摘要:

Objective:To evaluate the sensitivity of three recently developed questionnaires to mild traumatic brain injury (MTBI)-related effects.Design:Comparison of an MTBI group, within 3 weeks of injury, to a normal control group.Setting:Outpatient rehabilitation clinic.Subjects:120 MTBI patients and 120 age, education, sex, and preinjury socioeconomic status-matched normal control subjects.Main outcome measures:The Problem Checklist (PCL) from the New York Head Injury Family Interview to assess MTBI symptoms, the Short Form-36 Health Survey (SF-36) to assess functional burden associated with health problems, and the Community Integration Questionnaire (CIQ) to assess home, social, and productive activities.Results:Patients' self-ratings on the PCL and SF-36, but not the CIQ, were generally worse than those of the normal controls. The largest differences were obtained on SF-36 measures that appear to assess musculoskeletal injury effects.Conclusions:The PCL and SF-36 show promise as sensitive measures of MTBI-related effects. The SF-36 may be particularly useful in evaluating associated musculoskeletal injuries, which might otherwise be overlooked by MTBI health care providers.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To determine the relationship among neuropsychological variables, vocational outcomes, and vocational costs for Missouri Division of Vocational Rehabilitation (MO-DVR) clients with traumatic brain injury (TBI).Design:Clients referred for neuropsychological evaluations were followed until DVR case closure. Subjects were grouped according to the following DVR status at case closure: Successfully Employed, Services Interrupted, and No Services Provided. Spearman correlations with Bonferroni corrections were calculated to determine relationships among variables, and Kruskal-Wallis nonparametric one-way analyses of variance (ANOVAs) were conducted to evaluate differences in DVR group status in terms of neuropsychological variables and DVR costs.Setting:All evaluations were completed through a Midwestern university neuropsychology laboratory.Patients:110 consecutively referred DVR clients with nonacute TBI referred for neuropsychological evaluation.Main outcome measures:Absolute level (ie, raw/standard scores) of neuropsychological functioning and relative degree of decline in: intelligence (WAIS-R), memory (WMS-R General and Delayed Memory Indices), attention (WMS-R Attention Index), speed of processing (Trails A), and cognitive flexibility (Trails B); DVR costs at closure.Results:1) Surprisingly, the Successfully Employed group had significantly greater neuropsychological impairments; 2) Greater decline in delayed memory was associated with higher DVR costs (r= −0.30,P< .05); and 3) More indices of relative decline were significantly correlated with vocational outcomes (5/6) than were indices of absolute functioning (3/6).Conclusions:DVR is effective in providing services to individuals with the most significant neuropsychological deficits; it is important to consider both absolute level of functioning and relative decline in functioning when evaluating TBI.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objectives:(a) To design and pilot a culturally sensitive and neuropsychologically informed support group addressing barriers to emotional, social, and vocational adjustment among high-level functioning Hispanic/Latino TBI survivors. (b) To determine efficacy through outcome measures.Intervention:Ten-week multimodal, culturally sensitive support group focusing on TBI sequelae education, relaxation techniques, coping skills development, behavioral goal setting and monitoring, and family participation.Participants:Six Spanish-speaking high-level functioning TBI survivors aged 20–42.Setting:Outpatient neuropsychological assessment and treatment center.Outcome measures:Beck Hopelessness Scale; Purpose in Life Test; Perceived Self-Regulatory Ability Inventory.Results:Participants' sense of personal destiny and feelings of hopelessness improved, as evidenced by objective measures and self-report. A telephone interview a year later indicated that gains had been maintained, and most participants were vocationally active.Conclusions:Results underscore the importance of considering linguistic and ethnic factors in developing support groups.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To assess the relationship between the Functional Independence Measure (FIM) and the Functional Assessment Measure (FAM), and community integration and return to work in patients with severe traumatic brain injuries (TBI).Design:A cross-sectional, prospective design was used to collect data at 6 and 24 months postdischarge. The Return to Work Scale (RTW) and Community Integration Questionnaire (CIQ) were selected to assess return to work and community functioning. Predictor variables included the motor and cognitive subscales of the FIM and the FAM.Setting:Follow-up database of an inpatient and community TBI Rehabilitation Unit.Participants:All consenting patients with TBI admitted to the unit, aged 16 or above. There were 88 patients at 6 and 79 patients at 24 month follow-up.Results:At 6 months follow-up, the FAM and the FIM were roughly equivalent in their ability to predict RTW and CIQ scores. At 24 months, FAM motor was the only significant predictor of CIQ, and FAM cognitive scores displayed an advantage over the FIM in predicting employment status.Conclusions:The FAM subscales produced only modest gains in prediction of employment status and community integration at 24 months postdischarge. This may reflect ceiling effects on the functional measures, a limited range on the RTW measure, poor ecologic validity of functional disability measures in assessing handicap, or a combination of these factors.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To implement and evaluate the impact of telephone caregiver groups, compared with traditional face-to-face, on-site caregiver groups.Design:Quasi-experimental design comparing the two group types across time.Setting:An urban tertiary rehabilitation hospital with a brain injury program servicing a vast geographical area.Participants:Caregivers of an adult person with a brain injury participated in either one of the 10 telephone groups (TGs) (N= 52 caregivers who completed a full set of research forms) or one of the 10 on-site groups (OGs) (N= 39 caregivers who completed a full set of research forms). The combined total from both groups was 91.Intervention:Caregivers who lived within 40 km of the facility were placed in one of the OGs, and all others were placed in one of the TGs. Both types of groups met weekly for 9–10 weeks and were led by either social work or psychology professionals. The TGs met using teleconference technology.Main outcome measures:Profile of Moods States (POMS), Caregiver Burden Inventory (CBI), and the McMaster Model Family Assessment Devise (FAD), were administered 2 months before the first day of group, on the first day of group, on the last day of group, and 6 months after group. On the last day of group, a participant satisfaction survey was administered.Results:There were similar amounts of improvements for the outcomes from OGs and TGs. Rural caregivers had fewer difficulties on all measures at all measurement intervals. In both types of group, participants showed a statistically significant improvement in POMS scores and a trend toward improvement in FAD and CBI results. Participants of both group types rated their experience highly, although rural caregivers were somewhat more satisfied.Conclusions:Telephone groups offer a method of providing support and education to rural caregivers that is as effective as traditional inperson OGs.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Objective:To assess heterotopic ossification's (HO) impact on functional outcome after TBI.Design:Retrospective with matched control group, single center.Setting:TBI Model System of Care at the Medical College of Virginia of Virginia Commonwealth University, Richmond, VA.Participants:Twenty-six patients with TBI and triple-phase bone scan confirmed HO were matched with 26 patients without clinical evidence of HO.Main outcome measures:Acute and rehabilitation lengths of stay (LOS), Admission and Discharge Functional Independence Measure (FIM) scores, FIM change, FIM efficiency (FIM gains per week), and discharge disposition.Results:The two groups had similar acute care LOS. Patients with HO had significantly longer inpatient rehabilitation LOS and significantly lower FIM mobility and activities of daily living subscale scores on admission and discharge. FIM efficiency was significantly lower for the group with HO. Significantly fewer patients with HO were able to be discharged to home.Conclusions:HO is associated with a poorer functional outcome; however, it is not clear whether HO causes the decreased function or whether it may serve more generally as an indicator of those patients who will not progress as far or as rapidly during inpatient rehabilitation.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We evaluated evidence for the effectiveness of cognitive rehabilitation methods to improve outcomes for persons with traumatic brain injury (TBI). A search of MEDLINE, HealthSTAR, CINAHL, PsycINFO, and the Cochrane Library produced 600 potential references. Thirty-two studies met predetermined inclusion criteria and were abstracted; data from 24 were placed into evidence tables. Two randomized controlled trials and one observational study provided evidence that specific forms of cognitive rehabilitation reduce memory failures and anxiety, and improve self-concept and interpersonal relationships for persons with TBI. The durability and clinical relevance of these findings is not established. Future research utilizing control groups and multivariate analysis must incorporate subject variability and must include standard definitions of the intervention and relevant outcome measures that reflect health and function.

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1999

数据来源: OVID