摘要:

The advancement of acute care for persons with brain injury is predicated on the further clarification of the mechanical and biochemical processes that are begun at the time of the injury. Attempts to enhance survival and functional outcome have led to cerebral perfusion and intracranial pressure management techniques. In addition, novel neuroprotective pharmacotherapeutic strategies have been borne from an ever growing knowledge of the degradative biochemical injury that occurs subsequent to the initial insult. The link between the acute and rehabilitation phases of care continues to grow closer, thus compelling the rehabilitationist to be aware of the potential effect these processes and treatments have on outcome.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The severe hypermetabolism and hypercatabolism seen in patients with severe head injuries results in malnutrition that occurs very rapidly and can cause impaired healing and an increased tendency to infection and multiple organ failure. Thus, early adequate nutritional support plays a role in functional outcome. Total enteral nutrition (TEN) is preferred over total parenteral nutrition (TPN), but TPN should be supplied promptly while increasing TEN to a goal of at least 25 to 35 nonprotein kcal/kg/d and 2.0 to 2.5 g protein/kg/d. Nutritional formulas high in branched chain amino acids, glutamine, arginine, vitamins E and C, and zinc may also have some advantages. Growth hormone may improve anabolism. Hyperglycemia, especially glucose levels exceeding 200 mg/dL, must be prevented and/or treated promptly with insulin or decreased glucose intake. Careful monitoring with indirect calorimetry and nitrogen balance studies should help prevent inadequate protein or excessive carbohydrate intake.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Survivors of traumatic brain injury frequently develop respiratory complications that require specialized knowledge and management skills in both acute and postacute environments. This article discusses the pathophysiology of and treatment options for ventilatory failure, neurogenic pulmonary edema, and aspiration. Management of tracheostomies is also discussed, with particular attention paid to decision making regarding the removal of a tracheal appliance. Long-term tracheal complications are also outlined.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Venous thromboembolism is a life-threatening complication of traumatic brain injury. Consequently, knowledge of available screening, diagnostic, prophylactic, and treatment methods is critical to the management of the individual with traumatic brain injury. Venous thromboembolic risk varies among individuals, resulting in unique screening and prophylactic needs for each patient. In addition, anticoagulation, commonly employed for prophylaxis and treatment in other patient populations, may create an increased risk for intracranial hemorrhage when utilized following traumatic brain injury. The cost, sensitivity, specificity, efficacy, potential side effects, and alternatives for preventing, detecting, and treating venous thromboembolism are important considerations discussed in this article.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Evoked potentials (EPs) have been shown to have useful prognostic value during the acute phase of traumatic and anoxic coma. We have hypothesized that EPs obtained in the subacute phase can be used to assess prognosis for functional recovery in minimally responsive patients with diffuse brain damage due to either brain trauma or anoxia. This pilot study correlated graded brainstem auditory evoked potentials (BAEPs) and upper extremity somatosensory evoked potentials (UESSEPs) with outcome grade based on the discharge Disability Rating Scale (DRS) score of 33 patients admitted to a responsiveness assessment program of a brain injury rehabilitation unit with an initial DRS score of 22 or greater. Results indicated a significant correlation with outcome grade for both the BAEP grade (P< .02) and the UESSEP grade (P< .02). The BAEP had a higher sensitivity and lower specificity, as false-positive exceeded false-negative predictions. The UESSEP tended to predict outcome more accurately and with a balanced number of false-positive and false-negative predictions. EPs were also found to be useful for detecting occult impairment of sensory function. This pilot study demonstrates that EPs performed near the time of admission to the rehabilitation unit can be useful in guiding the rehabilitation management of the minimally responsive patient by helping to predict functional recovery and to detect occult impairment of sensory systems.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article describes a conceptual psychodynamic model for understanding the neurobehavioral manifestations of acute central nervous system damage (ACNSD) displayed by patients during the rehabilitation process. According to the proposed model, patients' behavioral responses are viewed as their only means of emotional expression and therefore may not be considered entirely abnormal when viewed from the perspective of patients' interpersonal contexts. An improved understanding of the dynamic processes through which recovering patients with ACNSD journey may lead to better interaction between the patient and the therapeutic environment, the interdisciplinary team, and family members. Combining this proposed psychodynamic model with an emerging understanding of the neurobehavioral foundations of aggression and depression may also lead to a more rational approach to intervention with various psychopharmacologic agents. During the rehabilitation process, understanding patients' cognitive deficits, motivational drives, and emotional needs and proper implementation of medical and environmental treatment can ultimately lead to a better psychosocial outcome.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID