摘要:

Individuals who have sustained traumatic brain injury may provide friends, family, and rehabilitation professionals with challenges through an increased likelihood of their engaging in socially inappropriate behaviours. At extremes the inappropriate behaviours include vocal and physical assault, non-compliance, self-injurious behaviours, elopement, and property destruction. While these maladaptive behaviours are by themselves troublesome, for some individuals they provide severe barriers to rehabilitation. One option for the challenging rehabilitation client is a neurobehavioural programme, typically offering an access-limited or otherwise secure physical environment and which focuses on behaviour reduction. While outcomes from neurobehavioural programmes are typically positive, their expense and the negative connotations of this type of programme will at times dissuade family members from enrolling the client. We describe an alternative, less restrictive behavioural programme operated in the physical and social context of a larger, more typical community-based rehabilitation programme for traumatically brain-injured individuals. This programme has been in operation for nearly three years, successfully serving more than 200 clients, of which approximately 20% posed behaviour management problems. Identified variables accounting for these successes include: formal guidelines for programme development, staff training and monitoring, data collection, integration of an interdisciplinary team, discharge planning and post-discharge follow-up. We provide a general programme description followed by discussions of four brief case studies to illustrate basic principles of the programme. Programme strengths are-discussed, as are constraints placed on the programme by the physical and social environments in which it operates.

ISSN:0269-9052    

DOI:10.3109/02699059209034944

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

Emotional lability or emotionalism is a relatively common phenomenon and frequently occurs following vascular or traumatic brain injury. It is distressing and embarrassing to sufferers and their families, and often interferes with rehabilitation. At present there is no satisfactory or reliable treatment for this condition. We describe an open trial using fluoxetine, a newer antidepressant with a specific serotonergic action, in the treatment of emotional lability due to brain injury. Six consecutive cases of emotional lability attending a rehabilitation unit were studied (five cases of cerebrovascular accident and one of traumatic brain injury). Response to treatment was measured using a modification of the scale described by Lawson and MacLeod [1]. All showed a marked improvement within one week of commencing fluoxetine and the drug was well tolerated with no reported side-effects. The speed of onset and degree of improvement suggest that fluoxetine may be a useful agent in the treatment of emotional lability due to brain injury. Our observations indicate that further investigation of the role of fluoxetine in the treatment of emotional lability is warranted.

ISSN:0269-9052    

DOI:10.3109/02699059209034945

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

The case of a 19-year-old male who sustained a severe brain injury is described. This patient was initially given a very gloomy prognosis, leading to poor expectations for recovery. Additionally, like many such patients in the United Kingdom, he was cared for by a ward team who were without specialized training in head injury rehabilitation. Despite these factors the patient went on to make a good recovery. The issues of specialized care and the need for more appropriate patient assessment procedures are raised. The MRC Head Injury Assessment Project is described.

ISSN:0269-9052    

DOI:10.3109/02699059209034946

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

This study is an attempt to characterize subgroups of families based on differing perceptions of problems and changes after traumatic brain injury. The Problem Checklist of the NYU Head Injury Family Interview was administered to 34 people with head injuries (PHI), and a significant other (SO) of each, between 1 and 3 years post-injury. Families were found to differ systematically in their responses and could be divided into three groups: High Agreement group (HAF), where there was high agreement between the PHI and the SO regarding problems and changes; High Disagreement—PHI endorsing more problems than the SO (HD-PHI); and High Disagreement—SO endorsing more problems than the PHI (HD-SO). No differences were found between these groups in age, sex, duration of coma, time since injury, educational achievement of the PHI, or the SO's relationship to the PHI. However, the HD-PHI group tended to have a higher return-to-work rate, the SOs in the HAF group reported the highest rates of subjective burden, and groups were found to differ in types of items endorsed by the PHI v. the SOs. Implications of findings are discussed regarding reliability of reporting problems, awareness issues in return to work and subjective burden of family members, and methodological and treatment issues.

ISSN:0269-9052    

DOI:10.3109/02699059209034947

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

A retrospective archival study of 129 moderate to severe closed head-injury patients from a university-based rehabilitation hospital was conducted to investigate the effect of blood alcohol level (BAL) at time of trauma on the length of post-traumatic amnesia (PTA), length of hospitalization and cognitive status on clearing PTA. While no statistical significance was obtained for the effect of BAL on length of PTA, a mean difference of 15–4 days between‘no alcohol’and‘intoxicated’patient groups was observed. A low, but significant correlation,r =0–249,p<0.05, indicated that as blood alcohol level increased, time to rehabilitation admission increased. The sex of the patient had a significant effect on length of PTA, BAL and time of recovery variableF(6,81) = 2.468,p<0.05. Females experienced longer length of PTA, but had lower BALs than males. Measures of cognitive status on clearing PTA did not show a statistically significant effect of BAL. Results are discussed in terms of mediating variables in the relationship between BAL and the length of acute hospitalization, prolonged PTA in patients with a positive BAL, and potential physiological bases for the interaction among sex, BAL and PTA duration.

ISSN:0269-9052    

DOI:10.3109/02699059209034948

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

Superior mesenteric artery syndrome is a rare cause of upper intestinal obstruction in both adults and children. Sixteen children with severe traumatic brain injury and spastic quadriparesis developed small intestinal obstruction while undergoing a rehabilitation programme between 1981 and 1990. Five patients met the roentgenographic diagnostic criteria. The presenting symptom was post-prandial bilious vomiting. The mean age was 13 (10–16) years. The mean time elapsed from injury to diagnosis was 53 days and from rehabilitation admission to diagnosis 22 days. The mean delay in diagnosis after onset of symptoms was 4 days. All patients were of disproportionately lower body weight in relation to height, with a mean weight loss of 7 kg. The mean percentile for weight was 18 and height 58, with a difference of 30 between height and weight percentiles. The patients were receiving nasogastric or gastrostomy tube feedings at the onset of the symptoms. All patients were treated non-surgically with gastric aspiration, nasojejunal or gastrojejunal feeding by passing a feeding tube distal to obstruction. No patient required intravenous hyperalimentation. There was no recurrence in any patient during the follow-up period of 1–5 years. Though rare, superior mesenteric artery syndrome can develop in brain-injured children with spastic quadriparesis, prolonged recumbency and recent weight loss. Increased awareness of occurrence of this condition and timely management will decrease morbidity and complications that may interfere with recovery.

ISSN:0269-9052    

DOI:10.3109/02699059209034949

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

We have examined the epidemiological background of 134 consecutive patients admitted to our centre who suffered from post-traumatic unconsciousness of over 1 month's duration. The incidence of such unconsciousness in Israel is estimated as 4 per 1,000,000, or one case in 410 hospitalizations for head trauma. The cause of trauma was a road accident in 69% of cases. Among victims, pedestrians and cyclists were more likely than four-wheeled vehicle drivers and their passengers to suffer from prolonged unconsciousness, from which they were less likely to recover.

ISSN:0269-9052    

DOI:10.3109/02699059209034950

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

Early rehabilitation has been shown to minimize complications and optimize functional outcomes in head-injured patients. Although cognitive, behavioural and vocational issues continue for years after injury, many investigators maintain that physical improvement is limited after 6 months. At 12 months after injury, expectations for physical improvement are generally limited. In addition, although repeated inpatient admissions for rehabilitation are common, gains in self-care and mobility skills during readmissions for rehabilitation have not been specifically investigated. In this retrospective study the records of 49 severely head-injured patients were evaluated. All were readmitted to an inpatient rehabilitation facility more than 12 months after injury. Barthel Index scores were obtained to evaluate physical function. Although previous studies would predict few improvements, in this study 53% (26 patients) showed improvement, and the difference between readmission and discharge Barthel scores was statistically significant (p= 0.0001). Gains were highly correlated with length of readmission, but not with age of patient, age at time of injury, length of coma, time since injury, or duration of previous rehabilitation. Patients with mid-range admission Barthel scores (21–85) demonstrated the largest gains, with 79% showing improvement. Gains averaged 11.2 points on the Barthel Index. Severely head-injured patients may show clinically significant improvement in physical function well after current standards predict a plateau.

ISSN:0269-9052    

DOI:10.3109/02699059209034951

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

A consecutive series of 93 severe closed-head injury (SCHI) patients, discharged from hospital in a conscious state, were rated on the Glasgow Outcome Scale at 6 and 12 months post-injury. Patients were included in this study if they had a period of post-traumatic amnesia (PTA) exceeding 24 h. Approximately 80% of patients had made a good recovery by 12 months post-injury; a better outcome than has been found in studies using the presence of coma during the first 6 h post-admission to hospital to define severe head injury. When analysed individually, duration of PTA and Glasgow Coma Scale scores on admission to hospital were both strongly correlated with outcome. Only duration of PTA, however, contributed significantly to outcome variance when potential outcome predictors were assessed using a stepwise multiple regression analysis. The definition of severe head injury, the higher than usual incidence of good recovery in the present study, and the relationship between injury severity and outcome are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059209034952

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor

摘要:

The Simulation Index was derived from 15 error types on the WAIS-R and WMS occurring with a high degree of specificity in a criterion simulation group (n= 16) and a further five error types specific to a group of patients sustaining severe head injury (n= 16). The reliability of the scoring criteria was evaluated in terms of the rate of agreement in scoring for the presence or absence in each of the 20 error types achieved by two independent neuropsychologists. Percentage agreement rates for each of the 20 error types ranged between 83 and 100%. When identification of group membership was attempted on the basis of simple inspection of the test protocols, diagnostic hit rates were at chance level. When identification of group membership was based on Simulation Index cut-off scores, each of the raters achieved a diagnostic hit rate of 94% for each of the simulation and head-injury group patients. The results support the reliability and clinical utility of the Simulation Index.

ISSN:0269-9052    

DOI:10.3109/02699059209034953

出版商:Taylor&Francis    

年代:1992

数据来源: Taylor