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Biomedical subjects

B Pentland

Publications and source records attributed to B Pentland.

At least 19 recordsLinked to original sources
PubMed2001

Relatives' reports of long term problems following traumatic brain injury or subarachnoid haemorrhage.

PURPOSE: To describe and compare the late outcome of traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH) in terms of the carers' perspectives, and their symptoms' profiles. METHOD: Postal survey to surviving patients who had been discharged from a Regional Neurosurgical Unit five to seven years previously. There were 288 patients identified retrospectively from hospital records, of whom 209 (126 TBI and 83 SAH) were alive and traced at follow-up. The Glasgow Outcome Scale (GOS) and the Relative's Questionnaire (RQ) were used. RESULTS: Relative's questionnaires were returned by 128 patients; 70 TBI and 58 SAH, giving response rates of 56% and 70% respectively. In terms of outcome, there was a high degree of similarity between groups. On the GOS, approximately half of each group were classified as moderately disabled (49% and 48% of the TBI and SAH groups respectively); a quarter remained severely disabled (27% and 22%); and the remaining quarter were adjudged to have made a good recovery (24% and 29%). There was a considerable overlap in terms of the most commonly reported symptoms. Cognitive and physical problems tended to be more commonly reported by relatives of the TBI patients, whilst emotional and subjective symptoms were reported equally in both patient groups. CONCLUSIONS: The effects of TBI and SAH persist for many years post-injury, leading to considerable disability and increased dependency. Although the demographic details and mechanisms of injury in these two patient groups differ, there is a high degree of similarity in the pattern of sequelae reported by carers.

Adult↗
PubMed2000

Brain injury - the perceived health of carers.

PURPOSE: This paper explores the perceived health and reported level of strain in the primary carers of severely brain injured individuals, 15 - 18 months after discharge from inpatient rehabilitation. METHOD: Seventy carers took part in a prospective descriptive study utilizing a semistructured interview and standardized measures including the SF36, The Carer Strain Index and the Relative Questionnaire. Functional consequences for the injured person were also assessed. RESULTS: The SF36 demonstrated a trend towards lower perceived health for carers than that reported in the general population. Neither perceived health status nor level of strain differed significantly according to the type of injury sustained (haemorrhagic or traumatic) nor initial severity of injury. Factors that contributed to carers having worse health status included the injured person's level of disability and interpersonal factors such as the nature of the relationship, with spouses having lower perceived health status than parents. CONCLUSIONS: Irrespective of cause of injury, generalised health consequences result for the carers of those with disabling consequences of brain injury. Factors independent of the injured individual themselves (such as the nature of the relationship to the carer) need to be taken into consideration when exploring wellbeing of carers and planning services.

Adolescent↗
PubMed2000

Reliability of the relative's questionnaire for assessment of outcome after brain injury.

PURPOSE: The relative's questionnaire (RQ) was developed to assess outcome after brain injury. The present study investigated its test-retest reliability when used in a postal survey. METHOD: Hospital records were used to identify and contact 288 surviving patients treated for brain injury five to seven years earlier. Patients were sent a copy of the RQ (RQ1) and one month later a second copy (RQ2) was sent to those who returned RQ1. RESULT: Two hundred and eleven patients were successfully contacted, of whom 128 (61%) returned RQ1, and 94 of these (73%) returned RQ2. The reliability of items was variable, with most having a kappa value of > 0.6 suggesting 'substantial agreement' or better. CONCLUSION: The data presented suggest that the RQ is a reliable instrument in collecting outcome information in brain-injured patients by postal survey. Further research is recommended to test the suitability of the RQ for the use as a telephone interview.

Adolescent↗
PubMed2000

Simple assessment of outcome after acute brain injury using the Glasgow Outcome Scale.

To evaluate alternative methods of determining Glasgow Outcome Scale scores, a postal survey was made of 288 general practitioners and 128 relatives of patients who had sustained acute brain injuries 5-7 years previously. The Glasgow Outcome Scale score from the general practitioner and relative were compared with that calculated from questionnaire information by an experienced rater. There was poor agreement between general practitioner and rater (K = 0.17) and relative and rater (K = 0.35) scores. Both general practitioners and relatives indicated more favourable outcomes than the rater, with a higher level of agreement (K = 0.61) between them. When Glasgow Outcome Scale scores are used, the methods employed should be valid and reliable; failure to ensure this may be responsible for a considerable proportion of variability in reported studies of brain injury outcome.

Acute Disease↗
PubMed2000

Information needs of families when one member has a severe brain injury.

Despite calls for health and social services to respond to the needs of informal carers, there is little evidence to guide practioners in the best way to provide support and/or information in situations of complex need such as brain injury. This study addressed such an intervention in a prospective descriptive study, using both qualitative and quantitative methodology. Eighty-nine patients who had been admitted to a regional neurorehabilitation unit for management of traumatic or haemorrhagic brain injuries were consecutively discharged to the community over a period of 12 months. Eighty-two of these people identified a carer who agreed to be interviewed at approximately six weeks after discharge regarding their concerns. The study identified that even soon after discharge from inpatient rehabilitation, carers wanted more information. In many cases the need for information was unrelated to either the severity of injury or level of functional deficit. In addition, requests for information were in many cases not sought spontaneously, but required prompting. Such findings have implications if interventions in this field are to have the optimum chance of succeeding in providing support and assistance.

Activities of Daily Living↗
PubMed1999

Cognitive and psychosocial outcome following moderate or severe traumatic brain injury.

The outcome of 96 consecutive adult patients with moderate to severe head injury was sequentially measured at 6, 12 and 24 months post-injury. In addition to global outcome using the Glasgow Outcome Scale (GOS) and a battery of neuropsychological tests of cognitive function, the Head Injury Symptom Checklist (HISC) and Relative's Questionnaire (RQ) were used. Although poorer GOS scores and severe cognitive impairments were typically associated with greater severity of initial injury, relatives reported similar functional problems irrespective of injury severity. This illustrates the legacy of moderate head injury in influencing many aspects of everyday life, supporting the argument that the needs of this group should not be overlooked.

Adaptation, Psychological↗
PubMed1999

Use of the functional assessment measure (FIM+FAM) in head injury rehabilitation: a psychometric analysis.

OBJECTIVES: The drive to measure outcome during rehabilitation after brain injury has led to the increased use of the functional assessment measure (FIM+FAM), a 30 item, seven level ordinal scale. The objectives of the study were to determine the psychometric structure, internal consistency, and other characteristics of the measure. METHODS: Psychometric analyses including both traditional principal components analysis and Rasch analysis were carried out on FIM+FAM data from 2268 assessments in 965 patients from 11 brain injury rehabilitation programmes. RESULTS: Two emergent principal components were characterised as representing physical and cognitive functioning respectively. Subscales based on these components were shown to have high internal consistency and reliability. These subscales and the full scale conformed only partially to a Rasch model. Use of raw item ratings, as opposed to transformed ratings, to produce summary scores for the two subscales and the full scale did not introduce serious distortion. CONCLUSION: The full FIM+FAM scale and two derived subscales have high internal reliability and the use of untransformed ratings should be adequate for most clinical and research purposes in comparable samples of patients with head injury.

Activities of Daily Living↗
PubMed1999

Persisting symptoms and carers' views of outcome after subarachnoid haemorrhage.

OBJECTIVE: To report the outcome of aneurysmal subarachnoid haemorrhage (SAH) in terms of subjective symptoms and carers' perspective over a period of two years. DESIGN: Forty-four consecutive patients admitted to a Regional Neurosurgical Unit and who survived aneurysmal SAH were invited for outpatient assessment at 6, 12 and 24 months post haemorrhage. MEASURES: The Glasgow Outcome Scale (GOS) was used to measure global outcome; the Hospital Anxiety and Depression Scale (HAD) to screen for affective symptoms; the Head Injury Symptom Checklist (HISC) to detect symptoms commonly reported after head trauma; and information was collected from a close friend or relative of the patient using the Relative's Questionnaire (RQ). RESULTS: GOS outcome was significantly related to the severity of the original haemorrhage, as classified by the World Federation of Neurological Surgeons (WFNS) Grading Scale, on admission to hospital. However, even in cases where patients had made a good recovery according to the GOS, a variety of problems were frequently reported by patients and relatives, and many of these persisted for the duration of the study. The three most common and persistent symptoms were tiredness (63%, 59% and 59% at 6, 12 and 24 months respectively), memory disturbance (50%, 52% and 56%) and passivity (61%, 47% and 46%). In contrast, the prevalence of disturbed mood, as reported using the HAD, was similar to that of the general population. CONCLUSIONS: Studies of outcome following SAH should address these subtle disturbances, and information pertaining to potential long-term problems should be provided to patients and relevant others.

Activities of Daily Living↗
PubMed1999

The Functional Assessment Measure (FIM + FAM) as part of the hospital discharge summary after brain injury rehabilitation.

OBJECTIVE: To assess the value of providing Functional Assessment Measure (FIM + FAM) data as part of the hospital discharge information after brain injury rehabilitation. DESIGN: Postal survey of general practitioners (GPs) and consultants. SUBJECTS: Consecutive discharges (n = 117) from an early brain injury rehabilitation unit over one year. RESULTS: Response rates were 81% from GPs and 54% from consultants. Eighty-four (89%) of GPs and 57 (82%) of consultants rated the information as useful; 87 (92%) and 51 (84%) respectively described the accompanying notes as easy to understand. CONCLUSIONS: The incorporation of FIM + FAM data in discharge summaries is worthwhile but the utility of this practice is still to be established.

Activities of Daily Living↗
PubMed1998

Rater reliability of Fahn's tremor rating scale in patients with multiple sclerosis.

OBJECTIVE: Assessment of movement disorders in patients with multiple sclerosis (MS) is difficult because of the complex nature of the movement disorders. The aim of this study was to determine the reliability of Fahn's Tremor Rating Scale (FTRS) in assessing movement disorders in patients with MS. METHOD: Videos were made of 10 patients with MS showing their rest, postural, action/intention, and goal-related movement disorders as well as their performance of spirometry, a volumetric task, and timed functional tasks. Ratings of tremor were carried out by one rater on two occasions 3 months apart and by 8 raters on one occasion using FTRS. RESULTS: Intrarater reliability was generally very good, with no significant "drift" in ratings over time. Interrater reliability was generally good, with some variation in interpretation of scoring criteria that may reflect raters' backgrounds. CONCLUSION: The FTRS is a reliable and potentially useful tool with which to assess movement disorders in patients with MS.

Activities of Daily Living↗
PubMed1998

Fluoxetine as a treatment for post-stroke emotionalism.

The effectiveness of fluoxetine compared to placebo in the treatment of post-stroke emotionalism was investigated in 20 patients using a double-blind protocol. A total of 19 patients completed the study, as one subject in the treatment group had to be withdrawn. The subjects receiving fluoxetine showed a statistically and clinically significant improvement in their emotionalism compared to the placebo group, which was apparent in the majority of subjects from the third day of treatment.

Aged↗
PubMed1998

Virtual reality: a new prosthesis for brain injury rehabilitation.

Virtual Reality (VR) technology is a relatively new application to rehabilitation medicine, yet it offers considerable potential to achieve significant successes in assessment, treatment and improved outcome, thereby increasing our knowledge of neuroplasticity. The capabilities of VR are especially evident in neurological rehabilitation, where cognitive and behavioural problems often interact with physical impairments to reduce the overall level of functioning and interaction. The need for effective interventions in neurological rehabilitation demands communication and collaboration between disciplines. This paper presents some of the current areas of the clinical applications of VR, emphasising the link between experimental evidence on recovery after brain damage and the clinical problems encountered in a ward setting.

Brain Injuries↗
PubMed1997

Parkinsonism associated with acute intracranial hematomas: an [18F]dopa positron-emission tomography study.

We present the case of a 36-year-old woman with a right temporal hematoma and an overlying subdural hematoma following rupture of a right middle cerebral artery aneurysm. Three weeks after recovering consciousness, she developed a levodopa-responsive parkinsonian syndrome involving the right limbs. A year after the vascular event, she reported subjective improvement in her parkinsonism, which has remained stable since. 18F-dopa positron-emission tomography showed a marked reduction of uptake in the left putamen, raising the possibility that the intracranial hemorrhage unmasked latent Parkinson's disease. To the best of our knowledge, this is the first case of parkinsonism associated with spontaneous acute intracerebral and subdural hematomas.

Acute Disease↗
PubMed1997

Head injury rehabilitation in the U.K.: an economic perspective.

The human and societal costs as a result of traumatic brain injury (TBI) are extensive with approximately 200-300/100,000 of the population requiring hospitalisation each year in the U.K. Advances in neurosurgical management have meant that more people sustaining head injuries are surviving. The need for rehabilitation programmes for these individuals is therefore ever increasing. While in the U.S.A. rehabilitation programmes for TBI patients are well established, in the U.K. the provision of such services is patchy and varies widely in different localities. The belated response to the rehabilitation needs of this group of individuals in the U.K. has coincided with an increased awareness of the economic efficiency of health care provision. This paper critically reviews published studies looking at the economics of rehabilitation services for brain injured patients. No studies in the U.K. were identified and all the sources discussed are from the U.S.A. The methodological guidelines underlying economic appraisal of health care are summarised and the studies assessed to determine the extent to which they fulfil these guidelines. The paper concludes that most studies purporting to provide evidence of cost-effectiveness did not include appropriate data, nor followed the methodological guidelines allowing such claims to be made. Some recommendations for future research are presented.

Brain Injuries↗
PubMed1997

Disability in patients following traumatic brain injury--which measure?

Head injury results in a wide range of functional sequelae. Thus, measuring solely physical aspects of functioning may fail to highlight the actual level of disability. This study compares a commonly used measure of physical disability, the Barthel Index, with three recently devised measures-the OPCS Scales of Disability, the Functional Independence Measure (FIM) and Functional Assessment Measure (FIM + FAM). Fifty-four head-injured subjects were assessed following discharge from an in-patient rehabilitation unit utilizing each measure. The majority of subjects had no detectable disability according to the Barthel Index. In contrast, only four subjects (7%) attained maximal scores for independence with the OPCS scale; two (4%) with the FIM and only one subject (2%) with the FIM + FAM. This reflected the nature of the disabilities in activities such as intellectual functioning, communication, behaviour and wider aspects of mobility measured by the OPCS, FIM and FIM + FAM but not in the Barthel Index. The relationship between all measures was significant (Spearman ranked correlations P < 0.001) but correlations were greater between OPCS, FIM and FIM + FAM than with the Barthel. The results of this study would support considering the use of scales other than the Barthel Index when describing disability following traumatic head injury.

Activities of Daily Living↗