NeuroRehabilitation
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NeuroRehabilitation · Jan 1997
Utilization of a comprehensive sensory stimulation program with a comatose tetraplegic patient.
To date, there has been a relative absence of studies which have examined the utility and effectiveness of sensory stimulation procedures in comatose, spinal-cord-injured patients. This report describes the interdisciplinary utilization (within an acute care setting) of a comprehensive sensory stimulation programme with a 21-year-old, comatose, tetraplegic male patient. To promote behavioural arousal, multiple sensory stimulation sessions were conducted with the patient daily. ⋯ There was also a non-significant trend of increased behavioural arousal during the post- as compared to the pre-treatment baselines (i.e. carry-over effect). By termination of this programme, the patient exhibited an overall increased level of arousal/behavioural responsiveness (i.e. decreased coma) as compared to his level at the initiation of this programme. These findings are discussed in light of factors that may affect the effectiveness and implementation of such sensory stimulation programmes with comatose, tetraplegic patients in acute care settings.
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NeuroRehabilitation · Jan 1997
Fostering effective team cooperation and communication: Developing community standards within interdisciplinary cognitive rehabilitation settings.
Cognitive rehabilitation is a promising and necessary component of interdisciplinary treatment for brain injured patients, but it remains an area that lacks universal definitions, empirically validated constructs, or standards of practice. This situation leads to difficulties for interdisciplinary teams in cognitive rehabilitation settings, since definitions, conceptions, and labels of cognitive constructs can differ across team members and disciplines. ⋯ Such a project was undertaken by a task force at the University of Missouri-Columbia School of Medicine, Rusk Rehabilitation Center. The process of establishing such a task force and the need for establishing community standards are described and outlined.
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NeuroRehabilitation · Jan 1996
Medical management of the comatose, vegetative, or minimally responsive patient.
This review outlines the range of medical problems occurring in brain injured patients in coma or emerging from coma, including the population of vegetative and minimally responsive patients. This range of medical problems includes those associated with the original brain injury or associated injuries, those representing complications of bedrest, and those caused by the use of medications that may retard recovery or contribute to an obtunded or comatose state. The review is organized by organ systems, each section including a brief discussion with reference to more indepth discussions in other sources. A number of algorithms are included to define approaches to evaluation of common clinical presentations which may be helpful to clinicians treating this population in acute or subacute settings.
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NeuroRehabilitation · Jan 1995
Families of children with traumatic injuries identify needs for research and training.
This paper summarizes the survey responses of 67 families with children who were hospitalized after traumatic injuries. The survey was conducted during the pre-planning phase of a major research proposal on the rehabilitation of children who had been injured. The purpose of the survey was to involve families in the identification of needs and determination of priorities for research and training in childhood injuries. ⋯ Written comments emphasized the emotional impact of physical trauma upon families and the need for longitudinal research, with pediatric rehabilitation viewed as a broad spectrum of care starting with emergency room care and hospitalization and continuing through school and community programs. As a result of this survey several projects were initiated. They include: revision of head sheets distributed by emergency rooms, physician training in communication skills, preparation of families as service coordinators, and development of materials and programs specifically for families.
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Posttraumatic agitation is perhaps the most dramatic behavioral consequence of severe traumatic brain injury. The mechanism for this behavior remains to be determined. ⋯ Concurrent neurologic or medical decline during the recovery from an acute traumatic brain injury may precipitate delirium, which has many clinical features that overlap with posttraumatic agitation. Hence, the differential diagnosis of posttraumatic agitation includes all medical and neurologic etiologies for transient declines in consciousness and cognition.