Articles: traumatic-brain-injuries.
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Neuropsychol Rehabil · Jan 2003
Neurorehabilitation and cognitive-behaviour therapy of anxiety disorders after brain injury: An overview and a case illustration of obsessive-compulsive disorder.
Survivors of acquired and traumatic brain injuries may often experience anxiety states. Psychological reactions to neurological trauma may be caused by a complex interaction of a host of factors. We explore how anxiety states may be understood in terms of a biopsychosocial formulation of such factors. ⋯ We show how CBT plus CR allows a biopsychosocial formulation to be developed of the survivor's concerns for guiding a goal-based intervention. The survivor made significant gains from intervention in terms of goals achieved and changes on clinical measures. We argue that large-scale research is needed for developing an evidence base for managing emotional disorders in brain injury.
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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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The purpose of this study was to evaluate the effect of altering the use of the protocol for brain death determination in traumatically injured patients, on time to brain death determination, medical complication rates, organ procurement rates and charges for care rendered during brain death determination. A retrospective chart review of trauma patients with lethal brain injuries at an urban tertiary care trauma center was performed. Two groups of trauma patients with lethal head injuries were compared. Group I consisted of patients pronounced brain dead using a protocol requiring two brain examinations, and group II contained patients evaluated using a protocol requiring one brain examination in conjunction with a nuclear medicine brain flow scan. ⋯ Medical complications are universal in the traumatized patient awaiting the determination of brain death. These complications necessitate aggressive and costly care in the intensive care unit in order to optimize organ function in preparation for possible transplantation. In our institution, the determination of brain death using a single clinical examination and a nuclear medicine flow study significantly shortened the brain death stay and reduced associated charges accrued during this period. The complication and organ procurement rates were not affected in this small, preliminary report sample.