Disability Rating Scale Scores Research Articles

Iodine-based Dual-Energy CT of Traumatic Hemorrhagic Contusions: Relationship to In-Hospital Mortality and Short-term Outcome.

BackgroundTraumatic hemorrhagic contusions are associated with iodine leak; however, quantification of leakage and its importance to outcome is unclear.PurposeTo identify iodine-based dual-energy CT variables that correlate with in-hospital mortality and short-term outcomes for contusions at hospital discharge.Materials and MethodsIn this retrospective study, consecutive patients with contusions from May 2016 through January 2017 were analyzed. Two radiologists evaluated CT variables from unenhanced admission head CT and follow-up head dual-energy CT scans obtained after contrast material-enhanced whole-body CT. The outcomes evaluated were in-hospital mortality, Rancho Los Amigos scale (RLAS) score, and disability rating scale (DRS) score. Logistic regression and linear regression were used to develop prediction models for categorical and continuous outcomes, respectively.ResultsThe study included 65 patients (median age, 48 years; interquartile range, 25-65.5 years); 50 were men. Dual-energy CT variables that correlated with mortality, RLAS score, and DRS score were iodine concentration, pseudohematoma volume, iodine quantity in pseudohematoma, and iodine quantity in contusion. The single-energy CT variable that correlated with mortality, RLAS score, and DRS score was hematoma volume at follow-up CT. Multiple logistic regression analysis after inclusion of clinical variables identified two predictors that enabled determination of mortality: postresuscitation Glasgow coma scale (P-GCS) (adjusted odds ratio, 0.42; 95% confidence interval [CI]: 0.2, 0.86; P = 0.01) and iodine quantity in pseudohematoma (adjusted odds ratio, 1.4 per milligram; 95% CI: 1.02 per milligram, 1.9 per milligram; P = 0.03), with a mean area under the receiver operating characteristic curve of 0.96 ± 0.05 (standard error). For RLAS, the predictors were P-GCS (mean coefficient, 0.32 ± 0.06; P < .001) and iodine quantity in contusion (mean coefficient, -0.04 per milligram ± 0.02; P = 0.01). Predictors for DRS were P-GCS (mean coefficient, -1.15 ± 0.27; P < .001), age (mean coefficient, 0.13 per year ± 0.04; P = .002), and iodine quantity in contusion (mean coefficient, 0.19 per milligram ± 0.07; P = .02).ConclusionIodine-based dual-energy CT variables correlate with in-hospital mortality and short-term outcomes for contusions at hospital discharge.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Talbott and Hess in this issue.

Longitudinal Changes in Disability Rating Scale Scores: A Secondary Analysis Among Patients With Severe TBI Enrolled in the Epo Clinical Trial.

Long-term neurological response to treatment after a severe traumatic brain injury (sTBI) is a dynamic process. Failure to capture individual heterogeneity in recovery may impact findings from single endpoint sTBI randomized controlled trials (RCT). The present study re-examined the efficacy of erythropoietin (Epo) and transfusion thresholds through longitudinal modeling of sTBI recovery as measured by the Disability Rating Scale (DRS). This study complements the report of primary outcomes in the Epo sTBI RCT, which failed to detect significant effects of acute treatment at 6 months post-injury. We implemented mixed effects models to characterize the recovery time-course and to examine treatment efficacy as a function of time post-injury and injury severity. The inter-quartile range (25th-75th percentile) of DRS scores was 20-28 at week1; 8-24 at week 4; and 3-17 at 6 months. TBI severity group was found to significantly interact with Epo randomization group on mean DRS recovery curves. No significant differences in DRS recovery were found in transfusion threshold groups. This study demonstrated the value of taking a comprehensive view of recovery from sTBI in the Epo RCT as a temporally dynamic process that is shaped by both treatment and injury severity, and highlights the importance of the timing of primary outcome measurement. Effects of Epo treatment varied as a function of injury severity and time. Future studies are warranted to understand the possible moderating influence of injury severity on treatment effects pertaining to sTBI recovery. (JINS, 2019, 25, 293-301).

Early recovery following traumatic brain injury and alcohol withdrawal management.

To compare recovery experienced during inpatient rehabilitation among individuals with traumatic brain injury (TBI) based on whether their acute care included the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol. Participants included 234 individuals with TBI who completed inpatient rehabilitation at a TBI Model Systems site. Of these, 67 patients were treated using the CIWA protocol (TBI + CIWA); 167 patients were treated for TBI alone (TBI only). Demographic, injury, and treatment variables between the 2 groups were compared. A repeated-measures analysis of variance (ANOVA) compared Disability Rating Scale (DRS) scores between the groups at admission and discharge from inpatient rehabilitation. The 2 groups did not significantly differ on DRS scores at admission to inpatient rehabilitation: TBI + CIWA, M = 9.6 (SD = 3.5) vs. TBI only, M = 10.1 (SD = 4.2). There was a significant difference in DRS scores at discharge, with the TBI + CIWA group having lower scores: TBI + CIWA, M = 6.4 (SD = 1.9) vs. TBI only, M = 7.0 (SD = 2.2). A repeated-measures ANOVA of DRS scores from admission to discharge revealed a significant between-subjects effect based on patients' Mississippi categorization of posttraumatic amnesia (PTA) duration (p < .001) and age (p = .016) but not based on their CIWA status (p = .068). A post hoc comparison including age as a covariate revealed a significant difference based on CIWA status (p = .013) within the "moderate" injury group at discharge, with the TBI + CIWA group having lower discharge DRS scores. Given the significant symptom overlap between alcohol withdrawal and PTA, it is likely that these 2 delirium presentations are confounded during the initial recovery from TBI, leading to "overestimation" of injury severity-particularly among individuals with moderate TBI. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Serum vitamin D deficiency in subjects with severe acquired brain injury and relationship with functional severity

ABSTRACTBackground: Vitamin D may be important for the development and function of the nervous system. Low serum vitamin D levels have been detected in several neurological diseases.Objective: To ascertain the relationship between 25(OH)D serum level and disability in subjects with severe acquired brain injury (sABI).Design: Prospective cross-sectional studyMethods: Consecutive subjects with sABI admitted to neuro-rehabilitation were enrolled. A sample of subjects from the neurological ward was considered the control group. Vitamin D serum levels and blood parameters were measured at admission. Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS), and Level of Cognitive Functioning (LCF) were used in assessing disability.Results: A total of 104 subjects (34 F, 70 M; mean age 53.9 ± 15.2 years) were enrolled: 54 (19 F, 35 M) with sABI and 50 (15 F, 35 M) subjects as control group. Deficient mean serum levels of vitamin D (19.2 ± 9.4 ng/mL) were detected in the subjects with sABI and a significant inverse correlation between vitamin D serum levels and DRS score was detected (p = 0.04).Conclusion: Subjects with sABI showed vitamin D deficiency that might correlate to disability severity. The reason is unclear and might represent a secondary phenomenon resulting from the inflammatory process.

Post-traumatic brain injury olfactory dysfunction: Factors influencing quality of life

Introduction/Background Previous studies have explored the quality of life (QoL) in people with olfactory dysfunction from various aetiologies. However, knowledge on QoL in people with post-traumatic brain injury (TBI) olfactory dysfunction is still limited. This study evaluates the impact of post-TBI olfactory dysfunction on QoL and determine factors influencing resultant QoL. Material and method A case-control study conducted in a single centre on 30 TBI adults with olfactory dysfunction; matched by age and gender with 32 TBI controls having intact olfactory function. All 64 adults self-rated their olfactory function using a Visual Analogue Scale (VAS). Sniffin’ Sticks test was used as an objective olfactory function assessment and results measured as TDI (Threshold, Discrimination and Identification) score. QoL was determined by a self-rated questionnaire; Questionnaire for Olfactory Disorders (QOD). Influential factors evaluated include age, gender, employment, level of education, marital status, smoking habit, TBI-related clinical information and Disability Rating Scale (DRS) score. A correlation test between the VAS and natural log TDI was also conducted. Results Mean QOD score of case group was significantly higher than control group (26.31 ± 14.37 vs 9.44 ± 8.30 respectively; P Conclusion Individuals with post-TBI olfactory dysfunction are at higher risk of developing a lower QoL. One of the factors influencing this is the severity of olfactory dysfunction itself.

Functional Outcomes of an Interdisciplinary Outpatient Rehabilitation Program for Patients with Malignant Brain Tumors

BackgroundMalignant brain tumors cause significant impairments in function because of the nature of the disease. Nevertheless, patients with malignant brain tumors can make functional gains equivalent to those with stroke and traumatic brain injury in the inpatient rehabilitation setting. However, the efficacy of outpatient rehabilitation in this population has received little study. ObjectiveTo determine if an interdisciplinary outpatient rehabilitation program will improve functional outcomes in patients with malignant brain tumors. DesignNonrandomized prospective longitudinal study. SettingSix affiliated outpatient sites of one institution. PatientsForty-nine adults with malignant brain tumors were enrolled. MethodsPatients received interdisciplinary therapy services, with duration determined by the therapist evaluations. The therapists scored the Day Rehabilitation Outcome Scale (DayROS) and Disability Rating Scale (DRS) on admission and discharge. The caregivers filled out the DRS at discharge, 1 month, and 3 months after discharge. Main Outcome MeasurementsThe primary study outcome measure was the DayROS, which is a functional measure similar to the Functional Independence Measure. DRS was another functional outcome measure assessing basic self-care, dependence on others, and psychosocial adaptability. ResultsForty-six of 49 enrolled patients (94%) completed the day rehabilitation program. The average length of stay was 76.9 days. There was a significant improvement in total DayROS (P < .001), mobility (P < .001), Activities of Daily Living ( P < .001), and communication (P < .001) DayROS subscores from admission to discharge. There were no significant changes over time in the DRS scores. Women had higher DayROS gains (P = .003) and better therapist DRS scores from admission to discharge than men (P = .010). ConclusionsPatients with malignant brain tumors can make functional gains in an interdisciplinary outpatient rehabilitation program. This level of care should be considered in this patient population. Level of EvidenceII

Frontal assessment battery (FAB) performance following traumatic brain injury hospitalized in an acute care setting

ABSTRACTThe Frontal Assessment Battery (FAB) has been shown to be useful in several clinical settings. The aim of the present study was to examine the performance of patients with traumatic brain injury (TBI) on the FAB and to predict their acute outcome. The FAB was administered to 89 patients with mild (27 = uncomplicated and 39 = complicated) and moderate (n = 23) TBI during hospitalization in an acute care setting. The length of stay in days (LOS), Glasgow Outcome Scale-Revised score (GOSE) and Disability Rating Scale (DRS) score were collected. Results showed no significant differences between the three groups on the FAB score, but age and education were significantly associated with the FAB score. Parietal lesions were associated with lower total FAB score, and with the Similarities, Motor series and Conflicting instructions subscales, while frontal lesions were associated with lower performance on the Motor series and Conflicting instructions subscales. Total FAB score was significantly correlated with all outcome measures, and together the FAB total score and the Glasgow Coma Scale (GCS) score explained 30.8% of the variance in the DRS score. The FAB may be useful clinically to acutely assess frontal and parietal lobe functions at bedside in patients with TBI and, in combination with the GCS score to measure TBI severity, can enable clinicians to predict early outcome.

Cost effectiveness of integrated care in patients with acquired brain injury

Introduction : Integrated care and Rehabilitation following acquired brain injury improves health outcomes, reduces disability, and improves quality of life. We assessed the cost effectiveness of inpatient rehabilitation after brain injury in individuals with brain injury admitted to the Irish national tertiary specialist rehabilitation centre in 2011. The brain injury team – which consists of a specialist multidisciplinary team including Doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, psychologists, clinical nutritionists, pharmacists and medical social workers – work with patients and their families and carers to achieve the best possible outcome for the patient with a person centred inpatient programme tailored to meet each patient's individual needs. Methods : The study included all patients discharged between 1 January 2011 and 31 December 2011 from the NRH Brain Injury Programme under one of the NRH rehabilitation consultants(AC).Patients’ score on the Disability Rating Scale (DRS) was recorded on admission and at discharge after intensive inpatient rehabilitation. Cost savings attributed to the rehabilitation programme were calculated as the difference between direct care costs on admission and discharge. Direct costs of care were calculated as the weekly cost of the care-assistant hours required to care for patients on the basis of their level of disability or daily nursing-home bed cost when this was required. Results : Of 63 patients, complete DRS information for admission and discharge was available for 41. DRS scores, and therefore average levels of functioning, differed significantly at admission (2.3, between mildly and moderately dependent) and discharge (1.1, independent in special environments, p Average weekly care costs fell from €629 to €242, with costs recouped within 30 months. Discussion : Although the cost of inpatient rehabilitation in this group is expensive initially, in the medium term these costs are covered by the savings in care costs. Ceiling and floor effects of dependency scales can result in underestimation of cost-effectiveness of rehabilitation.Thus, substantial savings result from inpatient rehabilitation, and these savings could have been greater had we considered also the economic benefit of enabling patients to return to employment. Limitations : A randomised controlled trial of rehabilitation versus no rehabilitation would provide more information but would generate an ethical dilemma, in that it would necessitate denying treatment, which is considered standard and has sufficient evidence to support its use, to a group of individuals. We have looked only at financial savings in this study. An analysis of gains in quality of life would clearly provide a more accurate reflection of the value of inpatient rehabilitation. Conclusion : This is the first analysis of the cost effectiveness of inpatient rehabilitation in an Irish setting. We have shown that, on average, the cost of inpatient rehabilitation is covered by the savings resulting from reductions in dependency within 30 months. Inpatient rehabilitation seems to be most cost effective in individuals with brain injury who are markedly dependent on admission, with only 15.6 months required to cover the inpatient cost in this group. After this time, calculated savings of over €50,000 per patient annually can be expected.

Right median nerve electrical stimulation for acute traumatic coma (the Asia Coma Electrical Stimulation trial): study protocol for a randomised controlled trial

BackgroundTraumatic brain injury (TBI) has become the most common cause of death and disability in persons between 15 and 30 years of age, and about 10–15% of patients affected by TBI will end up in a coma. Coma caused by TBI presents a significant challenge to neuroscientists. Right median nerve electrical stimulation has been reported as a simple, inexpensive, non-invasive technique to speed recovery and improve outcomes for traumatic comatose patients.Methods/designThis multicentre, prospective, randomised (1:1) controlled trial aims to demonstrate the efficacy and safety of electrical right median nerve stimulation (RMNS) in both accelerating emergence from coma and promoting long-term outcomes. This trial aims to enrol 380 TBI comatose patients to partake in either an electrical stimulation group or a non-stimulation group. Patients assigned to the stimulation group will receive RMNS in addition to standard treatment at an amplitude of 15–20 mA with a pulse width of 300 μs at 40 Hz ON for 20 s and OFF for 40 s. The electrical treatment will last for 8 h per day for 2 weeks. The primary endpoint will be the percentage of patients regaining consciousness 6 months after injury. The secondary endpoints will be Extended Glasgow Outcome Scale, Coma Recovery Scale-Revised and Disability Rating Scale scores at 28 days, 3 months and 6 months after injury; Glasgow Coma Scale, Glasgow Coma Scale Motor Part and Full Outline of Unresponsiveness scale scores on day 1 and day 7 after enrolment and 28 days, 3 months and 6 months after injury; duration of unconsciousness and mechanical ventilation; length of intensive care unit and hospital stays; and incidence of adverse events.DiscussionRight median nerve electrical stimulation has been used as a safe, inexpensive, non-invasive therapy for neuroresuscitation of coma patients for more than two decades, yet no trial has robustly proven the efficacy and safety of this treatment. The Asia Coma Electrical Stimulation (ACES) trial has the following novel features compared with other major RMNS trials: (1) the ACES trial is an Asian multicentre randomised controlled trial; (2) RMNS therapy starts at an early stage 7–14 days after the injury; and (3) various assessment scales are used to evaluate the condition of patients. We hope the ACES trial will lead to optimal use of right median nerve electrical treatment.Trial registrationClinicalTrials.gov, NCT02645578. Registered on 23 December 2015.

Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal.

Recovery of functional independence is possible in patients with brainstem traumatic axonal injury (TAI), also referred to as "grade 3 diffuse axonal injury," but acute prognostic biomarkers are lacking. We hypothesized that the extent of dorsal brainstem TAI measured by burden of traumatic microbleeds (TMBs) correlates with 1-year functional outcome more strongly than does ventral brainstem, corpus callosal, or global brain TMB burden. Further, we hypothesized that TMBs within brainstem nuclei of the ascending arousal network (AAN) correlate with 1-year outcome. Using a prospective outcome database of patients treated for moderate-to-severe traumatic brain injury at an inpatient rehabilitation hospital, we retrospectively identified 39 patients who underwent acute gradient-recalled echo (GRE) magnetic resonance imaging (MRI). TMBs were counted on the acute GRE scans globally and in the dorsal brainstem, ventral brainstem, and corpus callosum. TMBs were also mapped onto an atlas of AAN nuclei. The primary outcome was the disability rating scale (DRS) score at 1year post-injury. Associations between regional TMBs, AAN TMB volume, and 1-year DRS score were assessed by calculating Spearman rank correlation coefficients. Mean±SD number of TMBs was: dorsal brainstem=0.7±1.4, ventral brainstem=0.2±0.6, corpus callosum=1.8±2.8, and global=14.4±12.5. The mean±SD TMB volume within AAN nuclei was 6.1±18.7mm3. Increased dorsal brainstem TMBs and larger AAN TMB volume correlated with worse 1-year outcomes (R=0.37, p=0.02, and R=0.36, p=0.02, respectively). Global, callosal, and ventral brainstem TMBs did not correlate with outcomes. These findings suggest that dorsal brainstem TAI, especially involving AAN nuclei, may have greater prognostic utility than the total number of lesions in the brain or brainstem.

Office-based Electromyography-guided Botulinum Toxin Injection to the Cricopharyngeus Muscle: Optimal Patient Selection and Technique.

This retrospective study was carried out to investigate the effectiveness and safety of office-based electromyography-guided injection of botulinum toxin in the cricopharyngeus muscle of patients who did not show upper esophageal sphincter passage in a swallowing study in spite of maximal swallowing rehabilitation. Thirty-six patients who showed no or limited ability to oral feed after maximum swallowing rehabilitation were enrolled. Video fluoroscopic swallowing study, flexible endoscopic evaluation of swallowing, disability rating scale, penetration aspiration score, and National Institutes of Health swallowing safety scale were used in the evaluation of dysphagia. Success was defined as nondependence on gastrostomy for patients who previously were dependent on gastrostomy and improvement in disability rating scale score after botulinum toxin injections. The total success rate was 63.9%. The complication rate was very low, with only 1 patient showing temporary unilateral vocal fold paralysis. Botulinum toxin injection was more effective in patients with cranial nerve IX or X palsy than in those without it ( P = .006). This procedure can be a simple, safe, and effective tool in patients with cricopharyngeal dysfunction after swallowing rehabilitation, especially for cranial nerve IX or X palsy.

Randomization Test: An Alternative Analysis for the Difference of Two Means

Randomization Test: An Alternative Analysis for the Difference of Two Means

Predictive validity of disability rating scale in determining functional outcome in patients with severe traumatic brain injury.

Most patients with severe traumatic brain injury (TBI) are discharged when they have still not recovered completely. Many such patients are not available for follow up. We conducted this study to determine whether the condition at discharge from acute care setting, as assessed with disability rating scale (DRS), correlates with functional outcome at follow up. This study was conducted at a Neurosurgical intensive care unit (ICU) of a tertiary care referral center. This was a prospective observational study. Patients admitted to ICU with a diagnosis of severe TBI were enrolled for the study. On the day of discharge, all patients underwent DRS assessment. A final assessment was performed using Glasgow outcome scale extended (GOSE) at 6 months after discharge from the hospital. The correlation between the DRS scores at the time of discharge with DRS scores and GOSE categories at 6 months after discharge was determined using Spearman's rho correlation coefficient. A total of 88 patients were recruited for the study. The correlation coefficient of DRS at discharge for DRS at 6 months was 0.536 and for GOSE was -0.553. The area under the curve of DRS score at discharge for predicting unfavorable outcome and mortality at 6 months was 0.770 and 0.820, respectively. The predictive validity of DRS is fair to good in determining GOSE at follow-up. Pending availability of a more accurate outcome assessment tool, DRS at discharge can be used as a surrogate outcome for GOSE at follow up.

Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study.

To determine whether early mobilization of patients with severe acquired brain injury, performed in the intensive/neurointensive care unit, influences functional outcome. Prospective observational study. Fourteen centres in Italy. A total of 103 consecutive patients with acquired brain injury. Clinical, neurological and functional data, including the Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), the Rancho Los Amigos Levels of Cognitive Functioning (LCF), Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome Scale (GOS), and Functional Independence Measure (FIM) were collected at admission and every 3?5 days until discharge from the intensive/neurointensive care unit. Patients were divided into mobilization and no mobilization groups, depending on whether they received mobilization. Data were analysed by intragroup and intergroup analysis using a multilevel regression model. Sixty-eight patients were included in the mobilization group. At discharge, both groups showed significant improvements in GCS, DRS, LCF and ERBI scores. The mobilization group showed significantly better improvements in FIM cognitive, GOS and ERBI. The patients in the mobilization group stayed longer in the intensive care unit (p=0.01) and were more likely to be discharged to intensive rehabilitation at a significantly higher rate (p=0.002) than patients in the no mobilization group. No adverse events were reported in either group. Early mobilization appears to favour the clinical and functional recovery of patients with severe acquired brain injury in the intensive care unit.

Paroxysmal sympathetic hyperactivity in severe traumatic brain injury.

Paroxysmal sympathetic hyperactivity (PSH) is a less-known complication of traumatic brain injury (TBI). This study was done to assess the clinical features and outcome of patients who develop PSH following severe TBI. A prospective observational study was done on patients, admitted in the intensive care unit, for treatment of severe TBI. The clinical characteristics and outcome of patients, with and without PSH, was compared. At the time of discharge, patients were assessed with the Disability Rating Scale (DRS), and at 6months with the Glasgow Outcome Score Extended (GOSE). The incidence of PSH was 8% (29/343). Tachycardia, hypertension, and sweating were seen in all of the patients. Tachypnea was seen in 24 (82.8%), hyperthermia in 28 (96.6%), and posturing in 13 (44.8%) patients. Thirteen (44.8%) patients had all six symptoms of PSH. Follow-up data were available for 23 (79.3%) patients. At the end of 6months, 14 (60.9%) patients had died, seven (30.4%) were severely disabled, and two (8.7%) were moderately disabled. There was a significant correlation of GOSE with the number of symptoms of PSH (Spearman's rho = 0.502, p = 0.015). The patients with PSH had significantly higher DRS scores at discharge, 25.3 vs. 19.9, p < 0.001; higher mortality at 6months 60.9 vs. 30.4%, p < 0.001; and higher proportions with unfavorable outcome. Presence of PSH in patients with severe TBI was associated with prolonged hospital stay, poorer DRS at discharge, more deaths, and unfavorable outcome. The number of symptoms of PSH had a significant effect on outcome at 6months.

Community integration and health-related quality-of-life following acquired brain injury for persons living at home

Primary objective: To study predictors of community integration (CI) and health-related quality-of-life (HRQoL) in a sample of Canadian adult, urban, multi-ethnic persons with acquired brain injury (ABI) receiving publicly-funded community services. Hypothesis 1 examined the predictive utility of age, ratings of disability, functioning and cognition for CI and HRQoL. Hypothesis 2 examined the correlation between CI and HRQoL.Research design: Cohort study.Methods and procedures: A convenience sample of community-residing clients completed measures with their care co-ordinators: Resident Assessment Instrument-Home Care (RAI-HC), Disability Rating Scale (DRS), Community Integration Questionnaire (CIQ) and the Quality-of-Life after Brain Injury Instrument (QOLIBRI).Results: Regression analysis showed DRS scores explained significant variance in CIQ and QOLIBRI. Correlations also showed that cognitive skill and ADL/IADL functioning are strongly related to CI and the Daily life and autonomy QOLIBRI sub-scale. The CIQ Total was not correlated with QOLIBRI Total, although there were some significant correlations between the CIQ social sub-scale and QOLIBRI.Conclusions: Lesser degree of disability is a key predictor of greater CI and QoL. The present findings suggest that rehabilitation efforts should focus on minimizing disability and promoting social integration and involvement to avoid adverse long-term effects of ABI for community-resident persons.

The Impact of Preexisting Illness and Substance Use on Functional and Neuropsychological Outcomes Following Traumatic Brain Injury

Traumatic brain injury (TBI) is a significant public health problem in the US. Specific preexisting medical illnesses delay recovery after TBI and increase mortality or risk of repeat TBI. This study examined the impact of preexisting illness and substance use on patient rehabilitation outcomes following TBI. The Functional Independence Measure total score and Disability Rating Scale score measured functional outcomes at discharge from inpatient rehabilitation, while the Trail Making Test A and B and Total Trials 1-5 of the California Verbal Learning Test-II measured neuropsychological outcomes in 128 TBI survivors with moderate or severe TBI. Results showed that the presence of a heart condition or diabetes/high blood sugar was associated with lower functional outcomes by discharge. A history of a heart condition, stroke, or respiratory condition prior to TBI was associated with reduced cognitive flexibility. Those with preexisting diabetes/high blood sugar demonstrated poorer visual attention, visuomotor processing speed, and ability to learn and recall verbal information. Those with pre-TBI cancer also had greater auditory-verbal memory deficits. The findings showed that specific preexisting medical conditions are independently associated with lower functional and cognitive outcomes for patients with TBI. By screening patients for preexisting medical conditions, multidisciplinary TBI rehabilitation teams can identify patients who require more aggressive treatments or greater length of stay.

Cost effectiveness of inpatient rehabilitation in patients with brain injury

Rehabilitation following acquired brain injury improves health outcomes, reduces disability, and improves quality of life. We assessed the cost effectiveness of inpatient rehabilitation after brain injury in individuals with brain injury admitted to the Irish national tertiary specialist rehabilitation centre in 2011. Patients' score on the Disability Rating Scale (DRS) was recorded on admission and at discharge after intensive inpatient rehabilitation. Cost savings attributed to the rehabilitation programme were calculated as the difference between direct care costs on admission and discharge. Direct costs of care were calculated as the weekly cost of the care-assistant hours required to care for patients on the basis of their level of disability or daily nursing-home bed cost when this was required. Of 63 patients, complete DRS information for admission and discharge was available for 41. DRS scores, and therefore average levels of functioning, differed significantly at admission (2.3, between mildly and moderately dependent) and discharge (1.1, independent in special environments, p<0.01). Average weekly care costs fell from €629 to €242, with costs recouped within 30 months. Thus, substantial savings result from inpatient rehabilitation, and these savings could have been greater had we considered also the economic benefit of enabling patients to return to employment.

Morfeo Study II: Clinical Course and Complications in Patients With Long-Term Disorders of Consciousness

BackgroundThe life expectancy of patients with disorders of consciousness (DOCs) is ever-increasing, but little is known about their clinical course over late stages. Several issues (premorbid conditions, complications and pressure sores) are to be considered for their effect on clinical outcome, risk of death and recovery of functional performance. Unfortunately, in late stages of long-term rehabilitation, these aspects are still more neglected than in acute and postacute stages. The aim of this study was to investigate the clinical course and the complications of patients in the late stages of DOCs and to explore the relationship between mortality and specific biomarkers. Materials and MethodsA total of 112 patients, admitted over 10 years in a dedicated ward, were retrospectively studied. Sociodemographic data, preadmission and inpatient clinical features were collected. Disability Rating Scale scores, complications including pressure sores and blood markers were assessed monthly. Data were analyzed through descriptive statistics and correlations using SPSS. ResultsMost patients were men older than 50 years with a nontraumatic etiology and a history of hypertension (42.86%). The most common complication was pneumonia (76.79%). No association was found between sex and mortality or between etiology and mortality (P > 0.05). Mortality correlated significantly with sepsis (ρ = 0.253), albumin (ρ = −0.558), hemoglobin (ρ = −0.354) and white blood cells (ρ = 0.243). Only 42% of patients remained unchanged at Disability Rating Scale evaluation. ConclusionsThese data confirmed that DOCs are not static conditions and they require ongoing monitoring and assessment of clinical status, level of consciousness and laboratory biomarkers.

Atrial flutter in myotonic dystrophy type 1: Patient characteristics and clinical outcome

The prevalence and the incidence of atrial flutter in patients with myotonic dystrophy type 1 (DM1) and the most appropriate strategies for its management are unknown. We retrospectively included in the DM1 Heart Registry 929 adult patients with DM1 admitted to our Institutions between January 2000 and September 2013. We selected patients presenting with atrial flutter and analysed data relative to the occurrence of arterial thromboembolism, severe bradyarrhythmias and atrial flutter recurrences. Atrial flutter was present in 79 of the 929 patients included in our Registry, representing a 8.5% prevalence. Patients with atrial flutter were older, had a higher muscular disability rating scale score and had higher prevalence of other cardiac manifestations of DM1. Sixty patients presented with a first episode of atrial flutter, representing a 4.6% incidence. Severe bradyarrhythmias requiring permanent pacing were present in 4 patients (6.7%). Over a 53 ± 28 months mean follow-up duration, 2 patients (3.3%) had ischaemic stroke and 12 (20%) had atrial flutter recurrences. Patients who underwent radiofrequency ablation were more frequently free of atrial flutter recurrence than other patients (95 vs. 61%; HR = 0.17; P = 0.04). Atrial flutter is a common manifestation of DM1, potentially complicated by arterial thromboembolism or severe bradyarrhythmias. Radiofrequency catheter ablation is associated with a lower risk for recurrences.