| OBJECTIVE AND IMPORTANCE: We report the case of a 73-year-old patient who presented a right motor deficit caused by an ipsilateral acute subdural hematoma. A magnetic resonance imaging (MRI) demonstration of Kernohan-Woltman notch phenomenon was obtained. CLINICAL PRESENTATION: The woman sustained a major head injury at home, followed by loss of consciousness. On admission to the emergency room, she was comatose, anisochoric (left > right), and showed a reaction to pain with decerebrating movements of left limbs (glasgow coma scale (GCS) 4/15). A right severe hemiparesis was observed. Cerebral computed tomography scan showed a large right hemispheric subdural hematoma. INTERVENTION AND POST-OPERATIVE COURSE: A wide right craniotomy was performed and the subdural hematoma evacuated. During the post-operative period, the level of consciousness gradually improved. A MRI performed about 2 weeks after operation showed a small area of abnormal signal intensity in the left cerebral peduncle. On discharge, the woman was able to communicate with others, but her right hemiparesis was still severe. ( info) |
2/29. panic disorder in a patient with traumatic brain injury: a case report and discussion. Individuals that may be especially susceptible to panic attacks in the rehabilitation setting are patients who have suffered traumatic brain injuries, post-concussion syndrome, lesions, or encephalopathy. An individual is described who suffered a traumatic brain injury and was determined to have suffered a panic attack during his rehabilitation stay. The manifestations of panic attacks are described, using the case report as an example. The psychological aetiology of panic disorders is also reviewed, and treatment options using four major classes of neuropharmacologic agents: benzodiazepines, tricyclic antidepressants, monoamide oxidase inhibitors, and serotonin reuptake inhibitors, are discussed. Given the increasing incidence and survival of patients with traumatic brain injuries, the complications of panic attacks and disorders will become more important; they are a serious condition that can affect an individual's lifestyle, employment, and relationships, and increase the risk of suicide. rehabilitation specialists should be aware of the manifestations and management of panic attacks and come to appreciate that recognition of this treatable condition is important during all stages of rehabilitation. ( info) |
3/29. Treatment with amantadine potentiated motor learning in a patient with traumatic brain injury of 15 years' duration. This study sought to determine whether pharmacotherapy with amantadine potentiates motor recovery in an 18-year-old man with traumatic brain injury (TBI) of 15 years' duration. This uncontrolled single-case multiple-baseline design allowed preliminary evaluation of amantadine within the context of standard data-collection procedures on the TBI unit. Measurements tracked speed of wheelchair propulsion, wheelchair transfer, donning shirt, and inserting pegs into holes. Data were collected during a 3-week practice period, followed by a 6-week period of practice plus daily treatment with amantadine. The rate at which performance improved was significantly increased with drug treatment in the wheelchair transfer task. There was a statistically insignificant trend toward improvement in donning shirt. amantadine did not appear to potentiate recovery in the wheelchair propulsion or peg placement tasks. The results suggest that amantadine facilitates some measures of motor recovery in chronic brain injury. Further trials are warranted to investigate this issue. ( info) |
4/29. A treatment selection model for weight reduction in adults with acquired brain injury: applications and preliminary findings. This article presents a unique method for providing weight management assistance to persons who have experienced an acquired brain injury (ABI). Most of the available literature on this topic deals with weight loss methods for individuals who are not faced with the cognitive and behavioural challenges inherent in this population. A treatment selection protocol will be described that allows for appropriate selection of behavioural weight loss interventions. Interventions are based upon specific cognitive and behavioural difficulties that individuals with acquired brain injury may present. A detailed case study will also be presented depicting successful use of the treatment selection model with an adult male with an acquired brain injury. ( info) |
5/29. Global aphasia: an innovative assessment approach. OBJECTIVE: To provide an alternative language comprehension assessment strategy for patients unable to be tested with traditional verbally/behaviorally based methods. DESIGN: Event-related brain potentials were recorded from three midline scalp locations to visually and aurally computer-presented sentences, 50% of which were semantically appropriate and 50% semantically incongruous. SETTING: A rehabilitation hospital. PATIENT: A 21-year-old man with a traumatic brain injury. RESULTS: The patient exhibited brain response patterns to aurally presented congruous and incongruous sentences indicative of intact semantic processing capabilities. These findings resulted in reinstatement of individualized rehabilitative intervention, with a successful outcome. CONCLUSIONS: This innovative technique provides new opportunities for assessing intellectual function in noncommunicative patients who were patients previously unable to be tested. ( info) |
6/29. Assessment of minimally responsive patients: clinical difficulties of single-case design. Improved management of very severely central nervous system (CNS) injured individuals has given rise to an increasing number of patients in a minimally responsive state. There is a growing literature stressing the importance of accurately determining these patients' level of cognitive functioning and its role in appropriate rehabilitation and long term management. The single case design model appears to be the intervention of choice, with its great flexibility and tailored approach to each individual case. The recent literature has focused on the technical aspects of the assessment, offering clear procedural guidelines. Unfortunately, there is a dearth of information about clinical factors such as clinical setting and family involvement, which may interfere with or prevent a planned intervention. The case of MT is presented, who was the subject of a single case intervention 9 months following an extremely severe traumatic brain injury. The planned intervention was to examine the effects of a psychostimulant on MT's level of arousal, in order to improve his participation in the rehabilitation programme. Beyond the results (which were equivocal), the clinical difficulties in conducting single case study designs in rehabilitation are discussed. Ways to minimize these difficulties are proposed. ( info) |
7/29. Differential reinforcement of other behavior (DRO) to reduce aggressive behavior following traumatic brain injury. Severe brain injury can result in significant neurobehavioral and social functioning impairment. In rehabilitation settings, behavioral problems of aggression and nonadherence to therapeutic activities can pose barriers to maximal recovery of function. Behavioral interventions seem to be effective in reducing problem behavior among individuals recovering from severe brain trauma, but well-controlled studies examining the efficacy of such interventions are sparse. This article presents a single-case, multiple-baseline study of a differential reinforcement of other behavior (DRO) procedure in a 28-year-old, brain-injured male with aggressive behavior problems. The procedure successfully reduced the frequency of problem behavior by up to 74%, maintained at 1-month follow-up. Implications of this intervention for individuals with brain injury are discussed, and testing of this procedure using a between-group design seems indicated. ( info) |
8/29. Challenging a flexible neuropsychological battery under Kelly/Frye: a case study. The ability of the flexible neuropsychological battery approach to withstand a challenge under california's evidentiary standard, Kelly/Frye, was tested in an actual trial. Despite repeating many criticisms offered by the literature (e.g., no malingering measures, unknown accuracy rates, ignoring statistical limitations, not using age norms), the battery was allowed in "for the weight of the evidence," rather than being excluded as unreliable. ( info) |
9/29. Classical anomia: a neuropsychological perspective on speech production. We present data collected from two anomic aphasics. Thorough assessment of comprehension, oral reading and repetition revealed no underlying impairments suggesting that both patients were examples of classical anomia--word-finding difficulties without impaired semantics or phonology. We describe a series of experiments in which the degree of anomia was both increased and decreased, by cueing or priming with either a semantically related word or the target item. One of the patients also presented with an 'acquired' tip-of-the-tongue phenomenon. He was able to indicate with a high-degree of accuracy the syllable length of the target, and whether or not it was a compound word. Neither patient could provide the first sound/letter. The data are discussed in terms of discrete two-stage models of speech production, an interactive-activation theory and a distributed model in which the positive and negative computational consequences of the arbitrary relationship between sound and meaning are emphasised. ( info) |
10/29. Electronic memory aids for outpatient brain injury: follow-up findings. The introduction of highly portable computers extends the range of tools potentially useful to persons with functional impairments of prospective memory resulting from brain injury. This study reviews the experience of 12 patients with brain injury undergoing outpatient treatment using palmtop computers to assist with memory dependent activities in their everyday lives. During the initial supervised trial period, each was provided a palmtop computer based memory aid capable of generating audible and visible reminder cues. Subsequently, patients were contacted for follow-up between 2 months and 4 years after initial trial usage, and surveyed as to the utility of the computer. Nine patients found palmtop computers were useful during supervised trials. Seven of nine patients actually continued to use such devices after the usage trials had ended. Experience with this technology has shown it to be useful in a high proportion of patients for assisting with memory dependent functions. ( info) |