Brain and Spinal Cord Injury
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Spinal Cord Injury and Traumatic Brain Injury Research Grant Program Report 2020
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Spinal Cord Injury and Traumatic Brain Injury Research Grant Program Report January 15, 2020 Author About the Minnesota Office of Higher Education Alaina DeSalvo The Minnesota Office of Higher Education is a Competitive Grants Administrator cabinet-level state agency providing students with Tel: 651-259-3988 financial aid programs and information to help [email protected] them gain access to postsecondary education. The agency also serves as the state’s clearinghouse for data, research and analysis on postsecondary enrollment, financial aid, finance and trends. The Minnesota State Grant Program is the largest financial aid program administered by the Office of Higher Education, awarding up to $207 million in need-based grants to Minnesota residents attending eligible colleges, universities and career schools in Minnesota. The agency oversees other state scholarship programs, tuition reciprocity programs, a student loan program, Minnesota’s 529 College Savings Plan, licensing and early college awareness programs for youth. Minnesota Office of Higher Education 1450 Energy Park Drive, Suite 350 Saint Paul, MN 55108-5227 Tel: 651.642.0567 or 800.657.3866 TTY Relay: 800.627.3529 Fax: 651.642.0675 Email: [email protected] Table of Contents Introduction 1 Spinal Cord Injury and Traumatic Brain Injury Advisory Council 1 FY 2020 Proposal Solicitation Schedule -
Traumatic Brain Injury
REPORT TO CONGRESS Traumatic Brain Injury In the United States: Epidemiology and Rehabilitation Submitted by the Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Unintentional Injury Prevention The Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation is a publication of the Centers for Disease Control and Prevention (CDC), in collaboration with the National Institutes of Health (NIH). Centers for Disease Control and Prevention National Center for Injury Prevention and Control Thomas R. Frieden, MD, MPH Director, Centers for Disease Control and Prevention Debra Houry, MD, MPH Director, National Center for Injury Prevention and Control Grant Baldwin, PhD, MPH Director, Division of Unintentional Injury Prevention The inclusion of individuals, programs, or organizations in this report does not constitute endorsement by the Federal government of the United States or the Department of Health and Human Services (DHHS). Suggested Citation: Centers for Disease Control and Prevention. (2015). Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA. Executive Summary . 1 Introduction. 2 Classification . 2 Public Health Impact . 2 TBI Health Effects . 3 Effectiveness of TBI Outcome Measures . 3 Contents Factors Influencing Outcomes . 4 Effectiveness of TBI Rehabilitation . 4 Cognitive Rehabilitation . 5 Physical Rehabilitation . 5 Recommendations . 6 Conclusion . 9 Background . 11 Introduction . 12 Purpose . 12 Method . 13 Section I: Epidemiology and Consequences of TBI in the United States . 15 Definition of TBI . 15 Characteristics of TBI . 16 Injury Severity Classification of TBI . 17 Health and Other Effects of TBI . -
T5 Spinal Cord Injuries
Spinal Cord (2020) 58:1249–1254 https://doi.org/10.1038/s41393-020-0506-7 ARTICLE Predictors of respiratory complications in patients with C5–T5 spinal cord injuries 1 2,3 3,4 1,5 1,5 Júlia Sampol ● Miguel Ángel González-Viejo ● Alba Gómez ● Sergi Martí ● Mercedes Pallero ● 1,4,5 3,4 1,4,5 1,4,5 Esther Rodríguez ● Patricia Launois ● Gabriel Sampol ● Jaume Ferrer Received: 19 December 2019 / Revised: 12 June 2020 / Accepted: 12 June 2020 / Published online: 24 June 2020 © The Author(s), under exclusive licence to International Spinal Cord Society 2020 Abstract Study design Retrospective chart audit. Objectives Describing the respiratory complications and their predictive factors in patients with acute traumatic spinal cord injuries at C5–T5 level during the initial hospitalization. Setting Hospital Vall d’Hebron, Barcelona. Methods Data from patients admitted in a reference unit with acute traumatic injuries involving levels C5–T5. Respiratory complications were defined as: acute respiratory failure, respiratory infection, atelectasis, non-hemothorax pleural effusion, 1234567890();,: 1234567890();,: pulmonary embolism or haemoptysis. Candidate predictors of these complications were demographic data, comorbidity, smoking, history of respiratory disease, the spinal cord injury characteristics (level and ASIA Impairment Scale) and thoracic trauma. A logistic regression model was created to determine associations between potential predictors and respiratory complications. Results We studied 174 patients with an age of 47.9 (19.7) years, mostly men (87%), with low comorbidity. Coexistent thoracic trauma was found in 24 (19%) patients with cervical and 35 (75%) with thoracic injuries (p < 0.001). Respiratory complications were frequent (53%) and were associated to longer hospital stay: 83.1 (61.3) and 45.3 (28.1) days in patients with and without respiratory complications (p < 0.001). -
NIH Public Access Author Manuscript J Neuropathol Exp Neurol
NIH Public Access Author Manuscript J Neuropathol Exp Neurol. Author manuscript; available in PMC 2010 September 24. NIH-PA Author ManuscriptPublished NIH-PA Author Manuscript in final edited NIH-PA Author Manuscript form as: J Neuropathol Exp Neurol. 2009 July ; 68(7): 709±735. doi:10.1097/NEN.0b013e3181a9d503. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury Ann C. McKee, MD1,2,3,4, Robert C. Cantu, MD3,5,6,7, Christopher J. Nowinski, AB3,5, E. Tessa Hedley-Whyte, MD8, Brandon E. Gavett, PhD1, Andrew E. Budson, MD1,4, Veronica E. Santini, MD1, Hyo-Soon Lee, MD1, Caroline A. Kubilus1,3, and Robert A. Stern, PhD1,3 1 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts 2 Department of Pathology, Boston University School of Medicine, Boston, Massachusetts 3 Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts 4 Geriatric Research Education Clinical Center, Bedford Veterans Administration Medical Center, Bedford, Massachusetts 5 Sports Legacy Institute, Waltham, MA 6 Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts 7 Department of Neurosurgery, Emerson Hospital, Concord, MA 8 CS Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Abstract Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed “dementia pugilistica” and more recently, chronic traumatic encephalopathy (CTE). We review the 47 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 professional athletes: one football player and 2 boxers. -
Neurologic Deterioration Secondary to Unrecognized Spinal Instability Following Trauma–A Multicenter Study
SPINE Volume 31, Number 4, pp 451–458 ©2006, Lippincott Williams & Wilkins, Inc. Neurologic Deterioration Secondary to Unrecognized Spinal Instability Following Trauma–A Multicenter Study Allan D. Levi, MD, PhD,* R. John Hurlbert, MD, PhD,† Paul Anderson, MD,‡ Michael Fehlings, MD, PhD,§ Raj Rampersaud, MD,§ Eric M. Massicotte, MD,§ John C. France, MD, Jean Charles Le Huec, MD, PhD,¶ Rune Hedlund, MD,** and Paul Arnold, MD†† Study Design. A retrospective study was undertaken their neurologic injury. The most common reason for the that evaluated the medical records and imaging studies of missed injury was insufficient imaging studies (58.3%), a subset of patients with spinal injury from large level I while only 33.3% were a result of misread radiographs or trauma centers. 8.3% poor quality radiographs. The incidence of missed Objective. To characterize patients with spinal injuries injuries resulting in neurologic injury in patients with who had neurologic deterioration due to unrecognized spine fractures or strains was 0.21%, and the incidence as instability. a percentage of all trauma patients evaluated was 0.025%. Summary of Background Data. Controversy exists re- Conclusions. This multicenter study establishes that garding the most appropriate imaging studies required to missed spinal injuries resulting in a neurologic deficit “clear” the spine in patients suspected of having a spinal continue to occur in major trauma centers despite the column injury. Although most bony and/or ligamentous presence of experienced personnel and sophisticated im- spine injuries are detected early, an occasional patient aging techniques. Older age, high impact accidents, and has an occult injury, which is not detected, and a poten- patients with insufficient imaging are at highest risk. -
Update on Critical Care for Acute Spinal Cord Injury in the Setting of Polytrauma
NEUROSURGICAL FOCUS Neurosurg Focus 43 (5):E19, 2017 Update on critical care for acute spinal cord injury in the setting of polytrauma *John K. Yue, BA,1,2 Ethan A. Winkler, MD, PhD,1,2 Jonathan W. Rick, BS,1,2 Hansen Deng, BA,1,2 Carlene P. Partow, BS,1,2 Pavan S. Upadhyayula, BA,3 Harjus S. Birk, MD,3 Andrew K. Chan, MD,1,2 and Sanjay S. Dhall, MD1,2 1Department of Neurological Surgery, University of California, San Francisco; 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco; and 3Department of Neurological Surgery, University of California, San Diego, California Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stabil- ity, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord. There is general evidence for the maintenance of mean arterial pressure of > 85 mm Hg during imme- diate and acute care to optimize neurological outcome; however, the selection of vasopressor type and duration should be judicious, with considerations for level of injury and risks of increased cardiogenic complications in the elderly. Level II recommendations exist for early decompression, and additional time points of neurological assessment within the first 24 hours and during acute care are warranted to determine the temporality of benefits attributable to early surgery. -
Posttraumatic Stress Following Spinal Cord Injury: a Systematic Review of Risk and Vulnerability Factors
Spinal Cord (2017) 55, 800–811 & 2017 International Spinal Cord Society All rights reserved 1362-4393/17 www.nature.com/sc REVIEW Posttraumatic stress following spinal cord injury: a systematic review of risk and vulnerability factors K Pollock1,3, D Dorstyn1,3, L Butt2 and S Prentice1 Objectives: To summarise quantitatively the available evidence relating to pretraumatic, peritraumatic and posttraumatic characteristics that may increase or decrease the risk of developing posttraumatic stress disorder (PTSD) following spinal cord injury (SCI). Study design: Systematic review. Methods: Seventeen studies were identified from the PubMed, PsycInfo, Embase, Scopus, CINAHL, Web of Science and PILOTS databases. Effect size estimates (r) with associated 95% confidence intervals (CIs), P-values and fail-safe Ns were calculated. Results: Individual studies reported medium-to-large associations between factors that occurred before (psychiatric history r = 0.48 (95% CI, 0.23–0.79) P = 0.01) or at the time of injury (tetraplegia r = − 0.36 (95% CI, − 0.50 to − 0.19) Po0.01). Postinjury factors had the strongest pooled effects: depressed mood (rw = 0.64, (95% CI, 0.54–0.72)), negative appraisals (rw = 0.63 (95% CI, 0.52– 0.72)), distress (rw = 0.57 (95% CI, 0.50–0.62)), anxiety (rw = 0.56 (95% CI, 0.49–0.61)) and pain severity (rw = 0.35 (95% CI, 0.27– 0.43)) were consistently related to worsening PTSD symptoms (Po0.01). Level of injury significantly correlated with current PTSD severity for veteran populations (QB (1) = 18.25, Po0.001), although this was based on limited data. -
Amc Trauma Practice Management Guidelines: Traumatic Brian Injury
AMC TRAUMA PRACTICE MANAGEMENT GUIDELINES: TRAUMATIC BRIAN INJURY Original 10/2018 Revised 1/2020 AMC TRAUMA PRACTICE MANAGEMENT GUIDELINES: TRAUMATIC BRIAN INJURY Purpose: Neurotrauma care must be continuously available for all TRAUMATIC BRIAN INJURY (TBI) and Spinal Cord Injury patients. SUPPORTIVE DATA Policy Statements: Neurosurgical providers must respond and be present for consultation and management decisions for patients with TBI or spinal cord injury within 30 minutes of consultation by the Trauma Service based on institution specific criteria. Neurosurgery Attending will arrive within 30 minutes for decreasing GCS with midline shift requiring operative decompression. Institution Specific Criteria and Definitions: TBI Initial Encounter Codes S06.1 Traumatic Cerebral Edema S06.2 Diffuse Traumatic Brain Injury S06.3 Focal Traumatic Brain Injury S06.4 Epidural Hemorrhage S06.5 Traumatic Subdural Hemorrhage S06.6 Traumatic Subarachnoid Hemorrhage S06.8 Other Specified Intracranial Injuries S06.9 Unspecified Intracranial Injury Spinal Cord Injury Cervical Initial Encounter Codes S14.0xxa Concussion and Edema of Cervical Spinal Cord, Initial Encounter S14.1 Other and Unspecified Injuries of Cervical Spinal Cord Spinal Cord Injury Thoracic Initial Encounter Codes S24.0xxa Concussion and Edema of Thoracic Spinal Cord, Initial Encounter S24.1 Other and Unspecified Injuries of Thoracic Spinal Cord Lumbar & Sacral Initial Encounter Codes S34.0 Concussion and Edema of Lumbar and Sacral Spinal Cord S34.1 Other and Unspecified Injury of Lumbar and Sacral Spinal Cord S34.3xxa Injury of Cauda Equina, Initial Encounter Background: The following clinical practice guidelines for management of traumatic brain injury were abstracted directly from the Brain Trauma Foundation’s Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. -
Predictors of Clinical Complications in Patients with Spinomedullary Injury Preditores De Complicações Clínicas Em Pacientes Com Trauma Raquimedular
ORIGINAL ARTICLE/ARTIGO ORIGINAL/ARTÍCULO ORIGINAL PREDICTORS OF CLINICAL COMPLICATIONS IN PATIENTS WITH SPINOMEDULLARY INJURY PREDITORES DE COMPLICAÇÕES CLÍNICAS EM PACIENTES COM TRAUMA RAQUIMEDULAR PREDICTORES DE COMPLICACIONES EN PACIENTES CON TRAUMA RAQUIMEDULAR DIONEI FREITAS DE MORAIS1, JOÃO SIMÃO DE MELO NETO2, ANTONIO RONALdo SPOTTI1, WALDIR ANTONIO TOGNOLA1 ABSTRACT Objective: To analyze individuals with spinal cord injury who developed secondary clinical complications, and the variables that can influence the prog- nosis. Methods: A prospective study of 321 patients with spinal cord injury. The variables were collected: age, sex, cause of the accident, anatomical distribution, neurological status, associated injuries, in-hospital complications, and mortality only in patients who developed complications. Results: A total of 72 patients were analyzed (85% male) with a mean age of 44.72±19.19 years. The individuals with spinal cord injury who developed clinical complications were mostly male, over 50 years of age, and the main cause was accidental falls. These patients had longer hospitalization times and a higher risk of progressing to death. Pneumonia was the main clinical complication. With regard to the variables that can influence the prognosis of these patients, it was observed that spinal cord injury to the cervical segment with syndromic quadriplegia, and neurological status ASIA-A, have a higher risk of developing pneumonia, the most common complication, as well as increased mortality. Conclusion: Clinical complications secondary to spinal cord injury are influenced by demographic factors, as well as characteristics of the injury contributing to an increase in mortality. Keywords: Spinal cord injuries/complications; Spinal injuries; Mortality. RESUMO Objetivo: Analisar pacientes de um hospital terciário com trauma raquimedular que evoluíram com complicações clínicas intra-hospitalares, bem como as variáveis que podem interferir no prognóstico. -
Traumatic Brain Injury(Tbi)
TRAUMATIC BRAIN INJURY(TBI) B.K NANDA, LECTURER(PHYSIOTHERAPY) S. K. HALDAR, SR. OCCUPATIONAL THERAPIST CUM JR. LECTURER What is Traumatic Brain injury? Traumatic brain injury is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration impact, blast waves, or penetration by a projectile, leading to temporary or permanent impairment of brain function. Traumatic brain injury (TBI) has a dramatic impact on the health of the nation: it accounts for 15–20% of deaths in people aged 5–35 yr old, and is responsible for 1% of all adult deaths. TBI is a major cause of death and disability worldwide, especially in children and young adults. Males sustain traumatic brain injuries more frequently than do females. Approximately 1.4 million people in the UK suffer a head injury every year, resulting in nearly 150 000 hospital admissions per year. Of these, approximately 3500 patients require admission to ICU. The overall mortality in severe TBI, defined as a post-resuscitation Glasgow Coma Score (GCS) ≤8, is 23%. In addition to the high mortality, approximately 60% of survivors have significant ongoing deficits including cognitive competency, major activity, and leisure and recreation. This has a severe financial, emotional, and social impact on survivors left with lifelong disability and on their families. It is well established that the major determinant of outcome from TBI is the severity of the primary injury, which is irreversible. However, secondary injury, primarily cerebral ischaemia, occurring in the post-injury phase, may be due to intracranial hypertension, systemic hypotension, hypoxia, hyperpyrexia, hypocapnia and hypoglycaemia, all of which have been shown to independently worsen survival after TBI. -
Mild Traumatic Brain Injury and Concussion: Information for Adults
Mild Traumatic Brain Injury and Concussion: Information for Adults Discharge Instructions You were seen today for a mild traumatic brain injury (mild TBI) or concussion. Watch for Danger Signs Use this handout to help you watch In rare cases, a dangerous blood clot that for changes in how you are feeling crowds the brain against the skull can develop or acting and to help you feel better. after a TBI. The people checking on you should call 911 or take you to an emergency Be sure to let a family member or department right away if you have: friend know about your injury and the types of symptoms to look out • A headache that gets worse and does not for. They may notice symptoms go away before you do and can help you. • Significant nausea or repeated vomiting • Unusual behavior, increased confusion, Schedule a follow-up appointment restlessness, or agitation with your regular doctor. • Drowsiness or inability to wake up Due to your injury, you may need to take some • Slurred speech, weakness, numbness, or time off from things like work or school. If so, ask decreased coordination your doctor for written instructions about when • Convulsions or seizures (shaking or you can safely return to work, school, sports, twitching) or other activities such as driving a car, riding a • Loss of consciousness (passing out) bike, or operating heavy equipment. More information on mild TBI and concussion, as well as tips to help you feel better, can be found at www.cdc.gov/TraumaticBrainInjury. Learn About Your Injury Mild TBI and concussions are brain injuries. -
Guidelines for BLS/ALS Medical Providers Current As of March 2019
Tactical Emergency Casualty Care (TECC) Guidelines for BLS/ALS Medical Providers Current as of March 2019 DIRECT THREAT CARE (DTC) / HOT ZONE Guidelines: 1. Mitigate any immediate threat and move to a safer position (e.g. initiate fire attack, coordinated ventilation, move to safe haven, evacuate from an impending structural collapse, etc). Recognize that threats are dynamic and may be ongoing, requiring continuous threat assessments. 2. Direct the injured first responder to stay engaged in the operation if able and appropriate. 3. Move patient to a safer position: a. Instruct the alert, capable patient to move to a safer position and apply self-aid. b. If the patient is responsive but is injured to the point that he/she cannot move, a rescue plan should be devised. c. If a patient is unresponsive, weigh the risks and benefits of an immediate rescue attempt in terms of manpower and likelihood of success. Remote medical assessment techniques should be considered to identify patients who are dead or have non-survivable wounds. 4. Stop life threatening external hemorrhage if present and reasonable depending on the immediate threat, severity of the bleeding and the evacuation distance to safety. Consider moving to safety prior to application of the tourniquet if the situation warrants. a. Apply direct pressure to wound, or direct capable patient to apply direct pressure to own wound and/or own effective tourniquet. b. Tourniquet application: i. Apply the tourniquet as high on the limb as possible, including over the clothing if present. ii. Tighten until cessation of bleeding and move to safety.