1/85. resuscitation of the multitrauma patient with head injury.head injury remains the leading cause of death from trauma. The definitive method for eliminating preventable death from traumatic brain injury remains elusive. New research underscores the danger of inadequate or inappropriate support of oxygenation, ventilation, and perfusion to cerebral tissues. The belief that sensitivity to hypotension makes the patient with head injury fundamentally different is critical to nursing strategies. The conventional concept that fluid restriction decreases cerebral edema in patients with head injury must be weighed against mounting evidence that aggressive hemodynamic support decreases the incidence of subsequent organ system failure and secondary brain injury. New evidence has triggered a scrutiny of conventional interventions. A search for optimal treatments based on prospective randomized trials will continue. Development of neuroprotective drugs and use of hypertonic saline may be on the horizon. In an effort to ensure optimal outcome, contemporary trauma nursing must embrace new concepts, shed outmoded therapy, and ensure compliance with the basic tenets of critical care for the multitrauma patient with head injury.- - - - - - - - - - ranking = 1keywords = effort (Clic here for more details about this article) |
2/85. neuroleptic malignant syndrome induced by haloperidol following traumatic brain injury.The use of neuroleptics in the acute management of traumatic brain injury (TBI) is controversial and may be detrimental to recovery. The following case report describes a patient developing neuroleptic malignant syndrome (NMS) secondary to the use of haloperidol given to control the patient's agitation. The patient began to exhibit symptoms consistent with NMS (high fever, dystonia, diaphoresis, tachycardia, and decerebrate posturing) shortly after administration of the haloperidol. Upon transfer to a rehabilitation hospital, the symptoms persisted. When NMS is suspected, the first intervention is to remove the offending agent; thus, the administration of haloperidol was suspended, and the patient was placed on amantadine and propranolol. amantadine was used to increase the availability of dopamine to the mid-brain region, and the propranolol was used to control the fever, which was believed to be central in origin. The patient was able to complete his rehabilitation with no further incidence of fever or agitation. The patient met or exceeded all short-term physical therapy goals and was able to complete most of the neuropsychological tasks presented. The patient returned home 38 days after admission to the rehabilitation hospital and was able to perform most activities of daily living. At the 6-months follow-up visit, the patient was considering entrance into an adult vocational school.- - - - - - - - - - ranking = 0.84857908214372keywords = physical (Clic here for more details about this article) |
3/85. The effect of hyperbaric oxygen treatment on postural stability and gait of a brain injured patient: single case study.Hyperbaric oxygen (HBO) therapy has been found to reduce intracranial and cerebrospinal fluid pressures, and increase grey matter metabolic activity in patients with brain injuries. To date, few studies have quantitatively assessed the changes in the patient's functional outcomes following this expensive therapeutic intervention. The purpose of this case study was to examine the immediate and longer term changes in postural stability and gait in a 17 year old patient who sustained a traumatic brain injury, following administration of hyperbaric oxygen (HBO) therapy combined with physical and occupational therapy. The patient underwent assessments of postural stability and gait 1 week prior to HBO therapy, immediately following, and 6 weeks after completion of HBO therapy. Some improvements in postural stability were observed immediately following HBO, although these improvements were not evident 6 weeks later. Only slight improvements were noted in his walking abilities immediately following the intervention, with essentially little change evident 6 weeks later. The results of this do not support anecdotal evidence that there were substantial improvements in the subject's postural stability and gait following HBO therapy.- - - - - - - - - - ranking = 0.84857908214372keywords = physical (Clic here for more details about this article) |
4/85. 'Is this what life is going to be like?' The story of a 34 year old man (T) who suffered a severe head injury after a fall.Imagine this. You don't remember but you fell from a ladder, a distance of 20 ft onto concrete, on Christmas eve whilst cleaning windows. You suffered a severe head injury and emerged from a coma four weeks later yelling and fighting thinking that you are back in the Falklands. After 6 months in a specialist neurological unit, where you were for a majority of the time 'as unhelpful as possible', you are finally discharged home and your rehabilitation is 'complete'. You believed that your body would 'jump out of bed and go home' months ago but 'it did not respond to your orders'. This was the beginning of a 'long and painful journey back to a reasonable life'. Home was not the safe and loving environment that you thought it would be. Everyone was beginning to see that life was not going to be the same again. There was conflict and distress. wife: He was a vibrant, energetic physical man and now he is a shell of himself. All his anger and frustration he feels about his injury he is taking out on us and whilst we all feel compassion and sympathy for him, it's hard to take... The physical problems are easy to deal with but it is the psychological problems that are hardest. son: He has changed alot. He is more short tempered and we can't reason with him. Anything we say is classed as arguing. He won't let us give our views on matters. He's always right.- - - - - - - - - - ranking = 1.6971581642874keywords = physical (Clic here for more details about this article) |
5/85. behavior adjustments in traumatic brain injury. A case study.A traumatic assault to the brain often leaves significant residual effects, including severe behavioral dyscontrol. The person may demonstrate unwanted behaviors, such as physical aggression or verbal abuse, and lack motivation or the skills to engage in desirable behavior. ReMed, a community-based brain injury program, specializes in using a behavior analytic approach to address unwanted behaviors while understanding and developing strategies to further recovery from the brain injury.- - - - - - - - - - ranking = 0.84857908214372keywords = physical (Clic here for more details about this article) |
6/85. Continuous passive motion in the management of heterotopic ossification in a brain injured patient.We report a man admitted to inpatient rehabilitation 6 wk after traumatic brain injury, who presented with bilateral knee heterotopic ossification. In addition to conventional physical therapy, we applied a continuous passive motion device during 4 wk increasing the range of motion of the knees. On the basis of the limited current literature and this case, we suggest that the use of continuous passive motion devices for heterotopic ossification may be effective and safe and should be the subject of further study.- - - - - - - - - - ranking = 0.84857908214372keywords = physical (Clic here for more details about this article) |
7/85. Early management of craniocerebral injury with avoidance of post-traumatic leptomeningeal cyst formation. Report of two cases.Leptomeningeal cyst, or growing skull fracture, is a rare complication of pediatric head trauma. This entity is typically diagnosed several weeks or months following head trauma when an enlarging scalp mass is recognized. Progressive neurologic deficits (seizures, paresis) can accompany this process, which typically do not improve following conventional surgical treatment. Given that radiographic findings are highly predictive of which children are likely to develop a leptomeningeal cyst, we have adopted a policy of early management in an effort to avoid difficult surgical dissections and progressive neurologic sequelae seen with delayed intervention. The cases of two infants with skull fractures are used to illustrate our approach toward early management of post-traumatic leptomeningeal cysts.- - - - - - - - - - ranking = 1keywords = effort (Clic here for more details about this article) |
8/85. women and traumatic brain injury.women with TBI have been inadequately studied in relation to most aspects of pathophysiology, recovery, health and behavioral issues, and community integration. This is not entirely surprising in light of the preponderance of men with TBI but also reflects the traditional tendency of medical researchers to concentrate their efforts on men. Although most of the residual effects of TBI are gender-neutral, women may present some unique problems in relation to pain and endocrine issues, reproduction, and sexual functioning In addition, a woman's roles as wife, mother, and daughter are likely to result in a different constellation of family dynamics when TBI is introduced. attention to enrollment of women in research studies and the increasing number of multi-institutional studies of TBI may provide enlightenment on these issues in the future.- - - - - - - - - - ranking = 1keywords = effort (Clic here for more details about this article) |
9/85. Partial weight-bearing gait retraining for persons following traumatic brain injury: preliminary report and proposed assessment scale.The objectives of this investigation were to (1) document the recovery patterns of walking ability in two patients recovering from traumatic brain injury receiving partial weight-bearing gait retraining, and (2) introduce a new assessment scale of gait progress for patients receiving partial weight support therapy. The two patients were categorized as acute (< 6 months) and chronic (> 2 years) injury. Each patient received extensive in-patient rehabilitation, including physical therapy designed with twice-weekly partial body support gait training. The subjects made improvements in all measured indicators of gait ability (i.e. muscle strength, spasticity, standing balance). However, assessment of their improvement using standard assessment scales showed little progress. The newly devised missouri Assisted gait (MAG) scale, which includes developmental components of gait ability measured dramatic gains. This added precision of measurement was useful in communicating progress to both patients and providers.- - - - - - - - - - ranking = 0.84857908214372keywords = physical (Clic here for more details about this article) |
10/85. rehabilitation outcome in a patient awakened from prolonged coma.BACKGROUND: This article describes the rehabilitation of a patient recovering from a prolonged coma (defined as lasting longer than 4 weeks). The case is noteworthy because it exemplifies the possibilities and difficulties entailed in treating these patients, who are often regarded as too severely impaired to justify intensive rehabilitation efforts. CASE REPORT: The patient is a 28-year old Polish male, unmarried, who suffered serious closed head injuries in an automobile accident in April of 1999. He was in a comatose state for more than two months, with a GCS score of 5. When admitted for rehabilitation he was bedridden, with global aphasia, agraphia, limb apraxia, and executive dysfunction. The rehabilitation program developed for him is described in detail. RESULTS: Over the course of rehabilitation, which began in December 1999 and continues to this writing, the patient has regained locomotion capabilities (though with impairments), and his speech has improved considerably. The apraxia has largely resolved, and he is able to write his name and copy words. He is now capable of performing many activities of daily living. CONCLUSIONS: A comprehensive program of rehabilitation characterized by a strategic, heuristic approach is capable of achieving a good outcome even in very difficult cases, such as prolonged coma.- - - - - - - - - - ranking = 1keywords = effort (Clic here for more details about this article) |
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