Nutrition Support (Tube Feeding) as a Rehabilitation Intervention

James, Roberta; Gines, Deon J.; Menlove, Angela; Horn, Susan D.; Gassaway, Julie; Smout, Randall J.

doi:10.1016/j.apmr.2005.07.314

Cited by 35 publications

(23 citation statements)

References 25 publications

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“…Normal nutritional status was demonstrated by serum albumin Ͼ 3.5 g/dL, prealbumin Ͼ 25 mg/dL, transferrin Ͼ 200 mg/dL, total lymphocyte count Ͼ 1.800/mm 3 , and no significant weight loss (Ͼ5%, Ͼ7.5%, and Ͼ10% after 1, 3, and 6 months, respectively) during hospitalization (James et al, 2005). Serum electrolytes, glucose, total cholesterol, blood urea nitrogen, iron, magnesium, calcium, and phosphate were also determined.…”

Section: Methodsmentioning

confidence: 99%

Anterior Pituitary Function May Predict Functional and Cognitive Outcome in Patients with Traumatic Brain Injury Undergoing Rehabilitation

Bondanelli

Ambrosio

Cavazzini

et al. 2007

Journal of Neurotrauma

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Traumatic brain injury (TBI) is the leading cause of death and disability in young adults. Growth hormone-insulin-like growth factor I (GH-IGF-I) system has an important role in the recovery of the central nervous system. The aim of the study was to evaluate the relationship between pituitary function (in particular, the GH-IGF-I axis) and outcome from TBI. We studied 72 patients (56 males; mean age 37.2 +/- 1.8 years) receiving rehabilitation after TBI. According to the Glasgow Coma Scale (GCS), 10 patients had moderate and 52 severe TBI. Ten patients had growth hormone GH deficiency (GHD), 10 LH-FSH, three TSH, and three ACTH deficiency. Overall pituitary dysfunction occurred in 22 (30.5%) patients, with anterior hypopituitarism in 19 (26.4%), isolated diabetes insipidus in one, and isolated hyperprolactinemia in two. GH response to GHRH + ARG (arginine) positively correlated with Functional Independence Measure (FIM D; r = 0.267, p < 0.02) and Level of Cognitive Functioning Scale (LCFS D; r = 0.287, p < 0.01) at discharge, and negatively with Disability Rating Score at discharge (DRS D; r = -0.324, p < 0.005). Unfavorable outcome measures (FIM D, LCFS D, and DRS D) occurred in patients with hypopituitarism as compared with normal pituitary function (p < 0.05). Multiple regression analysis identified both GCS (p < 0.005) and GH peak (p < 0.05) as strong independent predictors of outcome. In conclusion, recovery after TBI may be negatively influenced by concomitant pituitary dysfunction. The GH peak value is an independent predictor of outcome, indicating that recovery during an intensive rehabilitation program after TBI may be positively influenced by normal GH secretion.

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Section: Methodsmentioning

confidence: 99%

Anterior Pituitary Function May Predict Functional and Cognitive Outcome in Patients with Traumatic Brain Injury Undergoing Rehabilitation

Bondanelli

Ambrosio

Cavazzini

et al. 2007

Journal of Neurotrauma

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“…PBE research methodology as applied in rehabilitation isolates specific components of rehabilitation interventions and determines how, and to what degree, each component is associated with outcomes, after controlling for individual patient differences (70)(71)(72)(73). Details of the SCIRehab study, which uses PBE methodology, are provided below.…”

Section: Evaluating Effectiveness Of Rehabilitationmentioning

confidence: 99%

New Approach to Study the Contents and Outcomes of Spinal Cord Injury Rehabilitation: The SCIRehab Project

Whiteneck

Gassaway

Dijkers³

et al. 2009

The Journal of Spinal Cord Medicine

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Background/Objective: Limited research evidence is available to show the effectiveness of the many specific interventions provided in spinal cord injury (SCI) rehabilitation; what is available typically focuses on effects of the full rehabilitation package but not specific therapy interventions, medical procedures, patient education, or counseling. Given the problems of conducting randomized controlled trials (RCTs) in rehabilitation, practice-based evidence (PBE) research has been suggested as an alternative methodology for identifying which rehabilitation interventions are associated most strongly with positive outcomes, after controlling for patient differences. Using the PBE research methodology, the SCIRehab project attempts to ''open the black box'' of acute SCI rehabilitation, provide detailed information on treatments delivered by all rehabilitation disciplines, and contribute to outcomes-based guidelines for clinical decision-making. Methods: The SCIRehab project includes 1,500 patients with acute SCI, consecutively admitted to 1 of 6 US inpatient rehabilitation facilities. Details of the rehabilitation process are captured by clinicians from multiple disciplines documenting their interventions in handheld personal digital assistants after sessions with their patients. Outcome data are abstracted from medical records (clinical outcomes data) and obtained from patient interviews at 6 and 12 months after injury. Extensive patient, injury, and other treatment characteristics are abstracted from medical records. SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. Results: SCIRehab is the first research project to collect detailed information on individual interventions offered by the full rehabilitation team. These findings are presented in a series of 9 articles. Conclusions: To date, SCIRehab's major contribution is a system for categorizing specific contributions of each discipline and a technology for documenting that detail. After data collection is complete, future manuscripts will relate those process elements to outcomes. The SCIRehab Project is an important step toward establishing outcomes-based guidelines for SCI rehabilitation.

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“…Enteral access can also facilitate the delivery of medications in patients whose illness limits their ability to take them by mouth (Phillips & Nay, 2008;El-Matary, 2008;Loser et al, 2005); and it can also facilitate hydration in these patients (Sleisenger et al, 2010). Neurogenic dysphagia secondary to stroke is the most common cause for PEG insertion in adults (James et al, 1998;James et al, 2005;Rimon et al, 2005;Gencosmanoglu, 2004); dysphagia occurs in around 40% of patients at the time of diagnosis, with up to 10% of stroke patients suffering long-term dysphagia (Barer, 1989;Gordon et al, 1987;Kidd et al, 1995;Laasch et al, 2003;O'Neill, 2000;Smithard et al, 1996). Early feeding (within the first week) via PEG is no longer recommended in the most recent guidelines for management of acute stroke, as it has not been shown to improve long-term survival, complication rates or length of hospitalization (Koretz et al, 2007;Kulick & Deen, 2011).…”

Section: Indications For Percutaneous Endoscopic Gastrostomymentioning

confidence: 99%

“…A recent meta-analysis of nutritional support in head-injured patients concluded that, while data are lacking, early feeding may be associated with a trend toward better outcomes in terms of survival and disability (Perel et al, 2006). Amyotrophic Lateral Sclerosis (ALS) is another condition where PEG is routinely employed (James et al, 1998;James et al, 2005;Rimon et al, 2005;Mitsumoto et al, 2003). In addition to progressive issues with dysphagia, ALS patients have increased energy needs, and it has been suggested that PEG can play an important role in preventing additional muscle loss (Desport et al, 1999;Spataro et al, 2011;Vaisman et al, 2009).…”

Section: Indications For Percutaneous Endoscopic Gastrostomymentioning

confidence: 99%