Gordon J. Horn

Neurologic continuum of care: Evidence-based model of a post-hospital system of care

BACKGROUND There is increasing need for a well-organized continuum of post-hospital rehabilitative care to reduce long term disability resulting from acquired brain injury. OBJECTIVE This study examined the effectiveness of four levels of post-hospital care (active neurorehabilitation, neurobehavioral intensive, day treatment, and supported living) and the functional variables most important to their success. METHODS Participants were 1276 adults with acquired brain injury who were being treated in one of the four program levels. A Repeated Measures MANOVA was used to evaluate change from admission to discharge on the Mayo Portland Adaptability Inventory-4 T-scores. Regression analyses were used to identify predictors of outcome. RESULTS Statistical improvement on the MPAI-4 was observed at each program level. Self-care and Initiation were the strongest predictors of outcome. CONCLUSION The results support the effectiveness of a continuum of care for acquired brain injury individuals beyond hospitalization and acute in-hospital rehabilitation. It is particularly noteworthy that reduction in disability was achieved for all levels of programming even with participants whose onset to admission exceeded 7 years post-injury.

Depression following traumatic brain injury: Impact on post-hospital residential rehabilitation outcomes

BACKGROUND A need exists to better understand the impact of depression on functional outcomes following TBI. OBJECTIVES To evaluate the prevalence and severity of depression among a large group of chronic TBI adults; to determine the impact of depression on outcomes of post-hospital residential rehabilitation programs; and to assess effectiveness of post-hospital residential rehabilitation programs in treating depression. METHODS 820 adults with moderate to severe traumatic brain injury (TBI) were assigned to one of four groups based on MPAI- 4 depression ratings: (1) Not Depressed, (2) Mildly Depressed, (3) Moderately Depressed, and (4) Severely Depressed. Functional status was assessed at admission and discharge with the MPAI-4 Participation Index. Differences among groups were evaluated using conventional parametric tests. Rasch analysis established reliability and validity of MPAI-4 data. RESULTS Rasch analysis demonstrated satisfactory construct validity and internal consistency (Person reliability = 0.89-0.92, Item reliability = 0.99). Of the 820 subjects, 39% presented with moderate to severe depressive symptoms at admission, These subjects demonstrated significantly higher MPAI-4 Participation scores than the mild and not depressed groups. Depressed groups realized significant improvement in symptoms, but, those remaining depressed at discharge had significantly greater disability than those who improved. CONCLUSIONS Depressive symptoms had a deleterious impact on outcome. Remediation of symptoms during rehabilitation significantly improved outcomes.

Examination of Post-Hospital Residential Brain Injury Rehabilitation OutcomesAcross the Age Spectrum

Objectives: To evaluate change in functional independence observed admission to discharge from post-hospital brain injury residential rehabilitation programs among a large group of chronic TBI adults and children and to determine the impact of participant age on those outcomes. Methods: Six hundred and fifty one adults and children with moderate to severe traumatic brain injury (TBI) were assigned to one of six groups based on age: (1) 5-17, (2) 18-29, (3) 30-39, (4) 40-49, (5) 50-59, and (6) 60 and older. Functional status was assessed at admission and discharge with the MPAI-4. Differences among groups were evaluated using conventional parametric tests. Rasch analysis established reliability and construct validity of MPAI-4 data. Results: Rasch analysis demonstrated satisfactory construct validity and internal consistency (Person reliability=0.90-0.94, Item reliability=0.99) for the admission and discharge MPAI-4s. Controlling for LOS and onset-to- admission interval, a RM MANCOVA revealed that each age group showed significant improvement in MPAI-4 Abilities, Adjustment, and Participation indices from admission to discharge (p<0.001). Improvement observed from admission to discharge was not significantly different across age groups. Conclusions: Post-hospital residential brain injury rehabilitation was effective in reducing disability for participants in each age group. Age was not a factor in rehabilitative outcome. The oldest participants on average realized a reduction in disability equivalent to that observed in the youngest participants independent of length of stay duration.

Anxiety following traumatic brain injury: Impact on post-hospital rehabilitation outcomes

Anxiety disorders are common comorbidities associated with traumatic brain injury (TBI) [1-3]. As defined by the Centers for Disease Control and Prevention, anxiety disorders have an aggregate 12 month prevalence of 10% among the general population [4]. Specified anxiety disorders like generalized anxiety, panic, and posttraumatic stress disorders have 12 month prevalence rates of 0.9% and 2-3%, 3.5%, respectively [5].

Clinical challenges of craniopharyngioma: Neurobehavioral sequelae and complex outcomes

Craniopharyngioma is a benign tumor with solid or mixed solid-cystic epithelial material found within the pituitary stalk hollow. These tumors have the capacity to impact hormonal regulation of hunger and thirst, kidney function, thyroid regulation, and adrenal gland management. It can occur at any age but most commonly presents in childhood from 5-14 year of age, with a second peak incidence in middle adulthood. Too often Patients with these tumors are often misdiagnosed until the size of the tumor aggressively infiltrates the region producing medical to neurological dysregulation. The current case highlights the complexity of measured outcomes with childhood onset. The case is further compared to two clinical samples for demonstration of impairment. Unfortunately, the damage caused from these tumors is life long and often requires significant supports and services. The goal is establishing and maintaining medical, neurological, and neurobehavioral stability with a multidisciplinary neurorehabilitation level of care. Correspondence to: Gordon J. Horn, Ph.D. 341 N. Maitland Avenue Suite 135 Maitland, FL 32751, USA; Tel: (727) 647-0697, E-mail: gordon.horn@ neurorestorative.com