1/5. Conceptual dilemmas in evaluating individuals with severely impaired consciousness.States of severely impaired consciousness (SIC) are characterized by cognitive and motor limitations. This case report describes a 45-year-old female with impaired consciousness who began to 'walk'. She initially presented to the hospital unresponsive and was subsequently diagnosed with metabolic encephalopathy due to severe hypoglycaemia. Traditional indices of consciousness indicated a low level of responsiveness; however, during physical therapy, she displayed reciprocal walking movements when lifted to a standing position by two therapists. Despite her ability to walk increased distances during and after neurorehabilitation, she was unable to consistently demonstrate responses indicative of higher levels of consciousness. This case illustrates the challenge of rating patients with limited behavioural repertoire using established measures of impaired consciousness.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/5. music therapy with patients in low awareness states: approaches to assessment and treatment in multidisciplinary care.This paper outlines the rationale for and role of music therapy as a clinical intervention and diagnostic tool in multidisciplinary (MDT) rehabilitation programmes for patients in low awareness states. A review of the literature indicates that music is a useful clinical tool in stimulating a range of behavioural, physiological and expressive responses in patients in low awareness states. Referral criteria for music therapy with this patient group are provided, along with suggested methods for collaborative multidisciplinary work. A case vignette is presented of a client whose diagnosis of vegetative state (VS) was contradicted by her purposeful responses within music therapy assessment, contributing towards a changed diagnosis to minimally conscious state (MCS). The case illustrates the particular role of music therapy in assisting with diagnosis in complex cases. music therapy provides a clinical forum in which recovery of function can be assessed in an informal way, using a medium which does not rely on language, is non-evasive and elicits emotional responses.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/5. Severe illness caused by the products of bacterial metabolism in a child with a short gut.An 8-year-old boy with a short gut had six episodes of metabolic acidosis and neurological dysfunction over a 1 month period. The neurological features consisted of a depressed conscious state, confusion, aggressive behaviour, slurred speech and ataxia. The organic acid profile of urine demonstrated increased amounts of lactic, 3-hydroxypropionic, 3-hydroxyisobutyric, 2-hydroxyisocaproic, phenyllactic, 4-hydroxyphenylacetic and 4-hydroxyphenyllactic acids. Of the lactic acid 99% was D-lactic acid. The anaerobic gut flora consisted almost entirely of Lactobacilli in unusually large numbers. A course of vancomycin prevented further episodes. A urinary organic acid profile may be diagnostic when a person with a short gut develops metabolic acidosis or an unusual encephalopathy and bacterial metabolites should be considered in other patients with unusual combinations of organic acids in the urine.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/5. Absence status: a report of two cases.Two known epileptics presented with abnormal behaviour. One was inattentive, aggressive and ataxic. The other carried out quite complex, though purposeless activity. EEG's revealed that the patients' behavioural abnormalities were due to uncontrolled seizures. Absence Status is an uncommon condition and its various manifestations can lead to delays in its recognition and treatment. It should be considered as a possible diagnosis in any patient who presents with recurring episodes of confusion.- - - - - - - - - - ranking = 2keywords = behaviour (Clic here for more details about this article) |
5/5. Psychiatric problems in intensive care. Five patients with acute confusional states and depression.Five case histories are presented of patients with multiple trauma or severe infection, who developed psychiatric symptoms after an initially favourable response to intensive therapy. Alterations in the level of consciousness and behavioural pattern were observed, associated with the presence of acute depression, possibly primarily endogenous in origin. Following intravenous clomipramine administration, considerable improvement was noted in all five patients, regarding both the depressive state and the clouding of consciousness. The importance of recognising psychiatric disorder in severly ill patients in an intensive therapy environment is stressed.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |