NeuroRehabilitation - Volume 7, issue 3

Authors: Kreutzer, Jeffrey S.

Article Type: Introduction

DOI: 10.3233/NRE-1996-7301

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 163-163, 1996

Authors: Curt, Armin | Dietz, Volker

Article Type: Research Article

Abstract: Examination of hand function and nerve conduction study of median and ulnar nerves was performed in 15 patients with acute and 26 patients with chronic tetraplegia due to cervical spinal cord injury (SCI). Thirty percent of patients showed a mild and 20% a severe axonal lesion of motor fibres of both nerves. The latter can be attributed to an intramedullary damage of ventral horn cells and anterior nerve roots, as the examination of sensory nerve fibres were normal in these patients. By median and ulnar nerve conduction study in tetraplegic patients with paresis of intrinsic hand muscles, it was possible …to differentiate between a predominant damage of ventral horn cells/anterior nerve roots (peripheral nervous system) and of pyramidal tract fibers (central nervous system) responsible for the paresis. The extent of motor nerve lesion depended upon the level of SCI and was most frequent and severest in lower cervical spinal cord injuries (C6-T1), where median and ulnar nerves originate. In the latter patients the development of an active hand function, which enables the patient to perform active grasping movements, was closely related to the result of motor nerve conduction study, already early after trauma. Therefore, this technique can be of prognostic value in cervical SCI to predict the outcome of hand function and to allow an early selection of the appropriate occupational therapy in tetraplegic patients. Show more

Keywords: Spinal cord injury, Tetraplegia, Motor nerve lesion, Nerve conduction study, Hand function

DOI: 10.3233/NRE-1996-7302

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 165-173, 1996

Authors: Witol, Adrienne D. | Sander, Angelle M. | Kreutzer, Jeffrey S.

Article Type: Research Article

Abstract: The present investigation assessed 38 family members' perceptions of unmet, partly met and met needs following the brain injury of a relative. Follow-up data was collected at two time intervals averaging 6 and 24 months post-injury. There was no significant difference between the proportion of needs rated as important or very important at time I or II. Highly ranked needs included requests for information, clear and honest explanations from professionals, reassurance, respite care, educational and social activities for the patient, emotional support, financial counseling, and advice about community resources. Relatives rated nearly half of the 40 needs as not met …at either time. A significant difference was noted in the proportion of un met/partly met needs within each factor scale at time I and II. A larger number of Emotional Support and Involvement with Care needs were reported as not met at time II. Needs for Professional Support were more frequently reported as met at time II. For both time periods, Health information needs were generally perceived as met while needs relating to Instrumental Support were largely unmet. The findings are discussed in light of implications for treatment and long term adjustment to injury related changes. Show more

Keywords: Family needs, Traumatic brain injury

DOI: 10.3233/NRE-1996-7303

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 175-187, 1996

Authors: Zafonte, Ross D. | Mann, Nancy R. | Fichtenberg, Norman L.

Article Type: Research Article

Abstract: The role of sleep disturbance in the behavioral and functional sequelae following Traumatic Brain Injury is becoming increasingly well understood. Sleep disturbances occurs commonly in Traumatic Brain injury patients. Survivors of Traumatic Brain Injury may experience sleep dysfunction during all stages of recovery. An effective understanding of the pathophysiology of sleep disturbance and the role medications play in both causation and treatment is essential for facilitation of rehabilitation management and functional recovery.

Keywords: Traumatic Brain Injury, Sleep, Pharmacology, Behavior

DOI: 10.3233/NRE-1996-7304

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 189-195, 1996

Authors: Rowland, Todd

Article Type: Research Article

Abstract: This article provides an overview of available stroke information on the World Wide Web for health care professionals and consumers. An increasing amount of high quality medical information is available online, primarily via the World Wide Web. Recommendations in regard to type of Internet access and software are provided to assist the new and intermediate users. Electronic mail proprietary online services, and Internet applications are briefly reviewed. The World Wide Web sites catalogued in this article have been linked to a single site, allowing ready access to these sites while reviewing the article; Internet address: http://griffin.vcu.edu/html/pmr/other/stroke.html . The intended audience …of the article is health care professionals, including those with limited experience with computers and the Internet. Show more

Keywords: Stroke, Brain, Online, Telecommunication, Internet, World wide web

DOI: 10.3233/NRE-1996-7305

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 197-202, 1996

Authors: Melia, Richard P.

Article Type: Research Article

Abstract: Many issues face the National Institute on Disability and Rehabilitation Research (NIDRR) and its role in the encouragement of Traumatic Brain Injury (TBI) rehabilitation research and the development of the TBI model systems of care. Yet, even though many complex difficulties face individuals who have sustained TBI, their families, care givers, researchers, and others whose lives have been changed by TBI, there is reason for optimism. Significant advances have been made in research, consumer involvement, and model systems of care for individuals who have experienced TBL Although accountability is a recurring watchword for public programs, particularly as a result of …Federal legislation enacted in 1993, the TBI model systems of care have many attributes of an effective results-oriented system when examined in the light of the new measures of program success. Show more

Keywords: Traumatic Brain Injury research, Consumer involvement, Model systems

DOI: 10.3233/NRE-1996-7306

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 203-209, 1996

Authors: Moreci, Gina

Article Type: Research Article

Abstract: This manuscript describes the development and implementation of a unique volunteer service intended to meet the support needs of individuals with traumatic brain injury (TBI) and their families. As a part of the Traumatic Brain Injury Model System of Care, funded by the National Institute on Disability and Rehabilitation Research (NIDRR), the TBI Peer Support Program provides a valuable service of volunteer support from admission through community integration after discharge. TBI Peer Support Volunteers give individual attention to people with TBI and families through active listening, referral to community resources, and provision of information regarding TBI. The importance of including …a structured individual peer support system is supported by clinical research review and patient and family interviews. The establishment and evolution of the program are described as well as suggestions for the creation and development of new volunteer TBI Peer Support Programs. Show more

Keywords: Peer support, Traumatic brain injury (TBI), Community program, Family support, Model system, Rehabilitation

DOI: 10.3233/NRE-1996-7307

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 211-218, 1996

Authors: Black, Kertia L. | Obayan, Abiola | Zafonte, Ross D. | Mann, Nancy R. | Hammond, Flora | Wood, Deborah

Article Type: Research Article

Abstract: Post-traumatic seizures can be a cause of multiple clinical and behavioral abnormalities. We present an unusual case of post-traumatic epilepsy resulting in blindness. The patient was a 35-year-old female with a past history of toxemia of pregnancy who was assaulted, sustaining a traumatic brain injury (TBI). Glasgow Coma Score upon presentation to the emergency department was 10. Initial CAT scan was negative. Subsequent MRI revealed occipital edema. On examination, she was found to be blind in both eyes. Consistent with cortical blindness, extra-ocular movements, pupillary reflexes and fundoscopic examination were normal. Unusual scanning eye movements were noted. Electroencephalography (EEG) revealed …epileptiform discharges in both occipital regions consistent with occipital status epilepticus. Seizures were eventually controlled with Phenytoin and Phenobarbital, with subsequent conversion to Carbamazepine. Central vision returned, but peripheral sight was never regained. Follow up EEG revealed no evidence of epileptiform activity. Post-traumatic occipital status epilepticus is rare. Cortical blindness in TBI patients with minimal occipital pathology on imaging is generally transient. This case points out the need for the treating rehabilitation professional to be vigilant in assessing for post-traumatic seizures in patients with persisting visual deficits. Show more

Keywords: Status epilepticus, Blindness, Hallucinations, Traumatic brain injury

DOI: 10.3233/NRE-1996-7308

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 219-221, 1996

Authors: Berde, Stuart | Johnson, Pamela | Rodrigues, Horacio | Johnson, Karin

Article Type: Research Article

Abstract: This applied study was designed to improve the time on task and accuracy for a woman, several years post traumatic brain injury (TBI), who previously did not reside in settings which provided individualized rehabilitation programs for persons with TBI. The program took place in a rural Adult Developmental Activity Program (ADAP) and employed a single subject design. The individual sat at a computer work station and pressed a Liberator, speech device, connected to a personal computer. The individual responded to questions concerning how she wanted to design greeting cards. Because this was a rehabilitation applied study, instructors changed her environmental …setting to enhance program success. Each external change is referred to as a phase. Instructors recorded her mean baseline time on task, subsequent mean times for each phase of the study and the percentage of accurate responses to the computer-based design questions. The individual's time on task increased, steadily, from her 4.8-min mean baseline, to a mean of over 90 min (with breaks). Her accuracy also improved from 0% to very high percentages, once scoring 100%. The applied study illustrates the rehabilitation gains that may occur when programs are individually designed to accommodate ongoing adjustments. The study also reinforces the resiliency of some individuals many years post injury. Show more

Keywords: Traumatic brain injury, Rehabilitation, Employment, Computer instruction

DOI: 10.3233/NRE-1996-7309

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 223-230, 1996

Authors: Chittum, William R.

Article Type: Research Article

Abstract: Acute care providers may encounter any number of potential traps when providing treatment to individuals with acquired brain injury (ABI) who present behavioral issues. These traps, or faulty ways of viewing the patient's recovery process, may lead to mistakes that significantly impact the likelihood of successful recovery. This article, designed to increase awareness of the possible issues which acute care providers often face, will discuss four such traps, as well as illustrate a treatment approach which utilizes a non-aversive cognitive-behavioral treatment plan through the experience of one individual.

Keywords: Brain injury, Unwanted behaviors, Predictors, Self-management, Post-acute rehabilitation

DOI: 10.3233/NRE-1996-7310

Citation: NeuroRehabilitation, vol. 7, no. 3, pp. 231-237, 1996