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(RSS) Trauma Research Blog

Selected new & juicy research papers, with editorial comment.

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Trauma Research Blog

Selected new & juicy research papers, with editorial comment.

Authors:

Recent Posts:

PubMed ID: 19627869
PM R. 2009 Jan;1(1):23-8
Authors: Sayer NA, Cifu DX, McNamee S, Chiros CE, Sigford BJ, Scott S, Lew HL.

Abstract:

OBJECTIVE: To describe the rehabilitation course of combat-injured service members who sustained polytraumatic injuries during the current wars in and around Iraq and Afghanistan. DESIGN: Retrospective descriptive analysis. SETTING: Department of Veterans Administration Polytrauma Rehabilitation Centers (PRCs). PARTICIPANTS: One hundred eighty-eight consecutive, acutely combat-injured service members suffering polytraumatic injuries requiring inpatient rehabilitation and being treated at PRCs between October 2001 and January 2006. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Medications prescribed, devices used, injuries and impairment information, and consultative services. RESULTS: Ninety-three percent of the patients had sustained a traumatic brain injury (TBI) and more than half of these were incurred secondary to blast explosions. Over half of the patients had infections or surgeries prior to PRC admission that required continued medical attention during their stay. Pain and mental health issues were present in 100% and 39%, respectively, of all patients admitted and added complexity to the brain injury rehabilitation process. Common treatment needs included cognitive-behavioral interventions, pain care, assistive devices, mental health interventions for both patients and their families, and specialty consultations, in particular to ophthalmology, otolaryngology, and neurology. CONCLUSIONS: Combat-injured polytrauma patients have complex rehabilitation needs that require a high level of specialized training and skill. Physical medicine and rehabilitation specialists treating war injured service members need a high level of expertise in assessment and treatment of co-occurring pain, TBI, and stress disorders. Physiatrists are playing an important role in providing and coordinating the rehabilitation care for individuals with significant polytraumatic war injuries from the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) conflicts.

Notes & Commentary:

PubMed ID: 19627946
PM R. 2009 Jun;1(6):560-75
Authors: Devine JM, Zafonte RD.

Abstract:

OBJECTIVE: Physical exercise has been shown to play an ever-broadening role in the maintenance of overall health and has been implicated in the preservation of cognitive function in both healthy elderly and demented populations. Animal and human studies of acquired brain injury (ABI) from trauma or vascular causes also suggest a possible role for physical exercise in enhancing cognitive recovery. DATA SOURCES: A review of the literature was conducted to explore the current understanding of how physical exercise impacts the molecular, functional, and neuroanatomic status of both intact and brain-injured animals and humans. STUDY SELECTION: Searches of the MEDLINE, CINHAL, and PsychInfo databases yielded an extensive collection of animal studies of physical exercise in ABI. Animal studies strongly tie physical exercise to the upregulation of multiple neural growth factor pathways in brain-injured animals, resulting in both hippocampal neurogenesis and functional improvements in memory. DATA EXTRACTION: A search of the same databases for publications involving physical exercise in human subjects with ABI yielded 24 prospective and retrospective studies. DATA SYNTHESIS: Four of these evaluated cognitive outcomes in persons with ABI who were involved in physical exercise. Three studies cited a positive association between exercise and improvements in cognitive function, whereas one observed no effect. Human exercise interventions varied greatly in duration, intensity, and level of subject supervision, and tools for assessing neurocognitive changes were inconsistent. CONCLUSIONS: There is strong evidence in animal ABI models that physical exercise facilitates neurocognitive recovery. Physical exercise interventions are safe in the subacute and rehabilitative phases of recovery for humans with ABI. In light of strong evidence of positive effects in animal studies, more controlled, prospective human interventions are warranted to better explore the neurocognitive effects of physical exercise on persons with ABI.

Notes & Commentary:

PubMed ID: 19630126
Am J Phys Med Rehabil. 2009 May;88(5):387-98.
Authors: Sirois MJ, Dionne CE, Lavoie A.

Abstract:

OBJECTIVES: The aims of this study were to compare regional differences in perceived needs for postacute rehabilitation services, perceived barriers to postacute rehabilitation services, and long-term functional and physical health outcomes among multiple trauma survivors. DESIGN: A population-based cohort study with retrospective measures of exposure and cross-sectional health outcomes measures was conducted in regions with different levels of rehabilitation services availability in the province of Quebec, Canada. The study included 435 participants, aged 18-65 yrs, admitted to level I or level II trauma centers in 2000-2001, who required rehabilitation services. The participants were interviewed by telephone 2-4 yrs postinjury. Needs for (yes/no) and perceived barriers (yes/no) to obtain 18 posttraumatic rehabilitation services were assessed. Physical health was measured with the medical outcome study SF-12 and functional status with the functional independence measure. RESULTS: There were no significant regional differences in the proportions of perceived barriers to functional rehabilitation (39.4%), to social/vocational rehabilitation (52.2%), and to community integration services (46.5%). Adjusted-SF-12 and functional independence measure scores were similar across regions. CONCLUSION: Contrary to expectations, there were no regional differences in perceived barriers to rehabilitation services for multiple trauma survivors. Rather, surprisingly high proportions of barriers were reported across the province.

Notes & Commentary:

Interesting - given Quebec 's a relatively mature and comprehensive trauma system.  Perhaps locals can comment on the perception of high barriers to rehab access across the province?

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