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Carroll C, McCray S, Utter J. Feasibility of a Hospital-Based Kitchen Garden. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:10-18. [PMID: 38757685 DOI: 10.1177/19375867241250318] [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: 05/18/2024]
Abstract
AIM To explore the chef's experience with a newly implemented indoor hospital-based kitchen garden designed to supplement herbs ordered for patient meals and improve staff engagement. BACKGROUND Hospital-based therapeutic and kitchen gardens have emerged as effective health-promoting tools in hospital healthcare environments. They promote emotional, mental, and physical well-being for patients, visitors, and staff. However, formal evaluations are limited, and studies focusing on indoor hospital kitchen gardens are noticeably absent in the literature. METHODS Qualitative evaluation of a hospital-based kitchen garden. Open-ended interviews were conducted approximately 6 months after garden implementation and explored key informants (n = 6) overall experience, engagement with the garden, perceived benefits, and opportunities for improvement. Interview data was analyzed using a thematic approach. RESULTS The implementation of the kitchen gardens was met with overall acceptance among staff. However, the project's feasibility faced challenges related to local food service leadership, communication, and certain aspects of the garden setup. Despite these obstacles, the gardens contributed positively to the quality of meals by including fresh herbs and fostering greater staff engagement. CONCLUSIONS The chefs viewed the concept of the hospital-based kitchen garden favorably, noting that it closely aligned with their mission of providing nutritious meals to patients. However, consideration of the broader issues facing hospital food services may be required to seamlessly integrate this task into the kitchen staff's daily routine. Further research is warranted to investigate the effective implementation and feasibility of indoor kitchen gardens in hospitals and their impact on patient menus, food service staff, and the workforce.
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Affiliation(s)
- Chloe Carroll
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Sally McCray
- Mater Dietetics and Foodservice, Mater Health, South Brisbane, Queensland, Australia
| | - Jennifer Utter
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- Mater Dietetics and Foodservice, Mater Health, South Brisbane, Queensland, Australia
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Carroll C, Higgs J, McCray S, Utter J. Implementation and Impact of Health Care Gardens: A Systematic Scoping Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:431-449. [PMID: 38011751 DOI: 10.1089/jicm.2023.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background: In community and school settings, gardens and garden interventions have been shown to confer several psychosocial, physiological, and nutritional benefits. However, little is known about the implementation and impact of health care gardens on patients, visitors, and staff health and well-being. The primary aim of this review is to identify and describe the types of gardens and common design elements implemented in health care settings and the impact these gardens have on the health and well-being of patients, visitors, and staff. A secondary aim is to assess the quality of available evidence. Methods: PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched on October 28, 2022. Primary qualitative and quantitative studies (excluding case reports and studies) were eligible for inclusion if they described the types of gardens and common design elements implemented in health care settings (hospitals, aged care, rehabilitation facilities, and medical centers) and/or assessed the impact of garden interventions on the health and well-being of patients, visitors, and staff. Review, selection, and data extraction were conducted by two independent researchers, with findings synthesized and presented in narrative form. Articles were critically appraised using the mixed methods appraisal tool (MMAT). Results: Eighteen articles were included. Eight studies provided detailed descriptions of the types of gardens implemented in health care settings (healing [n = 3], therapeutic [n = 2], sensory [n = 2], children's fairy gardens [n = 1], and enriched [n = 1] gardens). Studies examining the psychosocial impacts of gardens were most frequently reported (n = 16), followed by physical (n = 4) and nutritional (n = 2). A wide range of positive outcomes, predominantly relating to patients (n = 12), were reported, including improvements in stress, quality of life (QOL), cognitive function, physical activity, and fruit and vegetable intake. The evidence was heterogeneous and low-medium quality. Conclusions: The findings suggest that implementing gardens and garden interventions in health care settings may positively impact the health and well-being of patients, visitors, and staff. Most studies related to the impact of gardens on patients' mental health and QOL, indicating the need for further research to explore physical and nutritional outcomes, as well as health outcomes of staff and visitors. Findings also suggest the need for high-quality study designs (e.g., cluster control trials) and standardized measurement tools.
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Affiliation(s)
- Chloe Carroll
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Jennifer Higgs
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Sally McCray
- Nutrition and Dietetics, Mater Health, South Brisbane, Australia
| | - Jennifer Utter
- Nutrition and Dietetics, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
- Nutrition and Dietetics, Mater Health, South Brisbane, Australia
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Abstract
Covert consciousness is a state of residual awareness following severe brain injury or neurological disorder that evades routine bedside behavioral detection. Patients with covert consciousness have preserved awareness but are incapable of self-expression through ordinary means of behavior or communication. Growing recognition of the limitations of bedside neurobehavioral examination in reliably detecting consciousness, along with advances in neurotechnologies capable of detecting brain states or subtle signs indicative of consciousness not discernible by routine examination, carry promise to transform approaches to classifying, diagnosing, prognosticating and treating disorders of consciousness. Here we describe and critically evaluate the evolving clinical category of covert consciousness, including approaches to its diagnosis through neuroimaging, electrophysiology, and novel behavioral tools, its prognostic relevance, and open questions pertaining to optimal clinical management of patients with covert consciousness recovering from severe brain injury.
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Affiliation(s)
- Michael J. Young
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian L. Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Yelena G. Bodien
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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Norwood MF, Lakhani A, Watling DP, Marsh CH, Zeeman H. Efficacy of Multimodal Sensory Therapy in Adult Acquired Brain Injury: A Systematic Review. Neuropsychol Rev 2023; 33:693-713. [PMID: 36056243 PMCID: PMC10769951 DOI: 10.1007/s11065-022-09560-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 07/12/2022] [Indexed: 10/14/2022]
Abstract
Adults who experience an acquired brain injury often experience disorders of consciousness, physical difficulties, and maladaptive behaviours. Multimodal sensory therapy may benefit brain injured patients, however the extent this therapy can facilitate rehabilitation is not well understood. This systematic review aimed to synthesize multimodal sensory therapy research for adults affected by acquired brain injury. PRISMA guidelines were followed and searches for work published up until July 2021 were undertaken in 5 databases, finding 1054 articles. 43 articles were included in the study. Results describe 29 studies related to coma following an acquired brain injury and 14 to no coma studies (mostly stroke). Multimodal sensory therapy was mostly used as a coma arousal technique following traumatic brain injury, finding positive effects. Multimodal sensory therapy was less applied in stroke, no coma rehabilitation, where most studies found improvement in somatosensory sensation and motor control in an affected limb. In several no coma studies, effects were maintained after several months. The most common senses stimulated in coma studies were audio (N = 30), tactile (N = 28), visual (N = 26), olfactory (N = 22), and gustatory (N = 17), while the most common senses stimulated in stroke, no coma studies were proprioception (N = 7), tactile (N = 8), and stereognosis (N = 4). Multimodal sensory therapy can be beneficial for patients, especially those in a minimally conscious state or attempting physical rehabilitation following stroke. Negative findings are infrequent in the current literature base. Multimodal sensory therapy appears to be a low-risk intervention with positive outcomes.
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Affiliation(s)
- Michael Francis Norwood
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, 4131, Australia.
| | - Ali Lakhani
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, 4131, Australia
- The School of Psychology and Public Health, La Trobe University, 360 Collins St, Melbourne, VIC, 3000, Australia
| | - David Phillip Watling
- Australian Institute for Suicide Research and Prevention, School of Applied Psychology, W.H.O Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Brisbane, 4122, Australia
| | - Chelsea Hannah Marsh
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, 4131, Australia
- School of Applied Psychology, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD, 4131, Australia
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Jöhr J, Martinez T, Marquis R, Bruce S, Binz PA, Rey S, Hafner G, Attwell C, Diserens K. Measuring Salivary Cortisol to Assess the Effect of Natural Environments on Stress Level in Acute Patients With Severe Brain Injuries: An Exploratory Study. Cureus 2023; 15:e44878. [PMID: 37814730 PMCID: PMC10560321 DOI: 10.7759/cureus.44878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Salivary cortisol is a safe and non-invasive measure of hypothalamic-pituitary-adrenal axis function and is used as a biomarker of the human stress response. Natural environments are recognized to contribute to help reduce the effect of stress. OBJECTIVE To determine the feasibility of a salivary cortisol collection protocol for acute severely brain-injured patients, and to explore the influence of exposure to natural settings on salivary cortisol concentration as an index of stress level. METHODS An exploratory study on 17 acute patients with severe brain injury was performed. We collected salivary samples in a closed hospital ward and a therapeutic garden at the start of the session and after 30 minutes of rest time. Physiological parameters, level of communication, and subjective well-being were also assessed. RESULTS The primary objectives regarding the feasibility of the protocol were met overall. We found no significant differences in cortisol values when including the whole population. However, cortisol values were significantly higher in the indoor environment in patients with communication attempts. CONCLUSIONS A salivary collection protocol with brain-injured patients in the acute phase is feasible and safe, and this type of measurement could pave the way for future research supporting the benefits of nature as an additional resource in their neurorehabilitation.
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Affiliation(s)
- Jane Jöhr
- Department of Clinical Neurosciences/Neurology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, CHE
| | - Tania Martinez
- Department of Clinical Neurosciences/Neurology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, CHE
| | - Renaud Marquis
- Department of Clinical Neurosciences/Neurology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, CHE
| | - Stephen Bruce
- Laboratory of Clinical Chemistry/Biomedicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, CHE
| | - Pierre-Alain Binz
- Laboratory of Clinical Chemistry/Biomedicine, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, CHE
| | - Sabine Rey
- Department of Clinical Neurosciences/Neurology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, CHE
| | - Gaël Hafner
- Department of Clinical Neurosciences/Neurology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, CHE
| | - Caroline Attwell
- Department of Clinical Neurosciences/Neurology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, CHE
| | - Karin Diserens
- Department of Clinical Neurosciences/Neurology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, CHE
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Attwell C, Sauterel L, Jöhr J, Piquilloud L, Kuntzer T, Diserens K. Early detection of ICU-acquired weakness in septic shock patients ventilated longer than 72 h. BMC Pulm Med 2022; 22:466. [PMID: 36474276 PMCID: PMC9724444 DOI: 10.1186/s12890-022-02193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE ICU-acquired weakness, comprising Critical Illness Polyneuropathy (CIP) and Myopathy (CIM) is associated with immobilization and prolonged mechanical ventilation. This study aims to assess feasibility of early detection of CIP and CIM by peroneal nerve test (PENT) and sensory sural nerve action potential (SNAP) screening in patients with septic shock and invasively ventilated for more than 72 h. METHODS We performed repetitive PENT screening from 72 h after intubation until detecting a pathological response. We tested SNAPs in pathological PENT to differentiate CIP from CIM. We performed muscle strength examination in awake patients and recorded time from intubation to first in-bed and out-of-bed mobilization. RESULTS Eighteen patients were screened with PENT and 88.9% had abnormal responses. Mean time between intubation and first screening was 94.38 (± 22.41) hours. Seven patients (38.9%) had CIP, two (11.1%) had CIM, one (5.6%) had CIP and CIM, six (33.3%) had a pathological response on PENT associated with ICU-acquired weakness (but no SNAP could be performed to differentiate between CIP and CIM) and two patients had (11.1%) had no peripheral deficit. In patients where it could be performed, muscle strength testing concorded with electrophysiological findings. Twelve patients (66.7%) had out-of-bed mobilization 10.8 (± 7.4) days after admission. CONCLUSION CIP and CIM are frequent in septic shock patients and can be detected before becoming symptomatic with simple bedside tools. Early detection of CIP and CIM opens new possibilities for their timely management through preventive measures such as passive and active mobilization.
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Affiliation(s)
- Caroline Attwell
- grid.8515.90000 0001 0423 4662Acute Neuro-Rehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurent Sauterel
- grid.8515.90000 0001 0423 4662Lausanne University Hospital, Lausanne, Switzerland
| | - Jane Jöhr
- grid.8515.90000 0001 0423 4662Acute Neuro-Rehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Lise Piquilloud
- grid.8515.90000 0001 0423 4662Adult Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Kuntzer
- grid.8515.90000 0001 0423 4662Nerve-Muscle Unit, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Karin Diserens
- grid.8515.90000 0001 0423 4662Acute Neuro-Rehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
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Lancioni GE, Singh NN, O'Reilly MF, Sigafoos J, Desideri L. Behavioral intervention approaches for people with disorders of consciousness: a scoping review. Disabil Rehabil 2022; 44:7677-7692. [PMID: 34613851 DOI: 10.1080/09638288.2021.1985634] [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: 01/18/2023]
Abstract
PURPOSE This review was intended to provide an overall picture of work conducted during the last decade to assess the impact of behavioral intervention strategies on people with disorders of consciousness (i.e., comatose state, vegetative state/unresponsive wakefulness, or minimally conscious state). The intervention strategies considered were those not based on music or including music as a component of the intervention package. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, a scoping review was carried out to identify and provide a synthesis of eligible studies published in English during the 2010-2021 period. Three databases (i.e., PubMed, PsycINFO, and Web of Science) were employed for the literature search. RESULTS Forty studies met the inclusion criteria. Those studies were grouped into three categories based on whether they assessed the effects of: (i) verbal stories/messages, (ii) multiple stimulation, and (iii) response-contingent stimulation. Then, a narrative synthesis of the studies of each of the three categories was provided to specify the types of patients involved, the intervention and assessment conditions implemented, and the outcome attained. CONCLUSIONS The evidence reported in most of the studies might be considered encouraging and convincing. Even so, it might be very difficult to view the evidence of the various studies cumulatively and make general/conclusive statements due to a number of differences in the intervention conditions applied.Implications for rehabilitationAn informative picture of the studies using behavioral interventions with people with disorders of consciousness is essential to any professional working in the area.Such picture can be highly useful in providing a view of the intervention strategies used for those people, of the variations existing within and across strategies, and of the evidence available.An analysis of the strategies, their implementation and their effects may provide new insights for improving those strategies and eventually increasing their impact.The individuals charged with the implementation process (e.g., family members or nurses) may have a relevant influence on the overall impact of the strategy.
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Affiliation(s)
- Giulio E Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Nirbhay N Singh
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Mark F O'Reilly
- Department of Special Education, University of Texas at Austin, Austin, TX, USA
| | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
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Music Stimulation for People with Disorders of Consciousness: A Scoping Review. Brain Sci 2021; 11:brainsci11070858. [PMID: 34203250 PMCID: PMC8301821 DOI: 10.3390/brainsci11070858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Music stimulation is considered to be a valuable form of intervention for people with severe brain injuries and prolonged disorders of consciousness (i.e., unresponsive wakefulness/vegetative state or minimally conscious state). This review was intended to provide an overall picture of work conducted during the last decade to assess the impact of music on behavioral and non-behavioral responses of people with disorders of consciousness. Following the PRISMA-ScR checklist, a scoping review was carried out to identify and provide a synthesis of eligible studies published in English during the 2010–2021 period. Three databases (i.e., PubMed, PsycINFO, and Web of Science) were employed for the literature search. Thirty-four studies met the inclusion criteria. Those studies were grouped into three categories based on whether they assessed the effects of: (i) recorded music, (ii) interactive music, or (iii) response-contingent music. A narrative synthesis of the studies of each of the three categories was eventually provided. While the studies of all three categories reported fairly positive/encouraging results, several methodological questions make it difficult to draw conclusions about those results and their implications for intervention programs in daily contexts.
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Giachero A, Quadrini A, Pisano F, Calati M, Rugiero C, Ferrero L, Pia L, Marangolo P. Procedural Learning through Action Observation: Preliminary Evidence from Virtual Gardening Activity in Intellectual Disability. Brain Sci 2021; 11:766. [PMID: 34207553 PMCID: PMC8226894 DOI: 10.3390/brainsci11060766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 12/23/2022] Open
Abstract
Intellectual disability (ID) compromises intellectual and adaptive functioning. People with an ID show difficulty with procedural skills, with loss of autonomy in daily life. From an embodiment perspective, observation of action promotes motor skill learning. Among promising technologies, virtual reality (VR) offers the possibility of engaging the sensorimotor system, thus, improving cognitive functions and adaptive capacities. Indeed, VR can be used as sensorimotor feedback, which enhances procedural learning. In the present study, fourteen subjects with an ID underwent progressive steps training combined with VR aimed at learning gardening procedures. All participants were trained twice a week for fourteen weeks (total 28 sessions). Participants were first recorded while sowing zucchini, then they were asked to observe a virtual video which showed the correct procedure. Next, they were presented with their previous recordings, and they were asked to pay attention and to comment on the errors made. At the end of the treatment, the results showed that all participants were able to correctly garden in a real environment. Interestingly, action observation facilitated, not only procedural skills, but also specific cognitive abilities. This evidence emphasizes, for the first time, that action observation combined with VR improves procedural learning in ID.
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Affiliation(s)
- Alberto Giachero
- Aphasia Experimental Laboratory-Fondazione Carlo Molo Onlus, 10121 Turin, Italy; (A.G.); (M.C.); (C.R.)
- Dipartimento di Psicologia, University of Turin, 10124 Turin, Italy;
| | | | - Francesca Pisano
- Dipartimento di Studi Umanistici, University Federico II, 80133 Naples, Italy;
| | - Melanie Calati
- Aphasia Experimental Laboratory-Fondazione Carlo Molo Onlus, 10121 Turin, Italy; (A.G.); (M.C.); (C.R.)
| | - Cristian Rugiero
- Aphasia Experimental Laboratory-Fondazione Carlo Molo Onlus, 10121 Turin, Italy; (A.G.); (M.C.); (C.R.)
| | - Laura Ferrero
- Fondazione Agape dello Spirito Santo Onlus-Villa Lauro, 10132 Turin, Italy;
| | - Lorenzo Pia
- Dipartimento di Psicologia, University of Turin, 10124 Turin, Italy;
| | - Paola Marangolo
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy;
- Dipartimento di Studi Umanistici, University Federico II, 80133 Naples, Italy;
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Zuo J, Tao Y, Liu M, Feng L, Yang Y, Liao L. The effect of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury: A systematic review and meta-analysis. Int J Nurs Stud 2020; 115:103846. [PMID: 33485101 DOI: 10.1016/j.ijnurstu.2020.103846] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sensory stimulation has been used in the early rehabilitation of comatose patients with traumatic brain injury, but the effect of sensory stimulation involving family members is unclear. OBJECTIVES To evaluate the effects of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury and explore the factors that affect the outcomes. DESIGN A systematic review with a meta-analysis. DATA SOURCES Electronic databases including PubMed, Web of Science, Google Scholar, Cochrane Library, CINAHL, China National Knowledge Infrastructure, and WanFang were searched from October 2019 to May 2020. REVIEW METHODS Two reviewers independently assessed eligibility of potential studies and extracted data. Quality of included studies was assessed according to the evaluation criteria of Cochrane Evaluation Manual 5.1.0. Outcome measures of the meta-analysis were the Glasgow Coma Scale scores, the Western Neuro Sensory Stimulation Profile scores, awakening time, and satisfaction rate. To explore whether there was a difference in the effect between variants of the intervention, variables as subgroups were time to start intervention, type of intervention, duration of each intervention, daily frequency of intervention, days of intervention, and patient's area. RESULT Seventeen randomized controlled trials were included in the review and meta-analysis. Most studies were of medium quality. The improvement of the Glasgow Coma Scale score is significantly greater with the intervention implemented within 24 h compared to the intervention implemented 24 h later (mean difference 3.91, 95% confidence interval 3.44-4.38 vs. mean difference 1.90, 95% confidence interval 1.69-2.12, respectively). The results of subgroup analyses show that auditory stimulation combined with tactile stimulation and multi-sensory stimulation are associated with better outcomes than a single use of auditory stimulation. Studies from Asia report more positive outcomes than those from America (mean difference 1.94, 95% confidence interval 1.73-2.16 vs. mean difference 0.44, 95% confidence interval -0.87-1.75). And the improvement of the Glasgow Coma Scale score with the stimulation performed by family members is greater than that with the stimulation implemented by nurses (mean difference 2.17, 95% confidence interval 1.67-2.66). Besides, it is associated with better awakening time, awakening rate, and satisfaction rate compared to routine care. CONCLUSION Early family-centered sensory and affective stimulation is more effective than routine care and nurse-implemented sensory stimulation in improving the level of consciousness and cognition of comatose patients with traumatic brain injury, and multi-sensory stimulation is more effective than single stimulation. More studies with larger sample size and high quality in different countries are warranted.
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Affiliation(s)
- Jiaojiao Zuo
- University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, PR China.
| | - Yanling Tao
- Department of Nursing, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, PR China.
| | - Min Liu
- University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, PR China.
| | - Li Feng
- Department of Nursing, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, PR China.
| | - Yang Yang
- University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, PR China.
| | - Limei Liao
- University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, PR China.
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Pincherle A, Jöhr J, Pancini L, Leocani L, Dalla Vecchia L, Ryvlin P, Schiff ND, Diserens K. Intensive Care Admission and Early Neuro-Rehabilitation. Lessons for COVID-19? Front Neurol 2020; 11:880. [PMID: 32982916 PMCID: PMC7477378 DOI: 10.3389/fneur.2020.00880] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/29/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) requires admission to intensive care (ICU) for the management of acute respiratory distress syndrome in about 5% of cases. Although our understanding of COVID-19 is still incomplete, a growing body of evidence is indicating potential direct deleterious effects on the central and peripheral nervous systems. Indeed, complex and long-lasting physical, cognitive, and functional impairments have often been observed after COVID-19. Early (defined as during and immediately after ICU discharge) rehabilitative interventions are fundamental for reducing the neurological burden of a disease that already heavily affects lung function with pulmonary fibrosis as a possible long-term consequence. In addition, ameliorating neuromuscular weakness with early rehabilitation would improve the efficiency of respiratory function as respiratory muscle atrophy worsens lung capacity. This review briefly summarizes the polymorphic burden of COVID-19 and addresses possible early interventions that could minimize the neurological and systemic impact. In fact, the benefits of early multidisciplinary rehabilitation after an ICU stay have been shown to be advantageous in several clinical conditions making an early rehabilitative approach generalizable and desirable to physicians from a wide range of different specialties.
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Affiliation(s)
- Alessandro Pincherle
- Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland
- Neurology Unit, Department of Medicine, Hopitaux Robert Schuman—Luxembourg, Luxembourg, Luxembourg
- Departments of Cardiac and Pulmonary Rehabilitation, IRCSS Istituto Clinico Scientifico Maugeri, Milan, Italy
| | - Jane Jöhr
- Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland
| | - Lisa Pancini
- Departments of Cardiac and Pulmonary Rehabilitation, IRCSS Istituto Clinico Scientifico Maugeri, Milan, Italy
| | - Letizia Leocani
- Department of Neuro-Rehabilitation, Hospital San Raffaele, University Vita Salute, Milan, Italy
| | - Laura Dalla Vecchia
- Departments of Cardiac and Pulmonary Rehabilitation, IRCSS Istituto Clinico Scientifico Maugeri, Milan, Italy
| | - Philippe Ryvlin
- Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland
| | - Nicholas D. Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
| | - Karin Diserens
- Acute Neuro-Rehabilitation Unit and Neurology Unit, Department of Clinical Neurosciences, Lausanne University Hospital-CHUV, Lausanne, Switzerland
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Jöhr J, Halimi F, Pasquier J, Pincherle A, Schiff N, Diserens K. Recovery in cognitive motor dissociation after severe brain injury: A cohort study. PLoS One 2020; 15:e0228474. [PMID: 32023323 PMCID: PMC7001945 DOI: 10.1371/journal.pone.0228474] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/16/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the functional and cognitive outcomes during early intensive neurorehabilitation and to compare the recovery patterns of patients presenting with cognitive motor dissociation (CMD), disorders of consciousness (DOC) and non-DOC. METHODS We conducted a single center observational cohort study of 141 patients with severe acquired brain injury, consecutively admitted to an acute neurorehabilitation unit. We divided patients into three groups according to initial neurobehavioral diagnosis at admission using the Coma Recovery Scale-Revised (CRS-R) and the Motor Behavior Tool (MBT): potential clinical CMD, [N = 105]; DOC [N = 19]; non-DOC [N = 17]). Functional and cognitive outcomes were assessed at admission and discharge using the Glasgow Outcome Scale, the Early Rehabilitation Barthel Index, the Disability Rating Scale, the Rancho Los Amigos Levels of Cognitive Functioning, the Functional Ambulation Classification Scale and the modified Rankin Scale. Confirmed recovery of conscious awareness was based on CRS-R criteria. RESULTS CMD patients were significantly associated with better functional outcomes and potential for improvement than DOC. Furthermore, outcomes of CMD patients did not differ significantly from those of non-DOC. Using the CRS-R scale only; approximatively 30% of CMD patients did not recover consciousness at discharge. INTERPRETATION Our findings support the fact that patients presenting with CMD condition constitute a separate category, with different potential for improvement and functional outcomes than patients suffering from DOC. This reinforces the need for CMD to be urgently recognized, as it may directly affect patient care, influencing life-or-death decisions.
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Affiliation(s)
- Jane Jöhr
- Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland
- * E-mail:
| | - Floriana Halimi
- Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Alessandro Pincherle
- Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland
| | - Nicholas Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, United States of America
| | - Karin Diserens
- Department of Clinical Neurosciences, Neurology Service, Acute Neurorehabilitation Unit, University Hospital Lausanne, Lausanne, Switzerland
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