Retrospective Analysis of Vision Rehabilitation for Veterans With Traumatic Brain Injury-Related Vision Dysfunction.
Retrospective Analysis of Vision Rehabilitation for Veterans With Traumatic Brain Injury-Related Vision Dysfunction.
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患有创伤性脑损伤相关视力障碍的退伍军人的视力康复回顾性分析。
DOI：
10.1093/milmed/usad120
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发表时间：
2023
影响因子：
1.2
通讯作者：
Cockerham,GlennC
中科院分区：
文献类型：
--
作者：
Winkler,SandraL;Finch,Dezon;Llanos,Imelda;Delikat,Jemy;Marszalek,Jacob;Rice,Candice;Rakoczy,Chrystyna;Wang,Xinping;Pollard,Kendra;Cockerham,GlennC
创伤性脑损伤（traumatic brain injury，TBI）可引起视觉方面的后遗症，如视力异常、视前庭功能障碍、视野缺损、光敏感等。由于从伊拉克和阿富汗返回的作战战士患有TBI的频率越来越高，因此对TBI相关视力障碍的诊断和管理的需求也越来越大。本研究旨在探讨退伍军人外伤性视功能障碍诊断后复健服务的后遗症。为了实现这一目标，我们调查了视力康复评估和干预措施提供给退伍军人事务部（VA）专业多发伤设施的TBI相关的视觉功能障碍的退伍军人2年后，他们受伤。研究问题询问VA专科诊所提供了哪些评估、干预和规定的辅助设备（例如，职业治疗，多发性创伤，盲人康复），以及如何提供服务的人口和临床variable.Materials和MethodsA回顾性设计，使用自然语言处理的非结构化的临床笔记和结构化数据的逻辑回归分析VA数据。参与者包括350名患有TBI的退伍军人，他们在2008年至2017年期间在五个VA多发创伤康复中心（坦帕，佛罗里达州;里士满，弗吉尼亚州;明尼阿波利斯，明尼苏达州;圣安东尼奥，德克萨斯州;和帕洛阿尔托，加利福尼亚州）之一接受康复治疗，并接受了2008年国会授权的“创伤性脑损伤特定眼部健康和视觉功能检查”。结果变量是视力评估、干预措施和通过临床医生笔记的自然语言处理发现的处方辅助技术，以及提供临床护理的视力康复专科诊所（多发伤、作业治疗、门诊盲人康复、住院盲人康复、验光、和低视力）从VA结构化的管理数据中提取。结果接受TBI相关视力功能障碍康复的退伍军人最常被评估为扫视，调节视野和会聚最常提供的干预是手眼协调、扫视、调节、聚散和双眼功能障碍。提供的技术包括眼镜、轮椅/踏板车、步行者/手杖、盲人辅助设备和计算机。专科诊所提供的服务有重叠之处。服务提供和交付显着相关的合并症的每一个病人和专科诊所提供在每个VA多发伤康复Center.ConclusionsThe患者服务的交付应驱动的退伍军人的需求，而不是由系统级的因素，如在特定地点的特定视力康复服务的可用性。传统的低视力和盲人康复计划并不是为了治疗与TBI相关的合并症和症状。为了应对这一挑战，需要盲人康复和神经恢复交叉训练。我们的研究结果记录了五个VA多发伤康复中心如何在2008年实施这项培训。下一步是将这种新模式扩展到社区护理并使其标准化，这些部署后的患者现在居住在那里。
IntroductionTraumatic brain injury (TBI) can trigger vision-based sequelae such as oculomotor and accommodative abnormalities, visual–vestibular integrative dysfunction, visual field loss, and photosensitivity. The need for diagnosis and management of TBI-related vision impairment has increased because of the increasing frequencies of combat warfighters returning from Iraq and Afghanistan with TBIs. The purpose of this research was to learn the sequelae of rehabilitation service delivery to veterans with TBI-related visual dysfunction after they are diagnosed. To accomplish this, we investigated vision rehabilitation assessments and interventions provided to veterans with TBI-related visual dysfunction at the Department of Veterans Affairs (VA) specialty polytrauma facilities for the 2 years following their injury. The research questions asked what assessments, interventions, and prescribed assistive devices were provided by VA specialty clinics (e.g., occupational therapy, polytrauma, and blind rehabilitation) and how service delivery was affected by demographic and clinical variables.Materials and MethodsA retrospective design was used to analyze VA data using natural language processing of unstructured clinician notes and logistic regression of structured data. Participants included 350 veterans with TBI who received rehabilitation at one of the five VA Polytrauma Rehabilitation Centers (Tampa, FL; Richmond, VA; Minneapolis, MN; San Antonio, TX; and Palo Alto, CA) between 2008 and 2017 and who were administered the 2008 congressionally mandated “Traumatic Brain Injury Specific Ocular Health and Visual Functioning Exam.” The outcome variables were vision assessments, interventions, and prescribed assistive technology discovered via natural language processing of clinician notes as well as the vision rehabilitation specialty clinics providing the clinical care (polytrauma, occupational therapy, outpatient blind rehabilitation, inpatient blind rehabilitation, optometry, and low vision) extracted from VA structured administrative data.ResultsVeterans receiving rehabilitation for TBI-related vision dysfunction were most frequently assessed for saccades, accommodation, visual field, and convergence. Intervention was provided most frequently for eye-hand coordination, saccades, accommodation, vergence, and binocular dysfunction. Technology provided included eyeglasses, wheelchair/scooter, walker/cane, aids for the blind, and computer. There was an overlap in the services provided by specialty clinics. Services available and delivered were significantly associated with the comorbidities of each patient and the specialty clinics available at each VA Polytrauma Rehabilitation Center.ConclusionsThe delivery of patient services should be driven by the needs of veterans and not by system-level factors such as the availability of specific vision rehabilitation services at specific locations. Traditional low vision and blind rehabilitation programs were not designed to treat the comorbidities and symptoms associated with TBI. To address this challenge, blind rehabilitation and neurologic recovery cross training is needed. Our findings document how five VA Polytrauma Rehabilitation Centers implemented this training in 2008. The next step is to extend and standardize this new paradigm to community care, where these post-deployment patients now reside.
体外冲击波碎石系统研究结石破裂的实验模型。
DOI：
10.1016/s0022-5347(17)41643-0
发表时间：
1988
期刊：
The Journal of urology
影响因子：
--
作者：
Whelan,JP;Finlayson,B
通讯作者：
Finlayson,B
输尿管结石的预后。
DOI：
--
发表时间：
1956
期刊：
Acta chirurgica Scandinavica. Supplementum
影响因子：
--
作者：
E. Sandegard
通讯作者：
E. Sandegard