Tag Archives: Traumatic brain injury

Exercise as a treatment for brain injury

7 Aug

In the past rest has been widely recommend as the appropriate treatment for brain jury. Now this conventional wisdom is being challenged:

“Over the course of a year, Klein tracked more than 600 patients with brain injury, getting more than half of them up and out of bed as early as the first day they were admitted to the ICU. What she found was that getting up and moving had clear benefits. Patients who started their rehabilitation earlier spent less time in the ICU and less time in the hospital. “They have less (sic)  pressure ulcers, less (sic) infections and spend less time on the ventilator if they need ventilator therapy,” says Klein. And most say they feel a lot better.”

Bed rest was a traditional treatment for many illnesses, such as heart disease. Increasingly, physicians are seeing the benefits of getting up and moving.

 

 

Education and recovery from traumatic brain injury

26 Apr

Cognitive reserve  describes the brain’s capacity to recover from injury and its resistance to dementia. It is associated with measures such as brain size and neuronal density. I have been studying cognitive reserve because it is potential confounding variable for claims that education and cognitive engagement are protective against dementia. Education and cognitive engagement are correlated with cognitive reserve, which raises the possibility that education level and lower rates of dementia are actually out come variables caused by greater cognitive reserve.

Indeed, here is a study that uses education level as a proxy measure for cognitive reserve. The abstract reads:

“Objective: To evaluate the hypothesis that educational attainment, a marker of cognitive reserve, is a predictor of disability-free recovery (DFR) after moderate to severe traumatic brain injury (TBI).

Methods: Retrospective study of the TBI Model Systems Database, a prospective multicenter cohort funded by the National Institute on Disability and Rehabilitation Research. Patients were included if they were admitted for rehabilitation after moderate to severe TBI, were aged 23 years or older, and had at least 1 year of follow-up. The main outcome measure was DFR 1 year postinjury, defined as a Disability Rating Scale score of zero.

Results: Of 769 patients included, 214 (27.8%) achieved DFR at 1 year. In total, 185 patients (24.1%) had <12 years of education, while 390 (50.7%) and 194 patients (25.2%) had 12 to 15 years and ≥16 years of education, respectively. DFR was achieved by 18 patients (9.7%) with <12 years, 120 (30.8%) with 12 to 15 years, and 76 (39.2%) with ≥16 years of education (p < 0.001). In a logistic regression model controlling for age, sex, and injury- and rehabilitation-specific factors, duration of education of ≥12 years was independently associated with DFR (odds ratio 4.74, 95% confidence interval 2.70–8.32 for 12–15 years; odds ratio 7.24, 95% confidence interval 3.96–13.23 for ≥16 years).

Conclusion: Educational attainment was a robust independent predictor of 1-year DFR even when adjusting for other prognostic factors. A dose-response relationship was noted, with longer educational exposure associated with increased odds of DFR. This suggests that cognitive reserve could be a factor driving neural adaptation during recovery from TBI.”

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