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Long-term impact of a community-based adapted boxing program on physical functioning and quality of life of individuals with Parkinson's disease. 社区适应性拳击项目对帕金森病患者身体功能和生活质量的长期影响。
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-04-13 DOI: 10.3233/nre-230382
Félix-Antoine Savoie, Simon Benoit, Eléonor Riesco, Andréanne Tanguay
BACKGROUNDAdapted boxing can help improve the physical functioning and health-related quality of life (HRQoL) of individuals with Parkinson's disease (PD). Whether these benefits persist longitudinally is unclear.OBJECTIVEThe purpose of this retrospective study was to evaluate the impact of a community-based adapted boxing program on the physical functioning and HRQoL of individuals with PD over 1-1.5 years.METHODSTwenty-six individuals with PD agreed to share their results on tests administered upon enrollment in the program (PRE) and ∼431 days later (POST). The tests included the Fullerton Advanced Balance scale, (FAB), the Timed Up-and-Go test (TUG), the 30-second Sit-to-Stand test (30-STS), and the PD questionnaire-39 (PDQ-39).RESULTSFrom PRE to POST, performance significantly improved on the TUG and 30-STS tests (both p <  0.001), but not on the FAB (p = 0.79). Over the same period, PDQ-39 scores significantly increased (p = 0.05). No PRE to POST changes surpassed the minimal detectable change threshold.CONCLUSIONThe results of this study suggest that adapted boxing is at worst non-detrimental and at best potentially beneficial for muscle strength, endurance, and functional mobility in individuals with PD. However, adapted boxing probably cannot fully counteract the HRQoL decrements that accompany PD progression.
背景适应性拳击有助于改善帕金森病(PD)患者的身体功能和与健康相关的生活质量(HRQoL)。这项回顾性研究的目的是评估社区适应性拳击项目在 1-1.5 年内对帕金森病患者的身体功能和 HRQoL 的影响。方法26 名帕金森病患者同意分享他们在加入该项目(前)和 431 天后(后)进行的测试结果。测试内容包括富勒顿高级平衡量表(FAB)、定时起立行走测试(TUG)、30 秒坐立测试(30-STS)和帕金森病问卷-39(PDQ-39)。结果从前期到后期,TUG 和 30-STS 测试的成绩均有显著提高(P 均小于 0.001),但 FAB 的成绩没有提高(P = 0.79)。在同一时期,PDQ-39 的得分明显提高(p = 0.05)。本研究结果表明,适应性拳击在最坏的情况下对帕金森氏症患者的肌肉力量、耐力和功能活动性无损害,在最好的情况下可能有益。然而,适应性拳击可能无法完全抵消伴随帕金森病进展而出现的 HRQoL 下降。
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引用次数: 0
Therapeutic effects of deep pharyngeal electrical stimulation combined with modified masako maneuver on aspiration in patients with stroke 咽深部电刺激联合改良麻子手法对中风患者吸入的治疗效果
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-04-11 DOI: 10.3233/nre-240005
Bo-Ye Ni, Hua-Ping Jin, Wei Wu
BACKGROUND:Stroke patients often experience difficulty swallowing. OBJECTIVE:To assist in the improvement of dysphagia symptoms by introducing a novel approach to the treatment of patients with post-stroke aspiration. METHODS:A total of 60 patients with post-stroke aspiration were enrolled and divided into an experimental group (n = 30) and a control group (n = 30). The control group received standard treatment, sham intraoral stimulation, and the Masako maneuver, while the experimental group was administered standard treatment, deep pharyngeal electrical stimulation (DPES), and a modified Masako maneuver. Changes in their Functional Oral Intake Scale (FOIS) and Rosenbek scale scores were observed. RESULTS:The FOIS scores of both groups increased significantly after treatment (p < 0.01, respectively). The Rosenbek scale scores of both groups decreased significantly after treatment, with the experimental group scoring significantly lower than the control group (1.01±0.09 vs. 2.30±0.82) (p < 0.05). After treatment, the overall response rate in the experimental group (93.33%) was significantly higher than that in the control group (83.33%) (p < 0.001). CONCLUSION:In terms of effectively improving dysphagia in aspiration patients after stroke, DPES combined with modified Masako maneuver is clinically recommended.
背景:中风患者通常会出现吞咽困难。目的:通过引入一种治疗脑卒中后误吸患者的新方法,帮助患者改善吞咽困难症状。方法:共招募了 60 名中风后误吸患者,并将其分为实验组(30 人)和对照组(30 人)。对照组接受标准治疗、假口内刺激和正子手法,实验组则接受标准治疗、咽深部电刺激(DPES)和改良正子手法。观察他们的功能性口腔摄入量表(FOIS)和罗森贝克量表评分的变化。结果:治疗后,两组患者的功能性口腔摄入量表(FOIS)评分均有显著提高(P分别为0.01)。两组的罗森贝克量表评分在治疗后均明显下降,实验组的评分明显低于对照组(1.01±0.09 vs. 2.30±0.82)(p <0.05)。治疗后,实验组的总体反应率(93.33%)明显高于对照组(83.33%)(p <0.001)。结论:在有效改善脑卒中后误吸患者的吞咽困难方面,DPES 联合改良 Masako 手法值得临床推荐。
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引用次数: 0
Computational methodology to support functional vision assessment in premature infants: A viability study 支持早产儿功能性视力评估的计算方法:可行性研究
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-01-30 DOI: 10.3233/nre-230193
Ricardo Pires Maciel, Bruna Samantha Marchi, Henrique da Silva da Silveira, Giovana Pascoali Rodovanski, Aicha Al-Rob, Rodrigo Souza, Marcelo Fernandes Costa, Cristiane Aparecida Moran, Antonio Carlos Sobieranski
BACKGROUND:Premature newborns have a higher risk of abnormal visual development and visual impairment. OBJECTIVE:To develop a computational methodology to help assess functional vision in premature infants by tracking iris distances. METHODS:This experimental study was carried out with children upto two years old. A pattern of image capture with the visual stimulus was proposed to evaluate visual functions of vertical and horizontal visual tracking, visual field, vestibulo-ocular reflex, and fixation. The participants’ visual responses were filmed to compose a dataset and develop a detection algorithm using the OpenCV library allied with FaceMesh for the detection and selection of the face, detection of specific facial points and tracking of the iris positions is done. A feasibility study was also conducted from the videos processed by the software. RESULTS:Forty-one children of different ages and diagnoses participated in the experimental study, forming a robust dataset. The software resulted in the tracking of iris positions during visual function evaluation stimuli. Furthermore, in the feasibility study, 8 children participated, divided into Pre-term and Term groups. There was no statistical difference in any visual variable analyzed in the comparison between groups. CONCLUSION:The computational methodology developed was able to track the distances traveled by the iris, and thus can be used to help assess visual function in children.
背景:早产儿视觉发育异常和视力受损的风险较高。目的:开发一种计算方法,通过跟踪虹膜距离帮助评估早产儿的功能性视力。方法:这项实验研究的对象是两岁以下的儿童。我们提出了一种视觉刺激图像捕捉模式,以评估垂直和水平视觉跟踪、视野、前庭眼反射和固定等视觉功能。参与者的视觉反应被拍摄下来以组成一个数据集,并使用与 FaceMesh 相结合的 OpenCV 库开发了一种检测算法,用于检测和选择人脸、检测特定的面部点和跟踪虹膜位置。还对软件处理的视频进行了可行性研究。结果:41 名不同年龄和诊断结果的儿童参与了实验研究,形成了一个强大的数据集。该软件在视觉功能评估刺激中跟踪了虹膜位置。此外,在可行性研究中,有 8 名儿童参与,分为早产组和足月儿组。各组之间的视觉变量分析比较均无统计学差异。结论:所开发的计算方法能够跟踪虹膜移动的距离,因此可用于帮助评估儿童的视觉功能。
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引用次数: 0
Music, occupational, physical, and speech therapy interventions for patients in disorders of consciousness: An umbrella review 对意识障碍患者进行音乐、职业、物理和语言治疗干预:综述
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-01-23 DOI: 10.3233/nre-230149
Brooke Murtaugh, Ann-Marie Morrissey, Susan Fager, Heather E. Knight, Jess Rushing, Jennifer Weaver
BACKGROUND:Current clinical guidelines recommend that a multidisciplinary team inclusive of allied healthcare practitioners deliver assessment and intervention for disorders of consciousness. Allied health professionals include music, occupational, physical, and speech therapists. These allied health clinicians are challenged to select interventions due to a lack of evidence-based recommendations regarding rehabilitation interventions that support recovery of consciousness. This umbrella review synthesizes available systematic reviews (SRs) that describe occupational, speech and language, physical and/or musical therapeutic interventions for people with disorders of consciousness. OBJECTIVES:Identify and summarize evidence from systematic reviews (SRs) that examine allied healthcare interventions for patients with disorders of consciousness. Additionally, this umbrella review aims to evaluate the impact of allied health interventions on recovery of consciousness, methodological quality and risk of bias for the included systematic reviews. METHODS:An umbrella review was completed. The review was reported according to the Preferred Reporting Items for Overview of Reviews (PRIOR) guidance. Five academic databases (PubMed, CINAHL, PsycInfo, Web of Science, and the Cochrane Library) were searched for SRs and/or meta-analyses of allied health (i.e., music, occupational, physical, and speech therapy) interventions for disorders of consciousness. For included studies, data were extracted and quality of the SRs appraised using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 checklist. Data extracted from each SR identified the authors and years of primary studies, interventions, comparators, and outcomes related to recovery of consciousness (i.e., neurobehavioral/cognitive), functional status, physiological response pain, and adverse events. Rehabilitation interventions were categorized and described. RESULTS: Fifteen SRs were included and three of these reviews conducted meta-analyses. Identified rehabilitation interventions included: 1) sensory stimulation, 2) median nerve stimulation, 3) communication/environmental control through assistive technology, 4) mobilization, and 5) music-based therapy. SRs were published between 2002 and 2022 and included 2286 participants. Using the AMSTAR 2, the quality of reviews was critically low (k = 6), low (k = 3), moderate (k = 4), and high (k = 2). SRs within this umbrella review demonstrated significant heterogeneity in research methods and use of outcome measures to evaluate the recovery of consciousness within the primary studies. These factors influenced the ability to conduct meta-analyses. CONCLUSIONS:Sensory stimulation, median nerve stimulation, music therapy and mobilization are all interventions that demonstrate some level of benefit, but current SRs fail to prove benefit through high-level quality evidence. There is an indisputable need for continued rehabilitation research to expand op
背景:当前的临床指南建议,由包括专职医疗人员在内的多学科团队对意识障碍进行评估和干预。专职医疗人员包括音乐、职业、物理和语言治疗师。由于缺乏有关支持意识恢复的康复干预措施的循证建议,这些专职医疗人员在选择干预措施时面临挑战。本综述综合了现有的系统综述(SR),这些综述描述了针对意识障碍患者的职业、言语和语言、物理和/或音乐治疗干预措施。目的:确定并总结系统综述(SR)中的证据,这些综述研究了针对意识障碍患者的联合医疗干预措施。此外,本综述还旨在评估联合医疗干预对意识恢复的影响、所纳入系统综述的方法学质量和偏倚风险。方法:我们完成了一项总体综述。该综述根据《综述首选报告项目》(PRIOR)指南进行报告。在五个学术数据库(PubMed、CINAHL、PsycInfo、Web of Science 和 Cochrane Library)中检索了有关联合健康(即音乐、职业、物理和语言治疗)干预意识障碍的 SR 和/或荟萃分析。对于纳入的研究,采用系统综述评估测量工具(AMSTAR)2 核对表提取数据并评估SR的质量。从每篇 SR 中提取的数据确定了主要研究的作者和年份、干预措施、比较者以及与意识恢复(即神经行为/认知)、功能状态、生理反应疼痛和不良事件相关的结果。对康复干预措施进行了分类和描述。结果:共纳入 15 篇综述,其中 3 篇进行了荟萃分析。确定的康复干预措施包括1)感觉刺激;2)正中神经刺激;3)通过辅助技术进行交流/环境控制;4)移动;5)音乐治疗。研究报告发表于 2002 年至 2022 年之间,共纳入 2286 名参与者。根据 AMSTAR 2,综述质量分为极低(k = 6)、低(k = 3)、中(k = 4)和高(k = 2)。本综述中的研究报告显示,主要研究中评估意识恢复的研究方法和结果测量方法存在显著异质性。这些因素影响了进行荟萃分析的能力。结论:感官刺激、正中神经刺激、音乐疗法和动员都是能证明一定程度获益的干预措施,但目前的SR未能通过高质量的证据证明其获益。毋庸置疑,有必要继续开展康复研究,以扩大治疗方式的选择范围,并确保应用于DoC康复的干预措施以证据为基础,从而改善患者的意识和康复状况。
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引用次数: 0
Utility of in-session assessments during cognitive behavioral therapy for depression after traumatic brain injury: Results from a randomized controlled trial 认知行为疗法治疗脑外伤后抑郁期间的会话评估的效用:随机对照试验的结果
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-01-23 DOI: 10.3233/nre-230218
Jennifer M. Erickson, Ryan Williams, Charles H. Bombardier, Jesse R. Fann
BACKGROUND:The development of depression after moderate to severe traumatic brain injury (TBI) is common. Cognitive-behavioral therapy (CBT) can be used to treat post-TBI depression, but the symptoms response is poorly described. OBJECTIVE:This secondary analysis assessed: (1) the trajectory of depression symptoms up to 12 sessions of CBT, (2) which depressive symptom clusters were responsive to in-person and phone CBT, and (3) whether interim depression thresholds predict 16-week treatment response. METHOD:This secondary analysis of the IRB-approved Life Improvement Following Traumatic Brain Injury trial included 100 adults with major depressive disorder (MDD) within ten years of moderate to severe traumatic brain injury from throughout the US. We used a combination of descriptive, graphical, and diagnostic accuracy methods. RESULTS:Cardinal and cognitive-affective symptom clusters improved most from CBT over 16 weeks. At 8 and 16 weeks, the most responsive individual symptoms were anhedonia, depressed mood, and fatigue; the least responsive were sleep and appetite. PHQ-9 thresholds with a Negative Predictive Value greater than 0.7 for sessions 6, 7, and 8 were, respectively: >15, >10, and >9. CONCLUSION:In-person and phone CBT led to similar symptom responses during treatment. Additionally, using PHQ-9 thresholds for predicting intervention response within eight sessions may help identify the need for treatment adjustments.
背景:中度至重度创伤性脑损伤(TBI)后出现抑郁症很常见。认知行为疗法(CBT)可用于治疗创伤性脑损伤后抑郁症,但对症状反应的描述却很少。目的:这项二次分析评估了:(1)抑郁症状在接受 12 次 CBT 治疗后的变化轨迹;(2)哪些抑郁症状群对面对面和电话 CBT 治疗有反应;(3)中期抑郁阈值是否能预测 16 周的治疗反应。方法:这是对经 IRB 批准的 "创伤性脑损伤后生活改善 "试验进行的二次分析,包括来自美国各地的 100 名在中度至重度创伤性脑损伤后十年内患有重度抑郁症(MDD)的成人。我们结合使用了描述性、图表和诊断准确性方法。结果:在16周的CBT治疗中,心因性症状和认知情感症状群得到了最大改善。在 8 周和 16 周时,反应最明显的单个症状是失神、情绪低落和疲劳;反应最不明显的是睡眠和食欲。在第 6、7 和 8 次治疗中,PHQ-9 阴性预测值大于 0.7 的阈值分别为:15、10 和 9。结论:在治疗过程中,面对面和电话 CBT 可导致相似的症状反应。此外,使用 PHQ-9 阈值预测八个疗程内的干预反应可能有助于确定是否需要调整治疗方案。
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引用次数: 0
Prognosis and enhancement of recovery in disorders of consciousness 意识障碍的预后和恢复能力的提高
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-01-23 DOI: 10.3233/nre-230148
Mary E. Russell, Flora M. Hammond, Brooke Murtaugh

Abstract

Disorders of consciousness after severe brain injury encompass conditions of coma, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state. DoC clinical presentation pose perplexing challenges to medical professionals, researchers, and families alike. The outcome is uncertain in the first weeks to months after a brain injury, with families and medical providers often making important decisions that require certainty. Prognostication for individuals with these conditions has been the subject of intense scientific investigation that continues to strive for valid prognostic indicators and algorithms for predicting recovery of consciousness. This manuscript aims to provide an overview of the current clinical landscape surrounding prognosis and optimizing recovery in DoC and the current and future research that could improve prognostic accuracy after severe brain injury. Improved understanding of these factors will aid healthcare professionals in providing optimal care, fostering hope, and advocating for ethical practices in the management of individuals with DoC.

摘要 严重脑损伤后的意识障碍包括昏迷、植物人状态/无反应清醒综合征和微意识状态。意识障碍的临床表现给医疗专业人员、研究人员和家属带来了令人困惑的挑战。在脑损伤后的最初几周到几个月内,结果是不确定的,家属和医疗服务提供者往往需要做出确定性的重要决定。对这些患者的预后诊断一直是科学研究的热点,研究人员一直在努力寻找有效的预后指标和预测意识恢复的算法。本手稿旨在概述目前围绕 DoC 预后和优化恢复的临床情况,以及当前和未来可提高严重脑损伤后预后准确性的研究。加深对这些因素的了解将有助于医护人员提供最佳护理、培养希望并倡导在管理 DoC 患者时采取合乎道德的做法。
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引用次数: 0
Ethical issues of nosology in disorders of consciousness 意识障碍的命名伦理问题
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-01-23 DOI: 10.3233/nre-230120
Nathaniel M. Robbins MD, James L. Bernat MD
The current classification scheme for severe disorders of consciousness (DoC) has several shortcomings. First, there is no consensus on how to incorporate patients with covert consciousness. Second, there is a mismatch between the definitions of severe DoC, based on consciousness, and the diagnosisof these same DoC, which is based on observable motoric responsiveness. Third, current categories are grouped into large heterogeneous syndromes which share phenotype, but do not incorporate underlying pathophysiology. Here we discuss several ethical issues pertaining to the current nosology of severe DoC. We conclude by proposing a revised nosology which addresses these shortcomings.
目前对严重意识障碍(DoC)的分类方案有几个缺陷。首先,在如何纳入隐蔽意识障碍患者方面尚未达成共识。其次,以意识为基础的严重意识障碍定义与以可观察到的运动反应为基础的严重意识障碍诊断之间存在不匹配。第三,目前的分类归纳为多种不同的综合征,这些综合征具有相同的表型,但并不包含潜在的病理生理学。在此,我们讨论了与当前严重 DoC 命名相关的几个伦理问题。最后,我们将针对这些缺陷提出一个修订后的命名法。
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引用次数: 0
Efficacy of balance exercises intervention on postural control-related impairment in children with sensorineural hearing loss 平衡练习对感音神经性听力损失儿童姿势控制相关障碍的干预效果
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-01-23 DOI: 10.3233/nre-230284
Roshdy M. Kamel, Alaaeldin Khaireldin, Mohamed A. Gad Allah, Ramez Yousry Fawzy Bakhoom, Nadia Mohamed Abdelhakiem, Elsayed S. Mehrem
BACKGROUND:Sensorineural hearing loss is the most common type of permanent hearing impairment and results in postural control and motor deficits in children that may affect or delay all developmental indicators. OBJECTIVE:The purpose of the study was to investigate the efficacy of balance exercisesintervention on postural control-related impairment in children with sensorineural hearing loss. METHODS:Forty students of both genders, ages ranging from 10 to 16 years, diagnosed with severe to profound sensorineural hearing loss, were selected from the Public School for the Deaf and Hard of Hearing in El-Minia district, Minia governorate, Egypt. They divided randomly into two groups, 20 (study group), received balance exercises in addition to their ordinary daily living activities. Meanwhile, the control group of 20 children practiced only the ordinary daily living activities. The outcome was assessed pre-treatment and post-treatment by Humac Balance System and Bruininks-Oseretsky Test (BOT-2) subtest (5) for balance. RESULTS:Regarding the Humac balance system and subtest (5) of BOT-2, there was a statistically significant difference between pre-treatment data and post-treatment data of the study group with a p value equal to 0.036 or less. However, no statistically significant difference was observed in the control group with a p value equal to 0.096 or more. Finally, there was a statistically significant difference between the groups with respect to the post-treatment data, where the p value was 0.014 or less. CONCLUSION:Postural control of children with sensorineural hearing loss has been improved by balance exercises.
背景:感音神经性听力损失是最常见的永久性听力障碍,会导致儿童姿势控制和运动障碍,从而影响或延迟各项发育指标。目的:本研究旨在探讨平衡练习对感音神经性听力损失儿童姿势控制相关障碍的干预效果。方法:研究人员从埃及米尼亚省米尼亚地区的公立聋哑学校选取了 40 名被诊断为重度至极重度感音神经性听力损失的男女学生,他们的年龄从 10 岁到 16 岁不等。他们被随机分为两组,研究组的 20 名儿童在日常活动之外还接受了平衡训练。与此同时,对照组的 20 名儿童只进行普通的日常生活活动。治疗前和治疗后的结果由Humac平衡系统和Bruininks-Oseretsky测试(BOT-2)的平衡子测试(5)进行评估。结果:在 Humac 平衡系统和 BOT-2 测试子测试(5)方面,研究组治疗前数据与治疗后数据之间存在显著统计学差异,P 值等于或小于 0.036。然而,对照组没有观察到明显的统计学差异,P 值等于或大于 0.096。最后,在治疗后的数据方面,研究组与对照组之间存在明显的统计学差异,P 值等于或小于 0.014。结论:平衡练习改善了感音神经性听力损失儿童的姿势控制能力。
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引用次数: 0
The Life After Stroke In Northern Sweden Study (LASINS): Methodology, cohort demographics and initial results 瑞典北部中风后生活研究(LASINS):研究方法、队列人口统计和初步结果
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-01-22 DOI: 10.3233/nre-230278
Maria Kähler, Hanna M. Nilsson, Jan Lexell

Abstract

BACKGROUND:

To advance rehabilitation we need a comprehensive understanding of functioning and disability of people after stroke.

OBJECTIVE:

To present an overview of the methodology of the Life After Stroke In Northern Sweden Study, compare participants and non-participants regarding gender and age, and describe baseline sociodemographics, stroke characteristics and the participants’ self-rated degree of recovery.

METHODS:

Data were collected through a study specific questionnaire, from the participants’ medical records and with internationally established self-assessment tools focusing on sleep disturbances, depressive symptoms, fatigue, physical activity, and remaining physical and cognitive impairments, activity limitations, participation restrictions and life satisfaction.

RESULTS:

Of 301 potential participants, 160 comprise the final sample (response rate 53% ; 86 men and 74 women, mean age 73 years±26, mean time since stroke onset 35 months±11; 18– 61). Most participants had an ischemic stroke (87%), were retired (84%), cohabitant (63%) and walked independently (71%). The mean self-rated degree of recovery was 75 (SD±24; 0– 100).

CONCLUSIONS:

These baseline data together with forthcoming studies will describe stroke-related impairments, activity limitations, participation restrictions and life satisfaction more than one year after stroke, and deepen our understanding of factors of importance for a healthy and successful life after stroke.

摘要背景:为了促进康复,我们需要全面了解中风后患者的功能和残疾情况。目的:概述瑞典北部中风后生活研究(Life After Stroke In Northern Sweden Study)的方法,比较参与者和非参与者的性别和年龄,并描述基线社会人口统计、中风特征和参与者的自评康复程度。结果:在 301 位潜在参与者中,有 160 位构成了最终样本(回复率为 53%;男性 86 人,女性 74 人;平均年龄为 73 岁(±26)岁;平均卒中发病时间为 35 个月(±11)个月;18- 61 岁)。大多数参与者患有缺血性中风(87%),退休(84%),同居(63%),独立行走(71%)。结论:这些基线数据和即将开展的研究将描述中风一年多后与中风相关的损伤、活动限制、参与限制和生活满意度,并加深我们对中风后健康和成功生活重要因素的理解。
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引用次数: 0
Comorbid treatment of traumatic brain injury and mental health disorders 创伤性脑损伤和精神疾病的合并治疗
IF 2 4区 医学 Q2 Medicine Pub Date : 2024-01-20 DOI: 10.3233/nre-230235
Katie A. Ragsdale, Anastacia A. Nichols, Mansi Mehta, Jessica L. Maples-Keller, Carly W. Yasinski, Courtland S. Hyatt, Laura E. Watkins, Laura A. Loucks, Elizabeth Carbone, Sheila A. M. Rauch, Barbara O. Rothbaum
BACKGROUND:The Emory Healthcare Veterans Program (EHVP) is a multidisciplinary intensive outpatient treatment program for post-9/11 veterans and service members with invisible wounds, including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), substance use disorders (SUD), and other anxiety- and depression-related disorders. OBJECTIVE:This article reviews the EHVP. METHODS:The different treatment tracks that provide integrated and comprehensive treatment are highlighted along with a review of the standard, adjunctive, and auxiliary services that complement individualized treatment plans. RESULTS:This review particularly emphasizes the adjunctive neurorehabilitation service offered to veterans and service members with a TBI history and the EVHP data that indicate large reductions in PTSD and depression symptoms across treatment tracks that are maintained across 12 months follow up. Finally, there is a discussion of possible suboptimal treatment response and the pilot programs related to different treatment augmentation strategies being deploying to ensure optimal treatment response for all. CONCLUSION:Published data indicate that the two-week intensive outpatient program is an effective treatment program for a variety of complex presentations of PTSD, TBI, SUD, and other anxiety- and depression-related disorders in veterans and active duty service members.
背景:埃默里退伍军人医疗保健计划(EHVP)是一项多学科强化门诊治疗计划,针对 9/11 事件后的退伍军人和有隐形创伤的军人,包括创伤后应激障碍(PTSD)、创伤性脑损伤(TBI)、药物使用障碍(SUD)以及其他焦虑和抑郁相关障碍。目的:本文回顾了 EHVP。方法:文章重点介绍了提供综合全面治疗的不同治疗路径,以及补充个性化治疗计划的标准、辅助和辅助服务。结果:本综述特别强调了为有创伤性脑损伤病史的退伍军人和军人提供的辅助性神经康复服务,以及 EVHP 的数据,这些数据表明,在不同的治疗方案中,创伤后应激障碍和抑郁症状都有明显的减轻,并且在 12 个月的随访期间仍能保持。最后,还讨论了可能出现的次优治疗反应,以及与正在部署的不同治疗增强策略相关的试点项目,以确保所有人都能获得最佳治疗反应。结论:已发表的数据表明,为期两周的门诊强化治疗项目对退伍军人和现役军人的创伤后应激障碍、创伤后应激障碍、自发性精神障碍以及其他焦虑和抑郁相关障碍的各种复杂表现都是有效的治疗项目。
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NeuroRehabilitation
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