NeuroRehabilitation
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NeuroRehabilitation · Jan 1997
The role of emergency medical services for children (EMSC) in the care of children with traumatic brain injuries.
This article highlights the role that Emergency Medical Services for Children (EMSC) can play in the continuum of care for children with traumatic brain injuries. Through national efforts by the EMSC, several initiatives and recommendations are proposed regarding the development of a coordinated system of care for children with special healthcare needs that includes children with traumatic brain injuries. In particular, EMSC is addressing the need for expanded emergency and trauma care services for children and methods of improving continuity among emergency, acute, rehabilitation, and community services to enhance better long-term outcomes for these children and their families. Other identified needs include: training and education of providers; resolving differences in language and philosophy that exist across disciplines; developing standards for family-centered care; and improving communication and service coordination for children with special healthcare needs.
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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 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.