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Bogen Tpu 15A Manual |Free Full Text
Our payment security system encrypts your information during transmission. We don’t share your credit card details with third-party sellers, and we don’t sell your information to others. Please try again.Please try again.Please try again. Please try your request again later. Glossary of Terms, Selected Bibliography, Index. 251 pages. Then you can start reading Kindle books on your smartphone, tablet, or computer - no Kindle device required. Full content visible, double tap to read brief content. Videos Help others learn more about this product by uploading a video. Upload video To calculate the overall star rating and percentage breakdown by star, we don’t use a simple average. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. It also analyzes reviews to verify trustworthiness. Learn More. Objectives were to describe the types of educational interventions that have been developed; to review the effects of these interventions; and to determine gaps that might be filled by future research efforts. Of 88 articles meeting search criteria and subjected to data extraction, 34 concerned education about mild TBI and 54, moderate to severe TBI. Only 1 article incorporated elements of self-management training (SMT), a model proved effective in other chronic health conditions. We recommend further exploration of SMT principles in long-term TBI care, as well as more precise definition of treatment components in all patient and family interventions, so that the specific effects of education and other treatment elements may be more readily evaluated. Keywords: Brain injuries, patient education, family education, self-management Introduction Traumatic brain injury (TBI) is a major health problem affecting thousands of people annually in the US, with adverse effects on physical, cognitive, behavioural and emotional function.
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Moderate to severe TBI is accompanied by reduced participation in many spheres of life, including low rates of work or other productive activity and reduced social and recreational outlets ( 1 ). Family stress and burden are also common as the family system adapts to changed roles, ongoing care and supervision needs, and financial strain ( 3 ). Even so-called minor or uncomplicated mild TBI (mTBI), although followed by full recovery in the majority of cases, may result in persistent cognitive, physical, and emotional sequelae ( 4 ). The consequences of mTBI have attracted increased attention due to the debilitating problems experienced by many service members and Veterans, which are often comingled with symptoms of post-traumatic stress and chronic pain ( 5 ). Longitudinal studies have shown, however, that TBI may set off a dynamic process characterised by fluctuations in functional status over the lifespan ( 6 ). Thus instead of a static disability, TBI may best be treated as a chronic condition, with ongoing management and support provided to prevent deterioration and maximise recovery. However, the ideal components of long-term management for TBI have yet to be identified. In other chronic health conditions such as diabetes, asthma, and heart disease, much research has focused on designing and testing the optimal ways of helping affected persons to understand and manage the consequences of the condition. Patient education is a key component of chronic disease management, with decades of research examining the effects of different kinds of information and guidance on symptom management. As one example, an instructional model known as neuroscience education (NE) has gained increasing use in the management of chronic pain.
Rather than focusing on the anatomical or biomechanical aspects of pain, which can exacerbate anxiety, NE teaches patients about the way pain is processed within the nervous system, emphasises that physical activity can be helpful rather than harmful, and shows patients how to influence their own experiences of pain. A systematic review found compelling evidence that this kind of information, even when administered in brief sessions, reduces the perception of both acute and chronic pain and limits pain catastrophizing ( 7 ). Another highly influential model that includes patient education at its core is Self-Management Training (SMT), developed by Lorig and colleagues and used extensively for chronic disease management ( 8 ). SMT goes beyond the provision of information to include peer-led training in problem-solving and goal-setting related to chronic symptom management, as well as how to best make use of one’s healthcare resources. If we reconceptualise TBI as a chronic health condition, it is timely to ask whether and how patient education, perhaps including components of SMT, could help people with TBI to manage the long-term consequences of the disability. There appears to be great consumer demand: studies assessing the perceived needs of people with TBI and their caregivers have consistently identified as paramount the need for accurate, understandable information about the injury and its potential consequences ( 3, 9, 10 ). Considering the importance of this topic, in view of the expressed needs of people with TBI and their caregivers and the growing recognition of TBI as a chronic health condition, we conducted a scoping review to examine the literature on TBI education provided to patients and family caregivers.
Unlike a systematic review, in which the quality of the research is considered with the goal of evidence synthesis, a scoping review surveys the overall scope of published work on a particular topic toward the goal of identifying key concepts and gaps in the extant literature ( 13 ).What effects, if any, have been reported for different types of educational interventions. Is there a sufficient number of empirical studies to warrant a systematic review or meta-analysis. What are the gaps in the literature relative to the above questions, and how might they inform priorities for future research in this area. Method We conducted systematic searches for peer-reviewed articles published in English about the education and training of persons with TBI and their caregivers. Searches included studies using all designs, including meta-analyses and literature reviews. The databases searched were PubMed, CINAHL, PsycINFO, Cochrane Library, ABIEBR, Campbell Library, PROSPERO, and PsycBITE. Searches were performed using the appropriate subject heading terms and key words for TBI, head injury, concussion, and education, training, and instruction. Complete search strategies for each database, including all search terms used, are provided in Appendix A. The searches were completed on October 27, 2016 and yielded 3,209 unique titles. We browsed it to locate the sections relevant to Traumatic brain injury and education. Articles on other etiologies of acquired brain injury were included, as long as TBI was included as a topic or as part of a study sample. Because our main interest was in comprehensive brain injury education, we excluded articles that concerned the training of one specific or circumscribed skill such as wheelchair mobility, anger management, goal management, etc. However, we did include articles about programmes that systematically covered many individual topics in an educational format, e.g.
the specific physical, cognitive, and behavioural consequences of TBI, as coverage of multiple topics was felt to constitute comprehensive education. We excluded non-peer-reviewed pieces such as editorials and letters to the Editor, as well as articles intended for audiences such as coaches, educators, or the general public. We reviewed the full text of all articles that met these criteria. Articles that did not have an abstract or did not provide sufficient information to determine eligibility were automatically included for full-text review. All abstracts and full text articles were reviewed by at least two independent reviewers. Disagreements were resolved by discussion and, if necessary, by asking a third reviewer to break the tie. Data from eligible studies were extracted on variables related to: a) characteristics of the sample or intended audience of the education (e.g. severity and chronicity of TBI; age; intended for patient, family, or both); b) type of report (e.g. descriptive, experimental); c) the content, method of delivery, and duration of the TBI education; and d) results or author conclusions with regard to the education. Figure 1 provides detail on the abstract and full text review process. As shown in the Figure, 117 articles were determined to be eligible for data analysis. Open in a separate window Figure 1: Study selection flowchart Results When data had been extracted from all included articles, the study team examined the distributions of key variables to determine how the findings should be organised. Severity of injury was generally inferred in one of two ways. Some articles were readily classified by the title alone (e.g., “Information provision after mild traumatic brain injury”) or the contents of the title plus abstract. Others, particularly manuscripts reporting the results of studies, were classified on the basis of information provided on the study samples.
One experimental article ( 14 ) did not identify the severity of the sample but appeared to be more germane to mild injury and was included in that group. Table 1 presents an overview of the studies included in this review. As shown in the Table, there has been an increase in manuscripts concerning TBI education over time, particularly in the case of mTBI since 2010. The Table also reveals that educational efforts for mTBI have tended to target the injured individuals and to be focused on traumatic injury, while moderate and severe TBI education is more likely to target or include families and caregivers, and to include both traumatic and non-traumatic injury. The majority of manuscripts in both groups have discussed in-person education, as opposed to phone or web delivery. Mild TBI Mild TBI education provided in emergency care. Considerable attention has been devoted to examining the types of educational materials (i.e. discharge instructions) supplied to patients and caregivers admitted to emergency care with mTBI. Survey studies focused on collecting and comparing such materials from regional hospitals have been conducted in the United States and Canada ( 15 ), England ( 16 ), Australia ( 17 ), Scotland ( 18 ), and New Zealand ( 19 ). These reports have emphasised the wide variability in the content provided to patients with mTBI and have called for more uniform, more accurate, and easier-to-read materials. The span over which these papers have appeared—1997 to 2014—suggests that the need for such materials may remain unmet. Several empirical studies have examined the conditions under which patients receive mTBI-related education in emergency care, as well as patients’ or caregivers’ comprehension or memory for various kinds of discharge instructions. In two studies, patients with mTBI were interviewed after emergency discharge and queried about the discharge instructions they had received.
Both found that many patients did not recall having been given instructions even when they had ( 21, 22 ). Memory for instructions was inconsistent, and worse for those with longer periods of post-traumatic amnesia ( 21 ). A non-randomised controlled study found that instructions given in the Emergency Department to patients with mTBI were understood and recalled better after 48 hours when verbal instruction was given along with written material, compared to written material alone ( 23 ). Descriptions of mTBI education beyond emergency care. Eight papers were classified as descriptive reports concerning mTBI education outside of emergency care. One small qualitative investigation focused on the perceptions of benefit related to a treatment programme for persistent post-concussive symptoms that included not only education but stress management training and compensatory strategy development ( 24 ). The remaining six papers were descriptions of treatment models for mTBI that included education; one offered a written educational guide that could be copied and offered to patients ( 26 ). The two more recent papers emphasised the use of a biopsychosocial model to address the complexities of symptomatic mTBI, and both stressed the importance of keeping up with the burgeoning mTBI literature so that patient education and other treatment would continue to be evidence-based ( 30, 31 ). Eight randomised controlled trials (RCTs) examined the effects of education on various outcomes of mTBI. Two used a group educational series as a control for a reasoning skills intervention, with results that were non-contributory for our purposes ( 14, 32 ). Similarly, another study used education in the form of an information manual to control for nonspecific effects of various forms of cognitive and psychotherapeutic rehabilitation, in a military sample with chronic post-concussive symptoms (33.
) As hypothesised, the education condition had no significant impact on change in cognitive or functional status. However, an earlier RCT with 3- and 12-month follow-up in a civilian sample ( 34, 35 ) showed that a brief educational intervention was equally effective for ameliorating post-concussive symptoms, compared to a more intensive treatment programme that included neuropsychological evaluation with feedback, a Physical Therapy consultation, and treatment sessions as needed. These contrasting findings are likely due to differences in selection criteria: the civilian samples were drawn from consecutive admissions to emergency wards, many of whom would be expected to recover over the period of time that the education was administered. In contrast, the military sample consisted of persons with chronic symptoms for which they actively sought treatment; this sample likely also had a higher rate of comorbidities such as post-traumatic stress. Another intervention for Veterans with remote mTBI (mean 10 years post injury) and chronic problems led to improvement in community integration ( 37 ) and diminution in caregiver burden ( 38 ) when compared to usual care. This intervention included home visits as well as telephone contacts over a 4-month period, and used a variety of treatment approaches, such as goal setting and action planning, in addition to education. Two RCTs examined the effects of education delivered remotely to persons with mTBI. Although a previous pilot study had suggested benefit ( 40 ), little change was observed in the RCT. However, subgroup analyses showed greater benefit in those who were involved in mental health treatment, suggesting that education could serve as a useful adjuvant intervention. Moreover, participants who showed greater learning of the presented information also improved more on a measure of self-efficacy, i.e. perceived control over symptom management ( 39 ).
The other remote intervention was an RCT using symptom assessment delivered 3 times daily for 14 days via SMS (text messages), starting on the day of injury. Half of the participants also received follow-up texts offering reassurance, education, and guidance contingent on their symptom reports. These educational messages appeared to be effective in preventing or reducing anxiety and irritability, although there was low power to detect group differences in this small pilot trial ( 41 ). Importantly, the SMS-delivered intervention was shown to be feasible and well tolerated in persons with acute mTBI. A study using non-randomised cohorts suggested that a brief in-person intervention that included education, reassurance, and guidance on reducing alcohol intake resulted in less use of alcohol 3 months after mTBI compared to usual care ( 42 ). An uncontrolled, retrospective study reported beneficial effects of an 8-week programme involving in-home treatments from an Occupational Therapist and educational phone sessions with a psychologist for a group of patients who mostly had chronic mTBI ( 43 ). Two treatment models were described with pre- and post-test data suggesting improvement in emotional well-being, but without controls. One was a group treatment for Hispanic patients with chronic, predominantly mTBI that included education, relaxation training, and goal setting ( 44 ). The adapted treatment, developed for a military sample with mTBI, included educational workshops and written materials on TBI and post-traumatic stress, as well as on the health benefits of positive thinking and active problem-solving. A stated purpose of the education is to help normalise the stress experienced throughout the family, particularly in the marital relationship ( 45 ). Results of an uncontrolled pre-post study suggested improvement in coping with anger, improved social support and productive activity, and decreased caregiver burden.
Of note, cognitive impairment at baseline was predictive of less treatment response ( 46, 47 ). While undoubtedly useful at the time, these articles may now have limited utility; for example, one suggests the practice of videotaping to supplement discharge instructions ( 56 ), which is now commonplace. Others included bibliographies ( 52, 53 ), now outdated, that were intended to be shared with patients or family members. However, some of the more recent papers provide illustrations of interesting trends. A case report described the use of telehealth, including streamed video, to provide remote education and other services to families with restricted access to specialized care ( 64 ). Two papers described the development of TBI education and support services to meet the needs of specific communities, one in the United Kingdom ( 65 ) and the other in South Africa ( 66 ). Three additional papers were concerned with detailing the services provided to people affected by TBI, including education, although each followed a different approach. King et al. ( 67 ) described the interventions used in the treatment arm of a large stepped-care trial of education and advice given to patients with TBI during the 6 months postinjury. Not surprisingly, the need for advice and referral for services, in addition to education, was found to be greater for those with more severe TBI. These authors recommended that brief information leaflets, of the type used in their trial, should not be provided without the opportunity of contact with an interventionist to help explain the information and offer individual advice. Short and colleagues ( 68 ) described results of an online survey completed by Speech-Language Pathologists in Australia regarding information given to patients with TBI about their cognitive-communication deficits.
These authors similarly found that severity of TBI was a common consideration, along with awareness of deficits, guiding the decision as to who should receive factual information (e.g. patient versus caregiver) and when. Finally, Simpson et al. ( 69 ) conducted an observational study to ascertain the types and relative proportions of Social Work services provided in an inpatient rehabilitation setting for severe TBI. These papers described the findings of experimental or, more often, quasi-experimental studies such as pre-post-test or non-randomised control group designs. They were very diverse with regard to inclusion of participants with TBI only vs.The components of intervention added to education were also quite diverse but frequently included emotional support, counseling, or psychotherapy; coping skills training; goal-setting; provision of community resources; and individualised advice. Befitting these broad interventions, there were typically a variety of outcome domains measured, e.g. emotional function, family function, coping, caregiver burden, and individualised goal attainment. In such reports, it was not possible to examine quantitatively the specific effects of education; however, some of the papers included either author inferences or participants’ comments on the effectiveness of the information or education components. The other 7 mentioned the value of education for filling knowledge gaps or correcting misinformation ( 84 ), for understanding the point of view of others dealing with brain injury, specifically relating to injured persons developing empathy for family members ( 85 ), and for increasing one’s confidence in dealing with problems at home ( 86 ). Specific education topics that were reportedly most valuable for caregivers included cognitive and behavioural issues, such as memory impairments and impaired self-awareness ( 86, 87 ).
Negative aspects of education included information presented in too technical a fashion to be accessible to family members or patients ( 84 ), and lack of use of presented information. For example, one web-based intervention found that family members preferred an on-line support group function to a variety of educational resources, which were seldom used ( 88 ). Authors of an RCT on family education and problem-solving reported that many participants did not read the written materials that were prepared to support each session ( 89 ). Six studies were explicitly designed to test the specific effects of education, including 3 RCTs. Immediately after receiving their randomly assigned instructions, caregivers received vignettes depicting various problems at home and asking how they would handle each; caregivers receiving the more comprehensive education scored significantly higher on the quiz. A more elaborate educational programme, comprising 8 2.5-hour sessions, focused on written and oral didactic information presented separately to groups of people with chronic TBI and groups of caregivers. Compared to waitlisted controls, patient participants improved more on measures of emotional function and self-esteem, but caregivers showed no significant benefits ( 91 ). In the third RCT, Pegg and colleagues ( 92 ) compared two types of education delivered to patients with TBI on an inpatient rehabilitation unit. Those who received three 60-minute sessions of individualised education about their injuries, treatment plans, and progress in therapy were rated as putting forth more effort in Physical (but not Speech) Therapy and also achieved more gains on the Cognitive (but not Motor) FIM, compared to patients randomised to equivalent time spent in a more generic education.
The authors speculated that the experimental treatment might have led to a greater sense of control and involvement in rehabilitation, even though it was noted that not all patients completely understood the information. Neither paper reported significant effects on emotional function or family functioning. An uncontrolled pretest-posttest study examined the perceived preparedness of family caregivers for discharge from inpatient rehabilitation, before and after being given access to a website with information and resources. Item analyses showed improved preparedness scores for most domains of caregiving. However, the sample included caregivers of people with mixed diagnoses, and it was noted that the 5 caregivers of patients with brain injury showed the lowest preparedness scores at post-test ( 95 ). However, TBI education was reported as leading to more changes in emotional well-being, confidence, and understanding of TBI-related issues compared to Attention Process Training, which produced more changes in memory and attention, in a small within-subjects trial ( 101 ). The counseling, however, was individualised and included components other than education, such as problem-solving and suggestions for specific activities and exercises to promote recovery ( 102 ). We sought an overall perspective on the kinds of education provided, whether distinctive models had been developed and compared, and what effects of education had been reported. One purpose was to determine whether there were sufficient empirical reports to warrant a more detailed or quantitative systematic review. Another was to identify gaps in the research on this topic and provide suggestions for further study. We found a large variety of interventions that included education about TBI, frequently combined with other treatment elements such as coping skills, problem-solving, and resource facilitation, as well as peer support in group-based interventions.
From a research perspective, the descriptions of these multi-faceted programs do not allow for analysis of the effects of specific components of treatment, including the educational content. Regarding the question of distinct models that could be compared head-to-head or subjected to meta-analysis, it appeared that most studies developed educational content and other programme elements de novo. Considering the very wide variety of treatment approaches, we conclude that a more formal systematic review would be premature, and a meta-analytic approach would not be possible. From a qualitative synthesis of the literature, we offer the following conclusions about brain injury education for patients and families: Interest in mTBI education has risen in the last decade along with increased concern about the potentially serious consequences of repetitive injuries sustained in sports and in battle, and there appears to be consensus that education is a critical element in the treatment of mTBI ( 25 ). The rapid accumulation of knowledge about diagnosis and treatment of mTBI creates challenges for keeping education up-to-date ( 30, 31 ) and for helping patients separate fact from speculation. However, in the minority of patients for whom symptoms persist, education may not be effective unless accompanied by other psychotherapeutic treatment components ( 33 ). In such cases, a more comprehensive biopsychosocial approach to treatment is warranted ( 30, 31 ). While this approach may be economical in the clinical setting, it runs the risk of diluting information that could otherwise be of specific help to those with traumatic injuries. The existing literature provides few definitive findings as to the specific effects of education on recipients, other than the proximal outcome of increased knowledge ( 90 ).
Additional recommendations for future research in this area include the following: For mTBI, there may need to be further development and research devoted to finding the most clinically- and cost-effective ways of delivering early education, not only for flagging problems that should bring patients back to emergency care, but for helping to prevent symptom exacerbation. Remote delivery of interventions including education, via telephone, internet, or text messages, has begun to be tested and will undoubtedly increase. Further study in this area should take note of the somewhat mixed findings to date, which suggest that web-based education may be valuable as a supplement, rather than a replacement, for more traditional delivery methods ( 39, 40 ). The recent use of manualized treatments ( 77, 85 ) is a positive trend in this regard. We encourage more such efforts to help injured persons gain maximal control over the impact of their symptoms, even if help from others continues to be needed. Conclusion The provision of patient education plays a critical role in the management of chronic diseases such as diabetes and arthritis, yet the role of educational interventions in improving long-term health and quality of life after TBI have not been thoroughly investigated. Nonetheless, there are hints in the literature that providing even basic information can improve patient and caregiver self-efficacy and motivation for rehabilitation and recovery, and that persons with significant cognitive impairment can participate in self-management training. Given the opportunity for progress in this area of study, we call on clinicians and researchers to identify or develop evidence-based educational content and to develop systematic approaches to delivery of educational interventions along the continuum of TBI care. Acknowledgements We thank Melissa Shuman-Paretsky, PhD and Erica Kaplan, PhD, for their assistance in data abstraction.
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