The Experts below are selected from a list of 3705 Experts worldwide ranked by ideXlab platform

Jennie Ponsford - One of the best experts on this subject based on the ideXlab platform.

  • comparing the westmead posttraumatic Amnesia scale galveston orientation and Amnesia test and confusion assessment protocol as measures of acute recovery following traumatic brain injury
    Journal of Head Trauma Rehabilitation, 2020
    Co-Authors: Courtney Spiteri, Jennie Ponsford, Harvey Jones, Adam Mckay
    Abstract:

    Background The duration of the acute period of recovery following traumatic brain injury (TBI) remains a widely used criterion for injury severity and clinical management. Consensus regarding its most appropriate definition and assessment method has yet to be established. Objective The present study compared the trajectory of recovery using 3 measures: the Westmead Post-Traumatic Amnesia Scale (WPTAS), the Galveston Orientation and Amnesia Test (GOAT), and the Confusion Assessment Protocol (CAP). Patterns of symptom recovery using the CAP were explored. Participants Eighty-two participants with moderate to severe TBI in posttraumatic Amnesia (PTA) on admission to an inpatient rehabilitation hospital. Design Prospective longitudinal study. Outcome measures Length of PTA (days), agreement between measures (%, κ coefficient), and pattern of symptom recovery. Results Participants emerged from PTA earliest on the CAP followed the GOAT, and last on the WPTAS. There was good agreement between the CAP and the GOAT as to PTA status, but both tests had poor agreement with the WPTAS. Of patients considered out of PTA on the CAP, the majority exhibited signs of Amnesia on the WPTAS and one-third had clinical levels of agitation. Conclusion The WPTAS identifies a later stage of PTA recovery that requires specialized management due to ongoing Amnesia and agitation. The CAP and the GOAT are less sensitive to this extended period of PTA.

  • efficacy of motivational interviewing and cognitive behavioral therapy for anxiety and depression symptoms following traumatic brain injury
    Psychological Medicine, 2016
    Co-Authors: Jennie Ponsford, Adam Mckay, Dana Kirsty Wong, Kerrie Elizabeth Haines, Yvette Alway, Marina Downing, Christina Furtado, Meaghan Odonnell
    Abstract:

    BACKGROUND: Anxiety and depression are common following traumatic brain injury (TBI), often co-occurring. This study evaluated the efficacy of a 9-week cognitive behavioral therapy (CBT) program in reducing anxiety and depression and whether a three-session motivational interviewing (MI) preparatory intervention increased treatment response. METHOD: A randomized parallel three-group design was employed. Following diagnosis of anxiety and/or depression using the Structured Clinical Interview for DSM-IV, 75 participants with mild-severe TBI (mean age 42.2 years, mean Post-Traumatic Amnesia 22 days) were randomly assigned to an Adapted CBT group: (1) MI + CBT (n = 26), or (2) non-directive counseling (NDC) + CBT (n = 26); or a (3) waitlist control (WC, n = 23) group. Groups did not differ in baseline demographics, injury severity, anxiety or depression. MI and CBT interventions were guided by manuals adapted for individuals with TBI. Three CBT booster sessions were provided at week 21 to intervention groups. RESULTS: Using intention-to-treat analyses, random-effects regressions controlling for baseline scores revealed that Adapted CBT groups (MI + CBT and NDC + CBT) showed significantly greater reduction in anxiety on the Hospital Anxiety and Depression Scale [95% confidence interval (CI) -2.07 to -0.06] and depression on the Depression Anxiety and Stress Scale (95% CI -5.61 to -0.12) (primary outcomes), and greater gains in psychosocial functioning on Sydney Psychosocial Reintegration Scale (95% CI 0.04-3.69) (secondary outcome) over 30 weeks post-baseline relative to WC. The group receiving MI + CBT did not show greater gains than the group receiving NDC + CBT. CONCLUSIONS: Findings suggest that modified CBT with booster sessions over extended periods may alleviate anxiety and depression following TBI. Language: en

  • developing a targeted theory informed implementation intervention using two theoretical frameworks to address health professional and organisational factors a case study to improve the management of mild traumatic brain injury in the emergency department
    Implementation Science, 2015
    Co-Authors: Emma Tavender, Jennie Ponsford, Marije Bosch, Russell L Gruen, Sally Green, Jill J Francis, Susan Michie, Sue E Brennan
    Abstract:

    Despite the availability of evidence-based guidelines for the management of mild traumatic brain injury in the emergency department (ED), variations in practice exist. Interventions designed to implement recommended behaviours can reduce this variation. Using theory to inform intervention development is advocated; however, there is no consensus on how to select or apply theory. Integrative theoretical frameworks, based on syntheses of theories and theoretical constructs relevant to implementation, have the potential to assist in the intervention development process. This paper describes the process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention. A stepped approach was followed: (i) identification of locally applicable and actionable evidence-based recommendations as targets for change, (ii) selection and use of two theoretical frameworks for identifying barriers to and enablers of change (Theoretical Domains Framework and Model of Diffusion of Innovations in Service Organisations) and (iii) identification and operationalisation of intervention components (behaviour change techniques and modes of delivery) to address the barriers and enhance the enablers, informed by theory, evidence and feasibility/acceptability considerations. We illustrate this process in relation to one recommendation, prospective assessment of Post-Traumatic Amnesia (PTA) by ED staff using a validated tool. Four recommendations for managing mild traumatic brain injury were targeted with the intervention. The intervention targeting the PTA recommendation consisted of 14 behaviour change techniques and addressed 6 theoretical domains and 5 organisational domains. The mode of delivery was informed by six Cochrane reviews. It was delivered via five intervention components : (i) local stakeholder meetings, (ii) identification of local opinion leader teams, (iii) a train-the-trainer workshop for appointed local opinion leaders, (iv) local training workshops for delivery by trained local opinion leaders and (v) provision of tools and materials to prompt recommended behaviours. Two theoretical frameworks were used in a complementary manner to inform intervention development in managing mild traumatic brain injury in the ED. The effectiveness and cost-effectiveness of the developed intervention is being evaluated in a cluster randomised trial, part of the Neurotrauma Evidence Translation (NET) program.

  • retrospective analysis of the recovery of orientation and memory during posttraumatic Amnesia
    Neuropsychology (journal), 2015
    Co-Authors: Caroline M Roberts, Gershon Spitz, Jennie Ponsford
    Abstract:

    Objective Prospective monitoring of posttraumatic Amnesia (PTA) is recommended following moderate to severe traumatic brain injury (TBI). However, few studies have examined the typical order in which items recover on PTA scales. Different methods have been used to define recovery, and the order reported is not consistent across the literature. The purpose of this study was to improve understanding of the progression of PTA by reporting the duration to recovery of items and categories on the Westmead Post-Traumatic Amnesia Scale (WPTAS) according to different criteria. Method A retrospective analysis was conducted of 66 patients with TBI who were administered the WPTAS during hospital admission. The duration to recovery of items and categories was determined according to 3 criteria: first correct, correct 3 times in a row, and consistently correct. Results On the basis of the sample mean, date of birth (DOB), year, age, place, month, day, name, and memory for the 3 pictures recovered in this order according to all 3 criteria. However, the significance of differences between items and the order of recovery of categories depended on the criterion adopted. Although DOB recovered first in 74% of cases and the 3 pictures last in 63% of cases, there was a high degree of individual variability in the precise sequence of recovery. Conclusions The traditional view of PTA recovering in the order of person, place, time, and memory does not adequately describe the profile of recovery on the WPTAS. Considering the recovery of individual items is necessary to understand and account for individuals differences in the order of recovery.

  • the factor structure of the hospital anxiety and depression scale in individuals with traumatic brain injury
    Psychiatry Research-neuroimaging, 2010
    Co-Authors: Jennie Ponsford, Michael Schonberger
    Abstract:

    There is a lack of validated scales for screening for anxiety and depression in individuals with traumatic brain injury (TBI). The purpose of this study was to examine the factor structure of the Hospital Anxiety and Depression Scale (HADS) in individuals with TBI. A total of 294 individuals with TBI (72.1% male; mean age 37.1 years, S.D. 17.5, median Post-Traumatic Amnesia (PTA) duration 17 days) completed the HADS 1 year post-injury. A series of confirmatory factor analyses was conducted to examine the fit of a one-, two- and three-factor solution, with and without controlling for item wording effects (Multi-Trait Multi-Method approach). The one-, two- or three-factor model fit the data only when controlling for negative item wording. The results are in support of the validity of the original anxiety and depression subscales of the HADS and demonstrate the importance of evaluating item wording effects when examining the factor structure of a questionnaire. The results would also justify the use of the HADS as a single scale of emotional distress. However, even though the three-factor solution fit the data, alternative scales should be used if the purpose of the assessment is to measure stress symptoms separately from anxiety and depression.

Sung Ho Jang - One of the best experts on this subject based on the ideXlab platform.

  • complete monoplegia due to limb kinetic apraxia in a patient with traumatic brain injury a case report
    Medicine, 2020
    Co-Authors: Sung Ho Jang, You Sung Seo
    Abstract:

    RATIONALE Limb-kinetic apraxia (LKA) is a disorder of movement execution that is a result of injury to the corticofugal tracts (CFTs) from the secondary motor area. We report on a patient with traumatic brain injury (TBI) and complete monoplegia due to LKA, which was mainly ascribed to injury of the CFT from the secondary motor area using diffusion tensor tractography. PATIENT CONCERNS A 35-year-old male was struck by a car from the side during riding an autocycle and received direct head trauma as a result of falling to ground. He lost consciousness for approximately 1 month and experienced continuous Post-Traumatic Amnesia after the accident. The patient's Glasgow Coma Scale score was 3 and he showed quadriparesis including complete monoplegia of his left arm since the onset of TBI. DIAGNOSES The patient diagnosed complete monoplegia due to LKA after traumatic brain injury. INTERVENTIONS He underwent conservative management for TBI followed by rehabilitation at approximately 2 months after onset. OUTCOMES At 32-month after onset, weakness on left arm (Manual Muscle Test [MMT]:0) and partial weakness of left leg (MMT:3). OUTCOMES Results of electromyography and nerve conduction studies of left extremities were normal. Motor evoked potential values obtained from the abductor pollicis brevis muscle (APB) were: right APB latency 22.3msec, amplitude 1.6mV; left APB latency 22.8msec, amplitude 1.5mV. After 2 weeks of administration of dopaminergic drugs for improvement of LKA, left arm weakness had recovered to level that permitted movement against gravity (MMT:3). Diffusion tensor tractography at 32-month after onset showed right corticospinal tract discontinuation at the pontine level and partial tearing of the left corticospinal tract at the subcortical white matter. In addition, the left CFT from the supplementary motor area showed partial tearing at the subcortical white matter. LESSONS The LKA due to injury of the left supplementary motor area-CFT was demonstrated in a patient with complete monoplegia following TBI. Accurate diagnosis of LKA is important for successful rehabilitation because LKA is known to respond to dopaminergic drug treatment.

  • central pain due to spinothalamic tract injury by head trauma caused by falling object
    Annals of Rehabilitation Medicine, 2016
    Co-Authors: Sung Ho Jang
    Abstract:

    In this report, we described the case of a 54-year-old female who suffered trauma from a falling large box (100 cm×30 cm×30 cm) that hit the vertex of her head while seated in a subway car. The patient experienced loss of consciousness for several minutes, and Post-Traumatic Amnesia for several minutes, with a Glasgow Coma Scale score of 15. She experienced severe bursting pain in her head, neck and upper back immediately after the head trauma; and approximately 3 hours later, she began to feel pricking pain in her left arm and leg. Despite visits to several hospitals to determine the cause of pain, no specific diagnosis was confirmed. Ten months post-injury, she visited the Department of Rehabilitation of a Yeunnam University Hospital with the chief complaint of constant pain with hyperalgesia in her head, left arm, and leg. The characteristics and severity of pain were as follows: head, pricking sensation (visual analogue scale [VAS], 5–7]; left arm, pricking and squeezing (VAS, 3–7); and left leg, bursting sensation (VAS, 6–7). The subscales of Nottingham Sensory Assessment indicated normal kinesthetic sensation score of the left extremities (24 out of a possible 24 points), but impaired tactile sensation score (10 out of a possible 20 points). Brain and spine magnetic resonance imaging revealed no specific focal lesion; additionally, an electromyography study showed no evidence of peripheral neuropathy or radiculopathy.

  • degeneration of an injured spinothalamic tract in a patient with mild traumatic brain injury
    Brain Injury, 2016
    Co-Authors: Sung Ho Jang, Hyeok Gyu Kwon
    Abstract:

    AbstractObjectives: This study reports on a patient who developed degeneration of an injured spinothalamic tract (STT) detected on diffusion tensor tractography (DTT) following mild traumatic brain injury (TBI).Case description: A 56-year-old female had suffered from head trauma resulting from a pedestrian car accident. The patient did not experience loss of consciousness or Post-Traumatic Amnesia and the patient’s Glasgow Coma Scale score was 15. She had begun to feel pain in her left hand and foot at ~ 7 days after onset. The characteristics and severity of pain were as follows: constant tingling and pricking sensation without allodynia or hyperalgesia (Visual Analogue Scale score: 3~4). No specific focal lesion was observed on brain and spine MRI and an electromyography study showed no evidence of peripheral nerve injury or radiculopathy. At 6 months after onset, the central pain in the left hand and foot became aggravated, with a Visual Analogue Scale score of 6.Results: On 1-month DTT, partial tearin...

  • impaired consciousness caused by injury of the lower ascending reticular activating system evaluation by diffusion tensor tractography
    Neural Regeneration Research, 2016
    Co-Authors: Sung Ho Jang
    Abstract:

    A 34-year-old male patient underwent conservative management for traumatic hemorrhage in the right frontal lobe (Figure 1A). The patient lost consciousness for approximately 4 weeks and experienced Post-Traumatic Amnesia continuously from the time of the accident. The patient's Glasgow Coma Scale score (Teasdale et al., 1974) was 6 when he arrived at the hospital. At 5 weeks after onset, he was transferred to the rehabilitation department to undergo rehabilitation. Brain MRI showed malactic lesions in both the frontal lobes and right thalamus (Figure 1B). The patient exhibited impaired consciousness, with a Glasgow Coma Scale score of 9 and Coma Recovery Scale-Revised score of 8 (Giacino et al., 2004). Figure 1 Brain CT images, magnetic resonance images and diffusion tensor tractography (DTT) images of a 34-year-old male patient with traumatic brain injury. Diffusion tensor tractography (DTT) data were obtained at 6 weeks after onset using a 6-channel head coil on a 1.5 T Philips Gyroscan Intera (Philips, Best, the Netherlands) with single-shot echo-planar imaging. Imaging parameters were as follows: acquisition matrix = 96 × 96; reconstructed matrix = 192 × 192; field of view = 240 × 240 mm2; repetition time = 10,726 ms; echo time = 76 ms; parallel imaging reduction factor (SENSE factor) = 2; EPI factor = 49; b = 1,000 s/mm2; number of excitations = 1; and a slice thickness of 2.5 mm. FACT algorithm was used for fiber tracking. For ascending reticular activating system (ARAS) analysis, the seed region of interest (ROI) was given on the pontine reticular formation. According to previous reports (Yeo et al., 2013; Jang et al., 2014), the target ROI was placed on the thalamic intralaminar nuclei to analyze the connectivity of the intralaminar nuclei. The patient showed intact neural connectivity between the thalamic intralaminar nuclei the frontal lobe. However, the left lower ARAS between pontine reticular formation and thalamic intralaminar nuclei was thinner than the right lower one of the same patient and those in five age-matched healthy control subjects (Figure 1C). In this study, we evaluated the ARAS in a patient with severe traumatic brain injury through two portions: First, three-dimensional reconstruction at the lower ARAS between the pontine reticular formation and the thalamic intralaminar nuclei, second, neural connectivity of the upper ARAS between the thalamic intralaminar nuclei and the cerebral cortex. Our results showed that the left lower ARAS was thinner than that of the right side of the patient and those of normal subjects. These findings appear to suggest an injury of the left lower ARAS. This injury was attributed to traumatic axonal injury because the conventional brain MRI of the patient was normal in the left thalamus and brainstem. Before analysis of the ARAS, we assumed that the main lesion would be located in the right ARAS and left upper ARAS because the brain MRI showed malactic lesions in both frontal lobes and the right thalamus. The main lesion site was detected in the left lower ARAS between the thalamic reticular formation and the thalamic intralaminar nuclei (Edlow et al., 2013; Jang et al., 2015a, b). Our results suggest that analysis of the ARAS using DTT would be useful for elucidating the cause of impaired consciousness. However, limitation of DTT with 1.5 T MRI should be considered, because a higher tesla MRI such as 3.0 T, can show better resolution and identify small tract more precisely. This work was supported by the National Research Foundation (NRF) of Korea Grant funded by the Korean Government (MSIP), No. 2015R1A2A2A01004073.

  • appearance of a neural bypass between injured cingulum and brainstem cholinergic nuclei of a patient with traumatic brain injury on follow up diffusion tensor tractography images
    Neural Regeneration Research, 2015
    Co-Authors: Han Do Lee, Sung Ho Jang
    Abstract:

    The human brain is known to contain a maximum of eight cholinergic nuclei: the basal forebrain region: the medial septal nucleus (Ch 1), the vertical nucleus of the diagonal band (Ch 2), the horizontal limb of the diagonal band (Ch 3), and the nucleus basalis of Meynert (Ch 4); the brainstem: the pedunculopontine nucleus (Ch 5), the laterodorsal tegmental nucleus (Ch 6), and the parabigeminal nucleus (Ch 8); and the thalamus: the medial habenular nucleus (Ch 7) (Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009). The cingulum is the neural tract extending from the orbitofrontal cortex to the medial temporal lobe (Mufson and Pandya, 1984). The cingulum plays an important role in memory because it is a passage of the medial cholinergic pathway, which provides cholinergic innervations to the cerebral cortex after originating from Ch 1 and Ch 2 as well as Ch 4 (mainly) (Selden et al., 1998; Nieuwenhuys et al., 2008; Hong and Jang, 2010). Diffusion tensor tractography (DTT), which is derived from diffusion tensor imaging (DTI), enables three-dimensional visualization and estimation of the cingulum (Concha et al., 2005). As a result, many DTI studies have reported on injury of the cingulum following brain injury (Kraus et al., 2007; Sugiyama et al., 2009; Wu et al., 2010). On the contrary, several studies have reported on the mechanism for recovery of an injured cingulum: recovery of an injured cingulum and neural bypass between an injured cingulum and brainstem cholinergic nuclei (Yeo et al., 2012; Seo and Jang, 2013, 2014; Yoo et al., 2014), however, this recovery mechanism has not been clearly elucidated so far (Yeo et al., 2012; Seo and Jang, 2014; Yoo et al., 2014). In the current study, we report on a patient with traumatic brain injury in whom a neural bypass was found between an injured cingulum and brainstem cholinergic nuclei on follow-up DTTs. A 13-year-old male suffered from head trauma resulting from a pedestrian car accident. The patient lost consciousness for 2 months and experienced Post-Traumatic Amnesia for 4 months from the time of the accident. The patient's Glasgow Coma Scale score was 5 on the day of head trauma. He received conservative management under the diagnosis of intraventricular hemorrhage in the lateral ventricle and diffuse axonal injury. The patient underwent rehabilitative management beginning at 1 month after onset. No specific lesion was observed on brain MRI (T1-weighted, T2-weighted, and Fluid attenuated inversion recovery [FLAIR] images) performed at 5 months after onset (Figure 1A). The patient showed memory impairment at 5 months after onset: Wechsler Adult Intelligence Scale: 43, and the Memory Assessment Scale (MAS, global memory: 62 [1%ile], short term memory: 76 [6%ile], verbal memory: 69 [2%ile], and visual memory: 60 [1%ile>]) (Wechsler, 1981; Williams, 1991). However, his short-term memory impairment had recovered to normal range at 12 months after onset: Wechsler Adult Intelligence Scale: 43, and the Memory Assessment Scale (MAS, global memory: 64 [1%ile], short term memory: 91 [28%ile], verbal memory: 61 [1%ile>], and visual memory: 87 [19%ile]) (Wechsler, 1981; Williams, 1991). Five age-matched control subjects (five male; mean age: 15.3 years, range: 11–17) with no history of neurologic disease were recruited for comparison of the configuration of the fornix. Figure 1 Conventional magnetic resonance (MR) images and diffusion tensor tractography (DTT) images of a 13-year-old male patient with traumatic brain injury. DTIs were acquired twice, at 5 months and 12 months after onset, using a 1.5 T Philips Gyroscan Intera system (Philips, Ltd, Best, The Netherlands) equipped with a Synergy-L Sensitivity Encoding (SENSE) head coil using a single-shot, spin-echo planar imaging pulse sequence. For each of the 32 non-collinear diffusion sensitizing gradients, we acquired 60 contiguous slices parallel to the anterior commissure-posterior commissure line. Imaging parameters were as follows: acquisition matrix = 96 × 96, reconstructed to matrix = 192 × 192, field of view = 240 mm × 240 mm, repetition time = 10,398 ms, echo time = 72 ms, parallel imaging reduction factor (SENSE factor) = 2, echo planar imaging factor = 59 and b = 1,000 s/mm2, number of excitations = 1, thickness = 2.5 mm. Eddy current-induced image distortions were removed using affine multi-scale two-dimensional registration at the Oxford Centre for Functional Magnetic Resonance Imaging of Brain (FMRIB) Software Library (FSL; www.fmrib.ox.ac.uk/fsl). DTI-Studio software (CMRM, Johns Hopkins Medical Institute, Baltimore, MD, USA) was used for evaluation of the CST. The CST was reconstructed using fibers passing through two regions of interest (ROIs) on the color map. The cingulums were reconstructed using fibers passing through two ROIs on the color map (green color: middle and posterior portion of the cingulum). Termination criteria were fractional anisotropy (FA) 70°. DTTs of the cingulum in control subjects originated from the basal forebrain and extended posteriorly along and over the corpus callosum. On both 5-month and 12-month DTTs of the patient, discontinuations were observed in both anterior cingulums. On 5-month DTT of the patient and control subjects, we did not observe any neural bypass between injured cingulum and brainstem cholinergic nuclei. However, on 12-month DTT, a neural bypass was observed between the right injured cingulum and right brainstem cholinergic nuclei (Ch 6 and 8) (Figure 1A).

Mark Sherer - One of the best experts on this subject based on the ideXlab platform.

  • comparison of indices of traumatic brain injury severity glasgow coma scale length of coma and post traumatic Amnesia
    Journal of Neurology Neurosurgery and Psychiatry, 2007
    Co-Authors: Mark Sherer, Stuart A. Yablon, Margaret A Struchen, Yu Wang, Todd G Nick
    Abstract:

    Background: Classification of traumatic brain injury (TBI) severity guides management and contributes to determination of prognosis. Common indicators of TBI severity include Glasgow Coma Scale (GCS) scores, length of coma (LOC) and duration of Post-Traumatic Amnesia (PTA). Objective: To compare GCS, LOC and PTA by examining distributions and intercorrelations and develop multivariable linear regression models for estimating LOC and PTA duration. Methods: Prospective study of 519 of 614 consecutive patients with TBI. Indices of TBI severity studied were GCS, LOC, PTA and PTA–LOC (the interval from return of command-following to return of orientation). Candidate predictor variables for estimation of LOC, PTA and PTA–LOC intervals were age, years of education, year of injury (before 1997 vs 1997 or later), GCS, LOC (for PTA and PTA–LOC), pupillary responsiveness, type of injury, CT pathology and intracranial operations. Results: Although there was a severity/response relationship between GCS and LOC, PTA and PTA–LOC intervals, there was overlap in these intervals between GCS severity categories. Age, year of injury, GCS, pupillary responsiveness and CT pathology were predictive of LOC. Age, years of education, year of injury, GCS, LOC, pupillary responsiveness and intracranial operations were predictive of PTA duration. Age, years of education, year of injury, GCS, LOC and pupillary responsiveness were predictive of PTA–LOC. GCS and LOC effects were influenced by age. Conclusions: Predictors for estimating LOC, PTA and PTA–LOC intervals were determined and simple equations were developed. These equations will be helpful to clinicians, researchers and those counselling family members of patients with TBI.

  • prospective comparison of acute confusion severity with duration of post traumatic Amnesia in predicting employment outcome after traumatic brain injury
    Journal of Neurology Neurosurgery and Psychiatry, 2007
    Co-Authors: Risa Nakaserichardson, Stuart A. Yablon, Mark Sherer
    Abstract:

    Background: Measurement of the duration of Post-Traumatic Amnesia (PTA) is common practice, serving as an important index of the severity of traumatic brain injury (TBI) and a predictor of functional outcome. However, controversy exists regarding the nature of PTA; some studies indicate that it is a confusional state with symptoms that extend beyond disorientation and Amnesia. Objective: To evaluate the contribution of the severity of acute confusion 1 month after TBI to prediction of employment at 1 year after injury, comparing it with PTA duration. Methods: Prospective study involving 171 participants with complete data, who met the study criteria, from 228 consecutive TBI Model System admissions. Outcome measures included weekly administration of the Delirium Rating Scale-Revised-98 (DelRS-R98) to measure the severity of acute confusion. Evaluations closest to 1 month after injury were used for study purposes. Duration of PTA was defined as the interval from injury until two consecutive Galveston Orientation and Amnesia Test scores of ⩾76 were obtained within a period of 24–72 h. Univariable and multivariable logistic regression were used to predict employment status at 1 year after injury. Results: Age, education and DelRS-R98 were significant predictors accounting for 34% of outcome variance. Individuals with greater confusion severity at 1 month after injury, older age and lower levels of education were less likely to be employed at 1 year after injury. Severity of confusion was more strongly associated with employment outcome (r s  = −0.39) than was PTA duration (r s  = −0.34). Conclusions: In addition to demographic indices, severity of acute confusion makes a unique contribution to predicting late outcome after TBI.

R J Greenwood - One of the best experts on this subject based on the ideXlab platform.

  • assessment of post traumatic Amnesia after severe closed head injury retrospective or prospective
    Journal of Neurology Neurosurgery and Psychiatry, 1996
    Co-Authors: T M Mcmillan, E L M M Jongen, R J Greenwood
    Abstract:

    BACKGROUND: Post-Traumatic Amnesia is considered to be the best single indicator of the severity of closed head injury. Usually, it has been estimated retrospectively. For practical reasons this also tends to be the most common clinical method. It has been argued that prospective assessment is more accurate and reliable, but this has never been evaluated empirically in severe head injury. METHODS: Post-Traumatic Amnesia was initially assessed prospectively and later retrospectively by a separate observer in the same patients. RESULTS: The correlation between the two methods was high. In addition, both measures significantly correlated with other measures of severity of brain injury and with measures of outcome. CONCLUSION: Retrospective measurement of Post-Traumatic Amnesia is a valid method.

Marit V. Forslund - One of the best experts on this subject based on the ideXlab platform.

  • Global Outcome Trajectories up to 10 Years After Moderate to Severe Traumatic Brain Injury
    'Frontiers Media SA', 2019
    Co-Authors: Marit V. Forslund, Paul B. Perrin, Cecilie Røe, Solrun Sigurdardottir, Torgeir Hellstrøm, Svein A. Berntsen, Juan Carlos Arango-lasprilla
    Abstract:

    Aims: Based on important predictors, global functional outcome after traumatic brain injury (TBI) may vary significantly over time. This study sought to: (1) describe changes in the Glasgow Outcome Scale–Extended (GOSE) score in survivors of moderate to severe TBI, (2) examine longitudinal GOSE trajectories up to 10 years after injury, and (3) investigate predictors of these trajectories based on socio-demographic and injury characteristics.Methods: Socio-demographic and injury characteristics of 97 TBI survivors aged 16–55 years were recorded at baseline. GOSE was used as a measure of TBI-related global outcome and assessed at 1-, 2-, 5-, and 10-year follow-ups. Hierarchical linear models were used to examine global outcomes over time and whether those outcomes could be predicted by: time, time*time, sex, age, partner relationship status, education, employment pre-injury, occupation, cause of injury, acute Glasgow Coma Scale score, length of Post-Traumatic Amnesia (PTA), CT findings, and Injury Severity Score (ISS), as well as the interactions between each of the significant predictors and time*time.Results: Between 5- and 10-year follow-ups, 37% had deteriorated, 7% had improved, and 56% showed no change in global outcome. Better GOSE trajectories were predicted by male gender (p = 0.013), younger age (p = 0.012), employment at admission (p = 0.012), white collar occupation (p = 0.014), and shorter PTA length (p = 0.001). The time*time*occupation type interaction effect (p = 0.001) identified different trajectory slopes between survivors in white and blue collar occupations. The time*time*PTA interaction effect (p = 0.023) identified a more marked increase and subsequent decrease in functional level among survivors with longer PTA duration.Conclusion: A larger proportion of survivors experienced deterioration in GOSE scores over time, supporting the concept of TBI as a chronic health condition. Younger age, pre-injury employment, and shorter PTA duration are important prognostic factors for better long-term global outcomes, supporting the existing literature, whereas male gender and white collar occupation are vaguer as prognostic factors. This information suggests that more intensive and tailored rehabilitation programs may be required to counteract a negative global outcome development in survivors with predicted worse outcome and to meet their long-term changing needs

  • Employment Probability Trajectories Up To 10 Years After Moderate-To-Severe Traumatic Brain Injury
    Frontiers in Neurology, 2018
    Co-Authors: Emilie I. Howe, Nada Andelic, Paul B. Perrin, Cecilie Røe, Solrun Sigurdardottir, Juan Carlos Arango-lasprilla, Marianne Løvstad, Marit V. Forslund
    Abstract:

    Aims: To examine trajectories of employment probability up to 10 years following moderate-to-severe traumatic brain injury (TBI) and identify significant predictors from baseline socio-demographic and injury characteristics. Methods: A longitudinal observational study followed 97 individuals with moderate-to-severe TBI for their employment status up to 10 years post injury. Participants were enrolled at the Trauma Referral Center in South-Eastern Norway between 2005 and 2007. Socio-demographic and injury characteristics were recorded at baseline. Employment outcomes were assessed at 1, 2, 5, and 10 years. Hierarchical linear modeling (HLM) was used to examine employment status over time and assess the predictors of time, gender, age, relationship status, education, employment pre-injury, occupation, cause of injury, acute Glasgow Coma Scale (GCS) score, duration of Post-Traumatic Amnesia (PTA), CT findings, and injury severity score, as well as the interaction terms between significant predictors and time. Results: The linear trajectory of employment probabilities for the full sample remained at ~50% across 1, 2, 5, and 10-years post-injury. Gender (p = 0.016), relationship status (p = 0.002), employment (p < 0.001) and occupational status at injury (p = 0.005), and GCS (p = 0.006) yielded statistically significant effects on employment probability trajectories. Male gender, those in a partnered relationship at the time of injury, individuals who had been employed at the time of injury, those in a white-collar profession, and participants with a higher acute GCS score had significantly higher overall employment probability trajectories across the four time points. The time*gender interaction term was statistically significant (p = 0.002), suggesting that employment probabilities remained fairly stable over time for men, but showed a downward trend for women. The time*employment at injury interaction term was statistically significant (p = 0.003), suggesting that employment probabilities were fairly level over time for those who were employed at injury, but showed an upward trend over time for those who had been unemployed at injury. Conclusion: Overall employment probability trajectories remained relatively stable between 1 and 10 years. Baseline socio-demographic and injury characteristics were predictive of employment trajectories. Regular follow-up is recommended for patients at risk of long-term unemployment.