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Biomedical subjects

G Kinsella

Publications and source records attributed to G Kinsella.

29 records · Page 2Linked to original sources
PubMed1988

Evaluation of a remedial programme for attentional deficits following closed-head injury.

Although the frequency and implications of disorders of attention in head-injured subjects have been recognised in recent years, there have been few carefully controlled attempts to evaluate remedial interventions. The present study employed a multiple baseline across subjects design to evaluate a computer-mediated programme for the remediation of deficits in speed of information processing in 10 severely head-injured subjects, aged 17-38 years. Following a baseline period, the effectiveness of computer training alone was compared with that combined with therapist feedback and reinforcement in separate training phases, each lasting 3 weeks. The final phase involved a return to baseline conditions. Dependent measures of attention, taken across all phases, included psychometric measures of processing speed, a rating scale completed by the patient's Occupational Therapist, and a video of the patient working in therapy. Results suggested that, once spontaneous recovery and practice effect were controlled, the patients showed little response to the interventions in terms of the dependent measures used.

Adolescent↗
PubMed1987

Social interaction following severe closed head injury.

This paper describes research which sought to investigate and describe the interpersonal relationships and vulnerability to psychiatric disturbance in severely closed head injured subjects. The head injured subjects were severely injured, with mild or extremely severely injured individuals being excluded from this study. Self-report by the injured individual was compared with relatives' reports. Fifteen head injured people were individually matched with non-head injured people from the general population who acted as controls. Each subject nominated one 'close other' for comparative interview. The dependent variables included interpersonal relationships, non-psychotic psychiatric disturbance and behavioural change. The head injured group differed significantly from the control group in the quantity of interaction but not in the perceived quality of interaction. The groups differed significantly on behavioural change. No significant difference was found between responses given by the head injured and their 'close other' compared with the controls. Deficient quantity of interpersonal relationships and greater vulnerability to psychiatric disorders was shown in this sample. Further research on the assessment of long-term social outcome and psychiatric stability in the head injured could assist in the improved long-term rehabilitation of the survivors.

Adult↗
PubMed1985

Hemi-inattention and the recovery patterns of stroke patients.

A series of stroke patients (n = 31) were assessed at four stages: 4 weeks, 8 weeks, 12 weeks and 18 months post-trauma. Significant recovery was noted at 8 weeks, although a trend towards recovery continued throughout the assessment phases. Patients presenting with hemi-inattention at the 4-week assessment achieved significantly poorer levels of functional ability at the final assessment although in some cases the inattention had resolved on neuropsychological tests.

Activities of Daily Living↗
PubMed1981

Remedial therapy after stroke: a randomised controlled trial.

Of 1094 patients with a confirmed stroke admitted to Northwick Park, a district general hospital, 364 (33%) died while in hospital, 215 (20%) were fully recovered when discharged, and 329 (30%) were too frail or too ill from diseases other than stroke to be considered for active rehabilitation. Only 121 (11%) were suitable for intensive treatment. They and 12 patients referred direct to outpatients were allocated at random to one of three different courses of rehabilitation. Intensive was compared with conventional rehabilitation and with a third regimen which included no routine rehabilitation, but under which patients were encouraged to continue with exercises taught while in hospital and were regularly seen at home by a health visitor. Progress at three months and 12 months was measured by an index of activities of daily living. Improvement was greatest in those receiving intensive treatment, intermediate in those receiving conventional treatment, and least in those receiving no routine treatment. Decreasing intensity of treatment was associated with a significant increase in the proportions of patients who deteriorated and in the extent to which they deteriorated. Probably only a few stroke patients, mostly men, are suitable for intensive outpatient rehabilitation, but for those patients the treatment is effective and realistic.

Activities of Daily Living↗
PubMed1980

Acute recovery from patterns in stroke patients: neuropsychological factors.

Acute functional recovery after a stroke was evaluated in 31 subjects over a three-month period. Assessments were made at four, eight and 12 weeks after insult in the areas of activities of daily living, mobility, functional movement and cognitive abilities. Maximum recovery was achieved by eight weeks, although a trend towards recovery was continued to 12 weeks. Significant recovery was noted in activities of daily living, gait and functional movement, but not in cognitive abilities. A hemispheric difference in recovery rate was looked for, but not found, although unilateral spatial neglect, which, in this study, was exclusively found in right hemisphere lesions, emerged as a factor associated with poor outcome. The present results need to be confirmed by long term follow-up studies.

Activities of Daily Living↗
PubMed1979

Repeatability and validity of a modified activities of daily living (ADL) index in studies of chronic disability.

In order to measure disability in a randomised controlled trial of different intensities of rehabilitation following stroke, a modification of existing methods has been developed; it makes use of 17 items of activities of daily living (ADL) which are rated on a three-point scale, and it has been subjected to tests of repeatability and validity. While some activities (e.g. use of taps, ascending or descending stairs) are either redundant or repetitive, others provide independent measures of disability. There was no significant inter-observer variability; the assessors disagreed on 78 (3.7%) out of a total of 2,125 paired observations. In a study of short-term within-patient variability, different scores were assigned on 49 (14.4%) out of a total of 340 observations made on two separate occasions. Minor differences (mainly in activities involving equipment e.g. cookers) emerged when scores obtained in hospital were compared with those obtained at home, but the two sets of scores were still highly correlated (r = 0.962. There was, however, considerable discrepancy between the hospital scores and those derived from the patients' own estimates of their activities at home, the latter falling below actual capabilities as indicated by the hospital scores. A clinical validation of the index showed a significant association between the hospital ADL scores and the extent of cerebral lesions determined by the number of neurological deficits. This modified ADL index is sufficiently repeatable and valid for the assessment of patients with moderate disability as a result of stroke and other chronic diseases; in most circumstances, it can probably be simplified to include only five or six items.

Activities of Daily Living↗
PubMedDate not supplied

Using a memory handbook to improve everyday memory in community-dwelling older adults with memory complaints.

Community-dwelling, nondemented older people (60-70 years) with reported memory complaints were randomly assigned to either a memory-handbook (MHB) group (n = 20) or a placebo group (n = 20). The MHB group members were given a self-contained memory handbook and were individually trained on two of the handbook's sections that related to (a) remembering a person's name and (b) prospective memory, for approximately 30 minutes each. The placebo group was given an instructional pamphlet with a description of three list-learning mnemonics as a placebo treatment. Subjects were tested before and after the intervention. When compared with the placebo group, the MHB group members significantly improved their performance on a face-naming task and a strategies knowledge questionnaire, but not on the prospective memory measures, when compared with the placebo group. In addition, the MHB group showed a significant advantage on an everyday memory diary that was filled out by all subjects following the intervention. Following the study, the placebo group was also given the memory handbook, and both groups were then assessed on their knowledge and use of strategies by questionnaire at a 4-month follow-up. At this time the MHB group appeared to maintain most of its original gains, while the placebo group made some improvement.

Aged↗
PubMedDate not supplied

Survival of social relationships following head injury.

A retrospective search through the medical records at a rehabilitation hospital in Melbourne, Australia, identified 38 subjects (within the age range 19-34 years) suffering the effect of a severe closed-head injury 2-10 years post-trauma. In regard to social relationships, availability of post-trauma close attachment figures and looser social networks were markedly reduced for the head-injured group in relation to a matched community control group. However, they did not generally perceive these social relationships as inadequate when compared to a normal control sample. Moreover, within the head-injured group the perception of inadequate social relationships was not significantly associated with minor psychiatric disturbance. The implications of these results in terms of the social bond theory of depression are discussed, and issues in long-term social support of this population are raised.

Activities of Daily Living↗
PubMedDate not supplied

Premorbid emotional and behavioural adjustment in children with mild head injuries.

This study investigated the hypothesis that children sustaining a mild closed head injury have a higher prevalence of premorbid behavioural problems than children in the general community. The prevalence of emotional and behavioural problems among children with a mild closed head injury was compared with the prevalence of problems in children with a severe closed head injury, children in the general community, and children referred to a psychiatric outpatient clinic. The results showed that the children with a mild head injury did not have significantly more premorbid emotional and behavioural problems than other children in the community. The children with a mild head injury also had significantly fewer emotional and behavioural problems than children referred to a psychiatric outpatient clinic. The results suggest that the common assumption that children with a mild closed head injury have a higher prevalence of premorbid emotional and behavioural problems than other children in the general community may not be correct.

Adolescent↗