摘要:

The present case study describes the neurobehavioural, neurodiagnostic, and positron emission tomography (PET) scan findings in a child who sustained a whiplash-type injury in a motor vehicle accident. Although neck and back pain were reported immediately, neurobehavioural symptoms, such as staring spells, gradually increased in frequency over a 2-year period following the accident. At 4 years after the accident the patient's symptoms persisted, as reported by teachers and parents, and more extensive diagnostic work-up was initiated. Standard EEG was normal while two ambulatory EEGs were abnormal and interpreted as epileptiform. A PET scan showed evidence of marked hypometabolism in both temporal lobes. Neuropsychological findings were consistent with PET findings and reflected verbal and visual memory deficits in the context of high average intelligence. Treatment with carbamazepine, verapamil, and fluoxetine gready improved the patient's symptoms. The present case illustrates an example of a poor outcome in a paediatric case of mild traumatic brain injury, the importance of PET in demonstrating definitive evidence of brain dysfunction, and the child's positive response to anticonvulsant medication.

ISSN:0269-9052    

DOI:10.3109/02699059509008202

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The authors introduce a two-dimensional scale for rating closed-head injury, the Head Injury Severity Scale (HISS). This system is based on a five-interval severity classification (minimal through critical), determined primarily by the initial post-resuscitation Glasgow Coma Scale score. The second dimension is predicated on the presence or absence of complications, appropriate for each severity interval. The outcomes of almost 25, 000 patients with head injury encountered at our institution over a 7-year period were evaluated. We discovered that adding a complication dimension to each severity category resulted in significant outcome differences and effectively divided patients into groups with very different risks, prognosis and treatment requirements. The HISS is proposed as a framework on which further research can be done to guide care to predict outcome and to perform audits on head-injured patients.

ISSN:0269-9052    

DOI:10.3109/02699059509008203

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Balance characteristics, latency, amplitude, and symmetry were measured in 23 moderate and 23 severe traumatic brain-injured (TBI) patients. Patients received two graded forward and two graded backward linear perturbations. Although within normal limits, latency was high. Patients were able to appropriately grade force in relation to the size of the perturbation. Standing posture prior to and during perturbation was recorded by the amount of force generation through each lower extremity. Some individuals used an asymmetrical balance response following perturbations, whereas others shifted to a more symmetrical weight-bearing balance response. TBI patients may be prone to instability due to a combination of long latency of onset of the balance response coupled with asymmetrical stance patterns during recovery from an unexpected linear perturbation.

ISSN:0269-9052    

DOI:10.3109/02699059509008204

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Persons with brain injuries demonstrate an inconsistency in functioning over time and circumstances that requires a consideration of factors in addition to the size and location of the acquired brain lesions. A multi-factor account is presented in which neuropsychological disability on any occasion is attributed to some combination of neuropsychological deficits plus one or more of four personal factors (negative thinking, tension-arousal, fatigue, physical symptoms) and three situational factors (demands for complex attention, demands for rapid processing, external distractions). Citing pertinent research the paper discusses the development of, and possible mechanisms of influence by, these seven factors. It then broadly prescribes clinical interventions that might assist clients to reduce their adverse effects. It is suggested that the scope of brain injury rehabilitation be extended to include training clients to identify and manage non-organic conditions that may combine with direct brain injury effects to compromise productive work, complicate social relationships, or render the affected person less able to cope with stress.

ISSN:0269-9052    

DOI:10.3109/02699059509008205

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Preliminary findings from an ongoing investigation of the potential relationship between narrative discourse performance and executive functions in adults with traumatic brain injuries (TBI) are reported. Narrative stories were elicited from 32 adults with TBI. Stories were analysed at three levels: sentence production, intersentential cohesive adequacy, and story episode structure. These measures were then correlated with scores from the Wisconsin Card Sorting Test (WCST), the primary measure of executive function. A significant correlation was noted between a factor score from the WCST and the measure of story structure, but not sentence production or cohesive adequacy. These results suggest that executive functions may be a promising avenue to pursue in the search for underlying causal factors of narrative discourse dysfunction and, therefore to better delineate the nature of communicative deficits secondary to TBI.

ISSN:0269-9052    

DOI:10.3109/02699059509008206

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Principal-components analysis of 44 items from the Minnesota Multiphasic Personality Inventory (MMPI) identified as neurologically related was conducted on profiles obtained from 196 individuals with head injury. Four principal factors, that accounted for 36.5% of the total variance, were extracted. The first factor was composed of items tapping attention and memory complaints. The second factor consisted of items focusing on somatic complaints. Items primarily tapping behavioural disturbance made up the third factor, and the fourth factor was composed of items reflecting specific somatic or neurological complaints. These findings partially confirmed those obtained in previous research, and further illuminate the need for developing a specific and brief measure to characterize neurobehavioural dysfunction for neurological samples.

ISSN:0269-9052    

DOI:10.3109/02699059509008207

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

During the past decade the usage of dopaminergic agonists for the brain-injured population has become a more common treatment option during both the acute and subacute phases of recovery. We attempted to use Sinemet to address the functional limitations of a 74-year-old woman who was 7 months status post-traumatic brain injury secondary to a motor vehicle accident. The patient was administered a 3-month trial of Sinemet while continuing to receive structured sensory stimulation. Her baseline performance using Rappaport's Coma/Near-Coma (CNC) scale yielded a score in the moderate coma range. Weekly evaluations were conducted throughout the drug trial period using the CNC scale. Although the patient displayed modest improvement in her total score, functional change was negligible. Long-term follow-up suggested an absence of retention of earlier gains obtained on the CNC scale. The authors suggest that flawed research methodologies, heterogeneous patient populations, and potential difficulties obtaining reliable dependent measures makes the interpretation of brain injury research findings equivocal. However, given the many limitations, the current research design suggested that the long-term practical utility of Sinemet was unremarkable. Suggestions for future pharmacological research designs with the brain-injured population are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059509008208

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The need for developing team cooperation procedures when treating patients with traumatic brain injury (TBI) is stated. One approach in promoting team cooperation is to combine team development with a specific training programme. A memory training programme used in a subacute TBI rehabilitation unit is described. A combination of a team development procedure and memory training programme was performed in the unit. A questionnaire to assess team members' attitudes to team cooperation was administered before and after team development, and memory training procedures were implemented. The post-training questionnaire administration indicated a more positive perception among team members of how the team functioned. The efficacy of memory training showed variable results. The programme described may illustrate the advantages of combining a specific treatment programme with efforts to promote team development.

ISSN:0269-9052    

DOI:10.3109/02699059509008209

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Verbal memory and learning patterns, as measured by the California Verbal Learning Test (CVLT), following penetrating head injury (PHI) from gunshot wounds were studied in 10 acutely injured patients (mean age 25-3 years) at a mean of 21 months post-injury. Primary impairment was found on measures of free recall of new verbal information which appeared to be related to deficits in organisational and retrieval functions: (1) the group's learning characteristics were marked by disorganization and an underutilization of active learning strategies; (2) rate of acquisition also appeared to be mildly decreased; (3) nevertheless, the PHI group did not show severe disruption in all aspects of learning and memory. In fact, the group showed a relatively intact capacity to store new information in memory.

ISSN:0269-9052    

DOI:10.3109/02699059509008210

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Prediction of outcome for brain-injured individuals will facilitate effective rehabilitation programme planning which will ultimately improve the patient's quality of life. A sample of traumatic brain-injured subjects who had completed their rehabilitation were contacted post-discharge to identify predictive factors for return to work/school. Subjects were given a telephone interview and their charts were examined retrospectively along five subsets of variables in the predictive matrix: sociodemographics, chronicity, indices of severity, physical impairment, and cognitive functioning. Forty-five subjects were used as the study sample to investigate their vocational and educational outcome, and to generate the best predictive model for return to work/school. Twenty subjects made up the test sample used to evaluate the generalizability of the predictive model. Performance IQ score of the Wechsler Adult Intelligence Scale-Revised emerged as the most significant predictor of return to work/school. Implications of these findings for treatment and rehabilitation are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059509008211

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor