The neurorehabilitation of hemispatial neglect in patients with traumatic brain injury

Maria Pąchalska, Bogusław Frańczuk, Jan Talar, Wiesław Tomaszewski, Bruce MacQueen, Kay Neldon

Maria Pąchalska, Bogusław Frańczuk, Jan Talar, Wiesław Tomaszewski, Bruce MacQueen, Kay Neldon – The neurorehabilitation of hemispatial neglect in patients with traumatic brain injury. Fizjoterapia Polska 2001; 1(2); 143-154

Abstract
Background. The purpose of this article is to evaluate the relative effectiveness of differentiated rehabilitation programs for patients with hemispatial neglect subsequent to traumatic brain injury (TBI). In the literature, neglect is classified into two basic types: egocentric (“body-centered”), in which the patient neglect object situated in a given area of his field of vision, and allocentric )”objected-focused”), in which the patient neglects one side of objects presented to him, regardless of their location. The authors’ clinical practice indicates that the visual scanning technique traditionally used in neglect therapy is generally ineffective in patients with egocentric neglect. A spatio-motor training program has therefore been developed by the authors, elaborated on the basic of their program of semantically controlled motion patterns for the rehabilitation of apraxia, whose goal is to reestablish the proper relations between automatic and voluntary movements, to improve interhemisphere cooperation by symmetrical and asymmetrical modeling of motor exercises with both healthy and affected limbs, and to increase patient motivation by establishing clearcut goals and rewarding success. Both programs, visual scanning and spatio-motor training, have been implemented in clinical practice in the represented by the authors. Material and methods. The article describes in detail the rehabilitation of two TBI patients (JK, male, age 27, and AS, female, age 28) treated by the authors in the chronic phase of recovery after automobile accidents, as a result of which both patients were comatose for more than 4 weeks. In neuropsychological testing JK and AS both presented with persistent and significant leftsided hemispatial neglect: allocentric neglect in JK, and egocentric in AS. A modified AB-BA experimental design was used, where A represents spatio-motor training, and B is visual scanning. For patient JK, program A was first applied, followed by B, while for patient AS the reverse sequence was used. Each program included 10 therapy sessions, with a four-week interval between programs. The degree of neglect was measured using standard neuropsychological tests for quantitative and qualitative assessment of neglect, along with the analysis of drawings made during therapy by both patients. The patients were tested four times, before and after each of the two programs. Results. As the authors had hypothesized, patient JK did not show any progress in terms of neglect after conclusion of program A, while after program B he showed virtually no lingering neglect. In the case of patient AS the results were exactly opposite: after concluding program B (which she received first) there was no significant change, while after program A (administered second) there were no signs of neglect.Conclusion. The theoretical and clinical implications of these results for neuropsychological practice are discussed, and a model solution is proposed to explain the basic pathomechanism of both allocentric and egocentric neglect. These two types of neglect are sufficiently different in etiology and symptomatology to necessitate differentiated therapy programs in the course of neurorehabilitation.

Key words:
hemispatial neglect, traumatic brain injury, rehabilitation

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Early rehabilitation in intensive care for patients with closed head injuries

Maria Jaruga, Anna Ziemer

Maria Jaruga, Anna Ziemer – Early rehabilitation in intensive care for patients with closed head injuries. Fizjoterapia Polska 2001; 1(4); 337-345

Abstract
The goal of this article is to describe the process of evaluating patients with closed head injury preparatory to early rehabilitation. The research involved 26 patients under treatment in the Intensive Care Department at the Voivodeship Group Hospital in Poznań. Each patient was evaluated according to an Examination Chart, which contained the following information: 1. basic patient indentification; 2. examination dates (I – date of admission, II –date when decision is made commence rehabilitation procedures); 3. level of sedation according to the Ramsay Scale (if applicable); 4. patient score on the Glasgow Coma Scale; 5. patient score on the Reaction Level Scale 85.

Key words:
traumatic brain injury, patient examination chart, Glasgow Coma Scale, Reaction Level Scale

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Differences of opinion between patients aroused from prolonged coma and their caregivers in respect to the feeling of quality of life

Anna Pufal

Anna Pufal – Differences of opinion between patients aroused from prolonged coma and their caregivers in respect to the feeling of quality of life. Fizjoterapia Polska 2004; 4(3); 209-217

Abstract

Background. In recent years the problem of quality of life (QOL) has become increasingly important, especially in rehabilitation. In the case of patients aroused from prolonged coma, this issue is all the harder to resolve, because many patients experience a major change of life perspective, personality, etc. after their brain injury. This often leads to conflict between patients and their caregivers, caused by differences of opinion regarding QOL. The purpose of the present study was to evaluate these differences. Material and methods. The research involved 30 patients treated in 2002-03 in the Rehabilitation Clinic at the Rydygier Academy of Medicine in Bydgoszcz, Poland after brain and brainstem injury accompanied by coma, and their caregivers. Clinical interviews and the Pachalska-MacQueen QOL Scale were used. Differences in the scores obtained by patients and their caregivers were analyzed statistically. Results. The strongest correlation was found between the opinions of patients and caregivers in respect to the more physical parameters on the scale. There was no correlation in respect to psycho-social functions. The exception to this general rule was locomotion, a physical function that produced significant differences of opinion.Conclusions. Differences were found in the evaluation of QOL between patients and their caregivers in respect to some parameters, though not all. These differences of opinion often lead to conflict and disturbed family functioning. Training and therapy is necessary in this respect, for both patients aroused from prolonged coma and their caregivers.

Key words:
traumatic brain injury, brainstem, psychosocial disturbances
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Zastosowanie stymulacji polisensorycznej i wzorców globalnych w przypadku ciężkiego uszkodzenia czaszkowo-mózgowego

Wojciech Kiebzak, Anna Wysocka, Arkadiusz Żurawski, Marek Kiljański, Justyna Pogorzelska

W. Kiebzak, A. Wysocka, A. Żurawski, M. Kiljański, J. Pogorzelska – Application of the Polysensory Stimulation and the General Movement Patterns in Patients with the Serious Traumatic Brain Injury. FP 2015; 15(2); 6-20

Streszczenie
Wstęp. Urazy czaszkowo-mózgowe stanowią jedną z głównych przyczyn inwalidztwa oraz śmierci dzieci. Ich konsekwencją są zaburzenia sprawności motorycznej oraz dysfunkcje neuropsychologiczne. Stan taki szczególnie wymaga ograniczenia efektów jatrogennych.
Cel pracy. Celem pracy jest przedstawienie programu rehabilitacji pacjenta po ciężkim urazie czaszkowo-mózgowym.
Studium przypadku. Chłopiec lat 15 w wyniku wypadku komunikacyjnego doznał ciężkiego urazu ogólnego, oraz czaszkowo-mózgowego. Głęboko nieprzytomny, ocena w skali Glasgow – 4 pkt. Poddawany rehabilitacji przez okres 2 miesięcy w warunkach szpitalnych. Stosowano stymulację polisensoryczną, elementy metod: Vojty, NDT-Bobath, PNF, Castillo-Morales oraz Kinesiology taping. Uzyskano znacznego stopnia samodzielność łącznie z osiągnięciem chodu z niewielką pomocą.
Dyskusja. W przeciągu kilkunastu lat pojawiło się wiele prac dotyczących postępowania fizjoterapeutycznego chorych po urazach czaszkowo-mózgowych. Coraz częściej skuteczność procesu usprawniania warunkuje optymalnie wcześnie rozpoczęte i właściwie ukierunkowane leczenie usprawniające. Mimo to w piśmiennictwie obserwuje się znikomą liczbę opracowań sformalizowanych metod wczesnego postępowania. Stąd zachodzi potrzeba opracowania optymalnych zasad postępowania fizjoterapeutycznego.
Wnioski. Najważniejszym elementem postępowania terapeutycznego pacjentów po urazie czaszkowo-mózgowym jest interdyscyplinarna rehabilitacja w oparciu o stosowanie stymulacji polisensorycznej i globalnych wzorców ruchu, łączenia technik różnych metod. Programowanie postępowania fizjoterapeutycznego powinno opierać się na podstawowych zasadach dotyczących ciągłości, kompleksowości, systematyczności, a przede wszystkim wczesności rehabilitacji. Umiejętne postępowanie fizjoterapeutyczne odgrywa istotną role w przywróceniu funkcji poznawczo-emocjonalnych oraz w uzyskaniu optymalnego poziomu sprawności psychoruchowej.

Słowa kluczowe:
uraz czaszkowo-mózgowy, postępowanie fizjoterapeutyczne, stymulacja polisensoryczna, wzorce globalne

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