McKinney G, Tidman M. Physical Exercise Versus Intensive Balance Programs: A Review of the Effects Exercise Has on Balance for Patients with TBI and Use of the BESS. JEPonline 2022:25(2):70-81. ...Traumatic brain injury (TBI) has been in the spotlight for the past 10 years. Much of that exposure came from military operations in the Middle East and reports that surround Chronic Traumatic Encephalopathy. Health care providers and researchers have tirelessly worked to discover methods for prevention, treatment, and rehabilitation for TBI. Statistics from the Center for Disease Control and Prevention report TBI as having a high prevalence and affecting 2.2 million people annually. Treatment options may involve the prescription of medication and cognitive therapies. Recent evidence has supported exercise as an adjunctive treatment along with other treatment protocols. In addition to exercise as an option for recovery, providers often refer patients to physical therapy for intensive balance programs. Some health care providers caution against exercise due to the possibility of prolonging recovery. Exercise and balance programs can yield positive results under the correct application of programs that are designed by an exercise physiologist or a physical therapist. The purpose of this literature review is to add to the growing body of evidence and identify the need for continued research of the effects of exercise on TBI recovery. This paper reviewed 27 articles from PubMed, CINHAL, and DynaMed to compare physical exercise and intensive balance programs, and the effect they have on the balance recovery of patients with TBI. The reliability and validity of the Balance Error Scoring System (BESS) as an assessment tool has shown that aerobic exercise results in better effects on the body as a whole and increases cerebral blood flow (CBF) and improves neuroplasticity. Intensive balance programs have positive benefits for improved motor function and are safe, but they do not significantly improve balance. The decision to use traditional physical exercise or an intensive balance program depends on the patients' needs, including functional status, symptoms, and the ability. This literature review does not show that traditional physical exercise versus a balanced program yields better outcomes. Controlled and supervised physical exercise is a viable option to treat patients with TBI who are physically and emotionally able to participate. Healthcare providers should perform an extensive exam and history before prescribing an exercise prescription. Keywords: Balance, Concussion, Exercise, Traumatic Brain Injury
At least 3 million Americans sustain a mild traumatic brain injury (mTBI) each year, and 1 in 5 have symptoms that persist beyond 1 month. Standards of mTBI care have evolved rapidly, with numerous ...expert consensus statements and clinical practice guidelines published in the last 5 years. This Special Communication synthesizes recent expert consensus statements and evidenced-based clinical practice guidelines for civilians, athletes, military, and pediatric populations for clinicians practicing outside of specialty mTBI clinics, including primary care providers. The article offers guidance on key clinical decisions in mTBI care and highlights priority interventions that can be initiated in primary care to prevent chronicity.
In the US military, traumatic brain injury (TBI) is of distinct importance, at home and in the deployed setting, and is considered a "signature injury of the wars in Afghanistan and Iraq." Since ...2000, an estimated 468 424 service members (SMs) have been diagnosed with at least one TBI. We examined the clinical trajectories of a group of 18 comorbidities before and after a military-sustained mild TBI (mTBI).
Without making assumptions on causality, a group of 18 conditions often co-occurring with mTBI were identified through literature review and TBI subject matter workgroup consensus. Using data from Military Health System Data Repository, we identified SMs whose first lifetime military mTBI occurred between October 1, 2016, and October 30, 2019. Correlation analyses were used to determine the linear relationship between comorbidities prior to and after mTBI diagnosis. Changes in the period prevalence of comorbidities was calculated.
We identified 42 018 SMs with a first lifetime military mTBI, of which 77.6% had at least one comorbidity. Identified SMs were mostly young (46.1% ages 18-24 years), male (81.4%), and White (64.1%). Up to 180 days prior to an mTBI, the most frequently identified conditions were sleep-related conditions (21.7%), headaches (19.4%), posttraumatic stress disorders (PTSDs) (17.8%), anxiety disorders (11.3%), and cervicogenic disorders (eg, cervicalgia) (10.9%). In the period following mTBI diagnosis, the prevalence of diagnosed conditions increased, especially for visual disturbances (327.2%), cognitive conditions (313.9%), vestibular conditions (192.6%), those related to headache (152.2%), and hearing (72.9%). Sleep-related conditions showed moderate positive correlation with a group of co-occurring conditions, led by cognitive conditions (ϕc = 0.50), anxiety disorders (ϕc = 0.42), PTSDs (ϕc =0.43), and headaches and related conditions (ϕc = 0.38).
Results indicate that caring for SMs with mild TBI requires a holistic approach, one that considers the complex nature of SM conditions, prior to sustaining their mTBI, as well as after injury. We found a complex correlation of conditions that suggest SMs with mTBI are undergoing a multifaceted experience, one that may require the development of a targeted multidimensional clinical practice recommendation and practice.
McKinney G, Alexander J, Bordenave E. Correlation between Sway Balance and the Modified Balance Error Scoring System. JEPonline 2022;25(5):27-38. Falls are the leading cause of injury and death among ...older Americans. Approximately 3 million older adults will visit the emergency department annually for fall-related injuries. Health care professionals depend on reliable assessment tools to rule out balance dysfunction caused by several associated and comorbid conditions. Methods: This quantitative descriptive study evaluated and compared postural balance results using the mBESS and Sway Balance. A convenience sample of 36 participants from A.T. Still University Still Standing Falls Prevention Outreach Program engaged in a series of five stances used to assess balance. Results: The demographic ratio of females to males was 80% and 20%, respectively, ages 55 and older (M = 79.5, SD = 8 years). The average score for Sway Balance was M= 59.66, and for the mBESS, M=15.26. The Spearman correlation coefficient was negative (r.sub.s = -.131), an indication of the tendency for mBESS scores to decrease as Total Sway increased. The P-value was not statistically significant (P = 0.454); the two assessments were not correlated. Conclusions: Our study examined and compared comprehensive balance measures using validated instruments, providing a unique opportunity to deliver alternative options for objective assessments of postural instability. While study results found no correlation between Sway Balance and the mBESS scores; research does support Sway Balance as a viable solution for objective assessments for primary care providers to diagnose and treat balance problems. Further research is recommended to determine the maximum achievable enhancement of accelerometer technology like Sway Balance in the clinical setting. Keywords: Balance and Postural Stability, Falls, Technology
To develop new diagnostic criteria for mild traumatic brain injury (TBI) that are appropriate for use across the lifespan and in sports, civilian trauma, and military settings.
Rapid evidence reviews ...on 12 clinical questions and Delphi method for expert consensus.
The Mild Traumatic Brain Injury Task Force of the American Congress of Rehabilitation Medicine Brain Injury Special Interest Group convened a Working Group of 17 members and an external interdisciplinary expert panel of 32 clinician-scientists. Public stakeholder feedback was analyzed from 68 individuals and 23 organizations.
The first 2 Delphi votes asked the expert panel to rate their agreement with both the diagnostic criteria for mild TBI and the supporting evidence statements. In the first round, 10 of 12 evidence statements reached consensus agreement. Revised evidence statements underwent a second round of expert panel voting, where consensus was achieved for all. For the diagnostic criteria, the final agreement rate, after the third vote, was 90.7%. Public stakeholder feedback was incorporated into the diagnostic criteria revision prior to the third expert panel vote. A terminology question was added to the third round of Delphi voting, where 30 of 32 (93.8%) expert panel members agreed that 'the diagnostic label 'concussion' may be used interchangeably with 'mild TBI' when neuroimaging is normal or not clinically indicated.'
New diagnostic criteria for mild TBI were developed through an evidence review and expert consensus process. Having unified diagnostic criteria for mild TBI can improve the quality and consistency of mild TBI research and clinical care.
As part of an initiative led by the Brain Injury Special Interest Group Mild Traumatic Brain Injury (TBI) Task Force of the American Congress of Rehabilitation Medicine (ACRM) to update the 1993 ACRM ...definition of mild TBI, the present study aimed to characterize current expert opinion on diagnostic considerations.
Cross-sectional web-based survey.
Not applicable.
An international, interdisciplinary group of clinician-scientists (N=31) with expertise in mild TBI completed the survey by invitation between May and July 2019 (100% completion rate).
Not applicable.
Ratings of agreement with statements related to the diagnosis of mild TBI and ratings of the importance of various clinical signs, symptoms, test findings, and contextual factors for increasing the likelihood that the individual sustained a mild TBI, on a scale ranging from 1 (“not at all important”) to 10 (“extremely important”).
Men (n=25; 81%) and Americans (n=21; 68%) were over-represented in the sample. The survey revealed areas of expert agreement (eg, acute symptoms are diagnostically useful) and disagreement (eg, whether mild TBI with abnormal structural neuroimaging should be considered the same diagnostic entity as “concussion”). Observable signs were generally rated as more diagnostically important than subjective symptoms (Wilcoxon signed ranks test, Z=3.77; P<.001; r=0.68). Diagnostic importance ratings for individual symptoms varied widely, with some common postconcussion symptoms (eg, fatigue) rated as unhelpful (<75% of respondents indicated at least 5 out of 10 importance). Certain acute test findings (eg, cognitive and balance impairments) and contextual factors (eg, absence of confounds) were consistently rated as highly important for increasing the likelihood of a mild TBI diagnosis (≥75% of respondents indicated at least 7 out of 10).
The expert survey findings identified several potential revisions to consider when updating the ACRM mild TBI definition, including preferentially weighing observable signs in a probabilistic framework, incorporating symptoms and test findings, and adding differential diagnosis considerations.
Returning to Activity After a Concussion Reed, Nick; Silverberg, Noah D; Iaccarino, Mary Alexis ...
Archives of physical medicine and rehabilitation,
04/2019, Volume:
100, Issue:
4
Journal Article
From change projects to change agility Horney, Nick; Eckenrod, Mary; McKinney, Gary ...
People & strategy : journal of the Human Resource Planning Society,
03/2014, Volume:
37, Issue:
1
Magazine Article, Trade Publication Article
How well organizations are prepared to survive in this turbulent business climate is becoming a fundamental issue and challenge for CHROs. Now, more than ever, CEOs and boards will demand that their ...CHROs become strategic partners in equipping their organizations to be change-ready (agile) to adapt and thrive to the challenge of the turbulent 21st century. The practice of change management has been radically impacted by the continuing turbulent business environment characterized by rapidly fragmenting, information-intensive, demographically evolving, electronically wired and individually customized global marketplace. The business environment of the world today has overwhelmed the current change management models and forced organizations to find alternatives to the change management models of the past in order to create an agile capability to survive and thrive in a volatile, uncertain, complex and ambiguous environment. The benefits of agility give companies the freedom to make smart and fast decisions that are in the best long-term interest of the company.
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CEKLJ, IZUM, KILJ, NUK, PILJ, SAZU, UL, UM, UPUK
Thesis (M.S.)--University of North Carolina at Chapel Hill, 2006.
Title from electronic title page (viewed Oct. 10, 2007). "... in partial fulfillment of the requirements for the degree of Master of ...Science in Dental Hygiene Education in the Department of Dental Ecology, School of Dentistry." Discipline: Dental Ecology; Dental Hygiene Education; Department/School: Dentistry.
OBJECTIVE:Cross-sectional HIV incidence surveillance, using assays that distinguish ‘recent’ from ‘nonrecent’ infections, has been hampered by inadequate performance and characterization of incidence ...assays. In this study, the Consortium for the Evaluation and Performance of HIV Incidence Assays presents results of the first independent evaluation of five incidence assays (BED, Limiting Antigen Avidity, Less-sensitive Vitros, Vitros Avidity and BioRad Avidity).
DESIGN:A large repository of diverse specimens from HIV-positive patients was established, multiple assays were run on 2500 selected specimens, and data were analyzed to estimate assay characteristics relevant for incidence surveillance.
METHODS:The mean duration of recent infection (MDRI, average time ‘recent’ while infected for less than some time cut-off T) was estimated from longitudinal data on seroconverters by regression. The false-recent rate (FRR, probability of testing ‘recent’ when infected for longer than T) was explored by measuring the proportions of ‘recent’ results in various subsets of patients.
RESULTS:Assays continue to fail to attain the simultaneously large MDRI and small FRR demanded by existing performance guidelines. All assays produce high FRRs amongst virally suppressed patients (>40%), including elite controllers and treated patients.
CONCLUSIONS:Results from this first independent evaluation provide valuable information about the current performance of assays, and suggest the need for further optimization. Variation of ‘recent’/‘nonrecent’ thresholds and the use of multiple antibody-maturation assays, as well as other biomarkers, can now be explored, using the rich data generated by the Consortium for the Evaluation and Performance of HIV Incidence Assays. Consistently high FRRs amongst those virally suppressed suggest that viral load will be a particularly valuable supplementary marker.
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