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Young M, Peterson AH. Neuroethics across the Disorders of Consciousness Care Continuum. Semin Neurol 2022; 42:375-392. [PMID: 35738293 DOI: 10.1055/a-1883-0701] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Scholten J, Danford E, Leland A, Malecki H, Bidelspach D, Taylor B, Sayer N. Templated Interdisciplinary Rehabilitation Care Plan Documentation for Veterans With Traumatic Brain Injury. Prof Case Manag 2017; 21:266-276. [PMID: 27749702 PMCID: PMC5120540 DOI: 10.1097/ncm.0000000000000165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY Individualized interdisciplinary care is the hallmark for rehabilitation following traumatic brain injury (TBI). Veterans Health Administration (VHA) utilizes an electronic note template to document Interdisciplinary Rehabilitation and Community Reintegration (IRCR) care plans for Veterans with TBI requiring rehabilitation. All Veterans with a TBI diagnosis, receiving skilled therapy for TBI-related issues, and followed by a case manager must receive a care plan. The purpose of this study was to determine the level of compliance with the IRCR care plan requirements used to identify Veterans with TBI in need of the care plan and to evaluate the reasons for inconsistent compliance. In addition, the study sought to provide a more objective assessment of Veterans with TBI requiring an IRCR to assist in establishing a target metric. PRIMARY PRACTICE SETTING TBI outpatient clinics. METHODOLOGY AND SAMPLE Investigators conducted a retrospective medical record review of 546 Veterans with a TBI diagnosis seen at the Washington, DC VA Medical Center's outpatient polytrauma clinics in 2013. Cases were initially reviewed for referral or engagement with skilled therapy. Charts where Veterans were referred or engaged with skilled therapy were forwarded to 2 polytrauma clinicians to determine whether therapy was requested to treat a TBI-related condition. Finally, charts were reviewed for case management and analyzed for algorithm compliance. Analysis focused first on compliance with IRCR algorithm requirements and secondarily with identifying potential reasons for noncompliance. RESULTS In 2013, 42% of the TBI cohort met the criteria for an IRCR. The vast majority of cases with a TBI diagnosis complied with IRCR algorithm criteria; however, 14% of all reviewed cases required an IRCR but did not receive one. Provision of case management outside of the TBI/polytrauma clinic characterized a majority of noncompliant cases. IMPLICATIONS FOR CASE MANAGEMENT Interdisciplinary care can be challenging, particularly in the outpatient setting, due to patient availability and access to care. Improved documentation in the electronic health record may assist case managers and other clinicians in coordinating rehabilitation care for Veterans with TBI. Case managers in the VA and other settings may find templates and trackable health factors helpful to identify patients in need of care plans.
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Affiliation(s)
- Joel Scholten
- Department of Physical Medicine and Rehabilitation, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422
- Physical Medicine and Rehabilitation Program Office, Department of Veterans Affairs (VA), 810 Vermont Avenue, NW, Washington, DC 20420
- Department of Physical Medicine and Rehabilitation, Georgetown University Medical Center, 3900 Reservoir Road, NW Washington, DC 20007
| | - Ellen Danford
- Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington DC 20422
| | - Azadeh Leland
- Department of Physical Medicine and Rehabilitation, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422
| | - Heather Malecki
- Department of Physical Medicine and Rehabilitation, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422
| | - Douglas Bidelspach
- Physical Medicine and Rehabilitation Program Office, Department of Veterans Affairs (VA), 810 Vermont Avenue, NW, Washington, DC 20420
- Rehabilitation and Prosthetics Services, Lebanon VA Medical Center, 1700 S Lincoln Avenue, Lebanon, PA 17042
| | - Brent Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- Department of Medicine and Epidemiology and Community Health, University of Minnesota, 100 Church Street, SE, Minneapolis, MN 55455
| | - Nina Sayer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417
- Departments of Medicine and Psychiatry, University of Minnesota, 100 Church Street, SE, Minneapolis, MN 55455
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Mitsch V, Curtin M, Badge H. The provision of brain injury rehabilitation services for people living in rural and remote New South Wales, Australia. Brain Inj 2014; 28:1504-13. [DOI: 10.3109/02699052.2014.938120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Virginia Mitsch
- South West Brain Injury Rehabilitation Service
Albury, NSWAustralia
| | - Michael Curtin
- School of Community Health, Charles Sturt University
Albury, NSWAustralia
| | - Helen Badge
- Brain Injury Rehabilitation Directorate, NSW Agency for Clinical Innovation
Sydney, NSWAustralia
- Ingham Institute for Applied Medical Research
Liverpool, BCAustralia
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Talbot LR, Lévesque A, Trottier J. Process of implementing collaborative care and its impacts on the provision of care and rehabilitation services to patients with a moderate or severe traumatic brain injury. J Multidiscip Healthc 2014; 7:313-20. [PMID: 25114538 PMCID: PMC4122558 DOI: 10.2147/jmdh.s64897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The introduction of new services in a rehabilitation center is a unique opportunity to introduce a new model of care and services between two institutions. A hospital and a rehabilitation center experienced a clinical management model inspired by an American approach – collaborative care. The purpose of this study was to describe the implementation of this approach and to provide a perception of the quality of care and services provided to patients with moderate or severe traumatic brain injury and to their caregivers. Materials and methods In this qualitative study, individual semistructured interviews were conducted with patients and their caregivers in the hospital and rehabilitation center where the patients were treated. Individual semistructured interviews were conducted with administrators, and two focus groups were held with clinicians before and after the implementation. Results and conclusion Ten days’ waiting time were saved with the collaborative approach. Implementing the collaborative care approach has been found to have several benefits, including improved communication, coordination of services between institutions, and better preparation, awareness, and involvement of patients and their families. Administrators, clinicians, patients, and caregivers expressed their opinions on the organization of care and services, the needs and expectations of patients and their caregivers, their participation in terms of roles and responsibilities, their perception of continuity of care, their satisfaction with the care process, and their suggestions for improvements.
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Affiliation(s)
- Lise R Talbot
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, QC, Canada ; Étienne-Le Bel Clinical Research Centre and the Research Centre on Aging, Sherbrooke, QC, Canada
| | - Annie Lévesque
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, QC, Canada
| | - Josée Trottier
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, QC, Canada
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Jeyaraj JA, Clendenning A, Bellemare-Lapierre V, Iqbal S, Lemoine MC, Edwards D, Korner-Bitensky N. Clinicians' perceptions of factors contributing to complexity and intensity of care of outpatients with traumatic brain injury. Brain Inj 2013; 27:1338-47. [PMID: 23923818 DOI: 10.3109/02699052.2013.823650] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE This study investigated clinicians' perceptions on factors linked to patient complexity in traumatic brain injury (TBI) outpatient rehabilitation. METHOD Twelve clinicians from various disciplines, working in TBI outpatient programmes from three rehabilitation institutions in Montreal, Quebec, were recruited using convenience and snowball sampling. Data was collected through focus groups and individual interviews and thematic analysis was used to identify themes. MAIN OUTCOMES AND RESULTS Participants identified complexity factors falling under the following themes: sequelae of TBI (cognitive/behavioural/psychological impacts), personal factors (personality traits, pre-medical state, lifestyle and age), patients' environment (architectural, social, language, cultural and financial) and therapeutic relationship (mismatch, misunderstanding and personality clashes). Clinicians also reported facilitators to optimal treatment delivery such as quality of services and working in an interdisciplinary team. Limited time, training and resources were identified as barriers to treatment. CONCLUSION A substantial proportion of patients in outpatient TBI programmes seem to follow an atypical evolution and exhibit added complexity. In order to optimize quality of care, clinicians recommended increased community awareness about TBI, increased resources for rehabilitation clinicians and specialized services post-discharge. These findings are insightful for stakeholders; providing a basis for discussions on policy changes that can better meet this population's needs.
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Affiliation(s)
- Jerine Anton Jeyaraj
- School of Physical and Occupational Therapy, McGill University , Montreal , Canada
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Sloan S, Callaway L, Winkler D, McKinley K, Ziino C, Anson K. The Community Approach to Participation: Outcomes Following Acquired Brain Injury Intervention. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.10.3.282] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective: To investigate the participation outcomes of individuals with severe acquired brain injury (ABI) who were provided with up to 12 months of intervention based on the Community Approach to Participation (CAP). Method: A case series study design was undertaken with a total of 85 participants from two private practices specialising in community-based, CAP rehabilitation for people with severe ABI. Inclusion criteria were the person had sustained an acquired brain injury, was aged over 18 years and had received up to 12 consecutive months of CAP input from one of the two practices within a three-year period between January 2004 and January 2007. Twenty-six of the 85 participants were an average of 343 days post injury (Early group) and 59 of the participants were an average of 10.2 years post injury (Late group). They were living in a range of community environments and residential facilities. Initial participants were identified for the study in January 2005. Data were gathered using the Functional Independence Measure (FIM™), Community Integration Questionnaire (CIQ), and Role Checklist (RC Part 1) at two time points: prior to intervention (baseline), and after a 12-month period or at discharge (TI). Within the intervention period, all participants received a customised community occupational therapy (OT) rehabilitation program based on the key principles of the CAP. Intervention focused on participation goals of the individual, and development of the associated skills that underpinned valued role performance. Results: Participants each received an average of 51.01 hours of CAP OT during the 12-month period of intervention. Considerable improvement was seen in functional independence, community integration, and role participation after intervention in both the Early and Late groups. A statistically significant increase in FIM™ and CIQ total scores was found for all participants from Baseline to T1. The number of roles in which participants engaged increased on average by almost one role per participant following intervention, from a mean of 3.06 to 3.99. Increased participation in volunteer, home maintainer, participant in organisations and hobbyist roles were most common. Conclusion: Increased functional independence, community integration, and participation in both the Early and Late groups over a 12 month period demonstrates the potential for improved participation outcomes for people with complex needs following ABI, even many years post injury.
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Togher L, Taylor C, Aird V, Grant S. The Impact of Varied Speaker Role and Communication Partner on the Communicative Interactions of a Person With Traumatic Brain Injury: A Single Case Study Using Systemic Functional Linguistics. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.7.3.190] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis article presents preliminary findings on an investigation into the differences in communicative performance across varying speaking conditions, of an individual with a cognitive–linguistic impairment following traumatic brain injury (TBI). The article compares the communicative exchanges of an individual in a conversation with a therapist, a conversational dyad with a peer with TBI, and in a communication group task where they were interacting with other participants with TBI. The speaking conditions studied included an unstructured chat, the participant requesting information and the participant giving information. Results showed that the person with TBI responded to differences in communication partner and speaker role. He was best able to give information in the unstructured chat with the clinician and the information giving session in the group. Requesting was maximally facilitated in the information request condition with the clinician. Qualitatively, however, the most equal interactions occurred with the peer, with evidence of the person with TBI engaging in typical conversational strategies such as establishing common ground to facilitate topic development and co-constructing the discourse topics. These strategies did not occur in the clinician or group interactions, possibly due to power imbalance in the former and impaired cognitive–linguistic ability in the latter situation. Implications for clinical decision making regarding intervention strategies for patients with cognitive–communication deficits are discussed.
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Lamontagne ME, Swaine BR, Lavoie A, Careau E. Analysis of the strengths, weaknesses, opportunities and threats of the network form of organization of traumatic brain injury service delivery systems. Brain Inj 2011; 25:1188-97. [PMID: 21939374 DOI: 10.3109/02699052.2011.608211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Networks are an increasingly popular way to deal with the lack of integration of traumatic brain injury (TBI) care. Knowledge of the stakes of the network form of organization is critical in deciding whether or not to implement a TBI network to improve the continuity of TBI care. GOALS OF THE STUDY To report the strengths, weaknesses, opportunities, and threats of a TBI network and to consider these elements in a discussion about whether networks are a suitable solution to fragmented TBI care. METHODS In-depth interviews with 12 representatives of network organization members. Interviews were qualitatively analyzed using the EGIPSS model of performance. RESULTS The majority of elements reported were related to the network's adaptation to its environment and more precisely to its capacity to acquire resources. The issue of value maintenance also received considerable attention from participants. DISCUSSION The network form of organization seems particularly sensitive to environmental issues, such as resource acquisition and legitimacy. The authors suggest that the network form of organization is a suitable way to increase the continuity of TBI care if the following criteria are met: (1) expectations toward network effectiveness to increase continuity of care are moderate and realistic; (2) sufficient resources are devoted to the design, implementation, and maintenance of the network; (3) a network's existence and actions are deemed legitimate by community and organization member partners; and (4) there is a good collaborative climate between the organizations.
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Muenchberger H, Kendall E, Collings C. Beyond Crisis Care in Brain Injury Rehabilitation in Australia. J Prim Care Community Health 2010; 2:60-4. [DOI: 10.1177/2150131910383578] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The aim of this commentary was to bring together the various significant issues associated with delivering brain injury rehabilitation in Australia. Through observational critique, the authors aimed to identify gaps in practice and opportunities for change. Approach: In light of Australia’s national health reform process, it is necessary to consider rehabilitation practices and models for brain injury service delivery. There are lessons to be learned within the Australian system, but also opportunities to apply international reform. Conclusion: For those within the service delivery system, brain injury rehabilitation can often appear to be a crisis-driven response. Gaps in service provision persist, leaving individuals who have reduced cognitive and emotional capacity to self-navigate an unpredictable health system at a time in their lives when they are least prepared to do so. Deficiencies in the delivery of timely and appropriate psychosocial or behavioral rehabilitation services undoubtedly contribute to the current pressures on the health system created by increased length of stay in neurological and slow-to-recover rehabilitation units, repeat presentations to primary care, and frequent use of community mental health services. Implication: The experiences of people with acquired brain injury highlights the need for early and targeted interventions that can deal with emerging complexities and support needs, interorganizational approaches, and new accommodation options with a matched service philosophy. Rather than count on good fortune, individual outcomes, and the future of brain injury, rehabilitation ought to depend on deliberate and systemic design.
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The History and Evolution of Traumatic Brain Injury Rehabilitation in Military Service Members and Veterans. Am J Phys Med Rehabil 2010; 89:688-94. [DOI: 10.1097/phm.0b013e3181e722ad] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Lamontagne ME, Swaine BR, Lavoie A, Champagne F, Marcotte AC. Perceptions of traumatic brain injury network participants about network performance. Brain Inj 2010; 24:812-22. [DOI: 10.3109/02699051003789252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Reid-Arndt SA, Schopp L, Brenneke L, Johnstone B, Poole AD. Evaluation of the traumatic brain injury early referral programme in Missouri. Brain Inj 2009; 21:1295-302. [DOI: 10.1080/02699050701721802] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Geurtsen GJ, Martina JD, Van Heugten CM, Geurts ACH. A prospective study to evaluate a new residential community reintegration programme for severe chronic brain injury: The Brain Integration Programme. Brain Inj 2009; 22:545-54. [DOI: 10.1080/02699050802132479] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wongvatunyu S, Porter EJ. Changes in family life perceived by mothers of young adult TBI survivors. JOURNAL OF FAMILY NURSING 2008; 14:314-332. [PMID: 18617710 DOI: 10.1177/1074840708321473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Little is known about changes in family life perceived by mothers of young adult survivors of a traumatic brain injury (TBI). A phenomenological method was used to describe the changes that seven mothers of TBI survivors perceived in family life 6 months or more after the TBI. The five basic changes in family life reported by mothers were: getting attention from each other for different reasons now, getting along with each other since the injury, facing new financial hurdles, going our separate ways down this new path, and splitting the family apart against our will. Compared to literature on stress and coping, the findings offered a unique perspective on changes in family life. Nurses can use the findings to initiate therapeutic conversations with mothers about changes in family life after a TBI.
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Affiliation(s)
- Suporn Wongvatunyu
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand
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What do people with acquired brain injury think about respite care and other support services? Int J Rehabil Res 2008; 31:3-11. [DOI: 10.1097/mrr.0b013e3282f45215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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