Self-report of extent of recovery and barriers to recovery after traumatic brain injury: a longitudinal study.
ABSTRACT To examine the perspective of survivors of traumatic brain injury (TBI) regarding the extent and nature of their recovery over time.
Inception cohort, longitudinal study.
Level I trauma center.
One hundred fifty-seven consecutively hospitalized individuals with TBI (mean age, 36.1 yr; 80% men) with a broad range of injury severity.
Participants reported the extent of their recovery and barriers to full recovery at 1, 6, and 12 months.
Participants reported a median return to normal at the 3 follow-up times of 65%, 80%, and 85%. After 1 month, self-reported extent of recovery correlated well with performance on the Glasgow Outcome Scale (p <.001 at 6 and 12 mo) and Wechsler Adult Intelligence Scale Performance IQ (p =.001 at 12 mo). The major reported barrier to recovery was physical difficulties, which constituted over half of the concerns at all time periods. Report of physical-related concerns decreased significantly (p =.002) over time whereas cognition-related concerns increased significantly (p =.02).
Brain injury survivors consider themselves to have greater recovery than previously reported by clinicians or family members, consider physical problems a significant factor in their recovery, and appear to become more aware of cognitive impairments over time.
- SourceAvailable from: Paul G Harch
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- "Subjects had to be 18–65 years old, with one or more mild to moderate TBIs characterized by loss of consciousness due to blast injury that was a minimum of 1 year old and occurred after 9/11/01. They had to have a prior diagnosis of chronic TBI/PCS or TBI/PCS/PTSD by military or civilian specialists, with an absence of acute cardiac arrest or hemorrhagic shock at the time of TBI, Disability Rating Scale score (Rappaport et al., 1982) of 0–3, negative urine toxicology screen for drugs of abuse, negative pregnancy test in females, otherwise good health, and less than 90% on the Percent Back to Normal Rating Scale (PBNRS; Powell et al., 2001). "
ABSTRACT: This is a preliminary report on the safety and efficacy of 1.5 ATA hyperbaric oxygen therapy (HBOT) in military subjects with chronic blast-induced mild to moderate traumatic brain injury (TBI)/post-concussion syndrome (PCS) and post-traumatic stress disorder (PTSD). Sixteen military subjects received 40 1.5 ATA/60 min HBOT sessions in 30 days. Symptoms, physical and neurological exams, SPECT brain imaging, and neuropsychological and psychological testing were completed before and within 1 week after treatment. Subjects experienced reversible middle ear barotrauma (5), transient deterioration in symptoms (4), and reversible bronchospasm (1); one subject withdrew. Post-treatment testing demonstrated significant improvement in: symptoms, neurological exam, full-scale IQ (+14.8 points; p<0.001), WMS IV Delayed Memory (p=0.026), WMS-IV Working Memory (p=0.003), Stroop Test (p<0.001), TOVA Impulsivity (p=0.041), TOVA Variability (p=0.045), Grooved Pegboard (p=0.028), PCS symptoms (Rivermead PCSQ: p=0.0002), PTSD symptoms (PCL-M: p<0.001), depression (PHQ-9: p<0.001), anxiety (GAD-7: p=0.007), quality of life (MPQoL: p=0.003), and self-report of percent of normal (p<0.001), SPECT coefficient of variation in all white matter and some gray matter ROIs after the first HBOT, and in half of white matter ROIs after 40 HBOT sessions, and SPECT statistical parametric mapping analysis (diffuse improvements in regional cerebral blood flow after 1 and 40 HBOT sessions). Forty 1.5 ATA HBOT sessions in 1 month was safe in a military cohort with chronic blast-induced PCS and PTSD. Significant improvements occurred in symptoms, abnormal physical exam findings, cognitive testing, and quality-of-life measurements, with concomitant significant improvements in SPECT.Journal of neurotrauma 09/2012; 29(1):168-85. DOI:10.1089/neu.2011.1895 · 3.97 Impact Factor
- "It used to be interventions concentrated on the restoration of body functions originally with focus on physical dysfunctions. Then followed also a focus on consequences of cognitive dysfunctions, and at the present time, the scope of rehabilitation has expanded to include community based interventions as well, concentrating on long term consequences such as restriction on participation (Mazaux and Richer 1998; Powell, Machamer et al. 2001). "
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ABSTRACT: The Functional Status Examination (FSE) is a relatively new measure of functional outcome after traumatic brain injury (TBI). This study examines functional status limitations and what contributes to them to further enhance interpretability of the FSE and to continue its development as an outcome measure. The measure was given to 209 adults sustaining TBI with CT abnormalities who were followed prospectively until three to five years after injury. Relationships between functional status change as assessed by the FSE and characteristics of the injury and pre-injury characteristics of the person injured were evaluated as were relationships with concurrent measures of neuropsychological, emotional, and psychosocial functioning, health status, quality of life, and other functional status measures. Groups based on degree of functional status limitations due to the injury differ significantly on injury severity, especially length of impaired consciousness. They do not differ on most pre-injury characteristics of the person injured, although pre-existing conditions, primarily alcohol abuse, are more common in those with more negative functional changes after injury. All concurrent measures examined differ significantly among FSE groups with strongest relationships with measures of quality of life, psychosocial functioning, and other measures of health status and functional status (each p < 0.001). The Functional Status Examination shows promise as a measure reflecting a broad range of functional limitations. The FSE is an excellent tool combining clinical relevance, face validity, strong relationships to other measures of relevant constructs (criterion-related validity), and reasonable sensitivity to TBI severity even long after the injury and in a mostly moderately injured group.Journal of Neurotrauma 03/2003; 20(3):229-41. DOI:10.1089/089771503321532815 · 3.97 Impact Factor