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Gavin Williams Meg E. Morris Anthony Schache Paul R. McCrory 《Archives of physical medicine and rehabilitation》2009,90(4):587-593
Williams G, Morris ME, Schache A, McCrory PR. Incidence of gait abnormalities after traumatic brain injury.
Objective
To identify the most common gait abnormalities presenting after traumatic brain injury (TBI) and quantify their incidence rate.Design
Case series.Setting
Biomechanics laboratory.Participants
A convenience sample of 41 people with TBI receiving therapy for gait abnormalities, and a sample of 25 healthy controls.Intervention
Three-dimensional gait analysis.Main Outcome Measures
Spatiotemporal, kinematic, and kinetic data at a self-selected walking speed.Results
People with TBI walked with a significantly slower speed than matched healthy controls. There was a significant difference between groups for cadence, step length, stance time on the affected leg, double support phase, and width of base of support. The most frequently observed biomechanical abnormality was excessive knee flexion at initial foot contact. Other significant gait abnormalities were increased trunk anterior/posterior amplitude of movement, increased anterior pelvic tilt, increased peak pelvic obliquity, reduced peak knee flexion at toe-off, and increased lateral center of mass displacement. Ankle equinovarus at foot-contact occurred infrequently.Conclusions
People with TBI were found to have multijoint gait abnormalities. Many of these abnormalities have not been previously reported in this population. 相似文献6.
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Christine L. Karver Brad Kurowski Erin A. Semple Terry Stancin H. Gerry Taylor Keith O. Yeates Nicolay C. Walz Shari L. Wade 《Archives of physical medicine and rehabilitation》2014
Objective
To examine associations of clinical need, defined by elevated parent ratings of child behavior problems and utilization of behavioral health services in young children with traumatic brain injury (TBI) and an orthopedic injury (OI) comparison group.Design
Parents completed outcome measures 18 months after injury and at an extended follow-up conducted an average of 38 months postinjury.Setting
Children's hospitals and a general hospital.Participants
Participants included parents of 3 groups of children injured between 3 and 7 years of age (N=139): 47 children with complicated mild to moderate TBI, 18 with severe TBI, and 74 with OI.Interventions
Not applicable.Main Outcome Measures
Parents completed ratings of child behavior, mental health symptomology, and family functioning at both visits; at the extended follow-up, they reported utilization of behavior therapy or counseling services since the 18-month follow-up visit.Results
Children with TBI had more behavior problems than those with OI. Although clinical need at both follow-ups was associated with greater service utilization at the extended follow-up, all groups had unmet needs as defined by a clinical need in the absence of services. Lower socioeconomic status was associated with higher rates of unmet need across groups.Conclusions
The results document unmet long-term behavioral health needs after both TBI and OI in children and underscore the importance of monitoring and treatment of postinjury behavior problems. 相似文献14.
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Jeffrey S. Kreutzer Lisa J. Rapport Jennifer H. Marwitz Cynthia Harrison-Felix Tessa Hart Mel Glenn Flora Hammond 《Archives of physical medicine and rehabilitation》2009,90(6):939-946
Kreutzer JS, Rapport LJ, Marwitz JH, Harrison-Felix C, Hart T, Glenn M, Hammond F. Caregivers' well-being after traumatic brain injury: a multicenter prospective investigation.
Objective
To describe frequency and magnitude of caregivers' emotional distress and life satisfaction using standardized assessment procedures; compare distress levels among spouses, parents, and other caregivers; and identify risk factors.Design
Prospective collaborative cohort study.Setting
Six Traumatic Brain Injury Model System Centers providing neurotrauma care, rehabilitation, and outpatient follow-up.Participants
Caregivers (N=273) of patients who were 1, 2, or 5 years postinjury.Interventions
Acute neurotrauma care, inpatient interdisciplinary brain injury rehabilitation, and postacute services.Main Outcome Measure
Brief Symptom Inventory-18 Depression, Anxiety, and Somatic dimensions.Results
Levels of Depression, Anxiety, and Somatic symptoms were equally prevalent, with 1 in 5 caregivers scoring above the cutoff in each area. The proportion of participants with 1, 2, and 3 elevations was 17.9%, 5.5%, and 10.6%, respectively. Conversely, approximately two thirds (65.9%) had no scores exceeding cutoffs. Distress levels among spouses, parents, and other caregivers were comparable. Higher caregiver distress was associated with caring for survivors who had worse functional status, received more supervision, were less satisfied with life, and used alcohol excessively.Conclusions
Depression, Anxiety, and Somatic symptoms are common among caregivers. Findings substantiate the importance of clinical care systems addressing the needs of caregivers in the long term as well as survivors. 相似文献17.
Erik Grauwmeijer Majanka H. Heijenbrok-KalGerard M. Ribbers MD PhD 《Archives of physical medicine and rehabilitation》2014
Objectives
To evaluate the time course of health-related quality of life (HRQoL) after moderate to severe traumatic brain injury (TBI) and to identify its predictors.Design
Prospective cohort study with follow-up measurements at 3, 6, 12, 18, 24, and 36 months after TBI.Setting
Patients with moderate to severe TBI discharged from 3 level-1 trauma centers.Participants
Patients (N=97, 72% men) with a mean age ± SD of 32.8±13.0 years (range, 18–65y), hospitalized with moderate (23%) or severe (77%) TBI.Interventions
Not applicable.Main Outcome Measures
HRQoL was measured with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), functional outcomes with the Glasgow Outcome Scale (GOS), Barthel Index, FIM, and Functional Assessment Measure, and mood with the Wimbledon Self-Report Scale.Results
The SF-36 domains showed significant improvement over time for Physical Functioning (P<.001), Role Physical (P<.001), Bodily Pain (P<.001), Social Functioning (P<.001), and Role Emotional (P=.024), but not for General Health (P=.263), Vitality (P=.530), and Mental Health (P=.138). Over time there was significant improvement in the Physical Component Summary (PCS) score, whereas the Mental Component Summary (MCS) score remained stable. At 3-year follow-up, HRQoL of patients with TBI was the same as that in the Dutch normative population. Time after TBI, hospital length of stay (LOS), FIM, and GOS were independent predictors of the PCS, whereas LOS and mood were predictors of the MCS.Conclusions
After TBI, the physical component of HRQoL showed significant improvement over time, whereas the mental component remained stable. Problems of disease awareness seem to play a role in self-reported mental HRQoL. After TBI, mood status is a better predictor of the mental component of HRQoL than functional outcome, implying that mood should be closely monitored during and after rehabilitation. 相似文献18.
Keith D. Cicerone PhD Tasha Mott PhD Joanne Azulay PhD Mary A. Sharlow-Galella LCSW Wendy J. Ellmo MS CCC-SLP Susan Paradise MEd John C. Friel PhD 《Archives of physical medicine and rehabilitation》2008,89(12):2239-2249
Cicerone KD, Mott T, Azulay J, Sharlow-Galella MA, Ellmo WJ, Paradise S, Friel JC. A randomized controlled trial of holistic neuropsychologic rehabilitation after traumatic brain injury.
Objective
To evaluate the effectiveness of comprehensive, holistic neuropsychologic (NP) rehabilitation compared with standard, multidisciplinary rehabilitation for people with traumatic brain injury (TBI).Design
Randomized practical controlled trial.Setting
Postacute brain injury rehabilitation center within a suburban rehabilitation hospital.Participants
Participants with TBI were recruited from clinical referrals and referrals from the community. Sixty-eight participants who met inclusion criteria were randomly allocated to treatment conditions. Most participants (88%) had sustained moderate or severe TBI, and greater than half (57%) were more than 1 year postinjury at the beginning of treatment.Interventions
Treatment was conducted 15 hours per week for 16 weeks. Standard neurorehabilitation consisted primarily of individual, discipline specific therapies (n=34). Intensive cognitive rehabilitation emphasized the integration of cognitive, interpersonal, and functional interventions within a therapeutic environment (n=34).Main Outcome Measures
Primary outcomes were the Community Integration Questionnaire (CIQ) and Perceived Quality of Life scale (PQOL). Secondary outcomes included NP functioning, perceived self-efficacy, and community-based employment.Results
NP functioning improved in both conditions. Intensive cognitive rehabilitation participants showed greater improvements on the CIQ (effect size [ES]=0.59) and PQOL (ES=0.30) as well as improved self-efficacy for the management of symptoms (ES=0.26) compared with standard neurorehabilitation treatment. These gains were maintained at the 6-month follow-up. Standard neurorehabilitation participants showed improved productivity at the 6-month follow-up associated with the need for continued rehabilitation.Conclusions
Improvements seen after intensive cognitive rehabilitation may be related to interventions directed at the self-regulation of cognitive and emotional processes and the integrated treatment of cognitive, interpersonal, and functional skills. The results show the effectiveness of comprehensive holistic NP rehabilitation for improving community functioning and quality of life after TBI compared with standard rehabilitation. 相似文献19.