1/10. rehabilitation outcome in a patient awakened from prolonged coma.BACKGROUND: This article describes the rehabilitation of a patient recovering from a prolonged coma (defined as lasting longer than 4 weeks). The case is noteworthy because it exemplifies the possibilities and difficulties entailed in treating these patients, who are often regarded as too severely impaired to justify intensive rehabilitation efforts. CASE REPORT: The patient is a 28-year old Polish male, unmarried, who suffered serious closed head injuries in an automobile accident in April of 1999. He was in a comatose state for more than two months, with a GCS score of 5. When admitted for rehabilitation he was bedridden, with global aphasia, agraphia, limb apraxia, and executive dysfunction. The rehabilitation program developed for him is described in detail. RESULTS: Over the course of rehabilitation, which began in December 1999 and continues to this writing, the patient has regained locomotion capabilities (though with impairments), and his speech has improved considerably. The apraxia has largely resolved, and he is able to write his name and copy words. He is now capable of performing many activities of daily living. CONCLUSIONS: A comprehensive program of rehabilitation characterized by a strategic, heuristic approach is capable of achieving a good outcome even in very difficult cases, such as prolonged coma.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
2/10. Phantom smelling.A case of phantom smelling (phantosmia) is described in a 28-yr.-old man who developed permanent bilateral anosmia after a serious injury to olfaction-related brain structures at the age of 25 years. The findings indicate that, even years after loss of input from olfactory receptors, the neural representation of olfactory perception can still recreate olfactory sensations without any conscious recall of them. This indicates that the neural representation of olfactory sensations remains functional and implies that neuronal activity in the olfactory organ or in other brain structures gives rise to olfactory experiences perceived as originating from the perception of original odor substances. The report suggests the intriguing possibility that the olfactory perception is not a passive process that merely reflects its normal input from the olfactory system but is continuously generated by a neural representation in the olfactory organ or in other olfaction-related brain structures, based on both genetic and sensory determinants. To the author's knowledge this is the first reported case of its kind.- - - - - - - - - - ranking = 7.5662077904993keywords = perception (Clic here for more details about this article) |
3/10. The postconcussion syndrome and the sequelae of mild head injury.The postconcussion syndrome refers to a large number of symptoms and signs that may occur alone or in combination following usually mild head injury. The most common complaints are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity. Mild head injury is a major public health concern because the annual incidence is about 150 per 100,000 population, accounting for 75% or more of all head injuries. The postconcussion syndrome has been recognized for at least the last few hundred years and has been the subject of intense controversy for more than 100 years. The Hollywood head injury myth has been an important contributor to persisting skepticism and might be countered by educational efforts and counter-examples from boxing. The organicity of the postconcussion syndrome has now become well documented. Abnormalities following mild head injury have been reported in neuropathologic, neurophysiologic, neuroimaging, and neuropsychologic studies. There are multiple sequelae of mild head injury, including headaches of multiple types, cranial nerve symptoms and signs, psychologic and somatic complaints, and cognitive impairment. Rare sequelae include hematomas, seizures, transient global amnesia, tremor, and dystonia. neuroimaging and physiologic and psychologic testing should be used judiciously based on the problems of the particular patient rather than in a cookbook fashion. Prognostic studies clearly substantiate the existence of a postconcussion syndrome. Manifestations of the postconcussion syndrome are common, with resolution in most patients by 3 to 6 months after the injury. Persistent symptoms and cognitive deficits are present in a distinct minority of patients for additional months or years. risk factors for persisting sequelae include age over 40 years; lower educational, intellectual, and socioeconomic level; female gender; alcohol abuse; prior head injury; and multiple trauma. Although a small minority are malingerers, frauds, or have compensation neurosis, most patients have genuine complaints. Contrary to a popular perception, most patients with litigation or compensation claims are not cured by a verdict. Treatment is individualized depending on the specific complaints of the patient. Although a variety of medication and psychologic treatments are currently available, ongoing basic and clinical research of all aspects of mild head injury are crucial to provide more efficacious treatment in the future.- - - - - - - - - - ranking = 2.5220692634998keywords = perception (Clic here for more details about this article) |
4/10. Long-term amnesia: a review and detailed illustrative case study.Long-term amnesia is a slowly developing form of anterograde amnesia accompanied by retrograde amnesia of variable severity (Kapur, 1996; 1997) often associated with damage to the anterior temporal neocortex and epileptic seizures. The precise neural and functional deficits that underlie this condition are unknown. A patient, JL, who has this condition following a closed-head injury, is described in detail. Her injury caused bilateral anterior temporal neocortex damage that was more extensive on the left and right-sided damage to the perirhinal and orbitofrontal cortices. The hippocampus appeared to be intact bilaterally. epilepsy developed within two years of JL's injury. Apart from her memory impairments, JL's cognitive functions, including high-level visual perception, attention, semantic memory and executive functions were well preserved. Her memory also seemed well preserved for at least 30 minutes following encoding. The one exception was the patient's relatively greater impairment at difficult visual recognition tests for which verbalization may not have been an effective strategy. This problem may have been caused by JL's right-sided perirhinal and orbitofrontal cortex damage. Her recall and recognition was clearly impaired after a three-week delay. She also showed a retrograde amnesia, which appeared to be milder than her remote post-morbid memory deficit. JL's remote memory was preserved for information first encountered in either the pre- or post-morbid period provided the information had received sufficient rehearsal over long periods of time. Her long-term amnesia may have been caused by anterior temporal neocortex damage, possibly in association with her epileptic seizures. Whether the condition is heterogeneous, involves a deficit in slow consolidation, disruption of unconsolidated memories, or blockage of maintenance or disruption of insufficiently rehearsed memories whether or not these have been slowly consolidated is discussed.- - - - - - - - - - ranking = 2.5220692634998keywords = perception (Clic here for more details about this article) |
5/10. Clinical application of the multifocal visual evoked potential.BACKGROUND: Measures of visual function thresholds such as visual acuity and visual fields are generally dependent on subjective responses and assume maintenance of fixation, attention and motivation. In the young, elderly, cognitively impaired or malingering populations, such measures may be inaccurate or difficult to obtain. The Visual Evoked Response Imaging System (VERIS) has been claimed to give more objective topographic recordings of retinal and cortical function. This paper aims to explore the adequacy of this technique in four unusual, unrelated, clinically difficult cases. methods: Multifocal visual evoked potentials (mfVEPs) recorded on the VERIS System 3.01 are used to assess visual function in four cases with contradictory clinical findings or unreliable subjective responses. RESULTS: Patient 1 had sustained a head injury and had normal ocular and pupil examination but light perception in the right eye and 6/5 acuity in the left. Multifocal VEPs showed a marked depression of the right visual field with little macular response. Patient 2 had sustained a head injury, had a left field hemianopia, possible macular sparing and loss of much of the right field, reduced but variable visual acuities, good near vision and normal ocular fundi. Multifocal VEPs showed a severe depression in both visual fields (L more than R) with little macular response. Patient 3 had a left optic nerve meningioma and experienced great difficulty with visual field assessment. mfVEPs showed a bilateral depression in the superior field particularly the left field, with a larger deficit in the left eye. Patient 4 had unexplained visual acuity and peripheral field deficits. mfVEP results were inconclusive in this case. DISCUSSION: Where there is difficulty performing traditional techniques or conflicting clinical findings, mfVEPs may provide additional objective information to aid in the assessment of patients.- - - - - - - - - - ranking = 2.5220692634998keywords = perception (Clic here for more details about this article) |
6/10. Restoration of intelligible speech 13 years post-head injury.This case study demonstrates the efficacy of treatment of a patient with severe dysarthria long after the accepted period of 'neurological recovery'. A physiological approach to treatment was utilized and resulted in a change from non-verbal communication to functional verbal communication.- - - - - - - - - - ranking = 4keywords = speech (Clic here for more details about this article) |
7/10. Whatever happened after the 'return from silence'?A case is presented of a child who, following unexpected rapid recovery of functional communication skills 9 months post-severe closed head injury, continued to progress in speech and language skills even 4 years post-injury. Although the child did not recover to premorbid levels of functioning, her recovery over such a protracted period proved quite remarkable. The case is considered in the light of recent findings on the recovery of linguistic skills subsequent to childhood closed head injury.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
8/10. The challenge of unintelligible speech following traumatic brain injury.Management of unintelligible speech following traumatic brain injury is complex. In addition to multiple physiological system deficits, individuals typically present with complicating non-speech factors that impede their progress. The present case study illustrates the influence on outcome of impaired speech physiology, reduced cognitive abilities, pre-morbid personality characteristics, and psychosocial variables such as post-injury psychosis. Highlighted intervention strategies include optimizing the physiological system with a palatal lift prosthesis, reducing speaking rate by pacing, phonetically transcribing words to minimize apraxia of speech, adapting stimuli to optimize auditory comprehension, and providing therapy within functional contexts.- - - - - - - - - - ranking = 8keywords = speech (Clic here for more details about this article) |
9/10. Variability in the perceptual and physiological features of dysarthria following severe closed head injury: an examination of five cases.The perceptual and physiological features of the dysarthric speech of five severely closed-head-injured (CHI) subjects were examined in a case-by-case analysis. The five male CHI subjects included in the study were selected to reflect the range of severity and types of dysarthria evident in the CHI population. The perceptual profiles of each subject consisted of the findings of a perceptual speech analysis, the Frenchay dysarthria Assessment (FDA) and the Assessment of the Intelligibility of Dysarthric Speakers (ASSIDS). The subjects' physiological profiles included the results of instrumental assessments of the respiratory, laryngeal, velopharyngeal and articulatory subsystems of the speech-production mechanism. The case studies highlighted the variability among the individual subjects with respect to the location, physiological nature, and severity of impairment in their speech-production mechanisms. In addition, the interdependence of the various speech subsystems in determining speech outcome, the presence of differential subsystem impairment in dysarthria following CHI, and the varied therapeutic requirements of the individual subjects were identified. Clinically, the case studies highlighted the importance of developing individual treatment programmes based on comprehensive perceptual and physiological evaluations of the speech mechanism in each CHI subject with dysarthric speech.- - - - - - - - - - ranking = 8keywords = speech (Clic here for more details about this article) |
10/10. Age and recovery from brain injury: clinical opinions and experimental evidence.For many years the notion that brain damage causes less impairment in children than in adults (sometimes known as the 'Kennard Principle') has enjoyed widespread support among scientists and clinicians. More recently neuroscientists have questioned the Principle, most now taking an opposing view that damage to the rapidly developing brain can be more harmful than equivalent damage in adulthood. Many clinicians, however, appear reluctant to reject the Kennard Principle. This study investigates the extent to which the Kennard Principle still guides the judgement of different groups of health-care professionals (neurosurgeons, neurologists, neuropsychologists, general practitioners, nurses, physiotherapists, occupational therapists, and speech therapists). Subjects were asked to estimate the extent of recovery in clinically based but fictitious case studies which differed only in the reported age of the patient. The professions differed in their levels of optimism regarding the extent of recovery to be expected, but all predicted better recovery in younger patients (under 10) than in adults with otherwise similar brain injuries. The results are discussed in terms of their implications for the treatment of brain injuries in the young.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
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