Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-28T06:51:49.947Z Has data issue: false hasContentIssue false
  • English
  • Français

Feasibility of an Interdisciplinary Early Intervention for Patients with Low Levels of Responsiveness Following an Acquired Brain Injury

Published online by Cambridge University Press:  22 August 2013

Treena Seeto ,
Suzanne Kuys ,
Cassandra Budden ,
Erin Griffin ,
Haylee Kajewski  and
Steven McPhail
Treena Seeto
Affiliation:
Princess Alexandra Hospital, Brisbane, Australia
Suzanne Kuys
Affiliation:
The Prince Charles Hospital, Brisbane, Australia Griffith Health Institute, Griffith University, Gold Coast, Australia
Cassandra Budden
Affiliation:
Princess Alexandra Hospital, Brisbane, Australia
Erin Griffin
Affiliation:
Princess Alexandra Hospital, Brisbane, Australia Jacana Acquired Brain Injury Service, Brisbane, Australia
Haylee Kajewski
Affiliation:
Princess Alexandra Hospital, Brisbane, Australia Jacana Acquired Brain Injury Service, Brisbane, Australia
Steven McPhail*
Affiliation:
Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia Institute of Health and Biomedical Innovation and School of Public Health, Queensland University of Technology, Brisbane, Australia
*
Address for correspondence: Dr Steven McPhail, Centre for Functioning and Health Research, Princess Alexandra Hospital, c/o PO Box 6053, Buranda, QLD, 4102, Australia. E-mail: [email protected]
Get access

Abstract

There is a scarcity of research investigating interdisciplinary early rehabilitation intervention models for people with low levels of responsiveness following acquired brain injury. This is particularly problematic for service models in acute hospital settings where early rehabilitation of such patients may be assigned a low priority in comparison to other competing demands. This pilot study investigated the feasibility of implementing an interdisciplinary early rehabilitation intervention in an acute neurosciences ward within existing staffing, and describes clinical changes among intervention participants. A prospective longitudinal study, with a matched historical control (individually matched by Glasgow Coma Scale) was undertaken. Prospective intervention participants (n = 13) received up to twice-weekly interdisciplinary intervention in addition to usual care. Matched historical controls (n = 13) received only usual care. Implementing an interdisciplinary early intervention proved feasible in this acute care setting. Significant improvement (alpha = .05) among the patients receiving the interdisciplinary intervention was observed across all clinical outcomes, including: Coma Recovery Scale-Revised, Glasgow Coma Scale, Mental Status Questionnaire, Royal Brisbane Hospital Outcome Measure for Swallowing, selected subtests of the Functional Independence Measure, Acquired Brain Injury Physiotherapy Assessment and the Clinical Outcomes Variable Scale. A future randomised clinical trial is warranted.

Keywords

interdisciplinarylow levels of responsivenessbrain injuryrehabilitationimpaired consciousness
Type
Articles
Information
Brain Impairment , Volume 14 , Issue 2 , September 2013 , pp. 213 - 221
Copyright
Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adair, J.G. (1984). The Hawthorne Effect: A reconsideration of the methodological artifact. Journal of Applied Psychology, 69 (2), 334.CrossRefGoogle Scholar
Cowen, T.D., Meythaler, J.M., DeVivo, M.J., Ivie, C.S., Lebow, J. 3rd, & Novack, T.A. (1995). Influence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges. Archives of Physical Medicine and Rehabilitation, 76 (9), 797–803.CrossRefGoogle ScholarPubMed
Das-Gupta, R., & Turner-Stokes, L. (2002). Traumatic brain injury. Disability and Rehabilitation, 24 (13), 654–665.CrossRefGoogle ScholarPubMed
DeFina, P.A., Fellus, J., Thompson, J.W., Eller, M., Moser, R.S., Frisina, P.G., . . . Prestigiacomo, C.J. (2010). Improving outcomes of severe disorders of consciousness. Restorative Neurology and Neuroscience, 28 (6), 769–780.CrossRefGoogle ScholarPubMed
Eilander, H.J., Timmerman, R.B., Scheirs, J.G., Van Heugten, C.M., De Kort, P.L., & Prevo, A.J. (2007). Children and young adults in a prolonged unconscious state after severe brain injury: Long-term functional outcome as measured by the DRS and the GOSE after early intensive neurorehabilitation. Brain Injury, 21 (1), 53–61.CrossRefGoogle Scholar
Gesch, J., Nascimento, P., Passier, L., & Haines, T. (2005). Acute brain injury physiotherapy assessment: A new scale for an old problem [2005 National Neurology & Gerontology Joint Conference Abstracts]. Australian Journal of Physiotherapy, 51 (e-Supplement).Google Scholar
Giacino, J.T., Ashwal, S., Childs, N., Cranford, R., Jennett, B., Katz, D.I., . . . Zasler, N.D. (2002). The minimally conscious state: Definition and diagnostic criteria. Neurology, 58, 349–353.CrossRefGoogle ScholarPubMed
Gill, M.R., Reiley, D.G., & Green, S.M. (2004). Interrater reliability of Glasgow Coma Scale scores in the Emergency Department. Annals of Emergency Medicine, 43, 215–223.CrossRefGoogle ScholarPubMed
Groswasser, Z., & Sazbon, L. (1990). Outcome in 134 patients with prolonged posttraumatic unawareness. Part 2: Functional outcome of 72 patients recovering consciousness. Journal of Neurosurgery, 72 (1), 81–84.CrossRefGoogle ScholarPubMed
Husson, E.C., Ribbers, G.M., Willemse-van Son, A.H., Verhagen, A.P., & Stam, H.J. (2010). Prognosis of six-month functioning after moderate to severe traumatic brain injury: A systematic review of prospective cohort studies. Journal of Rehabilitation Medicine, 42 (5), 425–436.Google ScholarPubMed
Kalmar, K., & Giacino, J.T. (2005). The Coma Recovery Scale – Revised. Neuropsychology Rehabilitation, 15 (3–4), 454–460.CrossRefGoogle ScholarPubMed
Katz, D.I., Polyak, M., Coughlan, D., Nichols, M., & Roche, A. (2009). Natural history of recovery from brain injury after prolonged disorders of consciousness: Outcome of patients admitted to inpatient rehabilitation with 1–4 year follow-up. Progress in Brain Research, 177, 73–88.CrossRefGoogle ScholarPubMed
Kidd, D., Stewart, G., Baldry, J., Johnson, J., Rossiter, D., Petruckevitch, A., & Thompson, A. (1995). The Functional Independence Measure: A comparative validity and reliability study. Disability and Rehabilitation, 17 (1), 454–460.CrossRefGoogle Scholar
Lippert-Gruner, M., Wedekind, C., & Klug, N. (2002). Functional and psychosocial outcome one year after severe traumatic brain injury and early-onset rehabilitation therapy. Journal of Rehabilitation Medicine, 34 (5), 211–214.CrossRefGoogle Scholar
Low Choy, N., Kuys, S., Richards, M., & Isles, R. (2002). Measurement of functional ability following traumatic brain injury using the Clinical Outcomes Variable Scale: A reliability study. Australian Journal of Physiotherapy, 48, 35–39.CrossRefGoogle Scholar
Mackay, L.E., Bernstein, B.A., Chapman, P.E., Morgan, A.S., & Milazzo, L.S. (1992). Early intervention in severe head injury: long-term benefits of a formalized program. Archives of Physical Medicine and Rehabilitation, 73, 635–641.Google ScholarPubMed
Mayo, E. (1933). The human problems of an industrial civilization. New York: McMillan.Google Scholar
McPhail, S., Beller, E., & Haines, T. (2008). Two perspectives of proxy reporting of health-related quality of life using the Euroqol-5D, an investigation of agreement. Medical Care, 46 (11), 1140–1148.CrossRefGoogle ScholarPubMed
Meyer, M.J., Megyesi, J., Meythaler, J.M., Murie-Fernandez, M., Aubut, J., Foley, N., . . . Teasell, R. (2010). Acute management of acquired brain injury Part III: An evidence-based review of interventions used to promote arousal from coma. Brain Injury, 24 (5), 722–729.CrossRefGoogle ScholarPubMed
National Health and Medical Research Council. (2008). Ethical guidelines for the care of people in post-coma unresponsiveness (vegetative state) or a minimally responsive state. Canberra: Australian Government Publishing Service.Google Scholar
Prasad, K. (1996). The Glasgow Coma Scale: A critical appraisal of its clinimetric properties. Journal of Clinical Epidemiology, 49 (7), 755–763.CrossRefGoogle ScholarPubMed
Reid-Arndt, S.A., Schopp, L., Brenneke, L., Johnstone, B., & Poole, D. (2007). Evaluation of the Traumatic Brain Injury Early Referral Program in Missouri. Brain Injury, 21 (12), 1295–1302.CrossRefGoogle ScholarPubMed
Sazbon, L., & Groswasser, Z. (1990). Outcome in 134 patients with prolonged posttraumatic unawareness. Part 1: Parameters determining late recovery of consciousness. Journal of Neurosurgery, 72 (1), 75–80.CrossRefGoogle ScholarPubMed
Seaby, L., & Torrance, G. (1989). Reliability of a physiotherapy functional assessment used in a rehabilitation setting. Physiotherapy Canada, 41, 264–271.Google Scholar
Shiel, A., Burn, J.P., Henry, D., Clark, J., Wilson, B.A., Burnett, M.E., & McLellan, D.L. (2001). The effects of increased rehabilitation therapy after brain injury: Results of a prospective controlled trial. Clinical Rehabilitation, 15 (5), 501–514.CrossRefGoogle ScholarPubMed
Sorbo, A., Rydenhag, B., Sunnerhagen, K.S., Blomqvist, M., Svensson, S., & Emanuelson, I. (2005). Outcome after severe brain damage, what makes the difference? Brain Injury, 19 (7), 493–503.CrossRefGoogle ScholarPubMed
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2, 81–84.CrossRefGoogle ScholarPubMed
Turner-Stokes, L. (2008). Evidence for the effectiveness of multi-disciplinary rehabilitation following acquired brain injury: A synthesis of two systematic approaches. Journal of Rehabilitation Medicine, 40 (9), 691–701.CrossRefGoogle ScholarPubMed
Turner-Stokes, L., Disler, P B., Nair, A., & Wade, D.T. (2005). Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database of Systematic Reviews, 20 (3).CrossRefGoogle Scholar
Ward, E.C., & Conroy, A.-L. (1999). Validity, reliability and responsivity of the Royal Brisbane Hospital Outcome Measure for Swallowing. Asia Pacific Journal of Speech, Language and Hearing, 4, 109–129.CrossRefGoogle Scholar
Wilson, L.A., & Brass, W. (1973). Brief assessment of the mental status in geriatric domicilary practice. The usefulness of the Mental Status Questionnaire. Age and Ageing, 2, 92–101.CrossRefGoogle Scholar