摘要:

Glasgow Coma Scale (GCS), density spectral array (DSA), EEG, BAEP and circadian temperature rhythm were studied in comatose patients in order to determine level of arousal and appraise the prognostic capability of these combined measures. Subjects were 29 comatose patients in the neurosurgical ICU at the Rambam Medical Center suffering from head trauma, vascular disorders or metastatic growth. Results show that best prognostic capabilities were for DSA, GCS and BAEP, in that order. As a single parameter physiological response to a sound stimulus (increase in EMG, change in EEG frequency and appearance of sharp waves or k-complex) was the single best predictor for outcome, with significant response rates for the good, deficit, vegetative and death outcomes at 83%, 57%, 37% and 18%, respectively. Rectal temperature was analysed for 24 h circadian periodicity. Daily acrophases were found to shift forward or backward on the level of about 2-7 h a day with fluctuations about a stable or unstable mean. The absence of‘free-running rhythms’associated with environmental isolation studies might reflect an ability to respond to environmentalZeitgerberswhile unconscious. Temperature oscillations as well as 24 h rhythms were found even in the most severely braindamaged patients, reflecting the resilience of the circadian oscillators in the brain to trauma.

ISSN:0269-9052    

DOI:10.3109/02699059309029672

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

An exploratory needs assessment for AIDS education and prevention was conducted at a traumatic brain injury (TBI) rehabilitation facility among 29 clients that also experience coexisting substance abuse disorders. The results suggest that the surveyed clients possessed a moderate level of information about AIDS, Their knowledge level was variable with a major source of misinformation surrounding the use of condoms. The sample members' knowledge was not related to the type or severity of substance abuse, nor was it associated with safer sexual practices. The present results are compared to earlier findings that used an identical survey with a dual disordered population of psychiatrically impaired substance abusers [1]. The results should help in developing an AIDS educations and prevention programme for clients with the dual diagnosis of TBI and substance abuse. Clients need up-to-date information that can be comprehended and used. Education will need to be coupled with approaches that present both behavioural and attitudinal change strategies that are best suited to these clients.

ISSN:0269-9052    

DOI:10.3109/02699059309029673

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Based on the KAS-R1 ratings completed by 88 relatives of clients who had enrolled in a post-acute rehabilitation programme, the 10 component groups discerned by Fabiano and Goran [1] were submitted to a classical analysis of tests. Seventy-nine items were found to contribute to the internal consistency of their respective component groups, resulting in alpha values ranging from 0.75 to 0.93 for the component groups. Intercorrelations between components suggested that while some degree of overlap existed between groups, they represented discrete categories of neurobehavioural functioning. Second-order components, as determined by principal-component analysis, discern two significant component groups. These two components correlated moderately, yielding a value of 0.49. The findings indicate that the revised KAS-R1 exhibits considerable potential for clinical utility. Future research is needed to investigate the validity of this instrument in accurately depicting behavioural manifestations of those who have incurred traumatic brain injury.

ISSN:0269-9052    

DOI:10.3109/02699059309029674

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Litde is known about die effects of a parent's brain injury and subsequent disabilities on the children in the family. This study examines 24 families in which one parent is brain injured. In each family the children were born before die parent's injury and still lived at home at the time of interview. Reports of the uninjured parent indicate that most of the children experienced some degree of negative behavioural change after the parent's injury. In 10 of the families, significant and problematic changes occured. Types of problems included poor relationship with the injured parent, acting-out behaviour and emotional problems. Correlates of poor outcomes for the children were: (1) injured parent's gender, (2) compromised parenting performance of the injured parent, (3) compromised parenting performance of the uninjured parent and (4) depression in the uninjured parent. This study points to the importance of recognizing traumatic brain injury as a major family stressor.

ISSN:0269-9052    

DOI:10.3109/02699059309029675

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

This study examined 59 patients who had suffered closed head injuries with respect to their MMPI scores and Category Test scores as assessed shortly post-injury and on subsequent assessment. The number of MMPI scales elevated abovet=70 on the first assessment was negatively correlated with the magnitude of improvement made on the Category Test. Multiple regression analyses showed that the extent of cognitive deficit, as indicated by the Category Test, could be predicted from the degree of psychopathology, with MMPI scales 2 (depression), 7 (psychasthenia) and 8 (schizophrenia) being highly predictive of Category Test performance. These results suggest that patients with better psychological functioning perform at a higher level and make a greater post-traumatic recovery on neurocognitive tests. Although we cannot determine if the emotional impairment is due to neuropathology or is reactive in nature, there are clear implications for rehabilitation.

ISSN:0269-9052    

DOI:10.3109/02699059309029676

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The family life cycle model categorizes stresses on family systems in terms of their source and their effects on family members. Centripetal forces bring members together while centrifugal forces lead to loosened intrafamilial ties. This study examined the association of normative, developmental and centripetal illness-related, family forces with patient outcome. Hypothesized centripetal and centrifugal forces acting on 65 families of married male TBI patients were used as independent variables in stepwise multiple regressions with criterion measures of quality of life outcome used as dependent measures. Centripetal variables included measures of family coping, marital adjustment, and number of years married. Centrifugal variables included number of children, age of oldest child, and amount of perceived financial strain. Regression equations obtained had multipleR's ranging from 0.623 to 0.407 (pvalues<0.017). Results suggest that families normatively dealing with the developmental stage of the family with young children may face unique challenges when a husband sustains a TBI, particularly when financial strain exists. Stages in family development involving conflict between centripetal and centrifugal forces may be most problematic for families to resolve, and potentially the most effective periods for intervention.

ISSN:0269-9052    

DOI:10.3109/02699059309029677

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

A case history of a man with complex partial seizures resulting from a severe head injury following a road traffic accident is presented. Details of medical intervention and neuropsychological assessment are also presented and discussed, highlighting the difficulties of balancing therapeutic doses of anticonvulsant medication with cognitive functioning adequate to maintain expected quality of life. An interesting finding revealed that the patient's blood-sodium levels increased rather than decreased with rising doses of anticonvulsant medication.

ISSN:0269-9052    

DOI:10.3109/02699059309029678

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Post-traumatic seizures are a well-recognized complication of head injury; however, the issue of seizure risk assessment remains controversial. The authors present a critical review of the literature pertaining to post-traumatic seizures, with particular emphasis on current concepts of definitions, incidence and risk factors. Different methods of risk assessment are reviewed and the possibility of utilizing functional imaging techniques for seizure risk assessment is also explored.

ISSN:0269-9052    

DOI:10.3109/02699059309029679

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

One of the most disabling effects of traumatic brain injury is limited awareness of cognitive, emotional and interpersonal functioning. For this reason it is often difficult for a traumatically brain-injured person to form realistic goals and appreciate the need for rehabilitation. A goal-setting process is outlined in which therapists play a supportive but nondirective role and goals are developed which incorporate information in self-awareness. The aim of this approach is to create goals which are realistic and increase the likelihood of maintenance following treatment. Specific strategies to incorporate patient awareness during goal setting are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059309029680

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor