Anne-Kristine Schanke

Post-concussion symptoms after traumatic brain injury at 3 and 12 months post-injury: A prospective study

Primary objectives: To examine self-reported post-concussion symptoms from 3–12 months post-injury in adults with traumatic brain injury (TBI) and to identify predictors of these symptoms. Methods and procedures: A 1-year prospective study in Eastern Norway including 115 persons (16–55 years), with mild, moderate and severe TBI. The Rivermead Post Concussion Symptoms Questionnaire (RPQ) and Hospital Anxiety and Depression Scale (HADS) were administered. Magnetic resonance imaging (MRI) was performed at 12 months. Results: In the whole sample of TBI, 27.8% of cases developed post-concussion syndrome (PCS) at 3 months and 23.6% at 12 months post-injury. The mild and moderate groups showed a decline of PCS symptoms over time, in contrast to the severe TBI group. Greater levels of somatic, cognitive and anxiety symptoms at 3 months, as well as shorter PTA duration, were found to be important predictors for the severity of PCS symptoms at 12 months. Intracranial pathology, Glasgow Coma Scale (GCS) and demographic variables were not related to the severity of PCS symptoms. Conclusions: PCS symptoms were reported to a greater degree in persons with mild TBI at 3 months post-injury. One year after injury, no differences were found between TBI groups on the presence of PCS.

Does an Early Onset and Continuous Chain of Rehabilitation Improve the Long-Term Functional Outcome of Patients with Severe Traumatic Brain Injury?

There are currently no international guidelines regarding treatment in the early rehabilitation phase for persons with severe traumatic brain injury (TBI), and only a few studies have investigated the effect of integrating rehabilitation into acute TBI care. The aim of the study was to evaluate whether a continuous chain of rehabilitation that begins with the acute phase could improve the functional outcome of severe TBI patients, compared to a broken chain of rehabilitation that starts in the sub-acute phase of TBI. A total of 61 surviving patients with severe TBI were included in a quasi-experimental study conducted at the Level I trauma center in Eastern Norway. In the study, 31 patients were in the early rehabilitation group (Group A) and 30 patients were in the delayed rehabilitation group (Group B). The functional outcomes were assessed 12 months post-injury with the Glasgow Outcome Scale Extended (GOSE) and the Disability Rating Scale (DRS). A favorable outcome (GOSE 6-8) occurred in 71% of the patients from Group A versus 37% in Group B (p=0.007). The DRS score was significantly better in Group A (p=0.03). The ordinal logistic regression analysis was used to quantify the relationship between the type of rehabilitation chain and the GOSE. A better GOSE outcome was found in patients from Group A (unadjusted OR 3.25 and adjusted OR 2.78, respectively). These results support the hypothesis that better functional outcome occurs in patients who receive early onset and a continuous chain of rehabilitation.

Disability, physical health and mental health 1 year after traumatic brain injury

Purpose. The purpose of this study was to assess disability and the physical and mental health status 1 year after traumatic brain injury (TBI), using the International Classification of Functioning, Disability and Health (ICF) as a conceptual model for understanding TBI disability. Methods. A prospective study of 85 patients with moderate-to-severe TBI (aged 16–55 years) due to injury occurring from May 2005 to May 2007 and hospitalised at the Trauma Referral Centre in Eastern Norway were included. The severity of structural brain damage and overall trauma were used as indices of body structure impairments. Activity limitations were measured by the Functional Independence Measure, and participation restrictions were assessed via the Community Integration Questionnaire. Physical and mental health dimensions as reported on the Medical Outcome Survey Short-Form were chosen as outcome measures. Results. Roughly one quarter of the patients reported disability requiring personal assistance. One Quarter had major problems with social integration, and 42% were not working. Nearly half of the patients reported poor physical health, and 37% reported poor mental health. Regression models, including demographics, impairments, activity limitations and participation restrictions, accounted for 50% of the variance in physical health and 35% of the variance in mental health. More severe impairments, fewer activity limitations and fewer participation restrictions equated to better overall health. Conclusions. The results demonstrated that a significant proportion of TBI survivors face substantial disability and impaired overall health 1 year after injury. To optimise health and well-being outcomes, clinicians need to ensure that health needs of patients with less severe TBI are identified and treated during the post-acute period.

Fatigue in polio survivors

Objectives: Fatigue is commonly reported among polio survivors. The aims of the present study were to examine the incidence of perceived fatigue among a sample of Norwegian polio survivors, and to examine the association between the level of fatigue and sociodemographic and health variables.Materials and methods: A mailed questionnaire containing, among others, Fatigue Questionnaire, Fatigue Severity Scale, sociodemographic and health variables were sent to a representative group of 312 Norwegian polio survivors. 276 subjects (88%) answered the questionnaire.Results: The incidence of fatigue among the polio survivors were considerably higher than in the normative data. Physical fatigue, more than mental fatigue, represented the major problems. Polio subjects who reported severe fatigue had significantly more other diseases and health problems than the normative group.Conclusions: The diagnosis and treatment of other or related physical conditions should be given higher priority in the management of persons with late effects of poliomyelitis, as these conditions probably can be the reasons for fatigue more than poliomyelitis sequelae alone.Spinal Cord (2001) 39, 243–251.

Psychological distress, social support and coping behaviour among polio survivors: a 5-year perspective on 63 polio patients.

The aim of the study was to seek knowledge of psychological and psychosocial aspects of coping with late effects of polio. Sixty-three polio survivors, 43 women and 20 men (mean age 55.3 years) 3-5 years ago former inpatients at the Post-Polio Program at Sunnaas Rehabilitation Hospital, participated in the study. In addition to a semi-structured interview-guide, the Hospital Anxiety and Depression scale (HAD), the Sickness Impact Profile (SIP), Cope-Scale, Brief Type-A Questionnaire (BTAQ) and the Fatigue Severity Scale (FSS) were used. As a measure of physical status, we used working capacity defined as peak O2 (oxygen) uptake. Levels of working capacity did not correlate significantly with any psychological variables, and the subjects reporting improved psychological health over the last 3-5 years did not have higher levels of working capacity or less physical decrement. A significant correlation was found between self-reported fatigue. psychological variables and social support. Compared to previous studies, low psychological distress, normal type-A scores, high adjustment and problem-focused coping characterized the respondents, pointing to the importance of timing in psychosocial research of post-polio.

Anxiety, depression, and psychological well-being 2 to 5 years poststroke.

OBJECTIVES We sought to explore psychological well-being and the psychosocial situation in persons with stroke, 2 to 5 years after discharge from a specialized rehabilitation hospital. METHODS The Hospital Anxiety and Depression Scale; the 30-item General Health Questionnaire; and a questionnaire were mailed to 255 former patients. RESULTS A total of 64% answered (36% women), and the average age was 58 years. The Hospital Anxiety and Depression Scale identified problems in 47% (anxiety in 36% and depression in 28%) and 30-item General Health Questionnaire in 54%. About half had experienced periods of anxiety, depression, or both since discharge. Most were satisfied with support by family/friends (88%), home ward (68%), and community therapy services (57%). Marital status was as in the general population. CONCLUSIONS Long after stroke, almost half of the investigated patients with stroke had psychiatric problems according to the questionnaires. This is higher than in the general population but is comparable with some other chronic, somatic populations in Norway.

Driving behaviour after brain injury: a follow-up of accident rate and driving patterns 6-9 years post-injury

OBJECTIVE A follow-up of accident rate and driving patterns of patients 6-9 years after brain injury. DESIGN Postal questionnaire sent to patients with brain injury who were assessed consecutively in the period 1997-2000 and who were re-issued. SUBJECTS A total of 93 persons, 69 men and 24 women, mean age 57 years, average 9 years post-injury, 65 persons with brain injury after cerebrovascular accidents and 28 with traumatic brain injury. METHODS The questionnaire covered self-reported driving accidents pre- and post-injury, yearly distance driven, behaviour in traffic and self-reported care taken in driving. RESULTS The cerebrovascular accident group had reduced their driving significantly post-injury and had also changed their driving patterns. No significant changes were found in distance driven and driving patterns for the group with traumatic brain injury. Compared with normative data, reported accidents post-injury in the cerebrovascular accident group showed no increased accident rate, while the accident rate in the traumatic brain injury-group was more than 2 times higher. CONCLUSION Patients with traumatic brain injury represent a risk group for accidents post-injury, while those with brain injury after cerebrovascular accidents do not. Possible causes for this difference are discussed.

Effects of acute substance use and pre-injury substance abuse on traumatic brain injury severity in adults admitted to a trauma centre

BackgroundThe aims of this study were to describe the occurrence of substance use at the time of injury and pre-injury substance abuse in patients with moderate-to-severe traumatic brain injury (TBI). Effects of acute substance use and pre-injury substance abuse on TBI severity were also investigated.MethodsA prospective study of 111 patients, aged 16-55 years, injured from May 2005 to May 2007 and hospitalised at the Trauma Referral Centre in Eastern Norway with acute TBI (Glasgow Coma Scale 3-12). Based on structural brain damages shown on a computed tomography (CT) scan, TBI severity was defined by modified Marshall classification as less severe (score <3) and more severe (score ≥3). Clinical definition of substance use (alcohol and/or other psychoactive substances) was applied when hospital admission records reflected blood alcohol levels or a positive drug screen, or when a physician verified influence by examining the patient. Pre-injury substance abuse (alcohol and drug problems) was screened by using the CAGE questionnaire.ResultsForty-seven percent of patients were positive for substance use on admission to hospital. Significant pre-injury substance abuse was reported by 26% of patients. Substance use at the time of injury was more frequent in the less severe group (p = 0.01). The frequency of pre-injury substance abuse was higher in the more severe group (30% vs. 23%). In a logistic regression model, acute substance use at time of injury tended to decrease the probability of more severe intracranial injury, but the effect was not statistically significant after adjusting for age, gender, education, cause of injury and substance abuse, OR = 0.39; 95% CI 0.11-1.35, p = 0.14. Patients with positive screens for pre-injury substance abuse (CAGE ≥2) were more likely to have more severe TBI in the adjusted regression analyses, OR = 4.05; 95% CI 1.10-15.64, p = 0.04.ConclusionsAcute s ubstance use was more frequent in patients with less severe TBI caused by low-energy events such as falls, violence and sport accidents. Pre-injury substance abuse increased the probability of more severe TBI caused by high-energy trauma such as motor vehicle accidents and falls from higher levels. Preventive efforts to reduce substance consumption and abuse in at-risk populations are needed.

Depressive symptoms and psychological distress during the first five years after traumatic brain injury: Relationship with psychosocial stressors, fatigue and pain.

OBJECTIVE To determine the prevalence of depressive symptoms among individuals with traumatic brain injury (TBI) and to identify predictors of depressive symptoms and psychological distress. DESIGN A longitudinal study with assessments at 3 months, 1 year and 5 years after injury. SUBJECTS A total of 118 individuals (29% females; mean age 32.5; range 16-55 years) with mild-to-severe TBI who were hospitalized in the Trauma Referral Centre from 2005 to 2007. METHODS Self-report assessments using the Hospital Anxiety- and Depression Scale, the Symptom Checklist 90-Revised and the Fatigue Severity Scale. Injury severity, trauma scores, pain, fatigue, substance abuse and demographic characteristics were also recorded. RESULTS The prevalence of depressive symptoms was 18% at 3 months, 13% at 1 year and 18% at 5 years after injury. Only 4% had persistent depressive symptoms at all time-points. At 1 year post-injury, anxiety, age, ongoing stressors and employment status predicted depressive symptoms (R2 = 0.43, p < 0.001), and ongoing stressors, employment status, fatigue and pain predicted psychological distress (R2 = 0.45, p < 0.001). CONCLUSION Psychosocial stressors and employment status contributed to depressive symptoms and psychological distress, whereas injury severity did not have any predictive value. The prevalence of depressive symptoms remained stable over time, emphasizing the importance of recognizing and treating depression early after the injury.

Neuropsychological functioning in a national cohort of severe traumatic brain injury: demographic and acute injury-related predictors

Objectives:To determine the rates of cognitive impairment 1 year after severe traumatic brain injury (TBI) and to examine the influence of demographic, injury severity, rehabilitation, and subacute functional outcomes on cognitive outcomes 1 year after severe TBI. Setting:National multicenter cohort study over 2 years. Participants:Patients (N = 105), aged 16 years or older, with Glasgow Coma Scale score of 3 to 8 and Galveston Orientation and Amnesia Test score of more than 75. Main Measures: Neuropsychological tests representing cognitive domains of Executive Functions, Processing Speed, and Memory. Injury severity included Rotterdam computed tomography score, Glasgow Coma Scale score, and posttraumatic amnesia (PTA) duration, together with length of rehabilitation and Glasgow Outcome Scale–Extended score. Results:In total, 67% of patients with severe TBI had cognitive impairment. Executive Functions, Processing Speed, and Memory were impaired in 41%, 58%, and 57% of patients, respectively. Using multiple regression analysis, Processing Speed was significantly related to PTA duration, Glasgow Outcome Scale–Extended score, and length of inpatient rehabilitation (R2 = 0.30); Memory was significantly related to Glasgow Outcome Scale–Extended score (R2 = 0.15); and Executive Functions to PTA duration (R2 = 0.10). Rotterdam computed tomography and Glasgow Coma Scale scores were not associated with cognitive functioning at 1 year postinjury. Conclusion:Findings highlight cognitive consequences of severe TBI, with nearly two-thirds of patients showing cognitive impairments in at least 1 of 3 cognitive domains. Regarding injury severity predictors, only PTA duration was related to cognitive functioning.