Group Lifestyle Balance Adapted for Individuals With Impaired Mobility: Outcomes for 6-Month RCT and Combined Groups at 12 Months.

INTRODUCTION: This study examines the feasibility and effectiveness of an intensive lifestyle intervention adapted for people with impaired mobility. STUDY DESIGN: This was a randomized, wait-list controlled trial. The experimental group immediately received the 12-month weight loss program; the wait-list control group received it after a 6-month delay. Between-group comparisons were conducted for the 6-month RCT study design. Repeated measures were conducted for both groups combined after receiving the 12-month intervention. Data were collected August 2015-February 2017 and analyzed in 2017. SETTING/PARTICIPANTS: A community-based sample received 23, group-based sessions via a mix of telephone and in-person sessions in a hospital-based setting. Participants with impaired mobility (n=66) were middle-aged (49.80 [SD=11.37] years), mostly White (66.7%), female (66.7%), and most commonly had spinal cord injury (47.0%). INTERVENTION: The 12-month intervention delivered 23 group-based sessions that promoted weight loss through reducing caloric intake and increasing physical activity. MAIN OUTCOME MEASURES: Primary outcomes were effectiveness measured as change in weight and time spent in moderate physical activity. Feasibility was assessed in 12-month combined group analyses, measured as retention, attendance, and dietary self-monitoring. RESULTS: The 6-month RCT results showed that the immediate and delayed groups differed significantly (p<0.05) in weight (-1.66 [SD=4.42] kg loss vs 0.05 [SD=4.15] kg gain) and moderate physical activity (52.93 [SD=90.74] minutes/week increase vs -14.22 [SD=96.02] minutes/week decrease), accounting for baseline weight, time with disability, and age of onset. The 12-month results with groups combined demonstrated 74.2% retention and 77.7% core session attendance. Self-monitoring was higher in the delayed group (77.3%), who used a smartphone app, than the immediate group (47.3%), who mostly used paper trackers. Participants achieved significant 12-month weight loss of 3.31 (SD=10.13) kg (d=0.33) in mixed modeling analyses with groups combined yet did not significantly increase moderate physical activity. CONCLUSIONS: Group Lifestyle Balance Adapted for Individuals with Impaired Mobility is a feasible, effective approach to teach healthy lifestyle skills to individuals with mobility impairment, yielding modest weight loss and enhanced self-efficacy. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT03307187.

Hospital-Based Health Care After Traumatic Brain Injury.

OBJECTIVE: To investigate trends of hospital-based health care utilization after admission to a level I trauma center after acute traumatic brain injury (TBI). DESIGN: Retrospective review. SETTING: Large urban trauma hospital and a hospital council data registry consisting of 88 member institutions (>150 hospitals) covering 15,000 square miles. PARTICIPANTS: All patients (N=5291) admitted to a level I trauma center between January 1, 2006, and June 30, 2014, who experienced an acute TBI based on International Classification of Diseases, Ninth Revision coding. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Included the incidence and type of select hospital-based services received. Analyses were also categorized based on demographic and injury-related information. RESULTS: Of the 5291 patients with newly acquired TBI who were admitted, 512 died, leaving 4779 patients for inclusion in the final analysis. Additional health care utilization from January 1, 2006, and June 30, 2014, was recorded for 3158 patients (66%), totaling 12,307 encounters, with a median of 3 encounters (interquartile range, 1-5) and a maximum of 102 encounters. Most nonadmission urgent or procedural visits (96%) and inpatient encounters (93%) occurred in the first year. Of all the additional encounters, 9769 visits were nonadmission urgent or procedural visits (79%) with a median charge of $1955. The most common type of encounter was elective (46%), followed by medical emergency (29%). Of the remaining 2538 inpatient encounters (21%), the mean length of stay was 6 days with a median charge of $28,450. Medical emergency (39%) and elective admissions (33%) again were the most common encounter type. CONCLUSIONS: This analysis encompasses health care utilization across the range of TBI severity and numerous hospital systems, allowing for a more comprehensive and objective identification of reasons for readmission. This represents an initial step to developing a preventive intervention to manage secondary complications postinjury.

Brain-computer interface for individuals after spinal cord injury.

PURPOSE/OBJECTIVE: To investigate the feasibility of brain-computer interface (BCI) with patients on an inpatient spinal cord injury (SCI) unit. Research Method/Design: This study included 25 participants aged 18-64 who sustained traumatic or nontraumatic SCI and did not have severe cognitive or psychiatric impairment. Participants completed a variety of screening measures related to cognition, psychological disposition, pain, and technology experience/interest. The Emotiv electroencephalography system was used in conjunction with a cube rotation and manipulation game presented on a laptop computer. RESULTS: The majority of participants successfully completed the BCI game and reported enjoyment of the experience. Outside of a mild trend of lower performance among participants with a past or present head injury, there were no demographic variables, injury variables or screening measures significantly associated with BCI performance. CONCLUSIONS/IMPLICATIONS: The BCI paradigm demonstrated feasibility and safety across participant age range, educational and vocational background, and level of injury. Despite the rapid integration of technology into rehabilitation health care settings, there are few evidence-based studies regarding the feasibility of technology with specific inpatient populations. Clinical implications and challenges of using this technology in a rehabilitation setting are discussed. (PsycINFO Database Record

Functional recovery from neuroinvasive West Nile Virus: A tale of two courses.

OBJECTIVE: In 2012, the highest numbers of West Nile Virus (WNV) cases were reported by the Center for Disease Control since 2003. This outbreak included over half of the identified patients being classified with one of the more debilitating neuroinvasive subtypes of WNV. Despite improvements in diagnosis and treatment options in symptom management, longitudinal research on WNV neurocognitive and functional outcomes is limited by sample size, retrospective review, and/or reliance on self-report measures for cognitive status and level of independence. This study describes the cases of 2 patients diagnosed with WNV as they complete rehabilitation across the continuum of care. RESEARCH METHOD: Review of two cases that experience different rehabilitation outcomes 4-18 months post diagnosis. RESULTS: The cases presented here demonstrate the potentially differential courses of recovery and outcomes for physical (e.g., balance, ambulation, upper extremity function), cognitive (e.g., attention, executive functions, memory, language, visuospatial), and emotional functioning, as assessed via measures administered by the patient's physical therapists and neuropsychologists. These patients were evaluated as part of the standard clinical practice to monitor changes, track recovery, and provide recommendations across the continuum of care from admission to discharge from acute inpatient rehabilitation, during outpatient day neurorehabilitation, and while receiving outpatient neuropsychology services. CONCLUSIONS: These cases highlight the variability in rehabilitative course for individuals diagnosed with WNV. Consistent follow-up with patients is recommended to ensure management of remitting and chronic symptoms.

Psychometric properties and analysis of the physical activity Social Influence Scale for adults with traumatic brain injuries.

The study consisted of (a) assessing the validity and reliability of the Social Influence Scale (SIS) for adults with brain injuries and (b) examining the kinds and sources of social influence and demographic variables that affect participants' physical activity behaviors. Three confirmatory factor analyses, intraclass correlations, and a repeated measures MANOVA were completed on responses from 402 adults with brain injuries. Results provide evidence of the validity and reliability of the SIS, and post hoc analyses revealed that participants reported receiving different types of social influence from family, friends, and caregivers. Findings have implications for specialists and suggestions are provided on ways to enhance the physical activity participation of adults with brain injuries.