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Greenwald BD, Harris KA, Ayyala H, Gordon DJ. Community Reintegration After Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2024; 35:637-650. [PMID: 38945656 DOI: 10.1016/j.pmr.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Achieving effective community reintegration is important to maximize recovery in patients with traumatic brain injury, simultaneously limiting caregiver burden and improving satisfaction with quality of life. Certain medical complications that are common after brain injury may impact community reintegration, and should be addressed by the physician in a systematic approach. Additionally certain social and environmental factors such as mobility or return to work or school may arise, and should be addressed proactively by the physician. Inpatient/residential or outpatient programs with case management and a multi-disciplinary team can facilitate community reentry for patients, and should be considered when available.
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Affiliation(s)
- Brian D Greenwald
- Department of Physical Medicine and Rehabilitation, Hackensack Meridian School of Medicine, JFK Johnson Rehabilitation Institute, 65 James Street, Edison, NJ 08820, USA; Department of Physical Medicine & Rehabilitation, JFK Johnson Rehabilitation Institute, 65 James Street, Edison, NJ 08820, USA.
| | - Kristen A Harris
- Department of Physical Medicine and Rehabilitation, Hackensack Meridian School of Medicine, JFK Johnson Rehabilitation Institute, 65 James Street, Edison, NJ 08820, USA; Department of Physical Medicine & Rehabilitation, JFK Johnson Rehabilitation Institute, 65 James Street, Edison, NJ 08820, USA
| | - Harsha Ayyala
- Department of Physical Medicine and Rehabilitation, Hackensack Meridian School of Medicine, JFK Johnson Rehabilitation Institute, 65 James Street, Edison, NJ 08820, USA; Department of Physical Medicine & Rehabilitation, JFK Johnson Rehabilitation Institute, 65 James Street, Edison, NJ 08820, USA
| | - Dustin J Gordon
- Rehabilitation Specialists, 18-01 Pollitt Drive Suite 1A, Fair Lawn, NJ 07410, USA
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Kumar DS, Bodt BA, Galloway JC. Real-world environmental enrichment rehabilitation paradigm in people with severe traumatic brain injury: a pilot feasibility study. Brain Inj 2024; 38:742-749. [PMID: 38695288 DOI: 10.1080/02699052.2024.2347551] [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: 04/23/2023] [Accepted: 04/22/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND The use of Environmental Enrichment (EE) has been widely studied in animal models. However, the application of the same in humans is limited to rehabilitation settings. OBJECTIVE To investigate the feasibility of a community-based EE paradigm in adults with brain injury. METHODS Six individuals diagnosed with traumatic brain injury enrolled in the study. The Go Baby Go Café instrumented with a body weight harness system, provided physical and social enrichment as participants performed functional tasks for 2 hours, three times a week, for 2 months. Feasibility and safety outcomes were recorded throughout sessions. Clinical measures including 10-meter walk, timed up and go, jebsen hand function, 6-minute walk, and trail making tests were obtained pre and post intervention. RESULTS All participants completed the study. The attendance was 100% and adherence was 87%. Positive changes in clinical measures were statistically significant for the timed up and go (p = 0.0175), TUG-cognitive (p = 0.0064), 10-meter walk (p = 0.0428), six-minute walk (p = 0.0196), TMT-A (p = 0.034). Changes in JHFT were not significant (p = 0.0506), with one subject recording values counter to the trend. CONCLUSION The Café was a comprehensive EE-based intervention that was feasible, safe, and has the potential to enhance motor and cognitive function in individuals with brain injury.
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Affiliation(s)
- Devina S Kumar
- Burke Neurological Institute, White Plains, New York, USA
| | | | - James C Galloway
- University of Delaware, Newark, Delaware, USA
- Baylor University, Waco, Texas, USA
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Conklin JP, Wallace T, McCauley KL, Breitenstein J, Gore RK. Level of Evidence of Telehealth Rehabilitation and Behavioral Health Services for Traumatic Brain Injury: A Scoping Review. J Clin Psychol Med Settings 2024; 31:379-402. [PMID: 37903966 DOI: 10.1007/s10880-023-09981-1] [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] [Accepted: 09/20/2023] [Indexed: 11/01/2023]
Abstract
Traumatic brain injury (TBI) can result in significant impairments in functioning associated with partial or permanent disabilities. Examining the evidence for domain-specific telehealth interventions is necessary to guide the development of effective clinical and research programs for this population. The present scoping review characterizes the level of evidence across a range of TBI-related disabilities and impairments. A literature search was performed across comprehensive databases using search terms related to TBI, rehabilitation, telehealth, and outcome. A total of 19 publications from 17 studies met inclusion criteria. Articles focused on telehealth interventions to improve global, cognitive, emotional, and physical functioning post-TBI. Levels of evidence ranged from 1 to 4 across domains, with predominantly experimental designs (level 1). Outcomes demonstrating improvement or benefit from telehealth treatments were reported across all functional domains (50-80% of studies). Results highlight the potential of telehealth interventions across the span of comprehensive interdisciplinary rehabilitation care. Expanded research is needed on remote treatment options for physical symptoms, for subgroups within TBI populations (i.e., mild TBI, military populations), as well as on remote and hybrid comprehensive rehabilitation programs.
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Affiliation(s)
- Jessica P Conklin
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Tracey Wallace
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA.
| | - Katherine L McCauley
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Jackie Breitenstein
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
| | - Russell K Gore
- SHARE Military Initiative, Shepherd Center, 80 Peachtree Park Drive NE, Atlanta, GA, 30309, USA
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Ganesh A, Al-Shamli S, Mahadevan S, Chan MF, Burke DT, Al Rasadi K, Al Saadoon M, Al–Adawi S. The Frequency of Neuropsychiatric Sequelae After Traumatic Brain Injury in the Global South: A systematic review and meta-analysis. Sultan Qaboos Univ Med J 2024; 24:161-176. [PMID: 38828247 PMCID: PMC11139369 DOI: 10.18295/squmj.12.2023.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 06/05/2024] Open
Abstract
This study aimed to assess the prevalence of neuropsychiatric sequelae following traumatic brain injury (TBI) among the Western Asian, South Asian and African regions of the global south. All studies on psychiatric disturbances or cognitive impairment following TBI conducted (until August 2021) in the 83 countries that constitute the aforementioned regions were reviewed; 6 databases were selected for the literature search. After evaluating the articles using the Joanna Briggs Institute guidelines, the random effects model was used to estimate the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), TBI-related sleep disturbance (TBI-SD), obsessive-compulsive disorder (OCD) and cognitive impairment. Of 56 non-duplicated studies identified in the initial search, 27 were eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in 1,882 samples was 35.35%, that of anxiety in 1,211 samples was 28.64%, that of PTSD in 426 samples was 19.94%, that of OCD in 313 samples was 19.48%, that of TBI-SD in 562 samples was 26.67% and that of cognitive impairment in 941 samples was 49.10%. To date, this is the first critical review to examine the spectrum of post-TBI neuropsychiatric sequelae in the specified regions. Although existing studies lack homogeneous data due to variability in the diagnostic tools and outcome measures utilised, the reported prevalence rates are significant and comparable to statistics from the global north.
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Affiliation(s)
- Aishwarya Ganesh
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Sangeetha Mahadevan
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Moon Fai Chan
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - David T. Burke
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Khalid Al Rasadi
- Medical Research Center, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Muna Al Saadoon
- Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Samir Al–Adawi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Shen J, Wang Y, Quinn S, Suskauer SJ, Birch J, Busch T, Svingos A, Crawfis R, Yeates KO, Taylor HG. Efficacy of a virtual reality-based cognitive interactive training program for children with traumatic brain injuries: study protocol for a parallel-group randomized controlled trial. Trials 2024; 25:185. [PMID: 38481293 PMCID: PMC10935958 DOI: 10.1186/s13063-024-08049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of disability in children. Cognitive rehabilitation for this population is critical for their long-term health outcomes. This trial aims to evaluate the efficacy of a virtual reality-based program (VICT) for training executive functions in children with TBI. METHODS A parallel group randomized controlled trial will be conducted among up to 32 children with TBI. Children in the intervention group will receive the VICT training while children in the control group will play a comparable VR game without executive function training. Each participant will be assessed at baseline, post-intervention, and 1-month follow-up. Outcomes will include core executive functions, attention, and health-related quality of life measured by computerized tasks or standardized questionnaires. DISCUSSION Cognitive rehabilitation is among the top healthcare needs for pediatric TBI patients. Virtual reality-based training is promising due to its versatile content, flexibility, and potential cost savings for both patients and providers. Findings of this trial will provide data on the efficacy of the VICT program on core executive functions, attention problems, and health-related quality of life and serve as the empirical foundation for future larger multi-site effectiveness trials. TRIAL REGISTRATION ClinicalTrials.gov NCT04526639 . Registered on August 18, 2020.
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Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Massachusetts Lowell, Lowell, USA.
| | - Yan Wang
- Department of Psychology, University of Massachusetts Lowell, Lowell, USA
| | - Susan Quinn
- Inpatient Rehabilitation Unit, Spaulding Rehabilitation Hospital, Boston, USA
| | - Stacy J Suskauer
- Kennedy Krieger Institute and Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julia Birch
- Spaulding Rehabilitation Hospital, Boston, USA
| | - Tyler Busch
- Brain Injury Clinical Research Center, Kennedy Krieger Institute, Departments of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Adrian Svingos
- Brain Injury Clinical Research Center, Kennedy Krieger Institute, Departments of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Roger Crawfis
- Department of Computer Science & Engineering, The Ohio State University, Columbus, USA
| | | | - H Gerry Taylor
- Abigail Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, USA
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Galicia KE, Haider SD, Reidy LE, Anstadt MJ, Kubasiak JC, Gonzalez RP, Patel PP. Association Between Health Insurance and Outcomes After Traumatic Brain Injury: A National ACS-TQP-PUF Database Study. J Surg Res 2023; 290:16-27. [PMID: 37172499 PMCID: PMC10330247 DOI: 10.1016/j.jss.2023.03.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/16/2023] [Accepted: 03/26/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION According to the US Census Bureau, roughly 8.6% of the population lacks health care coverage. Increasing evidence suggests that insurance status plays a role in outcomes after trauma. However, its role in the setting of traumatic brain injury (TBI) remains poorly understood. METHODS The Trauma Quality Programs Participant Use Files were queried from 2017 to 2019. All patients with isolated TBI were identified. Isolated TBI was defined as: 1) Head Abbreviated Injury Scale (AIS) > 3 and 2) AIS <3 in all other anatomical regions. Patients dead on arrival, with Head AIS = 6, or missing key data were excluded. Demographic and clinical information was compared between those with and without insurance. Multivariate regressions were used to assess associations between insurance status and TBI outcomes (inhospital mortality, discharge to facility, total ventilator days, Intensive Care Unit length of stay (ICU LOS), and hospital LOS). RESULTS In total, 199,556 patients met inclusion criteria; 18,957 (9.5%) were uninsured. Compared to the insured, uninsured TBI patients were younger with a greater proportion of males. Uninsured patients were less severely injured and less comorbid. Uninsured patients had shorter unadjusted LOS in the ICU and hospital. Yet, uninsured patients experienced greater unadjusted inhospital mortality (12.7% versus 8.4%, P < 0.001). When controlling for covariates, lack of insurance was significantly associated with increased likelihood of mortality (OR 1.62; P < 0.001). This effect was most noticeable in patients with Head AIS = 4 (OR 1.55; P < 0.001) and Head AIS = 5 (OR 1.80; P < 0.001). Lack of insurance was also significantly associated with decreased likelihood of discharge to facility (OR 0.38), decreased ICU LOS (Coeff. -0.61), and decreased hospital LOS (Coeff. -0.82; all P < 0.001). CONCLUSIONS This study demonstrates that insurance status is independently associated with outcome disparities after isolated TBI. Despite the Affordable Care Act (ACA) reform, lack of insurance appears significantly associated with inhospital mortality, decreased likelihood of discharge to facility, and decreased time spent in the ICU and hospital.
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Affiliation(s)
- Kevin E Galicia
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois
| | - Sarah D Haider
- Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois.
| | - Lauren E Reidy
- Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois
| | - Michael J Anstadt
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois
| | - Richard P Gonzalez
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois
| | - Purvi P Patel
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
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Pearson A, Ortiz C, Eisenbaum M, Arrate C, Browning M, Mullan M, Bachmeier C, Crawford F, Ojo JO. Deletion of PTEN in microglia ameliorates chronic neuroinflammation following repetitive mTBI. Mol Cell Neurosci 2023; 125:103855. [PMID: 37084991 DOI: 10.1016/j.mcn.2023.103855] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/25/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023] Open
Abstract
Traumatic brain injury is a leading cause of morbidity and mortality in adults and children in developed nations. Following the primary injury, microglia, the resident innate immune cells of the CNS, initiate several inflammatory signaling cascades and pathophysiological responses that may persist chronically; chronic neuroinflammation following TBI has been closely linked to the development of neurodegeneration and neurological dysfunction. Phosphoinositide 3-kinases (PI3Ks) are a family of lipid kinases that have been shown to regulate several key mechanisms in the inflammatory response to TBI. Increasing evidence has shown that the modulation of the PI3K/AKT signaling pathway has the potential to influence the cellular response to inflammatory stimuli. However, directly targeting PI3K signaling poses several challenges due to its regulatory role in several cell survival pathways. We have previously identified that the phosphatase and tensin homolog deleted on chromosome 10 (PTEN), the major negative regulator of PI3K/AKT signaling, is dysregulated following exposure to repetitive mild traumatic brain injury (r-mTBI). Moreover, this dysregulated PI3K/AKT signaling was correlated with chronic microglial-mediated neuroinflammation. Therefore, we interrogated microglial-specific PTEN as a therapeutic target in TBI by generating a microglial-specific, Tamoxifen inducible conditional PTEN knockout model using a CX3CR1 Cre recombinase mouse line PTENfl/fl/CX3CR1+/CreERT2 (mcg-PTENcKO), and exposed them to our 20-hit r-mTBI paradigm. Animals were treated with tamoxifen at 76 days post-last injury, and the effects of microglia PTEN deletion on immune-inflammatory responses were assessed at 90-days post last injury. We observed that the deletion of microglial PTEN ameliorated the proinflammatory response to repetitive brain trauma, not only reducing chronic microglial activation and proinflammatory cytokine production but also rescuing TBI-induced reactive astrogliosis, demonstrating that these effects extended beyond microglia alone. Additionally, we observed that the pharmacological inhibition of PTEN with BpV(HOpic) ameliorated the LPS-induced activation of microglial NFκB signaling in vitro. Together, these data provide support for the role of PTEN as a regulator of chronic neuroinflammation following repetitive mild TBI.
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Affiliation(s)
- Andrew Pearson
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA; The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, United Kingdom.
| | - Camila Ortiz
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA; The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, United Kingdom
| | - Max Eisenbaum
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA; The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, United Kingdom
| | - Clara Arrate
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA
| | | | - Michael Mullan
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA; The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, United Kingdom
| | - Corbin Bachmeier
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA; The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, United Kingdom
| | - Fiona Crawford
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA; The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, United Kingdom; James A. Haley Veterans' Hospital, 13000 Bruce B Downs Blvd, Tampa, FL 33612, USA
| | - Joseph O Ojo
- The Roskamp Institute, 2040 Whitfield Avenue, Sarasota, FL 34243, USA; The Open University, Walton Hall, Kents Hill, Milton Keynes MK7 6AA, United Kingdom
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Yu Q, Wang Z, Li Z, Liu X, Oteng Agyeman F, Wang X. Hierarchical Structure of Depression Knowledge Network and Co-word Analysis of Focus Areas. Front Psychol 2022; 13:920920. [PMID: 35664156 PMCID: PMC9160970 DOI: 10.3389/fpsyg.2022.920920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
Contemporarily, depression has become a common psychiatric disorder that influences people's life quality and mental state. This study presents a systematic review analysis of depression based on a hierarchical structure approach. This research provides a rich theoretical foundation for understanding the hot spots, evolutionary trends, and future related research directions and offers further guidance for practice. This investigation contributes to knowledge by combining robust methodological software for analysis, including Citespace, Ucinet, and Pajek. This paper employed the bibliometric methodology to analyze 5,000 research articles concerning depression. This current research also employed the BibExcel software to bibliometrically measure the keywords of the selected articles and further conducted a co-word matrix analysis. Additionally, Pajek software was used to conduct a co-word network analysis to obtain a co-word network diagram of depression. Further, Ucinet software was utilized to calculate K-core values, degree centrality, and mediated centrality to better present the research hotspots, sort out the current status and reveal the research characteristics in the field of depression with valuable information and support for subsequent research. This research indicates that major depressive disorder, anxiety, and mental health had a high occurrence among adolescents and the aged. This present study provides policy recommendations for the government, non-governmental organizations and other philanthropic agencies to help furnish resources for treating and controlling depression orders.
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Affiliation(s)
- Qingyue Yu
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zihao Wang
- College of Medicine, Jiangsu University, Zhenjiang, China
| | - Zeyu Li
- Jingjiang College of Jiangsu University, Zhenjiang, China
| | - Xuejun Liu
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | | | - Xinxing Wang
- School of Management, Jiangsu University, Zhenjiang, China
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Chan V, Estrella MJ, Babineau J, Colantonio A. Protocol for a scoping review on rehabilitation among individuals who experience homelessness and traumatic brain injury. BMJ Open 2021; 11:e052942. [PMID: 34740933 PMCID: PMC8573664 DOI: 10.1136/bmjopen-2021-052942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Rehabilitation is key to improving outcomes and quality of life after traumatic brain injury (TBI). However, individuals experiencing homelessness are rarely represented in research that informs evidence-based rehabilitation guidelines even though TBI is disproportionately prevalent among this population. This protocol is for a scoping review to explore the extent to which rehabilitation, including the types of rehabilitation interventions, is available to, or used by, individuals who experience homelessness and TBI to inform (1) opportunities to integrate rehabilitation for individuals experiencing homelessness and TBI, (2) considerations for existing clinical and practice guidelines for rehabilitation and (3) recommendations for future research. METHODS AND ANALYSIS The scoping review will be guided by six stages described in scoping review methodology frameworks. Electronic databases (MEDLINE, Embase and Embase Classic, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, and Nursing and Allied Health), reference list of included articles and scoping or systematic reviews identified from the search and grey literature, defined as reports from relevant brain injury, housing and rehabilitation organisations, will be searched. Two reviewers will independently screen all articles based on predetermined inclusion and exclusion criteria. A descriptive numerical summary of data items will be provided and qualitative content analytic techniques will be used to identify and report common themes. Preliminary findings will be shared with stakeholders to seek feedback on the implications of the results. ETHICS AND DISSEMINATION Ethics review will not be required, as only publicly available data will be analysed. Findings from the scoping review will be published in a peer-reviewed journal and presented at scientific meetings and to stakeholders, defined as service providers in the housing and TBI sectors; health professionals who provide care for individuals with TBI and/or homelessness; health administrators, decision-makers and policy-makers; researchers; and caregivers or family members of individuals with lived experience of TBI and homelessness.
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Affiliation(s)
- Vincy Chan
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Maria Jennifer Estrella
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Babineau
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
- The Institute for Education Research, University Health Network, Toronto, Ontario, Canada
| | - Angela Colantonio
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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10
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Benavides AM, Finn JA, Tang X, Ropacki S, Brown RM, Smith AN, Stevens LF, Rabinowitz AR, Juengst SB, Johnson-Greene D, Hart T. Psychosocial and Functional Predictors of Depression and Anxiety Symptoms in Veterans and Service Members With TBI: A VA TBI Model Systems Study. J Head Trauma Rehabil 2021; 36:397-407. [PMID: 33656470 DOI: 10.1097/htr.0000000000000647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify psychosocial and functional predictors of self-reported depression and anxiety symptoms at year 2 following traumatic brain injury (TBI). SETTING Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs) within the TBI Model Systems (TBIMS). PARTICIPANTS A total of 319 service members/veterans enrolled in VA TBIMS who were eligible for and completed both 1- and 2-year follow-up evaluations. DESIGN Secondary analysis from multicenter prospective longitudinal study. MAIN MEASURES Demographic, injury-related, military, mental health, and substance use variables. Questionnaires included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Neurobehavioral Symptom Inventory. Rating scales included the Participation Assessment with Recombined Tools-Objective and Disability Rating Scale. RESULTS The final sample was largely male (96%) and predominantly White (65%), with a median age of 27 years. In unadjusted analyses, pre-TBI mental health treatment history and year 1 employment status, community activity, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 PHQ-9 scores; pre-TBI mental health treatment history and year 1 community activity, social contact, problematic substance use, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 GAD-7 scores. In multivariable analyses, only year 1 community activity and depression symptoms uniquely predicted year 2 PHQ-9 scores, and only year 1 employment status, community activity, problematic substance use, and anxiety symptoms uniquely predicted year 2 GAD-7 scores. CONCLUSION Anxiety and depression commonly occur after TBI and are important treatment targets. Some predictors (eg, participation and substance use) are modifiable and amenable to treatment as well. Early identification of anxiety and depression symptoms is key.
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Affiliation(s)
- Angela M Benavides
- Extended Care & Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota (Drs Benavides and Finn); Department of Psychiatry, University of Minnesota-Twin Cities, Minneapolis (Dr Finn); Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Dr Tang); Polytrauma System of Care, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Dr Ropacki); Center of Innovation for Disability and Rehabilitation Research, James A. Haley Veterans Affairs Medical Center, and Department of Anthropology, University of South Florida, Tampa, Florida (Dr Brown); Defense and Veterans Brain Injury Center, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Mr Smith and Dr Stevens); Departments of Psychology and Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond (Dr Stevens); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Drs Rabinowitz and Hart); Department of Rehabilitation, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Rabinowitz); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas (Dr Juengst); and Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, Florida (Dr Johnson-Greene)
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11
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The effectiveness of memory remediation strategies after traumatic brain injury: Systematic review and meta-analysis. Ann Phys Rehabil Med 2021; 64:101530. [PMID: 33957294 DOI: 10.1016/j.rehab.2021.101530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a steadily rising health concern associated with significant risk of emotional, behavioral and cognitive impairments. Cognitive memory impairment is one of the most concerning outcomes after TBI, affecting a wide range of everyday activities, social interactions and employment. Several comparative and comprehensive reviews on the effects of cognitive interventions in individuals with TBI have been conducted but usually with a qualitative rather than quantitative approach. Thus, evidence synthesis of the effects of TBI interventions on memory difficulties is limited. OBJECTIVE In this meta-analysis, we examined the memory-remediating effects of internal and external interventions, injury severity and the interaction of both factors for patients with TBI. METHODS Data were extracted from studies published between 1980 and 2020 that used objective memory measures (computerized or pencil-and-paper), and multiple meta-analyses were conducted to compare effectiveness across these interventions. Publication bias was assessed, as was quality of evidence using the Cochrane Risk of Bias tool for randomized controlled studies. Our final meta-analysis included 16 studies of 17 interventions classified into 3 categories: internal, external and mixed. RESULTS Mixed interventions demonstrated the highest average effect size for memory difficulties (Morris d=0.79). An evaluation of injury severity yielded 2 categories: mild-moderate and moderate-severe. Analyses demonstrated a homogenous medium effect size of improvement across injury severity, with moderate-severe injury with the largest average effect size (Morris d=0.65). Further evaluation of injury severity interaction with intervention type revealed a mediating effect for both factors, demonstrating the largest effect size for mixed interventions with moderate-severe injury (Morris d=0.81). CONCLUSION This study highlights the effectiveness of memory remediation interventions on memory impairment after TBI. A wide range of interventions are more effective because they address individual variability for severity and memory deficits. The study further supports and expands existing intervention standards and guidelines.
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Burkadze E, Axobadze K, Chkhaberidze N, Chikhladze N, Coman MA, Dulf D, Peek-Asa C. Epidemiology of Traumatic Brain Injury in Georgia: A Prospective Hospital-Based Study. Risk Manag Healthc Policy 2021; 14:1041-1051. [PMID: 33737845 PMCID: PMC7966295 DOI: 10.2147/rmhp.s290175] [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] [Received: 12/04/2020] [Accepted: 02/25/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality worldwide, disproportionally affecting low- and middle-income countries (LMICs). Epidemiological characteristics of TBI at a national level are absent for most LMICs including Georgia. This study aimed to establish the registries and assess causes and outcomes in TBI patients presenting to two major trauma hospitals in the capital city –Tbilisi. Patients and Methods The prospective observational study was conducted at Acad. O. Gudushauri National Medical Center and M. Iashvili Children’s Central Hospital from March, 1 through August, 31, 2019. Patients of all age groups admitted to one of the study hospitals with a TBI diagnosis were eligible for participation. Collected data were uploaded using the electronic data collection tool –REDCap, analyzed through SPSS software and evaluated to provide detailed information on TBI-related variables and outcomes using descriptive statistics. Results Overall, 542 hospitalized patients were enrolled during the study period, about 63% were male and the average age was 17.7. The main causes of TBI were falls (58%) and struck by or against an object (22%). The 97% suffered from mild TBI (GCS 13–15). Over 23% of patients arrived at the hospital more than 1 hour after injury and 25% after more than 4-hours post-injury. Moderate and severe TBI were associated with an increased hospital length of stay. Mortality rate of severe TBI was 54%. Conclusion This study provides important information on the major epidemiological characteristics of TBI in Georgia, which should be considered for setting priorities for injury management.
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Affiliation(s)
- Eka Burkadze
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Ketevan Axobadze
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Nino Chkhaberidze
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Nino Chikhladze
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Madalina Adina Coman
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Diana Dulf
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Corinne Peek-Asa
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA
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13
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Zeldovich M, Wu YJ, Gorbunova A, Mikolic A, Polinder S, Plass AM, Covic A, Asendorf T, Andelic N, Voormolen DC, von Steinbüchel N. Influence of Sociodemographic, Premorbid, and Injury-Related Factors on Post-Concussion Symptoms after Traumatic Brain Injury. J Clin Med 2020; 9:jcm9061931. [PMID: 32575667 PMCID: PMC7356324 DOI: 10.3390/jcm9061931] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Post-concussion symptoms (PCS) are often reported as consequences of mild and moderate traumatic brain injury (TBI), but these symptoms are not well documented in severe TBI. There is a lack of agreement as to which factors and covariates affect the occurrence, frequency, and intensity of PCS among TBI severity groups. The present study therefore aims to examine the association between sociodemographic, premorbid, and injury-related factors and PCS. METHODS A total of 1391 individuals (65% male) from the CENTER-TBI study were included in the analyses. The occurrence, frequency (number of PCS), and intensity (severity) of PCS were assessed using the Rivermead Post-concussion Symptoms Questionnaire (RPQ) at six months after TBI. To examine the association between selected factors (age, sex, living situation, employment status, educational background, injury and TBI severity, and premorbid problems) and PCS, a zero-inflated negative binomial model (ZINB) for occurrence and frequency of PCS and a standard negative binomial regression (NB) for intensity were applied. RESULTS Of the total sample, 72% of individuals after TBI reported suffering from some form of PCS, with fatigue being the most frequent among all TBI severity groups, followed by forgetfulness, and poor concentration. Different factors contributed to the probability of occurrence, frequency, and intensity of PCS. While the occurrence of PCS seemed to be independent of the age and sex of the individuals, both the frequency and intensity of PCS are associated with them. Both injury and TBI severity influence the occurrence and frequency of PCS, but are associated less with its intensity (except "acute" symptoms such as nausea, vomiting, and headaches). Analyses focusing on the mTBI subgroup only yielded results comparable to those of the total sample. DISCUSSION In line with previous studies, the results support a multifactorial etiology of PCS and show the importance of differentiating between their occurrence, frequency, and intensity to better provide appropriate treatment for individual subgroups with different symptoms (e.g., multiple PCS or more intense PCS). Although PCS often occur in mild to moderate TBI, individuals after severe TBI also suffer from PCS or post-concussion-like symptoms that require appropriate treatment. The chosen statistical approaches (i.e., ZINB and NB models) permit an ameliorated differentiation between outcomes (occurrence, frequency, and intensity of PCS) and should be used more widely in TBI research.
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Affiliation(s)
- Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Yi-Jhen Wu
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Anastasia Gorbunova
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Ana Mikolic
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 Rotterdam, The Netherlands
| | - Anne Marie Plass
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0450 Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models, 0373 Oslo, Norway
| | - Daphne C Voormolen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 Rotterdam, The Netherlands
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
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14
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Stiekema APM, Winkens I, Ponds R, De Vugt ME, Van Heugten CM. Finding a new balance in life: a qualitative study on perceived long-term needs of people with acquired brain injury and partners. Brain Inj 2020; 34:421-429. [PMID: 32064944 DOI: 10.1080/02699052.2020.1725125] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: Although the long-term consequences of acquired brain injury are frequent and diverse, care and support over the longer term is an under-addressed issue. This study aims to identify the perceived needs of people with acquired brain injury and their partners.Methods: Interviews with four focus groups of people with brain injury (n = 17) and three partner groups (n = 19) were audio- and videotaped, transcribed verbatim and analyzed using inductive content analysis.Results: Needs were perceived on the intrapersonal, social, healthcare and societal levels, focusing on three themes: 1) Adaptation to changes, including awareness of consequences, acceptance, role changes and dealing with these; 2) Understanding from relatives/friends, professionals, institutions and society; 3) Timely, individualized care, involving information, transition to home, searching for support, peer support and support for partner/family.Discussion: The variety and complexity of needs show that people with brain injury and their partners need to find a new balance in order to live a fulfilling life despite the consequences of brain injury. The overarching need for continuity of care from the transition to home onwards provides important implications for supporting the process of learning how to live well with brain injury.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands.,Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Ieke Winkens
- Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rudolf Ponds
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands.,Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.,Department of Brain Injury, Adelante Rehabilitation Centre, Hoensbroek, The Netherlands
| | - Marjolein E De Vugt
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Caroline M Van Heugten
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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15
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Efficacy of Postacute Neuropsychological Rehabilitation for Patients with Acquired Brain Injuries is Maintained in the Long-Term. J Int Neuropsychol Soc 2020; 26:130-141. [PMID: 31983377 DOI: 10.1017/s1355617719001024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We examined the long-term maintenance of treatment outcomes in patients with acquired brain injuries who participated in community-based neuropsychological rehabilitation (NR) programs, in a prospective, within-subject, longitudinal, partial double-blind cohort study. METHODS One hundred forty-three patients (39 females, mean age 33.5 years) who had experienced a brain injury (BI) (mean time since injury 3.95 years) were referred to a postacute community-based NR institute. Patients participated in one of the three programs aimed at improving their functional outcome: comprehensive-holistic neuropsychological rehabilitation, vocational-focused neuropsychological rehabilitation, and individual neuropsychological rehabilitation. Self-reported data regarding employment, community integration, perceived quality of life (PQoL), and mood were collected at program start and end, and annually for 3 years post program completion. Group placement was based on clinical considerations, such that the study did not aim to compare the programs, but rather to assess their long-term benefits. RESULTS Employment status and stability, community integration, and PQoL improved significantly after program completion and continued to improve for the following 3 years. The proportion of individuals with mood disturbances did not change during or after the programs. CONCLUSIONS A clear consensus regarding BI rehabilitation is that long-term maintenance of treatment outcomes is imperative to its efficacy. Our findings suggest that postacute NR programs provide participants with various tools, skills, and psychological perspectives that they continue to gain from and generalize to real life after program completion, reflecting transformational processes with stable long-term benefits.
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16
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Juengst SB, Osborne CL, Holavanahalli R, Silva V, Kew CL, Nabasny A, Bell KR. Feasibility Study of Problem-Solving Training for Care Partners of Adults With Traumatic Brain Injury, Spinal Cord Injury, Burn Injury, or Stroke During the Inpatient Hospital Stay. Arch Rehabil Res Clin Transl 2019; 1:100009. [PMID: 33543049 PMCID: PMC7853336 DOI: 10.1016/j.arrct.2019.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the feasibility of delivering an evidence-based self-management intervention, problem-solving training (PST), to care partners of individuals with traumatic brain injury (TBI), spinal cord injury (SCI), burn injury, or stroke during the inpatient hospital stay. DESIGN In this single group pre-post intervention pilot feasibility study. SETTING Inpatient rehabilitation or acute care and community. PARTICIPANTS Care partners (spouse or partner, family member, friend who is in any way responsible for the health or well-being of the care recipient) of individuals with TBI, SCI, burn injury, or stroke (N=39). INTERVENTION PST is a metacognitive self-management intervention that teaches individuals a global strategy for addressing self-selected problems. Participants received up to 6 sessions of PST in person or via telephone during their care recipient's inpatient stay. MAIN OUTCOME MEASURES We measured feasibility of recruitment, intervention delivery, and postintervention use of a smartphone app (Care Partner Problem Solving [CaPPS]) and participant satisfaction (Client Satisfaction Questionnaire [CSQ]) and engagement (Pittsburgh Rehabilitation Participation Scale [PRPS]) with the intervention. RESULTS Of 39 care partners approached, n=10 (25.6%) were ineligible. Of n=29 (74.4%) who were eligible, n=17 (58.6%) refused, and n=12 (41.4%) consented, of whom n=8 (66.7%) completed ≥3 PST sessions. Not perceiving any benefit was the most common reason for refusal, followed by no interest in research. Participants were very satisfied with PST (CSQ mean=3.35, SD=0.60), reported strong working alliance (Working Alliance Inventory mean=6.8, SD=3.1), and demonstrated very good engagement (PRPS mean=4.75, SD=1.41). CaPPS was downloaded and used by only n=3 participants. CONCLUSIONS Delivering a self-management intervention to care partners during the care recipient's acute hospital stay is feasible for a subset of potential participants. Short lengths of stay, language fluency, and perceiving no potential benefit were noted barriers. Boosters via smartphone app have potential, but several barriers must first be overcome.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Candice L. Osborne
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Valeria Silva
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chung Lin Kew
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew Nabasny
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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17
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O’Sullivan D, Watts JR, Strauser DR. Trauma-sensitive rehabilitation counseling: Paradigms and principles. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-191047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Izzy S, Liu Q, Fang Z, Lule S, Wu L, Chung JY, Sarro-Schwartz A, Brown-Whalen A, Perner C, Hickman SE, Kaplan DL, Patsopoulos NA, El Khoury J, Whalen MJ. Time-Dependent Changes in Microglia Transcriptional Networks Following Traumatic Brain Injury. Front Cell Neurosci 2019; 13:307. [PMID: 31440141 PMCID: PMC6694299 DOI: 10.3389/fncel.2019.00307] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/24/2019] [Indexed: 12/21/2022] Open
Abstract
The neuroinflammatory response to traumatic brain injury (TBI) is critical to both neurotoxicity and neuroprotection, and has been proposed as a potentially modifiable driver of secondary injury in animal and human studies. Attempts to broadly target immune activation have been unsuccessful in improving outcomes, in part because the precise cellular and molecular mechanisms driving injury and outcome at acute, subacute, and chronic time points after TBI remain poorly defined. Microglia play a critical role in neuroinflammation and their persistent activation may contribute to long-term functional deficits. Activated microglia are characterized by morphological transformation and transcriptomic changes associated with specific inflammatory states. We analyzed the temporal course of changes in inflammatory genes of microglia isolated from injured brains at 2, 14, and 60 days after controlled cortical impact (CCI) in mice, a well-established model of focal cerebral contusion. We identified a time dependent, injury-associated change in the microglial gene expression profile toward a reduced ability to sense tissue damage, perform housekeeping, and maintain homeostasis in the early stages following CCI, with recovery and transition to a specialized inflammatory state over time. This later state starts at 14 days post-injury and is characterized by a biphasic pattern of IFNγ, IL-4, and IL-10 gene expression changes, with concurrent proinflammatory and anti-inflammatory gene changes. Our transcriptomic data sets are an important step to understand microglial role in TBI pathogenesis at the molecular level and identify common pathways that affect outcome. More studies to evaluate gene expression at the single cell level and focusing on subacute and chronic timepoint are warranted.
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Affiliation(s)
- Saef Izzy
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Qiong Liu
- Department of Anatomy, Histology and Embryology, School of Basic Medical Sciences, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Shanghai, China
| | - Zhou Fang
- Harvard Medical School, Boston, MA, United States.,Systems Biology and Computer Science Program, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Sevda Lule
- Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Limin Wu
- Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Joon Yong Chung
- Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Aliyah Sarro-Schwartz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Alexander Brown-Whalen
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Caroline Perner
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Suzanne E Hickman
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, United States
| | - Nikolaos A Patsopoulos
- Harvard Medical School, Boston, MA, United States.,Systems Biology and Computer Science Program, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.,Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Joseph El Khoury
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Michael J Whalen
- Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States.,Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Abstract
Aims: To examine the epidemiology of traumatic brain injury (TBI) in Denmark, including the relative frequency, distribution of injuries and the external causes across the days of the week, sex and age. Methods: I carried out a nationwide register-based study of the full population aged 16–65 years with a diagnosis of TBI between 2008 and 2012, a total of 27,030 hospital contacts. I calculated the average annual relative frequency and the sex risk ratio for four TBI diagnoses across age. I report the distribution of five external causes and the odds ratio of acquiring a TBI during the weekend. Results: The relative frequency of TBI peaked among 16- to 35-year-olds for all diagnosis except for haemorrhages, which increase with age. During weekends, the relative frequency of concussions increases for men, whereas the relative frequency of severe TBI increases for young men and decreases for older men. The relative frequency of TBI is stable throughout the week for women aged 16–35 years, but decreases for women aged 36–65 years. For 16- to 35-year-olds, the main external causes of TBI are falls and road traffic accidents. During the weekend, the risk of violence-, sport- and fall-related TBI increases for 16- to 35-year-olds, whereas the risk of TBI related to road traffic accidents decreases for women and older men. The risk of sports-related TBI increases during weekends for older men. Conclusions: Injury patterns and external causes across TBI diagnoses differ substantially across sex, age and the day of week, indicating differences in the behavioural patterns that result in a TBI.
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20
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Care partner problem solving training (CP-PST) for care partners of adults with traumatic brain injury during inpatient rehabilitation: Study protocol for a multisite, randomized, single-blind clinical feasibility trial. Contemp Clin Trials 2019; 80:9-15. [DOI: 10.1016/j.cct.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/02/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022]
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21
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Ilie G, Wickens CM, Ialomiteanu A, Adlaf EM, Asbridge M, Hamilton H, Mann RE, Rehm J, Rutledge R, Cusimano MD. Traumatic brain injury and hazardous/harmful drinking: Concurrent and single associations with poor mental health and roadway aggression. Psychiatry Res 2019; 272:458-466. [PMID: 30611965 DOI: 10.1016/j.psychres.2018.12.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
This study describes the association among lifetime traumatic brain injury (TBI) and past year hazardous/harmful drinking, as well as their unique and synergistic effects, on mental health problems and roadway aggression among Canadian adults. A cross-sectional sample of 6074 Ontario adults aged 18 years or older were surveyed between 2011 and 2013. TBI was defined as trauma to the head resulting in loss of consciousness or overnight hospitalization. Past year hazardous/harmful drinking was assessed using the Alcohol Use Disorders Identification Test. An estimated 13.1% (95%CI:12.0,14.2) adults reported a prior TBI (no hazardous/harmful drinking), 2.7% (95%CI:2.2,3.3) reported a prior TBI while concurrently screening positive for past year hazardous/harmful drinking and 9.8% (95%CI:8.9,10.9) screened positive for hazardous/harmful drinking (no TBI). Men had significantly higher odds of exhibiting all three conditions compared to women, especially for the concurrent class. Younger adults had significantly greater odds of hazardous/harmful drinking, or the concurrent class compared to adults 55 years and older. Adults in any of the three conditions had greater odds for mental health problems and roadway aggression. Concordance of both conditions corresponded to a greater than additive effect and greater odds of mild roadway aggression, than either condition alone. Results show that singly and jointly, these conditions are associated with adverse health and behavioral impediments.
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Affiliation(s)
- Gabriela Ilie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.
| | - Christine M Wickens
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Anca Ialomiteanu
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | - Edward M Adlaf
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Hayley Hamilton
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robert E Mann
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robert Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada
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22
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Latella D, Maggio MG, De Luca R, Maresca G, Piazzitta D, Sciarrone F, Carioti L, Manuli A, Bramanti P, Calabro RS. Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue. J Clin Neurosci 2018; 58:1-6. [PMID: 30314923 DOI: 10.1016/j.jocn.2018.09.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/27/2018] [Indexed: 12/28/2022]
Abstract
Traumatic brain injury (TBI) is any damage to the skull and/or the brain and its frameworks due to an external force. Following TBI, patients may report cognitive, physiological and psychosocial changes with a devastating impact on important aspects of the patient's life, such as sexual functioning. Although sexual dysfunction (SD) occurs at a significantly greater frequency in individuals with TBI, it is not commonly assessed in the clinical setting and little information is available on this crucial aspect of patients' quality of life. As the number of people with TBI is on the rise, there is a need for better management of TBI problems, including SD, by providing information to patients and their caregivers to achieve sexual health, with a consequent increase in their quality of life. Discussing and treating sexual problems in TBI patients enters the framework of a holistic approach. The purpose of this narrative review is provide clinicians with information concerning changes in sexual functioning and relationships in individuals with TBI, for a better management of patient's functional outcomes and quality of life.
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Affiliation(s)
| | | | | | | | | | | | - Luigi Carioti
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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Prevention Strategies in Post-TBI Depression in Older Adults: A Case Study. Prof Case Manag 2018; 22:284-290. [PMID: 29016420 DOI: 10.1097/ncm.0000000000000224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe a theoretically focused intervention aimed toward chronic stress and depressive symptom management that is coordinated by a case manager and delivered within a home environment by the caregiver. PRIMARY PRACTICE SETTING Home care, community setting. METHODS A case study of an older adult with traumatic brain injury (TBI) secondary to a fall who had significant allostatic load at the time of his injury. "Allostatic load" is a theoretical construct that suggests the brain is experiencing chronic strain on its systems that flexibly respond to stressors. Sustained allostatic load can contribute to chronic conditions and poor outcomes. FINDINGS Through actions with the family as caregivers, the case manager was able to coordinate a structured home setting and gradual resumption of social activities for this older adult. Focus was on establishing structure, meaningful social interactions, and positive home experiences that maximized the older adult's interests and capacity and mitigated chronic stress. Gradually, the older adult returned to his preinjury capacity and lives independently within the family home. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The case management process has the potential to mitigate stressors and improve depression management through family-focused care. Although there is limited guidance on prevention of depression, this approach resulted in attainment of safe home care, no hospital readmissions, and return to previous lifestyle for the older adult. This could be useful in the prevention of post-TBI depression.
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Brain Injury Rehabilitation Outcome Measurement: Challenges and Future Directions. J Head Trauma Rehabil 2018; 33:375-377. [PMID: 29863621 DOI: 10.1097/htr.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schrieff-Elson LE, Ockhuizen JRH, During G, Thomas KGF. Attention-training with children from socioeconomically disadvantaged backgrounds in Cape Town. J Child Adolesc Ment Health 2018; 29:147-167. [PMID: 28974165 DOI: 10.2989/17280583.2017.1372285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Attention is a core process underlying competence in higher-order cognitive abilities. Previous research suggests that healthy children from low socioeconomic status (SES) backgrounds perform poorly, relative to those from higher SES backgrounds, on tasks assessing attentional abilities. In this pilot study, we investigated the effects of an attention-training intervention on task performance in low-SES children. METHOD We conducted a quasi-controlled trial with stratified randomisation, using a pre-test/ post-test design. Participants were low-SES children aged 7-13 years. Each was assigned to either an intervention group, a play control group, or a test-only control group (n = 5 per group). We implemented a ten-week manualised cognitive rehabilitation program, Pay Attention!, administering standardised tests of attention, working memory, and inhibition before and after the intervention. Between- and within-group analyses and Reliable Change Index statistics evaluated differences in scores from pre- to post-intervention. RESULTS Analyses detected no notable between-group differences at either pre- or post-intervention testing. However, on tests of selective attention, attentional control, and inhibition, there were significant within-group and positive individual reliable changes exclusive to the intervention-group participants. CONCLUSIONS Given the variability in our findings, more research needs be conducted with a larger sample to determine, with greater rigour, the efficacy of the intervention within samples of healthy children from low-SES backgrounds.
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Affiliation(s)
- Leigh E Schrieff-Elson
- a ACSENT Laboratory, Department of Psychology , University of Cape Town , Cape Town , South Africa
| | - Ju-Reyn H Ockhuizen
- a ACSENT Laboratory, Department of Psychology , University of Cape Town , Cape Town , South Africa
| | - Genevieve During
- a ACSENT Laboratory, Department of Psychology , University of Cape Town , Cape Town , South Africa
| | - Kevin G F Thomas
- a ACSENT Laboratory, Department of Psychology , University of Cape Town , Cape Town , South Africa
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Kreutzer JS, Marwitz JH, Sima AP, Mills A, Hsu NH, Lukow HR. Efficacy of the resilience and adjustment intervention after traumatic brain injury: a randomized controlled trial. Brain Inj 2018; 32:963-971. [DOI: 10.1080/02699052.2018.1468577] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Jeffrey S. Kreutzer
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer H. Marwitz
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam P. Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Ana Mills
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Nancy H. Hsu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Herman R. Lukow
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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Wu J, Faux SG, Poulos CJ, Harris I. Brain injury rehabilitation after road trauma in new South Wales, Australia - insights from a data linkage study. BMC Health Serv Res 2018; 18:204. [PMID: 29566689 PMCID: PMC5865364 DOI: 10.1186/s12913-018-3019-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 03/15/2018] [Indexed: 12/29/2022] Open
Abstract
Background Population-based patterns of care studies are important for trauma care but conducting them is expensive and resource-intensive. Linkage of routinely collected administrative health data may provide an efficient alternative. The aims of this study are to describe the rehabilitation pathway for trauma survivors and to analyse the brain injury rehabilitation outcomes in the two care settings (specialist brain injury and non-specialist general rehabilitation units). Methods This is an observational study using routinely collected registry data (New South Wales Trauma Registry linked with the Australasian Rehabilitation Outcomes Centre Inpatient Dataset). The study cohort includes 268 road trauma patients who were admitted to trauma services between 2009 and 2012 and received inpatient rehabilitation because of a brain injury. Results Of those who need inpatient rehabilitation, 62% (n = 166) were admitted to specialist units with the remainder (n = 102) admitted to non-specialist units. Those admitted to a specialist units were younger (p < 0.001), had a lower cognitive FIM score (p = 0.003) on admission than those admitted to non-specialist units. Specialist units achieved better overall FIM score improvements from admission to discharge (43 vs 30 points, p > 0.001) but at a cost of longer length of stay (median 47 vs 24 days, p < 0.001). There were very few discharges to residential aged care facilities from rehabilitation (2% in non-specialist units and none from specialist units). There was a long time lag between trauma and admission to inpatient rehabilitation with only a quarter of the patients admitted to a specialist unit by end of week four. Few older patients (19%) with brain injury were admitted to specialist units. Conclusions It is feasible to use routinely collected registry data to monitor inpatient rehabilitation outcomes of trauma care. There were differences in characteristics and outcomes of patients with traumatic brain injury admitted to specialist units compared with non-specialist units.
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Affiliation(s)
- Jane Wu
- St. Vincent's Hospital, Sacred Heart Rehabilitation Service, 170 Darlinghurst Road, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Steven G Faux
- St. Vincent's Hospital, Sacred Heart Rehabilitation Service, 170 Darlinghurst Road, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Christopher J Poulos
- School of Public Health and Community Medicine, University of New South Wales, University Clinics, 9 Judd Ave, Hammondville, NSW, 2170, Australia
| | - Ian Harris
- South Western Sydney Clinical School, UNSW; Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
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Wang KK, Yang Z, Zhu T, Shi Y, Rubenstein R, Tyndall JA, Manley GT. An update on diagnostic and prognostic biomarkers for traumatic brain injury. Expert Rev Mol Diagn 2018; 18:165-180. [PMID: 29338452 PMCID: PMC6359936 DOI: 10.1080/14737159.2018.1428089] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major worldwide neurological disorder of epidemic proportions. To date, there are still no FDA-approved therapies to treat any forms of TBI. Encouragingly, there are emerging data showing that biofluid-based TBI biomarker tests have the potential to diagnose the presence of TBI of different severities including concussion, and to predict outcome. Areas covered: The authors provide an update on the current knowledge of TBI biomarkers, including protein biomarkers for neuronal cell body injury (UCH-L1, NSE), astroglial injury (GFAP, S100B), neuronal cell death (αII-spectrin breakdown products), axonal injury (NF proteins), white matter injury (MBP), post-injury neurodegeneration (total Tau and phospho-Tau), post-injury autoimmune response (brain antigen-targeting autoantibodies), and other emerging non-protein biomarkers. The authors discuss biomarker evidence in TBI diagnosis, outcome prognosis and possible identification of post-TBI neurodegernative diseases (e.g. chronic traumatic encephalopathy and Alzheimer's disease), and as theranostic tools in pre-clinical and clinical settings. Expert commentary: A spectrum of biomarkers is now at or near the stage of formal clinical validation of their diagnostic and prognostic utilities in the management of TBI of varied severities including concussions. TBI biomarkers could serve as a theranostic tool in facilitating drug development and treatment monitoring.
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Affiliation(s)
- Kevin K Wang
- a Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry , University of Florida , Gainesville , Florida , USA
| | - Zhihui Yang
- a Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry , University of Florida , Gainesville , Florida , USA
| | - Tian Zhu
- a Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry , University of Florida , Gainesville , Florida , USA
| | - Yuan Shi
- b Department Of Pediatrics, Daping Hospital, Chongqing , Third Military Medical University , Chongqing , China
| | - Richard Rubenstein
- c Laboratory of Neurodegenerative Diseases and CNS Biomarker Discovery, Departments of Neurology and Physiology/Pharmacology , SUNY Downstate Medical Center , Brooklyn , NY , USA
| | - J Adrian Tyndall
- d Department of Emergency Medicine , University of Florida , Gainesville , Florida , USA
| | - Geoff T Manley
- e Brain and Spinal Injury Center , San Francisco General Hospital , San Francisco , CA , USA
- f Department of Neurological Surgery , University of California, San Francisco , San Francisco , CA , USA
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Depressive Symptomatology Mediates Associations With Community Reintegration in Veterans With TBI. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schrieff-Elson LE, Steenkamp N, Hendricks MI, Thomas KGF, Rohlwink UK. Local and global challenges in pediatric traumatic brain injury outcome and rehabilitation assessment. Childs Nerv Syst 2017; 33:1775-1784. [PMID: 29149382 DOI: 10.1007/s00381-017-3527-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/06/2017] [Indexed: 11/30/2022]
Abstract
Traumatic brain injury (TBI) is a major public health problem associated with high morbidity and mortality rates in children in both high- and low- and middle-income countries. Predicting outcome after pediatric TBI is challenging given the wide range of injury and non-injury-related factors which may have an impact. Some of these factors are relevant globally (like heterogeneity in patient and injury-related factors and research methodology) and others are more specific to local contexts (like sociodemographic and cultural factors). The assessment of rehabilitation outcomes post-TBI are similarly challenging given the various methodological limitations, disparities in access to rehabilitation, and limited awareness of deficits, which are encountered globally, as well as the lack of services in the local settings. In this article, we discuss these global and local challenges to outcome and rehabilitation assessment following pediatric TBI.
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Affiliation(s)
- L E Schrieff-Elson
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.
| | - N Steenkamp
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - M I Hendricks
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - K G F Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - U K Rohlwink
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
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Hart T, Whyte J, Watanabe T, Chervoneva I. Effects of dextroamphetamine in subacute traumatic brain injury: A randomized, placebo-controlled pilot study. J Neurosci Res 2017; 96:702-710. [DOI: 10.1002/jnr.24102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Tessa Hart
- Moss Rehabilitation Research Institute; Elkins Park Pennsylvania USA
| | - John Whyte
- Moss Rehabilitation Research Institute; Elkins Park Pennsylvania USA
| | - Thomas Watanabe
- Drucker Brain Injury Center; MossRehab Hospital; Elkins Park Pennsylvania USA
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia Pennsylvania USA
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32
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Juengst SB, Kumar RG, Wagner AK. A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges. Psychol Res Behav Manag 2017; 10:175-186. [PMID: 28652833 PMCID: PMC5476717 DOI: 10.2147/prbm.s113264] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and post-injury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine and Rehabilitation
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, TX
| | - Raj G Kumar
- Department of Physical Medicine and Rehabilitation
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation
- Department of Neuroscience
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
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Kumar DS, Reisman DS, Galloway JC. Go baby go café: a case study on an immersive rehabilitation environment to improve functional outcomes and quality of life. Disabil Rehabil 2017; 40:2343-2350. [DOI: 10.1080/09638288.2017.1334235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Devina S. Kumar
- Biomechanics and Movement Science, Physical Therapy, University of Delaware, Newark, DE, USA
| | - Darcy S. Reisman
- Biomechanics and Movement Science, Physical Therapy, University of Delaware, Newark, DE, USA
| | - James C. Galloway
- Biomechanics and Movement Science, Physical Therapy, University of Delaware, Newark, DE, USA
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Ledbetter C, Moore AL, Mitchell T. Cognitive Effects of ThinkRx Cognitive Rehabilitation Training for Eleven Soldiers with Brain Injury: A Retrospective Chart Review. Front Psychol 2017; 8:825. [PMID: 28588534 PMCID: PMC5439233 DOI: 10.3389/fpsyg.2017.00825] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/05/2017] [Indexed: 11/13/2022] Open
Abstract
Cognitive rehabilitation training is a promising technique for remediating the cognitive deficits associated with brain injury. Extant research is dominated by computer-based interventions with varied results. Results from clinician-delivered cognitive rehabilitation are notably lacking in the literature. The current study examined the cognitive outcomes following ThinkRx, a clinician-delivered cognitive rehabilitation training program for soldiers recovering from traumatic brain injury and acquired brain injury. In a retrospective chart review, we examined cognitive outcomes of 11 cases who had completed an average of 80 h of ThinkRx cognitive rehabilitation training delivered by clinicians and supplemented with digital training exercises. Outcome measures included scores from six cognitive skill batteries on the Woodcock Johnson – III Tests of Cognitive Abilities. Participants achieved gains in all cognitive skills tested and achieved statistically significant changes in long-term memory, processing speed, auditory processing, and fluid reasoning with very large effect sizes. Clinically significant changes in multiple cognitive skills were also noted across cases. Results of the study suggest that ThinkRx clinician-delivered cognitive training supplemented with digital exercises may be a viable method for targeting the cognitive deficits associated with brain injury.
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Affiliation(s)
- Christina Ledbetter
- Louisiana State University Health Sciences Center, ShreveportLA, United States
| | - Amy Lawson Moore
- Gibson Institute of Cognitive Research, Colorado SpringsCO, United States
| | - Tanya Mitchell
- Research and Development, LearningRx, Colorado SpringsCO, United States
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Lavoie S, Sechrist S, Quach N, Ehsanian R, Duong T, Gotlib IH, Isaac L. Depression in Men and Women One Year Following Traumatic Brain Injury (TBI): A TBI Model Systems Study. Front Psychol 2017; 8:634. [PMID: 28529492 PMCID: PMC5418333 DOI: 10.3389/fpsyg.2017.00634] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/09/2017] [Indexed: 11/30/2022] Open
Abstract
In the general population, females experience depression at significantly higher rates than males. Individuals with traumatic brain injury (TBI) are at substantially greater risk for depression compared to the overall population. Treatment of, and recovery from, TBI can be hindered by depression; comorbid TBI and depression can lead to adverse outcomes and negatively affect multiple aspects of individuals’ lives. Gender differences in depression following TBI are not well understood, and relevant empirical findings have been mixed. Utilizing the Patient Health Questionnaire-9 (PHQ-9) 1 year after TBI, we examined whether women would experience more severe depressive symptoms, and would endorse higher levels of depression within each category of depression severity, than would men. Interestingly, and contrary to our hypothesis, men and women reported mild depression at equal rates; PHQ-9 total scores were slightly lower in women than in men. Men and women did not differ significantly in any PHQ-9 depression severity category. Item analyses, yielded significant gender differences on the following items: greater concentration difficulties (cognitive problems) in men and more sleep disturbances (psychosomatic issues) in women per uncorrected two-sample Z-test for proportions analyses; however, these results were not significant after the family-wise Bonferroni correction. Our results indicate that, in contrast to the general population, mild depression in persons with moderate to severe TBI may not be gender-specific. These findings underscore the need for early identification, active screening, and depression treatment equally for men and women to improve emotional well-being, promote recovery, and enhance quality of life following TBI.
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Affiliation(s)
- Sarah Lavoie
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA
| | - Samantha Sechrist
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA
| | - Nhung Quach
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA
| | - Reza Ehsanian
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA.,Department of Neurosurgery, Stanford University, StanfordCA, USA
| | - Thao Duong
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA.,Department of Physical Medicine and Rehabilitation, Stanford University, StanfordCA, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, StanfordCA, USA
| | - Linda Isaac
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San JoseCA, USA.,Department of Physical Medicine and Rehabilitation, Stanford University, StanfordCA, USA
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Hegde S. A review of Indian research on cognitive remediation for schizophrenia. Asian J Psychiatr 2017; 25:54-59. [PMID: 28262174 DOI: 10.1016/j.ajp.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 07/25/2016] [Accepted: 10/07/2016] [Indexed: 12/22/2022]
Abstract
Cognitive deficits play a central role in recovery from Schizophrenia (SZ). Cognitive remediation (CR) is increasingly being examined to improve cognitive functions in SZ. It is becoming an inevitable component of treatment for this debilitating illness. This review article presents the current status of research on CR for SZ in India. In contrast to the numerous studies reported from across the globe, there are only five studies on CR for SZ published from India. Of the five, only two are randomized controlled trials, two are non-randomized studies and one is a series of case reports. With different strategies used for CR and a variety of tools and measurements as outcome measures, combined analysis of the data was not feasible. Improvement in cognitive functions and sustenance of the improvement observed at follow-up period ranging from 2 to 6 months duration was underscored by all the four studies. Indigenous methods such as home-based CR techniques and Yoga therapy as an adjunct CR technique have been researched upon. Established method of CR such as the Integrated Psychological Therapy (IPT) has been used with modifications made to suit the cultural scenario. Other treatment methods such as family therapy have been added along with CR for chronic patients. The limited number of research studies has tried to encompass various dimensions. However, there is a dire need for studies with larger sample size with stringent research methods. Culturally feasible CR technique and multi-centric studies with larger sample size can be the next way forward.
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Affiliation(s)
- Shantala Hegde
- Neuropsychology Unit, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru-560029, Karnataka, India.
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Ilie G, Mann RE, Boak A, Adlaf EM, Hamilton H, Asbridge M, Rehm J, Cusimano MD. Cross-sectional examination of the association of co-occurring alcohol misuse and traumatic brain injury on mental health and conduct problems in adolescents in Ontario, Canada. BMJ Open 2016; 6:e011824. [PMID: 28186929 PMCID: PMC5129005 DOI: 10.1136/bmjopen-2016-011824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study describes the impact of traumatic brain injury (TBI) and hazardous drinking on mental health and behavioural issues among Ontario adolescents. In particular, we assessed the incremental co-occurrence of hazardous drinking with a history of TBI, in comparison to experiencing just one of these conditions. METHODS A cross-sectional subsample of 3130 Ontario adolescents attending grades 9-12, and aged 10-21 were surveyed in 2013 as a part of the Centre for Addiction and Mental Health's Ontario Student Drug Use and Health Survey. Recent (past year) and former (lifetime and excluding the last year) TBI were defined as trauma to the head that resulted in loss of consciousness for at least 5 min or overnight hospitalisation. Current hazardous drinking was derived using the Alcohol Use Disorders Identification Test (AUDIT). RESULTS An estimated 11.8% of Ontario adolescents (95% CI 10.1% to 13.8%) reported a history of former TBI and were not hazardous drinkers; 4.0% (95% CI 2.9% to 5.5%) reported recent TBI and were not hazardous drinkers; 13.7% (95% CI 12.3% to 15.3%) were hazardous drinkers who never had a TBI; 4.1% (95% CI 2.9% to 5.8%) had former TBI with co-occurring hazardous drinking; and 2.2% (95% CI 1.6% to 3.0%) had recent TBI with co-occurring hazardous drinking. Most odds increased significantly and were two to three times higher for reporting compromised mental health, violent and non-violent conduct behaviours, and reported victimisation for classifying as a hazardous drinker at the time of testing with co-occurring either former or recent TBI compared to classifying as not having either of these conditions. Adolescents classified as hazardous drinkers with former TBI had numerous and higher ORs for conduct behaviours than those with recent TBI. CONCLUSIONS Results emphasise the strong interplay between TBI and hazardous drinking and point to the need for integrating prevention efforts to reduce these conditions and their co-occurrence among adolescents.
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Affiliation(s)
- Gabriela Ilie
- Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert E Mann
- Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela Boak
- Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Edward M Adlaf
- Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hayley Hamilton
- Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jürgen Rehm
- Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery and Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada
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Wang HQ, Bao CL, Jiao ZH, Dong GR. Efficacy and safety of penetration acupuncture on head for acute intracerebral hemorrhage: A randomized controlled study. Medicine (Baltimore) 2016; 95:e5562. [PMID: 27902622 PMCID: PMC5134766 DOI: 10.1097/md.0000000000005562] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Acupuncture, especially acupuncture treatment on head for acute intracerebral hemorrhage (ICH), has long been disputable. The aim of this study was to evaluate the efficacy and safety of penetration acupuncture on head in patients with acute ICH. METHODS Eighty-two patients with acute ICH were randomized to receive penetration acupuncture treatment on head combined with conventional treatment (treatment group [TG]) or conventional treatment only (control group [CG]). Acupuncture treatments were given in 24 sessions over 4 weeks, with 3-month follow-up period. Measures included Clinical Neurological Function Deficit Scale (CNFDS), Barthel Index (BI), vital signs (respiration, heart rate, blood pressure, and oxygen saturation), and hematoma absorption ratio. RESULTS Both groups showed a progressively improvement in CNFDS and BI scores from day 7 to 90. The TG showed a significantly greater improvement in CNFDS than CG over time (P < 0.05). However, BI failed to show significant difference between the 2 groups (P > 0.05). The vital signs were stable and no expansion of hematoma occurred over the course of acupuncture treatment. CONCLUSION Penetration acupuncture treatment on head appeared to be safe over the course of treatment on acute ICH and may result in additional functional improvements detected in the CNFDS but not reflected in the BI. A larger-scale clinical trial with longer follow-up assessments is required to confirm these findings.
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Affiliation(s)
- Hai-Qiao Wang
- Department of Traditional Chinese Medicine, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University
| | - Chun-Ling Bao
- Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhi-Hua Jiao
- Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gui-Rong Dong
- Department of Acupuncture, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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39
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Hallock H, Collins D, Lampit A, Deol K, Fleming J, Valenzuela M. Cognitive Training for Post-Acute Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2016; 10:537. [PMID: 27833541 PMCID: PMC5081379 DOI: 10.3389/fnhum.2016.00537] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/11/2016] [Indexed: 12/15/2022] Open
Abstract
Objective: To quantitatively aggregate effects of cognitive training (CT) on cognitive and functional outcome measures in patients with traumatic brain injury (TBI) more than 12-months post-injury. Design: We systematically searched six databases for non-randomized and randomized controlled trials of CT in TBI patients at least 12-months post-injury reporting cognitive and/or functional outcomes. Main Measures: Efficacy was measured as standardized mean difference (Hedges’ g) of post-training change. We investigated heterogeneity across studies using subgroup analyses and meta-regressions. Results: Fourteen studies encompassing 575 patients were included. The effect of CT on overall cognition was small and statistically significant (g = 0.22, 95%CI 0.05 to 0.38; p = 0.01), with low heterogeneity (I2 = 11.71%) and no evidence of publication bias. A moderate effect size was found for overall functional outcomes (g = 0.32, 95%CI 0.08 to 0.57, p = 0.01) with low heterogeneity (I2 = 14.27%) and possible publication bias. Statistically significant effects were also found only for executive function (g = 0.20, 95%CI 0.02 to 0.39, p = 0.03) and verbal memory (g = 0.32, 95%CI 0.14 to 0.50, p < 0.01). Conclusion: Despite limited studies in this field, this meta-analysis indicates that CT is modestly effective in improving cognitive and functional outcomes in patients with post-acute TBI and should therefore play a more significant role in TBI rehabilitation.
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Affiliation(s)
- Harry Hallock
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney Sydney, NSW, Australia
| | - Daniel Collins
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney Sydney, NSW, Australia
| | - Amit Lampit
- Regenerative Neuroscience Group, Brain and Mind Centre, University of SydneySydney, NSW, Australia; School of Psychology, University of SydneySydney, NSW, Australia
| | - Kiran Deol
- Sydney Medical School, University of Sydney Sydney, NSW, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of QueenslandBrisbane, QLD, Australia; Occupational Therapy Department, Princess Alexandra HospitalBrisbane, QLD, Australia; Centre for Functioning and Health Research, Metro South Hospital and Health ServiceBrisbane, QLD, Australia
| | - Michael Valenzuela
- Regenerative Neuroscience Group, Brain and Mind Centre, University of Sydney Sydney, NSW, Australia
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40
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Hart T, Whyte J, Poulsen I, Kristensen KS, Nordenbo AM, Chervoneva I, Vaccaro MJ. How Do Intensity and Duration of Rehabilitation Services Affect Outcomes From Severe Traumatic Brain Injury? A Natural Experiment Comparing Health Care Delivery Systems in 2 Developed Nations. Arch Phys Med Rehabil 2016; 97:2045-2053. [PMID: 27497825 DOI: 10.1016/j.apmr.2016.07.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/20/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the effects of inpatient and outpatient treatment intensity on functional and emotional well-being outcomes at 1 year after severe traumatic brain injury (TBI). DESIGN Prospective, quasiexperimental study comparing outcomes in a U.S. TBI treatment center with those in a Denmark (DK) center providing significantly greater intensity and duration of rehabilitation. SETTING Inpatient and outpatient TBI rehabilitation. PARTICIPANTS Persons with severe TBI (N=274). INTERVENTIONS Inpatient rehabilitation interventions were counted daily by discipline. Outpatient treatments were estimated per discipline using a structured interview administered to patients, caregivers, or both, at 12 months. MAIN OUTCOME MEASURES FIM, Glasgow Outcome Scale-Extended, Disability Rating Scale, Participation Assessment with Recombined Tools-Objective, Perceived Quality of Life, Medical Outcomes Study 12-Item Short-Form Health Survey, Brief Symptom Inventory-18-item version. RESULTS Despite identical inclusion criteria, patient severity on admission was greater at the DK site. After adjustment for patient/injury characteristics, there were no site differences in either functional or emotional outcome at 12 months. Significantly more inpatient plus outpatient treatment was administered to DK patients than to those in the U.S. For functional but not emotional treatments, more severely impaired patients received higher doses. One-year outcomes were predicted by admission severity, age, employment, and other baseline characteristics. CONCLUSIONS Contrary to expectation, DK patients who received significantly more rehabilitation services during the year after severe TBI did not differ in outcome from their less intensively treated U.S. counterparts, after adjusting for initial severity. The negative association of functional treatment dose with extent of early disability suggests that dose was driven by unmeasured factors reflecting need for services. Improved measures of injury-related factors driving treatment allocation are needed to model the independent effects of treatment on outcomes.
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Affiliation(s)
- Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, PA; Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA.
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA; Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Ingrid Poulsen
- Clinic of Neurorehabilitation, Research Unit on Brain Injury Rehabilitation, Rigshospitalet, Copenhagen, Denmark
| | - Karin Spangsberg Kristensen
- Clinic of Neurorehabilitation, Research Unit on Brain Injury Rehabilitation, Rigshospitalet, Copenhagen, Denmark
| | - Annette M Nordenbo
- Clinic of Neurorehabilitation, Research Unit on Brain Injury Rehabilitation, Rigshospitalet, Copenhagen, Denmark
| | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA
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41
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Perrin PB, Norup A, Caracuel A, Bateman A, Tjørnlund M, Arango-Lasprilla JC. An Actor-Partner Interdependence Model of Acquired Brain Injury Patient Impairments and Caregiver Psychosocial Functioning: A Dyadic-Report, Multinational Study. J Clin Psychol 2016; 73:279-293. [PMID: 27362465 DOI: 10.1002/jclp.22324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The purpose of this study was to use actor-partner interdependence modeling (APIM) to examine the simultaneous effects of both acquired brain injury (ABI) patient and caregiver ratings of patient impairments on both patient and caregiver ratings of caregiver psychosocial dysfunction. METHOD A sample of 968 individuals with ABI and their caregivers (n = 1,936) from 4 countries completed the European Brain Injury Questionnaire, a measure of ABI impairments and caregiver psychosocial functioning in the context of providing care for the person with ABI. RESULTS An APIM with all adequate or good fit indices found that patient ratings of their own impairments in the domains of social disadaptation and depression were uniquely and positively associated with patient ratings of caregiver psychosocial dysfunction, yet none of the patient ratings of their own impairments were uniquely associated with caregiver ratings of caregiver psychosocial dysfunction. Caregiver ratings of patient impairments across all 3 domains (cognition, social disadaptation, and depression) were uniquely and positively associated with caregiver ratings of caregiver psychosocial dysfunction. Yet only caregiver ratings of patient social disadaptation were uniquely and positively associated with patient ratings of caregiver psychosocial dysfunction. CONCLUSIONS These findings suggest that caregivers' views of ABI patients' impairments are likely much more associated with caregiver psychosocial functioning than are patients' views of their own impairments, pointing to caregivers' interpretations of their patients' impairments as a primary target for cognitive behavioral interventions.
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Affiliation(s)
| | - Anne Norup
- A national study on young brain injury survivors, Department of Neurology, Rigshospitalet, Copenhagen University Hospital
| | | | - Andrew Bateman
- Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England.,Department of Psychiatry, University of Cambridge.,Oliver Zangwill Centre for Neuropsychological Rehabilitation-Cambridgeshire Community Services NHS Trust
| | - Morten Tjørnlund
- Center for Rehabilitation of Brain Injury-University of Copenhagen
| | - Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Bizkaia, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
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42
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Curran C, Dorstyn D, Polychronis C, Denson L. Functional outcomes of community-based brain injury rehabilitation clients. Brain Inj 2016; 29:25-32. [PMID: 25180709 DOI: 10.3109/02699052.2014.948067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Community-based rehabilitation can help to maximize function following acquired brain injury (ABI); however, data on treatment outcome is limited in quantity. OBJECTIVE To describe and evaluate client outcomes of an outpatient programme for adults with moderate-to-severe traumatic and non-traumatic ABI. METHODS Two phase design involving retrospective and longitudinal study of programme completers with ABI (n = 47). Changes in functioning were measured with the Mayo-Portland Inventory (MPAI-4), administered pre- and immediately post-rehabilitation and at 3 years follow-up. Self-ratings were supplemented with MPAI-4 data from significant others (n = 32) and staff (n = 32). RESULTS Injured individuals and informants reported improved physical and psychosocial functioning immediately following the completion of community rehabilitation, with medium-to-large and significant treatment gains noted on the MPAI-4 ability, adjustment and participation sub-scales (Cohen's d range = 0.31-1.10). A deterioration in individuals' adjustment was further reported at follow-up, although this was based on limited data. Issues with longer-term rehabilitation service provision were additionally noted. CONCLUSIONS The data support the need for continuity of care, including ongoing emotional support, to cater to the complex and dynamic needs of the ABI population. However, these results need to be considered in the context of a small sample size and quasi-experimental design.
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Affiliation(s)
- Christine Curran
- a School of Psychology, Faculty of Health Sciences, University of Adelaide , Adelaide , South Australia , Australia and
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43
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Zaninotto AL, Vicentini JE, Fregni F, Rodrigues PA, Botelho C, de Lucia MCS, Paiva WS. Updates and Current Perspectives of Psychiatric Assessments after Traumatic Brain Injury: A Systematic Review. Front Psychiatry 2016; 7:95. [PMID: 27378949 PMCID: PMC4906018 DOI: 10.3389/fpsyt.2016.00095] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/19/2016] [Indexed: 01/06/2023] Open
Abstract
Neuropsychological and psychiatric disorders represent a major concern and cause of disabilities after the trauma, contributing to worse recovery after traumatic brain injury (TBI). However, the lack of well-defined parameters to evaluate patient's psychiatric disorders leads to a wide range of diagnoses and symptoms. The aim of this study was to perform a review of literature in order to gather data of the most common scales and inventories used to assess and diagnose depression, anxiety, and posttraumatic stress disorder (PTSD) after TBI. We conducted a literature search via MEDLINE, PubMed, and Web of Science. We included reviews, systematic reviews, and meta-analysis studies, and we used the following keywords: "traumatic brain injury OR TBI," "depression OR depressive disorder," "anxiety," and "posttraumatic stress disorder OR PTSD." From 610 titles, a total of 68 systematic reviews or meta-analysis were included in the section "Results" of this review: depression (n = 32), anxiety (n = 9), and PTSD (n = 27). Depression after TBI is a more established condition, with more homogeneous studies. Anxiety and PTSD disorders have been studied in a heterogeneous way, usually as comorbidity with other psychiatric disorders. Some scales and inventories designed for the general community may not be appropriate for patients with TBI.
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Affiliation(s)
- Ana Luiza Zaninotto
- Laboratory of Neuromodulation, Center for Clinical Research Learning, Harvard Medical School (HMS), Charlestown, MA, USA
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
| | - Jessica Elias Vicentini
- Department of Neurology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Center for Clinical Research Learning, Harvard Medical School (HMS), Charlestown, MA, USA
| | | | - Cibele Botelho
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
| | | | - Wellingson Silva Paiva
- Department of Neurology, School of Medicine, University São Paulo (USP-SP), São Paulo, Brazil
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44
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[Outcome in traumatic brain injury : Considered from a neurological viewpoint]. Unfallchirurg 2016; 119:554-9. [PMID: 27271326 DOI: 10.1007/s00113-016-0190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND There are many studies on the prognosis and mortality for the acute care of traumatic brain injury (TBI) during the first year. Prediction of the long-term outcome after TBI is more difficult, and can be ascribed to indistinct methods and the necessity of taking into account multiple influencing factors. OBJECTIVE The main factors that determine the long-term outcome of TBI are described. MATERIALS AND METHODES A summary of the relevant literature and experience of the reintegration of TBI patients are presented. RESULTS The major factors predicting the long-term outcome of TBI are well-known. They can be measured by International Classification of Functioning, Disability and Health (ICF) of the World Health Organization and self-reported quality of life, which are important for the prognosis. Returning to work has a particularly positive effect on the quality of life. CONCLUSIONS Environmental factors are most predictive of long-term TBI outcome. The awareness of the interaction of all these factors requires a individualized long-term rehabilitation.
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45
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Bhatnagar S, Iaccarino MA, Zafonte R. Pharmacotherapy in rehabilitation of post-acute traumatic brain injury. Brain Res 2016; 1640:164-179. [DOI: 10.1016/j.brainres.2016.01.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 11/30/2022]
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46
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A Telehealth Approach to Caregiver Self-Management Following Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:180-90. [DOI: 10.1097/htr.0000000000000167] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Patterson F, Fleming J, Doig E. Group-based delivery of interventions in traumatic brain injury rehabilitation: a scoping review. Disabil Rehabil 2016; 38:1961-86. [DOI: 10.3109/09638288.2015.1111436] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Freyr Patterson
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Jennifer Fleming
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health District, Queensland Health, Brisbane, Australia
| | - Emmah Doig
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health District, Queensland Health, Brisbane, Australia
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48
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Winter L, Moriarty HJ, Robinson K, Piersol CV, Vause-Earland T, Newhart B, Iacovone DB, Hodgson N, Gitlin LN. Efficacy and acceptability of a home-based, family-inclusive intervention for veterans with TBI: A randomized controlled trial. Brain Inj 2016; 30:373-387. [PMID: 26983578 DOI: 10.3109/02699052.2016.1144080] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) often undermines community re-integration, impairs functioning and produces other symptoms. This study tested an innovative programme for veterans with TBI, the Veterans' In-home Programme (VIP), delivered in veterans' homes, involving a family member and targeting the environment (social and physical) to promote community re-integration, mitigate difficulty with the most troubling TBI symptoms and facilitate daily functioning. SETTING Interviews and intervention sessions were conducted in homes or by telephone. PARTICIPANTS Eighty-one veterans with TBI at a VA polytrauma programme and a key family member. DESIGN This was a 2-group randomized controlled trial. Control-group participants received usual-care enhanced by two attention-control telephone calls. Follow-up interviews occurred up to 4 months after baseline interview. MAIN MEASURES VIP's efficacy was evaluated using measures of community re-integration, target outcomes reflecting veterans' self-identified problems and self-rated functional competence. RESULTS At follow-up, VIP participants had significantly higher community re-integration scores and less difficulty managing targeted outcomes, compared to controls. Self-rated functional competence did not differ between groups. In addition, VIP's acceptability was high. CONCLUSION A home-based, family-inclusive service for veterans with TBI shows promise for improving meaningful outcomes and warrants further research and clinical application.
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Affiliation(s)
- Laraine Winter
- a Philadelphia Research and Education Foundation.,b Nursing Service , Department of Veterans Affairs Medical Center , Philadelphia , PA , USA
| | - Helene J Moriarty
- b Nursing Service , Department of Veterans Affairs Medical Center , Philadelphia , PA , USA.,c Villanova University College of Nursing , Villanova , PA , USA
| | - Keith Robinson
- d Medical Rehabilitation Service , Department of Veterans Affairs Medical Center , Philadelphia , PA , USA.,e Perelman School of Medicine , University of Pennsylvania , PA , USA
| | - Catherine V Piersol
- f Thomas Jefferson University , School of Health Professions , Philadelphia , PA , USA
| | - Tracey Vause-Earland
- f Thomas Jefferson University , School of Health Professions , Philadelphia , PA , USA
| | - Brian Newhart
- d Medical Rehabilitation Service , Department of Veterans Affairs Medical Center , Philadelphia , PA , USA
| | - Delores Blazer Iacovone
- d Medical Rehabilitation Service , Department of Veterans Affairs Medical Center , Philadelphia , PA , USA
| | - Nancy Hodgson
- g The Center for Innovative Care in Aging, School of Nursing , Johns Hopkins University , Baltimore , MD , USA
| | - Laura N Gitlin
- g The Center for Innovative Care in Aging, School of Nursing , Johns Hopkins University , Baltimore , MD , USA
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49
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Weil ZM, Corrigan JD, Karelina K. Alcohol abuse after traumatic brain injury: Experimental and clinical evidence. Neurosci Biobehav Rev 2016; 62:89-99. [DOI: 10.1016/j.neubiorev.2016.01.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/16/2015] [Accepted: 01/21/2016] [Indexed: 01/06/2023]
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50
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Lau KM, Madden E, Neylan TC, Seal KH, Maguen S. Assessing for mild TBI among Iraq and Afghanistan veterans: Outcomes of injury severity and neurological factors. Brain Inj 2016; 30:287-94. [PMID: 26910483 DOI: 10.3109/02699052.2015.1089601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate injury severity markers and neurological symptoms associated with clinician-confirmed mild traumatic brain injury (TBI) among Iraq and Afghanistan veterans. SETTING Department of Veterans Affairs (VA) medical centre and five affiliated community-based outpatient clinics. PARTICIPANTS Three hundred and fifty Iraq and Afghanistan veterans with positive initial VA TBI screens between 1 April 2007 and 1 June 2010 and clinician-confirmed TBI status by 1 December 2010. METHODS Retrospective-cohort study of medical record data. Main measures included clinician-confirmed TBI status, injury severity markers (e.g. loss of consciousness (LOC), post-traumatic amnesia (PTA) or confusion/disorientation) and neurological symptoms. RESULTS Among veterans who screened positive on the initial VA TBI and then received a clinician evaluation, 60% were confirmed to have a TBI diagnosis. Veterans reporting at least one LOC, confusion or PTA were almost 18-times more likely to receive a confirmed TBI diagnosis. Odds of clinician-confirmed TBI were 2.5-3-times greater among those who endorsed dizziness, poor coordination, headaches, nausea, vision problems and/or irritability, compared to those not endorsing these symptoms. Nausea had greatest utility for confirming a TBI. CONCLUSIONS Identification of neurologic symptoms that most contribute to a clinician-confirmed diagnosis of TBI has potential for streamlining detection of TBI and symptoms needed for treatment.
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Affiliation(s)
- Karen M Lau
- a San Francisco VA Medical Center , San Francisco , CA , USA
| | - Erin Madden
- a San Francisco VA Medical Center , San Francisco , CA , USA
| | - Thomas C Neylan
- a San Francisco VA Medical Center , San Francisco , CA , USA.,b Department of Psychiatry
| | - Karen H Seal
- a San Francisco VA Medical Center , San Francisco , CA , USA.,b Department of Psychiatry.,c Department of Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Shira Maguen
- a San Francisco VA Medical Center , San Francisco , CA , USA.,b Department of Psychiatry
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