摘要:

The purpose of this study was to compare in normal and traumatic brain injury (TBI) subjects long latency cortical brain-evoked potential patterns obtained upon stimulation of the median nerves. Quantitative data were analysed involving nine peak latencies and eight amplitudes obtained simultaneously contralaterally and ipsilaterally. Left-right hemispheric differences were also analysed. The following was found: TBI latencies were significantly longer for five of nine peaks (N30, P40, N60, P185, P285). TBI amplitudes were significantly smaller for two of eight amplitudes (P185-N240 and N240-P285). A significant contralateral-ipsilateral latency difference occurred only at P40 where latencies in the contralateral hemisphere are shorter for both normals and TBIs. Significant contralateral-ipsilateral amplitude differences occurred in the four early amplitudes (N30-P40, P40-N60, N60-P105, P105-N140) with amplitudes being smaller on the ipsilateral side. A differential effect, however, was found for amplitudes N30-P40 and P40-N60 where the difference is significantly larger in the contralateral hemisphere for normals but not for TBIs. This suggests that contralateral-ipsilateral amplitude difference can be a marker of extent and severity of injury and may also be helpful in localizing site of injury, particularly interhemispheric or corpus callosal injury. The differential latency and amplitude responses for later peaks occurring in the P300 region suggest sensitivity to detecting impairments in pre-cognitive and early cognitive activities.

ISSN:0269-9052    

DOI:10.3109/02699059309008152

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Outcomes for 29 individuals with brain injuries (BI) were examined following a comprehensive-integrated rehabilitation programme. From programme admission to completion, proportion living with no supervision increased from 59% to 93%; proportion in transitional or competitive work placements increased from 7% to 59%; unemployment decreased from 76% to 31%. Significant changes in behaviour and functional abilities and achievement of individual goals were also documented with the Portland Adaptability Inventory (PAI) and Goal Attainment Scaling. One year follow-up of 21 graduates indicated general maintenance of gains in independent living and work. At follow-up 86% were living without supervision; 48% were in competitive work; one in transitional work; and 29% unemployed. Although individuals entering treatment less than 1 year after injury showed greater gains than those injured more than 1 year prior to admission, both early and late intervention groups showed significant changes on outcome measures. More extensive disabilities as measured by the PAI had a negative impact on programme outcome. Except for reading ability, neuropsychological measures obtained prior to admission did not significantly predict outcome. Programme costs are reported. Results indicate that the group-oriented comprehensive-integrated approach to post-acute brain injury rehabilitation is effective and cost-effective, and recommend early intervention for optimal outcomes.

ISSN:0269-9052    

DOI:10.3109/02699059309008153

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

A number of investigations have recently demonstrated the effectiveness of supported employment programmes in improving the vocational status of clients with traumatic brain injuries. The present study investigated a sample of 39 individuals participating in a return to work programme emphasizing a supported employment approach to identify key functional characteristics which differentiated successful and unsuccessful clients. Clinical ratings of employment specialists were used to identify two groups of individuals rated least and most difficult to place and maintain. Results indicated that the two groups differed markedly on key employment outcomes. Individuals rated most difficult tended to be younger, possess functional limitations such as visual and fine motor impairments, and display significant deficits in numerous work-related skills. Recommendations are made for applying these findings to assessment, placement, and training activities within vocational rehabilitation programmes for persons with traumatic brain injuries.

ISSN:0269-9052    

DOI:10.3109/02699059309008154

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Families of individuals who have survived brain injuries experience significant distress, and may resist accepting their relative's neurobehavioural deficits. Staff who work with brain-injured patients and their relatives are charged with the seemingly paradoxical task of helping families support rehabilitative efforts and be goal-oriented, while simultaneously communicating often negative realities about prognosis. In the midst of what may be an intermittently conflict-laden relationship, families and staff must become synergistically involved in a therapeutic partnership. This paper defines aspects of this 'adversarial alliance' which is often established between families and staff. The relationship between patient discharge outcome and perceived family stress and satisfaction with the rehabilitation programme was reviewed. Data analyses yielded the following conclusions: families evaluated retrospectively to have been 'highly stressed' were also perceived to experience more conflict with the rehabilitation team; family stress was related to poorer adjustment to the patient's disability (at admission); greater family/team conflict correlated with lower cognitive and physical functioning at admission, longer length of stay, younger patient age, and lower programme satisfaction. Implications for programme development and treatment guidelines are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059309008155

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

The suitability of Warrington's Recognition Memory Test (RMT) for detecting memory impairment after traumatic brain injury was investigated in a pilot study of 36 patients with moderate and severe brain injuries. The patients showed significant memory deficits on both RMT subtests, Words and Faces, with greater impairment on the Faces subtest. No significant gender differences were found. The left hemisphere lesion group obtained the lowest mean score on the Words subtest, and the right hemisphere lesion group had the lowest mean score on the Faces subtest, although these differences did not reach statistical significance. At the 90-94% specificity level the sensitivity of the Faces and Words subtests for the detection of memory impairment after traumatic brain injury was 81% and 63%, respectively. The RMT appears to be a promising instrument for measuring and describing patterns of memory impairment after brain injury.

ISSN:0269-9052    

DOI:10.3109/02699059309008156

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Hypernasality in the dysarthric speech of 20 severely closed-head- injured (CHI) subjects was investigated using both perceptual and instrumental techniques. A perceptual analysis of the speech of the CHI subjects was performed using a four-point rating scale for hypernasality. Instrumental assessment was carried out using a computerized accelerometric technique yielding a nasal coupling index. Results revealed a high incidence of perceived hypernasality (95%) in the speech of subjects in the CHI group. More than half of these subjects exhibited hypernasality of speech to a moderate to severe degree. When compared with a control group matched for age and sex the severely CHI subjects were perceived as being significantly more hypernasal. Instrumental assessment revealed that the functioning of the velopharyngeal valve in the group of CHI subjects was significantly impaired compared to the control group. The study highlighted the need to evaluate the perceptual and instrumental assessment results for the severely CHI subjects on an individual basis. The clinical implications of these findings are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059309008157

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

There is clinical support for the hypothesis that brain-injured patients benefit from the high degree of structure provided by an inpatient rehabilitation programme. However, they often experience mild to moderate regression in behavioural and functional skills when they are discharged to home. This paper presents an evaluation of an innovative phase within an acute brain injury programme designed to facilitate the patient's approach towards independence. 'Step-Up' programme patients, who spent the last weeks of their inpatient length of stay residing in a transitional living setting, were compared with inpatients who participated in the regular therapy programme. Eighteen months of descriptive data regarding cognitive (Rancho) and functional (Barthel) levels for 31 patients are compared. Based on survey data, the Step-Up patients reported more independence in activities of daily living than did inpatients. The Step-Up programme also proved to be more cost effective than the inpatient alternative. Challenges to innovative programming presented by payors, families, and clinicians are discussed.

ISSN:0269-9052    

DOI:10.3109/02699059309008158

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

Antipsychotic agents, most often used for treatment of schizophrenia, are sometimes prescribed for the agitated patient with an organic brain disorder. We report the case of a brain-injured patient who was prescribed chlorpromazine for agitation and who developed a delusional state while taking this antipsychotic agent. The emergence of this delusional state coincided with the exacerbation of certain cognitive deficits. Possible mechanisms for this phenomenon are discussed. Caution is advised when prescribing neuroleptics for patients with traumatic brain injury, especially those agents with significant cognitive side-effects or with a significant potential to precipitate seizures.

ISSN:0269-9052    

DOI:10.3109/02699059309008159

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

This case history describes the successful use of a commercially available memory book by a brain injury survivor, including a description of the characteristics which made the book acceptable. Implications of the normalization principle for memory rehabilitation are also discussed.

ISSN:0269-9052    

DOI:10.3109/02699059309008160

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor

摘要:

By this time in the evolution of cognitive rehabilitation most treatment facilities have a computer-assisted cognitive retraining programme. This programme will generally be housed in the department of neuropsychology, speech and language pathology or occupational therapy. While the debate about the efficacy of computer-assisted cognitive rehabilitation (CACR) programmes continues, many persons are interested in more basic issues such as 'Which computer to buy?' While this initially may appear to be a minimum expense for a department, few people realize that the initial choice of a computer dictates the choice of software for that computer, as well as any other peripheral devices, e.g. video monitor, laser printer, or adaptive hardware equipment. This column will briefly review the three main computer operating systems which are commercially available for institutional and home markets, and discuss positive and negative attributes of each system.

ISSN:0269-9052    

DOI:10.3109/02699059309008161

出版商:Taylor&Francis    

年代:1993

数据来源: Taylor