摘要:

Communicative hydrocephalus (CH) is considered as one of the late sequelae of severe craniocerebral injury. However, as most of the series of patients with CH described in the literature deal with the results of various shunting procedures, the incidence of post-traumatic communicative hydrocephalus is not documented. We have found that almost 3-9% of 335 severe craniocerebral-injured patients develop communicative hydrocephalus. These patients were unconscious for various periods of time, therefore the triad described by Hakim and Adams cannot by itself lead the clinician to suspect possible development of communicative hydrocephalus. It is suggested that in prolonged coma, or in the presence of arrest in clinical progress in conscious craniocerebral-injured patients, communicative hydrocephalus should be suspected.

ISSN:0269-9052    

DOI:10.3109/02699058809150897

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

The subject of stimulant treatment for patients with neurobehavioural sequelae of traumatic brain injury (TBI) has received a good deal of recent attention, although there have to date been no controlled studies published. This is a description of 15 TBI patients who received treatment with the psychostimulant methylphenidate. in a double-blind, placebo-controlled cross-over study, with behavioural and neuropsychological ratings. Three subjects remained on the drug for a year after the acute study, and were subsequently studied in a double-blind, placebo-controlled reversal. The results support the idea that at least some symptomatic improvement may be gained from low-dose stimulant reatment, although the statistical analysis of the data was compromised by the occurrence of carryover effects from one drug condition to another. This, in itself, is an interesting discovery, because such effects have never been observed in stimulant studies of other patient groups. There are clear implications for the design of further studies inthisarea. The long-term effects of methylphenidate treatment were not at all impressive, however. Although the findings presented below may be subject to differing interpretation, it is conceivable that stimulants act to advance the course of cortical recovery following TBI.

ISSN:0269-9052    

DOI:10.3109/02699058809150898

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Cerebral blood flow (CBF) and local cerebral glucose utilization (LCGU) were measured using radioactive microspheres and [14C]2-deoxyglucose, respectively, in 26 brain regions in control animals(n = 8)and in animals (n=4) sustaining low-level experimental brain injury. Examination of the initial (resting) CBF measurement in the uninjured cats revealed two subgroups with significantly (p<0-01) different CBF levels. In uninjured cats with normal CBF levels (33-4±1-8 ml/100 g/min) there was a close linear relationship between CBF and LCGU (n = 0-71, P<0-01). In contrast, the remainder of the uninjured cats exhibited abnormally high levels of CBF (72-6±9-9 ml/100 g/min) and the absence of a close relationship between CBF and LCGU (r= 0-27). One hour following low-level (20 atm) fluid percussion brain injury, CBF was increased and LCGU was decreased, though not significantly. The relationship between CBF and LCGU remained intact (r= 0-66,p<0-01) in most brain regions. However, the relationship between CBF and LCGU in the hippocampus differed significantly from the relationship between the two parameters in the rest of the brain. Thus, the use of the radioactive microsphere method for CBF measurements allows multiple measurements of CBF and permits the assessment of the status of the cerebral vasculature prior to experimental manipulations such as traumatic brain injury. In view of our current findings of an abnormal relationship between CBF and LCGU in cats with high resting CBF levels, this is an important advantage. In addition, the combination of the microsphere and 2-DG techniques within the same tissue samples allows for the investigation of the effects of traumatic injury on the important relationship between CBF and LCGU.

ISSN:0269-9052    

DOI:10.3109/02699058809150899

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

For several years carbamazepine has been used to treat intractible mania and it is frequently used in combination with lithium. Reports of toxicity have appeared in the past 2 years and some risk factors have been suggested. This paper reports four cases of brain-damaged adolescents treated with carbamazepine and lithium for both seizure and behaviour control who developed this reported neurotoxic phenomenon.A neurotoxic syndrome has been reported in psychiatric patients receiving both lithium and carbamazepine for the control of bipolar illness [1,2]. Although these patients may represent a more commonly encountered population for the general psychiatrist, the use of psychotropic agents in neurologically impaired patients is common. In these patients, the competing needs of effective behaviour control, adequate seizure prophylaxis and minimum side-effects must be balanced. This paper describes four adolescents with brain injury who developed lithium–carbamazepine neurotoxicity when treatment for behavioural disorders coincided with anticonvulsant therapy.

ISSN:0269-9052    

DOI:10.3109/02699058809150900

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Traumatic brain injury may be associated with agitated aggressive behaviour and the potential for injury to the patient and staff. We report two cases of recovering brain injury patients with difficult-to-treat destructive behaviour, whose agitation and aggression responded to amantadine. Direct-acting dopamine agonists such as amantadine may be the preferred treatment for patients with behaviour problems in the acute stages of recovery from coma.There are not many treatment alternatives for the agitated, assaultive, disorganized head-injury patient who is recovering from coma. More precisely, there are a number of medications to choose among–carbamazepine, lithium, benzodiazepines, antihistaminics, beta-blockers–but therapeutic effect is not always predictable. All too often, physicians are compelled to prescribe neuroleptics [1]. Neuroleptics are reliable tranquillizers in such circumstances, at least over the short term; but they may result in serious side-effects (extrapyramidal reactions, cognitive blunting, temperature disregulation); and there is preclinical evidence to suggest that dopamine antagonists may retard the course of cortical recovery [2].We have observed that the direct-acting dopamine agonist, amantadine, may sometimes be useful for the acute management of such patients. The fact that dopamine agonists may actually enhance the course of cortical recovery [2] suggests that amantadine may be arationaltreatment for the recovering brain-injured patient [1].

ISSN:0269-9052    

DOI:10.3109/02699058809150901

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Outcome data from 44 brain-injured clients discharged from a rehabilitation centre during 1 year were analysed. The outcome measures were employed or unemployed, and the independent living status of the client. The predictor variables were demographic, behavioural, psychological, and neuropsychological data for each client. Results revealed that nearly 70% of the adult clients were placed in a less restrictive setting, and over two-thirds were placed in productive employment. Follow-up reports, 3-12 months post-discharge, found that 59% of the adult clients continued to live in a less restrictive setting, and 50% maintained successful employment. Data on adolescents reveal that four out of five returned home to live with parents, and four out of five returned to public schools. Reasons for successful rehabilitation of brain-injured clients are discussed.

ISSN:0269-9052    

DOI:10.3109/02699058809150902

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

This article describes the development of the Brain Injury Rehabilitation Scale (BIRS), a 20-item scale rating attention, memory, cognition, goal-directed behaviour, social interaction, and adjustment to injury. The BIRS was designed to provide ratings of clinical progress during post-acute rehabilitation from the perspective of the patient, the family and the treating staff. The BIRS was administered to two groups. Group one included five patients in a post-acute rehabilitation programme who were administered the BIRS each week for the 24 weeks of the programme. Group two was a control group composed of 21 college students. The BIRS was administered to each control subject for three consecutive weeks. The BIRS was found to be a sensitive and reliable measure of rehabilitation progress. Inter-rater reliability was high. Further evaluation of the BIRS is warranted.

ISSN:0269-9052    

DOI:10.3109/02699058809150903

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

This study examined the application of several principles and procedures of operant conditioning in the rehabilitation of a closed head-injured 18-year-old male. The patient exhibited frequent and extreme verbal outbursts during therapy sessions, and he did not comply with rehabilitation exercises. After a goal-setting plus extinction procedure failed to improve compliance or to decrease disruptive vocalizations a contingent token reinforcement intervention was implemented to increase compliance with therapeutic activities. Frequency of disruptive vocalizations was measured as a covarying behaviour. The intervention was evaluated using a single-case experimental design. Results showed that both compliance with therapeutic activities and frequency of disruptive vocalizations changed as a function of contingent token reinforcement. The effect was replicated across three settings. This study demonstrates the generality of behavioural principles and procedures with closed head-injured populations in an acute rehabilitation setting. The functional equivalence of topographically dissimilar behaviours and the situation-specific control of behaviour is discussed.

ISSN:0269-9052    

DOI:10.3109/02699058809150904

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

摘要:

Behaviour analysis procedures are gaining increasing acceptance as a viable form of treatment in traumatic head injury rehabilitation. This is based in part on the variety of sequelae that persons who have experienced a traumatic brain injury present, and the ability of behavioural procedures to address some of these issues. A second role for behaviour analysis is based on the techniques of learning and functional skill development which correlate well with the goals of traumatic brain injury rehabilitation. Over the decades a number of effective learning procedures have been developed by behaviour analysts to help a variety of people with different capacities of learning develop new skills. A third role for behaviour analysis in rehabilitation is its emphasis on the use of functional measures when determining change and treatment outcome. In this manner treatment procedures and goals can be directly measured, allowing for precise management of intervention strategies. Ideally, this can help make treatment outcome more clinically efficient and cost-effective.Along with these promises come some limitations. As with any tool, behaviour analysis procedures are not all-encompassing and by themselves do not constitute proper rehabilitation. A behaviour analyst's perspective does not, and was never designed to, 'describe the world' or account for the entirety of human behaviour. Behaviour analysis represents a template for documenting and working with selected forms of human activity. Unfortunately it is frequently a misunderstood and often incorrectly applied technology. The purpose of this paper is to provide some insight into this field's development of some of the basic principles of behaviour analysis.

ISSN:0269-9052    

DOI:10.3109/02699058809150905

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor

ISSN:0269-9052    

DOI:10.3109/02699058809150906

出版商:Taylor&Francis    

年代:1988

数据来源: Taylor