Speech Language Pathologists (SLPs) Enactment of Dysphagia Education and Counselling in TBI Inpatient Rehabilitation.

Abstract Background Traumatic brain injury (TBI) incidence rates are rising significantly across all age groups, often requiring complex and expensive medical care. Common causes of TBI include motor-vehicle accidents, violence, sport injuries and falls. For some individuals, inpatient rehabilitation (IPR) is used as a care pathway to provide intervention(s) for the physiological, psychological, neurobehavioural and cognitive-communication sequelae of a TBI.Many patients with a TBI will also experience dysphagia, an impairment or disorder of deglutition (swallowing). Dysphagia affects hydration, nutritional intake, respiration and can significantly impact an individual’s quality of life. It has been identified as a contributing factor in the mortality and morbidity of patients in many hospital care settings. In the Province of Ontario, patients with dysphagia concomitant with a TBI often receive inpatient rehabilitative care by a Speech-Language Pathologist (SLP). Successful outcomes for dysphagia are best achieved when the patient, independently whenever possible, and the family when it is not possible, have been educated and counselled to know which foods they can and cannot safely consume and why this is important. This requires that the SLP enact education and counselling with the patient who has a cognitive-communication disorder related to the TBI and their family in an effective way to provide critical and understandable information about the assessment results and the risks and benefits of the various management choices under consideration. It is also considered part of the SLP’s scope of practice to ensure that all members of the interdisciplinary IPR team are aware and understand the assessment results, management recommendations and know how to recognize and respond to signs and symptoms that reflect a risk of harm. As a Speech-Language Pathologist (SLP) working in an IPR setting for over 20 years with patients who have a TBI and dysphagia,I have recognized that there is a lack of accessible, evidence-based, comprehensive methods that are patient and family-focused for SLPs to use to enact education and counselling within this practice context. Therefore the objectives of this thesis were to: (1) conduct a scoping review of the literature to better understand how SLPs enact education and counselling with patients who have dysphagia and a TBI, especially within the context of inpatient rehabilitation settings; and (2) use qualitative hermeneutic inquiry to understand how SLPs enact dysphagia education and counselling with patients who have a TBI and are in inpatient rehabilitation settings in Ontario. Methods This research started with a scoping review of the literature followed by a qualitative study using a philosophical hermeneutical perspective and semi-structured interviews with twelve SLPs working in IPR settings with individuals who have dysphagia and a TBI. Participants also provided for consideration the materials they used when enacting education and counselling with their patients. Results The scoping literature review helped to reveal important parts of the enactment of education and counselling, especially as it relates to the numerous people and groups of people within the inpatient practice context who must be part of the education and counselling conversations. The results of the hermeneutic inquiry revealed important information about the complexities and constraints of practice and provided evidence of how SLPs continually try to mitigate the risks within this environment to keep their patients safe. These important conversations also revealed that SLPs generated practice-based knowledge and used innovation(s) around education and counselling primarily due to the lack of guidance around education and counselling currently available within guideline documents. Conclusion This thesis project provided a useful framework for examining the individual accounts of the SLPs and bringing these together in a thematic manner to generate important information for SLPs, educators, policy makers, and health care administrators. It advanced our understanding of how SLPs enact dysphagia education and counselling for patients with a TBI within IPR settings in Ontario

Long term improvements in activities of daily living in patients with hemispatial neglect

No abstract available

Factors influencing community case management and care hours for clients with traumatic brain injury living in the UK

Objective: To investigate the relationship between deficits associated with traumatic brain injury (TBI) and case management (CM) and care/support (CS) in two UK community samples. Research design: Prospective descriptive study. Method: Case managers across the UK and from a single UK CM service contributed client profiles to two data sets (Groups 1 and 2, respectively). Data were entered on demographics, injury severity, functional skills, functional-cognition (including executive functions), behaviour and CM and CS hours. Relationships were explored between areas of disability and service provision. Results: Clients in Group 2 were more severely injured, longer post-injury and had less family support than clients in Group 1. There were few significant differences between Groups 1 and 2 on measures of Functionalskill, Functional-cognition and Behaviour disorder. Deficits in Functionalskills were associated with CS, but not CM. Deficits in measures of executive functions (impulsivity, predictability, response to direction) were related to CM, but not to CS. Insight was related to both CM and CS. Variables related to behaviour disorder were related to CM, but were less often correlated to CS. Conclusions: The need for community support is related not only to Functionalskills (CS), but also to behaviour disorder, self-regulatory skills and impaired insight (CM)

Examining Associations between Body Mass Index in 18⁻25 Year-Olds and Energy Intake from Alcohol:Findings from the Health Survey for England and the Scottish Health Survey

Evidence on the relationship between alcohol consumption and body mass index (BMI) is mixed, particularly for young adults. This study explored the relationship between energy obtained from alcoholic beverages and BMI using data for 18-25 year-olds (n = 7691) from pooled cross-sections of the 2008⁻2014 Health Survey for England and the Scottish Health Survey. Energy obtained from alcoholic beverages (excluding mixers) on the heaviest drinking day in the past week was expressed as percentage of total recommended dietary allowance (RDA) of energy (% RDA Energy). Linear regressions were estimated of BMI on alcohol intake categories controlling for intake frequency, physical activity, longstanding illness and other covariates, with separate analyses for men and women, and by beverage type. Significant associations with BMI were observed with the 'Very High' category of alcohol intake (>75% RDA Energy) for men (p 50% to 75% RDA Energy) (p 0⁻25% RDA Energy) category. Young adults drinking the highest levels of alcohol on a single occasion were more likely to be obese than those with the lowest intake. Interventions to address internationally rising youth obesity rates should also consider reducing alcohol consumption by increasing alcohol prices, and reducing availability and marketing exposure

Non-Pharmacological Interventions to Reduce Unhealthy Eating and Risky Drinking in Young Adults Aged 18–25 Years::A Systematic Review and Meta-Analysis

Alcohol use peaks in early adulthood and can contribute both directly and indirectly to unhealthy weight gain. This review aimed to systematically evaluate the effectiveness of preventative targeted interventions focused on reducing unhealthy eating behavior and linked alcohol use in 18⁻25-year-olds. Twelve electronic databases were searched from inception to June 2018 for trials or experimental studies, of any duration or follow-up. Eight studies (seven with student populations) met the inclusion criteria. Pooled estimates demonstrated inconclusive evidence that receiving an intervention resulted in changes to self-reported fruit and vegetable consumption (mean change/daily servings: 0.33; 95% CI -0.22 to 0.87) and alcohol consumption (mean reduction of 0.6 units/week; CI -1.35 to 0.19). There was also little difference in the number of binge drinking episodes per week between intervention and control groups (-0.01 sessions; CI -0.07 to 0.04). This review identified only a small number of relevant studies. Importantly, included studies did not assess whether (and how) unhealthy eating behaviors and alcohol use link together. Further exploratory work is needed to inform the development of appropriate interventions, with outcome measures that have the capacity to link food and alcohol consumption, in order to establish behavior change in this population group

The Effects of Perinatal Testosterone Exposure on the DNA Methylome of the Mouse Brain Are Late-Emerging

Background The biological basis for sex differences in brain function and disease susceptibility is poorly understood. Examining the role of gonadal hormones in brain sexual differentiation may provide important information about sex differences in neural health and development. Permanent masculinization of brain structure, function, and disease is induced by testosterone prenatally in males, but the possible mediation of these effects by long-term changes in the epigenome is poorly understood. Methods We investigated the organizational effects of testosterone on the DNA methylome and transcriptome in two sexually dimorphic forebrain regions—the bed nucleus of the stria terminalis/preoptic area and the striatum. To study the contribution of testosterone to both the establishment and persistence of sex differences in DNA methylation, we performed genome-wide surveys in male, female, and female mice given testosterone on the day of birth. Methylation was assessed during the perinatal window for testosterone\u27s organizational effects and in adulthood. Results The short-term effect of testosterone exposure was relatively modest. However, in adult animals the number of genes whose methylation was altered had increased by 20-fold. Furthermore, we found that in adulthood, methylation at a substantial number of sexually dimorphic CpG sites was masculinized in response to neonatal testosterone exposure. Consistent with this, testosterone\u27s effect on gene expression in the striatum was more apparent in adulthood. Conclusion Taken together, our data imply that the organizational effects of testosterone on the brain methylome and transcriptome are dramatic and late-emerging. Our findings offer important insights into the long-term molecular effects of early-life hormonal exposure

Mobility and Cognition in Seniors. Report from the 2008 Institute of Aging (CIHR) Mobility and Cognition Workshop

Background The annual Scientific Meeting of the Canadian Association on Gerontology was held on October 24 and 25, 2008 in London, Ontario. Prior to the annual meeting, mobility and cognition experts met on October 23, 2008 to engage in a pre-conference workshop. Methods Discussions during the workshop addressed novel areas of research and knowledge and research gaps pertaining to the interaction between mobility and cognition in seniors. Results Workshop presenters moved from the neuromuscular, biomechanics, and neurology of gait impairments, and falls through the role of cognition and mood on mobility regulation to the whole person in the environment. Research gaps were identified. Conclusions Despite a consensus that mobility and cognition are increasingly correlated as people age, several gaps in our understanding of mechanisms and how to assess the interaction were recognized. The gaps originally identified in 2008 are still pertinent today. Common and standardized assessments for “mobility and cognition” are still not in place in current practice. Interventions that target mobility and cognitive decline as a single entity are still lacking

Persistent SARS-CoV-2 infection in immunocompromised patients facilitates rapid viral evolution: Retrospective cohort study and literature review

BACKGROUND: Most patients with SARS-CoV-2 are non-infectious within 2 weeks, though viral RNA may remain detectable for weeks. However there are reports of persistent SARS-CoV-2 infection, with viable virus and ongoing infectivity months after initial detection. Beyond individuals, viral evolution during persistent infections may be accelerated, driving emergence of mutations associated with viral variants of concern. These patients often do not meet inclusion criteria for clinical trials, meaning clinical and virologic characteristics, and optimal management strategies are poorly evidence-based. METHODS: We analysed cases of SARS-CoV-2 infection from a regional testing laboratory in South-West England between March 2020 and December 2021, with at least two SARS-CoV-2 positive samples separated by ≥ 56 days were identified. Excluding those with confirmed or likely re-infection, we identified patients with persistent infection, characterised by an ongoing clinical syndrome consistent with COVID-19 alongside monophyletic viral lineage of SARS-CoV-2. We examined clinical and virologic characteristics, treatment, and outcome. We further performed a literature review investigating cases of persistent SARS-CoV-2 infection, reviewing patient characteristics and treatment. RESULTS: We identified six patients with persistent SARS-CoV-2 infection. All were hypogammaglobulinaemic and had underlying haematological malignancy, with four having received B-cell depleting therapy. Evidence of viral evolution, including accrual of mutations associated with variants of concern, was demonstrated in five cases. Four patients ultimately cleared SARS-CoV-2. In two patients, clearance followed treatment with casirivimab/imdevimab. Both survived beyond thirty days following viral clearance, having experienced infections of 305- and 269-days duration respectively, after failed attempts at clearance with alternative therapies. We found 60 cases of confirmed persistent infection in the literature, with a further 31 probable cases. Of those, 80% of patients treated with monoclonal antibodies cleared SARS-CoV-2, and none died. CONCLUSION: Haematological malignancy and patients receiving B-cell depleting therapies represent key groups at risk of persistent SARS-CoV-2 infection. Throughout persistent infection, SARS-CoV-2 can evolve rapidly, giving rise to significant mutations, including those implicated in variants of concern. Monoclonal antibodies appear to be a promising therapeutic option, potentially in combination with antivirals, crucial for individuals, and for public health