PubMed · 11103202
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J E Arrowsmith, S R Large. 2000. Off-pump revascularization and the brain.. https://pubmed.ncbi.nlm.nih.gov/11103202/
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PURPOSE: The aim of the present manuscript is to review current methods for classifying initial severity and final outcome in traumatic brain injury (TBI) and to suggest a direction and form of further research. METHOD: The literature on valid and reliable measurements used in TBI-research for classifying initial severity and final outcome was reviewed. RESULTS: Classifying initial severity in patients with head injury according to clinical condition or CT-parameters is valid. Classifying outcome according to measurement tools of disability showed adequate validity and reliability. CONCLUSIONS: Future research in TBI outcome, particularly in rehabilitation medicine, should focus on determinants of outcome, identifying those patients who will have the greatest chance of benefiting from intensive rehabilitation programmes. More research is needed to determine the long-term functional outcome in TBI, the long-term socio-economic costs, and the influence of behavioural problems on family cohesion. Finally, validation of outcome measures is required in the TBI-population; the relative value of various outcome measures needs to be determined, and the usefulness and applicability of measures for health related quality of life in TBI should be established.
Mirror writing occurs when individual letters and whole word strings are produced in reverse direction. By analogy, mirror reading refers to the preference to read mirror reversed over normally written words. These phenomena appear rarely after brain damage and offer insight into the nervous system's organization of visual-spatial and visual-motor representations. We present the case of a 51-year-old patient with persistent mirror writing and reading following traumatic brain injury. She preferred to write in the mirror direction with either hand. She drew asymmetric pictures with the same directional bias as normal right-handed subjects, and she did not exhibit left-right confusion regarding other pictures. By contrast, on picture-word matching and lexical decision tasks, she was faster and more accurate with mirrored than normally written words. This pattern of performance suggests that her behavior was not accounted for by reflected motor programs, or by the mirroring of visual-spatial representations in general. Rather, we suggest that her behavior was produced by privileged access to mirrored graphemes. Furthermore, because she seemed better able to read irregular words in mirrored than in normal formats, we suggest that mirrored representations may exist at the whole word level and not simply at the letter level.
Patients with severe head trauma were studied retrospectively to determine if Data Envelopment Analysis (DEA) could successfully model patients early in their stay in an intensive care unit. Variables examined were cerebral perfusion pressure, body temperature, mean arterial pressure, serum osmolarity and pCO2. Unlike regression-based models that focus on mean values for the group, DEA evaluates each patient individually calculating an "efficiency" score based on a patient's ability to maximize output for a given set of physiologic inputs. Patients with high efficiency scores were found to have a better chance of making a full recovery than similarly injured patients that were inefficient. This approach needs further study but may offer physicians the opportunity to improve patient outcome subject to the manipulation of individual variables from the results of a DEA model rather than aiming for normal or average physiologic values.