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.

Changes in Care and Support Needs Following Community-Based Intervention for Individuals With Acquired Brain Injury

2009 ◽  
Vol 10 (3) ◽  
pp. 295-306 ◽  
Author(s):  
Sue Sloan ◽  
Libby Callaway ◽  
Dianne Winkler ◽  
Kirsten McKinley ◽  
Carlo Ziino ◽  
...  
Keyword(s):  
Brain Injury ◽  
Community Integration ◽  
Acquired Brain Injury ◽  
Functional Independence ◽  
Support Needs ◽  
Intervention Period ◽  
Post Injury ◽  
Community Based ◽  
Care And Support ◽  
Life Roles

AbstractObjective:To examine the care and support and participation outcomes for individuals with severe Acquired Brain Injury (ABI) provided with three consecutive years of Community Approach to Participation (CAP) intervention.Method:A case series study design was undertaken with a total of 43 participants from two private occupational therapy practices specialising in community-based, CAP rehabilitation for people with severe ABI. Data were collected at four time points: January 2004 (Baseline), January 2005 (T1), January 2006 (T2), and January 2007 (T3) and included rating on the Care and Needs Scale (CANS); number of hours of paid and gratuitous weekly support; FIM™ and Community Integration Questionnaire scores; and number of current life roles (as recorded on Part 1 of the Role Checklist). Participants were an average of 6.73 years post injury and were living in a range of community environments and residential facilities.Results:There was considerable change in participants' CANS rating across the intervention period, with statistically significant decreases occurring from Baseline to T1 and T1 to T2. Ninety-five per cent of participants received some level of weekly paid support throughout the intervention period, with the amount varying considerably. Paid care decreased by an average of 10.78 hours per week from 85.85 hours per week at Baseline to 75.06 at T3. Although not statistically significant, this equated to an average cost saving of AU$324.84 per participant per week by the end of CAP intervention. There was an overall mean reduction of 4.96 hours of gratuitous care per week per participant over the intervention period, which was statistically significant. Increases in functional independence, community integration, and role participation were also found. On the FIM™, statistically significant improvement occurred between Baseline and T1 and on the CIQ between Baseline and T1 and T1 and T2. Significant increase on the Role Checklist occurred between Baseline and T1 and between T2 and T3. The number of life roles in which participants engaged increased by an average of 1.65 roles by the end of the intervention period. A reduction in care and support needs (measured by the CANS) was significantly associated with: (1) a reduction in total care hours, (2) and an increase in functional independence on the FIM™, and (3) an increase in community integration on the CIQ.Conclusion:With a long term approach and contextualised intervention targeted at skill development in the areas that underpin personally valued participation, increased role performance and community integration can be achieved by people with severe ABI, even many years post injury. This increased capacity has been found to be associated with a reduction in care and support needs, including paid and gratuitous care hours, over time.

Young Adults With Traumatic Brain Injury in Long-Term Care Homes: A Population-Based Study

2010 ◽  
Vol 11 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Angela Colantonio ◽  
Dana Howse ◽  
Jigisha Patel
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Long Term Care ◽  
Secondary Data ◽  
Population Based ◽  
Care Homes ◽  
Care Needs ◽  
Cross Sectional ◽  
Term Care

AbstractThe aim of this research was to identify the number and characteristics of adults under the age of 65 with a diagnosis of traumatic brain injury (TBI) living in long-term care homes (nursing homes, homes for the aged and charitable homes) in Ontario, Canada. Methods: The study used a cross-sectional design. Secondary data analysis of a comprehensive provincial database of long-term care homes was conducted. Results: Of the 399 residents coded as having a TBI, 154 were < 65 years of age. Virtually all residents were limited in personal care and required assistance for eating (94.2%), toileting (92.2%) and dressing (99.4%). A large percentage also required care for challenging behaviours, while care needs due to substance abuse was common among 12.3% of TBI residents. Conclusion: As similar research in Australia has found, young persons in long-term care homes in Ontario, Canada, have high level personal health needs, however the appropriateness of this environment is questionable.

Functional independence 6 months to 5 years after traumatic brain injury: Opportunities for recreational therapy

2018 ◽  
Vol 17 (1) ◽  
pp. 29
Author(s):  
Donna L. Gregory, MBA, CTRS ◽  
Brent L. Hawkins, PhD, LRT/CTRS ◽  
Leighton Chan, MD, MPH
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Psychosocial Adjustment ◽  
Social Skill ◽  
Functional Independence ◽  
Recreational Therapy ◽  
Community Based ◽  
Social Skill Development ◽  
Compensatory Strategies

Traumatic brain injury (TBI) can have a lasting and devastating impact on individuals and their families. The effects of TBI are complex and may impair cognitive and psychosocial function. The purpose of this study was to identify impairments 6 months to 5 years after TBI and to recognize opportunities for recreational therapy (RT) to address functional needs. Results indicated that psychosocial adjustment and cognitive improvements occurred between 90 and 180 days after injury. However, impairment in several cognitive and psychosocial adjustment subscales persisted 1 to 5 years after injury. Community-based RT interventions focused on cognitive compensatory strategies, environmental adaptation, and social skill development may help individuals experiencing long-term impairments.

Community integration questionnaire: Outcomes of people with traumatic brain injury and high support needs compared with multiple matched controls

Brain Injury ◽  
2016 ◽  
Vol 30 (10) ◽  
pp. 1201-1207 ◽  
Author(s):  
Christine Migliorini ◽  
Joanne Enticott ◽  
Libby Callaway ◽  
Sophie Moore ◽  
Barry Willer
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Community Integration ◽  
Support Needs ◽  
High Support

People Under 50 With Acquired Brain Injury Living in Residential Aged Care

2010 ◽  
Vol 11 (3) ◽  
pp. 299-312 ◽  
Author(s):  
Dianne Winkler ◽  
Sue Sloan ◽  
Libby Callaway
Keyword(s):  
Brain Injury ◽  
Community Integration ◽  
Acquired Brain Injury ◽  
Aged Care ◽  
Support Networks ◽  
Residential Aged Care ◽  
Service Development ◽  
Support Needs ◽  
Diverse Group ◽  
Care Needs

AbstractObjectives:The aim of this article is to describe the characteristics, needs and preferences of people under 50 with an acquired brain injury (ABI) living in residential aged care in Victoria and examine implications for service development.Participants:Sixty-one people under 50 with an ABI living in residential aged care in the state of Victoria.Measures:Care and Needs Scale, Community Integration Questionnaire, Overt Behaviour Scale, Health of the Nation Outcome Scale — ABI Version, Role Checklist, Resident Choice Scale.Results:The younger people with ABI in this study were a diverse group with a complex range of health and support needs that were not being adequately met within residential aged care. Many people (44%) required the highest level of support, indicating they could not be left alone while 26% could be left for part of the day and overnight. Most people (81%) and their support networks indicated they would like to explore moving out from residential aged care into community accommodation settings.Conclusions:This article provides clear direction for the development of services to meet the care needs of this group, to enable them to participate in the life of the community and to pursue a lifestyle of choice.

Community Integration Following Severe Traumatic Brain Injury: Outcomes and Best Practice

2004 ◽  
Vol 5 (1) ◽  
pp. 12-29 ◽  
Author(s):  
Sue Sloan ◽  
Dianne Winkler ◽  
Libby Callaway
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Best Practice ◽  
Community Integration ◽  
Theoretical Models ◽  
Poor Outcomes ◽  
Injury Outcomes ◽  
Life Roles ◽  
Extensive Clinical Experience

AbstractCommunity integration is often cited as the ultimate aim of rehabilitation. However, outcome studies show that following severe traumatic brain injury (TBI), many people do not return to valued life roles or reach previous levels of integration within their community. More recent research, in association with extensive clinical experience, reveals significant variability in outcomes within this group. Although some people return to productive activity and maintain a network of family and friends, others lead lives characterised by boredom and loneliness. This paper has two aims. The first is to examine TBI community integration outcome literature and selected theoretical models. The second is to describe a Community Approach to Participation (CAP), an individualised and collaborative model of community-based practice, which endeavours to address the poor outcomes identified following TBI. The CAP will be illustrated in the detailed case study of Sarah.

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.

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