[Abstract] Water-Based Exercise on Functioning and Quality of Life in Poststroke Persons: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVE:

To investigate the effects of water-based exercise on functioning and quality of life in poststroke persons.

DATA SOURCES:

We searched the following electronic database: MEDLINE, PeDro, Scielo, and the Cochrane Central Register of Controlled Trials up to September 2018 Study Selection: Only randomized controlled trials were included. Two review authors screened the titles and abstracts and selected the trials independently.

DATA EXTRACTION:

Two review authors independently extracted data of the included trials, using standard data-extraction model. We analyzed the pooled results using weighted mean differences, and standardized mean difference and 95% confidence intervals (CIs) were calculated.

DATA SYNTHESIS:

Twenty-four studies met the study criteria, but only 15 studies were included on meta-analyses. The studies presented moderate methodological quality, due to the lack of blinding of subjects and therapists and the nonperformance of the intention-to-treat analysis. Water-based exercise compared with land exercise had a positive impact on: muscle strength balance gait speed and mobility aerobic capacity and functional reach. Combined water-based exercise and land exercise was more effective than land exercise for improving balance, gait speed, and functional reach. The meta-analysis showed significant improvement in role limitations due to physical functioning and emotional problems, in vitality general mental health, social functioning, and bodily pain for participants in the water-based exercise and land exercise group versus land exercise group.

CONCLUSIONS:

Water-based exercise may improve muscle strength, balance, mobility, aerobic capacity, functional reach, joint position sense, and quality of life in poststroke persons and could be considered for inclusion in rehabilitation programs.

via Water-Based Exercise on Functioning and Quality of Life in Poststroke Persons: A Systematic Review and Meta-Analysis. – PubMed – NCBI

[ARTICLE] Effects of virtual reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: a multicenter, single-blinded, randomized, controlled pilot study – Full Text

Abstract

Background

Virtual reality (VR)-based rehabilitation is considered a beneficial therapeutic option for stroke rehabilitation. This pilot study assessed the clinical feasibility of a newly developed VR-based planar motion exercise apparatus (Rapael Smart Board™ [SB]; Neofect Inc., Yong-in, Korea) for the upper extremities as an intervention and assessment tool.

Methods

This single-blinded, randomized, controlled trial included 26 stroke survivors. Patients were randomized to the intervention group (SB group) or control (CON) group. During one session, patients in the SB group completed 30 min of intervention using the SB and an additional 30 min of standard occupational therapy; however, those in the CON group completed the same amount of conventional occupational therapy. The primary outcome was the change in the Fugl–Meyer assessment (FMA) score, and the secondary outcomes were changes in the Wolf motor function test (WMFT) score, active range of motion (AROM) of the proximal upper extremities, modified Barthel index (MBI), and Stroke Impact Scale (SIS) score. A within-group analysis was performed using the Wilcoxon signed-rank test, and a between-group analysis was performed using a repeated measures analysis of covariance. Additionally, correlations between SB assessment data and clinical scale scores were analyzed by repeated measures correlation. Assessments were performed three times (baseline, immediately after intervention, and 1 month after intervention).

Results

All functional outcome measures (FMA, WMFT, and MBI) showed significant improvements (p < 0.05) in the SB and CON groups. AROM showed greater improvements in the SB group, especially regarding shoulder abduction and internal rotation. There was a significant effect of time × group interactions for the SIS overall score (p = 0.038). Some parameters of the SB assessment, such as the explored area ratio, mean reaching distance, and smoothness, were significantly associated with clinical upper limb functional measurements with moderate correlation coefficients.

Conclusions

The SB was available for improving upper limb function and health-related quality of life and useful for assessing upper limb ability in stroke survivors.

Background

Virtual reality (VR)-based rehabilitation is being increasingly used for post-stroke rehabilitation [1]. A recent systematic review mentioned that VR is an emerging treatment option for upper limb rehabilitation among stroke patients [2]. The benefits of VR include real-time feedback, easy adaptability, and the provision of safe environments that mimic the real world [3, 4]. The gaming property of VR allows patients to experience fun, active participation, positive emotions, and engagement [5, 6]. Therefore, rehabilitation with VR enables more intense and repetitive training, which is important for rehabilitation and the promotion of neural plasticity [7].

VR systems commonly used in the entertainment industry, such as Wii and Kinect, could be used for rehabilitation. However, these game-like systems are only applicable to patients with muscle strength above a certain value, thus limiting their use by more affected patients. Therefore, adjunct therapies, such as functional electrical stimulation and robotics, have been combined with these systems [8, 9, 10, 11]. However, those adjunct therapies are costly and require continuous monitoring by healthcare professionals because of safety concerns [12, 13]. Therefore, their use is restricted to clinical settings, and they are not actively used for telerehabilitation or home-based rehabilitation. A non-motorized or non-assisted device is required for more active use of VR for rehabilitation.

We developed the Rapael Smart Board™ (SB; Neofect Inc., Yong-in, Korea), which is a VR-based rehabilitation device incorporating planar motion exercise that does not require additional gravity compensation. This two-dimensional planar movement with full gravitational support, which lessens the need for antigravity muscle facilitation, allows for much easier participation than three-dimensional movement under gravity. Additionally, it is known to be safe and easy to learn, and it has been shown to improve motor ability with less aggravation of shoulder pain and spasticity; therefore, it is useful to patients with reduced motor ability [14]. Planar motion exercises provoke less maladaptive compensatory movements. Additionally, the nearly zero friction of the linear guides enable a wide range of repetitive active range of motion (AROM) exercises. Furthermore, the SB adopted Rapael Clinic software that was originally developed for patients with disabilities and has proven efficacy for stroke rehabilitation [9, 15]. Therefore, the SB, which has multiple advantages because of its hardware and software, might be beneficial for the functional improvement of the upper extremities. Moreover, the SB could have a role as an assessment tool because VR has been reported to be useful for objective kinematic measurements of the upper extremities [16].

The present pilot study aimed to assess the availability of this newly developed VR-based rehabilitation device incorporating planar exercises for the upper extremities as an intervention and assessment tool among stroke patients in the chronic phase of recovery. To assess the availability in terms of clinical effectiveness, we compared the effects of an intervention involving the SB and that involving dose-matched occupational therapy (OT) on upper extremity function and health-related quality of life (HRQoL). We also investigated the correlations between kinematic data from the SB and data from clinical scales regarding upper extremity function.

[…]

Continue —>  Effects of virtual reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: a multicenter, single-blinded, randomized, controlled pilot study | SpringerLink

Fig. 1Hardware of the Smart Board. The board and forearm-supported controller. Three linear guides with an H-shape configuration enable two-dimensional planar motion of the handlebar, which is attached to the horizontal linear guide

[ARTICLE] Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial – Full Text

Abstract

Background

Mirror therapy for stroke patients was reported to be effective in improving upper-extremity motor function and daily life activity performance. In addition, game-based virtual reality can be realized using a gesture recognition (GR) device, and various tasks can be presented. Therefore, this study investigated changes in upper-extremity motor function, quality of life, and neck discomfort when using a GR device for mirror therapy to observe the upper extremities reflected in the mirror.

Material/Methods

A total of 36 subjects with chronic stroke were randomly divided into 3 groups: GR mirror therapy (n=12), conventional mirror therapy (n=12), and control (n=12) groups. The GR therapy group performed 3D motion input device-based mirror therapy, the conventional mirror therapy group underwent general mirror therapy, and the control group underwent sham therapy. Each group underwent 15 (30 min/d) intervention sessions (3 d/wk for 5 weeks). All subjects were assessed by manual function test, neck discomfort score, and Short-Form 8 in pre- and post-test.

Results

Upper-extremity function, depression, and quality of life in the GR mirror therapy group were significantly better than in the control group. The changes of neck discomfort in the conventional mirror therapy and control groups were significantly greater than in the GR mirror therapy group.

Conclusions

We found that GR device-based mirror therapy is an intervention that improves upper-extremity function, neck discomfort, and quality of life in patients with chronic stroke.

Background

In patients with acute stroke that occurred >6 months previously, 85% have upper-limb disorders, and 55% to 75% have upper-limb disorders [1]. The upper-limb movement function is decreased due to weakening of upper-limb muscles, which is primarily caused by changes in the central nervous system and secondarily by weakness due to inactivity and reduced activity [2,3].

Activities of daily living are limited due to body dysfunction, and most stroke patients have limited social interaction; these disorders reduce the quality of life [4–6]. In addition, stroke patients may experience depression due to reduced motivation [6]. Depression results in loss of interest and joy, anxiety, fear, hostility, sadness, and anger, which negatively affect functional recovery and rehabilitation in stroke patients [7].

Constraint-induced movement therapy, action observation training, and mirror therapy have been recently studied as therapies for upper-extremity motor function [8]. These interventions are used to increase the use of paralyzed limbs to overcome disuse syndromes, observe and imitate movement, and change the neural network involved in movement. Providing various tasks in upper-extremity rehabilitation is necessary and virtual reality is used as a method for providing various tasks [9,10].

Interventions using virtual reality require cognitive factors, such as judgment and memory, as the task progresses. It can use visual and auditory stimuli, and can induce interest and motivation, helping stroke patients to be mentally stable and motivated [11]. Gesture recognition (GR) is a topic that studies the reading of these movements using algorithms. These GR algorithms mainly focus on the movement of arm, hands, eyes, legs, and other body parts. The main idea is to capture body movements using capture devices and send the acquired data to a computer [12]. A remarkable example is shown in physical rehabilitation, where the low-cost hardware and algorithms accomplish outstanding results in therapy of patients with mobility issues. A 3D motion input device is required for upper-body rehabilitation in virtual reality. The Leap motion controller, a GR input device, has been recently released, which monitors hand and finger movements and reflects them on the monitor [13]. In addition, game-based virtual reality can be realized using a GR device, and various tasks can be presented.

Mirror therapy has been used as a therapeutic intervention for phantom pain in amputees. The painful and paralyzed body parts are covered with a mirror. The mirror is placed in the center of the body, and the movement of the paralyzed body is viewed through the mirror. The patient has a visual illusion that the paralyzed side is normally moving [14]. Mirror therapy for stroke patients was reported to be effective in upper-extremity motor function and daily life activity performance [15]. However, conventional mirror therapy methods require high concentration and can become tedious, making active participation difficult [16]. In addition, conventional mirror therapy differs from the actual situation wherein a mirror positioned at the center of the body should be viewed with the head sideways. Because patients are in a suboptimal posture, they may have neck discomfort after mirror therapy. The body has muscle strength disproportion when maintaining poor posture for a long time. This results in inadequate tension on adjacent muscles and joints, resulting in movement restriction, reduced flexibility, pain, and changes in bone and soft tissue [17].

This study investigated the effect on upper-extremity motor function, quality of life, and neck discomfort by using GR device mirror therapy in patients with chronic stroke, and evaluated the efficacy of this technique.

[…]

 

Continue —>  Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial

Figure 2
(A) Gesture recognition mirror therapy group, (B) Conventional mirror therapy, (C) Control group.

[Abstract] The Work Disability Functional Assessment Battery (WD-FAB) – Physical Medicine and Rehabilitation Clinics

Abstract

Accuracy in measuring function related to one’s ability to work is central to public confidence in a work disability benefits system. In the United States, national disability programs are challenged to adjudicate millions of work disability claims each year in a timely and accurate manner. The Work Disability Functional Assessment Battery (WD-FAB) was developed to provide work disability agencies and other interested parties a comprehensive and efficient approach to profiling a person’s function related to their ability to work. The WD-FAB is grounded by the International Classification of Functioning, Disability, and Health conceptual framework.

 

via The Work Disability Functional Assessment Battery (WD-FAB) – Physical Medicine and Rehabilitation Clinics

[ARTICLE] Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles – Full Text

Objective: To evaluate the efficacy, safety and economics of levetiracetam (LEV) for epilepsy.
Materials and methods: PubMed, Scopus, the Cochrane Library, OpenGrey.eu and ClinicalTrials.gov were searched for systematic reviews (SRs), meta-analyses, randomized controlled trials (RCTs), observational studies, case reports and economic studies published from January 2007 to April 2018. We used a bubble plot to graphically display information of included studies and conducted meta-analyses to quantitatively synthesize the evidence.
Results: A total of 14,803 records were obtained. We included 30 SRs/meta-analyses, 34 RCTs, 18 observational studies, 58 case reports and 2 economic studies after the screening process. The included SRs enrolled patients with pediatric epilepsy, epilepsy in pregnancy, focal epilepsy, generalized epilepsy and refractory focal epilepsy. Meta-analysis of the included RCTs indicated that LEV was as effective as carbamazepine (CBZ; treatment for 6 months: 58.9% vs 64.8%, OR=0.76, 95% CI: 0.50–1.16; 12 months: 54.9% vs 55.5%, OR=1.24, 95% CI: 0.79–1.93), oxcarbazepine (57.7% vs 59.8%, OR=1.34, 95% CI: 0.34–5.23), phenobarbital (50.0% vs 50.9%, OR=1.20, 95% CI: 0.51–2.82) and lamotrigine (LTG; 61.5% vs 57.7%, OR=1.22, 95% CI: 0.90–1.66). SRs and observational studies indicated a low malformation rate and intrauterine death rate for pregnant women, as well as low risk of cognitive side effects. But psychiatric and behavioral side effects could not be ruled out. LEV decreased discontinuation due to adverse events compared with CBZ (OR=0.52, 95% CI: 0.41–0.65), while no difference was found when LEV was compared with placebo and LTG. Two cost-effectiveness evaluations for refractory epilepsy with decision-tree model showed US$ 76.18 per seizure-free day gained in Canada and US$ 44 per seizure-free day gained in Korea.

Conclusion: LEV is as effective as CBZ, oxcarbazepine, phenobarbital and LTG and has an advantage for pregnant women and in cognitive functions. Limited evidence supports its cost-effectiveness

Background

Epilepsy ranks fourth after tension-type headache, migraine and Alzheimer disease in the world’s neurological disorders burden.¹ A systematic review (SR) and meta-analysis of international studies reported that the point prevalence of active epilepsy was 6.38 per 1,000 people, while the lifetime prevalence was 7.60 per 1,000 people. The annual cumulative incidence of epilepsy was 67.77 per 100,000 people, while the incidence rate was 61.44 per 100,000 person-years.² As a fairly common clinical condition affecting all ages and requiring long-term, sometimes lifelong, treatment, epilepsy incurs high health care costs for the society.¹ In 2010, the total annual cost for epilepsy was 13.8 billion and the total cost per patient was €5,221 in Europe.³ Meanwhile, in the USA, epilepsy-related costs ranged from $1,022 to $19,749 per person annually.⁴ What is more, drug-refractory epilepsy was a major cost driver,⁵ with main costs from anticonvulsants, hospitalization and early retirement.⁶

Currently, antiepileptic drugs (AEDs) are the main treatment method for epilepsy patients, and it was reported that approximately two-thirds of epileptic seizures were controlled by AEDs.⁷ Conventional AEDs such as carbamazepine (CBZ) and sodium valproate (VPA) have been proven to have good therapeutic effects and low treatment cost. However, some adverse events (AEs) related to these drugs, such as Stevens–Johnson syndrome, menstrual disorder and memory deterioration seriously affect the tolerance and compliance of patients. Compared with conventional AEDs, new AEDs have the potential to be safer, but also more expensive.⁸

Levetiracetam (LEV) is a novel AED that has been approved as an adjunctive therapy for adults with focal epilepsy since 1999 in the US. In 2006, it was licensed as monotherapy for adults and adolescents above 16 years of age with newly diagnosed focal-onset seizures with or without secondary generalization in Europe. Also, it has been indicated as an adjunctive therapy for partial-onset seizures in patients above 4 years of age in China since 2007. Although the precise mechanism of LEV is still unclear, current researches suggest that its pharmacological mechanism is different from those of other AEDs. It may bind to the synaptic vesicle protein 2A (SV2A), which presents on the synaptic vesicles and some neuroendocrine cells. SV2A may participate in the exocytosis of synaptic vesicles and regulate the release of neurotransmitters, especially the release of excitatory amino acids, and thus depress the epilepsy discharge.^9,10 Other possible mechanisms of LEV include the following: selective inhibition of voltage-dependent N-type calcium channels in hippocampal pyramidal cells and reduction of the negative allosteric agents’ inhibition, such as zinc ions and B-carbolines, on glycine and γ-aminobutyric acid neurons, which results in indirectly increasing central nervous system inhibition.¹¹

LEV is almost completely absorbed after oral administration and the absorption is unaffected by food. The bioavailability is nearly 100% and the steady-state concentrations are achieved in 2 days if LEV is taken twice daily. Sixty-six percent of LEV is renally excreted unchanged and its major metabolic pathway is enzymatic hydrolysis of the acetamide group, which is independent of liver CYP/CYP450; so, no clinically meaningful drug–drug interactions with other AEDs were found.¹² One published SR of LEV suggested LEV has an equal efficacy compared with conventional AEDs and it is well tolerated for long-term therapy without significant effect on the immune system.¹³ But in recent years, apart from the most frequent AEs of LEV, such as nausea, gastrointestinal symptoms, dizziness, irritability and aggressive behavior, some rare AEs of LEV have been reported, including eosinophilic pneumonia, rhabdomyolysis, thrombocytopenia, elevated kinase and reduced sperm quality.^14–17

Thus, we conducted a mapping review to evaluate the efficacy, safety and economic profiles of LEV compared with all other AEDs for epilepsy, to provide evidence-based information for the rational use of LEV and research agendas.

[…]

 

Continue —>  [Full text] Levetiracetam for epilepsy: an evidence map of efficacy, safety and ec | NDT

[Abstract] Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial

Abstract

Background. Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many.

Objective. To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes.

Methods. On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases.

Results. Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log–28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences.

Conclusions. Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier (ClinicalTrials.gov: Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at www.ClinicalTrials.gov/ClinicalTrials.gov. Identifier: NCT00871715).

via Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial – Rebecca Lewthwaite, Carolee J. Winstein, Christianne J. Lane, Sarah Blanton, Burl R. Wagenheim, Monica A. Nelsen, Alexander W. Dromerick, Steven L. Wolf, 2018

[BOOK] 22 ANNUAL CONFERENCE OF THE INTERNATIONAL FUCTIONAL ELECTRICAL STIMULATION SOCIETY – Abstracts

Enhancing quality of life
through electrical stimulation technology

22. ANNUAL CONFERENCE OF THE
INTERNATIONAL FUNCTIONAL
ELECTRICAL STIMULATION SOCIETY

All of the abstracts presented are available on line at http://ifess2018.com/down/IFESS2018_program.pdf

 

 

 

[Abstract + References] Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue

Highlights

• Sexuality has a significant impact on interpersonal relationships and psychological well-being.
• Up to 50% of patients with moderate to severe TBI report sexual problems.
• Sexual disorders in TBI are closely dependent on the damaged brain area.
• TBI patients and their caregivers should be provided with information useful to achieve a better sexual health.

Abstract

Traumatic brain injury (TBI) is any damage to the skull and/or the brain and its frameworks due to an external force. Following TBI, patients may report cognitive, physiological and psychosocial changes with a devastating impact on important aspects of the patient’s life, such as sexual functioning. Although sexual dysfunction (SD) occurs at a significantly greater frequency in individuals with TBI, it is not commonly assessed in the clinical setting and little information is available on this crucial aspect of patients’ quality of life. As the number of people with TBI is on the rise, there is a need for better management of TBI problems, including SD, by providing information to patients and their caregivers to achieve sexual health, with a consequent increase in their quality of life. Discussing and treating sexual problems in TBI patients enters the framework of a holistic approach. The purpose of this narrative review is provide clinicians with information concerning changes in sexual functioning and relationships in individuals with TBI, for a better management of patient’s functional outcomes and quality of life.

References

1. Menon, D.K., Schwab, K., Wright, D.W., Maas, A.I. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010;91:1637–1640.
   • Google Scholar
2. Lin, C., He, H., Li, Z., Liu, Y., Chao, H., Ji, J. et al, Efficacy of progesterone for moderate to severe traumatic brain injury: a meta-analysis of randomized clinical trials. Sci Rep. 2015;25:13442.
   • Google Scholar
3. Adams, H., Donnelly, J., Czosnyka, M., Kolias, A.G., Helmy, A., Menon, D.K. et al, Temporal profile of intracranial pressure and cerebrovascular reactivity in severe traumatic brain injury and association with fatal outcome: an observational study. PLoS Med. 2017;14: e1002353.
   • Google Scholar
4. Maas, A.I., Menon, D.K. Traumatic brain injury: rethinking ideas and approaches. Lancet Neurol. 2012;11:12–13.
   • Google Scholar
5. Giacino, J.T., Kalmar, K., Whyte, J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehab. 2004;85:2020–2029.
   • Google Scholar
6. Saatian, M., Ahmadpoor, J., Mohammadi, Y., Mazloumi, E. Epidemiology and pattern of traumatic brain injury in a developing country regional trauma center. Bull Emerg Trauma. 2018;6:45–53.
   • Google Scholar
7. Wilson, B.A. Neuropsychology rehabilitation: theory and practice. South Afr J Psych. 2013;43:267–277.
   • Google Scholar
8. Gordon, W.A., Zafonte, R., Cicerone, K., Cantor, J., Brown, M., Lombard, L. et al, Traumatic brain injury rehabilitation: state of the science. Am J Phys Med Rehabil. 2006;85:343–382.
   • Google Scholar
9. Ben-Yishai, Y. Foreward. Neuropsych Rehab. 2008;18:513–521.
   • Google Scholar
10. Cicerone, K.D., Mott, T., Azulay, J., Sharlow-Galella, M.A., Ellmo, W.J., Paradise, S. et al, A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury. Arch Phys Med Rehabil. 2008;89:2239–2249.
    • Google Scholar
11. Mazzucchi, A. La riabilitazione neuropsicologica. Premesse teoriche e applicazioni cliniche.Elsevier, Milano (IT); 2012.
    • Google Scholar
12. Ciurli, P., Formisano, R., Bivona, U., Cantagallo, A., Angelelli, P. Neuropsychiatric disorders in persons with severe traumatic brain injury: prevalence, phenomenology, and relationship with demographic, clinical, and functional features. J Head Trauma Rehabil. 2011;26:116–126.
    • Google Scholar
13. Ponsford, J. Sexual changes associated with traumatic brain injury. Neuropsychol Rehabil. 2013;13:275–289.
    • Google Scholar
14. Masel, B.E., DeWitt, D.S. Traumatic brain injury: a disease process, not an event. J Neurotr. 2010;27:1529–1540.
    • Google Scholar
15. Moreno, J.A., Arango Lasprilla, J.C., Gan, C., McKerral, M. Sexuality after traumatic brain injury: a critical review. Neuro Rehab. 2013;32:69–85.
    • Google Scholar
16. Hibbard, M.R., Gordon, W.A., Flanagan, Haddad, L., Labinsky, E. Sexual dysfunction after traumatic brain injury. Neuro Rehabil. 2000;15:107–120.
    • Google Scholar
17. Sandel, M.E., Williams, K.S., Dellapietra, L., Derogatis, L.R. Sexual functioning following traumatic brain injury. Brain Inj. 1996;10:719–728.
    • Google Scholar
18. Kreuter, M., Dahllöf, A.G., Gudjonsson, G., Sullivan, M., Siösteen, A. Sexual adjustment and its predictors after traumatic brain injury. Brain Inj. 1998;12:349–368.
    • Google Scholar
19. Bezeau, S.C., Bogod, N.M., Mateer, C.A. Sexually intrusive behaviour following brain injury: approaches to assessment and rehabilitation. Brain Inj. 2004;18:299–313.
    • Google Scholar
20. Simpson, G.K., Sabaz, M., Daher, M. Prevalence, clinical features, and correlates of inappropriate sexual behavior after traumatic brain injury: a multicenter study. J Head Trauma Rehabil. 2013;28:202–210.
    • Google Scholar
21. Aloni, R., Katz, S. A review of the effect of traumatic brain injury on the human sexual response.Brain Inj. 1999;13:269–280.
    • Google Scholar
22. Althof SE Psychological interventions for delayed ejaculation/orgasm. Int J Impot Res 2012; 24(4): 131–6..

    • Google Scholar
23. Katz, S., Aloni, R. Sexual dysfunction of persons after traumatic brain injury: perceptions of professionals. Int J Rehabil Res. 1999;22:45–53.
    • Google Scholar
24. Garden, F.H., Bontke, C.F., Hoffman, M. Sexual functioning and marital adjustment after traumatic brain injury. J Head Trauma Rehab. 2010;5:52–59.
    • Google Scholar
25. Sander, A.M., Maestas, K.L., Pappadis, M.R., Sherer, M., Hammond, F.M., Hanks, R. et al, Traumatic brain injury model systems module project on sexuality after TBI. Sexual functioning 1 year after traumatic brain injury: findings from a prospective traumatic brain injury model systems collaborative study. Arch Phys Med Rehabil. 2012;93:1331–1337.
    • Google Scholar
26. Hanks, R.A., Sander, A.M., Millis, S.R., Hammond, F.M., Maestas, K.L. Changes in sexual functioning from 6 to 12 months following traumatic brain injury: a prospective TBI model system multicenter study. J Head Trauma Rehabil. 2013;28:179–185.
    • Google Scholar
27. Downing, M.G., Stolwyk, R., Ponsford, J.L. Sexual changes in individuals with traumatic brain injury: a control comparison. J Head Trauma Rehabil. 2013;28:171–178.
    • Google Scholar
28. Mah, K., Hickling, A., Reed, N. Perceptions of mild traumatic brain injury in adults: a scoping review. Disabil Rehabil. 2018;40:960–973.
    • Google Scholar
29. Reddy, A., Ownsworth, T., King, J., Shields, C. A biopsychosocial investigation of changes in self-concept on the head injury semantic differential scale. Neuropsychol Rehabil. 2017;27:1103–1123.
    • Google Scholar
30. Iverson, G.L., Lange, R.T., Brooks, B.L., Rennison, V.L. “Good old days” bias following mild traumatic brain injury. Clin Neuropsychol. 2010;24:17–37.
    • Google Scholar
31. Sander, A.M., Maestas, K.L., Nick, T.G., Pappadis, M.R., Hammond, F.M., Hanks, R.A. et al, Predictors of sexual functioning and satisfaction 1 year following traumatic brain injury: a TBI model systems multicenter study. J Head Trauma Rehabil. 2013;28:186–194.
    • Google Scholar
32. Ponsford, J.L., Downing, M.G., Stolwyk, R. Factors associated with sexuality following traumatic brain injury. J Head Trauma Rehabil. 2013;28:195–201.
    • Google Scholar
33. Goldin, Y., Cantor, J.B., Tsaousides, T., Spielman, L., Gordon, W.A. Sexual functioning and the effect of fatigue in traumatic brain injury. J Head Trauma Rehabil. 2014;29:418–426.
    • Google Scholar
34. Cicerone, K.D., Azulay, J. Perceived self-efficacy and life satisfaction after traumatic brain injury. J Head Trauma Rehabil. 2007;22:257–266.
    • Google Scholar
35. Bellamkonda, E., Zollman, F. Relationship between employment status and sexual functioning after traumatic brain injury. Brain Inj. 2014;28:1063–1069.
    • Google Scholar
36. Miller, B.L., Cummings, J.L., McIntyre, H., Ebers, G., Grode, M. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatr. 1986;49:867–873.
    • Google Scholar
37. Simpson, G., Blaszczynski, A., Hodgkinson, A. Sex offending as a psychosocial sequela of traumatic brain injury. J Head Trauma Rehabil. 1999;14:567–580.
    • Google Scholar
38. Simpson, G., Tate, R., Ferry, K., Hodgkinson, A., Blaszczynski, A. Social, neuroradiologic, medical, and neuropsychologic correlates of sexually aberrant behavior after traumatic brain injury: a controlled study. J Head Trauma Rehabil. 2001;16:556–572.
    • Google Scholar
39. Mutarelli, E.G., Omuro, A.M., Adoni, T. Hypersexuality following bilateral thalamic infarction: case report. Arq Neuropsiquiatr. 2006;64:146–148.
    • Google Scholar
40. Bianchi-Demicheli, F., Rollini, C., Lovblad, K., Ortigue, S. Sleeping beauty paraphilia“: deviant desire in the context of bodily self-image disturbance in a patient with a fronto-parietal traumatic brain injury. Med Sci Monit. 2010;16:CS15-7.
    • Google Scholar
41. Graff-Radford, N.R., Damasio, H., Yamada, T., Eslinger, P.J., Damasio, A.R. Nonhaemorrhagic thalamic infarction. Clinical, neuropsychological and electrophysiological findings in four anatomical groups defined by computerized tomography. Brain. 1995;108:485–516.
    • Google Scholar
42. Formisano, R., Saltuari, L., Gerstenbrand, F. Presence of kluver-bucy syndrome as a positive prognostic feature for the remission of traumatic prolonged disturbances of consciousness. Acta Neurol Scand. 1995;91:54–57.
    • Google Scholar
43. Janszky, J., Fogarasi, A., Magalova, V., Tuxhorn, I., Ebner, A. Hyperorality in epileptic seizures: periictal incomplete Klüver-Bucy syndrome. Epilepsia. 2005;46:1235–1240.
    • Google Scholar
44. Wilkinson, C.W., Pagulayan, K.F., Petrie, E.C., Mayer, C.L., Colasurdo, E.A., Shofer, J.B. et al, High prevalence of chronic pituitary and target-organ hormone abnormalities after blast-related mild traumatic brain injury. Front Neurol. 2012;3:11.
    • Google Scholar
45. Schneider, H.J., Kreitschmann-Andermahr, I., Ghigo, E., Stalla, G.K., Agha, A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA. 2007;298:1429–1438.
    • Google Scholar
46. Lieberman, S.A., Oberoi, A.L., Gilkison, C.R., Masel, B.E., Urban, R.J. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury. J Clin Endocrinol Metab. 2001;86:2752–2756.
    • Google Scholar
47. Carroll, B.T., Goforth, H.W., Carroll, L.A. Anatomic basis of kluver-bucy syndrome. J Neuropsychiatry Clin Neurosc. 1999;11:116.
    • Google Scholar
48. Calabrò, R.S., Russo, M., Naro, A. Discussing sexual health after traumatic brain injury: an Unmet Need!. Innov Clin Neurosci. 2017;14:11–12.
    • Google Scholar
49. Rosen, R.C., Riley, A., Wagner, G., Osterloh, I.H., Kirkpatrick, J., Mishra, A. The international index of erectile function (IIEF) a multidimensional scale for assessment of erectile dysfunction. Urology. 2007;49:822–830.
    • Google Scholar
50. Stolwyk, R.J., Downing, M.G., Taffe, J., Kreutzer, J.S., Zasler, N.D., Ponsford, J.L. Assessment of sexuality following traumatic brain injury: validation of the brain injury questionnaire of sexuality. J Head Trauma Rehabil. 2013;28:164–170.
    • Google Scholar
51. Derogatis, L.R. The derogatis interview for sexual functioning (DISF/DISF-SR): an introductory report. J Sex Marital Ther. 1997;23:291–304.
    • Google Scholar
52. Gill, C.J., Sander, A.M., Robins, N., Mazzei, D.K., Struchen, M.A. Exploring experiences of intimacy from the viewpoint of individuals with traumatic brain injury and their partners. J Head Trauma Rehabil. 2011;26:56–68.
    • Google Scholar
53. Wedcliffe, T., Ross, E. The psychological effects of traumatic brain injury on the quality of life of a group of spouses/partners. S Afr J Commun Disord. 2001;48:77–99.
    • Google Scholar
54. Blais, M.C., Boisvert, J.M. Psychological adjustment and marital satisfaction following head injury. Which critical personal characteristics should both partners develop?. Brain Inj. 2007;21:357–372.
    • Google Scholar
55. Sander, A.M., Maestas, K.L., Pappadis, M.R., Hammond, F.M. Hanks multicenter study of sexual functioning in spouses/partners of persons with traumatic brain injury. RA Arch Phys Med Rehabil. 2016;97:753–759.
    • Google Scholar
56. Bivona, U., Antonucci, G., Contrada, M., Rizza, F., Leoni, F., Zasler, N.D. et al, biopsychosocial analysis of sexuality in adult males and their partners after severe traumatic brain injury. Brain Inj. 2016;30:1082–1095.
    • Google Scholar
57. Kreutzer, J.S., Zasler, N.D. Psychosexual consequences of traumatic brain injury: methodology and preliminary findings. Brain Inj. 1989;3:177–186.
    • Google Scholar
58. Gosling, J., Oddy, M. Rearranged marriages: marital relationships after head injury. Brain Inj. 1999;13:785–796.
    • Google Scholar
59. Kratz, A.L., Sander, A.M., Brickell, T.A., Lange, R.T., Carlozzi, N.E. Traumatic brain injury caregivers: a qualitative analysis of spouse and parent perspectives on quality of life. Neuropsychol Rehabil. 2017;27:16–37.
    • Google Scholar
60. Verschuren, J.E., Enzlin, P., Dijkstra, P.U., Geertzen, J.H., Dekker, R. Chronic disease and sexuality: a generic conceptual framework. J Sex Res. 2010;47:153–170.
    • Google Scholar
61. Calabrò, R.S., Polimeni, G., Bramanti, P. Current and future therapies of erectile dysfunction in neurological disorders. Recent Pat CNS Drug Discov. 2011;6:48–64.
    • Google Scholar
62. Calabrò, R.S., Furnari, A., Bramanti, P. Treatment and rehabilitation of sexual dysfunction in neurological diseases. in: R.S. Calabrò (Ed.) Male Sexual dysfunction in neurological disorders: From pathophysiology to rehabilitation. Nova, NY: Hauppauge; 2010.
    • Google Scholar

via Changes in sexual functioning following traumatic brain injury: An overview on a neglected issue – Journal of Clinical Neuroscience

[Abstract] Psychometric Comparisons of the Quality of Life after Brain Injury between Individuals with Mild and Those with Moderate/Severe Traumatic Brain Injuries

Abstract

This study compared psychometric properties of the Taiwanese version of the Quality of Life after Brain Injury (QOLIBRI) between patients with mild and those with moderate/severe traumatic brain injury (TBI). Of 683 participants, 548 had sustained a mild injury with Glasgow Coma Scale (GCS) scores of 13–15, and 135 had a moderate/severe injury with GCS scores of 3–12. The QOLIBRI comprises six domains: Cognition, Self, Daily Life and Autonomy, Social Relationships, Emotions, and Physical Problems. Results of the Rasch analysis showed that two items of “Problems with seeing/hearing” and “Finding one’s way about” were underfitting in the mild TBI group while the item “Problems with seeing/hearing” was underfitting and the item “TBI effects” was overfitting in the moderate/severe TBI group. The largest differential item functioning (DIF) between the mild and moderate/severe TBI groups appeared in the item “Energy,” followed by those of “Being slow/clumsy” and “Problems with seeing/hearing.” For both the mild and moderate/severe TBI groups, the two domains of Emotions and Physical Problems displayed strong ceiling effects, low person reliability and separation, and an incomplete range of the person measure covered by the item difficulty, while the remaining four domains had acceptable performances. While the psychometric performance of the QOLIBRI at the domain level was similar between the mild and moderate/severe TBI groups, certain items exhibited different functioning between the two groups. The reason why the two domains of the Emotions and Physical Problems performed poorly in the two TBI severity groups could be due to cross-cultural effects. The meanings of these DIF items, particularly for patients with a mild TBI, and factors contributing to the ceiling effect of the Emotions and Physical Problems domains in other ethnic Chinese populations need to be investigated further.

 

via Psychometric Comparisons of the Quality of Life after Brain Injury between Individuals with Mild and Those with Moderate/Severe Traumatic Brain Injuries | Journal of Neurotrauma

[Abstract] Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis

Abstract

Objective

To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, are safe and cost effective for patients with acute or sub-acute conditions.

Data sources

Electronic database (AMED, CINAHL, EMBASE, MEDLINE, PEDro, PubMed) searches were updated from 2010 through June 2017.

Study selection

Randomized controlled trials evaluating additional physical therapy services on patient health outcomes, length of stay or cost effectiveness were eligible. Searching identified 1524 potentially relevant articles, of which 11 new articles from 8 new randomized controlled trials with 1563 participants were selected. In total, 24 randomized controlled trials with 3262 participants are included in this review.

Data extraction

Data were extracted using the form used in the original systematic review. Methodological quality was assessed using the PEDro scale and The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was applied to each meta-analysis.

Data synthesis

Post intervention data were pooled with an inverse variance, random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). There is moderate quality evidence that additional physical therapy services reduced length of stay by 3 days in sub-acute settings (MD-2.8, 95%CI -4.6 to -0.9, I²0%) and low quality evidence that it reduced length of stay by 0.6 days in acute settings (MD -0.6, 95%CI -1.1 to 0.0, I² 65%). Additional physical therapy led to small improvements in self-care (SMD 0.11, 95%CI 0.03 to 0.19, I² 0%), activities of daily living (SMD 0.13, 95%CI 0.02 to 0.25, I² 15%) and health-related quality of life (SMD 0.12, 95%CI 0.03 to 0.21, I² 0%), with no increases in adverse events. There was no significant change in walking ability. One trial reported that additional physical therapy was likely to be cost-effective in sub-acute rehabilitation.

Conclusions

Additional physical therapy services improve patient activity and participation outcomes, while reducing hospital length of stay for adults. These benefits are likely safe and there is preliminary evidence to suggest they may be cost effective.

via Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation