Impact of brain tumour treatment on quality of life

Measurement of Health Related Quality of Life (HRQL) in brain tumour patients is important because brain tumours and brain tumour treatment usually affect physical, cognitive as well as emotional functioning. Measurement of HRQL is important for the understanding of disease burden and for the impact of specific tumour treatment. Quality of Life is a multidimensional concept consisting of physical, psychological and social phenomena. A large number of Quality of Life instruments have been developed. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the MOS Short-Form Health Survey are two frequently used general HRQL instruments. A specific brain tumour scale is the Brain Cancer Module, which is designed to be used in combination with general questionnaires. HRQL measurement and neuropsychological examination were used to investigate the impact of radiotherapy and surgery in low-grade glioma patients and the influence of tumour volume, tumour localization, performance status and age in both low-grade and high-grade glioma patients. Received: 10 April 2002 Accepted: 16 April 2002     

Doing it with mirrors: a case study of a novel approach to neurorehabilitation

Arm amputees can experience the perception of movement of a phantom limb while looking at a mirror reflection of the moving, intact arm superimposed on the perceived phantom. Such use of a mirror to provide illusory visual feedback of movement can be useful in rehabilitation of hemiparetic patients. In this case report, we describe the successful application of "mirror therapy" to the post-stroke rehabilitation of a patient with poor functional use of an upper extremity, due mainly to somatosensory deficits. Mirror therapy facilitated employment of a motor copy strategy (bimanual movements) and later progression to "forced use" of the affected arm. The end result was increased functional use of the affected upper limb.     

Accessibility for all: a case study of the access living headquarters

Access Living of Metropolitan Chicago is a nonresidential Center for Independent Living for people with all types of disabilities. This article describes the process of creating an accessible environment for their new headquarters. A charrette involving members of the Chicago disability community, as well as experts on accessibility and Universal Design, was conducted to investigate how architecture and technology could be integrated into the design that would help improve the function of the building. Design solutions for the building entrance, bathrooms, lighting, work stations, and elevators are described in this article. By understanding what the client needed and by doing careful research to find the right products, conventional products were used almost 100% of the time. With the exception of the TTYs in the elevator, there were no customized products. This meant that there was no need to pay more for the Universal Design when it came to building products.     

Breathing-impaired speech after brain haemorrhage: a case study

Results are presented from an auditory and acoustic analysis of the speech of an adult male with impaired prosody and articulation due to brain haemorrhage. They show marked effects on phonation, speech rate and articulator velocity, and a speech rhythm disrupted by "intrusive" stresses. These effects are discussed in relation to the speaker's very short breath-groups and consequent need to take breath within intonation-groups and even within rhythm-groups. The speaker appears to have various strategies for dealing with his speech problems to preserve the structural cohesion of his utterances, some seemingly more successful than others, including planning his frequent breath pauses, using falsetto phonation, control of pitch and inspiring air orally for rapid intake. Finally, it is suggested that these and other strategies designed to compensate for limitations and shortcomings in the speech production system should be recognized as a form of linguistic creativity.     

Treating attachment injured couples with emotionally focused therapy: a case study approach

This paper compared the attachment injury resolution process in two distressed couples undergoing ten sessions of Emotional Focused Therapy (EFT), a short-term empirically validated treatment for relational distress. An attachment injury is a newly coined clinical construct that denotes a specific type of betrayal within the couple's relationship. The incident is so potent that it calls into question assumptions about the safety of the relationship. The task analytic method was used to examine the pathways of change as related to attachment injury of each couple. Several outcome and process measures were employed in order to differentiate the therapeutic process between the resolved versus non-resolved couple. Results indicated that the couple who resolved their identified attachment injury at the outset of therapy adhered to the attachment injury resolution model, while the non-resolved couple showed marked deviations from the expected pathways of change. Findings suggest that the resolved couple tended to show more differentiation of interactional positions and greater levels of experiencing throughout the therapeutic process in relation to the non-resolved couple. It is recommended that further research is necessary to examine the clinical utility of the attachment injury resolution model in the context of a larger number of case studies.     

Heritability of depressive symptoms: a case study using a multilevel approach

We present a case study using a multilevel modeling approach to determine whether depressive symptoms are affected by genetic factors. Existing studies examining this question have focused on twins. The present study built on the literature by conducting a preliminary study of the heritability of depressive symptoms within extended families. At the same time, this study assessed the need for adjustment of a heritability measure in a family study using a multigenerational sample. The sample consisted of 230 community‐dwelling extended families that included 431 adult offspring, comprising full siblings, half siblings and cousins that participated in the University of Southern California Longitudinal Study of Generations. All participants filled out the Center for Epidemiologic Studies Depression (CES‐D) scale. The multilevel analysis allowed us to model the natural hierarchy of the extended family. Results indicate that the proportion of the phenotypic variance for CES‐D that occurs due to genetic differences is not significantly larger than zero among these participants [h² = 8.6%, 95% confidence interval (CI) = 0–57%, p = 0.71]. Our findings suggest that future studies examining depressive symptoms in this sample can focus on non‐genetic explanatory factors without the necessity to control for genetic variation. However, our study may be limited by measurement of prevalent depressive symptoms, which may not generalize to lifetime depressive symptoms. Copyright © 2009 John Wiley & Sons, Ltd.     

Caring for patients with cranial trauma: a new approach demonstrated in a case study

Until recently, the effects of a minor head injury have been minimalized by health care workers. Few resources have been available to individuals who experienced a mild traumatic brain injury who were discharged from hospital emergency services. Recognizing the needs of these individuals and their families, health care workers in Nova Scotia, including nurses, have developed a specific program of rehabilitation for patients who have suffered mild brain injuries.     

Membrane phospholipid composition and membrane fluidity of human brain tumour: a spin label study

Membrane fluidity in membrane phospholipids of brain tumours was investigated and compared with those of white and grey matter. Fifteen brain tumours including 5 gliomas, 5 meningiomas and 5 metastatic cancers were examined. These samples were frozen immediately after extirpation in liquid nitrogen. After extraction of total lipids from the tumour tissues, membrane phospholipids were separated and analysed by thin-layer and gas-liquid chromatography. The fluidity of the phospholipid membrane was studied by electron spin resonance (ESR) spectroscopy, using a stearate spin probe. The fatty acid composition of total phospholipid of brain tumours was characterized by an increase in linoleic and arachidonic acids when compared to the control brain. The percentage of palmitoleic acid was higher in gliomas and metastatic tumours than in meningiomas. Furthermore, in the brain tumour tissues, the decreases of phosphatidylethanolamine and phosphatidylserine and the increase of phosphatidylcholine were observed when compared with grey or white matter with the exception of meningioma. There was some difference in phospholipid membrane fluidity between brain tumour and control brain tissue. The order parameter calculated from ESR spectra became higher in the following order: metastatic brain tumour, less than meningioma, less than grey matter, less than glioma, less than white matter. These results suggest that the phospholipid metabolism in the brain tumour is different from that of the normal brain, and this difference may affect the alteration of membrane physical properties which exhibit in part the character of the transformation.     

Membrane phospholipid composition and membrane fluidity of human brain tumour: a spin label study

Membrane fluidity in membrane phospholipids of brain tumours was investigated and compared with those of white and grey matter. Fifteen brain tumours including 5 gliomas, 5 meningiomas and 5 metastatic cancers were examined. These samples were frozen immediately after extirpation in liquid nitrogen. After extraction of total lipids from the tumour tissues, membrane phospholipids were separated and analysed by thin-layer and gas-liquid chromatography. The fluidity of the phospholipid membrane was studied by electron spin resonance (ESR) spectroscopy, using a stearate spin probe. The fatty acid composition of total phospholipid of brain tumours was characterized by an increase in linoleic and arachidonic acids when compared to the control brain. The percentage of palmitoleic acid was higher in gliomas and metastatic tumours than in meningiomas. Furthermore, in the brain tumour tissues, the decreases of phosphatidylethanolamine and phosphatidylserine and the increase of phosphatidylcholine were observed when compared with grey or white matter with the exception of meningioma. There was some difference in phospholipid membrane fluidity between brain tumour and control brain tissue. The order parameter calculated from ESR spectra became higher in the following order: metastatic brain tumour, < meningioma, < grey matter, < glioma, < white matter. These results suggest that the phospholipid metabolism in the brain tumour is different from that of the normal brain, and this difference may affect the alteration of membrane physical properties which exhibit in part the character of the transformation.     

Visual agnosia with bilateral temporo-occipital brain lesions in a child with autistic disorder: a case study

A 2-year-old boy meeting the criteria for autistic disorder was diagnosed 2 years later with a visual agnosia characterised by a combination of certain aspects of associative and apperceptive agnosia. MRI then revealed a severe encephalomalacia of the right temporal lobe and bilateral temporo-occipital areas. This association is discussed in terms of a clinical and aetiological relation between autistic disorder and visual agnosia.     

Diffuse intravascular clotting associated with a primary brain tumour

A case of diffuse intravascular clotting associated with a primary brain tumour (oligodendroglioma) is described. The mechanisms of clotting and subsequent fibrinolytic syndromes are discussed with reference to the literature. On the basis of clinical, laboratory, and postmortem findings the possibility of the induction of diffuse intravascular clotting by primary brain tumours is stressed.     

Families living with acquired brain injury: a multiple family group experience

Although the use of multifamily group work is well established within the mental health field, it remains an underutilised method of treatment for families affected by brain injury. This paper reports on a pilot project exploring multifamily group work with families with a parent with an acquired brain injury. Six families met for a total of 12 sessions over a period of 6 months, with session themes informed by the Bouverie Family tasks model of adaptation post-ABI. The project was evaluated using qualitative and quantitative research methods, with pre, post group and 3 month follow up measures of individual, couple and family functioning. Parents reported generally reduced levels of personal distress at follow up but continuing high levels of marital and family dysfunction. Children were generally reported to be well functioning, although parents were particularly concerned about the impact of family disruption and violence on their children. Families were unequivocally positive about their participation in the group with benefits including reduced feelings of shame and isolation, provision of mutual support, increased understanding of brain injury, sharing of difficult experiences and movement from blame to compassion. Further research is warranted on the specific applications of multifamily group work with acquired brain injury.     

Lack of orientation due to a congenital brain malformation: a case study

Topographical disorientation is usually described in patients who have lost the ability to orient themselves as a consequence of acquired focal brain damage. Here, we describe the case of a 20-year-old woman with a congenital brain malformation who has never been able to orient herself within the environment. We addressed in detail her ability to orient and navigate within the environment by administering a number of tasks in both ecological and experimental surroundings. The results indicate a complete inability to use any kind of strategy useful for orientation.     

Impact of dining room environment on nutritional intake of Alzheimer's residents: a case study

This case study, in a Veterans Affairs Alzheimer's unit, was conducted to evaluate noise and lighting conditions at mealtimes and to assess the food intake of ambulatory dementia residents. The case study compared the noise, lighting, and nutritional intake of 16 Alzheimer's residents eating the same cycle menu in the extended-care (EC) dining room and the Alzheimer's unit (AU) dining room five weeks later. Noise was significantly lower in the EC (p < or = .02). Lighting was significantly higher in the EC (p < or = .001). Intake of calories and protein was slightly higher, with some days significantly higher, in the AU. Total five-day fluid intake at breakfast was significantly higher in the AU (p < or = .02). Although residents' total food and fluid intake was higher in the AU, the project identified a need to decrease noise and increase lighting in the AU. Lighting enhancement and noise reduction may further improve intake, which, in turn, may promote improved nutritional status.     

Effect of D-penicillamine treatment on brain metabolism in Wilson''s disease: a case study.

Sequential measurements of brain glucose metabolism were carried out in a patient with Wilson's disease, before and after successful treatment with D-penicillamine. They demonstrate an evolution of regional metabolism consistent with clinical improvement. The first study showed marked hypometabolism in the putamen on both sides. The second analysis showed bilateral improvement, with predominant residual deficits in the right putamen, while clinical symptoms of striatal dysfunction persisted on the left side. This observation suggests that positron emission tomography is able to follow the neurological evolution in cases of Wilson's disease.