摘要:

All skilled nursing facilities (SNF) in the state of Connecticut were surveyed to determine the number of residents with a primary diagnosis of brain injury, the incidence of agitation among these residents, and management strategies utilized for agitation in these residents, including consultation with brain injury specialists. One hundred and sixty-two, or 64%, of the SNF responded to the survey, and reported on 140 individuals with a primary diagnosis of brain injury. These individuals were residing in 39, or 24%, of the 162 facilities. Forty-five per cent of these 39 facilities had brain-injured residents who met the definition of agitation presented in the survey. Management of agitation was equally distributed between environmental manipulation, formal behaviour care plans and medications. The availability of specialist consultation was variable and included physiatrists (38%), psychiatrists (67%), neurologists (41%), and psychologists (36%). This survey study defined the prevalence of brain-injured residents in Connecticut's SNF, and examined management strategies for agitation in this patient population.

ISSN:0269-9052    

DOI:10.1080/026990596124412

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Many individuals suffer acquired brain injury (ABI) each year. This impacts on the need for rehabilitation supports and services that facilitate the achievement of personal goals. The role of assessment in the rehabilitation of people with ABI is examined. The extent to which assessment practices match (in any way) notions of achieving 'satisfying life' is canvassed, and functions of static and dynamic assessment conveyed. Evaluation of the functions of staticand dynamicassessment in facilitating community re-entry is undertaken. The response of 18 subjects with ABI (X CA, 27.5 years, X period since trauma 6.0 years) to static and dynamic assessment processes are compared. The paper concludes by reasoning that community re-entry is the main goal of people with ABI, and that dynamic assessment processes contribute to the achievement of this.

ISSN:0269-9052    

DOI:10.1080/026990596124421

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Forty-eight post-traumaticbrain-injured patients in postcoma-unawareness (PC-U) state, are included in this study. All recovered consciousness at least 1 month after the accident. The muscular tone and movement of all limbs was examined. At least two X-rays of the big joints were taken. Periarticular new bone formation appeared in 26 patients. This heterotopic ossification occurs in severely injured patients, primarily in proximal joints of the upper and lower extremities. Their aetiology in brain injury is unknown. Risk factors include prolonged coma, tone and movements in the involved extremity, and associated fractures. We found that the appearance of periarticular new bone formation had a close correlation with pathological movement (paresis or plegia), a borderline correlation with hypertonus, and no correlation with hypotonus or with associated fractures.

ISSN:0269-9052    

DOI:10.1080/026990596124430

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

The purpose of this study was to determine the intra- and inter-rater reliability of selected variables measuring motor function in adults following severe traumatic brain injury (TBI). Twelve adults with a severe TBI participated in the study and were assessed (independently) by two physical therapists with extensive clinical experience. Standardized testing protocols and two- or three-point ordinal rating scales were used to evaluate the following categories of variables: primitive reflexes, equilibrium/protective reactions and several motor skills. Intra-rater reliability was generally high for all variables, with kappa values exceeding 0.65 except for the scoring of equilibrium reactions in sitting and standing. Overall, inter-rater reliability was slightly lower, with kappa values ranging from 0 39 to 1.0, indicating 'fair' to 'almost perfect' agreement. The highest level of agreement was consistently reported for the scoring of motor skills. These results suggest that physical therapists trained in the use of standardized testing and scoring procedures can reliably assess primitive reflexes, equilibrium and protective reactions and a range of motor skills in TBI adults during the acute stage of recovery. Moreover, the results provide important information which will assist in the interpretation of data collected as part of a concurrently conducted longitudinal study of early motor recovery.

ISSN:0269-9052    

DOI:10.1080/026990596124449

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

A significant minority of patients who have sustained a mild traumatic brain injury (MTBI) may exhibit persistent disability. There have been few attempts to describe and evaluate the effectiveness of neurorehabilitation for these patients. We conducted a retrospective analysis of the results of a neuropsychological rehabilitation programme for 20 patients with MTBI. Based upon the ability to resume productive functioning after treatment, 10 patients were determined to exhibit a good outcome and 10 patients were considered to exhibit a poor outcome. Patients with good outcome exhibited significant pre-post-treatment improvements on both neuropsychological measures of cognitive functioning and self-reported post-concussive symptoms. Patients with poor outcome demonstrated little improvement in either area, and in some cases showed a decline in functioning. The results are consistent with the view that there may be significant variability in recovery and response to treatment after MTBI. There is a continued need to identify which patients may benefit from neurorehabilitation, develop specially tailored interventions, and conduct controlled, prospective studies in this area.

ISSN:0269-9052    

DOI:10.1080/026990596124458

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

This is a systematic presentation of the emotional and personality disorders of 33 patients who incurred minor traumatic brain injury (MTBI) in a vehicular accident. A wide spectrum of disorders was observed: cerebral personality disorder, persistent altered consciousness, post-traumatic stress, psychodynamic reactions to impairment, and complex reactions expressing neurological, somatic, and psychological dysfunctions (sexuality and somatization). Examples of each category are offered to aid identification. A total of 31/33 patients suffered an additional psychiatric disorder. Unreported head trauma and loss of consciousness (LOC) elicited by detailed interviews helped to explain the extent of impairment. Emotional disorders, added to persistent cognitive loss and other neuropsychological symptoms, greatly impair the capacity to adapt after traumatic brain injury (TBI). Clinical procedures (interview; Rorschach; observation; figure drawings; checklists) are recommended to obtain detailed personality information needed for diagnosis, prognosis, and treatment. Behavioural outcome after TBI reflects disturbance in the processing of internal and external stimulation, and disturbance of preexisting physiological and psychological processes. Emotional distress consistent with the accident and impairment adds to the credibility of patient complaints. There is an interaction between lesion effects and various emotional disturbances, which impacts employment, social relationships, and the enjoyment of life. Prompt and sympathetic treatment will contribute to more effective treatment, and may be anticipated to reduce or prevent some persistent symptoms after minor head injury.

ISSN:0269-9052    

DOI:10.1080/026990596124467

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

For many years the notion that brain damage causes less impairment in children than in adults (sometimes known as the 'Kennard Principle') has enjoyed widespread support among scientists and clinicians. More recently neuroscientists have questioned the Principle, most now taking an opposing view that damage to the rapidly developing brain can be more harmful than equivalent damage in adulthood. Many clinicians, however, appear reluctant to reject the Kennard Principle. This study investigates the extent to which the Kennard Principle still guides the judgement of different groups of health-care professionals (neurosurgeons, neurologists, neuropsychologists, general practitioners, nurses, physiotherapists, occupational therapists, and speech therapists). Subjects were asked to estimate the extent of recovery in clinically based but fictitious case studies which differed only in the reported age of the patient. The professions differed in their levels of optimism regarding the extent of recovery to be expected, but all predicted better recovery in younger patients (under 10) than in adults with otherwise similar brain injuries. The results are discussed in termsof theirimplicationsfor the treatment of brain injuries in the young.

ISSN:0269-9052    

DOI:10.1080/026990596124476

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

The development of multidisciplinary teams for the assessment and treatment of traumatic brain injury has not seen a parallel development in methods of coordinating and collating the information gathered by different professions. The team at the Head Injury Rehabilitation Centre (HIRC), Sheffield uses a process of assessment that encouragesthe coordination of such information, particularly across the areas that do not fall neatly into the remit of specific disciplines. The framework of the assessment is presented, together with discussion of methods of gathering information and of sharing that information. The advantages of this approach are discussed in terms of benefits for the client, for the professionals involved in the assessment and for other services that might be involved with the client.

ISSN:0269-9052    

DOI:10.1080/026990596124485

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor