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Jang SH, Kwak S, Lee MY. Prognosis prediction for impaired consciousness recovery in stroke patients using videofluoroscopic swallowing study: A retrospective observational study. Medicine (Baltimore) 2023; 102:e33860. [PMID: 37335688 DOI: 10.1097/md.0000000000033860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Prognosis prediction of impaired consciousness is clinically important for establishing therapeutic strategies, determining a rehabilitative goal and functional outcome, and estimating rehabilitative therapy duration. In this study, we investigated the prognosis prediction value of videofluoroscopic swallowing study (VFSS) in recovery of impaired consciousness in stroke patients. Fifty-one patients with impaired consciousness who underwent VFSS during the early stage of stroke between 2017 and 2021 were recruited in this retrospective study. VFSS were performed using modified Logemann protocol, and bonorex was used as the liquid contrast medium. The penetration-aspiration scale (PAS) was graded for all patients, and they were classified into 2 groups depending on the presence of aspiration on liquid material: the aspiration-positive group with a PAS score ≥ 6, and the aspiration-negative group with a PAS score < 6. The coma recovery scale-revised (CRS-R) was used to evaluate patients' conscious state at the time of VFSS and 3 months after. Statistical analysis was performed using independent t test and Pearson's correlation. The increase in total CRS-R score from time of VFSS to 3 months later was greater in aspiration-negative group than in aspiration-positive group (P < .05). A moderate negative correlation was observed between liquid PAS score and the increase in total CRS-R score (r = -0.499, P < .05). Among 6 CRS-R subscales, a strong negative correlation was observed between liquid PAS score and the communication score increase (r = -0.563, P < .05), while moderate negative correlations were detected between liquid PAS score and the increases in auditory (r = -0.465, P < .05), motor (r = -0.372, P < .05), oromotor (r = -0.426, P < .05), and arousal (r = -0.368, P < .05) scores. We observed that patients without aspiration on videofluoroscopic swallowing study showed better recovery of impaired consciousness, and the degree of penetration and aspiration had a predictive value for impaired consciousness prognosis in the early stage of stroke.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Lucca LF, Lofaro D, Pignolo L, Leto E, Ursino M, Cortese MD, Conforti D, Tonin P, Cerasa A. Outcome prediction in disorders of consciousness: the role of coma recovery scale revised. BMC Neurol 2019; 19:68. [PMID: 30999877 PMCID: PMC6472098 DOI: 10.1186/s12883-019-1293-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/31/2019] [Indexed: 01/05/2023] Open
Abstract
Background To evaluate the utility of the revised coma remission scale (CRS-r), together with other clinical variables, in predicting emergence from disorders of consciousness (DoC) during intensive rehabilitation care. Methods Data were retrospectively extracted from the medical records of patients enrolled in a specialized intensive rehabilitation unit. 123 patients in a vegetative state (VS) and 57 in a minimally conscious state (MCS) were included and followed for a period of 8 weeks. Demographical and clinical factors were used as outcome measures. Univariate and multivariate Cox regression models were employed for examining potential predictors for clinical outcome along the time. Results VS and MCS groups were matched for demographical and clinical variables (i.e., age, aetiology, tracheostomy and route of feeding). Within 2 months after admission in intensive neurorehabilitation unit, 3.9% were dead, 35.5% had a full recovery of consciousness and 66.7% remained in VS or MCS. Multivariate analysis demonstrated that the best predictor of functional improvement was the CRS-r scores. In particular, patients with values greater than 12 at admission were those with a favourable likelihood of emergence from DoC. Conclusions Our study highlights the role of the CRS-r scores for predicting a short-term favorable outcome.
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Affiliation(s)
- Lucia Francesca Lucca
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy.
| | - Danilo Lofaro
- Dipartimento di Ingegneria Meccanica, Energetica e Gestionale - DIMEG, UNICAL, Arcavata di Rende (CS), Rende, Italy.,Kidney and Transplantation Research Center, Annunziata Hospital, Cosenza, Italy
| | - Loris Pignolo
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Elio Leto
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Maria Ursino
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Maria Daniela Cortese
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Domenico Conforti
- Kidney and Transplantation Research Center, Annunziata Hospital, Cosenza, Italy
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Antonio Cerasa
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy. .,Neuroimaging Unit, IBFM-CNR, 88100, Catanzaro, Italy.
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Elbourn E, Togher L, Kenny B, Power E. Strengthening the quality of longitudinal research into cognitive-communication recovery after traumatic brain injury: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:1-16. [PMID: 27315590 DOI: 10.1080/17549507.2016.1193896] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 04/23/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE (i) To systematically review longitudinal and prognostic studies relating to the trajectory of cognitive-communication recovery after TBI and (ii) to provide recommendations to strengthen future research. METHOD Thirteen health literature databases were accessed up until July 2014. MAIN MEASURES Articles were screened systematically against pre-determined inclusion and exclusion criteria. Quality reviews were performed on the selected articles using a modified Downs & Black Rating Scale. Two independent reviewers performed the reviews. RESULT Sixteen longitudinal and prognostic articles met the inclusion criteria. There was evidence of either maintenance or improvement of cognitive-communication skills during the first 3 years post-injury. However, the studies did not provide detailed recovery trajectories, by failing to evaluate numerous data points over time. No studies evaluated recovery beyond 3 years post-injury. Injury severity, lesion location, brain volume loss and conversation skills may predict specific cognitive-communication outcomes. There was high variability in study characteristics and measures. CONCLUSION There is currently scarce evidence regarding cognitive-communication recovery and prognosis. People with TBI may recover or maintain pre-morbid cognitive-communication skills during the early rehabilitation stage. Further research detailing the recovery trajectory with a view to evaluating predictive factors is strongly indicated. Guidelines for future research are provided.
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Affiliation(s)
- Elise Elbourn
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
| | - Leanne Togher
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
| | - Belinda Kenny
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
| | - Emma Power
- a Faculty of Health Sciences; Disability and Communication Research Group Australia , The University of Sydney , Sydney , Australia ; and
- b National Health and Medical Research Council Centre of Research Excellence in Brain Recovery, The University of New South Wales , Sydney , Australia
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van Baalen B, Odding E, van Woensel MPC, Roebroeck ME. Reliability and sensitivity to change of measurement instruments used in a traumatic brain injury population. Clin Rehabil 2016; 20:686-700. [PMID: 16944826 DOI: 10.1191/0269215506cre982oa] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compile a minimum data set for the follow-up of traumatic brain injury patients from discharge from hospital to one year post injury to assess functioning and participation in the physical, cognitive and psychosocial domains, and in quality of life. Design: Repeated questionnaire interviews by two observers to establish interobserver reliability of the measurement instruments at discharge and at one year post injury, as well as their sensitivity to change over time in traumatic brain injury patients. Setting: Department of neurosurgery of an academic hospital, department of a rehabilitation centre, and at the patients' homes in the Netherlands. Subjects: The study at discharge included 25 patients aged 18-50 years with a moderate to severe traumatic brain injury (Glasgow Coma Scale score 3-14), whereas the one year post injury study included 14 patients aged 19-51 years. Main (outcome) measures: Physical domain: Barthel Index (BI), Functional Independence Measurement (FIM), Glasgow Outcome Scale (GOS), GOS Extended (GOSE). Cognitive domain: Disability Rating Scale (DRS), Functional Assessment Measurement (FAM), Levels of Cognitive Functioning Scale (LCFS), Neurobehavioural Rating Scale (NRS). Psychosocial domain: Community Integration Questionnaire (CIQ), Employability Rating Scale (ERS), Frenchay Activity Index (FAI), Multi Health Locus of Control (MHLC), Rehabilitation Activities Profile (RAP), Social Support List (SSL), Supervision Rating Scale (SRS), Wimbledon Self Reporting Rating Scale (WSRS). Quality of life: Coop/Wonca Charts (Coop), Rand SF-36 (Rand-36), Sickness Impact Profile-68 (SIP-68). Results: At both discharge and at one year post injury, in the physical domainthe FIM showed excellent squared weighted kappa (SWK ranging from 0.75 to 0.80), and intraclass correlation coefficient (ICC ranging from 0.75 to 0.92), and a relatively small standard error of measurement (SEM 3.22) and smallest detectable difference (SDD 8.92). In the cognitive domain the FAM and the NRS showed excellent SWK, and ICC, and a relatively small SEM and SDD. In the psychosocial domainthe FAI showed excellent SWK (0.89), and ICC (0.87), and a relatively small SEM (2.64) and SDD (7.31). For quality of life, at both discharge and at one year post injury the SIP-68 and the Coop showed excellent SWK (0.87), and ICC (0.89), and a relatively small SEM (3.79) and SDD (10.51). At both time points SWK and ICC ranged from 0.80 to 0.89, SEM ranged from 1.47 to 1.98, and the SDD was 4.07. Conclusions: An example of a reliable minimum data set that is also able to detect changes over time is: the FIM, the FAM and the Coop for the early stages in recovery, extended with the NRS, the FAI, and the SIP-68 later in recovery, thereby covering all relevant domains after traumatic brain injury.
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Affiliation(s)
- B van Baalen
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Steel J, Ferguson A, Spencer E, Togher L. Language and cognitive communication during post-traumatic amnesia: A critical synthesis. NeuroRehabilitation 2015; 37:221-34. [DOI: 10.3233/nre-151255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joanne Steel
- Speech Pathology, The University of Newcastle, Newcastle, NSW, Australia
- NHMRC Clinical Centre of Research Excellence in Aphasia Rehabilitation, Brisbane, QLD, Australia
| | - Alison Ferguson
- Speech Pathology, The University of Newcastle, Newcastle, NSW, Australia
- NHMRC Clinical Centre of Research Excellence in Aphasia Rehabilitation, Brisbane, QLD, Australia
| | - Elizabeth Spencer
- Speech Pathology, The University of Newcastle, Newcastle, NSW, Australia
| | - Leanne Togher
- Speech Pathology, The University of Sydney, Sydney, NSW, Australia
- NHMRC Clinical Centre of Research Excellence in Aphasia Rehabilitation, Brisbane, QLD, Australia
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Validation of the quality of life after brain injury in Chinese persons with traumatic brain injury in Taiwan. J Head Trauma Rehabil 2014; 29:E37-47. [PMID: 23474879 DOI: 10.1097/htr.0b013e3182816363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the psychometric properties of the Quality of Life After Brain Injury (QOLIBRI) in Chinese persons with traumatic brain injury (TBI) in Taiwan. PARTICIPANTS Three hundred one patients with TBI were interviewed face-to-face at baseline; of these, 132 completed a follow-up assessment 1 year later. SETTINGS Neurosurgery clinics of 6 teaching hospitals in northern Taiwan. MEASURE The 37-item QOLIBRI, including 6 domains of Cognition, Self, Daily Life and Autonomy, Social Relationships, Emotions, and Physical Problems. RESULTS A small percentage (<1%) of responses were missing, except the Sex Life item under the Social domain (5.9%). The QOLIBRI achieved adequate percentages for the floor value (0%-4%), ceiling value (1%-3.3%), internal consistency (0.79-0.95), and test-retest reliability (0.81-0.89). For construct validity, correlation coefficients (rs) for the QOLIBRI domains and selected clinical measures conceptually related to that domain were all 0.4 or more, except rs for QOLIBRI Cognition and Mini-Mental State Examination scores. A principal components analysis found that one item (Loneliness) of the Emotions domain did not converge with its corresponding domain of the original QOLIBRI (loading score <0.4). Effect sizes of responsiveness to changes in the Glasgow Outcome Scale-Extended over the 1-year period were clinically meaningful for all the QOLIBRI domains except the Emotions domain. CONCLUSION With modifications to the Emotions domain, the QOLIBRI would be suitable for use with Chinese people in Taiwan who have TBI.
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Saltychev M, Eskola M, Tenovuo O, Laimi K. Return to work after traumatic brain injury: Systematic review. Brain Inj 2013; 27:1516-27. [DOI: 10.3109/02699052.2013.831131] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cullen N, Vimalesan K, Taggart C. Efficacy of a functionally-based neurorehabilitation programme: a retrospective case-matched study of rehabilitation outcomes following traumatic brain injury. Brain Inj 2013; 27:799-806. [PMID: 23730824 DOI: 10.3109/02699052.2013.775488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the efficacy of a functionally-based neurorehabilitation programme. DESIGN Retrospective, case-matched cohort design. SETTING An inpatient acquired brain injury (ABI) service at a post-acute rehabilitation facility. In 2001, a functionally-based rehabilitation model was introduced that streams patients into neurocognitive (NC) and neurophysical (NP) treatment groups based on predominant functional deficits. METHODS Sixty-nine patients with TBI admitted to the ABI service before implementation of the functionally-based programme comprised a historical control group. These patients were individually case-matched to 69 participants admitted after the functionally-based programme began. Rehabilitation outcomes were compared between matched patients treated before and after implementation of the programme. OUTCOME MEASURES Rehabilitation length of stay (RLOS), Functional Independence Measure (FIM) and Disability Rating Scale (DRS) at rehabilitation discharge and FIM efficiency. RESULTS At discharge, the NP-stream had a significantly higher FIM motor efficiency compared to the historical control (0.41 vs. 0.29; p = 0.01). The NC-stream had significantly less disability, as measured by the DRS, compared to its control (3.63 vs. 5.05; p = 0.01). CONCLUSIONS This study presents preliminary evidence that a rehabilitation programme that targets functional needs rather than diagnosis may be useful in improving function after traumatic brain injury.
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Affiliation(s)
- Nora Cullen
- Research Department, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
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Zasler ND, Martelli MF. Mild traumatic brain injury: Impairment and disability assessment caveats. Neuropsychol Rehabil 2012; 13:31-41. [PMID: 21854326 DOI: 10.1080/09602010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Mild traumatic brain injury (MTBI) accounts for approximately 80% of all brain injuries, and persistent sequelae can impede physical, emotional, social, marital, vocational, and avocational functioning. Evaluation of impairment and disability following MTBI typically can involve such contexts as social security disability application, personal injury litigation, worker's compensation claims, disability insurance policy application, other health care insurance policy coverage issues, and the determination of vocational and occupational competencies and limitations. MTBI is still poorly understood and impairment and disability assessment in MTBI can present a significant diagnostic challenge. There are currently no ideal systems for rating impairment and disability for MTBI residua. As a result, medicolegal examiners and clinicians must necessarily familiarise themselves with the variety of disability and impairment evaluation protocols and understand their limitations. The current paper reviews recommended procedures and potential obstacles and confounding issues.
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Nightingale EJ, Soo CA, Tate RL. A Systematic Review of Early Prognostic Factors for Return to Work After Traumatic Brain Injury. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.8.2.101] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis article presents a systematic review identifying variables and their prognostic value for return to work (RTW) after traumatic brain injury (TBI). RTW has been identified as being a key goal following TBI, with estimates ranging from 10% to 70%. Prediction of postinjury employment is important for planning rehabilitation and structuring individualised vocational services. Studies examining prognostic factors were identified by searching four electronic databases, until June 2006. Searches yielded 1948 studies of which 55 met inclusion criteria and were subsequently rated for methodological quality. Mean methodological score for included studies was 3.9/6 (SD0.9, range 1–6). Analysis focused on a subset of 27 studies which provided sampling from all three domains of preinjury, injury and early postinjury variables. Few studies considered preinjury variables, apart from simple demographics. Only five studies considered preinjury employment, which was a significant predictor in each case. Severity of injury variables were invariably examined, but were significant predictors in only 8/27 studies (30%). For early postinjury variables, 14/27 studies entered cognitive variables with 12/14 (86%) identifying them as significant predictors; 3/27 studies examined neurophysical variables, with 2/3 (67%) studies finding them significant; and 12/27 studies examined multidimensional/participation variables which were statistically significant individual predictors in 8/12 (67%) cases. The results are discussed in the context of methodological issues encountered during the course of the review that require addressing in future studies.
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Tate RL, Broe GA, Cameron ID, Hodgkinson AE, Soo CA. Pre-Injury, Injury and Early Post-Injury Predictors of Long-Term Functional and Psychosocial Recovery After Severe Traumatic Brain Injury. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.2005.6.2.75] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground: Findings from prognostic studies of functional and psychosocial recovery after traumatic brain injury (TBI) reported to date have been limited by the restricted timeframe for prediction, generally within the first 5 years post-trauma. This investigation examined prediction of functional and psychosocial recovery in the medium-term (6 years post-trauma; Time 1) and long-term (23 years post-trauma; Time 2). Methods: The participants comprised a consecutive series of the first 100 patients with severe TBI receiving their primary rehabilitation at a regionally based unit. At the 23-year follow-up, 91% of the sample was traced: 17 had died, 5 declined participation, and 69 were interviewed, with 68 participating at both Time 1 and Time 2. Five outcome domains were examined: mobility, self-care, employability, relationships and living skills. Results: Very few of seven pre-injury variables were significantly correlated with any of the outcome variables. A series of logistic regression analyses successfully predicted levels of recovery in all domains using four predictor variables: pre-injury occupational status, duration of post-traumatic amnesia, and physical and neuropsychological disability at rehabilitation discharge. At Time 1, 60% or more of the variance was accounted for in four of the five domains, and at Time 2, more than 40% of the variance was accounted for in all domains. Sensitivity ranged from 62% (self-care) to 90% (mobility). With a single exception (employability at Time 2), specificity was also high, ranging from 80% (relationships) to 98% (mobility). Comparable accuracy rates were also found for positive and negative predictive power. Conclusions: These results demonstrate impressive predictive capacity of early post-trauma variables for the very long-term levels of recovery. They provide guidance for the tailoring of individual rehabilitation programs and the identification of people who may require special supports after rehabilitation discharge.
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van Baalen B, Odding E, Stam HJ. Cognitive status at discharge from the hospital determines discharge destination in traumatic brain injury patients. Brain Inj 2009; 22:25-32. [DOI: 10.1080/02699050701810662] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cullen NK, Park YG, Bayley MT. Functional recovery following traumatic vs non-traumatic brain injury: A case-controlled study. Brain Inj 2009; 22:1013-20. [DOI: 10.1080/02699050802530581] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nora K. Cullen
- University of Toronto and Toronto Rehabilitation Institute, Toronto, Canada
| | - Yoon-Ghil Park
- Yonsei University College of Medicine and Yongdong Severance Hospital, Seoul, South Korea
| | - Mark T. Bayley
- University of Toronto and Toronto Rehabilitation Institute, Toronto, Canada
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Chiu WT, Huang SJ, Hwang HF, Tsauo JY, Chen CF, Tsai SH, Lin MR. Use of the WHOQOL-BREF for Evaluating Persons with Traumatic Brain Injury. J Neurotrauma 2006; 23:1609-20. [PMID: 17115908 DOI: 10.1089/neu.2006.23.1609] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined psychometric properties of a brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) among persons with traumatic brain injury (TBI) and the relations of the WHOQOL-BREF domains, including physical capacity, psychological wellbeing, social relationships, and environment, to different indicators of TBI severity. Of the 354 eligible and available subjects from 22 hospitals in northern Taiwan over a 6-month period, 199 completed telephone interviews during data collection. Three indicators of TBI severity were used: the Glasgow Coma Scale, the presence of post-traumatic amnesia, and the abbreviated injury scale to the head. All domain scores of the WHOQOL-BREF had nearly symmetrical distributions: low percentages of ceiling and floor values (0-3%), low missing rates (0-0.5%) for all but one item (43.2%), and very good internal consistency (0.75-0.89) and test-retest reliability (0.74-0.95). The WHOQOL-BREF also exhibited excellent known-groups validity, as well as very good responsiveness and convergent validity with regard to employment, independence in daily life activities, social support, and depression. After adjustment for potential confounders, almost none of the domain scores of the WHOQOL-BREF significantly differed in the severity levels of the three severity indicators. In conclusion, the WHOQOL-BREF is an appropriate health-related quality of life (HRQL) instrument for persons with TBI. Furthermore, the initial severity of the TBI might not be suitable for predicting levels of HRQL in persons with TBI.
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Affiliation(s)
- Wen-Ta Chiu
- Department of Surgery, Wan-Fang Hospital and Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
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15
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Zasler ND. Neurorehabilitation issues in states of disordered consciousness following traumatic brain injury. FUTURE NEUROLOGY 2006. [DOI: 10.2217/14796708.1.4.439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The assessment and care of persons with disorders of consciousness (DOC) following catastrophic traumatic brain injury is often difficult and filled with both challenges and potential controversies. Rates of misdiagnosis of low-level neurological state (LLNS) patients with signs of awareness as being vegetative have been noted to be unacceptably high and call for better education and training regarding the assessment methodologies of individuals with DOC. Clinician knowledge regarding prognostication and neural recovery from LLNSs following traumatic brain injury is often lacking, as is awareness of the neurorehabilitative interventions that can potentially facilitate recovery, as well as minimize morbidity and mortality in this unique population of neurological patients.
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Affiliation(s)
- Nathan D Zasler
- Concussion Care Centre of Virginia, Ltd., Tree of Life Services, 10120 West Broad Street, Suite G & H, Glen Allen, VA 23060, USA
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Salmond CH, Menon DK, Chatfield DA, Pickard JD, Sahakian BJ. Cognitive Reserve as a Resilience Factor against Depression after Moderate/Severe Head Injury. J Neurotrauma 2006; 23:1049-58. [PMID: 16866618 DOI: 10.1089/neu.2006.23.1049] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Depression is one of the most frequently reported and distressing residual complaints in survivors of head injury. Studies investigating the pattern of neuropathology associated with depression post head injury have found little consistency. One explanation for this is that cognitive reserve "protects" against depression either through more efficient processing or more effective compensation. An alternative explanation is that previous studies have used relatively gross measures of lesion location, and variable inclusion criteria and times between scan and injury. This study explored these possibilities in a cohort of survivors of moderate-severe head injury at least 6 months post-injury. Volunteers completed neuropsychological assessments and structural magnetic resonance imaging (MRI) scans. A significant difference between depressed and non-depressed survivors was found, with higher intelligence associated with lower rates of depression. No significant anatomical differences were found between depressed and non-depressed survivors. These results suggest that premorbid intelligence may provide a resilience factor against depression in head injury survivors.
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Affiliation(s)
- Claire H Salmond
- Wolfson Brain Imaging Centre, University Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom.
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Aras MD, Kaya A, Cakc A, Gökkaya KO. Functional outcome following traumatic brain injury: the Turkish experience. Int J Rehabil Res 2004; 27:257-60. [PMID: 15572987 DOI: 10.1097/00004356-200412000-00001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objectives of this study were to describe the demographic characteristics and the nature of the functional recovery in a group of Turkish survivors of traumatic brain injury (TBI) who were referred for inpatient rehabilitation and identify variables correlated with discharge functional status as measured by the Functional Independence Measure (FIM). There were 40 patients in the study, 32 (69.6%) male and eight (17.4%) female, mean age 28+/-9.8 years. Motor vehicle accidents accounted for 62.5% of injuries, 22.5% of injuries occurred from violence and 15% resulted from falls. The mean durations of acute hospital stay, coma, and rehabilitation stay was 68, 26.7, and 78.4 days, respectively. Extracranial injuries including bone fractures were the most common associated injuries and medical complications such as spasticity and contractures were present in more than half of the patients.TBI survivors in this study made statistically significant functional improvements. Discharge FIM were significantly correlated with the admission FIM, durations of acute hospital stay and coma, and time since TBI. Multiple regression analysis of the data disclosed that FIM score obtained at the time of discharge from rehabilitation service was best predicted by two variables, time since brain injury and the FIM score at admission (multiple R=0.78, R=0.60, P<0.001). This sample of Turkish TBI survivors showed significant functional improvements after rehabilitation and admission functional status and the time since TBI had the most impact on discharge functional outcome.
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Affiliation(s)
- Meltem Dalyan Aras
- Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey.
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Hibbard MR, Ashman TA, Spielman LA, Chun D, Charatz HJ, Melvin S. Relationship between depression and psychosocial functioning after traumatic brain injury11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:S43-53. [PMID: 15083421 DOI: 10.1016/j.apmr.2003.08.116] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the relationship between depression and psychosocial functioning up to 5 years after traumatic brain injury (TBI). DESIGN Longitudinal cohort study with 2 assessments completed. SETTING Community. PARTICIPANTS Individuals (N=188) with TBI living in the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Structured Clinical Interview for Depression, self-reports of depression severity, functional symptoms, quality of life (QOL), unmet important needs, and psychosocial functioning. RESULTS Based on observed depression patterns at initial and repeat assessment, 4 subgroups were created: no depression, resolved depression, late-onset depression, and chronic depression. Groups were equivalent in terms of demographic and injury-related factors but differed significantly in perceived psychosocial functioning. The no-depression group reported fewer depressive symptoms and higher levels of psychosocial functioning, whereas the chronic-depression group reported the poorest psychosocial functioning, with a further decline in QOL at reassessment. Although the resolved-depression and late-onset-depression groups reported similar psychosocial functioning at initial assessment, psychosocial functioning had improved for the resolved-depression group and declined for the late-onset-depression group at reassessment. Pre- and postpsychiatric diagnoses were common in all groups, with pre-TBI diagnosis of depression not predictive of post-TBI depression. CONCLUSIONS Findings highlight the need for broad-based assessments and timely interventions for both mood and psychosocial challenges after TBI.
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Affiliation(s)
- Mary R Hibbard
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Tate RL. Impact of pre-injury factors on outcome after severe traumatic brain injury: Does post-traumatic personality change represent an exacerbation of premorbid traits? Neuropsychol Rehabil 2003; 13:43-64. [DOI: 10.1080/09602010244000372] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Labelle J, Swaine BR, Dykes RW. [Content validity of an information system used for head injury rehabilitation based on an analysis of medical records]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2002; 45:243-56. [PMID: 12076851 DOI: 10.1016/s0168-6054(02)00212-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examines the content validity of the TCC-Québec Information System based on an analysis of rehabilitation medical records. The goal was to determine the agreement between the variables of the TCC-Québec Information System identified by experts and based on an extensive literature review and those found in medical records. METHOD The medical records of 82 adults with a head injury were reviewed. The individuals had been hospitalized from 1997 to 1998 at three different acute care facilities or three rehabilitation centers. The abstractor determined if the information pertaining to a variable (e.g. personal history, impairments, or disabilities relating to sensori-motor function) was present in the record. A standardized and reliable procedure was used to ensure the quality of data extraction. The percentage of variables found in the medical records and the number of records in which each variable was documented were calculated for each clinical setting (acute care or rehabilitation) and for the different geographical regions. RESULTS The results suggest that a large discrepancy exists between what experts desired to be included in the information system and what is really documented clinically. No discrepancy exists between the different regions. Only 23% of variables were found in more than 70% of records. CONCLUSION This study provides recommendations about the most relevant variables to be included in an information system based on clinicians'information needs and the clinical reality. As such, these results should facilitate the use and implementation of the information system under study.
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Affiliation(s)
- J Labelle
- Ecole de réadaptation, faculté de médecine, université de Montréal, Québec, Canada
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Traumatic Brain Injury: Severity and Outcome. Intensive Care Med 2002. [DOI: 10.1007/978-1-4757-5551-0_60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bezner JR, Hunter DL. Wellness perception in persons with traumatic brain injury and its relation to functional independence. Arch Phys Med Rehabil 2001; 82:787-92. [PMID: 11387584 DOI: 10.1053/apmr.2001.23269] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To test the reliability and validity of a perceptual wellness measure in persons after traumatic brain injury (TBI) and to determine whether a relation exists between functional independence and wellness perceptions in the same population. DESIGN Survey research. SETTING A private, residential brain injury program. PARTICIPANTS A convenience sample of 49 patients (43 men, 6 women) with TBI whose mean age was 32.1 years (range, 18-61yr) and mean time since injury was 10.47 years (range, 1-21yr). MAIN OUTCOME MEASURES The Perceived Wellness Survey (PWS) assessed wellness. The PWS has 6 subscales measuring physical, psychologic, emotional, intellectual, spiritual, and social wellness. The FIM instrument was used to measure functional status. RESULTS The mean PWS score (15.99) for the sample was comparable to published samples of adults (mean, 15.31-16.51); however, the reliability of the composite score (alpha = .58) and the subscales (alpha = .32-.64) was less than that obtained in previous samples (composite alpha = 0.91; subscale alpha = .64-.81). The correlations between the PWS and the FIM scores were not significant. CONCLUSIONS The PWS in its composite form is a reliable measure for use with persons with TBI. The finding that perceived wellness and functional independence were not related suggests that these constructs are unique and thus should both be measured. The measurement of perceptions will enable the provider to consider a client holistically and to develop programs that address quality of life issues. Further, because perceptions influence behaviors, understanding a person's perceptions in multiple dimensions may provide a useful and necessary framework for developing intervention programs that address behavioral and cognitive issues that are important to that person.
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Affiliation(s)
- J R Bezner
- Department of Physical Therapy, Southwest Texas State University, San Marcos, TX 78666, USA.
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