Misconceptions about traumatic brain injury among educators and rehabilitation staff: A comparative study.

This study compared the responses of 184 educators and 111 rehabilitation specialists on a measure of knowledge about childhood traumatic brain injury (TBI). Educators displayed more misconceptions about TBI overall compared to rehabilitation staff. They underestimated the effect of TBI on cognition, behavior, and continued development. More specifically, educators showed more misconceptions than the rehabilitation staff in the following areas: coma, memory and new learning, anger management, and factors affecting recovery. An important task for rehabilitation staff members is to clarify educator misconceptions about TBI as children transition to school. Information provided should increase the level of teacher preparation and help to maximize children's academic success and adaptation following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cost-effectiveness of the diagnosis of renal artery stenosis

Variables were studied which predict at the acute stage the functional and occupational long-term outcome for patients with traumatic brain injury (TBI). Glasgow Coma Scale (GCS) score on hospital admission, length of coma (LOC) and duration of post-traumatic amnesia (PTA) were studied in a group of 508 TBI rehabilitation patients, age 0.8-71, mean age 19, followed up between five and over 20 years, mean of 12 years. Information from hospital charts and all data available before and after the injury were gathered and reviewed. The study was carried out among a consecutive sample of Finnish patients with TBI referred to a rehabilitation programme at the out-patient neurological clinic of Kauniala Hospital, which specializes in brain injuries in Finland. The patients came from various hospital districts in the country for an evaluation of their educational and vocational problems. Main outcome measures were functional outcome, as measured by the Glasgow Outcome Scale (GOS) at the end of follow-up, and post-injury occupational outcome. The patients' reemployment on the open job marklet, subsidized employment or inability to work was noted. The GCS score on hospital admission correlated clearly with the functional outcome of the patients at the end of follow-up. Length of coma and duration of post-traumatic amnesia correlated specifically with the patient's work history after the brain injury and with functional outcome measured by the GOS. Outcomes varied among age groups and seemed to be affected by age at injury. Accordingly, the extent of recovery and quality of life for rehabilitation patients with TBI can be estimated early on by prognostic factors reflecting injury severity in the acute phase. The results suggest that the GCS score, LOC and duration of PTA all have a strong predictive value in assessing functional or occupational outcome for TBI patients.     

Pharmacotherapy for postacute traumatic brain injury: A literature review for guidance in psychological practice.

Objectives: The purpose of this review is to educate and guide the actions of rehabilitation psychologists by providing a summary of the current literature on pharmacotherapies and treatment effectiveness for the chronic sequelae associated with severe traumatic brain injury (TBI). A number of medications are reviewed for use in treating deficits in arousal, cognition, function, and other problems associated with TBI. Findings for their use in this population are summarized. Cautions, limitations, and directions for future research are discussed. Conclusions: Pharmacological management of chronic symptoms of TBI is commonplace in rehabilitation practice. Clear clinical guidelines for the use of pharmacotherapy in TBI are lacking, however, because of the few conclusive findings regarding the effectiveness of any particular agent. Rehabilitation psychologists frequently encounter patients treated with numerous medications and, therefore, need to be aware of potential effects on cognitive and functional abilities. Additionally, rehabilitation psychologists should be aware of available and empirically supported pharmacotherapies as they are in a position to comprehensively assess the patient and provide requested consultation to the treating physician concerning the patient's need for and likelihood of benefiting from various pharmacological agents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life-sustaining treatment decisions by rehabilitation patients: The uncontested high ground.

There are 3 categories of patients for whom decisions must be made regarding the appropriate level life-sustaining efforts to be used if life-threatening situations occur during rehabilitation. These are patients who (1) are suffering from a terminal condition, (2) had limited treatment "code status" or orders in the institution from which they are being transferred, or (3) have completed advance directives that express their convictions regarding certain life-sustaining procedures. The psychologist in the rehabilitation setting can assume a leadership role with the rehabilitation team, providing assistance to team members and patients with the task of delineating patient preferences for treatments toward the end of life. Here case examples (1 young adult male and 2 middle-aged patients; 1 female) with commentaries are used to bring relevant ethical guidelines from the "high ground" of abstraction to the practical application level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computed tomography of the normal feline nasal cavity and paranasal sinuses

We studied physical, cognitive, emotional and quality-of-life changes noted by relatives in a sample of 65 severely traumatic brain injured (TBI) patients several years after injury. The purpose of the present study was to evaluate the families perception of these changes and their need for information concerning the consequences of TBI. Our results indicated that the perceived changes in behavioural and affective symptoms and in the patient's quality of life were most closely associated with the need expressed by family members for information concerning, TBI. We also found that family relationships were especially affected by problems in the behavioral and affective domain, and the decrease in patient quality of life, as reported by relatives. These findings underline the importance of providing the relatives of TBI patients with information about the consequences of the injury with particular emphasis on behavioural and emotional disturbances, in order that they might cope better with these problems.     

A multidiscipline approach in low vision rehabilitation

The first low vision clinic was instituted at the Industrial Home for the Blind in 1953 in response to a growing demand that more effective use be made of the residual vision in blind persons. The technology was there. Eye practitioners certainly knew enough about vision problems to offer many of these people an opportunity to enter a new life. The problem was: how to put that knowledge to work through a sound service delivery system. By its twentieth anniversary in 1973 the clinic had seen almost 5,000 patients for low vision evaluation and had built a service which consistently provided substantial and useful improvement in vision through the use of optical aids to a majority of its patients. The low vision optometric staff works as an integral part of a rehabilitation team. That team consists of a number of professionals, including ophthalmologists, social workers, teachers, and a variety of rehabilitation instructors. All members work simultaneously to create a total program of rehabilitation for thepartially sighted. We feel this teamwork approach is of basic importance to effective rehabilitation.     

Concordance of patients' and family members' ratings of neurobehavioral functioning after traumatic brain injury

OBJECTIVE: To examine differences in family and patient evaluation of neurobehavioral functioning in adults with traumatic brain injury (TBI). DESIGN: Differences were examined by conducting 70 paired sample t tests on scale items and 6 paired sample t tests on scale scores from a neurobehavioral inventory. SETTING: Medical center outpatient clinic. PARTICIPANTS: Three hundred one consecutive adult patients with TBI and 301 informants, primarily family members, completed the neurobehavioral inventory. MAIN OUTCOME MEASURE: Neurobehavioral Functioning Inventory (NFI) comprised of six scales with items describing symptoms and daily living problems. RESULTS: Paired t test analyses of the six scales indicated that patients reported a significantly greater level of communication problems than did their matched family members. No differences were found for the other five scales. Paired t test analyses of the 70 scale items revealed significant differences in patient and family ratings for only 13 items. In all 13 instances, patients reported greater levels of dysfunction than were reported by their family members. Analysis of variance (ANOVA) indicated a main effect of injury severity for only the Communication and Memory/Attention scales. CONCLUSIONS: Findings indicate general agreement between family members and patients regarding patients' everyday problems. Results do not support contentions that patients tend to underestimate difficulties. Agreement levels appear related to injury severity, item specificity, and item content. More research is needed to identify other variables relating to agreement levels, including age, injury severity, and amount of contact between patients and family members.     

Incidence of chronic pain following traumatic brain injury

OBJECTIVE: To index the frequency of reported chronic pain in patients with traumatic brain injury (TBI). DESIGN: A case series study was conducted on consecutive patients with TBI. SETTING: TBI patients were recruited from an adult tertiary care center brain injury clinic. PATIENTS: A consecutive sample of 132 patients who attended a brain injury rehabilitation center after TBI. The sample included 53 mild and 79 moderate/severe TBI patients. OUTCOME MEASURES: Patients were administered a protocol that indexed pain site, frequency, severity, and duration. RESULTS: Chronic pain was reported by 58% of mild TBI and 52% of moderate/severe TBI patients. Headaches were the most commonly reported pain problem. Chronic headaches were reported by 47% of mild TBI patients and 34% of moderate/ severe TBI patients. Neck/shoulder, back, upper limb, and lower limb pain were reported similarly by mild and moderate/severe TBI patients. CONCLUSIONS: Findings indicate that chronic pain is a significant problem in mild and moderate/severe TBI patients. More effective diagnosis of TBI patients with chronic pain may facilitate rehabilitation of these patients.     

Changes in orientation during acute rehabilitation after traumatic brain injury.

Objective: To examine the profile of scores on a measure of orientation in a sample of patients with traumatic brain injury (TBI) during acute rehabilitation as a means of (a) assessing the extent of neural compromise, (b) assessing recovery of functioning, and (c) determining the relative difficulty of different indicators of orientation. Design: Repeated measures. Setting: Acute rehabilitation hospital. Participants: Forty-three patients with severe TBI interviewed daily throughout rehabilitation. Measures: The Orientation Log (O-Log) is a 10-item measure of orientation to place, time, and situation. Items are scored 0–3 on the basis of whether they are recalled spontaneously (3), with cueing (2), via recognition (1), or not at all (0). Results: O-Log score was correlated with severity of TBI. Return of orientation followed a consistent trajectory, with initial gains preceding a plateau effect. Patients had relatively more difficulty orienting to hospital name and date than to year, month, and city. Conclusions: The O-Log is sensitive to the severity of TBI. Progress in orientation, on average, occurs at a similar rate across patients, including those who present as severely disoriented, although those with severe disorientation may not achieve orientation by rehabilitation discharge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Advances in clinical rehabilitation (Vol. 3).

Reviews the book, Advances in clinical rehabilitation (Vol. 3), edited by M. G. Eisenberg and R. C. Grzesiak (no year provided). The editors introduce this volume, the third in their ongoing series of multidisciplinary overviews of team treatment principles in rehabilitation, as a contribution to the continuing education literature for rehabilitation professionals in variety of distinct but interrelated fields. The goal of the volume, and of the series as a whole, is to provide in-depth, clinically practical updates on important issues in rehabilitation for all members of the treatment team. This is a difficult task since multidisciplinary specialization typically encourages deep, but narrow mastery of knowledge regarding management of health care problems that affect a specific organ system. The aim of the current volume and others in this series is to provide in-depth topical updates for selected rehabilitation professionals by leading specialists in those review areas. The series as a whole is meant to serve as a periodic topical update resource for multidisciplinary rehabilitative professionals, but it is not intended to be an encyclopedia or a textbook of rehabilitation practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A psychology intern on a psychiatric consultation team: An intern's perspective.

A rotation on a consultation-liaison team can provide the intern with a varied experience and exposure to the diversity of psychological concomitants of medical illness as well as more purely psychological problems. The intern's training also provides the opportunity to teach other team members about psychological factors that may be operative in their patients. Potential conflicts arising from differences between the training of psychiatry and psychology team members and the divergence between the medical and behavioral or social-developmental models are noted. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Driving, aging, and traumatic brain injury: Integrating findings from the literature.

Objective: In order to address the potential compounded risk in the population of aging traumatic brain injury (TBI) survivors who continue to drive, the authors synthesized literatures regarding the impact of aging or TBI on driving. Study Design: PubMed searches were conducted utilizing combinations of the following terms: driving, aging, elderly, TBI, cognition, seizures, vision, hearing, rehabilitation, sleep, fatigue, and assessment. Additional sources were also identified from the bibliographies of articles obtained and the Transportation Research Information Service electronic database. Clinically relevant human studies written in English were reviewed. Results: Using a conceptual framework developed by W. H. Brouwer and F. K. Withaar (1997), the authors of the current review highlight driving-related obstacles for TBI survivors and aging adults and suggest that individuals aging with TBI may be at increased risk for driving-related problems. Implications: Areas for clinical consideration include seizures, sleepiness and fatigue, vision, cognition, driving assessment, and caregiver involvement. The need for further study of postacute driving assessment and rehabilitation is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Impact of Patient-Centered Information on Patients' Treatment Satisfaction and Outcomes in Traumatic Brain Injury Rehabilitation.

Objective: To evaluate the effects on patients with traumatic brain injury (TBI) of detailed, personalized information about their injuries, acute care treatment, and rehabilitation progress. Participants: Twenty-eight former or present military personnel (mean age = 30 years) with moderate to severe TBI (mean of 29 days spent in intensive care before admission to TBI unit). Design: Two (personalized information vs. general information) × 2 (high- vs. low-patient preference for health care information) factorial design. Interpersonal behavior of patients, information providers, and health care staff were measured by the Impact Message Inventory. Outcome Measures: Rehabilitation Intensity of Therapy Scale, Functional Independence Measure, Treatment Satisfaction Questionnaire. Results: Patients given personalized information exerted greater effort in physical therapy, made greater improvement in functional independence, and were more satisfied with rehabilitation treatment. Patient preference for information and ratings of interpersonal behavior were largely unrelated to patient outcomes. Conclusion: Cognitively impaired TBI patients can benefit from interventions designed to enhance their sense of control and personal involvement in their own care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Cardiovascular rehabilitation: A comprehensive approach.

Reviews the book, Cardiovascular rehabilitation: A comprehensive approach, edited by Lyle H. Peterson (1983). This book is a thorough and concise book for the physician, psychologist, rehabilitation counselor, physical therapist, or nurse involved in a treatment team approach to cardiovascular rehabilitation. The text includes research data, philosophical rationale, current references, and an explanation of the theoretical bases of various treatment approaches. Of interest to psychologists are chapters dealing with specific tests, treatment modalities, and the role of the psychologist in the rehabilitation team. The authors attempt to prove with logic, data, and eloquence how a comprehensive cardiovascular rehabilitation center can benefit patients. They also attempt to show the importance of the management of psychological problems in rehabilitation. This text represents an attempt to incorporate psychology into parity with other disciplines in rehabilitation, and as such could be read with profit by both psychologist and nonpsychologist alike. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation after traumatic brain injury in adults

PURPOSE: Traumatic brain injury (TBI) stands as a major public health problem and one of the most important challenges for neurological rehabilitation. This review discusses advances that have occurred in the past 10 years in rehabilitation after severe TBI in adults. METHOD: First, theoretical concepts, goals of rehabilitation and organization of resources are reviewed. Then specific questions that arise in the rehabilitation of severe TBI patients are considered. RESULTS: Three phases are distinguished in post-traumatic evolution. Acute rehabilitation takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications, and to provide sensory stimulations with the hope of accelerating arousal. Secondly subacute (generally inpatient) rehabilitation is designed to facilitate and accelerate recovery of impairments, and to compensate for disabilities. Motility, cognition, behaviour, personality and affect should be simultaneously addressed in an holistic approach. Physical as well as psychological independence and self-awareness are the major goals to emphasize. A third, post-acute rehabilitation phase includes outpatient therapy for achieving physical, domestic and social independence, reduction of handicaps and re-entry into the community. CONCLUSIONS: Problems with returning home, obtaining financial independence, driving, returning to work, participating in social relationships and leisure activities, and the importance of psychosocial adjustment and self-acceptance, are outlined. Questions about economic aspects and rehabilitation in the future are addressed.     

Extremity fractures in the patient with a traumatic brain injury

Extremity fractures are common in patients with traumatic brain injuries (TBIs). These injuries are often inadequately treated and occasionally are completely missed due to the unique problems inherent to the TBI patient. However, appropriate evaluation of the TBI patient allows prompt diagnosis and optimal treatment of extremity fractures. The increased survival rate of these patients has resulted in a greater emphasis on minimizing dysfunction and disability, especially that due to concomitant orthopaedic trauma. Advances in anesthestic technique permit earlier operative fixation of extremity fractures. Most injuries, particularly those in the lower extremity, require operative stabilization to allow early mobilization and rehabilitation. Upper extremity fractures are often associated with peripheral nerve injuries. Heterotopic ossification is common, especially about the elbow and hip. Contrary to prevalent belief, fracture healing is not necessarily accelerated in the TBI patient; hypertrophic callus, myositis ossificans, and heterotopic ossification occur frequently and are often misperceived as accelerated healing.     

Serious traumatic brain injury: an evaluation of functional outcomes

OBJECTIVES: Evaluate independent living, productivity, and social outcomes of patients with serious traumatic brain injury (TBI) after inpatient rehabilitation. METHODS: Fifty-five adults with serious TBI (Abbreviated Injury Scale score > or = 3) were admitted to a Level I trauma center and subsequently transferred to a comprehensive inpatient rehabilitation hospital (Walton Rehabilitation Hospital). Functional Independence Measures were obtained at admission (Adm), discharge (D/C), and at 3- (n = 52) and 1-year (n = 51) follow-up. RESULTS: At 1 year, 90% of the patients were living at home. Eight (16%) required full-time supervision, while 41 (82%) were independent of supervision throughout most of the day. Thirteen (25%) patients had returned to work, eight full time and five with reduced responsibility and fewer hours than before injury. Nineteen shared household duties, while eight (16%) had primary responsibility. Fourteen (27%) patients demonstrated socially inappropriate or disruptive behavior at least weekly. [table: see text] CONCLUSION: Although cognitive skills were diminished for the majority of patients, many achieved a substantial reduction in disability within 18 months after TBI.     

Deep venous thrombosis: incidence on admission to a brain injury rehabilitation program

OBJECTIVE: To determine the incidence of deep venous thrombosis (DVT) in brain injured individuals at time of admission to a brain injury (BI) rehabilitation program. DESIGN: Prospective study, sequential case series. SETTING: University tertiary care BI rehabilitation center. DATA SET: Eighty-two traumatic brain injury (TBI) and 71 atraumatic brain injury (ABI) patients were consecutively admitted to our BI unit over a 12-month period and screened within 24 hours of admission for a lower extremity DVT with color flow duplex Doppler ultrasonography. All patients had been prophylaxed with either subcutaneous heparin anticoagulation therapy or intermittent compression devices, and all patients were within 2 months of the original BI. MAIN OUTCOME MEASURES: Evidence of intrinsic venous occlusion by duplex Doppler. RESULTS: DVTs were detected and treated prior to rehabilitation admission in three patients (2%), and these persisted at rehabilitation admission. New DVTs were detected at time of rehabilitation admission in 17 patients (11%). All were occult DVTs; none of the 17 patients had clinical findings indicative of acute DVT. No significant differences were noted in the TBI group when age, highest 24-hour Glasgow Coma Scale score, length of acute hospitalization, type of DVT prophylaxis, or presence of an extremity fracture were compared for individuals with and without DVT. No significant differences were noted in the ABI group when age, length of acute hospitalization, and type of DVT prophylaxis were compared for individuals with and without DVT. CONCLUSION: The overall incidence of DVTs was 13% and the incidence of occult DVT was 11%. Individuals with TBI had an overall incidence of DVTs of 20% and an occult DVT incidence of 18%. Individuals with ABI had an overall incidence of DVT's of 6% and an occult DVT incidence of 4%. These findings indicate the importance of baseline screening for DVT in this patient population.     

Care continuum in traumatic brain injury rehabilitation.

Discusses the range of services needed in traumatic brain injury (TBI) rehabilitation within the context of a services continuum owing to the nature of the recovery process. The TBI care continuum includes treatment during the following phases: injury onset, trauma center and emergency care, neurosurgery unit and acute hospitalization, coma stimulation, nursing home and long-term care programs, transitional living centers, day treatment and outpatient rehabilitation, supervised independent living center and support services, and vocational rehabilitation services. Obstacles to care continuity include funding concerns, lack of knowledge about TBI, the complex nature of TBI, and program accessibility issues. It is noted that major legislative, educational, and outreach efforts are under way to overcome these barriers to services provision. A comment by J. E. Sargent follows. (PsycINFO Database Record (c) 2010 APA, all rights reserved)