摘要:

This is a comprehensive review of the late-occurring effects of traumatic brain injury (TBI). It appears that TBI increases the risk over basal rates for the general population, to this degree: for depression, by a factor of five or 10; for seizures, by two to five; for psychotic disorders, by the same factor; and for dementia, by four or five. Severe TBI, or injuries with special characteristics, may increase the risk of delayed sequelae even further. One is not able, at this point, to estimate the relative occurrence of a newly described entity-delayed amnesia. An initial TBI increases the risk for subsequent TBI, by a factor of two. A second TBI increases the risk of yet another TBI eightfold.

ISSN:0269-9052    

DOI:10.3109/02699059109008093

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Somatosensory evoked potentials (SEPs) were found by several authors to have a prognostic value in traumatically brain-injured (TBI) patients and can serve for monitoring changes in the state of TBI patients. Most of the studies were performed in the acute phase of trauma and most of reports have dealt with the short-latency components. The present study reports on seven patients (mean age 26-2 years) who suffered severe blunt TBI and were in prolonged post-comatose unawareness (PCU) state, in whom early and late SEP components were recorded at least 5 weeks after sustaining trauma. The SEPs studied could not reveal a uniform pattern apart from prolonged central conduction time (CCT), which was common to all patients. This may be due to individual non-homogeneous patterns of brain damage in our severe TBI patients. Meaningful late recovery of consciousness occurred in one patient and correlated with shortening of CCT. We suggest that the prolonged CCT found in our patients is related to diffuse subcortical axonal injury and that the shortened CCT found during the second examination in this patient actually reflects late partial recovery—either structural or functional—of affected brain regions. This patient is also an example of the possible relationship between reduction of CCT and recovery of consciousness a long time after injury.

ISSN:0269-9052    

DOI:10.3109/02699059109008094

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

In 1983, Lezak described executive functioning as the ability to engage in independent, purposeful, self-directive and self-serving behaviour [1]. Self initiation, problem-solving and self-monitoring or regulation of behaviour are important components of executive functioning. This paper presents the results of efforts to improve executive functioning in three areas: problem solving, self-initiation and self-regulation.

ISSN:0269-9052    

DOI:10.3109/02699059109008095

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

A summary is presented of the major sequelae of traumatic brain injury and of the effects of these on the individual and the family. A series of guidelines is offered for use by family therapists when working with this population. The therapist must be directive, informed and informing. At times the therapist is an advocate, a model, a monitor and an agent of generalization.

ISSN:0269-9052    

DOI:10.3109/02699059109008096

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Aspects of productivity, content, and cohesion in the narrative and procedural discourse of 11 closed head-injured (CHI) adults and 21 normal adults were examined. Two narrative tasks, one involving retelling a story heard and the other formulating a story based on a comic strip, and one procedural task of telling how to buy groceries were administered to each subject. CHI subjects consistently produced fewer words, spoke slower, used more mazes (dysfluencies), produced fewer target content units, and used fewer cohesive ties per utterance, as compared to the normal subjects. Other significant differences in discourse occurred between the two groups, but these varied from task to task. Normal subjects varied characteristics of their discourse performance according to the discourse task. Significant differences across tasks occurred on seven of the 13 discourse measures. The CHI subjects, however, showed more limited variation in that their performance varied on only three of the 13 measures. Correlations among discourse, language, and memory measures were examined and discussed. The results of this study indicate that analysis of CHI narrative and procedural discourse has important clinical and theoretical implications.

ISSN:0269-9052    

DOI:10.3109/02699059109008097

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

MCMI (Millon Clinical Multiaxial Inventory) profiles of 79 head-injured patients were compared with self-report of personality change following head injury. Mean MCMI scale scores were highest on Scales D (Dysthymia), A (Anxiety), 6 (Antisocial), H (Somatoform), 5 (Narcissistic) and 7 (Compulsive). Taking only high-point codes above an adjusted base-rate score of 75, the sample showed most frequent elevations on A (Anxiety), D (Dysthymia), H (Somatoform), 5 (Narcissistic), 6 (Antisocial-Aggressive) and 8 (Passive-Aggressive), in order of cumulative frequency. Personality trait scales and clinical scales were compared with self-report of personality change. Elevated personality trait scales correlated with self-reports of dysfunction and so did clinical scale elevations. There was no relationship between the number of elevated scales and severity of head injury, nor between the number of elevated scales and interval after head injury.

ISSN:0269-9052    

DOI:10.3109/02699059109008098

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

This study aims to highlight the possible use of adapted leisure materials in the modification of behavioural responses within the brain-injured population. Single-case methodology was used to evaluate the effectiveness of contingent reinforcement in promoting head posture in an adult brain-injured male. A microswitch was implanted within a headband worn by the subject, attached to a portable radio and positioned such that correct head posture operated the switch, completed the electric circuit and activated the music. The target behaviour was defined as the percentage of time in a walking programme where correct head posture was maintained. The experimental procedure incorporated an A-BC-B-BC-A design and represented the following phases: (A) baseline; (BC) headband + music and (B) headband, no music. A follow-up assessment was also undertaken 1 month later. Overall, statistical analysis revealed a significant increase in the target behaviour and that this improvement was direcdy contingent on the provision of music inforcement. Results are discussed in further detail and the clinical significance of this finding, over and above the statistical significance, is highlighted in terms of this individual's rehabilitation.

ISSN:0269-9052    

DOI:10.3109/02699059109008099

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

A series of 36 patients who had been hospitalized following closed head injury (CHI) were followed up 4.06 (SD 3.71) years after the injury. Measures were taken of degree of psychosexual dysfunction (Golombok Rust Inventory of Sexual Satisfaction-GRISS), general psychiatric morbidity (General Health Questionnaire-GHQ), and clinical anxiety and depression (Hospital Anxiety and Depression Scale-HAD). These measures were completed by patients and partners. Resulting data revealed that 50% of male patients with current sexual partners produced psychosexual profiles that fell within the dysfunctional range. For both male patients and their partners, the chief psychosexual complaint was infrequency. Of the patients studied, 61% were classified (using the GHQ) as having degrees of emotional distress that would fall within the range of psychiatric 'caseness', while 25% of patients achieved HAD criteria for clinical anxiety and 22% met HAD criteria for depression. Of the partners, 41% met GHQ criteria for psychiatric 'caseness', 18% being classified using the HAD as anxiety cases and 6% as depression cases. No effects of severity of injury were observed on any of the main outcome measures. Age and time since injury were related to measures of psychosexual dysfunction. These results are discussed in relation to the existing literature on psychosocial outcome in closed head injury, and recommendations for therapeutic intervention are made.

ISSN:0269-9052    

DOI:10.3109/02699059109008100

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

The Visual Response Evaluation (VRE) was developed to meet the need for a formal and in-depth measure of visual responses in low-level brain-injured persons (Rancho Levels II and III) and to monitor and document minute changes in the recovery of these patients. Often, patients at these low functional levels exhibit little to no motoric or cognitive interaction with the environment, except that which occurs in response to sensory stimulation. Other tools have been developed to document responses to various types of stimulation; however, none contain the sensitivity to consistency and type of response that is necessary to show the small but vital progress that is characteristic of the Rancho II and III type patient. The VRE consists of 10 items separated into two general categories: (1) Observations, and (2) Response to Stimuli. The five items in the Observations section assess a patient's spontaneous responses, while the five items in the Response to Stimuli section document responses directly related to the presentation of a hierarchical order of stimuli. The VRE was administered to 10 patients with a mean age of 39.8 years at a mean time of 4.2 months post-injury. Statistical analyses of the pilot-study data show the VRE to be both internally reliable and criterion-related valid at theP<0.025 level of significance. The data supports further investigation in the areas of prognostic ability and implications for treatment. The VRE can be a useful tool for studying the recovery process and evaluating treatment programmes for low-level brain-injured persons.

ISSN:0269-9052    

DOI:10.3109/02699059109008101

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Four brain-injured clients continually demonstrated short-term memory deficits including difficulty learning new material and forgetting appointments. Training in the use of memory notebooks improved performance of homework assignments and keeping appointments.

ISSN:0269-9052    

DOI:10.3109/02699059109008102

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor