Effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients in the chronic phase after acquired brain injury.

The aim of this prospective cohort study was to examine the effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients with acquired brain injury in the chronic phase. Twenty-seven patients with acquired brain injury (i.e., stroke, traumatic brain injury, subarachnoid haemorrhage; 52% male) with a mean age of 49.5 (SD 9.2) years and 25 relatives with a mean age of 48.8 (SD 8.8) years were recruited to the study. Mean time since injury in the patient group was 1.9 years (SD 2.0). The group programme consisted of 15 weekly sessions of 2.5 hours and included cognitive strategy training, social skills training, and psycho-education. Patients also received homework. Relatives were invited to attend twice. Repeated measurements were taken: prior to treatment (baseline, T0); directly after treatment (T1, 21 weeks); and at follow-up (T2, 45 weeks). Primary outcome measures were individualised goals (GAS), cognitive failures (CFQ), and quality of life (SA-SIP). Patients did improve significantly on individual goals (p < .05) between T0 and T1 and the level of attainment remained stable between T1 and T2. Goals were mostly set in the cognitive and behavioural domains. There were no significant differences between the measurements (T0-T1-T2) on the CFQ and the SA-SIP. The programme had a positive effect on the individual goals set by the patients. However, this did not result in a higher participation level or a better quality of life. This may be due to the low intensity and short duration of the programme.

Long-term neuropsychological performance in a cohort of children and adolescents after severe paediatric traumatic brain injury.

OBJECTIVE: The purpose of the present study was to evaluate progress in neuropsychological performance in children and adolescents with severe paediatric traumatic brain injury (TBI), from admission to the rehabilitation centre up to 3-12 years after the trauma. METHODS: Children and adolescents (n = 31, mean age at injury 11.8 years, SD = 3.8; at follow-up 18.8 years; SD = 4.5) who all had suffered a TBI participated. A comprehensive neuropsychological test battery was administered at the start of rehabilitation (T1), around discharge (T2) and in the long-term (at least 3 years after rehabilitation; T3). T1 and T2 were clinical assessments; T3 was executed as a follow-up measurement for this study. RESULTS: At T1 and T2, most problems were in the domains of attention, memory and executive functioning. At the start of rehabilitation most deficits were with performal intelligence (61%); at discharge (mean length of stay 411 days) considerably less children had severe deficits on the intelligence domain (23%). At long-term follow-up, most problems were in the domains attention, mental speed and memory. From admission to discharge 42% of the children improved on two or more cognitive tests; from discharge to follow-up this percentage was 13%. CONCLUSIONS: In this unique study a clinical cohort of children with severe TBI was followed for many years after injury. Most cognitive deficits were found in the early phase of rehabilitation. Most children did improve on cognitive functioning (40%) during the first year after their injury, whereas at follow-up most children had not changed. At follow-up, more than half of the children (54%) attended a regular school or had a regular job, corresponding to their age and pre-morbid functioning.

Non-use of assistive technology in The Netherlands: a non-issue?

PURPOSE: To obtain insight into the prevalence of the non-use of assistive technology in The Netherlands. Relationships between non-use and possible determinants were also investigated. The results of the study might lead to improvement of products and of the service delivery system for assistive technology. METHOD: A study was performed into user satisfaction and the non-use of 14 categories of assistive technology provided by health care insurers. The design was a survey among a stratified sample of users who had received an assistive device, recruited through a sample of health insurance companies. Two independent samples were selected: one in 2001 and one in 2003. Three aspects of non-use were measured. The total number of respondents was 2272. RESULTS: Ninety-two percent of the respondents used the assistive device at the time of the survey. Less than 1% of the respondents never used the device. A majority of the respondents used the assistive device (about) as much as expected and 6% used the assistive device less than expected. Relationships between non-use and other investigated aspects were found. CONCLUSIONS: The average level of non-use of assistive technology found in this study is less than often reported in the literature and varies between the various categories of assistive technology. Improving the quality of the assistive technology and the services, and providing assistive technology that solves the users' problem as much as possible, could enhance the use of assistive technology provided.

[CBO guidelines to prevent accidental falls in the elderly: how can it be used in the institutionalized elderly?]. / CBO richtlijn preventie van valincidenten bij ouderen: wat kunnen verpleeghuizen hiermee?

Fall incidents occur frequently in the community dwelling elderly and even more in the institutionalised elderly. Fall-related research data indicate positive effects of a multifactorial intervention targeted on prevention of falls and fall-related injuries. In November 2004 the guideline "Prevention of fall incidents in the elderly" developed by The Dutch Institute for Healthcare Improvement (CBO) was published. This guideline pays attention to the risk factors for falling and the prevention of fall incidents in all settings. The highlights for nursing homes are: all nursing home patients are at risk; perform a fall risk assessment to direct fall preventive activities; together with specific fall prevention for the patient general fall prevention for the institute has to be undertaken; a multifactorial approach is indicated. In nursing homes it is possible to perform such approach multidisciplinary.

[Falls in nursing homes: on average almost two per bed per year, resulting in a fracture in 1.3%]. / Valincidenten in verpleeghuizen: gemiddeld bijna 2 per bed per jaar met bij 1.3% een fractuur als gevolg.

OBJECTIVE: To determine how many falls occur annually in Dutch nursing homes and how many fractures are the result of falls. DESIGN: Written questionnaire study. METHOD: All 371 Dutch nursing homes received a questionnaire requesting information on the number of somatic and psychogeriatric beds and the number of falls and fractures as a result of falls in 2000 and 2001. RESULTS: Of the 371 questionnaires, 202 (54%) were returned. These were distributed as follows over the three types of nursing homes: combined: 151 (75%), somatic: 15 (7%), psychogeriatric: 36 (18%). The average capacity of the participating nursing homes was 180 beds. There was an average of more than 300 reported falls per nursing home: 336 in 2000 (SD: 180; median 314) and 311 in 2001 (SD: 165, median 294). On average, there were almost 2 falls per bed per year. The number of falls per bed in the psychogeriatric group was higher than in the somatic group. There was an average of about 4 fractures per year per nursing home as a result of falls: 4.3 in 2000 (SD: 3.7; median 4.0) and 3.6 in 2oo1 (SD: 2.8; median 3.0). The average number of annual fractures due to a fall was about 23 per 1ooo beds. An average of 1.3% of the falls resulted in a fracture. There were no clear differences here between somatic and psychogeriatric patients. CONCLUSION: The reported number of falls per nursing-home bed averaged almost 2 per year, and an average of 1.3% of these falls resulted in a fracture.

CBO Richtlijn Preventie van valincidenten bij ouderen: wat kunnen verpleeghuizen hiermee?

Fall incidents occur frequently in the community dwelling elderly and even more in the institutionalised elderly. Fall-related research data indicate positive effects of a multifactorial intervention targeted on prevention of falls and fall-related injuries.In November 2004 the guideline "Prevention of fall incidents in the elderly" developed by The Dutch Institute for Healthcare Improvement (CBO) was published. This guideline pays attention to the risk factors for falling and the prevention of fall incidents in all settings. The highlights for nursing homes are: 1.all nursing home patients are at risk;2.perform a fall risk assessment to direct fall preventive activities;3.together with specific fall prevention for the patient general fall prevention for the institute has to be undertaken;4.a multifactorial approach is indicated. In nursing homes it is possible to perform such approach multidisciplinary.