Mild Traumatic Brain Injury: Implications for Social Work Research and Practice With Civilian and Military Populations

Over one million mild traumatic brain injuries (mTBI) are treated in U.S. hospitals each year. In addition, mTBI has affected thousands of soldiers returning from the Iraq and Afghanistan wars. Many individuals experience post-concussive symptoms immediately after mTBI; some experience severe and prolonged symptoms. Symptom etiology is not well understood, and effective psychosocial interventions have not been well developed. Because of the high incidence of mTBI, many social workers in health care settings will come in contact with mTBI patients and need specialized knowledge to provide appropriate services. Social work researchers can contribute to improved services by elucidating symptom course, and developing and testing effective interventions aimed at preventing or alleviating symptoms. This article provides an overview of civilian- and military-related mTBI outcomes and psychosocial interventions. Recommendations for current social work practice and research are made with the goal of improving the care of persons with mTBI.     

Mild Traumatic Brain Injury: A Place for Social Work

Mild traumatic brain injury (mTBI) has emerged as a significant public health issue. Increases in both the prevalence and awareness of this injury have resulted in a greater demand for mTBI-informed care. Our exploratory, qualitative study examines the work lives of front-line mTBI professionals. Findings suggest that mTBI rehabilitation work often requires substantial emotional energy given the impact that injury-related issues have on professionals’ therapeutic work with clients. We suggest that social work, with a focus on the psychosocial implications of injury and recovery, is well-positioned to take a larger role in mTBI care and rehabilitation.     

The Effect of Occupation‐based Cognitive Rehabilitation for Traumatic Brain Injury: A Meta‐analysis of Randomized Controlled Trials

Traumatic brain injury (TBI) is the leading cause of death and disability among people younger than 35 years in the United States. Cognitive difficulty is a common consequence of TBI. To address cognitive deficits of patients with TBI, various cognitive rehabilitation approaches have been used for the clinical setting. The purpose of this study was to investigate the overall effect of occupation‐based cognitive rehabilitation on patients' improvement in cognitive performance components, activity of daily living (ADL) performance, and values, beliefs and spirituality functions of patients with TBI. The papers used in this study were retrieved from the Cochrane Database, EBSCO (CINAHL), PsycINFO, PubMed and Web of Science published between 1997 and 2014. The keywords for searching were cognitive, rehabilitation, occupation, memory, attention, problem‐solving, executive function, ADL, values, beliefs, spirituality, randomized controlled trials and TBI. For the meta‐analysis, we examined 60 effect sizes from nine studies that are related to the occupation‐based cognitive rehabilitation on persons with TBI. In persons with TBI, overall mental functions, ADL, and values, beliefs and spirituality were significantly improved in the groups that received occupation‐based cognitive rehabilitation compared with comparison groups (mean d = 0.19, p < .05). Evidence from the present meta‐analytic study suggests that occupation‐based cognitive rehabilitation would be beneficial for individuals with TBI for improving daily functioning and positively be able to affect their psychosocial functions. Collecting many outcome measures in studies with relatively few participants and the final data are less reliable than the whole instrument itself. Future research should evaluate the effectiveness of specific occupation‐based cognitive rehabilitations programmes in order to improve consistency among rehabilitation providers. Copyright © 2015 John Wiley & Sons, Ltd.     

有创颅内压监测技术在重型颅脑损伤患者中的临床应用

目的：探讨有创颅内压监测技术在重型颅脑损伤患者中的临床应用价值。方法：选取本科2012年7月-2013年12月应用有创颅压监测技术的114例重型颅脑损伤患者进行前瞻性研究,按照随机数字表法将其分为监测组和对照组各57例。监测组于入院后24 h内或开颅手术后行有创颅内压监测;对照组依据患者意识、生命体征和CT检查等,进行常规治疗。对比两组患者治疗3个月后GOS评分。结果：监测组的预后良好率为66.7%明显高于对照组的45.6%,差异有统计学意义（P〈0.05）。结论：有创颅内压监测技术能动态观察重型颅脑损伤患者的颅内压变化情况,有利于及时采取有效治疗措施控制颅内压,改善患者预后,值得临床推广应用。     

Barriers to Nutrition Intervention for Patients With a Traumatic Brain Injury: Views and Attitudes of Medical and Nursing Practitioners in the Acute Care Setting

Background: Nutrition delivered to patients with a traumatic brain injury (TBI) is typically below prescribed amounts. While the dietitian plays an important role in the assessment and provision of nutrition needs, they are part of a multidisciplinary team. The views and attitudes of medical and nursing practitioners are likely to be crucial to implementation of nutrition to patients with TBI, but there is limited information describing these. Methods: A qualitative exploratory approach was used to explore the views and attitudes of medical and nursing practitioners on nutrition for patients with TBI. Participants at 2 major neurotrauma hospitals in Australia completed individual semi‐structured interviews with a set of questions and a case study. Interviews were transcribed and coded for themes. Results: Thirty‐four health practitioners participated: 18 nurses and 16 physicians. Three major themes emerged: (1) nutrition practices over the hospital admission reflect the recovery course, (2) there are competing priorities when caring for patients with TBI, and (3) the implementation of nutrition therapy is influenced by practitioner roles and expectations. Conclusion: Use of qualitative inquiry in the study of attitudes toward nutrition provision to patients with TBI provided detailed insights into the challenges of operationalizing nutrition therapy. These insights can be used to clarify communication between health practitioners working with patients with TBI across the continuum of care.     

手术治疗重症颅脑外伤患者的效果分析

目的探讨不同手术治疗重症颅脑外伤患者的效果。方法选取我院2016年3月至2017年1月收治的72例重症颅脑外伤患者,随机分为对照组与观察组各36例。对照组采用传统开颅减压术治疗,观察组采用双侧相继去骨瓣减压术治疗,对比两组患者的临床治疗效果。结果两组患者术后的GCS评分均优于术前(P <0.05),但组间比较差异无统计学意义(P>0.05)。观察组的术后住院时间明显短于对照组(P <0.05)。观察组术后并发症发生率为11.11%,明显低于对照组的30.56%(P <0.05)。观察组GOS评分为5分的比例高于对照组(P <0.05)。结论与传统开颅减压术相比,采用双侧相继去骨瓣减压术治疗重症颅脑外伤患者的效果显著,值得优先考虑。     

Traumatic Brain Injury in Older Adults: Characteristics,Outcomes, and Considerations. Results From the American Association for the Surgery of Trauma Geriatric Traumatic Brain Injury (GERI-TBI) Multicenter Trial

ObjectivesDescribe the epidemiology of a large cohort of older adults with isolated traumatic brain injury (TBI) and identify predictors of mortality, palliative interventions, and discharge to preinjury residence in those presenting with moderate/severe TBI.DesignProspective observational study of geriatric patients with TBI enrolled across 45 trauma centers.Setting and ParticipantsInclusion criteria were age ≥40 years, and computed tomography (CT)-verified TBI. Exclusion criteria were any other body region abbreviated injury scale score >2 and presentation at enrolling center >24 hours after injury.MethodsThe analysis was restricted to individuals aged ≥65 and stratified into 3 age groups: young-old (65–74), middle-old (75–84), and oldest-old (≥85). Demographic, clinical, and injury data were collected. Predictors of mortality, palliative interventions, and discharge to preinjury residence in the moderate/severe TBI group were identified using Classification and Regression Tree and Generalized Linear Mixed Models.ResultsOf the 3081 subjects enrolled in the study, 2028 were ≥65 years old. Overall, 339 (16.7%) presented with a moderate/severe TBI and experienced a 64% mortality rate. A Glasgow Coma Scale (GCS) score <9 was the main predictor of mortality, CT worsening (odds ratio [OR] = 1.7, P < .04), cerebral edema (OR = 2.4, P < .04), GCS <9, and age ≥75 (OR = 2.1, P = .007) were predictors for palliative interventions, and an injury severity score ≤24 (OR = 0.087, P = .002) was associated with increased likelihood of discharge to preinjury residence in the moderate/severe TBI group.Conclusion and ImplicationsIn this prospective study of a large cohort of older adults with isolated TBI, comparisons across the older age groups with moderate/severe TBI revealed that survival and favorable discharge disposition were influenced more by severity of injury rather than age itself. Indicating that chronological age alone maybe insufficient to accurately predict outcomes, and increased representation of older adults in TBI research to develop better diagnostic and prognostic tools is warranted.     

开颅术联合高压氧对重型颅脑损伤患者昏迷指数的影响

目的探讨开颅术联合高压氧对重型颅脑损伤患者昏迷指数的影响。方法选择2009年1月—2011年10月在我院住院治疗的60例重型颅脑损伤患者,按照随机数字表法将患者分为对照组和观察组,每组30例。在常规药物治疗基础上,对照组采用开颅术治疗,观察组采用开颅术联合高压氧治疗,术后对两组患者的临床疗效、昏迷指数(Glasgow comascale,GCS)评分,并与高压氧治疗前、治疗4周及治疗3个月随访时治疗结果分级(GOS)进行对比分析。结果观察组和对照组临床有效率分别为86.67%(26/30)和76.67%(23/30),两组患者临床有效率比较差异有显著性(P<0.05);高压氧治疗后1周GCS评分无明显差异,第2、3、4周高压氧治疗后GCS评分比较有统计学差异(P<0.05);两组患者第4周、3个月随访阶段的GOS预后评分比较有统计学意义(P<0.05)。结论开颅术联合高压氧治疗不仅对重型颅脑损伤患者早期意识改善和预后有显著效果,而且提高了患者的生活质量,可以促使患者早日康复。     

Tailoring Work-Life Interventions for Culturally Diverse Caregivers of Patients With Traumatic Brain Injury

With the increasing incidence of traumatic brain injury among culturally diverse families, there has also been increased attention to the dual demands of employment and caregiving. In this article, we contend that culturally diverse caregivers are an understudied group of workers. We examine literature to assist in conceptualizing the relationship between cultural orientation and caregiving, work-life stress, and organizational responses. Implications for strengthening the cultural responsiveness of work-life initiatives are discussed.     

Computer-Based Cognitive Retraining for Adults with Chronic Acquired Brain Injury: A Pilot Study

ABSTRACT

This study evaluated the effectiveness of a computer-based cognitive retraining (CBCR) program on improving memory and attention deficits in individuals with a chronic acquired brain injury (ABI). Twelve adults with a chronic ABI demonstrating deficits in memory and attention were recruited from a convenience sample from the community. Using a quasi-experimental one-group pretest–posttest design, a significant improvement was found in both memory and attention scores postintervention using the cognitive screening tool. This study supported the effectiveness of CBCR programs in improving cognitive deficits in memory and attention in individuals with chronic ABI. Further research is recommended to validate these findings with a larger ABI population and to investigate transfer to improvement in occupational performance that supports daily living skills.     

Promoting Family Resilience Through Evidence‐based Policy Making: Reconsidering the Link Between Adult–Infant Bedsharing and Infant Mortality

Evidence‐based policy making often has a direct or indirect goal of promoting family resilience. The authors consider the ways in which scholarly disagreements about evidence can challenge this goal, focusing on the debate regarding whether adult–infant bedsharing increases the risk of infant mortality. A central issue is whether scholars conclude that public policy should recommend against all bedsharing or only bedsharing in particular risky circumstances. The authors use context‐based evidence‐based policy making (Dobrow, Goel & Upshur, 2004) as a framework for a review of studies of sudden infant death syndrome (SIDS) correlates and SIDS mechanisms related to bedsharing as well as the reasons parents bed share. The authors discuss the implications of different interpretations of the evidence and point to the potential of adversarial collaboration in helping to address the points of disagreement and ultimately better support family resilience. The issues discussed in this case are broadly relevant to other debated evidence for family policy making.     

护理干预在颅脑损伤所致精神障碍患者中应用的临床效果观察

目的：观察护理干预在颅脑损伤所致精神障碍患者中应用的临床效果,探讨提高颅脑损伤所致精神障碍患者护理水平的措施。方法：选取颅脑损伤所致精神障碍的患者64例,按随机数字表法均分为传统组（n=32例）和干预组（n=32例）,传统组采取传统的护理措施,干预组在传统护理措施基础上给予护理干预措施,比较两组患者治疗后NOSIE-30评分、MMSE量表评分和MoCA量表评分。结果：治疗4周后,干预组的NOSIE-30评分优于传统组,差异有统计学意义（P〈0.05）;治疗第2、4周,干预组的MoCA评分和MMSE评分均优于传统组,差异均有统计学意义（P〈0.05）。结论：在颅脑损伤所致精神障碍患者临床护理过程中应积极加行护理干预措施,可促进患者临床症状的改善,有利于患者早日康复。     

Economic Evaluations in the Diagnosis and Management of Traumatic Brain Injury: A Systematic Review and Analysis of Quality

BackgroundEconomic evaluations provide a unique opportunity to identify the optimal strategies for the diagnosis and management of traumatic brain injury (TBI), for which uncertainty is common and the economic burden is substantial.ObjectiveThe objective of this study was to systematically review and examine the quality of contemporary economic evaluations in the diagnosis and management of TBI.MethodsTwo reviewers independently searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, Health Technology Assessment Database, EconLit, and the Tufts CEA Registry for comparative economic evaluations published from 2000 onward (last updated on August 30, 2013). Data on methods, results, and quality were abstracted in duplicate. The results were summarized quantitatively and qualitatively.ResultsOf 3539 citations, 24 economic evaluations met our inclusion criteria. Nine were cost-utility, five were cost-effectiveness, three were cost-minimization, and seven were cost-consequences analyses. Only six studies were of high quality. Current evidence from high-quality studies suggests the economic attractiveness of the following strategies: a low medical threshold for computed tomography (CT) scanning of asymptomatic infants with possible inflicted TBI, selective CT scanning of adults with mild TBI as per the Canadian CT Head Rule, management of severe TBI according to the Brain Trauma Foundation guidelines, management of TBI in dedicated neurocritical care units, and early transfer of patients with TBI with nonsurgical lesions to neuroscience centers.ConclusionsThreshold-guided CT scanning, adherence to Brain Trauma Foundation guidelines, and care for patients with TBI, including those with nonsurgical lesions, in specialized settings appear to be economically attractive strategies.     

Pattern and Outcome of Traumatic Brain Injury,Addis Ababa,Ethiopia: A Cross-sectional Hospital-based Study

BackgroundTraumatic brain injury (TBI) is the leading cause of death and disability in young adults in the world. This study assessed clinical characteristics and in-hospital outcomes among traumatic brain injury patients presenting to Addis Ababa Burn, Emergency, and Trauma hospital.MethodsA cross-sectional hospital-based survey was conducted at AaBET hospital from January 01/2020 to April 30/2020. Data were collected using structured questionnaires from the trauma registry and patient chart. The collected data were analyzed using statistical software SPSS v 25.0.ResultsAmong the 304 traumatic brain injury patients, 75% were males with a mean age of 30.4 + 15.7, and 59.2% came from the Oromia region. Road traffic injury was responsible for 45% of the cases, of which pedestrian struck accounts for 52.2% of the cases. Only 50 (16.4%) patients arrived below 02 hours. 201 (66.1%) patients had mild traumatic brain injury the rest had moderate to severe traumatic brain injury. Skullbone fracture (linear, DSF, & BSF) was the most common (n=157, 63.1%) followed by intracerebral lesions (DAI, brain contusion, & ICH) (n=140, 56.5%). Forty-three (14.1%) patients were intubated. 45(14.8%) cases had a neurosurgical intervention. The mortality rate of severe, moderate, & mild TBI were 25%, 8.0% & 2.0% respectively with an overall mortality of 5.6%.ConclusionThis study showed road traffic injury was the commonest cause of traumatic brain injury which affected young age groups. There was a delayed presentation to AaBET hospital Emergency. The mortality rate was lower than other Ethiopian hospital studies.     

Scientific Evidences of Calorie Restriction and Intermittent Fasting for Neuroprotection in Traumatic Brain Injury Animal Models: A Review of the Literature

It has widely been accepted that food restriction (FR) without malnutrition has multiple health benefits. Various calorie restriction (CR) and intermittent fasting (IF) regimens have recently been reported to exert neuroprotective effects in traumatic brain injury (TBI) through variable mechanisms. However, the evidence connecting CR or IF to neuroprotection in TBI as well as current issues remaining in this research field have yet to be reviewed in literature. The objective of our review was therefore to weigh the evidence that suggests the connection between CR/IF with recovery promotion following TBI. Medline, Google Scholar and Web of Science were searched from inception to 25 February 2022. An overwhelming number of results generated suggest that several types of CR/IF play a promising role in promoting post-TBI recovery. This recovery is believed to be achieved by alleviating mitochondrial dysfunction, promoting hippocampal neurogenesis, inhibiting glial cell responses, shaping neural cell plasticity, as well as targeting apoptosis and autophagy. Further, we represent our views on the current issues and provide thoughts on the future direction of this research field.     

Moving Back Into the Community: Obstacles for People With an Acquired Brain Injury or Physical Disability

ObjectivesTo investigate transitions from long-term institutional care to the community in people with an acquired brain injury (ABI) or a physical disability (PD). Secondary objectives were to identify barriers in each group.DesignRetrospective observational study based on a person-centered plan and structured interviews to identify potential barriers.Setting and ParticipantsLong-term institutional care; 2954 Medicaid participants younger than 65 interested in community living.MethodsAnalysis with SPSS 25 of 445 people with an ABI and 2509 with a PD living in long-term care between December 2008 and November 2017. The main outcome was transition to the community. Secondary measures identified specific barriers such as consumer engagement, gender, and age.ResultsOf the 2954 total cases, 1810 (61.3%) transitioned to the community; 57.5% of the ABI group (n = 256) and 61.9% of the PD group (n = 1554) transitioned. Although the PD group transitioned at a slightly higher rate, no significant association was found between the program (ABI or PD) and the likelihood of transitioning [χ² (df = 1) = 3.096, P = .078]. Overall, in the ABI group, difficulties with the funding program, OR = 0.373 ± 0.238, and other individuals, OR = 0.396 ± 0.344, decreased the odds of transitioning more than other challenges, whereas lack of consumer engagement, OR = 0.659 ± 0.100, had the strongest influence on preventing transitions in the PD group.Conclusions and ImplicationsLiving in the community improves quality of life and decreases costs. No previous studies have focused on the major obstacles for 2 specific groups, those with an ABI and those with a PD. Identifying transition rates and specific barriers for different groups is an important step to developing systems that will overcome these obstacles. In addition, the equivalent transition rates between these groups highlights the benefit of increased funding and range of services for those with complex needs and support requirements.     

Value of Nonpharmacological Interventions for People With an Acquired Brain Injury: A Systematic Review of Economic Evaluations

ObjectivesAcquired brain injury (ABI) has long-lasting effects, and patients and their families require continued care and support, often for the rest of their lives. For many individuals living with an ABI disorder, nonpharmacological rehabilitation treatment care has become increasingly important care component and relevant for informed healthcare decision making. Our study aimed to appraise economic evidence on the cost-effectiveness of nonpharmacological interventions for individuals living with an ABI.MethodsThis systematic review was registered in PROSPERO (CRD42020187469), and a protocol article was subject to peer review. Searches were conducted across several databases for articles published from inception to 2021. Study quality was assessed according the Consolidated Health Economic Evaluation Reporting Standards checklist and Population, Intervention, Control, and Outcomes criteria.ResultsOf the 3772 articles reviewed 41 publications met the inclusion criteria. There was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives and comparators used. Keeping these issues in mind, we find that 4 multidisciplinary interventions studies concluded that fast-track specialized services were cheaper and more cost-effective than usual care, with cost savings ranging from £253 to £6063. In 3 neuropsychological studies, findings suggested that meditated therapy was more effective and saved money than usual care. In 4 early supported discharge studies, interventions were dominant over usual care, with cost savings ranging from £142 to £1760.ConclusionsThe cost-effectiveness evidence of different nonpharmacological rehabilitation treatments is scant. More robust evidence is needed to determine the value of these and other interventions across the ABI care pathway.