NeuroRehabilitation - Volume 54, issue 1

Authors: Fins, Joseph J. | Shulman, Kaiulani S. | Wright, Megan S. | Shapiro, Zachary E.

Article Type: Research Article

Abstract: It is helpful to think about the needs of patients with moderate to severe brain injury through the lens of disability law. However, there are limitations to current disability law that contribute to ongoing segregation and marginalization of individuals with severe brain injury. Indeed, one of the paradoxes of American jurisprudence is that more clear constitutional protections accrue to those who have definitively immutable conditions. Thus, as neuroscience brings new therapies to those with brain injury, they may become less protected by the constitutional elements of disability law because their conditions have changed and become mutable . This is the …clinical progress that brain injury professionals all seek to achieve, but ironically these advances could potentially degrade the legal protections of patients who benefit from emerging treatments. In this paper, we will critically examine this paradox at the interface of medicine and the law and suggest that the Americans with Disabilities Act (ADA) could be nicely complemented by legislation we have named the Americans with Abilities Act (AWAA). Instead of focusing on disabilities that need protection, the AWAA seeks to sustain and foster newfound abilities made possible by the fruits of medicine and neuroscience. Show more

Keywords: Brain injury, neuroethics, disability law, Americans with Abilities Act, assisted living, vegetative state

DOI: 10.3233/NRE-230118

Citation: NeuroRehabilitation, vol. 54, no. 1, pp. 141-147, 2024

Authors: Zasler, Nathan D.

Article Type: Research Article

Abstract: BACKGROUND: The tasks and responsibilities that come with clinician involvement in medicolegal proceedings can be daunting and particularly so in challenging areas such as provision of medicolegal opinions in cases involving disorders of consciousness (DoC). OBJECTIVE: The aim of this narrative review was to provide education and advice to healthcare practitioners who by choice or circumstance are asked and/or required to provide medicolegal opinions in cases involving patients with DoC. METHODS: A literature search was conducted using PubMed Central and MedlinePlus for articles dealing with clinician involvement in medicolegal cases involving persons with …DoC. The information provided also integrates the authors’ nearly 40 years of clinical experience, brain injury medicine practice and “trials and tribulations” associated with medicolegal involvement in such cases. RESULTS: The literature was found to be replete with articles on brain death and withdrawal/withholding of care (which are not the focus of this review). The extant medical literature in brain injury medicine on the other hand is currently lacking in practical information for clinicians working “in the trenches” regarding the challenges and caveats of medicolegal involvement in such cases. CONCLUSION: This review provides the reader with a big picture overview of the most pertinent medicolegal topics inherent in clinical work with patients with DOC including pertinent nomenclature, caveats regarding forensic consultation including independent medical examinations, testimony tips, discussion of life expectancy/median survival concepts, prognostication in a medicolegal context, documentation and record keeping as well as some of the specific challenges pertinent to these types of brain injury cases that are not per se relevant in less severe injuries. Show more

Keywords: Medicolegal, legal, independent medical evaluation, brain injury, disorder of consciousness

DOI: 10.3233/NRE-230242

Citation: NeuroRehabilitation, vol. 54, no. 1, pp. 149-165, 2024

Authors: Chan, Soo Chin | Engkasan, Julia Patrick

Article Type: Other

Abstract: BACKGROUND: Stroke can lead to permanent and severe disability. Provision of information to stroke survivors and their carers could help them cope with consequences of stroke and aware of secondary prevention. OBJECTIVE: The aim of this Cochrane review was to assess the effects of active or passive information provision for stroke survivors or their carers. METHODS: The population addressed in this review included stroke survivors, their carers, or both. The intervention studied was provision of active or passive information compared to standard care or where information and another therapy were compared with the …other therapy alone, or where the comparison was between active and passive information provision. The primary outcomes were knowledge about stroke and stroke services, and anxiety. CONCLUSIONS: The authors concluded that the active provision of information may improve stroke survivors stroke-related knowledge and quality of life. It may reduce the cases and symptoms of anxiety and probably depression. The effect of active information provision to carers and passive information provision is still unclear; however, passive information may worsen stroke patients’ symptoms of anxiety and depression. Show more

Keywords: Information, stroke survivors, carers, rehabilitation

DOI: 10.3233/NRE-246001

Citation: NeuroRehabilitation, vol. 54, no. 1, pp. 167-169, 2024