Subjective well-being and quality of life following traumatic brain injury in adults: a long-term population-based follow-up

Primary objective: To assess subjective well-being and quality-of-life in nationally representative samples of patients at long intervals following traumatic brain injuries.

Methods and procedures: Patients with either cranial fractures or cerebral lesions were identified in a national computer-based register of hospital admissions and random samples were selected among those who had suffered the injury at 5, 10 or 15 years prior to the follow-up. Postal questionnaires were sent to them covering quality of life, e.g. return to employment, family relations and current subjective well-being in terms of symptomatology, e.g. somatic complaints, cognitive dysfunction. A response rate of 76% was obtained, comprising 114 patients with cranial fracture and 126 with cerebral lesions.

Main outcomes and results: The group with cerebral lesions had markedly poorer quality of life and subjective well-being than the group with cranial fractures and this did not vary across time. In both groups, the most common symptoms concerned cognition. Among the cerebral lesion group, quality of life outcome was fairly well predicted by severity of injury, but subjective well-being was less well predicted.

Conclusions: The negative consequences of traumatic cerebral lesions are marked and do not vary at long periods following injury.     

早期系统化康复护理对截瘫患者生活质量的影响

目的：探讨早期系统化康复护理对截瘫患者生活质量的影响及临床价值。方法：选择外伤性截瘫患者６４例,随机分为早期系统化康复护理组和传统护理组。对两组患者的日常生活活动能力采用ＦＩＭ量表和肢体运动功能用改良式Ｆｕｇｌ－Ｍｅｙｅｒ量表及并发症发生情况进行３个月的观察、评估。结果：早期系统化康复护理组在１个月和３个月时的ＦＩＭ、Ｆｕｇｌ－Ｍｅｙｅｒ得分显著提高,明显优于传统护理组（Ｐ〈０．０５）,并发症明显     

Outcome of intensive rehabilitation after severe brain injury: a long-term follow-up study

Fifty-five brain-injured adults (of 64 discharged) were followed up from 19 to 101 months after discharge from a rehabilitation unit. Change was assessed in terms of discharge and current placement, as compared with pre-admission placement. The results demonstrate that rehabilitation achieved improvements in functional skills and social behaviour that lastingly affected the type of placement possible, and thus improved quality of life. In most cases where improvements were seen during rehabilitation, further improvements occurred after discharge. The findings also have implications for the timing of rehabilitation and for discharge and resettlement planning.     

The long-term impact and rehabilitation of pediatric traumatic brain injury: a 50-year follow-up case study

Despite significant advances in the understanding of pediatric traumatic brain injury (TBI)-related sequelae, members of the medical community working with adult survivors often do not appreciate the impact of "latent" effects of these injuries. To assess deficits and facilitate intervention, the interactions among the nature of the TBI, the individual's developmental course, and the history of community response must be understood. This case study discusses the lifelong challenges faced by a 56-year-old individual who sustained a TBI at age 5. His case highlights the importance of developmental stage consideration, remote evaluation/intervention, and collaboration with mental health professionals.     

Psychosocial outcome following traumatic brain injury in adults: a long-term population-based follow-up

Primary objective: On a national basis to conduct a 5, 10 and 15 year follow-up study of representative samples of survivors after traumatic brain injury (TBI) and to identify factors of importance for long-term survival and life satisfaction after TBI occurring in 1982, 1987 or 1992. Research design: Epidemiological, register-based questionnaire survey. Main outcomes, result and conclusions: Out of 389 survivors randomly chosen from a national complete hospital register, 173 had suffered a cranial fracture, 186 a cerebral lesion (brain contusion or traumatic haemorrhage) and 30 patients a chronic subdural haematoma. Out of 337 survivors found eligible for a questionnaire, 76% responded. Among the data registered according to the above mentioned areas, the main findings were that 23-31% of the cerebral lesion responders were unable to maintain earlier work/education at pre-injury level, against up to 14% of cranial fracture patients. Significantly more cerebral lesion patients than cranial fracture patients found emotional control more difficult, as well as increased difficulties with memory and concentration, maintenance of leisure time interests and general life satisfaction. In the long run, an important factor influencing survival among cerebral lesion patients seemed to be whether relations with family and friends could be maintained at the pre-injury level.     

Self-concept and quality of life following acquired brain injury: a pilot investigation

Objective: To investigate through pilot exploration the relationships between depression, self-concept and perceived quality of life (QoL) in post-acute patients with acquired brain injury (ABI).

Methods: Nineteen patients with ABI were administered the Beck Depression Inventory-II and the Quality of Life Inventory, along with the Tennessee Self-Concept Scale-2 and the Head Injury Semantic Differential Scale, measures of self-concept. The relationships between these measures were explored using correlational analyses.

Results: Ratings of self-concept were correlated with perceived QoL, suggesting that poorer view of self was associated with lower subjective QoL. Additionally, depressive symptoms were associated with lower QoL ratings, consistent with previous research.

Conclusions: These results suggest that intra-personal variables, such as self-concept and depression, impact the perceived QoL of the ABI survivor. Future research exploring the mediating effects of these variables on QoL may clarify this relationship and may aid in developing more effective interventions for these individuals.     

Quality of life of patients operated on for lumbar stenosis: a long-term follow-up

Summary Background. We evaluated a sample of 28 patients surgically treated for lumbar stenosis (LS) four years after the first evaluation (length of the first follow-up mean 44.6 months, range 15–88) in order to evaluate the long-term follow-up of Quality of Life (QoL) after surgical treatment as LS may greatly impair the patients’ QoL. We previously assessed QoL in 30 patients operated on for LS four years before, by performing a retrospective follow-up through the Short-Form 36 Health Survey (SF-36). Methods. In this current study we performed a phone call evaluation administering the SF-36 and the official Italian version of the North American Spine Society (NASS) lumbar spine outcome assessment instrument. Findings. With regard to the SF-36 results at long term follow-up we observed a significant improvement of Physical Function, Bodily Pain, Mental Health and the Physical Composite Score with respect to the first follow-up. Conversely, Vitality worsened. Regarding the results of NASS an improvement of neurological symptoms was observed. Comparison of SF-36 mean scores in the current LS sample vs. the Italian normal population at the same age, showed similar QoL pattern. Conclusions. The long-term follow-up showed that patients operated on for LS continue to improve their QoL pattern even between the 4th and the 8th year after surgery.     

Direct clinician-delivered versus indirect family-supported rehabilitation of children with traumatic brain injury: a randomized controlled trial

Primary objectives: To explore the relative effectiveness of clinician-delivered vs family-supported interventions for children with chronic impairment after TBI.

Research design: Randomized controlled clinical trial.

Methods and procedures: Children aged 5-12 years in the chronic phase of their recovery were randomly assigned to the clinician-delivered or to the family-supported intervention group; both samples received intensive services for 1 year; physical outcome was measured by the SARAH scales, cognitive outcome by the WISC-III.

Main outcomes and results: Parents in the family-supported intervention sample efficiently acquired the skills needed to deliver physical and cognitive interventions within the context of everyday routines of the child's life at home; family education level was not a factor. Although both groups demonstrated improvements, only the children in the family-supported intervention group demonstrated statistically significant — and clinically important — improvements on both outcome measures.

Conclusions: This RCT provides compelling evidence for organizing cognitive and physical interventions and supports for children with TBI around the everyday routines of their lives, with intensive supports for their families.     

Psychosocial consequences of stroke: a long-term population-based follow-up

Primary objective: To investigate psychosocial status among nationally representative groups of stroke patients at long intervals post-stroke.

Methods and procedures: From a Danish national register of hospitalizations, three representative groups of surviving patients were selected who had suffered a stroke 5, 10 and 15 years previously. A follow-up postal questionnaire was sent to them comprising items concerning symptomatology, functioning and social conditions, together with the Nottingham Health Profile (NHP).

Main outcomes and results: Longer follow-up intervals were associated with younger age at stroke and better functioning at discharge. At follow-up, the majority of patients reported difficulties with attention, memory and emotional control, irrespective of follow-up interval. Return to employment, social relations and leisure activities were affected, but were comparatively better at longer follow-up intervals, as was self-rated functioning and several NHP symptom scales. However, multi-variate analyses suggest that these positive changes with time appear to be mediated by attrition related to age at stroke and discharge functioning rather than time since stroke itself.

Conclusions: Symptomatology, functioning and social conditions remain affected and perhaps stagnant in long-term survivors of stroke.     

The effects of normal ageing on neuropsychological functioning following traumatic brain injury

Increasing age is associated with greater absolute neuropsychological impairment (e.g. slower process ing speed, diminished memory , although it is unclear if older individuals with traumatic brain injury (TBI) show greater relative impairment than younger individuals with TBI. The current study evaluated the effects of normal ageing on TBI by using age based normative data to calculate indices of relative decline from pre morbid levels (expressed as z-deficit scores) for different age groups (20-39 years, 40-59 years, 60+ years). The sample included 279 individuals with TBI between the ages of 20 and 65 who were assessed in a department of rehabilitation neuropsychology laboratory over a 4-year period. Spearman correlations and ANOVAs did not show-age related differences in relative memory, attention or speed of processing abilities, although results did indicate that increasing age is associated with relatively less impairment in intelligence. The results suggest that the greater neuropsychological impairment noted in older individuals with TBI is most likely related to normal ageing. The importance of considering both absolute and relative degrees of impairment is discussed.     

Dupuytren's disease: analysis of 110 patients on a long-term follow-up

The analysis of the surgical therapy results of 110 patients suffering from Dupuytren's disease with an average follow-up of seven years is presented. This was done using the Tubiana staging system, the basis of which is carefully explained in the paper. By determining the recurrence rate (46.4%) and the extension rate (19.2%) in 125 operated hands, the importance and the gravity of recurrence in each of the 292 hand rays is emphasized. The influence on recurrence and extension of factors usually associated with Dupuytren's disease and the relationship between the severity of the initial stages of the disease and recurrence was studied. It was concluded that early surgical intervention, especially in patients under 50 years of age or presenting with ectopic deposits, is effective in lessening the frequency of recurrence.     

The relationship of neuropsychological status and productive outcomes following traumatic brain injury

Neuropsychological assessment is a standard component of traumatic brain injury rehabilitation programmes; however, the relationship between neuropsychological test scores and functional abilities is not clear. The current study compared serial neuropsychological test data with functional outcomes for 152 subjects. Outcome was operationally defined for three activity settings (home, school, work) with six levels of productivity for each. Productivity was defined as one's ability to function at increasing levels of independence. Demographic and caseload variables were analysed utilizing correlation and stepwise multiple regression analyses. Significant relationships to outcome were found between certain neuropsychological test scores, and certain demographic variables. Positive outcomes were related in part to patient's speed of information processing, memory skills, and simultaneous processing abilities. Also related to positive outcomes were mechanism of injury, level of insurance funding, premorbid educational level, and negative history of substance abuse. The activity setting influenced outcome such that it appeared to be most difficult to return to work, suggesting the necessity of adequate vocational assistance. However, cognitive and demographic variables accounted for less than 30% of the total variance in outcome. Therefore, brain injury rehabilitation must be multifaceted.     

The vegetative state: a report of two cases with a long-term follow-up

Objectives: To demonstrate that patients with Prolonged Vegetative State (PVS) can show signs of improvements and important changes and, consequently, to strengthen the necessity to evaluate them with long-term serial follow-ups. Setting: Rehabilitation of patients with severe traumatic brain injury (TBI). Participants: Two people with severe TBI discharged after a long period of inpatient rehabilitation in a condition of PVS. Results: After 5 years some important changes happened and the initial prognosis was proved to be wrong. Conclusion: Sometimes patients declared to be in PVS have the possibility to recover, especially when initial clinical conditions are particularly severe and do not allow the emergence of the state of consciousness. It is important to conduct regular follow-ups to better evaluate changes and, if it is necessary, to re-adjust the rehabilitation accordingly.     

The effect of laparoscopic sleeve gastrectomy on quality of life: A prospective cohort study with 5-years follow-up

Background

Obesity has a negative effect on quality of life (QoL). Bariatric surgery results in significant weight loss with improvement of QoL. Very few studies have evaluated QoL after sleeve gastrectomy (SG), especially with a long-term follow-up.

The influence of cultural background on motivation for and participation in rehabilitation and outcome following traumatic brain injury

AIMS: To compare motivation for and participation in rehabilitation, outcome, and distress over role changes in persons with traumatic brain injury (TBI) from the dominant English-speaking culture in Australia versus those from minority culturally and linguistically diverse (CALD) backgrounds. MAIN MEASURES: Motivation for Traumatic Brain Injury Rehabilitation Questionnaire; Craig Handicap Assessment Reporting Technique. PARTICIPANTS: Two groups of persons with TBI, 38 of English-speaking backgrounds and 32 of CALD backgrounds. RESULTS: Groups had similar education and preinjury employment status, both showed positive attitudes toward rehabilitation and participated equally in rehabilitation. However, CALD participants showed poorer outcomes in several domains, including postinjury employment status, cognitive independence, mobility and social integration, and showed greater distress about changes in ability to perform certain life roles. CONCLUSIONS: Differences in outcome and levels of distress over role changes may occur in those from CALD backgrounds following TBI, independent of socioeconomic background and access to rehabilitation. There is a need to further investigate possible reasons for this, including beliefs, coping style, and emotional response to injury.     

The impact of acute care medications on rehabilitation outcome after traumatic brain injury

Objectives: To examine the impact of medications with known central nervous system (CNS) mechanisms of action, given during the acute care stages after traumatic brain injury (TBI), on the extent of cognitive and motor recovery during inpatient rehabilitation.

Design: Retrospective extraction of data utilizing an inception cohort of moderate and severe TBI survivors.

Methods: The records of 182 consecutive moderate and severe TBI survivors admitted to a single, large, Midwestern level I trauma centre and subsequently transferred for acute inpatient rehabilitation were abstracted for the presence of 11 categories of medication, three measures of injury severity (worst 24 hour Glasgow Coma Scale, worst pupillary response, intra-cranial hypertension), three measures of outcome (Function Independence Measure (FIM) Motor and Cognitive scores at both rehabilitation admission and discharge and duration of post-traumatic amnesia (PTA)).

Main outcome and results: The narcotics, benzodiazepines and neuroleptics were the most common categories of CNS active medications (92%, 67% and 43%, respectively). The three categories of medications appeared to have no significant outcome on the FIM outcome variables. The neuroleptics affected cognitive recovery with almost 7 more days required to clear PTA in the neuroleptic treated group. The presence of benzodiazepines did tend to obscure the impact of neuroleptics on PTA duration but the negative impact of neuroleptics on PTA duration remained significant.

Conclusions: The results suggest that the use of neuroleptics during the acute care stage of recovery has a negative impact on recovery of cognitive function at discharge from inpatient rehabilitation. Due to the paucity of subjects with hemiplegia in this cohort, conclusions could not be drawn as to the impact of acute care medications on motor recovery.     

Complex specialized rehabilitation following severe brain injury: a UK perspective

This article describes the setup of brain injury rehabilitation services in the United Kingdom within the context of the National Health Service. The rehabilitation services are broadly divided into local general rehabilitation services, specialist district rehabilitation services, and complex specialized rehabilitation services. The Department of Health published the National Service Framework for Long-Term Neurological Conditions in 2005, setting out the 11 quality requirements to ensure provision of lifelong patient-centered care. A network of rehabilitation services, cited as a model of good practice by the Department of Health, including specialist inpatient and community outreach services for patients with complex brain injury, with research embedded within the clinical program and close collaboration between the clinicians and researchers are described.