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Biomedical subjects

R L Bruno

Publications and source records attributed to R L Bruno.

5 recordsLinked to original sources
PubMed1992

Driving after cerebral damage: a model with implications for evaluation.

Evaluation of the ability of cerebrally injured patients to return to driving is an important task for rehabilitation specialists. These evaluations require predictively valid methods of assessment based on identification of relevant skills and abilities. The present study tested a hypothetical model for driving after cerebral injury and determined its use in evaluating fitness to drive. Thirty-five patients with cerebral damage due to head injury or cerebrovascular accident participated in the study. All were administered (a) a predriver evaluation, that is, a battery of neuropsychological tests chosen a priori to test the model, (b) a simulator evaluation, and (c) a behind-the-wheel evaluation consisting of driving on a protected course and in traffic. The results showed that 93% of the driving outcome in traffic was explained cumulatively by findings from the predriver and simulator evaluations as well as from behavioral and operational measures during evaluation on the protected lot. These results supported the predictive validity of the model and are discussed in terms of methodology for evaluation of return to driving.

Adolescent↗
PubMed1991

The psychology of polio as prelude to post-polio sequelae: behavior modification and psychotherapy.

Even as the physical causes and treatments for post-polio sequelae (PPS) are being identified, psychological symptoms--chronic stress, anxiety, depression, and compulsive, Type A behavior--are becoming evident in polio survivors. Importantly, these symptoms are not only causing marked distress but are preventing patients from making the lifestyle changes necessary to treat their PPS. Neither clinicians nor polio survivors have paid sufficient attention to the acute polio experience, its conditioning of life-long patterns of behavior, its relationship to the development of PPS, and its effect on the ability of individuals to cope with and treat their new symptoms. We describe the acute polio and post-polio experiences on the basis of patient histories, relate the experience of polio to the development of compulsive, Type A behavior, link these behaviors to the physical and psychological symptoms reported in the National Post-Polio Surveys, and present a multimodal behavioral approach to treatment.

Activities of Daily Living↗
PubMed1991

Polioencephalitis, stress, and the etiology of post-polio sequelae.

Post-mortem neurohistopathologies that document polio virus-induced lesions in reticular formation and hypothalamic, thalamic, peptidergic, and monoaminergic neurons in the brain are reviewed from 158 individuals who contracted polio before 1950. This polioencephalitis was found to occur in every case of poliomyelitis, even those without evidence of damage to spinal motor neurons. These findings, in combination with data from the 1990 National Post-Polio Survey and new magnetic resonance imaging studies documenting post-encephalitis-like lesions in the brains of polio survivors, are used to present two hypotheses: 1) polioencephalitic damage to aging reticular activating system and monoaminergic neurons is responsible for post-polio fatigue, and 2) polioencephalitic damage to enkephalin-producing neurons is responsible for hypersensitivity to pain in polio survivors. In addition, the antimetabolic action of glucocorticoids on polio-damaged, metabolically vulnerable neurons may be responsible for the fatigue and muscle weakness reported by polio survivors during emotional stress.

Brain↗