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Biomedical subjects

Z Groswasser

Publications and source records attributed to Z Groswasser.

At least 37 records · Page 2Linked to original sources
PubMed1996

Vocational outcome of aphasic patients following severe traumatic brain injury.

The incidence and course of aphasia, and its impact on vocational outcome, were determined in a group of 351 patients with severe traumatic brain injury (TBI). Aphasia was found in 11.1%, the common forms being amnestic (56%, 22/39), expressive (10.3%, 4/39) and receptive (10.5%, 8/39), as found on the first language assessment. No age difference was found between the aphasic and non-aphasic patients. Coma was more common in the aphasics than the non-aphasics (95% and 82%, respectively), although its mean duration was shorter. Aphasics had more severe locomotor deficits (p < 0.01, Fisher test) and tended towards more severe cognitive disorders (p = 0.07, Fisher test). There was no difference between the groups in incidence of behavioural disturbances or occupational outcome. Most of the aphasic patients improved after therapy, and two recovered completely. The presence of aphasia did not have negative prognostic implications for occupational outcome.

Activities of Daily Living↗
PubMed1995

Stroop color-word task as a measure of selective attention: efficiency in closed-head-injured patients.

Deficits in attention and concentration are reported to be among the most common symptoms following head injury. Various underlying mechanisms of selective attention such as excitation, inhibition, and habituation have been isolated in recent studies. In the present study 27 control and 25 closed-head-injured (CHI) subjects were compared on four conditions based on the Stroop color-word task (neutral, habituation, Stroop, and negative priming). Cross-comparison of the different tasks enables examination of the various components of selective attention. The hypothesis that the control group's overall reading time would be faster than that of the CHI group was confirmed. Also confirmed was the hypothesis that the overall reading time pattern between task conditions would be neutral < habituation < Stroop < negative priming. The prediction that the CHI patients, due to their impaired inhibitory mechanism, would not show a slower reading time on the negative priming as compared to the Stroop condition, was confirmed as well. The theoretical and diagnostic implications of the results are discussed.

Adolescent↗
PubMed1994

Head-injured patients and control group: implicit versus explicit measures of frequency of occurrence.

This study was conducted in order to investigate the possibility that effortful processes are involved in the retrieval stage of the putative automatic task-frequency judgment. Head-injured (HI) and control groups were tested on a frequency of occurrence task under explicit-intentional retrieval (i.e., frequency estimation) and implicit-unintentional retrieval (i.e., word-stem priming) conditions. Subjects were presented with a list of nouns that appeared once, three times, and six times. Following presentation, subjects were first given a priming task, then a recall task, and finally a frequency judgment task. Although the control group performed better than the HI group on recall and frequency judgment tasks, the groups did not differ on the priming task. The results are discussed in terms of the relationship between effortful and automatic memory processes.

Adolescent↗
PubMed1994

Follow-up studies of somatosensory evoked potentials and auditory brainstem evoked potentials in patients with post-coma unawareness (PCU) of traumatic brain injury.

Some patients who suffer severe traumatic brain injury (TBI) fail to recover higher brain functions in spite of giving the appearance of sleep-wake cycles. Such a state is called post-coma unawareness (PCU) and varies in type and degree. Patients may remain in this state for months or even years. This study focused on the follow-up of upper-limb somatosensory evoked potential (USEP) measurements and auditory brainstem responses (ABR), with an emphasis on dynamic changes, in 10 patients with PCU resulting from TBI. The prognostic value of USEP and ABR was evaluated. Results showed that the presence of ABR in PCU patients had no prognostic value, because ABRs were found both in patients who recovered and those who did not, even a year after the trauma. The presence of normal ABR in PCU patients may suggest that the brainstem has been spared in the pathoanatomy of the PCU condition, with the significant damage occurring above this level, in cortical and subcortical (that is, hemispheral) areas. USEP was graded using the new system of Houlden [1] for 'acute' comatose patients. It was found that USEP measurements had some prognostic value in PCU patients. Most of the patients who remained in the PCU state had grade 2 or less initially, whereas most of the patients who later recovered or achieved at least a 'reduced life' state were grade 4 or more. On initial testing (when all patients were still in the PCU state), defined cortical potential (mainly in the slope of the building NI potential) was seen in only some of the patients who later recovered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Upper limb somatosensory evoked potentials as a predictor of rehabilitation progress in dominant hemisphere stroke patients.

BACKGROUND AND PURPOSE: The aim of this study was to determine the predictive yield of upper limb short latency somatosensory evoked potential (USEP) in patients with first stroke in the dominant hemisphere. METHODS: Nineteen patients (average age, 58 years) were evaluated twice: on arrival at the rehabilitation center, approximately 3 weeks after the stroke, and again approximately 10 weeks later. The clinical assessment included a quantitative evaluation of motor ability, independence in activities of daily living, and communication ability. USEP was recorded during the week of the initial clinical evaluation. Special attention was paid to the relations between USEP parameters and the dynamics of the clinical condition. RESULTS: The seven patients in whom no cortical potential could be detected showed the worst outcomes; however, the existence of cortical potentials in the remaining 12 patients did not provide a precise prediction of their "rehabilitative capacity" (ie, the extent of their progress). A correlation was established between the amplitude of the potentials recorded over both hemispheres and changes in communication ability. Additional findings included an association between shortened central conduction time over the damaged hemisphere during the first month after stroke and improvement in motor ability. CONCLUSIONS: USEP can serve as an adjuvant tool for predicting the recovery progress of stroke patients.

Adult↗
PubMed1993

Late CT findings in brain trauma: relationship to cognitive and behavioral sequelae and to vocational outcome.

OBJECTIVE: The purpose of this study was to determine the degree of correlation between cerebral atrophy observed on CT scans after severe blunt brain trauma and later neuropsychological status, as well as to evaluate the relative prognostic values of a number of indexes of cerebral atrophy. MATERIALS AND METHODS: The study group comprised 32 previously healthy men 18-65 years old who had severe blunt trauma of the brain (initial scores on Glasgow coma scale of 7 or less). Their cognitive and behavioral statuses were evaluated when the patients were discharged from the hospital, which occurred when the recovery process showed a plateau. Overall vocational status was evaluated 1 year after discharge. The clinical evaluation was performed by a multidisciplinary team. Multiple linear indexes derived from brain CT scans obtained about 3 months after injury in patients with blunt brain trauma were correlated with cognitive and behavioral sequelae of brain damage and with vocational placement, as evaluated by a rehabilitation team about 1 year after trauma. RESULTS: A high correlation was found between the width of the third ventricle and outcome. The prognostic value of the width of the third ventricle was superior to that of any other index studied, and it correlated best with late cognitive status (Spearman r = .57, p < .01). CONCLUSION: The width of the third ventricle is a useful prognostic index in cases of diffuse brain trauma. It indicates diencephalic atrophy, caused either by diffuse axonal injury or by hypoxia. It may indicate a role of diencephalic structures in higher cortical functions.

Adolescent↗
PubMed1992

Is the appearance of periarticular new bone formation related to local neurological disability?

The present work examined the relationship between the appearance of periarticular new bone formation (PNBF) and the presence of local sensorimotor disability, and the relationship between PNBF and the severity of the motor disability. The study population consisted of 18 patients with spinal cord lesions and 18 patients with traumatic brain injury. The confinement of PNBF below the level of neurological deficit in patients with spinal cord lesions, and mainly to paralysed or paretic limbs in brain injured patients, indicates a possible causal relationship between the presence of sensorimotor disability and PNBF. On the other hand, the high incidence of bilateral PNBF in patients with incomplete spinal lesions and the appearance of PNBF in some nonplegic and even paretic limbs in the brain injured patients, demonstrates the lack of connection between the severity of the motor deficit and the risk of PNBF. It is suggested that local factors which are related to sensorimotor disability are probably involved in PNBF induction, but additional elements may also play a role in the induction of PNBF and in its propagation.

Adolescent↗
PubMed1992

Temporally related changes of sleep complaints in traumatic brain injured patients.

Sleep complaints were obtained from 22 hospitalised patients with traumatic brain injury of recent onset (median 3.5 months after injury) and were compared with those of 77 discharged patients who had sustained brain injury about two to three years (median 29.5 months) previously. A high incidence of sleep complaints was noted in both groups (72.7% and 51.9% respectively). Disorders in initiating and maintaining sleep (DIMS) were the most common complaints among hospitalised patients (81.2%), whereas disorders of excessive somnolence (DOES) were common in discharged patients (72.5%). This difference in the nature of the complaints was apparently due to differences between the two groups in the time elapsed since injury, duration of coma, and immediate environmental conditions. In discharged patients with sleep complaints, neurobehavioural impairments and a poorer occupational outcome were more common than in those discharged patients without sleep complaints. It is suggested that early evaluation and treatment of sleep disturbances must be considered an integral part of the rehabilitation process.

Adult↗
PubMed1991

Medical complications and mortality of patients in the postcomatose unawareness (PC-U) state.

Almost half of all patients with traumatic brain injury who remain unconscious for more than one month will not recover consciousness and will remain in a state of prolonged postcomatose unawareness (PC-U). The aim of this work is to present the survival rate and medical complications of such patients. The survival time of the 62 patients studied ranged from 2 to 115 months, with a median of 15.5 +/- 22 months. Cumulative mortality figures were 15% at 3 months, 40% at 6 months and 60% and the end of the first year. The figures at the end of the second, third and fifth years were 86%, 87% and 94%, respectively. This type of data may aid in decisions regarding the management of these patients. The longer survival with better treatment of patients in a state of PC-U poses severe ethical, medical, legal and economic problems with which society will have to deal.

Adult↗
PubMed1991

Covariance analysis of laboratory variance in steady-state serum phenytoin concentrations.

Inpatients (n = 57) on long term prophylaxis with 2 oral phenytoin preparations were followed up via monthly checks of serum drug concentrations. Duplicate serum aliquots were submitted to 2 laboratories, and covariance analysis was used to estimate laboratory error. The laboratory-associated variance of examinations using the 'EMIT' or 'TDX' systems was 7.1 to 10 (mg/L)2, while that of chromatographic assays was 37.1 (mg/L)2. Laboratory errors were distributed in a non-normal fashion. The ratio of the maximum rate of metabolism (Vmax) and the Michaelis-Menten constant (Km) tended to remain constant between individuals. A linear analytical model showed little more residual variance than one based on Michaelis-Menten pharmacokinetics.

Administration, Oral↗
PubMed1990

Outcome in 134 patients with prolonged posttraumatic unawareness. Part 1: Parameters determining late recovery of consciousness.

A retrospective study of 134 patients in a condition of prolonged unawareness state (that is, in coma for over 1 month) following brain trauma was conducted in order to identify prognostic factors. Eight easily evaluated parameters were found to be significant for predicting nonrecovery of consciousness. The following six features were present during the early posttraumatic phase (that is, during the 1st week after trauma): fever of central origin; diffuse body sweating; disturbances in antidiuretic hormone secretion; abnormal motor reactivity; respiratory disturbances; and diffuse nonneurological injuries. The first three features were manifestations of hypothalamic damage. Two factors, evident at a late phase following injury (after the 1st week posttrauma), namely late epilepsy and communicating hydrocephalus, were also significant in predicting nonrecovery.

Adolescent↗
PubMed1990

Outcome in 134 patients with prolonged posttraumatic unawareness. Part 2: Functional outcome of 72 patients recovering consciousness.

Most publications regarding the outcome of traumatic brain injury include patients with periods of unconsciousness of varying durations. The aim of the present paper is to describe the outcome of 72 patients who suffered from prolonged unawareness for more than 30 days and subsequently recovered consciousness. Almost half of the patients were independent in activities of daily living and another 20% were only partially dependent. Cognitive and behavioral deficits were the most common central nervous system sequelae of injury. Eight patients (11.1%) were able to resume working in the open job market and 35 (48.6%) were engaged in sheltered workshops. Most of the patients (72%), including all those who were working, were living with their families. Although the mean rehabilitation period was about 15 months, over 70% of these severely injured patients are considered to be socially integrated, enabling them to enjoy a reasonable quality of life.

Activities of Daily Living↗
PubMed1990

Long-term follow-up review of 31 children with severe closed head trauma.

Thirty-one children aged 3 to 15 years were followed for 5 to 11 years after suffering severe closed head trauma which caused coma for 1 week or more (median duration of coma 3 weeks). One patient remained in a persistent vegetative state until his death 9 years later. The other 30 recovered consciousness and were discharged. All suffered diminution of their abilities, and 24 of them had major permanent disability. The most common motor disabilities were pure spastic hemiparesis (seven cases), basal ganglia syndromes (four cases), ataxia (three cases), and a combination of hemiparesis and ataxia (five cases). Of the 30 patients, 26 regained independent ambulation, seven were epileptic, and 14 were dysarthric in various degrees. Only 10 had the cognitive ability to profit from the normal educational system, and none had attempted postsecondary education. Social problems were common. The worst outcomes were associated with intracranial bleeding and/or brain contusion seen on computerized tomography (CT) scans at the acute stage; the best were associated with normal CT scans. The degree of residual disability in these children seems no less than that of adults with trauma of similar severity.

Adolescent↗
PubMed1989

Standing posture of craniocerebral injured patients: bi-lateral reactive force patterns.

Bi-lateral force measurements on the supporting limbs in postural sway while standing still were carried out to evaluate postural stability of craniocerebral injured (CCI) patients. Brain pathology of these patients was characterised by CT scans and MRI, as well as by their cognitive and behavioural disturbances. Normal subjects of the same age group were tested as controls. From the force tracings obtained, three oscillation frequencies were identified, with orders of magnitudes of 6, 1.5 and 0.1 Hz, respectively, of which the middle frequency, i.e. that corresponding to 1.5 Hz, was selected for subsequent processing and analysis, which included the determination of relative sequence of the force vectors on both feet and evaluation of timings and amplitudes of the waveforms. Weight-bearing imbalance was defined in the vertical direction to express the difference between the average forces supported by each of the legs. In the horizontal plane, two parameters were defined: Sway Total Activity (SA), to represent the vector summation of the absolute values of the horizontal force components acting on both legs; and Asymmetry (ASYM), to express the difference in activities between the two legs. The results presented disclose the reactive force patterns acting on each of the legs of CCI individuals, in comparison with normal individuals. Although the forces were shown to act synchronously on both legs, in most of the patients, they appeared to be asymmetrical in nature, with a typical vectorial pattern for every individual, which generally differed from that of normal subjects. Sway activity was found to be significantly higher in the CCI group as compared with that of the normal controls. These results justify the necessity to study the activity of each of the legs, rather than that corresponding to the resultant forces acting on the whole body, when treating the external forces involved in the stabilisation and regulation of the standing posture of these patients. An attempt to grade the patients according to ascending order of neurological deficits disclosed that their sway disturbances, as revealed by the magnitude of sway total activity and asymmetry, had a tendency to be related to the severity of neurobehavioural disturbances.

Adult↗
PubMed1989

Rehabilitation outcome after anoxic brain damage.

Outcome was analyzed in a group of 31 patients who were comatose for more than 24 hours after cardiopulmonary arrest and were thereafter referred for inpatient rehabilitation. Seventeen regained functional ambulation, 20 regained oral communication, and 13 regained full independence in activities of daily living. Two regained their approximate previous cognitive level, and one regained his previous level of employment. These outcomes are strikingly inferior to those of patients with prolonged coma after craniocerebral trauma who were hospitalized in the same center during the same period. Both age and coma duration were correlated with outcome. The relatively better outcomes were seen in patients who were 25 years or younger at the time of anoxic injury, and whose coma lasted less than 24 hours.

Activities of Daily Living↗
PubMed1988

Mutism associated with buccofacial apraxia and bihemispheric lesions.

Mutism following brain trauma is quite common, is usually transient, and recovery of speech is essentially the rule. Lasting total absence of speech without aphasia is highly unusual. Three such patients, two of traumatic and one due to vascular origin showing buccofacial apraxia (BFA) and computerized tomography (CT) evidence of bilateral frontal lesions are reported. It is suggested that complete lasting mutism associated with BFA is a result of bihemispheric lesions affecting mainly the opercular part of the inferior frontal gyrus and immediate adjacent regions.

Adult↗
PubMed1987

Magnetic resonance imaging in head injured patients with normal late computed tomography scans.

In 11 patients who had undergone blunt head injuries, computed tomography (CT) scans of the brain performed 4-24 months posttrauma were normal. The patients showed a variety of cognitive and behavioral disturbances. Magnetic resonance imaging (MRI) studies revealed abnormalities that were mainly confined to the frontal and temporal lobes. Magnetic resonance imaging revealed signals of increased intensity compatible with old contusions, loss of discrimination between gray and white matter, and irregular brain contours. It is suggested that MRI of the brain is a more sensitive technique than CT in the detection of brain lesions during the late posttraumatic period, allowing a better understanding of the patient's clinical and neurobehavioral disturbances.

Adolescent↗