Rehabilitation in brain disorders. 4. Specific disorders

This self-directed learning module highlights important aspects of medical rehabilitation of patients with brain disorders. The specific disorders reviewed in this module are traumatic brain injury, stroke, multiple sclerosis, Parkinson's disease, and other degenerative disorders. This module is a section of the chapter on rehabilitation of brain disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. The chapter is composed of four articles, and each builds on principles established in the others. Emphasis is given in this section on key elements of current medical practice, including epidemiology, pathophysiology, prognosis, and outcome. Neurologic assessment and management is highlighted for coma, amnesia, cranial nerve and late intracranial complications, postacute management, and postconcussive syndromes. The learner is directed to articles 1, 2, and 3 in this chapter for supporting information.     

Rehabilitation in brain disorders. 2. Clinical manifestations and medical issues

This self-directed learning module highlights advances in clinical manifestations of brain disorders. It is part of the chapter on rehabilitation in brain disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This chapter is composed of four articles, and each builds on principles established in the others. This article covers medical complications, neurobehavioral aspects, and cognitive deficits seen in patients with brain disorders, specifically seizures, hydrocephalus, heterotopic ossification, and cardiovascular/pulmonary, neuroendocrine, gastrointestinal, genitourinary, communication, motoric, and visual/spatial/sensory disorders. Advances that are covered in this section are neuroendocrine complications, seizure prophylaxis, and coma treatment. The learner is directed to articles 1, 3, and 4 in this chapter for supporting information.     

Rehabilitation of memory disorders: objectives, strategies and evaluation

Memory rehabilitation can be proposed to amnesic patients with mild or moderate isolated memory deficit and with some preserved memory components. It is necessary to study memory with global psychometric tests, specific memory examination and pragmatic study, and to have definite memory aims. The facilitating effects of mental imagery and mnemonic strategies, preserved learning and compensatory aids were analysed.     

Rehabilitation in spinal cord disorders. 3. Comprehensive management of spinal cord injury

This self-directed learning module highlights advances in the management of the person with a spinal cord deficit. Traumatic spinal cord injury is being used as the model, but the principles apply to all patients with spinal cord deficits. This article is part of the chapter on rehabilitation of spinal cord disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. Specifically, this section contains information regarding prehospital care, acute assessment and management, primary rehabilitation by systems, sexuality and psychosocial issues, management of pain and spasticity, functional goals, the role of functional electrical stimulation, and long-term follow-up.     

3. Rehabilitation outcomes

This self-directed learning module highlights rehabilitation outcomes in spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the multiple concerns for functional recovery after SCI, chiefly, the potential for ambulation, upper-extremity recovery, options for functional neuromuscular stimulation (FNS), sexual activity, and optimal outcome after a metastatic lesion. Motor incomplete patients have a better prognosis for ambulation than persons with sensory incomplete injury. Positive predictors for ambulation, including pinprick and lower-extremity motor scores greater than 20, are discussed. Meaningful recovery can occur in the upper extremities for at least 1 year. FNS options have been developed to promote functional control of the upper extremities for persons with tetraplegia, phrenic pacing, and bladder continence. A critical component of an individual's expression of self is his/her sexuality; sexual function after SCI is described in detail, including options for treatment of erectile dysfunction and various birth control methods for women. Expectations for an appropriate rehabilitation stay for a person with metastatic SCI differ for an individual with traumatic SCI. Differences may include changing routine pathways and timelines to focus on patient-centered quality of life for transition to home.Overall Article Objective:To identify potential outcomes in ambulation, upper-extremity function, FNS, and sexual function after SCI and after metastatic cancer.     

Rehabilitation of swallowing disorders

Optimal rehabilitation of dysphagia requires an understanding of normal and diseased physiology, a systematic functional evaluation of the patient's disability and a wide repertoire of rehabilitative techniques. Nonsurgical techniques should be used first, especially when the possibility of spontaneous improvement exists. Cricopharyngeal myotomy is effective in a patient with obstruction at the cricopharyngeal level and good airway protection. When oral feeding is not possible, esophagostomy is usually the preferred bypass procedure.     

急性脑卒中偏瘫的早期康复

对50例接受康复训练和32例接受神经科常规药物治疗的急性脑卒中偏瘫患者的治疗效果进行比较,结果显示,康复组运动模式和肌力恢复均优于常规治疗组。说明康复训练不但可改善运动的质量而且可改善肌力。但治疗后2组比较手功能未见差异,说明对手的训练方法有待加强。     

Tryptophan metabolites and brain disorders.

Tryptophan is metabolised primarily along the kynurenine pathway, of which two components are now known to have marked effects on neurons in the central nervous system. Quinolinic acid is an agonist at the population of glutamate receptors which are sensitive to N-methyl-D-aspartate (NMDA), and kynurenic acid is an antagonist at several glutamate receptors. Consequently quinolinic acid can act as a neurotoxin while kynurenic acid is neuroprotectant. A third kynurenine, 3-hydroxykynurenine, can generate free radicals and contribute to, or exacerbate, neuronal damage. Changes in the absolute or relative concentrations of these kynurenines have been implicated in a variety of central nervous system disorders such as the AIDS-dementia complex and Huntington's disease, raising the possibility that interference with their actions or synthesis could lead to new forms of pharmacotherapy for these conditions.     

综合干预对精神分裂症的康复效果观察

目的观察综合干预对恢复期精神分裂症患者的康复作用。方法200例恢复期住院精神分裂症患者随机分为干预组和对照组,各100例,干预组患者进行为期3个月的综合干预,对照组患者不做任何干预。采用住院精神病患者康复疗效评定量表(IPROS)、简明精神病量表(BPRS)、焦虑自评量表(SAS)、自评抑郁量表(SDS)于治疗前和治疗3个月末对两组患者进行评定。结果治疗前,干预组患者各量表评分总分及各因子分得分与对照组的差异均无统计学意义(P>0.05);治疗3个月末,干预组患者的各量表评分均明显低于对照组(P<0.01)。结论综合干预有利于恢复期精神分裂症患者减轻心理障碍,提高社会适应能力,早日康复,回归社会。     

Intervention strategies with multiproblem families. Part 1. A psychoanalytical approach

This discussion has focused on intervention strategies based on psychoanalytical theory. Recognizing that the birth of a baby is a developmental crisis in a family, the CHN can use one of three basic approaches. The choice of approach depends upon the family's need and their ability to respond to the approach. Fundamental to all three approaches is the establishment of a therapeutic relationship based on commitment. The nurse needs to be clear with her- or himself and with the family on what that commitment is.     

Rehabilitation in spinal cord disorders. 1. Epidemiology, prevention, and system of care of spinal cord disorders

This self-directed learning module highlights current concepts of the epidemiology, prevention, and systematic treatment of spinal cord disorders. It is part of the chapter on rehabilitation of spinal cord disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This article contains information regarding the incidence, prevalence, and causes of spinal cord injury, methods of prevention, and the components of a comprehensive system of care for spinal cord injury.     

护士工作倦怠的干预策略研究

目的 探讨护士工作倦怠与其自尊、成就动机和社会支持的关系,进而提出护士工作倦怠的干预策略.方法 用工作倦怠问卷、自尊量表、成就动机量表和社会支持评定量表对205名护士进行问卷调查,并对结果进行分析.结果 情感耗竭、人格解体和低成就感与自尊、成就动机存在显著负相关,人格解体和低成就感与社会支持存在显著负相关.自尊对情感耗竭具有负向预测作用,成就动机对情感耗竭、人格解体和低成就感具有负向预测作用,社会支持对低成就感具有负向预测作用.结论 护士的工作倦怠需要社会、医院和个人的努力才能克服.     

Therapeutic strategies of urinary disorders in MS. Practice and algorithms

ObjectiveReview the literature on therapeutic strategies and guidelines for the treatment of neurogenic bladder in multiple sclerosis.Material and methodA search on available articles on consensus, recommendations guidelines and algorithm of treatment of urinary tract dysfunction in multiple sclerosis.ResultsFive national consensus guidelines were recently published and proposed guidelines for the first and second line treatments.ConclusionMultiple sclerosis patients suffering from lower urinary tract disorders must benefit from an early diagnosis and simple first line evaluation and treatment. More complex and invasive evaluation in the neuro-urology unit is appropriate for patients who failed to first line treatment or in case of complications.     

Rehabilitation outcomes in children with brain injury

A pediatric rehabilitation facility has been treating children with head trauma for many years. Through direct observation it was concluded that early stage intensive therapy favorably influenced outcome. A comprehensive data collection instrument was retrospectively employed to compare and contrast outcomes of 160 children with a diagnosis of head trauma. The average age was 12.7, and there were twice as many boys as girls. Seventy-five percent of the injuries resulted from vehicular accidents. Sixty-nine percent of the children sustained both head and associated injuries. Of those requiring rehabilitation, 48 percent showed good recovery and 24 percent had moderate disability. Of the 68 percent comatose on admission, only 16 percent remained in a persistent vegetative state at discharge. This study not only encourages transfer of children to rehabilitation as early as possible to improve functional outcomes but also emphasizes the need to develop outcome criteria that will be more specific.     

Rehabilitation after traumatic brain injury in adults

Purpose: Traumatic brain injury (TBI) stands as a major public health problem and one of the most important challenges for neurological rehabilitation. This review discusses advances that have occurred in the past 10 years in rehabilitation after severe TBI in adults.

Method: First, theoretical concepts, goals of rehabilitation and organization of resources are reviewed. Then specific questions that arise in the rehabilitation of severe TBI patients are considered.

Results: Three phases are distinguished in post-traumatic evolution. Acute rehabilitation takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications, and to provide sensory stimulations with the hope of accelerating arousal. Secondly subacute (generally inpatient) rehabilitation is designed to facilitate and accelerate recovery of impairments, and to compensate for disabilities. Motility, cognition, behaviour, personality and affect should be simultaneously addressed in an holistic approach. Physical as well as psychological independence and self-awareness are the major goals to emphasize. A third, post-acute rehabilitation phase includes outpatient therapy for achieving physical, domestic and social independence, reduction of handicaps and re-entry into the community.

Conclusions: Problems with returning home, obtaining financial independence, driving, returning to work, participating in social relationships and leisure activities, and the importance of psychosocial adjustment and self-acceptance, are outlined. Questions about economic aspects and rehabilitation in the future are addressed.     

综合康复护理干预对脑卒中后抑郁患者的影响

目的探讨综合康复护理干预对脑卒中后抑郁患者的影响。方法80例卒中后抑郁患者随机分为两组,治疗组与对照组各40例。对照组采用神经内科常规治疗及护理,治疗组在神经内科常规治疗及护理的基础上加入康复护理干预。入院时及治疗2个月后均运用Hamilton抑郁量表（HAMD）进行抑郁评分。结果治疗组临床有效率为90％,对照组临床有效率为72．5％,两组总有效率比较,差异有统讣学意义（P〈0．05）。结论综合康复护理干预对脑卒中后抑郁患者有利于改善临床症状,提高疗效。