ISSN:0269-9052    

DOI:10.3109/02699059109008082

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

During the past decade the rehabilitation field has developed new, non-hospital based programmes of cognitive, behavioural, social, educational and vocational treatments to address the higher order cognitive, behavioural and social deficits following brain injury. These new arrays of programmes are referred to under the term 'post-acute' rehabilitation. No comprehensive, methodologically sound study of the effects of these new treatments has been made to date. This paper reports data from brain-injured patients who underwent treatment within a co-ordinated system of post-acute brain-injury rehabilitation programmes. This system consists of a continuum of neurobehavioural, residential, day treatment and community and home programmes, and provides overt components of medical and rehabilitation care: behavioural management; activities of daily living, self-management, substance-abuse, social, academic and vocational skills training; counselling; and family education. The changes in function during the course of treatment by this post-acute sequence of rehabilitation have been obtained and arc reported here. A defined total population ofN=192 is examined, with exclusions for appropriate causes (e.g. patients seen only for evaluation) producing a study population ofN=173; of these, follow-up was achieved in 145 cases, a follow-up rate of 83.8%. Time from date of injury to data of admission, severity of deficit at time of admission to programme, and other appropriate independent variables are used to characterize the population. A single-blind interview methodology was employed in obtaining dependent measures of outcome at 6, 12, or 24 month periods post-discharge. Measures of outcome included residential status, level of productivity activity and hours per day of attendant care or supervision required. Dependent variables were analysed for the total study population and a subgroup greater than 1 year from date of injury at entry to treatment and not from a treatment facility. Results are presented in terms of the percentage change in dependent measures from the point of admission to follow-up. Appropriate parametric and non-parametric statistical analyses of significance have been carried out. The results document substantial improvements in function during the post-acute rehabilitation of this population and such improvements are unlikely to be the result of spontaneous improvement alone.

ISSN:0269-9052    

DOI:10.3109/02699059109008083

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

The basic findings of brain-injured patients who underwent treatment within a co-ordinated system of post-acute brain-injury rehabilitation programmes have already been reported. The changes in function during the course of treatment by this post-acute sequence of rehabilitation were obtained and reported. A defined total population ofN=192 was examined, with exclusions for appropriate causes (e.g. patients seen only for evaluation) producing a study population ofN=173; of these, follow-up was achieved in 145 cases, a follow-up rate of 83.8%. Time from date of injury to date of admission, severity of deficit at time of admission to programme, and other appropriate independent variables were used to characterize the population. A single-blind interview methodology was employed in obtaining dependent measures of outcome at 6, 12 or 24 month periods post-discharge. Measures of outcome included residential status, level of productivity activity, and hours per day of attendant care or supervision required. In the work reported in this paper dependent variables are analysed for various subgroups of the total population. The subgroups analysed are: patients with traumatic brain injury only; mild moderate and severe grades of disability; and comparisons of outcomes at 6 months, 1 year, and 2 years post-discharge from treatment. The results are presented in terms of percentage change in dependent measures from point of admission to follow-up. Appropriate parametric and non-parametric statistical analyses of significance are carried out. Additionally, an analysis of cost associated with treatment, and some analysis of cost-benefit is provided. The results document substantial improvements in function during post-acute rehabilitation for both traumatic brain injury and brain dysfunction of other etiologies. Significant improvements are seen to occur in all grades of severity of dysfunction examined, and such improvements are robust and persist without evidence of decrement over the 2-year follow-up period. In addition, economic considerations suggest the potential for the recouping of costs of treatment within a reasonable period of time.

ISSN:0269-9052    

DOI:10.3109/02699059109008084

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

This is a study of the multiple outcomes of residential community re-entry programmes for disabled survivors of brain injury. The sample consisted of 82 clients from nine facilities across the USA. The level of functioning of the client at and before admission was determined from clinical evaluations reported in programme records. Telephone interviews assessed outcomes 1 year after discharge. The participation in the re-entry programmes led to enduring improvements in independent living and productive activities. Total supervision requirements decreased substantially. Paid employment increased, but benefits went much beyond this to include improvements in educational activities, unpaid vocational activities, and especially household management. For the most part, these improvements cannot be attributed to chronicity or natural healing. The benefits of the re-entry programmes were clearly multiple. The results generally affirm the effectiveness and utility of community re-entry programmes.

ISSN:0269-9052    

DOI:10.3109/02699059109008085

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

This report, the second part of a study of the outcomes of nine community re-entry programmes for brain injury survivors, examines more specific measures of programme and client outcome. Most results confirm those in Part 1, but some suggest qualifications or means to improve programme operations. The functioning of the client in self-care and mobility activities, in communication, and in emotional and social behaviour clearly improved. By and large these improvements cannot be attributed to chronicity or natural healing. Findings relevant to social integration, sources of stress, and client satisfaction are also presented. For a minority of cases, new behaviour problems emerged after discharge, raising issues of generalization of treatment. Though clients benefited in multiple ways, goal attainment percentages were not high and the most frequent dimensions of actual benefit (viz. improved independent living and household skills) were seldom documented as goals. Multivariate analysis identified a number of significant predictors of independent living outcomes. Finally, issues of cost-effectiveness are addressed. At over $100,000 per case, these programmes were expensive. No positive relationship between rehabilitative expense and client improvement could be identified. Means of improving cost-effectiveness are suggested.

ISSN:0269-9052    

DOI:10.3109/02699059109008086

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Verbal and spatial tests of learning were administered in five repeated sessions to nine subjects who were in post-traumatic amnesia (PTA) following extremely severe closed head injuries. PTA was operationally defined as having a score of 75 or less on the Galveston Orientation and Amnesia Test. Subjects showed no ability to learn verbal information (free recall and recognition of a word list) but showed some savings of spatial location information over the first three sessions. Results were interpreted as suggestive of a primarily passive mode of learning during PTA, regardless of the nature of the material to be learned.

ISSN:0269-9052    

DOI:10.3109/02699059109008087

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

The present investigation examined the incidence of alcohol use, drug use and criminal behaviour among persons with traumatic brain injury referred for supported employment services. Primary caretakers of 74 consecutive referrals completed the General Health and History Questionnaire, the brief version of the Michigan Alcohol Screening Test, and the Quantity-Frequency-Variability Index. Pre-injury, a fifth of the sample were abstinent from alcohol and 66% were labelled as moderate or heavy drinkers. Post-injury alcohol use declined. Half of the sample were abstinent and 28% were moderate or heavy drinkers. Thirty-six percent reported illicit drug use pre-injury. Reportedly, post-injury drug use declined to an incidence of 4%. Nearly 20% of the sample had been arrested pre-injury and 10% were arrested post-injury. Implications for further research and programme development are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059109008088

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

It is often assumed that age is an important variable in determining cognitive outcome following severe head injury. The present study was carried out to determine whether age at time of injury predicted severity of cognitive impairment. Our hypothesis was that the older the patient at time of head injury the worse should be the cognitive impairment. Cognitive impairment was assessed by scores on nine standardized tests. Scores were obtained from 144 consecutive referrals to a clinical psychologist; all subjects had sustained a severe head injury. Of these, 115 had suffered a closed head injury. Ages ranged from 13 to 65 years. Apart from Unusual Views and Verbal Fluency no significant correlations were found between age and test performance. Thus there was little evidence that age predicted performance on cognitive tests. A number of significant correlations were found between length of coma and cognitive performance. The findings would seem to confirm that cognitive outcome after severe head injury is predicted by length of coma (which reflects severity of brain damage) whilst age at time of injury does not appear to be a good predictor of outcome.

ISSN:0269-9052    

DOI:10.3109/02699059109008089

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

The Minnesota Multiphasic Personality Inventory (MMPI) was administered to 73 patients with traumatic brain injury to objectively evaluate emotional status. Profile analysis indicated that many patients were suffering from emotional disturbance. Higher distress levels were evident among those with minor head injury relative to severe head injury. Observed MMPI profiles for these two head injury groups were consistent with previous research and expectations related to the typical consequences of the post-concussion syndrome. The potential value of the MMPI with the head injury population as well as the need for cautious interpretation and integration of impressions derived from other sources is discussed.

ISSN:0269-9052    

DOI:10.3109/02699059109008090

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

This study examined the relationship between level of social skill and family problem-solving behaviour in a group of 18, community dwelling, very severe closed head injury (CHI) patients who had suffered their injury at least 18 months previously, and who were still in contact with rehabilitation services. The main findings of this study were a positive relationship between CHI patients' level of social skill and their rate of positive effect, and an inverse relationship between the CHI patients' level of social skill and the rate of facilitative behaviour displayed by relatives during problem-solving interactions. It is suggested that socially unskilled CHI patients may be more demanding to interact with, and that this may cause a significant burden for their relatives.

ISSN:0269-9052    

DOI:10.3109/02699059109008091

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor