Sanna Koskinen

Quality of life 10 years after a very severe traumatic brain injury (TBI): The perspective of the injured and the closest relative.

This study is a further follow-up of a group of 15 very severely injured TBI patients who have earlier been followed-up 5 years after the injury, and their closest relatives. The aim of this study was to evaluate the factors related to the quality of life of the injured and the strain felt by the relatives. The information was gathered by questionnaires for the injured and the relative and clinical ratings based on the observations of a clinician. The self-reported quality of life of both the injured and their closest relatives was rather high in spite of the various physical, cognitive and emotional/behavioral disturbances. However, the strain felt by many of the relatives was still high 10 years after the injury although it had decreased over the years. The neurobehavioral and emotional disturbances had the most significant effect on the quality of life of the injured and strain felt by the relative. The relationship between the quality of life of the injured and strain felt by the relative was not linear. The implications of the findings for developing different forms of rehabilitation and support systems is discussed.

Quality of Life after Brain Injury (QOLIBRI): Scale Validity and Correlates of Quality of Life

The QOLIBRI (Quality of Life after Brain Injury) is a novel health-related quality-of-life (HRQoL) instrument specifically developed for traumatic brain injury (TBI). It provides a profile of HRQoL in six domains together with an overall score. Scale validity and factors associated with HRQoL were investigated in a multi-center international study. A total of 795 adults with brain injury were studied from 3 months to 15 years post-injury. The majority of participants (58%) had severe injuries as assessed by 24-h worst Glasgow Coma Scale (GCS) score. Systematic relationships were observed between the QOLIBRI and the Glasgow Outcome Scale-Extended (GOSE), Hospital Anxiety and Depression Scale (HADS), and SF-36. Within each scale patients with disability reported having low HRQoL in two to three times as many areas as those who had made a good recovery. The main correlates of the total QOLIBRI score were emotional state (HADS depression and anxiety), functional status (amount of help needed and outcome on the GOSE), and comorbid health conditions. Together these five variables accounted for 58% of the variance in total QOLIBRI scores. The QOLIBRI is the first tool developed to assess disease-specific HRQoL in brain injury, and it contains novel information not given by other currently available assessments.

Traumatic brain injury in Finland 1991-2005: a nationwide register study of hospitalized and fatal TBI.

Primary objective: To examine the epidemiology of traumatic brain injury (TBI) in Finland in 1991–2005. Research design: Nationwide population based data of hospitalized and fatal TBI collected from the national registers of Finland. The incidence, age and gender distribution, aetiology, external causes, cursory outcome and mortality are presented. Methods and procedures: The data were collected from the National Hospital Discharge Register of Finland and from the official cause-of-death register of Statistics Finland. Main outcome and results: The average incidence of hospitalized TBI was 101/100 000 population and the mortality rate 18.1/100 000. The incidence increased by 59.4% in the patients aged 70 years or older while the incidence decreased by 2.4% in the younger age groups. The mortality rate decreased in men. The most common external causes were falls. The oldest patients needed 6.8-times longer stay in the hospital than the youngest. After discharge 54% of the patients needed at least occasional care. Conclusions: TBI prevention should be focused to the main groups at risk. The need for further care, rehabilitation and increasing the awareness of TBI is obvious.

Quality of life after traumatic brain injury: The clinical use of the QOLIBRI, a novel disease-specific instrument

Objective: To report the clinical use of the QOLIBRI, a disease-specific measure of health-related quality-of-life (HRQoL) after traumatic brain injury (TBI). Methods: The QOLIBRI, with 37 items in six scales (cognition, self, daily life and autonomy, social relationships, emotions and physical problems) was completed by 795 patients in six languages (Finnish, German, Italian, French, English and Dutch). QOLIBRI scores were examined by variables likely to be influenced by rehabilitation interventions and included socio-demographic, functional outcome, health status and mental health variables. Results: The QOLIBRI was self-completed by 73% of participants and 27% completed it in interview. It was sensitive to areas of life amenable to intervention, such as accommodation, work participation, health status (including mental health) and functional outcome. Conclusion: The QOLIBRI provides information about patients subjective perception of his/her HRQoL which supplements clinical measures and measures of functional outcome. It can be applied across different populations and cultures. It allows the identification of personal needs, the prioritization of therapeutic goals and the evaluation of individual progress. It may also be useful in clinical trials and in longitudinal studies of TBI recovery.

QOLIBRI Overall Scale: a brief index of health-related quality of life after traumatic brain injury

Background The Quality of Life after Brain Injury (QOLIBRI) scale is a recently developed instrument that provides a profile of health-related quality of life (HRQoL) in domains typically affected by brain injury. However, for global assessment it is desirable to have a brief summary measure. This study examined a 6-item QOLIBRI Overall Scale (QOLIBRI-OS), and considered whether it could provide an index of HRQoL after traumatic brain injury (TBI). Methods The properties of the QOLIBRI-OS were studied in a sample of 792 participants with TBI recruited from centres in nine countries covering six languages. An examination of construct validity was undertaken on a subsample of 153 participants recruited in Germany who had been assessed on two relevant brief quality of life measures, the Satisfaction With Life Scale and the Quality of Life Visual Analogue Scale. Results The reliability of the QOLIBRI-OS was good (Cronbachs α=0.86, test–retest reliability =0.81) and similar in participants with higher and lower cognitive performance. Factor analysis indicated that the scale is unidimensional. Rasch analysis also showed a satisfactory fit with this model. The QOLIBRI-OS correlates highly with the total score from the full QOLIBRI scale (r=0.87). Moderate to strong relationships were found among the QOLIBRI-OS and the Extended Glasgow Outcome Scale, Short-Form-36, and Hospital Anxiety and Depression scale (r=0.54 to -0.76). The QOLIBRI-OS showed good construct validity in the TBI group. Conclusions The QOLIBRI-OS assesses a similar construct to the QOLIBRI total score and can be used as a brief index of HRQoL for TBI.

Holistic neuropsychological rehabilitation in Finland: The INSURE program—a transcultural outgrowth of perspectives from Israel to Europe via the USA

Given the interaction of cognitive, behavioural, psychological, and physical factors resulting from traumatic brain injury (TBI), a comprehensive, multidisciplinary, and neuropsychologically oriented rehabilitation could prove to be particularly promising and efficacious in the neuropsychological rehabilitation of post‐acute brain‐injured individuals. Kurt Goldstein, an eminent pioneer in the development of holistic rehabilitation, stated that brain‐injured patients need environments that help them to avoid catastrophic reactions. In his view, the tasks of rehabilitation are to create, for the brain‐injured individual, an environment that will minimize the chances for the occurrence of catastrophic responses. In this environment, the individual can engage optimally in various remedial activities, which will gradually culminate in the individual finding new meaning in life after rehabilitation. Yehuda Ben‐Yishay incorporated many of Goldsteins ideas and developed a milieu or holistic rehabilitation progra...

Quality of life after traumatic brain injury: Finnish experience of the QOLIBRI in residential rehabilitation

OBJECTIVE To evaluate health-related quality of life of traumatic brain injury patients who have received intensive multidisciplinary residential rehabilitation. To examine the psychometric characteristics of the Finnish Quality of Life after Brain Injury (QOLIBRI) questionnaire. SUBJECTS A total of 157 adults with TBI, up to 15 years post-injury, who had been treated in the Käpylä Rehabilitation Centre, Helsinki, Finland. METHODS Functional status was assessed using the Extended Glasgow Outcome Scale. Emotional state was evaluated using the Hospital Anxiety and Depression Scale. Health-related quality of life was measured using a generic measure (Short Form-36) and the QOLIBRI. RESULTS Quality of life was related to depression, amount of help needed, anxiety, education level and age at injury. Quality of life was not associated with time since injury, but a paradoxical relationship was found with injury severity. Internal consistency (alpha = 0.79-0.95) and test-retest reliability (rtt = 0.75-0.87) of the Finnish QOLIBRI met standard psychometric criteria. CONCLUSION Quality of life remained relatively stable in the long term. Milder injuries were associated with lower life satisfaction, and careful follow-up is recommended to target patients in special need. This study confirms the reliability and validity of the Finnish QOLIBRI.

The insure Program and Modifications in Finland

insure (Individualized Neuropsychological Subgroup Rehabilitation Program) is a 6-week rehabilitation program tailored to the special needs of selected subgroups of traumatically brain injured (TBI) patients (Kaipio, Sarajuuri, & Koskinen, 1997) and based on neuroscientific research findings. The basic program costs

The feasibility of romberg quotient in assessment of balance after sport concussion

350 (US) per day. INSURE has been developed taking into account the overall care and management system needs. At the moment, while INSURE is being run only in the Kapyla Rehabilitation Centre, demand exceeds supply.

A novel approach to sports concussion assessment: computerized multilimb reaction times and balance control testing

Objective To evaluate the feasibility of a computerised balance test and a calculated Romberg Quotient in acute recognition of concussion Design Prospective pilot study. Setting Finnish national ice hockey league. Participants Four teams participated in the study (n=113, male). Nine athletes who sustained a head/neck-related injury and control group of seven non-concussed volunteer players were followed. Study procedure All participants underwent the baseline assessment before season. The study period was one hockey season 2009- 2010. All game related concussions during this time were recorded. Post-concussion assessment was administered within 36 hours after injury. Outcome measures Balance was measured using a portable computerised platform. Romberg test stances were used on hard surface and soft foam. The participants stood still for 30 seconds with a closed stance. A relative balance change, Romberg Quotient (RQ), was assessed by calculating the ratio between eyes open, and eyes closed parameters. RQ was computed for sway length, area and velocity in each condition Main results Concussed and control group did not differ in balance measures at baseline. At post-injury, soft foam measures showed a difference between groups in sway length (U=5.0, p=0.005) and velocity (U=5.0, p=0.005). Among the concussed, RQ mean in sway velocity was 2.02 (1.7–2.3, 95% confidence limits) at baseline and 2.14 (1.9–2.4) post-injury Conclusions Alternating between different visual and/or somatosensory conditions in balance testing brings out the effect of concussions. RQ is easy to calculate regardless of the measurement systems or scales and can be used as valid tool in sport concussion measurement Competing interests None.