- Email: [email protected]
Physical and rehabilitation medicine management of heterotopic ossification in brain injury
Light to moderate traumatic brain injuries / Annals of Physical and Rehabilitation Medicine 59S (2016) e131–e137
executive functions were evaluated by the DEX scale. The global social-functional evolution was measured by the GOS scale. Results The mean age was 32.19 ± 12.37 years with a sex-ratio of 3,5. The mean follow-up period was 3,9 ± 2.24 years. Fifteen patients (55.6%) had severe TBI. Memory disorders were observed in 9 patients (36%) when evaluated by the MMS scale and in 5 patients (18.5%) by the GOAT scale. Depressive symptoms were found in 17 patients (70.4%); Moreover, anxiety was noted in 15 patients (55.6%). Behavioral troubles, such as aggressiveness and agitation were noted respectively in 17 (63%) and 6 patients (22.2%). Severe agitation level was found in one patient (3.7%). Abnormal executive functions were noted in 17 patients (76.7%) with an average. Dex score of 23.68 ± 22.8. The most affected dimensions were intentionality and negative affect. Dex score of 23.68 ± 22.8. The most affected dimensions were intentionality and negative affect. We have found correlations between cognitive impairment and the education level (P < 0.01), between aggression and male sex (P < 0.01) and between abnormal executive functions and the initial GSC score (P = 0.04, r = –0.43). The lack of overall improvement (GOS scale) was correlated to the degree of abnormal executive function (P = 0.02). Discussion–conclusion The executive function disorders, depressed mood and the memory disorders seemed to be the most frequent among neuropsychological disorders in TBI. We noted that it is so important to evaluate neuropsychological disorders in TBI because they were underestimated. We have started this experience despite the lack of means in our department. The evaluation of the executive function in addition to the classic neurospsychological assessment is essential to propose efficient means of rehabilitation. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.302 PO018
Fatigue in traumatic brain injury patients
Sameh Ghroubi ∗ , Islem Feki , Samar Alila , Mohamed Habib Elleuch CHU Habib Bourguiba, service service de médecine physique, rééducation et réadaptation fonctionnelle, unité de recherche de l’évaluation des pathologies de l’appareil locomoteur UR12ES18, université de Sfax, route de l’Aéroport 0,5 km, BP 1169, 3029 Sfax, Morocco ∗ Corresponding author. E-mail address: [email protected] (S. Ghroubi) Objective The goal of the study was to assess fatigue in traumatic brain injury patients (TBI), identify potential predictors of its occurrence and its impact on quality of life. Material/patients and methods We conducted a cross-sectional descriptive study about 25 patients suffering from TBI conducted in the physical medicine and rehabilitation department. The fatigue assessment was performed by two scales: Fatigue Severity Scale (FSS) and EVA Fatigue (EVAF). Depression was evaluated by the HAD scale. Quality of life was assessed by (SF36) scale. Results The average age of our patients was 32.19 ± 12.37 with a sex-ratio of 3.5. Thirteen patients (52%) were victims of severe TBI. Fatigue was present in 64% of patients (FSS > 36). The mean score calculated by the FSS scale was 42.64 ± 16.43. The mean EVA Fatigue was 5.23 ± 2.32. Depressive symptoms was found in 68% of TBI, 94% of them have expressed fatigue (P = 0.01). The average score for quality of life assessed by SF36 was 43.63 ± 15.8. We found a significant correlation between the FSS score and the SF36 score (P < 0.01, r = –0.76). Fatigue was more common in males (P = 0.01, r = 0.53). In addition, fatigue was negatively correlated with the level of education (P = 0.03, r = –0.44). However, fatigue was not related to the period length after TBI, the initial GSG score or to the age.
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Discussion–conclusion Fatigue is a persistent symptom after traumatic brain injury. It is often undervalued. Depressive symptoms may be responsible for its appearance. Fatigue had a significant impact on quality of life. The proposal for specific rehabilitation protocols taking into account the aspect of fatigue may be efficient for these patients. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.303 PO019
Quality of life after traumatic brain injury
Sameh Ghroubi ∗ , Samar Alila , Islem Feki , Mohamed Habib Elleuch CHU Habib Bourguiba, service service de médecine physique, rééducation et réadaptation fonctionnelle, unité de recherche de l’évaluation des pathologies de l’appareil locomoteur UR12ES18, université de Sfax, route de l’Aéroport 0,5 km, BP 1169, 3029 Sfax, Morocco ∗ Corresponding author. E-mail address: [email protected] (S. Ghroubi) Objective The aim of this study was to assess the quality of life (QoL) of traumatic brain injury (TBI) patients and to explore its predictive factors. Material/patients and methods This is a descriptive and analytical cross-sectional study, including 27 TBI patients followed in the physical medicine and rehabilitation department (PMR). The collected data were: age, educational level, marital status, initial Glosgow score and intensive care unit length of stay. The assessment of the QoL was based on two scales, the first one was specific: Quality of Life after Brain Injury (QOLIBRI), while the second was generic: the SF-36. We had assessed memory disorders by the mini-mental state (MMS) and functional capacity by The Functional Independence Measure (FIM). The handicap was assessed by Go Outcome Scale (GOS). Possible correlations between QoL and the different variables were explored. Results The mean age of patients was 32.19 years. For QOLIBRI scale, the overall average score was 48.03%, the most affected dimensions were the feelings and social relations. Regarding the SF-36 scale, impaired QoL was found in 74% of these patients, the overall average score was 43.02. A significant correlation was found between QOLIBRI and mental composite score of the SF36 (P = 0.012). Memory disorder was significantly correlated with QoL (P = 0.037). There were no statistically significant correlations between QoL and the other variables. Discussion–conclusion Memory disorder was the main predictive factor of impaired quality of life of traumatic brain injury patients; however, there was no correlation between handicap and QoL. This alteration of QOL has clinical implications and highlights the necessity of more efforts to optimize the rehabilitation interventions. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.304 PO020
Physical and rehabilitation medicine management of heterotopic ossification in brain injury Khawla Achour , Eya Mersni , Bassem Krifa , Emna Bahlouli , Sonia Lebib ∗ , Catherine Dziri Institut d’orthopédie Kassab, médecine physique, La Mannouba, Tunisia ∗ Corresponding author. E-mail address: [email protected] (S. Lebib)
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Light to moderate traumatic brain injuries / Annals of Physical and Rehabilitation Medicine 59S (2016) e131–e137
Objective The aim of this work is to determine the epidemiological and characteristics and the therapeutic modalities of heterotopic ossification in brain injury. Material/patients and methods Retrospective study conducted between January 2010 and January 2016, including patients hospitalized for management of sequelae of an isolated head injury or associated with multiple trauma, and in whom the diagnosis of of heterotopic ossification (HO) was increased. A review of epidemiological data (including age, sex, occupation, type of neurological injury, discovering circumstances of HO), clinical data, the therapeutic choice and evolutivity. Results Twenty-nine patients with HO were included in the study, 22 adults and 7 children. A male predominance was noted with a sex ratio of 3/1. Mean Glasgow Outcome scale following the trauma was 6/15. Muscle retractions were noted in 23 patients, mainly affecting the upper limb muscles of the wrist and hands and leg sural triceps. Forty-three HO were found in 29 patients. The main locations of HO were respectively hips, knees and elbows. All patients had rehabilitation and working life skills adapted to the evolutionary stage of the brain trauma. Drug treatment included non-steroidal anti-inflammatory and analgesic. HO resection was performed in 15 patients having significant functional limitation or a painful nerve compression. Six adults were able to resume their old job and three children were able to resume normal schooling. Discussion–conclusion The recruitment of our patients has been among the severe trauma patients explaining the high incidence of heterotopic ossifications (HO). The hip is the location most frequently found which is comparable to the literature data. This work highlights the importance of early detection and multidisciplinary management of HO in brain injury patients. These HO will determine the functional prognosis and the social and professional reintegration of the brain injury patient. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.305 PO021
Factors influencing the quality of life in traumatic brain injury: Tunisian experience Emna bahlouli , Mariem Rekik , Bassam Krifa , Khawla Achour , Sonia Lebib ∗ , Fatma Ezzahra Ben Salah , Catherine Dziri Institut Kassab d’orthopédie de Tunis, médecine physique et réadaptation fonctionnelle, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (S. Lebib) Objective The aim of this study was to investigate the quality of life of patients with severe traumatic brain injury and their relatives by a visual analogue scale (0–10) and a distress companion score (1–6) and to establish correlations between Glasgow Coma Scale (GCS), Glasgow out scale (GOS), the Functional Independence Measure (FIM) and QOL. Material/patients and methods Retrospective study conducted in the department of physical and rehabilitation medicine of Kassab Institute of Traumatology and Orthopaedics concerning patients followed for severe traumatic brain injury sequalea. Results Thirty patients were included in the study. The mean initial GCS score was of 5.74/15. The GOS was of 5 in eleven patients, 4 in eight, and 3 in eleven. The mean FIM was 104/126 (74–126) but dependence in advanced activities was more severe than in elementary activities. The subjective QOL of patients was discretely lower (m = 4.7/10) than that estimated by close relatives (m = 5). The relatives QOL was similarly reduced (m = 4.47). The mean distress accompanying score was 3.7/6. The factors most influencing the patients and relatives QOL were the dependence in the advanced activities and the GOS.
Discussion–conclusion The reduction of patient and “relatives” QOL was mainly influenced by functional dependence however, new influencing factors have to be more studied, such as impairment, disability and handicap. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.306 PO022
Family vulnerability of children with traumatic brain injury Bassam Krifa , Leila Ghidaoui , Emna Bahlouli , Ines Loubiri , Mariem Rekik , Imen Miri ∗ , Fatma Ezzahra Ben Salah , Catherine Dziri Institut Kassab d’orthopédie de Tunis, médecine physique et réadaptation fonctionnelle, Tunis, Tunisie ∗ Corresponding author. E-mail address: [email protected] (I. Miri) Objective To report the family impact of traumatic brain injury in children. Material/patients and methods Prospective study conducted in the department of physical and rehabilitation medicine of Kassab Institute of Traumatology and Orthopaedics concerning children followed for traumatic brain injury sequalea. Results Twelve children were included in the study with a mean age of 8.3 years. Brain injury was related to a road accident in 11 children and domestic accident in 1 child. Seven children among 12 studied when the accident occurred, 4 have continued their studies after the trauma but with considerable learning difficulties. We noted conflict related to trauma in 4 families without divorce. Three parents had to interrupt work. Additional financial burdens have been reported in 11 families. The psychobalance of other noninjured children was disrupted in 6 families with school deflection. The extent of the distress felt by the parents was assessed (scored from 1 to 6) with an average of 5.2. No home adaptations have been made and no family has benefited from associative or social assistance. Discussion–conclusion Traumatic brain injury disturbs seriously the child’s mental balance and his family. It represents real public health problem. Disclosure of interest The author has not supplied his declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.307 PO023
Healthcare pathway after sever traumatic brain injury: About a Tunisian population Soumaya Boudokhane , Amine Kalai , Aymen Haj Salah , Houda Migaou , Sana Salah , Anis Jellad ∗ , Mourad Gahbiche , Zohra Ben Salah Frih CHU Fattouma Bourguiba Monastir, faculté de médecine, université de Monastir, médecine physique et réadaptation fonctionnelle, Monastir, Tunisia ∗ Corresponding author. E-mail address: [email protected] (A. Jellad) Objective The aim of our study was to determine the demographic characteristics and the pathway of severe traumatic brain injury (STBI) victims in the Tunisian population. Material/patients and methods Our study included 26 patients victims of STBI hospitalized in intensive care unit, among 450 traumatic head injuries admitted to the Teaching Hospital of Fattouma Bourguiba in Monastir during the year 2014. The studied parameters were: demographic characteristics of the population, circumstances of the accident, transport modalities to the hospi-
executive functions were evaluated by the DEX scale. The global social-functional evolution was measured by the GOS scale. Results The mean age was 32.19 ± 12.37 years with a sex-ratio of 3,5. The mean follow-up period was 3,9 ± 2.24 years. Fifteen patients (55.6%) had severe TBI. Memory disorders were observed in 9 patients (36%) when evaluated by the MMS scale and in 5 patients (18.5%) by the GOAT scale. Depressive symptoms were found in 17 patients (70.4%); Moreover, anxiety was noted in 15 patients (55.6%). Behavioral troubles, such as aggressiveness and agitation were noted respectively in 17 (63%) and 6 patients (22.2%). Severe agitation level was found in one patient (3.7%). Abnormal executive functions were noted in 17 patients (76.7%) with an average. Dex score of 23.68 ± 22.8. The most affected dimensions were intentionality and negative affect. Dex score of 23.68 ± 22.8. The most affected dimensions were intentionality and negative affect. We have found correlations between cognitive impairment and the education level (P < 0.01), between aggression and male sex (P < 0.01) and between abnormal executive functions and the initial GSC score (P = 0.04, r = –0.43). The lack of overall improvement (GOS scale) was correlated to the degree of abnormal executive function (P = 0.02). Discussion–conclusion The executive function disorders, depressed mood and the memory disorders seemed to be the most frequent among neuropsychological disorders in TBI. We noted that it is so important to evaluate neuropsychological disorders in TBI because they were underestimated. We have started this experience despite the lack of means in our department. The evaluation of the executive function in addition to the classic neurospsychological assessment is essential to propose efficient means of rehabilitation. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.302 PO018
Fatigue in traumatic brain injury patients
Sameh Ghroubi ∗ , Islem Feki , Samar Alila , Mohamed Habib Elleuch CHU Habib Bourguiba, service service de médecine physique, rééducation et réadaptation fonctionnelle, unité de recherche de l’évaluation des pathologies de l’appareil locomoteur UR12ES18, université de Sfax, route de l’Aéroport 0,5 km, BP 1169, 3029 Sfax, Morocco ∗ Corresponding author. E-mail address: [email protected] (S. Ghroubi) Objective The goal of the study was to assess fatigue in traumatic brain injury patients (TBI), identify potential predictors of its occurrence and its impact on quality of life. Material/patients and methods We conducted a cross-sectional descriptive study about 25 patients suffering from TBI conducted in the physical medicine and rehabilitation department. The fatigue assessment was performed by two scales: Fatigue Severity Scale (FSS) and EVA Fatigue (EVAF). Depression was evaluated by the HAD scale. Quality of life was assessed by (SF36) scale. Results The average age of our patients was 32.19 ± 12.37 with a sex-ratio of 3.5. Thirteen patients (52%) were victims of severe TBI. Fatigue was present in 64% of patients (FSS > 36). The mean score calculated by the FSS scale was 42.64 ± 16.43. The mean EVA Fatigue was 5.23 ± 2.32. Depressive symptoms was found in 68% of TBI, 94% of them have expressed fatigue (P = 0.01). The average score for quality of life assessed by SF36 was 43.63 ± 15.8. We found a significant correlation between the FSS score and the SF36 score (P < 0.01, r = –0.76). Fatigue was more common in males (P = 0.01, r = 0.53). In addition, fatigue was negatively correlated with the level of education (P = 0.03, r = –0.44). However, fatigue was not related to the period length after TBI, the initial GSG score or to the age.
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Discussion–conclusion Fatigue is a persistent symptom after traumatic brain injury. It is often undervalued. Depressive symptoms may be responsible for its appearance. Fatigue had a significant impact on quality of life. The proposal for specific rehabilitation protocols taking into account the aspect of fatigue may be efficient for these patients. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.303 PO019
Quality of life after traumatic brain injury
Sameh Ghroubi ∗ , Samar Alila , Islem Feki , Mohamed Habib Elleuch CHU Habib Bourguiba, service service de médecine physique, rééducation et réadaptation fonctionnelle, unité de recherche de l’évaluation des pathologies de l’appareil locomoteur UR12ES18, université de Sfax, route de l’Aéroport 0,5 km, BP 1169, 3029 Sfax, Morocco ∗ Corresponding author. E-mail address: [email protected] (S. Ghroubi) Objective The aim of this study was to assess the quality of life (QoL) of traumatic brain injury (TBI) patients and to explore its predictive factors. Material/patients and methods This is a descriptive and analytical cross-sectional study, including 27 TBI patients followed in the physical medicine and rehabilitation department (PMR). The collected data were: age, educational level, marital status, initial Glosgow score and intensive care unit length of stay. The assessment of the QoL was based on two scales, the first one was specific: Quality of Life after Brain Injury (QOLIBRI), while the second was generic: the SF-36. We had assessed memory disorders by the mini-mental state (MMS) and functional capacity by The Functional Independence Measure (FIM). The handicap was assessed by Go Outcome Scale (GOS). Possible correlations between QoL and the different variables were explored. Results The mean age of patients was 32.19 years. For QOLIBRI scale, the overall average score was 48.03%, the most affected dimensions were the feelings and social relations. Regarding the SF-36 scale, impaired QoL was found in 74% of these patients, the overall average score was 43.02. A significant correlation was found between QOLIBRI and mental composite score of the SF36 (P = 0.012). Memory disorder was significantly correlated with QoL (P = 0.037). There were no statistically significant correlations between QoL and the other variables. Discussion–conclusion Memory disorder was the main predictive factor of impaired quality of life of traumatic brain injury patients; however, there was no correlation between handicap and QoL. This alteration of QOL has clinical implications and highlights the necessity of more efforts to optimize the rehabilitation interventions. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.304 PO020
Physical and rehabilitation medicine management of heterotopic ossification in brain injury Khawla Achour , Eya Mersni , Bassem Krifa , Emna Bahlouli , Sonia Lebib ∗ , Catherine Dziri Institut d’orthopédie Kassab, médecine physique, La Mannouba, Tunisia ∗ Corresponding author. E-mail address: [email protected] (S. Lebib)
e136
Light to moderate traumatic brain injuries / Annals of Physical and Rehabilitation Medicine 59S (2016) e131–e137
Objective The aim of this work is to determine the epidemiological and characteristics and the therapeutic modalities of heterotopic ossification in brain injury. Material/patients and methods Retrospective study conducted between January 2010 and January 2016, including patients hospitalized for management of sequelae of an isolated head injury or associated with multiple trauma, and in whom the diagnosis of of heterotopic ossification (HO) was increased. A review of epidemiological data (including age, sex, occupation, type of neurological injury, discovering circumstances of HO), clinical data, the therapeutic choice and evolutivity. Results Twenty-nine patients with HO were included in the study, 22 adults and 7 children. A male predominance was noted with a sex ratio of 3/1. Mean Glasgow Outcome scale following the trauma was 6/15. Muscle retractions were noted in 23 patients, mainly affecting the upper limb muscles of the wrist and hands and leg sural triceps. Forty-three HO were found in 29 patients. The main locations of HO were respectively hips, knees and elbows. All patients had rehabilitation and working life skills adapted to the evolutionary stage of the brain trauma. Drug treatment included non-steroidal anti-inflammatory and analgesic. HO resection was performed in 15 patients having significant functional limitation or a painful nerve compression. Six adults were able to resume their old job and three children were able to resume normal schooling. Discussion–conclusion The recruitment of our patients has been among the severe trauma patients explaining the high incidence of heterotopic ossifications (HO). The hip is the location most frequently found which is comparable to the literature data. This work highlights the importance of early detection and multidisciplinary management of HO in brain injury patients. These HO will determine the functional prognosis and the social and professional reintegration of the brain injury patient. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.305 PO021
Factors influencing the quality of life in traumatic brain injury: Tunisian experience Emna bahlouli , Mariem Rekik , Bassam Krifa , Khawla Achour , Sonia Lebib ∗ , Fatma Ezzahra Ben Salah , Catherine Dziri Institut Kassab d’orthopédie de Tunis, médecine physique et réadaptation fonctionnelle, Tunis, Tunisia ∗ Corresponding author. E-mail address: [email protected] (S. Lebib) Objective The aim of this study was to investigate the quality of life of patients with severe traumatic brain injury and their relatives by a visual analogue scale (0–10) and a distress companion score (1–6) and to establish correlations between Glasgow Coma Scale (GCS), Glasgow out scale (GOS), the Functional Independence Measure (FIM) and QOL. Material/patients and methods Retrospective study conducted in the department of physical and rehabilitation medicine of Kassab Institute of Traumatology and Orthopaedics concerning patients followed for severe traumatic brain injury sequalea. Results Thirty patients were included in the study. The mean initial GCS score was of 5.74/15. The GOS was of 5 in eleven patients, 4 in eight, and 3 in eleven. The mean FIM was 104/126 (74–126) but dependence in advanced activities was more severe than in elementary activities. The subjective QOL of patients was discretely lower (m = 4.7/10) than that estimated by close relatives (m = 5). The relatives QOL was similarly reduced (m = 4.47). The mean distress accompanying score was 3.7/6. The factors most influencing the patients and relatives QOL were the dependence in the advanced activities and the GOS.
Discussion–conclusion The reduction of patient and “relatives” QOL was mainly influenced by functional dependence however, new influencing factors have to be more studied, such as impairment, disability and handicap. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.306 PO022
Family vulnerability of children with traumatic brain injury Bassam Krifa , Leila Ghidaoui , Emna Bahlouli , Ines Loubiri , Mariem Rekik , Imen Miri ∗ , Fatma Ezzahra Ben Salah , Catherine Dziri Institut Kassab d’orthopédie de Tunis, médecine physique et réadaptation fonctionnelle, Tunis, Tunisie ∗ Corresponding author. E-mail address: [email protected] (I. Miri) Objective To report the family impact of traumatic brain injury in children. Material/patients and methods Prospective study conducted in the department of physical and rehabilitation medicine of Kassab Institute of Traumatology and Orthopaedics concerning children followed for traumatic brain injury sequalea. Results Twelve children were included in the study with a mean age of 8.3 years. Brain injury was related to a road accident in 11 children and domestic accident in 1 child. Seven children among 12 studied when the accident occurred, 4 have continued their studies after the trauma but with considerable learning difficulties. We noted conflict related to trauma in 4 families without divorce. Three parents had to interrupt work. Additional financial burdens have been reported in 11 families. The psychobalance of other noninjured children was disrupted in 6 families with school deflection. The extent of the distress felt by the parents was assessed (scored from 1 to 6) with an average of 5.2. No home adaptations have been made and no family has benefited from associative or social assistance. Discussion–conclusion Traumatic brain injury disturbs seriously the child’s mental balance and his family. It represents real public health problem. Disclosure of interest The author has not supplied his declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.307 PO023
Healthcare pathway after sever traumatic brain injury: About a Tunisian population Soumaya Boudokhane , Amine Kalai , Aymen Haj Salah , Houda Migaou , Sana Salah , Anis Jellad ∗ , Mourad Gahbiche , Zohra Ben Salah Frih CHU Fattouma Bourguiba Monastir, faculté de médecine, université de Monastir, médecine physique et réadaptation fonctionnelle, Monastir, Tunisia ∗ Corresponding author. E-mail address: [email protected] (A. Jellad) Objective The aim of our study was to determine the demographic characteristics and the pathway of severe traumatic brain injury (STBI) victims in the Tunisian population. Material/patients and methods Our study included 26 patients victims of STBI hospitalized in intensive care unit, among 450 traumatic head injuries admitted to the Teaching Hospital of Fattouma Bourguiba in Monastir during the year 2014. The studied parameters were: demographic characteristics of the population, circumstances of the accident, transport modalities to the hospi-