Outcome after modern neurosurgical care and formalised rehabilitation following severe brain injury

Aims: The overall aims were to evaluate the results of the treatment concepts for severe brain injury including decompressive craniectomy (DC), early rehabilitation and long-term follow-up, primarily according to the psychosocial consequences of the brain damage and life satisfaction. The first study was a cross-sectional study to assess and compare the consequences for outcome for two groups with severe traumatic brain injury (TBI) or subarachnoid haemorrhage (SAH), one group that received early, long-term formalised rehabilitation and the other that received late or no formalised rehabilitation. The second study was a descriptive, prospective study with follow-up until five years after severe TBI/SAH. The third was a retrospective study of the long-term outcome in patients with malignant middle cerebral artery infarction (MMI) who were treated with DC, while the fourth was a prospective one-year follow-up study of patients with different diagnoses who were treated with DC. Methods: The main outcome measures were the structured form for the Swedish Neuro Database, the Glasgow Outcome Scale (GOS), the Extended Glasgow Outcome Scale (GOSE), the Functional Independence Measure (FIM), the Head Injury Evaluation Chart (HIEC), the Community Integration Questionnaire (CIQ), the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI), the short form health survey (SF-36) and the life satisfaction checklist (LiSat-11). Changes over time for the follow-up group and the individuals in the second study, as measured with the GOSE, were analysed using a statistical method that is suitable for small data sets and takes account of the non-metric properties of the data. Results: The first study revealed a better outcome for the group that received early formalised specialist rehabilitation and long-term follow-up. No patient remained in a vegetative state in this group as compared with three in the other, 50% were independent as compared with 17% in the other and the frequency of return to work was 55% among the former workers/students as compared to no return to work in the other group. In the second study, the change over time according to the degree of neurological deficit and day-to-day living abilities (GOSE) was significant at group level until one year after the injury, but important changes were found for some individuals until five years after injury. In the third retrospective study, the patients who were treated with DC because of MMI remained in an impaired neurological condition. Their life satisfaction was lower as compared with a healthy population, but 83% still rated “life as a whole” as satisfactory. The fourth study revealed that 20% of the surviving participants had a favourable outcome as measured with the GOSE. Of those who were able to convey their satisfaction with life, 88% reported that life as a whole was satisfactory one year after the injury/onset of disease. Conclusions: The studies show that an effective chain of medical and rehabilitation activities can produce a good outcome/living situation and that life can be satisfactory for patients after severe brain injuries in spite of neurological deficits

Patients’ Experiences of Self-Administered Electrotherapy for Spasticity in Stroke and Cerebral Palsy: A Qualitative Study

Objective: To explore patients’ experiences of a self-administered electrotherapy treatment for muscle spasticity in cerebral palsy and stroke; the Exopulse Mollii Suit®. Design: Qualitative design with an inductive approach Subjects: Fifteen patients with spasticity due to stroke or cerebral palsy, participating in a previous randomized controlled trial evaluating the treatment concept.Methods: Information letters were sent to all potential participants (n = 27) in the previous study. Semi-structured interviews (21–57 min) were carried out with all subjects who volunteered (n = 15), administered by an experienced interviewer who was not involved in the previous study. Transcribed interviews were subject to content analysis. Results: The 5 categories that emerged from the content analysis were “New method gives hope”, experiences related to “Using the assistive technology”, “Outcome from training with the assistive technology”, “The assistive technology” and “Taking part in the study”. Respondents felt hopeful when included in the previous study, motivated when experiencing a treatment effect, and disappointed when not. Conclusion: The qualitative approach used in this study elicited complementary information that was not evident from the previous randomized controlled trial. This included statements regarding increased mobility, reduced spasticity, reduced use of medication, and problems related to using the treatment concept

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After severe acquired brain injury some patients develop a prolonged disorder of consciousness (vegetative state or minimally conscious state), and as such cannot actively participate in neurorehabilitation. However, international opinion and recent research developments emphasize the need for involvement of rehabilitation medicine units in the care of these patients. The article presents recommendations for the care of adult patients with prolonged disorders of consciousness, which have been developed by a multidisciplinary working party, in order to promote good care, and identify areas for further improvements

Circulating Brain Injury Biomarkers: A Novel Method for Quantification of the Impact on the Brain After Tumor Surgery

BACKGROUND: Clinical methods to quantify brain injury related to neurosurgery are scarce. Circulating brain injury biomarkers have recently gained increased interest as new ultrasensitive measurement techniques have enabled quantification of brain injury through blood sampling. OBJECTIVE: To establish the time profile of the increase in the circulating brain injury biomarkers glial fibrillary acidic protein (GFAP), tau, and neurofilament light (NfL) after glioma surgery and to explore possible relationships between these biomarkers and outcome regarding volume of ischemic injury identified with postoperative MRI and new neurological deficits. METHODS: In this prospective study, 34 adult patients scheduled for glioma surgery were included. Plasma concentrations of brain injury biomarkers were measured the day before surgery, immediately after surgery, and on postoperative days 1, 3, 5, and 10. RESULTS: Circulating brain injury biomarkers displayed a postoperative increase in the levels of GFAP ( P < .001), tau ( P < .001), and NfL ( P < .001) on Day 1 and a later, even higher, peak of NFL at Day 10 ( P = .028). We found a correlation between the increased levels of GFAP, tau, and NfL on Day 1 after surgery and the volume of ischemic brain tissue on postoperative MRI. Patients with new neurological deficits after surgery had higher levels of GFAP and NfL on Day 1 compared with those without new neurological deficits. CONCLUSION: Measuring circulating brain injury biomarkers could be a useful method for quantification of the impact on the brain after tumor surgery or neurosurgery in general