NeuroRehabilitation - Volume 19, issue 1

Authors: DeVivo, Michael J.

Article Type: Introduction

DOI: 10.3233/NRE-2004-19101

Citation: NeuroRehabilitation, vol. 19, no. 1, pp. 1-2, 2004

Authors: Adkins, Rodney H.

Article Type: Research Article

Abstract: There are number of perspectives associated with the scientific study and interpretation of aging in the general population that also relate to the study of aging with spinal cord injury (SCI). These include era and survivor effects and have implications for design, analysis and interpretation of SCI aging research, which, in turn, have implications for planning, policy and clinical practice. Several factors specifically related to SCI also have implications for design, analysis and interpretation of SCI aging research. These include duration of injury, age at injury, neurological impairment (level and completeness of injury), and gender. Considering the skin, musculoskeletal, …cardiovascular, respiratory, genitourinary, gastrointestinal, nervous, endocrine, and immune physiologic systems, appropriate research specific to a particular system and related morbidity in those aging with spinal cord injury is currently limited to the musculoskeletal, cardiovascular and respiratory systems. Research on certain aspects of aging with SCI is not currently feasible due to the rate and magnitude of historical changes in treatment and rehabilitation of SCI; and currently most research pertaining to aging with SCI will be highly subject to survivor effects. Nevertheless, there is a need for research on aging with SCI and many opportunities with regard to gaps in knowledge. Show more

Keywords: aging research, spinal cord injury, morbidity

DOI: 10.3233/NRE-2004-19102

Citation: NeuroRehabilitation, vol. 19, no. 1, pp. 3-13, 2004

Authors: Charlifue, Susan | Gerhart, Kenneth

Article Type: Research Article

Abstract: Objective: to examine how scores on measures of stress, life satisfaction, depression, and psychological well-being relate to perceived quality of life among people with longstanding spinal cord injuries. Design: 189 members of a British population-based study of outcomes after spinal cord injury were evaluated at three-year intervals from 1990 to 1999. Participants rated their quality of life at each interval, and completed various psychosocial measures. Scores and results were analyzed to identify changes over time and correlations with perceived quality of life. Results: Self-ratings of quality of life were high and relatively stable over the duration …of the longitudinal study. There were strong concurrent relationships between perceived quality of life and psychosocial outcomes. Across time periods, the outcomes studied did not seem to strongly predict later quality of life, but earlier perceived quality of life did predict later stress, depression, and psychological well-being. Conclusions: Perceived quality of life among this group of individual with long duration spinal cord injuries was high and relatively stable over time. Significant relationships identified between earlier quality of life and later perceived stress, depression, and well-being suggest that quality of life, typically thought of as a key outcome may itself be a predictor of other outcomes. Show more

Keywords: spinal cord injury, aging, quality of life, stress, depression

DOI: 10.3233/NRE-2004-19103

Citation: NeuroRehabilitation, vol. 19, no. 1, pp. 15-23, 2004

Authors: Hammond, Flora M. | Grattan, Karyn D. | Sasser, Howell | Corrigan, John D. | Rosenthal, Mitchell | Bushnik, Tamara | Shull, William

Article Type: Research Article

Abstract: Objective: Study functional changes between one and five years after traumatic brain injury (TBI). Design: Prospective cohort. Setting and participants: TBI Model Systems National Database subjects using cohort with complete one and five year data (n = 301). Main outcome measures: Disability Rating Scale (DRS) Level of Functioning and Employability Items. Results: On Level of Functioning, 53 (18%) individuals improved, 228 (76%) stayed the same, and 20 (7%) worsened by more than one point from Year 1 to Year 5. On Employability, 50 (17%) individuals improved, 237 …(79%) stayed the same, and 14 (5%) worsened by greater than one point. Level of Functioning improvement was predicted by FIM™-Motor, FIM™-Cognitive, Rey Auditory Verbal Learning Test, Symbol Digit Modalities Test (written and oral), and Wechsler Adult Intelligence Scale-Revised Block Design, and worsening predicted by Symbol Digit Modalities Test (written and oral). Improvement in Employability was predicted by race, while Glasgow Coma Scale Eye Opening was predictive of worsening. Conclusions: Although the majority did not demonstrate meaningful change on the DRS items from year 1 to 5, some individuals made dramatic gains and a minority declined. There are demographic and functional indicators present at one-year post-injury that may be predictive of subsequent change. Show more

Keywords: brain injury, outcome, function, disability rating scale, prediction, employment

DOI: 10.3233/NRE-2004-19104

Citation: NeuroRehabilitation, vol. 19, no. 1, pp. 25-35, 2004

Authors: Brown, Allen W. | Leibson, Cynthia L. | Malec, James F. | Perkins, Patricia K. | Diehl, Nancy N. | Larson, Dirk R.

Article Type: Research Article

Abstract: This population-based retrospective cohort study identified all Olmsted County, MN residents with any diagnosis indicative of potential traumatic brain injury (TBI) during the years 1985 to 2000. The complete community-based medical records of a random sample (n = 7,175) were reviewed to confirm and characterize the event, and to determine vital status through 2002. The review identified 1,448 confirmed incident cases; 164 (11%) were moderate to severe; 1,284 were mild. The estimated 30-day case fatality rate was 29% for moderate to severe cases and 0.2% for mild cases. Comparison of observed mortality over the full period of follow-up …with that expected revealed a risk ratio (95% CI) of 5.29 (4.11–6.71) for moderate to severe cases and 1.33 (1.05–1.65) for mild cases. Proportional hazards modeling showed the adjusted hazard of all-cause mortality for moderate to severe cases relative to mild cases was 5.18 (3.65–7.3) within six months of the event and 1.04 (0.57–1.88) for the remaining follow-up period. This analysis indicates that persons who experience mild TBI exhibit a small but statistically significant reduction in long-term survival compared to the general population. The case fatality rate for persons with moderate to severe TBI is very high, but among six-month survivors, long-term survival is similar to that for persons with mild TBI. Show more

Keywords: brain injuries, head trauma, longevity, mortality

DOI: 10.3233/NRE-2004-19105

Citation: NeuroRehabilitation, vol. 19, no. 1, pp. 37-43, 2004

Authors: Harrison-Felix, Cynthia | Whiteneck, Gale | DeVivo, Michael | Hammond, Flora M. | Jha, Amitabh

Article Type: Research Article

Abstract: While many outcomes after traumatic brain injury (TBI) have been systematically investigated, the most basic of all outcomes – survival – has been neglected. The purpose of this study was to investigate mortality in a cohort of 2,178 individuals with TBI completing inpatient rehabilitation in one of 15 National Institute on Disability and Rehabilitation Research-funded TBI Model Systems of care. The study hypotheses were: (1) relative to the general population, TBI increases mortality and decreases life expectancy in individuals with TBI completing inpatient rehabilitation and surviving to one-year post-injury; and (2) within the TBI population, the risk of death …is greater in certain TBI subgroups. Results indicate that individuals with TBI were twice as likely to die compared to individuals in the general population of similar age, gender and race, resulting in an estimated average life expectancy reduction of seven years for individuals with TBI. Within the TBI population, the strongest independent risk factors for death after one-year post-injury were older age and not being employed at injury, and greater disability at rehabilitation discharge. This information is important to guide decision-making for treatment, utilization of limited medical resources, and planning for ongoing health care needs and lifetime planning. Show more

Keywords: traumatic brain injury, mortality, life expectancy

DOI: 10.3233/NRE-2004-19106

Citation: NeuroRehabilitation, vol. 19, no. 1, pp. 45-54, 2004

Authors: Minden, Sarah L. | Frankel, Debra | Hadden, Louise S. | Srinath, K.P. | Perloff, Jennifer N.

Article Type: Research Article

Abstract: This study compares the demographic, clinical, and health care characteristics of 2,156 persons over and under age 65 who are participants in the Sonya Slifka Longitudinal Multiple Sclerosis Study and examines the effects of current age, age at diagnosis, course, and duration of illness on disability-related outcomes. Compared to younger MS patients, significantly higher percentages of older patients lived alone, had lower incomes, and were severely disabled; 85% needed help with activities of daily living and 40% received home care services. Almost all older patients had health insurance, 75% had prescription drug coverage, and few reported difficulty accessing general medical …and specialized MS care; perceptions of health status and quality of life were relatively positive. Duration and course of illness were the major predictors of disability, although older current age and younger age at diagnosis were also associated. The relationship among age- and disease-related variables is complex and they likely exert independent effects on disability-related outcomes. Planning is needed by caregivers and policy makers to ensure that the specialized needs of elderly persons with MS are adequately met. Show more

Keywords: multiple sclerosis, aging, disability, chronic illness

DOI: 10.3233/NRE-2004-19107

Citation: NeuroRehabilitation, vol. 19, no. 1, pp. 55-67, 2004

Authors: Strauss, David | Ojdana, Kelly | Shavelle, Robert | Rosenbloom, Lewis

Article Type: Research Article

Abstract: The authors studied the pattern of functional abilities and decline of skills in adults with cerebral palsy. The data source was the California Developmental Disabilities data base, which included 904 subjects of age 60. For those individuals who are mobile when they become adults, there is a marked decline in ambulation, especially in late adulthood, and few of the 60 year-olds who walked well preserved this skill over the following 15 years. Older subjects frequently also lost the ability to dress themselves. Many other skills, however, seemed to be well preserved, including speech, self-feeding and the ability to order …meals in public. Whereas the great majority of young adults lived in their families' home or in small private group homes, 18% of the 60 year-olds lived independently or semi-independently, and 41% resided in facilities providing a higher level of medical care. Survival rates of the ambulatory older adults were only moderately worse than the general population. Survival was, however, much poorer among those who had lost mobility. Show more

Keywords: cerebral palsy, adults, activities of daily living, mortality, survival, decline in function

DOI: 10.3233/NRE-2004-19108

Citation: NeuroRehabilitation, vol. 19, no. 1, pp. 69-78, 2004