scholarly journals Trends in Utilization of Upper Extremity Reconstructive Surgery Following Traumatic Brain Injury and Stroke

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Bryan G. Beutel ◽  
Bryan J. Marascalchi ◽  
Eitan Melamed
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Upper Extremity ◽  
Reconstructive Surgery ◽  
Temporal Trends ◽  
Functional Independence ◽  
Case Volume ◽  
Reconstructive Procedures ◽  
Specific Patient ◽  
Over Time

Background: Spasticity resulting from traumatic brain injury (TBI) or stroke can lead to debilitating sequelae, including deformities from joint subluxation and spasticity, causing a loss of functional independence. Despite the effectiveness of surgery to address these issues, it is unclear how often these procedures are performed. The objective of the study was to determine the rate of, and trends associated with, reconstructive upper extremity surgery in patients following TBI or stroke. Methods: The National Inpatient Sample was queried for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for TBI and stroke as well as procedural codes representing functional upper extremity reconstruction from 2001 to 2012. Temporal trends were assessed for case volume, patient demographics, financial considerations, and hospitalizations. Results: A total of 2132 reconstructive procedures were performed in patients with TBI or stroke during the study period, with fewer than 230 cases conducted in any given year and no appreciable increase in case volume over time. This represented less than 1% of eligible, appropriate candidates undergoing surgery. Middle-aged, white females were the most common patients to have such surgery. Medicare was the primary payer for reconstruction, and the cost of surgery increased substantially over time. There was a trend toward longer hospital stays, and the inpatient mortality was approximately 0.5%. Conclusions: There is a substantial underutilization of upper extremity reconstructive surgery for patients with spasticity following TBI or stroke. Increasing costs and limited access to appropriate care may be contributing to differences in use among specific patient subgroups.

Long-Term Outcome Following Traumatic Brain Injury

2007 ◽  
Vol 8 (3) ◽  
pp. 251-261 ◽  
Author(s):  
Sue Sloan ◽  
Dianne Winkler ◽  
Katie Anson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Community Integration ◽  
Functional Independence ◽  
Cost Of Care ◽  
Support Needs ◽  
Care Needs ◽  
Life Roles ◽  
Over Time

AbstractObjectives: To investigate care needs, functional outcome, role participation and community integration approximately nine years following severe brain injury. To gain an understanding of the ongoing cost of care and support needs for this group. Participants: 13 individuals who had sustained an extremely severe traumatic brain injury (TBI), between 8 and 9 years previously participated in the study. These individuals were the remaining participants of a larger sample of consecutive admissions between 1996 and 1998 at Ivanhoe Manor Rehabilitation Hospital. Measures: Structured Interview, Functional Independence Measure, Community Integration Questionnaire, Care and Needs Scale and Role Checklist. Results: The majority of the participants were reported to have high support needs, with 6 participants (46%) requiring 24-hour support. Four participants were reported to able to be left alone for between a few hours per day to almost all week. Three participants reported that they were completely independent. The participant's characteristics are described in terms of functional independence, community integration and role participation. Overall care needs appear to have remained relatively stable between 2 and 9 years postinjury. However, there was a shift in the proportion of paid and gratuitous care over time, with a decrease in paid care and increased gratuitous care noted from the 2-year to long-term follow-up time points. Conclusions: Severe TBI has a long term influence on life roles, care needs and functional independence. The current study suggests that high care needs do not necessarily preclude participants from leading active lives and participating in valued life roles. The importance of social support in facilitating participation in activity and the potential issues for caregiver burden, given the increase in gratuitous care over time, should be acknowledged and further research in this area is recommended.

scholarly journals Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury

2021 ◽  
Vol 11 (8) ◽  
pp. 1044
Author(s):  
Cristina Daia ◽  
Cristian Scheau ◽  
Aura Spinu ◽  
Ioana Andone ◽  
Cristina Popescu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Severe Traumatic Brain Injury ◽  
Functional Independence ◽  
Unresponsive Wakefulness Syndrome ◽  
Coma Scale ◽  
Severe Tbi ◽  
Neuroprotective Treatment ◽  
Gcs Score

Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI.

Self-awareness four years after severe traumatic brain injury: discordance between the patient’s and relative’s complaints. Results from the PariS-TBI study

2017 ◽  
Vol 32 (5) ◽  
pp. 692-704 ◽  
Author(s):  
Camille Chesnel ◽  
Claire Jourdan ◽  
Eleonore Bayen ◽  
Idir Ghout ◽  
Emmanuelle Darnoux ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Significant Relationship ◽  
Injury Severity ◽  
Chronic Phase ◽  
Functional Independence ◽  
Severe Tbi

Objective: To evaluate the patient’s awareness of his or her difficulties in the chronic phase of severe traumatic brain injury (TBI) and to determine the factors related to poor awareness. Design/Setting/Subjects: This study was part of a larger prospective inception cohort study of patients with severe TBI in the Parisian region (PariS-TBI study). Intervention/Main measures: Evaluation was carried out at four years and included the Brain Injury Complaint Questionnaire (BICoQ) completed by the patient and his or her relative as well as the evaluation of impairments, disability and quality of life. Results: A total of 90 patient-relative pairs were included. Lack of awareness was measured using the unawareness index that corresponded to the number of discordant results between the patient and relative in the direction of under evaluation of difficulties by the patient. The only significant relationship found with lack of awareness was the subjective burden perceived by the relative (Zarit Burden Inventory) ( r = 0.5; P < 0.00001). There was no significant relationship between lack of awareness and injury severity, pre-injury socio-demographic data, cognitive impairments, mood disorders, functional independence (Barthel index), global disability (Glasgow Outcome Scale), return to work at four years or quality of life (Quality Of Life after Brain Injury scale (QOLIBRI)). Conclusion: Lack of awareness four years post severe TBI was not related to the severity of the initial trauma, sociodemographic data, the severity of impairments, limitations of activity and participation, or the patient’s quality of life. However, poor awareness did significantly influence the weight of the burden perceived by the relative.

CHANGES IN THE OUTCOME OF PEDIATRIC PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY OVER TIME

2004 ◽  
Vol 32 (Supplement) ◽  
pp. A101
Author(s):  
Kelly S Tieves ◽  
Cheryl A Muszynski ◽  
Bruce A Kaufman ◽  
Peter L Havens ◽  
Jayesh C Thakker
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Pediatric Patients ◽  
Over Time

A decision tree framework for understanding blast-induced mild Traumatic Brain Injury in a military medical database

2017 ◽  
Vol 14 (4) ◽  
pp. 389-398 ◽  
Author(s):  
Peter B Walker ◽  
Melissa L Mehalick ◽  
Amanda C Glueck ◽  
Anna E Tschiffely ◽  
Craig A Cunningham ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Personalized Medicine ◽  
Decision Tree ◽  
Mild Traumatic Brain Injury ◽  
Health Data ◽  
Decision Tree Classifier ◽  
Tree Classifier ◽  
Clustering Quality ◽  
Over Time

Personalized medicine is a ubiquitous term that has come to be used to describe a medical model that proposes the customization of healthcare, such that decisions and/or treatments are tailored to each individual patient. Under this type of clinical practice model, diagnostic and prognostic decisions are often based upon selecting the most appropriate therapy based on a patient’s genetic, demographic, and/or other pertinent information. The primary aim of this paper is to use a personalized medicine framework to better understand the relationship between neuropsychological testing and the progression of symptoms in a blast-induced mild Traumatic Brain Injury (mTBI) patient population. In this paper, we extended our earlier work on Constrained Spectral Partitioning (CSP), a graph-based approach that incorporates additional information from separate graphs to help improve the clustering quality on both graphs simultaneously. While our previous work demonstrated the effectiveness of this algorithm in its ability to accurately classify whether symptoms improved or declined over time, that work did not provide any insights into the progression of symptoms. Therefore, this paper sought to identify, from a clinical perspective, whether symptoms increased/decreased over time. To accomplish this, we developed a decision tree classifier to classify symptom progression based on the outputs from our CSP algorithm. We present results from four separate decision tree classifiers that illustrate the adaptability of these algorithms for utilization as decision rules for the treatment of patients following blast-induced mTBI. Decision tree classifier models are useful in the healthcare setting because patient health data (e.g., diagnosis of a condition or a type of treatment) can be imput into the model and, based on the health data variables, a resulting outcome can be suggested, and providers can use this outcome as information to direct their clinical treatment.

scholarly journals Modeling the Prospective Relationships of Impairment, Injury Severity, and Participation to Quality of Life Following Traumatic Brain Injury

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Ryan J. Kalpinski ◽  
Meredith L. C. Williamson ◽  
Timothy R. Elliott ◽  
Jack W. Berry ◽  
Andrea T. Underhill ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Life Satisfaction ◽  
Brain Injury ◽  
Injury Severity ◽  
Theoretical Models ◽  
Well Being ◽  
Functional Independence ◽  
Predictor Variables ◽  
Equation Modeling ◽  
Optimal Adjustment

Identifying reliable predictors of positive adjustment following traumatic brain injury (TBI) remains an important area of inquiry. Unfortunately, much of available research examines direct relationships between predictor variables and outcomes without attending to the contextual relationships that can exist between predictor variables. Relying on theoretical models of well-being, we examined a theoretical model of adjustment in which the capacity to engage in intentional activities would be prospectively associated with greater participation, which in turn would predict subsequent life satisfaction and perceived health assessed at a later time. Structural equation modeling of data collected from 312 individuals (226 men, 86 women) with TBI revealed that two elements of participation—mobility and occupational activities—mediated the prospective influence of functional independence and injury severity to optimal adjustment 60 months following medical discharge for TBI. The model accounted for 21% of the variance in life satisfaction and 23% of the variance in self-rated health. Results indicate that the effects of functional independence and injury severity to optimal adjustment over time may be best understood in the context of participation in meaningful, productive activities. Implications for theoretical models of well-being and for clinical interventions that promote adjustmentafter TBI are discussed.

scholarly journals Coping Strategies as a Predictor of Post-concussive Symptoms in Children with Mild Traumatic Brain Injury versus Mild Orthopedic Injury

2011 ◽  
Vol 17 (2) ◽  
pp. 317-326 ◽  
Author(s):  
Stacey E. Woodrome ◽  
Keith Owen Yeates ◽  
H. Gerry Taylor ◽  
Jerome Rusin ◽  
Barbara Bangert ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Coping Strategies ◽  
Mild Traumatic Brain Injury ◽  
Group Differences ◽  
Post Injury ◽  
Mild Tbi ◽  
Orthopedic Injury ◽  
Children's Coping ◽  
Over Time

AbstractThis study examined whether children's coping strategies are related to post-concussive symptoms following mild traumatic brain injury (TBI) versus orthopedic injury (OI). Participants were 8- to 15-year-old children with mild TBI (n = 167) or OI (n = 84). They rated their current preferred coping strategies and post-injury symptoms at 2 weeks (baseline) and 1, 3, and 12 months post-injury. Children's reported use of coping strategies did not vary significantly over time, so their baseline coping ratings were examined as predictors of post-concussive symptoms across time. Self-ratings of symptoms were positively related to emotion-focused strategies and negatively related to problem-focused engagement after both mild TBI and OI. Higher problem-focused disengagement predicted larger group differences in children's ratings of symptoms, suggesting that problem-focused disengagement moderates the effects of mild TBI. Coping strategies collectively accounted for approximately 10–15% of the variance in children's post-concussive symptoms over time. The findings suggest that coping may play an important role in accounting for children's perceptions of post-concussive symptoms after mild TBI. (JINS, 2011, 17, 317–326)

Metamemory adjustments over time in adults with and without traumatic brain injury

Brain Injury ◽  
2009 ◽  
Vol 23 (12) ◽  
pp. 965-972 ◽  
Author(s):  
Miriam Krause ◽  
Mary R. T. Kennedy
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Over Time
Sign in / Sign up

Export Citation Format

Share Document