Does age matter? A mixed methods study examining determinants of good recovery and resilience in young and middle-aged adults following moderate-to-severe traumatic brain injury

Often the Balance Error Scoring System (BESS) is used to assess balance during a clinical evaluation of a patient presenting with mild Traumatic Brain Injury (mTBI). Although recent research has shown the benefits of using inertial sensor measures such as the Root Mean Square (RMS) of the acceleration in place of clinical scoring, few normative data are available for clinicians to reference. The purpose of this paper was to provide normative data collected using wearable sensors for healthy controls across three age groups, as well as providing cohort data for mTBI participants across three stages following injury (acute, sub-acute and chronic). The RMS in the Medio-Lateral direction (ML RMS sway) of each condition (double stance – DS; single stance – SS; and tandem stance – TS) was extracted per participant for analysis. The average ML RMS sway across all conditions was also calculated (ML RMS-Av). Percentiles were calculated to provide normative data, and two multivariate general linear models were used to evaluate differences between 1) non-athlete controls, athlete controls, and athletes with acute mTBI, and 2) non-athletic cohorts of control, sub-acute and chronic mTBI groups across young, middle-aged, and older adults. Model 1 revealed athletes with acute mTBI had more ML RMS sway than athlete controls the for the DS condition ( p < 0.001), but no differences with non-athlete controls. Athlete controls also had less ML RMS sway for the SS condition and ML RMS-Av ( p ≤ 0.022) compared with non-athlete controls. Model 2 revealed less ML RMS sway in the control group than the sub-acute and chronic mTBI groups for DS ( p ≤ 0.004), but no differences between the sub-acute and chronic group, while more ML RMS sway occurred in the chronic group compared with the control and sub-acute groups for the TS condition and ML RMS-Av ( p ≤ 0.013). Older adults had more ML RMS sway than young and middle-aged adults for SS, TS and ML RMS-Av ( p ≤ 0.019), while there were no differences between the young and middle-aged adults. Normative values presented here can help increase the practical application of instrumented balance assessment of mTBI patients through wearable sensors. ML RMS sway in the DS condition provided the clearest distinction between control and mTBI groups, but we caution that young adult athletes need to be assessed against athletic peers in the absence of baseline normative values. In non-athlete cohorts, age and gender norms may not be necessary to consider when assessing DS performance; however, age may be an important factor to consider when accessing norms for other stance conditions or the average performance across all conditions.

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Evidence supports metacognitive strategy instruction for particular executive functions in young to middle-aged adults with chronic traumatic brain injury

Evidence-Based Communication Assessment and Intervention ◽

10.1080/17489539.2011.633786 ◽

2011 ◽

pp. 1-4

Author(s):

Therese M. O’Neil-Pirozzi

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Executive Functions ◽

Strategy Instruction ◽

Metacognitive Strategy ◽

Middle Aged ◽

Metacognitive Strategy Instruction ◽

Middle Aged Adults

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Post-Acute Traumatic Brain Injury Rehabilitation Treatment Variables: A Mixed Methods Study

Clinical Archives of Communication Disorders ◽

10.21849/cacd.2017.00185 ◽

2017 ◽

Vol 2 (3) ◽

pp. 209-213 ◽

Cited By ~ 1

Author(s):

Victoria Hardin ◽

Cynthia O’Donoghue ◽

Cara Meixner ◽

Frank Lewis ◽

Gordon Horn ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Mixed Methods ◽

Brain Injury ◽

Mixed Methods Study ◽

Injury Rehabilitation ◽

Rehabilitation Treatment ◽

Acute Traumatic Brain Injury

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A mixed-methods needs assessment of traumatic brain injury care in a low- and middle-income country setting: building neurocritical care capacity at two major hospitals in Cambodia

Journal of Neurosurgery ◽

10.3171/2019.10.jns192118 ◽

2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Ariana S. Barkley ◽

Laura J. Spece ◽

Lia M. Barros ◽

Robert H. Bonow ◽

Ali Ravanpay ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Mixed Methods ◽

Brain Injury ◽

Neurocritical Care ◽

Capacity Development ◽

Mixed Methods Study ◽

Assessment Tools ◽

World Health ◽

Middle Income ◽

Low And Middle Income

OBJECTIVEThe high global burden of traumatic brain injury (TBI) disproportionately affects low- and middle-income countries (LMICs). These settings also have the greatest disparity in the availability of surgical care in general and neurosurgical care in particular. Recent focus has been placed on alleviating this surgical disparity. However, most capacity assessments are purely quantitative, and few focus on concomitantly assessing the complex healthcare system needs required to care for these patients. The objective of the present study was to use both quantitative and qualitative assessment data to establish a comprehensive approach to inform capacity-development initiatives for TBI care at two hospitals in an LMIC, Cambodia.METHODSThis mixed-methods study used 3 quantitative assessment tools: the World Health Organization Personnel, Infrastructure, Procedures, Equipment, Supplies (WHO PIPES) checklist, the neurosurgery-specific PIPES (NeuroPIPES) checklist, and the Neurocritical Care (NCC) checklist at two hospitals in Phnom Penh, Cambodia. Descriptive statistics were obtained for quantitative results. Qualitative semistructured interviews of physicians, nurses, and healthcare administrators were conducted by a single interviewer. Responses were analyzed using a thematic content analysis approach and coded to allow categorization under the PIPES framework.RESULTSOf 35 healthcare providers approached, 29 (82.9%) participated in the surveys, including 19 physicians (65.5%) and 10 nurses (34.5%). The majority had fewer than 5 years of experience (51.7%), were male (n = 26, 89.7%), and were younger than 40 years of age (n = 25, 86.2%). For both hospitals, WHO PIPES scores were lowest in the equipment category. However, using the NCC checklist, both hospitals scored higher in equipment (81.2% and 62.7%) and infrastructure (78.6% and 69.6%; hospital 1 and 2, respectively) categories and lowest in the training/continuing education category (41.7% and 33.3%, hospital 1 and 2, respectively). Using the PIPES framework, analysis of the qualitative data obtained from interviews revealed a need for continuing educational initiatives for staff, increased surgical and critical care supplies and equipment, and infrastructure development. The analysis further elucidated barriers to care, such as challenges with time availability for experienced providers to educate incoming healthcare professionals, issues surrounding prehospital care, maintenance of donated supplies, and patient poverty.CONCLUSIONSThis mixed-methods study identified areas in supplies, equipment, and educational/training initiatives as areas for capacity development for TBI care in an LMIC such as Cambodia. This first application of the NCC checklist in an LMIC setting demonstrated limitations in its use in this setting. Concomitant qualitative assessments provided insight into barriers otherwise undetected in quantitative assessments.

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