Cases reported "Brain Injuries"

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1/35. Carotid artery-sygmoid sinus fistula: a rare complication of gunshot wound on the base of the cranium.

    Vascular lesions without clinical manifestation may occur in cranial-facial wounds produced by bullets that course the base of the cranium. This work describes a rare kind of vascular complication in cranial-facial gunshot wound. The authors present the case of a patient, the victim of a cranium-maxillary gunshot wound. Carotid angiography revealed a carotid-sygmoid sinus fistula that filled the sygmoid and transverse sinuses, concomitant to the arterial angiographic phase. A direct communication between the external carotid artery and the sygmoid sinus was disclosed. We are not aware of any other description of this vascular complication in cranial gunshot wound. It is important to recognize this kind of complication in cases of cranial-facial gunshot wound, because new factors harmful to the brain perfusion systems are introduced, in addition to the alterations to venous return and intracranial pressure, caused by the primary trauma. The new non-invasive vascular diagnostic methods are proving useful in filling the gap left by arteriography, which is no longer used in these cases.
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keywords = communication
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2/35. Paid attendant carers hold important and unexpected roles which contribute to the lives of people with brain injury.

    OBJECTIVE: Paid attendant carers spend many hours assisting people with a brain injury. Despite this considerable responsibility, most carers receive little support or training and their roles are often ill-defined. This exploratory study set out to define the key roles of paid carers. METHOD: Ten semi-structured interviews were conducted. Perspectives were sought from 10 participants: five people with a traumatic brain injury and five paid carers. A computer software package, NUD*IST was used during analysis to help identifvy and categorize commonly recurring themes. RESULTS: Five major roles were identified: Attendant, Protector, Friend, Coach and Negotiator. Friendship was the most important aspect of the care relationship for three of the people with a brain injury, most of whom had lost their pre-injury friends and associates. Carers were required to negotiate frequently with clients and their families, and with other service providers. sound communication skills were required. CONCLUSION: In addition to further research, industry guidelines are required which take account of the wider suite of roles fulfilled by paid carers, address training and support needs, and occupational health and safety issues.
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keywords = communication
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3/35. speech recognition training for enhancing written language generation by a traumatic brain injury survivor.

    Impairments in motor functioning, language processing, and cognitive status may impact the written language performance of traumatic brain injury (TBI) survivors. One strategy to minimize the impact of these impairments is to use a speech recognition system. The purpose of this study was to explore the effect of mild dysarthria and mild cognitive-communication deficits secondary to TBI on a 19-year-old survivor's mastery and use of such a system-specifically, Dragon Naturally Speaking. Data included the % of the participant's words accurately perceived by the system over time, the participant's accuracy over time in using commands for navigation and error correction, and quantitative and qualitative changes in the participant's written texts generated with and without the use of the speech recognition system. Results showed that Dragon NaturallySpeaking was approximately 80% accurate in perceiving words spoken by the participant, and the participant quickly and easily mastered all navigation and error correction commands presented. Quantitatively, the participant produced a greater amount of text using traditional word processing and a standard keyboard than using the speech recognition system. Minimal qualitative differences appeared between writing samples. Discussion of factors that may have contributed to the obtained results and that may affect the generalization of the findings to other TBI survivors is provided.
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keywords = communication
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4/35. 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.
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keywords = communication
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5/35. Increasing functional communication through relaxation training and neuromuscular feedback.

    The following research examined the effects of behavioural relaxation training and biofeedback on ataxic tremor of an adult with acquired brain injury. The participant was taught relaxation techniques before biofeedback was introduced. Once he was proficient in relaxation, these skills were then used as a foundation for biofeedback training. Specific skills, facilitating the use of a letter board, were taught when the participant was able to relax the appropriate musculature to criterion. The results demonstrated that the participant learned how to significantly decrease the severity of tremor. As a result, he became more proficient at communicating via his letter board. Collateral effects were increased attempts at communication and fewer episodes of anger.
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keywords = communication
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6/35. Compensating for executive function impairments after TBI: a single case study of functional intervention.

    The purpose of this study was to demonstrate the effectiveness of compensatory strategies for impairments in executive function. The strategies were designed to enable a client with traumatic brain injury (TBI) to obtain professional employment. In a series of individual speech-language therapy sessions, compensatory strategies were developed, refined, and trained in mock-interview situations. Significant improvements were noted in report-writing accuracy and self-reported stress during report-writing. The client was able to obtain and maintain competitive employment in his chosen profession. The results support the use of strategies aimed at supporting executive function to improve performance on verbal tasks, and were informative regarding the effects of self-perceived efficacy and stress on performance after TBI. They illustrate that intervention based on real-life supports may be effective even many years post-TBI. learning OUTCOMES: At the conclusion of this article, readers will: (1) identify aspects of executive function that relate to communication in the workplace, (2) describe the steps in considering intervention within a single subject research design framework, and (3) consider the effects of stress and perceived self-efficacy on performance of communication tasks.
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keywords = communication
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7/35. Temporary and permanent signs of interhemispheric disconnection after traumatic brain injury.

    The corpus callosum is frequently damaged by closed head traumas, and the resulting deficits of interhemispheric communication may vary according to the specific position of the lesion within the corpus callosum. This paper describes a single case who suffered a severe traumatic brain injury resulting in a lesion of the posterior body of the corpus callosum. Among the classical symptoms of interhemispheric disconnection, left hand anomia, left upper limb ideomotor dyspraxia, left visual field dyslexia and dysnomia, and left ear suppression in a dichotic listening task were observed shortly after the injury but recovered completely or almost completely with the passage of time. The only symptom of interhemispheric disconnection which was found to persist more than 4 years after the injury was an abnormal prolongation of the crossed-uncrossed difference in a simple visuomotor reaction time task. This prolongation was comparable with that observed in subjects with complete callosal lesions or agenesis. The results suggest that the posterior body of the corpus callosum may be an obligatory interhemispheric communication channel for mediating fast visuo-motor responses. The transient nature of other symptoms of interhemispheric disconnection suggests a relatively wide dispersion of fibers with different functions through the callosal body, such that parts of them can survive a restricted lesion and allow functional recovery of hemispheric interactions. An assessment of the evolution in time of symptoms of interhemispheric disconnection following restricted callosal lesions may reveal fine and coarse features of the anatomo-functional topography of the corpus callosum.
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ranking = 2
keywords = communication
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8/35. The use of a World Wide Web-based consultation site to provide support to telephone staff in a traumatic brain injury demonstration project.

    OBJECTIVES: Distance from expertise in traumatic brain injury (TBI) is often an impediment to appropriate TBI care from local health care providers, especially in rural areas. To overcome this barrier to care and to support a randomized, controlled trial of telephone follow-up after discharge from acute rehabilitation, we demonstrated the use of a confidential consultation Web site to provide expert recommendations and advice to front-line telephone staff at a different site. CONCLUSIONS: This use of internet communication proved convenient to all users, improved client confidence, and served as an excellent training tool to less experienced staff. In addition, use of a Web-based consultation method provided for archiving of all discussions for later review.
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ranking = 1
keywords = communication
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9/35. Brainstem auditory-evoked potentials as an objective tool for evaluating hearing dysfunction in traumatic brain injury.

    Because of the violent nature of traumatic brain injury, traumatic brain injury patients are susceptible to various types of trauma involving the auditory system. We report a case of a 55-yr-old man who presented with communication problems after traumatic brain injury. Initial results from behavioral audiometry and Weber/Rinne tests were not reliable because of poor cooperation. He was transferred to our service for inpatient rehabilitation, where review of the initial head computed tomographic scan showed only left temporal bone fracture. Brainstem auditory-evoked potential was then performed to evaluate his hearing function. The results showed bilateral absence of auditory-evoked responses, which strongly suggested bilateral deafness. This finding led to a follow-up computed tomographic scan, with focus on bilateral temporal bones. A subtle transverse fracture of the right temporal bone was then detected, in addition to the left temporal bone fracture previously identified. Like children with hearing impairment, traumatic brain injury patients may not be able to verbalize their auditory deficits in a timely manner. If hearing loss is suspected in a patient who is unable to participate in traditional behavioral audiometric testing, brainstem auditory-evoked potential may be an option for evaluating hearing dysfunction.
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keywords = communication
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10/35. Further recovery in a potential treatment withdrawal case 10 years after brain injury.

    A young woman was rendered tetraplegic and anarthric as a result of a traumatic brain injury in 1993. Two years later, she was considered to be in a minimally conscious state and became the subject of legal debate in the UK with regard to withdrawal of artificial feeding and hydration. Before injury, she made a verbal advanced directive that she would not wish to continue living if ever becoming severely disabled. Neuropsychological assessment found statistically significant evidence for sentience and expression of a wish to live and the application to Court was withdrawn. Further meaningful recovery occurred between 7-10 years after injury. She now lives in the community with 24 hour care. She speaks, initiates conversation and actions, expresses clear and consistent preferences and has a spontaneous sense of humour. She uses an electric wheelchair, eats solid food and drinks through a straw. Her mood is variable and sometimes low. This case demonstrates the need for careful consideration of advanced directives and for specialist neuropsychological assessment in people with severe cognitive and communication difficulties. It supports the view that routine assessment and follow-up of people thought to be in minimally conscious states is important. In addition, it shows that recovery with reduction in disability and significant implications for quality of life can continue for at least 10 years after extremely severe traumatic brain injury.
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keywords = communication
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