Review of Head injury rehabilitation: Children and adolescents.

Reviews the book, Head injury rehabilitation: Children and adolescents by Mark Yivisaker. This book is intended to be a practical guide for professionals seeking concrete guidance in the difficult and frustrating search for effective treatment strategies for head injured patients. While maintaining a commitment to scholarship, the authors of the treatment chapters of this textbook have taken as their primary responsibility the clear presentation of a treatment philosophy as well as specific principles and techniques of remediation" (p. xvii). It is clear that the contributors of this volume, most of whom work together at the Rehabilitation Institute of Pittsburgh, labored long and hard to accomplish this goal and, as a result, they have produced a lucid and thorough volume. This book provides a very helpful and coherent account of pediatric head injury rehabilitation. No important topics are overlooked and, although some crucial areas are given fairly short shrift, the coverage is quite within the stated purpose of the work and the task that the authors set for themselves. I think that this book will prove to be a useful manual for neophytes to the head injury rehabilitation field, and to many parents of head injured children. It certainly should be required reading for all who choose to prepare themselves for professional work with head injured children. One final point: although not explicitly stated, the enormous investment of time and effort required by the head injured child and his or her family reflects a capacity that arises more from the heart than from the mind. This commitment can only come from a well-integrated and devoted team of professionals such as the group who authored this book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of bonding agents on adhesion of composite resin following CO2 laser etching of dental enamel

This paper looks at the process of setting up a Head Injury Register whose aims are: (1) to identify reliably and rapidly patients who have sustained a head injury so that service can be offered to them; and (2) to obtain epidemiological data to identify needs and inform future service planning and development. The register records all cases of head injury in patients aged 16-65, regardless of severity, which present to hospital services in Oxfordshire whether or not admitted as inpatients. It was set up as part of a research project into the value of providing an early follow-up service for head injury patients. The paper highlights the difficulty of identifying these patients reliably. It details the administrative and technological problems encountered, together with some of their solutions.     

Closed head injuries of school-age children: neuropsychological sequelae in early adulthood

This study was undertaken in order to investigate the effects of closed head injury with coma, sustained during school age (7-14 years) on the neuropsychological performances of the subject examined at least 7 years later, in early adulthood (18-27 years). Twenty-one subjects who met these requirements were examined with neuropsychological tests, supplemented by complete neurological examinations and interviews with both the subject and at least one relative. Only 3 subjects out of 21 were found to be "impaired" from a neuropsychological point of view, since they fell below the cut-off scores in at least 4 tests out of 9. These findings suggest that the long-term prognosis of closed head injury in school-age children is generally good. The factors that may have influenced the prognosis in these patients are discussed.     

Onset of hepatocellular carcinoma in a non-cirrhotic patient affected with haemochromatosis

Forensic pathologists are frequently asked to describe the interval between injury and the onset of symptoms in child abuse head injury deaths. A prospective, postmortem study examined the interval between injury and onset of symptoms in 76 head injury deaths in which this information was available. The head injury deaths were divided by mechanism of injury. The mechanisms were shake (no impact), combined shake and blunt impact, and blunt impact (no history of shaking). The interval was less than 24 hours in 80% of shakes, 71.9% of combined, and 69.2% of blunt injuries. The interval was greater than 24 hours in more than 25% of each of these latter groups and was more than 72 hours in four children. The variable intervals between injury and severe symptoms warrant circumspection in describing the interval for investigators or triers of fact. It should be noted that in all of the cases where information was supplied by someone other than the perpetrator, the child was not normal during the interval.     

Comparison of two methods for enumerating malaria parasites in thick blood films

We evaluated the risk of brain tumor occurrence in relation to previous head injury in a population-based case-control study of 540 children with a primary brain tumor and 801 control children. The risk of a brain tumor among children with a previous head injury that resulted in medical attention was slightly elevated when compared with children with no reported head injury [odds ratio (OR) = 1.4; 95% confidence limits (CL) = 1.0, 1.9]. This effect was stronger when we restricted the head-injured group to the few children with loss of consciousness (OR = 1.6; 95% CL = 0.6, 3.9) or an overnight admission to a hospital (OR = 1.7; 95% CL 0.7, 4.6), relative to those with no head injury. We observed no appreciable association between brain tumor occurrence and birth injury involving the head or a forceps delivery. Among the few children with either a birth injury or forceps delivery and a subsequent head injury, we observed approximately twofold elevations in risk. The OR was 2.6 (95% CL = 1.1, 6.9) for those with a birth injury and subsequent head injury, relative to those with neither a birth injury nor head injury. Our results provide only weak evidence in support of head injury as an etiologic agent for brain tumor occurrence in children, although most of our exposed group had only mild head injury.     

Bone morphogenetic protein receptors

The relationship between physical trauma and Parkinson's disease is reviewed. Post-traumatic Parkinson's syndrome may occur following cumulative head trauma in contact sports and exceptionally rarely after single severe closed head injury. It remains uncertain, however, whether physical injury should be considered one aetiological factor in the pathogenesis of Parkinson's disease.     

The role of head injury in cognitive functioning, emotional adjustment and criminal behaviour

In two investigations, 50% of non-violent convicted felons, who avoided incarceration by participating in a day reporting programme, reported a prior history of head injury and current problems in cognitive and emotional functioning. Only 5% of a college sample in the first investigation and 15% of a community sample in the second investigation reported prior head injury. In a third investigation, 83% of felons who had reported a history of head injury also reported a date for their head injury that preceded the date of their first encounter with law enforcement. Some participants reported no trouble with the law until after experiencing a head injury that occurred in their late thirties. Considering the research reported here and elsewhere in the literature, it appears that many serious crimes follow a head injury. One implication of the findings reported here is that many crimes might not occur if people with head injury were given prompt and comprehensive treatment after the injury.     

Early single-photon emission computed tomography in mild head trauma. A controlled study

Although computed tomography (CT) and magnetic resonance imaging scans often appear normal after mild head trauma, many patients experience attentional or other cognitive disturbances that are difficult to quantify by neuropsychological testing in the absence of a premorbid profile. Within 2 days of mild head trauma, 14 patients with normal-appearing brain CTs were studied with single-photon emission computed tomography (SPECT). They were compared to 15 normal control subjects and to 12 patients with mild human immunodeficiency virus (HIV) encephalopathy. Ten of 14 head trauma patients were separated from the normal control subjects by both independent readers, blinded to the clinical diagnosis. None of the SPECT results from normal control subjects were "read" as trauma. Trauma could not be differentiated from HIV encephalopathy. The observed percentage agreement between raters was 0.83 (kappa = 0.72). SPECT is more sensitive than CT in detecting brain injury after mild head trauma.     

Topography of axonal injury as defined by amyloid precursor protein and the sector scoring method in mild and severe closed head injury

Axonal injury (AI), as defined by amyloid precursor protein (APP) positive axonal swellings, was recorded on a series of line diagrams of standard brain sections divided into 116 sectors to provide an Axonal Injury Sector Score (AISS) ranging from 0 to 116. This sector scoring method of recording axonal damage and providing a topographic overview of AI was applied to a series of 6 mild head injury cases [Glasgow Coma Scale (GCS) 13-15] and six severe head injury cases (GCS 3-8). The AISS ranged from 4 to 107 overall and varied from 4 to 88 in the mildly injured group and 76 to 107 in the severe head injury group, supporting the concept that there is a spectrum of AI in traumatic head injury and that the AISS is a measure of the extent of AI. APP immunostaining demonstrated positive axonal swellings 1.75 h after head injury and analysis of the pattern of AI in the mild and severe head injury groups showed that axons were more vulnerable than blood vessels and that the axons in the corpus callosum and fornices were the most vulnerable of all.     

Professionalism in emergency medicine. SAEM Ethics Committee. Society for Academic Emergency Medicine

INTRODUCTION: F-16 pilots have a high incidence of minor neck injuries. It was hypothesized that pilots who did neck strengthening exercises and pilots who used other preventive strategies would have fewer injuries. METHOD: We surveyed 268 U.S. Air Force F-16 pilots. Subjects were divided into two groups. Group I, the Early Intervention Group, performed an intervention, or not, from the start of their F-16 careers. Outcomes were measured as a percent of pilots reporting an injury during their F-16 careers. Group II, the Midstream Intervention Group, initiated an intervention after sustaining an injury. Injuries before and after the intervention were compared as a median injury rate per 100 h F-16 time. RESULTS: The 1 -yr prevalence of neck injury was 56.6% and for an F-16 career was 85.4%. For every 100 h in the F-16, the risk of injury increased by 6.9%. Only 26.9% of the pilots routinely did neck strengthening exercises. For the Early Intervention Group, fewer injuries were associated with neck strengthening exercises and placing the head against the seat prior to loading +Gz. For the Midstream Intervention Group, a lower median injury rate was associated with neck strengthening exercises, placing the head against the seat prior to loading, warming up with stretching or isometrics, prepositioning the head prior to loading, and unloading prior to moving the head. Interventions not associated with fewer injuries included body exercises and placing the head against the canopy. CONCLUSION: Certain strategies may prevent neck injuries. Prospective research is needed to confirm these results.     

Dizziness from whiplash and head injury: differences between whiplash and head injury

OBJECTIVE: Large discrepancies exist in the literature regarding incidence and types of symptomatology in whiplash. This is because of the evolution of whiplash injury over the years with the advent of head rests and seat belts. Previous authors have regarded symptoms of dizziness as a result of brainstem or cerebellar injury or both. It has been difficult in those studies to ascribe a mechanism of injury, as patients with whiplash injury only have been grouped with those who have incurred mild traumatic brain injury as a result of a significant blow to the head. The authors saw the need to delineate patients who had suffered whiplash injury from those who also had suffered mild head injury, as defined in the rehabilitation-neurosurgical literature, to attempt to define differences in symptoms, abnormalities, and mechanisms of recovery in these two groups. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary-quaternary referral clinic. PATIENTS: The records of 36 patients were reviewed. Nineteen of these patients suffered a whiplash-associated disorder and 17 suffered a mild head injury as well. These patients were referred for assessment of symptoms persisting for at least 2 years after their injury. Patients were excluded if they had not completed clinical assessment, including electronystagmography (ENG) and computerized dynamic posturography (CDP). INTERVENTIONS: A full history, otolaryngologic examination, including assessment of eye movements, corneal reflexes and gait, as well as an investigation, including ENG and CDP, and history taking and detailed recording of related complaints immediately before diagnostic work-up were performed. MAIN OUTCOME MEASURES: Symptoms reported by patients who had received either whiplash alone or whiplash plus mild head trauma as defined in the literature were measured. Patients were classified according to type of accident, type of injury suffered, and degree and nature of posturographic abnormalities. RESULTS: Patients often have similar complaints regardless of whether or not they had suffered a head injury. Although CDP showed abnormalities in both groups, standard ENG assessment, including caloric testing, showed abnormalities only in the head-injured group. The posturographic abnormalities also were analyzed in both groups, and it was found that there was a correlation between the type of posturographic abnormality and the type of injury suffered. Although ENG testing is done routinely, posturography is shown to be more sensitive in picking up abnormalities. In addition, the authors have shown that posturography can delineate the type of injury suffered by exhibiting the compensation strategy used as well as the efficacy of that compensation strategy. CONCLUSIONS: Because ENG abnormalities are limited to patients who have suffered a head injury, the inference is that these two groups of patients have suffered damage at different sites along the balance system pathways, but both of these lesions can lead to similar symptoms. Although the mechanisms of whiplash injury and how they affect the vestibular system are poorly understood, posturography testing is essential in inferring how a patient is recovering by measuring how and how well the patient is overcoming his or her deficit. This has important medical legal implications regarding legitimizing a patient's problem, prognostic factors, as well as rehabilitation plans, measures, and outcomes.     

Profile and cost of head injury patients admitted to the Waikato Hospital Intensive Care Unit

AIMS: To examine the profile and hospital costs of head injury patients admitted to the Waikato Hospital Intensive Care Unit (ICU). METHODS: Data were collected on head injury patients admitted to ICU over 41 months and costs of head injury patients in ICU, the High Dependency Unit (HDU) and other wards were calculated. RESULTS: There were 286 head injury patients admitted to ICU, of whom 62% had a Glasgow Coma Score < or = 8. Times in the ICU and hospital were 1760 and 7352 days respectively. Costs per day were $2280 in ICU, $800 in HDU and $500 in other wards. The cost for ICU was $1,174,478 per year, and for the total hospital treatment, $2.05 million (83 head injury patients) per year. Admissions of head injury patients to all New Zealand ICUs were 777 over the year to June 1996. Thus, assuming similar costs to the Waikato Hospital, New Zealand hospitals spend each year approximately 10.9 million dollars on head injury patients in ICUs and 19 million dollars on overall hospital stays (including ICU). In a selected group of 123 severe head injury patients, the six month Glasgow Outcome Scores showed that 36% were in the moderate to severe disability categories and likely to cause major ongoing ACC costs. The costs of the 80% of head injury patients admitted to hospital but not admitted to ICU, and their prehospital and postdischarge costs were not studied. CONCLUSIONS: The New Zealand epidemic of head injuries continues to consume large amounts of the health money and produce major social costs.     

Head trauma

Progress in research includes studies concerning the pathophysiology and outcome of pediatric head injury, the pathology of the hippocampus in fatal injury, and the use of multivariate statistics to predict outcome in survivors. Recent research has confirmed and extended findings regarding the differential effects of closed head injury, depending on the age of the individual. These studies indicate that the consequences of head injury are more severe in older adults and in children younger than 2 years. Neuroimaging findings include evidence for delayed brain injury as a major cause of mortality and disability. Functional brain imaging provides evidence for cerebral dysfunction that is not appreciated by structural brain imaging techniques and may have a stronger relationship to neurobehavioral sequelae. The neurobehavioral sequelae frequently implicate frontal dysfunction, even in the absence of structural findings on computed tomography or magnetic resonance imaging. Studies of mild head injury have expanded our knowledge concerning the pathogenesis of postconcussional symptoms, including a preinjury vulnerability based on recent life events. Persistent postconcussional symptoms after mild head injury are frequently associated with emotional disturbance of clinical proportions.     

Preparations of toxic components from Naja kaouthia venom by selective heat denaturation

Second impact syndrome (SIS) occurs when an athlete who has sustained an initial head injury, most often a concussion, sustains a second head injury before symptoms associated with the first have fully cleared. While most commonly reported in football, the SIS can occur during any sport that can produce head blows. Any athlete still complaining of post-concussion symptoms after a head injury must not be allowed to return to play.     

Nonepileptic seizures after head injury

PURPOSE: To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics. METHODS: Retrospective record review of patients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report. RESULTS: Of 102 patients with NES, nearly one-third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow-up at 1 year found poor long-term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor. CONCLUSIONS: Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES.     

Postconcussion syndrome occurs in children.

The consensus of evidence published since 1924 suggests that parents report attention deficits, hyperactivity, or conduct disorder after pediatric head injury rather than postconcussion syndrome. In this study, the symptoms reported by children after mild (n?=?38) and moderate-severe (n?=?27) head trauma were compared to those reported after orthopedic injury (n?=?47) and to adults matched for injury severity and chronicity by using a structured interview based on diagnostic criteria for postconcussion syndrome. Pediatric head trauma caused significantly more subjective symptoms after 6 weeks than orthopedic injury. These symptoms were related to head injury severity and the child's anxiety level. When assessed in a similar manner, children report postconcussion syndrome similar to that seen in adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Retraining memory: Techniques and applications.

Reviews the book, Retraining memory: Techniques and applications by Rick Parenté and Janet K. Anderson-Parenté (1991). This book, by rehabilitation neuropsychologist Rick Parenté and his wife, psychologist Janet Anderson-Parenté, was written as a practical manual of memory improvement strategies and approaches that anyone with difficulty remembering can use. The book was meant to serve a widely divergent audience: It was written to provide practical tips on improving memory and allied processes for cognitive rehabilitation therapists, psychologists, persons with head injury, or family members "anyone who feels that his or her memory is not what it used to be" (p. vii). While the book may not be the complete practical resource for "everyone" that was desired, it represents a valuable contribution to the cognitive rehabilitation literature by blending clinical and research aspects of memory retraining into a practical manual for psychologists and other professionals providing this form of training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)