摘要:

Trauma center intervention is the rate-limiting step that will decide the degree of functional recovery of persons with brain injuries. If these persons are to attain maximal functional recovery, then there must be a system of intensive, organized care that begins at the scene of the trauma and continues until disposition from the trauma center either to home or an acute rehabilitation hospital. The success of this system of care within a trauma center is dependent on five disciplines: prehospital care, emergency medicine, trauma teams or services, critical care medicine, and rehabilitation medicine.

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

There are increasing numbers of formalized early intervention programs at trauma centers and other acute medical/surgical hospitals. Integral components of this type of program include initiation of rehabilitation immediately after admission and an integrated team approach focused on the patient and family. Although their number is limited, studies do exist that demonstrate the benefits of these programs early in the recovery process in patients with severe head injuries. These benefits include decreased length of stay, improved quality of care, and improved functional outcomes.

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Management of patients with traumatic brain injury is directed at preventing secondary injury. Changes occur in cerebral blood flow that will affect cerebral perfusion. Metabolic alterations are also observed following severe head injury. Treatment centers around controlling intracranial pressure and preventing cerebral ischemia. Hyperventilation, osmotic diuretics, and other supportive measures to control intracranial hypertension are discussed.

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The evolution of trauma care in recent years has led to an increased survival rate for victims, necessitating major changes in rehabilitation to accommodate the needs of survivors and their families. Traditionally, rehabilitation implied the final stage of recovery for patients, often following discharge from acute care hospitals. This article discusses the advent of current trends In rehabilitation, which support early, aggressive initiation of treatment with patients with severe brain injuries in the intensive care unit. The roles of the various rehabilitation disciplines are discussed, with an emphasis on the importance of multidisciplinary communication.

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Patients with traumatic brain injury display disruption in their metabolic balance, with a resulting hypermetabolic state. Nutritional intervention must be implemented early in the acute course to offset ensuing malnutrition. This article discusses these issues and the importance of a multidisciplinary team approach to address complicating factors, including aspiration, gastric dysfunction, swallowing disorders, and cognitive- behavioral problems. The advantages, disadvantages, and implications of parenteral and enteral nutrition are reviewed, as well as factors affecting the early initiation of oral feeding in the acute hospital course.

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Orthopedic stabilization of fractures is necessary before the traumatic brain-injured (TOO patient is able to be mobilized. Early stabilization, within 24 hours of injury, allows early rehabilitation intervention, increasing the patient's potential for a good recovery. Late management of fractures results in longer immobilization of the patient, which can complicate the patient's recovery process. The immobile patient has a greater risk of infections, venous thrombosis development, pulmonary complications, skin breakdown, and contractures. With advances in monitoring and caring for the critically ill TBI patient, early orthopedic management is now possible for most patients, thus ensuring a better chance at a good recovery.

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The psychodynamic theory of crisis intervention is reviewed with particular relevance to its potential need and role in managing families of traumatically brain injured patients in the acute trauma setting. It is postulated that this immediate trauma period demands an aggressive educational and counseling intervention by the trauma care team if long-term family emotional and behavioral adjustment to the demands of a brain-injured family member is to be optimized. Specific suggestions and guidelines are offered for this early crisis intervention.

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Traumatic brain injury (TBI) is a significant problem in the United States, costing millions of dollars in hospital expenses each year and billions of dollars in lost productivity and wages. Current treatment regimens are not entirely satisfactory. This article examines some of the theories of the pathophysiology of TBI. It discusses some of the novel agents being offered for use in these patients and returns to some agents whose reintroduction may be aided by new information about the sequence of events after head injury. The possible significance of the sequence of events on the use of pharmacotherapy in head injury is also examined.

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Thirty-eight traumatic brain injury (TBI) patients who underwent a neuropsychologically oriented milieu rehabilitation program were compared with an historical control group of 38 TBI patients who did not receive this form of rehabilitation. Patients were matched according to admitting Glasgow Coma Scale (GCS) score, age at injury, and gender. Educational level and chronicity of brain injury were not completely matched but were controlled for in statistical analyses. A greater number of TBI patients who received this form of rehabilitation were productive (ie, a student, a worker, or both) compared with the untreated group. A good or excellent working alliance with the rehabilitation staff was significantly related to a positive productivity status. The same finding was observed when assessing the relationship of the working alliance with the patients' families and productivity status. The data support the proposition that specialty neurorehabilitation programs aimed at work reentry may be helpful in a selected group of TBI patients.

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1994

数据来源: OVID