In the U.S. nearly 275,000 people are hospitalized for traumatic brain injury (TBI) each year and with hospitalization, the TBI patient encounters a care environment that is not always supportive of recovery. As a part of the clinical care continuum, intermediate-care is the last rung of inpatient hospitalization and is often where an interdisciplinary team evaluates a patient's recovery from brain injury. The environment of care can be a barrier or facilitator to recovery post-TBI because it influences physiologic processes such as sleep. In patients with TBI intrinsic and extrinsic factors contribute to sleep disturbance Extrinsic factors like hospital noise, timing and exposure to light, and nighttime awakenings by hospital staff are noted as salient problems in both hospitalized patients and patients with TBI. However the available literature on sleep disturbance of patients with TBI housed in the intermediate care unit is sparse. Therefore, the purpose of this pilot study is to examine the pattern of the patient's sleep fragmentation together with environmental stimuli in order to describe the influence of the care environment on the intermediate-care patient with TBI. The patients number of nighttime awakenings will be recorded using actigraphy while environmental factors (sound, light, and contact (as part of care-provision) will be recorded with a sound level meter and a multipurpose sensor, respectively. Additionally, multilevel modeling analyses will be used describe associations of the patient's nighttime awakenings, environmental factors, and the change in functional status (measured with functional independence measure, FIM) measured at day 1, day 5, and at discharge from intermediate care.
Sleep is critical to the traumatic brain injury patient's recovery as nighttime awakenings may worsen sleep disturbance and decrease daytime vigilance and function. The care environment may foster or inhibit sleep. This proposed research study seeks to explore how environmental stimuli such as movement, sound and light influence the sleep of patients hospitalized following a traumatic brain injury (TBI).
|Cheng, Chieh; Chi, Nai-Ching; Williams, Ellita et al. (2018) Examining age-related differences in functional domain impairment following traumatic brain injury. Int J Older People Nurs 13:e12208|