共查询到20条相似文献，搜索用时 468 毫秒
1.
Andrea R.S. Huebner Amy Cassedy Tanya M. Brown H. Gerry Taylor Terry Stancin Michael W. Kirkwood Shari L. Wade 《PM & R》2018,10(5):462-471
Background
Mental health problems are common after pediatric traumatic brain injury (TBI). Many patients in need of mental health services do not receive them, but studies have not consistently used prospective and objective methods or followed samples for more than 1 year.Objective
To examine adolescents’ use of mental health services after TBI.Design
Secondary analysis from multicenter prospective randomized controlled trial.Setting
Five level 1 U.S. trauma centers.Participants
Adolescents aged 12-17 years with moderate-to-severe TBI were recruited for a randomized clinical trial (n = 132 at baseline, 124 at 6 months, 113 at 12 months, and 101 at 18 months).Methods
Participants were randomly assigned to counselor-assisted problem-solving or Internet resource comparison. Follow-up assessments were completed at 6, 12, and 18 months after baseline. Generalized estimating equations with a logit link were used to examine use of mental health services. Treatment group and participant impairment were examined as predictors of use.Main Outcome Measurements
Mental health care use was measured with the Service Assessment for Children and Adolescents; daily functioning and clinical outcome with the Child and Adolescent Functional Assessment Scale; behavioral and emotional functioning with the Child Behavior Checklist; and executive dysfunction with the Behavior Rating Inventory of Executive Function.Results
Use of mental health services ranged from 22% to 31% in the 2 years post-TBI. Participants with impairments were about 3 times more likely than those without impairments to receive services (odds ratio 4.61; 95% confidence interval 2.61-8.14; P < .001). However, 50%-68% of patients identified as impaired had unmet mental health care needs.Conclusions
Less than one half of adolescents with behavioral health needs after TBI received mental health services. Future studies are needed to examine barriers associated with seeking services after TBI and psychoeducation as preventive care for this population.Level of Evidence
II 相似文献2.
Jennifer H. Marwitz Adam P. Sima Jeffrey S. Kreutzer Laura E. Dreer Thomas F. Bergquist Ross Zafonte Douglas Johnson-Greene Elizabeth R. Felix 《Archives of physical medicine and rehabilitation》2018,99(2):264-271
Objectives
To evaluate (1) the trajectory of resilience during the first year after a moderate-severe traumatic brain injury (TBI); (2) factors associated with resilience at 3, 6, and 12 months postinjury; and (3) changing relationships over time between resilience and other factors.Design
Longitudinal analysis of an observational cohort.Setting
Five inpatient rehabilitation centers.Participants
Patients with TBI (N=195) enrolled in the resilience module of the TBI Model Systems study with data collected at 3-, 6-, and 12-month follow-up.Interventions
Not applicable.Main Outcome Measure
Connor-Davidson Resilience Scale.Results
Initially, resilience levels appeared to be stable during the first year postinjury. Individual growth curve models were used to examine resilience over time in relation to demographic, psychosocial, and injury characteristics. After adjusting for these characteristics, resilience actually declined over time. Higher levels of resilience were related to nonminority status, absence of preinjury substance abuse, lower anxiety and disability level, and greater life satisfaction.Conclusions
Resilience is a construct that is relevant to understanding brain injury outcomes and has potential value in planning clinical interventions. 相似文献3.
Background
Mild traumatic brain injury (mTBI) can have long-term cognitive and functional consequences, and recent mTBI has been associated with impaired performance on measures related to driving ability. However, it remains unclear whether mTBI history is associated with poorer driving performance.Objective
To examine the longer-term effects of mTBI on self-reported driving ability.Design
Retrospective cross-sectional study.Setting
Online.Participants
Three hundred eighty-nine participants (169 who reported an mTBI history and 220 without an mTBI history).Intervention
Comparing participants who report a history of mTBI with those who do not report a history of mTBI.Outcomes
Self-report measures of mTBI history, frequency of aberrant driving behaviors, recent history of car accidents and citations, and previous psychological diagnoses and current symptoms.Results
Participants with a history of mTBI reported an overall higher frequency of aberrant driving behaviors and committing more driving violations that risked the safety of others than comparison participants. Participants with mTBI also were more likely to have been involved in a car accident within the past 6 months and the past 3 years. Of participants with mTBI, reports of driving violations decreased with longer time since the most recent injury. Driving violations and crash risk also decreased with increased age and years of driving experience.Conclusions
Individuals with a history of mTBI are more likely to deliberately drive in a manner that risks the safety of others and are at a heightened risk of being involved in a recent car crash. Future work should examine predictor variables in greater depth and incorporate performance-based measures of driving ability to further explore these topics.Level of Evidence
III 相似文献4.
Sarah L. Martindale Erica L. Epstein Katherine H. Taber 《Archives of physical medicine and rehabilitation》2018,99(12):2485-2495
Objective
To characterize behavioral and health outcomes in veterans with traumatic brain injury (TBI) acquired in nondeployment and deployment settings.Design
Cross-sectional assessment evaluating TBI acquired during and outside of deployment, mental and behavioral health symptoms, and diagnoses.Setting
Veterans Affairs Medical Centers.Participants
Iraq and Afghanistan veterans who were deployed to a warzone (N=1399).Interventions
Not applicable.Main Outcome Measures
Comprehensive lifetime TBI interview, Structured Clinical Interview for DSM-IV Disorders, Combat Exposure Scale, and behavioral and health measures.Results
There was a main effect of deployment TBI on depressive symptoms, posttraumatic stress symptoms, poor sleep quality, substance use, and pain. Veterans with deployment TBI were also more likely to have a diagnosis of bipolar, major depressive, alcohol use, and posttraumatic stress disorders than those who did not have a deployment TBI.Conclusions
TBIs acquired during deployment are associated with different behavioral and health outcomes than TBI acquired in nondeployment environments. The presence of TBI during deployment is associated with poorer behavioral outcomes, as well as a greater lifetime prevalence of behavioral and health problems in contrast to veterans without deployment TBI. These results indicate that problems may persist chronically after a deployment TBI and should be considered when providing care for veterans. Veterans with deployment TBI may require treatment alterations to improve engagement and outcomes. 相似文献5.
Sean M. Phelan Lauren R. Bangerter Greta Friedemann-Sanchez Kandace A. Lackore Megan A. Morris Courtney H. Van Houtven Kathleen F. Carlson Michelle van Ryn Kristin J. Harden Joan M. Griffin 《Archives of physical medicine and rehabilitation》2018,99(11):2222-2229
Objective
To assess the association between perceived stigma and discrimination and caregiver strain, caregiver well-being, and patient community reintegration.Design
A cross-sectional survey study of 564 informal caregivers of U.S. military service veterans of wars in Iraq and Afghanistan who experienced traumatic brain injuries or polytrauma (TBI/PT).Setting
Care settings of community-dwelling former inpatients of U.S. Department of Veterans Affairs Polytrauma Rehabilitation Centers.Participants
Caregivers of former inpatients (N=564), identified through next-of-kin records and subsequent nominations.Interventions
Not applicable.Main Outcome Measures
Caregiver strain, depression, anxiety, loneliness, and self-esteem; as well as care recipient community reintegration, a key aspect of TBI/PT rehabilitation.Results
Family stigma was associated with strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration. Caregiver stigma-by-association was associated with strain, depression, anxiety, loneliness, and lower self-esteem. Care recipient stigma was associated with caregiver strain, depression, anxiety, loneliness, lower self-esteem, and less community reintegration.Conclusions
Perceived stigma may be a substantial source of stress for caregivers of U.S. military veterans with TBI/PT, and may contribute to poor outcomes for the health of caregivers and for the community reintegration of the veterans for whom they provide care. 相似文献6.
James F. Malec Timothy E. Stump Patrick O. Monahan Jacob Kean Dawn Neumann Flora M. Hammond 《Archives of physical medicine and rehabilitation》2018,99(2):281-288.e2
Objectives
To develop, for versions completed by individuals with traumatic brain injury (TBI) and an observer, a more precise metric for the Neuropsychiatric Inventory (NPI) Irritability and Aggression subscales using all behavioral item ratings for use with individuals with TBI and to address the dimensionality of the represented behavioral domains.Design
Rasch and confirmatory factor analyses of retrospective baseline NPI data from 3 treatment studies.Setting
Postacute rehabilitation clinic.Participants
NPI records (N = 525) consisting of observer ratings (n = 287) and self-ratings (n = 238) by participants with complicated mild, moderate, or severe TBI at least 6 months postinjury.Interventions
Not applicable.Main Outcome Measures
Frequency and severity ratings from NPI Irritability/Lability and Agitation/Aggression subscales.Results
Confirmatory factor analyses of both observer and participant ratings showed good fit for either a 1-factor or a 2-factor solution. Consistent with this, the Rasch model also fit the data well with aggression items indicating the more severe end of the construct and irritability items populating the milder end.Conclusions
Irritability and aggression appear to represent different levels of severity of a single construct. The derived Rasch metric offers a measure of this construct based on responses to all specific items that is appropriate for parametric statistical analysis and may be useful in research and clinical assessments of individuals with TBI. 相似文献7.
Megan Sutter Laiene Olabarrieta Landa Amilkar Calderón Chagualá Helmer Chacón Peralta Gina Vergara Torres Paul B. Perrin Juan Carlos Arango-Lasprilla 《PM & R》2017,9(1):8-14
Background
Stroke is a primary cause of death and disability in upper-middle–income countries such as Colombia. Given the lack of comprehensive rehabilitation for stroke patients in Colombia, there is a need to assess longitudinal mental health problems poststroke in this region.Objective
To compare the course of mental health in stroke patients to healthy controls over the first year poststroke in Ibague, Colombia.Design
Cross-sectional study.Setting
The Psychological Attention Center of Antonio Nariño University in Ibague, Colombia.Participants
Stroke patients (n = 50) and age- and gender-matched healthy controls (n = 50).Methods
Patients and controls completed self-report Spanish versions of demographic information, injury-related characteristics, and mental health questionnairesMain Outcome Measurements
Outcomes assessed included mental health (depression, anxiety, and stress) at 3, 6, and 12 months poststroke.Results
Hierarchical linear models suggested that stroke patients had worse depression and anxiety over time than controls (P < .001). Among patients, depression and anxiety decreased over time (P < .001), whereas stress increased over time (P < .01). The findings suggest that although anxiety and depression improved over time in stroke patients, their mental health remained significantly lower than that of controls.Conclusions
This is the first study to examine the course of mental health over the first year poststroke in Latin America, specifically in Ibague, Colombia. Despite the improvements in anxiety and depression over the first year poststroke, patient anxiety and depression were still worse in comparison to those in healthy controls. The current findings indicate a need for rehabilitation services in Colombia, especially targeting mental health issues.Level of Evidence
I 相似文献8.
James F. Malec Flora M. Hammond 《Archives of physical medicine and rehabilitation》2018,99(3):603-606.e1
Objective
To determine the minimal clinically important difference (MCID) for a Rasch measure derived from the Irritability/Lability and Agitation/Aggression subscales of the Neuropsychiatric Inventory (NPI)—the Rasch NPI Irritability and Aggression Scale for Traumatic Brain Injury (NPI-TBI-IA).Design
Distribution-based statistical methods were applied to retrospective data to determine candidates for the MCID. These candidates were evaluated by anchoring the NPI-TBI-IA to Global Impression of Change (GIC) ratings by participants, significant others, and a supervising physician.Setting
Postacute rehabilitation outpatient clinic.Participants
274 cases with observer ratings; 232 cases with self-ratings by participants with moderate-severe TBI at least 6 months postinjury.Interventions
Not applicable.Main Outcome Measure
NPI-TBI-IA.Results
For observer ratings on the NPI-TBI-IA, anchored comparisons found an improvement of 0.5 SD was associated with at least minimal general improvement on GIC by a significant majority (69%–80%); 0.5 SD improvement on participant NPI-TBI-IA self-ratings was also associated with at least minimal improvement on the GIC by a substantial majority (77%–83%). The percentage indicating significant global improvement did not increase markedly on most ratings at higher levels of improvement on the NPI-TBI-IA.Conclusions
A 0.5 SD improvement on the NPI-TBI-IA indicates the MCID for both observer and participant ratings on this measure. 相似文献9.
Ashraf S. Gorgey Gary J. Farkas David R. Dolbow Refka E. Khalil David R. Gater 《PM & R》2018,10(4):338-348
Background
Increase in visceral adipose tissue (VAT) is an independent risk for mortality and other health-related comorbidities.Objective
To examine the gender differences in VAT and subcutaneous adipose tissue (SAT) cross-sectional areas (CSA) between men and women with chronic spinal cord injury (SCI). The differences in the distribution of central adiposity were used to determine the association of VAT and SAT to metabolic dysfunction after SCI.Design
Cross-sectional design.Setting
Hospital-based study.Participants
Sixteen individuals (8 men and 8 women) with motor complete SCI were matched based on age, time since injury, and level of injury.Methods
Anthropometrics, dual x-ray absorptiometry (DXA), and magnetic resonance imaging were captured to measure lean mass, fat mass (FM), percentage FM, VAT, and SAT CSAs. Basal metabolic rate was measured, and intravenous glucose tolerance test and lipid panel were performed.Main Outcome Measurements
VAT, SAT, and metabolic profile.Results
SAT CSA was 1.6 -1.75 times greater in the upper and lower trunks in women compared to men with SCI (P < .05). VAT CSA was 1.8-2.6 times greater in the upper and lower trunks in men compared to women with SCI (P < .05). VAT adjusted to body weight was greater in men compared to women with SCI. High-density lipoprotein cholesterol (HDL-C) was positively related to SAT and negatively related to VAT. Glucose effectiveness was negatively related to lower trunk SAT (r = ?0.60, P = .02). HDL-C ratio and triglycerides were positively related to upper VAT, lower VAT, and VAT:SAT ratio.Conclusion
Magnetic resonance imaging demonstrated that there is a gender dimorphism in central adiposity in persons with chronic SCI. This gender dimorphism in central adipose tissue distribution may explain the higher prevalence of metabolic dysfunction in men with SCI, especially, the decrease in the HDL-C profile.Level of Evidence
IV 相似文献10.
11.
Flora M. Hammond William Sauve Fred Ledon Charles Davis Andrea E. Formella 《PM & R》2018,10(10):993-1003
Background
Dextromethorphan 20 mg / quinidine 10 mg (DM/Q) was approved to treat pseudobulbar affect (PBA) based on phase 3 trials conducted in participants with amyotrophic lateral sclerosis or multiple sclerosis. PRISM II evaluated DM/Q effectiveness, safety, and tolerability for PBA following stroke, dementia, or traumatic brain injury (TBI).Objective
To report results from the TBI cohort of PRISM II, including a TBI-specific functional scale.Design
Open-label trial evaluating twice-daily DM/Q over 90 days.Study Participants
Adults (n = 120) with a clinical diagnosis of PBA secondary to nonpenetrating TBI; stable psychiatric medications were allowed.Methods
PRISM II was an open-label, 12-week trial enrolling adults with PBA secondary to dementia, stroke, or TBI (NCT01799941). All study participants received DM/Q 20/10 mg twice daily. Study visits occurred at baseline and at day 30 and day 90.Setting
150 U.S. centers.Main Outcome Measurements
Primary endpoint was change in Center for Neurologic Study–Lability Scale (CNS-LS) score from baseline to day 90. Secondary outcomes included PBA episode count, Clinical and Patient Global Impression of Change (CGI-C; PGI-C), Quality of Life–Visual Analog Scale (QOL-VAS), treatment satisfaction, Neurobehavioral Functioning Inventory (NFI), Patient Health Questionnaire (PHQ-9), and Mini Mental State Examination (MMSE).Results
DM/Q-treated participants showed significant mean (SD) reductions in CNS-LS from baseline (day 30, –5.6 [5.2]; day 90, –8.5 [5.2]; both, P<.001). Compared with baseline, PBA episodes were reduced by 61.3% and 78.5% at days 30 and 90 (both, P<.001). At day 90, 78% and 73% of study participants had “much improved” or “very much improved” on the CGI-C and PGI-C. QOL-VAS scores were significantly reduced from baseline (–3.7 [3.3], P<.001). Mean (SD) PHQ-9 scores improved compared to baseline at day 30 (–3.2 [5.3], P<.001) and 90 (–5.2 [6.4], P<.001). NFI T scores were significantly improved (P<.001), whereas MMSE scores were unchanged. Adverse events (AEs) were consistent with the known DM/Q safety profile; the most common AE was diarrhea (8.3%).Conclusions
DM/Q was well tolerated, and it significantly reduced PBA episodes in study participants with TBI. Changes in CNS-LS and PBA episode count were similar to changes with DM/Q in phase 3 trials.Level of Evidence
II 相似文献12.
Cynthia Harrison-Felix Jody K. Newman Lenore Hawley Clare Morey Jessica M. Ketchum William C. Walker Kathleen R. Bell Scott R. Millis Cynthia Braden James Malec Flora M. Hammond C.B. Eagye Laura Howe 《Archives of physical medicine and rehabilitation》2018,99(11):2131-2142
Objective
To evaluate the effectiveness of a replicable group treatment program for improving social competence after traumatic brain injury (TBI).Design
Multicenter randomized controlled trial comparing 2 methods of conducting a social competency skills program, an interactive group format versus a classroom lecture.Setting
Community and veteran rehabilitation centers.Participants
Civilian, military, and veteran adults with TBI and social competence difficulties (N=179), at least 6 months postinjury.Interventions
The experimental intervention consisted of 13 weekly group interactive sessions (1.5h) with structured and facilitated group interactions to improve social competence, and the control consisted of 13 traditional classroom sessions using the same curriculum with brief supplemental individual sessions but without structured group interaction.Main Outcome Measures
Profile of Pragmatic Impairment in Communication (PPIC), an objective behavioral rating of social communication impairments after TBI. LaTrobe Communication Questionnaire (LCQ), Goal Attainment Scale (GAS), Satisfaction with Life Scale, Posttraumatic Stress Disorder Checklist-C (PCL) civilian version, Brief Symptom Inventory 18 (BSI-18), Scale of Perceived Social Self-Efficacy (PSSE).Results
Social competence goals (GAS) were achieved and maintained for most participants regardless of treatment method. Significant improvements in the primary outcome (PPIC) and 2 of the secondary outcomes (LCQ and BSI) were seen immediately posttreatment and at 3 months posttreatment in the alternative treatment arm only; however, these improvements were not significantly different between the group interactive structured treatment and alternative treatment arms. Similar trends were observed for PSSE and PCL-C.Conclusions
Social competence skills improved for persons with TBI in both treatment conditions. The group interactive format was not found to be a superior method of treatment delivery in this study. 相似文献13.
14.
Aqeel M. Alenazi Mohammed M. Alshehri Shaima Alothman Jason Rucker Kari Dunning Linda J. D’Silva Patricia M. Kluding 《PM & R》2018,10(8):806-816
Background
Falls are a common adverse event among people with stroke. Previous studies investigating risk of falls after stroke have relied primarily on retrospective fall history ranging from 6-12 months recall, with inconsistent findings.Objectives
To identify factors and balance assessment tools that are associated with number of falls in individuals with chronic stroke.Design
Secondary analysis of a randomized clinical trial.Setting
Multisite academic and clinical institutions.Participants
Data from 181 participants with stroke (age 60.67 ± 11.77 years, post stroke 4.51 ± 4.78 years) were included.Methods
Study participants completed baseline testing and were prospectively asked about falls. A multivariate negative binomial regression was used to identify baseline predictive factors predicting falls: age, endurance (6 minute walk test), number of medications, motor control (Fugl-Meyer lower extremity score), depression (Patient Health Questionnaire-9), physical activity (number of steps per week), and cognition (Mini Mental Status Exam score). A second negative binomial regression analysis was used to identify baseline balance assessment scores predicting falls: gait velocity (comfortable 10 Meter Walk), Berg Balance Scale (BBS), Timed Up and Go (TUG), and Functional Reach Test (FRT). Receiver operating characteristic (ROC) and area under the curve (AUC) were used to determine the cutoff scores for significant predictors of recurrent falls.Main Outcome Measurement
The number of falls during the 42-week follow-up period.Results
Baseline measures that significantly predicted the number of falls included increased number of medications, higher depression scores, and decreased FRT. Cutoff scores for the number of medications were 8.5 with an AUC of 0.68. Depression scores differentiated recurrent fallers at a threshold of 2.5 scores with an AUC of 0.62. FRT differentiated recurrent fallers at a threshold of 18.15 cm with an AUC of 0.66.Conclusions
Number of medications, depression scores, and decreased FRT distance at baseline were associated with increased number of falls. Increased medications might indicate multiple comorbidities or polypharmacy effect; increased depression scores may indicate psychological status; and decreased functional reach distance could indicate dynamic balance impairments.Level of Evidence
II 相似文献15.
Shannon D. Sullivan Mark S. Nash Eshetu Tefara Emily Tinsley Suzanne Groah 《PM & R》2018,10(4):373-381
Background
We reported previously that young men with chronic spinal cord injury (SCI) have a greater prevalence of testosterone deficiency compared with an age-matched, healthy control population. Young men with SCI also are at increased risk for developing cardiometabolic dysfunction after injury. It is unclear whether testosterone deficiency is associated with heightened cardiometabolic risk in men with SCI.Objective
To investigate associations among levels of testosterone in young men with chronic SCI and surrogate markers of cardiometabolic risk.Design
Secondary cross-sectional analysis.Setting
Rehabilitation research centers in Washington, DC, and Miami, Florida.Participants
Men (n = 58) aged 18-45 years with chronic (≥1 year), motor complete SCI without comorbidities or use of testosterone therapy.Methods
Plasma concentrations of testosterone, lipids, inflammatory markers (C-reactive protein and interleukin-6), percent hemoglobin A1c, glucose, and insulin were measured in a fasting state using standard assays. A 2-hour oral glucose tolerance test and Framingham Risk Score were assessed for each subject. Body composition was assessed by dual X-ray absorptiometry scan.Main Outcome Measurements
Surrogate markers of cardiometabolic risk among men based on the level of total testosterone (TT; ≤300, 301-500, or >500 ng/dL) and free testosterone (fT; ≤9 or >9 ng/dL). Comparisons were made between men with normal and low TT or fT.Results
Framingham Risk Score was significantly greater in men with low fT (P < .05). Percent body fat (P < .05) and waist-to-hip ratio (P < .05) but not body mass index (P > .08), were greater in men with low TT or low fT. Men with low TT or low fT had lower high-density lipoprotein cholesterol levels (P < .05) without differences in fasting triglycerides (P > .1) or low-density lipoprotein cholesterol (P > .07). Men with low TT had greater levels of inflammatory markers C-reactive protein (P < .05) and interleukin-6 (P < .05). Men with low TT or low fT had greater fasting glucose (P < .05) and greater insulin resistance (P < .04), without differences in percent hemoglobin A1c (P > .8).Conclusions
In young men with chronic SCI who undergo an accelerated aging process postinjury, hypogonadism is associated with an unfavorable cardiometabolic risk profile. Further research is needed to determine whether a causal relationship exists between hypogonadism and heightened cardiometabolic risk in men with SCI and whether routine screening for testosterone deficiency is warranted in this population.Level of Evidence
IV 相似文献16.
Alexandra E. Jacob Darryl L. Kaelin Abbey R. Roach Craig H. Ziegler Kathrin LaFaver 《PM & R》2018,10(11):1164-1172
Background
Functional movement disorders (FMDs) are conditions of abnormal motor control thought to be caused by psychological factors. These disorders are commonly seen in neurologic practice, and prognosis is often poor. No consensus treatment guidelines have been established; however, the role of physical therapy in addition to psychotherapy has increasingly been recognized. This study reports patient outcomes from a multidisciplinary FMD treatment program using motor retraining (MoRe) strategies.Objective
To assess outcomes of FMD patients undergoing a multidisciplinary treatment program and determine factors predictive of treatment success.Design
Retrospective chart review.Setting
University-affiliated rehabilitation institute.Patients
Thirty-two consecutive FMD patients admitted to the MoRe program from July 2014–July 2016.Intervention
Patients participated in a 1-week, multidisciplinary inpatient treatment program with daily physical, occupational, speech therapy, and psychotherapy interventions.Main Outcome Measurements
Primary outcome measures were changes in the patient-rated Clinical Global Impression Scale (CGI) and the physician-rated Psychogenic Movement Disorder Rating Scale (PMDRS) based on review of standardized patient videos. Measurements were taken as part of the clinical evaluation of the program.Results
Twenty-four of the 32 patients were female with a mean age of 49.1 (±14.2) years and mean symptom duration of 7.4 (±10.8) years. Most common movement phenomenologies were abnormal gait (31.2%), hyperkinetic movements (31.2%), and dystonia (31.2%). At discharge, 86.7% of patients reported symptom improvement on the CGI, and self-reported improvement was maintained in 69.2% at the 6-month follow-up. PMDRS scores improved by 59.1% from baseline to discharge. Longer duration of symptoms, history of abuse, and comorbid psychiatric disorders were not significant predictors of treatment outcomes.Conclusions
The majority of FMD patients experienced improvement from a 1-week multidisciplinary inpatient rehabilitation program. Treatment outcomes were not negatively correlated with longer disease duration or psychiatric comorbidities. The results from our study are encouraging, although further long-term prospective randomized studies are needed.Level of Evidence
III 相似文献17.
Anthony H. Lequerica Christian Lucca Nancy D. Chiaravalloti Irene Ward John D. Corrigan 《Archives of physical medicine and rehabilitation》2018,99(9):1811-1817
Objective
To test the feasibility and validity of an online version of an established interview designed to determine a lifetime history of traumatic brain injury (TBI).Design
Cross-sectional.Setting
General community.Participants
A volunteer sample of individuals (N= 265) from the general population across the United States.Interventions
Not applicable.Main Outcome Measure(s)
Online version of the Ohio State University Traumatic Brain Injury Identification Method, Rivermead Postconcussion Symptoms Questionnaire (RPQ), Patient-Reported Outcomes Measurement Information System Cognitive Concerns Scale.Results
The measure was completed by 89.4% of the sample with most participants completing the measure in <8 minutes. After controlling for age, sex, psychiatric history, drug or alcohol history, and history of developmental disability, worst TBI severity was significantly associated with scores on the RPQ, F(2,230)=4.56, P=.011, and having a TBI within the past 2 years was associated with higher scores on the cognitive factor subscale of the RPQ, F(1,75)=7.7, P=.007.Conclusions
The online administration of the Ohio State University Traumatic Brain Injury Identification Method appears to be feasible in the general population. Preliminary validity was demonstrated for the indices of worst TBI severity and time since most recent TBI. 相似文献18.
Noah D. Silverberg William J. Panenka Grant L. Iverson 《Archives of physical medicine and rehabilitation》2018,99(2):250-256
Objectives
To examine the completeness of return to work (RTW) and the degree of productivity loss in individuals who do achieve a complete RTW after mild traumatic brain injury (MTBI).Design
Multisite prospective cohort.Setting
Outpatient concussion clinics.Participants
Patients (N=79; mean age, 41.5y; 55.7% women) who sustained an MTBI and were employed at the time of the injury. Participants were enrolled at their first clinic visit and assessed by telephone 6 to 8 months postinjury.Interventions
Not applicable.Main Outcome Measures
Structured interview of RTW status, British Columbia Postconcussion Symptom Inventory (BC-PSI), Lam Employment Absence and Productivity Scale (LEAPS), Mini International Neuropsychiatric Interview, and brief pain questionnaire. Participants who endorsed symptoms from ≥3 categories with at least moderate severity on the BC-PSI were considered to meet International Classification of Diseases, 10th Revision criteria for postconcussional syndrome. RTW status was classified as complete if participants returned to their preinjury job with the same hours and responsibilities or to a new job that was at least as demanding.Results
Of the 46 patients (58.2%) who achieved an RTW, 33 (71.7%) had a complete RTW. Participants with complete RTW had high rates of postconcussional syndrome (44.5%) and comorbid depression (18.2%), anxiety disorder (24.2%), and bodily pain (30.3%). They also reported productivity loss on the LEAPS, such as “getting less work done” (60.6%) and “making more mistakes” (42.4%). In a regression model, productivity loss was predicted by the presence of postconcussional syndrome and a comorbid psychiatric condition, but not bodily pain.Conclusions
Even in patients who RTW after MTBI, detailed assessment revealed underemployment and productivity loss associated with residual symptoms and psychiatric complications. 相似文献19.
Nobushige Takahashi Hidetoshi Takahashi Osamu Takahashi Ryosuke Ushijima Rie Umebayashi Junji Nishikawa Yasutomo Okajima 《PM & R》2018,10(2):168-174
Background
Spasticity is a common sequela of upper motor neuron pathology, such as cerebrovascular diseases and cerebral palsy. Intervention for spasticity of the ankle plantarflexors in physical therapy may include tone-inhibiting casting and/or orthoses for the ankle and foot. However, the physiological mechanism of tone reduction by such orthoses remains unclarified.Objective
To investigate the electrophysiologic effects of tone-inhibiting insoles in stroke subjects with hemiparesis by measuring changes in reciprocal Ia inhibition (RI) in the ankle plantarflexor.Design
An interventional before–after study.Setting
Acute stroke unit or ambulatory rehabilitation clinic of a university hospital in Japan.Participants
Ten subjects (47-84 years) with hemiparesis and 10 healthy male control subjects (31-59 years) were recruited.Methods
RI of the spastic soleus in response to the electrical stimulation of the deep peroneal nerve was evaluated by stimulus-locked averaging of rectified electromyography (EMG) of the soleus while subjects were standing.Main Outcome Measurements
The magnitude of RI, defined as the ratio of the lowest to the baseline amplitude of the rectified EMG at approximately 40 milliseconds after stimulation, was measured while subjects were standing with and without the tone-inhibiting insole on the hemiparesis side.Results
Enhancement of EMG reduction with the tone-inhibiting insole was significant (P < .05) in the subjects with hemiparesis, whereas no significant changes were found in controls.Conclusion
Tone-inhibiting insoles enhanced RI of the soleus in subjects after stroke, which might enhance standing stability by reducing unfavorable ankle plantarflexion tone.Level of Evidence
III 相似文献20.
Lenore A. Hawley Jessica M. Ketchum Clare Morey Kathleen Collins Susan Charlifue 《Archives of physical medicine and rehabilitation》2018,99(8):1584-1590