Recovery from a Traumatic Brain Injury is a complex neurological process. Severe injuries commonly result in a wide range of impaired consciousness. Consciousness refers often to a person’s awareness of self and their interactions with their environment. Mild injuries may sometimes cause brief timeframes of impaired consciousness such as confusion or disorientation. However severe injuries may have a period of time whereby they have complete unconsciousness and no awareness of themselves or the world around them. Terms such as Coma, Vegetative State, Minimal Conscious State, Emerging Consciousness and Post-Traumatic Confusion or Post Traumatic Amnesia are often used by professionals caring for your family member but can be confusing to understand.
This video presentation is intended to demonstrate general patterns of improving consciousness and cognition following severe TBI. In this video, you may learn basic anatomy of TBI and what happens behaviorally step-step with improving consciousness. Your family member may not follow this sequence exactly and may skip steps depending on their more specific type of injury. Furthermore, as consciousness improves your family member may also have different types of impairments in their thinking abilities , referred to as Cognition. This presentation will highlight a step wise sequence of improving cognition and offer you as family members helpful suggestions on how to better assist your loved one during the rehabilitation process.
To learn more about Craig Hospital’s Brain Injury program visit: https://craighospital.org/programs/tr…
Background: New technologies to improve post-stroke rehabilitation outcomes are of great interest and have a positive impact on functional, motor, and cognitive recovery. Identifying the most effective rehabilitation intervention is a recognized priority for stroke research and provides an opportunity to achieve a more desirable effect. Objective: The objective is to verify the effect of new technologies on motor outcomes of the upper limbs, functional state, and cognitive functions in post-stroke rehabilitation. Methods: Forty two post-stroke patients (8.69 ± 4.27 weeks after stroke onset) were involved in the experimental study during inpatient rehabilitation. Patients were randomly divided into two groups: conventional programs were combined with the Armeo Spring robot-assisted trainer (Armeo group; n = 17) and the Kinect-based system (Kinect group; n = 25). The duration of sessions with the new technological devices was 45 min/day (10 sessions in total). Functional recovery was compared among groups using the Functional Independence Measure (FIM), and upper limbs’ motor function recovery was compared using the Fugl–Meyer Assessment Upper Extremity (FMA-UE), Modified Ashworth Scale (MAS), Hand grip strength (dynamometry), Hand Tapping test (HTT), Box and Block Test (BBT), and kinematic measures (active Range Of Motion (ROM)), while cognitive functions were assessed by the MMSE (Mini-Mental State Examination), ACE-R (Addenbrooke’s Cognitive Examination-Revised), and HAD (Hospital Anxiety and Depression Scale) scores. Results: Functional independence did not show meaningful differences in scores between technologies (p > 0.05), though abilities of self-care were significantly higher after Kinect-based training (p < 0.05). The upper limbs’ kinematics demonstrated higher functional recovery after robot training: decreased muscle tone, improved shoulder and elbow ROMs, hand dexterity, and grip strength (p < 0.05). Besides, virtual reality games involve more arm rotation and performing wider movements. Both new technologies caused an increase in overall global cognitive changes, but visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) were statistically higher after robotic therapy. Furthermore, decreased anxiety level was observed after virtual reality therapy (p < 0.05). Conclusions: Our study displays that even a short-term, two-week training program with new technologies had a positive effect and significantly recovered post-strokes functional level in self-care, upper limb motor ability (dexterity and movements, grip strength, kinematic data), visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) and decreased anxiety level.
Insufficient motor control compromises the ability of Stroke Patients (SP) to perform activities of daily living and will likely have a negative impact on the quality of life. Improving Upper Limb (UL) function is an important part of post-stroke rehabilitation in order to reduce disability . Recovery in the context of motor ability may refer to the return of pre-stroke muscle activation patterns or to compensation involving the appearance of alternative muscle activation patterns that attempt to compensate for the motor function deficit . The past decades have seen rapid development of a wide variety of assistive technologies that can be used in UL rehabilitation. These include electromyographic biofeedback, virtual reality, electromechanical and robotic devices, electrical stimulation, transcranial magnetic stimulation, direct current stimulation, and orthoses . Currently, two effective technologies that provide external feedback to SP during training, improve the retention of learned skills, and may be able to enhance the motor recovery are discussed .
Virtual Reality (VR): The Microsoft TM Kinect-based system provides feedback on movement execution and/or goal attainment . Incorporating therapy exercises into virtual games can make therapy more enjoyable and more realistic, such that task-based exercises have increased applicability in the clinical environment [6,7], increasing motivation and therefore adherence, which are useful for navigating this virtual environment; this has been identified as the most feasible for future implementation .
Electromechanical and robotic devices can move passive UL along more secure movement trajectories and provide either assistance or resistance to movement of a single joint or control of inter-segmental coordination. Recent technological advances have the ability to control multiple joints accurately at the same time, enabling them to produce more realistic task-based exercises for SP . Compared to manual therapy, robots have the potential to provide intensive rehabilitation consistently for a longer duration . Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires physiological limb muscle activation, which can be achieved through functional UL movement exercises and activation of the appropriate peripheral receptors . The Armeo Spring robot-assisted trainer device may improve UL motor function recovery as predicted by reshaping of cortical and transcallosal plasticity, according to the baseline cortical excitability . Knowledge of the potential brain plasticity reservoir after brain damage constitutes a prerequisite for an optimal rehabilitation strategy [12,13]. There is evidence that robot training for the hand is superior; during post-stroke rehabilitation, hand training is likely to be the most useful [8,13].
Previous studies have shown that the use of systems based on VR environments, motion sensors, and robotics can improve motor function. Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions [14,15,16].
The objectives of the study are to clarify in which area of functional UL recovery these new technologies are more suitable and effective and how much these interventions affect functional state and cognitive functions.
We raise the hypothesis that a robot-assisted device and virtual reality both have a positive effect on functional independence recovery in stroke-affected patients; however, having a different influence on UL motor function and cognitive changes. We assume that the robot-assisted device is more efficient and more accurately allows selecting tasks for developing specific motor function (range of motion, strength or dexterity of the affected arm), while Kinect-based games provide more free movements that are less suitable for specific motor function development and may be more targeted for cognitive functions.
Continue —> Influence of New Technologies on Post-Stroke Rehabilitation: A Comparison of Armeo Spring to the Kinect System
To explore the patterns of cognitive and motor recovery at four time points from admission to nine months post-discharge from IR and to investigate the association of therapeutic factors and pre- and post-discharge conditions with long-term outcomes.
Secondary analysis of traumatic brain injury-practice based evidence (TBI-PBE) dataset.
Inpatient rehabilitation (IR) in Ontario, Canada.
A total of 85 patients with TBI consecutively admitted for IR between 2008 and 2011 and had data available from admission to nine months follow-up.
Main outcome measure
Functional Independence Measure-Rasch cognitive and motor scores at admission, discharge, three, and nine months post-discharge.
Cognitive and motor recovery showed similar patterns of improvement with recovery up to three months but no significant change from three to nine months. Having fewer post-discharge health conditions was associated with better long-term cognitive scores (95% CI -13.06, -1.2) and added 9.9 % to the explanatory power of the model. More therapy time in complex occupational therapy activities (95% CI .02, .09) and fewer post-discharge health conditions (95% CI -19.5, -3.8) were significant predictors of better long-term motor function and added 14.3% and 7.2% to the explanatory power of the model, respectively.
Results of this study inform health care providers about the influence of the timing of IR on cognitive and motor recovery. In addition, it underlines the importance of making patients and families aware of residual health conditions following discharge from IR.
via Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients with Traumatic Brain Injury – Archives of Physical Medicine and Rehabilitation
Traumatic brain injury (TBI) is a significant cause of disability and death and its incidence is rising in some specific populations. TBI can result in various disabilities, cognitive problems and psychiatric disorders, depending on the location of the injury and premorbid patient conditions.
Effective pharmacological and surgical treatments, however, are currently limited. Most randomised clinical trials for TBI treatments carried out to date have failed to show significant benefits. Initiatives such as the TRACK-TBI have highlighted the large variability in TBI treatment quality at different hospitals and widely differing death rates. This stimulated the establishment of the International Initiative for TBI Research (InTIBR), which aims to improve disease characterisation and patient management.
The development of effective treatments for TBI and their evaluation requires an understanding of the complex neuroregenerative processes that follow an injury. In the case of haematoma in TBI, decompressive craniectomy can be a life-saving intervention but must be performed rapidly. The neurotrophic agent, Cerebrolysin®, acts by mimicking neurotrophic factors (NTFs) and by stimulating the endogenous production of NTF in brain tissue. Experimental models show that this drug increases neurogenesis following TBI but these findings need to be converted into clinical practice. The potential of Cerebrolysin in TBI was demonstrated in a large retrospective cohort trial in Romania (n=7,769 adults). Cerebrolysin significantly improved Glasgow Outcome Scores (GOS) and respiratory distress (RDS) in patients with moderate or severe TBI at 10 and 30 days compared with controls.
This and other experimental treatments have potential in TBI but, in developing such therapies, the design of clinical trials should closely reflect the reality of biological processes underlying natural recovery from brain injury.
Full Text HTML —> New Directions in Research and Therapies in Traumatic Brain Injury | Touch Neurology | Independent Insight for Medical Specialists.
…After a traumatic brain injury (TBI), cognitive functionality may
be severely altered. Some studies have aimed at identifying the best predictive
variables for cognitive recovery, however, results still remain unclear…
via Traumatic Brain Injury Resource Guide – Research Reports – Predictors of the recovery of cognitive functions in patients with traumatic brain injury.