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1.
Objective: To examine the impact of brain-injured patients' cognitive abilities on their working alliance (WA) with their therapist in post-acute rehabilitation.
Design: Cognitive tests were administered to brain-injured individuals at the beginning of post-acute, holistic brain-injury rehabilitation. Clients as well as their primary therapists rated their mutual WA at four time points throughout a 14-week rehabilitation programme. Subjects consisted of 86 clients as well as their primary therapists. Clients had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10).
Measures: (1) Neuropsychological tests of attention, memory and higher cognitive functions; (2) the Working Alliance Inventory, client and therapist short form.
Results: Overall, the relationships between cognitive tests and WA ratings were weak. The tests of attention, memory and higher cortical functions were differentially related to clients' and therapists' view of their mutual WA at the different stages of their collaborative work.
Discussion and conclusion: Clients' cognitive profile affects clients' and therapists' view of their WA in different ways. The weakness of the correlations between cognitive tests and WA ratings may indicate that a good WA is achievable also with clients with severe cognitive difficulties. 相似文献
Design: Cognitive tests were administered to brain-injured individuals at the beginning of post-acute, holistic brain-injury rehabilitation. Clients as well as their primary therapists rated their mutual WA at four time points throughout a 14-week rehabilitation programme. Subjects consisted of 86 clients as well as their primary therapists. Clients had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10).
Measures: (1) Neuropsychological tests of attention, memory and higher cognitive functions; (2) the Working Alliance Inventory, client and therapist short form.
Results: Overall, the relationships between cognitive tests and WA ratings were weak. The tests of attention, memory and higher cortical functions were differentially related to clients' and therapists' view of their mutual WA at the different stages of their collaborative work.
Discussion and conclusion: Clients' cognitive profile affects clients' and therapists' view of their WA in different ways. The weakness of the correlations between cognitive tests and WA ratings may indicate that a good WA is achievable also with clients with severe cognitive difficulties. 相似文献
2.
van Heugten CM Hendriksen J Rasquin S Dijcks B Jaeken D Vles JH 《Brain injury : [BI]》2006,20(9):895-903
Objective: The purpose of the present study was to evaluate progress in neuropsychological performance in children and adolescents with severe paediatric traumatic brain injury (TBI), from admission to the rehabilitation centre up to 3-12 years after the trauma.
Methods: Children and adolescents (n = 31, mean age at injury 11.8 years, SD = 3.8; at follow-up 18.8 years; SD = 4.5) who all had suffered a TBI participated. A comprehensive neuropsychological test battery was administered at the start of rehabilitation (T1), around discharge (T2) and in the long-term (at least 3 years after rehabilitation; T3). T1 and T2 were clinical assessments; T3 was executed as a follow-up measurement for this study.
Results: At T1 and T2, most problems were in the domains of attention, memory and executive functioning. At the start of rehabilitation most deficits were with performal intelligence (61%); at discharge (mean length of stay 411 days) considerably less children had severe deficits on the intelligence domain (23%). At long-term follow-up, most problems were in the domains attention, mental speed and memory. From admission to discharge 42% of the children improved on two or more cognitive tests; from discharge to follow-up this percentage was 13%.
Conclusions: In this unique study a clinical cohort of children with severe TBI was followed for many years after injury. Most cognitive deficits were found in the early phase of rehabilitation. Most children did improve on cognitive functioning (40%) during the first year after their injury, whereas at follow-up most children had not changed. At follow-up, more than half of the children (54%) attended a regular school or had a regular job, corresponding to their age and pre-morbid functioning. 相似文献
Methods: Children and adolescents (n = 31, mean age at injury 11.8 years, SD = 3.8; at follow-up 18.8 years; SD = 4.5) who all had suffered a TBI participated. A comprehensive neuropsychological test battery was administered at the start of rehabilitation (T1), around discharge (T2) and in the long-term (at least 3 years after rehabilitation; T3). T1 and T2 were clinical assessments; T3 was executed as a follow-up measurement for this study.
Results: At T1 and T2, most problems were in the domains of attention, memory and executive functioning. At the start of rehabilitation most deficits were with performal intelligence (61%); at discharge (mean length of stay 411 days) considerably less children had severe deficits on the intelligence domain (23%). At long-term follow-up, most problems were in the domains attention, mental speed and memory. From admission to discharge 42% of the children improved on two or more cognitive tests; from discharge to follow-up this percentage was 13%.
Conclusions: In this unique study a clinical cohort of children with severe TBI was followed for many years after injury. Most cognitive deficits were found in the early phase of rehabilitation. Most children did improve on cognitive functioning (40%) during the first year after their injury, whereas at follow-up most children had not changed. At follow-up, more than half of the children (54%) attended a regular school or had a regular job, corresponding to their age and pre-morbid functioning. 相似文献
3.
Cognitive training in home environment 总被引：1，自引：0，他引：1
Primary objective: To examine the efficacy of cognitive rehabilitation in the patient's home or vocational environment.
Research design: Pre-post-follow-up design.
Methods and procedures: Ten outpatients with acquired attention and memory problems received cognitive training three times weekly, for 3 weeks. They received individual attention training with Attention Process Training, training for generalization for everyday activities and education in compensatory strategies for self-selected cognitive problems. Treatment effects were evaluated with neuropsychological and occupational therapy instruments before and after the training and after 3 months on impairment, activity and participation levels.
Main outcomes and results: The results indicated a positive effect on some measures on impairment level, but no differences on activity or participation levels at follow-up.
Conclusions: The study indicates that home-based cognitive training improves some attentional and memory functions and facilitates learning of strategies. Future controlled studies are needed to confirm the results and analyse the efficacy of different aspects of home-based training. 相似文献
Research design: Pre-post-follow-up design.
Methods and procedures: Ten outpatients with acquired attention and memory problems received cognitive training three times weekly, for 3 weeks. They received individual attention training with Attention Process Training, training for generalization for everyday activities and education in compensatory strategies for self-selected cognitive problems. Treatment effects were evaluated with neuropsychological and occupational therapy instruments before and after the training and after 3 months on impairment, activity and participation levels.
Main outcomes and results: The results indicated a positive effect on some measures on impairment level, but no differences on activity or participation levels at follow-up.
Conclusions: The study indicates that home-based cognitive training improves some attentional and memory functions and facilitates learning of strategies. Future controlled studies are needed to confirm the results and analyse the efficacy of different aspects of home-based training. 相似文献
4.
Objective: To compare the functional outcomes of patients with anoxic brain injury (ABI) due to cardiac and non-cardiac aetiologies.
Design: Retrospective chart review over 4 years.
Setting: Freestanding rehabilitation hospital.
Participants: Thirteen patients with cardiac ABI and 13 patients with non-cardiac ABI.
Intervention: Comprehensive, multi-disciplinary inpatient rehabilitation services.
Main outcome measures: Rehabilitation hospital length of stay (LOS) and cost; Functional Independence Measure (FIM) scores and its various sub-sets on admission and discharge; FIM efficiency and change; and discharge disposition.
Results: Patients with cardiac ABI were similar in gender and ethnicity when compared to patients with non-cardiac ABI but were older (average age 52 vs 42) with a higher percentage of cardiac patients married (77% vs 39%). No statistically significant differences were found between the two groups on all sub-sets of the FIM on admission and discharge as well as the different FIM efficiencies. However, there was a trend for the cardiac ABI patients to have a greater efficiency in improving mobility during rehabilitation when compared to non-cardiac ABI patients. The rehabilitation hospital LOS was ∼28 days less for patients with cardiac ABI (41.49 vs 69.84 days), but this difference was not statistically significant (p = 0.26). The mean rehabilitation cost for patients with cardiac ABI was ∼ $14 000 less than that for those with non-cardiac ABI ($44 181 vs $58 187). This difference was not statistically significant (p = 0.15). Cardiac ABI patients were more likely to be discharged directly to home from rehabilitation when compared to non-cardiac ABI patients (p = 0.06).
Conclusion: This pilot study demonstrates some differences in the recovery patterns of patients with ABI who had a cardiac aetiology and those who had non-cardiac aetiologies. While both groups experienced similar progress during rehabilitation, those with cardiac ABI made gains with a shorter LOS and less rehabilitation costs when compared to non-cardiac ABI patients. These data suggest a trend towards greater cost and length of stay for patients with ABI who had non-cardiac aetiologies. 相似文献
Design: Retrospective chart review over 4 years.
Setting: Freestanding rehabilitation hospital.
Participants: Thirteen patients with cardiac ABI and 13 patients with non-cardiac ABI.
Intervention: Comprehensive, multi-disciplinary inpatient rehabilitation services.
Main outcome measures: Rehabilitation hospital length of stay (LOS) and cost; Functional Independence Measure (FIM) scores and its various sub-sets on admission and discharge; FIM efficiency and change; and discharge disposition.
Results: Patients with cardiac ABI were similar in gender and ethnicity when compared to patients with non-cardiac ABI but were older (average age 52 vs 42) with a higher percentage of cardiac patients married (77% vs 39%). No statistically significant differences were found between the two groups on all sub-sets of the FIM on admission and discharge as well as the different FIM efficiencies. However, there was a trend for the cardiac ABI patients to have a greater efficiency in improving mobility during rehabilitation when compared to non-cardiac ABI patients. The rehabilitation hospital LOS was ∼28 days less for patients with cardiac ABI (41.49 vs 69.84 days), but this difference was not statistically significant (p = 0.26). The mean rehabilitation cost for patients with cardiac ABI was ∼ $14 000 less than that for those with non-cardiac ABI ($44 181 vs $58 187). This difference was not statistically significant (p = 0.15). Cardiac ABI patients were more likely to be discharged directly to home from rehabilitation when compared to non-cardiac ABI patients (p = 0.06).
Conclusion: This pilot study demonstrates some differences in the recovery patterns of patients with ABI who had a cardiac aetiology and those who had non-cardiac aetiologies. While both groups experienced similar progress during rehabilitation, those with cardiac ABI made gains with a shorter LOS and less rehabilitation costs when compared to non-cardiac ABI patients. These data suggest a trend towards greater cost and length of stay for patients with ABI who had non-cardiac aetiologies. 相似文献
5.
McDougall J Servais M Sommerfreund J Rosen E Gillett J Gray J Somers S Frid P Dewit D Pearlman L Hicock F 《Brain injury : [BI]》2006,20(11):1189-1205
Primary objective: To examine the utility of a coordinated, family/community-focused programme (PABICOP) vs. a standard approach for improving outcomes for children with ABI and their families.
Research design: Pre-test-post-test design, with comparison group and follow-up.
Methods and procedures: Ninety-six children (64 children receiving PABICOP services and 32 children receiving standard care) participated in the study. Measures were completed at baseline and 3 and 12 months later.
Main outcomes and results: Parents/caregivers with more than 10 contacts with PABICOP scored significantly higher on an ABI knowledge quiz than either parents/caregivers with 10 contacts or less or the comparison group at post-test and follow-up. Parents/caregivers with 10 contacts or less with PABICOP reported significantly greater improvements in children's school and total competence on the CBCL than either parents/caregivers with more than 10 contacts or the comparison group at post-test and follow-up.
Conclusions: PABICOP may be more useful for enhancing knowledge of ABI for parents/caregivers and for integrating children into the community over a 1-year period than a standard approach. The amount of service received appears to influence outcomes. 相似文献
Research design: Pre-test-post-test design, with comparison group and follow-up.
Methods and procedures: Ninety-six children (64 children receiving PABICOP services and 32 children receiving standard care) participated in the study. Measures were completed at baseline and 3 and 12 months later.
Main outcomes and results: Parents/caregivers with more than 10 contacts with PABICOP scored significantly higher on an ABI knowledge quiz than either parents/caregivers with 10 contacts or less or the comparison group at post-test and follow-up. Parents/caregivers with 10 contacts or less with PABICOP reported significantly greater improvements in children's school and total competence on the CBCL than either parents/caregivers with more than 10 contacts or the comparison group at post-test and follow-up.
Conclusions: PABICOP may be more useful for enhancing knowledge of ABI for parents/caregivers and for integrating children into the community over a 1-year period than a standard approach. The amount of service received appears to influence outcomes. 相似文献
6.
Objective: It has become evident that the cerebellum plays a role in cognitive function, and Schmahmann et al. have introduced the term “Cerebellar cognitive affective syndrome (CCAS).” In the present paper we report a patient with cerebellar hemorrhage who developed CCAS.
Design: A case study.
Methods: The patient was a 61-year-old right-handed man who was admitted to our hospital because of sudden headache, dizziness and vomiting. The patient showed ataxia of the trunk and the extremities, but no paralysis and disturbance of sensation. He was disoriented in time and showed recent memory disturbance, disturbance of attention, impairment of executive functions and reduced volition, and due to these symptoms, his daily living was also severely impaired.
Results: With the aim of returning home, the patient received exercise therapy and cognitive rehabilitation, while home modification was performed, and living at home under the supervision of his family became possible. Cognitive function improved, while memory and attention disturbance, impairment of executive function remained.
Conslusion: Cognitive dysfunction in patients with cerebellar damage is assumed to develop from disturbance of the cerebrocerebellar circuit, and that rehabilitation of these patients must include assessment of not only the motor function, but also of detailed assessment of cerebral function. 相似文献
Design: A case study.
Methods: The patient was a 61-year-old right-handed man who was admitted to our hospital because of sudden headache, dizziness and vomiting. The patient showed ataxia of the trunk and the extremities, but no paralysis and disturbance of sensation. He was disoriented in time and showed recent memory disturbance, disturbance of attention, impairment of executive functions and reduced volition, and due to these symptoms, his daily living was also severely impaired.
Results: With the aim of returning home, the patient received exercise therapy and cognitive rehabilitation, while home modification was performed, and living at home under the supervision of his family became possible. Cognitive function improved, while memory and attention disturbance, impairment of executive function remained.
Conslusion: Cognitive dysfunction in patients with cerebellar damage is assumed to develop from disturbance of the cerebrocerebellar circuit, and that rehabilitation of these patients must include assessment of not only the motor function, but also of detailed assessment of cerebral function. 相似文献
7.
Meeting the long-term needs of adults with acquired brain injury through community-based programming
Primary objective: To determine the effectiveness of a community-based programme for meeting the long-term needs of survivors of acquired brain injury (ABI).
Methods and procedures: Qualitative and quantitative methods were employed. Surveys were administered to practicing clinicians to validate the needs found in the literature that should be provided by such programmes. Surveys administered to participants in the programme assessed how effective they perceived it to be in meeting those needs. Focus group discussion provided support to the survey findings.
Main outcomes and results: Survey responses indicate differences among members, caregivers and student interns participating in the programme on issues of emotional support, social support, recreation and transportation. Focus group participants agree that emotional, social and cognitive needs are the most important needs of the members. Overall, these member needs were found to be met by the programme. The needs that participants found to remain unmet include social support for caregivers, transportation issues and community education.
Conclusions: This community-based, posts-rehabilitation programme for survivors of ABI appears to effectively meet many long-term needs. Investigations that examine the role of similar programming to meet caregiver needs, educate the public and provide transportation for participants are required. 相似文献
Methods and procedures: Qualitative and quantitative methods were employed. Surveys were administered to practicing clinicians to validate the needs found in the literature that should be provided by such programmes. Surveys administered to participants in the programme assessed how effective they perceived it to be in meeting those needs. Focus group discussion provided support to the survey findings.
Main outcomes and results: Survey responses indicate differences among members, caregivers and student interns participating in the programme on issues of emotional support, social support, recreation and transportation. Focus group participants agree that emotional, social and cognitive needs are the most important needs of the members. Overall, these member needs were found to be met by the programme. The needs that participants found to remain unmet include social support for caregivers, transportation issues and community education.
Conclusions: This community-based, posts-rehabilitation programme for survivors of ABI appears to effectively meet many long-term needs. Investigations that examine the role of similar programming to meet caregiver needs, educate the public and provide transportation for participants are required. 相似文献
8.
Research objective: Children with acquired brain injury (ABI) can experience severe problems in establishing peer relationships. The attitudes peers hold toward a child with an ABI can significantly impact on their willingness to befriend. The present work sought to investigate the attitudes peers hold toward a fictional child with ABI.
Methods and procedures: Fifty children from a primary school were compared against a similar number from a secondary school. Gender was evenly split across both groups. A vignette describing a young boy acquiring a brain injury, and his subsequent change in behaviour, was presented to the children. The Friendship Activity Scale (FAS) was then used to judge how likely the children were to befriend the fictional character.
Outcomes and results: Results showed a statistically significant interaction between gender and age [F(1, 96) 6.285, p = 0.014] with older males expressing more positive attitudes than younger males.
Conclusion: The study suggests that children with ABI are more likely to experience negative attitudes in primary school, and concludes in calling for additional research to more fully explore the social experience of children with ABI. 相似文献
Methods and procedures: Fifty children from a primary school were compared against a similar number from a secondary school. Gender was evenly split across both groups. A vignette describing a young boy acquiring a brain injury, and his subsequent change in behaviour, was presented to the children. The Friendship Activity Scale (FAS) was then used to judge how likely the children were to befriend the fictional character.
Outcomes and results: Results showed a statistically significant interaction between gender and age [F(1, 96) 6.285, p = 0.014] with older males expressing more positive attitudes than younger males.
Conclusion: The study suggests that children with ABI are more likely to experience negative attitudes in primary school, and concludes in calling for additional research to more fully explore the social experience of children with ABI. 相似文献
9.
Objectives: To identify predictors of family system functioning after acquired brain injury (ABI).
Research design: Retrospective design.
Methods and procedures: Data on ABI-related impairments, level of awareness, neuropsychological functioning, caregiver strain and family system functioning were extracted from the files of 66 individuals with ABI and 148 family members who had enrolled in a community-based support programme.
Main outcomes and results: Individuals with ABI, mothers, spouses, siblings and the family as a unit reported significant distress in family functioning compared to the norm. Higher caregiver strain and client gender (i.e. female) were predictive of poorer family system functioning. Neither ABI impairments nor neuropsychological variables were correlated with family functioning.
Conclusions: The effects of ABI extend beyond the injured person and primary caregiver. The need for a family systems approach to family intervention after ABI is supported. Implications for practice and future research are discussed. 相似文献
Research design: Retrospective design.
Methods and procedures: Data on ABI-related impairments, level of awareness, neuropsychological functioning, caregiver strain and family system functioning were extracted from the files of 66 individuals with ABI and 148 family members who had enrolled in a community-based support programme.
Main outcomes and results: Individuals with ABI, mothers, spouses, siblings and the family as a unit reported significant distress in family functioning compared to the norm. Higher caregiver strain and client gender (i.e. female) were predictive of poorer family system functioning. Neither ABI impairments nor neuropsychological variables were correlated with family functioning.
Conclusions: The effects of ABI extend beyond the injured person and primary caregiver. The need for a family systems approach to family intervention after ABI is supported. Implications for practice and future research are discussed. 相似文献
10.
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. 相似文献
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. 相似文献
11.
Objective: To investigate the effects of Snoezelen therapy on physiological, cognitive and behavioural changes in children recovering from severe traumatic brain injury (TBI).
Methods: An observational study was conducted to assess the physiological, cognitive and behavioural changes of children recovering from severe TBI while receiving Snoezelen therapy. Fifteen subjects completed the pre- and post-Snoezelen treatment measurements computed over 10 consecutive sessions. Physiological, cognitive and behavioural measures were administered. Data was collected prospectively on each session in the Snoezelen room and were analysed by calculating the difference between pre- and post-treatment measurements for each Snoezelen session.
Results: Results revealed significant changes on physiological measures. Heart rates decreased for each subject in each treatment session and were found to be significant (p = 0.032). Muscle tone was decreased in all the affected extremities (right upper extremity p = 0.009, left upper extremity p = 0.020, right lower extremity p = 0.036 and left lower extremity p = 0.018). Agitation levels decreased over time and the overall cognitive outcome measures showed significant improvement when comparing the beginning of treatment with the end.
Conclusion: This study revealed a beneficial use of Snoezelen therapy with children recovering from severe brain injury. However, there continues to be a critical need for evidenced-based research for this patient population and others in this multi-sensory environment. 相似文献
Methods: An observational study was conducted to assess the physiological, cognitive and behavioural changes of children recovering from severe TBI while receiving Snoezelen therapy. Fifteen subjects completed the pre- and post-Snoezelen treatment measurements computed over 10 consecutive sessions. Physiological, cognitive and behavioural measures were administered. Data was collected prospectively on each session in the Snoezelen room and were analysed by calculating the difference between pre- and post-treatment measurements for each Snoezelen session.
Results: Results revealed significant changes on physiological measures. Heart rates decreased for each subject in each treatment session and were found to be significant (p = 0.032). Muscle tone was decreased in all the affected extremities (right upper extremity p = 0.009, left upper extremity p = 0.020, right lower extremity p = 0.036 and left lower extremity p = 0.018). Agitation levels decreased over time and the overall cognitive outcome measures showed significant improvement when comparing the beginning of treatment with the end.
Conclusion: This study revealed a beneficial use of Snoezelen therapy with children recovering from severe brain injury. However, there continues to be a critical need for evidenced-based research for this patient population and others in this multi-sensory environment. 相似文献
12.
Purpose: To examine the development and interaction of the therapeutic alliance, patients' compliance and awareness during the process of brain injury rehabilitation and the role of demographic and injury related variables in this process. Subjects were 86 patients who underwent a holistic neuropsychological outpatient rehabilitation programme. Patients had suffered a traumatic brain injury (n = 27), a cerebrovascular accident (n = 49) or another neurological insult (n = 10).
Measures: The therapeutic alliance between clients and their primary therapists, clients' awareness and their compliance were rated four times during the 14-week rehabilitation programme. The therapeutic alliance was rated by both clients and therapist using the Working Alliance Inventory (WAI), awareness and compliance were rated by the therapists.
Results: The development of the process measures over time is described in the article. Clients' and therapists' perspectives on their alliance tended to converge over time. Clients' experience of their emotional bond with their therapist added as much to the prediction of clients' awareness as the localization of their brain injury. Clients' awareness was related to their compliance and mediated the impact of the therapeutic alliance on their compliance.
Discussion: A good working alliance is the basis of successful rehabilitative work. The article discusses therapeutic implications of the results. 相似文献
Measures: The therapeutic alliance between clients and their primary therapists, clients' awareness and their compliance were rated four times during the 14-week rehabilitation programme. The therapeutic alliance was rated by both clients and therapist using the Working Alliance Inventory (WAI), awareness and compliance were rated by the therapists.
Results: The development of the process measures over time is described in the article. Clients' and therapists' perspectives on their alliance tended to converge over time. Clients' experience of their emotional bond with their therapist added as much to the prediction of clients' awareness as the localization of their brain injury. Clients' awareness was related to their compliance and mediated the impact of the therapeutic alliance on their compliance.
Discussion: A good working alliance is the basis of successful rehabilitative work. The article discusses therapeutic implications of the results. 相似文献
13.
Ratcliff JJ Greenspan AI Goldstein FC Stringer AY Bushnik T Hammond FM Novack TA Whyte J Wright DW 《Brain injury : [BI]》2007,21(10):1023-1030
Objective: To examine the relationship between gender and cognitive recovery 1 year following traumatic brain injury (TBI).
Methods: Patients with blunt TBI were identified from the TBI Model Systems of Care National Database, multi-centre cohort study. The included patients (n = 325) were 16-45 years at injury, admitted to an acute care facility within 24 hours, received inpatient rehabilitation, had documented admission Glasgow Coma Scale (GCS) scores, completed neuropsychological follow-up 1 year post-injury and did not report pre-morbid learning problems. Multivariate analyses of variance examined the unadjusted association between gender and six cognitive domains examining attention/working memory, verbal memory, language, visual analytic skills, problem-solving and motor functioning. Analyses of covariance models were constructed to determine if confounding factors biased the observed associations.
Results: Females performed significantly better than males on tests of attention/working memory and language. Males outperformed females in visual analytic skills. Gender remained significantly associated with performance in these areas when controlling for confounding variables.
Conclusions: These results suggest a better cognitive recovery of females than males following TBI. However, future studies need to include non-TBI patients to control for possible pre-injury gender-related differences, as well as to conduct extended follow-ups to determine the stability of the observed differences. 相似文献
Methods: Patients with blunt TBI were identified from the TBI Model Systems of Care National Database, multi-centre cohort study. The included patients (n = 325) were 16-45 years at injury, admitted to an acute care facility within 24 hours, received inpatient rehabilitation, had documented admission Glasgow Coma Scale (GCS) scores, completed neuropsychological follow-up 1 year post-injury and did not report pre-morbid learning problems. Multivariate analyses of variance examined the unadjusted association between gender and six cognitive domains examining attention/working memory, verbal memory, language, visual analytic skills, problem-solving and motor functioning. Analyses of covariance models were constructed to determine if confounding factors biased the observed associations.
Results: Females performed significantly better than males on tests of attention/working memory and language. Males outperformed females in visual analytic skills. Gender remained significantly associated with performance in these areas when controlling for confounding variables.
Conclusions: These results suggest a better cognitive recovery of females than males following TBI. However, future studies need to include non-TBI patients to control for possible pre-injury gender-related differences, as well as to conduct extended follow-ups to determine the stability of the observed differences. 相似文献
14.
Objective: The Memory and Behavior Problems Checklist-1990R (MBPC-1990R) is a carer-rated measure of (a) problem behaviours and (b) corresponding carer reaction. Although originally developed and validated for dementia, its items are relevant to acquired brain injury (ABI). This study evaluated its validity in this population.
Design: Cross-sectional study.
Methods: In a national postal survey carried out to inform service planning, 222 family carers of adults with TBI (49%), strokes (26%), infections (18%), other (7%) completed the MBPC-1990R, Head Injury Behaviour Scale (HIBS), Barthel Index (BI), Northwick Park Dependency Score (NPDS), Carer Burden Interview (CBI), WHOQOL-BREF and GHQ-28.
Results: MBPC-1990R problems correlated well with HIBS problems (r = 0.70), as did MBPC-1990R carer reaction with HIBS distress (r = 0.78) and CBI (r = 0.73) scores, indicating good convergent validity. Discriminant validity was inferred from absent/weak correlations between MBPC-1990R problems and both BI (r = -0.02) and NPDS (r = 0.24); likewise between MBPC-1990R carer reaction and WHOQOL-BREF physical, psychological, social, environmental sub-scales (r = -0.32 to -0.41) and GHQ-28 scores (r = 0.35). Factor analysis revealed excessive, cognitive, aggressive and passive/low mood sub-scales, which showed good internal consistency and varied across ABI groups.
Conclusions: The MBPC-1990R is supported as a measure of problem behaviours and carer reaction in ABI. Further validation in ABI groups is recommended. 相似文献
Design: Cross-sectional study.
Methods: In a national postal survey carried out to inform service planning, 222 family carers of adults with TBI (49%), strokes (26%), infections (18%), other (7%) completed the MBPC-1990R, Head Injury Behaviour Scale (HIBS), Barthel Index (BI), Northwick Park Dependency Score (NPDS), Carer Burden Interview (CBI), WHOQOL-BREF and GHQ-28.
Results: MBPC-1990R problems correlated well with HIBS problems (r = 0.70), as did MBPC-1990R carer reaction with HIBS distress (r = 0.78) and CBI (r = 0.73) scores, indicating good convergent validity. Discriminant validity was inferred from absent/weak correlations between MBPC-1990R problems and both BI (r = -0.02) and NPDS (r = 0.24); likewise between MBPC-1990R carer reaction and WHOQOL-BREF physical, psychological, social, environmental sub-scales (r = -0.32 to -0.41) and GHQ-28 scores (r = 0.35). Factor analysis revealed excessive, cognitive, aggressive and passive/low mood sub-scales, which showed good internal consistency and varied across ABI groups.
Conclusions: The MBPC-1990R is supported as a measure of problem behaviours and carer reaction in ABI. Further validation in ABI groups is recommended. 相似文献
15.
Background: People with traumatic brain injury (TBI) must often deal with cognitive problems, including social problem-solving. The study reported herein evaluated the effectiveness of a newly developed pictorial-based analogical problem-solving skills training programme. It is hypothesized that the programme can help people with TBI to learn better problem-solving skills through systematic, theoretically driven learning strategies.
Method: Based on the instrumental enrichment model and the hierarchy of daily problem-solving as suggested by Holloran and Bressler, analogical problem-solving training software was developed. Thirty subjects with TBI then attended a 20-session interactive analogical problem-solving skills training programme. Another 20 subjects with TBI and of similar demographics formed the control group. The outcome measures included session-based quizzes on analogical problem-solving, the Category Test of the Halstead Reitan Test Battery (HRTB) and the Lawton IADL Scale.
Findings: The analogical problem-solving training strategies were found to be effective in improving problem-solving skills. The subjects generally demonstrated a selective improvement in their functional and overall problem-solving skills, but not in their basic problem-solving skills. The subjects in the control group showed stable problem-solving skills over a 4-week interval (no statistically significant changes). The findings indicated the therapeutic significance of the training programme.
Conclusions: The results of the study suggested that innovative cognitive rehabilitation programmes can be customized to match the needs of clients with TBI. The applicability and implications of the interactive pictorial-based analogical problem-solving skill-training programme that was used in the study and possibilities for future study in this research area are also discussed. 相似文献
Method: Based on the instrumental enrichment model and the hierarchy of daily problem-solving as suggested by Holloran and Bressler, analogical problem-solving training software was developed. Thirty subjects with TBI then attended a 20-session interactive analogical problem-solving skills training programme. Another 20 subjects with TBI and of similar demographics formed the control group. The outcome measures included session-based quizzes on analogical problem-solving, the Category Test of the Halstead Reitan Test Battery (HRTB) and the Lawton IADL Scale.
Findings: The analogical problem-solving training strategies were found to be effective in improving problem-solving skills. The subjects generally demonstrated a selective improvement in their functional and overall problem-solving skills, but not in their basic problem-solving skills. The subjects in the control group showed stable problem-solving skills over a 4-week interval (no statistically significant changes). The findings indicated the therapeutic significance of the training programme.
Conclusions: The results of the study suggested that innovative cognitive rehabilitation programmes can be customized to match the needs of clients with TBI. The applicability and implications of the interactive pictorial-based analogical problem-solving skill-training programme that was used in the study and possibilities for future study in this research area are also discussed. 相似文献
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Primary objective: To establish whether, following acquired brain injury, intensive post-acute neuropsychological rehabilitation could have long-term beneficial effects.
Methods and procedures: A group of 37 adults who had suffered cerebrovascular accidents or traumatic brain injuries and who had undergone a rehabilitation programme were followed up 12-22 years post-injury, together with a non-rehabilitated control group of 13 adults, matched for brain-injury and demographics characteristics. Both groups completed a set of questionnaires concerning broad aspects of psychological well-being. Significant others completed similar questionnaires.
Main outcomes and results: The rehabilitation group showed significantly lower levels of brain injury symptoms and higher levels of competency at follow-up. They also rated internal locus of control and general self-efficacy as significantly higher than the control group. Anxiety and depression levels were significantly lower and quality of life significantly higher in the rehabilitation group for both the subjects themselves and for their significant others.
Conclusions: Within methodological limitations this study suggests that post-acute neuropsychological rehabilitation can have long-term beneficial effects. 相似文献
Methods and procedures: A group of 37 adults who had suffered cerebrovascular accidents or traumatic brain injuries and who had undergone a rehabilitation programme were followed up 12-22 years post-injury, together with a non-rehabilitated control group of 13 adults, matched for brain-injury and demographics characteristics. Both groups completed a set of questionnaires concerning broad aspects of psychological well-being. Significant others completed similar questionnaires.
Main outcomes and results: The rehabilitation group showed significantly lower levels of brain injury symptoms and higher levels of competency at follow-up. They also rated internal locus of control and general self-efficacy as significantly higher than the control group. Anxiety and depression levels were significantly lower and quality of life significantly higher in the rehabilitation group for both the subjects themselves and for their significant others.
Conclusions: Within methodological limitations this study suggests that post-acute neuropsychological rehabilitation can have long-term beneficial effects. 相似文献
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Teasell R Bayona N Marshall S Cullen N Bayley M Chundamala J Villamere J Mackie D Rees L Hartridge C Lippert C Hilditch M Welch-West P Weiser M Ferri C McCabe P McCormick A Aubut JA Comper P Salter K Van Reekum R Collins D Foley N Nowak J Jutai J Speechley M Hellings C Tu L 《Brain injury : [BI]》2007,21(2):107-112
Objective: To conduct a systematic review of the rehabilitation literature of moderate to severe acquired brain injuries (ABI) from traumatic and non-traumatic causes.
Methods: A review of the literature was conducted for studies looking at interventions in ABI rehabilitation. The methodological quality of each study was determined using the Downs and Black scale for randomized controlled trials (RCTs) and non-RCTs as well as the Physiotherapy Evidence Database (PEDro) scale for RCTs only.
Results: Almost 14 000 references were screened from which 1312 abstracts were selected. A total of 303 articles were chosen for careful review of which 275 were found to be interventional studies but only 76 of these interventional studies were RCTs. From this, 5 levels of evidence were determined with 177 conclusions drawn; however of the 177 conclusions only 7 were supported by two or more RCTs and 41 were supported by one RCT.
Conclusion: Only 28% of the interventional studies were RCTs. Over half of the 275 interventional studies were single group interventions, pointing to the need for studies of improved methodological quality into ABI rehabilitation. 相似文献
Methods: A review of the literature was conducted for studies looking at interventions in ABI rehabilitation. The methodological quality of each study was determined using the Downs and Black scale for randomized controlled trials (RCTs) and non-RCTs as well as the Physiotherapy Evidence Database (PEDro) scale for RCTs only.
Results: Almost 14 000 references were screened from which 1312 abstracts were selected. A total of 303 articles were chosen for careful review of which 275 were found to be interventional studies but only 76 of these interventional studies were RCTs. From this, 5 levels of evidence were determined with 177 conclusions drawn; however of the 177 conclusions only 7 were supported by two or more RCTs and 41 were supported by one RCT.
Conclusion: Only 28% of the interventional studies were RCTs. Over half of the 275 interventional studies were single group interventions, pointing to the need for studies of improved methodological quality into ABI rehabilitation. 相似文献
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Caregiver burden, time spent caring and health status in the first 12 months following stroke 总被引：1，自引：0，他引：1
Objective: To quantify time caring, burden and health status in carers of stroke patients after discharge from rehabilitation; to identify the potentially modifiable sociodemographic and clinical characteristics associated with these outcomes.
Methods: Patients and carers prospectively interviewed 6 (n = 71) and 12 (n = 57) months after discharge. Relationships of carer and patient variables with burden, health status and time analysed by Gaussian and Poisson regression.
Results: Carers showed considerable burden at 6 and 12 months. Carers spent 4.6 and 3.6 hours per day assisting patients with daily activities at 6 and 12 months, respectively. Improved patient motor and cognitive function were associated with reductions of up to 20 minutes per day in time spent in daily activities. Better patient mental health and cognitive function were associated with better carer mental health.
Conclusions: Potentially modifiable factors such as these may be able to be targeted by caregiver training, support and education programmes and outpatient therapy for patients. 相似文献
Methods: Patients and carers prospectively interviewed 6 (n = 71) and 12 (n = 57) months after discharge. Relationships of carer and patient variables with burden, health status and time analysed by Gaussian and Poisson regression.
Results: Carers showed considerable burden at 6 and 12 months. Carers spent 4.6 and 3.6 hours per day assisting patients with daily activities at 6 and 12 months, respectively. Improved patient motor and cognitive function were associated with reductions of up to 20 minutes per day in time spent in daily activities. Better patient mental health and cognitive function were associated with better carer mental health.
Conclusions: Potentially modifiable factors such as these may be able to be targeted by caregiver training, support and education programmes and outpatient therapy for patients. 相似文献