| 1. |
- Sörbo, Ann, 1955, et al.
(författare)
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Outcome after severe brain damage, what makes the difference?
- 2005
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Ingår i: Brain Inj. ; 19:7, s. 493-503
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess and compare the consequences for outcome in terms of the dimensions of activity and participation for two groups: group A, which received early formalized rehabilitation, and group B, which received late or no formalized rehabilitation. RESEARCH DESIGN: A cross-sectional study. PROCEDURE: Twenty-six patients (A: n = 14 and B: n = 12) with severe brain damage were included. The participants were assessed a mean of 26.6 months (SD 7.1, median 25, range 14-41) after the incident using the structured form for the Swedish Neuro database, the Glasgow Outcome Scale (GOS), the Extended Glasgow Outcome Scale (GOSE) and the Functional Independence Measure (FIM). RESULTS: The study reveals a better outcome for group A. No patient remained in a vegetative state in group A as compared with three in group B. In group A, 50% were independent as compared with 17% in group B. The frequency of return to work was 43% in group A, but no patient in group B had returned to work.
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| 2. |
- Bjerkne Wenneberg, Sandra, et al.
(författare)
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Long-term outcomes after aneurysmal subarachnoid hemorrhage: A prospective observational cohort study
- 2022
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146:5, s. 525-536
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The survival rates for patients affected by aneurysmal subarachnoid hemorrhage (aSAH) have increased in recent years; however, many patients continue to develop cognitive dysfunctions that affect their quality of life. The commonly used outcome measures often fail to identify these cognitive dysfunctions. This study aimed to evaluate the long-term outcomes at 1 and 3 years after aSAH to assess changes over time and relate outcomes to patient characteristics and events during the acute phase. Materials and Methods This prospective observational study included patients that experienced aSAH. Patients were assessed according to the extended Glasgow Outcome Scale, Life Satisfaction Questionnaire, Mayo-Portland Adaptability inventory-4, and Mental Fatigue scale. Results Patients were assessed after 1 year (n = 62) and 3 years (n = 54). At 3 years, the extended Glasgow Outcome Scale score improved in 15% and worsened in 12% of the patients. Mental fatigue was observed in 57% of the patients at 1 year. Patients <60 years of age at the time of aSAH had more self-assessed problems, including pain/headache (p < .01), than patients >60 years of age. Patients with delayed cerebral ischemia during the acute phase reported more dissatisfaction at 3 years, whereas no significant result was seen at 1 year. Conclusions Cognitive dysfunction, especially mental fatigue, is common in patients with aSAH, which affects quality of life and recovery. Patient outcome is a dynamic process developing throughout years after aSAH, involving both improvement and deterioration. This study indicates the importance of longer follow-up periods with broad outcome assessments.
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| 3. |
- Ertzgaard, P., et al.
(författare)
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Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial
- 2018
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 54:4, s. 507-517
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patient's everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mono, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants' homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each. followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patient's own rehabilitation goals is recommended and may increase the value of the evaluated concept.
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| 4. |
- Karlander, Markus, et al.
(författare)
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Risk and cause of death in post-traumatic epilepsy: a register-based retrospective cohort study
- 2022
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Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 269:11, s. 6014-6020
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Tidskriftsartikel (refereegranskat)abstract
- Objective Post-traumatic epilepsy (PTE) is common, but its impact on survival after traumatic brain injury (TBI) of different severity and in different demographic patient groups is unknown. We analyzed the risk of death associated with PTE with adjustment for TBI severity, causes of death, and the contribution of epilepsy as direct or contributing cause of death. Methods Register-based, retrospective cohort study. All individuals hospitalized in Sweden for a TBI between 2000 and 2010 without prior seizures were identified in the National Patient Register, with follow-up until 2017. Subsequent epilepsy was identified by ICD-10 codes. Time-dependent Cox proportional hazard ratio (HR) was used to assess hazard of death, with epilepsy as a time-updated covariate. Adjusted analyses for age, gender, injury severity and comorbidities were also performed. Causes of death were analyzed using the Cause of Death Register. Results Among 111 947 individuals with TBI, subsequent epilepsy diagnosis was associated with a crude HR of 2.3 (95% CI: 2.2-2.4) for death. Stratified analyses showed a HR of 7.8 (95% CI: 6.5-9.4) for death in younger individuals. Epilepsy was a more common underlying cause of death in younger individuals. Conclusion PTE is associated with a higher risk of death and epilepsy seems to contribute to a significant proportion of deaths, especially in younger age groups. Future studies on whether improved epilepsy treatment can reduce mortality are needed.
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| 5. |
- Ljungqvist, Johan, et al.
(författare)
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Longitudinal study of the diffusion tensor imaging properties of the corpus callosum in acute and chronic diffuse axonal injury.
- 2011
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Ingår i: Brain injury. - : Informa UK Limited. - 1362-301X .- 0269-9052. ; 25:4, s. 370-378
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Tidskriftsartikel (refereegranskat)abstract
- Background: Magnetic resonance diffusion tensor imaging (MR-DTI) is used increasingly to detect diffuse axonal injury (DAI) after traumatic brain injury (TBI). Primary objective: The primary objective was to investigate the changes in the diffusion properties of the corpus callosum in the acute phase and 6 months after TBI and to examine the correlation between DTI parameters and clinical outcome. Research design: Longitudinal prospective study. Methods and procedures: MR-DTI was performed in eight patients with suspected DAI within 11 days and at 6 months post-injury. Six controls were also examined. Fractional anisotropy (FA), trace and parallel and perpendicular diffusivity of the corpus callosum were analysed. The main outcome was the extended Glasgow Outcome Scale score, assessed at 6 months. Main outcomes and results: A significant reduction in FA in the corpus callosum was seen in the acute phase in patients compared with the healthy controls. There was no significant change in the parallel or perpendicular eigenvalues or trace. At 6 months, a significant reduction in FA and a significant increase in trace and perpendicular eigenvalues were noticed compared with controls. Conclusions: The diffusion properties of the corpus callosum correlated with clinical outcome in this longitudinal investigation.
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| 6. |
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| 7. |
- Sörbo, Ann, 1955, et al.
(författare)
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Mental fatigue assessment may add information after aneurysmal subarachnoid hemorrhage
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 9:7
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Tidskriftsartikel (refereegranskat)abstract
- Background Mental fatigue, as part of cognitive dysfunction, has been reported to be common after subarachnoid hemorrhage and it significantly affects quality of life. Aims of the Study The aim of this study was to assess mental fatigue one year after an aneurysmal subarachnoid hemorrhage and to correlate the degree of mental fatigue to functional outcome assessed with the Extended Glasgow Outcome Scale (GOSE). Methods One year after an aneurysmal subarachnoid hemorrhage, the GOSE was assessed and a questionnaire for self-assessment of mental fatigue, the Mental Fatigue Scale, was distributed to all included patients. The maximum score is 42 and a score of >= 10.5 indicates mental fatigue. Results All patients with GOSE 8, indicating full recovery, had a mental fatigue score of <10.5. A linear correlation between the GOSE and the mental fatigue score was observed (p < 0.0001). Conclusions Patients with a favorable outcome and GOSE 5-7 could benefit from the assessments of mental fatigue in order to receive satisfactory rehabilitation.
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| 8. |
- Sörbo, Ann, 1955
(författare)
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Outcome after modern neurosurgical care and formalised rehabilitation following severe brain injury
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The overall aims were to evaluate the results of the treatment concepts for severe brain injury including decompressive craniectomy (DC), early rehabilitation and long-term follow-up, primarily according to the psychosocial consequences of the brain damage and life satisfaction. The first study was a cross-sectional study to assess and compare the consequences for outcome for two groups with severe traumatic brain injury (TBI) or subarachnoid haemorrhage (SAH), one group that received early, long-term formalised rehabilitation and the other that received late or no formalised rehabilitation. The second study was a descriptive, prospective study with follow-up until five years after severe TBI/SAH. The third was a retrospective study of the long-term outcome in patients with malignant middle cerebral artery infarction (MMI) who were treated with DC, while the fourth was a prospective one-year follow-up study of patients with different diagnoses who were treated with DC. Methods: The main outcome measures were the structured form for the Swedish Neuro Database, the Glasgow Outcome Scale (GOS), the Extended Glasgow Outcome Scale (GOSE), the Functional Independence Measure (FIM), the Head Injury Evaluation Chart (HIEC), the Community Integration Questionnaire (CIQ), the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI), the short form health survey (SF-36) and the life satisfaction checklist (LiSat-11). Changes over time for the follow-up group and the individuals in the second study, as measured with the GOSE, were analysed using a statistical method that is suitable for small data sets and takes account of the non-metric properties of the data. Results: The first study revealed a better outcome for the group that received early formalised specialist rehabilitation and long-term follow-up. No patient remained in a vegetative state in this group as compared with three in the other, 50% were independent as compared with 17% in the other and the frequency of return to work was 55% among the former workers/students as compared to no return to work in the other group. In the second study, the change over time according to the degree of neurological deficit and day-to-day living abilities (GOSE) was significant at group level until one year after the injury, but important changes were found for some individuals until five years after injury. In the third retrospective study, the patients who were treated with DC because of MMI remained in an impaired neurological condition. Their life satisfaction was lower as compared with a healthy population, but 83% still rated “life as a whole” as satisfactory. The fourth study revealed that 20% of the surviving participants had a favourable outcome as measured with the GOSE. Of those who were able to convey their satisfaction with life, 88% reported that life as a whole was satisfactory one year after the injury/onset of disease. Conclusions: The studies show that an effective chain of medical and rehabilitation activities can produce a good outcome/living situation and that life can be satisfactory for patients after severe brain injuries in spite of neurological deficits.
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| 9. |
- Sörbo, Ann, 1955, et al.
(författare)
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Pre-traumatic conditions can influence cortisol levels before and after a brain injury
- 2020
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:4, s. 342-350
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Tidskriftsartikel (refereegranskat)abstract
- Objective Satisfactory anabolic reactions, including the activation of the hypothalamic-pituitary-adrenal (HPA) axis, are essential following severe traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH). Many factors may influence this activation. This study aimed to investigate whether individuals who reported chronic diseases, psychosocial afflictions, or stressful events before a severe brain injury display a different pattern regarding cortisol levels retrospectively and up to three months compared with those who did not report stressful experiences. Materials and Methods Fifty-five patients aged 16-68 years who were admitted to the neurointensive care unit (NICU) were included. Hair cortisol measurements offer a unique opportunity to monitor cortisol levels retrospectively and after the trauma. Hair strands were collected as soon as possible after admission to the NICU and every month until three months after the injury/insult. The participants/relatives were asked about stressful events, psychosocial afflictions and recent and chronic diseases. Results The group who reported chronic diseases and/or stressful events before the brain injury had more than twice as high median hair cortisol levels before the brain injury compared with those who did not report stress, but the difference was not statistically significant (P = .12). Those who reported stress before the brain injury had statistically significantly lower hair cortisol values after the brain injury and they remained until three months after the injury. Conclusions Stressful events and/or chronic disease before brain injury might affect mobilization of adequate stress reactions following the trauma. However, the large variability in cortisol levels in these patients does not allow firm conclusions and more studies are needed.
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| 10. |
- Sörbo, Ann, 1955, et al.
(författare)
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Psychosocial adjustment and life satisfaction until 5 years after severe brain damage.
- 2009
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Ingår i: International journal of rehabilitation research. Internationale Zeitschrift für Rehabilitationsforschung. Revue internationale de recherches de réadaptation. - 1473-5660. ; 32:2, s. 139-47
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Tidskriftsartikel (refereegranskat)abstract
- The objectives of this study were to describe psychosocial adjustment and outcome over time for severely brain-injured patients and to find suitable outcome measures for clinical practice during the rehabilitation process and for individual rehabilitation planning after discharge from hospital. The methods include a descriptive, prospective, population-based study. The participants were assessed at 6 months and annually until 5 years after traumatic brain injury or nontraumatic subarachnoid haemorrhage. Inclusion criteria were age 16-65 years, severe traumatic brain injury or nontraumatic subarachnoid haemorrhage defined as Glasgow Coma Scale 8 or worse and need for neurointensive care for at least 5 days. The main outcome measures were Head Injury Evaluation Chart, Glasgow Outcome Scale Extended (GOSE) and Life Satisfaction Questionnaire (LiSat)-11 checklist. Change over time for the group and the individuals, as measured with the GOSE, was analyzed by a statistical method that is suitable for small datasets and takes into account the nonmetric properties of the data. Eighteen patients were included. Three died and one was excluded for the long-term follow-up (n=14). The group had a good outcome with no participant remaining in a vegetative state, 93% (12 of 13) went home and 60% (six of 10) returned to work. Eighty percent (eight of 10) of participants rated 'life as a whole' as satisfactory 5 years after the injury. The change at group level was significant (GOSE) until 1 year after the injury. The GOSE and the LiSat-11 were most clinically useful as they were easy to use for the rater/participants.
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