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Sameh G, Islem F, Samar A, Hedi C, Mounir B, Habib EM. Neuropsychological and behavioral disorders, functional outcomes and quality of life in traumatic brain injury victims. Pan Afr Med J 2021; 38:346. [PMID: 34367425 PMCID: PMC8308941 DOI: 10.11604/pamj.2021.38.346.16120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction the assessment of neuropsychological and behavioral disorders outcomes, functional outcomes and quality of life in traumatic brain injury victims. It was also to evaluate initial means of care provided to these patients. Finally, to study correlations between neuropsychological and behavioral disorders with demographic characteristics, injury severity, functional status and quality of life. Methods it was a cross-sectional study including 50 patients with traumatic brain injury conducted in the physical medicine and rehabilitation department of Sfax. Memory disorders were tested by the mini mental state and the Glaveston orientation and amnesia tests. Executive functions were evaluated by the dysexecutive function scale. The psychological profile was evaluated using the hospital anxiety and depression scale and behavioral disorders were tested by the agitated behavior scale. Glasgow outcome scale has allowed the assessment of traumatic brain injury severity in terms of disability. Otherwise, functional capacity was measured by functional independence measure scale. Finally, health-related quality of life was measured using a generic measure (short-form-36) and the QOLIBRI scales. Results abnormal executive functions were noted in 41 patients (82%) with a dysexcutive function average score of 33.20 ± 22.74. About psychological profile, depressive symptoms were found in 32 patients (64%). Moreover anxiety was noted in 20 patients (40%). Behavioral disorders such as aggressiveness and agitation were noted respectively in 32 (64%) and 8 patients (16%). The global social functional evolution was considered as unfavorable in 42% of the patients and favorable in 58%. Regarding to functional independence measure scale, 92% of the victims showed impairment. Memory impairment and abnormal executive functions were statistically correlated with traumatic brain injury severity. Elementary brain injury lesions shown on computed tomography were correlated with memory disorders especially for temporal, cortical brain contusion and diffuse axonal injury. Our study showed that patients with severe memory impairment, abnormal executive functions and depressive mood had significant functional. Conclusion the executive function disorders, depressed mood and the memory disorders seemed to be the most frequent among neuropsychological disorders in traumatic brain injury. We noted that it is so important to evaluate neuropsychological disorders in traumatic brain injury because they were underestimated. We have already started this experience despite the lack of means in our department. The evaluation of the executive function in addition to the classic neuropsychological assessment is essential to propose efficient means of rehabilitation.
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Affiliation(s)
- Ghroubi Sameh
- Physical Medicine and Rehabilitation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Feki Islem
- Physical Medicine and Rehabilitation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Alila Samar
- Physical Medicine and Rehabilitation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Chelly Hedi
- Reanimation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Bouaziz Mounir
- Reanimation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
| | - Elleuch Mohamed Habib
- Physical Medicine and Rehabilitation Department, University Hospital Center Habib Bourguiba, Sfax, Tunisia
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Jourdan C, Bayen E, Vallat-Azouvi C, Ghout I, Darnoux E, Azerad S, Charanton J, Aegerter P, Pradat-Diehl P, Ruet A, Azouvi P. Late Functional Changes Post-Severe Traumatic Brain Injury Are Related to Community Reentry Support: Results From the PariS-TBI Cohort. J Head Trauma Rehabil 2017; 32:E26-34. [PMID: 28060204 DOI: 10.1097/HTR.0000000000000276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore late functional changes after a traumatic brain injury and their relation to patients' characteristics and reentry support. DESIGN Prospective follow-up of an inception cohort of adults with severe traumatic brain injury recruited in 2005-2007 in the Parisian area, France. One and 4-year assessments were performed by trained neuropsychologists. One-to-4-year change in the Glasgow Outcome Scale-Extended defined 3 groups: "improvement," "stability," and "worsening." Relationships between these groups and patients' characteristics were analyzed. RESULTS Among 504 recruited patients and 245 four-year survivors, 93 participated in both evaluations. Overall Glasgow Outcome Scale-Extended improved by 0.4. Forty percent of the sample improved, 44% were stable, and 16% worsened. Being in a more unfavorable group was related to preinjury alcohol abuse and to higher anxiety and depression at 4 years. Attendance to a specialized community reentry unit was related to higher chances of being in the "improvement" group in univariate analyses and after adjustment for age, time to follow command, preinjury alcohol and occupation, and mood disorders (adjusted odds ratio [OR] = 4.6 [1.1-20]). CONCLUSION Late functional changes were related to psychosocial variables and to reentry support. The effect of reentry support on late recovery needs to be confirmed by further investigations.
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Prouteau A, Stéfan A, Wiart L, Mazaux JM. The evaluation of behavioural changes in brain-injured patients: SOFMER recommendations for clinical practice. Ann Phys Rehabil Med 2016; 59:23-30. [PMID: 26797075 DOI: 10.1016/j.rehab.2015.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 12/06/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Behavioural changes are the main cause of difficulties in interpersonal relationships and social integration among traumatic brain injury (TBI) patients. The Société française de médecine physique et réadaptation (SOFMER) decided to develop recommendations for the treatment and care provision for these problem under the auspices of the French health authority, the Haute Autorité de la santé (HAS). Assessment of behaviour is essential to describe, understand and define situations, assess any change and suggest lines for intervention. The relationship of these behavioural changes with the brain lesion is likewise of crucial importance in legal and forensic expertise. AIMS Using a literature review and expert opinions, the aim was to define the optimal conditions for the collection of data on behavioural changes in individuals having sustained brain trauma, to identify the situations in which they arise, to review the instruments available, and to suggest lines of intervention. METHODS A literature search identified 981 articles, among which 122 on the target subject were selected and analysed in detail and confronted with the experience of professionals and user representatives. A first draft of the recommendations was produced by the working group, and then submitted to a review group for opinions and complements. RESULTS The literature on this subject is heterogeneous, and presents low levels of evidence. No article enabled the development of recommendations above the "expert opinion" level. After prior clarification of the aims of the evaluation, it is recommended first to carefully describe the changes in behaviour, from patient and third-person narratives, and where possible from direct observations. The information enabling the description of the phenomena occurring should be collected by different individuals (multi-source evaluation): the patient, his or her close circle, and professionals with different training backgrounds (multidisciplinary evaluation). The analysis of triggering or associated factors requires an assessment of cognitive functions and any neurological pathology (seizures). After confrontation and synthesis, the information should be completed using one or several behavioural scales, which provide objectivity and reproducibility. The main generic and specific scales are presented, with their advantages, drawbacks and validation references. The group did not wish to recommend any one of them in particular. CONCLUSION The evaluation of behavioural changes is essential, since without it a therapeutic strategy and appropriate orientation cannot be implemented. The emphasis should be put on contextualised, multi-source and multidisciplinary evaluation, including validated behavioural scales. In this area, nevertheless, evaluation is still restricted by several methodological limitations. Further research is needed to improve the standardisation of data collection and the psychometric properties of the instruments. A European harmonisation of these procedures is also greatly needed.
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Affiliation(s)
- A Prouteau
- Université de Bordeaux, EA 4139, « Psychologie, santé et qualité de vie", 33000 Bordeaux, France.
| | - A Stéfan
- Centre hospitalier universitaire de Nantes, 44093 Nantes, France
| | - L Wiart
- Centre hospitalier universitaire de Bordeaux, 33000 Bordeaux, France
| | - J M Mazaux
- Université de Bordeaux, EA 4139, « Psychologie, santé et qualité de vie", 33000 Bordeaux, France; Centre hospitalier universitaire de Bordeaux, 33000 Bordeaux, France
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Wiart L, Luauté J, Stefan A, Plantier D, Hamonet J. Non pharmacological treatments for psychological and behavioural disorders following traumatic brain injury (TBI). A systematic literature review and expert opinion leading to recommendations. Ann Phys Rehabil Med 2016; 59:31-41. [PMID: 26776320 DOI: 10.1016/j.rehab.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The non pharmacological approach is an important issue in the treatment of psychological and behavioural disorders in traumatic brain injury (TBI) patients. It remains nevertheless insufficiently known and defined. The objective of this work was to develop precise recommendations for caregivers and relatives. METHOD The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement, involving a systematic, critical review of the literature and the expert opinions of the French Society of Physical Medicine and Rehabilitation (SOFMER) group. RESULTS 458 articles were identified, among which 98 were selected for their relevance to the theme of the research. None of the studies reached the highest level of evidence. Fifteen controlled studies reached a relatively high level of evidence (level 2); other studies were case series or expert opinions, and other articles again were reviews of the literature and theoretical points of view. The holistic approach structured into programmes, cognitive-behavioural therapy, and family and systemic therapy, despite the low levels of proof, are recommended in first intention at all stages in the evolution of TBI. Relational and adaptive approaches, rehabilitation and vocational approaches, and psychoanalytical therapies may be useful, provided that therapists are familiar with and trained in traumatic brain injury. CONCLUSION Despite the small number of publications and a low level of proof, a number of recommendations for the non-pharmacological approach to psychological and behavioural disorders in TBI is proposed by the consensus conference of experts. Scientific research in this domain is needed to confirm and complete these first recommendations.
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Affiliation(s)
- Laurent Wiart
- Service de MPR, CHU Pellegrin, 33076 Bordeaux Cedex, France.
| | - Jacques Luauté
- Service de MPR, Hôpital Henri-Gabrielle, 69230 Saint Genis Laval, France
| | | | - David Plantier
- Service de MPR, Hôpital René-Sabran, 83400 Giens, France
| | - Julia Hamonet
- Service de MPR, Hôpital Dupuytren, 87042 Limoges cedex, France
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Jourdan C, Bayen E, Darnoux E, Ghout I, Azerad S, Ruet A, Vallat-Azouvi C, Pradat-Diehl P, Aegerter P, Weiss JJ, Azouvi P. Patterns of post-acute health care utilization after a severe traumatic brain injury: Results from the PariS-TBI cohort. Brain Inj 2015; 29:701-8. [DOI: 10.3109/02699052.2015.1004646] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Claire Jourdan
- APHP, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France,
- EA 4047 ECIPSY, Université de Versailles, Saint Quentin, France,
| | - Eleonore Bayen
- Université Paris-Dauphine, Laboratoire d’Économie et de Gestion des Organisations de Santé (LEDa-LEGOS), Paris, France,
- Université Pierre et Marie Curie, Paris, France,
- APHP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France,
| | - Emmanuelle Darnoux
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France,
- APHP, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France, and
| | - Idir Ghout
- APHP, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France, and
| | - Sylvie Azerad
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France,
- APHP, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France, and
| | - Alexis Ruet
- APHP, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France,
- EA 4047 ECIPSY, Université de Versailles, Saint Quentin, France,
| | - Claire Vallat-Azouvi
- APHP, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France,
- Antenne UEROS-SAMSAH92-UGECAM IDF, Hôpital Raymond Poincaré, Garches, France
| | - Pascale Pradat-Diehl
- Université Pierre et Marie Curie, Paris, France,
- APHP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Paris, France,
| | - Philippe Aegerter
- EA 4047 ECIPSY, Université de Versailles, Saint Quentin, France,
- APHP, Hôpital Ambroise Paré, Unité de Recherche Clinique (URC), Boulogne, France, and
| | - Jean-Jacques Weiss
- Centre Ressources Francilien du Traumatisme Crânien (CRFTC), Paris, France,
| | - Philippe Azouvi
- APHP, Hôpital Raymond Poincaré, Service de Médecine Physique et de Réadaptation, Garches, France,
- EA 4047 ECIPSY, Université de Versailles, Saint Quentin, France,
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Belio C, Prouteau A, Koleck M, Saada Y, Merceron K, Dayre E, Destaillats JM, Barral C, Mazaux JM. Participation restrictions in patients with psychiatric and/or cognitive disabilities: preliminary results for an ICF-derived assessment tool. Ann Phys Rehabil Med 2013; 57:114-37. [PMID: 24364986 DOI: 10.1016/j.rehab.2013.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 11/19/2013] [Accepted: 11/24/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED Participation in community life is a major challenge for most people with psychiatric and/or cognitive disabilities. Current assessments of participation lack a theoretical basis. However, the new International Classification of Functioning, Disability and Health (ICF) provides a relevant framework. AIMS The present study used an ICF-derived assessment tool to activity limitations and participation restrictions in two groups of participants with disabilities linked to schizophrenia or traumatic brain injury respectively. METHODS Twenty-six items (related to six ICF sections) were selected by reviewing the literature and gathering the clinician's opinions and representatives of patient associations. These items, yielded an ordinal rating of activity limitations, participation restrictions and contextual factors (social support, attitudes and, systems & politics). Special attention was paid to contextual and environmental factors. The final checklist (called the Grid for Measurements of Activity and Participation, G-MAP) was administered to 16 participants with traumatic brain injury (the TBI group) and 15 participants with schizophrenic disorders (the SD group). Psychometric assessments of cognition and, neurobehavioural, psychological and psychosocial functioning were also performed. RESULTS The internal consistencies for activity limitations (Cronbach's alpha coefficient=0.89) and participation restriction (Cronbach's alpha coefficient=0.89) were satisfactory. We did not observe any significant differences between the two groups in terms of the psychometric test results. The G-MAP scores demonstrated that the two groups were confronted with the same limitations in self care, domestic life, leisure and community life (i.e., the intergroup differences were not statistically significant in Mann-Whitney tests). However, interpersonal relationships and economic and social productivity appeared to be more severely limited in the SD group than in the TBI group. Similarly, participation restrictions in domestic life, interpersonal relationships and economic and social productivity were more severe in the SD group than in the TBI group. CONCLUSION G-MAP is a useful, feasible, relevant tool for performing a detailed, individualized assessment of participation restrictions in people with psychiatric and/or cognitive disabilities.
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Affiliation(s)
- C Belio
- EA4136 handicap et système nerveux, institut de formation en ergothérapie, université Bordeaux-Segalen, IMS rue F.-Ferrer, 33076 Bordeaux cedex, France.
| | - A Prouteau
- EA4139 santé et qualité de vie, université Bordeaux-Segalen, 33076 Bordeaux, France; Centre hospitalier de Jonzac, 17500 Jonzac, France
| | - M Koleck
- EA4139 santé et qualité de vie, université Bordeaux-Segalen, 33076 Bordeaux, France
| | - Y Saada
- EA4139 santé et qualité de vie, université Bordeaux-Segalen, 33076 Bordeaux, France
| | - K Merceron
- EA4139 santé et qualité de vie, université Bordeaux-Segalen, 33076 Bordeaux, France
| | - E Dayre
- EA4136 handicap et système nerveux, institut de formation en ergothérapie, université Bordeaux-Segalen, IMS rue F.-Ferrer, 33076 Bordeaux cedex, France
| | - J M Destaillats
- EA4136 handicap et système nerveux, institut de formation en ergothérapie, université Bordeaux-Segalen, IMS rue F.-Ferrer, 33076 Bordeaux cedex, France; Centre hospitalier de Jonzac, 17500 Jonzac, France
| | - C Barral
- EHESP MSSH, 35043 Rennes, France
| | - J M Mazaux
- EA4136 handicap et système nerveux, institut de formation en ergothérapie, université Bordeaux-Segalen, IMS rue F.-Ferrer, 33076 Bordeaux cedex, France
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Bonneterre V, Pérennou D, Trovatello V, Mignot N, Segal P, Balducci F, Laloua F, de Gaudemaris R. Interest of workplace support for returning to work after a traumatic brain injury: A retrospective study. Ann Phys Rehabil Med 2013; 56:652-62. [DOI: 10.1016/j.rehab.2013.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/23/2022]
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Pouliquen U, Etcharry-Bouyx F, Pinon K, Patureau F, Petit A, Lambert A, Richard I. Post-acute assessment programme for patients with traumatic brain injury: measuring the gap between patients' expectations on entering and end of programme recommendations. Brain Inj 2013; 27:789-92. [PMID: 23782304 DOI: 10.3109/02699052.2013.794960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the expectations of patients with brain injury (TBI) entering a post-acute programme to the recommendations made at the end. DESIGN Retrospective study (1997 and 2009). INTERVENTION This 12-week post-acute programme included ecological multidisciplinary assessment of physical and cognitive disabilities, independence in activities of daily living and work abilities. Recommendations made at the conclusion of the programme included advice regarding the ability to work in an unsheltered or a sheltered environment and possible social activities. RESULTS Two hundred and forty patients participated. The main objective of 95.8% was return-to-work: 93.7% expected a normal work environment, 2.1% considered a sheltered environment and 4% entered the programme with the aim of improving social abilities and integration in the community. The recommendations included return-to-work in 68.3% of cases, in an unsheltered environment in 44.2% and in a sheltered environment in 24.1% and advice for contact with social services in order to achieve better social integration in 31.7%. There was a discrepancy between expectations and recommendations in half of the cases. CONCLUSION The discrepancy between patients' expectations and recommendations is in part due to the cognitive disorders; long-term rehabilitation programmes should focus on this issue.
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Hamonet-Torny J, Fayol P, Faure P, Carrière H, Dumond JJ. Traumatic brain injury rehabilitation, the programs applied in French UEROS units, and the specificity of the Limoges experience. Ann Phys Rehabil Med 2013; 56:174-92. [DOI: 10.1016/j.rehab.2013.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 01/29/2013] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
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Prouteau A, Koleck M, Belio C, Saada Y, Merceron K, Dayre E, Jean-marcdestaillats, Barral C, Mazaux J. Mesurer la participation et l’environnement dans le handicap psychique et cognitif : validation préliminaire de la G-MAP. Alter 2012; 6:279-95. [DOI: 10.1016/j.alter.2012.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Vallat-Azouvi C, Pradat-Diehl P, Azouvi P. Rehabilitation of the central executive of working memory after severe traumatic brain injury: Two single-case studies. Brain Inj 2009; 23:585-94. [PMID: 19484632 DOI: 10.1080/02699050902970711] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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