Applying bifactor modelling to improve the clinical interpretive values of Functional Independence Measure in adults with acquired brain injury

2018 ◽  
Vol 42 (12) ◽  
pp. 1753-1761 ◽  
Author(s):  
Fengsong Gao ◽  
Michele Foster ◽  
Peter Newcombe ◽  
Timothy Geraghty
Keyword(s):  
Brain Injury ◽  
Functional Independence Measure ◽  
Acquired Brain Injury ◽  
Functional Independence

scholarly journals Nutritional and Rehabilitation goals in Acquired Brain Injury patients: a new decannulation protocol

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M d’Angelo ◽  
A Michelutti ◽  
E Biasutti ◽  
R Quattrin ◽  
S Brusaferro
Keyword(s):  
Brain Injury ◽  
Functional Independence Measure ◽  
Acquired Brain Injury ◽  
Rehabilitation Medicine ◽  
Functional Independence ◽  
Oral Feeding ◽  
Respiratory Complications ◽  
Outcome Indicators ◽  
Physical And Rehabilitation Medicine ◽  
Process And Outcome

Abstract Background One of the first goals for the rehabilitation of patients with Acquired Brain Injury (ABI) is the removal of the tracheocannula: the aim is not only to allow respiration by airways and reduce respiratory complications but also to obtain rehabilitation of dysphagia and verbal communication: for this purpose from July 2017 the ABI unit of the Institute of Physical and Rehabilitation Medicine ’Gervasutta” adopted a new decannulation protocol, recommended by the Italian Society of Physical Medicine and Rehabilitation (SIMFER). Methods Clinical data of ABI patients with tracheal cannula from May 2014 were collected as both process and outcome indicators associated with the adoption of the new protocol were defined. ABI patients were therefore divided into two groups depending on whether they were treated with or without the new procedure. Data have been processed with “Simple Interactive Statistical Analysis” (SISA) software. Results A sample of 141 patients with tracheocannula was analyzed; among these 57 (40.4%) were treated with the new decannulation protocol. No statistical significant differences were found between the two groups in terms of systemic or respiratory complications, Functional Independence Measure (FIM) or Level of Cognitive Functioning (LCF) at the entrance as well as for both the time (days) between entry or tracheotomy and decannulation. However decannulation rate is significantly higher when the new protocol is applied (OR = 1.8; 95% CI = 1.2- 9.8; p = 0.01) as the time (days) between entry and oral feeding resumption (p < 0.001; 95% CI = -10 - -34 days). Conclusions The introduction of the new protocol has allowed the achievement of both nutritional and rehabilitation goals with a significantly faster oral feeding resumption and an increase of decannulation rate and. Further efforts are needed to support its use in the future, with the aim of further improving of either process or outcome performances. Key messages Promising prospects for the decannulation of patients with acquired brain injury. Achievement of nutritional and rehabilitation goals.

Berg Balance Scale and Outcome Measures in Acquired Brain Injury

2001 ◽  
Vol 15 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Jody A. Feld ◽  
Meheroz H. Rabadi ◽  
Alan D. Blau ◽  
Barry D. Jordan
Keyword(s):  
Brain Injury ◽  
Functional Independence Measure ◽  
Quantitative Measure ◽  
Acquired Brain Injury ◽  
Functional Independence ◽  
Berg Balance Scale ◽  
Community Dwelling ◽  
Strongly Correlated ◽  
Balance Scale ◽  
Clinical Measures

Objective: To examine the relationship of the Berg Balance Scale (BBS) to out come after acquired brain injury. Methods: Forty consecutive patients with acquired brain injury were admitted for multidisciplinary rehabilitation. Patients were assessed with the BBS. The BBS was originally designed as a quantitative measure of balance and risk for falls in community-dwelling elderly patients. The BBS comprises 14 dif ferent tasks graded on a 56-point scale. Community-dwelling elders with a BBS score of ≤42 have >90% risk for falls. Results: In our study, there were 27 patients with a low BBS score (≤42) and 13 patients with a high BBS score (≥43). The discharge total Functional Independence Measure (FIM) scores were lower in the low BBS pa tients (96.4 ± 21.2) compared with the high BBS patients (111.5 ± 12.5) (p < 0.007). The length of stay (LOS) was significantly longer in the low BBS patients (38.9 ± 18.5 days) compared with the high BBS patients (14.2 ± 6.1 days; p < 0.000). Among the three patients that experienced falls during their hospitalization, all exhibited low BBS scores. The admission BBS score strongly correlated with admission total FIM scores (r = 0.86; p < 0.000) and moderately correlated with discharge total FIM scores (r = 0.56; p < 0.000) and LOS (r = -0.55; p < 0.000). Using a multiple regression analysis, the admission FIM score was found to be the better predictor of discharge FIM scores, and time admitted after injury was the better predictor of LOS. Conclusions: Prediction of rehabilitative outcome might be enhanced by the use of the BBS scores in combination with other clinical measures on admission to inpatient acute rehabil itation. Key Words: Functional Independence Measure—Berg Balance Scale—Ac quired brain injury.

Gender differences in the developmental outcomes of children with congenital cardiac defects

2012 ◽  
Vol 22 (5) ◽  
pp. 514-519 ◽  
Author(s):  
Annette Majnemer ◽  
Catherine Limperopoulos ◽  
Michael Shevell ◽  
Charles Rohlicek ◽  
Bernard Rosenblatt ◽  
...  
Keyword(s):  
Gender Differences ◽  
Brain Injury ◽  
Functional Independence Measure ◽  
Early Brain Injury ◽  
Functional Independence ◽  
Receptive Language ◽  
Full Scale ◽  
Fine Motor ◽  
Intellectual Quotient ◽  
Neuroprotective Strategies

AbstractObjectiveThis study compares the developmental and functional outcomes at school entry between boys and girls born with a congenital cardiac defect who required early surgical correction.Study designA prospective cohort of 94 children, including 49 percent boys, were followed up to 5 years of age and assessed for developmental progress. Developmental measures included Wechsler Preschool and Primary Scale of Intelligence – cognitive; Peabody Picture Vocabulary Test – receptive language; Peabody Developmental Motor Scale – motor; and Child Behaviour Checklist – behaviour. Measures of function included the Vineland Adaptive Behavior Scale and Functional Independence Measure for Children (WeeFIM).ResultsThe mean scores of the boys on the WeeFIM subscales, such as self-care, mobility, cognition, were significantly lower than that of the girls. There was a trend for a greater proportion of boys to have abnormalities on neurological examination (boys 37.5 percent abnormal, girls 19.5 percent abnormal). Verbal, performance, and full scale Intellectual Quotients were 5–7 points lower in boys but did not reach significance (full scale Intellectual Quotient: boys 87.7 plus or minus 22.2; girls 93.9 plus or minus 19.3). Boys were more likely to have fine motor delays (50 percent, 82.7 plus or minus 16.5) compared with girls (28.2 percent, 87.0 plus or minus 15.8). There were no gender differences in receptive language or behavioural difficulties.ConclusionsBoys born with congenital heart disease requiring early surgical repair appear to be at enhanced risk for neuromotor impairments and activity limitations. Findings support gender differences in the pathogenesis of early brain injury following hypoxic–ischaemic insults. This has implications for neuroprotective strategies to prevent brain injury.

scholarly journals Overview of Traumatic Brain Injury Patients at a Tertiary Trauma Centre

2005 ◽  
Vol 32 (2) ◽  
pp. 186-193 ◽  
Author(s):  
Elaine de Guise ◽  
Mitra Feyz ◽  
Joanne LeBlanc ◽  
Sylvain-Luc Richard ◽  
Julie Lamoureux
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Acute Care ◽  
Scale Score ◽  
Rating Scale ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Term Care ◽  
Traumatic Amnesia ◽  
Post Traumatic

ABSTRACT:Objective:The goal of this study was to provide a general descriptive and cognitive portrait of a population with traumatic brain injury (TBI) at the time of their acute care stay.Material and methods:Three hundred and forty-eight TBI patients were assessed. The following data were collected for each patient: age, level of education, duration of post-traumatic amnesia, Galveston Orientation Amnesia Test score, Glasgow Coma Scale score, results of cerebral imaging, Neurobehavioral Rating Scale score, the Functional Independence Measure cognitive score and the Glasgow Outcome Scale score.Results:The clinical profile of the population revealed a mean age of 40.2 (±18.7) and a mean of 11.5 (±3.6) years of education. Most patients presented with frontal (57.6%) and temporal (40%) lesions. Sixty-two percent had post-traumatic amnesia of less than 24 hours. Seventy percent presented with mild TBI, 14% with moderate and 15% with severe TBI. The cognitive deficits most frequently observed on the Neurobehavioral Rating Scale were in the areas of attention, memory and mental flexibility as well as slowness and mental fatigability. Most patients had good cognitive outcome on the Functional Independence Measure and scores of 2 and 3 were frequent on the GOS. Forty-five percent of the patients returned home after discharge, 51.7% were referred to in or out patient rehabilitation and 3.2% were transferred to long-term care facilities.Conclusion:Because of the specialized mandate of acute care institutions, the information provided here concerning characteristics of our TBI population is essential for more efficient decision-making and planning/programming with regards to care and service delivery.

scholarly journals A Single-center Comparison Using Exoskeleton Rehabilitation for Cerebrovascular Accidents and Traumatic Brain Injury in a Cohort of Hispanic Patients

2020 ◽  
Author(s):  
Lisa R Treviño ◽  
Kristina Vatcheva ◽  
Michael E Auer ◽  
Angela Morales ◽  
Lama M Abdurrahman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Functional Independence Measure ◽  
Retrospective Chart Review ◽  
The United States ◽  
Functional Independence ◽  
Similar Amount ◽  
Federal Drug Administration ◽  
Robotic Exoskeleton

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of disability in the United States. The EKSO GT Bionics® (EKSO®) is a robotic exoskeleton approved by the Federal Drug Administration (FDA) for rehabilitation following a cerebrovascular accident (CVA or stroke) and recently received approval for use in patients with TBI. The aim of the study was to examine if the use of exoskeleton rehabilitation in patients with TBI will produce beneficial outcomes. Methods This retrospective chart-review reports the use of the (EKSO®) robotic device in the rehabilitation of patients with TBI compared to patients with CVA. We utilized data from a single, private rehabilitation hospital for patients that received post-CVA or post-TBI robotic exoskeleton intervention. All patients that used the exoskeleton were discharged from the hospital between 01/01/2017 to 04/30/2020. Ninety-four percent of patients in the CVA groups and 100% of patients in the TBI group were of Hispanic or Latino ethnicity. Gains in total Functional Independence Measure (FIM), walking and cognition, and length of stay in the rehabilitation facility were measured. Results Patients in the TBI group (n = 11) were significantly younger than the patients in the CVA group (n = 66; p < 0.05). Both groups spent a similar amount of time active, number of steps taken, and the number of sessions in the exoskeleton. Both groups also started with similar admission FIM scores. The FIM gain in the TBI group was similar to that of the CVA group (37.5 and 32.0 respectively). The length of stay between groups was not different either. Conclusions The use of exoskeleton rehabilitation in patients with TBI appear to produce similar outcomes as for patients with CVA, prompting further attention of this intervention for this type of injury. Trial registration: Retrospectively registered on 07/09/2020 in clinicaltrials.gov number NCT4465019.

scholarly journals Rehabilitation Outcomes in Subjects with West Nile Neuro-Invasive Disease

2021 ◽  
Vol 11 (10) ◽  
pp. 1253
Author(s):  
Komal Patel ◽  
Brian D. Greenwald ◽  
Rosanna C. Sabini
Keyword(s):  
Brain Injury ◽  
Assisted Living ◽  
Functional Decline ◽  
Skilled Nursing Facility ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Functional Independence ◽  
West Nile ◽  
Rehabilitation Facility

West Nile Virus (WNV) is the most common mosquito borne cause of viral encephalitis in the United States. Physical and neuro-cognitive recovery from WNND may be prolonged or incomplete leading to chronic cognitive inefficiencies and functional decline. There continues to be no effective treatment of WNV and current management is primarily supportive. The objective of this review is to evaluate the functional outcomes and role of rehabilitation services in subjects with WNND. The charts of five subjects admitted to an acute inpatient brain injury rehabilitation facility from June to December 2012 were retrospectively reviewed. (Mean, Range)-Age (64.8, 43–78 years), Admission Functional Independence Measure (FIM) (45.2, 14–63), Discharge FIM (82.2, 61–100), FIM score gain (37, 24–60), Cognitive FIM gain (7, 1–18), Mobility FIM gain (17.4, 13–20), ADL FIM gain (12.6, 4–23); acute brain injury inpatient rehabilitation facility length of stay (LOS) (17.8, 14–21 days); acute hospital LOS (15, 10–22 days). Of the five subjects, three were discharged home, one was discharged to a skilled nursing facility, and one was discharged to an assisted living facility. Subjects with WNND have significant functional decline across all FIM subcategories and may benefit from a course of brain injury-specific acute inpatient rehabilitation.

scholarly journals Assessment of Intensive Inpatient Rehabilitation Program in Acquired Brain Injury Patients using UK FIM+FAM Scale: A Retrospective Study

2021 ◽  
Author(s):  
Harleen Uppal ◽  
Shipra Chaudhary ◽  
Siddharth Rai
Keyword(s):  
Brain Injury ◽  
Functional Outcome ◽  
Outcome Measure ◽  
Acquired Brain Injury ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
P Value ◽  
Functional Outcome Measure ◽  
The Uk

Introduction: Acquired Brain Injury (ABI) can lead to a combination of physical, cognitive, and behavioural impairments and requires comprehensive and structured inpatient rehabilitation program. A multidisciplinary rehabilitation program can deal comprehensively with all these issues together rather than focussing on a single aspect like motor function. Number of people suffering from Traumatic Brain Injury (TBI) in India has been documented to be between 1.5 million to two million per year whereas out of this approximately one million die due to TBI. The rationale of the present study was to document the outcome of multidisciplinary inpatient rehabilitation program objectively using a standard functional outcome measure. Aim: To determine the change in functional outcomes of ABI patients being rehabilitated with a multidisciplinary inpatient neurorehabilitation program using UK version of Functional Independence Measure and Functional Assessment Measure (UK FIM+FAM). Materials and Methods: The retrospective observational study was conducted in Medanta Hospital, Gurugram, Haryana, India, from September 2017 to June 2018. Retrospective analysis of previously maintained data was done from June 2018 to November 2018. Data was collected from the Department of Neurorehabilitation. Demographic data was collected including age, sex, type of injury, time from injury to admission and duration of stay in the neurorehabilitation unit. Functional outcome measure used in the study was the UK FIM+FAM. Data was collected in paper forms and collated in Microsoft Excel and transferred to IBM® Statistical Package for the Social Sciences (SPSS)® version 22.0 (IBM Corp., Armonk, NY) for analysis. The UK FIM+FAM data was analysed as aggregate total scores and motor and cognitive subscales. Non parametric tests were used as UK FIM+FAM is an ordinal scale. The test used to measure the change in score was Wilcoxon Test. The p-value <0.05 was considered statistically significant. Results: Total number of patients who were analysed in the study were 45. Motor subset of scores showed significant improvement from admission (50) to discharge (72) (p-value=0.001). Similarly, the cognitive subset of scores also showed a significant improvement from admission (58) to discharge (68, p value=0.002). Apart from motor and cognitive subscales of UK FIM+FAM, change in score in sub divisions of self-care and transfers showed the maximum change with p-value=0.001. Other sub divisions of locomotion, sphincter, communication, psychological and cognition also showed a significant difference of p-value <0.05. Conclusion: A physiatrist led intensive interdisciplinary inpatient rehabilitation program for patients with ABI may significantly reduce residual disability and improve functional independence. Such a program is not only effective in high income countries but also in Low Middle Income Countries (LMIC).

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