Posts Tagged recovery

[Abstract] Medical Mobile Applications for Stroke Survivors and Caregivers

Abstract

Background

Recent studies estimate nearly half of the US population can access mobile medical applications (apps) on their smartphones. The are no systematic data available on apps focused on stroke survivors/caregivers.

Objective

To identify apps (a) designed for stroke survivors/caregivers, (b) dealing with a modifiable stroke risk factor (SRF), or (c) were developed for other purposes but could potentially be used by stroke survivors/caregivers.

Methods

A systematic review of the medical apps in the US Apple iTunes store was conducted between August 2013 and January 2016 using 18 predefined inclusion/exclusion criteria. SRFs considered were: diabetes, hypertension, smoking, obesity, atrial fibrillation, and dyslipidemia.

Results

Out of 30,132 medical apps available, 843 (2.7%) eligible apps were identified. Of these apps, (n = 74, 8.7%) apps were specifically designed for stroke survivors/caregivers use and provided the following services: language/speech therapy (n = 28, 37%), communication with aphasic patients (n = 19, 25%), stroke risk calculation (n = 11, 14%), assistance in spotting an acute stroke (n = 8, 10%), detection of atrial fibrillation (n = 3, 4%), direction to nearby emergency room (n = 3, 4%), physical rehabilitation (n = 3, 4%), direction to the nearest certified stroke center (n = 1, < 2%), and visual attention therapy (n = 1, <2%). 769 apps identified that were developed for purposes other than stroke. Of these, the majority (n = 526, 68%) addressed SRFs.

Conclusions

Over 70 medical apps exist to specifically support stroke survivors/caregivers and primarily targeted language and communication difficulties. Apps encompassing most stroke survivor/caregiver needs could be developed and tested to ensure the issues faced by these populations are being adequately addressed.

via Medical Mobile Applications for Stroke Survivors and Caregivers – ScienceDirect

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[Abstract] Pharmacological interventions and rehabilitation approach for enhancing brain self-repair and stroke recovery

Abstract

Neuroplasticity is a natural process occurring in the brain for entire life. Stroke is the leading cause of long term disability and huge medical and financial problem throughout the world. Research conducted over the past decade focused mainly on neuroprotection in the acute phase of stroke while very little studies targets chronic stage. Recovery after stroke depends on the ability of our brain to reestablish structural and functional organization of neurovascular networks. Combining adjuvant therapies and drugs may enhance the repair processes and restore impaired brain functions. Currently, there are some drugs and rehabilitative strategies that can facilitate brain repair and improve clinical effect even years after stroke onset. Moreover, some of compounds such as citicoline, fluoxetine, niacin, levodopa etc. are already in clinical use or are being trial in clinical issues. Many studies testing also cell therapies, in our review we will focused on studies where cells have been implemented at the early stage of stroke. Next, we discuss pharmaceutical interventions. In this section selected methods of cognitive, behavioral and physical rehabilitation as well as adjuvant interventions for neuroprotection including non invasive brain stimulation and extremely low frequency electromagnetic field. The modern rehabilitation represents new model of physical interventions with limited therapeutic window up to six months after stroke. However, last studies suggest, that time window for stroke recovery is much longer than previous thought. This review attempts to present the progress in neuroprotective strategies, both pharmacological and non-pharmacological that can stimulate the endogenous neuroplasticity in post stroke patients.

 

via Pharmacological interventions and rehabilitation approach for enhancing brain self-repair and stroke recovery | Bentham Science

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[WEB SITE] The Comparison Trap | BrainLine

The Comparison Trap Caregiving After Brain Injury, Norma Myers

We can all relate to being guilty of spinning around in the dizzying comparison trap. Whether it’s love, family, career, financial, fashion, weight or cosmetic, somewhere along the line, we have compared ourselves to others. With the presence of social media, this trap has become even more intrusive.

From the moment we received the life-changing news of Aaron and Steven’s car accident, the comparison trap began. Aaron didn’t survive the accident that left Steven with a severe Traumatic Brain Injury (TBI). While the comparison trap from the loss of Aaron would set in later, it immediately bombarded us during Steven’s recovery.

Of all comparisons we thought we would face as parents, nothing prepared our ears to absorb the speech that began: don’t compare your child’s TBI progress to another survivor. A wonderful physician, who is now a friend, spoke those words to us. He then proceeded to inform us, “In a line-up of 10 TBI survivors, you would witness 10 different outcomes.” I did not want my son in a TBI line up or any part of the TBI community. All I wanted was to be able to turn back the calendar to August 13, 2012, and plan a totally different Sunday for our intact family of 4, a day close to home, together.

During Steven’s roller-coaster recovery, we were reminded often, felt like hourly, that with the severity of Steven’s injuries the recovery road was long, we should not get our hopes up. Really? Telling parents not to get their hopes up about their child’s survival was the same as telling us not to take our next breath! Of course, we were going to hope, pray, and never give up.

We admit, despite celebrating Steven’s recovery, we did fall into the dismal comparison trap.

Why is Steven’s rehab roommate already walking?

His accident was as severe as Steven’s; how did he escape a craniectomy and the helmet?

How did she escape the epilepsy curse?

These comparisons led me to wonder if I tapped into all available resources for Steven’s recovery?

As shock eventually lifted, we realize that some of our justifications for comparing were due to our lack of knowledge about TBI. How could we not compare? And while we have heard every lecture on not asking why, it’s human nature to ask, “Why?”

As my heart began to absorb the reality of Aaron’s death, I was faced with new comparisons. When it comes to Aaron’s life, it’s not all about comparisons; it’s more about mynatural mom instinct wondering what Aaron’s life would look like today, a mother’s shattered heart longing for what should have been.

Would Aaron be married?

Would we be grandparents?

Where would Aaron be in his career?

What would Aaron’s big trophy be this hunting season?

While I acknowledge that people mean well, and do not know what to say, the comparison that continues to leave me speechless is comparing child loss to losing a parent or a grandparent. Trust me, I have also experienced those deep losses, but it’s unequivocally not the same, it’s just not.

Lessons I learned from comparing

  • Seek connection, not comparisons. It’s most rewarding to spend time with those that nourish relationships, with those who see the real you.
  • By focusing on the good things in my life, I’m less likely to obsess about what I lack.
  • Comparisons can be never-ending and exhausting. The temptation to compare is as near as my next chat with a friend, a trip to the store, or check-in on social media. I must not get lost in others’ lives and forget to enjoy my own.
  • By shifting my focus, a comparison can turn into inspiration. Being inspired and learning from others can create happiness instead of misery.
  • When life is lived intentionally and thoughtfully, the comparison game becomes less attractive.
  • If I waste time comparing myself to others, I will rob myself of gratitude, joy, and fulfillment.
  • Even when it feels impossible, dig deep, find the courage to celebrate who you are, underneath the messiest of messes, there’s much to celebrate, we are each entirely unique.

When I find myself being drawn in as a pawn in the comparison game, I don’t beat myself up, I just say no! I refuse to stay in the game. After all, it’s not about comparisons, it’s about living for the ones I love and for those that need and love me. Instead of evaluating those in my life; past and present, I will celebrate them. I refuse to get lost in others idealizedlives, I will focus on being grateful for my life; right here, right now; a priceless lesson that Aaron taught me and one that I and the two men in my life attempt to remind each other of daily.

 

via The Comparison Trap | BrainLine

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[BOOK] Person Centered Approach to Recovery in Medicine – Luigi Grassi – Google Books

Bibliographic information

via Person Centered Approach to Recovery in Medicine – Luigi Grassi – Google Books

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[ARTICLE] Vojta Therapy in Patients with Acute Stroke – A New Approach in Stroke Rehabilitation – Full Text PDF

Abstract

Unilateral motor weakness is one of the most common deficits resulting
from stroke and one of the main causes of disability. Stroke rehabilitation is
multidisciplinary and the aim of physiotherapy should be to promote activation
and stabilisation of the remaining innervation and functions of the damaged
central nervous system. Scientific evidence demonstrating the values of
specific rehabilitation interventions after stroke is limited. It is still unclear, which
physiotherapeutic approaches in stroke rehabilitation are most effective. Modern
approaches follow the idea that functional improvement to a large extent relies
on the use of compensatory movement strategies, enabling patients to learn
to cope with their deficits. The Vojta therapy is based on a completely different
approach: the reflex locomotion. Vojta described inborn movement sequences
of reflex locomotion that are retrievable at all times. The therapist stimulates
these innate patterns of movement by applying pressure to defined zones. The
therapeutic use of reflex locomotion enables elementary patterns of movement
in patients with impaired locomotor system, for example due to brain damage
caused by stroke, to be restored once more, assuming that repeated stimulation
of these “reflex-like” movements can lead to something like “new networking”
within functionally blocked neuronal networks. After Vojta treatment, these
patterns are more spontaneously available to the patient. Clinical experience
shows, that Vojta therapy improves postural control, uprighting against gravity
and goal-directed movements. We will discuss implementation of Votja therapy
in stroke rehabilitation and introduce a first ever randomized controlled trial for
this approach in stroke rehabilitation.[…]
Download Full Text PDF

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[BLOG POST] 6 Ways to Get Past Plateau After Stroke

Past Plateau After Stroke

The road to recovery after stroke is not always a straight line. Oftentimes there is rapid recovery during the first three months, but then the progress slows down. This eventually leads to a plateau in recovery after about six months.

In a scenario where varying levels of paralysis are common, a shift in mindset and making little changes to lifestyle is all it takes to break the plateau. This blog offers few tips that can help you dissect that plateau and get past it.

1. Understand the root-cause

In order to break out of the plateau, it helps to understand what causes it to begin with. Some of the most significant functional improvements often occur during the early days, reflecting the initial plasticity of the brain. However, after few days, you may feel that the initial spike in progress was the end of rehabilitation and that there is no further improvement possible. But for many stroke survivors, the plateau phase is quite common and even to be expected. Understanding this will help both the stroke survivor and caregiver to avoid losing hope and persistence during this difficult time.

2. Revise your workout regime

If you aren’t making any progress, you might need something new and different to jump-start it back into rehabilitation mode. Traditional therapy that isn’t evidence-based can be ineffective and can actually cause a plateau. Thus, familiar exercises must be altered and adjusted. Try switching up your workout intensity, duration, frequency or exercises you do. For that, you will be needing your therapist’s expert guidance.

3. Find the right therapist

If the therapist isn’t modifying the treatment to your specific needs and incorporating the latest proven interventions because he hasn’t been trained in them, perhaps, it’s time to try a new therapist. Your new therapist should be able to prescribe a new evidence-based technique.

With the help of your therapist, learn to set SMART goal(s): specific, measurable, achievable, relevant, and time-bound. When you’re working systematically toward something, your motivation will stay high. After all, the recently damaged brain is taking the necessary time to heal and regrow. And, this requires setting relevant, short-term goals.

4. Learn and try new things

Along with making changes to your regimen (as recommended by the therapist, of course), pick a new skill you want to learn (like playing piano) and practice that. Simple changes like this will initiate Neuroplasticity and help you get past Plateau.

blog cta

Be part of the relevant research studies (only if your therapist allows you). It may not always work, but you may just luck out with a great new treatment. It’s also not a bad idea to join a stroke group.

5. Track your progress

Tracking everything is essential to making the stroke rehabilitation work for you. Take your current measurements to get a more accurate view of the progress made. Track these measures and compare them to your most recent stats. Apart from tracking your functional performance, it’s also wise to keep track of your:

  1. Daily meals (breakfast, lunch, and dinner) and snacks
  2. Exercise and activity
  3. BMI (Body Mass Index)
  4. Water/hydration

6. Handle emotional changes

Stroke recovery is a long (and often slow) process. Hence, frustration, anger, and depression are understandable obstacles to encounter. If you’re tired, sick, overwhelmed, or stressed, your speech or mobility may suffer.

Don’t give up hope. Many studies show that it is possible to break plateau after stroke. Everyone recovers at different rates. It’s best not to compare your recovery to others. Hope is the most powerful drug, hold onto it.

via 6 Ways to Get Past Plateau After Stroke – 9zest

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[ARTICLE] Behavioral Outcomes Following Brain–Computer Interface Intervention for Upper Extremity Rehabilitation in Stroke: A Randomized Controlled Trial – Full Text

Stroke is a leading cause of persistent upper extremity (UE) motor disability in adults. Brain–computer interface (BCI) intervention has demonstrated potential as a motor rehabilitation strategy for stroke survivors. This sub-analysis of ongoing clinical trial (NCT02098265) examines rehabilitative efficacy of this BCI design and seeks to identify stroke participant characteristics associated with behavioral improvement. Stroke participants (n = 21) with UE impairment were assessed using Action Research Arm Test (ARAT) and measures of function. Nine participants completed three assessments during the experimental BCI intervention period and at 1-month follow-up. Twelve other participants first completed three assessments over a parallel time-matched control period and then crossed over into the BCI intervention condition 1-month later. Participants who realized positive change (≥1 point) in total ARAT performance of the stroke affected UE between the first and third assessments of the intervention period were dichotomized as “responders” (<1 = “non-responders”) and similarly analyzed. Of the 14 participants with room for ARAT improvement, 64% (9/14) showed some positive change at completion and approximately 43% (6/14) of the participants had changes of minimal detectable change (MDC = 3 pts) or minimally clinical important difference (MCID = 5.7 points). Participants with room for improvement in the primary outcome measure made significant mean gains in ARATtotalscore at completion (ΔARATtotal = 2, p = 0.028) and 1-month follow-up (ΔARATtotal = 3.4, p= 0.0010), controlling for severity, gender, chronicity, and concordance. Secondary outcome measures, SISmobility, SISadl, SISstrength, and 9HPTaffected, also showed significant improvement over time during intervention. Participants in intervention through follow-up showed a significantly increased improvement rate in SISstrength compared to controls (p = 0.0117), controlling for severity, chronicity, gender, as well as the individual effects of time and intervention type. Participants who best responded to BCI intervention, as evaluated by ARAT score improvement, showed significantly increased outcome values through completion and follow-up for SISmobility (p = 0.0002, p = 0.002) and SISstrength (p = 0.04995, p = 0.0483). These findings may suggest possible secondary outcome measure patterns indicative of increased improvement resulting from this BCI intervention regimen as well as demonstrating primary efficacy of this BCI design for treatment of UE impairment in stroke survivors.

Introduction

Stroke

Each year there are approximately 800,000 new incidences of stroke in the United States (Benjamin et al., 2017), and in 2010 there were an estimated 16.9 million stroke events globally (Mozaffarian et al., 2015). Stroke occurs as a result of a blockage of blood flow in an area of the brain or by rupture of brain vasculature causing death or damage to local and distal brain tissue. In either etiology, survivors may experience some level of upper extremity (UE) physical impairment. Despite recent advances in acute care, an increasing number of stroke survivors face long-term motor deficits (Benjamin et al., 2017). Costs of care for long-term disability resulting from stroke are substantial with the direct medical costs of stroke estimated to $17.9 billion in 2013 (Benjamin et al., 2017). It is crucial that motor therapy for stroke enhances a survivor’s capacity to autonomously participate in activities of daily living (ADLs), thereby decreasing dependency on caregivers as well as the cost and level of care necessary (Dombovy, 2009Stinear, 2016). Efficacious motor therapy should be designed to improve the overall quality of life for the individual survivor based on their goals and needs (Remsik et al., 2016Stinear, 2016).

Need for Treatment

Survivors in the chronic stage of stroke are the most desperate for rehabilitation. Existing pharmacological treatments and behavioral therapy methods primarily serve to treat symptoms associated with stroke (Benjamin et al., 2017) and may not bring about optimal changes in brain function or connectivity (Power et al., 2011Nair et al., 2015). While a growing population of research suggests the greatest potential for recovery in the post-stroke brain occurs within the first months after insult (Stinear and Byblow, 2014), neuroplastic capacity has been demonstrated in both acute and chronic phases (Caria et al., 2011Ang et al., 2015). Spontaneous biological recovery (SBR) (Beebe and Lang, 2009Cramer and Nudo, 2010) in the initial days and weeks following stoke (acute phase) is thought to represent a critical period in the complex progression of motor recovery, which combines neurobiological processes and learning-related elements. After this window of SBR, it is posited a sensitive period of neurorecovery persists, plateauing around 6 months post-stroke (Wolf et al., 20062010Dromerick et al., 2009Cramer and Nudo, 2010). Traditional rehabilitation therapies generally lose efficacy after such time and the course of standard of care treatment options is exhausted leaving chronically impaired persons with few options.

Potential for Treatment

Motor and cognitive recovery after these initial windows may no longer occur in the same spontaneous nature as is observed during SBR. However, innovative therapeutic techniques show some efficacy generating functional motor recovery beyond the traditional rehabilitation windows (Cramer and Nudo, 2010Ang et al., 2015Irimia et al., 2016). Brain–computer interfaces (BCIs), a novel rehabilitation tool, have shown proof of concept for rehabilitating volitional movements in stroke survivors (Muralidharan et al., 2011Song et al., 20142015Young et al., 2014a,b,c,d2015Irimia et al., 2016). In this growing area of research, developing technologies demonstrate promising potential for treating hemiparesis in a clinically viable and efficient manner and they may offer an avenue to increased autonomy for patients reducing their cost and burden of care.

Effectiveness of Current BCI Therapies

There is currently considerable variability in design and efficacy of BCI therapies as well as little consensus with respect to proper arrangement, administration, and dosing (Muralidharan et al., 2011Ang and Guan, 2013Young et al., 2014aAng et al., 2015Irimia et al., 2016Remsik et al., 2016Bundy et al., 2017Dodd et al., 2017). Although acute stroke care has improved morbidity outcomes significantly, current treatments for persistent UE motor impairment resulting from stroke offer only limited restoration of UE motor function the further from stroke a survivor progresses (Wolf et al., 20062010Dromerick et al., 2009Benjamin et al., 2017Stinear et al., 2017). Evidence suggests both acute and chronic stroke patients respond to various neuro-rehabilitative BCI therapy strategies and can achieve clinically significant changes in measures of UE impairment (Young et al., 2014cIrimia et al., 2016Remsik et al., 2016). Furthermore, recent research also suggests that BCI therapy targeted at motor recovery may provide benefits in other brain regions outside of only the motor network (Mohanty et al., 2018).

Overview of This Study

This post hoc analysis of an ongoing clinical trial (NCT02098265) (Song et al., 20142015Young et al., 2014a,b,c,d2015) evaluates the effects of an interventional, non-invasive closed-loop electroencephalography (EEG)-based BCI intervention for the restoration of distal UE motor function in stroke survivors. Participants who showed measurable change in the primary outcome measure were grouped post hoc. This sub-analysis seeks to identify whether there are participant characteristics strongly associated with motor improvement as measured by primary and secondary outcome measures of UE function. These analyses are intended to inform future BCI research approaches and intervention designs as well as suggest and encourage appropriate participant selection.[…]

 

Continue —>  Frontiers | Behavioral Outcomes Following Brain–Computer Interface Intervention for Upper Extremity Rehabilitation in Stroke: A Randomized Controlled Trial | Neuroscience

FIGURE 2. BCI intervention block design: (1) A pre-session open-loop screening task of two attempted and then two imagined grasping tasks (left, right, rest) is used to set control features (BCI classifier) for the forthcoming intervention task (Cursor Task). (2) The closed-loop cursor and target (visual only) intervention condition consists of at least 10 runs of 10 trials of attempted grasping movements for the purpose of guiding a virtual cursor (Ball) either left, or right as cued by the target (Goal) presentation on the horizontal edge of the screen. (3) Following 10 successfully completed runs of the visual only condition, adjuvant stimuli are added to enrich the feedback environment and facilitate volitional movement of the affected extremity (grasping). Subsequent runs are attempted at the preferred pace of the participant, completing as many runs as time allows. (4) With 15 min remaining in the 2-h intervention session, the participant is switched into the post-session open-loop screening task of two imagined and then two attempted grasping tasks (left, right, rest).

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[Factsheet] Understanding TBI: Part 1 – What happens to the brain during injury and the early stages of recovery from TBI? – Model Systems Knowledge Translation Center (MSKTC)

Soccer players huddled around injured teammate

Written by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the MSKTC

What is a brain injury?

Traumatic brain injury (TBI) refers to damage to the brain caused by an external physical force such as a car accident, a gunshot wound to the head, or a fall. A TBI is not caused by something internal such as a stroke or tumor, and does not include damage to the brain due to prolonged lack of oxygen (anoxic brain injuries). It is possible to have a TBI and never lose consciousness. For example, someone with a penetrating gunshot wound to the head may not lose consciousness.

Commonly accepted criteria established by the TBI Model Systems (TBIMS) to identify the presence and severity of TBI include:

Damage to brain tissue caused by an external force and at least one of the following:

  • A documented loss of consciousness
  • The person cannot recall the actual traumatic event (amnesia)
  • The person has a skull fracture, post-traumatic seizure, or an abnormal brain scan due to the trauma

Causes of TBI

Statistics from Centers for Disease Control for 2002-2006 indicate that the leading cause of brain injury is falls (35%) followed by car crashes (17%) and being struck by an object (16%). Emergency room visits due to TBI caused by falls are increasing for both younger and older people. However, if you focus only on moderate to severe TBI (those injuries that require admission to a neurointensive care unit), car crashes are the most frequent cause of TBI, followed by gunshot wound, falls, and assault.

Types of injuries

The brain is about 3.4 pounds of extremely delicate soft tissue floating in fluid within the skull. Under the skull there are three layers of membrane that cover and protect the brain. The brain tissue is soft and therefore can be compressed (squeezed), pulled, and stretched. When there is sudden speeding up and slowing down, such as in a car crash or fall, the brain can move around violently inside the skull, resulting in injury.

Closed versus open head injury

Closed means the skull and brain contents have not been penetrated (broken into or through), whereas open means the skull and other protective layers are penetrated and exposed to air. A classic example of an open head injury is a gunshot wound to the head. A classic closed head injury is one that occurs as the result of a motor vehicle crash.

In a closed head injury, damage occurs because of a blow to the person’s head or having the head stop suddenly after moving at high speed. This causes the brain to move forward and back or from side to side, such that it collides with the bony skull around it. This jarring movement bruises brain tissue, damages axons (part of the nerve cell), and tears blood vessels. After a closed head injury, damage can occur in specific brain areas (localized injury) or throughout the brain (diffuse axonal injury).

Damage following open head injury tends to be localized and therefore damage tends to be limited to a specific area of the brain. However, such injuries can be as severe as closed head injuries, depending on the destructive path of the bullet or other invasive object within the brain.

Primary versus secondary injuries

Primary injuries occur at the time of injury and there is nothing that physicians can do to reverse those injuries. Instead, the goal of the treatment team in the hospital is to prevent any further, or secondary, injury to the brain. Below are some primary injuries.

  • Skull fracture occurs when there is a breaking or denting of the skull. Pieces of bone pressing on the brain can cause injury, often referred to as a depressed skull fracture.
  • Localized injury means that a particular area of the brain is injured. Injuries can involve bruising (contusions) or bleeding (hemorrhages) on the surface of or within any layer of the brain.
  • Diffuse axonal Injury (DAI) involves damage throughout the brain and loss of consciousness. DAI is a stretching injury to the neurons (the cell bodies of the brain) and axons (fibers that allow for communication from one neuron to another neuron). Everything our brains do for us depends on neurons communicating. When the brain is injured, axons can be pulled, stretched, and torn. If there is too much injury to the axon, the neuron will not survive. In a DAI, this happens to neurons all over the brain. This type of damage is often difficult to detect with brain scans.

Secondary injuries occur after the initial injury, usually within a few days. Secondary injury may be caused by oxygen not reaching the brain, which can be the result of continued low blood pressure or increased intracranial pressure (pressure inside the skull) from brain tissue swelling.

Measuring the severity of TBI

Severity of injury refers to the degree or extent of brain tissue damage. The degree of damage is estimated by measuring the duration of loss of consciousness, the depth of coma and level of amnesia (memory loss), and through brain scans.

The Glasgow Coma Scale (GCS) is used to measure the depth of coma. The GCS rates three aspects of functioning: eye opening, movement and verbal response. Individuals in deep coma score very low on all these aspects of functioning, while those less severely injured or recovering from coma score higher. A GCS score of 3 indicates the deepest level of coma, describing a person who is totally unresponsive. A score of 9 or more indicates that the person is no longer in coma, but is not fully alert. The highest score (15) refers to a person who is fully conscious.

A person’s first GCS score is often done at the roadside by the emergency response personnel. In many instances, moderately to severely injured people are intubated (a tube is placed down the throat and into the air passage into the lungs) at the scene of the injury to ensure the person gets enough oxygen. To do the intubation the person must be sedated (given medication that makes the person go to sleep). So, by the time the person arrives at the hospital he/she has already received sedating medications and has a breathing tube in place. Under these conditions it is impossible for a person to talk, so the doctors cannot assess the verbal part of the GCS. People in this situation often receive a T after the GCS score, indicating that they were intubated when the examination took place, so you might see a score of 5T, for instance. The GCS is done at intervals in the neurointensive care unit to document a person’s recovery.

Post-traumatic amnesia (PTA) is another good estimate for severity of a brain injury. Anytime a person has a major blow to the head he or she will not remember the injury and related events for sometime afterward. People with these injuries might not recall having spoken to someone just a couple of hours ago and may repeat things they have already said. This is the period of posttraumatic amnesia. The longer the duration of amnesia, the more severe the brain damage.

CT or MRI Scan Results

The cranial tomography (CT) scan is a type of X-ray that shows problems in the brain such as bruises, blood clots, and swelling. CT scans are not painful. People with moderate to severe TBI will have several CT scans while in the hospital to keep track of lesions (damaged areas in the brain). In some cases, a magnetic resonance imaging (MRI) scan may also be performed. This also creates a picture of the brain based on magnetic properties of molecules in tissue. Most people with severe TBI will have an abnormality on a CT scan or MRI scan. These scans cannot detect all types of brain injuries, so it is possible to have a severe TBI and be in coma even though the scan results are normal.

Brain tissue response to injury

Common Problems:

Increased intracranial pressure

The brain is like any other body tissue when it gets injured: it fills with fluid and swells. Because of the hard skull around it, however, the brain has nowhere to expand as it swells. This swelling increases pressure inside the head (intracranial pressure), which can cause further injury to the brain. Decreasing and controlling intracranial pressure is a major focus of medical treatment early after a TBI. If intracranial pressure remains high, it can prevent blood passage to tissue, which results in further brain injury.

Neurochemical problems that disrupt functioning

Our brains operate based on a delicate chemistry. Chemical substances in the brain called neurotransmitters are necessary for communication between neurons, the specialized cells within our central nervous system. When the brain is functioning normally, chemical signals are sent from neuron to neuron, and groups of neurons work together to perform functions.

TBI disturbs the delicate chemistry of the brain so that the neurons cannot function normally. This results in changes in thinking and behavior. It can take weeks and sometimes months for the brain to resolve the chemical imbalance that occurs with TBI. As the chemistry of the brain improves, so can the person’s ability to function. This is one reason that someone may make rapid progress in the first few weeks after an injury.

Natural plasticity (ability of change) of the brain

The brain is a dynamic organ that has a natural ability to adapt and change with time. Even after it has been injured, the brain changes by setting up new connections between neurons that carry the messages within our brains. We now know the brain can create new neurons in some parts of the brain, although the extent and purpose of this is still uncertain.

Plasticity of the brain occurs at every stage of development throughout the life cycle. Plasticity is more likely to occur when there is stimulation of the neural system, meaning that the brain must be active to adapt. Changes do not occur without exposure to a stimulating environment that prompts the brain to work. These changes do not occur quickly. That is one of the reasons that recovery goes on for months and sometimes years following TBI.

Rehabilitation sets in motion the process of adaptation and change. Keep in mind that formal rehabilitation, such as received in a hospital from professional therapists, is a good initial step, but in most cases this must be followed by outpatient therapies and stimulating activities in the injured person’s home.

What is the TBIMS?

The TBIMS is a group of 16 medical centers funded by the National Institute on Disability and Rehabilitation Research (NIDRR). The TBIMS works to maintain and improve a cost-effective, comprehensive service delivery system for people who experience a TBI, from the moment of their injury and throughout their life span.

Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

Source

Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model Systems directors.

Authorship

Understanding TBI was developed by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the Model System Knowledge Translation Center. Portions of this document were adapted from materials developed by the University of Alabama TBIMS, JFK Johnson Rehabilitation Institute, Baylor Institute for Rehabilitation, New York TBIMS, Moss TBIMS, and from Picking up the pieces after TBI: A guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002).

 

via Understanding TBI: Part 1 – What happens to the brain during injury and the early stages of recovery from TBI? | Model Systems Knowledge Translation Center (MSKTC)

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[Factsheet] Understanding TBI: Part 3 – The Recovery Process – Model Systems Knowledge Translation Center (MSKTC)

Military father putting his hat on his son

Written by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the MSKTC

Common stages

In the first few weeks after a brain injury, swelling, bleeding or changes in brain chemistry often affect the function of healthy brain tissue. The injured person’s eyes may remain closed, and the person may not show signs of awareness. As swelling decreases and blood flow and brain chemistry improve, brain function usually improves. With time, the person’s eyes may open, sleep-wake cycles may begin, and the injured person may follow commands, respond to family members, and speak. Some terms that might be used in these early stages of recovery are:

  • Coma: The person is unconscious, does not respond to visual stimulation or sounds, and is unable to communicate or show emotional responses.
  • Vegetative State: The person has sleep-wake cycles, and startles or briefly orients to visual stimulation and sounds.
  • Minimally Conscious State: The person is partially conscious, knows where sounds and visual stimulation are coming from, reaches for objects, responds to commands now and then, can vocalize at times, and shows emotion.

A period of confusion and disorientation often follows a TBI. A person’s ability to pay attention and learn stops, and agitation, nervousness, restlessness or frustration may appear. Sleeping patterns may be disrupted. The person may overreact to stimulation and become physically aggressive. This stage can be disturbing for family because the person behaves so uncharacteristically.

Inconsistent behavior is also common. Some days are better than others. For example, a person may begin to follow a command (lift your leg, squeeze my finger) and then not do so again for a time. This stage of recovery may last days or even weeks for some. In this stage of recovery, try not to become anxious about inconsistent signs of progress. Ups and downs are normal.

Later stages of recovery can bring increased brain and physical function. The person’s ability to respond may improve gradually.

Length of recovery

The fastest improvement happens in about the first six months after injury. During this time, the injured person will likely show many improvements and may seem to be steadily getting better. The person continues to improve between six months and two years after injury, but this varies for different people and may not happen as fast as the first six months. Improvements slow down substantially after two years but may still occur many years after injury. Most people continue to have some problems, although they may not be as bad as they were early after injury. Rate of improvement varies from person to person.

Long-term impacts

It is common and understandable for family members to have many questions about the long-term effects of the brain injury on the injured person’s ability to function in the future. Unfortunately, it is difficult to determine the long-term effects for many reasons.

  • First, brain injury is a relatively new area of treatment and research. We have only begun to understand the long-term effects in patients one, five, and ten years after injury.
  • Brain scans and other tests are not always able to show the extent of the injury, so it is sometimes difficult early on to fully understand how serious the injury is.
  • The type of brain injury and extent of secondary problems such as brain swelling varies a great deal from person to person.
  • Age and pre-injury abilities also affect how well a person will recover.

We do know that the more severe the injury the less likely the person will fully recover. The length of time a person remains in a coma and duration of loss of memory (amnesia) following the coma are useful in predicting how well a person will recover.

The Rancho Los Amigos Levels of Cognitive Functioning (RLCF) is one of the best and most widely used ways of describing recovery from brain injury. The RLCF describes ten levels of cognitive (thinking) recovery. Research has shown that the speed at which a person progresses through the levels of the RLCF can predict how fully a person will recover.

The Rancho Los Amigos Levels of Cognitive Functioning

Level 1– No Response: Person appears to be in a deep sleep.

Level 2– Generalized Response: Person reacts inconsistently and not directly in response to stimuli.

Level 3– Localized Response: Person reacts inconsistently and directly to stimuli.

Level 4– Confused/Agitated: Person is extremely agitated and confused.

Level 5– Confused-Inappropriate/Non-agitated: Person is confused and responses to commands are inaccurate.

Level 6– Confused-Appropriate: Person is confused and responds accurately to commands.

Level 7– Automatic-Appropriate: Person can go through daily routine with minimal to no confusion.

Level 8– Purposeful-Appropriate: Person has functioning memory, and is aware of and responsive to their environment.

Level 9– Purposeful-Appropriate: Person can go through daily routine while aware of need for stand by assistance.

Level 10– Purposeful-Appropriate/Modified Independent: Person can go through daily routine but may require more time or compensatory strategies.

Recovery two years after brain injury

Based on information of people with moderate to severe TBI who received acute medical care and inpatient rehabilitation services at a TBI Model System, two years post-injury:

  • Most people continue to show decreases in disability.
  • 34% of people required some level of supervision during the day and/or night.
  • 93% of people are living in a private residence.
  • 34% are living with their spouse or significant other; 29% are living with their parents.
  • 33% are employed; 29% are unemployed; 26% are retired due to any reason; and 3% are students.

Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

Source

Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model Systems directors.

Our health information content is based on research evidence and/or professional consensus and has been reviewed and approved by an editorial team of experts from the TBI Model Systems.

Authorship

Understanding TBI was developed by Thomas Novack, PhD and Tamara Bushnik, PhD in collaboration with the Model System Knowledge Translation Center. Portions of this document were adapted from materials developed by the Mayo Clinic TBIMS, Baylor Institute for Rehabilitation, and from Picking up the pieces after TBI: A guide for Family Members, by Angelle M. Sander, PhD, Baylor College of Medicine (2002).

via Understanding TBI: Part 3 – The Recovery Process | Model Systems Knowledge Translation Center (MSKTC)

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[Abstract] Modulation of Cerebellar Cortical Plasticity Using Low-Intensity Focused Ultrasound for Poststroke Sensorimotor Function Recovery

Background. Stroke affects widespread brain regions through interhemispheric connections by influencing bilateral motor activity. Several noninvasive brain stimulation techniques have proved their capacity to compensate the functional loss by manipulating the neural activity of alternative pathways. Over the past few decades, brain stimulation therapies have been tailored within the theoretical framework of modulation of cortical excitability to enhance adaptive plasticity after stroke.

Objective. However, considering the vast difference between animal and human cerebral cortical structures, it is important to approach specific neuronal target starting from the higher order brain structure for human translation. The present study focuses on stimulating the lateral cerebellar nucleus (LCN), which sends major cerebellar output to extensive cortical regions.

Methods. In this study, in vivo stroke mouse LCN was exposed to low-intensity focused ultrasound (LIFU). After the LIFU exposure, animals underwent 4 weeks of rehabilitative training.

Results. During the cerebellar LIFU session, motor-evoked potentials (MEPs) were generated in both forelimbs accompanying excitatory sonication parameter. LCN stimulation group on day 1 after stroke significantly enhanced sensorimotor recovery compared with the group without stimulation. The recovery has maintained for a 4-week period in 2 behavior tests. Furthermore, we observed a significantly decreased level of brain edema and tissue swelling in the affected hemisphere 3 days after the stroke.

Conclusions. This study provides the first evidence showing that LIFU-induced cerebellar modulation could be an important strategy for poststroke recovery. A longer follow-up study is, however, necessary in order to fully confirm the effects of LIFU on poststroke recovery.

via Modulation of Cerebellar Cortical Plasticity Using Low-Intensity Focused Ultrasound for Poststroke Sensorimotor Function Recovery – Hongchae Baek, Ki Joo Pahk, Min-Ju Kim, Inchan Youn, Hyungmin Kim, 2018

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