1/393. Technique of removal of an impacted sharp object in a penetrating head injury using the lever principle.Penetrating head injuries can be difficult to manage as the extensive surgery which may be required can result in severe morbidity and mortality in some patients. A conservative surgical approach with a "pull and see" policy was adopted successfully in a described case. Extraction can be achieved by using the mechanical advantage of the lever principle. By this method while removing the object any movements of sharp edges which will cause secondary damage can be reduced to a minimum.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
2/393. The role of early left-brain injury in determining lateralization of cerebral speech functions.Preparatory to craniotomy for the relief of medically refractory focal epilepsy, the lateralization of cerebral speech functions was determined by the Wada intracarotid Amytal test in 134 patients with clinical and radiologic evidence of an early left-hemisphere lesion. Their results were compared with those for 262 patients (140 right-handed, 122 left-handed), who were tested in a similar way. One-third of the patients with early lesions were still right-handed, and 81% of these right-handers were left-hemisphere dominant for speech. In the non-right-handers, speech was represented in the left cerebral hemisphere in nearly a third of the group, in the right hemisphere in half the group, and bilaterally in the remainder. Bilateral speech representation was demonstrated in 15% of the non-right-handers without early left-brain injury and in 19% of those with evidence of such early injury, whereas it was extremely rare in the right-handed groups. In addition, nearly half the patients with bilateral speech representation exhibited a complete or partial dissociation between errors of naming and errors in the repetition of verbal sequences after Amytal injection into left or right hemispheres. This points to the possibility of a functionally asymmetric participation of the two hemispheres in the language processes of some normal left-handers. The results of the Amytal speech tests in this series of patients point to locus of lesion as one of the critical determinants in the lateralization of cerebral speech processes after early left-brain injury. It is argued that in such cases the continuing dominance of the left hemisphere for speech in largely contingent upon the integrity of the frontal and parietal speech zones.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
3/393. bereavement and mourning in pediatric rehabilitation settings.Developmental changes in children's acquisition of death concepts and in their emotional reactions are reviewed. Moderating variables that may affect the nature of grieving processes after parental or sibling death are discussed, including circumstances of the loss, prior experience with death, and the child's cognitive functioning. Pragmatic issues (such as when and how to inform children of parental or sibling death) regarding bereavement and mourning in children with acquired brain injuries are reviewed and illustrated by means of case studies. Special challenges to rehabilitation professionals who must deal with these issues (including the concurrent treatment of secondary losses, cognitive deficits, and organic personality changes) are discussed.- - - - - - - - - - ranking = 659.95613987274keywords = person, ill (Clic here for more details about this article) |
4/393. Workers Compensation cases with traumatic brain injury: an insurance carrier's analysis of care, costs, and outcomes.The purpose of this survey was to review the medical care, medical costs, and outcomes of 86 Workers Compensation cases involving traumatic brain injury. An analysis of ICD-9 diagnoses, Rancho Los Amigos Cognitive Levels, age, sex, accident description, management techniques, costs, outcomes, and many other factors was conducted. The total indemnity (wage loss) and medical payments amounted to $27.1 million. For example, one case with temporal lobe hematoma, due to a fall in 1972, has had $1.1 million in medical payments since the injury occurred. The current average age is 40 years with 71% still residing at home. Only 10% are currently employed and 40% are known to be receiving other benefits. The increasing frequency and severity of these cases, as well as the extension of survival due to improved care and technology, highlight the need to address the question, "Who will be the caretakers, and what will be the associated costs?" Actuarial projections into the 21st century are given. It is concluded that, while further long-term studies are needed, Workers Compensation carrier representatives and health care providers must continue to work together on the interdisciplinary rehabilitation team.- - - - - - - - - - ranking = 5keywords = ill (Clic here for more details about this article) |
5/393. Minor traumatic brain injury: review of clinical data and appropriate evaluation and treatment.The clinical entity of minor traumatic brain injury (MTBI) is secondary to signs and symptoms encompassing neuropathological, neurochemical, neurobehavioral, neuropsychological and behavioral deficits. The patients who suffer this disorder are often given little help, medically, secondary to issues regarding the perceived reality of the disorder. A few individuals deny the existence of MTBI. Some believe the symptom complex to be strictly functional, while others believe that spontaneous recovery will occur and no treatment is necessary. When discussing traumatic brain injury the descriptors, "mild, moderate, and severe," are used to describe the severity of the acute injury. These labels do not describe the severity of the sequelae nor are they indicative of the intensity of specific treatment. A clear understanding of MTBI, its sequelae and necessary treatment is imperative to insure timely intervention. Delay or lack of early intervention appears to be responsible for "persistent sequelae" in MTBI. This paper will describe various aspects of the etiology of MTBI, with recommended evaluation and treatment guidelines. A functional assessment scale specifically for persons with MTBI is also presented. Several case histories are included for illustration purposes.- - - - - - - - - - ranking = 661.95613987274keywords = person, ill (Clic here for more details about this article) |
6/393. Helping brain injured children and their families.For many brain injured children, whether the injury is congenital or the result of subsequent illness or accident, there is little to be done to put right the underlying problem. Treatment programmes, however, can encourage better motor and cognitive function and better nutrition. NHS continuing care for brain injured children is under-resourced, often amounting to only half an hour of physiotherapy fortnightly or even monthly. The British Institute for Brain Injured Children (BIBIC) is a registered charity which exists to help families with a brain injured child to learn to apply simple, practical, inexpensive treatment programmes themselves, in their own homes. Initial assessments and training take place at the BIBIC Centre in Somerset. Families are asked to contribute towards costs if they are in a position to, but treatment does not depend on ability to pay. Treatment sessions often last about 30 minutes and families may be advised to carry out two or more sessions every day. telephone help and continuing support is available from BIBIC, and families are encouraged to retain contact with their GP and hospital consultants, and local services.- - - - - - - - - - ranking = 1.3988104479391keywords = ill, illness (Clic here for more details about this article) |
7/393. intelligence test scores from infancy to adulthood for a craniopagus twin pair neurosurgically separated at 4 months of age.Long-term effects in a neurosurgically separated twin pair were illuminated by standard psychological test scores obtained over a period from 2 to 38 years of age. Interdigitation of the gyri of their right frontal lobes had necessitated separation in two stages at 4 months of age. One twin clearly suffered some brain injury and showed some impairment during the testing at 5 years of age. The scores of both twins rose at the adult testing. The brighter twin has an IQ comparable to that of the mother. The unique data set is a kind of model for long-term assessment of early brain surgery, particularly with craniopagus twins.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
8/393. Dissociative disorder after traumatic brain injury.Several episodes of dissociative disorder, including depersonalization and multiple personality, have been observed in a 32-year old man during a period of a few months following a mild traumatic brain injury. The psychogenic or organic aetiology of these psychiatric disorders remains undetermined. This case highlights the need to consider dissociative disorder among the possible (temporary) outcomes of a brain injury.- - - - - - - - - - ranking = 1317.9122797455keywords = person (Clic here for more details about this article) |
9/393. Central auditory dysfunction.The numerous tests applicable to the assessment of central deafness are briefly reviewed. It is likely that the more specific verbal and non-verbal tests, which assess more complex auditory function, will prove to be most useful in the assessment of these problems. We believe that the concept of a spectrum of clinical-anatomical types of central deafness is useful, namely, cortical, brainstem and more peripheral forms; a detailed study of an example of a predominantly brainstem type of central deafness is presented. An interdisciplinary approach which applies the methods of the audiologist, otolaryngologist, and neurologist to these patients is required to localize the site of the lesion, to detect and describe the deafness and to establish its etiology.- - - - - - - - - - ranking = 1keywords = ill (Clic here for more details about this article) |
10/393. 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 = ill (Clic here for more details about this article) |
| | Next -> |