Biomedical subjects

M L Dombovy

Publications and source records attributed to M L Dombovy.

13 recordsLinked to original sources

PubMed1999

Cognitive and behavioural efficacy of amantadine in acute traumatic brain injury: an initial double-blind placebo-controlled study.

The objective of the current study was to determine the efficacy of amantadine in improving cognitive and behavioural performance in a traumatic brain injury (TBI) rehabilitation sample. The design was a prospective, randomized, double-blind, placebo-controlled, crossover design. Subjects were 10 adult traumatic brain injury patients in an acute brain injury rehabilitation unit. Subjects received a 2-week trail of amantadine or placebo, followed by a 2-week washout, then a 2-week trail of the alternative (placebo or amantadine). Neuropsychological outcome measures included orientation, attention, executive function, memory, orientation, behaviour, and a composite variable. Results of repeated measures ANOVA and regression analysis of slope/change showed a main effect of time, but no significant difference for amantadine versus placebo. In conclusion, although patients generally improved, this initial exploratory study found no differences in rate of cognitive improvement between subjects given amantadine versus those given placebo. However, the small sample size, heterogeneous population, acute time course, and large number of dependent variables limit power and generalizability. Implications are discussed for further research to better answer questions regarding efficacy of amantadine post-TBI.

Adult↗

PubMed1999

Rehabilitation outcomes in encephalitis--a retrospective study 1990-1997.

BACKGROUND: Encephalitis is an uncommon clinical entity compared to traumatic brain injury, and stroke. Many encephalitis survivors have disabling sequelae. There is scant information in the literature addressing outcome following inpatient rehabilitation for encephalitis. Further, it is unclear which of these patients will benefit from acute in-patient rehabilitation. PURPOSE: The purposes of this study are to (1) describe the outcome following in-patient rehabilitation in a cohort of patients with encephalitis, and (2) develop preliminary criteria to guide the selection of patients with encephalitis who may benefit from inpatient rehabilitation. METHOD: The demographic, clinical, functional (functional independence measure-FIM) and neuro-psychological data were retrospectively abstracted for eight subjects with a clinical diagnosis of encephalitis aged 5 to 75 years, who were admitted to a brain injury rehabilitation unit between 1990 and 1997. RESULTS: In the eight subjects, the mean age was 38 years, mean acute hospital stay (ALOS) was 40.3 days, and mean rehabilitation length of stay (RLOS) was 75.9 days. Mean admission FIM (AFIM) was 40.1, mean discharge FIM (DFIM) was 69.9. Mean FIM gain was 29.8 and mean FIM efficiency was 0.39. Adult subjects with an AFIM > 30 at 5 weeks from onset of illness (n = 4) had a FIM LOS efficiency of 0.64 and all four were discharged home. None of the adult subjects with an AFIM < 30 at 5 weeks from onset of illness (n = 3, FIM efficiency = 0.14) were discharged home. A child with an AFIM < 30 (n = 1) had a FIM LOS efficiency of 1.24, made good recovery and was discharged home. FIM LOS efficiency of 0.64 in encephalitis is less, as compared to traumatic brain injury (TBI -1.27) and stroke (1.06). CONCLUSIONS: The results of this study showed that, although subjects with encephalitis make functional gains in rehabilitation, the rate of recovery varies and is generally less than that for TBI and stroke. The study also suggests that FIM scores can be used for screening adult patients after encephalitis for admission to inpatient rehabilitation. Adult patients with an AFIM > 30, 5 weeks post onset of illness are likely to make reasonable progress and be discharged home. If replicated, these results suggest that despite low AFIM scores at 5 weeks from onset of illness (AFIM < 30), children may still make good progress and should be given a trial of in-patient rehabilitation.

Acyclovir↗

PubMed1998

Recovery and rehabilitation following subarachnoid haemorrhage: Part II. Long-term follow-up.

BACKGROUND AND PURPOSE: Subarachnoid haemorrhage (SAH) accounts for 5-10% of all strokes, strikes at a mean age of 50 years and results in a pattern of deficits similar to that of traumatic brain injury. This study is an extension of a previous study which described outcome at discharge from inpatient rehabilitation. The purpose of this follow-up study was to describe long-term functional, cognitive and psychosocial outcome in a cohort of SAH survivors who received inpatient rehabilitation. METHODS: Subjects were interviewed by telephone. Functional status was assessed using the Functional Independence Measure (FIM) and cognitive status with the Telephone Interview for Cognitive Status (TICS). Social function was determined via a brief questionnaire. RESULTS: Thirty two out of 80 subjects who received inpatient rehabilitation participated in the study. The 32 did not differ from the original group of 80 on any demographic or clinical criteria. The mean time from onset of SAH to follow-up was 28 months. Total FIM scores improved significantly between discharge and follow up (p < 0.0001) and most subjects functioned at a physically independent level. However, almost 40% scored in the cognitively impaired range on the TICS. Between 40% and 50% required help with common household activities, and none returned to full-time work. Functional and cognitive outcome was not related to any demographic or clinical characteristics at SAH onset. CONCLUSION: The majority of SAH survivors who received inpatient rehabilitation attain physical independence, but many continue to have cognitive impairments which result in social and vocational disabilities.

Activities of Daily Living↗

PubMed1998

Recovery and rehabilitation following subarachnoid haemorrhage. Part I: Outcome after inpatient rehabilitation.

BACKGROUND AND PURPOSE: Although subarachnoid haemorrhage (SAH) is a subtype of stroke, functional outcome following rehabilitation for SAH must be considered distinct from that of cerebral infarction because of the younger age and the difference in pathology and resultant neurologic deficits. The purposes of this study were to: (1) describe the demographic and clinical characteristics of SAH patients receiving rehabilitation; (2) describe functional outcomes following inpatient rehabilitation; and (3) investigate possible relationships between patient characteristics and functional outcomes. METHODS: Retrospective chart review of SAH patients admitted to inpatient rehabilitation. Functional Outcomes rated by the Functional Independence Measures (FIM). Analysis with descriptive and nonparametric statistics. RESULTS: Eighty patients with SAH admitted to a rehabilitation unit with a mean age of 54 years. Fifty-seven had identified aneurysms as a cause of SAH. Seventy-four subjects (93%) presented with Hunt and Hess grades of 3-5. The median length of stay was 26 days in acute care and 49 days in rehabilitation. Seventy patients (88%) were discharged home. The mean admission FIM was 59.5 and mean discharge FIM 91.0. The FIM efficiency (aggregate change in FIM/day) was 0.62/day and the average rate of FIM gain 0.97 points/day. Hydrocephalus negatively influenced outcome (p = 0.05). There was a trend for subjects with worse Hunt and Hess scores at onset to have poorer discharge FIM scores. CONCLUSION: SAH patients receiving inpatient rehabilitation make functional gains, although the rate of gain is less than for TBI or stroke. These SAH patients represent a subgroup with more severe SAH at onset than the total population of SAH survivors. The presence of hydrocephalus negatively impacts on outcome. Further detailed study of functional and neuropsychological outcome in SAH survivors is needed.

Activities of Daily Living↗

PubMed1997

Recovery and rehabilitation following traumatic brain injury.

Although most patients are discharged following traumatic brain injury (TBI) with "good recovery', recent reports indicate that many have persistent neuropsychological deficits. The purposes of this study were to: (1) determine if functional, neuropsychological and social outcome at 3 and 6 months in patients hospitalized following TBI could be ascertained via telephone follow-up, and (2) assess use of rehabilitation services in this population. Patients were identified through acute hospital admissions. A trained nurse practitioner abstracted data from acute charts. Using the Functional Independence Measure (FIM), Neurobehavioral Rating Scale (NRS), Telephone Interview for Cognitive Status (TICS), and a social questionnaire she obtained follow-up information at 3 and 6 months post-injury. Of 74 patients initially identified, 51 and 48 were available at 3 and 6 months, respectively. Most experienced mild to moderate TBI. Physical disability was minimal at follow-up as indicated by the FIM. Approximately half of the patients were rated cognitively impaired on the TICS at 3 months and over one-third remained impaired at 6 months. At 6 months 60.5% remained unemployed. Only eight of the 67 discharged survivors received any rehabilitation services. A brief telephone follow-up appears to be a cost-effective way to ascertain functional and neuropsychological outcome in TBI survivors. Since few of these patients received rehabilitation, a telephone follow-up may identify those who would potentially benefit from additional rehabilitation services.

Activities of Daily Living↗

PubMed1995

Recovery from stroke: rehabilitation.

Most of the neurological and functional recovery following stroke occurs during the first 3-6 months, although some patients show prolonged and unexpected levels of recovery. Research shows that the determination of outcome is multifactorial and includes demographics and psychosocial as well as medical factors. New information on how the brain recovers from injury has given us insights into which therapy approaches theoretically might be beneficial. In some cases recovery may be facilitated by the interaction of appropriate therapies and pharmacological interventions. Comprehensive rehabilitation programmes and integrated acute care rehabilitation stroke units appear to produce improved functional recovery over the standard of care. The reasons are unclear, but may include coordination and standardization of care as well as the early start of rehabilitation. Future research should continue to enhance the mechanisms of recovery from stroke and the approaches to facilitating the recovery process.

Brain Damage, Chronic↗

PubMed1988

Clinical observations on recovery from stroke.

Recovery from stroke occurs in a similar pattern in most patients, but the final functional status is difficult to predict. This recovery is most rapid in the first few months, but it may continue for years. The factors facilitating prolonged and more complete recovery are unclear and multiple. The neurophysiologic mechanisms of synaptic sprouting, unmasking, and redevelopment of inhibition may underlie recovery and provide the basis for developing therapeutic interventions in an attempt to promote return of function. Although the impact of current rehabilitation strategies on stroke recovery is uncertain, review suggests that it is beneficial in selected groups of patients. Further research is needed to answer the many questions surrounding recovery from stroke (a) to address the mechanisms of stroke recovery in human subjects with imaging or pathologic correlation, (b) to design therapeutic techniques based on neurophysiology and assess their effectiveness in groups of patients, (c) to determine if intensive rehabilitation reduces functional dependency resulting in decreased long-term social and economic costs, (d) to determine when rehabilitation should begin, where rehabilitation should take place, and how rehabilitation programs should be organized, and (e) to enable selection of patients most likely to succeed in rehabilitation programs. Although difficult to design, studies addressing these areas will provide much useful information that will further the development and delivery of rehabilitation services, resulting in improved patient care and reduced costs.

Central Nervous System↗

PubMed1987

Progesterone-induced changes in exercise performance and ventilatory response.

To further study the relationship between ventilatory response (VR) and exercise performance, and to investigate to what extent progesterone is responsible for ventilatory changes in the luteal phase of the menstrual cycle, we administered medroxyprogesterone acetate (MPA) to 10 normal males (20 mg three times a day for 5 doses) and compared results with those obtained in a similar study of females. With MPA, there was an increase in the resting VR to hypercapnia; the resting VR to hypoxia was not changed. There was a respiratory alkalosis at rest. During exercise, the PaCO2 remained lower but the pHa was not different because of a tendency toward lower bicarbonate concentration with MPA. Ventilation, when related to CO2 output, was increased at all exercise loads, indicating increased VR to endogenous CO2. However, ventilation was only minimally (3%) increased when related to oxygen uptake or workload. This apparent disparity is because of slightly lower CO2 output at a given oxygen uptake with MPA. As in females, maximal duration of exercise and maximal oxygen uptake were unchanged. Except for degree, MPA induced all the ventilatory changes seen in the menstrual cycle. Increased VR does not adversely affect exercise performance.

Adult↗

PubMed1987

Exercise performance and ventilatory response in the menstrual cycle.

We investigated the effects of the luteal phase of the menstrual cycle, as compared with the follicular phase, on ventilatory response (VR) and exercise performance in eight normally menstruating, non-athletic women. Subjects were studied near the predicted mid-point of each phase which was later documented by serum progesterone level. Resting VR to hypercapnia was greater, and VR to hypoxia tended to be greater in the luteal phase than in the follicular phase, but the increases in VRs were unrelated to progesterone level. There were no differences in maximal oxygen uptake, maximal duration of exercise, maximal heart rate, work efficiency, maximal ventilation (VE), anaerobic (ventilatory) threshold, gas exchange, cardiac output, or oxygen delivery. The PaCO2 was lower, and pHa tended to be higher during exercise. VE per unit CO2 output (VE/VCO2) was increased. R values (VCO2/VO2) were less, and maximal lactate values tended to be less, suggestive of increased dependence on fat for energy metabolism. At a given workload, exercise VE was unchanged due to the effect of less CO2 output at a given VO2 (lower R), balancing increased VE/VCO2. We conclude that, although ventilatory parameters are altered by the menstrual cycle, there is no overall effect on maximal exercise performance.

Adult↗

PubMedDate not supplied

Rehabilitation for stroke: a review.

Survivors of stroke are often left with severe mental and physical disabilities, which create a major social and economic burden. Many investigators have attempted to assess the role of rehabilitation in reducing such disability. Few controlled studies provide accurate assessment and documentation of benefit. Because of the presence of multiple variables and inadequate measures of outcome, it is difficult to design studies evaluating the effectiveness of rehabilitation for stroke. It is unclear how early rehabilitation should begin and what aspects of rehabilitation are important. Intensive rehabilitation is an expensive and limited resource; thus, the ability to identify the subgroup of patients with stroke who are likely to benefit is a critical issue. Although preliminary guidelines for the selection of patients who are appropriate for rehabilitation are given, no uniform criteria reliably differentiate patients who need rehabilitation from those who will recover spontaneously or do poorly. Controlled studies in the practice of rehabilitation for stroke will provide much useful information for patient management.

Activities of Daily Living↗

PubMedDate not supplied

Disability and use of rehabilitation services following stroke in Rochester, Minnesota, 1975-1979.

Medical records of all residents of Rochester, Minnesota, who had a first stroke in 1975-1979 were reviewed to determine level of disability, disposition, and use of rehabilitation services. Of the 292 persons with a first stroke, 251 (86%) (mean age 70 years) survived greater than 1 week. The mean Rankin disability score (Grade 1, no disability, through Grade 5, severe disability) changed from 1.7 before stroke to 2.8 in survivors at hospital discharge; 29% of those discharged required further institutional care. The level of disability in survivors remained relatively constant from 6 months after stroke through 5 years of observation. Of the 112 patients with an admission score of 5, 40 (36%) were alive at 1 year and only 5 of those (13%) improved to relative independence (Rankin scores of 1 or 2). The most common comorbidity contributing to disability was cardiovascular disease (31%). After the first 18 months, the mortality in patients with stroke was similar to that in a normal population having the same age and sex distribution. Of the 251 1-week survivors, 132 (53%) had rehabilitation (physiatrist) evaluations, 127 (51%) received physical therapy, 103 (41%) received occupational therapy, and 33 (13%) received speech therapy. Thirty-four of the 132 patients (26%) referred for rehabilitation evaluations were transferred to the rehabilitation unit.

Aged↗

PubMedDate not supplied

Clinical use of amantadine in brain injury rehabilitation.

We retrospectively reviewed the charts of 12 subjects with brain injury who were treated with amantadine. Ten of the 12 subjects exhibited some improvement in cognitive and/or physical function while on amantadine. Areas most consistently showing improvement included focused and sustained attention and concentration, orientation, alertness, arousal, processing, time, and psychomotor speed, mobility, vocalization, agitation, anxiety and participation in therapy. Two of the three subjects with severe agitation showed dramatic resolution of the agitation. Eight of nine low-arousal subjects displayed an increased level of responsiveness. Areas with inconsistent response included memory, assaultiveness, and confusion. No response was seen in depression or sexual inappropriateness. Possible side-effects of amantadine were noted in five of the 12 subjects, and included pedal oedema, hypomania, generalized seizure, and visual hallucinations. This work suggests amantadine may play a role in neurobehavioural recovery of brain injury, and demonstrates the need for more in-depth study.

Adult↗

PubMedDate not supplied

Amenorrhea.

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Amenorrhea↗