摘要:

Objective:To compare types and frequency of medical complications and comorbidities associated with violence-related penetrating traumatic brain injury (TBI) as compared to violence-related blunt TBI.Method:Data were collected prospectively at four medical centers participating in the TBI Model Systems (TBIMS) of Care project. A total of 317 individuals met the inclusion criteria for the TBIMS (i.e., showed evidence of a TBI, were age 16 or older, presented to the TBIMS emergency department within 24 hours of injury, and received acute and rehabilitation services within the model system).Main Outcome Measures:Frequency of medical complications and comorbid diseases.Results:Patients with penetrating injuries suffered significantly higher rates of respiratory failure (P= .004), pneumonitis/pneumonia, (P= .002), skull fracture (P= .001), cerebrospinal fluid leak (P= .0005), and hypotonia (P= .001) than did patients with blunt injuries. Prediction of complications and comorbidities via multiple regression revealed that a penetrating violent injury and the severity of injury were independent predictors of a higher rate of medical complications, whereas age and gender did not account for unique variance in the equation.Conclusions:Penetrating injuries are associated with higher rates of certain medical complications, especially to the pulmonary and central nervous systems. Acute care physicians and physiatrists must be prepared to treat these complications more often in patients with penetrating injuries.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective:To examine the concurrent validity of the Community Integration Questionnaire (CIQ) in assessing outcomes in traumatic brain injury (TBI) by comparing it with two widely used and well-validated measurements of rehabilitation outcome.Design:A retrospective relational study of the concurrent validity of the CIQ, Craig Handicap Assessment and Reporting Technique (CHART), and Disability Rating Scale (DRS).Setting:A postacute rehabilitation facility.Participants:Seventy patients with a medical diagnosis of TBI admitted between April 1996 and October 1998 participated in the study.Results:CIQ and CHART provide ratings that are similar in several areas to those provided by the DRS. Correlation (r) among total scores and subscales for all three instruments ranged from 0.021 to 0.671 (P< .01). Correlation between CIQ and CHART is stronger than that between CIQ and DRS or between CHART and DRS, and the correlation between CHART and DRS is stronger than that between CIQ and DRS.Conclusion:The CIQ appears to be the most appropriate instrument in quantifying rehabilitation outcome in patients with TBI at the participatory (handicap) level. The findings of this study can help clinicians gain a greater understanding of the nature, redundancy, and gaps among functional outcome measures. Monitoring outcomes can also help clinicians better understand the effectiveness of interventions.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective:To develop a measure suitable for retrospective analysis of qualitative brain injury outcome data, the Functional Independence Level (FIL), and document its reliability, validity, and utility.Design:Retrospective analysis of existing records, with inclusion based on availability of records, and quantitative or qualitative documentation of functional status at a minimum of 1.5 years after injury.Setting:Statewide acute and postacute rehabilitation facilities, as part of a State Head Injury Program.Participants:A total of 338 individuals, with documented moderate to severe traumatic brain injury; primarily males ages 16 to 45.Main Outcome Measures:Disability Rating Scale (DRS) at discharge from primary rehabilitation, Living Situation and Functional Independence Level coded from information in postacute rehabilitation reports, at an average of approximately 6 years after injury.Results:Inter-rater reliability coefficients for FIL ratings extracted from rehabilitation records, and between retrospective and in vivo assessments were highly significant. DRS scores at discharge from primary rehabilitation predicted a significant amount of variance in FIL scores at an average of 5 years after injury, and DRS scores remained a stable and significant predictor of FIL scores as the time period between discharge from rehabilitation and outcome ratings increased to 10 years after injury. FIL ratings were significantly lower for individuals living in residential facilities than those living with their families, as compared to living alone.Conclusions:The FIL is a reliable and useful tool for retrospective and prospective assessments of rehabilitation outcome. Gains made during primary rehabilitation by people with severe traumatic brain injury are generally maintained at long-term follow up. Retrospective ratings using the DRS and FIL can help guide postacute rehabilitation planning within state or regional head injury programs.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective:To demonstrate that the Barrow Neurological Institute (BNI) Screen for Higher Cerebral Functions (BNIS) can be used to briefly assess cognitive and affective disturbances during the acute stages after traumatic brain injury (TBI).Design and Outcome Measures:People with TBI were administered the BNIS during the first 60 days after injury and their performance compared to a convenience sample of control subjects used in the standardization of the BNIS.Setting:Inpatient units of a neurological institute and medical center.Subjects:Forty-two individuals with moderate-to-severe TBI and 21 control subjects.Results:Compared to patients with TBI, control subjects performed significantly better on the BNIS total and all subtest scores. TBI patients were best classified by poor performance on measures of affect disturbance and impaired awareness. Stepwise discriminant analysis identified disturbances in memory, awareness, and affect as contributing most to the classification of an individual as having TBI.Conclusions:Both cognitive and affective disturbances can be directly assessed during the early stages after significant TBI. The BNIS can be used for this purpose and help document that TBI specifically affects memory, awareness, and affect during its early stages and should be addressed in rehabilitation.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective:To investigate the use of telerehabilitation to support families caring at home for individuals with prolonged states of reduced consciousness.Design:A comparison group approach.Participants:Participants were recruited from a special program that is part of a Model Systems brain injury program located in the Southeast. Five patients, ranging from Rancho 1 to Rancho 3 were discharged home with family members as the primary caregivers.Procedures:Participant families were followed for 4 to 8 weeks via videophone. Follow-up telephone surveys were conducted with a family member 6 to 9 months after discharge and compared with a similar group that had not received the videophone follow-up.Main Outcome Measures:Present living status, number of emergency room visits, number of hospitalizations, the caregivers' perceptions of functional status and care needs, readmission for rehabilitation and perceived family needs as measured by the Family Needs Questionnaire (FNQ).Results:More patients in the videoconferencing group were still living at home and had returned for rehabilitation. On the FNQ, families in the videophone group reported more of their needs met than families in the comparison group.Conclusions:The use of videoconferencing to bridge the transition to home for families caring for a family member at the Rancho 1 to Rancho 3 level may assist families in successfully caring for the individual in the home and reducing the number of perceived family needs.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background:This case study describes a 33-year-old man who sustained a severe head injury with cerebrovascular complications in a road traffic accident.Method:His rehabilitation program focused on the everyday problems he faced as a result of cognitive deficits resulting from his brain injury. Twelve goals were set after negotiations between the man, his wife, and the rehabilitation team.Results:All goals were achieved by the end of his program. We describe how they were achieved and provide data for three goals in particular. We discuss the advantages of a goal planning approach in cognitive or neuropsychological rehabilitation.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective:To test the efficacy of a portable voice organizer in helping people with traumatic brain injury (TBI) to recall therapy goals and plans discussed with their clinical case managers.Design:Prospective within-subjects trial, in which individualized therapy goals were randomly assigned to intervention or no intervention.Setting:Comprehensive postacute TBI rehabilitation program.Participants:Ten people with moderate to severe TBI enrolled from 3 months to 18 years after injury.Outcome measure:Memory for therapy goals. Clinicians generated statements describing six current therapy goals, half of which were randomly assigned to be recorded on a voice organizer during the next case management session. Participants selected three times per day to listen to the recorded goals, prompted by an alarm. One-week recall was tested using both free- and cued-recall formats.Results:Recorded goals were recalled better than unrecorded goals and appeared to be associated with better awareness or follow-through with therapy objectives.Conclusion:Portable electronic devices have the potential to assist with treatment areas beyond tasks involving prospective memory.

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:2002

数据来源: OVID