Article

Feasibility of a brief neuropsychologic test battery during acute inpatient rehabilitation after traumatic brain injury.

JFK Johnson Rehabilitation Institute at JFK Medical Center, Edison, NJ 08818, USA.
Archives of physical medicine and rehabilitation (Impact Factor: 2.18). 05/2008; 89(5):942-9. DOI: 10.1016/j.apmr.2008.01.008
Source: PubMed

ABSTRACT To determine (1) if more than 50% of patients with moderate to severe traumatic brain injury (TBI) who met study criteria can complete a battery of neuropsychologic tests in less than 75 minutes 2 to 6 weeks after injury regardless of posttraumatic amnesia (PTA) status; (2) which tests are most likely to be completed; and (3) range of scores obtained.
Prospective multicenter observational study.
Acute inpatient neurorehabilitation hospitals.
Screened 543 Traumatic Brain Injury Model System patients with moderate to severe TBI; 354 were tested at 2 to 6 weeks postinjury.
Not applicable.
Percentage of patients able to complete the neuropsychologic tests in less than 75 minutes.
Two hundred eighteen (62%) patients completed the battery in 66 minutes on average. Mean interval from injury to testing was 28.3+/-7.1 days. Tests completed with the highest frequency were California Verbal Learning Test-II, FAS, and animal naming. Performance was less impaired (P<.001) on all measures for patients who had emerged from PTA.
Approximately two thirds of screened patients were able to complete a brief neuropsychologic test battery at 2 to 6 weeks postinjury, regardless of PTA status. Although patients out of PTA were less impaired on all test measures, confusion did not preclude participation in the test battery or prohibit assignment of test scores. Early neuropsychologic assessment after TBI is feasible even for many patients who are still in PTA.

3 Bookmarks
 · 
198 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic brain injury (TBI) is recognized as an important risk factor for the long-term cognitive health of military personnel, particularly in light of growing evidence that TBI increases risk for Alzheimer's disease and other dementias. In this article, we review the neurocognitive and neuropathologic changes after TBI with particular focus on the potential risk for cognitive decline across the life span in military service members. Implications for monitoring and surveillance of cognition in the aging military population are discussed. Additional studies are needed to clarify the factors that increase risk for later life cognitive decline, define the mechanistic link between these factors and dementia, and provide empirically supported interventions to mitigate the impact of TBI on cognition across the life span.
    Alzheimer's & Dementia. 01/2014; 10(3):S174–S187.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the effects of combination cathodal transcranial direct current stimulation (tDCS) and virtual reality (VR) therapy for upper extremity (UE) training in subacute stroke patients. This study was a pilot randomized controlled trial. Data are presented from 59 patients randomly assigned to one of three groups; group A received cathodal tDCS, group B received VR, and group C received combination therapy (cathodal tDCS was simultaneously applied during VR therapy). Asan Medical Center, University hospital. 59 patients with impaired unilateral UE motor function after stroke INTERVENTIONS: 15 sessions of treatment over a 3-week period. The modified Ashworth scale, manual muscle test (MMT), manual function test (MFT), Fugl-Meyer scale (FMS), and box-and-block test were used to assess UE functions. To evaluate activity of daily living, Korean-modified Barthel index (K-MBI) was used. All outcomes were measured before and immediately after treatment. After treatment, all groups demonstrated significant improvements in MMT, MFT, FMS, and K-MBI scores. The change in MFT and FMS was different between the three groups. Post-hoc analysis revealed that the improvement of MFT and FMS scores in the group C were significantly higher compared with those of the other two groups. In the present pilot study, the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone. This combination therapy might be a helpful method to enhance recovery of the paretic UE in stroke patients.
    Archives of physical medicine and rehabilitation 11/2013; · 2.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To prospectively characterize the prevalence, course, and impact of acute sleep abnormality among traumatic brain injury (TBI) neurorehabilitation admissions.DesignProspective observational study.SettingFreestanding rehabilitation hospital.ParticipantsPrimarily severe TBI (median emergency department Glasgow Coma Scale [GCS] score=7; N=205) patients who were mostly men (71%) and white (68%) were evaluated during acute neurorehabilitation.InterventionsNone.Main Outcome MeasureDelirium Rating Scale-Revised-98 (DelRS-R98) was administered weekly throughout rehabilitation hospitalization. DelRS-R98 item 1 was used to classify severity of sleep-wake cycle disturbance (SWCD) as none, mild, moderate, or severe. SWCD ratings were analyzed both serially and at 1 month postinjury.ResultsFor the entire sample, 66% (mild to severe) had SWCD at 1 month postinjury. The course of the SWCD using a subset (n=152) revealed that 84% had SWCD on rehabilitation admission, with 63% having moderate to severe ratings (median, 24d postinjury). By the third serial exam (median, 35d postinjury), 59% remained with SWCD, and 28% had moderate to severe ratings. Using general linear modeling and adjusting for age, emergency department GCS score, and days postinjury, presence of moderate to severe SWCD at 1 month postinjury made significant contributions in predicting duration of posttraumatic amnesia (P<.01) and rehabilitation hospital length of stay (P<.01).Conclusions Results suggest that sleep abnormalities after TBI are prevalent and decrease over time. However, a high percent remained with SWCD throughout the course of rehabilitation intervention. Given the brevity of inpatient neurorehabilitation, future studies may explore targeting SWCD to improve early outcomes, such as cognitive functioning and economic impact, after TBI.
    Archives of physical medicine and rehabilitation 05/2013; 94(5):875–882. · 2.18 Impact Factor

Full-text

Download
28 Downloads
Available from
Jun 5, 2014