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Problem: Uninterrupted nighttime sleep is associated with better cognition and functional outcomes in healthy adults, but the relationship between sleep and functional outcome in individuals hospitalized with severe traumatic brain injury (TBI) remains to be clarified. Objective: The aims of this study were to (1) describe nighttime rest-activity variables--wake bouts (counts), total wake time (minutes), and sleep efficiency (SE) (percentage; time asleep/time in bed)--in people on a neuroscience step-down unit (NSDU) post-TBI and (2) describe the association between injury and nighttime rest-activity on post-TBI functional outcome (using Functional Independence Measure [FIM] at discharge from inpatient care). Methods: This study is a cross-sectional, descriptive pilot study. We recruited participants from the NSDU (n = 17 [age: mean (SD), 63.4 (17.9)]; 82% male, 94% white) who wore wrist actigraphy (source of nighttime rest-activity variables) for up to 5 nights. For injury variables, we used Glasgow Coma Scale (GCS) score and Injury Severity Score (ISS). We used Spearman p and regression to measure associations. Results: Glasgow Coma Scale mean (SD) score was 8.8 (4.9), ISS mean (SD) score was 23.6 (6.7), and FIM mean (SD) score was 48 (14.5). Averages of nighttime rest-activity variables (8 PM-7 AM) were as follows: SE, 73% (SD, 16); wake bouts, 41 counts (SD, 18); total wake time, 74 minutes (SD, 47). Correlations showed significance between FIM and GCS (P = .005) and between SE and GCS (P = .015). GCS was the only statistically significant variable associated with FIM (P = .013); we eliminated other variables from the model as nonsignificant (P> .10). Sleep efficiency and FIM association was nonsignificant (P = .40). In a separate model (ISS, GCS, and SE [dependent variable]), GCS was significant (P = .04), but ISS was not (P = .25). Conclusion: Patients with severe TBI on the NSDU have poor actigraphic sleep at night. GCS has a stronger association to functional outcome than nighttime rest-activity variables. Keywords: actigraphy, neuro step-down unit, outcome, TBI, The quality of nighttime sleep is an important yet obscure phenomenon for the nearly 300 000 people in the United States who are in the hospital for traumatic brain injury [...]

Background. Peripheral sensory stimulation has been used in conjunction with upper extremity movement therapy to increase therapy-induced motor gains in patients with stroke. The limitation is that existing sensory stimulation methods typically interfere with natural hand tasks and thus are administered prior to therapy, requiring patients' time commitment. To address this limitation, we developed TheraBracelet. This novel stimulation method provides subthreshold (ie, imperceptible) vibratory stimulation to the wrist and can be used during hand tasks/therapy without interfering with natural hand tasks. Objective. The objective was to determine the feasibility of using TheraBracelet during therapy to augment motor recovery after stroke. Design. The design was a triple-blinded pilot randomized controlled trial. Methods. Twelve chronic stroke survivors were assigned to die treatment or control group. All participants completed 2-hour task practice therapy sessions thrice weekly for 2 weeks. Both groups wore a small vibrator on the paretic wrist, which was turned on to provide TheraBracelet stimulation for the treatment group and turned off for the control group to provide sham stimulation. Outcome measures (Box and Block Test [BBT] and Wolf Motor Function Test [WMFT]) were obtained at baseline, 6 days after therapy, and at follow-up 19 days after therapy. Results. The intervention was feasible with no adverse events. The treatment group significantly improved their BBT scores after therapy and at follow-up compared with baseline, whereas die control group did not. For WMFT, the group x time interaction was short of achieving significance. Large effect sizes were obtained (BBT d = 1.43, WMFT d = 0.87). No indication of desensitization to TheraBracelet stimulation was observed. Limitations. The limitation was a small sample size. Conclusions. TheraBracelet could be a promising therapy adjuvant for upper extremity recovery after stroke., Stroke is the leading cause of long-term disability in the United States. (1,2) More than two-thirds of nearly 7 million stroke survivors in the United States (2) have persistent impairment [...]

Keywords: outcome, patient centered, stroke Background An outcome measure to assess functional recovery after stroke that is easily obtainable and meaningful to the patient can be very useful for assessing [...]

By the time you've decided to undergo a total knee replacement (TKR), you've probably reached a low point. The pain in your arthritic knee has become intolerable, and traversing a [...]

When you or your child has a disability, I am sure that you try to stay up to date with what the latest research is studying--and what results seem promising. [...]