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Brain injury rehabilitation in adults 13 The evidence base 13.1 SySTEMATIC lITERATuRE REVIEW 50 | The evidence base for this guideline was synthesised in accordance with SIGN methodology. A systematic review of the literature was carried out using an explicit search strategy devised by a SIGN Evidence and Information Scientist. Databases searched include Medline, Embase, Cinahl, PsycINFO and the Cochrane Library. The year range covered was 1990-2011. Internet searches were carried out on various websites including the US National Guidelines Clearinghouse. The main searches were supplemented by material identified by individual members of the development group. Each of the selected papers was evaluated by two members of the group using standard SIGN methodological checklists before conclusions were considered as evidence. 13.1.1 LITERATURE SEARCH FOR PATIENT ISSUES At the start of the guideline development process, a SIGN Evidence and Information Scientist conducted a literature search for qualitative and quantitative studies that addressed patient issues of relevance to rehabilitation of patients with a brain injury. Databases searched include Medline, Embase, Cinahl and PsycINFO, and the results were summarised and presented to the guideline development group. 13.2 RECoMMENDATIoNS foR RESEARCH The guideline development group was not able to identify sufficient evidence to answer all of the key questions asked in this guideline (see Annex 1). The following areas for further research have been identified: y pharmacological and psychological therapies for the management of different symptoms in patients following MTBI y the use of virtual reality training in rehabilitation following ABI y the effectiveness and cost-effectiveness of specific therapies for spasticity in patients following ABI, including: ~ physical therapies including casting and stretching ~ pharmacological therapies ~ functional electrical stimulation ~ surgery ~ occupational therapy y the effects of AFO on mobility and muscle activity in discrete TBI populations y physical interventions (eg fitness training, treadmill training, use of walking aids) for recovery of mobility and function in discrete TBI populations y pharmacological and psychological therapies for the management of depression in patients with ABI y pharmacological and psychological therapies for the management of patients in the minimally conscious and vegetative state y pharmacological therapies for the management of anxiety disorders in patients with ABI y the effectiveness of rhythmic auditory stimulation in improving elements of gait in patients with ABI y a framework for vocational rehabilitation research which: ~ addresses insensitivity regarding return to work outcomes ~ takes account of the heterogeneous nature of rehabilitation ~ develops a standardised measure of VR needs ~ explores the provision of an intervention which is both standardised and allows for individualisation ~ explores the long term impact of VR and employment after TBI y therapies to manage incontinence in patients following ABI y therapies to improve problems with language or functional communication
y therapies to improve disordered social communication skills y restorative exercises to improve dysphagia y restitution cognitive rehabilitation through computerised technology y development and evaluation of interventions that can improve insight and awareness given the potential impact of insight difficulties on the ability to engage in rehabilitation. It is vital that studies also examine the impact of increased awareness/insight on participation in rehabilitation and long term outcome. 13.3 REVIEW AND uPDATING 13 • The evidence base This guideline was published in 2013 and will be considered for review in three years. Any updates to the guideline in the interim period will be noted on the SIGN website: www.sign.ac.uk | 51
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SIGN 130 • Brain injury rehabilit
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Scottish Intercollegiate Guidelines
Page 5 and 6: Contents 1 Introduction ...........
Page 7 and 8: 1 Introduction 1.1 THE NEED foR A G
Page 9 and 10: 1.3.3 BRAIN INjURy SEVERITy Long te
Page 11 and 12: Functional therapies tend to be saf
Page 13 and 14: Prior to any prescribing, the licen
Page 15 and 16: 3 Assessment and treatment of mild
Page 17 and 18: False positives on cognitive testin
Page 19 and 20: 3 • Assessment and treatment of m
Page 21 and 22: 4.1.3 TASk-SPECIFIC AND REPETITIVE
Page 23 and 24: One further RCT (n=35) compared two
Page 25 and 26: 4.4 CoNTINENCE PRoBlEMS 4 • Physi
Page 27 and 28: It has been argued that there are v
Page 29 and 30: 6 Rehabilitation of behavioural and
Page 31 and 32: elationship between specific compon
Page 33 and 34: 7 Communication and swallowing 7.1
Page 35 and 36: 7.1.6 TRAINING COMMUNICATION PARTNE
Page 37 and 38: No evidence was identified relating
Page 39 and 40: 8 • Vocational rehabilitation The
Page 41 and 42: 9.1.2 MINIMALLy CONSCIOUS STATE A p
Page 43 and 44: A Cochrane review of evidence for m
Page 45 and 46: 10.2 CoMMuNITy REHABIlITATIoN 10.2.
Page 47 and 48: of improvement. There were no signi
Page 49 and 50: Evidence has also suggested the pot
Page 51 and 52: 11 Provision of information This se
Page 53 and 54: or has mental health or addiction p
Page 55: 12 • Implementing the guideline y
Page 59 and 60: Guideline development and literatur
Page 61 and 62: Dr killian Welch Consultant Neurops
Page 63 and 64: NMES neuromuscular electrical stimu
Page 65 and 66: 5. What is the evidence for the eff
Page 67 and 68: 15. Is there any evidence of improv
Page 69 and 70: 31. Bryant RA, Harvey AG. Relations
Page 71 and 72: 94. Goverover Y, Johnston MV, Togli
Page 73 and 74: 157. Practice parameters: assessmen
Page 75: ISBN 978 1 905813 98 8 www.sign.ac.
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