Article

Recommendations From the 2013 Galveston Brain Injury Conference for Implementation of a Chronic Care Model in Brain Injury

Rehabilitation Medicine, New York University School of Medicine and Rusk Institute of Rehabilitation Medicine, NYU-Langone Medical Center, New York (Dr Flanagan)
The Journal of head trauma rehabilitation (Impact Factor: 2.92). 11/2013; 28(6):476-83. DOI: 10.1097/HTR.0000000000000003
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Available from: Mark Sherer, Apr 20, 2015
    • "TBI no longer flies under the radar. Indeed, this increased awareness has led to the recognition of TBI's often persistent sequelae, and the recommendation to treat it as a chronic health condition across the lifespan (Malec et al., 2013). In civilian populations, there are approximately 1.7 million TBIs sustained annually (Faul et al., 2010). "
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    ABSTRACT: Sleep disturbance following mTBI is commonly reported as debilitating and persistent. However, the nature of this disturbance is poorly understood. This study sought to characterize sleep following mTBI compared to a control group. A cross-sectional matched case control design was used. Thirty-three individuals with recent mTBI (1-6 months ago) and 33 age, gender, and ethnicity matched controls completed established questionnaires of sleep quality, quantity, timing, and sleep-related daytime impairment. MTBI participants were compared to an independent sample of close-matched controls (CMCs; n = 33) to allow partial internal replication. Compared to controls, people with mTBI reported significantly greater sleep disturbance, more severe insomnia symptoms, a longer duration of wake after sleep onset (WASO), and greater sleep-related impairment (all medium to large effects, Cohen's d >0.5). No differences were found in sleep quantity, timing, sleep onset latency, sleep efficiency or daytime sleepiness. All findings except a measure of sleep timing (i.e., sleep midpoint) were replicated for CMCs. These results indicate a difference in the magnitude and nature of perceived sleep disturbance following mTBI compared with controls, where people with mTBI report poorer sleep quality and greater impairment from their sleep. The finding that other sleep parameters did not differ has implications for treatment. These findings should guide the provision of clearer advice to patients about the aspects of their sleep that may change following mTBI and which treatments may be suitable.
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