摘要:

Over the past three or four decades two treatment technologies have been evolving in parallel, recently to some extent merging. The first of these technologies is behaviour analysis, with its emphasis on identification and manipulation of variables external to the individual as controlling agents. The second is neurological rehabilitation, with a characteristic focus of resources on recovery of function following neurological damage. The histories of both of these technologies are similar in that they emerged from basic laboratory research with non-human subjects, followed by extension of findings to research with humans, culminating in widespread formal application of results. The past 5 years have seen a convergence of behaviour analytic and neurological rehabilitation techniques resulting in major shifts in treatment service delivery systems. We briefly chronicle the emergence of these two technologies from their basic underpinnings through world-wide use. Further, discussion is provided describing our and others' experience with the combining of behaviour and neurological rehabilitation. Finally, we give an account of an innovative neurological rehabilitation service delivery system designed to deliver effective cost-efficient treatment in the patient's natural environment. Implicit in the design and implementation of this real-world model of rehabilitation is the combination of behavioural technology and neurological rehabilitation towards the achievement of functional outcomes which endure. Our purpose in the above is to provide an introduction to present use and future potential of behaviour analytic methodologies and technologies in rehabilitation.

ISSN:0269-9052    

DOI:10.3109/02699059509008213

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Neuropsychological functioning and level of subjective symptomatology was assessed in 15 adults at 2 weeks, 1 month, and 3 months post-concussion. Performance by the concussion subjects was compared to the results obtained by a matched group of normal controls. At 2 weeks post-injury the concussion subjects had deficits in intellectual, attentional, memory, and language abilities. Visuospatial constructional abilities were relatively preserved. Concussed subjects also reported high levels of disturbance in affective, cognitive, and social functioning. By 3 months post-injury the concussed subjects were still displaying deficits in attentional and language functioning. The level of subjective symptoms reported by the concussed subjects was not significantly different from that reported by controls. Results provide some support for the 'coping hypothesis' explanation of post-concussion syndrome.

ISSN:0269-9052    

DOI:10.3109/02699059509008214

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Demographic and functional data were obtained on 102 patients from three subacute rehabilitation units specializing in low-level traumatic brain injury (TBI) patients. Functional assessment evaluation was performed using the Disability Rating Scale (DRS). The average admission and discharge DRS scores were 17-4 and 13-6, respectively. On average this patient population improved from an extremely severe level of disability to a severe level. The TBI patient subset improved on average from 20-4 to 13-1. Significant correlation exists between admission, discharge, and differential DRS scores, as has been demonstrated previously in the evaluation of this scale among only TBI patients. No significant correlation was demonstrated between demographic information and DRS scores. Thus, no demographic predictors of good or bad functional outcome were identified. In addition, analyses of relationships between diagnosis, length of stay, and age will provide information about subactute rehabilitation, an emerging but little-studied branch of rehabilitation medicine.

ISSN:0269-9052    

DOI:10.3109/02699059509008215

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Neuropsychologists often use traditional psychological tests to assess depression following a head injury; but the assumption that depression with a head injury resembles that in an uninjured person is suspect. The current study attempts to examine the cognitive manifestations of depression with and without a coexisting head-injury. Advanced statistical methods are used to assess whether or not the two depressions 'look alike' with respect to the neuropsychological sequelae of the disorders. A total of 1182 people were entered into one of two discriminant function analyses (DFA) for depression. Each person was a member of one of the following groups: (a) depressed, (b) non-depressed, (c) head-injured, or (d) head-injured and depressed. Two functions were performed for depression, one on the population of head-injured people and one on the population of uninjured people. Cross-validations were performed for each population and across populations in order to assess the utility of each population's function for the opposite group. This comparison allows the researcher to indirectly compare depression in the two populations. Both functions were successfully applied to either population when MMPI variables were included in the analyses. However, when only cognitive variables were included the function performed on the non-head-injured population did not correctly classify head-injured people as depressed or non-depressed. One explanation for this is that the range of cognitive scores in head-injured people is so great that it allows for a less accurate but more generalizable function. Suggestions for future research are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059509008216

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Operant conditioning-based behavioural interventions are commonly used for the behavioural problems of individuals with mental retardation. There is also growing evidence of the benefits of these interventions for treating some of the behavioural problems of individuals with acquired cognitive deficits resulting from brain trauma. However, the effects of behavioural interventions on behavioural problems occurring during acute neurorehabilitation, when orientation and memory are most impaired, have not been studied.In this empirical case study, operant conditioning-based procedures were applied with an 8-year-old girl recovering from brain trauma and related neurosurgery. Screaming, non-compliance and aggression, which were disrupting rehabilitation therapies and follow-up neuroimaging, were treated using differential positive reinforcement techniques. Beneficial behavioural intervention effects were demonstrated using single-subject experimental methods. Aberrant behaviour during physical and occupational therapies was reduced, and cooperation with a computerized tomography (CT) scan without sedation was accomplished using operant behavioural intervention. Results support the use of operant interventions early in recovery from brain trauma, and highlight the importance of interdisciplinary collaboration for the implementation and further study of early behavioural interventions.

ISSN:0269-9052    

DOI:10.3109/02699059509008217

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

As most of those experiencing traumatic brain injury tend to be young, disabled survivors will be gradually accruing in each locality as each year passes. How many need continuing care a decade after injury? How many need day care, or need help with finding work, or continuing support for carers? 190 patients who had been admitted to two UK regional neurosurgical units on average some 7 years earlier were followed up. With an average age of 29 years these patients stayed in hospital for an average 33 days. At follow-up 23% were classified as having moderate disability or worse on the Glasgow Outcome Scale, including 7.4% who had died subsequent to discharge. Survivors were given a neuropsychological assessment and a socioeconomic interview. Of the survivors, 17% had failed to make a good recovery, but 36% were failing to occupy their time in a meaningful way. Age over 30 at time of injury, not occupied before injury, and above-average length of stay were some of the predictors for failing to occupy time. Quality of life was severely curtailed for those who could not occupy their time, as was the case for their carers. Appropriate counselling, vocational evaluation and family support in the early years following injury may help to improve quality of life for both the head-injured person and their carers.

ISSN:0269-9052    

DOI:10.3109/02699059509008218

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

A total of 74 brain-injured patients and 46 non-neurological matched controls consecutively admitted to a specialist medical rehabilitation unit were administered the 'Ways of Coping' checklist and the 'Headley Court psychosocial rating scale'. The relatives of all participants were sent the psychosocial rating scale. An analysis of the 'Ways of Coping' checklist showed the brain-injured patients used four strategies for coping, namely problem-focused, emotion-focused, avoidance, and wishful thinking. Correlations between these four factors and the responses on the 'Headley Court psychosocial rating scale' showed that less use of emotion-focused, avoidance, and wishful thinking coping strategies predicts better psychosocial functioning in the brain-injured group, a result similar to those reported for a wide variety of other health problems. The implications for treatment and management are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059509008219

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

'Reality orientation training' (ROT) is a well-established therapy used with the elderly, especially those with dementia. It aims to improve orientation and reduce negative behaviours, e.g. confusion. ROT has been recommended for non-demented patients with acquired neurological impairment. However, this suggestion has not been investigated further in controlled trials. This paper describes an informal 24 h ROT programme with an amnesic subject (H.J.). It combined single-case experimental designs derived from behaviour therapy. Target behaviours were items of temporal orientation—current time/time of day, year, season, month and day of week. Orientation regarding the current date was not trained, and thus served as control variable for non-specific effects (e.g. spontaneous recovery). In order to improve oriented behaviour in different relevant situations outside the clinic, we chose 24 h ROT instead of formal therapeutic sessions. The patients' spouse offered 24 h ROT at home 7 days a week. This consisted of reminding the patient of orientation information, e.g. the current day of the week in different situations. Furthermore, negative behaviours such as irrelevant questions were ignored. The patients' spouse was trained and supervised to carry out this task in 27 sessions each lasting 10 min. For 14 weeks supervision was provided twice a week in the clinic (i.e. 2×10 min). Afterwards the spouse continued to apply ROT at home without further supervision in two follow-up periods. As expected, learning was slow but reliable. Generalization of improvement to another setting was shown (home vs clinic). Stable therapeutic gains over a long follow-up period could be demonstrated. Temporal orientation neither improved nor worsened after cessation of supervision, suggesting that booster sessions would be crucial for further improvement.

ISSN:0269-9052    

DOI:10.3109/02699059509008220

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Watershed infarction has previously been described after cerebral trauma, when it is due to raised intracranial pressure or systemic hypotension. A case is reported, so far as is known for the first time, of bilateral watershed infarction following blunt systemic trauma, without injury to the head or neck. The importance of resuscitation in preventing secondary brain injury caused by systemic hypotension is highlighted. The advantages of HMPAO-SPET in detecting cerebral perfusion defects are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059509008221

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Patients' olfactory functioning is rarely considered by rehabilitation specialists because this capacity is seen as unnecessary for most vocational and academic purposes. However, several recent studies have shown that intermittent exposure to fragrances can help subjects sustain attention more efficiently. As this effect is especially pronounced when subjects report attention-maintenance difficulties, accessory olfactory stimulation may enhance the sustained attention capacities of head-injured subjects. Another study is cited in which subjects who lost their sense of smell following head injuries were found to experience more difficulty in maintaining employment. This effect is probably related to orbital lobe damage, which usually accompanies post-traumatic anosmia. The implications of these studies for rehabilitation professionals are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059509008222

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor