Improved phonation during fever in brainstem dysarthrophonia.
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Adult↗
Biomedical subjects
Z Groswasser
Publications and source records attributed to Z Groswasser.
[Periarticular new bone formation associated with head injuries].
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Coma↗
Heterotopic new bone formation in the cervical spine following head injury. Case report.
Heterotopic new bone formation, associated with head injuries, usually affects the shoulder, elbow, and hip joints. The authors present a case with an unusual involvement of the cervical spine, confirmed by bone scanning and computerized tomography. Although the etiology of heterotopic new bone formation is not well understood, factors such as minor local trauma and increased release of growth hormone are considered as possible contributors. The role of drugs and surgery is discussed.
Adult↗
Pattern- and flash-evoked potentials in the assessment and management of optic nerve gliomas.
Visual evoked potentials were recorded in 25 young patients with optic nerve glioma. In only eight patients could pattern responses be recorded from the affected eyes and these were invariably abnormal. In nine cases with no pattern responses it was still possible to elicit flash responses from the affected eyes. Six patients showed pattern evoked potential changes indicating involvement of fibres from the fellow eye crossing at the chiasm. Serial recording showed a remarkable improvement in the pattern responses of two patients. Flash responses were far less sensitive and less reliable than pattern responses in monitoring patients.
Adolescent↗
Survivors of severe traumatic brain injury in childhood. II. Late residual disability.
36 survivors of very severe traumatic childhood brain injury have been followed for a median period of 48 months after injury. One remains in a vegetative state and 35 have been discharged. 34 regained ambulation, and motor function became essentially normal in 14 of them. Ataxia and movement disorders were as common among the residua as was spasticity. Only one child remained aphasic, but 14 showed dysarthria. Six of the 36 showed major dementia and most of the rest showed very significant new impairment of cognitive and social function. This impairment was greater than expected from changes in the I.Q. Motor and speech function showed prolonged recovery while learning ability and social function did not. The overall degree of recovery seems not much better in these children than in adults.
Adolescent↗
Divided attention in brain-injured patients.
Clinical observations have shown that brain-injured patients perform poorly in tasks requiring attention. While selective and sustained attention has been extensively investigated, there is little systematic information on how brain-injured patients perform on divided attention tasks requiring simultaneous handling of and responding to two sources of information. This study was designed to analyse the behavior of hospitalized brain-injured patients as compared with matched normal controls in performing a dual task consisting of pursuit motor tracking coupled with delayed digit recall (DDR). Four two-minute trials were given. Time on target (TOT) and number of recall errors were recorded. It was assumed that the brain-injured group would (a) have lower TOT and more recall errors; and (b) show less learning effect. Results confirmed both expectations: (1) for the brain-injured group, TOT was lower and did not improve across trials; moreover, the number of recall errors was higher, increasing across trials; (2) for the control group, the number of recall errors was negligible across trials and TOT improved with time; (3) the normal trade-off between two simultaneous difficult tasks was not observed in the brain-injured group as they failed in both tasks; (4) the number of recall errors of the brain-injured subjects markedly increased towards the end of each trial, suggesting rapidly increasing fatigue. Thus, brain-injured patients appeared limited not only in their attention capacity but also in the variety of strategies they employ in processing information.
Adult↗
Attention capacity limitation, psychiatric parameters and their impact on work involvement following brain injury.
A follow-up study conducted among brain-injured patients explored the correlation between attention capacity limitation and psychiatric parameters as well as their impact on work involvement, two years after hospitalization. Capacity limitation was identified as difficulties in dual-task performance which requires simultaneous attention and response to two sources of stimulation. Poor performance on one or both tasks included in the dual-task paradigm (pursuit motor tracking task and a verbal task) was correlated with psychiatric parameters of behavior, personality and thought. This also correlated with the inability reported by the patients to concentrate for long periods of time and to the feeling of fatigue after physical and mental effort. In addition, it was found that dual-task performance correlated with work involvement. It was concluded that there is a reciprocal relationship between the variables studied. Attention capacity limitations are manifested in various psychiatric parameters; conversely, some psychiatric parameters affect the performance on the dual-task. This highlights the difficulty such patients have in coping with work demands and their consequent inability to maintain steady employment.
Adult↗
Behavioral disturbances as an expression of severity of cerebral damage.
The present study was designed to validate our ongoing clinical observations, which reveal that distinct clusters of psychiatric symptoms tend to develop following mild or severe brain injury, independently of injury location. These clusters are termed "Extroversion" and "Introversion" syndromes respectively. The symptoms constituting each syndrome manifest themselves along four domains: behavior, personality, affect and cognition. The study sample included 85 brain-injured patients recalled for a follow-up examination 2-3 years after discharge from hospital. Classification into Extroversion and Introversion was done on the basis of a structured psychiatric interview. Severity of brain damage was independently assessed by combinations of five parameters: unconsciousness and PTA duration, cognitive deficiencies, communication and locomotor disorders. The results supported our clinical observations, suggesting that severity of brain damage could also be assessed by the nature of psychiatric symptomatology exhibited following the injury.
Adolescent↗
Day Center experience in rehabilitation of craniocerebral injured patients.
The Day Center for head-injured patients specialises in treating patients at later stages following brain trauma. The goal of therapy is social reintegration as measured by the quality of family and social life and by actual occupational status. At this later stage, a year or more since injury, the cognitive and behavioral aspects of brain damage determine the outcome of rehabilitation. The therapy aims at preserving as well as improving patients' overall performance including family life and therefore their families are treated as well. As the patients are not hospitalised at this stage, the asset of this model is that it constitutes an arresting factor in preventing regressive attitudes acquired during hospitalisation which is a sheltered framework. The Day Center System encourages the patients to cope "in vivo" with reality, while the therapy given strives at providing them with the instruments needed for coping in actual life situations. We present here our experience in 38 patients admitted consecutively during the course of a year. The results show that the therapeutic milieu was of great help in preserving as well as improvement patients' performance; furthermore, it is evident that some improvement was achieved even after several years post trauma.
Adolescent↗
Survivors of severe traumatic brain injury in childhood. I. Incidence, background and hospital course.
Survivors of severe craniocerebral injury in childhood require prolonged rehabilitation care. We have surveyed the incidence, social characteristics and early hospital course of such patients in Israel. Yearly incidence was 1:100,000. Thirty-six patients were surveyed. Thirteen of these patients (36%) were described as suffering from cognitive deficits prior to injury and in 11 families (30%), the parent pair showed disturbed function before the injury. Thirty-three of the patients (92%) were victims of road accidents, the child being a pedestrian in 70% of these. Duration of coma was over 1 week in all the children but one, and only a minority of the children underwent neurosurgical interventions. The data on premorbid disturbed function are highly suggestive but not conclusive in the absence of a relevant control group. However, the findings are in accord with findings in adult craniocerebral injured patients in whom recognizable social factors seem clearly associated with craniocerebral injury.
Accidents, Traffic↗
Age and aphasic syndromes.
275 patients with CVA and 62 with CCI were examined within one month of the event and again, after 4-6 months. Previous reports have indicated that the average age of patients with Wernicke's aphasia is significantly higher than that of Broca's aphasia. Our findings after the second examination, support these reports. First month examinations, however, showed only a weak trend, lacking statistical significance. Our findings did not show more fluent aphasia in older patients than in younger ones. There is minimal literature on the positive relationship between age and auditory comprehension in aphasia. We found this to be the most highly correlated relationship. Our studies emphasize the importance of changes during the early post-event period in comparing aphasic syndromes in older versus younger patients, since there is a clear shift in the age/syndrome relationship in that period. Age differences in such changes can affect prognosis for rehabilitation.
Adult↗
Auditory perpetual dysfunction in patients with CCI, with implications for therapy.
Injury to the head, as from impact, can result in damaged function of the auditory receptive (peripheral) or perceptual (central) system, or both. The altered function may be clearly apparent, as in a loss of hearing, or may be exposed only through specially devised tests. At the Loewenstein Rehabilitation Hospital tests were designed or adapted to evaluate processing in the auditory periphery, the brain stem and the cortex. With speech as the the stimulus the tasks explore binaural interaction, cerebral hemisphere dominance and suppression, and cognitive efficiency in understanding degraded speech messages. Other stimuli, such as pure tones and musical patterns are employed to reveal dysfunction on various levels of the system. This report concentrates on tests which require the cerebral hemispheres to listen competitively. Results are given for earphone listening and for two new types of selective listening tasks in the sound field (loudspeaker) mode.
Adult↗
Rehabilitation outcome of combat head injuries: comparison of October 1973 War and Lebanon War, 1982.
A comparative study between two series of penetrating head injuries that occurred during the October 1973 (Yom Kippur) War and the Lebanon War, 1982, was conducted following the clinical impression that patients wounded in 1982 experienced shorter periods of unconsciousness. Patients in both series were of similar age and educational levels. Duration of coma was shorter, transfer to rehabilitation hospitals quicker and the overall hospital stay shorter, all significantly so, in the 1982 series. Other significant differences were the abundance of associated chest and abdominal injuries in the 1982 series and the fact that not a single patient underwent tracheostomy in the later series, in contrast to 64% of the 1973 patients. No differences were noted with regard to neurological sequelae, independence in activities of daily living, and high mental functions. Rehabilitation outcome, as evaluated by actual work placement, differed significantly in favor of the 1982 series. This was probably due to faster patient transfer to rear hospitals for definitive interventions, thus reducing secondary brain damage and resulting in shorter periods of unconsciousness.
Adolescent↗
Rehabilitation outcome of brain damaged patients after severe head injury.
The multidisciplinary team approach to the prolonged treatment of head injured patients in widely discussed. The rehabilitation process of the 147 subjects of this paper started while they were comatose and continued throughout the various stages of their progress towards full integration into society; the assessment of this process was carried out by testing their reintegration into work according to their capacities. Brain damage is classified in four categories: Physical-locomotor, communicative, cognitive and behavioural. The gap between the team's expectations and the patients' factual functioning within the community was found to be proportional to the extent of damage caused by the original injury. Treatment procedures and the influence of various factors on the factual functional state are discussed at length.
Adolescent↗
Re-evaluation of prognostic factors in rehabilitation after severe head injury. Assessment thirty months after trauma.
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Behavior↗
Prognostic factors in rehabilitation after severe head injury. Assessment six months after trauma.
After initial neurosurgical treatment, 40 patients who regained consciousness 1 to 90 days after major cerebral trauma, were admitted for rehabilitation. Six months after their injury they were assessed in terms of: 1) Locomotor function, 2) Intellectual performance, 3) Communication disorder, and 4) behaviour disturbances. The usefulness of these parameters as prognostic factors in rehabilitation is discussed. Eight patients without significant disabilities in all 4 parameters returned to normal life. Patients who showed locomotor, communicative and behaviour impairment but no gross intellectual deficits, were considered capable of being retrained. The poorest prospects for social and vocational rehabilitation were found in 15 patients with cognitive defects.
Adult↗
Rehabilitation after severe head injury.
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Accidents, Traffic↗
Incidence, CT findings and rehabilitation outcome of patients with communicative hydrocephalus following severe head injury.
Communicative hydrocephalus (CH) is considered as one of the late sequelae of severe craniocerebral injury. However, as most of the series of patients with CH described in the literature deal with the results of various shunting procedures, the incidence of post-traumatic communicative hydrocephalus is not documented. We have found that almost 3.9% of 335 severe craniocerebral-injured patients develop communicative hydrocephalus. These patients were unconscious for various periods of time, therefore the triad described by Hakim and Adams cannot by itself lead the clinician to suspect possible development of communicative hydrocephalus. It is suggested that in prolonged coma, or in the presence of arrest in clinical progress in conscious craniocerebral-injured patients, communicative hydrocephalus should be suspected.
Activities of Daily Living↗