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Objective: To determine whether a 12-week home-based walking programme can decrease perceived stress and depressive symptoms in persons with a traumatic brain injury (TBI). Setting: Community- and home-based. Participants: Sixty-nine participants with a TBI. Design: Comparative effectiveness cross-over design with random assignment to treatment sequence and blinded post-hoc assessment of outcome where participants completed a 12-week walking intervention and a nutrition education module. The walking intervention utilized pedometers to track the amount of steps each participant walked daily. With the assistance of an assigned coach, weekly goals were given with the intent of increasing the amount of walking that the participant was initially completing. The nutrition control group was created to offset the impact of the coaching calls. Main measures: Measurement of perceived stress and depressive symptoms was completed through the use of the Perceived Stress Scale (PSS) and Center for Epidemiological Studies-Depression (CES-D). These measures were collected at three time points: baseline and following each 12-week intervention. Results: Results indicated that both perceived stress and depression symptoms significantly improved following the walking intervention. Conclusions: While limitations existed with the study, it is evident that walking can be used as an efficient and cost-effective tool to manage perceived stress and depressive symptoms in persons who have sustained a TBI. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) is a potentially disabling neurologic injury that can occur in horseback riding. To date, no published study has examined the epidemiology of SCI from horseback riding in the United States, and few international studies exist on this topic. Several studies have described traumatic brain injuries, spine fractures, and extremity injuries; however, SCI patterns and outcomes in horseback riders are poorly understood.Purpose: This study was undertaken to characterize the demographics, SCI patterns, and neurologic outcomes of persons with SCIs related to horseback riding.Study Design: Descriptive epidemiologic study.Methods: This is a retrospective review of 121 SCI cases from horseback riding in the National SCI Statistical Center database from 1973 to 2008. The treatment setting was 26 U.S. SCI Model Systems of Care. The number of injuries, gender, age, and SCI type for horseback riding were compared with other sports and activities. The level of preserved neurologic function, SCI completeness, American Spinal Injury Association classification, and mechanical ventilation use at discharge were examined in the horseback riding group.Results: The mean age of injury was 37.8 years (standard deviation, 15.2). The majority of patients were white (88%) and female (50.4%). Compared with diving, motorcycle riding, football, and gymnastics, horseback riding involved a significantly higher number of women (P < .005), a higher mean age of injury, and an equal likelihood of resulting in paraplegia and tetraplegia. The most common levels of preserved neurologic function were C4-C6, T12, and L1. Spinal cord injury from horseback riding most commonly resulted in incomplete tetraplegia (41%) followed by complete paraplegia (24%). Only 4 patients required mechanical ventilation on discharge from acute inpatient rehabilitation.Conclusion: Spinal cord injury from horseback riding affects an equal proportion of women and men, has a wide age range, and most commonly results in incomplete tetraplegia followed by complete paraplegia. Study findings improve awareness of the demographics and neurologic outcomes of individuals with SCI from horseback riding and can help guide future studies evaluating SCI mechanisms in horseback riders to improve injury prevention and management. [ABSTRACT FROM PUBLISHER]

Objective: Define associations between post-traumatic brain injury (TBI) fatigue and abnormalities in neuroendocrine axes, sleep, mood, cognition and physical functioning. Design: Survey. Setting: Large community hospital-based rehabilitation centre. Participants: Convenience sample of 119 individuals at least 1 year post-TBI. Outcome measures: Multidimensional Assessment of Fatigue (MAF); Fatigue Severity Scale (FSS); neuroendocrine assessments-growth hormone (GH) reserve, thyroid, cortisol and testosterone levels; visual analogue pain rating; Pittsburgh Sleep Quality Index; Beck Depression Inventory-II; Disability Rating Scale; Craig Handicap Assessment and Reporting Technique; Neurobehavioural Functioning Inventory. Results: Fifty-three per cent reported fatigue on the MAF and one-third on the FSS; 65% were found to have moderate/severe GH deficiency; 64% had adrenal insufficiency (low fasting cortisol); 12% had central hypothyroidism; and 15% of men had testosterone deficiency. Pituitary dysfunction did not correlate with fatigue or other symptoms. Predictors of MAF total scores were female gender, depression, pain and self-assessed memory deficits. Predictors of FSS scores were depression, self-assessed motor deficits and anti-depressant usage. Conclusions: Robust correlates of fatigue were gender, depression, pain and memory and motor dysfunction. Investigation of post-TBI fatigue should include screening for depression, pain and sleep disturbance. There was no correlation between pituitary dysfunction and fatigue; however, the relatively high prevalence of hypothyroidism and adrenal dysfunction suggests screening for these hormone deficiencies. [ABSTRACT FROM AUTHOR]

Objectives: To assess the suitability of the HIV-Related Fatigue Scale (BFS) [corrected] for assessment of posttraumatic brain injury (post-TBI) fatigue., Design: Analysis of self-report data., Setting: Community., Participants: 183 individuals with TBI in California, and 233 individuals with TBI and a comparison group of 85 persons without brain injury in New York., Interventions: None., Results: Both individuals with TBI and comparison participants reported high levels of fatigue on the Fatigue Severity Scale and the Fatigue Assessment Instrument, which can be scored from the BFS. Factor analysis of 40 BFS items resulted in 5 factors; because factors appeared to be based on both substantive issues and the format and location of the items, a BFS scoring algorithm was not pursued. The other 16 BFS items provided useful information in understanding post-TBI fatigue., Conclusions: The BFS in its current format is not recommended for assessing fatigue as a multidimensional entity after TBI. It may have utility for the 3 widely known fatigue measures that can be derived from it, and it generates information on the circumstances of fatigue.