1/16. dihydropyrimidine dehydrogenase deficiency and acute neurological presentation.Dihydropyrimidine dehydrogenase (DPD) deficiency has been linked to 5-fluorouracil toxicity, but patients may present a wide clinical spectrum. We describe a 1-year-old Tunisian girl with a dramatic onset of neurological symptoms suggesting the possible triggering role of environmental factors.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/16. Understanding and treating motivation difficulties in ventilator-dependent SCI patients.motivation for spinal cord injury rehabilitation is a difficult management task for clinicians. Ventilator-dependent quadriplegics experience conditions which are particularly likely to lead to motivational problems. The following article provides a theoretical model with which to understand patient motivation. The model conceptualizes patient motivation as a patient-rehabilitation environment fit problem and employs concepts from social learning theory to facilitate understanding and intervention with such difficulties. The model is applied to two ventilator-dependent rehabilitation cases. Recommendations for clinical practice are provided.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/16. Evaluating movement for switch use in an adult with severe physical and cognitive impairments.Miranda's family members are most supportive of the goal for her to have a powered wheelchair and encourage her when they visit. motivation has been the key to Miranda's success at learning to operate switches in order to explore and learn from her environment. As long as the outcome available from operation of a switch is desirable for Miranda, she works hard at controlling her movements so as to activate it. Conversely, if the ultimate advantage of operating the switch is unclear to her, she is unwilling to make the effort. The occupational therapist's role is crucial, in that she realizes the importance of motivation and consequently designs activities and rewards that are important and meaningful for Miranda. Miranda's life has been considerably enriched by the introduction of mechanical aids into her leisure sphere. She has become more interested in her surroundings and is excited about exploring possibilities for future rewarding activities, such as academics. A notable additional benefit has been that Miranda now displays a more assertive attitude on her own behalf.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/16. A treatment program for functional paraplegia/munchausen syndrome.Two patients, referred following lengthy, extensive and frequent medical evaluations, were diagnosed as suffering from chronic factitious disorder with physical symptoms (DSM III). A treatment plan to eliminate the positive reinforcements apparently operating in the hospital and home environment, while preventing "loss of face" of the patient, was formulated and successfully carried out. Two detailed case histories to provide evidence for the diagnosis, the "faradic massage" treatment, patient response, and follow-up are documented.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/16. The use of powered leisure and communication devices in a switch training program.The ability to operate switches in order to communicate more effectively and to control leisure activities has greatly enriched Pam's life. The switches have opened up a world of entertainment that she can enjoy independently. Both her desire and her ability to explore and master her environment have increased--a major thrust of functional independence so important in occupational therapy.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/16. The locked-in syndrome: a review and presentation of two chronic cases.The locked-in syndrome (LIS) is a state of an upper motor neurone quadriplegia involving the cranial nerve pairs with usually a lateral gaze palsy, paralytic mutism, full consciousness and awareness by the patient of his environment. A historical presentation of the LIS is given as well as a short description of the clinicoanatomic lesion causing LIS. The usual cause is vascular and corresponds to a pontine infarction due to an obstruction of the basilar artery but other lesions in the brainstem can also be the cause. Non-vascular aetiologies, especially traumatic, are reviewed. The use of electroencephalography (EEG), brain auditory evoked potentials (BAEP) and somesthesic evoked potentials (SEP) are discussed as well as the use in the acute stage of computed tomography (CT), angiography, and magnetic resonance imagery (MRI). The last method may show well delineated ischaemic lesions some time after the event. The communication disability is probably the most difficult to overcome. Two cases of LIS are presented.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/16. Evaluating the potential for powered mobility.It has been 5 years since Chris was evaluated for a powered wheelchair, and she has had two occupational therapists and three physical therapists since the evaluation and training process began. It has been a long and arduous process, full of triumphs and setbacks. Chris's level of functional mobility, self-confidence, and ability to socialize, however, have increased dramatically as a result of her perseverance. The powered wheelchair, which she can control herself, has increased her ability to explore her environment and to master the increased activities made available through an expanded environment.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
8/16. rehabilitation of quadriplegic patients with phrenic nerve pacers.patients with viable phrenic nerves and adequate diaphragm and lung function can be freed from mechanical ventilation by the use of phrenic nerve pacers. Four quadriplegic patients with phrenic nerve pacers were admitted to a rehabilitation facility between April 1981 and September 1986. These patients made significant gains after undergoing a comprehensive rehabilitation program. They developed skills to maximize their independence, including independent electric wheelchair mobility and independent use of environmental control systems. They were able to communicate verbally by corking their tracheostomies, to write and type by using mouthsticks, and to use computers with mouth-sticks or pneumatic switches. All four patients were discharged to home with a family member as the primary care-provider. Successful discharge can be achieved only by adequate family teaching and counseling, optimal equipment prescription, adequate nursing and other community support for the primary care-provider, and close medical follow-up.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/16. The choice to end life as a ventilator-dependent quadriplegic.A 17-year-old male sustained a C5/6 fracture dislocation and complete C5 quadriplegia in a diving accident. Three days later sensory and motor function deteriorated and he required mechanical ventilation. Surgical exploration found no cause and a fusion was done. Neurologic function stabilized after three weeks with a C1 sensory level, no neck movement, and slight weakness of the tongue. Patient and family were followed closely by the spinal cord injury rehabilitation team from onset of injury. The patient was transferred to the ventilator-dependent pediatric rehabilitation program after ten weeks. Bowel, bladder, skin, and nutritional management were stabilized and taught to his parents who remained with him constantly. communication was achieved with a "talking tracheostomy." He learned to use "Sip-n-Puff" control for driving an electric wheelchair and for Morse code input to a computer. He was passive but cooperative during hospitalization. Eight months after injury he was discharged to his home, which had been modified to meet his needs. A computer word processor, environmental control unit, and modified van were obtained; nursing care was provided around the clock. The patient enrolled in a community college course. Soon after discharge he contacted an attorney to explore legal actions for ending his life, which he considered intolerable. After obtaining medical and psychiatric reports, a court order was issued, which established his legal competence and directed people taking care of him to follow his directions. A few weeks later, 25 months after his injury, he privately said goodbye to his family, asked to be disconnected from the ventilator, and died. Medical and legal issues raised by this case are discussed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/16. technology and occupational therapy in the rehabilitation of the bedridden quadriplegic.In recent years, home health care services have been expanded considerably. These services, combined with current technological advances, allow severely disabled, even bedbound, people to remain at home. This report demonstrates how one individual, although bedridden and quadriplegic, has successfully adapted his home environment. His functional independence has been markedly improved through computers, environmental control units, innovative carpentry, and adaptations by the occupational therapist. His need for attendant care has been reduced and his quality of life significantly enhanced through increased control of his surroundings. This paper suggests innovative and technological solutions to environmental problems at home. These ideas may aid the home health care occupational therapist in treating individuals who are bedbound.- - - - - - - - - - ranking = 3keywords = environment (Clic here for more details about this article) |
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