NeuroRehabilitation - Volume 6, issue 1

Authors: Zasler, Nathan D.

Article Type: Introduction

DOI: 10.3233/NRE-1996-6101

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 1-2, 1996

Authors: Zasler, Nathan D.

Article Type: Research Article

Abstract: In the past few years, there has been a burgeoning of interest in reassessing the appropriateness and applicability of historically well entrenched nomenclature germane to persons in low level neurological states following brain injury. Surprisingly, the effort to develop a cross-disciplinary uniform set of clinical definitions for low level states has only been a very recent endeavor within the neuroscience community. The intent of this review is to provide clinicians with a better understanding of some of the history and ongoing issues pertinent to appropriate diagnostic labeling and the ultimate rationale of a uniform terminology for this special population of …neurologic patients. Show more

Keywords: Nomenclature, Coma, Vegetative state

DOI: 10.3233/NRE-1996-6102

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 3-8, 1996

Authors: Sandel, M. Elizabeth

Article Type: Research Article

Abstract: This review outlines the range of medical problems occurring in brain injured patients in coma or emerging from coma, including the population of vegetative and minimally responsive patients. This range of medical problems includes those associated with the original brain injury or associated injuries, those representing complications of bedrest, and those caused by the use of medications that may retard recovery or contribute to an obtunded or comatose state. The review is organized by organ systems, each section including a brief discussion with reference to more indepth discussions in other sources. A number of algorithms are included to define approaches …to evaluation of common clinical presentations which may be helpful to clinicians treating this population in acute or subacute settings. Show more

Keywords: Brain injury, Medical complications, Coma, Vegetative state

DOI: 10.3233/NRE-1996-6103

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 9-17, 1996

Authors: Zafonte, Ross D. | Hammond, Flora M. | Peterson, Jill

Article Type: Research Article

Abstract: Prognostication of recovery in the slow to respond patient is difficult at best. Acute and subacute parameters have been employed to predict mortality. Variables have been identified that assist in prognostication of mortality and broadly categorized functional outcome. However, few studies have looked at specific functional outcome parameters. This review will attempt to describe and discuss the acute and subacute parameters most pertinent to the slow to respond patient.

Keywords: Traumatic brain injury, Outcome, Prognostication, Function, Disability

DOI: 10.3233/NRE-1996-6104

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 19-32, 1996

Authors: Antoinette, Terri

Article Type: Research Article

Abstract: The survival of patients in low level neurologic states following traumatic brain injury requires the provision of quality rehabilitation nursing care. This article presents a concise, multi-system overview of the nursing care issues most commonly encountered in patients who are functioning at Rancho Levels I, II, and III. Included is a review of the most frequently encountered complications and nursing interventions. Reaction patterns of family members and the role of the nurse in providing support and therapeutic interventions is also discussed. The importance of astute observation of neurobehavioral responsiveness and subsequent input to the interdisciplinary team is addressed, including discussion …of the nurse's core role as an integral member of the team. Show more

Keywords: Traumatic brain injury, Rehabilitation nursing, Coma, Arousal, Vegetative states

DOI: 10.3233/NRE-1996-6105

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 33-44, 1996

Authors: O'Dell, Michael W. | Jasin, Philip | Lyons, Nancy | Stivers, Maria | Meszaros, Frank

Article Type: Research Article

Abstract: Among the most significant advances in the care and rehabilitation of severely brain injured, minimally-responsive patients (MRP) has been the development of standardized assessment scales. Currently available instruments include the Coma/Near Coma Scale (CNC), Coma Recovery Scale (CRS), Sensory Stimulation Assessment Measure (SSAM), and the Western Neuro Sensory Stimulation Profile (WNSSP). Each scale is reviewed in terms of content, psychometric properties, and clinical attributes. Data is then presented comparing converted, percentile admission scores for the CRS, WNSSP, and CNC in a group of ten MRP at Rancho Levels II–IV, with a mean age of 31 years and mean time from …injury of 37.5 days. Admission CNC and CRS scores tended to group in the middle range, while WNSSP scores tended to group in the lower quartile. This suggests the potential concern for ‘floor effect’ with the WNSSP. At admission, none of the three scales was able to effectively distinguish between dichotomized outcome variables: disposition (home vs. nursing home), advancement to active rehabilitation, or discharge Functional Independence Measure score (> 80 vs. < 80). The data indicate the CRS demonstrates moderately strong relationships with both the CNC and WNSSP. Full delineation of how these scales relate to one another awaits both cross-sectional and longitudinal analyses in larger samples and should include the SSAM. Show more

Keywords: Traumatic brain injury, Vegetative state, Functional assessment, Rehabilitation, Health status, Minimally responsive

DOI: 10.3233/NRE-1996-6106

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 45-55, 1996

Authors: Elovic, Elie

Article Type: Research Article

Abstract: Pharmacological management of the low level patient is a very challenging prospect for the doctor treating these patients. The use of medications to expedite recovery and improve the function of arousal and attention in this population is both an exciting prospect and at the same time a most daunting task. Review of past literature is of limited value as it consists primarily of case reports, studies with small sample sizes and studies demonstrating limited clinical efficacy. The author has tried in this paper to offer some guidance by reviewing literature defining arousal and attention, briefly discussing the neuroanatomy of the …brain, critiquing past literature and offering his own recommendations based on experience. Show more

Keywords: Brain injury, Low level patient, Pharmacology, Stimulants, Dopamine, Antidepressants, Anticonvulsants

DOI: 10.3233/NRE-1996-6107

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 57-67, 1996

Authors: Giacino, Joseph T.

Article Type: Research Article

Abstract: The use of sensory stimulation (SS) to promote recovery from coma has enjoyed widespread acceptance in rehabilitation settings. This has occurred despite the paucity of research regarding its effectiveness as well as opposing viewpoints concerning its utility. The purpose of this article is to: (1) outline the theoretical basis underlying the arguments for and against the use of SS; and (2) to review representative studies on the effectiveness of SS using a scientific evidence-based classification system. It is suggested that few conclusions can be drawn regarding the efficacy of SS because of the lack of well-designed clinical studies on this …subject. Consequently, it is incumbent upon clinicians to clearly present to family members the high degree of uncertainty associated with this form of treatment. Show more

Keywords: Coma, Vegetative state, Rehabilitation, Outcome

DOI: 10.3233/NRE-1996-6108

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 69-78, 1996

Authors: Rosenberg, Jay | Ashwal, Stephen

Article Type: Research Article

Abstract: Practice parameters including the development of standards, guidelines and options are becoming an increasingly important aspect of contemporary medicine. It is important that such parameters are based on evidentiary data and that consensus be reached by the various professional specialty groups involved in the multidisciplinary care of patients. In this paper, we review how these concepts have recently been applied to issues related to patients in the vegetative state.

Keywords: Guidelines, Outcomes, Practice parameter, Standards, Vegetative state

DOI: 10.3233/NRE-1996-6109

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 79-87, 1996

Article Type: Other

DOI: 10.3233/NRE-1996-6110

Citation: NeuroRehabilitation, vol. 6, no. 1, pp. 89-90, 1996