Arlene I. Greenspan

Intense Tai Chi Exercise Training and Fall Occurrences in Older, Transitionally Frail Adults: A Randomized, Controlled Trial

Objectives: To determine whether an intense tai chi (TC) exercise program could reduce the risk of falls more than a wellness education (WE) program in older adults meeting criteria for transitioning to frailty.

Factors influencing failure to return to work due to traumatic brain injury.

About 63% of all traumatic brain injuries (TBI) occur in teenagers and adults aged 15-64 years, the primary working population. Since reports of failure to return to work (FTRTW) vary, understanding the factors that influence FTRTW is key to improving work outcomes for this primarily working-age population. Our study sample consists of 343 previously employed persons who were hospitalized following TBI and had either returned to work at 1 year or had failed to return to work because of their injury (injury-related FTRTW). Medical records were reviewed and participants were interviewed by telephone at 1 year post-discharge. Individuals with injury-related FTRTW were far more likely to report dependence or modified independence on the Functional Independence Measure (FIM) than those who were employed at 1 year. The joint distribution of motor and cognitive items suggests that, for a given level of cognitive function, the addition of a motor limitation will result in greater injury-related FTRTW. In addition as motor function declines, FTRTW is further increased. Injury-related FTRTW is also associated with being unmarried and not completing high school. While the importance of behavioural, economic, and psychosocial factors should not be minimized, services aimed at improving function can be expected to have an impact on RTW after TBI.

Unintentional fall injuries associated with walkers and canes in older adults treated in U.S. emergency departments.

OBJECTIVES: To characterize nonfatal, unintentional, fall‐related injuries associated with walkers and canes in older adults.

Gender and traumatic brain injury: Do the sexes fare differently?

Objective: To examine the relationship between gender and cognitive recovery 1 year following traumatic brain injury (TBI). Methods: Patients with blunt TBI were identified from the TBI Model Systems of Care National Database, multi-centre cohort study. The included patients (n = 325) were 16–45 years at injury, admitted to an acute care facility within 24 hours, received inpatient rehabilitation, had documented admission Glasgow Coma Scale (GCS) scores, completed neuropsychological follow-up 1 year post-injury and did not report pre-morbid learning problems. Multivariate analyses of variance examined the unadjusted association between gender and six cognitive domains examining attention/working memory, verbal memory, language, visual analytic skills, problem-solving and motor functioning. Analyses of covariance models were constructed to determine if confounding factors biased the observed associations. Results: Females performed significantly better than males on tests of attention/working memory and language. Males outperformed females in visual analytic skills. Gender remained significantly associated with performance in these areas when controlling for confounding variables. Conclusions: These results suggest a better cognitive recovery of females than males following TBI. However, future studies need to include non-TBI patients to control for possible pre-injury gender-related differences, as well as to conduct extended follow-ups to determine the stability of the observed differences.

Tai Chi and perceived health status in older adults who are transitionally frail : A randomized controlled trial

Background and Purpose Tai chi, a Chinese exercise derived from martial arts, while gaining popularity as an intervention for reducing falls in older adults, also may improve health status. The purpose of this study was to determine whether intense tai chi (TC) exercise could improve perceived health status and self-rated health (SRH) more than wellness education (WE) for older adults who are transitionally frail. Subjects Study subjects were 269 women who were ≥70 years of age and who were recruited from 20 congregate independent senior living facilities. Methods Participants took part in a 48-week, single-blind, randomized controlled trial. They were randomly assigned to receive either TC or WE interventions. Participants were interviewed before randomization and at 1 year regarding their perceived health status and SRH. Perceived health status was measured with the Sickness Impact Profile (SIP). Results Compared with WE participants, TC participants reported significant improvements in the physical dimension and ambulation categories and borderline significant improvements in the body care and movement category of the SIP. Self-rated health did not change for either group. Discussion and Conclusion These findings suggest that older women who are transitionally frail and participate in intensive TC exercise demonstrate perceived health status benefits, most notably in ambulation.

Symptoms of post-traumatic stress: Intrusion and avoidance 6 and 12 months after TBI

Primary objectives: (1) To examine survivors with traumatic brain injury (TBI) for symptoms of avoidance and intrusion, two dimensions of post-traumatic stress (PTS) at 6 and 12 months post-injury. (2) To identify risk factors associated with these symptoms. Research design: Prospective follow-up study. Methods and procedures: Georgia and North Carolina Model Brain Injury Systems participants (n = 198) with mild (19%), moderate (21%) and severe (60%) TBI were interviewed by telephone at 6 and 12 months post-injury. The Impact of Event Scale (IES) was used to identify intrusion and avoidance symptoms. Results: Symptoms consistent with severe PTS increased from 11% at 6 months to 16% 12 months post-injury (p < 0.003). African-Americans (p < 0.01) and women (p < 0.05) reported greater symptomatology at 12 months compared to their counterparts. TBI severity and memory of the event were not associated with PTS-like symptoms. Symptoms increased over time when examined by race, injury intent, gender and age (p < 0.05). Conclusions: Regardless of severity, survivors with TBI are at risk for developing symptoms consistent with PTS. Amnesia for the injury event was not protective against developing these symptoms. African-Americans appear to be at greatest risk.

National Estimates of Outdoor Recreational Injuries Treated in Emergency Departments, United States, 2004–2005

Abstract Objective.—To provide national estimates of nonfatal outdoor recreational injuries treated in US emergency departments (EDs). Methods.—Outdoor recreational injuries from January 2004 through December 2005 were identified using the National Electronic Injury Surveillance System–All Injury Program, a nationally representative sample of ED visits. National estimates of outdoor recreational injuries were calculated, and activities leading to injury, demographic characteristics, principal diagnoses, and primary body parts affected were described. Results.—From January 2004 through December 2005, an estimated 212 708 (95% CI = 113 808– 311 608) persons were treated each year in US EDs for outdoor recreational injuries. The annual rate of injuries was 72.1 per 100 000 population (95% CI = 38.6–105.6). Males accounted for 68.2% of the injuries. The lower limb (27%), upper limb (25%), and head and neck region (23.3%) were the most commonly injured body regions. Fractures (27.4%) and sprains or strains (23.9%) were the most common diagnoses. Traumatic brain injuries were diagnosed in 6.5% of injuries, and 5% of injuries resulted in hospitalization or transfer to another hospital. Conclusions.—The results of this study provide a starting point for further research into the epidemiology of outdoor and wilderness injury. The results reinforce many common perceptions about the nature of these injuries while highlighting the potential severity and long-term consequences of the injuries. The general recommendations of proper planning, preparation, and problem anticipation for outdoor and wilderness injury prevention should be followed to reduce both the number and severity of injuries.

Restraint use and seating position among children less than 13 years of age: Is it still a problem?

INTRODUCTION The purpose of this study was to calculate national estimates and examine the extent to which children prematurely use adult seat belts and ride in the front seat of a vehicle during a 30 day period. METHODS Data were obtained from a nationally representative cross-sectional random-digit-dial telephone survey that included child-specific questions on motor vehicle restraint use and seating position. RESULTS Among children less than 13 years, parents reported an estimated 618,337 who rode unrestrained and more than one million who rode in the front seat of a vehicle at least some of the time in the past 30 days. During the same time period, close to 11 million children 8 years and younger reportedly used only adult seat belts. DISCUSSION Our results highlight the need for continued outreach to parents regarding optimal restraint use and rear seating position for children every trip, every time.

Severity of injury and service utilization following traumatic brain injury: the first 3 months.

Objective:To describe the medical and rehabilitation service use of model systems by brain injured participants 1 to 3 months postdischarge from inpatient rehabilitation. Design:Prospective follow-up study. Setting:Georgia Model Brain Injury System (GAMBIS). Participants:Seventy-three GAMBIS subjects consenting to participate in the utilization substudy. Main Outcome Measures:Receipt of services and intensity of service use. Analysis:Chi-square analysis of receipt of services by severity of injury. Results:The likelihood of service use did not vary with severity of injury. Data suggest that intensity of service use was a function of injury severity. Conclusions:Subjects with mild and moderate injuries were as likely to use a range of medical and rehabilitation services during the 3-month postdischarge period as those with severe injuries. Traditional rehabilitation services, such as physical therapy, were far more likely to be used, than nontraditional services, such as psychological counseling, in spite of the high level of cognitive and social disability associated with traumatic brain injury.

Child passenger restraint use and emergency department–reported injuries: A special study using the National Electronic Injury Surveillance System–All Injury Program, 2004

INTRODUCTION In 2004, more than 180,000 child passengers aged <or=12 years sought care in U.S. hospital emergency departments (EDs) for injuries sustained in motor-vehicle crashes (MVCs). METHOD We expanded the National Electronic Injury Surveillance System-All Injury Program for 635 injured children aged <or=12 years treated at 15 hospital EDs in 2004 by collecting multiple injury diagnoses and interviewing parents about MVC circumstances. RESULTS Nine percent of the children were unrestrained and 36% were inappropriately restrained. Blacks and Hispanics were about six times more likely to be unrestrained than Non-Hispanic Whites (12% and 14%, respectively, vs. 2%). Seventy-seven percent of inappropriate restraint use occurred among children aged 4-8 years, who were prematurely placed in seatbelts. Eight percent of children required hospitalization; unrestrained children were three times more likely to be hospitalized than restrained children (21% vs. 7%). CONCLUSION Age-appropriate restraint use should be promoted for child passengers, particularly among Blacks, Hispanics, and children riding in trucks.