Y. Wooten Evidence Based Article Week 5

Gould, K., Johnston, L.,  Ponsford, J.L., Schonberger, M. (2011).  Predictive and           associated factors of psychiatric disorders after traumatic brain injury: a prospective study.  Journal of Neurotrauma. 28(7): 1155-63

       The occurrence of psychiatric disorders following traumatic brain injury (TBI) is common and well documented in research.  However, it has not been completely clear which factors are predictive of these disorders and which are simply associated with TBI.   In this study 122 participants with TBI are being evaluated during their in-patient admission and 12 months post injury.  The aim of this study is determine which factors, if any are predictors of psychiatric disorders 12 months post TBI and if any particular disorders are more common place than others.   Participants are given structured clinical interviews consisting of the following inventories:  Alcohol Use Disorders Identification Test (AUDIT), Brief Pain Inventory, Quality of Life Inventory and Coping Scale for Adults.   Results show that a history of mental health counseling and unemployment are significant factors in predicting psychiatric disorders 12 months post injury.  Limb injury is also a significant predictor. Disorders that are most commonly associated with post TBI are: anxiety, major depression, and bipolar disorder.  TBI patients with these disorders commonly have poor coping skills, unemployment, and pain.

       It’s important for therapists to be aware of any psychiatric issues their patients may have through chart reviews and speaking with hospital or facility staff.  These issues can often impede treatment by decreasing session tolerance and attention leading to self-doubt or even aggression.  Therapists need to be able to use clinical judgement and flexibility in using appropriate activities for when psychiatric issues are exacerbated.  Most importantly therapists need to keep in mind the necessary safety measures for ensuring a safe environment.

Article:

Predictive and Associated Factors of Psychiatric Disorders after Traumatic Brain Injury: A Prospective Study

Author: Gould, Kate Rachel; Ponsford, Jennie Louise; Johnston, Lisa; Schönberger, Michael

ProQuest document link

Abstract:

Psychiatric disorders are common and often debilitating following traumatic brain injury (TBI). However, there is little consensus within the literature regarding the risk factors for post-injury psychiatric disorders. A 1-year prospective study was conducted to examine which pre-injury, injury-related, and concurrent factors were associated with experiencing a psychiatric disorder, diagnosed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, at 1 year post-injury. Participants were 122 adults with TBI and 88 proxy informants. Psychiatric disorders were common both pre-injury (54.1%) and at 12 months post-injury (45.9%). Results of regression analyses indicated individuals without a pre-injury psychiatric disorder or psychiatric symptomatology in the acute post-injury period were less likely to have a psychiatric disorder at 12 months post-injury. These findings confirm the importance of pre-injury history for the prediction of post-injury psychiatric disorders. Limb injury also emerged as a useful early indicator of later psychiatric disorder. Post-injury psychiatric disorders were associated with concurrent unemployment, pain, poor quality of life, and use of unproductive coping skills. The clinical implications of these findings are discussed. [PUBLICATION ABSTRACT]

Links:Check for Full Text at CCBC

Full text: Not available.

Subject: Mental disorders; Brain damage; Head injuries; Neuropsychology; Risk factors

MeSH: Adolescent, Adult, Aged, Aged, 80 & over, Brain Injuries -- complications, Comorbidity, Delirium, Dementia, Amnestic, Cognitive Disorders -- etiology, Female, Humans, Incidence, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Risk Factors, Time Factors, Young Adult, Brain Injuries -- diagnosis (major), Brain Injuries -- epidemiology (major), Delirium, Dementia, Amnestic, Cognitive Disorders -- diagnosis (major), Delirium, Dementia, Amnestic, Cognitive Disorders -- epidemiology (major)

Week 4 Suliman: Fear Avoidance behaviors

Sam's had a lot of thinking to do on OT's role in pain management. In preparation for his presentation, he decided to look into some suggestions on good frames of reference for pain psych functional outcome measurements, leading to his interest in the Fear Avoidance Behavior Questionnaire:

The study he read is attached here:
http://mab.to/4Mj1qXEUi

Occupational therapy was once defined in a very unique way. Thinking of anything that occupies your time, and maintaining a personal plateau of independence. With that being said, it is hard to complete any activity that normally occupies our time when pain is being experienced. Many people use compensatory body mechanics in order to self-relieve experienced pain. Often movement will initiate pain response which causes people to fear re-injuring and injury. The article summarized is a cross-sectional study of psychological and social factors perceived with fear-avoidance. This study was focused on work absences due to back pain, and up to ninety percent of medical and compensation costs. Participants in this study were referred to a neck and back pain clinic as part of the initiating criteria. The participants ranged from eighteen through sixty years of age as well as ranging in socioeconomically diverse backgrounds. A comorbidity questionnaire was used to isolate patients experiencing back pain independent of other medical conditions as a way to evaluate back pain specifically in reference to fear-avoidance. This article concluded that those who have very little reward in returning to their optimal functioning were more susceptible to fear-avoidance. Those who gained the most from returning to optimal functioning expressed more motivation in the recovery processed and moved more frequently. This study is important in gaging motivation as well as psychological impacts of patients in treatment sessions. Understanding this will allow therapist to implement more client-centered therapy.

Info on Bed Bugs

**I just recieved these resources to increase awareness and knowledge on bed bugs (Unfortunately a problem many of our clients face in the ADCs). Feel free to share with ADC staff and patients! The below info is copied directly from the Hopkins email I received from Johns Hopkins Hospital. **

Bed Bug Information

What are bed bugs?

Bed bugs (Cimex lectularius) are small, flat, parasitic insects that feed solely on the blood of people and animals while they sleep. Bed bugs are reddish-brown in color, wingless, range from 1mm to 7mm (roughly the size of Lincoln’s head on a penny), and can live several months without a blood meal.

Where are bed bugs found?

Bed bug infestations usually occur around or near the areas where people sleep. These areas include apartments, shelters, rooming houses, hotels, cruise ships, buses, trains, and dorm rooms. They hide during the day in places such as seams of mattresses, box springs, bed frames, headboards, dresser tables, inside cracks or crevices, behind wallpaper, or any other clutter or objects around a bed. Bed bugs have been shown to be able to travel over 100 feet in a night but tend to live within 8 feet of where people sleep.

Do bed bugs spread disease?

Bed bugs should not be considered as a medical or public health hazard. Bed bugs are not known to spread disease. Bed bugs can be an annoyance because their presence may cause itching and loss of sleep. Sometimes the itching can lead to excessive scratching that can sometimes increase the chance of a secondary skin infection.

What health risks do bed bugs pose?

A bed bug bite affects each person differently. Bite responses can range from an absence of any physical signs of the bite, to a small bite mark, to a serious allergic reaction. Bed bugs are not considered to be dangerous; however, an allergic reaction to several bites may need medical attention.

What are the signs and symptoms of a bed bug infestation?

One of the easiest ways to identify a bed bug infestation is by the tell-tale bite marks on the face, neck, arms, hands, or any other body parts while sleeping. However, these bite marks may take as long as 14 days to develop in some people so it is important to look for other clues when determining if bed bugs have infested an area. These signs include:

·       the bed bugs’ exoskeletons after molting

·       bed bugs in the fold of mattresses and sheets

·       rusty–colored blood spots due to their blood-filled fecal material that they excrete on the mattress or nearby furniture, and a sweet musty odor.

How do I know if I’ve been bitten by a bed bug?

It is hard to tell if you’ve been bitten by a bed bug unless you find bed bugs or signs of infestation. When bed bugs bite, they inject an anesthetic and an anticoagulant that prevents a person from realizing they are being bitten. Most people do not realize they have been bitten until bite marks appear anywhere from one to several days after the initial bite. The bite marks are similar to that of a mosquito or a flea -- a slightly swollen and red area that may itch and be irritating. The bite marks may be random or appear in a straight line. Other symptoms of bed bug bites include insomnia, anxiety, and skin problems that arise from profuse scratching of the bites.

Because bed bug bites affect everyone differently, some people may have no reaction and will not develop bite marks or any other visible signs of being bitten. Other people may be allergic to the bed bugs and can react adversely to the bites. These allergic symptoms can include enlarged bite marks, painful swellings at the bite site, and, on rare occasions, anaphylaxis.

How did I get bed bugs?

Bed bugs are experts at hiding. Their slim flat bodies allow them to fit into the smallest of spaces and stay there for long periods of time, even without a blood meal. Bed bugs are usually transported from place to place as people travel. The bed bugs travel in the seams and folds of luggage, overnight bags, folded clothes, bedding, furniture, and anywhere else where they can hide. Most people do not realize they are transporting stow-away bed bugs as they travel from location to location, infecting areas as they travel.

How are bed bugs treated and prevented?

Bed bug bites usually do not pose a serious medical threat. The best way to treat a bite is to avoid scratching the area and apply antiseptic creams or lotions and take an antihistamine. Bed bug infestations are commonly treated by insecticide spraying.

Tenant and Homeowner
Bed Bugs Baltimore Resources

Bed bug control problems that have been spreading through Baltimore and other major cities. In Baltimore, the number of bed bug related 311 calls grew from an average of 0.16 per month in 2004 to 8.5 per month in 2008. The increase in calls has precipitated the government response indicated below.

Government Resources

If you have a Bed Bugs Baltimore problem, and live in the City of Baltimore, dial the free 311 service. The Baltimore City Health Department will send an inspector as part of their "Healthy Homes" initiative. This service is FREE and will confirm that you in fact have a bed bug problem. They will also provide advice on how to get rid of bed bugs in your home. Renters of single family homes are responsible for the bed bugs and should call 311 for help.

If you live in an apartment, contact the building's landlord in writing. They have an obligation to treat for bedbugs.

Often bed bugs are brought into an apartment building by visitors or when a used mattress or furniture is picked up from the street. Even rented furniture has been known to carry some risk or a new mattress that arrived on a truck that is also transporting older mattresses. Bed bugs do not appear because a person has clutter or isn't clean. They either travel from an adjoining apartment, or are carried into a household.

The Maryland Attorney Generals office has a hot line for Landlord and Tenant rights issues. The hot line number is toll-free (800) 487-6007.

You can also review the Baltimore City Health Department Bed bugs Baltimore information website (http://health.baltimorecity.gov/node/2026).

Bed Bug Advice for Baltimore Tenants - What to do

If you cannot afford Bed Bugs Baltimore treatment, and if you are a tenant that has requested bed bug treatment in writing (must be in a dated later sent registered mail), and have not gotten a bed bug inspection or treatment, we suggest:

1.     Calling the above Attorney General’s office number for help and advice. If you are still not satisfied then...

2.     Contact the firm described below (Whitney & Boris) to see if they will handle your case on contingency, which means that they will get a percentage of the settlement.

3.     As an alternative, if you are a low income resident. You can contact Maryland Legal aid for assistance at (410) 951-7777.

Do not navigate the law without the help of an attorney.

Bed Bug Advice for Baltimore Home Owners

The best approach is to call in an experienced bed bugs Baltimore based exterminator. Bed bug populations grow rapidly, and as they spread they could become more expensive to treat. We suggest starting by calling a national network such as Service Magic (1.877.233.1145). Members of the network are per-screened, licensed and insured.

So don't wait. We also have a list of pest control companies that are specifically qualified to treat bed bugs.

Go to http://www.bed-bugs-handbook.com/bed-bug-exterminator.html to find a qualified local bedbug exterminator near you. Please keep in mind that if the bed bugs are not treated correctly, insects missed will begin to multiply and the problem will return. Don't use a pest control company unless they have extensive experience treating bed bugs.

Tip: Be sure to ask about any costs, and ask if they provide a written guarantee as multiple treatments (2 to 3) are often needed.

Do It Yourself Treatment Advice

Some home owners prefer a do it yourself approach to bed bug treatment. This will work, although be prepared for some hard work.

Do it yourself kits are available that contain organic products (Bed Bug Patrol) or you can buy an insecticide based bed bug kit. The choice is a matter of preference. A kit is the best way to go as they provide the combination of products required to effectively end the infestation. No single spray alone will do the job. At minimum, be sure to purchase a knock down or contact spray which kills bed bugs on contact, and a residual spray that provides lasting protection. Kits also contain bed bug dust (also called diatomaceous earth or fossil dust) which is applied after spray treatment to provide another layer of protection.

It can take an entire day to do the job right. If bed bugs reappear after 2 to 3 treatments, consider hiring a professional. See the rest of this site for step by step directions on how to kill bedbugs.

Do not use foggers or bug bombs as these are not effective against bed bugs Baltimore problems. They just drive the bed bugs into the walls, only to have them return in 1 to 2 weeks.

http://www.bed-bugs-handbook.com/Bed-Bugs-Baltimore.html

Week 5 EBP article: E. Gaylor

A study published in 1983 in The American Journal of Occupational Therapy examined the effects of 5 different exercises on finger extension of CVA patients.  Ten post-CVA patients were recruited for the study from the outpatient population of Braintree Hospital, in Braintree, Massachusetts.  The five exercises that were used were resisted grasp, resisted extension, rapid extension, unresisted slow extension, and unresisted grasp/release.  Electromyography of the extrinsic finger muscles and electrogoniometry of the wrist and finger joints were used to measure motor unit recruitment and ROM. 

The results showed that resisted and rapid exercises recruited the highest percentages of output of the extensor digitorum, flexor digitorum profundus, and the flexor digitorum superficialis.  Slow, unresisted exercises preferentially recruited the extensor digitorum.  None of the exercises caused immediate significant changes in ROM flexor/extension balance, time required to open the hand, or level of activity of the extensor digitorum during the opening of the hand.  Resisted grasp did not limit finger extension. 

The original hypothesis that resisted extension would recruit the highest level of motor output of the extensor digitorum than any of the other exercises was not supported by the data.  Higher levels were seen during resisted grasp and rapid, unresisted extension.  The use of slow, unresisted extensor activity or release of large objects selectively recruited the extensor digitorum over the flexor muscles the most. 

                                                                                                                           

Trombly, C. A., & Quintana, L. A. (1983). The Effects of Exercise on Finger Extension of CVA Patients. American Journal of Occupational Therapy, 37(3), 195-202. doi:10.5014/ajot.37.3.195

Article

Week 4 Y. Wooten EBP Article

Gilmore, H. (2015). Chronic pain, activity restriction and flourishing mental health.  Health Reports, 26(1): 15-22.

       Studies of the past twenty years document the association between pain and depression.  Recent studies are now exploring the mediation factors that may explain this relationship such as age, intensity, and activity restriction. In this study the Activity Restriction (AR) model hypothesizes that pain intensity affects mental health by limiting activities of daily living (ADLs), work, leisure, and family roles. The study uses the Mental Health Continuum-Short Form (MHC-SF) to evaluate a sample 26,420 respondents from the Canadian Community Health Survey (CCHS) that report having chronic pain.  The MHC-SF consists of 14 questions that ask participants how they felt in terms of three factors: emotional, psychological, social well-being. Responses are given to one of five categories ranging “almost always” to “never”.

       Using this data as well as other information from the CCHS, the study concludes that participants with higher pain intensity are less likely to be in flourishing mental health than those with lower pain intensity.  Second greater pain intensity increases activity restriction.  This activity restriction mediates in large part the relationship between pain and mental health.  However, since age is also a mediator of pain intensity, further investigations are needed to determine whether it has more or less impact.  This is especially true for the older population.  Implications of this research call for an increase in occupational therapy (OT) practitioners.  OT practitioners are skilled in treating those patients with chronic pain conditions to participate in desire daily activities through rehabilitation, adaptations, and/or modifications.

Article

Week 4 EBP: Erin Gaylor

      A study published in the 2015 in Manual Therapy examined the effects of graded activity versus physiotherapy in patients with chronic low back pain in a randomized controlled trial.  66 patients with chronic nonspecific low back pain were recruited from Specialized Rehabilitation Services at Taboão de Serra in Sao Paulo, Brazil.  The participants were all between the ages of 10 to 65 years, and had a minimum pain intensity score of three in the 11-point Pain Numerical Rating Scale.  Before the intervention treatment, the patients were screened by a physiotherapist who assessed pain intensity and disability, along with secondary outcomes such as quality of pain, quality of life, global perceived effect, return to work, physical activity, physical capacity, and kinesiophobia. 

             For the intervention, the patients were randomized into either the Graded Activity Group or Physiotherapy Exercise Group.  Both groups went to hourly sessions twice a week for six weeks, for a total of 12 1-hour sessions.   The physiotherapy group performed stretching exercises that focused on the erector spinae, hamstrings, and triceps surae as well as strengthening exercises focusing on the rectus abdominus, abdominus obliques internus, and abdominus obliques externus.   They also performed motor control exercises focusing on the TrA and lumbar multifidus muscles. 

            The Graded Activity Group followed a program that consisted of individual sessions of progressive and sub-maximal exercises that aim to improve physical fitness and stimulate changes in behavior and attitude.  They performed aerobic training on a treadmill and lower limb and trunk strengthening exercises.  The patients also selected one or two activities that they considered difficult and received guidance on these throughout the treatment.  They also received an educational booklet with information on how to take care of the spine. 

            The results showed significant improvements in all outcome measures of both groups, with a non-significant difference between the groups. This study provided evidence that both graded activity and physiotherapy were effective for patients with chronic nonspecific low back pain.

Article