Multidimensional Assessment of Acute Confusion After Traumatic Brain Injury

Sherer, Mark; Nakase-Thompson, Risa; Yablon, Stuart A.; Gontkovsky, Samuel T.

doi:10.1016/j.apmr.2004.09.029

Cited by 116 publications

(93 citation statements)

References 28 publications

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“…The full constellation of symptoms associ ated with ACS includes temporal and spatial disorientation, distractibility, anterograde amnesia, impaired judgement, perceptual disturbance, restlessness, sleep disorder, and emotional lability. Formal criteria have recently been proposed to establish the onset and resolu tion of the post-traumatic confusional state, 25 and specific symptoms of ACS have been linked to functional outcome. 26 Coexisting peripheral and cortical sensory impairments (for example, deafness, blindness) and cognitive dysfunction (for example, apraxia, agnosia) and language disturbance (for example, aphasia) should be ruled out as contributing or causative factors in patients who fail to meet the criteria for reliable communication ability or functional object use, although this is often difficult to accomplish on bedside examination.…”

Section: Acute Confusional Statementioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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| The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

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Section: Acute Confusional Statementioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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“…1,2 When present, agitation can be distressing for the patient, family, and staff, elevating the risk of injury to self and others and posing a significant barrier to participation in rehabilitation. [3][4][5][6][7] Unfortunately, few wellcontrolled interventional studies are currently available to guide the management of agitation. 8,9 Despite the weak evidence base, pharmacologic interventions are being used to manage agitation both directly and indirectly.…”

mentioning

confidence: 99%

Predictors of Agitated Behavior During Inpatient Rehabilitation for Traumatic Brain Injury

Bogner¹,

Barrett²,

Horn³

et al. 2015

Archives of Physical Medicine and Rehabilitation

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“…The CAP was developed as part of the TBI Model Systems research program, initially tested with a sample of 92 participants and cross-validated on a separate sample of 93 participants. 3 Research has supported the construct and criterion validity of the CAP. PTC classification (i.e., confused/not confused) based on the CAP was consistent with DSM-IVYbased delirium classification, with 84% overall classification accuracy.…”

Section: Confusion Assessment Protocolmentioning

confidence: 98%

Posttraumatic Confusion Predicts Patient Cooperation During Traumatic Brain Injury Rehabilitation

Silva

Nakase‐Richardson

Sherer

et al. 2012

American Journal of Physical Medicine &Amp; Rehabilitation

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Scant research has examined the relationship between posttraumatic confusion (PTC) and cooperation during rehabilitation from moderate to severe traumatic brain injury. In this study, PTC and cooperation were examined in a prospective cohort of 74 inpatients with traumatic Brain Injury. Confusion was measured using the Confusion Assessment Protocol. Cooperation was rated on a 0-100 scale by rehabilitation therapists. Using multiple regression analysis, PTC significantly predicted cooperation (R(2) = 0.33, P < 0.001). Age at injury, education, days since injury, and Glasgow Come Scale scores were not significant predictors. Bivariate analyses indicated that four PTC symptoms significantly predicted poorer cooperation: daytime hypersomnolence (ρ = -0.42, P < 0.001), agitation (ρ = -0.39, P = 0.001), psychosis (ρ = -0.39, P = 0.001), and cognitive impairment (ρ = -0.24, P = 0.04). Results provide empirical support that PTC is associated with poorer cooperation and empirical justification for interventions to manage confusion during early recovery from traumatic brain injury.

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Multidimensional Assessment of Acute Confusion After Traumatic Brain Injury

Cited by 116 publications

References 28 publications

Disorders of consciousness after acquired brain injury: the state of the science

Disorders of consciousness after acquired brain injury: the state of the science

Predictors of Agitated Behavior During Inpatient Rehabilitation for Traumatic Brain Injury

Posttraumatic Confusion Predicts Patient Cooperation During Traumatic Brain Injury Rehabilitation

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