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Biomedical subjects

J Speed

Publications and source records attributed to J Speed.

10 recordsLinked to original sources
PubMed2005

Factors related to recovery after mild traumatic brain injury.

PRIMARY OBJECTIVES: To study the variables that relate to outcome after mild traumatic brain injury (TBI). METHODS AND PROCEDURES: Sixty-seven adults with disappointing recoveries after mild TBI most occurring in a compensation or litigation context were studied with regard to pre-injury, neuro-trauma, physical, emotional and cognitive variables on outcome. Validity of physical, emotional and cognitive symptoms was controlled for. MAIN OUTCOMES AND RESULTS: Except for prior psychological traumatization, neither pre-injury, neuro-trauma or cognitive variables were related to outcome. Variables most consistently related to outcome were depression, pain and symptom invalidity on measures of response bias. These factors accounted for the majority of variance in outcome. CONCLUSIONS: In cases of poor recovery after mild TBI where compensation or litigation may be a factor, most of the variance in recovery seems to be explained by depression, pain and symptom invalidity, rather than by the injury variables themselves.

Adult↗
PubMed2003

UK laboratory intercomparison on internal dosimetry.

A laboratory intercomparison for internal dose assessment from a variety of intake scenarios is described. This is the first UK intercomparison using the revised ICRP Human Respiratory Tract and biokinetic models. Four United Kingdom laboratories participated and six cases were assessed. Overall, the agreement in internal dose assessments between laboratories was considered satisfactory with 79% of the assessed committed effective doses, e(50), for cases within a band of +/- 40% of the median value. The range (highest/lowest) in e(50) estimated by the laboratories was smallest (1.2) for a case involving inhalation of 137Cs. The range was greatest (6.0) for a case involving a wound with, and possible inhalation of, 238Pu, 239Pu and 241Am; the variation between laboratories in assessment of intakes could not be considered to be satisfactory in this case. Judgements on the most appropriate data to use in estimating intakes, choice of parameter values for use with the ICRP models and allowing for the effects of treatment with DTPA were important sources of variability between laboratories.

Body Burden↗
PubMed2001

The association between mild traumatic brain injury and psychiatric conditions.

The majority of patients with mild traumatic brain injury (TBI) recover fairly quickly and are usually restored to their previous level of functioning. However, a significant minority have prolonged, complicated, or incomplete recoveries and have outcomes disproportionately worse than would have been predicted by the objective facts of the injury. This failure to recover as expected was the focus of this study. The participants were 80 adults with actual or suspected mild TBI who were referred to an outpatient mild TBI clinic. Most were characterized by problematic recoveries. The results indicated that those individuals who only had brain injuries made good recoveries, but that those with psychiatric comorbidity did not (chi(2) = 19.65, p = 0.0002). Most of the new psychiatric conditions responsible for poor recovery consisted of depression, anxiety disorders or conversion disorder. Dissociative phenomena appeared common after mild TBI and scores on the Dissociative Experiences Scale predicted brain injury outcome with 77% accuracy.

Adult↗
PubMed1998

Post-craniectomy intracranial hypotension: potential impact on rehabilitation.

More aggressive neurosurgical management of intractably elevated intracranial pressure has resulted in increased survival of severely brain injured patients, many of whom are transferred for inpatient rehabilitation status post-craniectomy. Positional headache due to intracranial hypotension has been described in the literature, but is rarely reported as a complicating factor for patients receiving rehabilitation therapies. Low cerebrospinal fluid (CSF) pressure symptoms include postural headache, vertigo, nausea, vomiting, visual symptoms, auditory symptoms, and rarely cognitive changes. This report describes a patient who sustained a severe traumatic brain injury requiring craniectomy for management of increased intracranial pressure who subsequently developed intracranial hypotension. One month post-craniectomy, she developed postural headaches with cognitive and functional decline, which significantly impaired her rehabilitation. Aggressive efforts at conservative management including hydration and empiric blood patch were unsuccessful. Once the bone flap was replaced, she made rapid and dramatic functional gains, with total resolution of headache. This paper hypothesizes that the mechanism of low CSF pressure after extensive craniectomy is related to loss of hydrostatic pressure following removal of the skull vault. In rehabilitation of severely brain injured patients with craniectomies, it is important to recognize and appropriately treat this syndrome to avoid compromising patient care and prolonging hospitalization.

Brain Concussion↗
PubMed1998

Pharmacologic management of movement disorder after midbrain haemorrhage.

Movement disorders following midbrain haemorrhage are infrequently encountered in rehabilitation, and are uncommonly corrected by pharmacologic means. This report describes a 20 year-old male with a prior history of cocaine abuse who presented with a 4 day history of dysarthria and blurred vision following methamphetamine abuse. Physical examination demonstrated hypertension, left facial hemispasm, bilateral upward gaze paresis and ataxic gait. Magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) showed multifocal parenchymal haematomas in the mesencephalic tegmentum, subcortical left front region and right anterior thalamus consistent with cavernous angiomas. The patient was transferred to rehabilitation on hospital day 5. The following day, he developed choreoathetoid movements, dystonia, and aphasia, secondary to an extension of the midbrain haemorrhage. Cogentin was initiated with slight improvement in choreoathetoid movements. The patient began intensive multidisciplinary rehabilitation therapy but after 18 days of therapy, the patient remained totally dependent in activities of daily living (ADLs), transfers, mobility and was unable to communicate in any manner. A trial of Sinemet was initiated, with resultant steady improvement in functional ability over the next month. By discharge, the patient was independent in ADLs and ambulation. By 9 months post discharge follow-up, the patient was fully independent with normal cognition, and had self tapered all medications without ill effect. Dopamine agonist trials of appropriate duration appear indicated in cases of movement disorder (paucity or excess) following midbrain lesions.

Activities of Daily Living↗
PubMed1997

Behavioral management of conversion disorder in children.

OBJECTIVE: To describe the behavioral management of conversion disorder in children and to preliminarily assess its effectiveness. DESIGN: Retrospective case series. SETTING: Inpatient pediatric rehabilitation unit. PATIENTS: The first eight patients with conversion disorder treated on our pediatric rehabilitation unit, between 9 and 18 years of age. Six were girls. Three cases are described in detail. INTERVENTIONS: All patients were treated as inpatients, using a behavioral approach. Inadvertent reinforcement of illness behavior was identified, and a reward system was established for good attainment. Some patients had a "level" system instituted, with increasing privileges for goal achievement. All patients and their families had psychological assessment and instruction in pain and stress management strategies. MAIN OUTCOME MEASURES: Restoration of normal gait and function, independence in activities of daily living (ADL), and symptom recurrence after discharge. RESULTS: All patients attained normal gait and ADL function before discharge. CONCLUSIONS: (1) Behavioral management of conversion disorder in children appears to be as effective as in adults, although at times a behavioral reward or "level" system may be necessary for adequate reinforcement. (2) Instruction of the patient and family in appropriate stress and pain management appears key to maintaining treatment effect over time.

Adolescent↗
PubMed1996

Behavioral management of conversion disorder: retrospective study.

OBJECTIVE: To assess whether operant behavioral treatment of conversion disorder provides effective and durable symptom resolution, and to evaluate the prognostic value of duration of symptoms, as to the time required to effect symptom resolution. DESIGN: Retrospective case series (consecutive sample). SETTING: Inpatient rehabilitation unit in a tertiary care center. PATIENTS: The first 10 patients with conversion disorder treated by the author. There were 5 men and 5 women, age range 19 to 69 years, mean 32.7 years. The duration of conversion disorder symptoms (all involving gait) ranged from 0.5 to more than 112 weeks (mean 27.8 weeks, median 12 weeks). Follow-up range was 7 to 36 months (mean 20 months). INTERVENTION: All patients were treated as inpatients using a behavioral approach. A 'pseudo-scientific' explanation of the symptoms was provided, with an explanation that stressors can exacerbate symptoms. patients were in a wheelchair when no in therapy, and a physical therapy program was devised, using a treatment sequence based treatment of the analogous neurological condition. Other therapies were also utilized for positive reinforcement of normal function. All patients had psychological evaluation, with treatment as indicated. Patients were hospitalized long enough to restore normal gait and begin psychological treatment. MAIN OUTCOME MEASURES: Functional Independence Measure ambulation score at admission, discharge, and follow-up, and descriptive data, including symptom recurrence after discharge, new neurological symptoms after discharge, new treatment since discharge, and new psychiatric or neurological diagnosis since discharge. RESULTS: All patients attained normal ambulation before discharge (n = 10, Wilcoxon signed rank test p = .002). At followup, 7 of 9 patients maintained normal ambulation (Wilcoxon signed rank test of pretreatment ambulation score versus followup ambulation score p = .1016). Two patients resumed partial dependence on wheelchair use. There was a Spearman correlation coefficient of .68196 (p = .0298) when comparing duration of symptoms against duration of treatment. No patient had symptom substitution or new diagnosis made during the follow-up period. CONCLUSION: (1) Behavioral treatment of conversion disorder is effective, and appears to provide a clinically (but not statistically) significant long-lasting resolution of symptoms. (2) There is a strong positive correlation between duration of conversion symptoms and the time required to eradicate them.

Adolescent↗
PubMed1995

Therapist's experience, training, and skill in brief therapy: a bicoastal survey.

California and Massachusetts psychologists (N = 850, 58% response rate) returned a questionnaire to ascertain clinicians' brief-therapy experience, training, self-assessed skill, and attitude. Results indicate respondents spend a considerable portion (40%) of their clinical time doing brief therapy. A disturbing finding is that one-third of those presently doing brief therapy reported that they had received little or no training in brief-therapy theory or techniques. Self-rated skill in brief therapy was found to be best predicted by a combination of one's experience, training, and attitude. We conclude that, while the number of therapists using brief therapy has increased rapidly and apparently will continue to increase due to the expansion of managed health care, many psychologists do not have adequate training to use brief therapy successfully. Implications of this finding in terms of its potentially harmful effects and suggestions for future training are discussed.

Adult↗