Burden and preparedness amongst informal caregivers of adults with moderate to severe traumatic brain injury
- Lieshout, Kirsten, Oates, Joanne, Baker, Anne, Unsworth, Carolyn, Cameron, Ian, Schmidt, Julia, Lannin, Natasha
- Authors: Lieshout, Kirsten , Oates, Joanne , Baker, Anne , Unsworth, Carolyn , Cameron, Ian , Schmidt, Julia , Lannin, Natasha
- Date: 2020
- Type: Text , Journal article
- Relation: International Journal of Environmental Research and Public Health Vol. 17, no. 17 (2020), p. 1-12
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- Description: This study examined the patterns of informal (unpaid) caregiving provided to people after moderate to severe traumatic brain injury (TBI), explore the self-reported burden and preparedness for the caregiving role, and identify factors predictive of caregiver burden and preparedness. A cross-sectional cohort design was used. Informal caregivers completed the Demand and Difficulty subscales of the Caregiving Burden Scale; and the Mutuality, Preparedness, and Global Strain subscales of the Family Care Inventory. Chi-square tests and logistic regression were used to examine the relationships between caregiver and care recipient variables and preparedness for caregiving. Twenty-nine informal caregivers who reported data on themselves and people with a moderate to severe TBI were recruited (referred to as a dyad). Most caregivers were female (n = 21, 72%), lived with the care recipient (n = 20, 69%), and reported high levels of burden on both scales. While most caregivers (n = 21, 72%) felt “pretty well” or “very well” prepared for caregiving, they were least prepared to get help or information from the health system, and to deal with the stress of caregiving. No significant relationships or predictors for caregiver burden or preparedness were identified. While caregivers reported the provision of care as both highly difficult and demanding, further research is required to better understand the reasons for the variability in caregiver experience, and ultimately how to best prepare caregivers for this long-term role. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.
- Description: Data collection for this project was supported by the NSW Lifetime Care and Support Scheme (now iCare Foundation). N.A.L. is supported by a Future Leader Fellowship (Award ID 102055) from the National Heart Foundation of Australia.
- Authors: Lieshout, Kirsten , Oates, Joanne , Baker, Anne , Unsworth, Carolyn , Cameron, Ian , Schmidt, Julia , Lannin, Natasha
- Date: 2020
- Type: Text , Journal article
- Relation: International Journal of Environmental Research and Public Health Vol. 17, no. 17 (2020), p. 1-12
- Full Text:
- Reviewed:
- Description: This study examined the patterns of informal (unpaid) caregiving provided to people after moderate to severe traumatic brain injury (TBI), explore the self-reported burden and preparedness for the caregiving role, and identify factors predictive of caregiver burden and preparedness. A cross-sectional cohort design was used. Informal caregivers completed the Demand and Difficulty subscales of the Caregiving Burden Scale; and the Mutuality, Preparedness, and Global Strain subscales of the Family Care Inventory. Chi-square tests and logistic regression were used to examine the relationships between caregiver and care recipient variables and preparedness for caregiving. Twenty-nine informal caregivers who reported data on themselves and people with a moderate to severe TBI were recruited (referred to as a dyad). Most caregivers were female (n = 21, 72%), lived with the care recipient (n = 20, 69%), and reported high levels of burden on both scales. While most caregivers (n = 21, 72%) felt “pretty well” or “very well” prepared for caregiving, they were least prepared to get help or information from the health system, and to deal with the stress of caregiving. No significant relationships or predictors for caregiver burden or preparedness were identified. While caregivers reported the provision of care as both highly difficult and demanding, further research is required to better understand the reasons for the variability in caregiver experience, and ultimately how to best prepare caregivers for this long-term role. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.
- Description: Data collection for this project was supported by the NSW Lifetime Care and Support Scheme (now iCare Foundation). N.A.L. is supported by a Future Leader Fellowship (Award ID 102055) from the National Heart Foundation of Australia.
Growth mixture modeling of depression symptoms following traumatic brain injury
- Gomez, Rapson, Skilbeck, Clive, Thomas, Matt, Slatyer, Mark
- Authors: Gomez, Rapson , Skilbeck, Clive , Thomas, Matt , Slatyer, Mark
- Date: 2017
- Type: Text , Journal article
- Relation: Frontiers in Psychology Vol. 8, no. AUG (2017), p. 1-14
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- Description: Growth Mixture Modeling (GMM) was used to investigate the longitudinal trajectory of groups (classes) of depression symptoms, and how these groups were predicted by the covariates of age, sex, severity, and length of hospitalization following Traumatic Brain Injury (TBI) in a group of 1074 individuals (696 males, and 378 females) from the Royal Hobart Hospital, who sustained a TBI. The study began in late December 2003 and recruitment continued until early 2007. Ages ranged from 14 to 90 years, with a mean of 35.96 years (SD = 16.61). The study also examined the associations between the groups and causes of TBI. Symptoms of depression were assessed using the Hospital Anxiety and Depression Scale within 3 weeks of injury, and at 1, 3, 6, 12, and 24 months post-injury. The results revealed three groups: low, high, and delayed depression. In the low group depression scores remained below the clinical cut-off at all assessment points during the 24-months post-TBI, and in the high group, depression scores were above the clinical cut-off at all assessment points. The delayed group showed an increase in depression symptoms to 12 months after injury, followed by a return to initial assessment level during the following 12 months. Covariates were found to be differentially associated with the three groups. For example, relative to the low group, the high depression group was associated with more severe TBI, being female, and a shorter period of hospitalization. The delayed group also had a shorter period of hospitalization, were younger, and sustained less severe TBI. Our findings show considerable fluctuation of depression over time, and that a non-clinical level of depression at any one point in time does not necessarily mean that the person will continue to have non-clinical levels in the future. As we used GMM, we were able to show new findings and also bring clarity to contradictory past findings on depression and TBI. Consequently, we recommend the use of this approach in future studies in this area. © 2017 Gomez, Skilbeck, Thomas and Slatyer.
- Authors: Gomez, Rapson , Skilbeck, Clive , Thomas, Matt , Slatyer, Mark
- Date: 2017
- Type: Text , Journal article
- Relation: Frontiers in Psychology Vol. 8, no. AUG (2017), p. 1-14
- Full Text:
- Reviewed:
- Description: Growth Mixture Modeling (GMM) was used to investigate the longitudinal trajectory of groups (classes) of depression symptoms, and how these groups were predicted by the covariates of age, sex, severity, and length of hospitalization following Traumatic Brain Injury (TBI) in a group of 1074 individuals (696 males, and 378 females) from the Royal Hobart Hospital, who sustained a TBI. The study began in late December 2003 and recruitment continued until early 2007. Ages ranged from 14 to 90 years, with a mean of 35.96 years (SD = 16.61). The study also examined the associations between the groups and causes of TBI. Symptoms of depression were assessed using the Hospital Anxiety and Depression Scale within 3 weeks of injury, and at 1, 3, 6, 12, and 24 months post-injury. The results revealed three groups: low, high, and delayed depression. In the low group depression scores remained below the clinical cut-off at all assessment points during the 24-months post-TBI, and in the high group, depression scores were above the clinical cut-off at all assessment points. The delayed group showed an increase in depression symptoms to 12 months after injury, followed by a return to initial assessment level during the following 12 months. Covariates were found to be differentially associated with the three groups. For example, relative to the low group, the high depression group was associated with more severe TBI, being female, and a shorter period of hospitalization. The delayed group also had a shorter period of hospitalization, were younger, and sustained less severe TBI. Our findings show considerable fluctuation of depression over time, and that a non-clinical level of depression at any one point in time does not necessarily mean that the person will continue to have non-clinical levels in the future. As we used GMM, we were able to show new findings and also bring clarity to contradictory past findings on depression and TBI. Consequently, we recommend the use of this approach in future studies in this area. © 2017 Gomez, Skilbeck, Thomas and Slatyer.
Analysis of a severe head injury in World Cup alpine skiing
- Yamazaki, Junya, Gilgien, Matthias, Kleiven, Svein, McIntosh, Andrew, Nachbauer, Werner, Muller, Erich, Bere, Tone, Bahr, Roald, Krosshaug, Tron
- Authors: Yamazaki, Junya , Gilgien, Matthias , Kleiven, Svein , McIntosh, Andrew , Nachbauer, Werner , Muller, Erich , Bere, Tone , Bahr, Roald , Krosshaug, Tron
- Date: 2015
- Type: Text , Journal article
- Relation: Medicine and Science in Sports and Exercise Vol. 47, no. 6 (2015), p. 1113-1118
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- Description: Traumatic brain injury (TBI) is the leading cause of death in alpine skiing. It has been found that helmet use can reduce the incidence of head injuries between 15% and 60%. However, knowledge on optimal helmet performance criteria in World Cup alpine skiing is currently limited owing to the lack of biomechanical data from real crash situations. Purpose: This study aimed to estimate impact velocities in a severe TBI case in World Cup alpine skiing. Methods: Video sequences from a TBI case in World Cup alpine skiing were analyzed using a model-based image matching technique. Video sequences from four camera views were obtained in full high-definition (1080p) format. A three-dimensional model of the course was built based on accurate measurements of piste landmarks and matched to the background video footage using the animation software Poser 4. A trunk-neck-head model was used for tracking the skier's trajectory. Results: Immediately before head impact, the downward velocity component was estimated to be 8 m.s(-1). After impact, the upward velocity was 3 m.s(-1), whereas the velocity parallel to the slope surface was reduced from 33 m.s(-1) to 22 m.s(-1). The frontal plane angular velocity of the head changed from 80 radIsj1 left tilt immediately before impact to 20 rad.s(-1) right tilt immediately after impact. Conclusions: A unique combination of high-definition video footage and accurate measurements of landmarks in the slope made possible a high-quality analysis of head impact velocity in a severe TBI case. The estimates can provide crucial information on how to prevent TBI through helmet performance criteria and design.
- Authors: Yamazaki, Junya , Gilgien, Matthias , Kleiven, Svein , McIntosh, Andrew , Nachbauer, Werner , Muller, Erich , Bere, Tone , Bahr, Roald , Krosshaug, Tron
- Date: 2015
- Type: Text , Journal article
- Relation: Medicine and Science in Sports and Exercise Vol. 47, no. 6 (2015), p. 1113-1118
- Full Text:
- Reviewed:
- Description: Traumatic brain injury (TBI) is the leading cause of death in alpine skiing. It has been found that helmet use can reduce the incidence of head injuries between 15% and 60%. However, knowledge on optimal helmet performance criteria in World Cup alpine skiing is currently limited owing to the lack of biomechanical data from real crash situations. Purpose: This study aimed to estimate impact velocities in a severe TBI case in World Cup alpine skiing. Methods: Video sequences from a TBI case in World Cup alpine skiing were analyzed using a model-based image matching technique. Video sequences from four camera views were obtained in full high-definition (1080p) format. A three-dimensional model of the course was built based on accurate measurements of piste landmarks and matched to the background video footage using the animation software Poser 4. A trunk-neck-head model was used for tracking the skier's trajectory. Results: Immediately before head impact, the downward velocity component was estimated to be 8 m.s(-1). After impact, the upward velocity was 3 m.s(-1), whereas the velocity parallel to the slope surface was reduced from 33 m.s(-1) to 22 m.s(-1). The frontal plane angular velocity of the head changed from 80 radIsj1 left tilt immediately before impact to 20 rad.s(-1) right tilt immediately after impact. Conclusions: A unique combination of high-definition video footage and accurate measurements of landmarks in the slope made possible a high-quality analysis of head impact velocity in a severe TBI case. The estimates can provide crucial information on how to prevent TBI through helmet performance criteria and design.
- Baker, Anne, Barker, Samantha, Sampson, Amanda, Martin, Clarissa
- Authors: Baker, Anne , Barker, Samantha , Sampson, Amanda , Martin, Clarissa
- Date: 2017
- Type: Text , Journal article
- Relation: Clinical Rehabilitation Vol. 31, no. 1 (2017), p. 45-60
- Full Text: false
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- Description: Aim: To identify factors reported with negative and positive outcomes for caregivers of the traumatic brain injury and spinal cord injury cohorts, to investigate what interventions have been studied to support carers and to report what effectiveness has been found. Methods: Scoping systematic review. Electronic databases and websites were searched from 1990 to December 2015. Studies were agreed for inclusion using pre-defined criteria. Relevant information from included studies was extracted and quality assessment was completed. Data were synthesised using qualitative methods. Results: A total of 62 studies reported caregiver outcomes for the traumatic brain injury cohort; 51 reported negative outcomes and 11 reported positive outcomes. For the spinal cord injury cohort, 18 studies reported caregiver outcomes; 15 reported negative outcomes and three reported positive outcomes. Burden of care was over-represented in the literature for both cohorts, with few studies looking at factors associated with positive outcomes. Good family functioning, coping skills and social support were reported to mediate caregiver burden and promote positive outcomes. A total of 21 studies further described interventions to support traumatic brain injury caregivers and four described interventions to support spinal cord injury caregivers, with emerging evidence for the effectiveness of problem-solving training. Further research is required to explore the effects of injury severity of the care recipient, as well as caregiver age, on the outcome of the interventions. Conclusion: Most studies reported negative outcomes, suggesting that barriers to caregiving have been established, but not facilitators. The interventions described to support carers are limited and require further testing to confirm their effectiveness. © SAGE Publications.
- Lannin, Natasha, Galea, Claire, Coulter, Megan, Gruen, Russell, Jolliffe, Laura, Ownsworth, Tamara, Schmidt, Julia, Unsworth, Carolyn
- Authors: Lannin, Natasha , Galea, Claire , Coulter, Megan , Gruen, Russell , Jolliffe, Laura , Ownsworth, Tamara , Schmidt, Julia , Unsworth, Carolyn
- Date: 2021
- Type: Text , Journal article
- Relation: International journal for quality in health care : journal of the International Society for Quality in Health Care Vol. 33, no. 1 (2021), p.
- Full Text: false
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- Description: BACKGROUND: Reorientation programmes have been an important component of neurotrauma rehabilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI); however, research testing the efficacy of acute programmes is limited. OBJECTIVE: This study aimed to determine if it is feasible to provide a standardized environmental reorientation programme to adults suffering from PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial. METHODS: We conducted a randomized controlled trial with concealed allocation and intention-to-treat analysis. A total of 40 participants suffering from PTA after TBI were included. The control group received usual care; the experimental group received usual care plus a standardized orientation programme inclusive of environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA Scale, assessed daily from hospital admission or on regaining consciousness. RESULTS: Adherence to the orientation programme was high, and there were no study-related adverse responses to the environmental orientation programme. Although there were no statistically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardized reorientation programme (9.0 (6.4-11.6) versus 13.0 (4.5-21.5) days). Multivariate analysis showed that the Glasgow Coma Scale (GCS) at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors contributing to the longer length of PTA. CONCLUSION: Providing an orientation programme in acute care is feasible for adults suffering from PTA after TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and a power of 80%. © The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved.
- Description: BACKGROUND: Reorientation programmes have been an important component of neurotrauma rehabilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI); however, research testing the efficacy of acute programmes is limited. OBJECTIVE: This study aimed to determine if it is feasible to provide a standardized environmental reorientation programme to adults suffering from PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial. METHODS: We conducted a randomized controlled trial with concealed allocation and intention-to-treat analysis. A total of 40 participants suffering from PTA after TBI were included. The control group received usual care; the experimental group received usual care plus a standardized orientation programme inclusive of environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA Scale, assessed daily from hospital admission or on regaining consciousness. RESULTS: Adherence to the orientation programme was high, and there were no study-related adverse responses to the environmental orientation programme. Although there were no statistically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardized reorientation programme (9.0 (6.4-11.6) versus 13.0 (4.5-21.5) days). Multivariate analysis showed that the Glasgow Coma Scale (GCS) at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors contributing to the longer length of PTA. CONCLUSION: Providing an orientation programme in acute care is feasible for adults suffering from PTA after TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and a power of 80%. © The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Persistent symptoms and activity changes three months after mild traumatic brain injury
- Cooksley, Rebecca, Maguire, Emma, Lannin, Natasha, Unsworth, Carolyn, Farquhar, Michelle
- Authors: Cooksley, Rebecca , Maguire, Emma , Lannin, Natasha , Unsworth, Carolyn , Farquhar, Michelle
- Date: 2018
- Type: Text , Journal article
- Relation: Australian Occupational Therapy Journal Vol. 65, no. 3 (2018), p. 168-175
- Full Text: false
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- Description: Background/aim: Approximately, 80% of traumatic brain injuries are considered mild in severity. Mild traumatic brain injury (mTBI) may cause temporary or persisting impairments that can adversely affect an individual's ability to participate in daily occupations and life roles. This study aimed to identify symptoms, factors predicting level of symptoms and functional and psycho-social outcomes for participants with mTBI three months following injury. Method: Patients discharged from the Emergency Department of a major metropolitan hospital with a diagnosis of mTBI were contacted by telephone three months after injury. An interview with two questionnaires was administered: The Concussion Symptom Inventory (CSI) Scale and the Rivermead Head Injury Follow-Up Questionnaire (RHIFUQ). Data obtained were used to determine the type and prevalence of post-concussion symptoms and their impact on activity change. Results: Sixty-three people with mTBI participated in the study. The majority of participants (81%) reported that all symptoms had resolved within the three-month time frame. Of those still experiencing symptoms, workplace fatigue (22%) and an inability to maintain previous workload/standards (17%) were reported. Conclusion: There is a small, but clinically significant, subgroup of patients who continue to experience symptoms three-month post-mTBI. Symptoms experienced beyond the expected three-month recovery timeframe have the potential to adversely affect an individual's ability to participate in daily occupation and return to work. © 2018 Occupational Therapy Australia. **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Carolyn Unsworthy” is provided in this record**
Head accelerations during a 1-on-1 rugby tackling drill performed by experienced rugby union players
- Reha, Tahere, McNabb, Colm, Netto, Kevin, Davey, Paul, Lavender, Andrew
- Authors: Reha, Tahere , McNabb, Colm , Netto, Kevin , Davey, Paul , Lavender, Andrew
- Date: 2021
- Type: Text , Journal article
- Relation: Brain Sciences Vol. 11, no. 11 (2021), p.
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- Description: Rugby Union is a popular sport played by males and females worldwide, from junior to elite levels. The highly physical skill of tackling occurs every few seconds throughout a match and various injuries associated with tackling are relatively common. Of particular interest are head injuries that result in a concussion. Recently, repeated non-injurious head impacts in sport have attracted the attention of researchers interested in brain health. Therefore, this study assessed head movement during repeated rugby tackle drills among experienced Rugby Union players. Experienced male and female participants performed 15 1-on-1 tackles in a motion analysis laboratory to measure the head movements of the ball carrier and tackler during each tackle, using three-dimensional motion capture. The average peak acceleration of the head for ball carriers was 28.9 ± 24.08 g and 36.67 ± 28.91 g for the tacklers. This study found that the type of head impacts common while performing a tackle in Rugby Union are similar to those experienced by soccer players during heading, which has been found to alter brain function that lasts hours after the event. This has important implications for player health and suggests that mitigation strategies should be considered for Rugby Union. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
Head accelerations during a 1-on-1 rugby tackling drill performed by experienced rugby union players
- Authors: Reha, Tahere , McNabb, Colm , Netto, Kevin , Davey, Paul , Lavender, Andrew
- Date: 2021
- Type: Text , Journal article
- Relation: Brain Sciences Vol. 11, no. 11 (2021), p.
- Full Text:
- Reviewed:
- Description: Rugby Union is a popular sport played by males and females worldwide, from junior to elite levels. The highly physical skill of tackling occurs every few seconds throughout a match and various injuries associated with tackling are relatively common. Of particular interest are head injuries that result in a concussion. Recently, repeated non-injurious head impacts in sport have attracted the attention of researchers interested in brain health. Therefore, this study assessed head movement during repeated rugby tackle drills among experienced Rugby Union players. Experienced male and female participants performed 15 1-on-1 tackles in a motion analysis laboratory to measure the head movements of the ball carrier and tackler during each tackle, using three-dimensional motion capture. The average peak acceleration of the head for ball carriers was 28.9 ± 24.08 g and 36.67 ± 28.91 g for the tacklers. This study found that the type of head impacts common while performing a tackle in Rugby Union are similar to those experienced by soccer players during heading, which has been found to alter brain function that lasts hours after the event. This has important implications for player health and suggests that mitigation strategies should be considered for Rugby Union. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
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