TRAUMATIC BRAIN INJURY
Sleep disorders linked to dementia risk
My patient with a traumatic brain injury (TBI) was having difficulty sleeping in the hospital due to frequent disturbances and noise. We have incorporated several environmental approaches to improve sleep hygiene and he is sleeping better now. Are there any long-term risks to sleep disorders in patients with TBI?—H.P., FLA.
Yes, according to findings in a recent study of 712,708 patients that examined potential associations between sleep disorders and dementia in patients with a TBI. All patients were age 18 or older and free of dementia when they were admitted to an ED or other acute care setting between 2003 and 2013 with a TBI. Most patients (59%) were male with a mean age of 44 and a median follow-up period of 52 months. During that time, 32,834 (4.6%) of patients, both male and female, developed dementia.
The researchers found a statistically significant association between sleep disorders and dementia in patients who had experienced a TBI. They recommended screening these patients for sleep disorders regularly, as undiagnosed sleep disorders may also contribute to cognitive deficits independent of TBIs.
Sources: Mollayeva T, Hurst M, Escobar M, Colantonio A. Contribution of sleep disorders to dementia incidence following traumatic brain injury: a decade-long retrospective cohort study. Sleep. 2021;44(suppl 2):A309-A310. Sleep disorders are associated with increased dementia risk in patients with TBI. American Academy of Sleep Medicine. News release. June 8, 2021.
Virtual reality achieves real results
One of my pediatric patients with cerebral palsy (CP) has trouble ambulating. He has benefited from conventional physical therapy but is not always engaged by it. I've heard of individuals using virtual reality or motion-censor video games to improve their fitness. Can these games help patients with CP during the physical therapy process?—R.R., NEV.
Healthcare professionals often use every tool available to them to care for patients, including those that are somewhat outside the box. A recent meta-analysis was conducted to examine the use of Nintendo Wii therapy (NWT) for improving functional and dynamic balance in pediatric patients with CP. Participants using the Nintendo Wii interact with a virtual environment projected on a screen using a handheld controller or joystick with or without a force platform called the Wii Balance Board. Analyzing data from 11 randomized controlled trials on NWT, Spanish researchers found moderate-quality evidence supporting the benefits of this therapy for improving functional balance in patients with CP. They concluded, “NWT can be considered an effective treatment for improving functional and dynamic balance in children with CP, especially when combined with [conventional physical therapy] in 30-minute sessions with interventions lasting longer than 3 weeks.”
Used as a multisensory and active therapy in rehabilitation settings or in the home, NWT may represent a relatively low-cost tool to help improve mobility in children like your patient. Active, playful therapies such as NWT may also increase engagement and encourage children to adhere to physical therapy over time.
Sources: Montoro-Cárdenas D, Cortés-Pérez I, Zagalaz-Anula N, Osuna-Pérez MC, Obrero-Gaitán E, Lomas-Vega R. Nintendo Wii Balance Board therapy for postural control in children with cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. [E-pub June 8, 2021] Nintendo® Wii may help improve balance in children with cerebral palsy. Wiley. News release. June 9, 2021.
Infection prevention for older adults with cognitive impairments
During the pandemic, my unit at a long-term-care facility cared for older adults with Alzheimer disease and other dementias. Enforcing safety protocols to prevent the spread of COVID-19 was especially challenging due to the cognitive impairments experienced by these patients. How can nurses who work with this patient population prevent the spread of similar airborne illnesses?—K.C., PA.
The CDC recommends strategies for infection prevention and control to address the challenges of patient safety during the COVID-19 pandemic. For example, the patients you describe may have had difficulty adhering to mask mandates, social distancing recommendations, and hand hygiene practices. Additionally, behavioral changes such as increased agitation, aggression, and/or confusion can indicate stress or anxiety in these patients. As such, the CDC stressed the importance of understanding and recognizing these changes in patients with cognitive impairments.
In healthcare facilities like yours, the CDC recommends keeping patient routines and environments as consistent as possible, limiting outside personnel, providing structured activities to maintain both physical and mental health, and frequent surface cleaning in common areas. For patients with suspected or confirmed COVID-19 infection, implementing room restrictions or moving these individuals to a different unit may present additional challenges related to patient stress or anxiety, such as possible wandering. If a facility opts to keep the patient on the unit with dedicated personnel, the CDC recommends a protective eyewear and respirator mandate for all healthcare staff. If the patient is moved to a designated unit, the staff should explain the move thoroughly and repeatedly to the patient, move familiar belongings into the new room, and advise the receiving unit about the patient's habits and schedule ahead of time.
Source: Centers for Disease Control and Prevention. Considerations for memory care units in long-term care facilities. 2020. www.cdc.gov/coronavirus/2019-ncov/hcp/memory-care.html.