Posts Tagged FIM

[VIDEO] FIM Scale – YouTube

A demonstration of the FIM Scale.

via Waverly Glen – FIM Scale – YouTube

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[Research Report] Functional level during the first 2 years after moderate and severe traumatic brain injury – CNS

Research Reports – Functional level during the first 2 years after moderate and severe traumatic brain injury

Brain Inj. 2015 Sep 11:1-8. [Epub ahead of print]

Sandhaug M(1,)(2), Andelic N(3,)(4), Langhammer B(1,)(5), Mygland A(6,)(7,)(8).

BACKGROUND: Long-term outcomes after TBI are examined to a large extent, butlongitudinal studies with more than 1-year follow-up time after injury have beenfewer in number. The course of recovery may vary due to a number of factors and it is still somewhat unclear which factors are contributing.

AIM: The aim of this study was to describe the functional level at four time points up to 24 months after traumatic brain injury (TBI) and to evaluate the predictive impact of pre-injury and injury-related factors.

DESIGN: A cohort study.

SETTING: Outpatient.

POPULATION: Sixty-five patients with moderate (n = 21) or severe (n = 44) TBI.

METHODS: The patients with TBI were examined with Functional Independence Measure(FIM) and Glasgow Outcome Scale Extended (GOSE) at 3 months, 12 months and 24months after injury. Possible predictors were analysed in a regression modelusing FIM total score at 24 months as the outcome measure.

RESULTS: FIM scores improved significantly from rehabilitation unit discharge to 24 months after injury, with peak levels at 3 and 24 months after injury(p < 0.001), for the whole TBI group and the group with severe TBI. The moderateTBI group did not show significant FIM score improvement during this time period. GOSE scores for the whole group and the moderate group improved significantlyover time, but the severe group did not. FIM at admission to the rehabilitation unit and GCS score at admission to the rehabilitation unit were closest to being significant predictors of FIM total scores 24 months after injury (B = 0.265 and2.883, R(2 )= 0.39, p = 0.073, p = 0.081).

CONCLUSION: FIM levels improved during the period from rehabilitation unitdischarge to 3 months follow-up; thereafter, there was a ‘plateauing’ of recovery. In contrast, GOSE ‘plateauing’ of recovery was at 12 months.

CLINICAL REHABILITATION IMPACT: The study results may indicate that two of themost used outcome measures in TBI research are more relevant for assessment of the functional recovery in a sub-acute phase than in later stages of TBI recovery.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Functional level during the first 2 years after moderate and severe traumatic brain injury

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[ARTICLE] Comparison of Rehabilitation Outcomes for Long Term Neurological Conditions: A Cohort Analysis of the Australian Rehabilitation Outcomes Centre Dataset for Adults of Working Age – Full Text HTML

Fig 2.  Radar Charts (FIM-Splats) showing median FIM scores on admission and discharge for the 12 groups.Abstract

Objective

To describe and compare outcomes from in-patient rehabilitation (IPR) in working-aged adults across different groups of long-term neurological conditions, as defined by the UK National Service Framework.

Design

Analysis of a large Australian prospectively collected dataset for completed IPR episodes (n = 28,596) from 2003-2012.

Methods

De-identified data for adults (16–65 years) with specified neurological impairment codes were extracted, cleaned and divided into ‘Sudden-onset’ conditions: (Stroke (n = 12527), brain injury (n = 7565), spinal cord injury (SCI) (n = 3753), Guillain-Barré syndrome (GBS) (n = 805)) and ‘Progressive/stable’ conditions (Progressive (n = 3750) and Cerebral palsy (n = 196)). Key outcomes included Functional Independence Measure (FIM) scores, length of stay (LOS), and discharge destination.

Results

Mean LOS ranged from 21–57 days with significant group differences in gender, source of admission and discharge destination. All six groups showed significant change (p<0.001) between admission and discharge that was likely to be clinically important across a range of items. Significant between-group differences were observed for FIM Motor and Cognitive change scores (Kruskal-Wallis p<0.001), and item-by-item analysis confirmed distinct patterns for each of the six groups. SCI and GBS patients were generally at the ceiling of the cognitive subscale. The ‘Progressive/stable’ conditions made smaller improvements in FIM score than the ‘Sudden-onset conditions’, but also had shorter LOS.

Conclusion

All groups made gains in independence during admission, although pattern of change varied between conditions, and ceiling effects were observed in the FIM-cognitive subscale. Relative cost-efficiency between groups can only be indirectly inferred. Limitations of the current dataset are discussed, together with opportunities for expansion and further development.

Continue —>  PLOS ONE: Comparison of Rehabilitation Outcomes for Long Term Neurological Conditions: A Cohort Analysis of the Australian Rehabilitation Outcomes Centre Dataset for Adults of Working Age.

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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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