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Williams G, Hassett L, Clark R, Bryant AL, Morris ME, Olver J, Ada L. Ballistic resistance training has a similar or better effect on mobility than non-ballistic exercise rehabilitation in people with a traumatic brain injury: a randomised trial. J Physiother 2022; 68:262-268. [PMID: 36253280 DOI: 10.1016/j.jphys.2022.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
QUESTIONS In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life? DESIGN A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement. PARTICIPANTS A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury. INTERVENTION For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training. OUTCOME MEASURES The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months). RESULTS After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI -1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT. CONCLUSION This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations. TRIAL REGISTRATION ACTRN12611001098921.
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Affiliation(s)
- Gavin Williams
- Physiotherapy Department, Epworth Healthcare, Melbourne, Australia; School of Physiotherapy, Faulty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Leanne Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Ross Clark
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Adam L Bryant
- School of Physiotherapy, Faulty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Meg E Morris
- The Victorian Rehabilitation Centre Healthscope & Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia
| | - John Olver
- Rehabilitation Medicine, Epworth Healthcare, Melbourne, Australia
| | - Louise Ada
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Physical Activity Intolerance and Cardiorespiratory Dysfunction in Patients with Moderate-to-Severe Traumatic Brain Injury. Sports Med 2020; 49:1183-1198. [PMID: 31098990 DOI: 10.1007/s40279-019-01122-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Moderate-to-severe traumatic brain injury (TBI) is a chronic health condition with multi-systemic effects. Survivors face significant long-term functional limitations, including physical activity intolerance and disordered sleep. Persistent cardiorespiratory dysfunction is a potentially modifiable yet often overlooked major contributor to the alarmingly high long-term morbidity and mortality rates in these patients. This narrative review was developed through systematic and non-systematic searches for research relating cardiorespiratory function to moderate-to-severe TBI. The literature reveals patients who have survived moderate-to-severe TBI have ~ 25-35% reduction in maximal aerobic capacity 6-18 months post-injury, resting pulmonary capacity parameters that are reduced 25-40% for weeks to years post-injury, increased sedentary behavior, and elevated risk of cardiorespiratory-related morbidity and mortality. Synthesis of data from other patient populations reveals that cardiorespiratory dysfunction is likely a consequence of ventilator-induced diaphragmatic dysfunction (VIDD), which is not currently addressed in TBI management. Thus, cardiopulmonary exercise testing should be routinely performed in this patient population and those with cardiorespiratory deficits should be further evaluated for diaphragmatic dysfunction. Lack of targeted treatment for underlying cardiorespiratory dysfunction, including VIDD, likely contributes to physical activity intolerance and poor functional outcomes in these patients. Interventional studies have demonstrated that short-term exercise training programs are effective in patients with moderate-to-severe TBI, though improvement is variable. Inspiratory muscle training is beneficial in other patient populations with diaphragmatic dysfunction, and may be valuable for patients with TBI who have been mechanically ventilated. Thus, clinicians with expertise in cardiorespiratory fitness assessment and exercise training interventions should be included in patient management for individuals with moderate-to-severe TBI.
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Hassett L, Moseley AM, Harmer AR. Fitness training for cardiorespiratory conditioning after traumatic brain injury. Cochrane Database Syst Rev 2017; 12:CD006123. [PMID: 29286534 PMCID: PMC6486048 DOI: 10.1002/14651858.cd006123.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Reduced cardiorespiratory fitness (cardiorespiratory deconditioning) is a common consequence of traumatic brain injury (TBI). Fitness training may be implemented to address this impairment. OBJECTIVES The primary objective of this updated review was to evaluate whether fitness training improves cardiorespiratory fitness in people who have sustained a TBI. The secondary objectives were to evaluate whether fitness training improves body function and structure (physical and cognitive impairments, psychological responses resulting from the injury), activity limitations and participation restrictions in people who have sustained a TBI as well as to evaluate its safety, acceptance, feasibility and suitability. SEARCH METHODS We searched 10 electronic databases (the Cochrane Injuries Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Embase; PubMed (MEDLINE); CINAHL; AMED; SPORTDiscus; PsycINFO; PEDro and PsycBITE) and the International Clinical Trials Registry Platform for relevant trials. In addition we screened reference lists from systematic reviews related to the topic that we identified from our search, and from the included studies, and contacted trialists to identify further studies. The search was run in August 2017. SELECTION CRITERIA Randomised controlled studies with TBI participants were eligible if they compared an exercise programme incorporating cardiorespiratory fitness training to usual care, a non-exercise intervention, or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened the search results, extracted data and assessed bias. We contacted all trialists for additional information. We calculated mean difference (MD) or standardised mean difference (SMD) and 95% confidence intervals (CI) for continuous data, and odds ratio with 95% CI for dichotomous data. We pooled data when there were sufficient studies with homogeneity. MAIN RESULTS Two new studies incorporating 96 participants were identified in this update and were added to the six previously included studies. A total of eight studies incorporating 399 participants are included in the updated review. The participants were primarily men aged in their mid-thirties who had sustained a severe TBI. No studies included children. The studies were clinically diverse with regard to the interventions, time postinjury and the outcome measures used. At the end of intervention, the mean difference in peak power output was 35.47 watts (W) in favour of fitness training (MD 35.47 W, 95% CI 2.53 to 68.41 W; 3 studies, 67 participants; low-quality evidence). The CIs include both a possible clinically important effect and a possible negligible effect, and there was moderate heterogeneity among the studies.Five of the secondary outcomes had sufficient data at the end of intervention to enable meta-analysis: body composition (SMD 0.29 standard deviations (favouring control), 95% CI -0.22 to 0.79; 2 studies, 61 participants; low-quality evidence), strength (SMD -0.02 (favouring control), 95% CI -0.86 to 0.83; 2 studies, 23 participants; very low-quality evidence), fatigue (SMD -0.32 (favouring fitness training), 95% CI -0.90 to 0.26; 3 studies, 130 participants; very low-quality evidence), depression (SMD -0.43 (favouring fitness training), 95% CI -0.92 to 0.06; 4 studies, 220 participants; very low-quality evidence), and neuromotor function (MD 0.01 m (favouring fitness training), 95% CI -0.25 to 0.27; 2 studies, 109 participants; moderate-quality evidence). It was uncertain whether fitness training was more or less effective at improving these secondary outcomes compared to the control interventions. Quality of life was assessed in three trials, but we did not pool the data because of substantial heterogeneity. Five of the eight included studies had no dropouts from their intervention group and no adverse events were reported in any study. AUTHORS' CONCLUSIONS There is low-quality evidence that fitness training is effective at improving cardiorespiratory deconditioning after TBI; there is insufficient evidence to draw any definitive conclusions about the other outcomes. Whilst the intervention appears to be accepted by people with TBI, and there is no evidence of harm, more adequately powered and well-designed studies are required to determine a more precise estimate of the effect on cardiorespiratory fitness, as well as the effects across a range of important outcome measures and in people with different characteristics (e.g. children). In the absence of high quality evidence, clinicians may be guided by pre-exercise screening checklists to ensure the person with traumatic brain injury is safe to exercise, and set training parameters using guidelines established by the American College of Sports Medicine for people who have suffered a brain injury.
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Affiliation(s)
- Leanne Hassett
- The University of SydneyDiscipline of Physiotherapy, Faculty of Health Sciences and Musculoskeletal Health Sydney, School of Public HealthSydneyAustralia
| | - Anne M Moseley
- School of Public Health, The University of SydneyMusculoskeletal Health SydneyPO Box M179Missenden RdSydneyNSWAustralia2050
| | - Alison R Harmer
- The University of SydneyFaculty of Health SciencesC42 ‐ Cumberland CampusRoom 208, O BlockSydneyNew South WalesAustraliaNSW 1825
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Kolakowsky-Hayner SA, Bellon K, Yang Y. Unintentional injuries after TBI: Potential risk factors, impacts, and prevention. NeuroRehabilitation 2017; 39:363-70. [PMID: 27497469 DOI: 10.3233/nre-161368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The top three causes of fatal unintentional injuries are falls, motor vehicle crashes, and being struck against or struck by objects or persons. These etiologies also happen to be the leading causes of TBI, a serious public health problem, in the US. Reduced cognitive functioning, poor decision making, increased risk taking, disinhibition, diminished safety skills and substance use, place individuals with TBI at an increased risk for subsequent unintentional injuries. The caregiving, psychological, social and financial burden of initial injuries is enormous. Unintentional injuries post-TBI add to that burden significantly. Many unintentional injuries can be prevented with simple education and environment and lifestyle changes. Injury prevention requires collaboration among many. OBJECTIVE This literature review will share information regarding potential triggers or causes of unintentional injuries after TBI to identify potential issues. The many impacts of these injuries will be reviewed. Best practices in prevention will be presented. CONCLUSION Ultimately, education, discussion, and awareness across multiple stakeholders can aid in preventing unintentional injuries after TBI.
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Affiliation(s)
- Stephanie A Kolakowsky-Hayner
- Brain Trauma Foundation, Campbell, CA, USA.,Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Kimberly Bellon
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Yvonne Yang
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, USA
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Abstract
A pilot study was performed to assess the value of aerobic training as part of the rehabilitation programme for patients with a single incident brain injury requiring admission to an inpatient neurological rehabilitation unit. The cohort consisted of six patients with a combination of impairments including weakness, spasticity, taxia and cognitive problems. Each patient performed an exercise test at the beginning and end of the study to assess changes in aerobic fitness and performance. The aerobic training programme consisted of 20-30 minute sessions on an exercise bike three times a week for eight to 12 weeks. The post-training exercise test showed significant increases in duration ( p < 0.01) and in workload ( p < 0.025) compared to the pretraining test. There were no adverse effects from the training programme. Aerobic training should be considered in the rehabilitation programmes devised for patients with recent brain injury. Further research is needed to determine the best way to integrate this with other aspects of rehabilitation.
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Affiliation(s)
| | | | - Kathy Fulcher
- National Sports Medicine Institute, St Bartholomew's Medical College
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Abstract
It is time to stop using the term concussion as it has no clear definition and no pathological meaning. This confusion is increasingly problematic as the management of ‘concussed’ individuals is a pressing concern. Historically, it has been used to describe patients briefly disabled following a head injury, with the assumption that this was due to a transient disorder of brain function without long-term sequelae. However, the symptoms of concussion are highly variable in duration, and can persist for many years with no reliable early predictors of outcome. Using vague terminology for post-traumatic problems leads to misconceptions and biases in the diagnostic process, producing uninterpretable science, poor clinical guidelines and confused policy. We propose that the term concussion should be avoided. Instead neurologists and other healthcare professionals should classify the severity of traumatic brain injury and then attempt to precisely diagnose the underlying cause of post-traumatic symptoms.
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Affiliation(s)
- David J Sharp
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Peter O Jenkins
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
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Watson MJ. Do Patients with Severe Traumatic Brain Injury Benefit from Physiotherapy? A Review of the Evidence. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/ptr.2001.6.4.233] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ponsford JL, Ziino C, Parcell DL, Shekleton JA, Roper M, Redman JR, Phipps-Nelson J, Rajaratnam SMW. Fatigue and sleep disturbance following traumatic brain injury--their nature, causes, and potential treatments. J Head Trauma Rehabil 2012; 27:224-33. [PMID: 22573041 DOI: 10.1097/htr.0b013e31824ee1a8] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although fatigue and sleep disturbance are commonly reported following traumatic brain injury (TBI), understanding of their nature and treatment remains limited. OBJECTIVES This article reviews a series of investigations of the nature and causes of fatigue and sleep disturbance following TBI. METHODS A large cohort of community-based patients with TBI, recruited from a TBI rehabilitation program, completed measures of subjective fatigue and sleep disturbances, as well as attentional measures. A subgroup of participants completed polysomnography and assessment of dim light melatonin onset. RESULTS Fatigue and sleep disturbance are common. Both are associated with anxiety, depression, and pain. However, fatigue is also associated with slowed information processing and the need for increased effort in performing tasks. Sleep disturbances contribute to fatigue. Objective sleep studies show reduced sleep efficiency, increased sleep onset latency, and increased time awake after sleep onset. Depression and pain exacerbate but cannot entirely account for these problems. There is increased slow-wave sleep. Individuals with TBI show lower levels of evening melatonin production, associated with less rapid-eye movement sleep. CONCLUSIONS These findings suggest potential treatments including cognitive behavior therapy supporting lifestyle modifications, pharmacologic treatments with modafinil and melatonin, and light therapy to enhance alertness, vigilance, and mood. Controlled trials of these interventions are needed.
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Affiliation(s)
- Jennie L Ponsford
- School of Psychology and Psychiatry, Monash University, Victoria, Australia.
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Williams G, Willmott C. Higher levels of mobility are associated with greater societal participation and better quality-of-life. Brain Inj 2012; 26:1065-71. [DOI: 10.3109/02699052.2012.667586] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hassett LM, Tate RL, Moseley AM, Gillett LE. Injury severity, age and pre-injury exercise history predict adherence to a home-based exercise programme in adults with traumatic brain injury. Brain Inj 2011; 25:698-706. [DOI: 10.3109/02699052.2011.579934] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mossberg KA, Amonette WE, Masel BE. Endurance training and cardiorespiratory conditioning after traumatic brain injury. J Head Trauma Rehabil 2010; 25:173-83. [PMID: 20473091 PMCID: PMC2885899 DOI: 10.1097/htr.0b013e3181dc98ff] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the importance of cardiorespiratory conditioning after traumatic brain injury (TBI) and provide recommendations for patients recovering from TBI. METHOD Review of literature assessing the effectiveness of endurance training programs. MAIN OUTCOMES AND RESULTS A sedentary lifestyle and lack of endurance are common characteristics of individuals with TBI who have a reduction in peak aerobic capacity of 25% to 30% compared with healthy sedentary persons. Increased physical activity and exercise training improves cardiorespiratory fitness in many populations with physical and cognitive impairments. Therefore, increasing the endurance and cardiorespiratory fitness of persons with TBI would seem to have important health implications. However, review of the TBI literature reveals that there have been few well-designed, well-controlled studies of physiologic and psychological adaptations of fitness training. Also lacking are long-term follow-up studies of persons with TBI. CONCLUSIONS Assessing endurance capacity and cardiorespiratory fitness early in the TBI rehabilitation process merits consideration as a standard of care by professional rehabilitation societies. Also, providing effective, safe, and accessible training modalities would seem to be an important consideration for persons with TBI, given the mobility impairments many possess. Long-term follow-up studies are needed to assess the effectiveness of cardiorespiratory training programs on overall morbidity and mortality.
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Affiliation(s)
- Kurt A Mossberg
- University of Texas Medical Branch, Galveston, Texas 77555, USA.
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12
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Williams GP, Morris ME. High-level mobility outcomes following acquired brain injury: A preliminary evaluation. Brain Inj 2009; 23:307-12. [DOI: 10.1080/02699050902774170] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Madeleine A. Grealy, Dorothy Heffer. The rehabilitation of brain injured children: the case for including physical exercise and virtual reality. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/13638490110045438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Tolfts A, Stiller K. Do patients with traumatic brain injury benefit from physiotherapy? A review of the evidence. Physiother Theory Pract 2009. [DOI: 10.3109/09593989709036463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Driver S, Rees K, O'Connor J, Lox C. Aquatics, health-promoting self-care behaviours and adults with brain injuries. Brain Inj 2009; 20:133-41. [PMID: 16421061 DOI: 10.1080/02699050500443822] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PRIMARY OBJECTIVE To determine the effect of an aquatic programme on the health promoting behaviours of adults with brain injuries. MAIN OUTCOMES AND RESULTS Eighteen individuals participated in the programme and were randomly assigned to an experimental (n = 9) or control group (n = 9). Health promoting behaviours, physical self-concept and self-esteem were measured pre- and post-intervention. Significant differences and large effect sizes were found between scores for the experimental group only, indicating an increase in health promoting behaviours, physical self-concept and self-esteem. CONCLUSIONS Results have useful implications for health professionals as exercise prescription may enhance health promoting behaviours and decrease health care costs after a brain injury.
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Hassett LM, Harmer AR, Moseley AM, Mackey MG. Validity of the modified 20-metre shuttle test: Assessment of cardiorespiratory fitness in people who have sustained a traumatic brain injury. Brain Inj 2009; 21:1069-77. [PMID: 17891570 DOI: 10.1080/02699050701630375] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVE To validate the modified 20-metre shuttle test in adults who have sustained a traumatic brain injury (TBI). DESIGN Single-sample validity study. SETTING Brain injury rehabilitation unit. PARTICIPANTS Twenty-four adults with severe TBI, discharged from hospital for at least 6-months. PROTOCOL Participants attended the facility for a familiarization session, followed by a symptom-limited treadmill test and a modified shuttle test on two separate days. The treadmill test was based on an individualised protocol which used a physiotherapist-selected speed and increments in gradient every minute until volitional fatigue. The modified shuttle test was externally-paced and commenced with a speed of 2.4 km h(-1) which increased every minute until volitional fatigue. MAIN MEASURES Four primary measures were taken from both tests: peak oxygen uptake, peak heart rate, maximal velocity and rating of perceived exertion. RESULTS All participants completed the study. There were no adverse events. A high correlation was observed between the modified shuttle test and the treadmill test for peak oxygen uptake, peak heart rate and maximal velocity (r = 0.96, r = 0.80, r = 0.82, respectively; p < 0.001), but not for rating of perceived exertion (r = 0.013, p = 0.952). CONCLUSION The modified shuttle test is a valid measure of cardiorespiratory fitness in people who have sustained a TBI.
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Affiliation(s)
- L M Hassett
- Discipline of Physiotherapy, The University of Sydney, Lidcombe, NSW, Australia.
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Thornton M, Marshall S, McComas J, Finestone H, McCormick A, Sveistrup H. Benefits of activity and virtual reality based balance exercise programmes for adults with traumatic brain injury: Perceptions of participants and their caregivers. Brain Inj 2009; 19:989-1000. [PMID: 16263641 DOI: 10.1080/02699050500109944] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore multi-dimensional benefits of exercise participation perceived by adults with traumatic brain injury (TBI) and their caregivers. METHODS Adults (n=27, aged 18-66) with moderate or severe TBI 6 months or more earlier participated in focus groups following 6 weeks of an activity-based (ABE) or a virtual reality (VR) delivered balance exercise programme. Family members and care providers participated in separate focus groups. Perceptions related to programme participation as well as balance confidence and lower extremity function were extracted from focus group verbatim and quantitative scales, respectively. OUTCOMES Benefits in three domains, psychosocial, physical and programme, were identified from transcription and analyses of focus group verbatim. Improvements were noted in balance confidence and function in both groups. Substantially greater enthusiasm and knowledge was expressed by participants in the VR group and their caregivers. CONCLUSIONS Both exercise programmes offered benefits in addition to improved balance. The VR participants had greater improvements on quantitative measures and provided more comments expressing enjoyment and improved confidence. Applications in terms of community reintegration and quality of life are discussed.
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Affiliation(s)
- M Thornton
- School of Human Kinetics, University of Ottawa, and Children's Hospital of Eastern Ontario, Canada
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Hassett LM, Moseley AM, Tate R, Harmer AR. Fitness training for cardiorespiratory conditioning after traumatic brain injury. Cochrane Database Syst Rev 2008:CD006123. [PMID: 18425937 DOI: 10.1002/14651858.cd006123.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cardiorespiratory deconditioning is a common sequelae after traumatic brain injury (TBI). Clinically, fitness training is implemented to address this impairment, however this intervention has not been subject to rigorous review. OBJECTIVES The primary objective was to evaluate whether fitness training improves cardiorespiratory fitness in people who have sustained a TBI. SEARCH STRATEGY We searched ten electronic databases (Cochrane Injuries Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; PubMed (MEDLINE); CINAHL; AMED; SPORTDiscus; PsycINFO; PEDro and PsycBITE) and two clinical trials registers (TrialsCentral and Current Controlled Trials). The last search was August 2007. In addition we screened reference lists from included studies and contacted trialists to identify further studies. SELECTION CRITERIA Randomised controlled studies with TBI participants were eligible if they compared an exercise programme incorporating cardiorespiratory fitness training to usual care, a non-exercise intervention or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened the search output, extracted data and assessed quality. All trialists were contacted for additional information. Mean difference and 95% confidence intervals (CI) were calculated for continuous data and risk difference or odds ratio and 95% CI were calculated for dichotomous data. Data were pooled when there were sufficient studies with clinical and statistical homogeneity. MAIN RESULTS Six studies, incorporating 303 participants, were included. The participants were primarily males, in their mid thirties who had sustained a severe TBI. The studies were clinically diverse with regard to the interventions, time post-injury and the outcome measures used; therefore, the primary outcome could not be pooled. Three of the six studies indirectly assessed change in cardiorespiratory fitness after fitness training using the peak power output obtained during cycle ergometry (either at volitional fatigue or at a predetermined endpoint, that is, a percentage of predicted heart rate maximum). Cardiorespiratory fitness was improved after fitness training in one study (mean difference 59 watts, 95% CI 24 to 94), whilst there was no significant improvement in the other two studies. Four of the six studies had no drop-outs from their intervention group and no adverse events were reported in any study. AUTHORS' CONCLUSIONS There is insufficient evidence to draw any definitive conclusions about the effects of fitness training on cardiorespiratory fitness. Whilst it appears to be a safe and accepted intervention for people with TBI, more adequately powered and well-designed studies are required to determine the effects across a range of outcome measures.
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Affiliation(s)
- L M Hassett
- Liverpool Health Service, Brain Injury Rehabilitation Unit, Locked Bag 7103, Liverpool BC, NSW, Australia, 1871.
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Maki AL, Rudrud EH, Schulze KA, Rapp JT. Increasing therapeutic exercise participation by individuals with acquired brain injury using self-recording and reinforcement. BEHAVIORAL INTERVENTIONS 2008. [DOI: 10.1002/bin.255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Blake H, Batson M. Exercise intervention in acquired brain injury rehabilitation: A discussion. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2008. [DOI: 10.12968/ijtr.2008.15.4.29037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Holly Blake
- School of Nursing, Faculty of Medicine & Health Science, University of Nottingham, B Floor, Medical School Queen's Medical Centre Nottingham, NG7 2UH
| | - Mindi Batson
- Institute for Work, Health and Organisations, University of Nottingham, UK
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A randomized trial of modafinil for the treatment of fatigue and excessive daytime sleepiness in individuals with chronic traumatic brain injury. J Head Trauma Rehabil 2008; 23:52-63. [PMID: 18219235 DOI: 10.1097/01.htr.0000308721.77911.ea] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study examines the efficacy of modafinil in treating fatigue and excessive daytime sleepiness in individuals with traumatic brain injury (TBI). METHODS A single-center, double-blind, placebo-controlled cross-over trial, where 53 participants with TBI were randomly assigned to receive up to 400 mg of modafinil, or equal number of inactive placebo tablets. Main eligibility criteria were being at least 1 year post-TBI severe enough to require inpatient rehabilitation. The primary outcome measures were fatigue (Fatigue Severity Scale, FSS) and daytime sleepiness (Epworth Sleepiness Scale, ESS). RESULTS After adjusting for baseline scores and period effects, there were no statistically significant differences between improvements seen with modafinil and placebo in the FSS at week 4 (-0.5 +/- 1.88; P = .80) or week 10 (-1.4 +/- 2.75; P = .61). For ESS, average changes were significantly greater with modafinil than placebo at week 4 (-1.2 +/- 0.49; P = .02) but not at week 10 (-0.5 +/- 0.87; P = .56). Modafinil was safe and well tolerated, although insomnia was reported significantly more often with modafinil than placebo (P = .03). CONCLUSIONS While there were sporadic statistically significant differences identified, a clear beneficial pattern from modafinil was not seen at either week 4 or week 10 for any of the 12 outcomes. There was no consistent and persistent clinically significant difference between treatment with modafinil and placebo.
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Patterns of fatigue and its correlates over the first 2 years after traumatic brain injury. J Head Trauma Rehabil 2008; 23:25-32. [PMID: 18219232 DOI: 10.1097/01.htr.0000308718.88214.bb] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study used a prospective longitudinal design to quantify fatigue and associated factors during the first 2 years after traumatic brain injury (TBI). Fifty-one individuals were assessed at 3 time points: within the first 6, 12, and 18-24 months after TBI. Self-reported fatigue improved during the first year, as did pain, sleep quality, cognitive independence, and involvement in productive activity. Further changes up to 2 years after TBI were not observed. The subset of individuals who reported significant increases in fatigue over the first 2 years demonstrated poorer outcomes in cognition, motor symptoms, and general functioning than those with decreased or stable fatigue.
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Mossberg KA, Ayala D, Baker T, Heard J, Masel B. Aerobic capacity after traumatic brain injury: comparison with a nondisabled cohort. Arch Phys Med Rehabil 2007; 88:315-20. [PMID: 17321823 DOI: 10.1016/j.apmr.2006.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare aerobic capacity of people recovering from traumatic brain injury (TBI) with an age- and sex-matched group of nondisabled sedentary people. DESIGN Descriptive comparative study of peak and submaximal physiologic responses. SETTING Residential postacute treatment center. PARTICIPANTS Convenience sample of 13 people with TBI and 13 age- and sex-matched nondisabled subjects. All subjects could walk 5.3 kph (3.3 mph), follow 2-step commands, and comply with testing using the gas collection apparatus. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Subjects performed a graded maximal treadmill test during which heart rate, minute ventilation (VE), oxygen consumption (VO2), carbon dioxide production, and respiratory exchange ratio (RER) were measured every minute until exhaustion. Ventilatory equivalents for oxygen (VE/VO2) and oxygen pulse were calculated. RESULTS Subjects recovering from TBI had significantly lower peak responses for heart rate, VO2, VE, and oxygen pulse TBI (P<.01). Peak RER and VE/VO2 were similar. There were significant differences in submaximal responses for VE/VO2 and oxygen pulse. CONCLUSIONS Patients with TBI were significantly more deconditioned than a comparable group of sedentary people without disability. Participation in cardiorespiratory fitness programs after TBI should be encouraged to prevent secondary disability.
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Affiliation(s)
- Kurt A Mossberg
- Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX 77555-1144, USA.
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Bhambhani Y, Rowland G, Farag M. Reliability of peak cardiorespiratory responses in patients with moderate to severe traumatic brain injury. Arch Phys Med Rehabil 2003; 84:1629-36. [PMID: 14639562 DOI: 10.1053/s0003-9993(03)00343-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the test-retest reliability of acute physiologic responses in patients with traumatic brain injury (TBI). DESIGN Repeated measures within 1 week. SETTING Brain injury rehabilitation program and community rehabilitation hospital. PARTICIPANTS Thirty-six inpatients or their legal guardians. INTERVENTIONS Each patient performed a symptom-limited incremental cycle ergometer test to voluntary fatigue on 2 separate occasions within 1 week. MAIN OUTCOME MEASURES Peak values of power output and cardiorespiratory responses measured with a metabolic cart interfaced with an electrocardiogram. RESULTS Intraclass correlations between the 2 trials were as follows: power output,.96; absolute oxygen uptake,.98; relative oxygen uptake,.97; heart rate,.82; ventilation rate,.96; and respiratory exchange ratio,.81. Bland-Altman plots showed that all data points were within the 95% confidence limits of the mean value of the 2 trials for each variable. CONCLUSIONS The reliability of the peak cardiorespiratory responses during non-weight-bearing exercise was high in patients with TBI in a controlled laboratory setting. Therefore, aerobic exercise programs can be accurately prescribed, and changes resulting from such interventions can be confidently evaluated in this population.
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Affiliation(s)
- Yagesh Bhambhani
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
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Warms CA, Bryant J. Physical Activity and Exercise for Women with Mobility Impairments. Phys Med Rehabil Clin N Am 2001. [DOI: 10.1016/s1047-9651(18)30083-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grealy MA, Johnson DA, Rushton SK. Improving cognitive function after brain injury: the use of exercise and virtual reality. Arch Phys Med Rehabil 1999; 80:661-7. [PMID: 10378492 DOI: 10.1016/s0003-9993(99)90169-7] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the impact of exercise and virtual reality (VR) on the cognitive rehabilitation of persons with traumatic brain injury (TBI). DESIGN Before-after trial assessed cognitive function after a 4-week intervention program. A random allocation crossover assessed changes in reaction and movement times after a single bout of VR exercise and a no-exercise control condition. SETTING Brain injury rehabilitation unit in Edinburgh, Scotland. PATIENTS (1) Four-week intervention: a consecutive sample of 13 suitable TBI adults were compared to control populations (n > 25) of previous TBI patients of similar age, severity, and time postinjury. (2) Single-bout intervention: a consecutive sample of 13 suitable adults with moderate TBI, 6.29 to 202.86 weeks postinjury. INTERVENTION Nonimmersive VR exercise. MAIN OUTCOME MEASURES (1) Tests of attention, information processing, learning, and memory. (2) Reaction and movement times. RESULTS After the 4-week intervention patients performed significantly better than controls on the digit symbol (p < .01). verbal (p < .01), and visual learning tasks (p < .05). Significant improvements in reaction times (p < .01) and movement times (p < .05) were gained following a single bout of VR exercise. CONCLUSION Exercising in a virtual environment offers the potential for significant gains in cognitive function.
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Affiliation(s)
- M A Grealy
- Institute of Biomedical and Life Sciences, University of Glasgow, Scotland, UK
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Abstract
PURPOSE Traumatic brain injury (TBI) stands as a major public health problem and one of the most important challenges for neurological rehabilitation. This review discusses advances that have occurred in the past 10 years in rehabilitation after severe TBI in adults. METHOD First, theoretical concepts, goals of rehabilitation and organization of resources are reviewed. Then specific questions that arise in the rehabilitation of severe TBI patients are considered. RESULTS Three phases are distinguished in post-traumatic evolution. Acute rehabilitation takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications, and to provide sensory stimulations with the hope of accelerating arousal. Secondly subacute (generally inpatient) rehabilitation is designed to facilitate and accelerate recovery of impairments, and to compensate for disabilities. Motility, cognition, behaviour, personality and affect should be simultaneously addressed in an holistic approach. Physical as well as psychological independence and self-awareness are the major goals to emphasize. A third, post-acute rehabilitation phase includes outpatient therapy for achieving physical, domestic and social independence, reduction of handicaps and re-entry into the community. CONCLUSIONS Problems with returning home, obtaining financial independence, driving, returning to work, participating in social relationships and leisure activities, and the importance of psychosocial adjustment and self-acceptance, are outlined. Questions about economic aspects and rehabilitation in the future are addressed.
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Affiliation(s)
- J M Mazaux
- Centre Hospitalier Universitaire de Bordeaux, France
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Vitale AE, Sullivan SJ, Jankowski LW, Fleury J, Lefrançois C, Lebouthillier E. Screening of health risk factors prior to exercise or a fitness evaluation of adults with traumatic brain injury: a consensus by rehabilitation professionals. Brain Inj 1996; 10:367-75. [PMID: 8735666 DOI: 10.1080/026990596124377] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A modified Delphi technique was used to obtain group consensus among 31 rehabilitation professionals (RPs) from nine rehabilitation centres throughout the province of Québec (Canada) to ascertain their expert opinion on the health risk factors (HRF) to be verified prior to beginning an exercise programme or evaluation for patients with traumatic brain injury (TBI). From the initial survey 87 items were generated, which were later regrouped into 27 HRFs. The relative importance of each HRF in regard to being screened before exercise in a population with TBI was then assessed by each RP using a five-point ordinal scale (1 = not important to 5 = extremely important). HRFs that were considered extremely important by at least 50% of HPs include: angina pectoris, aortic stenosis, exertional syncope, musculoskeletal sequelae which are exacerbated by exercise, outward aggressivity, pulmonary embolism, uncontrolled epilepsy (seizures), and ventricular arrhythmias. Professionals involved in exercising patients with TBI may find these factors useful to the efficient conduct of their rehabilitation programme.
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Affiliation(s)
- A E Vitale
- Ecole de réadaptation, Faculte de médecine, Université de Montréal, Québec, Canada
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Vitale AE, Sullivan SJ, Jankowski LW. Underestimation of subjects' monitored radial pulse rates following traumatic brain injury. Percept Mot Skills 1995; 80:57-8. [PMID: 7624219 DOI: 10.2466/pms.1995.80.1.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The measurement of heart rate is fundamental to the scientific programming of physical activity. In this analysis, 20 male subjects with traumatic brain injuries underestimated their heart rates as measured by the radial pulse both at rest and after brief, light exercise.
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Affiliation(s)
- A E Vitale
- Ecole de réadaptation, Université de Montréal, Québec, Canada
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