Abstract Introduction: Differences in care pathways/the delivery of rehabilitation care for young people with acquired brain injury (ABI) across rehabilitation centers (RCs), may lead to unwanted practice variations. Objective: Identifying potential similarities/differences regarding the care structure across RCs. Methods: In this cross-sectional study, Healthcare professionals from Dutch RCs that work with young people(<25 years) with ABI were invited to complete a 21-item questionnaire (12 yes/no& nine corresponding open-ended-questions). Questions were divided into three topics: admission/discharge criteria (n=2&2), organization of rehabilitation (n=7&5), and aftercare (n=3&2). Answers to open-ended questions were thematically analyzed/categorized. Differences across RCs were defined as an item being present/described in <75% of the RCs. Results: Rehabilitation professionals from 12 RCs participated. Similarities and differences were found regarding the structure of rehabilitation care. Concerning admission criteria(present in all RCs), “an ABI diagnosis” was seen by all RCs as an essential criterium, whereas all other admission criteria were described differently. The discharge criterium "goal-attainment" was the only criterium found in ≥75% of the RCs. Regarding the organization of rehabilitation, most RCs (≥75%) described “the presence of specialized teams”&“diagnosis-specific consultation appointments”. Differences were found, e.g., the “presence of transition-teams” for young adults (<75%). Concerning aftercare, similarities were found in the “presence of structural end-reports”&“discharge/follow-up appointments”. However, differences were seen in the “timing between discharge&follow-up”. Conclusion: Besides similarities between RCs, differences were found regarding the structure of outpatient rehabilitation. Gaining insights into differences across RCs and reducing practice variation could reinforce collaborations between RCs to harmonize/optimize care quality for young people with ABI.
Assessment of metabolic energy expenditure from indirect calorimetry is currently limited to sustained (>4 min) cyclic activities, because of steady-state requirements. This is problematic for patient populations who are unable to perform such sustained activities. Therefore, this study explores validity and reliability of a method estimating metabolic energy expenditure based on oxygen consumption (V.O (2) ) during short walking bouts. Twelve able-bodied adults twice performed six treadmill walking trials (1, 2 and 6min at 4 and 5km/h), while V.O (2) was measured. Total V.O (2) was calculated by integrating net V.O (2) over walking and recovery. Concurrent validity with steady-state V.O (2) was assessed with Pearson's correlations. Test-retest reliability was assessed using intra-class correlation coefficients (ICC) and Bland-Altman analyses. Total V.O (2) was strongly correlated with steady-state V.O (2) (r=0.91-0.99), but consistently higher. Test-retest reliability of total V.O (2) (ICC=0.65-0.92) was lower than or comparable to steady-state V.O (2) (ICC=0.83-0.92), with lower reliability for shorter trials. Total V.O (2) discriminated between gait speeds. Total oxygen uptake provides a useful measure to estimate metabolic load of short activities from oxygen consumption. Although estimates are less reliable than steady-state measurements, they can provide insight in the yet unknown metabolic demands of daily activities for patient populations unable to perform sustained activities.
OBJECTIVE:To safely and effectively train the exercise capacity of post-COVID-19 patients it is important to test for cardiopulmonary risk factors and to assess exercise limitations. The goal of this study was to describe the exercise capacity and underlying exercise limitations of mechanically ventilated post-COVID-19 patients in clinical rehabilitation.DESIGN:A retrospective cohort study.METHOD:Twenty-four post-COVID-19patients that were mechanically ventilated at ICU and thereafter admitted for clinical rehabilitation performed a symptom-limited cardiopulmonary exercise test (CPET) with breath-by-breath gas-exchange monitoring, ECG-registration, blood pressure- and saturation monitoring. In absence of a primary cardiac or ventilatory exercise limitation patients were considered to be limited primarily by decreased peripheral muscle mass.RESULTS:Twenty-three patients could perform a maximal exercise test and no adverse events occurred. Cardiorespiratory fitness was very poor with a median peak oxygen uptake of 15.0 [10.1-21.4] mlO2/kg/min (57% of predicted values). However, we observed large differences within the group in both exercise capacity and exercise limitations. While 7/23 patients were primarily limited by ventilatory function, the majority (70%) was limited primarily by the decreased peripheral muscle mass.CONCLUSION:Cardiorespiratory fitness of post-COVID-19 patients in clinical rehabilitation is strongly deteriorated. The majority of patients seemed primarily limited for exercise by the decreased peripheral muscle mass.
Insomnia symptoms following acquired brain injury are serious and common, associated with cognitive and emotional complaints. This systematic review aims to summarize and appraise the current knowledge regarding the efficacy of non-pharmacological treatments for insomnia after traumatic brain injury and stroke in adults. A systematic search in the electronic databases of Medline, PsycINFO and Embase was conducted on January 15, 2019. The search strategy included traumatic brain injury or stroke and a combination of keywords and Boolean operators to represent the concept of insomnia. Articles were restricted to those in English and study populations of human adults. A total of 4341 studies were found, of which 16 were included, representing seven different non-pharmacological treatments. While the quality and quantity of the studies does not allow for firm conclusions, the outcomes suggest that cognitive behavioural therapy improves insomnia and sleep quality. The results highlight the need for larger studies of better methodological quality on non-pharmacological interventions for insomnia following brain injury.
