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Bassingthwaighte L, Gustafsson L, Molineux M, Bell R, Pinzon Perez W, Shah D. On-road driving remediation following acquired brain injury: a randomized controlled trial. Brain Inj 2024:1-12. [PMID: 38994668 DOI: 10.1080/02699052.2024.2376763] [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: 02/10/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To investigate the relationship between on-road driving remediation and achieving fitness to drive following acquired brain injury. DESIGN Randomized controlled trial. SETTING Tertiary hospital outpatient driver assessment and rehabilitation service, Australia. PARTICIPANTS Thirty-five participants (54.3% male), aged 18-65 years, 41 days-20 years post-acquired brain injury (including stroke, aneurysm, traumatic brain injury) recommended for on-road driving remediation following occupational therapy driver assessment were randomly assigned to intervention (n = 18) and waitlist control (n = 17) groups. INTERVENTION Intervention group received on-road driving remediation delivered by a qualified driving instructor in a dual-control vehicle. The waitlist control group completed a 6 week period of no driving-related remediation. MAIN MEASURE Fitness to drive rated following the conduct of an on-road occupational therapy driver assessment with a qualified driving instructor where outcome assessors were blinded to group allocation. RESULTS The intervention group were significantly more likely to achieve a fit to drive recommendation than no driving specific intervention (p = 0.003). CONCLUSION Following comprehensive assessment, individualized on-road driving remediation programs devised by an occupational therapist with advanced training in driver assessment and rehabilitation and delivered by a qualified driving instructor are significantly associated with achieving fitness to drive after acquired brain injury.
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Affiliation(s)
- Louise Bassingthwaighte
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Driving Assessment and Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Matthew Molineux
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Ryan Bell
- Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia
- The Hopkins Centre, Menzies Health Institute of Queensland, Griffith University, Brisbane, Australia
| | - William Pinzon Perez
- QCIF Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Darshan Shah
- Department of Internal Medicine, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, Griffith University, Nathan, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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2
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Corrigan F, Wee IC, Collins-Praino LE. Chronic motor performance following different traumatic brain injury severity-A systematic review. Front Neurol 2023; 14:1180353. [PMID: 37288069 PMCID: PMC10243142 DOI: 10.3389/fneur.2023.1180353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/05/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) is now known to be a chronic disease, causing ongoing neurodegeneration and linked to increased risk of neurodegenerative motor diseases, such as Parkinson's disease and amyotrophic lateral sclerosis. While the presentation of motor deficits acutely following traumatic brain injury is well-documented, however, less is known about how these evolve in the long-term post-injury, or how the initial severity of injury affects these outcomes. The purpose of this review, therefore, was to examine objective assessment of chronic motor impairment across the spectrum of TBI in both preclinical and clinical models. Methods PubMed, Embase, Scopus, and PsycINFO databases were searched with a search strategy containing key search terms for TBI and motor function. Original research articles reporting chronic motor outcomes with a clearly defined TBI severity (mild, repeated mild, moderate, moderate-severe, and severe) in an adult population were included. Results A total of 97 studies met the inclusion criteria, incorporating 62 preclinical and 35 clinical studies. Motor domains examined included neuroscore, gait, fine-motor, balance, and locomotion for preclinical studies and neuroscore, fine-motor, posture, and gait for clinical studies. There was little consensus among the articles presented, with extensive differences both in assessment methodology of the tests and parameters reported. In general, an effect of severity was seen, with more severe injury leading to persistent motor deficits, although subtle fine motor deficits were also seen clinically following repeated injury. Only six clinical studies investigated motor outcomes beyond 10 years post-injury and two preclinical studies to 18-24 months post-injury, and, as such, the interaction between a previous TBI and aging on motor performance is yet to be comprehensively examined. Conclusion Further research is required to establish standardized motor assessment procedures to fully characterize chronic motor impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols. Longitudinal studies investigating the same cohort over time are also a key for understanding the interaction between TBI and aging. This is particularly critical, given the risk of neurodegenerative motor disease development following TBI.
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Affiliation(s)
- Frances Corrigan
- Head Injury Lab, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Ing Chee Wee
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Lyndsey E. Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
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Cognitive Deficits among Individuals Admitted to a Post-Acute Pneumological Rehabilitation Unit in Southern Italy after COVID-19 Infection. Brain Sci 2023; 13:brainsci13010084. [PMID: 36672066 PMCID: PMC9857316 DOI: 10.3390/brainsci13010084] [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: 11/22/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
(1) Background: We investigated the differences in the neuropsychological profile as well as the pneumological and motor functions in two groups of patients admitted to rehabilitation who received different respiratory support during their COVID-19 infection. (2) Methods: Group-1 (n = 18; 15 male, median age 67.5) consisted of patients who received non-invasive mechanical ventilation; Group-2 (n = 19; 16 male, median age 63) consisted of patients who received invasive mechanical ventilation. All patients underwent a neuropsychological assessment including Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and the Repeatable Battery for the Assessment of Neuropsychological Status (R-BANS) to evaluate the patients' cognition. Depression and anxiety were also measured at admission and discharge to rehabilitation. (3) Results: At admission, patients impaired at MMSE were 44% in Group-1 and 5% in Group-2, while patients impaired at FAB were 88% in Group-1 and 26% in Group-2. Wilcoxon's effect size revealed meaningful differences between groups for FAB, R-BANS global score, immediate and delayed memory, and attention-coding task, with Group-2 performing better than Group-1 across all measures. At discharge, 52% of the 25 patients re-assessed still had mild to moderate cognitive deficits, while 19% had depression and 35% had anxiety. (4) Conclusions: Patients who received oxygen therapy experienced higher levels of acute and chronic stress compared to those who benefitted from invasive mechanical ventilation. Despite patients showing a meaningful improvement at discharge, cognitive impairment persisted in a great number of patients; therefore, long-term neuropsychological follow-up and treatment for COVID-19 patients are recommended.
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Alhasani R, Godbout M, Durand A, Auger C, Lamontagne A, Ahmed S. Informing the development of an outcome set and banks of items to measure mobility among individuals with acquired brain injury using natural language processing. BMC Neurol 2022; 22:464. [PMID: 36494770 PMCID: PMC9733317 DOI: 10.1186/s12883-022-02938-1] [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: 03/17/2021] [Accepted: 10/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The sheer number of measures evaluating mobility and inconsistencies in terminology make it challenging to extract potential core domains and items. Automating a portion of the data synthesis would allow us to cover a much larger volume of studies and databases in a smaller fraction of the time compared to the usual process. Thus, the objective of this study was to identify a comprehensive outcome set and develop preliminary banks of items of mobility among individuals with acquired brain injury (ABI) using Natural Language Processing (NLP). METHODS An umbrella review of 47 reviews evaluating the content of mobility measures among individuals with ABI was conducted. A search was performed on 5 databases between 2000 and 2020. Two independent reviewers retrieved copies of the measures and extracted mobility domains and items. A pre-trained BERT model (state-of-the-art model for NLP) provided vector representations for each sentence. Using the International Classification of Functioning, Disability, and Health Framework (ICF) ontology as a guide for clustering, a k-means algorithm was used to retrieve clusters of similar sentences from their embeddings. The resulting embedding clusters were evaluated using the Silhouette score and fine-tuned according to expert input. RESULTS The study identified 246 mobility measures, including 474 domains and 2109 items. Encoding the clusters using the ICF ontology and expert knowledge helped in regrouping the items in a way that is more closely related to mobility terminology. Our best results identified banks of items that were used to create a 24 comprehensive outcome sets of mobility, including Upper Extremity Mobility, Emotional Function, Balance, Motor Control, Self-care, Social Life and Relationships, Cognition, Walking, Postural Transition, Recreation, and Leisure Activities, Activities of Daily Living, Physical Functioning, Communication, Work/Study, Climbing, Sensory Functions, General Health, Fatigue, Functional Independence, Pain, Alcohol and Drugs Use, Transportation, Sleeping, and Finances. CONCLUSION The banks of items of mobility domains represent a first step toward establishing a comprehensive outcome set and a common language of mobility to develop the ontology. It enables researchers and healthcare professionals to begin exposing the content of mobility measures as a way to assess mobility comprehensively.
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Affiliation(s)
- Rehab Alhasani
- grid.14709.3b0000 0004 1936 8649School of Physical and Occupation Therapy, Faculty of Medicine, McGill University, 3655 Sir William-Osler, Montreal, QC H3G 1Y6 Canada ,grid.420709.80000 0000 9810 9995Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec Canada ,grid.449346.80000 0004 0501 7602Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mathieu Godbout
- grid.23856.3a0000 0004 1936 8390Université Laval, Laval, Quebec, Canada
| | - Audrey Durand
- grid.23856.3a0000 0004 1936 8390Université Laval, Laval, Quebec, Canada ,Mila - Quebec Artificial Intelligent Institute, Montreal, Quebec Canada
| | - Claudine Auger
- grid.420709.80000 0000 9810 9995Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec Canada ,grid.14848.310000 0001 2292 3357School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec Canada ,grid.459278.50000 0004 4910 4652Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Quebec Canada
| | - Anouk Lamontagne
- grid.14709.3b0000 0004 1936 8649School of Physical and Occupation Therapy, Faculty of Medicine, McGill University, 3655 Sir William-Osler, Montreal, QC H3G 1Y6 Canada ,grid.420709.80000 0000 9810 9995Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec Canada ,grid.414993.20000 0000 8928 6420Jewish Rehabilitation Hospital, CISSS de Laval, Laval, Quebec Canada
| | - Sara Ahmed
- grid.14709.3b0000 0004 1936 8649School of Physical and Occupation Therapy, Faculty of Medicine, McGill University, 3655 Sir William-Osler, Montreal, QC H3G 1Y6 Canada ,grid.420709.80000 0000 9810 9995Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec Canada ,grid.63984.300000 0000 9064 4811McGill University Health Center Research Institute, Clinical Epidemiology, Center for Outcome Research and Evaluation, Montreal, Quebec Canada ,grid.459278.50000 0004 4910 4652Constance Lethbridge Rehabilitation Center, CIUSSS Centre- Ouest de l’Îile de Montreal, Montreal, Quebec Canada
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Huertas-Hoyas E, Rojo-Mota G, Carretero-Serrano Y, Martínez-Piédrola RM, Pérez-de-Heredia-Torres M, Camacho-Montaño LR, Pedrero-Pérez EJ. Clinical validation of the Allen's Cognitive Level Screen in acquired brain injury. Brain Inj 2022; 36:775-781. [PMID: 35446745 DOI: 10.1080/02699052.2022.2065031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND The evaluation of functional cognition is a central concern in clinical practice. However, there are few standardized or validated tools, and many of them take too long, requiring screening tests. AIMS To explore the convergent validity of the ACLS-5 with other cognitive screening test and functional independence test in a sample of people with acquired brain injury. Moreover, to examine the prediction of ACLS-5 on functioning and cognitive performance outcomes. MATERIALS AND METHODS A cross-sectional design was applied following the guidelines of the STROBE checklist. A consecutive sample of people with acquired brain injury was recruited from rehabilitation centers. A cognitive screening test and daily living activity tests were implemented, such as ACLS-5, MoCA, Barthel, and FIM+FAM. Data were analyzed using non-parametric methods. In addition, a structural analysis and simple regression models were performed. RESULTS Eighty patients with chronic acquired brain injury, with a mean age of 52, were recruited. All tests are significantly related to the ACLS-5 score, a moderate effect size for MoCA (ρ = 0.36), and a strong effect size for the other two (ρ > 0.50). CONCLUSIONS ACLS-5 predicts functional and cognitive performance quickly and effectively, optimizing assessment time and avoiding mental fatigue or physical exhaustion.
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Affiliation(s)
- Elisabet Huertas-Hoyas
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Alcorcón, Spain
| | - Gloria Rojo-Mota
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Alcorcón, Spain
| | | | - Rosa Mª Martínez-Piédrola
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Alcorcón, Spain
| | - Marta Pérez-de-Heredia-Torres
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Alcorcón, Spain
| | - Lucia Rocío Camacho-Montaño
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Rey Juan Carlos University, Alcorcón, Spain
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Alhasani R, Auger C, Paiva Azevedo M, Ahmed S. Quality of mobility measures among individuals with acquired brain injury: an umbrella review. Qual Life Res 2022; 31:2567-2599. [PMID: 35275377 PMCID: PMC9356944 DOI: 10.1007/s11136-022-03103-4] [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] [Accepted: 02/01/2022] [Indexed: 11/13/2022]
Abstract
Background and objective While several mobility measures exist, there is large variability across measures in how mobility is conceptualized, the source of information and the measurement properties making it challenging to select relevant mobility measures for individuals with acquired brain injury (ABI). Therefore, the objective was to conduct a comprehensive synthesis of existing evidence on the measurement properties, the interpretability and the feasibility of mobility measures from various sources of information (patients, clinicians, technology) using an umbrella review of published systematic reviews among individuals with ABI. Methods Ovid MEDLINE, CINHAL, Cochrane Library and EMBASE electronic databases were searched from 2000 to March 2020. Two independent reviewers appraised the methodological quality of the systematic reviews using the Joanna Briggs Institute critical appraisal checklist. Measurement properties and quality of evidence were applied according to COnsensus-based Standards for the Selection of Health Measurement Instrument (COSMIN) guidelines. Mobility measures were categorized using international standards with the international classification of functioning, disability and health (ICF). Results Thirty-five systematic reviews were included covering 147 mobility measures, of which 85% were mapped to the ICF Activity and Participation component. Results showed an acceptable overall "sufficient" rating for reliability, construct validity and responsiveness for 132 (90%), 127 (86%) and 76 (52%) of the measures, respectively; however, among these measures, ≤ 25% of the methods for evaluating these properties were rated as ‘high’ quality of evidence. Also, there was limited information that supports measure feasibility and scoring interpretability. Conclusions Future systematic reviews should report measures’ content validity to support the use of the measure in clinical care and research. More evaluations of the minimal important difference and floor and ceiling effects are needed to help guide clinical interpretation. Registration information International Prospective Register of Systematic Reviews (PROSPERO); ID: CRD42018100068. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03103-4.
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Affiliation(s)
- Rehab Alhasani
- School of Physical and Occupation Therapy, Faculty of Medicine, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Claudine Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada.,Site Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Matheus Paiva Azevedo
- School of Physical and Occupation Therapy, Faculty of Medicine, McGill University, Montreal, Canada
| | - Sara Ahmed
- School of Physical and Occupation Therapy, Faculty of Medicine, McGill University, Montreal, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada. .,Constance Lethbridge Rehabilitation Center, CIUSSS Centre-Ouest de l'Île de Montreal, Montreal, Canada.
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Bassingthwaighte L, Gustafsson L, Molineux M. On-road driving remediation following acquired brain injury: a scoping review. Brain Inj 2022; 36:239-250. [DOI: 10.1080/02699052.2022.2033837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Louise Bassingthwaighte
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Queensland, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, The Hopkins Centre, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
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Ahmed S, Archambault P, Auger C, Durand A, Fung J, Kehayia E, Lamontagne A, Majnemer A, Nadeau S, Pineau J, Ptito A, Swaine B. Biomedical Research & Informatics Living Laboratory for Innovative Advances of New Technologies in Community Mobility Rehabilitation: Protocol for a longitudinal evaluation of mobility outcomes (Preprint). JMIR Res Protoc 2022; 11:e12506. [PMID: 35648455 PMCID: PMC9201706 DOI: 10.2196/12506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/02/2022] [Indexed: 01/23/2023] Open
Abstract
Background Rapid advances in technologies over the past 10 years have enabled large-scale biomedical and psychosocial rehabilitation research to improve the function and social integration of persons with physical impairments across the lifespan. The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies (BRILLIANT) in community mobility rehabilitation aims to generate evidence-based research to improve rehabilitation for individuals with acquired brain injury (ABI). Objective This study aims to (1) identify the factors limiting or enhancing mobility in real-world community environments (public spaces, including the mall, home, and outdoors) and understand their complex interplay in individuals of all ages with ABI and (2) customize community environment mobility training by identifying, on a continuous basis, the specific rehabilitation strategies and interventions that patient subgroups benefit from most. Here, we present the research and technology plan for the BRILLIANT initiative. Methods A cohort of individuals, adults and children, with ABI (N=1500) will be recruited. Patients will be recruited from the acute care and rehabilitation partner centers within 4 health regions (living labs) and followed throughout the continuum of rehabilitation. Participants will also be recruited from the community. Biomedical, clinician-reported, patient-reported, and brain imaging data will be collected. Theme 1 will implement and evaluate the feasibility of collecting data across BRILLIANT living labs and conduct predictive analyses and artificial intelligence (AI) to identify mobility subgroups. Theme 2 will implement, evaluate, and identify community mobility interventions that optimize outcomes for mobility subgroups of patients with ABI. Results The biomedical infrastructure and equipment have been established across the living labs, and development of the clinician- and patient-reported outcome digital solutions is underway. Recruitment is expected to begin in May 2022. Conclusions The program will develop and deploy a comprehensive clinical and community-based mobility-monitoring system to evaluate the factors that result in poor mobility, and develop personalized mobility interventions that are optimized for specific patient subgroups. Technology solutions will be designed to support clinicians and patients to deliver cost-effective care and the right intervention to the right person at the right time to optimize long-term functional potential and meaningful participation in the community. International Registered Report Identifier (IRRID) PRR1-10.2196/12506
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Affiliation(s)
- Sara Ahmed
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Lethbridge-Layton-Mackay, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, McGill University Health Center Research Institute, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Philippe Archambault
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Claudine Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Audrey Durand
- Computer Science and Software Engineering Department, Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Eva Kehayia
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Jewish Rehabilitation Hospital, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, McGill University Health Center Research Institute, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Sylvie Nadeau
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Joelle Pineau
- School of Computer Science, McGill University, Montreal, QC, Canada
| | - Alain Ptito
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University Health Centre Research Institute, Montreal, QC, Canada
| | - Bonnie Swaine
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
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Samuelkamaleshkumar S, Reethajanetsureka S, Elango A, Padankatti SM, John JA, George J, Thomas R. Community reintegration of people with traumatic brain injury in south India: role of a comprehensive transdisciplinary rehabilitation programme. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2020.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Successful community reintegration is the ultimate goal of traumatic brain injury rehabilitation and care. The aim of this study was to explore the community reintegration of people with a traumatic brain injury living in south India who had completed a comprehensive holistic rehabilitation programme. The level of community reintegration based on the demographic variables of the patients was also investigated. Methods A total of 104 community-dwelling people with a traumatic brain injury, and a minimum of 1 year post injury, received treatment from a rehabilitation team in a therapeutic centre for 7 hours a day, 6 days a week for a maximum of 16 weeks. A usual care, transdisciplinary service delivery model was implemented, and the Craig Handicap Assessment and Reporting Technique was used to quantify the main outcome measures. Results The mean and standard deviation scores for each Craig Handicap Assessment and Reporting Technique domain were physical independence (91 ± 23), social integration (87 ± 20), cognitive independence (70 ± 33), economic self-sufficiency (67 ± 40), occupation (66 ± 40) and mobility (63 ± 29). The participants who had gone back to work after their traumatic brain injury showed significantly higher scores in all the domains of the Craig Handicap Assessment and Reporting Technique than those who were unemployed. Only the occupation and mobility domain scores were influenced by the severity of the traumatic brain injury. The economic self-sufficiency, occupation and mobility domain scores were higher among married patients compared to those who were unmarried. Conclusions A significant proportion of the participants were able to return to work and reintegrate into community life through this service delivery model. This comprehensive, holistic approach, which targets physical, cognitive and psychosocial needs and then provides adequate vocational rehabilitation, can result in good outcomes in people with a traumatic brain injury.
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Affiliation(s)
- Selvaraj Samuelkamaleshkumar
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Stephen Reethajanetsureka
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Arumugam Elango
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Sanjeev M Padankatti
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Judy Ann John
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Jacob George
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
| | - Raji Thomas
- Department of Physical Medicine and Rehabilitation Christian Medical College, Dr. Mary Verghese Rehabilitation Institute, Vellore, India
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Alhasani R, Radman D, Auger C, Lamontagne A, Ahmed S. Clinicians and individuals with acquired brain injury perspectives about factors that influence mobility: creating a core set of mobility domains among individuals with acquired brain injury. Ann Med 2021; 53:2365-2379. [PMID: 34894914 PMCID: PMC8676689 DOI: 10.1080/07853890.2021.2015539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To identify factors which may influence mobility and could be considered during the evaluation of mobility in individuals with acquired brain injury (ABI) following qualitative focus groups with both clinicians and individuals with ABI, to assess their needs and preferences in order to individualize their care management plans. METHODS Five focus groups were held, three with clinicians from 3 rehabilitation sites of CRIR (CRDM: n = 4; IURDPM: n = 3; JRH: n = 10) and two with individuals with ABI from one rehabilitation site (CRDM) (individuals with stroke: n = 5; individuals with TBI: n = 5). Focus group discussions were transcribed and analyzed using inductive and deductive thematic content approaches. RESULTS Four themes were identified: considering mobility holistically and individual needs, preferences, and unique experiences; assessment and intervention guidelines; support network; and uncertainty about symptoms and recovery. Using the ten-rule International Classification, Functioning, Disability, and Health framework linking process, codes were categorized into Body Functions Activity and Participation, and Environmental Factors exploring the prominent domains that mostly identify factors influencing mobility. CONCLUSIONS Comprehensive measurement of mobility remains an ongoing challenge owing to multiple contributing factors, ranging from personal and psychosocial factors to the influence of a myriad of environmental and community considerations. Preparing individuals with ABI for community mobility can be substantially improved if healthcare professionals employ communicative tools to facilitate shared decision making with patients and to deliver patient-centred rehabilitation care.
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Affiliation(s)
- Rehab Alhasani
- Faculty of Medicine, School of Physical and Occupation Therapy, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Dennis Radman
- Faculty of Medicine, School of Physical and Occupation Therapy, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Claudine Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Canada
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Anouk Lamontagne
- Faculty of Medicine, School of Physical and Occupation Therapy, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Jewish Rehabilitation Hospital, CISSS de Laval, Laval, Canada
| | - Sara Ahmed
- Faculty of Medicine, School of Physical and Occupation Therapy, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Constance Lethbridge Rehabilitation Center, CIUSSS Centre-Ouest de l'Îile de Montreal, Montreal, Canada
- McGill University Health Center Research Institute, Clinical Epidemiology, Center for Outcome Research and Evaluation (CORE), Montreal, Canada
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11
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Hadgu RM, Borghol A, Gillard C, Wilson C, Elqess Mossa S, McKay M, Jastram C, Onor IO. Evaluation of Outcomes in Patients Receiving Amantadine to Improve Alertness After Traumatic Brain Injury. Hosp Pharm 2021; 56:486-494. [PMID: 34720150 DOI: 10.1177/0018578720920803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Amantadine has been used off-label to improve alertness after traumatic brain injury (TBI). The goal of this study is to assess the mean change at 72 hours and in course of therapy (COT) Glasgow Coma Scale (GCS) score after amantadine initiation and to correlate the change in GCS score with participation in physical therapy (PT) and occupational therapy (OT) among patients with TBI receiving amantadine during the first hospitalization. Methods: This single-center, retrospective, cohort study included patients ≥18 years old hospitalized for a TBI from August 2012 to February 2018 and received ≥1 dose of amantadine to increase alertness. The primary endpoint is the mean change in 72-hour GCS score after amantadine initiation. The secondary endpoint is the mean change in COT GCS score after amantadine initiation and the correlation between the change in GCS score and percent PT and OT participation at 72 hours and during the COT. Results: Seventy-nine patients were included. The mean age of patients was 41 years, and 79.8% of the patients were men. The mean change in 72-hour GCS score was +0.75 (95% confidence interval [CI] = 0.09-1.42, P = .027), and the mean change in COT GCS score was +2.29 (95% CI = 1.68-2.90, P < .001). There was no significant correlation between the increase in GCS score and percent PT/OT session participation at 72 hours and during the COT, r = -0.15 (P = .24) and r = -0.02 (P = .74), respectively. The percent PT/OT session participation at 72-hour post-amantadine initiation was 61.3% compared with 65.9% during the COT. Conclusion: There were small but statistically significant increases in the mean change at 72 hours and in COT GCS score; however, they were not correlated with percent PT/OT participation. Other studies are needed to determine the appropriate time and GCS score to initiate amantadine along with the optimal dose in the inpatient setting.
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Affiliation(s)
- Rim M Hadgu
- Xavier University of Louisiana, New Orleans, USA.,Midwestern University, Glendale, AZ, USA
| | - Amne Borghol
- Xavier University of Louisiana, New Orleans, USA
| | | | | | | | - Megan McKay
- Xavier University of Louisiana, New Orleans, USA
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12
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Afsar M, Shukla D, Bhaskarapillai B, Rajeswaran J. Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India. J Neurosci Rural Pract 2021; 12:295-301. [PMID: 33927520 PMCID: PMC8064862 DOI: 10.1055/s-0041-1722817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective
Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI.
Materials and Methods
The present single-group intervention study with a pre–post design included 12 patients diagnosed with moderate to severe TBI within 3–24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale—Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention.
Statistical Analysis
Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test.
Results
The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved.
Conclusion
CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.
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Affiliation(s)
- Mohammed Afsar
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Binukumar Bhaskarapillai
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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13
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Manee FS, Nadar MS, Alotaibi NM, Rassafiani M. Cognitive Assessments Used in Occupational Therapy Practice: A Global Perspective. Occup Ther Int 2020; 2020:8914372. [PMID: 32934613 PMCID: PMC7471821 DOI: 10.1155/2020/8914372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/22/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022] Open
Abstract
This exploratory study was aimed at evaluating the current status of global occupational therapy practice on the use of assessments for clients with cognitive impairments and providing recommendations for ongoing evidence. We targeted international occupational therapy clinicians working with clients experiencing neurocognitive impairments. 323 occupational therapists from a wide range of clinical practice areas participated in the study. A large number of therapists used noncognitive specific assessments with a focus on functional approaches. The most commonly used standardized assessments were the COPM (56.7%), followed by MMSE (54.2%) and MoCA (45.5%), while the nonstandardized assessments were clinical observation (38.4%) and generic ADL assessment (34.1%). The use of main assessments was significantly different across world regions (p < 0.05), as were the reasons for choosing them (p < 0.05). The occupational therapists' use of assessment tools with clients suffering from neurocognitive impairments is inconsistent across the globe. The identification of international best practices for selecting and implementing proper outcome measures is warranted. It is essential to promote the development of an occupational therapy initiative to support the use of appropriate assessments at the international levels to facilitate consistent best practice.
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Affiliation(s)
- Fahad S. Manee
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Mohammed Shaban Nadar
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Naser M. Alotaibi
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Mehdi Rassafiani
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait
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14
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Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients With Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100:1274-1282. [DOI: 10.1016/j.apmr.2018.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023]
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