ABSTRACT
OBJECTIVE: To assess reliability between persons with Traumatic Brain Injury (TBI) and their self-selected proxies. DESIGN: Intraclass Correlation Coefficients were used to assess participant-proxy reliability on the Craig Handicap Assessment and Reporting Technique (CHART), the Community Integration Questionnaire (CIQ), and the Functional Independence Measure (FIM). SETTING: Participants had been discharged to the community from inpatient rehabilitation between six months and approximately five years prior to the study's beginning. PARTICIPANTS: 204 persons with moderate to severe TBI and their self-selected proxies. RESULTS: Eighty-seven percent of the items on the three instruments exhibited moderate to high intraclass correlation (ICC), with strongest participant-proxy agreement for questions assessing concrete, observable information. Participant-proxy agreement was poorest when assessing cognitive and money management capacity as well as out-of-home activities. CONCLUSIONS: For many types of items, participant-proxy reliability is sufficient to merit the use of proxies in TBI outcome research when the participants are allowed to select their own proxy.
Subject(s)
Brain Injuries/rehabilitation , Cognition Disorders/rehabilitation , Proxy , Surveys and Questionnaires , Adolescent , Adult , Aged , Aged, 80 and over , Brain Injuries/complications , Brain Injuries/diagnosis , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Female , Health Surveys , Humans , Injury Severity Score , Male , Middle Aged , Patient Participation , Patient Satisfaction , Reproducibility of Results , Treatment OutcomeABSTRACT
STUDY DESIGN: Retrospective review of patient medical records comparing the outcomes of two groups of individuals with high-level (C3-4) tetraplegia- those with high-volume and those with low-volume mechanical ventilation. OBJECTIVES: To determine if higher volume mechanical ventilation contributes to faster weaning from the ventilator with fewer complications in individuals with ventilator dependent high-level tetraplegia. SETTING: A Model Spinal Injury Center, located in Colorado, USA, which treats patients referred from throughout the Rocky Mountain region as well as other states. METHODS: The medical records of 42 individuals with ventilator dependent C3-4 tetraplegia, admitted consecutively to the Rocky Mountain Regional Spinal Injury System between 1983 and 1993, were reviewed. All had required full-time mechanical ventilation upon admission, but had successfully weaned by discharge. They were divided into two groups that differed with respect to the ventilator tidal volumes used during their treatment and weaning: a large volume group (> 20 mls/kg of body weight) and a smaller volume group (< 20 mls/kg of body weight). RESULTS: Though the two groups were equivalent in neurological level and completeness, muscular function, initial spontaneous vital capacity, the weaning method used (T-piece), and final spontaneous vital capacity, those in the large tidal volume group successfully weaned an average of 21 days faster than the lower tidal volume group (37.6 days vs 58.7 days, P=0.02). They also had significantly less atelectasis (P=0.01) than the lower tidal volume group. CONCLUSION: This research suggests that the use of higher ventilator tidal volumes may speed up the weaning process and lessen respiratory complications. Because of the potential for this to decrease the length and cost of the rehabilitation programs for persons with high-level tetraplegia, further large-scale research is needed to verify these single-center findings.
Subject(s)
Quadriplegia/physiopathology , Tidal Volume/physiology , Ventilator Weaning , Adolescent , Adult , Female , Humans , Male , Middle Aged , Quadriplegia/therapy , Retrospective StudiesABSTRACT
Posttraumatic syringomyelia as a cause of progressive neurologic deterioration has been well described. More recently, the noncystic posttraumatic tethered cord has been associated with identical progressive neurologic deterioration. A retrospective analysis of patients treated surgically with spinal cord untethering and/or cyst shunting to arrest a progressive myelopathy from a posttraumatic tethered and/or cystic cord was performed. Emphasis was on outcome using the American Spinal Injury Association (ASIA) sensory and motor scoring systems. During an 18-month period from May 1993 to December 1994, 70 patients with spinal cord injury were operated upon for tethered and/or cystic spinal cords because of a progressive myelopathy and deteriorating ASIA sensory/motor scores. Fifty-nine patients had follow-up data 1 year postoperatively. At the 1 year follow-up, there was small improvement in light touch sensory scores (0.67 points), pinprick scores (1.3 points), and motor scores (0.41 points) demonstrating that the progression of the myelopathic process was arrested. Thirty-four of these 59 patients had no previous surgery to their spinal cords. At 1 year follow-up, light touch scores improved on average 2.38 points, pinprick scores 3.88 points (p < 0.05), and motor scores 1.47 points, suggesting better outcome with first-time surgery. Of this latter group, 64.3% regained a lost function, 62.5% saw improvement in spasticity, 55.6% had substantial improvement in neurogenic pain, and 95.8% felt that surgery prevented further neurologic deterioration.
