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This article reports on the use of a theoretical model addressing integrated self-awareness in the treatment of individuals with traumatic brain injury. The Self- Determination Model, developed by ReMed a community-based provider ...
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This article reports on the use of a theoretical model addressing integrated self-awareness in the treatment of individuals with traumatic brain injury. The Self- Determination Model, developed by ReMed a community-based provider of post-acute services, is presented here along with three case studies. The ability for an individual with a traumatic brain injury to monitor their own behavior is essential to increase their levels of independence in their activities of daily living and in handling social situations. The Self-determination Model is an interventive practice model to assist individuals in home and community based long-term rehabilitation settings in developing self-awareness.
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{\it Objectives:} To determine whether a community-based, interdisciplinary, traumatic brain injury (TBI) team was more beneficial than existing services, and whether Early was better than Late intervention. {\it Design:} Subjects...
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{\it Objectives:} To determine whether a community-based, interdisciplinary, traumatic brain injury (TBI) team was more beneficial than existing services, and whether Early was better than Late intervention. {\it Design:} Subjects were consecutive hospital admissions. Assignment, to pre-discharge (Early), post-discharge (Late) intervention or control condition (existing services only), was by a prespecified timetable. Outcomes were compared at six months post-injury using logistic regression analyses. {\it Results:} 104 (73%) of those eligible participated. Adjusting for potential confounding factors confirmed a clinically plausible superior outcome for both intervention groups compared to the control group in some areas but not others. These were not statistically significant ($p>0.01$). {\it Conclusions:} The lack of evidence of effectiveness must be treated with caution due to limitations with certain design issues (e.g. statistical power). Analysis of intervention data suggested that team-working took place but lack of experience may have hindered their efficacy at identifying all those in need of intervention.
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The highest incidence of TBI is among young adult males who also have the highest incidence of substance abuse [1]. Since these individuals have long life expectancies, it is important that they are productive post injury; however...
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The highest incidence of TBI is among young adult males who also have the highest incidence of substance abuse [1]. Since these individuals have long life expectancies, it is important that they are productive post injury; however, the employment rate is extremely low. This is understandable, given the fact that a person with either a TBI or substance abuse disorder would have difficulties with work. Naturally, the combination of the two compounds the problem and further complicates matters. This article provides an overview of how a Supported Employment approach can be used to assist persons with a TBI and substance abuse problems with returning to work.
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Background Head injuries that cross midline structures of the brain are bihemispheric. Other terms have been used to describe such injuries, but bihemispheric is the most accurate and should be standard nomenclature. Bihemispheric...
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Background Head injuries that cross midline structures of the brain are bihemispheric. Other terms have been used to describe such injuries, but bihemispheric is the most accurate and should be standard nomenclature. Bihemispheric head injuries are associated with greater mortality and morbidity than other penetrating traumatic brain injuries (TBIs). Currently, there is a tendency to manage severe gunshot wounds (GSWs) to the head nonoperatively, despite reports of improved outcome in military patients treated aggressively. Thus, controversy exists in the management of civilian TBI. Methods PubMed was searched for query terms, and PRISMA guidelines were used. Studies were selected by relevance and inclusion of data regarding etiology, diagnosis, and management of bihemispheric TBI. Case reports, studies not in English, and records lacking information on mechanism or bihemispheric injuries were excluded. Results Thirteen studies were included and most contained level IV evidence. The mean mortality rate of all head GSWs was 62% in adults and 32% in children. Bihemispheric GSWs had greater mortality rates of 82% in adults and 60% in children. There was a larger proportion of self-inflicted injury in studies with greater rates of bihemispheric injuries. Conclusions Bihemispheric injuries have greater mortality rates than other penetrating TBI. Violation of midline brain structures such as the diencephalon and mesencephalon, increased rate of self-inflicted wounds, and lack of a standard management algorithm may increase the lethality of these injuries. Although bihemispheric injuries historically have been considered nonsalvageable, an aggressive surgical approach has been shown to improve outcomes, particularly in the military population.
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Individuals 65 years of age and over have the highest rates of traumatic brain injury (TBI)-related hospitalizations and deaths, and older adults (defined variably across studies) have particularly poor outcomes after TBI. The fac...
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Individuals 65 years of age and over have the highest rates of traumatic brain injury (TBI)-related hospitalizations and deaths, and older adults (defined variably across studies) have particularly poor outcomes after TBI. The factors predicting these outcomes remain poorly understood, and age-specific care guidelines for TBI do not exist. This study provides an overview of TBI in older adults using data from the National Trauma Data Bank (NTDB) gathered between 2007 and 2010, evaluates age group-specific trends in rates of TBI over time using U.S. Census data, and examines whether routinely collected information is able to predict hospital discharge status among older adults with TBI in the NTDB. Results showed a 20-25% increase in trauma center admissions for TBI among the oldest age groups (those >=75 years), relative to the general population, between 2007 and 2010. Older adults (>=65 years) with TBI tended to be white females who have incurred an injury from a fall resulting in a "severe" Abbreviated Injury Scale (AIS) score of the head. Older adults had more in-hospital procedures, such as neuroimaging and neurosurgery, tended to experience longer hospital stays, and were more likely to require continued medical care than younger adults. Older age, injury severity, and hypotension increased the odds of in-hospital death. The public health burden of TBI among older adults will likely increase as the Baby Boom generation ages. Improved primary and secondary prevention of TBI in this cohort is needed.
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BACKGROUND: It is vital to engage in systematic screening to identify and serve children who may have sustained an acquired brain injury (ABI) - either traumatic or non-traumatic, so they can be successfully transitioned between e...
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BACKGROUND: It is vital to engage in systematic screening to identify and serve children who may have sustained an acquired brain injury (ABI) - either traumatic or non-traumatic, so they can be successfully transitioned between environments and life stages. This is particularly important for children and adolescents given the impact an ABI can have on learning and social functioning over the course of the neurodevelopmental process. A pattern of repeated, undiagnosed mild brain injuries may lead to mood or behavior disorders, learning problems. Despite increasing awareness of brain injury as a public health issue, there has not been implementation of systematic screening practices in schools or other public health settings similar to other conditions (e.g., vision disorders, Autism Spectrum Disorders).
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Older adults tend to have poorer outcomes compared to younger adults following moderate-to-severe traumatic brain injury (TBI). Currently, there is a need for research focusing on how elderly TBI has changed as the U.S. population...
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Older adults tend to have poorer outcomes compared to younger adults following moderate-to-severe traumatic brain injury (TBI). Currently, there is a need for research focusing on how elderly TBI has changed as the U.S. population shifts. This study provides a statewide account of moderate-to-severe TBI in regard to injury-related variables and incidence rates in the elderly. Data from Pennsylvania accredited trauma centers collected in the Pennsylvania Trauma Outcome Study between 1992 and 2009 were used in the current study. Incidence rates for TBI were calculated using U.S. Census Bureau estimates for individuals aged 65-90 years (separated into three subgroups: ages 65-73, 74-82, and 83-90 years). In addition, we focused on describing the following injury-related variables: mechanism of injury, injury severity, hospital length of stay, and functional status at discharge. The results indicate that the incidence of elderly TBI has approximately doubled in the past 18 years, and that the increase in elderly TBI is greatest for individuals between the ages of 83 and 90. Furthermore, this age group had the poorest outcomes following TBI. Prevention and awareness of TBI in the elderly is imperative in reducing the likelihood of injury and disability. Continued statewide work is needed to demonstrate trends in elderly TBI nationwide to further add to the knowledge base used for prevention and rehabilitation work.
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Approximately 75% of traumatic brain injuries (TBI) are classified mild (mTBI). Despite the high frequency of mTBI, it is the least well studied. The prevalence of mTBI among service personnel returning from Operations Iraqi Freed...
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Approximately 75% of traumatic brain injuries (TBI) are classified mild (mTBI). Despite the high frequency of mTBI, it is the least well studied. The prevalence of mTBI among service personnel returning from Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) and the recent reports of an association between repeated mTBI and the early onset of Alzheimer's and other types of dementias in retired athletes has focused much attention on mTBI. The study of mTBI requires the development and validation of experimental models and one of the most basic requirements for an experimental model is that it replicates important features of the injury or disease in humans. mTBI in humans is associated with acute symptoms such as loss of consciousness and pre- and/or posttraumatic amnesia. In addition, many mTBI patients experience long-term effects of mTBI, including deficits in speed of information processing, attention and concentration, memory acquisition, retention and retrieval, and reasoning and decision-making. Although methods for the diagnosis and evaluation of the acute and chronic effects of mTBI in humans are well established, the same is not the case for rodents, the most widely used animal for TBI studies. Despite the magnitude of the difficulties associated with adapting these methods for experimental mTBI research, they must be surmounted. The identification and testing of treatments for mTBI depends of the development, characterization and validation of reproducible, clinically relevant models of mTBI.
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Objective: This retrospective study aimed to describe the volume, severity, and injury mechanism of all hospital-admitted pediatric traumatic brain injury (pTBI) at Oslo University Hospital (OUH), emphasizing consequences for prev...
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Objective: This retrospective study aimed to describe the volume, severity, and injury mechanism of all hospital-admitted pediatric traumatic brain injury (pTBI) at Oslo University Hospital (OUH), emphasizing consequences for prevention and factors indicating a need for follow-up programs. Method: Data were extracted from the OUH Trauma registry on 176 children, 0-15 years old, admitted to OUH in 2015 and 2016 with a pTBI diagnosis. The dataset contains demographic data, injury mechanism, type, and severity (Glasgow coma scale, GCS; abbreviated injury scale, AIS; injury severity score, ISS), ICD-10 diagnosis codes, level of treatment, and destination of discharge. Results: 79.5% had mild, 9% moderate, and 11.4% severe TBI. The incidence of hospital-treated pTBI in Oslo was 29 per 100,000 per year. The boy: girl ratio was 1.9:1, but in the young teenage group (14-15 years), the ratio was 1:1. Intracranial injury (ICI) identified on CT/MRI was associated with extended hospital stays, with a median of 6 days compared to 1 day for patients without ICI. 27% of the patients assessed as mild TBI at admission had ICI. Children below eight years of age had a higher incidence of moderate and severe ICI from trauma (53% v.s. 28% in children > eight years). Conclusion: The injury characteristics of hospital-treated pTBI are in line with other European countries, but we find the boy-girl ratio different as young teenage girls seem to be catching up with the boys. ICI and length of stay should be considered when deciding which patients need follow-up and rehabilitation. ? 2021 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
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This proteomic study investigates the widely observed clinical phenomenon, that after comparable brain injuries, geriatric patients fare worse and recover less cognitive and neurologic function than younger victims. Utilizing a ra...
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This proteomic study investigates the widely observed clinical phenomenon, that after comparable brain injuries, geriatric patients fare worse and recover less cognitive and neurologic function than younger victims. Utilizing a rat traumatic brain injury model, sham surgery or a neocortical contusion was induced in 3 age groups. Geriatric (21 months) rats performed worse on behavioral measures than young adults (12-16 weeks) and juveniles (5-6 weeks). Motor coordination and certain cognitive deficits showed age-dependence both before and after injury. Brain proteins were analyzed using silver-stained two-dimensional electrophoresis gels. Spot volume changes (>2-fold change, p<0.01) were identified between age and injury groups using computer-assisted densitometry. Sequences were determined by mass spectrometry of tryptic peptides. The 19 spots identified represented 13 different genes that fell into 4 general age- and injury-dependent expression patterns. Fifteen isoforms changed differentially with respect to both age and injury (p<0.05). Further investigations into the nature and function of these isoforms may yield insights into the vulnerability of older patients and resilience of younger patients in recovery after brain injuries.
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