摘要:

What should clinical neuropsychologists look out for when asked to assess someone with hypoxic brain damage? To determine whether there are typical cognitive profiles of hypoxic patients, all referrals for a neuropsychological assessment made to the author over a period of 16 years were scanned to identify those with a primary diagnosis of cerebral hypoxia as recorded in the hospital notes. From a total sample of 567 patients, 18 (3·17%) had sustained primary cerebral hypoxia from a variety of causes including carbon monoxide poisoning, cardiac arrest, anaesthetic accident, respiratory failure following a pulmonary embolus, hanging and drowning. Not surprisingly, in view of the different degrees of brain damage, the cognitive functioning of the 18 patients was variable, with the greatest number showing deficits of memory and executive functioning (n= 6). Three presented with an amnesic syndrome; two with memory, executive and visuospatial deficits; and three with visuospatial or visuoperceptual problems without severe memory impairments. The remaining four patients were very severely impaired intellectually (VSI), with widespread cognitive deficits precluding the use of neuropsychological assessment procedures designed for adults.

ISSN:0269-9052    

DOI:10.1080/026990596123846

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Changes in the delivery of health care have resulted in new sites for rehabilitation of patients with severe brain injury BI. Adjustments in the training of resident physicians in physical medicine and rehabilitation are likely to ensue. We utilized Likert scales and open-ended questions to survey 1 residents who were assigned over a 2½-year period to a subacute BI rehabilitation unit SRU. 2 Residents were surveyed about their desire to participate in a SRU training site, and the usefulness of such a rotation, and compared the rotation to traditional settings in which patients with similar diagnoses were treated. The results indicated that significant positive changes in residents' attitudes towards this type of training site occurred (p= 0·01). The rotation was felt to be useful (p= 0·008) despite initial misgivings. Positive educational aspects were exposure to the unique problems of patients with severe BI (e.g. spasticity and agitation) and a sense of independence and competence in leadership roles. Problematic aspects included the management of medically unstable patients without supportive resources, and a lack of nurses trained in rehabilitation principles. Training of residents in the rehabilitation management of patients with severe BI can be perceived as a valuable educational experience by trainees.

ISSN:0269-9052    

DOI:10.1080/026990596123855

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

We studied influence of age and educational level before injury on the social and vocational outcome among a group of traumatic brain injury TBI patients with post-injury problems in their education and employment. Patients with TBI, followed up for at least 5 years, and who were admitted to a rehabilitation and re-employment programme, were selected for evaluation of long-term outcome. We used the Glasgow Coma Scale GCS scores at the time of emergency admission to the hospital to measure brain injury severity. Age at the time of TBI and educational status before TBI were correlated with the outcome measures at the end of follow-up separately in each category of brain injury severity. The study was carried out at the Kauniala outpatient neurological clinic, which specializes in brain injuries in Finland; it works closely with the Departments of Neurology and Neurosurgery at the Helsinki University Central Hospital. Main outcome measures were functional outcome measured by the Glasgow Outcome Scale GOS, the educational level reached, and postinjury occupation, as well as the incapacity for work at the end of follow-up. In the severe category of brain injuries, children 7 years or younger at the time of injury suffered severe disability as measured by 2 the GOS scores more often than did the older age groups (p= 0·010,χ2). They were less often 2 capable of independent employment (p= 0·011,χ2) than the children injured at the age of 8-16. Patients with a higher education usually had a better outcome. In the category of mild brain injuries the majority of the patients, regardless of age, recovered well according to the GOS, and were capable of independent employment at the end of follow-up. Our patients were selected from the TBI population as survivors with problems in education and re-employment. Those with severe injury sustained early in life childhood and early teens coupled with poor educational attainment had relatively worse social and vocational outcome; better outcomes were enjoyed by those severely injured individuals whose injuries were sustained later late teens or early adulthood. In the groups of patients with moderate and mild brain injuries such a relationship was not found between age or pre-injury education and outcome.

ISSN:0269-9052    

DOI:10.1080/026990596123864

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Automatic tasks are performed with minimal attentional guidance. Neural pathways subserving attention are often impaired in traumatic brain injury TBI. Therefore, the process of automatization is crucial in skill development, due to the fact that it allows attention to be directed towards the more abstruse components of task [1]. Automatic and cognitive categories were created by aggregating three of the motor items and three of the cognitive items respectively of the Functional Independence Measure FIM. The averages of these categories were calculated for every evaluation of the FIM, and their relationshp to each other was examined. Over a 9-month period 24 patients were selected from a TBI population with a major component of diffuse axonal injury (DAI). Eight-eight per cent (n= 21) of the patients reached independence for the automatic category, but only 29 % (v= 7) reached this level for the cognitive category. When independence was achieved, the average time to do so for the automatic category 6·7 weeks) was not significantly different from the time it took to reach cognitive independence (6·9 weeks). It was found that there were significant statistical differences in the scores between the two categories. Premorbid IQ had no effect on these categories. However, the rate which these two categories increased, from the time of admission to discharge, was not significantly different.

ISSN:0269-9052    

DOI:10.1080/026990596123873

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

A 28-year-old woman with acquired brain damage suffered subsequent profound mental disability and an intense hyperphagic syndrome complete with life-threatening pica. She was the single subject of two consecutive experiments. In the first, Naltrexone, an orally administered opiate blocker, was given to reduce hyperphagia and distress, but was associated with even greater urgency when eating meals and a manifest increase in distress. While distress reduced to premedication levels on withdrawal of treatment, urgency of eating did not reduce so quickly. In the second experiment a laser acupuncture procedure was used at 2 5 Hz and 10 Hz for 10 days each with an intervening 10-day placebo condition to increase the availability of the subject's endogenous opiates, and thus hopefully produce opposite effects to the first experiment and effect a positive treatment. The 10 Hz condition produced a significant but transient reduction in pica measured by attempts at pica on a supervised walk shortly after each treatment. The subject was also easier to manage on walks, and appeared happier. Further studies using physical exercise or acupressure to achieve similar or better results are discussed.

ISSN:0269-9052    

DOI:10.1080/026990596123882

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

ISSN:0269-9052    

DOI:10.1080/026990596123891

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor