Relationship between Glasgow Outcome Scale and neuropsychological measures after brain injury.

The present study was conducted to further our understanding of the relationship between performance on neuropsychological tests and functional status after head injury and to provide information on the relative usefulness of neuropsychological tests as outcome measures in clinical trials of brain injury. We sought to select the fewest number of 19 neuropsychological tests administered to 110 patients that, in combination, were most closely related to outcome (as measured by the Glasgow Outcome Scale (GOS) and to the remaining neuropsychological measures. The relationship of memory and intellectual deficits to functional status was also considered. To address these questions, we analyzed 19 neuropsychological measures and GOS scores of 110 severely brain injured patients from the Traumatic Coma Data Bank. Of 19 neuropsychological measures compared with GOS at 3 and 6 months, four tests (Controlled Oral Word Association, Grooved Pegboard, Trailmaking Part B, and Rey-Osterrieth Complex Figure Delayed Recall) provided the closest relationship to GOS and to the remaining 15 tests. Similar analyses were performed on 30 moderately injured patients to test the generality of our findings across different levels of patient severity. The same four tests were found to be highly predictive of GOS. Grooved Pegboard, a test of fine motor coordination, accounted for 80% of the variation in GOS. Fifteen percent of 116 patients with severe brain injury could not complete a neuropsychological battery and 39% were excluded because of previous brain injury or known substance abuse.

A survey of accredited and other rehabilitation facilities: education, training and cognitive rehabilitation in brain-injury programmes.

Although it is routinely acknowledged that cognitive rehabilitation therapy comprises a major part of the services provided to survivors of brain injury, there continues to be no general consensus regarding the methods and training of those who provide cognitive rehabilitation services. This survey of 398 head-injury rehabilitation facilities includes information on which disciplines are providing and supervising cognitive rehabilitation therapy, which therapy formats are used, and a first attempt to define the costs and providers for cognitive therapy staff training in Commission on Accreditation of Rehabilitation Facilities (CARF) approved and other (non-CARF) facilities. The education and training of junior and senior staff members is compared, and respondents suggest changes in the education and training of those who provide cognitive rehabilitation therapy. The results of this survey suggest no significant differences in the organization and delivery of cognitive rehabilitation therapy in CARF and non-CARF programmes. They indicate that cognitive rehabilitation therapy and the education and training of providers deserve further study and definition, given the widespread provision of cognitive rehabilitative services.

Oral hygiene following traumatic brain injury: a programme to promote dental health.

Dental care and oral hygiene programmes for persons with traumatic brain injury (TBI) have been relatively ignored areas of clinical care and research. Data regarding the need for structured oral hygiene programmes with this population are sorely lacking. Further, evidence to support or contraindicate the efficacy of such interventions is negligible. The purpose of the present study was to address the need for ongoing dental follow-up and oral hygiene programmes in the post-acute phase of rehabilitation care. A group of 20 TBI patients (10 experimental, 10 control) who were at least 1 month post-injury and had Rancho Los Amigos Scale scores of 6 or greater, were randomly selected for participation in the study. Oral hygiene status was assessed by a dental hygienist using a plaque index score developed by Silness and Loe. The experimental group received individualized oral hygiene instruction along with dental supplies for their personal use, including a dental mirror and red disclosing tablets. The control group received no such instructions or supplies. At 5-6 weeks following initial evaluation, 18 patients (nine from each group) were reassessed via the plaque index score. Comparisons between the control and experimental groups revealed significant differences on follow-up plaque scores with a lower mean score for the experimental group only on baseline and follow-up data yielding a significant decrease in plaque scores over time. These results suggest that dental hygiene interventions for patients following TBI can effectively promote dental plaque control.