Traumatic Brain Injury Should be Recognized as Chronic Condition, Study Argues
By American Academy of Neurology
People with traumatic brain injury (TBI) may continue to improve or decline years after their injury, making it a more chronic illness, according to a study published in the June 21, 2023, online issue of Neurology.
"Our results dispute the notion that TBI is a one-time event with a stagnant outcome after a short period of recovery," said study author Benjamin L. Brett, Ph.D., of the Medical College of Wisconsin in Milwaukee. "Rather, people with TBI continue to show improvement and decline across a range of areas including their ability to function and their thinking skills."
The study involved people at 18 level 1 trauma center hospitals with an average age of 41. A total of 917 people had mild TBI and 193 people had moderate to severe TBI. They were matched to 154 people with orthopedic injuries but no head injuries. Participants were followed for up to seven years.
Participants took three tests on thinking, memory, mental health and ability to function with daily activities annually from two to seven years post-injury. They also completed an interview on their abilities and symptoms, including headache, fatigue, and sleep disturbances.
When researchers looked at all test scores combined, 21% of people with mild TBI experienced decline, compared to 26% of people with moderate to severe TBI and 15% of people with orthopedic injuries with no head injury.
Among the three tests, researchers saw the most decline over the years in the ability to function with daily activities. On average, over the course of 2 to 7 years post-injury, a total of 29% of those with mild TBI declined in their abilities and 23% of those with moderate to severe TBI.
Yet some people showed improvement in the same area, with 22% of those with mild TBI improving over time and 36% of those with moderate to severe TBI.
"These findings point out the need to recognize TBI as a chronic condition in order to establish adequate care that supports the evolving needs of people with this condition," Brett said. "This type of care should place a greater emphasis on helping people who have shown improvement continue to improve and implementing greater levels of support for those who have shown decline."
A limitation of the study was that all participants were seen at a level 1 trauma center hospital within 24 hours of their injury, so the findings may not apply to other populations. |
Trouble Falling Asleep, Staying Asleep Linked to Increased Risk of Stroke
By American Academy of Neurology
People who have insomnia symptoms such as trouble falling asleep, staying asleep and waking up too early, may be more likely to have a stroke, according to a study published in Neurology. In addition, researchers found the risk was much higher in people under 50 years old. The study does not prove that insomnia symptoms cause stroke; it only shows an association.
"There are many therapies that can help people improve the quality of their sleep, so determining which sleep problems lead to an increased risk of stroke may allow for earlier treatments or behavioral therapies for people who are having trouble sleeping and possibly reducing their risk of stroke later in life," said study author Wendemi Sawadogo, MD, MPH, Ph.D., of Virginia Commonwealth University in Richmond and member of the American Academy of Neurology.
The study involved 31,126 people with an average age of 61. Participants had no history of stroke at the beginning of the study.
Participants were asked four questions about how often they had trouble falling asleep, trouble with waking up during the night, trouble with waking up too early and not being able to return to sleep, and how often they felt rested in the morning. Response options included "most of the time", "sometimes" or "rarely or never." Scores ranged from zero to eight, with a higher number meaning more severe symptoms.
The people were then followed for an average of nine years. During that time, there were 2,101 cases of stroke.
After adjusting for other factors that could affect the risk of stroke including alcohol use, smoking and level of physical activity, researchers found that people with one to four symptoms had a 16% increased risk of stroke compared to people with no symptoms. Of the 19,149 people with one to four symptoms, 1,300 had a stroke. Of the 6,282 people with no symptoms, 365 had a stroke. People with five to eight symptoms of insomnia had a 51% increased risk. Of the 5,695 people with five to eight symptoms, 436 had a stroke.
The link between insomnia symptoms and stroke was stronger in participants under age 50 with those who experienced five to eight symptoms having nearly four times the risk of stroke compared to people with no symptoms. Of the 458 people under age 50 with five to eight symptoms, 27 had a stroke. People age 50 or older with the same number of symptoms had a 38% increased risk of stroke compared to people with 33 had a stroke.
"This difference in risk between these two age groups may be explained by the higher occurrence of stroke at an older age, " Sawadogo added. "The list of stroke risk factors such as high blood pressure and diabetes can grow as people age, making insomnia symptoms one of many possible factors. This striking difference suggests that managing insomnia symptoms at a younger age may be an effective strategy for stroke prevention. Future research should explore the reduction of stroke risk through management of sleeping problems."
This association increased further for people with diabetes, hypertension, heart disease and depression.
A limitation of the study was that people reported their own symptoms of insomnia, so the information may not have been accurate.
More information: Neurology (2023).
Journal information: Neurology |
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President’s Legislative Update
The State Legislative Session ended in mid-May. It was an extraordinarily busy session. The Association Lobbyist followed multiple bills important to Physical Therapists in Colorado. Chris Edmundson, Governance Affairs Chair, testified on behalf of APTACO on House Bill 1116-Contracts Between Carriers and Providers. This Bill requires that any contract between a health insurance carrier and a health care provider include at least one method of payment to the provider that does not have a fee and prohibits that contractor from only accepting virtual credit card payments. In addition, the bill allows providers to charge a reasonable fee related to transaction management, data management or other value-added services back to the carrier-essentially allowing you to recoup fees on virtual payments. Enforcement of this section is under the Commissioner of Insurance. The Bill had bipartisan support with a 57-2 vote in the House and 35-0 vote in the Senate and was signed into law by Governor Polis. This law will go into effect on August 7, 2023. At this time, APTA is not able to provide guidance on what would be considered a reasonable fee or how best to charge the carrier. Through coordination with the bill sponsors and other provider groups, we intend to send out guidance to our members prior to August 7th.
Our Lobby team, with speed and foresight, headed off Medicaid’s attempt to require Electronic Visit Verification (EVV) compliance for outpatient therapies that are delivered by telehealth. This was a departure from the Association’s understanding that EVV requirements would only be limited to Home Health. We shared our concerns and our plan to run a bill to prevent the EVV requirement resulting in Medicaid decision not to move forward with the changes.
Our Bill to allow physical therapists and physical therapists assistants to obtain Level 1 Accreditation in the Colorado Worker’s Compensation System was not introduced. With many new members in the State Legislature and their desire to advance their causes, our Bill was not considered. House Leadership was incredibly strict on what bills would be introduced and ours was not one of them. We did secure bipartisan sponsorship and will re-introduce the Bill next year.
Sunset Update
In 2024 the Colorado Physical Therapy Practice Act is up for Sunset Review. This means that our Practice Act may be modified by the State Legislature. APTA Colorado has been gathering input from members on potential revisions to the Practice Act and we have begun discussions with interested parties. The Association met with the Department of Regulatory Agencies’ (DORA) Analyst three times. We have discussed our answers to the required Statutory Questions and the changes we will be pursuing in Colorado’s Physical Therapy Practice Act. The Analyst accepted our offers to observe classes at Regis University and Sarah Gallagher’s Private Practice South Valley PT. Our interest in providing those opportunities was to deepen the Analyst ‘s understanding of Physical Therapist education and practice. Dora’s report will be completed in October of 2023. In the meantime, we are meeting with other interested parties, identifying physical therapists we may need to testify on our behalf and continue to raise money to support the Sunset 10/30 Campaign. I want to THANK you if you have donated your $30 to the campaign. If not, you can donate by texting “APTA” to 243725. We have raised $5,880.00 of our goal of $60,000 on our text to give site.
Jill Flaherty, PT, MS
President
American Physical Therapy Association Colorado Chapter |
Share Your Research, Knowledge and Expertise!
Call for Poster Abstracts and Platforms for the 2023 Fall Conference!
We encourage all PTs, PTAs, and students to submit poster abstracts and platforms on case reports, special interest reports, or research projects. Posters and platforms submitted will be selected for presentation that demonstrates quality research and clinical relevance.
Please submit your abstract no later than Sunday, July 30, 2023 by e-mail to Melissa Tran, PT, DPT, MPH, Co-Chair of the Research Committee: [email protected]. When submitting your abstract, please indicate if you are submitting for a poster, platform or both.
For more information, click here! |
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