摘要:

A group of 175 traumatic brain injury (TBI) patients who had undergone intensive rehabilitation at Bethesda Hospital attended a follow-up interview 2 years after injury. The majority of patients had suffered severe TBI. Outcome was documented in ten areas: medical/physical, mobility, activities of daily living (ADLs) accommodation, marital status, leisure and recreation, employment/study, communication, cognition and behaviour. Whilst most patients were physically independent and competent in personal and domestic activities of daily living, a third of the group were still reliant on assistance with community skills and transport, and more than half of those who previously had a job, were not working at 2 years post-injury. Around two-thirds of the sample reported cognitive, behavioural and emotional changes. There is clearly a need for ongoing community-based support and assistance in dealing with practical difficulties and psychological problems as they are experienced after return to the community.

ISSN:0269-9052    

DOI:10.3109/02699059509004565

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The present study used a multivariate approach to investigate which of a range of variables relating to demographic factors, injury severity and degree of disability on admission to rehabilitation were the best predictors of employment status 2 years after traumatic brain injury (TBI). Subjects were 74 TBI patients who had been working prior to injury, had undergone rehabilitation at Bethesda Hospital and attended a review clinic 2 years after injury. A cross-validation sample consisted of a further 50 such subjects. Following preliminary analysis four input variables were selected: age under or over 40 at time of injury, Glasgow Coma Scale score on acute hospital admission, duration of post-traumatic amnesia and total score on the Disability Rating Scale (DRS) on admission to rehabilitation. Stepwise discriminant function analysis resulted in a discriminant function consisting of three variables—total score on the Disability Rating Scale, Glasgow Coma Scale Score and age—which correctly classified 74% of grouped cases. A second analysis using the original discriminant function correctly classified 68% of the cross-validation sample. Chi-square analysis showed no significant difference between these results, thus confirming these variables, in combination, as predictors of employment status 2 years after TBI.

ISSN:0269-9052    

DOI:10.3109/02699059509004566

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The present study investigated the possible role of a number of pre- peri-, and post-traumatic factors in the experience of post-concussion syndrome (PCS). These factors included: (1) history of premorbid risk factors, (2) severity of injury, and (3) post-morbid functioning and environmental factors. Subjects were 55 persons with mild brain injury. PCS was defined in terms of the severity and impact of 'late-onset' symptoms. Pre- and peri-traumatic factors were not associated with level of PCS symptom impact. Among post-traumatic factors, only level of psychological distress was strongly associated with impact level. The results suggest the importance of psychological factors in prolonged PCS.

ISSN:0269-9052    

DOI:10.3109/02699059509004567

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The present study examined whether patients (n= 11) with post-concussional symptoms (PCS) 12-34 months after mild head injury (MHI) performed less well on selected neuropsychological tests than patients with MHI without PCS (n = 11) and healthy controls (n= 11). Patients with PCS were individually matched with controls for the time elapsed after the injury, age, sex, education and IQ. There were no overall gross differences between the groups in cognitive functioning, except for an isolated deficit on a sustained attention task. Post-hoc analysis of results obtained with two behavioural rating scales showed that patients with higher ratings on a post-concussive/cognitive complaints scale performed less well on a sustained attention task than subjects with lower ratings.

ISSN:0269-9052    

DOI:10.3109/02699059509004568

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Much has been written in recent years on methods for detecting malingered memory deficits. However, previous research has focused exclusively on quantitative analyses of the data. The purpose of this study was to investigate more qualitative aspects of malingering. Undergraduates, community volunteers, psychiatric inpatients, and federal inmates who participated in analogue malingering studies were interviewed to elicit their self-reported strategies for faking memory impairment. Some of these subjects indicated that if they were to malinger they may show poor cooperation, aggravation and frustration, slow response times and frequent hesitations, and general confusion during the testing process. The strategy reported with the greatest frequency was to fake total amnesia (i.e. for personal identity, past knowledge, family and friends, and all aspects of the accident).

ISSN:0269-9052    

DOI:10.3109/02699059509004569

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

All patients admitted to a rehabilitation unit with closed-head injury over a 3-year period were reviewed for carbamazepine use exceeding 30 days in the hospital. Nine patients met the study inclusion criteria for age and duration of carbamazepine therapy. On review of the dose: serum concentration relationship, significant changes were noted in four patients. An initial increase in the dose: serum concentration ratio during the first few months of therapy was thought to reflect the well-known auto-induction of carbamazepine metabolism. However, unexplainable decreases in the dose: serum concentration occurred in the following months, and suggested alteration of carbamazepine pharmacokinetics in patients with traumatic brain injury. The finding may be important in determining the optimal approach to therapeutic drug monitoring of carbamazepine in brain-injured patients.

ISSN:0269-9052    

DOI:10.3109/02699059509004570

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

Severe amotivation, apathy, and abulia, significantly retard rehabilitation following traumatic brain injury. Preliminary, uncontrolled research has suggested possible benefit with amantadine for this behavioural syndrome. This N of 1, double-blind, placebo-controlled study employed amantadine 100 mg three times daily in one such patient. Therapists and nurses completed inventories scoring efforts towards initiation of therapeutic activities during each session, progress in therapy, and participation in therapy. Four treatment periods (two active medication, two placebo), of 2 weeks duration, were completed. Across four therapists, and for both treatment pairs, the average effect score increased from 0.86 on placebo to 1.74 on amantadine (possible range 0-6, 3 = 'average'). There were no side-effects. The study suggests possible benefit with amantadine for patients with amotivational syndrome after traumatic brain injury; a randomized clinical trial appears warranted and required.

ISSN:0269-9052    

DOI:10.3109/02699059509004571

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The neuropsychological spectrum was investigated in a traumatically brain-damaged population. In this spectrum neuropsychological measures were regarded as the most biologically oriented, achievement measures as the most acquired skill-oriented, and intellectual measures as having an intermediate position. It was found that the achievement measures correlated the most highly with each other, the intellectual measures intercorrelated to a lesser extent, and the intercorrelations of neuropsychological measures yielded a zero-order median correlation. It was further found that the correlations of measures with those in other categories had the same ranking. It was inferred that brain damage alters the pattern of the neuropsychological spectrum because of disproportionate impairment in the biological direction of the spectrum.

ISSN:0269-9052    

DOI:10.3109/02699059509004572

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The relation of electrodermal response measures to outcome from early post-traumatic vegetative state (VS) was investigated in 15 brain-injured and five control subjects. Brain-injured subjects were in acute VS or persistent VS (PVS), or had recovered from acute VS (RVS). Significant group differences were found on all electrodermal response measures, primarily due to the greater amplitude, number and consistency of responses in control subjects. Group differences in electrodermal habituation and orientation to auditory tones reflected the absence of orientation in most RVS subjects and the absence of both habituation and orientation PVS subjects. The groups differed in their response to matching faces and names. All of the control subjects, two of five RVS subjects and none of five acute subjects produced significant responses. Surprisingly, two PVS subjects also produced significant responses. For acute subjects a positive outcome at 6 months post-trauma was associated with early electrodermal startle amplitude and baseline lability. These results indicate that electrodermal responsiveness is generally reduced following acute VS, even in subjects with a relatively good recovery. Greater electrodermal activity in early VS may be associated with better potential for recovery.

ISSN:0269-9052    

DOI:10.3109/02699059509004573

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor

摘要:

The psychosocial problems of decreased social contact, depression, and loneliness that occur for many with traumatic brain injury (TBI) create a major challenge for enhancing efforts at community re-entry. Despite dramatic physical progress within the first six months after injury, these psychosocial problems remain a persistent long-term problem for the majority of individuals with severe TBI. Researchers have consistently suggested that the psychosocial problems associated with TBI may actually be the major challenge facing rehabilitation. The majority of individuals who sustain TBI are young males between the ages of 19 and 25, who are in the early stages of establishing their independence in areas including friendships, leisure activities, intimate relationships, residence, and employment. The problems of social isolation and decreased leisure activities create a renewed dependence of the survivor on his/her family to meet these needs. In this article we review a large number of papers which examine the psychosocial and emotional sequelae for TBI patients. The results of those studies demonstrate four primary themes. The first theme depicts that individuals who experience severe TBI are at high risk for a significant decrease in their friendships and social support. The second theme relates to the lack of opportunity for establishing new social contacts and friends. The third theme relates to the decrease in leisure activities for individuals with severe TBI. Finally, anxiety and depression are found at high levels for prolonged periods of time following severe TBI. Several clinical recommendations are drawn from this literature review. They are: (1) Clinicians such as psychiatric social workers, psychologists, or psychiatrists may need to be called upon more quickly for intervention. The treating physiatrist cannot be expected to provide the insight and frequency of psychological services that may be necessary for many of these patients. (2) Since the literature seems to suggest that the presence of one psychosocial deficit, e.g., anxiety, will often be followed by other similar types of problems, e.g. depression, the treatment team needs to be sensitive to how rapidly these problems can cascade into a very dangerous situation. (3) Perhaps the most compelling recommendation we can make is for community rehabilitation specialists to focus significantly more energies and resources upon the psychological health of clients with TBI. Staff need to be trained to detect these signals that clients with TBI are often sending. It is apparent that psychosocial factors contribute to a rising obstacle level to community adjustment.

ISSN:0269-9052    

DOI:10.3109/02699059509004574

出版商:Taylor&Francis    

年代:1995

数据来源: Taylor