Elisabeth Elgmark Andersson

Mild traumatic brain injuries: the impact of early intervention on late sequelae. A randomized controlled trial

SummaryBackground. Positive results from early clinical intervention of mild traumatic brain injury (MTBI) patients by rehabilitation specialists have been reported. Various treatments have been used, but few controlled studies are published. We hypothesised that early rehabilitation of selected MTBI patients would reduce long term sequelae.Method. A randomised controlled trial with one year follow-up. Among 1719 consecutive patients with MTBI, 395 individuals, 16–60 years of age, met the MTBI definition. Exclusion criteria were: previous clinically significant brain disorders and/or a history of substance abuse. The control group (n = 131) received regular care. The intervention group (n = 264) was examined by a rehabilitation specialist. 78 patients were mainly referred to an occupational therapist. The problems were identified in daily activities and in terms of post-concussion symptoms (PCS), an individualised, tailored treatment was given. Primary endpoint was change in rate of PCS and in life satisfaction at one-year follow-up between the groups.Findings. No statistical differences were found between the intervention and control groups. Patients who experienced few PCS two to eight weeks after the injury and declined rehabilitation recovered and returned to their pre-injury status. Patients who suffered several PCS and accepted rehabilitation did not recover after one year.Interpretation. In this particular MTBI sample, early active rehabilitation did not change the outcome to a statistically-significant degree. Further studies should focus on patients with several complaints during the first 1–3 months and test various types of interventions.

Mild traumatic brain injuries: a 10-year follow-up.

OBJECTIVE AND DESIGN Long-term consequences of mild traumatic brain injuries were investigated based on a 10-year follow-up of patients from a previously-published randomized controlled study of mild traumatic brain injuries. One aim was to describe changes over time after mild traumatic brain injuries in terms of the extent of persisting post-concussion symptoms, life satisfaction, perceived health, activities of daily living, changes in life roles and sick leave. Another aim was to identify differences between the intervention and control groups. PATIENTS The intervention group comprised 142 persons and the control group 56 persons. METHODS Postal questionnaires with a response rate of 56%. RESULTS No differences over time were found for the intervention and control groups in terms of post-concussion symptoms. In the intervention group some variables in life satisfaction, perceived health and daily life were decreased. Some roles had changed over the years for both groups. No other differences between the intervention and control groups were found. However, in both groups sick leave decreased. CONCLUSION Early individual intervention by a qualified rehabilitation team does not appear to impact on the long-term outcome for persons with symptoms related to mild traumatic brain injuries. The status after approximately 3 weeks is indicative of the status after 10 years.

Concurrent Validity of the Executive Function Performance Test in People with Mild Stroke

Introduction: Studies have shown that executive dysfunction is common in adults after stroke. Occupational therapists working in acute care assess the performance of activities of daily living; most instruments focus on personal care. However, the assessment of instrumental activities of daily living has been shown to discriminate executive dysfunction more effectively. An instrument for assessing executive dysfunction in more complex activities that is easy to handle in acute care is consequently required for clinical use. The Executive Function Performance Test (EFPT) was recently introduced into Sweden. The purpose of this study was to evaluate the concurrent validity of the EFPT in acute care for patients with mild stroke. Method: Twenty-three patients from an acute stroke unit were assessed with both the EFPT and the Assessment of Motor and Process Skills (AMPS). Results: The correlation between the EFPT and the AMPS assessments was highly significant (p = 0.003) and the concurrent validity was rho = 0.61. Conclusion: Since there is a risk that adult patients with mild stroke are discharged without rehabilitation, and there is a lack of a relevant instrument for occupational therapists that discriminates executive dysfunction in acute stroke care, the EFPT may be a suitable instrument to use with these patients.

Mild traumatic brain injuries in children between 0-16 years of age : A survey of activities and places when an accident occurs

Objective: The aim of this study was to identify what activities cause most mild traumatic brain injury (MTBI) among boys and girls between 0–16 years of age. Methods: Based on a randomized controlled study, a retrospective analysis was conducted among 765 children. Result: The most common causes of injury were falls from a height and falls from the same level. The most common place where the accident occurred was at ‘home’ followed by ‘pre-school/school’. The highest incidence was ‘play’ followed by ‘hit by another person’, thereafter ‘baby nursing’. Boys are more often injured than girls, but with no difference between boys and girls in terms of which activities that cause MTBI. Conclusion: Supervision during play at home as well as better designed schoolyards and playgrounds are required to prevent accidents. Furthermore, well-documented medical records are necessary to identify activities causing MTBI among children.

Social Service Utilisation Patterns among Children with Mild Intellectual Disability--Differences between Children Integrated into Mainstream Classes and Children in Self-Contained Classes.

Background. Children with a mild intellectual disability (ID) and their families often require social services; however, because of the characteristics of the formal service system, these families may be at risk of not receiving necessary services. The aim of this study was to obtain knowledge regarding the types and number of services that families receive from social services because of the child’s disability and because of social problems. Another aim was to acquire knowledge regarding the percentage of families receiving services and to evaluate the received services in relation to the child’s gender, school setting and age. Method. Utilisation of social services among 84 children with a mild ID and their families in two municipalities in Sweden was examined using existing social services records. Results. Approximately one-third of the families received services because of the child’s disability and one-fourth because of social problems. Children integrated into mainstream classes were significantly less likely to receive services from social services because of their disability than children in self-contained classes. The most commonly utilised services because of the child’s disability were companion service, short period of supervision for schoolchildren and special transportation services. The services most utilised because of social problems were help from a personal contact, a contact family for the child’s siblings and financial assistance for the child’s parents. Conclusions. Social services must engage in outreach activities, especially in schools, so that families having a child with mild ID are recognised and receive necessary services.

The inter-rater and test–retest reliability of the Self-care and Transfer scales, and intra-rater reliability of all scales of the Swedish Translation of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT-S)

Abstract Objective: The Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) are used internationally to measure the outcomes of occupational therapy services across diagnoses, ages, and health care settings. This study reports on the inter-rater and test–retest reliability of the Self-care and Transfer scales as well as the intra-rater reliability of all scales of the Swedish (AusTOMs-OT-S) translation. Methods: Fifteen occupational therapists rated 11 case study clients on two occasions, separated by two weeks. Test–retest reliability and inter-rater reliability were calculated for the Self-care scale and Transfer scales. Moreover, intra-rater reliability was calculated for each of the 15 therapists across all 12 scales. Results: The inter-rater reliability intraclass correlation coefficients (ICCs) were all found to be high to very high, ranging from ICC 0.762 to 0.904; the intra-rater reliability coefficients were also very good with 11 of the 15 therapists achieving ICCs of 0.745 or over, and finally the test–retest ICCs were also found to be high, ranging from 0.705 to 0.920. Conclusions: Although further research is required to confirm reliability, preliminary reliability of the AusTOMs-OT Swedish translation has been demonstrated and therapists can have confidence when using the scales.

Mild traumatic brain injury: A description of how children and youths between 16 and 18 years of age perform leisure activities after 1 year

Objective: The aim is to describe how children and youths perform leisure activities, 1 year after a mild traumatic brain injury (MTBI). Methods: Basis is to compile previously collected material; patients were extracted from a prospective randomized controlled trial of MTBI. A retrospective analysis was conducted among 73 children and youths between 16 and 18 years of age. The entire group administrated the Interest Checklist at baseline and at 1-year follow-up. Results: Statistical significant difference was found in 31 of 50 different activities. The result showed that children and youths did not return to perform leisure activities. Fewer returned in the intervention group than in the control group. Conclusion: An occupational therapist can help children and youths to have balance in their life and continue a functional life after a MTBI. Continued research is needed, how to prevent MTBI and how to support children and youths to continue with leisure activities.

Traumatic brain injury in children between 7-12 years of age.

Objective: The purpose of this study was to describe the amount of traumatic brain injuries among children in the western part of Sweden. Methods: Based on a randomized controlled study, a retrospective analysis was conducted of data for children of 257 children 7–12 years of age. The journals were collected from 1997–2000. Results: The results showed that the most common causes were play and sports and that the accidents occurred in the school environment in the afternoon, whilst the least amount of accidents took place in the home. Nearly half of all the children were admitted to the hospital. Most accidents occurred in March and the least number of accidents occurred during the summer months. Conclusion: Prevention strategies are needed, especially for play and sport activities in recreation centres and playgrounds. These places are a high risk in causing a TBI for children after a day at school.

A modified Job Demand, Control, Support model for active duty police.

BACKGROUND The Job Demand Control Support model (JDCS) is one of the most widely used theoretical models relating job characteristics to health and wellbeing. OBJECTIVE This study aimed to assess the predictive power of the JDCS model for determining job satisfaction and fatigue in uniformed Swedish police. An additional aim was to determine if predictive power of the model would be improved with the addition of two occupation specific items. METHODS Questionnaire data, based upon the Swedish Work Environment Survey were collected from Swedish police (n = 4244). A hierarchical multiple regression analysis was run to explore the predictive value of the model and to determine if the additional variables improved predictive power with respect to job satisfaction and fatigue. RESULTS Regression analysis demonstrated that the JDSC model had high predictive power in relation to job satisfaction and fatigue. Job demands was the strongest predictor of fatigue (14%), while support was the strongest predictor of job satisfaction (12%). The addition of exposure to threats significantly improved predictive power for both job satisfaction and fatigue, while addition of shift work did not significantly affect predictive power of the model. CONCLUSIONS Workplace interventions to address issues related to job satisfaction and fatigue in police should focus on maintaining a bearable level of job demands and provision of adequate support.

Perceived needs among parents of children with a mild intellectual disability in Sweden

Parents of children with a mild intellectual disability experience more distress and require more support than other parents. The aim was to investigate the perceived family needs of parents of children with an MID and to investigate the relationship between parents’ perceived self-efficacy in their parental role and in collaborating with professionals as well as with their perceived needs for support. Interviews were based on questionnaires to the parents of 38 children. The results revealed that parents perceived need for information, respite, and venues in which to meet other parents in similar situations. The informational needs were related to parental self-efficacy and obtaining support. A lower need for information was related to higher perceived control over services. In conclusion, it appears that professionals need to work to strengthen parents’ ability to ask for support and to express the needs. Well-informed parents will develop stronger parental self-efficacy and perceived control over services.