ISSN:0269-9052    

DOI:10.3109/02699059309029681

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The following issues in the practice of brain injury rehabilitation are explored: (1) validity of support for efficacy based on experience in clinical practice, (2) validity of support for efficacy based on research, (3) consumer protection, (4) qualifications and regulation of individual providers, (5) regulation of programme development and marketing. Ethical responses to these issues from each of three cultural belief systems (humanism, science and self-interest) are examined from a metaphilosophical perspective based on contemporary cognitive psychology and on philosophies of social constructionism and existentialism.

ISSN:0269-9052    

DOI:10.3109/02699059309029682

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Post-comatose unawareness (PCU) is one of the possible outcomes of severe brain injury. Patients with severe brain injury have an increased susceptibility to severe nosocomial infections for multifactorial reasons, including immune suppression at different levels. We studied different immunological aspects in 11 PCU patients. Impaired humoral immunity was found in 27% of them. Two patients had decreased haemolytic activity of the classical complement pathway, associated with decreased levels of the components C1q, C1r and C4. Another patient had very low levels of IgG2 and IgG4. The neutrophil killing activity was impaired in these three patients, but was completely restored with the addition of a heterologous serum, suggesting a humoral defect. Neutrophils showed normal chemotaxis and random migration, and the superoxide anion release by neutrophils was also found to be normal. Understanding the immunological events in PCU patients contributes to a better and more intensive therapeutic approach, which might accelerate the rehabilitation of these patients.

ISSN:0269-9052    

DOI:10.3109/02699059309029683

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Abstract abilities were studied in a sample of 34 individuals with severe TBI and a control group. The results indicate that TBI interferes with performance on tests requiring individuals to process information into new categories. There appears to be a dissociation between verbal abstract abilities and visual-perceptual abstract abilities. There is evidence that Goldstein and Sheerer's [1] postulate of a general‘abstract attitude’was at least partially correct. This attitude does not appear to be related to a general verbal ideational process, as dysphasic subjects were only deficient on a purely verbal abstract task.

ISSN:0269-9052    

DOI:10.3109/02699059309029684

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The authors have investigated two commonly used methods of assessing neurological status in patients with mild head injury to determine whether they can predict intracranial damage. Of 686 such patients with cranial computed tomography (CT) scans, scan results were recorded, along with total and motor components of the Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85). Despite relatively normal admission neurological examinations, 127 of the 689 patients (18.4%) had intracranial lesions, and 38 (5.5%) required surgery. There was no significant difference in distribution of the GCS in patients with and without intracranial lesions. The RLS85 was superior to the GCS in predicting intracranial pathology, and a significant association between RLS85 and lesions on CT scanning was noted. However, even this test was normal in 19 patients found to have intracranial pathology, including nine who required surgery. The authors conclude that a normal or near-normal mental status examination in a head-injured patient on arrival at the emergency room is inadequate to exclude a potentially serious intracranial lesion. It is unlikely that further refinements in the clinical evaluation will result in diagnostic accuracy comparable with that of CT scanning. Accordingly, we recommend that any patient who has suffered a loss of consciousness or amnesia following head injury have an urgent cranial CT scan.

ISSN:0269-9052    

DOI:10.3109/02699059309029685

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Immediate and 45-minute delayed recall of a paragraph-length story and of a complex geometric figure were investigated in a sample of 30 children with traumatic brain injury. There was no significant difference between children with mild to moderate injuries and children with severe injuries with regard to general level of verbal recall. However, there was a trend for children with mild to moderate injuries to have better recall of visual information than children with severe injuries. Recall of verbally presented information deteriorated significantly over the 45-minute delay, regardless of injury severity. No such deterioration was found for recall of visually presented information. Clinical and research implications are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059309029686

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The incidence of visual dysfunction and effectiveness of visual exercises in acute traumatically brain injured inpatients in a rehabilitation programme were studied. Vision evaluation norms were established on 23 hospital staff. The evaluation was then administered to 51 inpatients within days after admission. An additional 21 patients were unable to participate, usually due to decreased cognition or agitation. Thirty of 51 (59%) scored impaired in one or more of the following: pursuits, saccades, ocular posturing, stereopsis, extra-ocular movements, and near/far eso-exotropia. For patients having dysfunction in pursuits or saccades, a 2-week baseline was followed by vision exercises. During the baseline interval patients were evaluated by an optometrist to verify therapists' findings. Six patients who participated in several weeks of treatment were evaluated at 2-week intervals by an independent rater. Progress is graphically illustrated. Conclusions were that the suitability of an inpatient vision programme, from our experience, is questionable. However, an initial evaluation proved valuable for informing staff of patients' visual status and for referral to an optometrist/ophthalmologist for further treatment.

ISSN:0269-9052    

DOI:10.3109/02699059309029687

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Although significant gains in acquisition of a variety of skills following traumatic brain injury have been demonstrated, generalization of acquired skills presents a formidable challenge. Incidental teaching procedures refer to a sequence of interactions between a trainer and a learner which take advantage of teaching opportunities that arise naturally in unstructured situations and appear to be particularly applicable to communication deficits common to persons with traumatic brain injury. This paper presents an overview of incidental teaching procedures and a case study in which incidental teaching procedures were utilized in a multiple-baseline fashion across three sequential environments to increase complete requesting skills. Results show that complete requesting increased to nearly 100% of the trials in each new environment upon procedural implementation, compared to extremely low baseline levels. In addition, significant increases in independently initiated, rather than cued, requests occurred within the first few treatment sessions. Implications of incidental teaching procedures and case study results are discussed with suggestions for future research.

ISSN:0269-9052    

DOI:10.3109/02699059309029688

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The results of 138 surveys assessing the training needs of case managers in the area of traumatic brain injury were analysed. Sixty-six per cent of the respondents were case managers working primarily with adults in a variety of work settings. Respondents rated working with families, vocational rehabilitation, and community re-entry as the top three areas for training. Mild traumatic brain injury, paediatric traumatic brain injury, neuropsychological assessment, and medicolegal aspects received the highest rankings by case managers with more than 8 years experience. The need for certification of case managers in specialty areas was supported by 83% of all respondents.

ISSN:0269-9052    

DOI:10.3109/02699059309029689

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Pharmacological interventions in the treatment of various cognitive, behavioural and neurological problems after brain injury often may involve combinations of medications from various drug classes. This carries the implication of potentially new or previously undereported drug interactions. A case report is presented in which a commonly used anticonvulsant drug, valproic acid, and a commonly used antidepressant, desipramine, interacted in such a manner as to cause potentially toxic serum concentrations of desipramine. This case demonstrates the important point that it is not simply the addition of one drug to another that may cause interaction, but the withdrawal of a particular drug which may then adversely impact the remaining drug regimen.

ISSN:0269-9052    

DOI:10.3109/02699059309029690

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor