The term "storming" has often been used colloquially to characterize brain injured patients who showed signs and symptoms of elevated heart rate, blood pressure, respiratory rate, temperature, and motor posturing. Recently, the term paroxysmal sympathetic hyperactivity (PSH) has been used as the unifying term to describe these acute episodes of elevated sympathetic hyperactivity. Various pharmaceutical and management options are available, but no single drug or protocol has been deemed superior to the others. Data on prognosis and recovery in relation to PSH are limited, but point toward poorer functional outcome and increased mortality. Overall, the phenomenon of PSH requires further research to aid rehabilitative efforts so that patients can effectively participate in therapy. A review of the literature has revealed sparse information on the management of sympathetic storming within rehabilitation facilities. This narrative review seeks to provide an up-to-date synopsis and recommendations on the management of rehabilitation inpatients with PSH.
BACKGROUND: Sleep plays an integral role in several physiologic functions such as cognition and functional ability. Sleep disturbances are common after brain injury and can interfere with rehabilitation and recovery. There are several pathways by which sleep is initiated, and thus various ways to target common complaints as well. OBJECTIVES: To review alternative and non-pharmacological treatment approaches to sleep disorders following TBI. METHODS: The authors present a review of the literature on various alternative treatment methods for treating sleep disorders, and discuss evidence for safety and efficacy. CONCLUSIONS: Typical management include conservative measures and pharmacologic treatment. This article provides a review of the available nonpharmacologic treatment options for sleep disorders in patients with traumatic brain injury. There are a number of non-pharmacological treatment methods available for treatment of sleep disorders in this population.
Context Previous studies have demonstrated the effectiveness of osteopathic manipulative treatment (OMT) for various headache types, with limited evidence of its use for headaches related to mild traumatic brain injury (MTBI). No studies prior studies were found regarding OMT for headaches in patients with postconcussion syndrome (PCS), defined as symptom persistence for longer than 3 months after MTBI. Objectives To evaluate OMT for headaches in patients with PCS. Methods A controlled pilot study was conducted of patients with PCS who presented to an outpatient interdisciplinary rehabilitation clinic; patients with symptoms lasting longer than 3 months were enrolled and randomly assigned to an OMT treatment group or a control group. Primary outcome measures were immediate change in headache scores according to a Visual Analog Scale (VAS) and change in the six item Headache Impact Test (HIT-6) between baseline and follow up visits. The participants in the control group completed the HIT-6 between baseline and follow up visits but did not receive OMT and did not complete the VAS. Mean immediate VAS score change for the treatment group and mean improvement in HIT-6 scores for both groups between baseline and follow up were analyzed for statistical significance. Results A total of 26 patients were included in this study: 13 (50%) in the treatment group and 13 (50%) in the control group. Six patients (23.1%), three from each group, did not complete the study, so 10 subjects in each group were included in the final analysis. Statistically significant improvement in VAS scores was seen immediately after OMT in the treatment group (mean change, 2.1;p=0.002). Mean HIT-6 scores showed improvement in the treatment group compared with the control group, although the change was not statistically significant (p=0.15) from baseline to follow up visit. No adverse effects from treatments were noted. Conclusions Patients with headaches secondary to PCS showed immediate benefit in headache pain intensity after OMT. However, no sustained benefit was found on the follow up visit compared with the control group.
A study to assess the correlation between frustration and family climate among undergraduate students of selected colleges at Kollam. The objectives of the study were to: a) assess the frustration among undergraduate students of selected colleges at Kollam. b) assess the family climate among undergraduate students of selected colleges at Kollam. c) find out the association between frustration and selected demographic variables among undergraduate students of selected colleges at Kollam. d) find out the association between family climate and selected demographic variables among undergraduate students of selected colleges at Kollam. e) assess the correlation between frustration and family climate among undergraduate students of selected colleges at Kollam. A quantitative research approach was adopted. Sampling technique adopted was convenient sampling. Sample size was 100. The investigators assessed undergraduate college students using questionnaires on frustration and family climate. The study showed that 23% of students had high frustration, 46% had moderate frustration and 31% had low frustration. 29% of students had unfavorable family climate 52% had moderate family climate and 19% favorable family climate. There was no association found between frustration and selected demographic variables. But an association was found between family climate and selected demographic variables such as age, type of family and type of residence. There was no association found between family climate and selected demographic variables such as sex, education of parent, occupation of parent, monthly income of parent and type of course. The value of r was -0.09. So, there was a slight negative correlation between frustration and family climate. The relationship between the two variables is weak. That is when family climate become favorable frustration decreases and vice versa.
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