May 19, 2016 - inferencing in bilingual people with brain injury (BI). Tuba Yarbay .... motionâinteraction software offers a training environment that is more ...
ISSN: 0269-9052 (Print) 1362-301X (Online) Journal homepage: http://www.tandfonline.com/loi/ibij20
Accepted Abstracts from the International Brain Injury Association’s Eleventh World Congress on Brain Injury To cite this article: (2016) Accepted Abstracts from the International Brain Injury Association’s Eleventh World Congress on Brain Injury, Brain Injury, 30:5-6, 481-817, DOI: 10.3109/02699052.2016.1162060 To link to this article: http://dx.doi.org/10.3109/02699052.2016.1162060
Published online: 19 May 2016.
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Date: 20 May 2016, At: 13:15
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Assessment (MAA) is a supplementary tool for use alongside the RCSE-M score to describe and quantify the types of medical resources actually used and, thus, to characterize the co-dependencies of hyper-acute rehabilitation services, i.e. the interventions from other specialties that patients may need to access during their rehabilitation. In this study, MAA data were recorded alongside RCS-E scores at weekly intervals over 1 year. Resource use in terms of medical input (doctor hours/week) was recorded through the Northwick Park Therapy Dependency Assessment Medical Score. Results: Four hundred and twenty-one parallel data points were recorded from 36 patients (mean age = 41 (SD = 13) and mean length of stay = 108 (SD = 35) days). The majority of diagnoses were: 45% Trauma, 32% Anoxic brain injury. On discharge, 38% had emerged while 19% remained in vegetative state and 33% Minimally conscious state. Overall, specialist input was required from 20 different medical specialties. The commonest were ENT/tracheostomy team 79 (19%), Neurology 28 (7%), Neurosurgery 28 (7%), Radiology 15 (4%). The RCS-M scores in 223 (53%) data-points identified medical instability. One hundred and sixty-one (72%) medically unstable data-points required between 2.5–6 hours/week of medical input. The commonest reasons for requiring medical intervention were bowel management 45 (20%), respiratory distress/desaturation 43 (19%), autonomic dys-regulation (‘sympathetic storming’) 30 (13%) and sepsis 16 (7%). This group of patients frequently required medical interaction with family and 155 (70%) data-points included informal family meetings. Conclusions: Prolonged Disorder of Consciousness patients in a hyper-acute rehabilitation service require an extensive range of on-site specialist medical and emergency services. These patients need both medical time for intervention as well as family discussions during the time of assessment and establishment of the level of consciousness.
0822 Appropriate management of patients with traumatic brain injury and dysphagia in our hospitals or not? Valentina Blažinčić, Ivica Ščurić, Marija Jeršek, Ivan Dubroja Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice, Croatia Objectives: Traumatic brain injury (TBI) is the cause of various neurological deficits including swallowing disorders. Until now, the studies in patients with TBI show the incidence of dysphagia from 17.2–61%. Enteral nutrition is the preferential route of nutrition, fluid and drug administration vs parenteral nutrition. Percutaneous endoscopic gastrostom (PEG) feeding should be considered if the patient can not have an adequate intake of nutrients (qualitatively or quantitatively) orally for a period of 2–3 weeks. The aim of this study was to establish if the patients with TBI have proper treatment when having dysphagia before arrival in rehabilitation. Methods: This retrospective study included 114 patients with TBI and disphagia (96 men and 18 women) that needed a feeding tube and were on craniocerebral rehabilitation. Inclusion criteria were: age over 18 years, traumatic brain injury and first rehabilitation after injury. Exclusion criteria
Brain Inj, 2016; 30(5–6): 481–817
were: other aetiology of disphagia and second time on rehabilitation or death during rehabilitation. We have analysed patients dating from I January 2012 to 1 September 2015. Results: Twenty-six per cent of patients with TBI needed feeding tube becouse of disphagia on their first rehabilitation after trauma. 24% had NG tube and 2% had PEG when they arrived on craniocerebral rehabilitation. Time from injury to arrival at rehabilitation was from 4 weeks to 20 weeks. At discharge from rehabilitation 15% of patients needed feeding tube. Conclusions: All 24% patients with TBI and NG tube needed to be referred with PEG on rehabilitation. Appropriate managment of these patients can reduce complications that manifest during medical rehabilitation (e.g. the risk of malnutrition, risk of aspiration, risk of pneumonia, affect the length of the stationary type of medical rehabilitaton). In addition, there is evidence on an intermediate level that postpyloric feeding associated with lower risk for pneumonia (30% compared to gastric feeding). According to the literature, placement of a percutaneous endoscopic gastrostomy or percutaneous endoscopic jejunostomy tube is simple, safe and well-tolerated by patients. Doctors who manage patients with traumatic brain injury and disphagia should be informed about the aforementioned.
0823 Using evidential stories to assess epistemic inferencing in bilingual people with brain injury (BI) Tuba Yarbay Duman University of Amsterdam, Amsterdam, The Netherlands Objectives: People with BI have difficulty inferring the intended meaning of a message. Consistent problems in inferencing can result in difficulty achieving social communication and vocational goals. However, possible sources of inferencing difficulty in people with BI have not yet been investigated. This is the first study that examined the ability to infer from epistemic state of events (understanding the possibility/ probability or certainty of an event occurrence) using evidential stories. Epistemic language is central to understand the functions and intentions of utterances as well as the scenes around us. Evidential cues help inassigning epistemic inferences in linguistic and non-linguistic settings. Methods: An integrated approach was used: linguistic (Test I) and non-linguistic (Test II) epistemic inferencing were tested. For Test I, three story types (24 sentences) were presented to a group of three people with cerebrovascular BI and three ageand education-matched healthy adults. Each story type provided a different evidential cue: direct evidence (positive perceptual), indirect evidence (negative perceptual) and no evidence (no perceptual cue). Epistemically modalized utterances (can: possibility vs must: certainty) were used as a linguistic tool. For Test II, the same participants were presented only with the three evidential picture-set-stimuli used in Test I, with no linguistic mean. The participants determined epistemic certainty levels within three-picture sets. Both tests were performed in both languages spoken by the participants since the presence of an epistemic deficiency after BI was expected to influence both languages similarly.
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Results: In Test I, healthy participants scored significantly higher than participants with BI on indirect evidence and no evidence conditions in both languages (Chi-square, p < 0.05). However, no significant between-group differences were found for direct evidence for either language (Chi-square, p > 0.05). These findings indicate that correct linguistic epistemic inferences people with BI make may depend on the type of evidence in a context. In Test II, significant between-group differences were present for both languages (Chi-square, p < 0.05), suggesting that failure in epistemic inferencing is not specific to language. Conclusions: This study presented the first preliminary results in developing a task for people with BI that would identify difficulties in epistemic inferencing using evidential stories. Although the current sample is yet small (data collection is ongoing), it appears that there exist people with BI experiencing problems in epistemic inferencing: they are epistemically uncertain as to the occurrence of an event when there is no direct perceptual evidential cue. This information can help the rehabilitation teams in identifying language and cognitive ability of people with BI when contextual information is and is not a cue for understanding the message of a sentence. Improving epistemic inferencing may help people with BI in understanding language and the world around them better.
0824 Blast-induced traumatic brain injury and neonatal hydrocephalus: Assessing similarities of pressure-induced cellular injury patterns
assays and immunohistochemistry for markers of injury (Caspace-3, apoptosis-inducing factor) or repair (microtubule-associated protein 2) were used to evaluate and quantify pressure-induced cellular injury. Results: When compared to controls, both sustained pressure (30 mmHg for 2 hours) and repeated pressure pulses (80–100 mmHg repeated 1–10 times) increased the release of intracellular ATP when compared to controls. Sustained pressure elevation produced a 3-fold higher ATP release compared to pulsed pressures of 3-fold higher magnitude. Conclusions: Using our recently developed PC3I, we are able to maintain neuronal cell cultures at physiological and pathological pressure to determine how altering pressure alone affects the release of various cell-injury biomarkers. CNS cells grown in 3-D alginate hydrogel cell culture matrixes at physiologic pressures deemed to be normal for a developing neonatal brain, as well as incremental pressure differences, which are pathologic conditions of untreated hydrocephalus. Pulsed pressure, mimicking bTBI and intermittent VP-shunt malfunction, produces measurable cell-mediated stress response. Preliminary results suggest pathologic pressure alone demonstrates characteristics of cell injury through ATP release, which is the primary mediator in purinergic signalling. However, lower magnitude pathologic pressure, when sustained without relief, may be more injurious. Continued work is exploring if, after pulsed pathologic pressure, CNS cells are left more vulnerable to a second injury of the same or lesser magnitude.
Michael Smith, Rickey Miller, Ramin Eskandari Medical University of South Carolina, Charleston, SC, USA Objectives: Elevated intracranial pressure (ICP) is evident in a number of neurological disorders. Increased ICP and microstructural changes in white matter tracts are present following both blast-induced traumatic brain injury (bTBI) and neonatal hydrocephalus. While much effort has focused on identifying and/or protecting the brain from the initial injury processes, secondary cellular injury is often responsible for poor outcomes by both patient populations. Understanding signalling cascades of these secondary injury mechanisms should provide a means to both assess the degree of injury and develop therapeutic interventions to mitigate long-term deficits induced by both disease processes. Methods: Using a novel pressure controlled cell culture incubator (PC3I) to model pressure-induced brain injury, 3-D alginate hydrogel cultures of primary and progenitor central nervous system (CNS) cells were grown at normal and pathophysiological pressures (sustained and pulsed pressures). During sustained pressure exposures, a model of hydrocephalus and ventriculoperitoneal (VP) shunt malfunction, cells were subjected to different pressures (10, 20 and 30 mmHg) for periods of 5 minutes, 30 minutes, 1 hour, 2 hours and 24 hours. Pulsed pressure, which mimics pressure injury in bTBI and concussion, exposes cells to single/multiple pathological pressure pulses (80– 100 mmHg 1, 5 or 10 times). Vulnerability for repeat injury was assessed by repeating a single pathologic pulse pressure 7 days later. ATP-release assays, live/dead
0825 Using cognitive training based on adaptive motion-interaction video games for rehabilitation of executive functions in acquired brain injury— Experience and potential benefits Rotem Eliav1,2, Yifat Swartz2, Barak Blumenfeld3, Sivan Maoz3, Son Preminger3,4, Debbie Rand1, Yaron Sacher2 1
Department of Occupational Therapy, Tel Aviv University, Tel Aviv, Israel, 2Traumatic Brain Injury Department, Lowenstein Rehabilitation Center, Ra’anana, Israel, 3Intendu Ltd, Arsuf Kedem, Israel, 4School of Psychology, Interdisciplinary Center, Herzliya, Israel Objectives: Deficits in executive functions are common following an acquired brain injury (ABI). Computerized software for cognitive training is becoming more popular; however, this software is often hard to use by individuals with impairments and there is limited evidence that transfer of the improvements to real-life performance occurs. Cognitive training using motion–interaction software offers a training environment that is more realistic and natural, therefore may facilitate transfer to everyday-life performance. Cognitive software that adapts in real-time to the patient’s behaviour may potentially enhance the usability by these individuals. The goal of the experiments presented here was to assess the experience of training with dynamically-adaptive motion-interaction cognitive training software for improving executive functions and assess the potential benefits for individuals with ABI. Methods: Seven participants from the Loewenstain rehabilitation hospital (inpatient) with moderate-to-severe TBI with