Baylor Scott and White Institute for Rehabilitation

Driver, S., S. Juengst, M. Reynolds, E. McShan, C. L. Kew, M. Vega, K. Bell and R. Dubiel (2019). “Healthy lifestyle after traumatic brain injury: a brief narrative.” Brain Inj 33(10): 1299-1307.

Full text of this article.

Individuals living with traumatic brain injury (TBI) are at an increased risk for developing chronic conditions such as diabetes, heart disease, and hypertension compared to the non-injured population. Furthermore, TBI-specific challenges such as physical limitations, pain, mood, and impaired cognition make it difficult to live a healthy lifestyle. Key health behaviors that contribute to overall health and well-being after TBI include physical activity and healthy eating, sleep, participation, eliminating substance abuse, and managing stress. The objectives of this narrative are to (1) describe the key components of a healthy lifestyle for individuals with a TBI, (2) identify the challenges that individuals with TBI face when attempting to establish these health behaviors, and (3) discuss approaches and supports to achieve these health behaviors after TBI, including the role of self-management.

Hammond, F. M., J. D. Corrigan, J. M. Ketchum, J. F. Malec, K. Dams-O’Connor, T. Hart, T. A. Novack, J. Bogner, M. N. Dahdah and G. G. Whiteneck (2019). “Prevalence of Medical and Psychiatric Comorbidities Following Traumatic Brain Injury.” J Head Trauma Rehabil 34(4): E1-e10.

Full text of this article.

OBJECTIVE: To examine the prevalence of selected medical and psychiatric comorbidities that existed prior to or up to 10 years following traumatic brain injury (TBI) requiring acute rehabilitation. DESIGN: Retrospective cohort. SETTING: Six TBI Model Systems (TBIMS) centers. PARTICIPANTS: In total, 404 participants in the TBIMS National Database who experienced TBI 10 years prior. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Self-reported medical and psychiatric comorbidities and the onset time of each endorsed comorbidity. RESULTS: At 10 years postinjury, the most common comorbidities developing postinjury, in order, were back pain, depression, hypertension, anxiety, fractures, high blood cholesterol, sleep disorders, panic attacks, osteoarthritis, and diabetes. Comparing those 50 years and older to those younger than 50 years, diabetes (odds ratio [OR] = 3.54; P = .0016), high blood cholesterol (OR = 2.04; P = .0092), osteoarthritis (OR = 2.02; P = .0454), and hypertension (OR = 1.84; P = .0175) were significantly more prevalent in the older cohort while panic attacks (OR = 0.33; P = .0022) were significantly more prevalent in the younger cohort. No significant differences in prevalence rates between the older and younger cohorts were found for back pain, depression, anxiety, fractures, or sleep disorders. CONCLUSIONS: People with moderate-severe TBI experience other medical and mental health comorbidities during the long-term course of recovery and life after injury. The findings can inform further investigation into comorbidities associated with TBI and the role of medical care, surveillance, prevention, lifestyle, and healthy behaviors in potentially modifying their presence and/or prevalence over the life span.

Criminger, C. and C. Swank (2019). “Impact of dual-tasking on mobility tasks in Parkinson’s disease as described through 2D kinematic analysis.” Aging Clin Exp Res Jul 3. [Epub ahead of print].

Full text of this article.

BACKGROUND: Walking for people with Parkinson’s disease (PD) degrades during motor-cognitive interplay (i.e., dual task conditions). Declining gait mechanics and turning ability result in more frequent falls and an interruption of daily activities in persons with PD. AIMS: To determine the impact of dual-tasking on key mobility elements during a walking task in people with PD with 2D motion analysis. METHODS: Participants performed Timed Up and Go (TUG) single, dual task conditions (TUGalone, TUGmotor, and TUGcognitive). 2D motion analysis application was used to quantify seven key mobility elements including: sit-to-walk (STW) (s), walking turn time (WTT) (s), number of turn steps, turn-to-sit (TTS) (s), total number of TUG steps, total TUG time and turn strategy (on-the-spot or u-shaped). RESULTS: Thirty-one participants with PD completed this study [age M= 69 +/- 8.19, UPDRSm M= 23.21 +/- 10.03, HY MED= 2 (range 1-4)]. All key elements were significantly different between TUG conditions with the exception of sit-to-walk and turn strategy. Turn strategy was consistent across TUG tasks despite added cognitive loading. Repeated-measures MANOVA differences were observed in WTT (p = 0.01), number of turn steps (p = 0.03), TTS (p < 0.001), total number of TUG steps (p = 0.01), and total TUG time (p = 0.01). No significant relationships were found between disease severity (HY/UPDRSm) and turn strategy. DISCUSSION/CONCLUSION: Key mobility elements were significantly affected across dual task walking conditions in persons with PD. The use of 2D motion analysis assisted with identification of key mobility elements impacted during the single and dual task conditions.

Borsh, S., S. Sikka, L. Callender, M. Bennett, M. Reynolds and S. Driver (2019). “Borsh, S., S. Sikka, L. Callender, M. Bennett, M. Reynolds and S. Driver (2019). “Implementation of a Neurogenic Bowel Program for Spinal Cord Injury in the Acute Care Setting: Perceptions of Patients and Staff.” Occup Ther Health Care 33(3): 306-322.

Full text of this article.

A prospect cohort and case-control was employed to (1) establish a neurogenic bowel (NB) program after spinal cord injury (SCI) in the acute care setting; (2) examine clinician knowledge ability to deliver the NB program; and (3) evaluate patient knowledge, satisfaction, and quality of life. Educational in-service describing NB clinical practice guidelines (CPGs) and order set was delivered to staff followed by a pre-/post-education, 3- and 12-month survey. The patient intervention followed 24 patients with NB to evaluate the program and compared to 28 retrospective case-control patients followed by a pre-/post-intervention survey to measure knowledge of SCI, NB program and quality of life. Injury information and bowel medication use was compared between cases and controls. Clinician knowledge of NB CPGs improved. There were no significant clinical differences between patient groups. Patient knowledge and satisfaction improved post-intervention. Education to staff and patients is imperative to facilitate a NB program to meet the needs for individuals with SCI.

Kenedi, H., J. Campbell-Vance, J. Reynolds, M. Foreman, C. Dollaghan, D. Graybeal, A. M. Warren and M. Bennett (2019). “Implementation and Analysis of a Free Water Protocol in Acute Trauma and Stroke Patients.” Crit Care Nurse 39(3): e9-e17.

Full text of this article.

BACKGROUND: Free water protocols allow patients who aspirate thin liquids and meet eligibility criteria to have access to water or ice according to specific guidelines. Limited research is available concerning free water protocols in acute care settings. OBJECTIVES: To compare rates of positive clinical outcomes and negative clinical indicators of a free water protocol in the acute care setting and to continue monitoring participants discharged into the hospital system’s rehabilitation setting. Positive clinical outcomes were diet upgrade, fewer days to diet upgrade, and fewer days in the study. Negative clinical indicators were pneumonia, intubation, and diet downgrade. METHODS: A multidisciplinary team developed and implemented a free water protocol. All eligible stroke and trauma patients (n = 104) treated over a 3-year period were randomly assigned to an experimental group with access to water and ice or a control group without such access. Trained study staff recorded data on positive outcomes and negative indicators; statistical analyses were conducted with blinding. RESULTS: No significant group differences in positive outcomes were found (all P values were > .40). Negative clinical indicators were too infrequent to allow for statistical comparison of the 2 groups. Statistical analyses could not be conducted on the small number (n = 15) of patients followed into rehabilitation, but no negative clinical indicators occurred in these patients. CONCLUSIONS: Larger-scale studies are needed to reach decisive conclusions on the positive outcomes and negative indicators of a free water protocol in the acute care setting.