Research Reports - Prevalence of low bone mineral density in inpatients with traumatic brain injury receiving neurobehavioural rehabilitation

Physiotherapy. 2013 Mar 5

Banham-Hall N, Kothwal K, Pipkin J, Bentley J, Dickens GL

BACKGROUND: Osteoporosis is characterised by low bone mineral density (BMD)
leading to an increased risk of fracture. Patients who have sustained a
significant traumatic brain injury may have an increased risk of secondary
reduced BMD as a result of immobility and other factors. OBJECTIVES: To describe
BMD in a cohort of patients recovering from traumatic brain injury, and to
discuss the implications of the findings for physiotherapy practice. DESIGN:
Prospective, observational. SETTING: Specialist, residential unit providing care
for individuals with brain injury, many with a history of severe challenging
behaviour. PARTICIPANTS: Current inpatients (n=51, 80% male) with the capacity to
provide consent, as judged by their responsible clinician. The median age was 41
years (range 20 to 60 years), and the median time since the brain injury was
sustained was 22 years (range 4 to 54 years). METHODS: Participants' BMD was
measured at the radius and tibia using quantitative ultrasound. Various clinical
and demographic details were collected. RESULTS: Participants had suboptimal BMD
measurements that were generally low for their age and gender. Nine (18%)
participants met the criteria for osteopenia measured at the radius, and 26 (51%)
participants met criteria for osteoporosis or osteopenia measured at the tibia.
CONCLUSIONS: Some participants had reduced BMD, putting them at risk of fracture
or of developing such risk in the future. This group is at particular risk
because they frequently display challenging aggressive behaviours that may be met
with responses including proportionate use of manual restraint. Physiotherapists
should bear this increased risk in mind when devising exercise programmes
assessing risk in neurobehavioural rehabilitation settings.

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