Barriers and enablers to aligning rehabilitation goals to patient life roles following acquired brain injury

Sansonetti, Danielle; Nicks, Rebecca; Unsworth, Carolyn A.

doi:10.1111/1440-1630.12492

Cited by 10 publications

(4 citation statements)

References 22 publications

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“…Like every provider who treats patients with TBI, the VCP will often need to refer patients to members of the TBI-treatment team who might not already have been recruited and to facilitate communication of rehabilitative plans. The value of including a patient's significant social supporters in these conversations cannot be overstated [124].…”

Section: The Post-examination Conversationmentioning

confidence: 99%

From Provider to Advocate: The Complexities of Mild Traumatic Brain Injury Prompt the Evolution of Provider Engagement

Singman¹

2021

Preprint

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Treating a patient with traumatic brain injury requires an interdisciplinary approach because of the pervasive, profound and protean manifestations of this condition. In this review, key aspects of the medical history and review of systems will be described in order to highlight how the role of any provider must evolve to become a better patient advocate. Although this review is written from the vantage point of a vision care provider, it is hoped that patients, caregivers and providers will recognize the need for the team approach; it truly takes a village.

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Section: The Post-examination Conversationmentioning

confidence: 99%

From Provider to Advocate: The Complexities of Mild Traumatic Brain Injury Prompt the Evolution of Provider Engagement

Singman¹

2021

Preprint

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“…Repeated PAM clustering using the second proximity matrix to generate the new classes. 6. We then calculated the CVIs with the cluster.stats function of the fpc R package.…”

Section: Combined Cluster Analysis Approaches: Unsupervised Random Fomentioning

confidence: 99%

“…Patients with TBI can show various combinations of motor, cognitive, behavioral, psychosocial, and environmental issues that have a huge impact on everyday activities [5], and these issues can greatly interfere with the effectiveness of rehabilitation interventions. It has been proposed that the efficacy of the rehabilitation would increase if programs moved from disease-centered to person-centered issues such that the rehabilitation is tailored to individual needs [6,7]. A number of studies have suggested that brain injury does not have any prototypical pattern of cognitive performance and outcome but may be best characterized by heterogeneity, both in regard to cognitive deficit and ultimate level of functioning [8].…”

Section: Introductionmentioning

confidence: 99%

Personalized Web-Based Cognitive Rehabilitation Treatments for Patients with Traumatic Brain Injury: Cluster Analysis (Preprint)

García-Rudolph¹,

García-Molina²,

Opisso³

et al. 2019

Preprint

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BACKGROUND Traumatic Brain Injury (TBI) is a leading cause of disability worldwide. TBI patients are characterized by a wide heterogeneity, one of the most significant barriers to effective therapeutic interventions. Cluster analysis (CA) to identify homogeneous subgroups based on performance in neuropsychological baseline tests has been extensively applied in state-of-the-art. Nevertheless, most analyzed samples are rarely larger than n = 100, different CA approaches and cluster validity indices (CVI) have been scarcely compared and not applied in web-based rehabilitation treatments. OBJECTIVE 1) Apply state-of-the-art CVIs to different cluster strategies: hierarchical, partitional and model based. 2) Apply combined strategies of dimensionality reduction by means of principal components analysis and random forests and perform stability assessment to the final profiles 3) Characterize the identified profiles by means of demographic and clinically relevant variables 4) Study the external validity of the obtained clusters considering three relevant aspects of TBI rehabilitation: Glasgow Coma Scale (GCS), functional independence measure (FIM) and executions of web-based cognitive tasks. METHODS Different cluster strategies were executed with mclust, factoextra and cluster R packages. For combined strategies we used the factominer and random forest R packages. Stability analysis was performed with fpc R package. Between groups comparisons for external validation were performed using T-test, chi-square test or Mann-Whitney U test as appropriate. The period under study is August 2008 to July 2019 RESULTS We analyzed 574 adult (mostly severe) TBI patients undergoing web-based rehabilitation. We identified and characterized 3 clusters with strong internal validation: 1) moderate attentional impairment and moderate disexecutive syndrome with mild memory impairment and normal spatio-temporal perception being 66% highly educated (P<.05) 2) severe disexecutive syndrome with severe attentional and memory impairments and normal spatio-temporal perception being 49.2% highly educated (P<.05) 3) very severe cognitive impairment, being 45.2% highly educated (P<.05). We externally validated them with severity of injury (P<.006), and functional independence assessments: cognitive (P< .001), motor(P<.001) and total(P<.001). We mapped 151,763 web based cognitive rehabilitation tasks performed by the 574 participants during the whole period (all cognitive functions) to the 3 obtained clusters (P<.001) and confirmed the identified patterns. Stability analysis indicates that Cluster 1 and 2 were respectively rated as 0.6 and 0.75 therefore they are indeed measuring a pattern and Cluster 3 was rated as highly stable. CONCLUSIONS CA in web-based cognitive rehabilitation treatments allows for ii)identifying and characterizing strong patterns of response to neuropsychological tests, iii) externally validating the obtained clusters using important aspects of TBI rehabilitation (severity or functional independence in daily activities) iv) tailoring cognitive web based tasks executed in the web platform to the identified profiles providing clinicians a tool for treatments’ personalization not addressed in previous traditional CA. iv) extension of a similar approach to other medical conditions CLINICALTRIAL

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“…Indeed these patients can show various combinations of clinical, cognitive, behavioral, psychosocial, and environmental issues (2), which can interfere with the effectiveness of rehabilitation interventions. It has been proposed that the efficacy of rehabilitation should increase if programs would move from disease-centered to person-centered, tailored on the needs of every single individual (3, 4). In this way, it would be simpler to target routines, occupations, and relationships more effectively (5).…”

Section: Introductionmentioning

confidence: 99%

The Reliability of the Progression of Autonomies Scale Applied on Acquired Brain Injured Patients

et al. 2019

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The Progression of Autonomies Scale (PAS) is a behavioral scale useful to assess the autonomy levels in acquired brain-injured patients. It provides a broad profile, assessing different domains of human activities ranging from personal, domestic, and extradomestic autonomies. This cross-sectional study is aimed at evaluating the reliability of this scale on a large cohort of acquired brain injury (ABI) patients. Fifty-one ABI patients (49% traumatic, 33.3% hemorrhagic, 17.7% other etiologies), hospitalized in the S. Anna Institute of Crotone, Italy (mean age male 46.08 ± 14.53 and mean age female patients 43.2 ± 11.3) were recruited. We found a high level of reliability of the scale, with a coefficient at the inter-rater agreement between substantial (0.61 ≤ k ≤ 0.8) and almost perfect (0.81 ≤ k ≤ 1), and almost perfect at the test-retest (intra-rater). We confirm that the PAS is a well-structured tool for the assessment of the autonomy levels in brain-injured patients. These findings encourage the application of this scale in the clinical practice of rehabilitation unit to design a tailored rehabilitation treatment on real goals and to monitor the generalization of the recovered abilities to the daily routine activities.

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Barriers and enablers to aligning rehabilitation goals to patient life roles following acquired brain injury

Cited by 10 publications

References 22 publications

From Provider to Advocate: The Complexities of Mild Traumatic Brain Injury Prompt the Evolution of Provider Engagement

From Provider to Advocate: The Complexities of Mild Traumatic Brain Injury Prompt the Evolution of Provider Engagement

Personalized Web-Based Cognitive Rehabilitation Treatments for Patients with Traumatic Brain Injury: Cluster Analysis (Preprint)

The Reliability of the Progression of Autonomies Scale Applied on Acquired Brain Injured Patients

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