ABSTRACT
OBJECTIVE: To characterize demographic, pre-injury, and outcome data within the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and Veterans Affairs (VA) Traumatic Brain Injury Model Systems (TBIMS) cohorts with severe traumatic brain injury (TBI) with no command-following ability at time of admission to acute rehabilitation. DESIGN: Retrospective cohort. SETTING: NIDILRR and VA TBI Model Systems (TBIMS) centers. PARTICIPANTS: 396 NIDILRR and 72 VA participants without command-following ability who experienced TBI with subsequent Disorder of Consciousness (DoC). MAIN OUTCOME MEASURE: Pre-injury and injury characteristics, rehabilitation outcomes, and 1-year self-reported outcomes. RESULTS: VA TBIMS cohort included individuals who were active duty or had military service before their injury. The VA cohort were more likely to be re-hospitalized at 1-year follow-up or residing in a long-term care or rehab setting. The NIDILRR TBIMS cohort had higher FIM and DRS scores at rehabilitation discharge, while the VA participants saw longer lengths of stay and higher numbers of "violent" injury types. CONCLUSIONS: This study allows for a better understanding of the comparability between VA and NIDILRR DoC cohorts providing guidance on how veteran and civilian samples might be merged in future TBIMS studies to explore predictors of recovery from a DoC.
Subject(s)
Brain Injuries, Traumatic , Brain Injuries , Veterans , Humans , Consciousness Disorders/etiology , Consciousness Disorders/rehabilitation , Retrospective Studies , Brain Injuries, Traumatic/complications , Brain Injuries, Traumatic/rehabilitation , Brain Injuries/rehabilitationABSTRACT
Mild traumatic brain injuries (MTBIs) are of increasing concern in both the military and civilian populations as the potential long-term effects and costs of such injuries are being further recognized. Injuries from conflicts in Afghanistan and Iraq have increased public awareness and concern for TBI. The Proponency Office for Rehabilitation and Reintegration, Office of the Surgeon General, US Army tasked a team of physical and occupational therapists to assemble evidence-informed guidelines for assessment and intervention specific to MTBI. Given the paucity of specific guidelines for physical therapy related to MTBI, we focused on literature that dealt with the specific problem area or complaint of the Service member following MTBI. Recommendations, characterized as practice standards or practice options based on strength of evidence, are provided relative to patient/client education, activity intolerance, vestibular dysfunction, high-level balance dysfunction, posttraumatic headache, temporomandibular disorder, attention and dual-task performance deficits, and participation in exercise. While highlighting the need for additional research, this work can be considered a starting point and impetus for the development of evidence-based practice in physical therapy for our deserving Service members.
Subject(s)
Brain Injuries/diagnosis , Brain Injuries/rehabilitation , Military Personnel , Occupational Therapy/standards , Physical Therapy Modalities/standards , Practice Guidelines as Topic , Adult , Disability Evaluation , Female , Follow-Up Studies , Glasgow Coma Scale , Humans , Injury Severity Score , Male , Middle Aged , Recovery of Function , Risk Assessment , Treatment Outcome , United States , Warfare , Young AdultABSTRACT
Dizziness and impaired balance are common complaints after traumatic brain injury as a result of injuries to many systems. Ambient visual and vestibular system impairments are strong contributors to imbalance and dizziness, often leading to problems with spatial orientation and gaze stability during movement. The purpose of this review is to provide an overview of visual-vestibular impairments common to traumatic brain injury and summarize the contribution impairments in these systems will have on higher-level mobility. Standard visual and vestibular tests and measures are described and summarized, followed by several case presentations discussing the examination and evaluation processes and interventions chosen for visual-vestibular difficulties and their relationship to higher-level mobility.
