Brain Impairment最新文献

Background Stroke now represents the condition with the highest need for physical rehabilitation worldwide, with only low or moderate-level evidence testing telerehabilitation compared to in-person care. We compared functional ambulation in subacute patients with stroke following telerehabilitation and matched in-person controls with no biopsychosocial differences at baseline. Methods We conducted a matched case-control study to compare functional ambulation between individuals with stroke following telerehabilitation and in-person rehabilitation, assessed using the Functional Ambulation Categories (FAC) and the Functional Independence Measure™ (FIM). Results The telerehabilitation group (n =38) achieved significantly higher FAC gains (1.5 (1.3) vs 1.0 (1.0)) than the in-person rehabilitation group, with no differences in ambulation efficiency, in individuals: admitted to rehabilitation within 60days after stroke onset; aged 49.8 (±11.4) years at admission; 55.3% female sex; moderate stroke severity; 42.1% with 'good' motor FIM at baseline; mostly living with sentimental partner (73.7%); with 21.1% holding an university education degree. Conclusions The groups showed no significant differences in ambulation efficiency, though the telerehabilitation group achieved higher FAC gains. Our results suggest that home telerehabilitation can be considered a good alternative to in-person rehabilitation when addressing ambulation in patients with moderate stroke severity and whose home situation mostly includes a cohabiting partner.

Background Many people with traumatic brain injury (TBI) report problems with social functioning that can have immediate and enduring impacts. We aimed to explore perceptions of social functioning after TBI and understand attitudes towards medication that could improve long-term social outcomes. Method A qualitative descriptive approach using interview methods was conducted in Victoria, Australia. Using purposive sampling we conducted 15 semi-structured interviews with people with moderate to severe TBI between July and September 2021. Results Using a framework approach, we thematically identified three themes: (1) impacts of TBI on social roles and activities, including changes in recreational activities and role changes in family units; (2) change in social networks, resulting from shifts in attitudes to social activities and mental health issues; and (3) openness to novel treatments to improve social functioning - willingness to take potential medication to improve social functioning and the factors that have an impact on decision making. Conclusion Our results highlight that people with TBI experience a range of changes in social participation post-TBI, and that they have a strong interest in improving their social functioning. Such insights provide opportunities to tailor patient-centric treatments and circumnavigate barriers in the early stages of medication development for successful translation into practice in this population.

Background This scoping review aimed to identify literature describing allied health interventions used to address challenging behaviour for adults with an acquired brain injury (ABI) living in community settings and identify the impact of these interventions on outcomes across the domains of behaviour, activity, and participation. Methods The Polyglot Search Translator for scoping reviews guided the search of six databases: (1) Ovid Medline®, (2) EmCARE (Ovid), (3) CINAHL Complete, (4) Embase (Ovid), (5) Scopus, and (6) Cochrane Library to identify literature published between 1990 and 2023. Results Of the 1748 records screened, 16 articles met the inclusion criteria. Studies commonly described therapeutic, least restrictive approaches to challenging behaviour founded on a positive behaviour support framework. Interventions were individualised, combining multiple elements to effect change in the environment, behaviour of the people providing support, and/or skills and behaviour of the person with ABI. Although most studies reported clinical gains from intervention, study designs used a range of methods and either single cases or mixed populations. Conclusions The findings of this review suggest that allied health interventions have the potential to reduce challenging behaviour experienced by people with ABI. However, further research addressing the impact of interventions on activity and participation is required to inform clinical practice and improve long-term outcomes.

Background: A recent consensus statement on post-stroke fatigue noted the Fatigue Severity Scale (FSS) should be the primary outcome measure in post-stroke fatigue research. It also noted that data to calculate clinically reliable changes on the FSS have not been established for stroke. We present FSS data collected at 1 and 12 months post stroke, allowing the assessment of clinically reliable change by stroke type and subtype for ischaemic stroke (IS).

Methods: The sample included all participants of the fifth Auckland Region Community Outcomes of Stroke study (ARCOS-V) who consented and had FSS data (n = 338). Stroke type was recorded (IS, intracerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH)), and IS subtypes were defined using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications. 'Clinically reliable change' between 1 and 12 month FSS scores was calculated using Jacobsen and Traux's updated formula.

Results: Participants with ICH had the highest FSS scores at 1 month. Across IS subtypes, those with small vessel disease had the highest FSS scores at 1 month, and this increased at 12 months. Statistically significant reductions in mean FSS were found for patients with IS of other aetiology and SAH. Regarding clinically reliable changes, the greatest proportion of individuals had no clinically reliable change in FSS, up to 20% experienced reliable reductions, and 0-11% experienced reliable increases in FSS scores.

Conclusion: Although most participants had no clinically reliable change in fatigue between 1 and 12 months, statistically significant reductions in FSS were identified for patients with IS and SAH. Of those who did experience reliable change, the majority had reductions in fatigue over time.

Background Depression is commonly studied post stroke, while anxiety is less studied. This study presents prevalence of depression and anxiety at 1- and 12-months post ischemic stroke alongside three methods for examining within-subjects change over time. Methods Participants were ischemic stroke patients of the Auckland Regional Community Stroke Study (ARCOS-V) with Hospital Anxiety and Depression Scale data at 1- (n =343) and 12-months (n =307). Change over time was examined using within-subjects repeated measures ANOVA, calculation of the Reliable Change Index, and a Sankey diagram of those meeting cut-off scores (>7) for caseness over time. Results Using repeated measures ANOVA, depression scores didn't change significantly over time, while anxiety symptoms decreased significantly. When reliable change was calculated, 4.2% of individuals had reliable decreases in anxiety symptoms, while 5.7% had reliable decreases in depression symptoms. Those who had a reliable decrease in one tended to have a reliable decrease in the other. In the Sankey, the proportion of those meeting the cut-off score for anxiety did not change over time (12.8 and 12.7% at 1- and 12-months), while those meeting the cut-off for depression increased slightly (3.7-4.5%) and those meeting cut-offs for both decreased from 10.4 to 8.1%. Conclusion The three methods produced very different findings. Use of cut-off scores is common but has limitations. Calculation of clinically reliable change is recommended. Further work is needed to ensure depression and anxiety are monitored over time post-stroke, and both should be the subject of intervention efforts in both acute and late stages post-stroke.

Background and objectives Falls research has explored the characteristics of patients with a brain injury who experienced falls and the nature of these falls. However, the characteristics of falls with consequence have not yet been investigated. This study aimed to explore the consequences of patient falls in inpatient brain injury rehabilitation. Method Data were retrospectively analysed from incident reports and patient medical charts. Participants were included who had fallen during brain injury rehabilitation at a metropolitan hospital between January 2017 and December 2021. Falls with a reported consequence including pain, laceration, soft tissue injury, fracture and traumatic brain injury (consequential falls) were compared to falls that did not have a consequence. Significant patient and fall variables for a fall with consequence were explored. Results Over the 5-year study period 855 patients were admitted and 161 patients (64% male) experienced 276 falls. Of the 161 patients, 90 (56%) experienced a consequence from one or more falls, with 119 (43%) of falls having consequences. The odds of a consequential fall increased 1.03 times for each year increase in age. The odds of a consequential fall in autumn, winter, and spring were two to three times higher than in summer and were 3.6 times higher when the fall was unwitnessed by staff. Conclusions More falls with consequence occurred with increasing age and when unwitnessed by staff. This knowledge supports the need for older persons to have additional supervision and assistance during inpatient brain injury rehabilitation to reduce harm from falls.

Background We aimed to investigate the association between protein intake and quadriceps quantity and quality on the paretic and non-paretic sides during rehabilitation in people with subacute stroke. Method Eighty-six people with stroke were recruited from a rehabilitation ward. We measured quadriceps muscle quantity and quality on the paretic and non-paretic sides using ultrasonography at admission and after 4weeks. Protein intake was assessed 2 or 3weeks after admission, and participants were classified into two groups: adequate and inadequate protein intake groups. Analysis of covariance was used to determine the effects of protein intake on quadriceps muscle quantity and quality. Results The mean age (standard deviation), median interval between stroke onset and admission (interquartile range) and male proportion of the study participants were 67.6 (13.5) years, 22.5 (16.8-31.3) days, and 54.7%, respectively. The adequate protein intake group showed significantly greater improvements in paretic-side quadriceps thickness than the inadequate group (group-by-time interaction, F =8.771, P =0.004). In contrast, no significant interactions were observed in quadriceps thickness on the non-paretic side (F =2.383, P =0.127) and quadriceps echo intensity on both sides (paretic-side: F =0.020, P =0.887, non-paretic side: F =0.181, P =0.672). Conclusions Adequate protein intake may be useful for improving quadriceps quantity on the paretic side in people with subacute stroke undergoing rehabilitation. However, quadriceps quantity on the non-paretic side and quadriceps quality on both sides were not significantly associated with adequate protein intake.

Background Wearable devices, such as accelerometers, offer novel approaches to measuring post-stroke upper limb activity. Limited studies have explored feasibility of accelerometry. Guided by the Bowen Feasibility Framework, this feasibility study aimed to examine the practicality, acceptability, and limited efficacy of accelerometry in a self-directed upper limb program with stroke survivors using a pre-post study of sequentially eligible inpatients. Method Key metrics were: practicality (60% of participants had 10hours of wear per day for 3 or more days), acceptability (adherence to recommended wear-time), and limited efficacy (correlation between Wolf Motor Function Test (WMFT) and upper limb use from accelerometry data). Results Twelve stroke survivors were recruited over 7 months, mean age 73years (range 39-94years). Eight participants (67%) met the practicality and acceptability criteria. A moderate positive correlation existed between WMFT and upper limb use at admission (r s =0.33, P =0.42) and at discharge (r s =0.42, P =0.34). Conclusion Wearable devices were feasible and acceptable for most stroke survivors, however, one-third found the devices uncomfortable, and this should be factored into sample size calculations of future studies.

Background Understanding health professional perceptions and experiences when supporting post-stroke physical activity may assist with development of strategies targeting low physical activity observed in this group. The aims of this study were to explore health professionals' perceptions and experiences of post-stroke physical activity, the barriers they experience and potential facilitators when supporting people with stroke to be active. Methods Ten focus groups were conducted with 57 health professionals (physiotherapists, occupational therapists, nurses, exercise physiologists, psychologists and sports scientists) and allied health students. Data were analysed via inductive thematic analysis. Results Health professionals were reluctant to recommend moderate intensity physical activity. Barriers included: (1) post-stroke barriers being varied and individual; (2) resources being under pressure and (3) physical activity goals falling through the cracks. Suggested facilitators included: (1) clearly defined roles, processes and environments which encourage activity; (2) funding for more staff; (3) improving health professional skills and confidence and (4) using internal motivation and social supports after stroke. Conclusions Post-stroke physical activity is a complex goal. Varied and individual barriers require tailored solutions. Health professionals report insufficient time, resources and skills to address these individual barriers as well as limited pathways to access physical activity support. Resource-efficient interventions and care models that allow routine strategies targeting post-stroke physical activity are required.