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Sansonetti D, Fleming J, Patterson F, De Lacy L, Lannin NA. Factors associated with self-awareness impairment in an inpatient brain injury rehabilitation cohort. Brain Inj 2024; 38:699-707. [PMID: 38634476 DOI: 10.1080/02699052.2024.2344096] [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: 01/29/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Self-awareness impairment is common following acquired brain injury and can impact rehabilitation outcomes. Knowledge of factors associated with impaired self-awareness may assist with rehabilitation planning. OBJECTIVES To identify factors associated with self-awareness and determine predictors of self-awareness impairment for adults with traumatic brain injury (TBI) and stroke. DESIGN AND METHODS A retrospective cohort study of rehabilitation inpatients was conducted by medical record audit. Self-awareness was measured using the Self-awareness of Deficits Interview (SADI). Relationships between SADI scores and demographic and clinical variables were identified with non-parametric statistics. Predictors of SADI scores were identified using ordinal regression analyses for TBI and stroke groups. RESULTS Participants were 149 adults (18-70 years) with TBI (n = 110) and stroke (n = 39). For TBI, longer post-traumatic amnesia (PTA), lower functional cognition/communication, and behaviors of concern (BoC) were significantly associated with higher SADI scores (i.e. impaired self-awareness). For stroke, lower functional cognition/communication and motor scores were associated with higher SADI scores. Impaired self-awareness was predicted by PTA duration, acute length of stay and presence of BoC for the TBI group, and by functional cognition/communication for the stroke group. CONCLUSION Different factors were associated with impaired self-awareness for individuals with TBI and stroke during inpatient rehabilitation.
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Affiliation(s)
- Danielle Sansonetti
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Freyr Patterson
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Laura De Lacy
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia
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Troeung L, Mann G, Martini A. Patterns and predictors of ten-year mortality after discharge from community-based post-acute care for acquired brain injury: A retrospective cohort study (ABI-RESTaRT), Western Australia, 1991-2017. Disabil Health J 2024; 17:101591. [PMID: 38429203 DOI: 10.1016/j.dhjo.2024.101591] [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: 03/29/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Survivors of acquired brain injury (ABI) are left with long-term disability and an increased risk of mortality years post-injury. OBJECTIVE To examine 10-year mortality in adults with ABI after discharge from post-acute care and identify modifiable risk factors to reduce long-term mortality risk. METHODS Retrospective cohort study of 586 adults with traumatic (TBI) or non-traumatic brain injury (NTBI), or neurologic condition, consecutively discharged from a post-acute rehabilitation service in Western Australia from 1-Mar-1991 to 31-Dec-2017. Data sources included rehabilitation records, and linked mortality, hospital, and emergency department data. Survival status at 10 years post-discharge was determined. All-cause and cause-specific age- and sex-adjusted standardised mortality ratios (SMR) by ABI diagnosis were calculated using Australian population reference data. Risk factors were examined using multilevel cox proportional hazards regression. RESULTS Compared with the Australian population, 10-year all-cause mortality was significantly elevated for all diagnosis cohorts, with the first 12 months the highest risk period. Accidents or intentional self-harm deaths were elevated in TBI (13.2, 95%CI 5.4; 12.1). Neurodegenerative disease deaths were elevated in Neurologic (21.9, 95%CI 13.0; 30.9) and Stroke (19.8; 95%CI 2.4; 27.2) cohorts. Stroke (20.8; 95%CI 7.9; 33.8) and circulatory disease deaths (6.2; 95%CI 2.3; 9.9) were also elevated in Stroke. Psychiatric comorbidity was the strongest risk factor followed by older age, geographical remoteness, and cardiac, vascular, genitourinary and renal comorbidity. Clinically significant improvement in functional independence and psychosocial functioning significantly reduced mortality risk. CONCLUSIONS Individuals with ABI have an elevated risk of mortality years post-injury. Comorbidity management, continuity of care, and rehabilitation are important to reduce long-term mortality risk.
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Affiliation(s)
- Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia.
| | - Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia; School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
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Mccarthy A, Robinson K, Dockery F, McLoughlin K, O'Connor M, Milos A, Corey G, Carey L, Steed F, Haaksma M, Whiston A, Tierney A, Galvin R. Long-term outcomes of older adults with acute COVID-19 following inpatient geriatric rehabilitation: a prospective cohort study from the Republic of Ireland. Ir J Med Sci 2024:10.1007/s11845-024-03723-4. [PMID: 38856964 DOI: 10.1007/s11845-024-03723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/19/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND There is a paucity of research reporting the long-term outcomes of older adults who have completed geriatric rehabilitation following COVID-19. AIM The primary aim of this study is to describe the long-term functional outcomes of a cohort of older adults with acute COVID-19 who have completed inpatient geriatric rehabilitation. METHODS This is a subgroup analysis of Irish data from a pan-European prospective cohort study. Functional ability, patient reported symptoms, and quality of life were measured using the Barthel index, the COVID-19 Yorkshire Rehabilitation Screen, and the EQ-5D-5L, respectively. RESULTS Thirty patients enrolled in the study. The rate of mortality was 23.3% at 6 months after discharge from rehabilitation. Patients achieved a return to pre-admission functional ability but reported a significant increase in patient reported symptoms and their quality of life did not return to pre-admission levels when assessed at 6 months after discharge from rehabilitation. CONCLUSIONS Multidisciplinary rehabilitation for older adults with acute COVID-19 infection can assist patients to return to their premorbid functional ability. On discharge from rehabilitation, ongoing follow-up of older adults is recommended to assist them to negotiate and manage ongoing symptomatology such as breathlessness or fatigue.
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Affiliation(s)
- Aoife Mccarthy
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute and Ageing Research Centre, University of Limerick, Limerick, Ireland.
- UL Hospitals Group, University Hospital Limerick, Limerick, Ireland.
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute and Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Frances Dockery
- Department of Geriatric and Stroke Medicine, and Integrated Care Team for Older People North Dublin, Beaumont Hospital, Dublin, Ireland
| | - Kara McLoughlin
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute and Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Antonella Milos
- UL Hospitals Group, University Hospital Limerick, Limerick, Ireland
| | - Gillian Corey
- UL Hospitals Group, University Hospital Limerick, Limerick, Ireland
| | - Leonora Carey
- UL Hospitals Group, University Hospital Limerick, Limerick, Ireland
| | - Fiona Steed
- Department of Health, Baggot Street, Dublin, Ireland
| | - Miriam Haaksma
- Coordinator EU-COGER Study, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- University Network for the Care Sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - Aoife Whiston
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute and Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Audrey Tierney
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute and Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute and Ageing Research Centre, University of Limerick, Limerick, Ireland
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Troeung L, Sarunga Raja TL, Mann G, Wagland J, MacLeod C, Martini A. IMproving psYchosocial adjustment to Traumatic Brain Injury from acute to chronic injury through development and evaluation of the myTBI online psychoeducation platform: protocol for a mixed-methods study. BMJ Open 2024; 14:e080030. [PMID: 38508623 PMCID: PMC10953309 DOI: 10.1136/bmjopen-2023-080030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION This protocol describes the myTBI study which aims to: (1) develop an online psychoeducation platform for people with traumatic brain injury (TBI), their family members/caregivers, and healthcare staff to improve psychosocial adjustment to TBI across different phases of injury (acute, postacute, and chronic), and (2) undertake an evaluation of efficacy, acceptability, and feasibility. METHODS AND ANALYSIS A three-stage mixed-methods research design will be used. The study will be undertaken across four postacute community-based neurorehabilitation and disability support services in Western Australia. Stage 1 (interviews and surveys) will use consumer-driven qualitative methodology to: (1) understand the recovery experiences and psychosocial challenges of people with TBI over key stages (acute, postacute, and chronic), and (2) identify required areas of psychosocial support to inform the psychoeducation platform development. Stage 2 (development) will use a Delphi expert consensus method to: (1) determine the final psychoeducation modules, and (2) perform acceptance testing of the myTBI platform. Finally, stage 3 (evaluation) will be a randomised stepped-wedge trial to evaluate efficacy, acceptability, and feasibility. Outcomes will be measured at baseline, postintervention, follow-up, and at final discharge from services. Change in outcomes will be analysed using multilevel mixed-effects modelling. Follow-up surveys will be conducted to evaluate acceptability and feasibility. ETHICS AND DISSEMINATION Ethics approval was granted by North Metropolitan Health Service Mental Health Research Ethics and Governance Office (RGS0000005877). Study findings will be relevant to clinicians, researchers, and organisations who are seeking a cost-effective solution to deliver ongoing psychoeducation and support to individuals with TBI across the recovery journey. TRIAL REGISTRATION NUMBER ACTRN12623000990628.
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Affiliation(s)
- Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
| | - Thilaga L Sarunga Raja
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
- Oats Street Rehabilitation Centre, Brightwater Care Group, East Victoria Park, Western Australia, Australia
| | - Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Janet Wagland
- Disability Services, Brightwater Care Group, Inglewood, Western Australia, Australia
| | - Colin MacLeod
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
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Ward J, Foley G, Horgan F. Occupational therapists' assessment and reporting of functional cognition in stroke care. Disabil Rehabil 2024:1-10. [PMID: 38299538 DOI: 10.1080/09638288.2024.2310760] [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: 06/06/2023] [Accepted: 01/20/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE To investigate how functional cognition of people post-stroke is evaluated and reported by occupational therapists in Ireland. Functional cognition refers to the use and integration of cognitive skills for daily function. METHODS This study used a qualitative design. Six focus groups and one individual interview were conducted with 20 occupational therapists purposively sampled for variation across different clinical grades. Data were analysed according to the Braun and Clark thematic analysis framework. RESULTS Participants felt that assessment of functional cognition was an integral feature of occupational therapy assessment in stroke care but acknowledged that terminology used by occupational therapists for functional cognition was inconsistent. Non-standardised observational assessment was routinely used by participants. Challenges were reported with respect to written documentation of non-standardised observations. Participants reported that use of standardised cognitive assessments required considered clinical reasoning before administration. Standardised performance-based assessments were not widely implemented by participants. CONCLUSION Occupational therapists in Ireland reported a multi-component assessment process to evaluate functional cognition post-stroke. Establishing practice guidelines for the assessment of functional cognition may be of benefit to occupational therapists working in stroke care. Further research is needed to quantify procedures in this assessment process to account for variation in practice.
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Affiliation(s)
- Jana Ward
- Occupational Therapy Department, Galway University Hospital, Galway, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Ireland
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Mann G, Troeung L, Martini A. Sex/gender differences in service use patterns, clinical outcomes and mortality risk for adults with acquired brain injury: a retrospective cohort study (ABI-RESTART). J Rehabil Med 2023; 55:jrm5303. [PMID: 37698453 PMCID: PMC10506514 DOI: 10.2340/jrm.v55.5303] [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: 12/19/2022] [Accepted: 07/11/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE To identify sex/gender differences in functional, psychosocial and service use patterns in community-based post-acute care for acquired brain injury. Design: Retrospective cohort study. SUBJECTS/PATIENTS Adults with acquired brain injury enrolled in post-acute neurorehabilitation and disability support in Western Australia (n = 1,011). METHODS UK Functional Independence Measure and Functional Assessment Measure (FIM + FAM), Mayo-Portland Adaptability Inventory-4, goal attainment, length of stay (LOS), number of episodes of care and deaths were evaluated using routinely collected clinical and linked administrative data. RESULTS At admission, women were older (p < 0.001) and displayed poorer functional independence (FIM + FAM; p < 0.05) compared with men. At discharge, there were no differences in goal attainment, psychosocial function or functional independence between men and women. Both groups demonstrated functional gains; however, women demonstrated clinically significant gains (+ 15.1, p < 0.001) and men did not (+ 13.7, p < 0.001). Women and men had equivalent LOS (p = 0.205). Aboriginal and/or Torres Strait Islander status predicted longer LOS for women but not for men. Being partnered predicted reduced LOS for women but not men. Women had a higher risk of multiple episodes of care (p < 0.001), but not death (p = 0.409), compared with that of men. CONCLUSION At admission to rehabilitation and disability support services for acquired brain injury, women have poorer functional independence and higher risk of multiple episodes of care, compared with men, suggesting greater disability in the community. By the time of discharge from these services, women and men make equivalent functional and psychosocial gains. The higher risk of multiple episodes of care for women relative to men suggest women may need additional post-discharge support, to avoid readmission.
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Affiliation(s)
- Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Australia.
| | - Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Australia.
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, Australia.
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Siegert RJ, Narayanan A, Turner-Stokes L. Prediction of emergence from prolonged disorders of consciousness from measures within the UK rehabilitation outcomes collaborative database: a multicentre analysis using machine learning. Disabil Rehabil 2023; 45:2906-2914. [PMID: 36031885 PMCID: PMC9612927 DOI: 10.1080/09638288.2022.2114017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Predicting emergence from prolonged disorders of consciousness (PDOC) is important for planning care and treatment. We used machine learning to examine which variables from routine clinical data on admission to specialist rehabilitation units best predict emergence by discharge. MATERIALS AND METHODS A multicentre national cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes (UKROC) database 2010-2018. Patients (n = 1170) were operationally defined as "still in PDOC" or "emerged" by their total UK Functional Assessment Measure (FIM + FAM) discharge score. Variables included: Age, aetiology, length of stay, time since onset, and all items of the Neurological Impairment Scale, Rehabilitation Complexity Scale, Northwick Park Dependency Scale, and the Patient Categorisation Tool. After filtering, prediction of emergence was explored using four techniques: binary logistic regression, linear discriminant analysis, artificial neural networks, and rule induction. RESULTS Triangulation through these techniques consistently identified characteristics associated with emergence from PDOC. More severe motor impairment, complex disability, medical and behavioural instability, and anoxic aetiology were predictive of non-emergence, whereas those with less severe motor impairment, agitated behaviour and complex disability were predictive of emergence. CONCLUSIONS This initial exploration demonstrates the potential opportunities to enhance prediction of outcome using machine learning techniques to explore routinely collected clinical data. Implications for rehabilitationPredicting emergence from prolonged disorders of consciousness is important for planning care and treatment.Few evidence-based criteria exist for aiding clinical decision-making and existing criteria are mostly based upon acute admission data.Whilst acknowledging the limitations of using proxy data for diagnosis of emergence, this study suggests that key items from the UKROC dataset, routinely collected on admission to specialist rehabilitation some months post injury, may help to predict those patients who are more (or less) likely to regain consciousness.Machine learning can help to enhance our understanding of the best predictors of outcome and thus assist with clinical decision-making in PDOC.
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Affiliation(s)
- Richard J. Siegert
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Ajit Narayanan
- School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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Colomer C, Llorens R, Sánchez C, Ugart P, Moliner B, Navarro MD, Noé E, Ferri J. Reliability and validity of the Spanish adaptation of the Functional Independence Measure + Functional Assessment Measure. Eur J Phys Rehabil Med 2023; 59:452-457. [PMID: 37226445 PMCID: PMC10548398 DOI: 10.23736/s1973-9087.23.07841-3] [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: 12/22/2022] [Revised: 04/05/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The Functional Independence Measure + Functional Assessment Measure (FIM+FAM) Scale is one of the most widely used instruments to measure functional independence post-stroke, and features many cultural adaptations to various languages. AIM The aim of this study was to determine the psychometric properties of a Spanish cross-cultural adaptation of the FIM+FAM for use in the stroke population. DESIGN Observational study. SETTING Outpatient long-term service of a neurorehabilitation unit. POPULATION One hundred and twenty-two individuals with stroke. METHODS The functional independence of the participants was assessed with the adapted version of the FIM+FAM. Additionally, the functional, motor and cognitive condition of the participants was assessed with a battery of standardized clinical instruments. Finally, a group of 31 participants out of the total were evaluated a second time with the FIM+FAM by a different evaluator than the one who performed the first evaluation. Internal consistency, inter-rater reliability and convergent validity with other clinical instruments of the adapted version of the FIM+FAM were determined. RESULTS The internal consistency of the adapted version of the FIM+FAM was excellent, as evidenced by Cronbach's α values that exceeded 0.973. The inter-rater reliability was likewise excellent, with correlations above 0.990 in all domains and subscales. Additionally, the convergent validity of the scale adaptation with clinical instruments was variable, with values ranging from 0.264 to 0.983, but consistent with the construct assessed in the different instruments examined. CONCLUSIONS The internal consistency, inter-rater reliability and convergent validity of the Spanish-adapted version of the FIM+FAM Scale showed excellent reliability and validity of the adaptation, which supports its use to assess functional independence after stroke. CLINICAL REHABILITATION IMPACT Availability of a valid adaptation for the evaluation of functional independence after stroke in Spanish population.
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Affiliation(s)
- Carolina Colomer
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain -
| | - Roberto Llorens
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
- Neurorehabilitation and Brain Research Group, Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, Universitat Politècnica de València, Valencia, Spain
| | - Clara Sánchez
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - Patricia Ugart
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - Belén Moliner
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - María D Navarro
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - Enrique Noé
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
| | - Joan Ferri
- Instituto de Rehabilitación Neurológica (IRENEA), Fundación Vithas, Valencia, Spain
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Jackson H, Mann G, Martini A, Troeung L, Beros K, Prinsloo A. Change in care hours, cost, and functional independence following continence and assistive technology intervention in an acquired brain injury population. Disabil Rehabil 2023; 45:1208-1219. [PMID: 35442857 DOI: 10.1080/09638288.2022.2055169] [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: 11/03/2022]
Abstract
PURPOSE After acquired brain injury (ABI) dependence on intervention for continence management is common. This preliminary investigation aimed to (i) quantify toileting care hours and costs in a community-based ABI rehabilitation and disability setting, and (ii) measure change in care needs, costs, and functional independence after intervention with assistive technologies (ATs). METHOD Pragmatic pre-post intervention pilot study of 14 adults with ABI and toileting disability accessing community-based neurorehabilitation or disability support in Western Australia. Toileting and functional independence were assessed monthly from baseline (T0) to 3-month follow-up (T3). Basic and nursing care hours (Northwick Park Dependency Score), cost of care estimates (Northwick Park Care Needs Assessment), functional independence (Functional Independence and Assessment Measure), and cost of consumables were examined pre- and post-intervention with ATs. Multilevel mixed-effects models with bootstrap estimation were conducted. RESULTS Cost of consumables significantly declined (AU$69/week), and functional independence significantly improved following intervention (+23.5 points). There was a non-significant reduction in care needs for toileting (4 h/week) and in the cost of toileting care (AU$633/week). CONCLUSION Toileting disability substantially impacts care hours and costs. This study provides preliminary evidence that comprehensive continence management is beneficial in reducing costs and supporting people with an ABI to increase their independence.IMPLICATIONS FOR REHABILITATIONA comprehensive continence assessment and management plan reduces the number of care hours, cost of care, and cost of continence products in a neurorehabilitation and disability support sample for people with acquired brain injury (ABI).Assistive technologies for continence management are beneficial in supporting people with ABI to increase independence, and reduce costs.Providing comprehensive continence assessment and management plan reduces reliance on staff for continence care, and improves functional independence.
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Affiliation(s)
- Hayley Jackson
- Brightwater Care Group, Brightwater Research Centre, Perth, Australia
| | - Georgina Mann
- Brightwater Care Group, Brightwater Research Centre, Perth, Australia
| | - Angelita Martini
- Brightwater Care Group, Brightwater Research Centre, Perth, Australia
| | - Lakkhina Troeung
- Brightwater Care Group, Brightwater Research Centre, Perth, Australia
| | - Katie Beros
- Brightwater Care Group, Brightwater Research Centre, Perth, Australia
| | - Annelize Prinsloo
- Brightwater Care Group, Brightwater Research Centre, Perth, Australia
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Ashford S, Elsmore C, Steed A, Diggins A, Walden-Smith A, Williams H. Ankle contracture in people with acquired brain injury (ABI), intervention, and outcome following inpatient neurorehabilitation categorized by severity. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2023. [DOI: 10.1097/ph9.0000000000000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Psychosocial functioning mediates change in motor and cognitive function throughout neurorehabilitation for adults with acquired brain injury (ABI-RESTaRT). Neurol Sci 2023:10.1007/s10072-023-06645-8. [PMID: 36780031 DOI: 10.1007/s10072-023-06645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/24/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the mediational role of change in psychosocial abilities, adjustment and participation on change in motor and cognitive function from admission to discharge from a staged community-based brain injury rehabilitation (SCBIR) service in Western Australia, 2011-2020. METHODS A retrospective cohort study of n = 324 adults with ABI enrolled in SCBIR using routinely collected rehabilitation outcome measures data. Motor and cognitive function were assessed with the UK Functional Independence and Assessment Measure and psychosocial function with the Mayo-Portland Adaptability Inventory-4. Six multilevel mediation regression analyses were conducted to determine whether change in psychosocial function (abilities, adjustment and participation) mediated change in motor and cognitive function from admission to discharge. RESULTS Participants demonstrated clinically significant improvements in both motor (+ 11.8, p < 0.001) and cognitive (+ 9.5, p < 0.001) functioning from admission to discharge. Statistically significant improvements in psychosocial abilities (- 4.8, p < 0.001), adjustment (- 2.9, p = 0.001) and participation (- 2.5, p < 0.001) were also seen but were not clinically significant. Mediation analyses showed that participation accounted for 81% of improvements in motor function at discharge and 71% of cognitive function improvements. Adjustment accounted for 26% and 32% of change in motor and cognitive function, respectively. Abilities accounted for 60% of change in cognitive function but did not significantly influence change in motor function. Changes in psychosocial participation fully mediated change in motor function during neurorehabilitation. CONCLUSIONS Psychosocial function, particularly participation, is an important driver of motor and cognitive recovery throughout neurorehabilitation. Functional rehabilitation programs should target psychosocial improvement as an important mechanism of change.
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Turner-Stokes L, Rose H, Knight A, Williams H, Siegert RJ, Ashford SA. Prolonged disorders of consciousness: identification using the UK FIM + FAM and cohort analysis of outcomes from a UK national clinical database. Disabil Rehabil 2023; 45:620-629. [PMID: 35166637 DOI: 10.1080/09638288.2022.2037754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE 1: To determine whether Total UK FIM + FAM scores can identify patients in VS/MCS. 2: Using the identified cut-off points, to examine outcomes from specialist rehabilitation. METHODS Part 1: Retrospective analysis of a consecutive clinical cohort (n = 388) presenting to a single specialist PDOC evaluation programme 2007-2021. FIM + FAM scores were analysed by PDOC diagnosis to define cut-off points for vegetative (VS) and minimally conscious states (MCS). Part 2: Multicentre cohort analysis of prospectively-collected clinical outcomes data from the UK Rehabilitation Outcomes Collaborative database of adults in PDOC registered 2011-2020 (n = 2384 in 68 centres). RESULTS Cut-off points of ≤31 and 32-35 in FIM + FAM total scores respectively identified patients in VS/MCS-Minus and MCS-Plus. Approximately 365 PDOC patients are admitted to specialist rehabilitation units in England each year. By discharge, 43% have emerged into consciousness and demonstrate a wide range of disability. A few reached full independence, but the majority remained severely dependent. Nevertheless, those who emerged generated mean net life-time savings of over £436,000 (£400 million for this cohort). CONCLUSION In absence of a dedicated PDOC registry, FIM + FAM scores can identify patients in VS/MCS at population level. Identifying those who emerge and providing timely rehabilitation generates cost-savings well-exceeding the cost of the evaluation/rehabilitation programme.Implications for rehabilitationThe UK National Health Service currently collects no systematic data to identify patients in PDOC, so we have no accurate information on how many patients there are, where they are managed or what their outcomes are.In the absence of more direct data, total FIM + FAM scores of < =31 and 32-35 respectively can be used to identify patients in vegetative and minimally conscious states.Of the 365 or so patients admitted to specialist rehabilitation units per year, 43% emerge into consciousness leaving about 150 patients per year in PDOC states that are likely to be permanent.Identifying those who emerge and providing timely rehabilitation generates cost-savings that pay for the entire PDOC evaluation/rehabilitation programme many times over.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Nursing Midwifery and Palliative care, King's College London, London, UK.,Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Hilary Rose
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Alison Knight
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Heather Williams
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK
| | - Richard J Siegert
- Department of Psychology and Neuroscience, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Stephen A Ashford
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Nursing Midwifery and Palliative care, King's College London, London, UK.,Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK
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13
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Troeung L, Mann G, Wagland J, Martini A. Effects of comorbidity on post-acute outcomes in acquired brain injury: ABI-RESTaRT 1991-2020. Ann Phys Rehabil Med 2022; 66:101669. [PMID: 35483646 DOI: 10.1016/j.rehab.2022.101669] [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: 11/28/2021] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Current understanding of comorbidities associated with acquired brain injury (ABI) and the effects on post-acute ABI outcomes is poor. OBJECTIVE To describe the prevalence, severity and patterns of comorbidity for the pre-injury, acute and post-acute phases, and to examine the effects of post-acute comorbidities on functional independence and length of stay (LOS) at discharge from post-acute care. METHODS Retrospective whole-population cohort study of n = 1,011 individuals with traumatic (TBI) or non-traumatic brain injury (NTBI), or eligible neurologic conditions admitted to a post-acute neurorehabilitation and disability support service in Western Australia (WA) between 1991 and 2020. Comorbidities were ascertained from internal electronic medical records and linked hospital and emergency department data from the WA Data Linkage System. We measured comorbidities across 14 body systems using the Cumulative Illness Rating Scale (CIRS) and Elixhauser Comorbidity Index (ECI), and functional independence with the UK Functional Independence Measure and Functional Assessment Measure (UK FIM+FAM). We used multilevel mixed-effect regression models to determine the effects of comorbidity on post-acute outcomes. RESULTS NTBI was the most common diagnosis (54%), followed by TBI (34%) and neurologic conditions (10%). Pre-injury comorbidities were present in over half the cohort. Comorbidity prevalence increased significantly from 57% to 84% (∆+27%) and severity (mean ECI score) increased significantly from 2.1 to 13.8 (∆+11.7) between pre-injury and the acute phase and remained elevated at admission to post-acute services (82%, mean ECI score 7.3). Psychiatric comorbidity was the most prevalent (56%) and was associated with significantly poorer functional outcomes at discharge and an increase in LOS of 6.5 months. Genitourinary, musculoskeletal, eye, ear nose and throat, and renal comorbidities also had significant effects on post-acute outcomes. CONCLUSIONS ABI has a long-term impact on multiple body systems. Identification and management of comorbidities is critical to maximize functional outcomes and reduce the cost of post-acute care.
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Affiliation(s)
- Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, 355 Scarborough Beach Rd, Osborne Park, WA 6017, Australia.
| | - Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, 355 Scarborough Beach Rd, Osborne Park, WA 6017, Australia
| | - Janet Wagland
- Disability Services, Brightwater Care Group, Osborne Park, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, 355 Scarborough Beach Rd, Osborne Park, WA 6017, Australia; The University of Western Australia, Crawley, WA, Australia
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14
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Seneviratne H, Mann G, Troeung L, Martini A. The association between functional independence and quality of life for individuals with acquired brain injury undergoing community-based rehabilitation and disability support. NeuroRehabilitation 2022; 51:291-302. [DOI: 10.3233/nre-220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Following acquired brain injury (ABI), cognitive and physical barriers can prevent access to a previously enjoyed lifestyle, reducing quality of life. OBJECTIVE: This study aimed to examine predictors of health-related quality of life (HRQoL) in adults with ABI receiving post-acute community-based rehabilitation and disability support services, using tools developed for this population. METHODS: Retrospective cross-sectional design. Main outcome measures were the Quality of Life after Brain Injury Inventory (QOLIBRI) and Functional Independence and Assessment Measure (FIM + FAM) for adults with ABI (n = 67) undergoing post-acute rehabilitation in Western Australia, 2015–2021. RESULTS: Mean QOLIBRI total score (±standard deviation) was 57.2±17.4, indicating impaired HRQoL, with mood disorders likely prevalent. Regression analysis demonstrated no differences in HRQoL between different age groups, sexes or brain injury types. Shorter time since injury and lower total FIM + FAM score significantly predicted poorer HRQoL in the model. CONCLUSION: This population appears vulnerable to psychological illness, although HRQoL is addressed for a minority of clients during routine post-acute care (19%). As improvement in quality of life is a fundamental goal of rehabilitation post-ABI, understanding the relationship between potentially modifiable factors such as functional independence and HRQoL is critical to improve outcomes and provide the best chance at a satisfying life.
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Affiliation(s)
- Harshana Seneviratne
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, WA, Australia
- The University of Western Australia, Crawley, WA, Australia
| | - Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, WA, Australia
| | - Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, WA, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, WA, Australia
- The University of Western Australia, Crawley, WA, Australia
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15
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Troeung L, Mann G, Cullinan L, Wagland J, Martini A. Rehabilitation outcomes at discharge from staged community-based brain injury rehabilitation: A retrospective cohort study (ABI-RESTaRT), Western Australia, 2011–2020. Front Neurol 2022; 13:925225. [PMID: 36212668 PMCID: PMC9534320 DOI: 10.3389/fneur.2022.925225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate change in functional independence, psychosocial functioning, and goal attainment at discharge from a slow-stream Staged Community-Based Brain Injury Rehabilitation (SCBIR) service in Western Australia, 2011–2020. Methods Retrospective cohort study of n = 323 adults with acquired brain injury (ABI) enrolled in a post-acute SCBIR service compared against a control cohort of n = 312 with ABI admitted to three non-rehabilitation programs. Outcome measures were the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM), Mayo Portland Adaptability Inventory-4 (MPAI-4), and Goal Attainment Scale. Change in FIM+FAM and MPAI-4 scores and predictors of goal attainment at discharge were evaluated using multilevel mixed-effects regression. Results Median SCBIR length of stay was 20.5 months. Rehabilitation clients demonstrated clinically significant functional gains at discharge, adjusted mean change = +20.3, p < 0.001 (FIM+FAM). Peak gains of +32.3 were observed after 24–30 months and clinically significant gains were observed 5 years post-admission. Individuals discharged ≤6 months had the smallest functional gains (+12.7). Small psychosocial improvements were evidenced at discharge, mean reduction = −2.9T, p < 0.001 (MPAI-4) but not clinically significant. 47% of rehabilitation clients achieved their goals at the expected level or higher at discharge. Compared to the control, rehabilitation clients evidenced significantly greater functional gains and psychosocial improvement but lower goal attainment. Significant predictors of goal attainment at discharge were >2 years since injury, higher cognitive function and higher emotional adjustment at admission. Conclusions Functional recovery after ABI is a gradual and ongoing process. SCBIR is effective for functional rehabilitation post-injury but can be improved to achieve clinically meaningful psychosocial improvement.
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Affiliation(s)
- Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
- *Correspondence: Lakkhina Troeung
| | - Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
| | - Lily Cullinan
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Janet Wagland
- Disability Services, Brightwater Care Group, Inglewood, WA, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Inglewood, WA, Australia
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16
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Howard MM, Block ES, Mishreki D, Kim T, Rosario ER. The Effect of Sensory Level Versus Motor Level Electrical Stimulation of Pharyngeal Muscles in Acute Stroke Patients with Dysphagia: A Randomized Trial. Dysphagia 2022; 38:943-953. [PMID: 36127447 PMCID: PMC9488887 DOI: 10.1007/s00455-022-10520-7] [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: 01/18/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022]
Abstract
Dysphagia is a serious cause of morbidity and mortality in stroke survivors. Electrical stimulation is often included as part of the treatment plan for dysphagia and can be applied at a sensory or motor level intensity. However, evidence to support these different modes of stimulation is lacking. This study compared the effectiveness of sensory and motor level stimulation on post-stroke dysphagia. This is a randomized trial conducted in an inpatient rehabilitation facility. Thirty-one participants who had dysphagia caused by stroke within 6 months prior to enrolment were included. Participants were excluded if they had a contraindication for electrical stimulation, previous stroke, psychiatric disorder, contraindications for modified barium swallow study (MBSS), or pre-morbid dysphagia. Each patient received ten sessions that included 45 min of anterior neck sensory or motor level electrical stimulation in addition to traditional dysphagia therapy. Motor stimulation was administered at an intensity sufficient to produce muscle contractions. Sensory stimulation was defined as the threshold at which the patient feels a tingling sensation on their skin. Swallow functional assessment measure (FAM), dysphagia outcome severity scale (DOSS), national outcome measurement system (NOMS), penetration aspiration scale (PAS), diet change, and the swallowing quality of life questionnaire (SWAL-QOL). Clinical outcomes were analyzed using a Wilcoxon signed-rank test, Mann–Whitney U test, RM ANOVA, or chi-square analysis. There was no significant difference in age, length of stay, or initial swallow FAM between groups. Patients in the sensory group showed significant improvement on swallow FAM, DOSS, and NOMS, while those in the motor group did not (Sensory: Swallow FAM (S = 48, p = 0.01), DOSS (S = 49.5, p = 0.001), NOMS (S = 52.5, p = 0.006); Motor: Swallow FAM (S = 20.5, p = 0.2), DOSS (S = 21, p = 0.05), NOMS (S = 29.5, p = 0.2)). When the groups were combined, there was statistically significant improvement on all measures except the PAS (Swallow FAM (S = 138.5, p = 0.003), DOSS (S = 134.5, p < 0.001), NOMS (S = 164, p = 0.0004)). When comparing motor to sensory NMES, there was no significant difference between groups for Swallow FAM (p = .12), DOSS (p = 0.52), or NOMS (p = 0.41). There was no significant difference in diet change for solid food or liquids among the groups, although 50% more participants in the sensory group saw improvement in diet. This study supports the use of electrical stimulation as part of the treatment plan for post-stroke dysphagia. Sensory-level stimulation was associated with greater improvement on outcome measures compared to motor level stimulation.
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Affiliation(s)
- Melissa M Howard
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA
| | - Elliott S Block
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA
| | - Demiana Mishreki
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA
| | - Tom Kim
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA
| | - Emily R Rosario
- Casa Colina Hospital and Centers for Healthcare, 255 East Bonita Avenue, Pomona, CA, 91767, USA.
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17
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Svingos AM, Robicsek SA, Hayes RL, Wang KK, Robertson CS, Brophy GM, Papa L, Gabrielli A, Hannay HJ, Bauer RM, Heaton SC. Predicting Clinical Outcomes 7-10 Years after Severe Traumatic Brain Injury: Exploring the Prognostic Utility of the IMPACT Lab Model and Cerebrospinal Fluid UCH-L1 and MAP-2. Neurocrit Care 2022; 37:172-183. [PMID: 35229233 DOI: 10.1007/s12028-022-01461-y] [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: 09/16/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is a major contributor to disability and mortality in the industrialized world. Outcomes of severe TBI are profoundly heterogeneous, complicating outcome prognostication. Several prognostic models have been validated for acute prediction of 6-month global outcomes following TBI (e.g., morbidity/mortality). In this preliminary observational prognostic study, we assess the utility of the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) Lab model in predicting longer term global and cognitive outcomes (7-10 years post injury) and the extent to which cerebrospinal fluid (CSF) biomarkers enhance outcome prediction. METHODS Very long-term global outcome was assessed in a total of 59 participants (41 of whom did not survive their injuries) using the Glasgow Outcome Scale-Extended and Disability Rating Scale. More detailed outcome information regarding cognitive functioning in daily life was collected from 18 participants surviving to 7-10 years post injury using the Cognitive Subscale of the Functional Independence Measure. A subset (n = 10) of these participants also completed performance-based cognitive testing (Digit Span Test) by telephone. The IMPACT lab model was applied to determine its prognostic value in relation to very long-term outcomes as well as the additive effects of acute CSF ubiquitin C-terminal hydrolase-L1 (UCH-L1) and microtubule associated protein 2 (MAP-2) concentrations. RESULTS The IMPACT lab model discriminated favorable versus unfavorable 7- to 10-year outcome with an area under the receiver operating characteristic curve of 0.80. Higher IMPACT lab model risk scores predicted greater extent of very long-term morbidity (β = 0.488 p = 0.000) as well as reduced cognitive independence (β = - 0.515, p = 0.034). Acute elevations in UCH-L1 levels were also predictive of lesser independence in cognitive activities in daily life at very long-term follow-up (β = 0.286, p = 0.048). Addition of two CSF biomarkers significantly improved prediction of very long-term neuropsychological performance among survivors, with the overall model (including IMPACT lab score, UCH-L1, and MAP-2) explaining 89.6% of variance in cognitive performance 7-10 years post injury (p = 0.008). Higher acute UCH-L1 concentrations were predictive of poorer cognitive performance (β = - 0.496, p = 0.029), whereas higher acute MAP-2 concentrations demonstrated a strong cognitive protective effect (β = 0.679, p = 0.010). CONCLUSIONS Although preliminary, results suggest that existing prognostic models, including models with incorporation of CSF markers, may be applied to predict outcome of severe TBI years after injury. Continued research is needed examining early predictors of longer-term outcomes following TBI to identify potential targets for clinical trials that could impact long-ranging functional and cognitive outcomes.
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Affiliation(s)
- Adrian M Svingos
- Brain Injury Clinical Research Center, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven A Robicsek
- Departments of Anesthesiology, Neurosurgery, and Neuroscience, University of Florida, Gainesville, FL, USA
| | | | - Kevin K Wang
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, FL, USA
| | | | - Gretchen M Brophy
- Pharmacotherapy and Outcomes Science and Neurosurgery, Virginia Commonwealth University Medical College of Virginia Campus, Richmond, VA, USA
| | - Linda Papa
- Department of Emergency Medicine, Orlando Health Orlando Regional Medical Center, Orlando, FL, USA
| | - Andrea Gabrielli
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA
| | - H Julia Hannay
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Russell M Bauer
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, FL, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shelley C Heaton
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
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18
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Omega-3 fatty acids in the treatment of spinal cord injury: untapped potential for therapeutic intervention? Mol Biol Rep 2022; 49:10797-10809. [DOI: 10.1007/s11033-022-07762-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
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19
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Griffin A, O`Gorman A, Robinson D, Gibb M, Stapleton T. The impact of an occupational therapy group cognitive rehabilitation program for people with dementia. Aust Occup Ther J 2022; 69:331-340. [PMID: 35288954 PMCID: PMC9314719 DOI: 10.1111/1440-1630.12795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study was conducted to examine the impact of a group cognitive rehabilitation program for people with dementia on everyday memory function and quality of life. METHODS Participants included in the study were community-dwelling adults with a diagnosis of dementia. The intervention was a 5-week occupational therapy lead group cognitive rehabilitation program delivered once a week for 1.5 h. Outcome measures included standardised memory tests, subjective everyday memory function and quality of life ratings. The measures were completed at baseline, post-intervention and 3-month post-intervention. RESULTS Outcome measures were completed with 58 participants. Statistically significant improvements in standardised memory scores were noted following the intervention. Similarly, self-rated everyday memory function and quality of life scores significantly improved following the intervention. All standardised scores and subjective ratings were maintained at 3-month follow-up. CONCLUSION Group-based cognitive rehabilitation programs can positively impact the quality of life and everyday memory function among people with dementia.
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Affiliation(s)
- Aislinn Griffin
- Medicine for the Elderly DepartmentSt. James's HospitalDublinIreland
| | - Aoife O`Gorman
- Medicine for the Elderly DepartmentSt. James's HospitalDublinIreland
| | - David Robinson
- Medicine for the Elderly DepartmentSt. James's HospitalDublinIreland
| | - Matthew Gibb
- Dementia Services Information and Development CentreSt. James's HospitalDublinIreland
| | - Tadhg Stapleton
- Discipline of Occupational Therapy, School of MedicineTrinity CollegeDublinIreland
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20
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Forsyth R, Hamilton C, Ingram M, Kelly G, Grove T, Wales L, Gilthorpe MS. Demonstration of functional rehabilitation treatment effects in children and young people after severe acquired brain injury. Dev Neurorehabil 2022; 25:239-245. [PMID: 34463178 DOI: 10.1080/17518423.2021.1964631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine relationships between functional outcomes after pediatric acquired brain injury (ABI) and measures of rehabilitation dose. METHODS An observational study of children receiving residential neurorehabilitation after severe ABI. RESULTS Basic total rehabilitation dose shows a paradoxical inverse relationship to global outcome. This is due to confounding by both initial injury severity and length of stay, and variation in treatment content for a given total rehabilitation dose. Content-aware rehabilitation dose measures show robust positive correlations between fractions of rehabilitation treatment received and plausibly related aspects of outcome: specifically, between rates of recovery of gross motor function and the fraction of rehabilitation effort directed to active practice and motor learning. This relationship was robust to adjustment for therapists' expectations of recovery. CONCLUSION Content-aware measures of rehabilitation dose are robustly causally related to pertinent aspects of outcome. These findings are step toward a goal of comparative effectiveness research in pediatric neurorehabilitation.
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Affiliation(s)
- Rob Forsyth
- Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Harrison Research Centre, Tadworth, UK
| | - Colin Hamilton
- Harrison Research Centre, Tadworth, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Matthew Ingram
- Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | | | - Tim Grove
- Harrison Research Centre, Tadworth, UK
| | | | - Mark S Gilthorpe
- University of Leeds, Leeds, UK.,The Alan Turing Institute, London, UK
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21
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De Icco R, Putortì A, Allena M, Avenali M, Dagna C, Martinelli D, Cristina S, Grillo V, Fresia M, Bitetto V, Cosentino G, Valentino F, Alfonsi E, Sandrini G, Pisani A, Tassorelli C. Non-Invasive Neuromodulation in the Rehabilitation of Pisa Syndrome in Parkinson's Disease: A Randomized Controlled Trial. Front Neurol 2022; 13:849820. [PMID: 35493824 PMCID: PMC9046718 DOI: 10.3389/fneur.2022.849820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Pisa syndrome (PS) is a frequent postural complication of Parkinson's disease (PD). PS poorly responds to anti-parkinsonian drugs and the improvement achieved with neurorehabilitation tends to fade in 6 months or less. Transcranial direct current stimulation (t-DCS) is a non-invasive neuromodulation technique that showed promising results in improving specific symptoms in different movement disorders. Objectives This study aimed to evaluate the role of bi-hemispheric t-DCS as an add-on to a standardized hospital rehabilitation program in the management of PS in PD. Methods This study included 28 patients with PD and PS (21 men, aged 72.9 ± 5.1 years) who underwent a 4-week intensive neurorehabilitation treatment and were randomized to receive: i) t-DCS (t-DCS group, n = 13) for 5 daily sessions (20 min−2 mA) with bi-hemispheric stimulation over the primary motor cortex (M1), or ii) sham stimulation (sham group, n = 15) with the same duration and cadence. At baseline (T0), end of rehabilitation (T1), and 6 months later (T2) patients were evaluated with both trunk kinematic analysis and clinical scales, including UPDRS-III, Functional Independence Measure (FIM), and Numerical Rating Scale for lumbar pain. Results When compared to the sham group, the t-DCS group achieved a more pronounced improvement in several variables: overall posture (p = 0.014), lateral trunk inclination (p = 0.013) during upright standing position, total range of motion of the trunk (p = 0.012), FIM score (p = 0.048), and lumbar pain intensity (p = 0.017). Conclusions Our data support the use of neuromodulation with t-DCS as an add-on to neurorehabilitation for the treatment of patients affected by PS in PD.
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Affiliation(s)
- Roberto De Icco
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- *Correspondence: Roberto De Icco
| | - Alessia Putortì
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marta Allena
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Micol Avenali
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Carlotta Dagna
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniele Martinelli
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Silvano Cristina
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina Grillo
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mauro Fresia
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Vito Bitetto
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Valentino
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Alfonsi
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giorgio Sandrini
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antonio Pisani
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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22
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Saverino A, Sonabend R, Wong S, Symeon C. The Wolfson Assessment Matrix: a potential tool to support clinicians in establishing access to specialized neuro rehabilitation by capturing important prognostic factors. Sharing more equitable and transparent criteria. Eur J Phys Rehabil Med 2022; 58:161-170. [PMID: 34823336 PMCID: PMC9981235 DOI: 10.23736/s1973-9087.21.07022-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Specialized Rehabilitation Services (SRSs) are designed to offer intensive multidisciplinary rehabilitation to patients with complex needs, who are expected to make significant functional gains in their ADLs over a relatively limited period of time. Although national guidelines offer a guidance on how to band patients by complexity, there is no consensus on how to screen patients with regard to rehabilitation prognosis. AIM The aim of this study was to improve the selection of patients admitted to an SRS, defining transparent and equitable prognostic criteria to guide clinicians' decision making. DESIGN This is a retrospective observational study SETTING: an SRS in the UK. POPULATION We included 121 patients affected by a neurological condition consecutively admitted for multidisciplinary rehabilitation. METHODS Rehabilitation Complexity Scale Extended is used to describe rehabilitation complexity. A short list of potential barriers to rehabilitation was analysed to predict the functional outcome measured by the Functional Independent Measure and the Barthel Index. RESULTS Older age, a heavier burden of co-morbidities, pre-morbid cognitive difficulties or dementia and a lower function level at admission were the most important variables to predict a lower functional gain. CONCLUSIONS We have used this list of barriers to create the Wolfson Assessment Matrix as a potential support tool to guide clinicians navigating through the different rehabilitation service options when assessing complex patients for eligibility to an SRS. CLINICAL REHABILITATION IMPACT SRSs are highly expensive services representing a possible step along the rehabilitation pathway for patients with complex needs. A tool such as the Wolfson Assessment Matrix would represent a step forward to help consistency in decision making regarding appropriateness for SRSs. It would also help to set realistic long-term goals with patients and families and support Health Services in the further development of alternative rehabilitation settings.
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Affiliation(s)
- Alessia Saverino
- Wolfson Neuro Rehabilitation Center, St George's Hospital, London, UK - .,Maugeri Clinical Scientific Institute, Genoa, Italy -
| | - Raphael Sonabend
- Department of Statistical Science, University College London, London, UK
| | - Sancho Wong
- Wolfson Neuro Rehabilitation Center, St George's Hospital, London, UK
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Ashford S, Singer B, Rose H, Turner-Stokes L. The impact of spasticity and contractures on dependency and outcomes from rehabilitation. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/ijprm.jisprm-000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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FitzGerald A, Main L, Duff U, Foggo J, Rowney F, Haire N, McLean R. Does amantadine maintain function in long-established brain injury? A single case experimental design. Brain Inj 2021; 35:1443-1450. [PMID: 34686097 DOI: 10.1080/02699052.2021.1972341] [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: 10/20/2022]
Abstract
OBJECTIVE The role of dopamine agonist (DA) in restoring consciousness and cognition in recovery phase following acquired brain injury (ABI) is established (1-5). The role in later recovery is less well defined. We report a single case experimental design (SCED) trial of amantadine demonstrating improvement in function, six years following ABI. METHOD A scoring system based on established abilities in personal care and interaction was used to identify tasks with component actions, 34 actions in total, each ranked in terms of quality of response to a request or prompt. Actions were scored on maintenance dose amantadine; on withdrawal; and after reintroduction. Daytime sleep duration was also recorded. RESULTS At 3rd and 5th weeks post withdrawal, deterioration was noted in 27 of 34 graded activities. At 3rd and 5th weeks following reintroduction, all but 3 grades returned to baseline or better. Afternoon sleep duration increased from 35 to 80 minutes during withdrawal period returning towards baseline on amantadine resumption. CONCLUSION We believe this provides evidence for benefit of amantadine in sustaining function following ABI. The SCED model used provides a template for others to use to identify comparable change in similar trials.
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Affiliation(s)
- A FitzGerald
- Department of Neurological Rehabilitation, NHS Lothian, Astley Ainslie Hospital, Edinburgh, Scotland
| | - L Main
- Department of Neurological Rehabilitation, NHS Lothian, Astley Ainslie Hospital, Edinburgh, Scotland
| | - U Duff
- Department of Neurological Rehabilitation, NHS Lothian, Astley Ainslie Hospital, Edinburgh, Scotland
| | - J Foggo
- Case Management Services, Edinburgh, Scotland
| | - F Rowney
- Balanced Movement, Edinburgh, Scotland
| | - N Haire
- Lecturer, Music Therapy, Division of Occupational Therapyand Arts Therapies, School of Health Sciences, Queen Margaret Universit, Musselburgh, Scotland
| | - R McLean
- Department of Neurological Rehabilitation, NHS Lothian, Astley Ainslie Hospital, Edinburgh, Scotland
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Putortì A, Corrado M, Avenali M, Martinelli D, Allena M, Cristina S, Grillo V, Martinis L, Tamburin S, Serrao M, Pisani A, Tassorelli C, De Icco R. The Effects of Intensive Neurorehabilitation on Sequence Effect in Parkinson's Disease Patients With and Without Freezing of Gait. Front Neurol 2021; 12:723468. [PMID: 34557151 PMCID: PMC8453149 DOI: 10.3389/fneur.2021.723468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The sequence effect (SE), defined as a reduction in amplitude of repetitive movements, is a common clinical feature of Parkinson's disease (PD) and is supposed to be a major contributor to freezing of gait (FOG). During walking, SE manifests as a step-by-step reduction in step length when approaching a turning point or gait destination, resulting in the so-called destination sequence effect (dSE). Previous studies explored the therapeutic effects of several strategies on SE, but none of them evaluated the role of an intensive rehabilitative program. Objectives: Here we aim to study the effects of a 4-week rehabilitative program on dSE in patients with PD with and without FOG. Methods: Forty-three patients (30 males, 70.6 ± 7.5 years old) with idiopathic PD were enrolled. The subjects were divided into two groups: patients with (PD + FOG, n = 23) and without FOG (PD - FOG, n = 20). All patients underwent a standardized 4-week intensive rehabilitation in-hospital program. At hospital admission (T0) and discharge (T1), all subjects were evaluated with an inertial gait analysis for dSE recording. Results: At T0, the dSE was more negative in the PD + FOG group (-0.80 ± 0.6) when compared to the PD - FOG group (-0.39 ± 0.3) (p = 0.007), even when controlling for several clinical and demographic features. At T1, the dSE was reduced in the overall study population (p = 0.001), with a more pronounced improvement in the PD + FOG group (T0: -0.80 ± 0.6; T1: -0.23 ± 0.4) when compared to the PD - FOG group (T0: -0.39 ± 0.3; T1: -0.22 ± 0.5) (p = 0.012). At T1, we described in the overall study population an improvement in speed, cadence, stride duration, and stride length (p = 0.001 for all variables). Conclusions: dSE is a core feature of PD gait dysfunction, specifically in patients with FOG. A 4-week intensive rehabilitative program improved dSE in PD patients, exerting a more notable beneficial effect in the PD + FOG group.
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Affiliation(s)
- Alessia Putortì
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Michele Corrado
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Micol Avenali
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniele Martinelli
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marta Allena
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvano Cristina
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina Grillo
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Luca Martinis
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Pavia, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
- Movement Analysis Laboratory, Policlinico Italia, Rome, Italy
| | - Antonio Pisani
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Roberto De Icco
- Movement Analysis Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Mann G, Troeung L, Wagland J, Martini A. Cohort profile: the Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT), Western Australia, 1991-2020. BMJ Open 2021; 11:e052728. [PMID: 34475189 PMCID: PMC8413932 DOI: 10.1136/bmjopen-2021-052728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/06/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Transition back into the community following acute management of acquired brain injury (ABI) is a critical part of recovery. Post-acute rehabilitation and transitional care can significantly improve outcomes. The Acquired Brain Injury Community REhabilitation and Support Services OuTcomes CohoRT (ABI-RESTaRT) is a novel whole-population cohort formed to better understand the needs of individuals with ABI receiving post-acute rehabilitation and disability services in Western Australia (WA), and to improve their outcomes. To do this a unique combination of (1) internal clinical/rehabilitation data, and (2) externally linked health data from the WA Data Linkage System was used, including hospitalisations, emergency department presentations, mental health service use and death records, to measure longitudinal needs and outcomes of individuals with ABI over 29 years, making this the largest, most diverse post-acute ABI cohort in Australia to date. PARTICIPANTS Whole-population cohort of individuals (n=1011) with an ABI who received post-acute community-based neurorehabilitation or disability support services through Brightwater Care Group from 1991 to 2020. FINDINGS TO DATE Comprehensive baseline demographic, clinical and rehabilitation data, outcome measures and linked health data have been collected and analysed. Non-traumatic brain injury (eg, stroke, hypoxia) was the main diagnostic group (54.9%, n=555), followed by traumatic brain injury (34.9%, n=353) and eligible neurological conditions (10.2%, n=103). Mean age at admission was 45.4 years, and 67.5% were men (n=682). The cohort demonstrated significant heterogeneity, socially and clinically, with differences between ABI groups across a number of domains. FUTURE PLANS ABI-RESTaRT is a dynamic whole-population cohort that will be updated over time as individuals enrol in the service. Future analyses will assess longitudinal brain injury outcomes, the changing health and social needs of individuals with ABI and evaluate and inform post-acute services to best support these individuals. REGISTRATION This cohort is not linked to a clinical trial, and is not registered.
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Affiliation(s)
- Georgina Mann
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Lakkhina Troeung
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Janet Wagland
- Disability Services, Brightwater Care Group, Osborne Park, Western Australia, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Osborne Park, Western Australia, Australia
- School of Social Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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Wales L, Davis K, Kelly G, Lynott H. Long Term Participation Outcomes for Severe Acquired Brain Injury in Childhood - An Expanded Scoping Review. Dev Neurorehabil 2021; 24:379-387. [PMID: 33615981 DOI: 10.1080/17518423.2021.1886191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Participation in childhood Acquired Brain Injury (ABI) lacks clarity in definition and determinants influencing long-term outcome. This paper aims to investigate and identify the factors that impact long-term outcomes, and prioritize the measures that focus on and endorse children, young people, and their family's concept of participation.Methods: A scoping review was carried out using research literature and non-research data sources including data review, child/family interviews, and expert consultation.Results: Six peer-reviewed papers sourced. Families reported that participation for the whole family is important and recovers in a non-linear manner after rehabilitation. Experts agreed the priority and complexity of participation following severe ABI.Conclusion: Review highlights that regaining participation through the attendance at, and the engagement in life situations, for children after severe ABI, is important, complex and is affected by many factors.Future research requires a flexible approach to understand participation and inform future targeted interventions.
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Affiliation(s)
- Lorna Wales
- Research Professional Lead, The Children's Trust, Tadworth, UK
| | - Kathy Davis
- Research Nurse, The Children's Trust, Tadworth, UK
| | - Gemma Kelly
- Research Physiotherapist, the Children's Trust, Tadworth, UK
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Turner-Stokes L, Lafeuillee G, Francis R, Nayar M, Nair A. Functional outcomes and cost-efficiency of specialist in-patient rehabilitation following spinal cord injury: a multi-centre national cohort analysis from the UK Rehabilitation Outcomes Collaborative (UKROC). Disabil Rehabil 2021; 44:5603-5611. [PMID: 34282991 DOI: 10.1080/09638288.2021.1946603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multi-centre cohort of inpatients with spinal cord injury (SCI)-comparison based on age and aetiology.Methods and materials: Retrospective analysis of prospectively collected data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database from 2012-2019. Adults with SCI admitted for a rehabilitation programme in levels 1 and 2 specialist rehabilitation Units in England, were included if they had valid UK Functional Assessment Measure (UK FIM + FAM) and Northwick Park Dependency Scale (NPDS) scores recorded on admission and discharge (n = 2506 of 3321 admissions).Results: Approximately 425 patients were admitted yearly. 1344(56%) patients were under 65. 736(29%) had traumatic aetiology. Older and Traumatic SCI patients were more likely to have cervical cord damage (X2, p < 0.001). There was a significant improvement in all parameters of functional independence (UK FIM + FAM) (p < 0.001), with the reduction in dependency and care costs (NPDS/NPCNA) (p < 0.001). 1817(72.5%) patients were discharged home. Mean care-costs savings were £25 500/year per patient. Year-on-year trends showed admissions with increasing age, higher complexity and dependency with corresponding increasing episode costs (ANOVA p < 0.001). However, the time taken to offset the cost of rehabilitation did not change significantly (ANOVA p = 0.57).Conclusions: Specialist rehabilitation services provide effective and cost-efficient rehabilitation for patients with spinal cord injury.Implications for RehabilitationApproximately a third of patients who access specialist inpatient rehabilitation following spinal cord injury (SCI) in England are managed in the Specialist Level 1 and 2 neuro-rehabilitation units, rather than in the eight designated national SCI Centres.Despite admitting progressively more complex and dependent patients over eight years, these specialist rehabilitation units continue to provide highly cost-efficient care.The mean annual savings amount to £25,500 per patient. With a mean admission rate of 425 patients, this would generate total savings in excess of £10 million per year for the cohort.Specialist rehabilitation services play an important, but under-recognised, role in the spinal cord injury care pathway.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,UK Rehabilitation Outcomes Collaborative, Northwick Park Hospital, London, UK
| | - Gisele Lafeuillee
- Queen Mary's Hospital, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Richard Francis
- UK Rehabilitation Outcomes Collaborative, Northwick Park Hospital, London, UK
| | - Meenakshi Nayar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Hillingdon Hospital, The Hillingdon Hospitals NHS Foundation Trust, London, UK
| | - Ajoy Nair
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.,Hillingdon Hospital, The Hillingdon Hospitals NHS Foundation Trust, London, UK
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Dellweg D, Siemon K, Höhn E, Barchfeld T, Köhler D. [Early Pulmonary Rehabilitation after Long Term Mechanical Ventilation]. Pneumologie 2021; 75:432-438. [PMID: 34116576 PMCID: PMC8195616 DOI: 10.1055/a-0978-1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Einleitung
Unter Frührehabilitation versteht man eine frühzeitig bei- oder nach akuter Erkrankung einsetzende, rehabilitationsmedizinische Behandlung die im § 39SGB V verankert ist. Ziel dieser Untersuchung ist es, die Ergebnisqualität der pneumologischen Frührehabilitation zu untersuchen und darzustellen.
Methoden
Prospektive Erhebung von funktionellen Parametern, Beatmungsstatus und Entlass-Disposition in einer spezialisierten Abteilung für pneumologische Frührehabilitation über den Zeitraum von einem Jahr.
Ergebnisse
Von den 190 Patienten waren 179 (94,2 %) zuvor invasiv beatmet. Während einer Behandlungsdauer von 39 ± 17 Tagen stieg der FAM-Index von 84,4 ± 19,8 auf 118,5 ± 23,3 (Ci 30,9 – 37,3, Cohen’s d 1,58; p < 0,001), der Barthel-Index von 30,5 ± 13,8 auf 58,3 ± 16,2 (Ci 25,4 – 33,8, Cohen’s d 1,4; p < 0,001) und die Wegstrecke von 12,9 ± 40,1 m auf 131,4 ± 85,2 m (Ci 105,6 – 131,4 m, Cohen’s d 1,78; p < 0,001). Die Patienten wurden weniger häufig in eine weitere Anschlussheilbehandlung verlegt, wenn sie beatmet waren.
Diskussion
Patienten in der pneumologischen Frührehabilitation sind bei Aufnahme schwer kompromittiert, es lässt sich aber eine sehr gute Ergebnisqualität erzielen, die unabhängig davon zu sein scheint, ob der Patient eigenständig atmet oder mittels nicht-invasiver oder invasiver Beatmung versorgt wird. Die weitere Disposition dieser Patienten ist vor allem dann schwierig, wenn eine Beatmung vorliegt.
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Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - K Siemon
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - E Höhn
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
| | - T Barchfeld
- Klinikum Westfalen, Knappschaftskrankenhaus Dortmund; Medizinische Klinik 2
| | - D Köhler
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie I
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Williams E, Jackson H, Wagland J, Martini A. Community Rehabilitation Outcomes for Different Stroke Diagnoses: An Observational Cohort Study. Arch Rehabil Res Clin Transl 2021; 2:100047. [PMID: 33543075 PMCID: PMC7853334 DOI: 10.1016/j.arrct.2020.100047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective To determine the differences in functional and cognitive rehabilitation gains made in community-based rehabilitation following a stroke based on stroke diagnosis (left or right hemisphere, hemorrhagic, or ischemic). Design A 12-month follow-up observational retrospective cohort study. Setting Staged community-based brain injury rehabilitation. Participants Clients (N=61) with hemorrhagic left brain stroke (n=10), hemorrhagic right brain stroke (n=8), ischemic left brain stroke (n=27), or ischemic right brain stroke (n=16) participating in rehabilitation for at least 12 months. Intervention Not applicable. Main Outcome Measures The Mayo-Portland Adaptability Inventory-4 (MPAI-4) was completed at admission and 12 months post admission to staged community-based brain injury rehabilitation by consensus of a multidisciplinary team. Results After 12 months in staged community-based brain injury rehabilitation, the study population made significant gains in Total (P<.001) and across Ability (P<.001) and Participation (P<.001) subscales of the MPAI-4. All diagnostic groups made significant gains in Participation T-scores, and no groups made significant gains in Adjustment. The ischemic left and right hemisphere stroke groups also made significant gains in Ability and Total T-scores from admission to 12 months. Clients with ischemic left hemisphere stroke had more severe limitations in motor speech (P<.05) than clients with right hemisphere stroke at admission and/or review and were also more impaired in verbal communication (P<.01) than the hemorrhagic right hemisphere group at admission. Conclusions There are some differences in outcomes on presentation to rehabilitation based on type of stroke; there are also differences in rehabilitation gains. Improvement in physical ability does not always translate to improvement in social participation and independence; those with right brain stroke need further assistance to translate physical gains into participatory outcomes.
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Affiliation(s)
- Elly Williams
- Brightwater Care Group, Research Centre, Perth, Australia
| | - Hayley Jackson
- Brightwater Care Group, Research Centre, Perth, Australia.,University of Western Australia, Faculty of Science, School of Psychological Science, Perth, Australia
| | - Janet Wagland
- Brightwater Care Group, Research Centre, Perth, Australia
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Wernhart S, Hedderich J, Wunderlich S, Schauerte K, Weihe E, Dellweg D, Siemon K. The Feasibility of High-Intensity Interval Training in Patients with Intensive Care Unit-Acquired Weakness Syndrome Following Long-Term Invasive Ventilation. SPORTS MEDICINE-OPEN 2021; 7:11. [PMID: 33527199 PMCID: PMC7849616 DOI: 10.1186/s40798-021-00299-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/11/2021] [Indexed: 12/17/2022]
Abstract
Background Intensive care unit-acquired weakness syndrome (ICUAWS) can be a consequence of long-term mechanical ventilation. Despite recommendations of early patient mobilisation, little is known about the feasibility, safety and benefit of interval training in early rehabilitation facilities (ERF) after long-term invasive ventilation. Methods and Results We retrospectively analysed two established training protocols of bicycle ergometry in ERF patients after long-term (> 7 days) invasive ventilation (n = 46). Patients conducted moderate continuous (MCT, n = 24, mean age 70.3 ± 10.1 years) or high-intensity interval training (HIIT, n = 22, mean age 63.6 ± 12.6 years). The intensity of training was monitored with the BORG CR10 scale (intense phases ≥ 7/10 and moderate phases ≤ 4/10 points). The primary outcome was improvement (∆-values) of six-minute-walk-test (6 MWT), while the secondary outcomes were improvement of vital capacity (VCmax), forced expiratory volume in 1 s (FEV1), maximal inspiratory pressure (PImax) and functional capabilities (functional independence assessment measure, FIM/FAM and Barthel scores) after 3 weeks of training. No adverse events were observed. There was a trend towards a greater improvement of 6 MWT in HIIT than MCT (159.5 ± 64.9 m vs. 120.4 ± 60.4 m; p = .057), despite more days of invasive ventilation (39.6 ± 16.8 days vs. 26.8 ± 16.2 days; p = .009). VCmax (∆0.5l ± 0.6 vs. ∆0.5l ± 0.3; p = .462), FEV1 (∆0.2l ± 0.3 vs. ∆0.3l ± 0.2; p = .218) PImax (∆0.8 ± 1.1 kPa vs. ∆0.7 ± 1.3pts; p = .918) and functional status (FIM/FAM: ∆29.0 ± 14.8pts vs. ∆30.9 ± 16.0pts; p = .707; Barthel: ∆28.9 ± 16.0 pts vs. ∆25.0 ± 10.5pts; p = .341) improved in HIIT and MCT. Conclusions We demonstrate the feasibility and safety of HIIT in the early rehabilitation of ICUAWS patients. Larger trials are necessary to find adequate dosage of HIIT in ICUAWS patients. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00299-6.
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Affiliation(s)
- Simon Wernhart
- Department of Cardiology, Fachkrankenhaus Kloster Grafschaft, Annostrasse 1, 57392, Schmallenberg, Germany. .,Department of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Jürgen Hedderich
- Medistat-Biomedical Statistics, Medistat GmbH, Kronshagen, 24119, Germany
| | - Svenja Wunderlich
- Department of Pneumology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, 57392, Germany
| | - Kunigunde Schauerte
- Department of Pneumology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, 57392, Germany
| | - Eberhard Weihe
- Institute of Anatomy and Cell Biology of the Philipps-University Marburg, Marburg, 35037, Germany
| | - Dominic Dellweg
- Department of Pneumology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, 57392, Germany
| | - Karsten Siemon
- Department of Pneumology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, 57392, Germany
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32
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Mateen BA, Boakye N, Sonabend R, Russell N, Saverino A. The role of impulsivity in neurorehabilitation: A prospective cohort study of a potential cognitive biomarker for fall risk? J Neuropsychol 2020; 15:379-395. [PMID: 33377618 DOI: 10.1111/jnp.12239] [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: 11/30/2022]
Abstract
BACKGROUND Executive dysregulation and impulsivity can both predispose individuals to risk-prone actions. Although the risk of falls is well established in people with poor executive function, its association to impulsivity is less clear. PURPOSE To describe and assess the prognostic capabilities of the relationship between impulsivity, executive function, functional capability, and falls in the in-patient neurorehabilitation population. MATERIALS AND METHODS A prospective cohort study in a 26-bed neurorehabilitation unit in London, recruiting 121 patients, of whom 94 were deemed eligible for inclusion. Cognitive-behavioural assessment was undertaken using the short (16-item) version of the Urgency-Premeditation-Perseverance-Sensation Seeking-Positive Urgency (UPPS) impulsive behaviour scale, and the Trail Making Test (TMT). Patients also underwent a functional assessment at admission and discharge using the UK Functional Independence and Assessment Measure tool (FIM + FAM). The main outcome of interest was falling during an in-patient episode, which are routinely recorded in a computerized registry of adverse incidents. RESULTS Measurements of impulsivity (based on the UPPS-Short form) and executive function (based on the Trail Making Test) were not found to be significantly associated with functional improvement, or risk of falling. Predictive modelling experiments demonstrated that neither of the aforementioned results were capable of identifying individuals at risk of falling more accurately than an informed guess. CONCLUSION Where impulsivity is present, measurement using structured tools such as the UPPS may be informative to guide individualized rehabilitation programmes; however, its usefulness as the basis of risk prediction models for falls is less likely given the results of this study.
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Affiliation(s)
- Bilal A Mateen
- Wolfson Neuro Rehabilitation Centre, St George's Hospital, London, UK.,Kings College Hospital, London, UK
| | - Ndidi Boakye
- Wolfson Neuro Rehabilitation Centre, St George's Hospital, London, UK
| | - Raphael Sonabend
- Department of Statistical Science, University College London, UK
| | - Noreen Russell
- Wolfson Neuro Rehabilitation Centre, St George's Hospital, London, UK
| | - Alessia Saverino
- Wolfson Neuro Rehabilitation Centre, St George's Hospital, London, UK.,Rehabilitation Unit, ICS Maugeri, Genoa, Italy
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Worthington E, Whitehead P, Li Z, Golding-Day M, Walker M. An audit of dressing practice by occupational therapists in acute stroke settings in England. Br J Occup Ther 2020. [DOI: 10.1177/0308022620926103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Dressing independence is commonly affected after stroke, with clinical guidelines recommending that dressing practice should routinely be provided for those with dressing difficulties. The aim of this study was to update the literature on current practice in the treatment of dressing problems in stroke rehabilitation units. Method A questionnaire survey of occupational therapists experienced in stroke care was sent to 157 stroke units in England. Results Responses were received from 70 stroke units. Frequency and duration of dressing practice varied substantially between units, with respondents typically providing dressing practice for six to 10 patients per week and spending 30 to 45 minutes per treatment session. Only 17 respondents (24.3%) stated that they regularly used standardised assessments of dressing ability. The functional approach was used more widely than the remedial approach. Service priorities, working environment and limitations of time and staffing were reported to influence dressing practice. Conclusion There is widespread variability in dressing practice. There is a lack of use of standardised dressing assessments, and therapists’ rationale for their choice of approach is unclear.
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Affiliation(s)
- Esme Worthington
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Phillip Whitehead
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Zhaoying Li
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Miriam Golding-Day
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | - Marion Walker
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
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Chia KX, Polakhare S, Bruno SD. Possible affective cognitive cerebellar syndrome in a young patient with COVID-19 CNS vasculopathy and stroke. BMJ Case Rep 2020; 13:13/10/e237926. [PMID: 33060143 PMCID: PMC7566287 DOI: 10.1136/bcr-2020-237926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Early case series suggest that about one-third of patients with COVID-19 present with neurological manifestations, including cerebrovascular disease, reported in 2%–6% of hospitalised patients. These are generally older patients with severe infection and comorbidities. Here we discuss the case of a previously fit and well 39-year-old man who presented with fever and respiratory symptoms, evolving in pneumonia with hypoxia but only requiring continuous positive airway pressure. After resolution of the respiratory disease, the patient developed focal neurology and was found to have bilateral occipital, thalamic and cerebellar infarcts. A diagnosis of COVID-19 central nervous system vasculopathy was made. He developed a florid neuropsychiatric syndrome, including paranoia, irritability, aggression and disinhibition, requiring treatment with antipsychotics and transfer to neurorehabilitation. Neuropsychometry revealed a wide range of cognitive deficits. The rapid evolution of the illness was matched by fast resolution of the neuropsychiatric picture with mild residual cognitive impairment.
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Affiliation(s)
- Kai Xin Chia
- Blackheath Brain Injury Rehabilitation Centre, London, UK
| | | | - Stefania Dafne Bruno
- Blackheath Brain Injury Rehabilitation Centre, London, UK .,IOPPN, King's College London, London, UK
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Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom. J Head Trauma Rehabil 2020; 34:205-214. [PMID: 30801440 PMCID: PMC6687405 DOI: 10.1097/htr.0000000000000473] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. Objectives: To evaluate cost-efficiency of rehabilitation following severe traumatic brain injury (TBI) and estimate the life-time savings in costs of care. Setting/Participants: TBI patients (n = 3578/6043) admitted to all 75 specialist rehabilitation services in England 2010–2018. Design: A multicenter cohort analysis of prospectively collated clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database. Main Measures: Primary outcomes: (a) reduction in dependency (UK Functional Assessment Measure), (b) cost-efficiency, measured in time taken to offset rehabilitation costs by savings in costs of ongoing care estimated by the Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA), and (c) estimated life-time savings. Results: The mean age was 49 years (74% males). Including patients who remained in persistent vegetative state on discharge, the mean episode cost of rehabilitation was £42 894 (95% CI: £41 512, £44 235), which was offset within 18.2 months by NPCNA-estimated savings in ongoing care costs. The mean period life expectancy adjusted for TBI severity was 21.6 years, giving mean net life-time savings in care costs of £679 776/patient (95% CI: £635 972, £722 786). Conclusions: Specialist rehabilitation proved highly cost-efficient for severely disabled patients with TBI, despite their reduced life-span, potentially generating over £4 billion savings in the cost of ongoing care for this 8-year national cohort.
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36
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Pick S, Hodsoll J, Stanton B, Eskander A, Stavropoulos I, Samra K, Bottini J, Ahmad H, David AS, Purves A, Nicholson TR. Trial Of Neurostimulation In Conversion Symptoms (TONICS): a feasibility randomised controlled trial of transcranial magnetic stimulation for functional limb weakness. BMJ Open 2020; 10:e037198. [PMID: 33028550 PMCID: PMC7539585 DOI: 10.1136/bmjopen-2020-037198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Transcranial magnetic stimulation (TMS) has been used therapeutically for functional (conversion) motor symptoms but there is limited evidence for its efficacy and the optimal protocol. We examined the feasibility of a novel randomised controlled trial (RCT) protocol of TMS to treat functional limb weakness. DESIGN A double-blind (patient, outcome assessor) two parallel-arm, controlled RCT. SETTING Specialist neurology and neuropsychiatry services at a large National Health Service Foundation Trust in London, UK. PARTICIPANTS Patients with a diagnosis of functional limb weakness (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition). Exclusion criteria included comorbid neurological or major psychiatric disorder, contraindications to TMS or previous TMS treatment. INTERVENTIONS Patients were randomised to receive either active (single-pulse TMS to primary motor cortex (M1) above resting motor threshold) or inactive treatment (single-pulse TMS to M1 below resting motor threshold). Both groups received two TMS sessions, 4 weeks apart. OUTCOME MEASURES We assessed recruitment, randomisation and retention rates. The primary outcome was patient-rated symptom change (Clinical Global Impression-Improvement scale, CGI-I). Secondary outcomes included clinician-rated symptom change, psychosocial functioning and disability. Outcomes were assessed at baseline, both TMS visits and at 3-month follow-up. RESULTS Twenty-two patients were recruited and 21 (96%) were successfully randomised (active=10; inactive=11). Nineteen (91%) patients were included at follow-up (active=9; inactive=10). Completion rates for most outcomes were good (80%-100%). Most patients were satisfied/very satisfied with the trial in both groups, although ratings were higher in the inactive arm (active=60%, inactive=92%). Adverse events were not more common for the active treatment. Treatment effect sizes for patient-rated CGI-I scores were small-moderate (Cliff's delta=-0.1-0.3, CIs-0.79 to 0.28), reflecting a more positive outcome for the active treatment (67% and 44% of active arm-rated symptoms as 'much improved' at session 2 and follow-up, respectively, vs 20% inactive group). Effect sizes for secondary outcomes were variable. CONCLUSIONS Our protocol is feasible. The findings suggest that supramotor threshold TMS of M1 is safe, acceptable and potentially beneficial as a treatment for functional limb weakness. A larger RCT is warranted. TRIAL REGISTRATION NUMBER ISRCTN51225587.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - John Hodsoll
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Biba Stanton
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Amy Eskander
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ioannis Stavropoulos
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kiran Samra
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Julia Bottini
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Hena Ahmad
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Alistair Purves
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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Chan T, Marta M, Hawkins C, Rackstraw S. Cognitive and Neurologic Rehabilitation Strategies for Central Nervous System HIV Infection. Curr HIV/AIDS Rep 2020; 17:514-521. [PMID: 32844275 PMCID: PMC7497368 DOI: 10.1007/s11904-020-00515-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Cognitive impairment leading to disability is increasingly seen in people living with human immunodeficiency virus (PLWH). Rehabilitation can alleviate the effects of cognitive impairment upon function. The aim of this paper is to discuss the strategies that have been used in cognitive and neurologic rehabilitation in PLWH. RECENT FINDINGS Studies examining pharmacological and non-pharmacological strategies were analysed. Medical management of HIV and co-morbidities should be optimised. Non-pharmacological strategies, including nerve stimulation techniques, exercise-based interventions, and paper and computer-based cognitive rehabilitation, have some evidence supporting their use in PLWH either as stand-alone interventions or as part of a multidisciplinary approach. Both pharmacological and non-pharmacological rehabilitation strategies have been used with PLWH. More intervention trials are needed to assess cognitive and neurological rehabilitation strategies and further evaluate their potential benefit in PLWH.
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Affiliation(s)
- Terrence Chan
- Mildmay Hospital, 19 Tabernacle Gardens, London, E2 7DZ, UK
| | - Monica Marta
- Grahame Hayton Unit, I&I and Neurology Department, Barts Health NHS Trust, London, UK
- Neurosciences, Blizard Institute, Queen Mary University of London, London, UK
| | | | - Simon Rackstraw
- Mildmay Hospital, 19 Tabernacle Gardens, London, E2 7DZ, UK.
- Grahame Hayton Unit, I&I and Neurology Department, Barts Health NHS Trust, London, UK.
- Neurosciences, Blizard Institute, Queen Mary University of London, London, UK.
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38
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Gual N, Pérez LM, Castellano-Tejedor C, Lusilla-Palacios P, Castro J, Soto-Bagaria L, Coll-Planas L, Roqué M, Vena AB, Fontecha B, Santiago JM, Lexell EM, Chiatti C, Iwarsson S, Inzitari M. IMAGINE study protocol of a clinical trial: a multi-center, investigator-blinded, randomized, 36-month, parallel-group to compare the effectiveness of motivational interview in rehabilitation of older stroke survivors. BMC Geriatr 2020; 20:321. [PMID: 32887564 PMCID: PMC7472581 DOI: 10.1186/s12877-020-01694-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Rehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants' experiences and functional status at 3 months. METHODS We will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors´ goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and cost-utility analysis. DISCUSSION Final results are expected by end of 2020. This study will provide relevant information on the implementation of MI as a rehabilitation reinforcement tool in older stroke survivors. A potential reduction in post-stroke disability and dependence would increase person's health-related quality of life and well-being and reduce health and social care costs. IMAGINE has the potential to inform practice and policymakers on how to move forward towards shared decision-making and shared responsibilities in the vulnerable population of older stroke survivors. TRIAL REGISTRATION ClinicalTrials.gov: NCT03434938 , registered on January 2018.
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Affiliation(s)
- Neus Gual
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Laura Mónica Pérez
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Carmina Castellano-Tejedor
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain. .,Autonomous University of Barcelona, Bellaterra, Spain.
| | | | - Judith Castro
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Luís Soto-Bagaria
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Laura Coll-Planas
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Universitat Autònoma de Barcelona, Barcelona, Spain.,Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | - Marta Roqué
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Universitat Autònoma de Barcelona, Barcelona, Spain.,Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain
| | | | - Benito Fontecha
- Hospital General de l'Hospitalet (Consorci Sanitari Integral), Hospitalet de Llobregat, Spain
| | - Jose M Santiago
- Hospital General de l'Hospitalet (Consorci Sanitari Integral), Hospitalet de Llobregat, Spain
| | - Eva Månsson Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
| | - Carlos Chiatti
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
| | - Susanne Iwarsson
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund-Malmö, Sweden
| | - Marco Inzitari
- REFiT BCN Research Group-Parc Sanitari Pere Virgili-Vall d'Hebron Institute of Research, Barcelona, Spain.,Autonomous University of Barcelona, Bellaterra, Spain
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39
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Gunn S, Burgess GH. Factors predicting rehabilitation outcomes after severe acquired brain injury in trauma, stroke and anoxia populations: A cohort study. Neuropsychol Rehabil 2020; 32:179-210. [PMID: 32880210 DOI: 10.1080/09602011.2020.1810077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Severe acquired brain injury has long-term physical and cognitive effects. Identifying patient variables predictive of recovery in different brain injury populations would generate improved prognostic information and help rehabilitation teams set appropriate therapeutic goals. This cohort study of 447 NHS neurorehabilitation inpatients aimed to identify functional and cognitive predictors of recovery following severe acquired brain injury caused by trauma, stroke and anoxia. Motor and cognitive impairment ratings were collected at admission and discharge using the Functional Independence Measure and Functional Assessment Measure (FIM+FAM), and injury-related and demographic data were collated from medical records. Predictors of physical, cognitive and overall recovery were identified via hierarchical regression analyses. Several key findings emerged. Firstly, on-admission motor skills predicted functional and overall outcomes across groups. Secondly, on-admission social interaction skills predicted cognitive discharge outcomes in stroke and trauma, and overall outcomes for stroke, but did not predict anoxia outcomes. Thirdly, age predicted all forms of recovery for stroke only. Further group-specific factors were also identified as predicting motor and cognitive recovery, indicating that factors key to the rehabilitation trajectory may differ between populations. These variables should be considered in rehabilitation goal planning, although further research is required to explore their contributions to recovery.
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Affiliation(s)
- Sarah Gunn
- Neuroscience, Psychology and Behaviour, Collesge of Life Sciences, University of Leicester, Leicester, UK
| | - Gerald H Burgess
- Neuroscience, Psychology and Behaviour, Collesge of Life Sciences, University of Leicester, Leicester, UK
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40
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Ayton LN, Rizzo JF, Bailey IL, Colenbrander A, Dagnelie G, Geruschat DR, Hessburg PC, McCarthy CD, Petoe MA, Rubin GS, Troyk PR. Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials: Recommendations from the International HOVER Taskforce. Transl Vis Sci Technol 2020; 9:25. [PMID: 32864194 PMCID: PMC7426586 DOI: 10.1167/tvst.9.8.25] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/08/2019] [Indexed: 01/05/2023] Open
Abstract
Translational research in vision prosthetics, gene therapy, optogenetics, stem cell and other forms of transplantation, and sensory substitution is creating new therapeutic options for patients with neural forms of blindness. The technical challenges faced by each of these disciplines differ considerably, but they all face the same challenge of how to assess vision in patients with ultra-low vision (ULV), who will be the earliest subjects to receive new therapies. Historically, there were few tests to assess vision in ULV patients. In the 1990s, the field of visual prosthetics expanded rapidly, and this activity led to a heightened need to develop better tests to quantify end points for clinical studies. Each group tended to develop novel tests, which made it difficult to compare outcomes across groups. The common lack of validation of the tests and the variable use of controls added to the challenge of interpreting the outcomes of these clinical studies. In 2014, at the bi-annual International “Eye and the Chip” meeting of experts in the field of visual prosthetics, a group of interested leaders agreed to work cooperatively to develop the International Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials (HOVER) Taskforce. Under this banner, more than 80 specialists across seven topic areas joined an effort to formulate guidelines for performing and reporting psychophysical tests in humans who participate in clinical trials for visual restoration. This document provides the complete version of the consensus opinions from the HOVER taskforce, which, together with its rules of governance, will be posted on the website of the Henry Ford Department of Ophthalmology (www.artificialvision.org). Research groups or companies that choose to follow these guidelines are encouraged to include a specific statement to that effect in their communications to the public. The Executive Committee of the HOVER Taskforce will maintain a list of all human psychophysical research in the relevant fields of research on the same website to provide an overview of methods and outcomes of all clinical work being performed in an attempt to restore vision to the blind. This website will also specify which scientific publications contain the statement of certification. The website will be updated every 2 years and continue to exist as a living document of worldwide efforts to restore vision to the blind. The HOVER consensus document has been written by over 80 of the world's experts in vision restoration and low vision and provides recommendations on the measurement and reporting of patient outcomes in vision restoration trials.
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Affiliation(s)
- Lauren N Ayton
- Department of Optometry and Vision Sciences and Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Joseph F Rizzo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ian L Bailey
- School of Optometry, University of California-Berkeley, Berkeley, CA, USA
| | - August Colenbrander
- Smith-Kettlewell Eye Research Institute and California Pacific Medical Center, San Francisco, CA, USA
| | - Gislin Dagnelie
- Lions Vision Research and Rehabilitation Center, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Duane R Geruschat
- Lions Vision Research and Rehabilitation Center, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Philip C Hessburg
- Detroit Institute of Ophthalmology, Henry Ford Health System, Grosse Pointe Park, MI, USA
| | - Chris D McCarthy
- Department of Computer Science & Software Engineering, Swinburne University of Technology, Melbourne, Australia
| | | | - Gary S Rubin
- University College London Institute of Ophthalmology, London, UK
| | - Philip R Troyk
- Armour College of Engineering, Illinois Institute of Technology, Chicago, IL, USA
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Teager AJ, Methley A, Dawson B, Wilson H. The use of cognitive screens within major trauma centres in England: A survey of current practice. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619871801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction Major trauma centres are effective in reducing morbidity and mortality rates following serious injury. Many patients attending major trauma centres present with traumatic brain injuries, requiring specialist assessment in screening for potential cognitive deficits. Numerous cognitive screens exist but it is currently unclear which are used most frequently within major trauma centres. This study aimed to identify which screening tools are used most frequently in major trauma centres in England to enable discussion around their suitability for this clinical population. Method Electronic surveys were distributed via a mailing list to Clinical Psychologists and Clinical Neuropsychologists in major trauma centres across England to gather data on the use of cognitive screens. Results Fourteen Clinical Psychologists in Neuropsychology participated. Results suggest major trauma centres in England are currently using the ACE-III (50%) or MoCA (42%) as the most frequently used screens for cognitive difficulties following traumatic brain injury. Cognitive screening pathways are multi-disciplinary involving OTs (86%), psychologists (qualified 79%; assistant 57%) psychiatrists (36%), mental health nurses (7%) and therapy assistants (7%). Conclusions Major trauma centres are using evidence-based cognitive screens at present, but further work is needed to develop more effective, better validated cognitive screens for traumatic brain injury populations. Increased inter-professional discussion on the practice of cognitive screening would be beneficial for patients seen within major trauma centres.
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Affiliation(s)
- AJ Teager
- Salford Care Organisation, Clinical Sciences Building, Salford Royal NHS Foundation Trust Hospital, Salford, UK
| | - A Methley
- Salford Care Organisation, Clinical Sciences Building, Northern Care Alliance NHS Group, Salford, UK
| | - B Dawson
- Salford Care Organisation, Salford, UK
| | - H Wilson
- Salford Royal NHS FT, Salford, UK
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Fleming MK, Smejka T, Henderson Slater D, van Gils V, Garratt E, Yilmaz Kara E, Johansen-Berg H. Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery. Neurorehabil Neural Repair 2020; 34:661-671. [PMID: 32508249 PMCID: PMC7327954 DOI: 10.1177/1545968320929669] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background. Sleep is important for consolidation of motor
learning, but brain injury may affect sleep continuity and therefore
rehabilitation outcomes. Objective. This study aims to assess
the relationship between sleep quality and motor recovery in brain injury
patients receiving inpatient rehabilitation. Methods.
Fifty-nine patients with brain injury were recruited from 2 specialist inpatient
rehabilitation units. Sleep quality was assessed (up to 3 times) objectively
using actigraphy (7 nights) and subjectively using the Sleep Condition
Indicator. Motor outcome assessments included Action Research Arm test (upper
limb function), Fugl-Meyer Assessment (motor impairment), and the Rivermead
Mobility Index. The Functional Independence Measure (FIM) was assessed at
admission and discharge by the clinical team. Fifty-five age- and gender-matched
healthy controls completed one assessment. Results. Inpatients
demonstrated lower self-reported sleep quality (P < .001)
and more fragmented sleep (P < .001) than controls. For
inpatients, sleep fragmentation explained significant additional variance in
motor outcomes, over and above that explained by admission FIM score
(P < .017), such that more disrupted sleep was
associated with poorer motor outcomes. Using stepwise linear regression, sleep
fragmentation was the only variable found to explain variance in rate of change
in FIM (R2adj = 0.12, P
= .027), whereby more disrupted sleep was associated with slower recovery.
Conclusions. Inpatients with brain injury demonstrate
impaired sleep quality, and this is associated with poorer motor outcomes and
slower functional recovery. Further investigation is needed to determine how
sleep quality can be improved and whether this affects outcome.
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Affiliation(s)
- Melanie K Fleming
- University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Tom Smejka
- University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Henderson Slater
- University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Veerle van Gils
- University of Oxford, Oxford, UK.,Maastricht University, Maastricht, The Netherlands
| | | | - Ece Yilmaz Kara
- University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Williams E, Martini A, Jackson H, Wagland J, Turner-Stokes L. Time between acquired brain injury and admission to community-based rehabilitation: differences in cognitive and functional gains. Brain Inj 2020; 34:713-722. [PMID: 32255368 DOI: 10.1080/02699052.2020.1740943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine differences in rehabilitation gains made by people with an acquired brain injury undergoing staged community-based brain injury rehabilitation (SCBIR) at different times between injury and admission. METHOD Retrospective cohort analysis of routinely collected demographic and rehabilitation data from clients admitted to SCBIR service 2011-2017 (n=92). Outcome measures: Mayo-Portland Adaptability Inventory-4 (MPAI-4) and UK Functional Assessment Measure (UK FIM+FAM) collected on admission and annually thereafter until discharge. Analysis was stratified by time since injury on admission: 'Early' (<1 year (n=36)), 'Middle' (1-2 years (n=34)) and 'Late' (>2 years (n=22)). Between-group differences were tested using bootstrapped one-way ANOVA. Within-group differences were tested using paired T tests. RESULTS Total cohort made significant gains in MPAI-4 and UK FIM+FAM total and all subscales (p = .001). Early group made greatest change in all subscales of both outcome measures (p < .01). Middle cohort improved significantly in all subscales (p < .02) excluding MPAI-4 Adjustment. Late cohort still made statistically significant gains in all UK FIM+FAM subscales (p < .05) and MPAI-4 Participation (p < .01). Item level changes are presented. CONCLUSION More than 2 years after injury, people are able to make improvements in participation and functional independence following SCBIR.
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Affiliation(s)
- Elly Williams
- Brightwater Research Centre, Brightwater Care Group , Perth, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group , Perth, Australia
| | - Hayley Jackson
- Brightwater Research Centre, Brightwater Care Group , Perth, Australia.,School of Psychological Science, University of Western Australia , Perth, Australia
| | - Janet Wagland
- Brightwater Research Centre, Brightwater Care Group , Perth, Australia.,Brightwater Care Group , Perth, Australia
| | - Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London , London, UK.,Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust , London, UK
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44
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Turner-Stokes L, Harding R, Yu P, Dzingina M, Gao W. Cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis: A multicentre prospective cohort analysis of the UK Rehabilitation Outcomes Collaborative national clinical dataset for rehabilitation centres in England. Mult Scler J Exp Transl Clin 2020; 6:2055217320912789. [PMID: 32206333 PMCID: PMC7079310 DOI: 10.1177/2055217320912789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/13/2020] [Accepted: 02/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Rehabilitation is effective for multiple sclerosis, but is it value for
money? Objectives To evaluate functional outcomes, care needs and cost-efficiency of specialist
inpatient rehabilitation for adults with multiple sclerosis (MS). Methods A multicentre cohort study of prospectively collected clinical data from the
UK Rehabilitation Outcomes Collaborative national clinical database. Data
included all adults with MS (n = 1007) admitted for
specialist inpatient (Level 1 or 2) rehabilitation in England,
2010–2018. Outcome measures Dependency/care needs: Northwick Park Dependency Scale/Care Needs Assessment,
Functional independence: UK Functional Assessment Measure (UK FIM+FAM).
Cost-efficiency. Patients were analysed in three dependency groups
(High/Medium/Low). Results All groups showed significant reduction in dependency between admission and
discharge on all measures (paired t-tests:
p < 0.001). Mean reduction in care costs/week was
greatest in the most dependent patients: High: £519 (95% CI: 447–597),
Medium: £148 (76–217), Low: £36 (12–83). Despite longer stays, time taken to
offset the cost of rehabilitation was shortest in the most dependent
patients: High: 12.9 (12.0–14.1) months; Medium: 29.3 (21.3–51.8); Low: 76.8
(0–36.1). Item-level changes corresponded with clinical experience. Conclusions Specialist rehabilitation provided good value for money in patients with MS,
yielding improved outcomes and substantial savings in ongoing care costs,
especially in high-dependency patients.
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Affiliation(s)
- Lynne Turner-Stokes
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
- Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK
| | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
| | - Peihan Yu
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
| | - Mendwas Dzingina
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing Midwifery and Palliative Care, King’s College London, UK
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45
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Young J, Moss C. Orthotic care needs in a cohort of neurological rehabilitation inpatients. Disabil Rehabil Assist Technol 2019; 16:609-613. [PMID: 31746242 DOI: 10.1080/17483107.2019.1685018] [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: 10/25/2022]
Abstract
AIM Orthotic management is frequently part of the rehabilitation of various neurological conditions in adults such as stroke, peripheral neuropathies, spinal cord injuries and multiple sclerosis. Despite this, there are limited data available on the implementation of orthotic care in practice. The primary aim of this study is to establish the proportion of inpatients in a mixed neurorehabilitation cohort which receive orthotic assessment and treatment. The secondary aim was to document the overall care pathway. METHODS Existing data were reviewed retrospectively. Data gathered included patient demographics such as age, gender and diagnosis, type of orthoses prescribed, number of orthotic treatment sessions required and outcome measures used. The paper was prepared in accordance with the STROBE statement for observational studies. RESULTS During a 6 month period, 54 patients were admitted as inpatients. Of these, 25 (46%) were referred to the orthotic service for assessment, with 23 (43%) receiving a lower limb orthosis and 19 (35%) subsequently being discharged using either an ankle-foot orthosis or knee-ankle-foot orthosis. The conditions most commonly seen were stroke (40%), incomplete spinal cord injuries (28%) and peripheral neuropathies (16%). Significant improvements were recorded at discharge using the Functional Independence Measure (FIM) and Functional Assessment Measure (FAM). Various aspects of the orthotic care process are described. CONCLUSIONS This study suggests that orthotic treatment is needed with high frequency in a mixed inpatient neurorehabilitation cohort. In terms of service planning, these data support existing the recommendation that neurological rehabilitation centres should have good access to orthotic services.Implications for rehabilitationCustom orthoses such as AFOs and KAFOs are frequently needed by neurological rehabilitation inpatients.Orthoses may facilitate standing and walking at an earlier stage during rehabilitation.Those responsible for neurological rehabilitation services should ensure appropriate access to orthotic services.
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Affiliation(s)
- Joshua Young
- Orthotic Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Cameron Moss
- Wolfson Neurorehabilitation Centre, St George's University Hospitals NHS Foundation Trust, London, UK
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46
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Pacheco N, Mollayeva S, Jacob B, Colantonio A, Mollayeva T. Interventions and cognitive functioning in adults with traumatic spinal cord injuries: a systematic review and meta-analysis. Disabil Rehabil 2019; 43:903-919. [PMID: 31354083 DOI: 10.1080/09638288.2019.1644380] [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: 10/26/2022]
Abstract
AIM This research synthesized scientific evidence on the impact of interventions for adults with traumatic spinal cord injury on cognition, to understand if current intervention approaches are appropriate in light of the risk of post-injury cognitive impairments. METHOD Medline, Central, Embase, Scopus, PsycINFO and PubMed were searched for intervention in persons with SCI assessing cognition pre- and post-intervention. Study quality was completed using the National Institutes of Health quality assessment tools. Results were grouped by type of intervention. The meta-analysis involved calculation of pooled effect sizes for interventions utilizing the same cognitive measure. RESULTS Eleven studies of moderate quality discussed drug therapy, transcutaneous tibial nerve stimulation, diet modification and dietary supplements, and inpatient rehabilitation. Some aspects of cognition were negatively affected by drugs while diet modification and supplement use, and transcutaneous tibial nerve stimulation showed no evidence of a difference in cognitive scores when compared with no intervention. Inpatient rehabilitation revealed a small but beneficial effect, when results of seven studies were pooled. CONCLUSION Evidence on the effects of interventions on cognitive functioning in patients with traumatic spinal cord injury is sparse and inconclusive, so work in this area is timely. It is valuable to know not only which interventions are effective for improving cognition, but also how other commonly used interventions, intended to treat other injury sequela, can affect cognition. PROSPERO: CRD42018087238.Implications for rehabilitationHistorically, rehabilitation of patients with traumatic spinal cord injury has targeted physical impairments, with little attention to cognition; this research aimed to understand if current interventions are appropriate in light of the risk of patients' cognitive impairments. Evidence on the effects of drug therapy, diet and dietary supplements interventions on cognitive functioning in traumatic spinal cord injury is sparse and inconclusive.Combining multiple inpatient rehabilitation interventions shows a positive but heterogeneous effect on the cognitive functioning; interventions applied earlier show greater gains.A major challenge for clinicians is to select an outcome measure sensitive to change over time, and to relate the results to patients' change in cognitive abilities with intervention applicationResearch to understand the functional effect of spinal cord injury on the widely distributed networks of the central and autonomic nervous systems subserving cognition, is timely.
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Affiliation(s)
- Nicole Pacheco
- Faculty of Honours Life Sciences, McMaster University, Toronto, Canada.,Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Shirin Mollayeva
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Binu Jacob
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Angela Colantonio
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Faculty of Occupational Science and Occupational Therapy, University of Toronto, Canada
| | - Tatyana Mollayeva
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada.,Faculty of Occupational Science and Occupational Therapy, University of Toronto, Canada
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47
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Alderman N, Pink AE, Williams C, Ramos SDS, Oddy M, Knight C, Jenkins KG, Barnes MP, Hayward C. Optimizing measurement for neurobehavioural rehabilitation services: A multisite comparison study and response to UKROC. Neuropsychol Rehabil 2019; 30:1318-1347. [DOI: 10.1080/09602011.2019.1582432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nick Alderman
- Elysium Neurological Services, Elysium Healthcare, Badby Park, Daventry, UK
- Department of Psychology, Swansea University, Swansea, UK
| | - Aimee E Pink
- Department of Psychology, Swansea University, Swansea, UK
- Independent Neurorehabilitation Providers Alliance, UK
| | | | | | - Michael Oddy
- Brain Injury Rehabilitation Trust, The Disabilities Trust, Burgess Hill, UK
| | - Caroline Knight
- The Oakleaf Group, Northampton, UK
- School of Psychology, University of Leicester, Leicester, UK
- Elysium Neurological Services, Elysium Healthcare, St Neots Hospital, Cambridge, UK
| | - Keith G Jenkins
- National Brain Injury Centre, St Andrew’s Healthcare, Northampton, UK
| | | | - Chloë Hayward
- Independent Neurorehabilitation Providers Alliance, UK
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48
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Berra E, De Icco R, Avenali M, Dagna C, Cristina S, Pacchetti C, Fresia M, Sandrini G, Tassorelli C. Body Weight Support Combined With Treadmill in the Rehabilitation of Parkinsonian Gait: A Review of Literature and New Data From a Controlled Study. Front Neurol 2019; 9:1066. [PMID: 30800095 PMCID: PMC6375880 DOI: 10.3389/fneur.2018.01066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/23/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Gait disorders represent disabling symptoms in Parkinson's Disease (PD). The effectiveness of rehabilitation treatment with Body Weight Support Treadmill Training (BWSTT) has been demonstrated in patients with stroke and spinal cord injuries, but limited data is available in PD. Aims: The aim of the study is to investigate the efficacy of BWSTT in the rehabilitation of gait in PD patients. Methods: Thirty-six PD inpatients were enrolled and performed rehabilitation treatment for 4-weeks, with daily sessions. Subjects were randomly divided into two groups: both groups underwent daily 40-min sessions of traditional physiokinesitherapy followed by 20-min sessions of overground gait training (Control group) or BWSTT (BWSTT group). The efficacy of BWSTT was evaluated with clinical scales and Computerized Gait Analysis (CGA). Patients were tested at baseline (T0) and at the end of the 4-weeks rehabilitation period (T1). Results: Both BWSTT and Control groups experienced a significant improvement in clinical scales as FIM and UPDRS and in gait parameters for both interventions. Even if we failed to detect any statistically significant differences between groups in the different clinical and gait parameters, the intragroup analysis captured a specific pattern of qualitative improvement associated to cadence and stride duration for the BWSTT group and to the swing/stance ratio for the Control group. Four patients with chronic pain or anxious symptoms did not tolerate BWSTT. Conclusions: BWSTT and traditional rehabilitation treatment are both effective in improving clinical motor functions and kinematic gait parameters. BWSTT may represent an option in PD patients with specific symptoms that limit traditional overground gait training, e.g., severe postural instability, balance disorder, orthostatic hypotension. BWSTT is generally well-tolerated, though caution is needed in subjects with chronic pain or with anxious symptoms. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03815409.
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Affiliation(s)
- Eliana Berra
- Neurorehabilitation Unit and Parkinson Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Neurorehabilitation Unit and Parkinson Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Micol Avenali
- Neurorehabilitation Unit and Parkinson Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Carlotta Dagna
- Neurorehabilitation Unit and Parkinson Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Silvano Cristina
- Neurorehabilitation Unit and Parkinson Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Claudio Pacchetti
- Neurorehabilitation Unit and Parkinson Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Mauro Fresia
- Neurorehabilitation Unit and Parkinson Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giorgio Sandrini
- Neurorehabilitation Unit and Parkinson Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Cristina Tassorelli
- Neurorehabilitation Unit and Parkinson Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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49
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Hussein Y, Rose M, Gurr B. Evaluating the Functional and Cognitive Examination for patients with acute acquired brain injury. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2017.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The Functional and Cognitive Examination is a cross-battery neuropsychological baseline assessment. It was designed specifically for patients with acquired brain injury in the acute rehabilitation stage. This investigation focused on the utility of the Functional and Cognitive Examination to identify the association between the functional and cognitive performance of acquired brain injury patients and the construct validity of the battery. Methods: The Functional and Cognitive Examination is administered as a standard for all patients admitted to the inpatient neurological assessment and specialist rehabilitation unit. Forty two patients had been recruited over a two year period. Raw scores have been analysed and descriptive data is provided. Spearman's correlations were used to observe associations between functional and cognitive performance. The Functional and Cognitive Examination was also correlated against the Functional Assessment Measure and the Northwick Park Therapy Dependency Assessment. Findings: There was a positive association between lower performance on the Functional and Cognitive Examination cognitive component and the Functional and Cognitive Examination functional task. Similarly, lower scores on the Functional Assessment Measure had positive associations with performance on the Functional and Cognitive Examination functional task. Conclusions: The Functional and Cognitive Examination is a useful neuropsychological baseline assessment. It illustrates that cognitive and functional components are associated and the Functional and Cognitive Examination outcomes are associated with the Functional Assessment Measure.
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Affiliation(s)
- Yasmin Hussein
- Clinical psychologist, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Mark Rose
- Clinical psychologist, Dorset Healthcare University Foundation Trust, Poole, Dorset, UK
| | - Birgit Gurr
- Consultant clinical neuropsychologist; clinical lead of the Community Brain Injury and Adult Neuropsychology Services Dorset; Poole Stroke Care Unit; visiting fellow, Bournemouth University, UK
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50
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Gunn S, Burgess GH, Maltby J. A Factor Analysis of Functional Independence and Functional Assessment Measure Scores Among Focal and Diffuse Brain Injury Patients: The Importance of Bifactor Models. Arch Phys Med Rehabil 2018; 99:1805-1810. [DOI: 10.1016/j.apmr.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/27/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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