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OBJECTIVE: To examine political participation after traumatic brain injury (TBI). DESIGN: Qualitative, participatory research via interviews and observations. Each participant was interviewed to discuss their experience of voting in 2007 or 2008. Data were coded using Grounded Theory to develop themes, metacodes, and theories. SETTING: Community. PARTICIPANTS: A total of 57 individuals with history of TBI and 28 family members (N=85). MAIN OUTCOME MEASURES: Not applicable. RESULTS: Four themes emerged from the data: (1) people with TBI have barriers to voting; (2) the voting process can be improved for people with TBI; (3) voting is the responsibility of members of society; and (4) voting is one way we have a voice in society. CONCLUSIONS: The data support the importance of voting as an American right regardless of the presence of disability. While persons with TBI report voting represents their freedom and voice, there may be barriers that can threaten or limit their voice.
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Lesiones Traumáticas del Encéfalo/psicología , Personas con Discapacidad/psicología , Empoderamiento , Familia/psicología , Política , Adulto , Investigación Participativa Basada en la Comunidad , Femenino , Teoría Fundamentada , Humanos , Masculino , Persona de Mediana Edad , North Carolina , Investigación CualitativaAsunto(s)
Enfermedad de Alzheimer , Enfermedad de Parkinson , Deficiencia de Vitamina D , Humanos , Vitamina D , Encéfalo , CabezaRESUMEN
Attention to health care quality and safety has increased dramatically. The internal focus of an organization is not without influence from external policy and research findings. Compared with other specialties, efforts to align and advance rehabilitation research, practice, and policy using electronic health record data are in the early stages. This special communication defines quality, applies the dimensions of quality to rehabilitation, and illustrates the feasibility and utility of electronic health record data for research on rehabilitation care quality and outcomes. Using data generated at the point of care provides the greatest opportunity for improving the quality of health care, producing generalizable evidence to inform policy and practice, and ultimately benefiting the health of the populations served.
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Difusión de Innovaciones , Registros Electrónicos de Salud/estadística & datos numéricos , Difusión de la Información , Calidad de la Atención de Salud/organización & administración , Investigación en Rehabilitación/organización & administración , Comunicación , Eficiencia Organizacional , Humanos , Seguridad del Paciente , Atención Dirigida al Paciente/organización & administración , Políticas , Calidad de la Atención de Salud/normas , Administración de la Seguridad/organización & administración , Factores de TiempoRESUMEN
PURPOSE: To examine the prevalence of poststroke depression (PSD) among African American stroke survivors and the association of depression with functional status at inpatient rehabilitation facility (IRF) discharge. METHODS: Secondary data analysis was conducted of a patient cohort who received care at 3 IRFs in the United States from 2009 to 2011. Functional status was measured by the Functional Independence Measure (FIM). Multiple linear regression models were used to examine associations of PSD and FIM motor and cognitive scores. RESULTS: Of 458 African American stroke survivors, 48.5% were female, 84% had an ischemic stroke, and the mean age was 60.8 ± 13.6 years. Only 15.4% (n = 71) had documentation of PSD. Bivariate analyses to identify factors associated with depression identified a higher percentage of patients with depression than without who were retired due to disability (17.1% versus 11.6%) or employed (31.4% versus 19.6%) prestroke (P = .041). Dysphagia, cognitive deficits, and a lower admission motor FIM score were also significantly more common among those with depression. There was no significant relationship between depression and functional status after adjusting for patient characteristics. CONCLUSIONS: In this study, 15% of the African Americans who received rehabilitation after a stroke had documentation of PSD but this was not associated with functional status at discharge.
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Depresión/etiología , Pacientes Internos , Recuperación de la Función/fisiología , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular , Sobrevivientes/psicología , Actividades Cotidianas , Adolescente , Adulto , Negro o Afroamericano , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Alta del Paciente/estadística & datos numéricos , Centros de Rehabilitación , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/mortalidad , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Individuals with a history of traumatic brain injury (TBI) may have chronic problems with irritability, which can negatively affect their lives. OBJECTIVES: (1) To describe the experience (thoughts and feelings) of irritability from the perspectives of multiple people living with or affected by the problem, and (2) to develop a conceptual model of irritability. DESIGN: Qualitative, participatory research. PARTICIPANTS: Forty-four stakeholders (individuals with a history of TBI, family members, community professionals, healthcare providers, and researchers) divided into 5 focus groups. PROCEDURES: Each group met 10 times to discuss the experience of irritability following TBI. Data were coded using grounded theory to develop themes, metacodes, and theories. MEASURES: Not applicable. RESULTS: A conceptual model emerged in which irritability has 5 dimensions: affective (related to moods and feelings); behavioral (especially in areas of self-regulation, impulse control, and time management); cognitive-perceptual (self-talk and ways of seeing the world); relational issues (interpersonal and family dynamics); and environmental (including environmental stimuli, change, disruptions in routine, and cultural expectations). CONCLUSIONS: This multidimensional model provides a framework for assessment, treatment, and future research aimed at better understanding irritability, as well as the development of assessment tools and treatment interventions.
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Lesiones Traumáticas del Encéfalo/psicología , Genio Irritable , Adaptación Psicológica , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Familia , Femenino , Grupos Focales , Teoría Fundamentada , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Investigación Cualitativa , Adulto JovenAsunto(s)
Accidentes por Caídas/prevención & control , Enfermedad de Alzheimer/complicaciones , Terapias Complementarias , Dieta , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Ambiente , Ejercicio Físico , Humanos , Fuerza Muscular , Grupo de Atención al Paciente , Zapatos , Sueño , Participación Social , Apoyo SocialRESUMEN
OBJECTIVE: To examine sociodemographic and clinical characteristics independently associated with discharge home compared with discharge to a skilled nursing facility (SNF) after acute inpatient rehabilitation. DESIGN: Retrospective cohort study. SETTING: Three tertiary accredited acute care rehabilitation facilities. PARTICIPANTS: Adult patients with stroke (N=2085). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Of 2085 patients with stroke treated at 3 centers over a 4-year period, 78.2% (n=1631) were discharged home and 21.8% (n=454) discharged to an SNF. Findings from a multivariable logistic regression analysis indicated that patients were less likely to be discharged home if they were older (odds ratio [OR], .98; 95% confidence interval [CI], .96-.99), separated or divorced (compared with married; OR, .61; 95% CI, .48-.79), or with Medicare health insurance (compared with private insurance; OR, .69; 95% CI, .55-.88), or had dysphagia (OR, .83; 95% CI, .71-.98) or cognitive deficits (OR, .79; 95% CI, .77-.81). The odds of being discharged home were higher for those admitted with a higher motor FIM score (OR, 1.10; 95% CI, 1.09-1.11). The following were not associated with discharge disposition: sex, race, prestroke vocational status, availability of secondary health insurance, number of days from stroke onset to rehabilitation facility admission, stroke type, impairment group, cognitive FIM on admission, other stroke deficits (aphasia, ataxia, neglect, or speech disturbance), stroke complications of hyponatremia or urinary tract infection, or comorbid conditions. CONCLUSIONS: One in 5 patients with stroke were discharged to an SNF after inpatient rehabilitation. On admission, several sociodemographic and clinical characteristics were identified that could be considered as important factors in early discussions for discharge planning.
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Pacientes Internos , Alta del Paciente/estadística & datos numéricos , Centros de Rehabilitación/estadística & datos numéricos , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Rehabilitación de Accidente Cerebrovascular , Adulto , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Femenino , Estado de Salud , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To examine the comparative efficacy of 3 common measures of traumatic brain injury (TBI) severity for predicting inpatient outcomes upon hospital discharge. SETTING: Acute brain injury rehabilitation unit at level 1 trauma center. PARTICIPANTS: 100 patients with TBI. DESIGN: Retrospective analysis of injury severity, demographic, and outcome data. MAIN MEASURES: Glasgow Coma Scale (GCS) at admission, time to follow commands (TTC), duration of posttraumatic amnesia (PTA), and Functional Independence Measure at hospital discharge. RESULTS: A hierarchal multiple regression revealed that duration of PTA was a significant and powerful unique predictor of Functional Independence Measure scores at discharge (ß = -0.46, P = .001), while TTC (ß = 0.26, P = .056) and GCS (ß = 0.16, P = .143) were not. These effects were present even after controlling for age, gender, educational level, racial/ethnic minority status, cause of injury, history of substance abuse, and neurosurgical intervention. CONCLUSION: Although clinicians often use GCS scores and TTC when assessing acute TBI severity and during treatment formulation, this study provides evidence that duration of PTA may be a more meaningful predictor of patients' functional levels at discharge.
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Lesiones Encefálicas/rehabilitación , Adulto , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/psicología , Femenino , Escala de Coma de Glasgow , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Factores Socioeconómicos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To assess vestibular deficits in response to disequilibrium in ambulatory individuals with amyotrophic lateral sclerosis (ambALS). DESIGN: All participants completed standard protocols for the Sensory Organization Test (SOT) by computerized dynamic posturography. SETTING: Multidisciplinary amyotrophic lateral sclerosis clinic at an academic medical center. PARTICIPANTS: Study participants (N=34) consisted of ambALS (n=19) and healthy controls (HC) (n=15). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Equilibrium scores (ESs) obtained from averaged sway amplitude in condition 5 (ES5) and condition 6 (ES6) of the SOT. RESULTS: In conditions of altered somatosensory information with vision absent or vision sway-referenced, the mean ± SD scores for ambALS (ES5=51.4±22.5; ES6=50.8±22.1) were lower than those for HC (ES5=65.4±11.7, P≤.03; ES6=58.9±12.5, P>.05). Seven ambALS (37%) experienced a total of 19 falls during the sway-referenced support test conditions. There were no falls in the HC. CONCLUSIONS: Nearly 37% of ambALS with normal clinical balance testing have decreased ability to use the vestibular input and required increased reliance on visual input for postural orientation to sustain equilibrium. The mechanism of this alteration in sensory preference is not completely clear. Extrapyramidal involvement early in ALS may be indicated.
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Accidentes por Caídas , Esclerosis Amiotrófica Lateral/fisiopatología , Equilibrio Postural/fisiología , Propiocepción/fisiología , Enfermedades Vestibulares/fisiopatología , Anciano , Esclerosis Amiotrófica Lateral/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Vestibulares/complicaciones , Percepción Visual/fisiología , CaminataRESUMEN
OBJECTIVE: To determine the test-re-test reliability of the timed 10-metre walk test (10MWT) among adults with traumatic brain injury (TBI) enrolled in inpatient rehabilitation. DESIGN: Prospective reliability study using a correlational design. SETTING: Inpatient rehabilitation unit of a rehabilitation hospital. PARTICIPANTS: Twenty-three consecutive adults with acute TBI, mean age = 35.87, SD = 14.2 years (range = 18-64 years). This study tested 22 males and one female, who were 15.6 (SD = 9.1) days in inpatient rehabilitation at time of gait testing. METHOD: Repeated, timed 10-metre gait test within a 1-hour testing period with six trials at self-selected pace (SSP) and six trials at fastest pace (FP), recorded to the nearest 1/10 second with a hand-held stopwatch. RESULT: Gait speed measurements for SSP and FP were shown to have excellent test-re-test reliability (Intra Class Correlation coefficient = 0.964 and 0.961, respectively). CONCLUSIONS: These results add to the literature that the timed 10MWT is a reliable measure of gait velocity in adults with acute TBI for both FP and SSP.
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Lesiones Encefálicas/rehabilitación , Prueba de Esfuerzo/métodos , Caminata , Adolescente , Adulto , Lesiones Encefálicas/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación del Resultado de la Atención al Paciente , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
Non-pharmacological interventions, including cognitive-behavioral therapy (CBT), non-invasive brain stimulation (NIBS), electroconvulsive therapy (ECT), light therapy (LT), and physical rehabilitation/exercise, have shown promise as effective approaches to treat symptoms of depression and anxiety in individuals with Parkinson's disease (PD). In this narrative literature overview, we discuss the state-of-the-art regarding these treatment options and address future perspectives for clinical practice and research. Non-pharmacological interventions hold promise to treat depression and anxiety in PD. There is meta-analytic evidence for the efficacy of CBT, NIBS, ECT, LT, and exercise on improving depressive symptoms. For the treatment of anxiety symptoms, CBT shows large effects but scientific evidence of other non-pharmacological interventions is limited. Importantly, these treatments are safe interventions with no or mild side-effects. More research is needed to tailor treatment to the individuals' needs and combined interventions may provide synergistic effects.We conclude that non-pharmacological interventions should be considered as alternative or augmentative treatments to pharmacological and neurosurgical approaches for the treatment of depression and anxiety in individuals with PD.
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Ansiedad , Terapia Cognitivo-Conductual , Depresión , Enfermedad de Parkinson , Humanos , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/terapia , Depresión/terapia , Depresión/etiología , Ansiedad/terapia , Ansiedad/etiología , Terapia Cognitivo-Conductual/métodos , Terapia Electroconvulsiva , Fototerapia/métodos , Terapia por EjercicioRESUMEN
INTRODUCTION: Exercise therapy may increase brain-derived neurotrophic factor (BDNF) levels and improve clinical outcomes in people living with Parkinson's disease (PD). This systematic review was performed to investigate the effect of exercise therapy on BDNF levels and clinical outcomes in human PD and to discuss mechanisms proposed by authors. METHOD: A search on the literature was performed on PubMed up to December 2023 using the following key words: Parkinson's disease AND exercise, exercise therapy, neurological rehabilitation AND brain-derived neurotrophic factor, brain-derived neurotrophic factor/blood, brain-derived neurotrophic factor/cerebrospinal fluid AND randomized clinical trial, intervention study. Only randomized clinical trials comparing an exercise intervention to treatment as usual, usual care (UC), sham intervention, or no intervention were included. RESULTS: A meta-analysis of BDNF outcomes with pooled data from five trials (N = 216 participants) resulted in a significant standardized mean difference (SMD) of 1.20 [95% CI 0.53 to 1.87; Z = 3.52, p = 0.0004, I2 = 77%], favoring exercise using motorized treadmill, Speedflex machine, rowing machine, and non-specified exercise. Significant improvements were found in Unified Parkinson's Disease Rating Scale (UPDRS), UPDRS-III, 6 Minute Walk Test (6MWT), and Berg Balance Scale (BBS). Methodological quality of trials was categorized as "good" in three trials, "fair" in one trial, and "poor" in one trial. CONCLUSION: Key results of this systematic review are that exercise therapy is effective in raising serum BDNF levels and seems effective in alleviating PD motor symptoms. Exercise therapy confers neuroplastic effects on Parkinson brain, mediated, in part, by BDNF.
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BACKGROUND: Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. OBJECTIVE: The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. METHODS: The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. RESULTS: The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. CONCLUSIONS: Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.
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Personas con Discapacidad , Terapia Ocupacional , Enfermedad de Parkinson , Humanos , Calidad de Vida , LogopediaRESUMEN
BACKGROUND: Cognitive decline affects up to 50% of patients with Parkinson's disease (PD) in the course of the disease and may be amenable to exercise interventions. To accurately set adequate training intensities, standardized exercise testing is required but such testing takes considerable time and effort. The aim of this pilot study was to investigate the feasibility of a graded peak cycle ergometer exercise test in cognitively impaired patients with Parkinson's Disease (PD), and to define whether age-predicted maximal heart rate (HRmax) matched measured HRmax. METHODS: A convenience sample of seven patients with PD (Hoehn and Yahr: 2-4, and cognitive impairment (Montreal Cognitive Assessment (MoCA) ≤ 26) completed a graded peak cycle ergometer test to voluntary exhaustion. Borg Rating of Perceived Exertion was used to record the individual's perception of exertion. Pre-defined age-predicted HRmax (calculated as 208-(0.7 × age) was compared with the measured HRmax using Bland-Altman plot and a two-one-sided test. RESULTS: All PD patients completed the graded exercise test between 8-12 minutes, showing therefore 100% compliance to the test protocol. No adverse events occurred. Predicted HRmax and measured HRmax did not differ. CONCLUSION: We demonstrate feasibility of graded peak cycle ergometer testing in PD patients with cognitive impairment. The good correspondence of age-predicted HRmax equation with measured HRmax, in this small sample, may in the future provide clinicians with a tool to define training intensities in cognitively impaired PD, without cardiac disease. However, further research is needed to confirm these results.