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T Galski

Publications and source records attributed to T Galski.

17 recordsLinked to original sources
PubMed2000

Effects of opioids on driving ability.

Driving has been regarded as an activity of daily living that is important in maintaining a person's independence in the community, access to employment, and social activities. Many patients, however, using opioid medications on a regular basis (Chronic Opioid Analgesic Therapy: COAT) to ameliorate their intractable pain have been restricted from driving out of concern that skills would be impaired and driving safety compromised by these medications. Yet there are no driving studies which have explored the effects of using opioid analgesics for an extended period of time. This pilot study was designed to determine the effects of medically prescribed, stable opioid use on the driving abilities of patients with persistent, nonmalignant pain. Sixteen patients with chronic nonmalignant pain on COAT, who met criteria for participation in the study, underwent a comprehensive off-road driving evaluation using measures which have been shown to be sensitive in predicting on-road driving performance. The evaluation consisted of a pre-driver evaluation (PDE), a simulator evaluation (SDE), and behavioral observation during simulator performance. Patients in the COAT group were compared to a historical control group of 327 cerebrally compromised patients (CComp) who had undergone the same evaluation and then passed an on-road, behind-the-wheel evaluation (BTW Pass; n = 162) or failed (BTW Fail; n = 165). Results revealed that COAT patients generally outperformed the CComp patients as a group by equaling or exceeding PDE and SDE scores of the BTW Fail patients as well as the BTW Pass patients on all measures that differentiated the groups. Notably, COAT patients had a relatively poorer performance than CComp patients on specific neuropsychometric tests in the PDE; however, the differences were not statistically significant and did not imply a systematic pattern of scores that reflected domain-specific deficits. Behaviorally, COAT patients were generally superior to CComp patients, also; however, COAT patients had greater difficulty in following instructions and as well as a tendency toward impulsivity, like the BTW fail group. While there was general support for the notion that COAT did not significantly impair the perception, cognition, coordination, and behavior measured in off-road tests that have been regarded as requisite for on-road driving, methodological problems may limit the generalizability of results and recommendations are made for research beyond a pilot study.

Analgesics, Opioid↗
PubMed2000

Evaluating fitness to drive after cerebral injury: basic issues and recommendations for medical and legal communities.

Specialists in rehabilitation are typically called upon to evaluate and render an opinion about whether or not a person can be entrusted to resume driving. And, because driving is an individual privilege to be balanced against the public's right to safety and protection from the dangers of a driver whose residual deficits may impede ability to drive safely, these specialists have developed a number of methods to assess fitness to drive. Unfortunately, many evaluators remain unfamiliar with research used as basis for evaluations or lack understanding of the strengths and weaknesses of tests in use. Therefore, there may be unquestioning trust in tests and methods that leads to errors of significant consequence in decisions about fitness to drive as well as unawareness of expanding risks of litigation that can emanate from inappropriate recommendations. This article intends to draw attention to issues, considerations, and problems underlying the conduct of driver evaluations, including focus on ways in which the legal and medical communities approach question of fitness, legal and medical definitions and terminology, responsibility for assessment as well as tests and methods used in evaluations. Conclusions are drawn from discussion of these matters and recommendations are outlined for addressing identified problems at the interface between medical and legal communities.

Automobile Driving↗
PubMed1998

Low back pain in college athletes. A prospective study correlating lower extremity overuse or acquired ligamentous laxity with low back pain.

STUDY DESIGN: A prospective evaluation of the incidence of low back pain in college athletes was undertaken. OBJECTIVES: To evaluate prospectively leg length discrepancy, hip flexor tightness, and lower extremity acquired laxity or overuse as predictive factors for low back pain in college athletes. SUMMARY OF BACKGROUND DATA: A pilot study found an association between low back pain and the factors to be studied. Several allusions to the kinetic chain theory appear in the literature, but little prospective research has been done in examining the effects of lower extremity involvement on the back. METHODS: Two-hundred fifty-seven college athletes representing nine varsity sports were screened during a preseason sports physical examination. Measures of flexibility, ligamentous stability, leg length discrepancy, and overuse syndromes were recorded. Athletes were observed throughout the ensuing year for low back pain requiring treatment by the athletic trainer. Those athletes with low back pain as the result of direct trauma to the region were excluded from the data. RESULTS: Twenty-four athletes (9.3%) received treatment for low back pain. Thirteen of 87 women (15%) compared with 11 of 170 men (6%) required treatment for low back pain (P = 0.048). Of 57 athletes with lower extremity acquired laxity or overuse, low back pain developed in 14 (P < 0.001). CONCLUSIONS: Athletes with lower extremity acquired ligamentous laxity or overuse may be at risk for the development of noncontact low back pain during athletic competition. Female athletes with lower extremity involvement appeared to have a higher incidence of low back pain treatment compared with their male counterparts. Inflexibility of the lower extremities or leg length discrepancy were not associated with future low back pain treatment.

Adult↗
PubMed1998

Competence in discourse as a measure of social integration and quality of life in persons with traumatic brain injury.

Persisting difficulties in communication are a serious handicap faced by many after traumatic brain injury (TBI) and a major barrier to community reintegration. Conventional approaches to the study of communication problems after TBI have focused on the form of language production and expression, usually in terms of phonological, semantic, and syntactical features. Most TBI patients, however, perform overall within normal ranges on these conventional indicators. More recently, attention has focused on language in its naturally-occurring form, that is, discourse, which is heavily influenced by linguistic, cognitive and social skills. Because most TBI patients are left with residual deficits in these areas, study of discourse abilities seem to be particularly suited to understanding their problems in communication and facilitating eventual reintegration into the community. This study was designed to determine if and how the conversational discourse of TBI patients differs from a matched non-TBI group and whether any identified variables are related to measures of outcome as measured by community integration and quality of life. Additionally, the study was designed to explore the relationship between TBI and features of discourse across conversational, narrative, procedural genres. TBI patients (n = 30) from an out-patient brain injury programme were compared to matched controls (n = 10) in the three discourse genres. Bivariate and multivariate analyses evaluated 23 measures of discourse efficiency, complexity, topic management, information and pragmatic behaviours in each genre as well as measures of psychosocial adjustment, particularly social integration and quality of life. Results indicated that TBIs were significantly different from controls on several measures of discourse and psychosocial adjustment. A number of other features of discourse were found to correlate significantly with social integration and quality of life. Interestingly, discourse variables appeared to correlate with social integration more strongly than age, gender, education, and other conventional psychosocial factors. Contrary to prediction, features of conversational discourse did not correlate more strongly than other types of discourse with social integration and quality of life. Discussion centred on the apparent comorbidity of features in everyday discourse and psychosocial determinants that were associated with quality of life and social integration.

Adult↗
PubMed1998

Estimates of driving abilities and skills in different conditions.

OBJECTIVES: This research was a preliminary effort to determine whether various driving situations seemed to require different driving skills and abilities and to identify the relative demands of specific physical, perceptual, cognitive, behavioral, and operational skills and abilities in different driving situations. METHOD: Experienced driver evaluators and trainers estimated the magnitude of driving abilities and skills for different photographed driving situations. Pictures of driving scenarios were counterbalanced for road type, traffic condition, and weather condition. RESULTS: A multifactorial analysis of variance of the total score for each scenario revealed significant main effects for road type and traffic condition but not for weather condition. Highway and city driving were rated as significantly more demanding overall than residential driving, but no difference was found between city and highway driving. Estimates of the overall demands for driving in heavy traffic were significantly greater than in light traffic. However, driving in inclement weather was not regarded as significantly more demanding than driving in sunny weather. Additionally, significant interaction effects were found for road type by weather condition and traffic by weather condition but not for road type by traffic condition. Through multivariate methods to evaluate the significance of individual abilities and skills across conditions, significant main and interactive effects were found for road type, traffic condition, and weather condition. Post hoc analyses showed the impact of these effects on such abilities and skills as scanning, attention and concentration, information-processing speed, and others. CONCLUSION: Evaluators' quantified estimates of driving demands showed driving as a complex task that (a) requires high levels of abilities and skills in all situations; (b) demands greater abilities in some situations than in others; and (c) involves different kinds and various degrees of abilities and skills, depending on the demand characteristics of the situation.

Adult↗
PubMed1997

Off-road driving evaluations for persons with cerebral injury: a factor analytic study of predriver and simulator testing.

OBJECTIVES: Off-road evaluations composed of psychometric testing and simulator driving are commonly used in rehabilitation settings to assess a person's fitness to resume driving after a cerebral injury. Although the results of these evaluation methods separately provide information about ability to drive, there is no clear understanding about what is measured in comprehensive off-road evaluations as a whole. This study explored the interrelationship of perceptual, cognitive, behavioral, and operational variables that form the basis for off-road evaluations in order to determine whether there are basic dimensions underlying performance in these evaluations and to derive a small set of variables that could help in refining methods for evaluating persons with cerebral injuries. METHODS: One-hundred six persons with cerebral damage due to brain injury or cerebrovascular accident were administered a predriver evaluation that consisted of selected neuropsychometric tests. Subjects were also evaluated in a driving simulator that measured their operational responses to filmed driving situations and assessed their behaviors. Principal component analysis was used to identify manifest and latent variables contributing to the results of the evaluations. RESULTS: The analysis produced a model with five independent (orthogonal) eigenvectors, or factors, for this population: Higher Order Visuospatial Abilities, Basic Visual Recognition and Responding, Anticipatory Braking, Defensive Steering, and Behavioral Manifestations of Complex Attention. These factors accounted for 66.14% of the total variance in the subjects' responses to comprehensive off-road evaluations. CONCLUSION: These factors were useful in understanding driving performance and the role of predriver and simulator testing in driver evaluations.

Adolescent↗
PubMed1995

Occurrence and impact of suspected delirium in hospitalized elderly patients.

The records of 95 consecutive people older than 65 years and admitted to a community hospital were retrospectively reviewed to determine the prevalence of undiagnosed delirium in hospitalized elderly patients. Chart review focused on identification of patients with documented diagnosed delirium according to Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) criteria and patients with unrecognized delirium. Unrecognized delirium was considered present when information contained in a patient's chart met some or all criteria for delirium as described in DSM-III-R, but the physician's progress notes failed to indicate delirium as a diagnosed clinical entity. The prevalence of diagnosed delirium was 2%. Thirty-six percent of the patients were suspected of having unrecognized delirium. The mean length of hospital stay and the rate of mortality were significantly higher for patients with suspected delirium than for non-delirious patients. The findings of this study suggest that unrecognized delirium in the hospitalized elderly may occur frequently and is associated with an increased length of hospital stay and increased mortality.

Age Distribution↗
PubMed1994

Predicting physical and verbal aggression on a brain trauma unit.

Brain injury often results in cognitive impairments and neurobehavioral deficits that effect recovery, rehabilitation, and general adjustment. Aggressive behaviors and agitation, well-known consequences of cerebral damage, are the most difficult for caregivers to evaluate and manage and the most stressful for patients and families. This study was designed to determine the efficacy of an observational protocol (Cognitive Behavioral Rating Scale, CBRS) in evaluating cognition and its usefulness with demographic, medical, and psychological information in predicting aggressive behaviors of cerebrally damaged patients. Twenty-eight brain-injured patients consecutively admitted to a brain injury unit were evaluated by nurses who used the CBRS after first establishing interrater reliability in using the instrument. Relationships were determined between results of the CBRS, demographic information, medical and psychological information; the variable in each category that was most highly correlated with aggressive behaviors was then used in a multiple linear regression to predict the frequency of aggressive behaviors. Discussion focused on disorientation to place and time as the most significant predictors of aggressive behaviors, as well as the prescriptive use of antiseizure medications and the number of medical comorbidities.

Adult↗
PubMed1994

The neuroanatomy of post-polio fatigue.

Fatigue is the most commonly reported, most debilitating, and most poorly understood Post-Polio Sequelae (PPS). Postmortem studies of 50 years ago documented frequent and severe poliovirus-induced lesions within the Reticular Activating System (RAS). Recently, neuropsychological testing has documented marked attention deficits in polio survivors reporting severe fatigue. However, neither of these findings has yet been related to the pathophysiology of post-polio fatigue. Magnetic resonance imaging of the brain was performed in 22 polio survivors carefully screened to eliminate the effect of comorbidities. Subjects rated the severity of their daily fatigue and subjective problems with attention, cognition, and memory. Small discrete or multiple punctate areas of hyperintense signal (HS) in the reticular formation, putamen, medial leminiscus, or white matter tracts were imaged in 55% of the subjects reporting high fatigue and in none of those reporting low fatigue. The presence of HS significantly correlated with fatigue severity and subjective problems in attention, concentration, staying awake, recent memory, and thinking clearly. The lack of significant correlations between HS or fatigue severity and age, severity of the acute polio, depressive symptoms, or difficulty sleeping militates against these factors as either causing HS or producing fatigue. These preliminary findings suggest that poliovirus-induced lesions in the Brain Activating System may underlie the subjective fatigue and attention deficits reported by polio survivors.

Adult↗
PubMed1993

The neuropsychology of post-polio fatigue.

To test the hypothesis that post-polio fatigue and its concomitant cognitive deficits are associated with an impairment of attention and not of higher-level cognitive processes, six carefully screened polio survivors were administered a battery of neuropsychological tests. Only subjects reporting severe fatigue, and not those with mild fatigue, demonstrated clinically significant deficits on all tests of attention, concentration, and information processing speed while showing no impairments of cognitive ability or verbal memory. These findings suggest that an impaired ability to maintain attention and rapidly process complex information appears to be a characteristic in polio survivors reporting severe fatigue, because these deficits were documented even when their subjective rating of fatigue was low. This finding supports the hypothesis that a polio-related impairment of selective attention underlies polio survivors' subjective experience of fatigue and cognitive problems.

Adult↗
PubMed1993

Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients. The dominant role of higher-order cognition.

BACKGROUND AND PURPOSE: Research in recent years has revealed factors that are important predictors of physical and functional rehabilitation: demographic variables, visual and perceptual impairments, and psychological and cognitive factors. However, there is a remaining uncertainty about prediction of outcome and a need to clinically apply research findings. This study was designed to identify the relative importance of medical, functional, demographic, and cognitive factors in predicting length of stay in rehabilitation, functional outcome, and recommendations for postdischarge continuation of services. METHODS: The influence of these factors was determined by comparing diagnostic, medical, demographic, functional, and neuropsychological information that was retrospectively obtained by reviewing the records of 86 patients admitted for comprehensive rehabilitation due to stroke (n = 36) or orthopedic injury (n = 50). Multiple linear regression with statistical adjustment to control for overprediction of variance was used to predict outcomes. RESULTS: The study revealed the primary importance of higher-order cognitive impairments (comprehension, judgment, short-term verbal memory, and abstract thinking) in extending length of stay and increasing referrals for outpatient therapies and home services after discharge for the cerebrovascular accident patients in comparison with orthopedic cohorts. CONCLUSIONS: The need is discussed for early, comprehensive assessment of deficits in cognition that affect a stroke survivor's ability to participate in a rehabilitation program and remediation that facilitates functional improvement by building on residuals of impaired abilities or teaching compensatory behaviors.

Aged↗
PubMed1993

Prediction of behind-the-wheel driving performance in patients with cerebral brain damage: a discriminant function analysis.

Rehabilitation specialists, particularly occupational therapists, are often involved in evaluating clients' fitness to resume driving after cerebral damage due to head injury or stroke. Their available methods include separate or combined administration of predriver, simulator, and behind-the-wheel evaluations. However, use of these methods without a theoretical model on which to base test selection has yielded some criticism and little research about the effectiveness of these methods in predicting driving performance. Using the authors' Cybernetic Model of Driving as the basis for assessing abilities and behaviors relevant to driving outcome, this study sought to determine the effectiveness of the evaluation methods by discriminant analysis and measurements of sensitivity in predicting behind-the-wheel failures. Comprehensive evaluations of 106 patients revealed that residual deficits in cognition per se did not render a person unfit to drive and underscored the importance of considering behaviors in determining fitness. The methods of evaluation were shown to be relatively sensitive in predicting outcome; off-road and on-road evaluation reached sensitivities of 90% and 92% with the inclusion of behavioral measures. Formulae for predicting outcome based on methods of evaluation are provided and reasons for failures in behind-the-wheel evaluations are discussed.

Adolescent↗
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↗
PubMed1990

An assessment of measures to predict the outcome of driving evaluations in patients with cerebral damage.

The evaluation of the ability of patients to return to driving after cerebral damage stands out as one of the most important tasks confronted by rehabilitation professionals. The present study was designed to critically assess evaluations that were developed at one facility to determine fitness to drive: an offroad, predriver evaluation of skills regarded as important in driving and an on-road, behind-the-wheel evaluation of abilities needed to drive in actual traffic situations. The evaluation results of 3-patients with cerebral damage due to traumatic head injury or cerebrovascular accident were studied retrospectively. Only 4 out of 21 items on the predriver evaluation significantly predicted the outcome of the predriver evaluation and none of the predriver evaluation items predicted the outcome of the behind-the-wheel evaluation. Only 6 of the 26 tasks on the behind-the-wheel evaluation significantly predicted the outcome of the behind-the-wheel evaluation. None of the items on the predriver evaluation or the behind-the-wheel evaluation explained a significant portion of variance related to outcome. The lack of internal and predictive validity of driver evaluations is discussed in light of these findings, and recommendations are given for improving the predictive power of driving evaluations.

Adolescent↗
PubMed1983

Hair pulling (trichotillomania).

Based on the findings in this case and common elements reported in other articles on trichotillomania, there seems to be evidence that the "irresistible urge" to pull out the hair has its beginnings in the early years of a child's life. The nature of the parent-child relationships appears to be especially important in establishing psychological antecedents for the later development of trichotillomania. Specifically, the trichotillomanic's mother sets the stage for the emergence of this symptom by extending the child's dependence upon her as the primary need-gratifier beyond early childhood into latency, adolescence, and adulthood. As a result the child is not gradually propelled to participate in newer and more complex learning experiences that ultimately lead to a sense of mastery and independent functioning in the environment. Important developmental stimuli are not presented at the appropriate times and the child is not exposed to certain types of interactions at the optimal times so that some very important ego functions do not develop, or develop minimally, or in a distorted manner. Simply, the mother cannot "let go" of her child, apparently deriving gratification of her own needs through infantilization of the child; as a result the child develops a limited or illusory sense of self sufficiency. Continuation of such an unhealthy symbiotic relationship, however, is found in many forms of psychopathology and the fact that it also underlies trichotillomania may partially account for hair pulling as a symptom associated with such a wide range of nosological categories. It is the main contention of this study, however, that the quality of the parent-child relationships impairs the ego development and causes failure of the trichotillomanic patient to establish object constancy. Without the establishment of object constancy an individual requires visible evidence that the object/person capable of gratifying basic security needs is present or available. In trichotillomania the hair seems to symbolize the need-gratifying object/person who is lost when the hair is pulled out and, more importantly, regained when it is eaten or restored. It appears to be this latter component of trichotillomania, i.e., reincorporation of the need-gratifying object/person, which reassures the patient that infantile needs can be gratified and security can be reestablished. Unfortunately, the trichotillomanic is driven to repeatedly and compulsively remove hair so that it can be regained temporarily since object constancy is never really established.

Adult↗
PubMedDate not supplied

Nurses' assessment of patients' cognitive orientation in a rehabilitation setting.

Orientation is a critical determinant of a patient's neurological status and an indicator of change in condition during hospitalization. The ways rehabilitation nurses assess orientation and the manner in which findings are interpreted and reported can have significant implications for the care of neurologically compromised patients. This study used a questionnaire to examine how 52 nurses appraised and reported the results of orientation evaluations. Analyses produced descriptive statistics and correlational measures for determining nurses' tendencies and consistency in evaluating orientation. Most respondents, regardless of their education and experience, used a clinical interview, rather than psychometric tests, as a basis for forming opinions about orientation. Although most evaluations included assessments in terms of person, time, place, and circumstance, no consistent pattern emerged regarding questioning or in the ways results were reported. Findings revealed a significant lack of consensus in terms of assessing and reporting orientation results, which could reflect insufficient awareness about the importance of maintaining consistency in evaluations, the relevance of using standardized evaluations and comparing measures over time, and the necessity of agreeing on how to report cognitive disturbances.

Adult↗