Shinakee Gumber

What is post TBI fatigue

BACKGROUND Fatigue is among the most common sequelae of traumatic brain injury (TBI). OBJECTIVES To summarize the empirical and theoretical literature on Post TBI fatigue (PTBIF) and identify some of the challenges that continue to confront clinicians, researchers and individuals with TBI. METHODS Qualitative literature review. The epidemiology, characteristics, and correlates of PTBIF are described. Challenges in the operational definition and measurement of fatigue are discussed and the empirical literature on measurement of PTBIF and theoretical models of the potential etiology of PTBIF is summarized. Existing treatments of PTBIF and the research supporting them are reviewed. Future directions for clinical research are presented. RESULTS Although PTBIF is a high incidence condition after TBI that is related to significant suffering and reduced quality of life, it remains inadequately measured and treated. Its etiology and precipitants are poorly understood and intervention research is inadequate. CONCLUSION Further research is necessary to develop psychometrically-sound objective and subjective measures of PTBIF and examine the efficacy of treatments for fatigue. Interventions shown to improve fatigue in other populations should be considered in treating PTBIF.

Systematic review of interventions for fatigue after traumatic brain injury: a NIDRR traumatic brain injury model systems study.

Objective:To conduct a systematic review of the evidence on interventions for posttraumatic brain injury fatigue (PTBIF). Methods:Systematic searches of multiple databases for peer-reviewed studies published in English on interventions targeting PTBIF as a primary or secondary outcome through January 22, 2014. Reference sections were also reviewed to identify additional articles. Articles were rated using the 2011 American Academy of Neurology Classification of Evidence Scheme for therapeutic studies. Results:The searches yielded 1526 articles. Nineteen articles met all inclusion criteria: 4 class I, 1 class II/III, 10 class III, and 4 class IV. Only 5 articles examined fatigue as a primary outcome. Interventions were pharmacological and psychological or involved physical activity, bright blue light, electroencephalographic biofeedback, or electrical stimulation. Only 2 interventions (modafinil and cognitive behavioral therapy with fatigue management) were evaluated in more than 1 study. Conclusions:Despite areas of promise, there is insufficient evidence to recommend or contraindicate any treatments of PTBIF. Modafinil is not likely to be effective for PTBIF. Piracetam may reduce it, as may bright blue light. Cognitive behavioral therapy deserves additional study. High-quality research incorporating appropriate definition and measurement of fatigue is required to explore the potential benefits of promising interventions, evaluate fatigue treatments shown to be effective in other populations, and develop new interventions for PTBIF.

Use of Complementary and Alternative Medicine in Treating Individuals with Traumatic Brain Injury

This article presents an overview of the clinical trials literature on complementary and alternative medicine for traumatic brain injury. In searches of PubMed and the Allied and Complementary Medicine Database, trials of acupuncture, acupressure, creatine, homeopathy, hyperbaric oxygen therapy, mindfulness-based practices, music therapy, neurotherapy, Tai Chi, and yoga were identified. Because of the high risk of bias in most of the studies reviewed, the evidence base is inadequate to recommend any specific complementary and alternative medicine treatments for traumatic brain injury, although promising findings were identified for a number of treatments. Safety data on many of the interventions were lacking.

Beyond These Walls: Can Psychosocial Clubhouses Promote the Social Integration of Adults With Serious Mental Illness in the Community?

Objective: The study examined factors associated with community integration experiences of adults with serious mental illness who were members of psychosocial rehabilitation clubhouses in New York City. Method: Ninety-two clubhouse members completed an online survey. The study examined relative contribution of adults’ reports of individual factors (self-reported psychiatric symptoms, self-esteem), community supports (self-reported employment status and perceived family support), and the clubhouse environment (self-reported time spent in the clubhouse, clubhouse supportiveness, and practical orientation) in accounting for variation in members’ reports of social integration within the clubhouse and within the larger community. Results: Hierarchical linear regression results suggest a differential pattern of variables associated with participants’ experience of social integration within the clubhouse versus outside the clubhouse with the larger non-mental-health consumers. Adults’ reports of more time spent in the clubhouse and perceptions of clubhouse environment as having a more practical orientation were associated with adults’ reports of greater social integration within the clubhouse. In contrast, greater self-esteem and being independently employed were associated with greater social integration outside the clubhouse. Perceived family support was associated with higher levels of social integration both within and outside the clubhouse setting. Conclusion and Implication for Practice: Greater social integration of clubhouse members both in and outside the clubhouse environment is essential in understanding community integration. Recommendations for the clubhouse model to improve community integration experiences of its members are discussed.