 36188837 PMCID: PMC9397897 DOI: 10.3389/fresc.2021.726452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022]
Abstract
Background: A common and debilitating challenge experienced by people with TBI is gait-associated mobility impairment and persisting cognitive impairments. Cognitive and physical impairments are often addressed independently during rehabilitation, however, increasing evidence links cognitive and motor processes more closely.Objectives: (1) To determine if correlations exist between measures of cognitive and gait recovery, post-TBI. (2) To investigate the predictive power of cognition at 2-months on gait outcomes at 12-months post-TBI.Methods: In this secondary, longitudinal study of cognitive and neural recovery, data from 93 participants admitted to an inpatient neurorehabilitation program were analyzed. Spatiotemporal gait variables [velocity, step time variability (STV), step length variability (SLV)] were collected along with cognitive variables [Trail Making Test-B (TMT-B), Digit Span-Forward (DS-F)]. Spearman's correlation coefficients were calculated between gait and cognitive variables. Multilinear and step wise regression analyses were calculated to determine predictive value of cognitive variables at 2-months on gait performance at 12-months-post TBI.Results: At 2-months post-injury, TMT-B was significantly correlated with gait velocity and STV; and DS-F was significantly correlated with velocity. At 12-months post-injury, TMT-B and DS-F was still significant correlated with velocity. TMT-B at 2-months was correlated with SLV and STV at 12-months; and DS-F correlated significantly with velocity. Regression models showed TMT-B at 2-months predicting STV, SLV, and velocity at 12-months.Conclusions: Significant associations and predictions between physical and cognitive recovery post-TBI were observed in this study. Future directions may consider a “neural internetwork” model as a salient rehabilitation approach in TBI that integrates physical and cognitive functions.
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Affiliation(s)
- Veronica Vuong
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
- *Correspondence: Veronica Vuong
| | - Kara K. Patterson
- Knowledge, Innovation, Talent, Everywhere (KITE) Research Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lauren Patricia Cole
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
| | - Tara Lynn Henechowicz
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
| | - Conor Sheridan
- Knowledge, Innovation, Talent, Everywhere (KITE) Research Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robin E. A. Green
- Knowledge, Innovation, Talent, Everywhere (KITE) Research Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael H. Thaut
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Sathananthan N, Dimech-Betancourt B, Morris E, Vicendese D, Knox L, Gillanders D, Das Nair R, Wong D. A single-case experimental evaluation of a new group-based intervention to enhance adjustment to life with acquired brain injury: VaLiANT (valued living after neurological trauma). Neuropsychol Rehabil 2021; 32:2170-2202. [PMID: 34433379 DOI: 10.1080/09602011.2021.1971094] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adjustment to life with acquired brain injury (ABI) requires self-identity and behaviour to be updated, incorporating injury-related changes. Identifying and enabling new values-consistent behaviours could facilitate this process. We evaluated the feasibility, acceptability, and preliminary efficacy of VaLiANT, a new group intervention that aims to enhance "valued living" following ABI. We used a non-concurrent multiple baseline single-case experimental design (SCED) with an 8-week follow-up phase and randomization to multiple baseline lengths (5-7 weeks). Eight participants (50% women, aged 26-65; 4 Stroke, 3 Traumatic Brain Injury, 1 Epilepsy) attended eight group sessions with assessments before, during, and after the group. Target behaviour was valued living, assessed weekly by the Valued Living Questionnaire. Secondary outcomes included measures of wellbeing, mood, psychological acceptance, self-efficacy regarding ABI consequences, cognitive complaints, and intervention acceptability. Target behaviour was analysed through visual and statistical analysis while secondary outcome data were analysed via reliable change indices and descriptive statistics. Target behaviour data displayed no convincing patterns of improvement. Reliable improvements were found for most participants on secondary outcomes, particularly subjective wellbeing and anxiety. Intervention delivery was feasible with high acceptability ratings. Further investigation of VaLiANT is warranted, based on the feasibility and acceptability of intervention delivery and signals of efficacy identified across adjustment-related secondary outcomes.
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Affiliation(s)
- Nick Sathananthan
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Eric Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Don Vicendese
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Lucy Knox
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Roshan Das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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11
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Driver S, Douglas M, Reynolds M, McShan E, Swank C, Dubiel R. A narrative review of biopsychosocial factors which impact overweight and obesity for individuals with acquired brain injury. Brain Inj 2021; 35:1075-1085. [PMID: 34324396 DOI: 10.1080/02699052.2021.1953596] [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: 10/20/2022]
Abstract
Primary Objective: To discuss the biopsychosocial factors that affect being overweight or obese after acquired brain injury (ABI)Research Design: Narrative reviewMethods and Procedures: Based on the biopsychosocial model, we discuss the unique injury-specific factors that can affect bring overweight or obese among individuals with ABI including: (1) biological, (2) psychological and (3) social/ecological factors.Main Outcomes and Results: Injury-specific factors that impact being overweight or obese following ABI include endocrine dysfunction, pain, bowel and bladder incontinence, balance problems and motor impairment, medications, sleep quality and fatigue, alcohol and tobacco use, psychological disorders and symptoms, cognitive changes, social support, isolation, participation, transportation, independence, and knowledge. These factors may also compound general factors impacting weight management, making it difficult for individuals with ABI to maintain a healthy lifestyle.Conclusions: It is important to recognize the biopsychosocial factors that impact weight-loss and lifestyle change after ABI so that interventions can be tailored to meet individuals' unique needs. Empirical research is needed to better understand how biopsychosocial factors interact and impact overweight/ obesity after ABI.
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Affiliation(s)
- Simon Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Megan Douglas
- Rehabilitation Research Department, Baylor Scott and White Research Institute, Dallas, Texas
| | - Megan Reynolds
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Evan McShan
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Chad Swank
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
| | - Randi Dubiel
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, United States of America
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12
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Affiliation(s)
- Bruno S Subbarao
- Physical Medicine and Rehabilitation Department, Phoenix Veterans Healthcare System, Building 34, 650 E Indian School Rd, Phoenix, AZ 85012, USA.
| | - Jesse Stokke
- HonorHealth Rehabilitation Hospital, 8850 E Pima Center Pkwy, Scottsdale, AZ 85258, USA
| | - Samuel J Martin
- HonorHealth Rehabilitation Hospital, 8850 E Pima Center Pkwy, Scottsdale, AZ 85258, USA
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13
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Mitchell E, Philips N, Ahern E, McGettrick G, Mockler D, Fitzpatrick K, Trepel D. The effectiveness of community neurorehabilitation for persons with an acquired brain injury: protocol for a systematic review. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13196.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Acquired brain injury (ABI) refers to any type of brain damage after birth. ABI from either traumatic or non-traumatic origin is a leading cause of death and long-term disability globally. The impact of an ABI can be cognitive and/ or physical, greatly affecting their ability to function independently. With a lack of specialist inpatient rehabilitation facilities and services many of these survivors reside within the community either alone, with family or in residential facilities. Up-to-date evidence is required to indicate which forms of community rehabilitation are most effective in improving cognitive and physical outcomes for survivors. This systematic review aims to explore the clinical effectiveness of community neuro-rehabilitation services for persons living with an ABI. Methods: A systematic review of relevant electronic databases will be undertaken to identify eligible published randomised controlled trials. The PRISMA statement will be used to guide the systematic review. From running the initial search, we aim to submit the paper for publishing within 6 months. This process will be completed using Covidence software. Two reviewers will independently screen the search results and select studies using pre-defined selection criteria, extract data from and assess risk of bias for selected studies. Discussion: This systematic review will aim to explore the clinical effectiveness of community neuro-rehabilitation services for persons with an ABI. It plans to review and synthesize the current best available evidence base. A goal of this study is to positively inform ongoing service development within a quality framework. Systematic review registration: PROSPERO CRD42020148604 (26/02/2020)
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14
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Evensen J, Soberg HL, Sveen U, Hestad KA, Bronken BA. The Applicability of the Patient-Specific Functional Scale (PSFS) in Rehabilitation for Patients with Acquired Brain Injury (ABI) - A Cohort Study. J Multidiscip Healthc 2020; 13:1121-1132. [PMID: 33116558 PMCID: PMC7553661 DOI: 10.2147/jmdh.s259151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/24/2020] [Indexed: 12/05/2022] Open
Abstract
Aim The primary aim of this study was to investigate the applicability of the Patient-Specific Functional Scale (PSFS) in patients with acquired brain injury (ABI) admitted to a specialized rehabilitation unit in a regional hospital. A secondary aim was to identify patient characteristics and functioning that predicted changes in the PSFS. Patients and Methods In a cohort study, 59 patients with ABI were assessed for the ability to complete the PSFS. A trained multidisciplinary team applied the PSFS as part of a collaborative development of rehabilitation goals. The modified Rankin Scale (mRS), the Functional Ambulation Categories (FAC), the Rivermead Behavioural Memory Test (RBMT), the Norwegian Basic Aphasia Assessment (NBAA) and the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) were used to identify characteristics of the sample. Multivariate regression analyses were performed to investigate associations between changes in the PSFS score from admission to discharge and a selected set of participant baseline characteristics and functioning. Results Fifty-four patients (92%) of the patients with ABI were able to complete the PSFS. The five (8%) who were unable to complete the PSFS had severe cognitive or language impairment. The PSFS score improved by a mean of 2.6 (SD 2.0) points from admission to discharge. The LOTCA score made the strongest unique contribution to explain the change in the PSFS score (beta = 0.477, p= 0.020). Conclusion In the present study, most patients with ABI (92%) were able to complete the PSFS. Cognitive function on admission was a predictor of improved functioning on the PSFS.
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Affiliation(s)
- Janne Evensen
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Gjøvik, Norway
| | - Helene Lundgaard Soberg
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Unni Sveen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Knut A Hestad
- Department of Health and Nursing Sciences, Faculty of Health- and Social Sciences, The Inland Norway University of Applied Sciences, Elverum, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
| | - Berit Arnesveen Bronken
- Department of Health and Nursing Sciences, Faculty of Health- and Social Sciences, The Inland Norway University of Applied Sciences, Elverum, Norway
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15
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Rajdev K, Mehan S. Neuroprotective Methodologies of Co-Enzyme Q10 Mediated Brain Hemorrhagic Treatment: Clinical and Pre-Clinical Findings. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2020; 18:446-465. [PMID: 31187715 DOI: 10.2174/1871527318666190610101144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/22/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022]
Abstract
Cerebral brain hemorrhage is associated with the highest mortality and morbidity despite only constituting approximately 10-15% of all strokes classified into intracerebral and intraventricular hemorrhage where most of the patients suffer from impairment in memory, weakness or paralysis in arms or legs, headache, fatigue, gait abnormality and cognitive dysfunctions. Understanding molecular pathology and finding the worsening cause of hemorrhage will lead to explore the therapeutic interventions that could prevent and cure the disease. Mitochondrial ETC-complexes dysfunction has been found to increase neuroinflammatory cytokines, oxidative free radicals, excitotoxicity, neurotransmitter and energy imbalance that are the key neuropathological hallmarks of cerebral hemorrhage. Coenzyme Q10 (CoQ10), as a part of the mitochondrial respiratory chain can effectively restore these neuronal dysfunctions by preventing the opening of mitochondrial membrane transition pore, thereby counteracting cell death events as well as exerts an anti-inflammatory effect by influencing the expression of NF-kB1 dependent genes thus preventing the neuroinflammation and energy restoration. Due to behavior and biochemical heterogeneity in post cerebral brain hemorrhagic pattern different preclinical autologous blood injection models are required to precisely investigate the forthcoming therapeutic strategies. Despite emerging pre-clinical research and resultant large clinical trials for promising symptomatic treatments, there are very less pharmacological interventions demonstrated to improve post operative condition of patients where intensive care is required. Therefore, in current review, we explore the disease pattern, clinical and pre-clinical interventions under investigation and neuroprotective methodologies of CoQ10 precursors to ameliorate post brain hemorrhagic conditions.
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Affiliation(s)
- Kajal Rajdev
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India
| | - Sidharth Mehan
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India
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16
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Jones C. The Use of Therapeutic Music Training to Remediate Cognitive Impairment Following an Acquired Brain Injury: The Theoretical Basis and a Case Study. Healthcare (Basel) 2020; 8:E327. [PMID: 32911698 PMCID: PMC7551415 DOI: 10.3390/healthcare8030327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022] Open
Abstract
Cognitive impairment is the most common sequelae following an acquired brain injury (ABI) and can have profound impact on the life and rehabilitation potential for the individual. The literature demonstrates that music training results in a musician's increased cognitive control, attention, and executive functioning when compared to non-musicians. Therapeutic Music Training (TMT) is a music therapy model which uses the learning to play an instrument, specifically the piano, to engage and place demands on cognitive networks in order to remediate and improve these processes following an acquired brain injury. The underlying theory for the efficacy of TMT as a cognitive rehabilitation intervention is grounded in the literature of cognition, neuroplasticity, and of the increased attention and cognitive control of musicians. This single-subject case study is an investigation into the potential cognitive benefit of TMT and can be used to inform a future more rigorous study. The participant was an adult male diagnosed with cognitive impairment as a result of a severe brain injury following an automobile accident. Pre- and post-tests used standardized neuropsychological measures of attention: Trail Making A and B, Digit Symbol, and the Brown- Peterson Task. The treatment period was twelve months. The results of Trail Making Test reveal improved attention with a large decrease in test time on both Trail Making A (-26.88 s) and Trail Making B (-20.33 s) when compared to normative data on Trail Making A (-0.96 s) and Trail Making B (-3.86 s). Digit Symbol results did not reveal any gains and indicated a reduction (-2) in free recall of symbols. The results of the Brown-Peterson Task reveal improved attention with large increases in the correct number of responses in the 18-s delay (+6) and the 36-s delay (+7) when compared with normative data for the 18-s delay (+0.44) and the 36-s delay (-0.1). There is sparse literature regarding music based cognitive rehabilitation and a gap in the literature between experimental research and clinical work. The purpose of this paper is to present the theory for Therapeutic Music Training (TMT) and to provide a pilot case study investigating the potential efficacy of TMT to remediate cognitive impairment following an ABI.
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Affiliation(s)
- Cheryl Jones
- Department of Music, Wilfrid Laurier University, Waterloo, ON N2L 3C5, Canada
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17
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Pasipanodya EC, Dirlikov B, Castillo K, Shem KL. Cognitive Profiles Among Individuals With Spinal Cord Injuries: Predictors and Relations With Psychological Well-being. Arch Phys Med Rehabil 2020; 102:431-439. [PMID: 32739506 DOI: 10.1016/j.apmr.2020.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To examine predictors of profiles of cognitive functioning among individuals receiving acute inpatient spinal cord injury (SCI) rehabilitation, as well as associations between their cognitive functioning and psychological well-being (life satisfaction and depression) 6 months after the baseline assessment. DESIGN Prospective observational study design, with 2 assessments approximately 6 months apart. SETTING A rehabilitation unit at a level 1 trauma hospital during acute SCI hospitalization and outpatient setting after discharge. PARTICIPANTS Individuals (N=89) with SCI. INTERVENTION None. MAIN OUTCOME MEASURES Cognitive functioning (assessed by the Repeatable Battery for the Assessment of Neuropsychological Status), life satisfaction (measured by the Life Satisfaction Index A), and depressive symptoms (measured by the Patient Health Questionnaire-9). RESULTS Latent profile analysis identified 3 classes of individuals with similar patterns of cognitive functioning: class1 (average levels of cognitive performance across all assessed domains; n=48), class 2 (average cognitive performance, except in recall and memory; n=23), and class 3 (low cognitive functioning across multiple domains of cognition; n=18). Fewer years of education, history of smoking, history of substance use other than alcohol, and greater postconcussion symptoms were associated with higher odds of classification in class 3 (P<.05). Six months post baseline, individuals in class 3 reported significantly lower levels of life satisfaction than individuals in class 1 (χ2(1)=5.86; P=.045) and marginally higher depressive symptoms than individuals in class 2 (χ2(1)=5.48; P=.057). CONCLUSIONS: The impact of impaired cognition during acute rehabilitation may persist after discharge and influence the psychological well-being of individuals with SCI. Identifying individuals with cognitive dysfunction and attending to modifiable risk factors and may help ameliorate maladjustment after SCI.
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Affiliation(s)
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA
| | - Kathleen Castillo
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA
| | - Kazuko L Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA
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18
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Cognitive Neurorehabilitation in Acquired Neurological Brain Injury. Behav Neurol 2019; 2019:8241951. [PMID: 31781294 PMCID: PMC6875356 DOI: 10.1155/2019/8241951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 11/18/2022] Open
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19
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Patil M, Gupta A, Khanna M, Taly AB, Soni A, Kumar JK, Thennarasu K. Cognitive and Functional Outcomes following Inpatient Rehabilitation in Patients with Acquired Brain Injury: A Prospective Follow-up Study. J Neurosci Rural Pract 2019; 8:357-363. [PMID: 28694613 PMCID: PMC5488554 DOI: 10.4103/jnrp.jnrp_53_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI). DESIGN AND SETTING This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital. PATIENTS AND METHODS Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18-60), mean duration of illness 77.87 days (SD 91.78, range 21-300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared. RESULTS Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3-30), 31.57 (SD = 15.6, range 12-63), and 23.47 (SD = 9.7, range 5-35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3-30, motor FIM® = 61.33 ± 18.7 range 12-89, Cog FIM® =27.23 ± 8.10 range 9-35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6-27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14-35) and motor FIM® =72.89 ± 16.2 range 40-96) as compare to discharge scores. CONCLUSIONS Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.
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Affiliation(s)
- Maitreyi Patil
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arun B Taly
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Amit Soni
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - J Keshav Kumar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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20
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Williams MW, Rapport LJ, Hanks RA, Parker HA. Engagement in rehabilitation therapy and functional outcomes among individuals with acquired brain injuries. Disabil Rehabil 2019; 43:33-41. [PMID: 31099267 DOI: 10.1080/09638288.2019.1613682] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purpose : The purpose was to examine the role of therapy engagement as a potential mediator for the relationship between neuropsychological performance and functional outcomes. Materials and method : Participants were 94 adults with medically documented ABI recruited from three outpatient rehabilitation clinics at the start of occupational therapy. Participants (57% men) ranged from 18 to 82 in age, with the majority (81%) having completed 12 or more years of education. They completed a comprehensive neuropsychological assessment at baseline. Separately, occupational therapists (OTs) assessed functional independence and disability at baseline and follow up. The OTs also rated the participants' therapy engagement. Results : Therapy engagement predicted functional outcomes and mediated the relationship between neuropsychological performance and outcomes. Moreover, therapy engagement accounted for unique variance in functional outcome, even after accounting for education, comorbid health conditions, emotional distress, apathy, and baseline functional ability. Conclusions : Engagement in therapy is a crucial patient characteristic in successful rehabilitation outcome. Cognitive deficits associated with ABI undermine full engagement in rehabilitation therapy, which in turn diminishes potential gains made in therapy and functional recovery. Neuropsychological assessment can enhance rehabilitation outcomes by identifying characteristics that underlie therapy engagement, which can ultimately be used to maximize the effectiveness of individualized treatment plans. Implications for rehabilitation Neuropsychological assessment can identify cognitive abilities that are strongly related to functional outcomes during occupational therapy for acquired brain injury. Therapy engagement is an important pathway by which neuropsychological impairment predicts functional outcomes after acquired brain injuries.
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Affiliation(s)
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA.,Rehabilitation Institute of Michigan, Detroit, MI, USA
| | - Hillary A Parker
- Department of Psychology, Wayne State University, Detroit, MI, USA
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21
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Sargeant M, Sykes E, Saviour M, Sawhney A, Calzolari E, Arthur J, McGoldrick A, Seemungal BM. The utility of the Sports Concussion Assessment Tool in hospitalized traumatic brain injury patients. JOURNAL OF CONCUSSION 2018. [DOI: 10.1177/2059700218808121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Sports Concussion Assessment Tool 3rd version is a sports screening tool that is often used to support return to play decisions following a head injury. The Sports Concussion Assessment Tool 3rd version is presumed to identify brain dysfunction (implying a degree of brain injury); however, the Sports Concussion Assessment Tool has never been validated with patients with definite acute brain injury. In this study, we found that all three Sports Concussion Assessment Tool 3rd version domains – symptoms, cognitive and balance assessments – were sensitive in discriminating traumatic brain injury patients (all with abnormal acute neuroimaging) from healthy controls. Through a correlation matrix (Bonferroni corrected), we found no correlation between the subjective (symptoms) and objective (examination) Sports Concussion Assessment Tool 3rd version assessments, e.g. complaints of imbalance and memory dysfunction were not correlated, respectively, with performance on testing balance and memory function. When relaxing the correction for multiple comparisons we found that of all Sports Concussion Assessment Tool 3rd version symptoms, a feeling of ‘pressure in the head’ had the largest number of co-correlations (including affective symptoms) and overwhelmingly in a pattern indicative of migraine. Taken together, that objective and subjective assessments in the Sports Concussion Assessment Tool 3rd version are poorly correlated, could suggest that symptoms in the Sports Concussion Assessment Tool 3rd version poorly reflect brain injury but rather indicate non-brain injury processes such as migraine. It follows that the current prominent orthodoxy of resting athletes following a head injury until their symptoms settle for fear of exacerbating brain injury may be unfavourable for their recovery – at least in some cases. Prospective clinical studies would be required to assess patient recovery from concussion with early active investigation and treatment versus rest – a notion supported by recent international consensus.
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Affiliation(s)
- M Sargeant
- Brain and Vestibular Group, Neuro-Otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - E Sykes
- Brain and Vestibular Group, Neuro-Otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - M Saviour
- Brain and Vestibular Group, Neuro-Otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - A Sawhney
- Brain and Vestibular Group, Neuro-Otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - E Calzolari
- Brain and Vestibular Group, Neuro-Otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - J Arthur
- Brain and Vestibular Group, Neuro-Otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | | | - BM Seemungal
- Brain and Vestibular Group, Neuro-Otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
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22
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Postol N, Marquez J, Spartalis S, Bivard A, Spratt NJ. Do powered over-ground lower limb robotic exoskeletons affect outcomes in the rehabilitation of people with acquired brain injury? Disabil Rehabil Assist Technol 2018; 14:764-775. [PMID: 30241453 DOI: 10.1080/17483107.2018.1499137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To assess the effects of lower limb robotic exoskeletons on outcomes in the rehabilitation of people with acquired brain injury.Materials and methods: A systematic review of seven electronic databases was conducted. The primary outcome of interest was neuromuscular function. Secondary outcomes included quality of life, mood, acceptability and safety. Studies were assessed for methodological quality and recommendations were made using the GRADE system.Results: Of 2469 identified studies, 13 (n = 322) were included in the review. Five contained data suitable for meta-analysis. When the data were pooled, there were no differences between exoskeleton and control for 6-Minute Walk Test, Timed Up and Go or 10-Meter Walk Test. Berg Balance Scale outcomes were significantly better in controls (MD = 2.74, CI = 1.12-4.36, p = 0.0009). There were no severe adverse events but drop-outs were 11.5% (n = 37). No studies reported the effect of robotic therapy on quality of life or mood. Methodological quality was on average fair (15.6/27 on Downs and Black Scale).Conclusions: Only small numbers of people with acquired brain injury had data suitable for analysis. The available data suggests no more benefit for gait or balance with robotic therapy than conventional therapy. However, some important outcomes have not been studied and further well-conducted research is needed to determine whether such devices offer benefit over conventional therapy, in particular subgroups of those with acquired brain injury.Implications for RehabilitationThere is adequate evidence to recommend that powered over-ground lower limb robotic exoskeletons should not be used clinically in those with ABI, and that use should be restricted to research.Further research (controlled trials) with dependent ambulators is recommended.Research of other outcomes such as acceptability, spasticity, sitting posture, cardiorespiratory and psychological function, should be considered.
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Affiliation(s)
- Nicola Postol
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Australia.,University of Newcastle Hunter Medical Research Institute, New Lambton, Australia
| | - Jodie Marquez
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Australia.,University of Newcastle Hunter Medical Research Institute, New Lambton, Australia
| | - Stephanie Spartalis
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,University of Newcastle Hunter Medical Research Institute, New Lambton, Australia
| | - Andrew Bivard
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Australia.,University of Newcastle Hunter Medical Research Institute, New Lambton, Australia
| | - Neil James Spratt
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Australia.,University of Newcastle Hunter Medical Research Institute, New Lambton, Australia.,Hunter New England Local Health District, New Lambton, Australia
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23
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Withiel TD, Wong D, Ponsford JL, Cadilhac DA, Stolwyk RJ. Feasibility and effectiveness of computerised cognitive training for memory dysfunction following stroke: A series of single case studies. Neuropsychol Rehabil 2018; 30:829-852. [PMID: 30058468 DOI: 10.1080/09602011.2018.1503083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Computerised cognitive training (CCT) approaches to memory rehabilitation represent an attractive alternative to traditional approaches; however, there is limited empirical evidence to support their use. An AB with follow up single case design was repeated across five participants to explore the feasibility and effectiveness of CCT on subjective memory in patients with stroke. Target behaviour was subjective everyday and prospective memory failures which were assessed weekly. Following baseline (three weeks), participants completed six weeks of LumosityTM training in their homes. Data were analysed visually and statistically. The frequency of prospective memory failures decreased during intervention for one participant, while the frequency of prospective and everyday memory failures decreased significantly during the follow up period for another participant. Yet, significantly more everyday and prospective memory failures were reported following training by one study participant. No significant change in subjective memory ratings was found for remaining participants. Regarding secondary outcomes, meaningful changes on objective measures of memory were not observed, despite considerable inter-individual variability. Three participants reported improvement in individualised memory goals, while two participants described a decline. Overall, LumosityTM training appears feasible; however, no consistent evidence to support effectiveness of this CCT on subjective or objective memory was found.
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Affiliation(s)
- Toni D Withiel
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia.,Allied Health, Royal Melbourne Hospital, Melbourne, Australia
| | - Dana Wong
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences, Monash University, Melbourne, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.,Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
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24
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The Effect of Leisure Activities, Purpose in Life, and Spirituality on Short-Term Outcomes of Geriatric Rehabilitation. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Burn Injuries and Their Impact on Cognitive-Communication Skills in the Inpatient Rehabilitation Setting. J Burn Care Res 2018; 38:e359-e369. [PMID: 27404164 PMCID: PMC9996409 DOI: 10.1097/bcr.0000000000000388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prevalence and extent of cognitive-communication disorders and factors that have impact on outcomes are examined in the burn population within an inpatient rehabilitation facility. A retrospective data analysis was conducted on adults diagnosed with burn injury (n = 144). Descriptive statistics were used to identify the prevalence of cognitive-communication deficits on admission and discharge. The main outcomes were cognitive-communication ratings on discharge from inpatient rehabilitation as measured by the memory and problem-solving domains of the Functional Independence Measure (FIM) and composite score of the Functional Communication Measure (FCM). Medical, demographic and rehabilitation predictors of the main outcomes were assessed using regression analyses. On admission to inpatient rehabilitation, 79% of the total population presented with cognitive-communication impairments, and of them, 27% presented with persistent deficits on discharge. Admission FIM memory score, marital status, and age were significant predictors of discharge FIM memory score. Admission FIM problem-solving score, age, marital status, and prehospital living-with were significant predictors of discharge FIM problem-solving score. Admission FCM score and age were significant predictors of discharge FCM cognitive score. Persons with burn injuries are at risk for cognitive-communication impairments, which may persist after inpatient rehabilitation. FIM data obtained on admission can be used as a screening tool to identify these at-risk patients. Future work is needed to assess the efficacy of speech-language pathologist intervention for cognitive-communication deficits within the burn injury population.
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Byrne C, Coetzer R, Addy K. Investigating the discrepancy between subjective and objective cognitive impairment following acquired brain injury: The role of psychological affect. NeuroRehabilitation 2017; 41:501-512. [DOI: 10.3233/nre-162015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christopher Byrne
- North Wales Clinical Psychology Programme, Bangor University, Bangor, UK
| | - Rudi Coetzer
- North Wales Brain Injury Service, Betsi Cadwaladr University Health Board, NHS Wales, UK
- School of Psychology, Bangor University, Bangor, UK
| | - Karen Addy
- North Wales Neuropsychology Services, Bangor, UK
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27
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Krebs J, Scheel-Sailer A, Oertli R, Pannek J. The effects of antimuscarinic treatment on the cognition of spinal cord injured individuals with neurogenic lower urinary tract dysfunction: a prospective controlled before-and-after study. Spinal Cord 2017; 56:22-27. [PMID: 28786411 DOI: 10.1038/sc.2017.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Prospective controlled before-and-after study. OBJECTIVES To investigate the effects of antimuscarinic treatment of neurogenic lower urinary tract dysfunction on the cognition of individuals with spinal cord injury (SCI) during the early post-acute phase. SETTING Single SCI rehabilitation center. METHODS Patients with acute traumatic SCI admitted for primary rehabilitation from 2011 to 2015 were screened for study enrollment. Study participants underwent baseline neuropsychological assessments prior to their first urodynamic evaluation (6-8 weeks after SCI). Individuals suffering from neurogenic detrusor overactivity received antimuscarinic treatment, and those not requiring antimuscarinic treatment constituted the control group. The neuropsychological follow-up assessment was carried out 3 months after the baseline assessment. The effects of group and time on the neuropsychological parameters were investigated. RESULTS The data of 29 individuals were evaluated (control group 19, antimuscarinic group 10). The group had a significant (P≤0.033) effect on immediate recall, attention ability and perseveration. In the control group, individuals performed significantly (P≤0.05) better in immediate recall both at baseline (percentile rank 40, 95% CI 21-86 versus 17, 95% CI 4-74) and follow-up (percentile rank 40, 95% CI 27-74 versus 16, 95% CI 2-74). The time had a significant (P≤0.04) effect on attention ability, processing speed, word fluency and visuospatial performance. The individuals in both groups performed better at the follow-up compared to the baseline assessment. CONCLUSION Even though, we did not observe cognitive deterioration in the investigated, cognitively intact SCI individuals during the first 3 treatment months, the concerns regarding deleterious effects of antimuscarinics on cognition remain.
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Affiliation(s)
- J Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - A Scheel-Sailer
- Rehabilitation and Quality Management, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - R Oertli
- Neurology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - J Pannek
- Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland
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Heyman N, Tsirulnicov T, Ben Natan M. Prediction of geriatric rehabilitation outcomes: Comparison between three cognitive screening tools. Geriatr Gerontol Int 2017; 17:2507-2513. [PMID: 28707303 DOI: 10.1111/ggi.13117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/26/2017] [Accepted: 05/09/2017] [Indexed: 02/06/2023]
Abstract
AIM Comparison between the predictions of functional rehabilitation outcomes at a department of geriatric rehabilitation using three cognitive screening tools - Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). METHODS This study is a prospective study. The study participants were 212 patients aged 65 and older admitted to rehabilitation departments at a geriatric facility in central Israel, from April 2016 to October 2016. The cognitive functioning of each patient was assessed using the MMSE, MoCA, and IQCODE. Upon discharge, rehabilitation outcomes were examined using the Functional Independence Measure (FIM), cognitive FIM, delta FIM (Δ FIM), and ADL. RESULTS Cognitive impairment was found to interfere with the rehabilitation process. The MMSE was the best predictor of functional rehabilitation outcomes at discharge, compared to the IQCODE, while the MoCA did not predict these measures. In addition, when distinguishing between patients by ethnicity (Jewish versus Arab), the MMSE and the IQCODE predicted FIM upon discharge among Jewish patients, while only the IQCODE predicted FIM upon discharge among Arab patients. CONCLUSIONS The research findings show that cognitive assessment upon admission for rehabilitation - MMSE among Jewish patients and IQCODE among Arab patients - can help predict functional rehabilitation outcomes and make the appropriate adaptations in the rehabilitation program. Geriatr Gerontol Int 2017; 17: 2507-2513.
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Affiliation(s)
- Noemi Heyman
- Department of Geriatrics, Shoham Medical Center, Pardes Hana, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Pardes Hana, Israel
| | - Tatyana Tsirulnicov
- Department of Geriatrics, Shoham Medical Center, Pardes Hana, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Pardes Hana, Israel
| | - Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Israel
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29
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Eghdam A, Bartfai A, Oldenburg C, Koch S. How Do Persons with Mild Acquired Cognitive Impairment Use Information and Communication Technology and E-Services? Results from a Swedish National Survey. PLoS One 2016; 11:e0159362. [PMID: 27427947 PMCID: PMC4948839 DOI: 10.1371/journal.pone.0159362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 07/02/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Mild acquired cognitive impairment is a term used to describe a sub-group of persons with mild cognitive impairment who are expected to reach a stable cognitive level over time. One tactic that can be considered for further developing treatment for this group is the use of information and communication technology and e-services. The purpose of this study was to investigate the current use of regular e-services and social media by this group as well as their user experiences. Methods and Materials Data were collected through a self-administered survey and analyzed using quantitative methods. The questionnaire included questions regarding the participants’ use of and experience with e-services. Categorization of e-services was based on and cross-validated with the International Classification of Functioning, Disability and Health (ICF). To estimate participants’ degree and type of impairment, the Cognitive Failure Questionnaire (CFQ), measuring cognitive difficulties in performing everyday tasks, was added. Results In total, 282 persons with acquired brain injury participated in the survey. The participants’ CFQ scores showed that they were suffering from mild to moderate cognitive impairments, most often acquired from traumatic brain injuries (40%). The majority (89%) used e-services in different categories whereof the most popular and essential ones were communication services (59%) and banking (39%) services. Participants with higher total CFQ scores (>58) used more e-services in most of the categories compared to participants with lower scores (<31). Although participants were interested in social media, they were annoyed by advertisements and the Internet speed in general. Some participants reported privacy concerns and addictive behavior. However, they mostly considered e-services to be trustworthy and supportive in different contexts. The usage of electronic devices decreased by age with the exception of electronic tablets that were used by older participants approximately as frequently as by other age groups. Conclusions Although persons with mild to moderate acquired brain injury used various e-services that are not customized for them, very few participants used self-care health services (apps) and readers (e-readers). Further studies are needed on utilizing these identified aspects for this group to support them with their chronic condition.
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Affiliation(s)
- Aboozar Eghdam
- Health Informatics Centre (HIC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Aniko Bartfai
- Division of Rehabilitation Medicine, Department of Clinical Sciences Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Christian Oldenburg
- Division of Rehabilitation Medicine, Department of Clinical Sciences Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sabine Koch
- Health Informatics Centre (HIC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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30
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Ronca RD, Myers AM, Ganea D, Tuma RF, Walker EA, Ward SJ. A selective cannabinoid CB2 agonist attenuates damage and improves memory retention following stroke in mice. Life Sci 2015; 138:72-7. [PMID: 26032254 DOI: 10.1016/j.lfs.2015.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/30/2015] [Accepted: 05/17/2015] [Indexed: 10/23/2022]
Abstract
AIMS We have recently demonstrated that treatment with a cannabinoid CB2 agonist was protective in a mouse middle cerebral artery occlusion model of cerebral ischemia/reperfusion injury. The present study aimed to determine whether these protective effects of CB2 agonism would extend to a mouse photoinjury model of permanent ischemia and determine associated alterations in cognition and infarct size. MAIN METHODS Mice received three injections of the CB2 selective agonist O-1966 or vehicle 1h prior to and 2 and 5days following induction of stroke. Infarct size was assessed at 1, 3, or 7days post-injury and learning and memory effects of injury and O-1966 treatment were assessed on days 6 and 7 using a novel object recognition task and an operant acquisition and retention procedure. KEY FINDINGS O-1966 treated mice had significantly smaller infarct volumes compared with vehicle treated mice. Photoinjury was also associated with a significant memory impairment on day 7 post-injury, and this deficit was reversed with O-1966 treatment. Surprisingly, sham-operated mice receiving O-1966 treatment showed a significant learning deficit in both the recognition and operant tasks compared with vehicle treated sham mice. SIGNIFICANCE We conclude that CB2 activation is protective against cognitive deficits and tissue damage following permanent ischemia, but may dysregulate glial or neuronal function of learning and memory circuits in the absence of injury and/or inflammation.
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Affiliation(s)
- Richard D Ronca
- Center for Substance Abuse Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Alyssa M Myers
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA 19140, USA
| | - Doina Ganea
- Department of Microbiology and Immunology, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Ronald F Tuma
- Center for Substance Abuse Research, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Ellen A Walker
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA 19140, USA
| | - Sara Jane Ward
- Center for Substance Abuse Research, Temple University School of Medicine, Philadelphia, PA 19140, USA.
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Clancy O, Edginton T, Casarin A, Vizcaychipi MP. The psychological and neurocognitive consequences of critical illness. A pragmatic review of current evidence. J Intensive Care Soc 2015; 16:226-233. [PMID: 28979415 DOI: 10.1177/1751143715569637] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mortality rates alone are no longer a sufficient guide to quality of care. Due to medical advances, patients are surviving for longer following critical illness and major surgery; therefore, functional outcomes and long-term quality of life are of increasing consequence. Post-operative cognitive dysfunction has been acknowledged as a complication following anaesthesia for many years, and interest in persistent cognitive dysfunction following a critical illness is growing. Psychological and neurocognitive sequelae following discharge from intensive care are acknowledged to occur with sufficient significance to have recently coined the term 'the post-intensive care syndrome'. Rehabilitation following critical illness has been highlighted as an important goal in recently published national UK guidelines, including the need to focus on both physical and non-physical recovery. Neuropsychological and cognitive consequences following anaesthesia and critical illness are significant. The exact pathophysiological mechanisms linking delirium, cognitive dysfunction and neuropsychological symptoms following critical illness are not fully elucidated but have been studied elsewhere and are outside the scope of this article. There is limited evidence as yet for specific peri-operative preventative strategies, but early management and rehabilitation strategies following intensive care discharge are now emerging. This article aims to summarise the issues and appraise current options for management, including both neuroprotective and neurorehabilitative strategies in intensive care.
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Affiliation(s)
- Olivia Clancy
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Imperial College Faculty of Medicine, London, UK
| | - Trudi Edginton
- Department of Psychology, The University of Westminster, London, UK
| | - Annalisa Casarin
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Department of Anaesthesia, Watford General Hospital, London, UK
| | - Marcela P Vizcaychipi
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Imperial College Faculty of Medicine, London, UK
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32
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Purohit M, Goldstein R, Nadler D, Mathews K, Slocum C, Gerrard P, DiVita MA, Ryan CM, Zafonte R, Kowalske K, Schneider JC. Cognition in patients with burn injury in the inpatient rehabilitation population. Arch Phys Med Rehabil 2014; 95:1342-9. [PMID: 24582616 DOI: 10.1016/j.apmr.2014.01.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze potential cognitive impairment in patients with burn injury in the inpatient rehabilitation population. DESIGN Rehabilitation patients with burn injury were compared with the following impairment groups: spinal cord injury, amputation, polytrauma and multiple fractures, and hip replacement. Differences between the groups were calculated for each cognitive subscale item and total cognitive FIM. Patients with burn injury were compared with the other groups using a bivariate linear regression model. A multivariable linear regression model was used to determine whether differences in cognition existed after adjusting for covariates (eg, sociodemographic factors, facility factors, medical complications) based on previous studies. SETTING Inpatient rehabilitation facilities. PARTICIPANTS Data from Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury (N=5347) were compared with other rehabilitation populations (N=668,816). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Comparison of total cognitive FIM scores and subscales (memory, verbal comprehension, verbal expression, social interaction, problem solving) for patients with burn injury versus other rehabilitation populations. RESULTS Adults with burn injuries had an average total cognitive FIM score ± SD of 26.8±7.0 compared with an average FIM score ± SD of 28.7±6.0 for the other groups combined (P<.001). The subscale with the greatest difference between those with burn injury and the other groups was memory (5.1±1.7 compared with 5.6±1.5, P<.001). These differences persisted after adjustment for covariates. CONCLUSIONS Adults with burn injury have worse cognitive FIM scores than other rehabilitation populations. Future research is needed to determine the impact of this comorbidity on patient outcomes and potential interventions for these deficits.
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Affiliation(s)
- Maulik Purohit
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; National Intrepid Center of Excellence, Intrepid Spirit One, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Deborah Nadler
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Katie Mathews
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Chloe Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Paul Gerrard
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Margaret A DiVita
- Uniform Data System for Medical Rehabilitation, Amherst, NY; Health Department, State University of New York at Cortland, Cortland, NY
| | - Colleen M Ryan
- Sumner Redstone Burn Center, Surgical Services Massachusetts General Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.
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