Posts Tagged Long-term

[WEB SITE] Long Term Depression Permanently Changes the Brain

Long-lasting cases of depression may need to be treated differently than newer cases.

Chelsea Gohd February 27th 2018

Depression Inflammation

New research from the Centre for Addiction and Mental Health (CAMH) in Toronto has revealed something remarkable about mental illness: years of persistent depression-caused inflammation permanently and physically alter the brain. This may dramatically affect how we understand mental illness and how it progresses over time.

In a study published in The Lancet Psychiatry, researchers found that those who had untreated depression for over a decade had significantly more inflammation in their brains, when compared to those with untreated clinical depression for less than a decade. This work jumps off of senior author Jeff Meyer’s previous work, in which he found the first concrete evidence that those with clinical depression experience inflammation of the brain.

This study went even further, proving for the first time that long-term depression can cause extensive and permanent changes in the brain. Dr. Meyer thinks that this study could be used to create treatments for different stages in depression. This is important because now it is clear that treating depression immediately after diagnosis should be significantly different than treatment after 10 years with the illness.

Improving Understanding

Once a doctor and patient find a treatments for depression that works for the patient, treatment typically remains static throughout the course of the patient’s life. Taking this new study into account, this might not be the most effective method.

A PET image of a slice of human brain, showing areas of blue and red coloring. This method was used to measure depression-caused inflammation in this study.
A PET image of a slice of human brain. Image Credit: Jens Maus

This study examined a total of 25 patients who have had depression for over a decade, 25 who had the illness for less time, and 30 people without clinical depression as a control group. The researchers measured depression-caused inflammation using positron emission tomography (PET), which can pick out the protein markers, called TSPO, that the brain immune cells produce due to inflammation. Those with long-lasting depression had about 30 percent higher levels of TSPO when compared to those with shorter periods of depression, as well as higher levels than the control group.

Many misunderstand mental illness to be entirely separate from physical symptoms, but this study shows just how severe those symptoms can be. These findings could spark similar studies with other mental illnesses.

It is even possible that depression might now be treated as a degenerative disease, as it affects the brain progressively over time: “Greater inflammation in the brain is a common response with degenerative brain diseases as they progress, such as with Alzheimer’s disease and Parkinson’s disease,” Meyer said in a press release.

 

via Long Term Depression Permanently Changes the Brain

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[Abstract] Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients with Traumatic Brain Injury

Abstract

Objective

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.

Design

Secondary analysis of traumatic brain injury-practice based evidence (TBI-PBE) dataset.

Settings

Inpatient rehabilitation (IR) in Ontario, Canada.

Participants

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.

Interventions

Not applicable.

Main outcome measure

Functional Independence Measure-Rasch cognitive and motor scores at admission, discharge, three, and nine months post-discharge.

Results

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.

Conclusion

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

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[Guideline] Stroke Rehabilitation – Long term rehabilitation after stroke – National Clinical Guideline Centre UK – PDF 591 pages

Stroke is a major health problem in the UK. Each year in England, approximately 110,000 people 230, in Wales 11,000 and in Northern Ireland 4,000 people have a first or recurrent stroke 250. Most people survive a first stroke, but often have significant morbidity. More than 900,000 people in England are living with the effects of stroke. Stroke mortality rates in the UK have been falling steadily since the late 1960s25. The development of stroke units following the publication of the Stroke Unit Trialists Collaboration meta analysis of stroke unit care 1 , and the further reorganisation of services following the advent of thrombolysis have resulted in further significant improvements in mortality and morbidity from stroke (as documented in the National Sentinel Audit for Stroke 123). However, the burden of stroke may increase in the future as a consequence of the ageing population.

Despite improvements in mortality and morbidity, stroke survivors need access to effective rehabilitation services. Over 30% of people have persisting disability and they need access to stroke services long term. Stroke rehabilitation is a multidimensional process, which is designed to facilitate restoration of, or adaptation to, the loss of physiological or psychological function when reversal of the underlying pathological process is incomplete. Rehabilitation aims to enhance functional activities and participation in society and thus improve quality of life.

A stroke rehabilitation service comprises a multidisciplinary team of people who work together towards goals for each patient, involve and educate the patient and family, have relevant knowledge and skills to help address most common problems faced by their patients276 Key aspects of rehabilitation care include multidisciplinary assessment, identification of functional difficulties and their measurement, treatment planning through goal setting, delivery of interventions which may either effect change or support the individual in managing persisting change, and evaluation of effectiveness. […]

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[Abstract] Long-term Dosing of Intrathecal Baclofen in the Treatment of Spasticity after Acquired Brain Injury

Abstract

Background

Intrathecal baclofen (ITB) is often used to treat severe spasticity of cerebral origin. Though literature exists regarding efficacy of ITB, there has been minimal investigation related to dosing in the adult acquired brain injury population, particularly at long-term duration.

Objective

To investigate long-term dosing of ITB in adult patients with spasticity of cerebral origin due traumatic brain injury (TBI), stroke, and hypoxic-ischemic encephalopathy (HIE).

Design

Retrospective cohort study

Setting

An academic outpatient rehabilitation clinic

Patients

42 adult patients with spasticity secondary to TBI, stroke, or HIE treated with ITB for greater than three years.

Methods

Medical records and device manufacturer records of included patients were reviewed to obtain demographic data, dosing information, dates of pump and catheter placements and revisions.

Main Outcome Measure

Average daily ITB doses and mean change in ITB dose over 1, 2, and 3 years. Goal of ITB treatment (active function versus comfort/care/positioning) was also compared.

Results

Of 42 total patients, spasticity was attributed to either TBI (n=19), stroke (n=11), or HIE (n=12). The mean (standard deviation) age was 35.21 (10.17), 56.7 (13.1), and 35.1 (12.4) years for the TBI, stroke, and HIE groups, respectively (p < .001). There was a significant difference in the goal of therapy with “improving functional independence” accounting for 27.8%, 72.8 %, and 0% in the TBI, stroke, and HIE groups, respectively (p = .002). The mean duration of ITB therapy was 8.5 (5.0), 7.8 (3.4), and 9.1 (4.6) years in the TBI, stroke, and HIE groups, respectively (p = .79). The mean daily ITB dose was 596.9 (322.8) μg/day, 513.2 (405.7) μg/day, and 705.2 (271.7) μg/day for the TBI, stroke, and HIE groups, respectively (p= 0.39). In the subset of the cohort with ITB therapy for more than 5 years, the mean percent change in daily ITB dose between time of chart review and 1, 2, and 3 years prior was 7.3% (13.6), 12.7% (16), and 24.7% (50.3), respectively. A complex dosing pattern was used more frequently in those with stroke (36.4%) compared to the TBI and HIE (9.7%) groups (p = .04).

Conclusion

Despite the long-term use of ITB therapy in this cohort, the mean daily dose of intrathecal baclofen continued to require adjustments. There was no significant difference in the mean daily dose between patients with a diagnosis of TBI, stroke, or HIE. A complex dosing pattern was used more frequently in patients with stroke.

Source: Long-term Dosing of Intrathecal Baclofen in the Treatment of Spasticity after Acquired 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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[THESIS] A Cost-Effectiveness Study of Home-Based Stroke Rehabilitation – Full Text PDF

Abstract

Stroke is often a severe and debilitating event that requires ongoing rehabilitation. The Community Stroke Rehabilitation Teams (CSRT) offer home-based stroke rehabilitation to individuals for whom further therapy is unavailable or inaccessible.

The objective of this study was to evaluate the cost-effectiveness of the CSRT program compared with a ‘No Therapy’ cohort. Data were collected on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to rehabilitation.

Literature derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35 years. One-way, two-way, and Probabilistic Sensitivity Analyses were performed. Results demonstrate that the CSRT has a Net Monetary Benefit of $43,115 over No Therapy, and is both less costly and more effective. The CSRT model of care should be considered when evaluating potential stroke rehabilitation delivery methods.

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