Articles: brain-injuries.
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Arch Phys Med Rehabil · Feb 1996
Association between injury indices and outcome after severe traumatic brain injury in children.
(1) To determine whether indices of traumatic brain injury (TBI) in children are associated with outcome at hospital discharge and 5 to 7 years later; (2) to describe persisting disabilities. ⋯ Early and late outcome after severe TBI are related to variables measured at and after injury. Subjects had long-term educational and vocational problems but often did not utilize the medical model of neurorehabilitation.
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To study sequential changes in heart rate, respiratory rate, blood pressure, heart rate power spectra, and plasma catecholamine concentrations in patients with acute brain injury and correlate these variables with the severity of neurologic dysfunction and patient outcome. ⋯ Our results imply that autonomic nervous system control of heart rate is disrupted in proportion to the degree of neurologic insult in children after acute brain injury. Thus, heart rate power spectral analysis and plasma catecholamine concentrations may prove to be useful adjuncts in determining severity of neurologic injury and prognosis for recovery in children suffering from brain injury. In addition, these techniques may aid in the determination of brain death.
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Severe traumatic brain injuries are extremely heterogeneous. At least seven of the secondary derangements in the brain that have been identified as occurring after most traumatic brain injuries also occur after cardiac arrest. These secondary derangements include posttraumatic brain ischemia. ⋯ Stepwise measures to prevent lethal brain swelling after traumatic brain injury need experimental exploration, based on the multifactorial mechanisms of brain swelling. Novel treatments have so far influenced primarily healthy tissue; future explorations should benefit damaged tissue in the penumbra zones and in remote brain regions. The prehospital arena is unexplored territory for traumatic brain injury research.
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There is no doubt that vegetative patients need the appropriate medical and nursing procedures as well as family involvement, education and counselling. Additional structured stimulation programmes are used for the treatment of coma and vegetative state. The theoretical foundation is derived from animal studies. ⋯ The studies of human sensory stimulation give more an orientation than a definitive statement. Very recently, hypotheses concerning sensory regulation have begun to be evaluated. Further investigations are required to provide a more definite conclusion.
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Early neurological rehabilitation means starting rehabilitation of brain damaged patients already during the acute phase of the trauma or illness. It meanwhile is commonly accepted that early onset of specific neurological rehabilitation interventions will enhance medical improvement and social reintegration potential. On the other hand, the number of treatment places required for adequate early neurological rehabilitation remains a controversial, and as yet unresolved, issue in Germany. ⋯ A total of 146 early rehabilitation treatments was found, which is equivalent to 80 treatments a year. These results are compared with the figures and recommendations given by Kuratorium ZNS. Also, our findings document the apparent deficits in neurological rehabilitation at the time in the Land Bremen, which undoubtedly jeopardize our daily objectives, the progress and successes achieved in early intensive care.