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Biomedical subjects

W High

Publications and source records attributed to W High.

9 recordsLinked to original sources
PubMed2005

Neuropsychological outcome and community re-integration following traumatic brain injury: the impact of frontal and non-frontal lesions.

PRIMARY OBJECTIVE: To examine the relationship between cortical lesion location and brain injury outcome. It was hypothesized that focal frontal lesions after traumatic brain injury (TBI) would result in decreased executive and memory functioning and poor community participation outcome. RESEARCH DESIGN: Three quasi-experimental, prospective studies employed a total of 643 patients with focal frontal, fronto-temporal, non-frontal or no lesions in CT scans. METHODS AND PROCEDURES: CT scan analysis, neuropsychological assessment, the Neurobehavioural Functioning Inventory (NFI), the Community Integration Questionnaire (CIQ). MAIN RESULTS: In study 1, frontal and fronto-temporal groups performed worse in executive functioning and better in constructional ability. Study 2 found no differences in neuropsychological and community re-integration measures at 1-year follow-up. Study 3 found comparable neuropsychological test score improvement across groups over 1 year. CONCLUSIONS: Results are consistent with previous findings and document the potential for test score improvement with rehabilitation and suggest that lesion location needs to be considered when individual rehabilitation plans are being implemented in the post-acute stage of TBI.

Accidental Falls↗
PubMed2001

Charges and lengths of stay for acute and inpatient rehabilitation treatment of traumatic brain injury 1990-1996.

This investigation evaluated yearly trends in charges and lengths of stay for patients with brain injury in acute care and rehabilitation settings over a 7 year period. Data was collected from 800 consecutive patients enrolled in four NIDRR Model Systems Traumatic Brain Injury programmes. Acute care daily charges showed almost routine increases, averaging nearly $550 per year. Conversely, lengths of stay generally showed a downward trend, with annual reductions averaging 2.25 days. Admission lengths of stay averaged 22-29 days between 1990-1994. Admissions averaged less than 20 days beginning in 1995, with the 1996 average of 16 days, nearly half that of the 1993 average. Between 1990-1996, average daily rehabilitation charges increased each year, with the rise averaging $83 or 7%. The rise in daily rehabilitation charges was offset by corresponding decreases in lengths of stay averaging 3.65 days or 8% annually. Increases in daily charges for brain injury rehabilitation care were roughly comparable to those for general medical care prices. However, the rate of change in acute care charges was substantially greater, with annual increases averaging 10% more than national medical care prices. The steady downward trend in lengths of stay raises serious concerns about the future availability of health care services to persons with brain injury.

Adult↗
PubMed1999

Contribution of functional ratings to prediction of longterm employment outcome after traumatic brain injury.

The present study investigated the contribution of functional ratings to prediction of employment outcome after traumatic brain injury (TBI). Previous studies have suggested that functional ratings obtained at a significant time post-injury can supplement neurologic, pre-injury, neuropsychologic, and other post-injury variables in predicting long-term employment outcome. Functional ratings studied were patients' needs for physical, cognitive, and behavioural supervision. This investigation also addressed the issue of predicting long-term outcome for the select group of TBI patients who receive post-acute brain injury rehabilitation. Subjects were 76 patients with TBI. The mean age (25th, 50th, and 75th percentiles) was 32 (22, 28, 39) years and mean premorbid education level was 13 (12, 12, 14) years. Predictors studied were severity of injury, premorbid education level, pre-injury substance use, and needs for physical, cognitive and behavioural supervision at discharge from post-acute rehabilitation. Supervision needs ratings were obtained an average of 9.6 (4.2, 5.9, 11.2) months post-injury. Productivity status was assessed an average of 22.5 (12.6, 20.7, 30.5) months post-injury and 12.9 (4.9, 12.4, 16.6) months post-discharge from treatment. Spearman correlation coefficients revealed that premorbid educational level, pre-injury substance use, and needs for physical and behavioural supervision were related to long-term functional outcome (p < 0.05). However, multiple logistic regression analysis revealed that only level of pre-injury substance use was predictive of long-term productivity outcome once adjusted for the effects of the other predictors. Patients with no history of pre-injury substance use were more than eight times as likely to be employed at follow-up as those with a history of pre-injury substance abuse (p < 0.01).

Adult↗
PubMed1998

Prediction of employment outcome one to three years following traumatic brain injury (TBI).

The current study investigated the relationship between age, education (EDUC), pre-injury productivity (PIP), Glasgow Coma Scale score, and a functional rating score at admittance and discharge from rehabilitation (Disability Rating Scale [DRS]) to employment status at one to three years following traumatic brain injury. EDUC, admit DRS, discharge DRS, and PIP all correlated significantly with follow-up employment status, 0.29, -0.32, -0.36, and 0.25 respectively. All possible combinations were then evaluated by Mallow's Cp statistic. The best fitting model was then used in a discriminant function analysis. The discriminant function correctly classified 84% of the employed subjects, 66% of the unemployed, and 75% across both groups. The current results compare favourably with those obtained in previous studies.

Adult↗
PubMed1998

The Awareness Questionnaire: factor structure and internal consistency.

Patients with traumatic brain injuries often show impaired awareness of their impairments. This impaired awareness can decrease motivation for treatment and limit eventual functional outcome. The importance of this phenomenon has led to the development of multiple techniques and scales for measuring impaired awareness. The present paper briefly reviews the various methods of operationalizing impaired awareness and describes a new scale (the Awareness Questionnaire) designed to incorporate all these methods. Findings of previous studies supporting the validity of the Awareness Questionnaire are presented. The present investigation examined the factor structure and internal consistency of the Awareness Questionnaire with samples of 126 traumatic brain injury survivors and 75 family members/significant others. Principal components factor analysis with varimax rotation indicated three factors: cognitive, behavioural/affective, and motor/sensory. Investigation of internal consistency (Cronbach Coefficient Alpha) in both the patient and family sample yielded satisfactory results. These findings are supportive of continued use and investigation of the Awareness Questionnaire.

Activities of Daily Living↗
PubMed1997

Anti-arthritic activity of hydroxamic acid-based pseudopeptide inhibitors of matrix metalloproteinases and TNF alpha processing.

OBJECTIVE AND DESIGN: The effects of two hydroxamate inhibitors of metalloproteinase and tumor necrosis factor alpha (TNF alpha) processing on endotoxin-induced plasma TNF alpha and arthritic lesions in adjuvant-induced arthritic (AA) rats were determined. MATERIAL AND TREATMENT: BB-1101 and BB-1433 were administered orally twice daily to AA Lewis rats with an established disease (days 13 to 22). AA rats (day 16) or normal rats were injected with bacterial endotoxin and plasma levels of TNF alpha were also determined. METHODS: Hindpaw swelling was measured plethysmographically. Bone degradation was determined by radiography and bone mineral densitometry. TNF alpha was quantified using a sandwich ELISA. RESULTS: The hydroxamic-acid pseudopeptides inhibited plasma. TNF alpha levels in vivo and significantly reduced swelling and bone degradation of the tibiotarsal joints of AA rats in the range of 10-50 mg/kg given orally (p < 0.01 by Student's t-test). CONCLUSIONS: Thus, these novel compounds offer a new disease modifying therapy for arthritis and the results also suggest that inhibition of TNF alpha production may contribute, at least in part, to their anti-arthritic activity.

Animals↗
PubMed1997

Acute predictors of successful return to work 1 year after traumatic brain injury: a multicenter analysis.

OBJECTIVE: To investigate the influence of acute injury characteristics on subsequent return to work in traumatic brain injury (TBI) patients. DESIGN: Descriptive statistics were performed in a comparative study of 49 TBI patients who were competitively employed at 1-year follow-up and 83 unemployed patients. Independent t tests were then performed to examine the differences between the two groups on specific measures including the Disability Rating Scale (DRS), Functional Assessment Measure (FIM), Rancho Los Amigos Scale (RLAS), Glasgow Coma Scale (GCS), Neurobehavioral Rating Scale (NRS), and neuropsychological test results. SETTING: Four medical centers in the federally sponsored Traumatic Brain Injury Model Systems Project that provide emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services. PARTICIPANTS: Patients were selected from a national database of 245 rehabilitation inpatients admitted to acute care within 8 hours of TBI and seen at 1-year follow-up. MAIN OUTCOME MEASURE: Return to work at 1-year follow-up. RESULTS: Persons employed at 1-year follow-up obtained significantly better scores on specific acute measures of physical functioning (Admission FIM, Admission DRS, Discharge DRS), cognitive functioning (Logical Memory Delay), behavioral functioning (Admission RLAS, Discharge RLAS, NRS Excitement factor), and injury severity (Admission GCS, Highest GCS, Length of Coma, Length of PTA) than their unemployed counterparts. CONCLUSIONS: Persons obtaining better scores on certain acute measures (e.g., Admission GCS) are more likely to return to the workforce. Future research should focus on developing a standardized tool to assess a patient's ability to return to work, as well as an operational definition for successful employment.

Adult↗
PubMed1996

Functional outcomes of older adults with traumatic brain injury: a prospective, multicenter analysis.

OBJECTIVE: To investigate improvement rates and medical services costs in older brain injured adults relative to younger patients. DESIGN: Descriptive statistics were computed in a prospective comparative study of 50 patients 55 years and older and 50 patients 18 to 54 years old matched for gender and injury severity (number of days in coma, admission Glasgow Coma Score, intracranial pressure). Independent t tests were performed to examine differences between the two samples on specific variables. SETTING: Five medical centers in the federally sponsored Traumatic Brain Injury Model Systems Project that provide emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services. PARTICIPANTS: Patients were selected from a national database of 531 rehabilitation inpatients admitted to acute care within 8 hours of traumatic brain injury between 1989 and 1994. MAIN OUTCOME MEASURES: Disability Rating Scale, Functional Independence Measure, Rancho Los Amigos Levels of Cognitive Functioning Scale, length of stay, acute care and rehabilitation charges, and discharge disposition. RESULTS: Older persons averaged a significantly longer rehabilitation length of stay, higher total rehabilitation charges, and a lower rate of change on functional measures. No significant differences between groups were found for acute care length of stay, daily rehabilitation charges, acute care charges (daily or total), or discharge disposition. CONCLUSIONS: Although older persons demonstrated functional changes, the cost of change was substantially higher than for younger patients, coincident with longer lengths of stay. These higher overall charges and slower rates of change may effect changes in referral and management patterns.

Activities of Daily Living↗