1/8. Multi-channel cochlear implantation in patients with a post-traumatic sensorineural hearing loss.There are few accounts of cochlear implantation in adults with post-traumatic sensorineural hearing loss. We report our experience with multichannel implantation in three such patients. Two patients experienced no cognitive or communication deficits as a result of their head injury. At nine months post-implant, compared with our experience of non-head-injured implantees, these patients achieved average or above average scores on audiological performance tests. The third patient presented with cognitive, behavioural and communicative deficits. The level of improvement achieved by this patient, when lip-reading was supplemented with electrical stimulation, in both BKB sentence and connected discourse tracking (CDT) tests was comparable with that of the non-head-injured group. However, his absolute performance at nine months post-implant was well below average. Performance at 18 months on BKB sentences and environmental sound recognition showed little change, and was again well below average, however his score on CDT with lip-reading and electrical stimulation improved considerably and was similar to the average achieved by the non-head-injured group. The major difficulties experienced with this patient were increasing depression and low implant use. Considerably more time was spent in the assessment and rehabilitation of this patient and involved liaison with a number of other agencies. When considering such patients for cochlear implantation it is strongly recommended that these additional requirements are taken into account.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/8. Six cases of severe head injury treated by exercise in addition to other therapies.Six cases of severe head injury treated with vigorous early morning exercise in addition to more orthodox therapies are presented. Observations on behaviour and psychometric testing have been used to assess results. Discussion is centred round the benefits of early morning exercise.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/8. Diagnostic ambiguities in a case of post-traumatic narcolepsy with cataplexy.narcolepsy arising from trauma can present particular problems of differential diagnosis. In this case study presentation the patient suffered a head trauma, without unconsciousness, and began to experience unusual episodic behaviours. Symptom presentation differed from the typical clinical manifestations of idiopathic narcolepsy leading to an 8-year search for a definitive diagnosis. Key relevant aspects that led to diagnostic ambiguities were the order of symptom development, negative for the antigen HLA DR2, significance of the Multiple sleep Latency Test (MSLT) mean sleep latency versus number of sleep onset rapid eye movement periods, the somewhat atypical features of cataplexy, the coexistence of sleep apnoea, and the mildness of the original head injury. It is argued that cases of post-traumatic narcolepsy should be considered in the context of their clinical development over time and that practitioners should be aware that this form of narcolepsy can differ from the typical clinical history of idiopathic narcolepsy.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/8. Rehabilitating severely head-injured adolescents: three case reports.The case reports of 3 severely head-injured adolescents, who developed psychiatric sequelae after the trauma, are presented. All 3 cases displayed various socially disinhibited behaviours. Individually tailored treatment programmes helped these young people manage their maturational tasks of adolescence. Several issues, central to this rehabilitative work, are discussed, including the personal significance of the adolescent's injury, identity issues and defence mechanisms; a family perspective on coping with the injured adolescent and the components of a therapeutic package.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/8. head injury and mental handicap.A clinical and pathological study of head injury and the implications in mental handicap are outlined. Non-accidental injury as a form of child abuse is suspected as contributing considerably to the cause of mental handicap in populations resident in long-stay hospital, but this is unlikely to be the best environment for such patients. A number of mentally handicapped epileptic patients who injure their heads during fits and patients who repeatedly bang their heads as a feature of self-injurious behaviour are exposed to progressive neurological deficits associated with lesions in the brain which could further impair the efficiency of brain function.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
6/8. automatism re-visited: post-traumatic automatism as a defence to a serious criminal charge.A case is described of a policeman who assaulted the man he was arresting after receiving a concussive blow to the head. The defence argued he was suffering from post-traumatic automatism and after juries were unable to agree a verdict in two trials he was acquitted. Aspects of post-traumatic automatism in English law are described and theories of the neurology of concussion and aggressive behaviour are discussed. Guidelines are proposed for the evaluation of cases of post-traumatic automatism.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/8. Structured habituation training for movement provoked vertigo after severe traumatic brain injury: a single-case experiment.The purpose of this study was to evaluate the effect of structured habituation training (HT) for movement provoked vertigo (PV) secondary to unilateral peripheral hypofunction in a 16 year old patient who had sustained a severe TBI. Treatment of PV with severe TBI patients can be quite different from other patients with vestibular deficits because of the physiological, behavioural and cognitive sequelae of brain trauma. A single-subject experimental paradigm using an ABA protocol was used to assess efficacy of HT. The data were submitted to C statistic analysis. The transformed data were submitted to combined visual and statistical analysis by the celeration line with a directional one-tailed test and the two-standard deviation band method. Significant change in duration from sitting to supine without triggering vertigo was found between baseline phase (A) and structured HT phase (B) and was maintained for 1 month after the end of treatment. This single-case experiment demonstrates successful structured HT for PV for a 16 year old severe TBI patient. Important clinical decisions (time of introduction of treatment, type of activity, pacing, frequency, intensity, repetition, support and education) necessary to achieve optimal resolution of PV with HT in severe TBI patients are discussed.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
8/8. Obsessive compulsive disorder following head injury.Although researchers continue to report neurological abnormalities and neuropsychiatric associations in patients with obsessive compulsive disorders, there is a paucity of published reports on this condition following head injury. Such a case is described here, including the efficacy of behavioural intervention in ameliorating the symptoms.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |