This study examined the predictive value of variables known early in the course of posttraumatic amnesia (PTA) on length of PTA and functional outcome of acute rehabilitation. Forty patients with traumatic brain injury who had PTA at admission for acute inpatient rehabilitation were included (29 men and 11 women; aged 18-91 years). This article presents the characteristics of the patients who came out of PTA and those who did not emerge during the acute inpatient rehabilitation stay. These data suggest that the location of the lesion (specifically, parietal lobe lesions) and initial cognitive scores are helpful in prognosticating patient trajectories.
results were found for high-risk alcohol use (time, p<.001; severity X time, pZ.022) and drug use (time, p<.001; severity X time, pZ.016). The proportion of participants using drug pre-injury was greater in moderate-severe than in mild TBI, but there was no difference in postinjury use. Conclusions: Substance use declined in the early months following TBI but increased before the end of the first year. This was especially true for alcohol use in participants with mild injury. Given that substance use may alter recovery, prevention strategies need to be reinforced, even more so for individuals not getting inpatient rehabilitation.
Research Objectives
To contribute to COVID-19 data by reporting experiences from Speech Language Pathologists (SLPs) working at the height of the COVID-19 pandemic in New York City. We report incidence of dysphagia, cognitive impairments, and/or dysphonia in patients at acute inpatient rehabilitation facility (IRF), and summarize facility changes implemented to meet patient needs while maintaining requirements of an IRF.
Design
This is a retrospective study; data obtained through retroactive chart reviews of electronic medical records.
Setting
Data gathered at Rusk Rehabilitation NYU Langone Orthopedic Hospital (LOH) in New York City. In March 2020, NYU LOH converted 75 orthopedic surgical beds to acute COVID-19 medicine beds. Simultaneously, rehabilitation unit shifted to managing rehabilitation needs of patients with COVID-19 related debility post-ICU/acute care.
Participants
Subjects include 61 patients, ages 18+, who received SLP services during inpatient rehabilitation with primary diagnosis of COVID-19-acute respiratory failure, ARDS, or COVID-19 related debility. Admissions occurred April 1st-June 30th 2020. Reported demographics include age, gender, and discharge destination. Patients excluded if primary diagnosis was neurological with incidental positive COVID-19.
Interventions
Patients received daily SLP intervention per IRF requirements. Intensity of daily services (30 vs 60 minute sessions) determined by therapy team based on individual patient needs/tolerance.
Main Outcome Measures
Dysphagia outcomes are reported using the Functional Oral Intake Scale (FOIS) for admitting and discharge diets. Data for other disorders presented as incidence findings.
Results
Data presents strong evidence for presence of dysphagia, cognitive impairments and dysphonia following COVID-19. 31.2% demonstrated dysphagia, 57.3% of patients demonstrated cognitive impairments, and 52.4% of patients demonstrated dysphonia. Practice reflections include: importance of PPE, reducing infection spread, establishing safe objective swallowing assessments, and inclusion of virtual modalities.
Conclusions
There is a high occurrence of dysphagia, cognitive impairments, and dysphonia in patients with severe cases of COVID-19. Standard practice of rehabilitation for patients with COVID-19 illness should include SLP contribution to help patients achieve highest level of function.
Author(s) Disclosures
All authors work full-time and are currently employed by the facility where this research occurred. No other financial or non-financial connections/conflicts to disclose.
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