RESUMEN
OBJECTIVE: To investigate whether a computer-assisted training (CAT) program for patients with left unilateral neglect would decrease symptoms of this disorder. DESIGN: Case-control study. SETTING: Inpatient rehabilitation unit of a government medical center. PATIENTS: Twenty right-handed patients who showed left unilateral neglect on screening measures (Rey-Osterrieth Complex Figure, Random Letter Cancellation Test) were assigned to a CAT treatment group; and 20 patients who showed similar levels of unilateral neglect on the screening measures were assigned to a control group. INTERVENTIONS: All subjects were inpatients in an acute rehabilitation unit and received rehabilitation therapy, including physical and occupational therapy. The treatment group received the experimental, CAT program, 12 to 20 sessions of about 45 minutes each. Treatment consisted of 5 modules, each of increasing complexity, to improve attention to stimuli in the left hemisphere, and 2 simulated wheelchair obstacle courses to propel a wheelchair while avoiding obstacles. MAIN OUTCOME MEASURES: Computer tasks designed for this study (Video Tracking Test, Video Obstacle Course Test), a real-life wheelchair obstacle course (WCOC), and incident reports indicating falls and accidents. RESULTS: Trained subjects performed significantly better on the WCOC than control subjects (F(1,36) = 23.41, p = .00003). Also, trained subjects had fewer incident reports than control subjects during their hospitalization (chi(2)(1,)(n)(=38) = 5.15, p = .023). CONCLUSIONS: CAT can reduce unilateral neglect symptoms on experimental tasks and some measures of accident risk.
Asunto(s)
Daño Encefálico Crónico/rehabilitación , Instrucción por Computador , Lateralidad Funcional , Trastornos de la Percepción/rehabilitación , Silla de Ruedas , Análisis de Varianza , Atención , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Percepción Espacial , Percepción VisualRESUMEN
Corticosteroid injections into the spinal epidural space are frequently used to effect a relief of back pain and associated radicular extremity symptoms. Spinal epidural lipomatosis has been documented after the use of systemic corticosteroid therapy. This case report documents the development of epidural lipomatosis after the administration of multiple epidural steroid injections. The development and subsequent resolution after discontinuation of the steroid injections are demonstrated with serial magnetic resonance imaging.
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Corticoesteroides/efectos adversos , Analgésicos/efectos adversos , Lipomatosis/inducido químicamente , Dolor de la Región Lumbar/tratamiento farmacológico , Analgesia Epidural/efectos adversos , Femenino , Humanos , Inyecciones Epidurales/efectos adversos , Lipomatosis/diagnóstico , Región Lumbosacra , Imagen por Resonancia Magnética , Persona de Mediana EdadRESUMEN
Pain intensity, disability, and depressive symptoms are hallmarks of chronic pain conditions, but little is known about the relationships among these symptoms in the transition from acute to chronic pain. In this study, an inception cohort of men with low back pain (N = 78) was assessed at 2, 6, and 12 months after pain onset. At 6 months, pain intensity, disability, and depressive symptoms were predicted only by their respective levels at 2 months after pain onset. At 12 months, pain intensity and depressive symptoms were predicted by heightened disability at 6 months after pain onset; 12-month depressive symptoms also were predicted by 2-month disability. Pain intensity was not predictive of changes in disability or depressive symptoms. These findings suggest that functional disability plays a more prominent role than pain intensity in the transition from acute to chronic pain. A "failure to adapt" conceptual model is presented to account for these results.
Asunto(s)
Trastorno Depresivo/diagnóstico , Evaluación de la Discapacidad , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/psicología , Adolescente , Adulto , Enfermedad Crónica , Estudios Transversales , Trastorno Depresivo/psicología , Progresión de la Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Valor Predictivo de las Pruebas , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
OBJECTIVE: To determine the extent to which job satisfaction predicts pain, psychological distress, and disability 6 months after an initial episode of low back pain (LBP). DESIGN: A longitudinal design was used to follow an inception cohort experiencing first-episode low back pain with assessment at 2 and 6 months after pain onset. SETTING: Urban medical center outpatient orthopedic clinic. PATIENTS: The consecutive sample was comprised of 82 men with initial-onset acute LBP (T6 or below, daily pain for 6 to 10 weeks). INTERVENTION: Usual orthopedic care. MAIN OUTCOME MEASURES: The primary study outcomes were pain (Descriptor Differential Scale, Visual Analog Scales); disability (Sickness Impact Profile, Quality of Well-Being); and psychological distress (Beck Depression Inventory, Hamilton Rating Scale for Depression, Automatic Thoughts Questionnaire); predictor variables were orthopedic impairment (Waddell Physical Impairment Index) and job satisfaction (Job Descriptive Index, Work APGAR). RESULTS: Measures of job satisfaction, pain, disability, and psychological distress at baseline and 6 months after pain onset were separately reduced into factors using principle components factor analysis. In hierarchical multiple regression analyses, baseline job satisfaction significantly predicted variance in outcome scores at 6 months after pain onset, beyond the variance explained by control factors (demographics; baseline pain, mood, and disability; orthopedic impairment). Zero-order correlations between job satisfaction and orthopedic impairment were small and nonsignificant, suggesting that these two variables act independently in predicting outcome. Although type of work performed (desk work or work requiring light, moderate, or heavy lifting) and social position were correlated with job satisfaction at baseline, neither contributed to the prediction of outcome at 6 months. CONCLUSIONS: Satisfaction with one's job may protect against development of chronic pain and disability after acute onset back pain and, alternatively, dissatisfaction may heighten risk of chronicity. Vocational factors should be considered in the rehabilitation of acute back injury.
Asunto(s)
Satisfacción en el Trabajo , Dolor de la Región Lumbar/psicología , Dolor de la Región Lumbar/rehabilitación , Enfermedad Aguda , Adulto , Enfermedad Crónica , Indicadores de Salud , Humanos , Masculino , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: We have shown that the administration of 0.8 mg/kg of morphine (M) to patients with COPD resulted in a 20% increase in the maximum oxygen consumption (Vo2max), but was associated with significant drowsiness and euphoria. The objective of the present study was to ascertain whether lower doses of M alone or in combination with prochlorperazine (PC) or promethazine (P) could elicit significant increases in exercise tolerance. DESIGN: The exercise capacity, psychological status, and reaction times were assessed before and 60 min after the patients received placebo (PLAC), 30 mg M orally, 30 mg M plus 10 mg PC (M-PC), or 30 mg M plus 25 mg P (M-P) in a randomized double-blind crossover study. In a secondary study, nine patients were tested on three separate days before and after receiving PLAC, 25 mg P, or 30 mg M plus 25 mg P. PATIENTS: Seven COPD patients (FEV1=0.99 +/- 0.30 L, Vo2max=990 +/- 315 mL/min) who were ventilatory-limited. SETTING: Veterans Affairs medical center. RESULTS: After the patients ingested M-P, the increase in the Vo2max (129.0 +/- 104 mL/min), the workload (10.0 +/- 6.5 W) and the maximum minute ventilation (4.0 +/- 3.9 L/min) were significantly greater (p<0.05) than after PLAC ingestion (-4.8 +/- 79 mL/min, 1.4 +/- 6.9 W, and -1.6 +/- 2.4 L/min, respectively). Changes after the ingestion of M, P, o r M-PC were intermediate. The M-PC combination adversely affected the patient's reported mental status (Bond visual analog scale) more than the M-P or M regimens. No regimen significantly affected the reaction time. CONCLUSIONS: We conclude that the administration of 30 mg of M plus 25 mg of P significantly improves the exercise tolerance of patients with COPD, without significantly impairing the mental capabilities of the subjects. The utility of this regimen over longer time periods needs to be evaluated.
Asunto(s)
Antagonistas de Dopamina/uso terapéutico , Tolerancia al Ejercicio/efectos de los fármacos , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Enfermedades Pulmonares Obstructivas/fisiopatología , Morfina/uso terapéutico , Narcóticos/uso terapéutico , Proclorperazina/uso terapéutico , Prometazina/uso terapéutico , Administración Oral , Anciano , Dióxido de Carbono/metabolismo , Estudios Cruzados , Antagonistas de Dopamina/administración & dosificación , Método Doble Ciego , Combinación de Medicamentos , Euforia/efectos de los fármacos , Volumen Espiratorio Forzado/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Antagonistas de los Receptores Histamínicos H1/administración & dosificación , Humanos , Masculino , Procesos Mentales/efectos de los fármacos , Persona de Mediana Edad , Morfina/administración & dosificación , Morfina/efectos adversos , Narcóticos/administración & dosificación , Narcóticos/efectos adversos , Consumo de Oxígeno/efectos de los fármacos , Placebos , Proclorperazina/administración & dosificación , Prometazina/administración & dosificación , Ventilación Pulmonar/efectos de los fármacos , Tiempo de Reacción/efectos de los fármacos , Fases del Sueño/efectos de los fármacosRESUMEN
OBJECTIVE: To investigate whether rightward orienting bias, without neglect of left hemispace, increased accident risk. DESIGN: Case-control study. SETTING: Inpatient rehabilitation unit of department of government medical center. PATIENTS: Successive right-cerebrovascular accident (CVA) admissions were reviewed over a 2-year period. Only patients with left hemisphere damage, recent abusive drinking, dementia, or inpatient stays of less than 3 weeks were excluded. Fifty-five right-CVA subjects were divided into three groups, based on starting point and omissions in left hemispace on the Rey-Osterreith Complex Figure Drawing and Random Letter Cancellation test. Thirty-two patients were placed in the L-OMIT group (omitted stimuli in left hemispace), 11 patients were placed in the R-BIAS group (began tasks to the right without omissions), and 12 patients were placed in the Non-Neglect Stroke group (no evidence of unilateral neglect). Twenty male inpatients with no history of brain damage served as controls (Normal Control). MAIN OUTCOME MEASURES: Frequency of hospital falls and wheelchair obstacle course contacts. RESULTS: Both the L-OMIT and the R-BIAS groups had more inpatient falls than the other groups F(3,71) = 6.11, p < .001. On the wheelchair obstacle course, the L-OMIT group made more left-sided wheelchair collisions than any other group. However, the R-BIAS group also made more errors than the Non-Neglect Stroke and the Normal Control groups, F(3,55) = 5.72, p < .01). CONCLUSIONS: Results suggest that rightward orienting bias has clinical significance, even without more serious symptoms of unilateral neglect.
Asunto(s)
Accidentes por Caídas , Trastornos Cerebrovasculares/rehabilitación , Orientación , Silla de Ruedas , Estudios de Casos y Controles , Femenino , Humanos , MasculinoRESUMEN
This study tested the alternative hypotheses of Weinberg et al. (J. clin. Psychol. 28, 361, 1976) and Robertson (Neuropsychologia 28, 217-222, 1990) regarding the nature of dysfunctions underlying impaired backward digit span among patients with unilateral neglect. Results support the Weinberg et al. hypothesis that visual imagery plays a primary role in performance of Digits Backward. The findings also indicate a unilateral component to the Digits Backward task. Both neglecting and non-neglecting patients with high digit span discrepancy (DD) evidenced attentional bias to right space and a specific impairment in rotating objects in left space. Results were not consistent with Robertson's hypothesis that high DD arises from a general attentional deficit. In fact, patients with low DD evidence greatest impairment on tests of attention.
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Atención/fisiología , Daño Encefálico Crónico/fisiopatología , Dominancia Cerebral/fisiología , Hemiplejía/fisiopatología , Pruebas Neuropsicológicas , Aprendizaje Seriado/fisiología , Daño Encefálico Crónico/psicología , Corteza Cerebral/fisiopatología , Infarto Cerebral/fisiopatología , Infarto Cerebral/psicología , Lateralidad Funcional/fisiología , Hemiplejía/psicología , Humanos , Imaginación/fisiología , Orientación/fisiología , Reconocimiento Visual de Modelos/fisiología , Desempeño Psicomotor/fisiología , Retención en Psicología/fisiología , Escalas de WechslerRESUMEN
The impact of hemispatial neglect on wheelchair navigation was investigated using a wheelchair obstacle course. The results replicated the findings of Webster et al. (1988): Right-CVA patients with hemispatial neglect (n = 25) struck more objects on their left and ran directly into obstacles placed in their path (p < .0001). Right-CVA patients who did not omit left-space targets on letter cancellation (n = 23) did not run directly into obstacles; however, they did sideswipe more obstacles and struck more left-sided obstacles than did left-CVA (n = 20) and nonpatient controls (n = 19; p < .0001). Both hemi-neglecting patients and right-CVA patients who committed left-space sideswipes (n = 12) evidenced attentional bias to right space, as measured by more rightward starting points on letter cancellation and the Rey-Osterreith Complex Figure copy (p < .0001).
Asunto(s)
Atención/fisiología , Dominancia Cerebral/fisiología , Hemianopsia/fisiopatología , Hemiplejía/fisiopatología , Infarto del Miocardio/fisiopatología , Orientación/fisiología , Desempeño Psicomotor/fisiología , Silla de Ruedas , Anciano , Daño Encefálico Crónico/diagnóstico , Daño Encefálico Crónico/fisiopatología , Daño Encefálico Crónico/psicología , Femenino , Hemianopsia/diagnóstico , Hemianopsia/psicología , Hemiplejía/diagnóstico , Hemiplejía/psicología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/psicología , Pruebas Neuropsicológicas , Lóbulo Parietal/fisiopatologíaRESUMEN
The purpose of the study was to examine neuropsychological and general medical risk factors for falls among a high-risk patient group in an inpatient rehabilitation setting. The sample consisted of 32 nonambulatory males who had sustained a right-hemisphere stroke (R-CVA). The Fall Assessment Questionnaire (FAQ) was introduced as a measure of known risk factors for falls in an inpatient setting. Neuropsychological assessment included measures of attention, perceptual deficits, hemispatial neglect, and impulsivity. A predictive model generated using multiple regression found that the FAQ combined with a measure of behavioral impulsivity successfully predicted fall status in 78% to 81% of cases, depending upon the cutting score used (p < .003). R-CVA patients who fell were more impulsive (p < .001) and received higher FAQ scores (p < .001). Perceptual deficit as measured by the Rey-Osterreith Complex Figure and general inattention as measured by Digit Span (reverse) were associated with falls (p < .04); however, they did not add to the model predicting which of the R-CVA patients would fall. It was suggested that impulsivity may act as an important mediating factor in determining individual risk for fall.
Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Trastornos Cerebrovasculares/rehabilitación , Centros de Rehabilitación/estadística & datos numéricos , Anciano , Análisis de Varianza , Trastornos Cerebrovasculares/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tiempo de Reacción , Análisis de Regresión , Factores de Riesgo , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaRESUMEN
We developed a relationally processing-based scoring system (RPSS) for the Wechsler Memory Scale's (WMS) Logical Memory subtest. Information from the stories was classified as either essential to the plot (Essential proposition) or nonessential to the plot (Detail proposition). The subjects' responses were also scored for intrusion errors (Self-Generated propositions). The normal control group's performance was compared with the performance of a right cerebrovascular accident group (R-CVA), and a left cerebrovascular accident group (L-CVA), each consisting of 20 right-handed subjects. ANOVAs revealed that the R-CVA group recalled significantly fewer Detail propositions and produced significantly more Self-Generated propositions than did the Normal Control group. In contrast, these groups recalled approximately the same number of Essential propositions. The L-CVA group recalled fewer Essential propositions than did any other group, but also produced the fewest intrusion errors.
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Nivel de Alerta/fisiología , Atención/fisiología , Daño Encefálico Crónico/fisiopatología , Dominancia Cerebral/fisiología , Recuerdo Mental/fisiología , Percepción del Habla/fisiología , Aprendizaje Verbal/fisiología , Escalas de Wechsler/estadística & datos numéricos , Daño Encefálico Crónico/diagnóstico , Daño Encefálico Crónico/psicología , Corteza Cerebral/fisiopatología , Infarto Cerebral/diagnóstico , Infarto Cerebral/fisiopatología , Infarto Cerebral/psicología , Formación de Concepto/fisiología , Femenino , Humanos , Masculino , PsicometríaRESUMEN
We report the case of a healthy young Hispanic man with Salmonella typhimurium bacteremia and leukocytoclastic vasculitis. Leukocytoclastic vasculitis has not been previously reported as a complication of salmonella gastroenteritis and bacteremia. Salmonella gastroenteritis is rarely associated with bacteremia in healthy young adults.
Asunto(s)
Infecciones por Salmonella/complicaciones , Vasculitis/etiología , Humanos , Masculino , Salmonella typhimurium , Enfermedades de la Piel/etiología , Enfermedades de la Piel/patología , Vasculitis/patologíaRESUMEN
The initial experiment of this paper investigated the role of hemispatial neglect in wheelchair-related accidents of right-hemisphere stroke victims. Twelve subjects with and 12 subjects without neglect of left space drove their wheelchairs through an obstacle course. Two types of obstacle course errors were evaluated: direct hits and sideswipes. The neglecting group made significantly more direct hits but there were no significant differences between groups in sideswipe errors. In Experiment 2, the nonneglecting group's data were compared with a left-hemisphere stroke group without neglect and three motor control groups to investigate if their errors resulted from motor deficits. The right-hemisphere stroke group made significantly more left-sided errors and errors in contralateral space than any other group. In Experiment 3, 13 subjects with neglect were taught to scan to the left which resulted in significant decreases in direct hits but not in sideswipes on the obstacle course. These results suggest that obstacle course performance is sensitive to more than hemispatial neglect.
Asunto(s)
Trastornos Cerebrovasculares/fisiopatología , Dominancia Cerebral/fisiología , Hemiplejía/fisiopatología , Orientación/fisiología , Desempeño Psicomotor/fisiología , Silla de Ruedas , Propensión a Accidentes/fisiología , Atención/fisiología , Encéfalo/fisiopatología , Trastornos Cerebrovasculares/rehabilitación , Femenino , Lateralidad Funcional/fisiología , Humanos , Masculino , Persona de Mediana Edad , Modalidades de FisioterapiaRESUMEN
From the literature on compensatory training it is clear that brain injured patients can learn to perform tasks they were incapable of soon after their brain injury. At present, little more can be said about the efficacy of cognitive retraining for several reasons. First, the bulk of our studies do not permit prediction to real-life recovery because they have focused on improvements on psychometric tests or experimental procedures with little social validity. Second, most studies have failed to assess the patient's ability to self-initiate the acquired skills and even they have, few studies have shown that patients can use the skill effectively to solve problems on their own. Third, the majority of studies have used only a few subjects and do not allow an evaluation of the power of a given technique for a given neuropsychological problem. In studies using multiple single cases, many researchers typically have had to modify the techniques to the unique psychological and neuropsychological strengths and weaknesses of their subjects. Hence, even very similar procedures at the outset often have been so radically changed during the course of therapy that they share few characteristics across subjects by the end of training. Finally, most important to the future of cognitive retraining is the continuation of research and development. Although the initial results of cognitive retraining efforts have been encouraging, clinical retraining techniques may be more popular than the extant treatment outcome data warrant. Promising the public a technology that has not been adequately developed is bound to produce negative repercussions for both patients and agencies willing to fund such treatment.
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Terapia Conductista/métodos , Daño Encefálico Crónico/rehabilitación , Trastornos Neurocognitivos/rehabilitación , Pruebas Neuropsicológicas , Afasia/rehabilitación , HumanosRESUMEN
The present paper introduces the Tension Mannequin, a self-report questionnaire on which tension levels of various muscle groups are rated. In Experiment 1 this instrument was administered to 44 normal adults preceding and following relaxation training. Questionnaire results revealed that subjects used three tension level ratings across muscles. Only 14% of the sample rated all muscle groups identically. Pre-training correlations between the individual muscle ratings and a general rating of tension suggested that the general rating was made by averaging tension in various muscle sites. The questionnaire appeared to be sensitive to the effects of relaxation training since pre- and post-comparisons of all muscle groups were significantly different. Experiment 2 investigated whether the questionnaire would differentiate subjects suffering at least three tension headaches per week from those reporting less than three. Results revealed that the frequent headache group had greater subjective tension in the forehead and neck. A case example illustrates how the Tension Mannequin revealed the importance of back discomfort to a patient's experience of tension headaches and general tension.
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Contracción Muscular , Relajación Muscular , Tono Muscular , Adulto , Anciano , Trastornos de Ansiedad/terapia , Dolor de Espalda/terapia , Terapia Combinada , Femenino , Cefalea/terapia , Humanos , Masculino , Maniquíes , Persona de Mediana Edad , Estrés Psicológico/complicacionesAsunto(s)
Retroalimentación , Objetivos , Esfuerzo Físico , Cognición , Femenino , Humanos , Masculino , Aptitud Física , Refuerzo en PsicologíaRESUMEN
Assessed the utility of two brief neuropsychological tests in screening patients referred to a neuropsychological consulting service. Forty-three cortically impaired and 19 neurologically intact Ss completed the Cognitive Capacity Screening Exam (CCSE) and the Memory-for-Designs (MFD). The results of these tests analyzed individually and in combination were compared with the Ss' neurological reports. The analysis revealed that the combined system was significantly better than either single test in accurately detecting neuropathology. A closer look at the data suggests that the MFD was superior in identifying unilateral, right hemispheric damaged patients, while the CCSE was superior in identifying Ss with unilateral, left hemispheric damage. Results are discussed with reference to the difficulty in using single screening tests for detecting deficits that result from unilateral cortical dysfunction.