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Biomedical subjects

D G Kewman

Publications and source records attributed to D G Kewman.

14 recordsLinked to original sources
PubMed2001

Hierarchical linear modeling of FIM instrument growth curve characteristics after spinal cord injury.

OBJECTIVE: To examine the recovery of aspects of functional independence as a continuous process using growth curve analysis. DESIGN: Retrospective database review of functional outcome assessment data from inception cohort. SETTING: Inpatient rehabilitation unit; community. PATIENTS: A total of 142 subjects (79.6% men; age range, 18-77yr; mean age +/- standard deviation, 36.2 +/- 15.5yr) who were admitted to a rehabilitation unit between March 1986 and November 1994 with a minimum of 4 postinjury FIM assessments. Neurologic subgroups included 63 individuals with paraplegia, 36 with low tetraplegia, 24 with high tetraplegia, and 19 with incomplete injury. MAIN OUTCOME MEASURE: FIM instrument. RESULTS: Growth curve analyses with hierarchical linear modeling using a decelerating recovery function yielded a reliable model in which longer rehabilitation length of stay was associated with a more rapid rate of recovery but lower plateau. Neurologic injury category had expected effects on rate and degree of recovery. Level of impairment-specific results included an age effect in which older age was associated with lower level of plateau. In specific neurologic groups there was a significant gender effect, in which men made more rapid recovery than women, and a significant effect of level of education, in which higher education was associated with more rapid rate of recovery. Rate of FIM recovery was reliably modeled in the sample with incomplete injuries, but none of the demographic predictors was significant. CONCLUSIONS: Functional recovery can be modeled as a decelerating rather than simple linear function. The study of predictors of recovery characteristics, including rate of recovery and plateau, offers a valuable way of understanding rehabilitative needs and outcomes. Gender and education effects on the recovery process are intriguing and warrant further investigation.

Adult↗
PubMed1996

Attentional performance of children with traumatic brain injury: a quantitative and qualitative analysis of digit span.

Previous studies have indicated that digit span performance is not particularly sensitive to the effects of traumatic brain injury (Baddeley & Warrington, 1970; Brooks, 1975; Sterne, 1969). However, clinical lore posits poorer backward vs. forward performance compared to normals due to the greater attentional demands of the backward task. This study examined qualitative aspects of Digit Span performance including forward/backward span discrepancies and error patterns in children with traumatic brain injury (n = 20) and normals (n = 19). The hypothesis of greater forward/backward discrepancy with traumatic brain injury was not supported. Children with traumatic brain injury make a significantly greater number of preceiling errors than normals, consistent with other findings of increased performance variability. Preceiling errors are errors that occur in trials prior to the two failed trials, resulting in discontinuation of the task. In addition, cognitive correlates of error types, such as WISC-R factor scores, were significantly different between groups. The results of this study suggest that a more detailed analysis of performance on attentional tasks previously described as resilient to brain injury may shed further light on the nature of acquired attentional deficits.

Journal Article↗
PubMed1991

Cognitive impairment in musculoskeletal pain patients.

To assess the incidence and relationship of cognitive/intellectual impairments to pain problems, seventy-three adults with musculoskeletal pain seen in a PM&R outpatient clinic were screened using the Neurobehavioral Cognitive Status Examination (NCSE). Subjective pain complaints were assessed using portions of the McGill Pain Questionnaire. Patients with prior diagnoses of neurocognitive problems or those who had taken narcotic analgesics in the last 24 hours were excluded. Results showed that 32 percent of subjects had impaired performance in at least one cognitive domain. Individuals with poorer performance on the NCSE had higher levels of reported pain or disability and psychological distress. Possible factors contributing to poor performance on cognitive tasks include psychological disorders or distress, undiagnosed organic brain dysfunction, social/psychological factors such as education, or a combination of these. Results suggest the need for further research to understand the relationship of poor performance on cognitive tasks to the etiology, maintenance and rehabilitation of pain problems.

Adult↗
PubMed1988

A randomized controlled trial of hospital discharge three days after myocardial infarction in the era of reperfusion.

To evaluate the feasibility and cost savings of hospital discharge three days after acute myocardial infarction, we screened 507 consecutive patients prospectively for clinical complications and exercise-test performance. Of 179 patients whose condition was classified as uncomplicated (no angina, heart failure, or arrhythmia 72 hours after admission), 126 underwent early exercise testing and 90 had no provocable myocardial ischemia. Eighty of these patients were randomly assigned to early (day 3) or conventional (days 7 to 10) hospital discharge. Seventy-six of them had received coronary reperfusion therapy (thrombolysis, angioplasty, or both). At six months of follow-up, there were no deaths or new ventricular aneurysms, and the early-discharge and conventional-discharge groups had similar numbers of hospital readmissions (6 and 10), reinfarctions (none and 5), and patients with angina (3 and 8). In the early-discharge group, 25 of 29 previously employed patients returned to work 40.7 +/- 21.9 days (mean +/- SD) after admission, as compared with 25 of 27 patients in the conventional-discharge group, who returned to work after a mean of 56.9 +/- 30.3 days (P = 0.054). The mean cumulative hospital and professional charges were $12,546 +/- 3,034 in the early-discharge group, as compared with $17,868 +/- 3,688 in the conventional-discharge group (P less than 0.0001). In carefully selected patients with uncomplicated myocardial infarction, hospital discharge after three days is feasible and leads to a substantial reduction in hospital charges. Before this strategy can be widely recommended, however, its safety must be confirmed in larger prospective clinical trials.

Clinical Trials as Topic↗
PubMed1987

Behavioral rehabilitation of functional alexia.

A 10-year-old boy with a functional reading deficit (i.e. functional alexia) was successfully treated with hospital based escape/avoidance procedures. A multiple baseline design was used to evaluate the effectiveness of treatment. Generalization of treatment effects across individuals, settings and time was demonstrated. Extension of these procedures to other functional deficits is discussed.

Behavior Therapy↗
PubMed1986

Training of color and form identification in cortical blindness: a case study.

A procedure was developed for retraining color and form identification in a multiply handicapped cortically blind adolescent girl who had sustained anoxic brain damage. Treatment involved systematic presentation of four different colored shapes with verbal feedback on performance. The trainer used a multiple choice procedure and traced the edge of the stimulus with a pointer. The patient attained near perfect performance with the four colored shapes in less than 10 sessions, while identification of visual and tactile stimulus materials not used in training remained essentially unchanged. Results suggest a specific effect of training on performance.

Adolescent↗
PubMed1985

Behavior modification of abnormal gait and chronic pain secondary to somatization disorder.

An interdisciplinary team, which included a physiatrist, psychologist, physical therapist, occupational therapist, social worker, and nursing staff, undertook the treatment of a 33-year-old woman with a 16-year history of gait problems and multiple somatic complaints. Previously, she had been followed by a number of physicians and had undergone both invasive and noninvasive diagnostic procedures as well as several surgical procedures. After limited response to such treatment, she was referred to the outpatient PM&R clinic for evaluation. Physical and psychologic study led to a primary diagnosis of somatization disorder, leading to inpatient treatment which combined a systematic gait-training program, withdrawal of reinforcement for maladaptive disability-related behavior, and reinforcement of increases in normal activities. The patient attained all of the goals in her program in 11 weeks.

Adaptation, Psychological↗
PubMed1983

An alternative perspective on biofeedback efficacy studies: a reply to Steiner and Dince.

Clinical applications of biofeedback have proliferated and considerable lore surrounding the application of these techniques has evolved. Many assertions about the effectiveness of biofeedback training are based on findings of the least well-controlled studies, while many of the better controlled studies have failed to show that biofeedback directly mediates target symptoms or is superior to other treatments. Steiner and Dince (1981) suggest that the failure of these controlled studies is primarily attributable to methodological deficiencies. We believe that the question of whether or not there is a specific effect of biofeedback training is still frequently confused with the question of whether or not the treatment package as a whole has therapeutic value. Biofeedback is often therapeutic; however, evidence is often lacking that its effectiveness is due to biofeedback-trained changes in a target physiological process.

Autonomic Nervous System↗
PubMed1982

Minnesota Multiphasic Personality Inventory: two automated forms.

Two automated forms of the MMPI have been developed which are of particular utility in a rehabilitation setting with some individuals who have impairment of upper extremity functioning or mild visual problems. One form involving the sorting of IBM punch cards with printed questions into true and false piles, has been adapted and improved for scoring, profile generation and storage using a high speed campus computational facility. The 2nd form utilizes a small microcomputer for individual administration, scoring, profile generation and storage of information.

Humans↗
PubMed1981

Driving and perceptual/cognitive skills: behavioral consequences of brain damage.

This study investigated the effects of brain damage on perceptual/cognitive skills and driving. The subjects included 23 persons with brain damage, 18 persons with spinal-cord damage, and 10 able-bodied persons. Each subject was evaluated using a battery of perceptual and cognitive tests, a set of driving tasks in a parking lot, and actual in-traffic driving over a fixed route. The results indicate that (1) while persons with brain damage, as a group, exhibited impaired perceptual/cognitive skills and also impaired driving, those who scored well on certain perceptual/cognitive tests tended to show good driving performance as well, (2) different perceptual/cognitive tests are good predictors of driving performance by persons with and without brain damage, and (3) the driving problems exhibited by some of the persons with brain damage likely result, in part, from the deficits in their perceptual and cognitive skills.

Adult↗
PubMedDate not supplied

Lower extremity lawn-mower injuries in children.

Lower extremity lawn-mower injuries in children result in significant morbidity with a significant financial burden to the family and society. We reviewed 24 children with lower extremity lawn-mower injuries; all mothers completed standardized psychologic assessments of their children, and 18 children were interviewed. Fifty percent of the mothers had defensive profiles on the standardized psychologic assessment, suggesting the likelihood of denial or underreporting of the child's psychologic difficulties. Therefore, we found the interview with the child to be a more accurate measure of psychologic distress. Prevention measures aimed at parents must emphasize that a child must not be allowed in a yard that is being mowed with a riding mower.

Accident Prevention↗
PubMedDate not supplied

Assessment of distractibility in auditory comprehension after traumatic brain injury.

In a simulated functional task involving comprehension of a spoken passage, the performance of 20 traumatically brain-injured and 14 non-brain-injured control patients was compared under conditions which included the presence and absence of competing vocal stimuli. The subjects heard 10 target paragraphs which were approximately 1 minute in length. Five of these paragraphs were transmitted without any interference, while the other five were presented with distraction caused by a second voice reading a different paragraph with equal volume and intensity. Based on the answers to subsequent multiple-choice questions, the traumatically brain-injured subjects had significantly more difficulty comprehending the target passages in the presence of the interfering or competing passages compared to control subjects. The results of this study suggest the need for specific rehabilitation programmes to aid brain-injured persons in improving their auditory comprehension in everyday situations where distracting or competing auditory stimuli are present.

Adolescent↗