1/41. Helping brain injured children and their families.For many brain injured children, whether the injury is congenital or the result of subsequent illness or accident, there is little to be done to put right the underlying problem. Treatment programmes, however, can encourage better motor and cognitive function and better nutrition. NHS continuing care for brain injured children is under-resourced, often amounting to only half an hour of physiotherapy fortnightly or even monthly. The British Institute for brain Injured Children (BIBIC) is a registered charity which exists to help families with a brain injured child to learn to apply simple, practical, inexpensive treatment programmes themselves, in their own homes. Initial assessments and training take place at the BIBIC Centre in Somerset. Families are asked to contribute towards costs if they are in a position to, but treatment does not depend on ability to pay. Treatment sessions often last about 30 minutes and families may be advised to carry out two or more sessions every day. telephone help and continuing support is available from BIBIC, and families are encouraged to retain contact with their GP and hospital consultants, and local services.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
2/41. Transitions to independent living after ABI.One of the most challenging questions facing service providers and policy makers alike is the appropriate level of supervision for adults living in the community following a brain injury. In a 3-year province-wide study of people entering the community following brain injury rehabilitation, four individuals (out of 22 studied) made a transition from fully supervised living to lower levels of formal supervision during their first year in the community. The present study seeks to provide more information about these four individuals, the factors that allowed them to move to lower levels of supervision, and the perceived success of that transition. For each participant, the interviews conducted over the 1 year period in the initial study were reviewed in detail for information about independent living. In addition, each participant was interviewed again for this study, along with his significant other and three of the community programme staff who were most closely involved with his transition. To summarize, factors most salient in the success of transition included: (1) Roles and relationships of family and programme personnel; (2) staying away from drugs and alcohol; (3) availability of structured daily activities, including productive activity or community programme; (4) financial management; and (5) emotion and behaviour self-control. Secondary themes related to successful community living also included the availability of transportation and prior experience with community living since the onset of brain injury. These results offer the experience of four individuals in moving towards independent living. As such, they provide a starting point for further discussions of the process of supporting individuals to pursue the ultimate goal of independent living.- - - - - - - - - - ranking = 1.5keywords = programme (Clic here for more details about this article) |
3/41. rehabilitation of a person with severe traumatic brain injury.A case study report of a long and intensive rehabilitation programme for a young woman after she sustained a severe diffuse axonal injury in a motor vehicle accident is described in detail. The purpose of this paper is to encourage specialist brain injury rehabilitation services to offer extended rehabilitation programmes to patients, even with very severe injuries. Significant functional improvements and enhanced quality of life frequently reward the high cost and hard work involved.- - - - - - - - - - ranking = 1keywords = programme (Clic here for more details about this article) |
4/41. The rehabilitation of attention in individuals with mild traumatic brain injury, using the APT-II programme.Traumatic brain injury (TBI) is a prevalent cause of cognitive impairments and dysfunctions and affects over 2 million individuals each year. Mild traumatic brain injury (MTBI) is generally defined by a brief loss of consciousness, and post-traumatic amnesia that lasts for less than 24 hours. One region of the brain that is likely affected in patients with MTBI is the pre-frontal cortex. This region mediates several functions, including those required for adequate attention. Three individuals, diagnosed with MTBI and difficulties with attention, volunteered to participate in the study. Individuals were presented with 10 weeks of cognitive retraining with the attention Process Training-II (APT-II) programme, followed by 6 or 7 weeks of educational and applicational programmes. Cognitive tests were administered both pre- and post-training to assess the effectiveness of the programme. Analysis of the results showed that the APT-II programme improved attention and performance speed in each of the three individuals. In addition, any rehabilitated cognitive skills remained stable in each individual in the absence of the rehabilitation programme for at least 6 weeks.- - - - - - - - - - ranking = 4.5keywords = programme (Clic here for more details about this article) |
5/41. Combined motor disturbances following severe traumatic brain injury: an integrative long-term treatment approach.patients surviving severe traumatic brain injury (TBI) often suffer from residual impairments in motor control, communication skills, cognition and social behaviour. These distinctly hamper their capability to return to their 'pre-trauma' activity. Comprehensive and integrated rehabilitation programmes initiate, during the acute phase, a prolonged treatment process which starts at the most sophisticated medical systems. There is no clear end point for the treatment of these patients, since the recovery process and the rehabilitation activity may continue for years, even after patients return home to live with their families. The inherent inability to make a firm early prediction regarding outcome of patients and the late appearance of additional symptoms stress the need for a comprehensive close long-term follow-up. The following presentation concerns the description of the treatment strategy and long-term improvement of a 22-year-old male who suffered from very severe TBI. On admission to the emergency room, he was in the decerebrated position and his glasgow coma scale (GCS) was at the lowest (3). The focus of this presentation is on the recovery of motor function. The initial motor disabilities included weakness in all four limbs, in particular left hemiplegia, and right hemiparesis with severe bilateral ataxic elements and a marked tremor of the right arm. Range of motion was limited in hips, and he suffered from stiff trunk and neck. goals of physiotherapy were directed towards improving range of motion (ROM) and active movement. Casting, use of orthoses, biofeedback, hydrotherapy, hippotherapy, medication and nerve blocks for reducing spasticity were timely applied during the process. The motor improvement in this very severe TBI patient who is now over 3 years post-injury still continues and has a functional meaning. He has succeeded in being able to stand up by himself from a chair and is able to walk unaided and without orthoses for very short distances--up to five steps. He is able to drink soup without assistance and play a few notes on the piano. Marked cognitive improvement occurred as well. It is concluded that motor improvement may be evident over long periods of time and various timely interventions may assist in the process.- - - - - - - - - - ranking = 0.5keywords = programme (Clic here for more details about this article) |
6/41. Reduction of chronic aggressive behaviour 10 years after brain injury.This study demonstrates the successful management of aggressive behaviour with a client 10 years post-injury in a small, residential neurorehabilitation unit. The case presented is unusual for two main reasons. First, it proved possible to significantly modify previously chronic challenging behaviour many years after brain injury had been sustained. Secondly, the rehabilitation environment in which treatment was conducted did not comprise a highly specialized neurobehavioural service, Instead, staff were specifically trained regarding the administration of the treatment programme, which was based on principles derived from behaviour modification and applied neuropsychology. Specific interventions used included those of differential reinforcement and graduated increase of expectations. Recordings made over the course of 85 weeks demonstrate a significant decrease in the frequency and severity of aggression. Successful inhibition of challenging behaviour attained a level which facilitated transfer of the client to a non-institutionalized community home. Reasons underlying the success of the intervention, and the limitations inherent in attempting to manage aggression within neurorehabilitation environments will be discussed.- - - - - - - - - - ranking = 0.5keywords = programme (Clic here for more details about this article) |
7/41. Self-regulatory learning and generalization for people with brain injury.PRIMARY OBJECTIVE: brain injury can result in the loss of previous learnt behaviours that affect an individual's daily functioning. The use of self-regulation helps the individual to relearn the lost behaviours by bringing him/her to self-conscious level through independent and reflective learning derived using a social cognitive perspective. The purpose of this paper is to report on clinical observations made with the use of self-regulation in people with brain injury during the relearning of lost functions. methods AND PROCEDURES: daily tasks were used to assess the relearning ability of the subjects pre- and post-programme. Experimental intervention: one-week self-regulatory training on five selected daily tasks. MAIN OUTCOMES and RESULTS: these provisory observations would suggest that, with specific guidance for people with different needs, such as with impaired cognitive function and depression, self-regulation is effective in enhancing their relearning. CONCLUSION: Self-regulatory training is effective in enhancing the relearning of lost functions.- - - - - - - - - - ranking = 0.5keywords = programme (Clic here for more details about this article) |
8/41. The family systems approach to treating families of persons with brain injury: a potential collaboration between family therapist and brain injury professional.Although brain injury may have a great impact on the family as a whole, family reactions are not adequately addressed in rehabilitative programmes. When they are, treatment tends to be approached from a family education and support perspective and not from a family therapy perspective. The aim of the following paper is to illustrate the important role that a family systems approach can play in treating families of individuals with brain injury. In particular, clinical examples taken from the literature will be presented that illustrate how family roles can be modified as a consequence of a brain injury, and the importance of re-establishing or re-distributing these roles. It will be argued that an intimate collaboration between family therapist and brain injury professional is essential, and that the ideal professional make-up of clinicians working with families of persons with brain injury are those well-versed in both brain injury rehabilitation and family therapy.- - - - - - - - - - ranking = 0.5keywords = programme (Clic here for more details about this article) |
9/41. Treatment of oro-facial hypersensitivity following brain injury.A 56 year old man who was 10 months post-severe traumatic brain injury was unable to tolerate oral hygiene. He had oro-facial hypersensitivity, oral dyspraxia and limited oral function. Poor oral hygiene with coating of oral structures and infection was present. An intensive systematic desensitization programme over 2 weeks, even at this late stage post-injury, increased oral tolerance and allowed full oral hygiene. Participation in oral hygiene and functional patterns of movement also improved, enabling some oral nutritional intake. This case study provides controlled evidence, very little of which exists in the literature, to demonstrate the effectiveness of these treatment techniques- - - - - - - - - - ranking = 0.5keywords = programme (Clic here for more details about this article) |
10/41. Treatment of premature ejaculation after traumatic brain injury.premature ejaculation (PE) is the most common male sexual disturbance occurring in the general community. Surveys of sexual dysfunction after traumatic brain injury (TBI) have identified that between 17-36% of males report a number of different post-injury ejaculatory problems, including PE. Whilst there are a number of studies that document effective treatment of PE in the general population, there have been no reports of treatment interventions for this problem amongst males with TBI. This paper reports on the assessment and successful treatment of PE in a young male with severe TBI. The treatment programme trialed combined pharmacotherapy (namely, the application of a topical anaesthetic), behavioural and educational approaches. The case report suggests that existing sex therapy techniques, albeit with modifications to compensate for motor sensory, cognitive and affect related injury sequelae, provide one option for the treatment of PE after TBI.- - - - - - - - - - ranking = 0.5keywords = programme (Clic here for more details about this article) |
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