Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Dec 2008
Randomized Controlled Trial Multicenter Study Comparative StudyRehabilitation of traumatic brain injury in active duty military personnel and veterans: Defense and Veterans Brain Injury Center randomized controlled trial of two rehabilitation approaches.
To determine the relative efficacy of 2 different acute traumatic brain injury (TBI) rehabilitation approaches: cognitive didactic versus functional-experiential, and secondarily to determine relative efficacy for different patient subpopulations. ⋯ Results from this large multicenter randomized controlled trial comparing cognitive-didactic and functional-experiential approaches to brain injury rehabilitation indicated improved but similar long-term global functional outcome. Participants in the cognitive treatment arm achieved better short-term functional cognitive performance than patients in the functional treatment arm. The current increase in war-related brain injuries provides added urgency for rigorous study of rehabilitation treatments. (http://ClinicalTrials.gov ID# NCT00540020.).
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Arch Phys Med Rehabil · Dec 2008
Comparative StudyMagnetic resonance imaging evidence of progression of subacute brain atrophy in moderate to severe traumatic brain injury.
To demonstrate subacute progression of brain atrophy (from 4.5-29mo postinjury) in moderate to severe traumatic brain injury (TBI) using structural magnetic resonance imaging (MRI). ⋯ This study provides strong MRI evidence for subacute progression of atrophy, as distinct from early, acute neurologic changes observed.
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Arch Phys Med Rehabil · Dec 2008
Comparative StudyExamining moderators of cognitive recovery trajectories after moderate to severe traumatic brain injury.
To examine the influence of cognitive reserve-related moderator variables on recovery trajectories during the first year after traumatic brain injury (TBI). Using mixed effects models, we measured (1) the level of cognitive function at 2 and 12 months postinjury and (2) the trajectories of cognitive recovery during the first 12 months postinjury. ⋯ Recovery of speed of processing (both simple and complex) was favorably moderated by younger age. Older age is associated with more neuronal loss and less integrity of white matter, and speed of processing is associated with white matter networks. The recuperative effects of younger age may therefore be attributable to greater reserve capacity (as indexed by white matter integrity). Lower age and higher estimated premorbid IQ were associated with higher functioning on a variety of cognitive outcomes. This may reflect the buffering effects of reserve capacity or premorbid differences in age and IQ-related cognitive functioning. Implications for rehabilitation and recovery mechanisms are discussed.
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Arch Phys Med Rehabil · Dec 2008
Comparative StudyTraumatic brain injury in patients with traumatic spinal cord injury: clinical and economic consequences.
To evaluate the clinical and economic burden of traumatic brain injury (TBI) in people with traumatic spinal cord injury (SCI). ⋯ The presence of TBI in SCI has a range of clinical and economic consequences. This dual diagnosis has the potential to affect SCI rehabilitation negatively, as well as quality of life and reintegration in the community. Specialized care appears to be needed to improve outcomes and to minimize clinical and economic burden, but further research is required.
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Arch Phys Med Rehabil · Dec 2008
Comparative StudyUse of diffusion-tensor imaging in traumatic spinal cord injury to identify concomitant traumatic brain injury.
To characterize and differentiate cerebral white matter (WM) changes related selectively to traumatic brain injury (TBI) or spinal cord injury (SCI) in patients with SCIs in order to improve diagnostic accuracy of TBI in people with SCI. ⋯ DTI is a sensitive tool to detect TBI-related WM damage in patients with SCI who have suffered concomitant TBI. No WM abnormalities on DTI could be attributed to SCI alone, although this finding should be further explored in future studies. Therefore, DTI may be a valuable tool to identify TBI in the SCI population. Further research to produce normative FA values is needed to allow identification of TBI in individual patients with SCI.