Differentiating essential hypertension from autonomic dysreflexia: a case report.

Introduction: Autonomic dysreflexia (AD), a condition of critically raised blood pressure, is a severe complication of spinal cord injury. Primary (essential) hypertension may present with similar blood pressure levels to AD, though the causes, pathophysiology, presentation and treatment will differ.

Case Presentation: We report a case of a 74-year-old patient with a C1 spinal injury, who developed primary (essential) hypertension during her rehabilitation phase of care, requiring extensive investigations for autonomic dysreflexia.

Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial.

Study Design: Randomised double-blind factorial-design placebo-controlled trial.

Objective: Urinary tract infections (UTIs) are common in people with spinal cord injury (SCI). UTIs are increasingly difficult to treat due to emergence of multi-resistant organisms.

Constraint Induced Aphasia Therapy: Volunteer-led, unconstrained and less intense delivery can be effective.

Background: Constraint Induced Aphasia Therapy (CIAT) has been shown to be effective in the treatment of aphasia, but clinicians have expressed concern regarding how far CIAT is practical to implement in clinical practice.

Objective: To determine whether CIAT delivered in a less-intense, lower dose, reduced constraint and volunteer-led format could produce positive outcomes in people with chronic aphasia.

Methods: Two groups were run, each with two people with chronic aphasia.

Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a study protocol for a randomised controlled trial.

Background: Urinary tract infections [UTIs] are very common in people with Spinal Cord Injury [SCI]. UTIs are increasingly difficult and expensive to treat as the organisms that cause them become more antibiotic resistant. Among the SCI population, there is a high rate of multi-resistant organism [MRO] colonisation.

Maintenance of treatment effects of an occupation-based intervention with video feedback for adults with TBI.

Background: Video feedback interventions have been found to improve self-awareness and occupational performance to a greater extent than other feedback interventions after traumatic brain injury (TBI). However, it is unclear whether the effects of video feedback are maintained over time.

Objective: To evaluate the maintenance of gains in self-awareness achieved with a video feedback intervention in people with TBI.

Effects of concomitant spinal cord injury and brain injury on medical and functional outcomes and community participation.

Background: There are limited data on the interactions between concomitant spinal cord injury (SCI) and traumatic brain injury (TBI) in terms of medical, psychological, functional, and community outcomes.

Objective: To investigate the hypothesis that in addition to SCI-associated sensory-motor impairments, people with dual diagnosis would experience additional TBI-associated cognitive impairments that would have a negative impact on community reintegration.

Methods: Cross-sectional, case-matched study comparing a consecutive sample of participants with dual diagnosis (n = 30) to an SCI group (n = 30) and TBI group (n = 30).

INCOG recommendations for management of cognition following traumatic brain injury, part III: executive function and self-awareness.

Introduction: Traumatic brain injury (TBI) results in complex cognitive (and other) sequelae. Impairments in executive function and self-awareness are among the most characteristic neuropsychological sequelae and can exert a profound effect on resuming previous life roles. An international group of researchers and clinicians (known as INCOG) convened to develop recommendations for interventions to improve impairments in executive functioning and self-awareness after TBI.

INCOG recommendations for management of cognition following traumatic brain injury, part II: attention and information processing speed.

Introduction: Traumatic brain injury, due to its diffuse nature and high frequency of injury to frontotemporal and midbrain reticular activating systems, may cause disruption in many aspects of attention: arousal, selective attention, speed of information processing, and strategic control of attention, including sustained attention, shifting and dividing of attention, and working memory. An international team of researchers and clinicians (known as INCOG) convened to develop recommendations for the management of attentional problems.

Methods: The experts selected recommendations from published guidelines and then reviewed literature to ensure that recommendations were current.

INCOG recommendations for management of cognition following traumatic brain injury, part I: posttraumatic amnesia/delirium.

Introduction: After traumatic brain injury (TBI) and emergence from coma, the majority of people experience posttraumatic amnesia (PTA), characterized by confusion, disorientation, retrograde and anterograde amnesia, poor attention, and sometimes agitation and delusions. An international team of researchers and clinicians developed recommendations for assessment and management of PTA.

Methods: The experts met to select recommendations, then reviewed literature to ensure they were current.

Contextual influences on employment of people with dual diagnosis: spinal cord injury and traumatic brain injury.

Background/aim: Research into the paid employment of people with spinal cord injury or traumatic brain injury is prevalent; however, little research has examined the factors that may support employment for adults with a concomitant spinal cord injury and traumatic brain injury (dual diagnosis). This study aimed to determine the level of paid employment reported by people with dual diagnosis and to explore contextual factors that supported paid employment.

Methods: This cross-sectional cohort study recruited 30 participants with dual diagnosis from a specialist spinal rehabilitation unit.

The impact of simulated ankle plantarflexion contracture on the knee joint during stance phase of gait: a within-subject study.

Background: Ankle plantarflexion contractures are common in adults with neurological disorders and known to cause secondary gait deviations. However, their impact on the knee joint is not fully understood. The aims of this study are to describe the effect of simulated plantarflexion contractures on knee biomechanics during the stance phase and on the spatiotemporal characteristics of gait.

An intensive programme of passive stretch and motor training to manage severe knee contractures after traumatic brain injury: a case report.

Purpose: While contemporary management of contractures (a common secondary problem of acquired brain injury that can be difficult to treat) includes passive stretch, recent evidence indicates that this intervention may not be effective. This may be because clinical trials have not provided a sufficient dose or have not combined passive stretch with other treatments. The purpose of this case report is to describe a programme of intensive passive stretch combined with motor training administered over a 1.

Using the unbiased perspectives of people living with a spinal cord injury in assessments of mobility.

Study Design: Clinometrics study.

Objective: To devise a way of capturing the unbiased perspectives of people living with a spinal cord injury (SCI) in assessments of mobility.

Setting: SCI unit and community.

Electrical stimulation and splinting were not clearly more effective than splinting alone for contracture management after acquired brain injury: a randomised trial.

Question: Is electrical stimulation and splinting more effective than splinting alone for the management of wrist contracture following acquired brain injury?

Design: A multi-centre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis.

Participants: Thirty-six adults with first stroke or traumatic brain injury and mild to moderate wrist flexion contractures.

Intervention: The experimental group received electrical stimulation to the wrist and finger extensor muscles for 1 hour a day over 4 weeks while the control group did not.

Feedback interventions for improving self-awareness after brain injury: a protocol for a pragmatic randomised controlled trial.

Background: Occupational therapists working in brain injury rehabilitation use functional tasks as a means of providing feedback to improve self-awareness of people who have a brain injury and ultimately improve their occupational performance.

Purpose: To compare the effectiveness of video, verbal and experiential feedback for improving self-awareness in people with traumatic brain injury.

Methods: A randomised controlled trial will be conducted to compare the efficacy of video and verbal feedback during occupational therapy.

Retrospective cohort study of accident outcomes for individuals who have successfully undergone driver assessment following stroke.

Background: The occupational role of 'driver' is highly valued. Stroke can have a significant impact on an individual's ability to drive safely. Multi-disciplinary driver assessments are conducted to assess the safety of post-stroke individuals returning to driving, however, little follow-up of drivers following successful assessment has been performed.

Measuring community integration after spinal cord injury: validation of the Sydney psychosocial reintegration scale and community integration measure.

Objectives: To evaluate the reliability, validity, sensitivity to change, and clinical usefulness of the Sydney Psychosocial Reintegration Scale (SPRS) and Community Integration Measure (CIM) for people with spinal cord injury (SCI).

Methods: A sample of 58 people with recent traumatic SCI was followed up at 12 months post-discharge from inpatient rehabilitation. The SPRS, CIM, Craig Handicap Assessment and Reporting Technique (CHART) and SF-6D Health Utility Scale (SF-6D) were administered.

A snapshot of rehabilitation referrals in rural New South Wales.

The aim of this paper is to describe patterns of referral to inpatient rehabilitation in rural NSW. Archival records of referrals to one rural speciality medical rehabilitation service during 2004 and 2005 were analysed using descriptive statistics displayed using tables and graphs. Seventy-six referrers referred 922 patients for inpatient rehabilitation.

Nurses create a rehabilitative milieu.

Despite the recognition of milieu therapy as a nursing intervention, nursing's contribution to the creation of inpatient environments that facilitate patient rehabilitation has been underresearched. A large study conducted in five inpatient rehabilitation units in Australia that sought to develop a grounded theory of nursing's contribution to inpatient rehabilitation has begun to address this gap in the literature. Analysis of data collected from 53 nurses during interviews and observations of their everyday practice revealed that nurses act purposefully to create a milieu conducive to rehabilitation.

Post-traumatic amnesia and its relationship to the functional outcome of people with severe traumatic brain injury.

Objective: To investigate the relationship between Post-Traumatic Amnesia (PTA) duration, length of stay and functional outcomes in Australian in-patients with severe traumatic brain injury (TBI).

Design: Retrospective, descriptive study using prospectively collected data from the Uniform Data Set for Medical Rehabilitation (UDSMR).

Methods: Prospective collection of Westmead PTA scores and analysis of database for admissions for primary TBI rehabilitation from 1993-2003.

Building rehabilitation capacity in rural in New South Wales.

Introduction: The aim of this article is to report on a study of the expansion of specialist rehabilitation services in central New South Wales, Australia, through the introduction of rehabilitation as a new service type at 2 small rural multi-casemix hospitals, within an integrated area-wide model of rehabilitation service delivery.

Methods: Mixed methods were used. Information about bed occupancy and patient participation in rehabilitative activities were collected from hospital data bases and patient observation by staff over a 10 month period, and analysed quantitatively using descriptive statistics.

Opting in and opting out: a grounded theory of nursing's contribution to inpatient rehabilitation.

Aim: To develop a grounded theory of nursing's contribution to patient rehabilitation from the perspective of nurses working in inpatient rehabilitation.

Design: Grounded theory method, informed by the theoretical perspective of symbolic interactionism, was used to guide data collection and analysis, and the development of a grounded theory.

Setting: Five inpatient rehabilitation units in Australia.

Coaching patients to self-care: a primary responsibility of nursing.

Aim.  To explore the process nurses use to guide and support patients to actively re-establish self-care. Background.

Interventions for apathy after traumatic brain injury.

Background: Apathy is a deficiency in overt behavioural, emotional and cognitive components of goal-directed behaviour. It is a common occurrence after traumatic brain injury (TBI), with widespread impact. We have systematically reviewed studies examining the effectiveness of interventions for apathy in the TBI population.

Rehabilitation and Disability Services' Quality Projects: A Comparison against the Australian Council on Healthcare Standards' Clinical Criteria.

The Australian Council on Healthcare Standards (ACHS) Evaluation, Quality and Improvement (EQuIP 4) standards provide a useful clinical and corporate framework for the analysis of quality projects by both health and disability services. Two ACHS EQuIP 4 clinical standards were used to compare quality projects conducted by community-based and on-site rehabilitation and disability services, as generated by a commercial database. Reliable information is a major asset for healthcare organisations, and the use of the ACHS clinical standards to interpret quality project data can overcome a lack of conceptual framework to interpret data.