Traumatic brain injury (TBI) affects approximately 1.7 million Americans annually, and over 5.3 million people in the US are living with a TBI-related disability. Recently the TBI rehabilitation co...

Multi-level, multi-discipline, and temporally-diverse handoffs in traumatic brain injury rehabilitation:

Chapter 8 – Neurogenic disorders of speech, language, cognition-communication, and swallowing

This chapter covers important clinical information pertaining to traumatic brain injury (TBI): prognosis, outcome measures, and prevention. Providing an individualized prognosis is one of the most challenging aspects of TBI management. Successful prediction of survival in more severe TBI has improved; however, this success does not translate to prediction of detailed functional outcome for less severe cases of TBI. A number of outcome measures have been developed for assisting with predicting and monitoring recovery, and these will be reviewed in this chapter. Finally, a discussion pertaining to preventative measures will be presented.

Prognosis, Outcome Measures, and Prevention

Mental workload measurement has been a traditional and well-used method in human factors for over 50 years and continues to be highly relevant today. It has been applied to a variety of fields, including healthcare, though subjects have been clinicians rather than patients. Subjective mental workload measures are based on the assumptions that subjects can report self-functioning (i.e. persons with complete cognitive functioning). Thus, if subjective mental workload is applied to a population of persons with limited and / or dynamically changing cognitive functioning, then the basic assumptions of subjective mental workload are violated. This paper explores the considerations for incorporating subjective mental workload measurement tools into rehabilitative practices for cognitive deficits, such as traumatic brain injury and stroke patients.

Considerations For Using Subjective Mental Workload Measures In Populations With Cognitive Deficits

Background: Adequate food intake and adequate water intake (AWI) plays a vital role in body development, human health and total wellbeing. Water intake (WI) is one of the major and crucial nutrients for health promotion and disease prevention. Beverage consumption is also a medium through which water is consumed but the content of the beverage is very important to staying hydrated and living healthy. Despite this, there is a viaduct in proper knowledge about the exact amount of total water intake (TWI) and hydration status among students in Obuda University. Aim: The primary aim of this study is to bring an awareness among Obuda University students about how important water is to health and staying hydrated which further enhance a good study performance. To check if the students suffer from any dehydration-related symptoms and to conduct descriptive analysis on which channels they acquire information about hydration. Therefore, we focus on water drinking habits by investigating if Obuda University students from Africa, Asia and Europe adheres to hydration policy as regards to the recommended daily total water intake (TWI) according to the European Food Safety Authority (EFSA) for Europeans and the World Health Organization (WHO) for Africans and Asians, and to explore if they are well hydrated. Methods: A cross-platform survey was distributed to extort data about drinking habits and the awareness of hydration among the students. The questions contained in the survey took approximately 5 minutes to complete. There were 385 responses but 323 were qualified for the investigation. Data analysis was conducted using SPSS v26 and descriptive statistics are presented throughout the study. Results: There were 323 young-aged participants between the ages of 18–35 years from Africa, Asia, and Europe included in the study. Between 10%-22% of the population were aware of the TWI by both EFSA and WHO which induce that many among the student population are suffering from dehydration symptoms. Nevertheless, water was the most preferred beverage among the students when thirsty (83.3% prefer to drink water when thirsty) but they still do not consume enough as recommended. However, only 35.0% and 33.7% of the students could correctly indicate the daily TWI recommended by EFSA and WHO for both male and female respectively. Our study also revealed that the symptoms of dehydration is more severe in the students between the ages of 25–35 years than in students between ages 18–24 years. Conclusion: Our study revealed that 99.7% of the students agreed with the fact that water is an essential factor for staying hydrated and living healthy, but they do not have the knowledge of the adequate amount of water required to keep the body functioning optimally. Therefore, it is recommended that they should be educated about the proper means of retrieving information about hydration and have a full knowledge of the sources of dietary water intake in order to avoid overhydration. In this study, dehydration has also been confirmed to affect the cognitive performance of the students during summer time; 42.1 % of the students are below average, 30.0% are on the average and 27.9% are above average based on their academic performance. While during winter; 18.9% of the students are below average, 38.1 % are on the average and 43.0% are above average based on their academic performance.

Hydration Assessment Among Foreign University Students

Each year, over 1 million individuals in the US with a traumatic brain injury (TBI) are treated and released from hospital emergency departments. Approximately two-thirds of those who die from a severe TBI and come to autopsy have been found to have structural abnormalities in the hypothalamic–pituitary axis. The incidence of hypopituitarism in survivors of a moderate to severe TBI is approximately 40%.

The incidence of growth hormone deficiency in TBI survivors is approximately 20%. Metabolic complications include fatigue, increased abdominal fat, and increased risk of cardiovascular disease. Neuropsychological complications include: memory and concentration impairment, fatigue, anxiety, and depression.

Gonadal deficiencies, present in approximately 10%, may produce weakness, decreased libido, and fertility. Testosterone deficiencies have been associated with poorer rehabilitation outcomes. Progesterone may be useful as a neuroprotective agent.

Thyroid deficiencies, seen in 5% of survivors, may produce weakness, fatigue, and decreased muscle mass. Neuropsychological and psychiatric complications have been found in individuals with both overt and subclinical hypothyroidism.

Adrenal deficiencies, seen in 5% of survivors, can produce weakness, fatigue, metabolic disturbances, and psychiatric symptoms. For example, diminished cortisol levels have been associated with fatigue, whereas elevated levels may lead to anxiety symptoms.

It is recommended that TBI survivors be screened for hypopituitarism.

104 – Traumatic Brain Injury

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104 – Traumatic Brain Injury