A longitudinal study of awareness of deficit after moderate to severe traumatic brain injury.
ABSTRACT Lack of awareness of deficits is a common problem after traumatic brain injury (TBI), and is associated with worse functional outcome and poor compliance with rehabilitation. Little is known, however, about the course of awareness of deficits after TBI. Using a longitudinal design, we examined changes in self-awareness between the subacute stage (about 45 days after injury) and one-year follow-up in a sample of 123 individuals with moderate to severe TBI. Awareness of deficits was operationalised as the discrepancy between patient and family ratings on the Awareness Questionnaire (AQ) and Patient Competency Rating Scale (PCRS). Compared to baseline, awareness was improved at one year, as evidenced by smaller discrepancy scores and stronger correlations between participant and family ratings. Changes in awareness were most pronounced for the behavioural/affective domain and least pronounced for the motor/sensory domain, which showed best agreement at baseline. Even at one year, participants rated themselves as higher functioning than did their relatives. Awareness at baseline and, for the AQ, time to follow commands, significantly predicted awareness at one year. These results suggest that awareness of deficits improves between the subacute and post-acute stages after TBI, and highlight the need for effective interventions for persons with impaired awareness and for flexible timing of rehabilitation efforts.
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ABSTRACT: To evaluate the outcomes of early comprehensive rehabilitation protocols for traumatic brain injury (TBI) using the functional independence measure (FIM), and to study the relationship between FIM and Glasgow coma scale (GCS) variables to determine which patients will be best served by rehabilitation therapies. Fifty-one subjects with diagnosed TBI receiving treatment at a single inpatient rehabilitation facility at Jordan University of Science and Technology, Teaching Hospital, Irbid, Jordan were enrolled in this experimental study between August 2006 and February 2008. Of the enrolled subjects, 47 completed the study. The mean age of the participants was 33 years (8 females and 39 males). Glasgow coma scale was measured on admission. Functional independence measure score was measured on admission and on discharge. According to the GCS, the participants were divided into 3 groups as severe injury (GCS: 3-8 [n=24]), moderate injury (GCS: 9-12 [n=12]), and mild or no injury (GCS: 13-15 [n=11]). The FIM score and CGS and their relation were evaluated. Evaluation outcomes revealed a significant improvement in FIM scores after rehabilitation compared to the FIM admission (p=0.00006) in severe TBI. In moderate TBI, the FIM scores were significantly improved (p=0.0004) after rehabilitation. However, with minimal injury, the FIM scores were not significantly improved (p=0.15). Early rehabilitation interventions significantly improved the FIM scores in moderate and severe TBI patients. ERRATUM NOTICE PUBLISHED IN NEUROSCIENCES 2009; 14: 306.Neurosciences 01/2009; 14(1):41-4. · 0.39 Impact Factor
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ABSTRACT: To investigate common TBI misconceptions among ethnic minorities with TBI. Cross-sectional study. Level I trauma center. Fifty-eight persons with TBI (28 black and 30 Hispanic) discharged from the neurosurgery unit and living in the community. Forty-item Common Misconceptions about Traumatic Brain Injury Questionnaire (CM-TBI). Participants displayed misconceptions about approximately one-third of the 40 items, most regarding amnesia and recovery. Fewer misconceptions were found in the brain damage/injury and sequelae categories. A greater percentage of TBI misconceptions was associated with having lower education, actively practicing religion, being Spanish-speaking and non-US born. After controlling for education and actively practicing religion, Spanish-speaking Hispanics reported a greater percentage of misconceptions than English-speaking Hispanics and blacks. Understanding common TBI misconceptions can assist rehabilitation staff in tailoring education programs for racial/ethnic minorities including those who are Spanish-speaking. Educational attainment and cultural factors should be considered when developing educational interventions for persons with TBI from diverse backgrounds. Inaccurate information regarding TBI, especially the recovery process, may hinder treatment planning by rehabilitation professionals and may result in disappointment and the setting of unrealistic goals for persons with injury and their families.The Journal of head trauma rehabilitation 01/2010; 26(4):301-11. DOI:10.1097/HTR.0b013e3181e7832b · 3.00 Impact Factor