1/146. 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 = sensitivity (Clic here for more details about this article) |
2/146. Real-time continuous visual biofeedback in the treatment of speech breathing disorders following childhood traumatic brain injury: report of one case.The efficacy of traditional and physiological biofeedback methods for modifying abnormal speech breathing patterns was investigated in a child with persistent dysarthria following severe traumatic brain injury (TBI). An A-B-A-B single-subject experimental research design was utilized to provide the subject with two exclusive periods of therapy for speech breathing, based on traditional therapy techniques and physiological biofeedback methods, respectively. Traditional therapy techniques included establishing optimal posture for speech breathing, explanation of the movement of the respiratory muscles, and a hierarchy of non-speech and speech tasks focusing on establishing an appropriate level of sub-glottal air pressure, and improving the subject's control of inhalation and exhalation. The biofeedback phase of therapy utilized variable inductance plethysmography (or Respitrace) to provide real-time, continuous visual biofeedback of ribcage circumference during breathing. As in traditional therapy, a hierarchy of non-speech and speech tasks were devised to improve the subject's control of his respiratory pattern. Throughout the project, the subject's respiratory support for speech was assessed both instrumentally and perceptually. Instrumental assessment included kinematic and spirometric measures, and perceptual assessment included the Frenchay dysarthria Assessment, Assessment of Intelligibility of Dysarthric speech, and analysis of a speech sample. The results of the study demonstrated that real-time continuous visual biofeedback techniques for modifying speech breathing patterns were not only effective, but superior to the traditional therapy techniques for modifying abnormal speech breathing patterns in a child with persistent dysarthria following severe TBI. These results show that physiological biofeedback techniques are potentially useful clinical tools for the remediation of speech breathing impairment in the paediatric dysarthric population.- - - - - - - - - - ranking = 23.702846741825keywords = visual (Clic here for more details about this article) |
3/146. Assessment of command-following in minimally conscious brain injured patients.OBJECTIVE: To develop a method for establishing the presence of command-following in individuals with traumatic brain injury, based on the principles of single-subject experimental design. DESIGN: A series of single-subject experiments, individualized to the particular command-following question about a particular patient. SETTING: An inpatient rehabilitation hospital with a specialized program for vegetative and minimally conscious brain injured patients. patients: Eight individuals with serious brain injury of traumatic or nontraumatic origin, presenting in vegetative or minimally conscious states. INTERVENTIONS: The frequency of performance of the behavior in question was assessed in response to commands and in relation to appropriate control conditions. Data were analyzed with chi2 or Fisher's exact test, as well as measures derived from signal detection theory. MAIN OUTCOME MEASURES: The frequency of performance of a specific behavior in the presence of a command and in relevant contrasting conditions. RESULTS: This method identified whether a specific behavior was being performed in response to command and whether the reliability of this behavior was changing over time either spontaneously or in response to treatment. CONCLUSIONS: Quantitative assessment of command-following based on principles of single-subject experimental design can determine whether patients are capable of following commands and whether this ability changes over time or in response to treatment.- - - - - - - - - - ranking = 1.1898901945133keywords = contrast (Clic here for more details about this article) |
4/146. Clinical effectiveness of dramatherapy in the recovery from neuro-trauma.PURPOSE: To investigate the clinical effectiveness of a short course of dramatherapy (an eclectic term encompassing all the arts therapies), delivered in a one-to-one interaction, in a sample of 10 patients in a neuro-rehabilitation unit. METHOD: Each participant received five individual one-to-one sessions of therapy over a 5 week period. A semi-structured interview was carried out with each participant following the course. RESULTS: Qualitative analysis of the taped interviews elicited how the therapy contrasted and complemented the rest of the rehabilitation setting and therapies and how it helped psychological adjustment to severe disabilities resulting from neurotrauma. There were four ways in which it appeared to empower the participants and nurture their self esteem. It provided them with a sense of personal space in an otherwise institutional setting; it allowed escapism and enjoyment; it awakened creativity and a sense of potency; and it provided a metaphor to explore personal issues. CONCLUSION: Dramatherapy made an important contribution to the healthy adjustment of some patients both to hospital life and to acquired disability. The reports from the patients indicated that this approach to rehabilitation should be further incorporated and developed in neuro-rehabilitation.- - - - - - - - - - ranking = 1.1898901945133keywords = contrast (Clic here for more details about this article) |
5/146. Differential pupillary constriction and awareness in the absence of striate cortex.The fact that the pupil constricts differentially to visual stimuli in the absence of changes in light energy makes it a valuable tool for studying normal function as well as residual capacity in hemianopic subjects. When pupillometrically effective stimuli such as equiluminant gratings or coloured patches with an abrupt onset and offset are presented to the 'blind' hemifield, a hemianopic subject with damage largely restricted to striate cortex (V1) sometimes reports being 'aware' of the transient onset/offset, although without 'seeing' as such. The question addressed here is whether the pupil still responds in the condition of blindsight in its strict sense--i.e. discriminative capacity in the absence of acknowledged awareness--when stimuli are deliberately designed to eliminate awareness. This was accomplished by making stimulus onset and offset slow and gradual. The results with a well-studied hemianope, G.Y., demonstrate that there is still a pupillary constriction to isoluminant achromatic gratings and red-coloured stimuli, although reduced in size, in the absence of acknowledged awareness.- - - - - - - - - - ranking = 3.9504744569709keywords = visual (Clic here for more details about this article) |
6/146. Fatal head injury in children: a new approach to scoring axonal and vascular damage.As part of a multidisciplinary study of brain damage in children fatally injured in motor vehicle accidents, a simple method to quantify and visualise the distribution and extent of injury has been developed. Vascular and axonal injury were assessed using coronal brain sections stained for haematoxylin and eosin, or reacted immunohistochemically for beta-amyloid precursor protein. Subsequent analysis was carried out using NIH Image software, and the resulting information is displayed in schematic diagrams. These summary diagrams simply and clearly show the distribution of injury in both the coronal and horizontal planes. This technique offers an advantage over previous scoring methods in that it provides both a quantitative and a visual summary of the distribution and extent of brain injury. This information can then be used to compare the injury distribution and severity with estimated impact points and acceleration data.- - - - - - - - - - ranking = 7.9009489139417keywords = visual (Clic here for more details about this article) |
7/146. Enhanced accuracy in differential diagnosis of radiation necrosis by positron emission tomography-magnetic resonance imaging coregistration: technical case report.OBJECTIVE AND IMPORTANCE: To demonstrate the usefulness of positron emission tomography-magnetic resonance imaging (MRI) coregistration for differentiation of radiation necrosis and recurrent tumor in stereotactic planning. CLINICAL PRESENTATION: T1-weighted MRI scans of a 43-year-old woman revealed a contrast-enhancing lesion 4 years after open removal of a recurrent, right parieto-occipital Grade II oligodendroglioma and subsequent external radiation therapy. The suspected contrast-enhancing lesion revealed only moderate tracer uptake (1.3 times the uptake in the contralateral normal cortex) in a coregistered [11C]methionine positron emission tomographic scan. Approximately 15 mm posterior and mesial to the center of the contrast-enhancing lesion, however, an area of higher tracer uptake was found (1.8 times that of the contralateral normal cortex), which exhibited only very minor contrast enhancement on MRI. TECHNIQUE: The coregistered images were used for planning stereotactic serial biopsies, from the contrast-enhancing lesion as well as from the area with higher methionine uptake. Histological examination demonstrated that the contrast-enhancing lesion with low methionine uptake was necrotic tissue, and the nonenhancing area with high methionine uptake was recurrent tumor. CONCLUSION: High-resolution positron emission tomography and modern coregistration techniques allow differentiation of contrast enhancement and methionine uptake in irradiated brain tissue within small areas. High methionine uptake is typical for recurrent tumor tissue and can be differentiated from minor tracer accumulation resulting from disruption of the blood-brain barrier or macrophage activity within the necrotic area.- - - - - - - - - - ranking = 8.3292313615928keywords = contrast (Clic here for more details about this article) |
8/146. Intraocular contrast enhancement in Adams pattern III hypoxic brain damage: MRI.The MRI findings of a patient with diffuse cortical hypoxic brain damage (Adams pattern III) are presented. Besides intense cortical contrast enhancement, a peculiar leakage of contrast medium at the anterior chambers of the eye was observed. The pathogenetic mechanism of this enhancement is discussed.- - - - - - - - - - ranking = 7.1393411670795keywords = contrast (Clic here for more details about this article) |
9/146. A 12-year ophthalmologic experience with the shaken baby syndrome at a regional children's hospital.PURPOSE: To examine the ophthalmologic experience with the shaken baby syndrome (SBS) at one medical center, including clinical findings, autopsy findings, and the visual outcome of survivors. methods: One hundred sixteen patients admitted from 1987 to 1998 for subdural hematomas of the brain secondary to abuse were included. RESULTS: Retinal hemorrhages were detected in 84% of the children, but this important finding had been missed often by nonophthalmologists. Poor visual response, poor pupillary response, and retinal hemorrhage correlated strongly with demise of the child. One child who died had pigmented retinal scars from previous abuse, a condition not previously observed histopathologically. The clinical and autopsy findings varied somewhat, probably because of the differing conditions for examination. No correlation could be made between computerized tomography scans done during life and the subdural hemorrhage of the optic nerve found on autopsy. Half of the surviving patients were known to have good vision. One fourth of the patients had poor vision, largely due to cerebral visual impairment from bilateral injury posterior to the optic chiasm. Severe neurologic impairment correlated highly with loss of vision. CONCLUSION: This series provides information on the frequency of eye findings in SBS patients. No fundus finding is pathognomonic for SBS. When retinal hemorrhages are found in young children, the likelihood that abuse occurred is very high. The difficulty that nonophthalmologists have in detecting retinal hemorrhage may be an important limiting factor in finding these children so they may be protected from further abuse.- - - - - - - - - - ranking = 11.851423370913keywords = visual (Clic here for more details about this article) |
10/146. Impaired social response reversal. A case of 'acquired sociopathy'.In this study, we report a patient (J.S.) who, following trauma to the right frontal region, including the orbitofrontal cortex, presented with 'acquired sociopathy'. His behaviour was notably aberrant and marked by high levels of aggression and a callous disregard for others. A series of experimental investigations were conducted to address the cognitive dysfunction that might underpin his profoundly aberrant behaviour. His performance was contrasted with that of a second patient (C.L.A.), who also presented with a grave dysexecutive syndrome but no socially aberrant behaviour, and five inmates of Wormwood Scrubs prison with developmental psychopathy. While J.S. showed no reversal learning impairment, he presented with severe difficulty in emotional expression recognition, autonomic responding and social cognition. Unlike the comparison populations, J.S. showed impairment in: the recognition of, and autonomic responding to, angry and disgusted expressions; attributing the emotions of fear, anger and embarrassment to story protagonists; and the identification of violations of social behaviour. The findings are discussed with reference to models regarding the role of the orbitofrontal cortex in the control of aggression. It is suggested that J.S.'s impairment is due to a reduced ability to generate expectations of others' negative emotional reactions, in particular anger. In healthy individuals, these representations act to suppress behaviour that is inappropriate in specific social contexts. Moreover, it is proposed that the orbitofrontal cortex may be implicated specifically either in the generation of these expectations or the use of these expectations to suppress inappropriate behaviour.- - - - - - - - - - ranking = 1.1898901945133keywords = contrast (Clic here for more details about this article) |
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