Biomedical subjects

G Whiteneck

Publications and source records attributed to G Whiteneck.

8 recordsLinked to original sources

PubMed2006

Domains of a TBI minimal data set: community reintegration phase.

Efforts to establish a minimal data set for the period of community integration after traumatic brain injury (TBI) have been the focus of a working group of leading researchers, clinicians and advocates attending the Galveston Brain Injury Symposium in 2001 and 2002. The purpose of the data set is to increase the consistency and interpretability of TBI research and programme evaluation by providing a common set of measures to document key aspects of community integration. It is intended to be sensitive to intervention, comprehensive, reflect satisfaction and outcome and promote future treatment/therapy. In deciding on the components of a minimal data set, the tri-partite model of outcomes was adopted (initially employed in psychotherapy, adapted to TBI) which focuses on the needs of the individual, society and the health provider. Scales are recommended for the respective components of the model.

Age Factors↗

PubMed2000

Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial.

OBJECTIVE: To investigate the effect of gabapentin on subject self-report and physician-administered spasticity scales in individuals with multiple sclerosis. DESIGN: Prospective, double-masked, placebo-controlled, crossover design. SETTING: The Multiple Sclerosis Center at the Denver Veterans Affairs Medical Center. INTERVENTION: Subjects were titrated to either 900 mg gabapentin orally three times a day or placebo over a 6-day period. Subjects underwent a 14-day washout and then were crossed over. No other changes were made to their medication regimen. MAIN OUTCOME MEASURES: The outcome measures were divided into two categories: subject self-report scales physician-administered scales. Subject self-report scales included the spasm frequency scale, spasm severity scale, interference with function scale, painful spasm scale, and global assessment scale. Physician-administered scales included the Modified Ashworth Scale, clonus scale, deep tendon reflexes, plantar stimulation response, and the Kurtzke Expanded Disability Status (EDSS) Scale. Digit Span and Digit Symbol subtests of the WAIS-R Intelligence Scale were administered to assess for possible impaired concentration. The Fatigue Impact Scale was administered to assess for changes in fatigue. The adjective generation technique was administered to assess for alterations in mood. RESULTS: A statistically significant reduction in the impairment of spasticity was found in the gabapentin-treated subjects compared with placebo as measured by the self-report scales of the spasm severity scale, interference with function scale, painful spasm scale, and global assessment scale and by the physician-administered scales of the Modified Ashworth and plantar stimulation response. No significant difference was noted in the Digit Span, Digit Symbol, adjective generation technique, and EDSS. CONCLUSION: Gabapentin reduces the impairment of spasticity, compared with placebo, without the side effects of worsening concentration and fatigue.

Acetates↗

PubMed2000

Measures of social outcomes in disability research.

OBJECTIVES: To describe instruments that have been developed to quantify (aspects of) social outcomes in research on persons with a disability, and to evaluate the clinimetric characteristics of some of the more prominent and promising measures. DATA SOURCES: Literature in social health, social psychiatry, developmental disabilities, independent living, gerontology, medical rehabilitation, and quality of life studies. STUDY SELECTION: Social outcomes are defined as those changes or differences in the social functioning (broadly defined) of persons with disabilities that result directly or indirectly from impairments and functional limitations. Excluded were measures that focus on purely physical or psychologic aspects of functioning, apply to children only, or quantify 1 social domain only. DATA EXTRACTION: For 16 instruments the distribution of items across the participation domains of the International Classification of Impairments, Activities, and Participation is presented, as well as a distribution of items by metrics used. For 5, clinimetric information from published studies were reviewed and summarized in letter grades. DATA SYNTHESIS: Several instruments have broad coverage, acceptable respondent burden, and moderate to good reliability, validity, and sensitivity. CONCLUSIONS: Social outcomes should be more routinely included in disability and rehabilitation research. Recommendations for selection and further development are made.

Persons with Disabilities↗

PubMed1999

Predicting community reintegration after spinal cord injury from demographic and injury characteristics.

OBJECTIVE: To determine the influence of demographic and injury characteristics on the community reintegration of people with spinal cord injury (SCI). DESIGN: Prospective cross-sectional and longitudinal examination of individuals with SCI. SETTING: Follow-up of individuals at 1, 2, 5, 10, 15, and 20 years after SCI who received their initial rehabilitation in a Regional Model Spinal Cord Injury System. PARTICIPANTS: A total of 3,835 individuals who met the inclusion criteria for the National SCI Database were studied cross-sectionally, and a subset of 347 individuals who were also enrolled in a longitudinal study of aging with SCI. MAIN OUTCOME MEASURES: Subscales of the Craig Handicap Assessment and Reporting Technique (CHART). RESULTS: Neurologic classification, age, years postinjury, gender, ethnicity, and education explain 29% of the variance in physical independence, 29% of the variance in mobility, 28% of the variance in occupation. 9% of the variance in social integration, and 18% of the variance in economic self-sufficiency. CONCLUSIONS: Although these factors are inadequate to explain most of the variation in community reintegration (handicap) after SCI, they might appropriately be used to adjust for case-mix differences when comparing rehabilitation facilities and techniques.

Activities of Daily Living↗

PubMed1997

Traumatic brain injury: designing and implementing a population-based follow-up system.

Craig Hospital and the Colorado Department of Public Health and Environment began designing a population-based follow-up system for persons with traumatic brain injury (TBI) in 1994. With funding from the Centers for Disease Control and Prevention, the Colorado TBI Follow-up System addresses the issue, "What happens to persons with TBI after they are discharged from the hospital?" Two methods of data collection are used, medical record review and annual telephone surveys to gather long-term outcomes. The design calls for following all persons hospitalized with severe TBI (defined as any person with inpatient rehabilitation and/or with an Abbreviated Injury Scale [AIS] score for the head of 3 or greater) and a 20% random sample of persons hospitalized with less severe TBI. An expert panel was used to select variables for retrospective abstracting and prospective interviewing. Information obtained from medical records includes data verifying eligibility, diagnoses, radiological results, circumstances of injury, and severity of injury, as well as demographic data. The interview instrument includes questions and scales related to health status, disability, handicap, quality of life, and service utilization. Both methods of data collection have been pilot-tested and are now used routinely in the Colorado TBI Follow-up System.

Brain Injuries↗

PubMed1997

Bowel management outcomes in individuals with long-term spinal cord injuries.

Outcomes of bowel management were evaluated in 1993 among 221 British long-term spinal cord injury survivors who were followed-up as part of a longitudinal study of aging with spinal cord injury. Representing a population-based sample followed up by two regional spinal cord injury treatment centres - Stoke Mandeville Hospital in Aylesbury and the District General Hospital in Southport, England - all had been injured at least 20 years when the study was begun in 1990; all underwent comprehensive assessments and extensive interviewing at their centres in 1990 and 1993. When assessed in 1993, 42% of the entire sample reported constipation, 35% reported gastrointestinal pain, and 27% complained of bowel accidents. Physician examiners diagnosed significantly more hemorrhoids among those using primarily suppositories and enemas to manage their bowels (P < 0.05) and more constipation among persons with paraplegia (P < 0.05) and those using digital stimulation, manual evacuation, or increased abdominal pressure in their bowel programs. Fecal incontinence and diarrhea was diagnosed three times more often in participants with tetraplegia as in other neurological groupings. These and other findings suggest future research needs and directions relative to long-term bowel management for spinal cord injury survivors.

Aging↗

PubMed1994

Two methods of weaning persons with quadriplegia from mechanical ventilators.

Two commonly-used methods of weaning individuals with quadriplegia from mechanical ventilators were compared. The medical records were reviewed of 52 patients who were injured at the C3 or C4 levels, were ventilator dependent following their injury, and were treated at the participating facilities. The study subjects had a total of 82 separate wean attempts: 26 utilized intermittent mandatory ventilation, 34 used progressive ventilator-free breathing (T-piece weaning) and 22 used either a combination of these approaches or a different approach. With an overall weaning success rate of 83%, this study demonstrated that individuals with C3 and C4 quadriplegia are indeed candidates for ventilator weaning. Comparing the two weaning methods, progressive ventilator-free breathing was found to be successful more often than intermittent mandatory ventilation (67.6% compared to 34.6%). In addition, progressive ventilator-free breathing appeared superior in its ability to provide a more functional alternative to individuals unable to wean completely.

Adolescent↗

PubMed1993

Occupational spinal cord injury: demographic and etiologic differences from non-occupational injuries.

Most spinal cord injuries (SCIs) are the result of motor vehicle accidents (MVAs). There are no published reports specifically addressing SCIs that occur in the workplace. We report a cohort survey study examining the frequency and etiology of SCI in the workplace. Through a cooperative program, an evaluation of all SCIs seen in Colorado during a 5 1/2-year period (January 1, 1986 through June 6, 1991) is presented. We report a detailed analysis of specific data of all SCIs occurring in the workplace. There were a total of 566, with 74 (13.1%) due to injuries that occurred during the course of employment. The most common cause of occupational SCI was falls, which occurred in 37 (50%), as compared with only 15.9% of non-occupational SCIs. Only 14 (18.9%) occupational SCIs resulted from MVAs, compared with 59.3% of non-occupational SCIs. Other major etiologies for occupational SCI included being hit by a falling object in 14 individuals (18.9%), gunshot wound in three (4%), skiing in one (1.4%), stabbing in one (1.4%), and other causes in four (5.4%). Construction occupations were over-represented in occupational SCIs with 41.9% of cases as compared with only 6.3% for the non-occupational group. Because of the large percentage of occupational SCIs, efforts should be aimed at educating workers in at-risk occupations to prevent this serious injury.

Accidents, Occupational↗