Posts Tagged Traumatic Brain Injury

[WEB SITE] Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community – CNS

PURPOSE: To explore the experiences of individuals who have had a severe
traumatic brain injury (TBI) and their carers in the first month post-discharge
from in-patient rehabilitation into living in the community.

METHOD: Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers.

RESULTS: Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future.

CONCLUSIONS: Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services. Implications for Rehabilitation Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer. Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead – this dissonance adds to anxiety. The study’s findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors. A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and
carer, are at the center of service provision.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community

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[WEB SITE] Traumatic Brain Injury Resource Guide – Neuroplasticity

Neuroplasticity

by Lisa Kreber, Ph.D. CBIS
Senior Neuroscientist, Centre for Neuro Skills

What is Neuroplasticity?
Neuronal Firing
How Neuroplasticity Works
Mechanisms of Plasticity
Synaptogenesis
Stem Cells
Modulation of Neurotransmission
Unmasking
Forms of Neuronal Plasticity
Neuronal Remodeling
Depression and Hippocampal Plasticity
Appreciating Plasticity
Ten Principles of Neuroplasticity
Learning, Injury and Recovery

Source: Traumatic Brain Injury Resource Guide – Neuroplasticity

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[Abstract] Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community

PURPOSE: To explore the experiences of individuals who have had a severe
traumatic brain injury (TBI) and their carers in the first month post-discharge
from in-patient rehabilitation into living in the community.

METHOD: Using a qualitative approach underpinned by critical realism, we explored the narratives of 10 patients and nine carers using semi-structured interviews approximately one month post-discharge. Thematic analysis was carried out independently by two researchers.

RESULTS: Firstly, perceptions of support were mixed but many patients and carers felt unsupported in the inpatient phase, during transitions between units and when preparing for discharge. Secondly, they struggled to accept a new reality of changed abilities, loss of roles and loss of autonomy. Thirdly, early experiences post-discharge exacerbated fears for the future.

CONCLUSIONS: Most patients and carers struggled to identify a cohesive plan that supported their transition to living in the community. Access to services required much persistence on the part of carers and tended to be short-term, and therefore did not meet their long-term needs. We propose the need for a case manager to be involved at an early stage of their rehabilitation and act as a key point for information and access to on-going rehabilitation and other support services. Implications for Rehabilitation Traumatic Brain Injury (TBI) is a major cause of long-term disability. It can affect all areas of daily life and significantly reduce quality of life for both patient and carer. Professionals appear to underestimate the change in abilities and impact on daily life once patients return home. Community services maintain a short-term focus, whereas patients and carers want to look further ahead – this dissonance adds to anxiety. The study’s findings on service fragmentation indicate an urgent need for better integration within health services and across health, social care and voluntary sectors. A link person/case manager who oversees the patient journey from admission onwards would help improve integrated care and ensure the patient, and carer, are at the center of service provision.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Experiences of patients with traumatic brain injury and their carers during transition from in-patient rehabilitation to the community

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[Abstract] Educational and Vocational Issues in Traumatic Brain Injury 

This article describes some of the current issues related to return to school and employment for individuals with traumatic brain injury. A strong, collaborative partnership between an individual’s health care providers and key stake holders is essential toa smooth transition back to school or work. Ways to improve current practices andensure more timely and appropriate educational and employment services and supports for individuals with traumatic brain injury are described. Some recommendations on areas for future research are also offered.

Source: Educational and Vocational Issues in Traumatic Brain Injury – Physical Medicine and Rehabilitation Clinics

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[ARTICLE] Visual dysfunction is underestimated in patients with acquired brain injury – Full Text

Abstract

Objectives: More than 50% of human cerebral activity is related to vision. Visual impairments are therefore common after acquired brain injury, although they are often overlooked. In order to evaluate the prevalence of visual deficits in our Out-patient Brain Injury Program, a structured screening questionnaire, the Visual Interview, was administered.

Methods: A total of 170 patients with acquired brain injury, mean age 47 years, who were enrolled in the programme during 2010–12, underwent the Visual Interview. The interview consists of 18 questions concerning visual impairment and was performed on admission. The different types of visual impairment were compared with regard to sex and diagnosis.

Results: Fifty-four percent of the patients reported visual changes, mainly reading difficulties, photosensitivity, blurred vision and disorders of the visual field. Sixteen patients who did not experience visual changes also reported visual symptoms in 4–9 questions. Only slight differences were noted in the occurrence of visual symptoms when correlated with sex or diagnosis.

Conclusion: Visual impairments are common after acquired brain injury, but some patients do not define their problems as vision-related. A structured questionnaire, covering the most common visual symptoms, is helpful for the rehabilitation team to facilitate assessment of visual changes.

Introduction

The visual system is widely distributed in the brain. It is integrated in more than 50% of human cerebral activity and is fundamental for interpretation of, and interaction with, the environment (1, 2).

A pyramidal hierarchical model of visual perceptual function was presented by Warren in 1993 (3). In this model, visual cognition forms the top level, followed by, in descending order: visual memory, pattern recognition, scanning, attention and a base level holding acuity, visual fields, and ocular motor control. The model illustrates how higher visual skills evolve from integration and interaction with lower skills and how visual cognition depends on well-functioning lower levels of visual perception.

Base level disturbances, such as visual field defects (VFDs), visual acuity changes, diplopia, strabismus, photophobia and different types of binocular disorders, are common after acquired brain injury (ABI) (4, 5), and lead to chronic headache, fatigue, dizziness, reading problems, and difficulties navigating the environment (6, 7). Although a complete VFD or manifest diplopia seldom escapes notice, disturbances of ocular motor abilities and photophobia are likely to be overlooked. Examinations of convergence and accommodation are not customary in standard ophthalmological assessments. Ordinary short examinations are unable to reveal declining attention ability and fatigue. Thus, the true problems may remain hidden.

Several reports of prevalence and quality of visual deficits after ABI document visual dysfunctions in approximately 50–75% of patients (8–13). The occurrence of different visual symptoms differs between the studies, including reading disturbances, VFD, diplopia, ocular motor dysfunction and photophobia. Nevertheless, visual symptoms are often overlooked in neurorehabilitation. The observations of Sand et al. (14) are noteworthy, i.e. that 1 of 4 stroke patients with VFD, 6 months after onset of stroke, considered that their visual problems reduced quality of life and increased their disability.

Visual disturbances after ABI are common and lead to reduced quality of life. An important question is why they are so often overlooked in neurorehabilitation? A possible explanation is the difficulty for different professionals to co-operate. Vision disturbances are complex and many different professionals operate in the field. An ability to co-operate is needed for a high-quality assessment. Another explanation could be the patients’ difficulty describing their shortcomings. They experience decreased reading speed, fatigue and dizziness, but do not recognize these problems as expressions of visual deficits. A structured questionnaire at admission would help the clinician to obtain informative answers.

In 1990, Kerkhoff et al (15). compiled an “Interview Questionnaire” in order to capture visual disorders after ABI. This interview was used by Wilhelmsen 2003 (12). Jacobsson & Hamelius translated it from Norwegian to Swedish in 2010 (16). During the last 5 years we have used this questionnaire, slightly modified, termed the Vision Interview (TVI), as an aid to discover visual deficits in our Out-patient Brain Injury Program.

The aim of the present study was to examine and analyse the occurrence of self-reported visual changes in a Swedish out-patient group with medium to severe ABI, based on TVI.

Continue —> Journal of Rehabilitation Medicine – Visual dysfunction is underestimated in patients with acquired brain injury – HTML

 

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[Abstract] The trajectories of overall disability in the first 5 years after moderate and severe traumatic brain injury – CNS Web Site

PRIMARY OBJECTIVES: To assess longitudinal trajectories of overall disability after moderate-to-severe traumatic brain injury (TBI) and to examine whether those trajectories could be predicted by socio-demographic and injury characteristics.

METHODS: Demographics and injury characteristics of 105 individuals with moderate-to-severe TBI were extracted from medical records. At the 1-, 2-, and 5-year follow-ups, TBI-related disability was assessed by the GOSE. A hierarchical linear model (HLM) was used to examine functional outcomes up to 5 years following injury and whether those outcomes could be predicted by: time, gender, age, relationship, education, employment pre-injury, occupation, GCS, cause of injury, length of post-traumatic amnesia (PTA), CT findings and injury severity score, as well as the interactions between each of these predictors and time.

RESULTS: Higher GOSE trajectories (lower disability) were predicted by younger age at injury and shorter PTA, as well as by the interaction terms of timePTA and timeemployment. Those who had been employed at injury decreased in disability over time, while those who had been unemployed increased in disability.

CONCLUSION: The study results support the view that individual factors generally outweigh injury-related factors as predictors of disability after TBI, except for PTA.

Source: Traumatic Brain Injury Resource Guide – Research Reports – The trajectories of overall disability in the first 5 years after moderate and severe traumatic brain injury

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[WEB SITE] ‘Microwave helmet’ may cut time taken to evaluate head injuries – Medical News Today

Published: Friday 10 March 2017

A portable device that covers the head and uses microwave technology to examine brain tissue in prehospital settings could cut the time it takes to evaluate brain injuries. So conclude researchers after evaluating their “microwave helmet” in a small trial.

The researchers – including members from Chalmers University of Technology and Sahlgrenska University Hospital, both in Gothenburg, Sweden – report their findings in the Journal of Neurotrauma.

They suggest that the results of their small trial show that microwave technology can be used for the rapid detection of intracranial bleeding that can result from head injuries.

First author Dr. Johan Ljungqvist, a specialist in neurosurgery at the Sahlgrenska University Hospital, says: “The microwave helmet could improve the medical assessment of traumatic head injuries even before the patient arrives at the hospital.”

He notes that even though their study was small, and they only focused on one type of head injury, “the result indicates that the microwave measurements can be useful in ambulances and in other care settings.”

In their study paper, he and his colleagues note that microwave technology has already been evaluated for other medical applications – such as distinguishing between strokes caused by blood clots and strokes caused by bleeding in the brain.

TBI is a leading cause of disability and death

Traumatic brain injury (TBI) is disruption of normal brain function due to trauma that results from an injury that bumps, jolts, hits, or penetrates the head. The severity of trauma ranges from “mild” (the most common kind, also known as concussion) to “severe.”

Fast facts about TBI

  • In the U.S. between 2006 and 2010, TBI-related deaths were highest in people aged 65 and older
  • Over that period, vehicle crashes were the leading cause of TBI-related deaths for young people aged between 5 and 24
  • Among nonfatal TBI-related injuries, rates of ED visits were highest for children aged 4 and under.

Learn more about TBI

TBI can disrupt memory, thinking, movement, vision, hearing, and emotional functioning. It can also result in personality changes and depression. The effects are not confined to individuals; they can also impact families, friends, and communities.

TBI is a major cause of death and disability in the United States, where estimates from the Centers for Disease Control and Prevention (CDC) suggest that 138 people die every day from injuries that include TBI.

The majority of TBI survivors experience effects that last a few days, while others are left with enduring disabilities that can last for the rest of their lives.

In the U.S. in 2010, the amount of visits to emergency departments (EDs), admissions to hospitals, and deaths either related to TBI alone or to TBI linked with other injuries totaled around 2.5 million.

CDC figures for between 2006 and 2010 show falls as the leading cause of TBI (accounting for 40.5 percent of ED visits, hospitalizations, and deaths), followed by unintentional blunt trauma (15.5 percent), and motor vehicle crashes (14.3 percent).

Dr. Ljungqvist and colleagues note that the key to improving outcomes for people who sustain TBIs is to reduce the time it takes from when the injury occurs to deciding the right treatment.

Microwave helmet

The microwave helmet has three parts: a helmet incorporating microwave antennae that is placed on the patient’s head; a microwave signal generator; and a computer that controls the equipment, collects the data, and processes them through advanced mathematical algorithms.

The microwave generator sends signals through transmit antennae in the helmet into the patient’s brain.

Receiving antennae in the helmet pick up the signals after they have been scattered by and reflected from the brain tissue.

The advanced algorithms analyze the complex patterns in the microwave signals to deduce what they might indicate about changes in the brain.

Dr. Ljungqvist and colleagues evaluated the ability of their microwave technology to differentiate between people with brain bleeds due to injury and people without brain injury.

Microwave technology ‘shows promise in early triage of TBI’

The team tested the device on 20 patients with traumatic intracranial hematomas, 20 patients with chronic subdural hematoma, and 20 healthy volunteers. The patients were hospitalized for surgery in a Swedish hospital.

The participants also underwent traditional scanning with computerized tomography (CT). The CT scan results were then compared with the microwave helmet results.

The authors conclude that the microwave technology “shows promise as a tool to improve triage accuracy.” It detected the hematomas at 100 percent sensitivity and 75 percent specificity.

Sensitivity indicates how well a test rules out disease, and specificity indicates how well it rules it in. Thus, in this study, the microwave helmet “over-diagnosed” 25 percent of the cases (that is, 25 percent were “false positives.”)

The researchers note that plans are already in place to test the microwave helmet with more acute head injury patients in Sweden and other countries.

“Microwave technology has the potential to revolutionize medical diagnostics by enabling faster, more flexible, and more cost-effective care.”

Mikael Persson, professor of biomedical engineering, Chalmers University of Technology

Learn how a molecule discovery may lead to new drugs for brain and spinal cord injury.

Source: ‘Microwave helmet’ may cut time taken to evaluate head injuries – Medical News Today

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[Abstract] Neurosurgery and Music; The effect of Wolfgang Amadeus Mozart

Abstract

Background

The nervous system works like a great orchestra. Specially the music of Mozart with its´ “Mozart´s effect” is appropriate to use in neurosurgery. The paper investigates the relationship between music and neurosurgery, Mozart´s music in neurosurgical practice.

Material and Methods

We used digital catalogues like “pubmed” as well as the libraries of universities. Key words were “Wolfgang Amadeus Mozart”, “neurosurgery and music”.

Results

At the first half of 20 century, neurosurgical approach of some musicians have resulted with fatal outcome such as Maurice Ravel, Josef Hassid,George Gershwin. The cause of this is probably that neurosurgery has not been developed yet in the first half of the 20th century. In last three decades, the neurosurgical operations of musician show that musicians has rich associations between auditory, somatic, and sensorial systems.

Conclusion

It is clear that we have much to learn from studies about music and brain function that derive from our surgical experiences with patients. The neuronal plasticity of musician‘s brain may be different than non-musicians´. Musicians with enhanced motor skills have greater capacity for plasticity because of enriched interhemispheric connections. Listening music, and of Mozart´s effect in neurosurgical practice, intensive care, or rehabilitation was documented in much studies. As authors, we mean something different: Its effectiveness shouldbe studied. We can concluded that, in current neurosurgical practice that Mozart has an effect. More research and clinical studies are needed.

Source: Neurosurgery and Music; The effect of Wolfgang Amadeus Mozart

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[WEB SITE] Studies uncover long-term effects of traumatic brain injury

Doctors are beginning to get answers to the question that every parent whose child has had a traumatic brain injury (TBI) wants to know: What will my child be like 10 years from now?

In a study to be presented Friday Feb. 10 at the annual meeting of the Association of Academic Physiatrists in Las Vegas, researchers from Cincinnati Children’s will present research on long-term effects of TBI—an average of seven years after injury. Patients with mild to moderate brain injuries are two times more likely to have developed , and those with severe injuries are five times more likely to develop secondary ADHD. These researchers are also finding that the family environment influences the development of these attention problems.

  • Parenting and the exert a powerful influence on recovery. Children with severe TBI in optimal environments may show few effects of their injuries while children with milder injuries from disadvantaged or chaotic homes often demonstrate persistent problems.
  • Early family response may be particularly important for long-term outcomes suggesting that working to promote effective parenting may be an important early intervention.
  • Certain skills that can affect social functioning, such as speed of information processing, inhibition, and reasoning, show greater .
  • Many children do very well long-term after brain injury and most do not have across the board deficits.

More than 630,000 children and teenagers in the United States are treated in emergency rooms for TBI each year. But predictors of recovery following TBI, particularly the roles of genes and environment, are unclear. These environmental factors include family functioning, parenting practices, home environment, and socioeconomic status. Researchers at Cincinnati Children’s are working to identify genes important to recovery after TBI and understand how these genes may interact with to influence recovery.

  • They will be collecting salivary DNA samples from more than 330 children participating in the Approaches and Decisions in Acute Pediatric TBI Trial.
  • he primary outcome will be global functioning at 3, 6, and 12 months post injury, and secondary outcomes will include a comprehensive assessment of cognitive and behavioral functioning at 12 months post injury.
  • This project will provide information to inform individualized prognosis and treatment plans.

Using neuroimaging and other technologies, scientists are also learning more about brain structure and connectivity related to persistent symptoms after TBI. In a not-yet-published Cincinnati Children’s study, for example, researchers investigated the structural connectivity of brain networks following aerobic training. The recovery of structural connectivity they discovered suggests that aerobic training may lead to improvement in symptoms.

Over the past two decades, investigators at Cincinnati Children’s have conducted a series of studies to develop and test interventions to improve cognitive and behavioral outcomes following pediatric . They developed an innovative web-based program that provides family-centered training in problem-solving, communication, and self-regulation.

  • Across a series of randomized trials, online family problem-solving treatment has been shown to reduce behavior problems and executive dysfunction (management of cognitive processes) in older children with TBI, and over the longer-term improved everyday functioning in 12-17 year olds.
  • Web-based parenting skills programs targeting younger children have resulted in improved parent-child interactions and reduced behavior problems. In a computerized pilot trial of attention and memory, children had improvements in sustained attention and parent-reported executive function behaviors. These intervention studies suggest several avenues for working to improve short- and long-term recovery following TBI.

Explore further: Drug shown to aid injured adult brains may exacerbate cognitive problems in children

Source: Studies uncover long-term effects of traumatic brain injury

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[ARTICLE] How Can We Improve Current Practice in Spastic Paresis? – Full Text

Abstract:

Spastic paresis can arise from a variety of conditions, including stroke, spinal cord injury, multiple sclerosis, cerebral palsy, traumatic brain injury and hereditary spastic paraplegia. It is associated with muscle contracture, stiffness and pain, and can lead to segmental deformity. The positive, negative and biomechanical symptoms associated with spastic paresis can significantly affect patients’ quality of life, by affecting their ability to perform normal activities. This paper – based on the content of a global spasticity interdisciplinary masterclass presented by the authors for healthcare practitioners working in the field of spastic paresis – proposes a multidisciplinary approach to care involving not only healthcare practitioners, but also the patient and their family members/carers, and improvement of the transition between specialist care and community services. The suggested treatment pathway comprises assessment of the severity of spastic paresis, early access to neurorehabilitation and physiotherapy and treatment with botulinum toxin and new technologies, where appropriate. To address the challenge of maintaining patients’ motivation over the long term, tailored guided self-rehabilitation contracts can be used to set and monitor therapeutic goals. Current global consensus guidelines may have to be updated, to include a clinical care pathway related to the encompassing management of spastic paresis.

Spastic paresis may be caused by a variety of conditions, including stroke, spinal cord injury, multiple sclerosis, retroviral and other infectious spinal cord disorders, cerebral palsy, traumatic brain injury and hereditary spastic paraplegia.1 The exact prevalence of spastic paresis (in which spasticity is the most commonly recognised manifestation) is not known. However, it is estimated that around 30% of stroke survivors are affected by significant spasticity2 and 50% who present to hospital with stroke develop at least one severe contracture.3

Spastic paresis is a complex condition that may be associated with soft tissue contracture, pain and limitations of day-to-day activities, which have a substantial impact on patients’ and caregivers’ quality of life.4 Although treatment guidelines have been developed for (focal) spasticity,5 there remains a lack of consensus on key aspects of diagnosis, approaches to care and the care pathway that would help healthcare practitioners to more fully understand and manage this condition.

To address some of these limitations, a group of physicians and a physiotherapist with expertise in the management of spastic paresis developed a global spasticity masterclass for healthcare practitioners working in this field in order to share best practices and to discuss issues and current trends in the management of patients with spasticity. The outputs of this masterclass are presented here.

Continue —> How Can We Improve Current Practice in Spastic Paresis? | Touch Neurology | Independent Insight for Medical Specialists

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