NeuroRehabilitation - Volume 10, issue 1

Authors: Kreutzer, Jeffrey S.

Article Type: Introduction

DOI: 10.3233/NRE-1998-10101

Citation: NeuroRehabilitation, vol. 10, no. 1, pp. 1-1, 1998

Authors: Hall, Karyl M. | Wallbom, Agnes S. | Englander, Jeffrey

Article Type: Research Article

Abstract: The literature is replete with studies investigating predictors of outcomes in traumatic brain injury. Few, however, have addressed the pre morbid life events and behaviors that may significantly impact the physical, behavioral, cognitive, and/or psychosocial and vocational status of individuals after a traumatic brain injury (TBI). Findings of studies on premorbid history are reviewed and data are presented on a sample of 82 cases on which premorbid psychosocial information, severity of initial injury and outcome status were obtained. Cases were dichotomized into groups at high risk and at low risk for TBI, based on premorbid history. High risk and low …risk groups were comparable in the severity of initial injury. Outcomes were defined by the Functional Independence Measure and the Disability Rating Scale scores at 1 year after injury. No differences were found in FIMTM or DRS scores between those with and without premorbid learning disability, psychiatric history, incarcerations, arrests, academic difficulties, or substance abuse. Explanations for the lack of significant differences are discussed. Based on experience in completing this study, a screening tool incorporating documentation of a number of pre morbid factors that might impact status at outcome is presented. Show more

Keywords: Premorbid history, Traumatic brain injury, Outcome, Prediction

DOI: 10.3233/NRE-1998-10102

Citation: NeuroRehabilitation, vol. 10, no. 1, pp. 3-12, 1998

Authors: Stewart, Deborah G. | Miller, Michelle A. | Cifu, David X.

Article Type: Research Article

Abstract: Subacute rehabilitation is increasingly being used as a treatment option in the continuum of care. What constitutes subacute rehabilitation has not been uniformly defined. Therefore, considerable variability exists in subacute rehabilitation programs. This review outlines assessment and management of early recovery brain-injured individuals and offers a pragmatic schema for levels of care which are best suited to each recovery stage based on the Rancho Los Amigos cognitive scale.

Keywords: Subacute rehabilitation, Traumatic brain injury

DOI: 10.3233/NRE-1998-10103

Citation: NeuroRehabilitation, vol. 10, no. 1, pp. 13-23, 1998

Authors: Sherer, Mark | Oden, Kathryn | Bergloff, Paula | Levin, Ellen | High Jr., Walter M.

Article Type: Research Article

Abstract: Impaired self-awareness of deficits is a common finding in patients who have suffered traumatic brain injury. Impaired awareness can limit motivation for treatment and contribute to poor outcome. Consequently, it is important for brain injury rehabilitation professionals to understand this phenomenon and utilize treatment approaches that may improve patient awareness. The present article reviews the existing literature on measurement of impaired awareness, characteristics of impaired awareness, the relationship of impaired awareness to functional outcome, possible treatment approaches for impaired awareness and empirical investigations of interventions to improve awareness. The treatment strategies we use to address impaired awareness in our community …re-integration program for brain injury survivors are described in detail. These approaches include: establishment of the therapeutic alliance, family interventions, peer feedback, education, roleplaying, videotape feedback, real world experiences, therapeutic milieu and psychotherapy. Show more

Keywords: Impaired awareness, Traumatic brain injury, Rehabilitation, Treatment, Community re-integration

DOI: 10.3233/NRE-1998-10104

Citation: NeuroRehabilitation, vol. 10, no. 1, pp. 25-37, 1998

Authors: Wall, Jacqueline R. | Niemczura, John G. | Rosenthal, Mitchell

Article Type: Research Article

Abstract: Occupational entry is an important issue for persons with disabilities, as many become or remain unemployed after their injury. After traumatic brain injury (TBI), individuals exhibit high unemployment rates, especially those persons with injuries of greater severity, a limited premorbid work history and/or persons from economically disadvantaged backgrounds. Vocational rehabilitation programs have been developed to improve employability. Traditional vocational rehabilitation approaches, based on integrating work skills with cognitive rehabilitation models have proven only minimally effective with TBI. The supported employment model has been demonstrated to be much more effective with this group, as has an approach that combines vocational and …psychosocial skills training along with job support. Even with these generally successful approaches, the literature on vocational rehabilitation in clients from economically disadvantaged environments who are diagnosed with TBI is limited. An approach for the economically disadvantaged, which combines work skills training in a real work community along with supported employment is presented. Show more

Keywords: Traumatic brain injury, Vocational rehabilitation, Work adjustment training, Supported employment, Community-based training

DOI: 10.3233/NRE-1998-10105

Citation: NeuroRehabilitation, vol. 10, no. 1, pp. 39-49, 1998

Authors: Hatten, John L.

Article Type: Research Article

Abstract: Community Case Management (or Case Management Services) is defined and distinguished from insurance, hospital, non-profit and independent case management. The areas of focus of Community Case Management — disseminating information, personal adjustment counseling and acting as a personal resource — are defined and explained. A Community Case Management services program is summarized and the results of community case management are documented. Case Management with the Hispanic population is discussed. Two case studies are presented, one for a young Hispanic man and the other for a young Anglo man. Suggestions for working with a Hispanic case load are discussed.

Keywords: Traumatic brain injury, Community Case Management, Case Management, Hispanic

DOI: 10.3233/NRE-1998-10106

Citation: NeuroRehabilitation, vol. 10, no. 1, pp. 51-59, 1998

Authors: Zafonte, Ross | Black, Kertia | Mann, Nancy | Nepa, Shelley | Watanabe, Thomas

Article Type: Research Article

Abstract: Superior sagittal sinus thrombosis (SSST) is a rare complication of non-penetrating brain injuries. However, this is not an uncommon event in those patients who have suffered a gun shot wound (GSW) to the head. Disturbances in blood flow, lead to development of SST, endothelial injury and clotting abnormalities. Complications include increased weakness, mental status changes, seizures and potential mortality. The purpose of this paper is to illustrate three cases of SSST and the need to be alert for this entity. Our cases involve three young female patients each of whom suffered a GSW to the head, with resultant severe brain …injury. In each case, severe disability ensued and imaging studies revealed the presence of the superior sagittal sinus syndrome. The cases demonstrate three different presentations and time courses of this entity, along with the appropriate treatment choices. This condition may appear in the immediate post-injury period, in the post-acute rehabilitation period or even at distant follow-up; therefore, patients with TBI secondary to GSW need to be monitored for an extended time interval for clinical signs which may be indicative of SSST. Show more

Keywords: Superior sagittal sinus thrombosis, Penetrating head injury, Gun shot wound

DOI: 10.3233/NRE-1998-10107

Citation: NeuroRehabilitation, vol. 10, no. 1, pp. 61-66, 1998

Authors: Wisor, Douglas | Miller, Michelle A. | Kreutzer, Jeffrey S.

Article Type: Research Article

Abstract: This article provides both consumers and healthcare professionals who share a common interest in brain injury with a basic overview of both how to access the Internet and how to use it effectively to gather and exchange online information. Recommendations regarding computer hardware requirements, connection options and popular software programs for web browsing, sending e-mail and searching topics are addressed. Some of the more interesting brain injury-related Internet sites and newsgroups are listed. Finally, specific technologic advancements that may facilitate computer use in a disabled population are discussed.

Keywords: Brain, Injury, Online, Internet, World wide web, Newsgroups

DOI: 10.3233/NRE-1998-10108

Citation: NeuroRehabilitation, vol. 10, no. 1, pp. 67-73, 1998

Authors: Poole, Janet L.

Article Type: Research Article

Abstract: Objective: The purpose of this study was to examine and compare the performance of children with developmental dyspraxia and adults with apraxia to learn and retain two sequencing tasks. Study design: Three groups of subjects with dyspraxia and apraxia (children and young adults with both dyspraxia and learning disabilities and older adults with apraxia and left hemisphere strokes) and three groups of age-matched control subjects learned one-handed shoe tying and a hand sequence task. Retention was assessed after a 5-min delay. Performance was scored as the number of trials needed to perform each task and the types of …errors that were made. Results: For both the tasks, the control groups performed better than the groups with dyspraxia/apraxia and performance during the retention trials was better than performance during the learning trials. On the hand sequence task, the children and young adult groups performed better than the older adult groups. Conclusions: Subjects with dyspraxia and apraxia have difficulty with similar sequencing tasks. However, the poorer performance by the older adult group with apraxia suggests that the underlying mechanisms for sequencing may be different for apraxia than for dyspraxia. Show more

Keywords: Apraxia, Developmental dyspraxia, Motor learning, Stroke, Learning disabilities

DOI: 10.3233/NRE-1998-10109

Citation: NeuroRehabilitation, vol. 10, no. 1, pp. 75-82, 1998