摘要:

Objective:To broaden the investigation of those injured violently by examining neuropsychological and psychosocial outcomes in relation to circumstances of traumatic brain injury and preinjury factors.Design:A prospective, longitudinal study.Participants:A total of 752 adults with traumatic brain injury was grouped into those injured by violent or nonviolent circumstances and followed to 1-year post injury.Main outcome measures:Circumstance groups were compared on demographics, preexisting conditions, brain injury severity, and neuropsychological and psychosocial outcomes.Results:The results indicate significant differences between the groups on demographics, preexisting conditions, and head injury severity. Neuropsychological and psychosocial outcome did not differ between the circumstance groups when all other factors were taken into account.Conclusions:Injury severity and characteristics of the person that predate the injury were important to outcome rather than the circumstances of the injury itself.

ISSN:0885-9701    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To evaluate the contribution of vestibular pathology to cognitive and affective complaints of patients with and without brain trauma.Setting:An outpatient balance disorders clinic within a tertiary care neuroscience institute.Participants:200 patients with dizziness—half with a recent history of brain trauma and half without.Main Outcome Measures:The Dizziness Handicap Inventory, the Beck Depression Inventory, and the Neurobehavioral Symptom Inventory were prospectively administered. Neurological examination and vestibular testing were performed to arrive at a diagnosis for the dizziness. Multiple regression analyses were carried out using vestibular diagnosis, psychiatric diagnosis, and trauma history as predictors of the inventory scores.Results:Perceived disability was higher in dizzy patients with a history of brain trauma compared with dizzy patients without a history of trauma. A diagnosis of vestibular disease had no influence on perceived disability. Similarly, cognitive complaints were more common in dizzy patients with a history of brain trauma compared to dizzy patients without a history of trauma, but a diagnosis of vestibular disease had no influence on the frequency of cognitive complaints.Conclusions:In patients with postconcussive dizziness, cognitive complaints are likely due to neurologic injury or affective disturbance. In dizzy patients without brain trauma, cognitive complaints are likely due to concurrent affective disturbance.

ISSN:0885-9701    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:Investigate the impact of race on productivity outcome after traumatic brain injury (TBI) and evaluate the influence of confounding factors on this relationship.Design:Inception cohort of 1083 adults with TBI for whom 1-year productivity follow-up data were available.Results:Univariable logistic regression indicated that race was a significant predictor of productivity outcome after TBI. African Americans were 2.76 times more likely to be nonproductive than whites and other racial minorities were 1.92 times more likely to be nonproductive than whites. Multivariable logistic regression analyses revealed that the effect of race on employability was influenced by confounds with preinjury productivity, education level, and cause of injury. After adjustment for other predictors, African Americans were 2.00 times more likely to be nonproductive than whites and other racial minorities were 2.08 times more likely to be nonproductive than whites. The multivariable logistic regression model with all predictors except race accounted for 39% of the variability in productivity outcome (R2-Nagelkerke = 0.39), whereas the full logistic regression model including race accounted for 41% of the variability in productivity outcome (R2-Nagelkerke = 0.41); a difference of only 2%.Conclusion:Any effect of race on productivity is significantly influenced by confounding with preinjury productivity, education level, and cause of injury.

ISSN:0885-9701    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To develop a survey instrument that assesses implementation of key components of outpatient neurorehabilitation programs and test the capacity of this instrument to differentiate between rehabilitation approaches.Design:The Neurorehabilitation Program Styles Survey (NPSS) was administered to 18 outpatient facilities: 10 specialized and 8 discipline-specific outpatient neurorehabilitation programs. Scores were compared between types of programs using independent samplesttests.Results:The NPSS showed good reliability and contrasted groups validity, significantly differentiating between types of programs.Conclusions:The NPSS holds considerable promise as a tool for distinguishing among different types of brain injury programs, and for assessing the differential effectiveness of specialized versus discipline-specific outpatient brain rehabilitation programs. Future research on the NPSS will assess the stability of the instrument over time, its content validity, and capacity to differentiate the full continuum of neurorehabilitation programs.

ISSN:0885-9701    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective:To determine the long-term outcome of patients with stable locked-in syndrome.Setting:The community.Design:Retrospective phone survey. This study was further follow-up on a previously reported cohort.Participants:Twenty-nine persons with locked-in syndrome were included in an initial cohort 11 years prior to the current study. Records or contact with family showed that 16 were deceased. Telephone interviews were made with 1 living patient and the caregivers of 11 others. Public records documented survival of 1 nonrespondent.Outcome measures:Survival, codified responses regarding functional activities, social activities, and satisfaction with life.Results:Five-, 10-, and 20-year survival were 83%, 83%, and 40%, respectively. Ten subjects had not been hospitalized in the previous year. Eight lived with family. Little change in impairment occurred, but care was simplified. Improvements in communication related to technology, including computer and Internet access. Eleven left home at least monthly. Caregivers reported seven expressed satisfaction with life; five were occasionally depressed. No deaths could be attributed to euthanasia and no survivor had a “no code” status. One patient wished to die, seven had never considered euthanasia, six had considered and rejected it.Conclusions:Persons with initially stable locked-in syndrome can have prolonged survival, can live in the community if there is enough support, and have some measure of quality of life.

ISSN:0885-9701    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objectives:To evaluate a suicide prevention training workshop for staff working in the field of traumatic brain injury (TBI) and to develop new measures for evaluation of similar training in the future.Design:A prospective controlled pre- and posttest evaluation with a 6-month follow-up.Subjects:Multidisciplinary TBI rehabilitation and disability staff from the state of Victoria attending the workshop (n = 50) and an equivalent control group (n = 28) recruited from New South Wales.Setting:A statewide training workshop was held at a major rehabilitation center in Melbourne.Outcome measures:Three designed measures including an objective knowledge test, a self-assessment inventory of knowledge/skills and an attitudinal inventory.Results:Participants recorded statistically significant increases in their scores comparing the pre- to postworkshop evaluations. Many of these gains were maintained at the 6-month follow-up evaluation. In contrast, the control group had scores equivalent to those of workshop participants on the pretest evaluations but recorded no similar increase at follow-up. Factor analysis found that the knowledge and skills self-assessment inventory had 2 factors, each having good internal reliability.Conclusion:The current workshop has proved effective in increasing staff knowledge and skills in the assessment and management of people with TBI exhibiting suicidal behaviors. Finally, the initial development of a knowledge and skills self-assessment measure shows promise, providing a resource for the ongoing evaluation of suicide prevention training in the TBI field.

ISSN:0885-9701    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Employment, or return-to-work, is a common goal for adults who have experienced brain injury. Unfortunately, many individuals suffer significant psychosocial, cognitive, and physical deficits as a result of the injury that negatively affect their ability to seek or maintain employment. Research points to the importance of addressing these deficits using a supportive vocational rehabilitation team approach that focuses on assessing a wide range of cognitive, physical, and functional variables. The purpose of this article is to describe the Brain Injury Assessment Model (BIAM) for use as a vocational assessment tool for clients diagnosed with acquired brain injury and who are seeking employment or are returning to work.

ISSN:0885-9701    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Return to work remains a central issue for many traumatic brain injury (TBI) patients. The present literature generally ignores the complex work issues involved for high-functioning individuals, in whose hands may lie the fate of many other workers. This case discusses return-to-work challenges facing a 64-year-old high-technology company founder and president. Following a bicycling accident, he sustained intracerebral hemorrhage with an initial Glasgow Coma Scale of score 12. Although postmorbidly he still maintained a relatively high level of cognitive functioning, his case highlights special challenges during workplace rehabilitation of patients with cognitively demanding jobs, including (a) a higher potential for patient frustration given the gap between function and job expectations and (b) confidentiality issues regarding business employees and competitors. Rehabilitation health care providers can benefit from lessons learned here, including tapping into these patients' strong motivation for return to work, accessing the likely higher remaining cognitive level, and drawing upon the likely strong social and professional networks available. Finally, the importance of the role of stress-management techniques in order to cope with high frustration levels is highlighted.

ISSN:0885-9701    

出版商:OVID    

年代:2003

数据来源: OVID