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Jimbo K, Miyata K, Yuine H, Takahama K, Yoshimura T, Shiba H, Yasumori T, Kikuchi N, Shiraishi H. Classification of upper-limb dysfunction severity and prediction of independence in activities of daily living after cervical spinal-cord injury. Spinal Cord 2024:10.1038/s41393-024-01005-5. [PMID: 38886575 DOI: 10.1038/s41393-024-01005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
STUDY DESIGN Prospective observational study. OBJECTIVES Classification of spinal-cord injury and prediction of independence in activities of daily living (ADL) based on performance evaluations such as upper-limb function have not been reported. Therefore, this study aimed to establish a severity classification and calculate cutoff values for independence in ADL using the Capabilities of Upper Extremity Test (CUE-T) for individuals with cervical spinal-cord injury (CSCI). SETTING A spinal-cord injury rehabilitation center in Japan. METHODS This study included individuals with subacute CSCI. Collected data included the CUE-T and Spinal Cord Independence Measure III (SCIM III) scores. The severity classification was used for the hierarchical cluster analysis using the CUE-T. The cutoff values of CUE-T scores for independence in ADL were calculated using an adjustment model with logistic regression analysis. The dependent variable was binary (independent/non-independent) for each SCIM III Self-care item, and the independent variable was CUE-T. RESULTS A total of 71 participants were included in the analysis. The severity of upper-limb dysfunction was classified into four categories using CUE-T. Significant differences in upper-limb function and ADL were observed between clusters. The cutoff values for CUE-T score for independence in ADL ranged from 37 to 91 points. All cutoff values showed good results in the internal validation, sensitivity analysis. CONCLUSIONS This study determined the severity of upper limb function in CSCI and the cutoff values of CUE-T scores for independence in ADL. These results may help set criteria and goals for interventions in the clinical and research fields. SPONSORSHIP None.
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Affiliation(s)
- Kazumasa Jimbo
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan.
- Department of Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ami, Japan.
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroshi Yuine
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Kousuke Takahama
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan
| | - Tomohiro Yoshimura
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan
| | - Honoka Shiba
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan
| | - Taichi Yasumori
- Department of Rehabilitation Treatment, Chiba Rehabilitation Center, Chiba, Japan
| | - Naohisa Kikuchi
- Department of Rehabilitation Medicine, Chiba Rehabilitation Center, Chiba, Japan
| | - Hideki Shiraishi
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
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Rich TL, Truty T, Muschler K, Gravely A, Marth LA, Barrett B, Mortimer D, Hansen AH. Virtual Reality Game Selection for Traumatic Brain Injury Rehabilitation: A Therapist's Wish List for Game Developers. Games Health J 2023; 12:445-449. [PMID: 37498203 DOI: 10.1089/g4h.2022.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
This project explored the selection process of commercially available virtual reality (VR) games for traumatic brain injury rehabilitation. Occupational therapy practitioners (OTPs) developed a classification framework that they used to evaluate VR games. The classification framework focused on movements required to effectively play the game, cognitive demand, position for game play, ease in menu navigation, and perceived therapeutic applications. OTPs used the ratings to aid in game selection and identified relevant game examples that allowed customizable settings and basic navigation with a game focus on functional activities. The OTPs and the research team identified the need for further work on accessibility and adaptability of game features (e.g., difficulty and limb usage) allowing for more individualization to optimize outcomes of VR-enhanced rehabilitation. The classification framework was useful in evaluating the potential therapeutic benefit of commercially available VR games. However, trial of the game by clinicians prior to use was still warranted.
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Affiliation(s)
- Tonya L Rich
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
- University of Minnesota, Division of Rehabilitation Medicine, Minneapolis, Minnesota, USA
| | - Timothy Truty
- Minneapolis VA Health Care System, Research Service Line, Minneapolis, Minnesota, USA
| | - Katherine Muschler
- Minneapolis VA Health Care System, Research Service Line, Minneapolis, Minnesota, USA
| | - Amy Gravely
- Minneapolis VA Health Care System, Research Service Line, Minneapolis, Minnesota, USA
| | - Lindsay A Marth
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
| | - Benjamin Barrett
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
| | - Diane Mortimer
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
- University of Minnesota, Division of Rehabilitation Medicine, Minneapolis, Minnesota, USA
| | - Andrew H Hansen
- Minneapolis VA Health Care System, Rehabilitation & Extended Care Service Line, Minneapolis, Minnesota, USA
- University of Minnesota, Division of Rehabilitation Medicine, Minneapolis, Minnesota, USA
- University of Minnesota, Department of Biomedical Engineering, Minneapolis, Minnesota, USA
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Pasipanodya EC, Teranishi R, Dirlikov B, Duong T, Huie H. Characterizing Profiles of TBI Severity: Predictors of Functional Outcomes and Well-Being. J Head Trauma Rehabil 2023; 38:E65-E78. [PMID: 35617636 DOI: 10.1097/htr.0000000000000791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To identify profiles of acute traumatic brain injury (TBI) severity and relate profiles to functional and well-being outcomes. SETTING Acute inpatient rehabilitation and general community settings. PARTICIPANTS Three hundred and seventy-nine individuals with moderate-severe TBI participating in the Traumatic Brain Injury Model Systems. DESIGN Longitudinal observational study. MAIN MEASURES At discharge-length of stay, Functional Independence Measure (FIM), and Disability Rating Scale (DRS). One-year post-injury-Glasgow Outcome Scale-Extended (GOS-E), FIM, and Satisfaction with Life Scale (SWLS). RESULTS Latent profile analysis (LPA) was used to identify subgroups with similar patterns across 12 indicators of acute injury severity, including duration of posttraumatic amnesia, Glasgow Coma Scale, time to follow commands, and head CT variables. LPA identified 4 latent classes, least to most severe TBI (Class 1: n = 75, 20.3%; Class 2: n = 124, 33.5%; Class 3: n = 144, 38.9%; Class 4: n = 27, 7.3%); younger age, lower education, rural residence, injury in motor vehicle accidents, and earlier injury years were associated with worse acute severity. Latent classes were related to outcomes. Compared with Class 1, hospital stays were longer, FIM scores lower, and DRS scores larger at discharge among individuals in Class 3 and Class 4 (all P s < .01). One-year post-injury, GOS-E and FIM scores were significantly lower among individuals in Class 3 and Class 4 than those in Class 1 ( P s < .01). SWLS scores were lower only among individuals in Class 3 ( P = .036) compared with Class 1; other comparisons relative to Class 1 were not significant. CONCLUSIONS Meaningful profiles of TBI severity can be identified from acute injury characteristics and may suggest etiologies, like injury in motor vehicle accidents, and premorbid characteristics, including younger age, rural residence, and lower education, that heighten risk for worse injuries. Improving classification may help focus on those at elevated risk for severe injury and inform clinical management and prognosis.
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Affiliation(s)
- Elizabeth C Pasipanodya
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California (Dr Pasipanodya and Mr Dirlikov); Department of Physical Medicine and Rehabilitation, Atrium Health Carolinas Rehabilitation, Charlotte, North Carolina (Dr Teranishi); and Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California (Drs Duong and Huie)
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Bailey A, Chenoweth T, Fisher Z, Joannides M, Watters S, Mazzucchelli J, Taylor S, Harris C. Identifying Suitable Cognitive Assessments for Children and Adolescents with Acquired Brain Injury for use by Occupational Therapists in Acute and Subacute Hospital Contexts: A Scoping Review. Dev Neurorehabil 2022; 25:485-500. [PMID: 35850609 DOI: 10.1080/17518423.2022.2099031] [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: 11/03/2022]
Abstract
AIM To appraise the literature evaluating psychometric properties and clinical utility of cognitive assessments available for use by occupational therapists in acute and subacute hospital contexts with children aged 4-18 years diagnosed with an acquired brain injury. METHODS Scoping review. Assessments and associated studies were evaluated for their methodologic quality using the COnsensus-based standard for the Selection of health Measurement INstruments (COSMIN) strategy. RESULTS Forty-one studies evaluated 49 different assessments and reported on assessment psychometrics (n = 40), clinical utility (n = 1) and five reported on both. Fourteen assessments with the strongest psychometric properties and clinical utility were shortlisted. CONCLUSION A gold standard assessment was not identified. Instead, a shortlist of functional, performance-based, technology-based, and self-report assessments were identified as relevant for the setting and population, but requiring further investigation. Future development of a cognitive assessment in partnership with therapists working in tertiary pediatric settings will ensure optimal clinical utility and validity.
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Affiliation(s)
- Ashleigh Bailey
- School of Allied Health, Curtin University, Perth, Australia
| | | | - Zoe Fisher
- School of Allied Health, Curtin University, Perth, Australia
| | | | - Samantha Watters
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
| | - Jodie Mazzucchelli
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
| | - Susan Taylor
- School of Allied Health, Curtin University, Perth, Australia.,Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
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Kimura Y, Otobe Y, Suzuki M, Masuda H, Kojima I, Tanaka S, Kusumi H, Yamamoto S, Saegusa H, Yoshimura T, Yamada M. The effects of rehabilitation therapy duration on functional recovery of patients with subacute stroke stratified by individual's age: a retrospective multicenter study. Eur J Phys Rehabil Med 2022; 58:675-682. [PMID: 36052892 PMCID: PMC10019476 DOI: 10.23736/s1973-9087.22.07581-5] [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: 11/08/2022]
Abstract
BACKGROUND The duration of rehabilitation therapy is one of the key elements for promoting post-stroke functional recovery. However, whether an individual's age affects the effectiveness of the duration of rehabilitation therapy on post-stroke functional recovery remains unclear. AIM This study aimed to investigate whether age has an influence on the relationship between the duration of rehabilitation therapy and post-stroke functional recovery. DESIGN This is a retrospective observational study. SETTING Six convalescent inpatient rehabilitation hospitals in Japan. POPULATION The population of the study was represented by a total of 1186 participants with subacute stroke. METHODS Participants were stratified into four groups according to their age (≤59, 60-69, 70-79, and ≥80 years). The data of minutes involved in performing rehabilitation therapy for participants during hospitalization per day (extracted from the medical records of each hospital). The outcome measurement was the absolute change in the functional independence measure (FIM) score during hospitalization. RESULTS The mean FIM gains in the ≤59 years, 60-69 years, 70-79 years, and the ≥80 years groups were 38.7 (18.8), 32.8 (18.0), 29.7 (16.6), and 25.4 (17.2), respectively. The results of the multivariate regression analyses showed that there was a significant association between the duration of daily rehabilitation therapy and the FIM gain in the 70-79 years and the ≥80 years groups (-70-79 years group: B=1.289, β=0.290, 95% confidence intervals (CIs): 0.718-1.859, P<0.001; the ≥80 years group: B=2.375, β=0.371, 95% CIs: 1.644-3.107, P<0.001), but not in the other groups. CONCLUSIONS For patients with subacute stroke in rehabilitation hospitals, a higher duration of daily rehabilitation therapy was associated with better functional recovery in the 70-79 years group and ≥80 years groups. Understanding the responsiveness of patients with stroke to rehabilitation therapy by age group helps to better allocate medical resources and develop more effective approaches. CLINICAL REHABILITATION IMPACT An increased duration of daily rehabilitation therapy may be helpful in older adults with stroke selected for intensive rehabilitation for improvement of basic daily functioning.
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Affiliation(s)
- Yosuke Kimura
- College of Science and Engineering, Health and Sports Technology Course, Kanto Gakuin University, Yokohama, Japan -
| | - Yuhei Otobe
- School of Medicine, Department of Rehabilitation Science, Physical Therapy Course, Osaka Metropolitan University, Osaka, Japan
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hiroaki Masuda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Iwao Kojima
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shu Tanaka
- School of Health Sciences, Department of Rehabilitation, Tokyo University of Technology, Tokyo, Japan
| | - Haruhiko Kusumi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Seiya Yamamoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hiroki Saegusa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Tomohiro Yoshimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan
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Yabuno S, Yasuhara T, Murai S, Yumoto T, Naito H, Nakao A, Date I. Predictive Factors of Return Home and Return to Work for Intensive Care Unit Survivors after Traumatic Brain Injury with a Follow-up Period of 2 Years. Neurol Med Chir (Tokyo) 2022; 62:465-474. [PMID: 36130904 PMCID: PMC9637400 DOI: 10.2176/jns-nmc.2022-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intensive care unit (ICU) survivors after traumatic brain injury (TBI) frequently have serious disabilities with subsequent difficulty in reintegration into society. We aimed to investigate outcomes for ICU survivors after moderate to severe TBI (msTBI) and to identify predictive factors of return home (RH) and return to work (RTW). This single-center retrospective cohort study was conducted on all trauma patients admitted to the emergency ICU of our hospital between 2013 and 2017. Of these patients, adult (age ≥ 18 years) msTBI patients with head Abbreviated Injury Scale ≥ 3 were extracted. We performed univariate/multivariate logistic regression analyses to explore the predictive factors of RH and RTW. Among a total of 146 ICU survivors after msTBI, 107 were included (median follow-up period: 26 months). The RH and RTW rates were 78% and 35%, respectively. Multivariate analyses revealed that the predictive factors of RH were age < 65 years (P < 0.001), HR < 76 bpm (P = 0.015), platelet count ≥ 19 × 104/μL (P = 0.0037), D-dimer < 26 μg/mL (P = 0.034), and Glasgow Coma Scale (GCS) score > 8 (P = 0.0015). Similarly, the predictive factors of RTW were age < 65 years (P < 0.001) and GCS score > 8 (P = 0.0039). This study revealed that “age” and “GCS score on admission” affected RH and RTW for ICU survivors after msTBI.
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Affiliation(s)
- Satoru Yabuno
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Satoshi Murai
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Isao Date
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
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Lee EY, Sohn MK, Lee JM, Kim DY, Shin YI, Oh GJ, Lee YS, Lee SY, Song MK, Han JH, Ahn JH, Lee YH, Chang WH, Choi SM, Lee SK, Joo MC, Kim YH. Changes in Long-Term Functional Independence in Patients with Moderate and Severe Ischemic Stroke: Comparison of the Responsiveness of the Modified Barthel Index and the Functional Independence Measure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9612. [PMID: 35954971 PMCID: PMC9367998 DOI: 10.3390/ijerph19159612] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/26/2022]
Abstract
This study investigated the long-term functional changes in patients with moderate-to-severe ischemic stroke. In addition, we investigated whether there was a difference between the modified Barthel Index (MBI) and Functional Independence Measure (FIM) according to severity. To evaluate the changes in the long-term functional independence of the subjects, six evaluations were conducted over 2 years, and the evaluation was performed using MBI and FIM. A total of 798 participants participated in this study, of which 673 were classified as moderate and 125 as severe. During the first 3 months, the moderate group showed greater recovery than the severe group. The period of significant change in the National Institutes of Health Stroke Scale (NIHSS) score was up to 6 months after onset in the moderate group, and up to 3 months after onset in the severe group. In the severe group, MBI evaluation showed significant changes up to 6 months after onset, whereas FIM showed significant changes up to 18-24 months. Our results showed that functional recovery of patients with ischemic stroke in the 3 months after onset was greater in the moderate group than in the severe group. FIM is more appropriate than MBI for evaluating the functional status of patients with severe stroke.
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Affiliation(s)
- Eun Young Lee
- Department of Rehabilitation Medicine, Institute of Brain Science Research, Wonkwang University School of Medicine, Iksan 54538, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Korea
| | - Jong Min Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Korea
| | - Gyung Jae Oh
- Department of Preventive Medicine, Wonkwang University, School of Medicine, Iksan 54538, Korea
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41566, Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju 63241, Korea
| | - Min Keun Song
- Department of Physical and Rehabilitation Medicine, Chunnam National University Medical School, Kwangju 61469, Korea
| | - Jun Hee Han
- Department of Statistics, Hallym University, Chuncheon 24252, Korea
| | - Jeong Hoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Korea
| | - Young Hoon Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu 41566, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Soo Mi Choi
- Division of Chronic Disease Prevention, Korea Centers for Disease Control and Prevention, Center for Disease, Cheongju 28159, Korea
| | - Seon Kui Lee
- Division of Chronic Disease Prevention, Korea Centers for Disease Control and Prevention, Center for Disease, Cheongju 28159, Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan 54538, Korea
| | - Yun Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
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Rehabilitation of social cognition impairment after traumatic brain injury: a systematic review. NEUROLOGÍA (ENGLISH EDITION) 2020; 37:767-780. [DOI: 10.1016/j.nrleng.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
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Calthorpe S, Kimmel LA, Webb MJ, Gabbe BJ, Holland AE. Measurement of mobility and physical function in hospitalised trauma patients: A systematic review of instruments and their measurement properties. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619879326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
IntroductionIt is well recognised that organised trauma systems reduce trauma patient mortality. As established systems mature, there is an increasing need to better understand the patient recovery trajectory. Mobility and physical function are key aspects of recovery, but the optimal instruments for measurement in the acute hospital setting remain unclear.MethodsA systematic review was undertaken to identify and describe mobility and physical function instruments scored by direct patient assessment, in adult trauma patients in an acute hospital setting. Databases were searched with no date restrictions. Instruments that were specific to subgroups or related to individual conditions, diseases or joints were excluded. The consensus-based standards for the selection of health measurement instruments checklist was used to assess risk of bias where relevant. Clinimetric properties were reported where possible, including reliability, validity and responsiveness.ResultsFourteen thousand one hundred and fourteen articles were identified with 37 eligible for final review, including six instruments. None had been specifically designed for use in a heterogeneous range of trauma patients. The Functional Independence Measure was the most commonly cited (n = 10 studies), with evidence of construct validity, responsiveness and minimal floor/ceiling effects (<3%). The Acute Care Index of Function (n = 1 study) was found to be valid and responsive whilst the modified Iowa Level of Assistance (n = 2 studies) was reliable and responsive, but ceiling effects ranged from 26% to 37%. Little clinimetric data were available for other measures.ConclusionEvidence from a few studies show promise for the use of the Functional Independence Measure, Acute Care Index of Function and modified Iowa Level of Assistance to measure mobility and physical function in trauma patients, however comprehensive clinimetric data are lacking. Future research should test these scores in specifically designed clinimetric property studies in defined trauma patient populations. This would enable the identification of a gold standard measure for evaluating treatment effectiveness, enabling benchmarking between centres, allow prediction of recovery pathways and optimise trauma patient outcomes.
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Affiliation(s)
- Sara Calthorpe
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melissa J Webb
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, UK
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
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Factors affecting functional outcome in patients with traumatic brain injury sequelae: Our single-center experiences on brain injury rehabilitation. Turk J Phys Med Rehabil 2019; 65:67-73. [PMID: 31453545 DOI: 10.5606/tftrd.2019.2281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/01/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the effect of rehabilitation on functional level of traumatic brain injury (TBI) patients and to examine the associated factors on functional gain in this patient population. Patients and methods Between October 2010 and November 2015, a total of 71 patients (63 males, 8 females; mean age 26.6±8.1 years; range, 18 to 56 years) who were admitted to our rehabilitation clinic with moderate-to-severe TBI were retrospectively analyzed. Functional recovery was assessed using the Functional Independence Measure (FIM) and Functional Ambulation Classification (FAC) scales. The patients were divided into two groups according to time from TBI to the initiation of rehabilitation: early (<6 months) and late (≥6 months). Possible predictive factors associated with FIM gain were evaluated. Results There was a significant improvement in the FIM scores from admission to discharge (p<0.001). There was a statistically significant difference in the FIM gain and FIM efficiency between the patient groups according to the initiation of rehabilitation (p<0.001). The FAC scores increased from admission to discharge, showing statistical significance (p<0.001). Duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis were found to be significant factors associated with FIM gain (p<0.001). Conclusion Our study results suggest that rehabilitation is effective for functional gain, particularly in the early period in patients with moderate- to-severe TBI and duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis are also predictors of functional improvement.
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Injury, Sleep, and Functional Outcome in Hospital Patients With Traumatic Brain Injury. J Neurosci Nurs 2019; 51:134-141. [PMID: 30964844 DOI: 10.1097/jnn.0000000000000441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PROBLEM Uninterrupted nighttime sleep is associated with better cognition and functional outcomes in healthy adults, but the relationship between sleep and functional outcome in individuals hospitalized with severe traumatic brain injury (TBI) remains to be clarified. OBJECTIVE The aims of this study were to (1) describe nighttime rest-activity variables-wake bouts (counts), total wake time (minutes), and sleep efficiency (SE) (percentage; time asleep/time in bed)-in people on a neuroscience step-down unit (NSDU) post-TBI and (2) describe the association between injury and nighttime rest-activity on post-TBI functional outcome (using Functional Independence Measure [FIM] at discharge from inpatient care). METHODS This study is a cross-sectional, descriptive pilot study. We recruited participants from the NSDU (n = 17 [age: mean (SD), 63.4 (17.9)]; 82% male, 94% white) who wore wrist actigraphy (source of nighttime rest-activity variables) for up to 5 nights. For injury variables, we used Glasgow Coma Scale (GCS) score and Injury Severity Score (ISS). We used Spearman ρ and regression to measure associations. RESULTS Glasgow Coma Scale mean (SD) score was 8.8 (4.9), ISS mean (SD) score was 23.6 (6.7), and FIM mean (SD) score was 48 (14.5). Averages of nighttime rest-activity variables (8 PM-7 AM) were as follows: SE, 73% (SD, 16); wake bouts, 41 counts (SD, 18); total wake time, 74 minutes (SD, 47). Correlations showed significance between FIM and GCS (P = .005) and between SE and GCS (P = .015). GCS was the only statistically significant variable associated with FIM (P = .013); we eliminated other variables from the model as nonsignificant (P > .10). Sleep efficiency and FIM association was nonsignificant (P = .40). In a separate model (ISS, GCS, and SE [dependent variable]), GCS was significant (P = .04), but ISS was not (P = .25). CONCLUSION Patients with severe TBI on the NSDU have poor actigraphic sleep at night. GCS has a stronger association to functional outcome than nighttime rest-activity variables.
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Quach NT, Ehsanian R, Dirlikov B, Sechrist S, Mohole J, McKenna S, Isaac L, Duong TT. Burden of Care Implications and Association of Intracranial Hypertension With Extremely Severe Post-traumatic Amnesia After Traumatic Brain Injury: A 5-Year Retrospective Longitudinal Study. Front Neurol 2019; 10:34. [PMID: 30761071 PMCID: PMC6361805 DOI: 10.3389/fneur.2019.00034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022] Open
Abstract
Post-traumatic amnesia (PTA) is characterized by a state of disorientation and confusion following traumatic brain injury (TBI). Few studies have looked at the effect of prolonged PTA on the functional outcomes beyond 1 year post-injury. This study aims to evaluate the burden of care in individuals with extremely severe PTA (esPTA; PTA >28 days) from acute inpatient rehabilitation admission to 5 years post-injury as well as the association between intracranial hypertension (ICH; Intracranial pressure (ICP) ≥20 mmHg) and esPTA status. Three hundred and forty-two individuals with moderate to severe TBI enrolled in the Northern California TBI Model System (TBIMS) of Care were included in this study. The FIM® instrument was chosen as the outcome measurement as it is a widely used functional assessment in the rehabilitation community. Repeated measure ANOVA revealed greater burden of care based on FIM® total scores (p < 0.001) from admission to 5-year follow-up for the esPTA group compared to the non-esPTA group (PTA ≤ 28 days). Unlike the non-esPTA group where FIM® total score plateaued 1 year post-injury, FIM® total score continued to improve up to 2 years post-injury for the esPTA group. The odds of developing esPTA was ~3 times higher for individuals with ICH vs. individuals without ICH (p < 0.001). In conclusion, individuals with esPTA have increased short- and long-term burden of care and the presence of ICH during hospitalization increased the odds of experiencing esPTA. These results may help the rehabilitation team and family in planning care post rehabilitation discharge.
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Affiliation(s)
- Nhung T. Quach
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Reza Ehsanian
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Samantha Sechrist
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Jyodi Mohole
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Stephen McKenna
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
- Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, United States
| | - Linda Isaac
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Thao T. Duong
- Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, United States
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Rodríguez-Rajo P, Leno Colorado D, Enseñat-Cantallops A, García-Molina A. Rehabilitation of social cognition impairment after traumatic brain injury: A systematic review. Neurologia 2018; 37:S0213-4853(18)30202-0. [PMID: 30553571 DOI: 10.1016/j.nrl.2018.07.003] [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: 04/17/2018] [Revised: 06/26/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Many studies have described the presence of difficulty processing and generating social behaviour in patients who have suffered a traumatic brain injury (TBI). These difficulties in social cognition (SC) deteriorate personal relationships in the family, at work, or in the community. However, therapeutic programmes aiming to improve SC continue to be an outstanding issue in clinical practice. We performed a systematic review of the existing literature on the recovery of SC in patients with TBI, assessing the methodological quality of the included studies and the therapeutic effectiveness of the rehabilitation strategies used. DEVELOPMENT We performed a bibliographic search of papers published before June 2018 in the Medline/PubMed, Google Scholar, PsycINFO, and ClinicalTrials.gov databases. Of the 198 potentially relevant articles, 10 met our eligibility criteria. Two of the authors independently and blindly assessed the methodological quality of these studies using the PEDro scale. CONCLUSIONS The articles included in this systematic review essentially studied the effect of different interventions aimed at the rehabilitation of SC in patients with chronic TBIs. The analysis showed adequate methodological quality and an acceptable level of evidence. Future research should analyse the effect of these interventions in patients with TBIs in the sub- and post-acute phases.
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Affiliation(s)
- P Rodríguez-Rajo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España.
| | - D Leno Colorado
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España
| | - A Enseñat-Cantallops
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España
| | - A García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, España
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14
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Al-Hassani A, Strandvik GF, El-Menyar A, Dhumale AR, Asim M, Ajaj A, Al-Yazeedi W, Al-Thani H. Functional Outcomes in Moderate-to-Severe Traumatic Brain Injury Survivors. J Emerg Trauma Shock 2018; 11:197-204. [PMID: 30429628 PMCID: PMC6182963 DOI: 10.4103/jets.jets_6_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: We aimed to analyze the functional outcomes based on the admission characteristics in individuals with moderate-to-severe traumatic brain injury (TBI) over a 5-year period. Methods: A retrospective cohort study was conducted to assess the cognitive, physical, and functional outcomes based on traditional and novel metrics used in potential outcome prediction. Results: A total of 201 participants were enrolled with a mean age of 31.9 ± 11.9 years. Glasgow Coma Score (GCS) at emergency department did not correlate with the functional independence measure (FIM) score or Ranchos Los Amigos (RLA) scores at discharge. The absolute functional gain was significantly higher in individuals who sustained TBI with RLA 4–5 (34.7 ± 18.8 vs. 26.5 ± 15.9, P = 0.006). Participants with RLA 4–5 on admission to rehabilitation showed good correlation with the absolute FIM gain. On multivariate regression analysis, only age (odds ratio 0.96; 95% confidence interval: 0.93–0.98; P = 0.005) was found to be the independent predictor of good functional outcome. Conclusions: Initial GCS is not a predictor of functional outcome in individuals who sustained TBI. Consideration of age and development of novel functional measures might be promising to predict the outcomes in individuals with moderate-to-severe TBI.
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Affiliation(s)
- Ammar Al-Hassani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Gustav F Strandvik
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma Surgery Section, Clinical Research, Hamad General Hospital, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Amit R Dhumale
- Qatar Rehabilitation Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Asim
- Department of Surgery, Trauma Surgery Section, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Ahmed Ajaj
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Wafa Al-Yazeedi
- Qatar Rehabilitation Institute, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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15
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Raymer AM, Roitsch J, Redman R, Michalek AMP, Johnson RK. Critical appraisal of systematic reviews of executive function treatments in TBI. Brain Inj 2018; 32:1601-1611. [PMID: 30240277 DOI: 10.1080/02699052.2018.1522671] [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: 10/28/2022]
Abstract
OBJECTIVE To appraise the quality of systematic reviews (SRs) and meta-analyses (MAs) that summarize the treatment literature for executive function (EF) impairments following traumatic brain injury (TBI). METHODS We used five data sources (PubMed; PsycINFO; ANCDS.org; Cochrane Collaboration; American Speech-Language-Hearing Association Compendium; Psychological Database for Brain Impairment Treatment Efficacy) and identified 19 reviews that met eligibility criteria (adults with TBI; behavioural treatments for EF impairments; no pharmacologic treatments). Two reviewers independently and reliably rated each paper using two appraisal tools (Critical Appraisal of Systematic Review or Meta-Analysis and Evidence in Augmentative and Alternative Communication systematic review scale). RESULTS Five MAs received highest ratings. Four SRs also addressed the majority of SR criteria. Reviews were better at addressing SR criteria as outcome measures across studies varied considerably, posing a challenge to quantitatively synthesize TBI outcomes. The strongest research evidence favours compensatory treatments that train individuals with TBI to use strategies to circumvent EF impairments in daily activities. Smaller effects are reported for direct training approaches. CONCLUSIONS Researchers need to identify core outcome measures to facilitate future rigorous MAs of the EF rehabilitation literature. SRs/MAs need to be conducted with thorough methods that are reported with detail.
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Affiliation(s)
- Anastasia M Raymer
- a Department of Communication Disorders & Special Education , Old Dominion University , Norfolk , VA , USA
| | - Jane Roitsch
- a Department of Communication Disorders & Special Education , Old Dominion University , Norfolk , VA , USA
| | - Rachael Redman
- a Department of Communication Disorders & Special Education , Old Dominion University , Norfolk , VA , USA
| | - Anne M P Michalek
- a Department of Communication Disorders & Special Education , Old Dominion University , Norfolk , VA , USA
| | - Rachel K Johnson
- a Department of Communication Disorders & Special Education , Old Dominion University , Norfolk , VA , USA
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16
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Zarshenas S, Cullen N. Association between cognitive ability and functional outcomes following traumatic brain injury- using a computer-based neurocognitive battery. Brain Inj 2018; 32:1678-1683. [DOI: 10.1080/02699052.2018.1517223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sareh Zarshenas
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University Centre, University Health Network, Toronto, Canada
| | - Nora Cullen
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University Centre, University Health Network, Toronto, Canada
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17
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Lu J, Roe C, Sigurdardottir S, Andelic N, Forslund M. Trajectory of Functional Independent Measurements during First Five Years after Moderate and Severe Traumatic Brain Injury. J Neurotrauma 2018; 35:1596-1603. [PMID: 29466920 PMCID: PMC6016092 DOI: 10.1089/neu.2017.5299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A better understanding of long-term functional recovery process for patients with traumatic brain injury (TBI) facilitates effective rehabilitations. The aim of this study was to classify and characterize patients with moderate-to-severe TBI based on their functional trajectories up to 5 years post-injury. The study included 121 patients with moderate-to-severe TBIs (International Classification of Diseases, Tenth Revision [ICD-10], S06.0-S06.9), 16-55 years of age, and admitted at Trauma Referral Hospital within 24 h of injury between 2005 and 2007. Demographics and injury characteristics were documented at the admission, and functional status was recorded at 3 months and 1 and 5 years post-injury using Functional Independence Measure motor (FIM-M) and cognitive (FIM-C) subscales. We used group-based trajectory models to classify patients' functional trajectories over a 5-year period. For FIM-M, three trajectories were identified: 8.2% of patients showed stable low recovery (13.6 ± 1.5, 17.9 ± 8.8, and 21.0 ± 17.9), 9.2% elevated good recovery (35.8 ± 14.5, 75.5 ± 12.4, and 85.5 ± 8.1), and 82.6% stable good recovery (89.0 ± 3.6, 90.3 ± 1.9, and 90.8 ± 1.0) at the three follow-up points, respectively. For FIM-C, four trajectories were revealed: 4.1% of patients showed stable low recovery (5.0 ± 0, 5.0 ± 0, and 5.0 ± 0), 12.6% delayed moderate recovery (8.9 ± 3.5, 20.6 ± 4.6, and 28.3 ± 3.8), 28.7% elevated good recovery (27.0 ± 3.8, 30.4 ± 7.3, and 31.1 ± 2.3), and 54.6% stable good recovery (32.8 ± 2.3, 34.6 ± 1.0, and 34.7 ± 1.0). The results suggest that three FIM-M and four FIM-C trajectories described various patterns of functional recovery 5 years after moderate-to-severe TBI, with stable good recovery being the most common trajectory. Identifying and characterizing the trajectory memberships should enable targeted rehabilitation programs, inform patient-centered care, and improve long-term outcomes.
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Affiliation(s)
- Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, Virginia
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Roe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solrun Sigurdardottir
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marit Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway
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18
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Lueckel SN, Kosar CM, Teno JM, Monaghan SF, Heffernan DS, Cioffi WG, Thomas KS. Outcomes in nursing home patients with traumatic brain injury. Surgery 2018; 164:S0039-6060(18)30102-8. [PMID: 29751966 DOI: 10.1016/j.surg.2018.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 01/05/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Traumatic brain injury is a leading cause of death and disability in the United States. In survivors, traumatic brain injury remains a leading contributor to long-term disability and results in many patients being admitted to skilled nursing facilities for postacute care. Despite this very large population of traumatic brain injury patients, very little is known about the long-term outcomes of traumatic brain injury survivors, including rates of discharge to home or risk of death in long-term nursing facilities. We hypothesized that patient demographics and functional status influence outcomes of patients with traumatic brain injury admitted to skilled nursing facilities. METHODS We conducted a retrospective cohort study of Medicare fee-for-service beneficiaries aged 65 and older discharged alive and directly from hospital to a skilled nursing facility between 2011 and 2014 using the prospectively maintained Federal Minimum Data Set combined with Medicare claims data and the Centers for Medicare and Medicaid Services Vital Status files. Records were reviewed for demographic and clinical characteristics at admission to the skilled nursing facility, including age, sex, cognitive function, ability to communicate, and motor function. Activities of daily living were reassessed at discharge to calculate functional improvement. We used robust Poisson regression with skilled nursing facility fixed effects to calculate relative risks and 99% confidence intervals for mortality and functional improvement associated with the demographic and clinical characteristics present at admission. Linear regression was used to calculate adjusted mean duration of stay. RESULTS Overall, 87,292 Medicare fee-for-service beneficiaries with traumatic brain injury were admitted to skilled nursing facilities. The mean age was 84 years, with 74% of patients older than age 80. Generally, older age, male sex, and poor cognitive or functional status at admission to a skilled nursing facility were associated with increased risk for poorer outcomes. Older patients (age ≥80 years) with traumatic brain injury had a 1.5 times greater risk of death within 30 days of admission compared with adults younger than 80 years (relative risk = 1.49, 99% confidence interval = 1.36, 1.64). Women were 37% less likely to die than men were (relative risk = 0.63, 99% confidence interval = 0.59, 0.68). The risk of death was greater for patients with poor cognitive function (relative risk = 2.55, 99% confidence interval = 2.32, 2.77), substantial motor impairment (relative risk = 2.44, 99% confidence interval = 2.16, 2.77), and patients with impairment in communication (relative risk = 2.58, 99% confidence interval = 2.32, 2.86) compared with those without the respective deficits. One year after admission, these risk factors continued to confer excess risk for mortality. Duration of stay was somewhat greater for older patients (30.1 compared with 27.5 average days) and patients with cognitive impairment (31.7 vs 27.5 average days). At discharge, patients with cognitive impairment (relative risk = 0.86, 99% confidence interval = 0.83, 0.88) and impairment in the ability to communicate (relative risk = 0.67, 99% confidence interval = 0.54, 0.82) were less likely to improve in physical function. CONCLUSION Our results suggest that among patients with traumatic brain injury admitted to skilled nursing facilities, the likelihood of adverse outcomes varies significantly by key demographic and clinical characteristics. These findings may facilitate setting expectations among patients and families as well as providers when these patients are admitted to skilled nursing facilities for rehabilitation after their acute episode.
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Affiliation(s)
- Stephanie N Lueckel
- Brown University School of Public Health, Providence, RI; Warren Alpert Medical School at Brown University, Providence, RI.
| | - Cyrus M Kosar
- Brown University School of Public Health, Providence, RI
| | - Joan M Teno
- University of Washington School of Public Health, Seattle, WA
| | - Sean F Monaghan
- Warren Alpert Medical School at Brown University, Providence, RI
| | - Daithi S Heffernan
- Brown University School of Public Health, Providence, RI; Department of Veterans Affairs Medical Center, Providence, RI
| | - William G Cioffi
- Warren Alpert Medical School at Brown University, Providence, RI
| | - Kali S Thomas
- Brown University School of Public Health, Providence, RI; Department of Veterans Affairs Medical Center, Providence, RI
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19
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Rosenbaum AM, Gordon WA, Joannou A, Berman BA. Functional outcomes following post-acute rehabilitation for moderate-to-severe traumatic brain injury. Brain Inj 2018; 32:907-914. [DOI: 10.1080/02699052.2018.1469040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Amy M. Rosenbaum
- Traumatic Brain Injury Rehabilitation Department, Park Terrace Care Center, Rego Park, NY, USA
| | - Wayne A. Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antigone Joannou
- Traumatic Brain Injury Rehabilitation Department, Park Terrace Care Center, Rego Park, NY, USA
| | - Brady A. Berman
- Traumatic Brain Injury Rehabilitation Department, Park Terrace Care Center, Rego Park, NY, USA
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20
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Wu J, Faux SG, Poulos CJ, Harris I. Brain injury rehabilitation after road trauma in new South Wales, Australia - insights from a data linkage study. BMC Health Serv Res 2018; 18:204. [PMID: 29566689 PMCID: PMC5865364 DOI: 10.1186/s12913-018-3019-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 03/15/2018] [Indexed: 12/29/2022] Open
Abstract
Background Population-based patterns of care studies are important for trauma care but conducting them is expensive and resource-intensive. Linkage of routinely collected administrative health data may provide an efficient alternative. The aims of this study are to describe the rehabilitation pathway for trauma survivors and to analyse the brain injury rehabilitation outcomes in the two care settings (specialist brain injury and non-specialist general rehabilitation units). Methods This is an observational study using routinely collected registry data (New South Wales Trauma Registry linked with the Australasian Rehabilitation Outcomes Centre Inpatient Dataset). The study cohort includes 268 road trauma patients who were admitted to trauma services between 2009 and 2012 and received inpatient rehabilitation because of a brain injury. Results Of those who need inpatient rehabilitation, 62% (n = 166) were admitted to specialist units with the remainder (n = 102) admitted to non-specialist units. Those admitted to a specialist units were younger (p < 0.001), had a lower cognitive FIM score (p = 0.003) on admission than those admitted to non-specialist units. Specialist units achieved better overall FIM score improvements from admission to discharge (43 vs 30 points, p > 0.001) but at a cost of longer length of stay (median 47 vs 24 days, p < 0.001). There were very few discharges to residential aged care facilities from rehabilitation (2% in non-specialist units and none from specialist units). There was a long time lag between trauma and admission to inpatient rehabilitation with only a quarter of the patients admitted to a specialist unit by end of week four. Few older patients (19%) with brain injury were admitted to specialist units. Conclusions It is feasible to use routinely collected registry data to monitor inpatient rehabilitation outcomes of trauma care. There were differences in characteristics and outcomes of patients with traumatic brain injury admitted to specialist units compared with non-specialist units.
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Affiliation(s)
- Jane Wu
- St. Vincent's Hospital, Sacred Heart Rehabilitation Service, 170 Darlinghurst Road, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Steven G Faux
- St. Vincent's Hospital, Sacred Heart Rehabilitation Service, 170 Darlinghurst Road, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Christopher J Poulos
- School of Public Health and Community Medicine, University of New South Wales, University Clinics, 9 Judd Ave, Hammondville, NSW, 2170, Australia
| | - Ian Harris
- South Western Sydney Clinical School, UNSW; Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
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21
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Divita C, George S, Barr CJ. Traumatic brain injury and post-traumatic amnesia: a retrospective review of discharge outcomes. Brain Inj 2017; 31:1840-1845. [PMID: 28829629 DOI: 10.1080/02699052.2017.1346288] [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: 10/19/2022]
Abstract
PRIMARY OBJECTIVE To investigate if patients with traumatic brain injury, who are discharged to the community before emergence from post-traumatic amnesia (PTA), experience more adverse outcomes than those discharged after emergence from PTA. RESEARCH DESIGN A retrospective review of previously collected data and medical records. METHODS AND PROCEDURES Occurrences of adverse events including hospital readmissions, disengagement from follow-up services, non-compliance with discharge precautions, support system breakdown or undue carer strain at the post-discharge clinic review were recorded. The Glasgow Outcome Scale - Extended (GOS-E) and Supervision Rating Scale (SRS) were completed, retrospectively. Twenty-seven patients discharged to the community, prior to emergence from PTA, were compared to 20 patients discharged within seven days of emergence from PTA. MAIN OUTCOMES AND RESULTS Patients discharged prior to emergence from PTA did not experience an increase in adverse outcomes and showed a higher level of engagement in follow-up services (p = 0.015). There was no difference between groups in the improvements from discharge to clinic review on the GOS-E (p = 0.113) and SRS (p = 0.165). CONCLUSIONS Patients can be discharged prior to emergence from PTA, if all other discharge criteria have been met, without an increase in adverse outcomes.
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Affiliation(s)
- Carlo Divita
- a Rehabilitation Aged and Extended Care , Faculty of Medicine, Nursing and Health Sciences, Flinders University , Adelaide , Australia.,b Allied Health Department , Fiona Stanley Hospital , Murdoch , Australia
| | - Stacey George
- a Rehabilitation Aged and Extended Care , Faculty of Medicine, Nursing and Health Sciences, Flinders University , Adelaide , Australia
| | - Christopher J Barr
- a Rehabilitation Aged and Extended Care , Faculty of Medicine, Nursing and Health Sciences, Flinders University , Adelaide , Australia
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22
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Kabore AF, Ouedraogo A, Ki KB, Traore SSI, Traore IA, Bougouma CTH, Arnaudovski D, Diallo O, Zabsonre S, Ouedraogo N, Augustin P. Head Computed Tomography Scan in Isolated Traumatic Brain Injury in a Low-Income Country. World Neurosurg 2017; 107:382-388. [PMID: 28826717 DOI: 10.1016/j.wneu.2017.07.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Head computed tomography scan (HCTS) is the cornerstone of the management of traumatic brain injury (TBI). The impact of performing a HCTS in TBI has been scarcely investigated in low-income countries (LICs). Furthermore, the cost of a HCTS is a burden for family finances. METHODS A prospective observational study was conducted in Burkina Faso. All consecutive patients with isolated TBI needing a HCTS were included. Result and impact of HCTS were evaluated. RESULTS There were 183 patients prescribed a HCTS for an isolated TBI. Mild, moderate, and severe TBIs represented 55%, 31%, and 14% of the cases, respectively. In 72 patients, HCTS was not performed because of economic barrier. Among the 110 HCTSs performed, there were intracranial lesions in 81 (74%) patients. Among the 110 performed HCTS, 34 (31% [22.3%-39.5%]) HCTSs altered the management of TBI, with 16 (15%) cases of surgical indications, and 20 (18%) cases of modification of the medical treatment. In patients without neurologic signs, the rate of alteration of management was 28%. The realization of the HCTSs was associated with the presence of neurologic signs and income level. In-hospital mortality was 11% (n = 21). Among the 162 patients discharged alive from the hospital, 27 (20%) were discharged with a severe disability state (Glasgow Outcome Scale score ≤3). The rate of return to work was 77%. CONCLUSIONS No modification of guidelines can be advocated from this study. However, given the financial burden on family of performing HCTS, research may identify criteria allowing for avoiding HCTS. Guidelines specific to LICs are needed to get closer to the best interest of patients.
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Affiliation(s)
- Armel Flavien Kabore
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso; Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso
| | - Aziz Ouedraogo
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso
| | - Kélan Bertille Ki
- Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso; Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina-Faso
| | - Salah Seif Idriss Traore
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso
| | - Ibrahim Alain Traore
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina-Faso; Universite Polytechnique de Bobo Dioulasso, Bobo Dioulasso, Burkina-Faso
| | - Cheik Tidiane Hafiz Bougouma
- Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso; Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina-Faso
| | - Darko Arnaudovski
- Département d'anesthésie réanimation, Centre Hospitalier Universitaire Bichat Claude Bernard, Paris, France
| | - Ousseini Diallo
- Service d'Imagerie Médicale, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso; Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso
| | - Sylvain Zabsonre
- Service de Neurochirurgie, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso; Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso
| | - Nazinigouba Ouedraogo
- Service d'Anesthésie Réanimation, Centre Hospitalier Universitaire, Yalgado Ouédraogo, Ouagadougou, Burkina-Faso; Université Ouaga 1 Pr Joseph KI-Zerbo, Unité de Formation et de recherche en sciences de la santé, Ouagadougou, Burkina-Faso
| | - Pascal Augustin
- Département d'anesthésie réanimation, Centre Hospitalier Universitaire Bichat Claude Bernard, Paris, France.
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Factors Associated With Rehabilitation Outcomes After Traumatic Brain Injury: Comparing Functional Outcomes Between TBIMS Centers Using Hierarchical Linear Modeling. J Head Trauma Rehabil 2017; 32:E1-E10. [PMID: 28489704 DOI: 10.1097/htr.0000000000000270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine differences in patient outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers and factors that influence these differences using hierarchical linear modeling (HLM). SETTING Sixteen TBIMS centers. PARTICIPANTS A total of 2056 individuals 16 years or older with moderate to severe traumatic brain injury (TBI) who received inpatient rehabilitation. DESIGN Multicenter observational cohort study using HLM to analyze prospectively collected data. MAIN OUTCOME MEASURES Functional Independence Measure and Disability Rating Scale total scores at discharge and 1 year post-TBI. RESULTS Duration of posttraumatic amnesia (PTA) demonstrated a significant inverse relationship with functional outcomes. However, the magnitude of this relationship (change in functional status for each additional day in PTA) varied among centers. Functional status at discharge from rehabilitation and at 1 year post-TBI could be predicted using the slope and intercept of each TBIMS center for the duration of PTA, by comparing it against the average slope and intercept. CONCLUSIONS HLM demonstrated center effect due to variability in the relationship between PTA and functional outcomes of patients. This variability is not accounted for in traditional linear regression modeling. Future studies examining variations in patient outcomes between centers should utilize HLM to measure the impact of additional factors that influence patient rehabilitation functional outcomes.
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Dahdah MN, Barnes S, Buros A, Dubiel R, Dunklin C, Callender L, Harper C, Wilson A, Diaz-Arrastia R, Bergquist T, Sherer M, Whiteneck G, Pretz C, Vanderploeg RD, Shafi S. Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes. Arch Phys Med Rehabil 2016; 97:1821-1831. [DOI: 10.1016/j.apmr.2016.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/11/2016] [Accepted: 05/02/2016] [Indexed: 11/27/2022]
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Dahdah MN, Barnes SA, Buros A, Allmon A, Dubiel R, Dunklin C, Callender L, Shafi S. The impact of preexisting illness and substance use on functional and neuropsychological outcomes following traumatic brain injury. Proc (Bayl Univ Med Cent) 2016; 29:271-6. [PMID: 27365869 DOI: 10.1080/08998280.2016.11929433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Traumatic brain injury (TBI) is a significant public health problem in the US. Specific preexisting medical illnesses delay recovery after TBI and increase mortality or risk of repeat TBI. This study examined the impact of preexisting illness and substance use on patient rehabilitation outcomes following TBI. The Functional Independence Measure total score and Disability Rating Scale score measured functional outcomes at discharge from inpatient rehabilitation, while the Trail Making Test A and B and Total Trials 1-5 of the California Verbal Learning Test-II measured neuropsychological outcomes in 128 TBI survivors with moderate or severe TBI. Results showed that the presence of a heart condition or diabetes/high blood sugar was associated with lower functional outcomes by discharge. A history of a heart condition, stroke, or respiratory condition prior to TBI was associated with reduced cognitive flexibility. Those with preexisting diabetes/high blood sugar demonstrated poorer visual attention, visuomotor processing speed, and ability to learn and recall verbal information. Those with pre-TBI cancer also had greater auditory-verbal memory deficits. The findings showed that specific preexisting medical conditions are independently associated with lower functional and cognitive outcomes for patients with TBI. By screening patients for preexisting medical conditions, multidisciplinary TBI rehabilitation teams can identify patients who require more aggressive treatments or greater length of stay.
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Affiliation(s)
- Marie N Dahdah
- Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel); Baylor Scott & White Medical Center at Plano, Plano, Texas (Dahdah); North Texas Traumatic Brain Injury Model System, Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel, Dunklin, Callender, Shafi); and Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas (Barnes, Buros, Allmon, Shafi)
| | - Sunni A Barnes
- Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel); Baylor Scott & White Medical Center at Plano, Plano, Texas (Dahdah); North Texas Traumatic Brain Injury Model System, Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel, Dunklin, Callender, Shafi); and Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas (Barnes, Buros, Allmon, Shafi)
| | - Amy Buros
- Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel); Baylor Scott & White Medical Center at Plano, Plano, Texas (Dahdah); North Texas Traumatic Brain Injury Model System, Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel, Dunklin, Callender, Shafi); and Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas (Barnes, Buros, Allmon, Shafi)
| | - Andrew Allmon
- Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel); Baylor Scott & White Medical Center at Plano, Plano, Texas (Dahdah); North Texas Traumatic Brain Injury Model System, Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel, Dunklin, Callender, Shafi); and Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas (Barnes, Buros, Allmon, Shafi)
| | - Rosemary Dubiel
- Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel); Baylor Scott & White Medical Center at Plano, Plano, Texas (Dahdah); North Texas Traumatic Brain Injury Model System, Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel, Dunklin, Callender, Shafi); and Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas (Barnes, Buros, Allmon, Shafi)
| | - Cynthia Dunklin
- Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel); Baylor Scott & White Medical Center at Plano, Plano, Texas (Dahdah); North Texas Traumatic Brain Injury Model System, Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel, Dunklin, Callender, Shafi); and Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas (Barnes, Buros, Allmon, Shafi)
| | - Librada Callender
- Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel); Baylor Scott & White Medical Center at Plano, Plano, Texas (Dahdah); North Texas Traumatic Brain Injury Model System, Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel, Dunklin, Callender, Shafi); and Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas (Barnes, Buros, Allmon, Shafi)
| | - Shahid Shafi
- Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel); Baylor Scott & White Medical Center at Plano, Plano, Texas (Dahdah); North Texas Traumatic Brain Injury Model System, Baylor Institute for Rehabilitation, Dallas, Texas (Dahdah, Dubiel, Dunklin, Callender, Shafi); and Office of the Chief Quality Officer, Baylor Scott & White Health, Dallas, Texas (Barnes, Buros, Allmon, Shafi)
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Chang WH, Sohn MK, Lee J, Kim DY, Lee SG, Shin YI, Oh GJ, Lee YS, Joo MC, Han EY, Kim MS, Jang SY, Kim JH, Kim YH. Long-term functional outcomes of patients with very mild stroke: does a NIHSS score of 0 mean no disability? An interim analysis of the KOSCO study. Disabil Rehabil 2016; 39:904-910. [DOI: 10.3109/09638288.2016.1170214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Busan, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, University of Jeju School of Medicine, Jeju, Republic of Korea
| | - Min Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Shin Yi Jang
- Center for Cardiovascular and Stroke Imaging, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Science and Technology, Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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Fulkerson DH, White IK, Rees JM, Baumanis MM, Smith JL, Ackerman LL, Boaz JC, Luerssen TG. Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4. J Neurosurg Pediatr 2015; 16:410-9. [PMID: 26140392 DOI: 10.3171/2015.3.peds14679] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Patients with traumatic brain injury (TBI) with low presenting Glasgow Coma Scale (GCS) scores have very high morbidity and mortality rates. Neurosurgeons may be faced with difficult decisions in managing the most severely injured (GCS scores of 3 or 4) patients. The situation may be considered hopeless, with little chance of a functional recovery. Long-term data are limited regarding the clinical outcome of children with severe head injury. The authors evaluate predictor variables and the clinical outcomes at discharge, 1 year, and long term (median 10.5 years) in a cohort of children with TBI presenting with postresuscitation GCS scores of 3 and 4. METHODS A review of a prospectively collected trauma database was performed. Patients treated at Riley Hospital for Children (Indianapolis, Indiana) from 1988 to 2004 were reviewed. All children with initial GCS (modified for pediatric patients) scores of 3 or 4 were identified. Patients with a GCS score of 3 were compared with those with a GCS score of 4. The outcomes of all patients at the time of death or discharge and at 1-year and long-term follow-up were measured with a modified Glasgow Outcome Scale (GOS) that included a "normal" outcome. Long-term outcomes were evaluated by contacting surviving patients. Statistical "classification trees" were formed for survival and outcome, based on predictor variables. RESULTS Sixty-seven patients with a GCS score of 3 or 4 were identified in a database of 1636 patients (4.1%). Three of the presenting factors differed between the GCS 3 patients (n = 44) and the GCS 4 patients (n = 23): presence of hypoxia, single seizure, and open basilar cisterns on CT scan. The clinical outcomes were statistically similar between the 2 groups. In total, 48 (71.6%) of 67 patients died, remained vegetative, or were severely disabled by 1 year. Eight patients (11.9%) were normal at 1 year. Ten of the 22 patients with long-term follow-up were either normal or had a GOS score of 5. Multiple clinical, historical, and radiological factors were analyzed for correlation with survival and clinical outcome. Classification trees were formed to stratify predictive factors. The pupillary response was the factor most predictive of both survival and outcome. Other factors that either positively or negatively correlated with survival included hypothermia, mechanism of injury (abuse), hypotension, major concurrent symptoms, and midline shift on CT scan. Other factors that either positively or negatively predicted long-term outcome included hypothermia, mechanism of injury, and the assessment of the fontanelle. CONCLUSIONS In this cohort of 67 TBI patients with a presenting GCS score of 3 or 4, 56.6% died within 1 year. However, approximately 15% of patients had a good outcome at 10 or more years. Factors that correlated with survival and outcome included the pupillary response, hypothermia, and mechanism. The authors discuss factors that may help surgeons make critical decisions regarding their most serious pediatric trauma patients.
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Affiliation(s)
- Daniel H Fulkerson
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine
| | - Ian K White
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Jacqueline M Rees
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Maraya M Baumanis
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Jodi L Smith
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine
| | - Laurie L Ackerman
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine
| | - Joel C Boaz
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine
| | - Thomas G Luerssen
- Department of Neurological Surgery, Baylor College of Medicine, Texas Children's Hospital, Pediatric Neurosurgery, Houston, Texas
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Sandhaug M, Andelic N, Langhammer B, Mygland A. Functional level during the first 2 years after moderate and severe traumatic brain injury. Brain Inj 2015; 29:1431-8. [PMID: 26361939 DOI: 10.3109/02699052.2015.1063692] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Long-term outcomes after TBI are examined to a large extent, but longitudinal studies with more than 1-year follow-up time after injury have been fewer in number. The course of recovery may vary due to a number of factors and it is still somewhat unclear which factors are contributing. AIM The aim of this study was to describe the functional level at four time points up to 24 months after traumatic brain injury (TBI) and to evaluate the predictive impact of pre-injury and injury-related factors. DESIGN A cohort study. SETTING Outpatient. POPULATION Sixty-five patients with moderate (n = 21) or severe (n = 44) TBI. METHODS The patients with TBI were examined with Functional Independence Measure (FIM) and Glasgow Outcome Scale Extended (GOSE) at 3 months, 12 months and 24 months after injury. Possible predictors were analysed in a regression model using FIM total score at 24 months as the outcome measure. RESULTS FIM scores improved significantly from rehabilitation unit discharge to 24 months after injury, with peak levels at 3 and 24 months after injury (p < 0.001), for the whole TBI group and the group with severe TBI. The moderate TBI group did not show significant FIM score improvement during this time period. GOSE scores for the whole group and the moderate group improved significantly over time, but the severe group did not. FIM at admission to the rehabilitation unit and GCS score at admission to the rehabilitation unit were closest to being significant predictors of FIM total scores 24 months after injury (B = 0.265 and 2.883, R(2 )= 0.39, p = 0.073, p = 0.081). CONCLUSION FIM levels improved during the period from rehabilitation unit discharge to 3 months follow-up; thereafter, there was a 'plateauing' of recovery. In contrast, GOSE 'plateauing' of recovery was at 12 months. CLINICAL REHABILITATION IMPACT The study results may indicate that two of the most used outcome measures in TBI research are more relevant for assessment of the functional recovery in a sub-acute phase than in later stages of TBI recovery.
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Affiliation(s)
- Maria Sandhaug
- a Institute of Physiotherapy, Oslo and Akershus University College , Oslo , Norway .,b Head Office and Department of Acquired Brain Injury , Statped , Oslo , Norway
| | - Nada Andelic
- c Department of Physical Medicine and Rehabilitation , Oslo University Hospital , Ulleval , Norway .,d Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM) , Oslo University , Oslo , Norway
| | - Birgitta Langhammer
- a Institute of Physiotherapy, Oslo and Akershus University College , Oslo , Norway .,e Sunnaas Rehabilitation Hospital , Nesoddtangen , Norway
| | - Aase Mygland
- f Department of Habilitation , Sørlandet Hospital , Kristiansand , Norway .,g Department of Neurology , Sørlandet Hospital , Kristiansand , Norway , and.,h Department of Clinical Medicine , Bergen University , Bergen , Norway
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Briggs R, Brookes N, Tate R, Lah S. Duration of post-traumatic amnesia as a predictor of functional outcome in school-age children: a systematic review. Dev Med Child Neurol 2015; 57:618-627. [PMID: 25599763 DOI: 10.1111/dmcn.12674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2014] [Indexed: 11/30/2022]
Abstract
AIM In adults, duration of post-traumatic amnesia (PTA) is a powerful early predictor of functional outcomes in traumatic brain injury. The aim of this work was to assess the predictive validity of PTA duration for outcomes in children (6-18y). METHOD PsycINFO, MEDLINE, Web of Science, and Embase were searched for papers published to January 2014. Ten studies met inclusion criteria: they used standardized instruments to assess PTA and functional outcomes, and examined relationships between the two. Outcomes were classified according to (1) the International Classification of Functioning, Disability and Health (ICF) core sets for neurological conditions for post-acute care and (2) global functioning and quality of life. Methodological quality was rated for each study. RESULTS The search identified 10 studies of moderate mean quality (M=11.8 out of 18). Longer PTA duration related to worse functional outcomes: global functioning and in the two ICF categories ('body function', 'activities and participation'). Relationships between PTA duration and quality of life and the ICF category of 'body structure' were not examined. PTA duration was, in 46 out of 60 (76.67%) instances, a stronger predictor of outcomes than other indices of injury severity. CONCLUSION Longer PTA duration is a valid predictor of worse outcomes in school-age children. Thus, PTA should be routinely assessed in children after traumatic brain injury.
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Affiliation(s)
- Rachel Briggs
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Naomi Brookes
- Brain Injury Rehabilitation Program, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robyn Tate
- Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
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Briggs R, Birse J, Tate R, Brookes N, Epps A, Lah S. Natural sequence of recovery from child post-traumatic amnesia: A retrospective cohort study. Child Neuropsychol 2015; 22:666-78. [PMID: 26069988 DOI: 10.1080/09297049.2015.1038988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
UNLABELLED The aim of this study was to determine the sequence of skills recovery during post-traumatic amnesia (PTA) in children with moderate to severe traumatic brain injuries (TBIs). SETTING Fifty children aged 8 to 15 years consecutively admitted to a children's hospital with TBI and PTA>24 were tested in a retrospective cohort study where the main measure was the Westmead PTA Scale (WPTAS). The group analyses show that orientation to time took longer to recover than orientation to person and place, but not memory, while the individual analyses revealed that when orientation to time was grouped with memory, 94% of children recovered orientation to person and place before orientation to time and memory (examiner and pictures). Correlation coefficients between age and the number of days taken to recover skills were not found to be significant. It was established that, in terms of the natural sequence of skills recovery in children aged 8 to 15 years following moderate to severe TBI, recovery of orientation to time is more closely aligned to memory than to orientation to person and place. It was also established that WPTAS items are developmentally appropriate for children aged 8 to 15 years who have sustained TBI. These findings are clinically important because monitoring recovery from PTA both impacts the rehabilitation offered to individuals during acute care and aids discharge planning.
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Affiliation(s)
- Rachel Briggs
- a School of Psychology , The University of Sydney , Sydney , NSW , Australia.,b Australian Research Council Centre of Excellence in Cognition and its Disorders , Sydney , NSW , Australia
| | - Jason Birse
- c Brain Injury Rehabilitation Program , Sydney Children's Hospital , Randwick , NSW , Australia
| | - Robyn Tate
- d NHMRC Centre of Research Excellence for Traumatic Brain Injury Rehabilitation , Sydney , NSW , Australia.,e Rehabilitation Studies Unit, Northern Clinical School , Sydney Medical School, The University of Sydney , Sydney , NSW , Australia
| | - Naomi Brookes
- c Brain Injury Rehabilitation Program , Sydney Children's Hospital , Randwick , NSW , Australia
| | - Adrienne Epps
- c Brain Injury Rehabilitation Program , Sydney Children's Hospital , Randwick , NSW , Australia
| | - Suncica Lah
- a School of Psychology , The University of Sydney , Sydney , NSW , Australia.,b Australian Research Council Centre of Excellence in Cognition and its Disorders , Sydney , NSW , Australia
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Comparative effectiveness of traumatic brain injury rehabilitation: differential outcomes across TBI model systems centers. J Head Trauma Rehabil 2015; 29:451-9. [PMID: 24052093 DOI: 10.1097/htr.0b013e3182a61983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To measure patient functional outcomes across rehabilitation centers. SETTING Traumatic Brain Injury Model System (TBIMS) centers. PARTICIPANTS Patients with traumatic brain injury (TBI) admitted to 21 TBIMS rehabilitation centers (N = 6975, during 1999-2008). DESIGN Retrospective analysis of prospectively collected data. MAIN MEASURES Center-specific functional outcomes of TBI patients using Functional Independence Measure, Disability Rating Scale, and Glasgow Outcome Scale-Extended. RESULTS There were large differences in patient characteristics across centers (demographics, TBI severity, and functional deficits at admission to rehabilitation). However, even after taking those factors into account, there were significant differences in functional outcomes of patients treated at different TBIMS centers. CONCLUSION There are significant differences in functional outcomes of TBI patients across rehabilitation centers.
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Sandhaug M, Andelic N, Langhammer B, Mygland A. Community integration 2 years after moderate and severe traumatic brain injury. Brain Inj 2015; 29:915-20. [DOI: 10.3109/02699052.2015.1022880] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bilgin S, Guclu-Gunduz A, Oruckaptan H, Kose N, Celik B. Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury. Neural Regen Res 2015; 7:1978-84. [PMID: 25624828 PMCID: PMC4298893 DOI: 10.3969/j.issn.1673-5374.2012.25.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/15/2012] [Indexed: 11/21/2022] Open
Abstract
Fifty-one patients with mild (n = 14), moderate (n = 10) and severe traumatic brain injury (n = 27) received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score. Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.
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Affiliation(s)
- Sevil Bilgin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Arzu Guclu-Gunduz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Hakan Oruckaptan
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nezire Kose
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Bülent Celik
- Department of Biostatistics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Karic T, Sorteberg A, Haug Nordenmark T, Becker F, Roe C. Early rehabilitation in patients with acute aneurysmal subarachnoid hemorrhage. Disabil Rehabil 2014; 37:1446-54. [DOI: 10.3109/09638288.2014.966162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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LeBlanc J, de Guise E, Champoux MC, Couturier C, Lamoureux J, Marcoux J, Maleki M, Feyz M. Early conversational discourse abilities following traumatic brain injury: An acute predictive study. Brain Inj 2014; 28:951-8. [DOI: 10.3109/02699052.2014.888760] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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37
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Kushner DS, Johnson-Greene D. Changes in cognition and continence as predictors of rehabilitation outcomes in individuals with severe traumatic brain injury. ACTA ACUST UNITED AC 2014; 51:1057-68. [DOI: 10.1682/jrrd.2014.01.0002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/06/2014] [Indexed: 11/05/2022]
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Liberatore G, Clarelli F, Nuara A, Ungaro D, Gatti R, Rovaris M, Martinelli V, Comola M, Comi G, Rossi P, Martinelli-Boneschi F. Predictors of effectiveness of multidisciplinary rehabilitation treatment on motor dysfunction in multiple sclerosis. Mult Scler 2013; 20:862-70. [PMID: 24166355 DOI: 10.1177/1352458513508834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 09/15/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To identify clinical predictors of effectiveness of a motor rehabilitation treatment in a cohort of multiple sclerosis (MS) patients. MATERIALS AND METHODS We analysed 212 consecutive patients who underwent a short-term (3-7 weeks) intensive (two hours per day, five days per week), individualised, goal-oriented inpatient rehabilitation program. Activity limitation and impairment were measured on admission and discharge of the rehabilitation trial using the motor sub-items of the Functional Independence Measure (mFIM) and the Expanded Disability Status Scale (EDSS) score. Multivariate logistic regression models have been tested to evaluate the role of clinical baseline features on rehabilitation effectiveness. RESULTS According to pre-defined outcome measures, 75.1% of MS patients improved in either activity limitation (≥5 points delta mFIM) or impairment (≥1.0 delta EDSS score if baseline EDSS was ≤5.5, or ≥0.5 if baseline EDSS was >5.5), and 35.4% of MS patients improved in both outcomes. A relapsing-remitting course of disease, a more severe baseline impairment and activity limitation level, a shorter disease duration and a less severe balance dysfunction were predictive of the effectiveness of rehabilitation. DISCUSSION These data confirm that an intensive inpatient rehabilitation program is able to produce a short-term relevant improvement on clinical and functional outcome measures and suggest some clinical features which can be considered as potential predictors of the outcome of rehabilitative intervention.
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Affiliation(s)
- G Liberatore
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy Laboratory of Genetics of Neurological Complex Disorders, San Raffaele Scientific Institute, Italy
| | - F Clarelli
- Laboratory of Genetics of Neurological Complex Disorders, San Raffaele Scientific Institute, Italy
| | - A Nuara
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - D Ungaro
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - R Gatti
- Laboratory of Movement Analysis, San Raffaele Scientific Institute, Italy
| | - M Rovaris
- Neurorehabilitation Unit, Don C. Gnocchi Foundation ONLUS, Italy
| | - V Martinelli
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - M Comola
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - G Comi
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy
| | - P Rossi
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy Clinica Hildebrand, Centro Riabilitazione Brissago, Switzerland
| | - F Martinelli-Boneschi
- Neurorehabilitation Unit and Department of Neurology, San Raffaele Scientific Institute and Ospedale San Raffaele, Italy Laboratory of Genetics of Neurological Complex Disorders, San Raffaele Scientific Institute, Italy
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de Guise E, Alturki AY, LeBlanc J, Champoux MC, Couturier C, Lamoureux J, Desjardins M, Marcoux J, Maleki M, Feyz M. The Montreal Cognitive Assessment in Persons with Traumatic Brain Injury. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:128-35. [DOI: 10.1080/09084282.2013.778260] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Elaine de Guise
- a Traumatic Brain Injury Program and Neurosurgery Department , McGill University Health Centre-Montreal General Hospital, Montreal , Quebec , Canada
| | - Abdulrahman Yaqub Alturki
- b Neurosurgery Department , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
- c Neurology and Neurosurgery , The National Neuroscience Institute , Riyadh , Saudi Arabia
| | - Joanne LeBlanc
- d Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Marie-Claude Champoux
- d Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Céline Couturier
- d Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Julie Lamoureux
- e Social and Preventive Medicine Department , University of Montreal , Montreal , Quebec , Canada
| | - Monique Desjardins
- f Psychiatry Department , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Judith Marcoux
- b Neurosurgery Department , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Mohammed Maleki
- b Neurosurgery Department , McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
| | - Mitra Feyz
- d Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital , Montreal , Quebec , Canada
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Austin CA, Slomine BS, Dematt EJ, Salorio CF, Suskauer SJ. Time to follow commands remains the most useful injury severity variable for predicting WeeFIM® scores 1 year after paediatric TBI. Brain Inj 2013; 27:1056-62. [PMID: 23781827 DOI: 10.3109/02699052.2013.794964] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the relationship between injury severity variables, particularly time to follow commands (TFC) and long-term functional outcomes in paediatric traumatic brain injury (TBI). METHODS AND PROCEDURE Participants included 40 children with moderate-to-severe TBI discharged from inpatient rehabilitation. Measures of severity were initial Glasgow Coma Scale score, TFC, duration of Post Traumatic Amnesia (PTA) and total duration of impaired consciousness (TFC + PTA). Functional outcome was measured by age-corrected Functional Independence Measure for Children (WeeFIM®) scores at 1-year after discharge. RESULTS Correlations indicated that injury severity variables (TFC, PTA and TFC + PTA) were all associated with functional outcome. Regression analyses revealed that TFC and TFC + PTA similarly accounted for 49% or 47% of the variance, respectively, in total WeeFIM® score. Thirty-seven of 40 children had good outcome; of the three children with TFC >26 days, two had poor outcome. CONCLUSION PTA and TFC + PTA do not provide a benefit over TFC alone for prediction of long-term outcome and TFC is identified earlier in the recovery course. TFC remains an important predictor of functional outcome 1-year after discharge from inpatient rehabilitation after paediatric TBI.
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Affiliation(s)
- Cynthia A Austin
- Pediatric Rehabilitation, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205 USA
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Chitambira B. Novel use of optokinetic chart stimulation to restore muscle strength and mobility in patients with subdural haemorrhage: two case studies. Brain Inj 2013; 27:758-62. [PMID: 23611416 DOI: 10.3109/02699052.2013.775480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE The aim of these case studies is to report on the novel use of optokinetic chart stimulation to restore muscle strength and functional independence in severely disabled patients with subdural haemorrhage. METHODOLOGY An optokinetic chart was moved in front of the patient: from side to side, up and down and finally forwards and backwards. Once the patient could stand optokinetic chart stimulation was supplemented by sensory interaction for balance. RESULTS In first case study contractures in the knees improved from 90° short of full passive knee extension bilaterally to full active extension of the right knee joint and 25° short of full active extension of the left knee joint. The Barthel index improved from 0/20 to 18/20. In the second case study the Barthel Index improved from 0/20 to 18/20. From being bed bound the patients were independently mobile with a walking aid, on discharge. DISCUSSION With optokinetic chart stimulation leading to reversal of knee flexor contractures in one case and restoration of independent mobility in both cases, more research is needed to investigate use of optokinetic chart stimulation in patients with severe subdural haemorrhages and other traumatic brain injuries.
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Affiliation(s)
- Benjamin Chitambira
- Department of Physiotherapy, Richard Stevens Stroke Unit, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, UK.
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Dagher JH, Richard-Denis A, Lamoureux J, de Guise E, Feyz M. Acute global outcome in patients with mild uncomplicated and complicated traumatic brain injury. Brain Inj 2013; 27:189-99. [DOI: 10.3109/02699052.2012.729288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Jehane H. Dagher
- Physical Medicine and Rehabilitation Department, McGill University Health Centre-Montreal General Hospital,
Montreal, Quebec, Canada
- Physical Medicine and Rehabilitation Department, Institut de Readaptation Lindsay Gingras de Montreal,
| | - Andreane Richard-Denis
- Physical Medicine and Rehabilitation Department, Institut de Readaptation Lindsay Gingras de Montreal,
| | - Julie Lamoureux
- Social and Preventive Medicine Department, University of Montreal,
Montreal, Quebec, Canada
| | - Elaine de Guise
- Traumatic Brain Injury Program,
- Neurology and Neurosurgery Department, McGill University Health Centre-Montreal General Hospital,
Montreal, Quebec, Canada
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Springer BA. Ride 2 Recovery's Project HERO: using cycling as part of rehabilitation. Phys Ther Sport 2012; 14:77-86. [PMID: 23257397 DOI: 10.1016/j.ptsp.2012.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 11/09/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
Ride 2 Recovery was founded in 2008 by a former world-class cycling competitor and coach to enhance the physical and psychological recovery of our nation's wounded, ill and injured service members and veterans through the sport of cycling. Ride 2 Recovery's most notable endeavor is Project HERO (Healing Exercise Rehabilitation Opportunity) which uses staff members and volunteers to promote cycling as an integral part of rehabilitation at select military facilities to enhance physical, psychological, spiritual and social recovery. Project HERO is directed by a retired military physical therapist that spent the last decade caring for service men and women wounded in Iraq and Afghanistan. This article describes all facets of the Project HERO initiative and highlights the profound impact it has had in the lives of US military members and veterans.
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Vogl SM. Management of acute neurorehabilitation programs. Continuum (Minneap Minn) 2012; 17:617-29. [PMID: 22810871 DOI: 10.1212/01.con.0000399076.84814.a2] [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
Outcome management, performance improvement, evidence-based practice, and policy payment mechanisms are critical operational drivers at every level of health care delivery. It is essential that all health care providers involved in patient care have a working knowledge of health care operations, including the policies and reimbursement mechanisms that drive their particular clinical practice. Providing excellent patient care includes understanding health care policies, regulations, and outcomes that have a historical and current impact on health care delivery. Some of these factors include patient access, patient safety, and information measurement and management. Inpatient acute neurorehabilitation programs have standard outcome measures and a unique set of fiscal rules and regulations. This article discusses the most common variables and terms found in program evaluation systems for acute neurorehabilitation programs as well as some of the clinical and regulatory requirements and reimbursement and level-of-care considerations that are critical for neurorehabilitation health care practitioners. The current health care environment requires providers to understand and continually evaluate quality outcomes, patient access, and patient safety, all within the confines of an efficacy-based care delivery system.
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Wagner AK, Zitelli KT. A Rehabilomics focused perspective on molecular mechanisms underlying neurological injury, complications, and recovery after severe TBI. ACTA ACUST UNITED AC 2012; 20:39-48. [PMID: 22444246 DOI: 10.1016/j.pathophys.2012.02.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The molecular mechanisms underlying TBI pathophysiology and recovery are both complex and varied. Further, the pathology underlying many of the clinical sequelae observed in this population evolve over the acute injury period and encompass the subacute and chronic phases of recovery, supporting the contemporary concept that TBI is a chronic disease rather than a static insult from which limited recovery occurs. TBI related complications can also span from acute care to the very chronic stages of recovery that occur years after the initial trauma. Despite ongoing neurodegeneration, the TBI recovery period is also characterized by a propensity for neuroplasticity and rewiring through multiple mechanisms. This review summarizes key elements of acute pathophysiology, how they link to structural damage and ongoing degeneration, and how this process coincides with a permissive neuroplastic environment. The pathophysiology of selected TBI related complications is also discussed. Each of these concepts is studied through the lens of Rehabilomics, wherein an emphasis is placed on biomarker studies characterizing these pathophysiological mechanisms, and biomarker profiles are assessed in relation to multi-modal outcomes and susceptibility to rehabilitation relevant complications. In reviewing these concepts, implications for future research and theranostic principles for patient care are presented.
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Affiliation(s)
- Amy K Wagner
- Department of Physical Medicine and Rehabilitation, United States; Safar Center for Resuscitation Research, United States; Center for Neuroscience University of Pittsburgh, United States.
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Zampolini M, Zaccaria B, Tolli V, Frustaci A, Franceschini M, on behalf of GISCAR Group. Rehabilitation of traumatic brain injury in Italy: A multi-centred study. Brain Inj 2011; 26:27-35. [DOI: 10.3109/02699052.2011.635358] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Andelic N, Bautz-Holter E, Ronning P, Olafsen K, Sigurdardottir S, Schanke AK, Sveen U, Tornas S, Sandhaug M, Roe C. Does an early onset and continuous chain of rehabilitation improve the long-term functional outcome of patients with severe traumatic brain injury? J Neurotrauma 2011; 29:66-74. [PMID: 21864138 DOI: 10.1089/neu.2011.1811] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are currently no international guidelines regarding treatment in the early rehabilitation phase for persons with severe traumatic brain injury (TBI), and only a few studies have investigated the effect of integrating rehabilitation into acute TBI care. The aim of the study was to evaluate whether a continuous chain of rehabilitation that begins with the acute phase could improve the functional outcome of severe TBI patients, compared to a broken chain of rehabilitation that starts in the sub-acute phase of TBI. A total of 61 surviving patients with severe TBI were included in a quasi-experimental study conducted at the Level I trauma center in Eastern Norway. In the study, 31 patients were in the early rehabilitation group (Group A) and 30 patients were in the delayed rehabilitation group (Group B). The functional outcomes were assessed 12 months post-injury with the Glasgow Outcome Scale Extended (GOSE) and the Disability Rating Scale (DRS). A favorable outcome (GOSE 6-8) occurred in 71% of the patients from Group A versus 37% in Group B (p=0.007). The DRS score was significantly better in Group A (p=0.03). The ordinal logistic regression analysis was used to quantify the relationship between the type of rehabilitation chain and the GOSE. A better GOSE outcome was found in patients from Group A (unadjusted OR 3.25 and adjusted OR 2.78, respectively). These results support the hypothesis that better functional outcome occurs in patients who receive early onset and a continuous chain of rehabilitation.
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Affiliation(s)
- Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital Ulleval, Oslo, Norway.
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Cattran CJ, Oddy M, Wood RL, Moir JF. Post-injury personality in the prediction of outcome following severe acquired brain injury. Brain Inj 2011; 25:1035-46. [DOI: 10.3109/02699052.2011.607787] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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