scholarly journals Spatial Neglect Hinders Success of Inpatient Rehabilitation in Individuals With Traumatic Brain Injury

2015 ◽  
Vol 30 (5) ◽  
pp. 451-460 ◽  
Author(s):  
Peii Chen ◽  
Irene Ward ◽  
Ummais Khan ◽  
Yan Liu ◽  
Kimberly Hreha
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Current Knowledge ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Spatial Neglect ◽  
Future Research ◽  
Discharge Disposition ◽  
The Impact

Background. Current knowledge about spatial neglect and its impact on rehabilitation mostly originates from stroke studies. Objective. To examine the impact of spatial neglect on rehabilitation outcome in individuals with traumatic brain injury (TBI). Methods. The retrospective study included 156 consecutive patients with TBI (73 women; median age = 69.5 years; interquartile range = 50-81 years) at an inpatient rehabilitation facility (IRF). We examined whether the presence of spatial neglect affected the Functional Independence Measure (FIM) scores, length of stay, or discharge disposition. Based on the available medical records, we also explored whether spatial neglect was associated with tactile sensation or muscle strength asymmetry in the extremities and whether specific brain injuries or lesions predicted spatial neglect. Results. In all, 30.1% (47 of 156) of the sample had spatial neglect. Sex, age, severity of TBI, or time postinjury did not differ between patients with and without spatial neglect. In comparison to patients without spatial neglect, patients with the disorder stayed in IRF 5 days longer, had lower FIM scores at discharge, improved slower in both Cognitive and Motor FIM scores, and might have less likelihood of return home. In addition, left-sided neglect was associated with asymmetric strength in the lower extremities, specifically left weaker than the right. Finally, brain injury–induced mass effect predicted left-sided neglect. Conclusions. Spatial neglect is common following TBI, impedes rehabilitation progress in both motor and cognitive domains, and prolongs length of stay. Future research is needed for linking specific traumatic injuries and lesioned networks to spatial neglect and related impairment.

Early versus Late Tracheostomy: Is There an Outcome Difference?

2019 ◽  
Vol 85 (4) ◽  
pp. 370-375 ◽  
Author(s):  
Adel Elkbuli ◽  
Raed Ismail Narvel ◽  
Paul J. Spano ◽  
Valerie Polcz ◽  
Astrid Casin ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Primary Outcome ◽  
Injury Severity ◽  
Future Research ◽  
Trauma Patients ◽  
Early Tracheostomy ◽  
Outcome Difference ◽  
The Impact

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days ( P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P << 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.

Risk Factors for Conversion to Permanent Ventricular Shunt in Patients Receiving Therapeutic Ventriculostomy for Traumatic Brain Injury

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. 85-88 ◽  
Author(s):  
David F. Bauer ◽  
Gerald. McGwin ◽  
Sherry M. Melton ◽  
Richard L. George ◽  
James M. Markert
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Average Length ◽  
Discharge Disposition ◽  
Csf Diversion ◽  
History Of Culture

Abstract BACKGROUND: Intracranial pressure is routinely monitored in patients with severe traumatic brain injury (TBI). Patients with TBI sometimes develop hydrocephalus, requiring permanent cerebrospinal fluid (CSF) diversion. OBJECTIVE: To quantify the need for permanent CSF diversion in patients with TBI. METHODS: Patients who received a ventriculostomy after TBI between June 2007 and July 2008 were identified, and their medical records were abstracted to a database. RESULTS: Sixteen of 71 patients (22.5%) receiving a ventriculostomy required a ventriculoperitoneal or ventriculoatrial shunt before discharge from the hospital. The average number of days between ventriculostomy and shunt was 18.3. Characteristics that predispose these patients to require permanent CSF diversion include the need for craniotomy within 48 hours of admission (odds ratio, 5.20; 95% confidence interval, 1.48-18.35) and history of culture-positive CSF (odds ratio, 5.52; 95% confidence interval, 1.19-25.52). Length of stay was increased in patients receiving permanent CSF diversion (average length of stay, 61 vs 31 days; P = .04). Patient discharge disposition was similar between shunted and nonshunted patients. CONCLUSION: In this retrospective study, 22% of TBI patients who required a ventriculostomy eventually needed permanent CSF diversion. Patients with TBI should be assessed for the need for permanent CSF diversion before discharge from the hospital. Care must be taken to prevent ventriculitis. Future studies are needed to evaluate more thoroughly the risk factors for the need for permanent CSF diversion in this patient population.

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.

The Impact of Introducing a Physical Medicine and Rehabilitation Consultation Service to an Academic Burn Center

2019 ◽  
Vol 40 (5) ◽  
pp. 648-651
Author(s):  
Lawrence R Robinson ◽  
Matthew Godleski ◽  
Sarah Rehou ◽  
Marc Jeschke
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Trauma Patients ◽  
Physical Medicine ◽  
Consultation Service ◽  
Physical Medicine And Rehabilitation ◽  
The Impact

Abstract Prior retrospective studies suggest that physical medicine and rehabilitation (PM&R) acute care consultation improves outcome and reduces acute care length of stay (ACLOS) in trauma patients. There have not been prospective studies to evaluate this impact in burn patients. This cohort study compared outcomes before and after the introduction of a PM&R consultation service to the acute burn program, and the inpatient rehabilitation program, at a large academic hospital. The primary outcome measures were length of stay (LOS) in acute care and during subsequent inpatient rehabilitation. For the acute care phase, there were 194 patients in the preconsultation group and 114 who received a consultation. There was no difference in age, Baux score, or LOS in these patients. For the rehabilitation phase, there were 109 patients in the prephysiatrist group and 104 who received PM&R care. The LOS was significantly shorter in the latter group (24 days vs 30 days, P = .002). Functional independence measure (FIM) change, unexpected readmission, and discharge destination were not significantly different. The addition of a burn physiatrist did not influence ACLOS. However, there was a significant reduction in inpatient rehabilitation LOS.

scholarly journals In-Hospital Mortality Following Traumatic Brain Injury Among Older Medicare Beneficiaries, Comparing Statin Users With Nonusers

2017 ◽  
Vol 33 (6) ◽  
pp. 225-236 ◽  
Author(s):  
Bilal Khokhar ◽  
Linda Simoni-Wastila ◽  
Julia F. Slejko ◽  
Eleanor Perfetto ◽  
Min Zhan ◽  
...  
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Health Concern ◽  
Future Research ◽  
Small Scale ◽  
Medicare Beneficiaries ◽  
The Impact ◽  
Statin Use

Background: Traumatic brain injury (TBI) is a significant public health concern for older adults. Small-scale human studies have suggested pre-TBI statin use is associated with decreased in-hospital mortality following TBI, highlighting the need for large-scale translational research. Objective: To investigate the relationship between pre-TBI statin use and in-hospital mortality following TBI. Methods: A retrospective study of Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 was conducted to assess the impact of pre-TBI statin use on in-hospital mortality following TBI. Exposure of interest included atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. Beneficiaries were classified as current, recent, past, and nonusers of statins prior to TBI. The outcome of interest was in-hospital mortality. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) comparing current, recent, and prior statin use to nonuse. Results: Most statin users were classified as current users (90%). Current atorvastatin (OR = 0.88; 95% = CI 0.82, 0.96), simvastatin (OR = 0.84; 95% CI = 0.79, 0.91), and rosuvastatin (OR = 0.79; 95% CI = 0.67, 0.94) use were associated with a significant decrease in the risk of in-hospital mortality following TBI. Conclusions: In addition to being the most used statins, current use of atorvastatin, rosuvastatin, and simvastatin was associated with a significant decrease in in-hospital mortality following TBI among older adults. Future research must include clinical trials to help exclude the possibility of a healthy user effect in order to better understand the impact of statin use on in-hospital mortality following TBI.

A Clinical Approach to Neuromuscular Electrical Stimulation for Speech and Swallow in an Acute Rehabilitation Facility

2019 ◽  
Vol 4 (5) ◽  
pp. 1044-1048
Author(s):  
Melissa M. Howard ◽  
Emily R. Rosario
Keyword(s):  
Electrical Stimulation ◽  
Brain Injury ◽  
Patient Population ◽  
Neuromuscular Electrical Stimulation ◽  
Inpatient Rehabilitation ◽  
Future Research ◽  
Clinical Approach ◽  
Rehabilitation Facility ◽  
Acute Rehabilitation ◽  
The Impact

Purpose Neuromuscular Electrical Stimulation (NMES) is a widely used treatment modality for dysphagia therapy despite the inconclusive evidence of its effectiveness. Our objective was to complete a retrospective review to analyze the results of NMES with our patient population in an acute rehabilitation facility. In this clinical focus article, we briefly review the current literature on NMES, discuss a clinical protocol of NMES use in an inpatient rehabilitation hospital, and discuss the need for future research in this area. Conclusions As with much of the NMES literature, we observed improvement in the ability to swallow following a cerebrovascular accident and traumatic brain injury when a combination of swallowing therapy and NMES treatment was used. Although this combination works for our patients to improve swallow function, the impact of swallow therapy alone remains unclear. Further investigative research to clarify NMES protocols and patient population is needed to optimize results. Therefore, a large randomized clinical trial would be beneficial to clearly define the role of NMES in recovery of swallowing ability following a brain injury.

Liver Cirrhosis and Traumatic Brain Injury: A Fatal Combination Based on National Trauma Databank Analysis

2011 ◽  
Vol 77 (3) ◽  
pp. 311-314 ◽  
Author(s):  
Thomas Lustenberger ◽  
Peep Talving ◽  
Lydia Lam ◽  
Kenji Inaba ◽  
Bernardino Castelo Branco ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Liver Cirrhosis ◽  
Brain Injury ◽  
Length Of Stay ◽  
Propensity Scores ◽  
Unit Length ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
National Trauma ◽  
The Impact

The purpose of this study was to evaluate the impact of liver cirrhosis on in-hospital outcomes in victims of isolated traumatic brain injury (TBI). This was a National Trauma Databank study over a 5-year period, including patients with isolated TBI. Propensity scores were calculated to match cirrhotic with noncirrhotic TBI patients in a 1:2 ratio. Primary outcomes included mortality, hospital and surgical intensive care unit length of stay, and ventilator days. Of the 35,005 patients with isolated TBI, 47 (0.13%) had documented liver cirrhosis. After matching with 94 noncirrhotic, isolated TBI patients, no differences with regards to demographic and clinical injury characteristics were observed comparing the two groups. The mean SICU length of stay for cirrhotic and noncirrhotic patients was 5.4 ± 8.8 days and 3.7 ± 7.0 days, respectively ( P = 0.079). Cirrhotic patients experienced significantly more ventilator days compared with their noncirrhotic counterparts (2.9 ± 6.4 days vs 2.0 ± 6.4 days; P = 0.001). Overall mortality in the study population was 23.4 per cent with significantly higher in-hospital mortality among cirrhotic versus noncirrhotic TBI patients [34.0% vs 18.1%; odds ratio (95% confidence interval): 2.34 (1.05-5.20); P = 0.035]. Traumatic brain injury in conjunction with liver cirrhosis is associated with two-fold increased mortality and significantly prolonged ventilator requirements when compared with their noncirrhotic counterparts of isolated TBI.

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