Archive for category TBI
[ARTICLE] Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review – Full Text
Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians.
In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time.
Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included.
In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMT)was the most commonly used measure (in 36% of studies). Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72%) combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL), the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus.
The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke.
[WEB SITE] Research Reports – Psychotropic medication use during rehabilitation for traumatic brain injury
Research Reports – Psychotropic medication use during rehabilitation for traumatic brain injury
OBJECTIVE: To describe psychotropic medication administration patterns during
inpatient rehabilitation for traumatic brain injury (TBI) and their relation to
patient preinjury and injury characteristics.
DESIGN: Prospective observational cohort.
SETTING: Multiple acute inpatient rehabilitation units or hospitals.
PARTICIPANTS: Individuals with TBI (N=2130; complicated mild, moderate, or
severe) admitted for inpatient rehabilitation.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Not applicable.
RESULTS: Most frequently administered were narcotic analgesics (72% of sample),
followed by antidepressants (67%), anticonvulsants (47%), anxiolytics (33%),
hypnotics (30%), stimulants (28%), antipsychotics (25%), antiparkinson agents
(25%), and miscellaneous psychotropics (18%). The psychotropic agents studied
were administered to 95% of the sample, with 8.5% receiving only 1 and 31.8%
receiving ≥6. Degree of psychotropic medication administration varied widely
between sites. Univariate analyses indicated younger patients were more likely to
receive anxiolytics, antidepressants, antiparkinson agents, stimulants,
antipsychotics, and narcotic analgesics, whereas those older were more likely to
receive anticonvulsants and miscellaneous psychotropics. Men were more likely to
receive antipsychotics. All medication classes were less likely administered to
Asians and more likely administered to those with more severe functional
impairment. Use of anticonvulsants was associated with having seizures at some
point during acute care or rehabilitation stays. Narcotic analgesics were more
likely for those with history of drug abuse, history of anxiety and depression
(premorbid or during acute care), and severe pain during rehabilitation.
Psychotropic medication administration increased rather than decreased during the
course of inpatient rehabilitation in each of the medication categories except
for narcotics. This observation was also true for medication administration
within admission functional levels (defined by cognitive FIM scores), except for
those with higher admission FIM cognitive scores.
CONCLUSIONS: Many psychotropic medications are used during inpatient
rehabilitation. In general, lower admission FIM cognitive score groups were
administered more of the medications under investigation compared with those with
higher cognitive function at admission. Considerable site variation existed
regarding medications administered. The current investigation provides baseline
data for future studies of effectiveness.