Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: A randomised controlled trial

Background: Survivors of a cardiac arrest frequently have cognitive and emotional problems and their quality of life is at risk. We developed a brief nursing intervention to detect cognitive and emotional problems, provide information and support, promote self-management, and refer them to specialised care if necessary. This study examined its effectiveness. Methods: Multicentre randomised controlled trial with measurements at two weeks, three months and twelve months after cardiac arrest. 185 adult cardiac arrest survivors and 155 caregivers participated. Primary outcome measures were societal participation and quality of life of the survivors at one year. Secondary outcomes were the patient's cognitive functioning, emotional state, extended daily activities and return to work, and the caregiver's well-being. Data were analysed using 'intention to treat' linear mixed model analyses. Results: After one year, patients in the intervention group had a significantly better quality of life on SF-36 domains Role Emotional (estimated mean differences (EMD) = 16.38, p = 0.006), Mental Health (EMD = 6.87, p = 0.003) and General Health (EMD = 8.07, p = 0.010), but there was no significant difference with regard to societal participation. On the secondary outcome measures, survivors scored significantly better on overall emotional state (HADS total, EMD = -3.25, p = 0.002) and anxiety (HADS anxiety, EMD = -1.79, p = 0.001) at one year. Furthermore, at three months more people were back at work (50% versus 21%, p = 0.006). No significant differences were found for caregiver outcomes. Conclusion: The outcomes of cardiac arrest survivors can be improved by an intervention focused on detecting and managing the cognitive and emotional consequences of a cardiac arrest. Trial registration: Current controlled trials, ISRCTN74835019. (C) 2015 Elsevier Ireland Ltd. All rights reserved

Het effect van intramusculaire botuline-toxinetoediening bij een patiënt met een spastische hemiparese op de loopvaardigheid en het loopcomfort.

Doel van de studie: Een indruk krijgen van de invloed van intramusculaire botuline-toxinetoediening (BTX) op de vaardigheid van het lopen bij patiënten na een CVA. Methode: In deze single case studie is gekozen voor een pre-experimenteel design. Gestandaardiseerde metingen (n=9) vonden plaats één week voor de interventie met BTX (baseline) en drie weken na de interventie. Resultaten: Na de injectie met BTX leek verbetering te zijn opgetreden in loopsnelheid, loopafstand en snelheid van verplaatsen in de omgeving. Tevens gaf de proefpersoon aan een verbetering in het loopcomfort te ervaren. De symmetrie in duur van stand- en zwaaifase en de gemiddelde maximale gewichtsname op het linker- en rechterbeen lijkt onveranderd. Conclusie: Toediening van BTX in de M.tibialis posterior bij een CVA-patiënt lijkt het lopen positief te beïnvloeden. De resultaten dienen vanwege het design van de studie met enige voorzichtigheid geïnterpreteerd te worden. (aut.ref.

Effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients in the chronic phase after acquired brain injury

The aim of this prospective cohort study was to examine the effectiveness of a low intensity outpatient cognitive rehabilitation programme for patients with acquired brain injury in the chronic phase. Twenty-seven patients with acquired brain injury (i.e., stroke, traumatic brain injury, subarachnoid haemorrhage; 52% male) with a mean age of 49.5 (SD 9.2) years and 25 relatives with a mean age of 48.8 (SD 8.8) years were recruited to the study. Mean time since injury in the patient group was 1.9 years (SD 2.0). The group programme consisted of 15 weekly sessions of 2.5 hours and included cognitive strategy training, social skills training, and psycho-education. Patients also received homework. Relatives were invited to attend twice. Repeated measurements were taken: prior to treatment (baseline, T0); directly after treatment (T1, 21 weeks); and at follow-up (T2, 45 weeks). Primary outcome measures were individualised goals (GAS), cognitive failures (CFQ), and quality of life (SA-SIP). Patients did improve significantly on individual goals (p .05) between T0 and T1 and the level of attainment remained stable between T1 and T2. Goals were mostly set in the cognitive and behavioural domains. There were no significant differences between the measurements (T0-T1-T2) on the CFQ and the SA-SIP. The programme had a positive effect on the individual goals set by the patients. However, this did not result in a higher participation level or a better quality of life. This may be due to the low intensity and short duration of the programme

Social work practice with traumatic brain injury: the results of a structured review

Objectives: To determine public perception of: 1) mild traumatic brain injury (mTBI) amongst British service personnel; and 2 (veteran healthcare). Methods: The study was posted online and participants were also recruited offline from town councils, public libraries, religious organisations, social networking sites such as Facebook and Twitter. Twelve questions of public perceptions of mild traumatic brain injury and veteran healthcare were presented after a vignette on a service personnel’s account of mild traumatic brain injury. The responses were analysed using thematic analysis. Results: Three themes were identified. The right to quality healthcare, awareness or lack thereof of the injury, and empathy towards the experiences of service personnel with mTBI. Members of the public have a firm opinion that veterans have a right to healthcare. Their service to their nation warrants proper treatment. There is empathy towards service personnel with the injury. However there is little awareness as to the nature of mTBI and the full extent of its impact on the lives of service personnel. Respondents cited that this might be due to the issue being low on the political agenda. Conclusion: Participants indicated that they had not previously given thought to the injury or had not heard about it previously. Most respondents were also not familiar with the services available to veterans with the injury. Empathising with the experiences while at the same time recognising the extent of their ability to render support for service personnel with the injury seemed to resonant. More public awareness campaigns on the extent of the injury and what the injury entails would ensure greater understanding of service personnel with the injury

Accelerometry Measuring the Outcome of Robot-Supported Upper Limb Training in Chronic Stroke: A Randomized Controlled Trial

Purpose: This study aims to assess the extent to which accelerometers can be used to determine the effect of robot-supported task-oriented arm-hand training, relative to task-oriented arm-hand training alone, on the actual amount of arm-hand use of chronic stroke patients in their home situation. Methods: This single-blind randomized controlled trial included 16 chronic stroke patients, randomly allocated using blocked randomization (n = 2) to receive task-oriented robot-supported arm-hand training or task-oriented (unsupported) arm-hand training. Training lasted 8 weeks, 4 times/ week, 2 Chi 30 min/ day using the (T-) TOAT ((Technology-supported)-Task-Oriented-Arm-Training) method. The actual amount of arm-hand use, was assessed at baseline, after 8 weeks training and 6 months after training cessation. Duration of use and intensity of use of the affected arm-hand during unimanual and bimanual activities were calculated. Results: Duration and intensity of use of the affected arm-hand did not change significantly during and after training, with or without robot-support (i.e. duration of use of unimanual use of the affected arm-hand: median difference of -0.17% in the robot-group and -0.08% in the control group between baseline and after training cessation; intensity of the affected arm-hand: median difference of 3.95% in the robot-group and 3.32% in the control group between baseline and after training cessation). No significant between-group differences were found. Conclusions: Accelerometer data did not show significant changes in actual amount of arm-hand use after task-oriented training, with or without robot-support. Next to the amount of use, discrimination between activities performed and information about quality of use of the affected arm-hand are essential to determine actual arm-hand performance