Posts Tagged Acquired Brain Injury

[Abstract] The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury – CNS

Abstract

OBJECTIVE: This pilot study measured the feasibility and impact of an 8-week yoga programme on the quality-of-life of adults with acquired brain injury (ABI).

METHODS: Thirty-one adults with ABI were allocated to yoga (n = 16) or control (n = 15) groups. Participants completed the Quality of Life After Brain Injury (QOLIBRI) measure pre- and post-intervention; individuals in the yoga group also rated programme satisfaction. Mann-Whitney/Wilcoxon and the Wilcoxon Signed Rank tests were used to evaluate between- and within-group differences for the total and sub-scale QOLIBRI scores, respectively.

RESULTS: No significant differences emerged between groups on the QOLIBRI pre- or post-intervention. However, there were significant improvements on overall quality-of-life and on Emotions and Feeling sub-scales for the intervention group only. The overall QOLIBRI score improved from 1.93 (SD = 0.27) to 2.15 (SD = 0.34, p = 0.01). The mean Emotions sub-scale increased from 1.69 (SD = 0.40) to 2.01 (SD = 0.52, p = 0.01), and the mean Feeling sub-scale from 2.1 (SD = 0.34) to 2.42 (SD = 0.39, p = 0.01).

CONCLUSION: Adults with ABI experienced improvements in overall quality-of-life following an 8-week yoga programme. Specific improvements in self-perception and negative emotions also emerged. High attendance and satisfaction ratings support the feasibility of this type of intervention for people with brain injury.

Source: Traumatic Brain Injury Resource Guide – Research Reports – The feasibility and impact of a yoga pilot programme on the quality-of-life of adults with acquired brain injury

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[Poster] Relationship Between Positive Personality Traits and Rehabilitation Outcomes Following Acquired Brain Injury Several Years Post-Injury

The study investigated the relationship between positive personality traits of hope and optimism and rehabilitation outcomes of participation and quality of life in individuals with Acquired Brain Injury (ABI), living in the community. Self-awareness to injury related deficits was also examined.

Source: Relationship Between Positive Personality Traits and Rehabilitation Outcomes Following Acquired Brain Injury Several Years Post-Injury – Archives of Physical Medicine and Rehabilitation

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[Abstract] Pilot study of intensive exercise on endurance, advanced mobility and gait speed in adults with chronic severe acquired brain injury – CNS

Brain Inj. 2016 Jul 28:1-7. [Epub ahead of print]

BACKGROUND AND PURPOSE: Effects of high-intensity exercise on endurance, mobility and gait speed of adults with chronic moderate-to-severe acquired brain injury (ABI) were investigated. It was hypothesized that intensive exercise would be associated with improvements in impairment and activity limitation measures.

PARTICIPANTS: Fourteen adults with chronic ABI in supported independent living who could stand with minimal or no assist and walk with or without ambulation device were studied. Eight presented with low ambulatory status.

METHODS: This was a single group pre- and post-intervention study. Participants received a 6-week exercise intervention for 60-90 minutes, 3 days/week assisted by personal trainers under physical therapist supervision. Measures (6MWT, HiMAT and 10MWT) were collected at baseline, post-intervention and 6 weeks later. Repeated measures T-test and Wilcoxon Signed Ranks test were used.

RESULTS: Post-intervention improvements were achieved on average on all three measures, greater than minimal detectable change (MDC) for this population. Three participants transitioned from low-to-high ambulatory status and maintained the change 6 weeks later.

DISCUSSION AND CONCLUSION: People with chronic ABI can improve endurance, demonstrate the ability to do advanced gait and improve ambulatory status with 6 weeks of intensive exercise. Challenges to sustainability of exercise programmes for this population remain.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Pilot study of intensive exercise on endurance, advanced mobility and gait speed in adults with chronic severe acquired brain injury

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[BOOK] Effective Learning after Acquired Brain Injury: A practical guide to support adults with neurological conditions – Google Books

Front Cover[BOOK] Effective Learning after Acquired Brain Injury: A practical guide to support adults with neurological conditions

G Lowings, B Wicks – 2016 – books.google.com
Effective Learning After Acquired Brain Injury provides clear guidance on delivering productive educational programmes for adolescents and adults with acquired brain injury (ABI). Written for the non-specialist, the book provides an accessible overview of the

Source: Lowings: Effective Learning after Acquired Brain… – Google Scholar

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[WEB SITE] Combating Struggles with Acquired Brain Injury – RehabVisions

Posted: 6/10/15
RehabVisions

The physical, neurological and emotional challenges that may arise from an acquired brain injury (ABI) are vast. Different causes and injuries create consequences that vary among individuals. Therapists need to be perceptive in order to both address struggles and provide avenues for constructive thinking.

One of the largest hurdles therapists encounter in rehabilitation with individuals who have suffered an ABI is the patient often lacks insight into their own deficits. Their injured brain signals they are fine and can successfully perform activities they used to do before injury, when in fact they may be struggling with anything from orientation and memory to executive function. This is challenging for family members and caregivers and is also is a barrier for treatment if the patient does not come to terms with these new deficits. Although insight typically improves to some degree as the patient progresses, giving the right level and amount of explanation about what has happened and future planning is helpful.

A thorough evaluation should be completed early on to identify cognitive deficits. Once strengths and deficits are identified, treatment can begin. Include tasks to promote gains in deficit areas such as memory and attention, such as deductive and/or abstract reasoning tasks, working memory tasks or word-retrieval activities. Also think about how strengths can be utilized to assist in this process. If a patient’s reading comprehension is better than auditory comprehension, printed information should be used to improve their ability to comprehend spoken information.

Combat common struggles by demonstrating compensatory strategies that aid the individual in participating in life activities. For patients experiencing memory and organization deficits, be prepared with a list of smart phone apps and functions they can use to set alerts for appointments, manage tasks, make lists, etc.

Fatigue is common in individuals recovering from a brain injury. Their brain is working “overtime” to make sense of things, and performing tasks successfully may take a great deal of conscious thought and effort. Assist patients in creating a schedule to work on their cognitive exercises and/or stay active in doing their daily activities, and include rest to help the brain recover. Once the brain begins to fatigue, there is a decrease in function. The patient will notice activities and tasks become harder, and head pain may also occur. This should signal the patient that it’s time to rest.

Lastly, there are things the brain injury survivor can focus on that will help their recovery, including:

  • Accepting their new persona
  • Allowing themselves to make mistakes
  • Striving to keep a positive attitude
  • Remembering they can continue to improve

Continued improvements may be the most important point in keeping your patient motivated. In years past, it was commonly accepted that after a window of about three years, the brain would not have any further recovery. It is now known that neuroplasticity allows for continued recovery over time with focused effort. Different parts of the brain can establish neuropathways and take over functions lost through damage to other parts of the brain.

Area Manager Jean Herauf, SLP has 30+ years’ experience, more than 20 of them with RehabVisions. Jean is active in her clinic’s local brain injury support group and has attended numerous courses over the years, and read a good deal on ABI.

Source: Combating Struggles with Acquired Brain Injury – RehabVisions

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[Abstract] Multi-disciplinary rehabilitation for acquired brain injury in adults of working age (Cochrane review) [with consumer summary]

Turner-Stokes L, Pick A, Nair A, Disler PB, Wade DT

Cochrane Database of Systematic Reviews 2015;Issue 12

systematic review

BACKGROUND: Evidence from systematic reviews demonstrates that multi-disciplinary rehabilitation is effective in the stroke population, in which older adults predominate. However, the evidence base for the effectiveness of rehabilitation following acquired brain injury (ABI) in younger adults has not been established, perhaps because this scenario presents different methodological challenges in research.

OBJECTIVES: To assess the effects of multi-disciplinary rehabilitation following ABI in adults 16 to 65 years of age.

SEARCH METHODS: We ran the most recent search on 14 September 2015. We searched the Cochrane Injuries Group Specialised Register, The Cochrane Library, OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID MEDLINE Daily and OVID OLDMEDLINE, Embase Classic+Embase (OVIDSP), Web of Science (ISI WOS) databases, clinical trials registers, and we screened reference lists.

SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing multi-disciplinary rehabilitation versus routinely available local services or lower levels of intervention; or trials comparing an intervention in different settings, of different intensities or of different timing of onset. Controlled clinical trials were included, provided they met pre-defined methodological criteria.

DATA COLLECTION AND ANALYSIS: Three review authors independently selected trials and rated their methodological quality. A fourth review author would have arbitrated if consensus could not be reached by discussion, but in fact, this did not occur. As in previous versions of this review, we used the method described by van Tulder 1997 to rate the quality of trials and to perform a ‘best evidence’ synthesis by attributing levels of evidence on the basis of methodological quality. Risk of bias assessments were performed in parallel using standard Cochrane methodology. However, the van Tulder system provided a more discriminative evaluation of rehabilitation trials, so we have continued to use it for our primary synthesis of evidence. We subdivided trials in terms of severity of brain injury, setting and type and timing of rehabilitation offered.

MAIN RESULTS: We identified a total of 19 studies involving 3,480 people. Twelve studies were of good methodological quality and seven were of lower quality, according to the van Tulder scoring system. Within the subgroup of predominantly mild brain injury, ‘strong evidence’ suggested that most individuals made a good recovery when appropriate information was provided, without the need for additional specific interventions. For moderate to severe injury, ‘strong evidence’ showed benefit from formal intervention, and ‘limited evidence’ indicated that commencing rehabilitation early after injury results in better outcomes. For participants with moderate to severe ABI already in rehabilitation, ‘strong evidence’ revealed that more intensive programmes are associated with earlier functional gains, and ‘moderate evidence’ suggested that continued outpatient therapy could help to sustain gains made in early post-acute rehabilitation. The context of multi-disciplinary rehabilitation appears to influence outcomes. ‘Strong evidence’ supports the use of a milieu-oriented model for patients with severe brain injury, in which comprehensive cognitive rehabilitation takes place in a therapeutic environment and involves a peer group of patients. ‘Limited evidence’ shows that specialist in-patient rehabilitation and specialist multi-disciplinary community rehabilitation may provide additional functional gains, but studies serve to highlight the particular practical and ethical restraints imposed on randomisation of severely affected individuals for whom no realistic alternatives to specialist intervention are available.

AUTHORS’ CONCLUSIONS: Problems following ABI vary. Consequently, different interventions and combinations of interventions are required to meet the needs of patients with different problems. Patients who present acutely to hospital with mild brain injury benefit from follow-up and appropriate information and advice. Those with moderate to severe brain injury benefit from routine follow-up so their needs for rehabilitation can be assessed. Intensive intervention appears to lead to earlier gains, and earlier intervention whilst still in emergency and acute care has been supported by limited evidence. The balance between intensity and cost-effectiveness has yet to be determined. Patients discharged from in-patient rehabilitation benefit from access to out-patient or community-based services appropriate to their needs. Group-based rehabilitation in a therapeutic milieu (where patients undergo neuropsychological rehabilitation in a therapeutic environment with a peer group of individuals facing similar challenges) represents an effective approach for patients requiring neuropsychological rehabilitation following severe brain injury. Not all questions in rehabilitation can be addressed by randomised controlled trials or other experimental approaches. For example, trial-based literature does not tell us which treatments work best for which patients over the long term, and which models of service represent value for money in the context of life-long care. In the future, such questions will need to be considered alongside practice-based evidence gathered from large systematic longitudinal cohort studies conducted in the context of routine clinical practice.

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Source: PEDro – Search Detailed Search Results

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[ARTICLE] Fitness to drive after acquired brain damage: Who should be assessed, and how?

Acquired brain damage such as stroke, traumatic brain injury (TBI), brain anoxia or encephalitis may impair fitness to drive in no less than 300,000 adults every year in France. Identifying peoples at risk and addressing the assessment methods were priority concerns in context of the guidelines developed on behalf of the French Rehabilitation Medicine Society SOFMER, the French Higher Health Authority (HHA) and other groups of interest.

Objective

To draw from the literature guidelines regarding who should benefit from an assessment of fitness to drive, and how this assessment should be conducted.

Method

Two hundred and nine studies were analyzed among 326 references from the literature and discussed by a multidisciplinary work group. A preliminary draft was drawn, then submitted to a reviewing group and improved according to recommendations. Then guidelines were submitted to HHA.

Results

Peoples with mild TBI are advised not to drive again within 24 hours after their TBI.Three processes were defined:

– process A: medical examination aiming at detecting mild motor and/or cognitive impairments (Montreal Cognitive Assessment was recommended), and ensuring visual acuity and visual field;

– process B: comprehensive fitness to drive assessment including medical examination, cognitive tests (attention, visual scanning, memory and executive functions) and a standardized on road assessment (a least 45 minutes, with different driving situations);

– process C: medical advice from a designed general practitioner before a revalidation of the driving license by authorities.Peoples with transient ischemic attack or mild impairment after stroke, brain anoxia or encephalitis: 2 weeks delay before driving again and process A + C. Peoples with moderate to severe TBI, stroke, brain anoxia or encephalitis with significant impairments needing rehabilitation: process B + C. Peoples with persistent neglect are urged to refrain from driving. Seizures and/or hemianopia are legal exclusions from driving.

Discussion-conclusion

The committee emphasized the need for forthcoming studies providing French validated versions of international assessment battery such as: Stroke Driver Screening Assessment, as well as further information about driving simulators.

Source: Fitness to drive after acquired brain damage: Who should be assessed, and how?

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[ARTICLE] Resonance: An Interactive Tabletop Artwork for Co-located Group Rehabilitation and Play

Abstract

In this paper we describe the design and development of Resonance, an interactive tabletop artwork that targets upper-limb movement rehabilitation for patients with an acquired brain injury. The artwork consists of several interactive game environments, which enable artistic expression, exploration and play. Each environment aims to encourage collaborative, cooperative, and competitive modes of interaction for small groups (2-4) of co-located participants.

We discuss how participants can perform movement tasks face-to-face with others using tangible user interfaces in creative and engaging activities. We pay particular attention to design elements that support multiple users and discuss preliminary user evaluation of the system.

Our research indicates that group based rehabilitation using Resonance has the potential to stimulate a high level of interest and enjoyment in patients; facilitates social interaction, complements conventional therapy; and is intrinsically motivating.

via Resonance: An Interactive Tabletop Artwork for Co-located Group Rehabilitation and Play – Springer.

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[WEB SITE] Classification and Complications of Traumatic Brain Injury: Practice Essentials, Epidemiology, Pathophysiology

Practice Essentials

Traumatic brain injury (TBI), also known as acquired brain injury, head injury, or brain injury, causes substantial disability and mortality. It occurs when a sudden trauma damages the brain and disrupts normal brain function. TBI may have profound physical, psychological, cognitive, emotional, and social effects.

According to the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control, in the United States annually at least 1.4 million people sustain a TBI, and approximately 50,000 people die from such injuries.

See Pediatric Concussion and Other Traumatic Brain Injuries, a Critical Images slideshow, to help identify the signs and symptoms of TBI, determine the type and severity of injury, and initiate appropriate treatment.

Essential update: Metabolic biomarkers may help predict TBI severity and outcome

In a study of 256 consecutive adult patients with acute TBI and 36 control patients with acute orthopedic trauma and no acute or previous brain disorders, presented in October 2014 at the annual meeting of the Congress of Neurological Surgeons, Posti et al found 43 potential metabolic biomarkers that differed significantly in expression patterns between TBI patients and control subjects.[1] These differences were most pronounced among patients with severe TBI.

These metabolic biomarkers included small fatty acids, amino acids, and sugar derivatives.[1] Several metabolites (eg, decanoic acid, octanoic acid, glycerol serine, and 1H-indole-3-acetic acid) were significantly upregulated in cerebrospinal fluid and brain microdialysate samples from newly arrived patients with severe TBI, suggesting disruption of the blood-brain barrier. Marked intergroup differences were still evident in samples taken the day after injury. Metabolic profiles were strongly associated with outcomes, as measured by Glasgow Outcomes Scale scores.

Classification

Primary and secondary injuries

  • Primary injury: Induced by mechanical force and occurs at the moment of injury; the 2 main mechanisms that cause primary injury are contact (eg, an object striking the head or the brain striking the inside of the skull) and acceleration-deceleration [2]
  • Secondary injury: Not mechanically induced; it may be delayed from the moment of impact, and it may superimpose injury on a brain already affected by a mechanical injury [2]

Focal and diffuse injuries

These injuries are commonly found together; they are defined as follows:

  • Focal injury: Includes scalp injury, skull fracture, and surface contusions; generally caused by contact
  • Diffuse injury: Includes diffuse axonal injury (DAI), hypoxic-ischemic damage, meningitis, and vascular injury; usually caused by acceleration-deceleration forces

Measures of severity

See the list below:

  • Glasgow Coma Scale (GCS): A 3- to 15-point scale used to assess a patient’s level of consciousness and neurologic functioning [3, 4] ; scoring is based on best motor response, best verbal response, and eye opening (eg, eyes open to pain, open to command)
  • Duration of loss of consciousness: Classified as mild (mental status change or loss of consciousness [LOC] 6 hr)
  • Posttraumatic amnesia (PTA): The time elapsed from injury to the moment when patients can demonstrate continuous memory of what is happening around them [5]

Complications

Complications include the following:

  • Posttraumatic seizures: Frequently occur after moderate or severe TBI
  • Hydrocephalus
  • Deep vein thrombosis: Incidence as high as 54% [6]
  • Heterotopic ossification: Incidence of 11-76%, with a 10-20% incidence of clinically significant heterotopic ossification [7]
  • Spasticity
  • Gastrointestinal and genitourinary complications: Among the most common sequelae in patients with TBI
  • Gait abnormalities
  • Agitation: Common after TBI

Long-term physical, cognitive, and behavioral impairments are the factors that most commonly limit a patient’s reintegration into the community and his/her return to employment. They include the following:

  • Insomnia
  • Cognitive decline
  • Posttraumatic headache: Tension-type headaches are the most common form, but exacerbations of migraine-like headaches are also frequent
  • Posttraumatic depression: Depression after TBI is further associated with cognitive decline, [8, 9] anxiety disorders, substance abuse, dysregulation of emotional expression, and aggressive outbursts

Outcome measures

The following tools are commonly used to measure outcome after TBI[10, 11] :

  • Functional Independence Measure (FIM): An 18-item scale used to assess the patient’s level of independence in mobility, self-care, and cognition
  • Glasgow Outcome Scale (GOS)
  • Disability Rating Scale (DRS): Measures general functional changes over the course of recovery after TBI (see the image below)
  • Disability Rating Scale (DRS).

Continue —>  Classification and Complications of Traumatic Brain Injury: Practice Essentials, Epidemiology, Pathophysiology.

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[RESEARCH REPORT] Reading Comprehension in College Students after Acquired Brain Injury – WEB SITE

Purpose: This exploratory study builds upon the small body of existing research investigating reading comprehension deficits in college students with acquired brain injury (ABI).

Method: Twenty-four community college students with ABI completed a battery of questionnaires and standardized tests to characterize self-perceptions of academic reading ability, performance on a standardized reading comprehension measure, and a variety of cognitive functions of this population. Half of the participants in the sample reported traumatic brain injury (n = 12) and half reported non-traumatic ABI (n = 12).

Results: College students with both traumatic and non-traumatic ABI cite problems with reading comprehension and academic performance post injury. Mean performance on a standardized reading measure, the Nelson Denny Reading Test (NDRT), was low to below average and was significantly correlated with performance on the Speed and Capacity of Language Processing test (SCOLP). Injury status of traumatic versus non-traumatic ABI did not differentiate results. Regression analysis showed that measures of verbal attention and suppression obtained from the California Verbal Language Test-II (CVLT-II) predicted total scores on the NDRT.

Conclusions: College students with ABI are vulnerable to reading comprehension problems. Results align with other research suggesting that verbal attention and suppression problems may be contributing factors.

via Traumatic Brain Injury Resource Guide – Research Reports – Reading Comprehension in College Students after Acquired Brain Injury.

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