摘要:

A retrospective clinical hospital chart study was undertaken to prepare a statistical profile of traumatic brain-injured patients in rehabilitation. It included 498 consecutive admissions to the Traumatic Brain Injury Rehabilitation Program of the Queen Elizabeth Hospital (Toronto, Canada) from 1978 to 1991. Descriptive statistics were obtained for age, gender, marital status, educational status, occupational status, history of drug and alcohol use, cause of injury, month of injury and length of coma. Comparisons are made between the studied population and several Canadian centres, as well as international brain injury demographics in the literature. Results are discussed in terms of the gender differences and lifestyle parameters associated with brain injury.

ISSN:0269-9052    

DOI:10.3109/02699059309034955

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The respiratory abilities of a group of 20 subjects with a speech disorder resulting from severe closed head injury (CHI) were assessed using both spirometric and kinematic techniques and compared with those of a group of 20 non-neurologically impaired controls matched for age and gender. Results of the spirometric assessment showed that the CHI subjects as a group had lower vital capacities and lower forced expiratory volumes 1 second than the controls. Kinematic assessment also showed that the CHI subjects had problems co-ordinating the action of the rib-cage and abdomen when carrying out speech tasks such as vowel prolongations, syllable repetitions and reading. Results are discussed in terms of the effects of CHI on neuromuscular function.

ISSN:0269-9052    

DOI:10.3109/02699059309034956

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

This study was set up to test the reliability of the Glasgow Outcome Scale (GOS) when information was obtained from different sources. Eighty assessments were carried out on a group of 58 patients at three different time intervals up to 24 months post-injury. Each assessment consisted of three independently obtained GOS scores for each patient; (i) a score by a research psychologist after interview and neuropsychological testing of the patient; (ii) a score, obtained by post, by the patient's general practitioner (GP), and (iii) a score made by a research worker based on questionnaire information obtained from relatives by post. The agreement between the psychologist's score and that based on the relatives' information was high (r= 0.79p= 0.001) whereas the correlation between the psychologist's score and that of the GP was low (r=0.49p= 0.001). The GPs tended to make overoptimistic assessments and this was most notable at 6 months post-injury when only 50% of the GPs' assessments agreed with those of the psychologist. We have shown that reliability of the GOS varies with the method of obtaining data. Ideally patients should be interviewed and tested by staff who have not been involved in the acute care of the patient. Failing this, information should be obtained from relatives of the patient and used by staff, trained in the use of the GOS to assign a GOS score.

ISSN:0269-9052    

DOI:10.3109/02699059309034957

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Although it is routinely acknowledged that cognitive rehabilitation therapy comprises a major part of the services provided to survivors of brain injury, there continues to be no general consensus regarding the methods and training of those who provide cognitive rehabilitation services. This survey of 398 head-injury rehabilitation facilities includes information on which disciplines are providing and supervising cognitive rehabilitation therapy, which therapy formats are used, and a first attempt to define the costs and providers for cognitive therapy staff training in Commission on Accreditation of Rehabilitation Facilities (CARF) approved and other (non-CARF) facilities. The education and training of junior and senior staff members is compared, and respondents suggest changes in the education and training of those who provide cognitive rehabilitation therapy. The results of this survey suggest no significant differences in the organization and delivery of cognitive rehabilitation therapy in CARF and non-CARF programmes. They indicate that cognitive rehabilitation therapy and the education and training of providers deserve further study and definition, given the widespread provision of cognitive rehabilitative services.

ISSN:0269-9052    

DOI:10.3109/02699059309034958

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Closed head injuries (CHI) may produce permanent, disabling changes in cognitive functions and social behaviour. Recent clinical case reports have suggested that stimulant medications may improve neurobehavioural functioning in CHI patients. In the present study, we evaluated the effects of methylphenidate (0-3 mg/kg b.i.d.) in 12 chronic CHI patients (14 to 108 months post-injury) using a double-blind, placebo-controlled, randomized, crossover design. Outcome measures consisted of cognitive tests of attention, learning and cognitive processing speed. In addition, a rating scale was completed by a close friend or relative to assess social behaviour. No significant differences were found between drug and placebo conditions on any of the neurobehavioural measures. These data do not support the clinical use of methylphenidate in the treatment of CHI patients.

ISSN:0269-9052    

DOI:10.3109/02699059309034959

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Dental care and oral hygiene programmes for persons with traumatic brain injury (TBI) have been relatively ignored areas of clinical care and research. Data regarding the need for structured oral hygiene programmes with this population are sorely lacking. Further, evidence to support or contraindicate the efficacy of such interventions is negligible. The purpose of the present study was to address the need for ongoing dental follow-up and oral hygiene programmes in the post-acute phase of rehabilitation care. A group of 20 TBI patients (10 experimental, 10 control) who were at least 1 month post-injury and had Rancho Los Amigos Scale scores of 6 or greater, were randomly selected for participation in the study. Oral hygiene status was assessed by a dental hygienist using a plaque index score developed by Silness and Loe. The experimental group received individualized oral hygiene instruction along with dental supplies for their personal use, including a dental mirror and red disclosing tablets. The control group received no such instructions or supplies. At 5–6 weeks following initial evaluation, 18 patients (nine from each group) were reassessed via the plaque index score. Comparisons between the control and experimental groups revealed significant differences on follow-up plaque scores with a lower mean score for the experimental group only on baseline and follow-up data yielding a significant decrease in plaque scores over time. These results suggest that dental hygiene interventions for patients following TBI can effectively promote dental plaque control.

ISSN:0269-9052    

DOI:10.3109/02699059309034960

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The case of a traumatic brain injury (TBI) patient with dramatic cognitive deterioration in the absence of medical aetiology other than simultaneous decline in serum sodium led to an investigation of the association between declines in sodium levels and cognitive status. In a population of 50 persons undergoing TBI rehabilitation, 12 (24%) had relative (3 mEq/L) decreases in serum sodium while five (10%) experienced absolute hyponatremia (136mEq/L).Correlation with cognitive status was significant when the absolute hyponatremia group was compared with those whose sodium levels remained above 136 mEq/L. A case-matched study of the relative hyponatremia group yielded no significant association between sodium-level decreases and cognitive status. These data support previous conclusions indicating wide variation in individual responses to changes in serum sodium. The threshold for significant effects of hyponatremia may be higher in patients with TBI than in populations studied previously.

ISSN:0269-9052    

DOI:10.3109/02699059309034961

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The results of a series of eight individual case reports in which protriptyline, an activating tricyclic antidepressant, was used as a 'stimulant' medication are presented. For some patients with head injury, traditional stimulants, such as methylphenidate, or dopaminergic stimulants, such as levodopa-carbidopa, amantadine, or bromocriptine, may be partially or totally ineffective or not tolerated. Protriptyline can be a very effective alternative and, for some patients, may be the most effective stimulant tried. In low to moderate doses, protriptyline should be considered for trials as an activating/stimulant medication in patients with head injury.

ISSN:0269-9052    

DOI:10.3109/02699059309034962

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

This paper reports the case of a 16-year-old man who had sustained a traumatic head injury. Neuroradiological examinations showed haemorrhagic lesion in corpus callosum. The patient initially demonstrated several symptoms of disconnection syndrome; however, these clinical signs later resolved in subtle dysfunctions that could be evidenced only by statistical analyses of performances to specific tests. It is thus suggested that comparable cases may be undetected by standard examination procedures.

ISSN:0269-9052    

DOI:10.3109/02699059309034963

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The Repatriation Community Programs pilot project was funded by the Ontario Ministry of Health in 1990. Its mandate is to facilitate the return of brain-injured individuals from US rehabilitation facilities to their home communities in Ontario. Most Ontario residents receiving rehabilitation in the US fall into one of two‘hard to serve’groups: (1) those with severe behavioural difficulties; and (2) those at various levels of post-comatose unawareness whose families are unwilling to accept chronic care‘maintenance’. The pilot programme has been charged with demonstrating the feasibility of community-based care for severely brain-injured individuals and their families, as well as developing a model of service delivery and interagency collaboration which will expedite province-wide implementation of similar programmes. This paper describes the collaborative model developed over the first 2 years of the project. Issues leading to this model are identified and elements of the model are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059309034964

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor