In order to obtain indicative data regarding intellectual, behavioural and social outcome into adulthood of subjects with a history of childhood head injury (CHI), twenty adults were selected who had been referred to the Neuropsychology Unit at the University of Parma at the time of a traumatic brain injury (TBI) at an age between 8 and 14 years. The level of intellectual and behavioural impairment was determined and rated by WISC and WAIS IQa and by the frequency of maladjustive behaviour. GOS score and Barthel index were used to detect the level of disability. Social adjustment and community integration were determined by the Social Adjustment Scale (SAS) and the Community Integration Questionnaire (CIQ) respectively. Results indicate that (1) subjects who suffer a severe CHI present a higher pre-injury incidence of character disturbances than the normal population and injury-related difficulties to socialize which persist long-term and add to other problems; (2) even though intellectual and functional sequelae are frequent in these children in adulthood and do not improve in their correlation to age, these do not appear to be the prevailing problems and (3) the prevailing problems seem to be social maladjustment and poor quality of life, which are still present several years post-injury and seem to be related to behavioural and psychosocial disorders in spite of an increased ADL-functioning. This has already been clearly demonstrated in the case of adulthood trauma.
This systematic review indicates that there is no reliable evidence to support the effectiveness of multisensory stimulation programmes in patients in coma or the vegetative state.
Safe removal of tracheal cannula is a major goal in the rehabilitation of tracheostomised patients to achieve progressive independence from mechanical support and reduce the risk of respiratory complications. A tracheal cannula may also cause significant discomfort to the patient, making verbal communication difficult. Particularly when cuffed, tracheal cannula reduces the normal movement of the larynx which can further compromise the basic swallowing defect. A close connection between respiratory, phonating, swallowing and feeding abilities to be recovered, implies a strict integration among different professionals of the rehabilitation team. An appropriate management of tracheostomy cannula is closely connected with assessment and treatment of swallowing disorders in order to limit the development of severe pulmonary and nutritional complications, but at present there are no uniform protocols in the scientific literature. Furthermore, several studies report as an essential criterion for decannulation the presence of good patient consciousness, which is often altered in patients with tracheostomy, but a general agreement is lacking.
BackgroundComa and vegetative state follow traumatic brain injury in about one out of eight patients, and in patients with non traumatic injury the prognosis is worse. The use of sensory stimulation for coma and vegetative state has gained popularity during the 1980's but beliefs and opinions about its e ectiveness vary substantially among health professionals.
ObjectivesTo assess the e ectiveness of sensory stimulation programmes in patients in coma or vegetative state.
Search methodsWe searched the Injuries Group specialised register, the Cochrane Controlled trials register, EMBASE, MEDLINE, CINAHL and PSYCHLIT from 1966 to January 2002, without language restriction. Reference lists of articles were scanned and we contacted experts in the area to find other relevant studies.
Selection criteriaRandomised or controlled trials that compared sensory stimulation programmes with standard rehabilitation in patients in coma or vegetative state.
Data collection and analysisAbstracts and papers found were screened by one reviewer. Three reviewers independently identified relevant studies, extracted data and assessed study quality resolving disagreement by consensus.
Main resultsThree studies were identified with 68 patients in total. The overall methodological quality was poor and studies di ered widely in terms of outcomes measures, study design and conduct. We therefore did not carry out any quantitative synthesis but reviewed results of available studies qualitatively.Sensory stimulation for brain injured individuals in coma or vegetative state (Review)
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