NeuroRehabilitation - Volume 5, issue 4

Article Type: Other

DOI: 10.3233/NRE-1995-5401

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 289-289, 1995

Authors: Kreutzer, Jeffrey S.

Article Type: Introduction

DOI: 10.3233/NRE-1995-5402

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 291-291, 1995

Authors: Bogner, Jennifer | Corrigan, John D.

Article Type: Research Article

Abstract: Agitation, while considered an important factor influencing outcome following traumatic brain injury (TBI), has been a poorly defined construct. As a result, the literature on agitation has been confusing and incomplete in regard to incidence rates, causes and correlates, intervention methods, and long-term outcomes. In this article, we review previous research on incidence rates, concluding that differences in definition have greatly limited current knowledge. We then review how agitation has been operationalized in previous clinical and research efforts, and we recommend a definition that we believe will allow future studies to proceed in a more systematic manner.

Keywords: Brain injury, Agitation, Incidence, Aggression, Lability, Disinhibition

DOI: 10.3233/NRE-1995-5403

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 293-297, 1995

Authors: Sandel, M. Elizabeth | Zwil, Alexander S. | Fugate, Lisa P.

Article Type: Research Article

Abstract: The Special Interest Group on Brain Injury of the American Academy of Physical Medicine and Rehabilitation is developing a practice parameter for the agitated patient following traumatic brain injury (TBI). The eventual goal of the project is to create an interdisciplinary practice guideline for classifying and treating these patients using a common nosology, based on contributions from the literatures of neurosurgery, psychology, psychiatry and rehabilitation medicine. It is envisioned that a uniform classification system would ultimately promote interdisciplinary research and serve to advance our understanding and treatment of this patient population. In the acute post-injury period, many TBI patients can …be characterized by confusion, agitation, post-traumatic amnesia and delirium. In various acute care settings, psychiatrists, psychologists or rehabilitation medicine physicians (physiatrists) are asked to evaluate and treat this population of patients. Each of these disciplines employ specialty-based diagnostic criteria and rating instruments, with little or no consensus across disciplines concerning the appropriateness of these tools. This article reviews the classification and rating systems utilized within the fields of neurosurgery, rehabilitation medicine, psychology and psychiatry, to describe patients displaying agitated behaviors. The authors review the literature establishing the definitions, measurement and possible neuroanatomic and neurophysiologic substrate for delirium and brain-injury agitation, with its characteristic cognitive and behavioral manifestations. Pharmacologic treatment is briefly reviewed to emphasize the significantly different viewpoints from the fields of rehabilitation medicine and psychiatry. The authors explore support from the literature for an interdisciplinary definition for agitation following TBI which includes criteria for delirium, post-traumatic amnesia, and associated behavioral excesses such as disinhibition, aggression, or emotional lability. Wide acceptance of this definition by medical and research professionals may potentially lead to a greater understanding of this clinical state and its neuropathogenesis through promotion of intra- and inter-disciplinary research. Show more

Keywords: Brain injury, Head injury, Delirium, Psychomotor agitation, Psychopharmacology

DOI: 10.3233/NRE-1995-5404

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 299-308, 1995

Authors: Herstein Gervasio, Amy | Matthies, Brigitte K.

Article Type: Research Article

Abstract: This paper outlines general management strategies used to prevent and control agitation throughout the continuum of recovery from traumatic brain injury. These include environmental management, alterations in the behavior of staff and family, use of physical and chemical restraints, redirection and substitution, time out, operant procedures, self monitoring and relaxation training. The need for both flexibility in choice of strategies and consistency in application is emphasized, along with the importance of staff training and patient and family participation.

Keywords: Traumatic brain injury, Agitation, Aggression, Behavior therapy, Management

DOI: 10.3233/NRE-1995-5405

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 309-316, 1995

Authors: Deaton, Ann V. | Metzger, Stephanie | Maillet Wheeler, Amy

Article Type: Research Article

Abstract: Children and adolescents who sustain brain injuries often experience episodic agitation during the course of their recovery. In the early stages after an injury, agitation may be the direct effect of the neurological insult itself as well as the child's response to physical pain and to his or her confusing surroundings. Later during the recovery process, agitation may occur in response to increasing demands made of the child and in response to feelings of loss. Children's agitation is best managed by viewing it as a communication and attempting to provide the child with comfort, support, and alternative ways to communicate. …Health care staff and family members can remain therapeutic if they understand the underlying factors driving agitation and recognize it as a transient phase of recovery. Show more

Keywords: Agitation, Pediatric brain injury, Disinhibition, Rehabilitation, Aggression

DOI: 10.3233/NRE-1995-5406

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 317-321, 1995

Authors: Bryan, Martha R.

Article Type: Research Article

Abstract: The incidence of acquired brain injury in infants and pre-school children is increasing, creating new challenges for assessment and intervention. This paper presents a context for assessment and interventions by describing the developmental effects of traumatic brain injury in young children, from birth to the age of 5 years. A review of the literature on the developmental and learning issues of the infants, toddlers and young children who sustain traumatic brain injury is presented. Information on resources including the federally-funded, state-administered Infant and Toddler and Pre-school Programs is included, along with suggestions for interventions.

Keywords: Brain injury, Pre-school children, Developmental and learning issues

DOI: 10.3233/NRE-1995-5407

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 323-330, 1995

Authors: Lash, Marilyn | Russo, Dennis C. | Navalta, Carryl P. | Baryza, Mary Jo

Article Type: Research Article

Abstract: This paper summarizes the survey responses of 67 families with children who were hospitalized after traumatic injuries. The survey was conducted during the pre-planning phase of a major research proposal on the rehabilitation of children who had been injured. The purpose of the survey was to involve families in the identification of needs and determination of priorities for research and training in childhood injuries. The first part of the survey focused on direct services that children and their families received through medical, psychosocial, educational and vocational interventions and providers. The second part concerned the immediate and long-term effects of a …child's injury upon the family. Families were asked to indicate: (1) the direct care services they considered most important in their child's recovery; (2) areas needing more research and study; (3) training needed by professionals; and (4) information needed by families. Major findings were the importance to families of emergency room treatment and the quality of hospital care; concerns about communication between professionals and parents; the uncertainty of expectations for the future; and lack of information on community resources. Written comments emphasized the emotional impact of physical trauma upon families and the need for longitudinal research, with pediatric rehabilitation viewed as a broad spectrum of care starting with emergency room care and hospitalization and continuing through school and community programs. As a result of this survey several projects were initiated. They include: revision of head sheets distributed by emergency rooms, physician training in communication skills, preparation of families as service coordinators, and development of materials and programs specifically for families. Show more

Keywords: Families, Children, Traumatic injuries, Need for research and training

DOI: 10.3233/NRE-1995-5408

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 331-346, 1995

Authors: Söderback, Ingrid | Lilja, Margareta

Article Type: Research Article

Abstract: An ethnographic approach (Fetterman DM. Ethnography Step by Step. Applied Social Research Methods Series, Vol. 17. London, New Delhi, SAGA Publication, 1990) with thematic interviews, participatory observations, the ‘activity log’ (Yerxa EJ, Baum S. Engagement in daily occupations and life satisfaction among people with spinal cord injuries. Occup Ther J Res 1986;(6)4;318–326), and the ‘satisfaction with performance scaled questionnaire’ (Yerxa EJ, Burnett-Beaulieu SE, Stocking S, Azen SP. Development of the satisfaction with performance scaled questionnaire (SPSQ). Am J Occup Ther 1988;42:215–221) were used to investigate, in their homes, the performance of occupation/activity in 15 stroke victims dependent in activities of …daily living. The data were categorised according to Spradley (Participants Observation. USA, Holt, Rinehart and Winston, 1980). The study describes the activities performed by the individuals themselves, activities done for them, patterns of activity over time and the individuals' satisfaction with, and feelings about, each activity. Show more

Keywords: Occupation, Occupational therapy, Stroke, Ethnographic

DOI: 10.3233/NRE-1995-5409

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 347-357, 1995

Authors: Schwartz, Carolyn E. | Fierston, Stanley

Article Type: Research Article

Abstract: A significant number of people with multiple sclerosis experience pathological laughing and weeping. This article presents two perspectives on these symptoms. First, the neurological literature is reviewed. Then, the patient's perspective is described in an essay written by a man who lives with pathological laughing and weeping, and his evaluations of the apparent costs and surprising benefits of these symptoms. Finally, psychological theories are discussed which link these two perspectives.

Keywords: Pseudobulbar, Pathological laughing and weeping, Patient-centered, Multiple sclerosis, Affective disorder

DOI: 10.3233/NRE-1995-5410

Citation: NeuroRehabilitation, vol. 5, no. 4, pp. 359-365, 1995