THE EARLY STAGES OF recovery from traumatic brain
|
|
- Egbert Ward
- 6 years ago
- Views:
Transcription
1 521 BRIEF REPORT Sequence of Recovery During the Course of Emergence From the Minimally Conscious State Christine M. Taylor, BAppSc, Vanessa H. Aird, BAppSc, Robyn L. Tate, MPsychol, PhD, Michele H. Lammi, BAppSc ABSTRACT. Taylor CM, Aird VH, Tate RL, Lammi MH. Sequence of recovery during the course of emergence from the minimally conscious state. Arch Phys Med Rehabil 27;88: Objective: To document and examine recovery profiles of persons during the course of emergence from a minimally conscious state (MCS) after traumatic brain injury (TBI). Design: Case series. Setting: Participants in an inpatient brain injury rehabilitation program. Participants: Nine people with TBI who emerged from MCS. Interventions: Not applicable. Main Outcome Measure: The Western Neuro Sensory Stimulation Profile. Results: In all cases, stereotyped (nonreflexive) movement was the first behavior to resolve, yet by itself it was never sufficient to indicate emergence from the MCS. Two of the 9 patients showed consistent object manipulation before all 3 elements of functional communication. Conversely, in 2 patients, all 3 components of functional communication emerged before object manipulation. In the remaining 5 patients, object manipulation occurred along with components of functional communication. Conclusions: During the course of data collection, issues were raised about differentiation between the MCS and posttraumatic amnesia. The data are also discussed within the context of the work of Giacino et al and the development of their scale to measure duration of the MCS. These data support the theory that functional communication and object manipulation are the 2 key indicators of emergence from MCS. Key Words: Brain injuries; Minimally conscious state; Rehabilitation. 27 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation THE EARLY STAGES OF recovery from traumatic brain injury (TBI) are characterized by various states of altered consciousness, including coma, and, depending on injury severity, the vegetative state (VS) and minimally conscious state (MCS). Patients with TBI also subsequently transit through a period of posttraumatic amnesia (PTA). Although operational definitions have been applied successfully to coma and VS, the MCS and its surrounding terminology have had a more recent history. The MCS is a condition that follows coma and is defined by the Aspen From the Brain Injury Rehabilitation Service, Royal Rehabilitation Centre Sydney, Ryde, Australia (Taylor, Aird, Lammi); and Rehabilitation Studies Unit, University of Sydney, Sydney, Australia (Tate). No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Reprint requests to Christine M. Taylor, BAppSc, Brain Injury Rehabilitation Service, Royal Rehabilitation Centre Sydney, PO Box 6, Ryde NSW 16, Australia, christine.taylor@royalrehab.com.au /7/ $32./ doi:1.116/j.apmr workgroup as severely altered consciousness in which the person demonstrates minimal but definite behavioral evidence of self or environmental awareness. 1(p84),2 This expert group further outlined 5 criteria to characterize entry into the MCS. One or more of the following behaviors must be observed, even if inconsistently, for a diagnosis of MCS: (1) comprehension of simple commands, (2) manipulation of objects, (3) gestural or verbal yes-no response, (4) intelligible verbalizations, and (5) stereotyped (but nonreflexive) movements. Although clear diagnostic guidelines for entry into the MCS have been established, criteria for emergence from the MCS are less clear. In 22, Giacino et al 2 proposed 2 essential features for emergence, comprising reliable and accurate (1) functional interactive communication and (2) functional use of 2 different objects. The criteria are consensus based, and the authors point to the limited availability of empirical evidence at this stage. In their group of 15 patients, they reported that in 47% functional object use emerged first, in 2% functional communication emerged first, and in the remaining 33% they coincided. The interval between emergence for object use and functional communication ranged from 5 to 14 days. Our group studied the natural history of recovery from the MCS in a small group of 21 patients and reported on the postacute neurobehavioral profiles 3 and longer-term functional and psychosocial recovery. 4 The purpose of this study was to contribute additional empirical data on patterns of emergence from the MCS. Specifically, like Giacino, we examine the sequence of emergence of specific domains. We also examine latencies among emergence in specific domains. METHODS The sample has been described previously and comprised 21 patients admitted to a regionally based brain injury rehabilitation unit from an acute facility, 18 of whom had participated in the follow-up study reported by Lammi et al. 4 In brief, all 21 patients had sustained an extremely severe TBI and were participating in their initial period of postacute rehabilitation. They were admitted to the rehabilitation unit a median of 39 days posttrauma (range, d). The group was predominantly male (n 17 [81%]), aged 39 years when injured (range, 15 69y), with the injuries occurring as a result of road traffic crashes (n 13 [62%]) or falls (n 8 [38%]). On admission to the rehabilitation unit, each patient presented with a severely altered state of consciousness (one was in coma; the others were deemed to be in an MCS). All patients were routinely administered the Western Neuro Sensory Stimulation Profile (WNSSP), 5 with administration frequency determined by clinical need. This scale was specifically designed to monitor and predict change in the slow-to-recover population as well as in those patients who are functioning between levels II and V on the Rancho Los Amigos Scale. 6 The 33 items of the WNSSP cover 9 domains: arousal/attention, auditory response, auditory comprehension, expressive communication, visual tracking, visual comprehension, tactile response, object manipulation, and olfactory response. This tool was developed before the more recent developments in refining nomenclature in this subject group; however, it does specifically measure the defining MCS behaviors. Arch Phys Med Rehabil Vol 88, April 27
2 522 EMERGENCE FROM THE MINIMALLY CONSCIOUS STATE, Taylor Table 1: Descriptive Data for Day Posttrauma of Emergence of Specific Behaviors (N 9) Characteristic Median Range Interquartile Range Estimated duration of MCS Day admitted to rehabilitation Stereotyped (nonreflexive) movement Object manipulation Intelligible verbalization rehension Yes-no response Functional communication Sequence (irrespective of domain) First Second Third Fourth Fifth The 5 agreed behaviors that signal entry to MCS (ie, comprehension of simple commands, manipulation of objects, gestural or verbal yes-no response, intelligible verbalizations, stereotyped nonreflexive movements) were monitored with the WNSSP throughout the course of each patient s recovery. We used these same 5 behaviors to identify the point of emergence from MCS, requiring that each of the behaviors was performed consistently on more than 1 test occasion. Specifically, as per the following WNSSP criteria: functional interactive communication was assessed by (1) the comprehension of simple commands using the auditory and visual comprehension subtests (eg, shake my hand ), in which the correct response was required; (2) yes-no response used the expressive communication subtest yes-no response (eg, Do you live in ), but the correct response was not required, as per the WNSSP manual; and (3) intelligible verbalization was assessed by the expressive communication subtest vocalization, which required intelligible, relevant speech. Stereotyped nonreflexive movements were examined via the arousal/attention, visual tracking, tactile response, and olfactory subtests. Functional object use was assessed with the object manipulation subtest (eg, This is a. Show me how you would use it ) in which the correct response was required. Although these criteria for emergence appear to differ from those of Giacino et al, 2 the differences reflect surface labeling issues (ie, both our functional interactive communication and that of Giacino require accurate comprehension to be shown). For the precise day of emergence in specific domains, we used the daily documentation that was made in the patient s medical record. RESULTS Duration of the MCS was able to be determined in 17 patients and was a median of 54 days (range, d). The remaining 4 patients had either died before emerging (n 1) or not emerged from the MCS when they were last contacted between 4 to 5 years posttrauma (see Lammi et al 4 ). Only nonreflexive movement was ever shown during the course of observations in any of these 4 patients, occurring at 58, 136, and 77 days posttrauma in 3 patients whom we documented as still in the MCS at 141, 16, and 1825 days after trauma, respectively. The data from 8 of the 17 patients who emerged from the MCS were not suitable for detailed study of patterns of emergence because of impairments confounding the examinations (one with severe aphasia; one with anarthria and spastic tetraplegia) or the patients emerged from the MCS fairly rapidly after admission to the rehabilitation unit (n 6). In these latter cases, the WNSSP had only been administered on 1 or 2 test occasions, and thus there were insufficient data to meaningfully examine patterns of emergence. The final 9 patients emerging from the MCS during inpatient rehabilitation were assessed on multiple occasions with the WNSSP in relation to the 5 behavioral domains, and they were monitored until the point of emergence. Descriptive data are presented in table 1. Specific comparison was made regarding the time taken to emerge of the 2 behavioral domains suggested by Giacino, 2 namely, functional object use (at a median of day 54 after trauma) and functional communication (median of day 64). The result of a Wilcoxon signed-rank test was not statistically significant (z.51, P.5). Table 2 shows the sequence of emergence, irrespective of the behavioral domain. Repeated measures analyses performed by using Wilcoxon tests compared day posttrauma of emergence of adjacent categories (1st vs 2nd behavioral domain, 2nd vs 3rd, and so on). Results showed a significant difference between day of injury (as well as admission to the rehabilitation unit) and emergence of the first of the defining behaviors (day posttrauma: z 2.67, P.9; day postadmission z 2.68, P.8), but the remaining analyses did not meet the Bonferroni-adjusted level of P less than.1 (although 3/4 comparisons were significant at the P.5 level). These data show that emergence generally occurred over approximately a 6- to 12-week period posttrauma and a period of 4 to 6 weeks after admission to rehabilitation. Case ID (Lammi et al 4 ) Table 2: Day Posttrauma at Which the MCS Defining Behaviors Occurred in Individual Cases Estimated Duration of MCS lications OM Yes-No Funct Comm A Trache B Trache, ROM C Trache D None E Trache F Trache, dysarth G None H None I None Abbreviations:, admission to rehabilitation;, comprehension; dysarth, dysarthria; Funct Comm, functional communication;, nonreflexive movement; OM, object manipulation; ROM, range of motion;, verbalization; Trache, tracheostomy intubation. Arch Phys Med Rehabil Vol 88, April 27
3 EMERGENCE FROM THE MINIMALLY CONSCIOUS STATE, Taylor 523 Individual data are presented in table 2 and are also depicted graphically in figure 1. In all patients, stereotyped (nonreflexive) movement was the first behavior to be identified, yet by itself it was never sufficient to indicate emergence from the MCS. Nonetheless, Spearman correlation coefficients between duration of the MCS and the 5 behaviors were all highly statistically significant (r range,.92.99), including nonreflexive movements (r.92, P.1). This latter result indicates that there is a close association between occurrence of nonreflexive movements and emergence from the MCS. Moreover, the descriptive data show that in this small sample, for the 8 patients who were not physically restricted and emerged from the MCS, this occurred within approximately 6 weeks of first showing nonreflexive movements. In other words, from the point in time that these particular patients were classified as nonvegetative and noncomatose, it is weeks rather than months later that they emerged from the MCS. We do, however, recognize that other patients may remain in the MCS for many months or years despite having nonreflexive movements, and we described 3 such patients from this series in our outcome study. 4 At an individual level, 2 of the 9 patients (cases A, D in fig 1, table 2) showed consistent object manipulation before any of the 3 elements of functional communication, with a time lag of 21 and 26 days, respectively. Conversely, in 2 patients (cases B, G), each of the 3 components of functional communication emerged before object manipulation, by 84 and 15 days, respectively, but in 1 of these (case B) object manipulation was compromised by severely restricted range of movement. In the remaining 5 cases (cases C, E, F, H, I), object manipulation occurred along with components of functional communication. Within the domain of functional communication, the pattern of emergence of the 3 constituent behaviors did not show a consistent trend. Three of the 9 patients (cases D, G, I) showed intelligible verbalizations as the first domain to emerge, which occurred 7 to 1 days before other functional communication behaviors. For 1 patient (case A), yes-no response emerged 1 week before other behaviors and for another (case H) comprehension emerged 1 week before the next communication behavior. In 2 patients, cases B and F, comprehension and yes-no response emerged simultaneously, 1 week or more before intelligible verbalization. In the remaining 2 patients (cases C, E), all 3 components emerged within a few days of each other. In determining the timeframe from early communication attempts (ie, the first of the 3 functional communication behaviors to occur) to the establishment of a consistent functional communication repertoire (ie, showed consistency in all 3 behaviors), the latency between the first and the third of these was calculated. The results indicated variable latencies between 2 and 2 days (median, 7d). DISCUSSION Data from this small, independent sample contribute to those published by Giacino et al. 2 In agreement with their findings, we observed variability in emergence in the 2 key domains: functional object use emerged before the repertoire of functional communication in 2 of 9 (22%) patients, vice versa in another 2 of 9 (22%), and over the same period of time in 5 of 9 (56%). In all patients, nonreflexive movements were the first of the behaviors to emerge. These included turning or looking toward the source of a voice or to a tactile stimulus or visual tracking of a person, object, or mirror. Although on its own nonreflexive behavior was never an indicator of emergence, those patients who did go on to emerge showed the other behaviors within weeks of the onset of nonreflexive movement. Moreover, the correlation coefficient between return of nonreflexive movement and duration of MCS was very high (r.92). Therefore, it may be important to routinely monitor the latency from the onset of nonreflexive movement to the commencement of functional object use and functional communication because it may provide important prognostic information regarding emergence from MCS. In a slightly different vein by using functional magnetic resonance imaging with a patient in the VS, Owen et al 7 showed that specific brain areas showed differential activation when the patient was asked to imagine she was playing tennis (supplementary motor area) or imagine that she was walking through her home (parahippocampal gyrus, posterior parietal cortex, lateral premotor cortex). These kinds of data suggest she had at least some capacity for comprehension and response to spoken language. If this occurs in patients in VS, then it reinforces the absolute importance of monitoring patients in the MCS at a very early stage of this period of recovery. In the course of monitoring recovery during the MCS, a number of issues arose regarding the process of emergence from the MCS that deserve further examination. Although the impact of aphasia and dyspraxia on a person s performance has been addressed, 8 the effect of PTA on MCS duration warrants discussion. Patients in PTA are defined as being confused, amnesic, and likely to evidence behavioral disturbance. 9(p675) Unreliability and inaccuracy of response is a characteristic feature of the patient in PTA. There continues to be debate about many aspects of PTA, 1 including defining features and nomenclature, 11 as well as operational definitions of exit. 12,13 Although Levin et al 9 suggested that PTA was measured from the end of coma, the convention has been to measure PTA from the date of the injury. This clearly encompasses the period of MCS. At a clinical level, however, we believe it is important to make a clear differential diagnosis between PTA and resolved MCS, which, like coexisting impairments in speech and dyspraxia, may be difficult for those patients whose executive and regulative abilities are compromised because of the presence of PTA. From many perspectives including counseling families, rehabilitation program planning, and accuracy of nomenclature, it is important to know whether the patient is still in MCS or has transited to the next stage of recovery, PTA. Clinicians need to know whether they are testing for MCS or PTA; families welcome this obvious sign of progress toward recovery. More specifically, in our rehabilitation setting, it is the emergence from MCS that signifies a readiness to increase participation in rehabilitation, which will often involve PTA testing. If a patient is able to participate in a question-answer dyad, follow simple instructions, and shows some attempt to consider the response, regardless of accuracy, they would be classified as having emerged from the MCS. There is no longer... minimal but definite behavioral evidence... 1(p84) but rather an ability to interact consistently and to more actively engage in the rehabilitation process. At this stage, it may be more relevant clinically to describe the impact of PTA and confusion on a patient s performance, as opposed to MCS. We consider that the continuum of the MCS needs to be further described to include a description at the higher end of functioning in this state (ie, at the ceiling of Rancho level IV [confusedagitated]). A patient at this level may be engaging in functional activities but showing more pronounced evidence of confusion or amnesia, contributing to their difficulty in accurately producing some responses. An important next step will be to obtain a more detailed examination of the natural history of the transition period between emergence from the MCS and entry to PTA. CONCLUSIONS The contribution of the present data set from an independent sample lends strength to the exit criteria from the MCS proposed by Giacino. 2 That is, even with the use of different assessment tools, it is clear that functional communication and Arch Phys Med Rehabil Vol 88, April 27
4 524 EMERGENCE FROM THE MINIMALLY CONSCIOUS STATE, Taylor Case A (Tracheostomy) Case B (Tracheostomy; range of mvt) Case C (Tracheostomy) Case D Case E (Tracheostomy) Case F (Tracheostomy) Fig 1. Pattern of emergence from MCS in 9 participants. The heavy line denotes emergence from MCS. Abbreviations:, admission to rehabilitation;, comprehension;, nonreflexive movement;, object manipulation;, verbalization. Arch Phys Med Rehabil Vol 88, April 27
5 EMERGENCE FROM THE MINIMALLY CONSCIOUS STATE, Taylor Case G Case H Case I Fig 1. (Continued) functional object use are useful indicators of emergence from the MCS. However, we suggest that a clearer distinction between PTA and MCS be made so that length of MCS does not become artificially inflated because of the well known and distinct syndrome of PTA. References 1. Giacino JT, Zasler ND, Katz DI, Kelly JP, Rosenberg JH, Filley CM. Development of practice guidelines for assessment and management of the vegetative and minimally conscious states. J Head Trauma Rehabil 1997;12: Giacino JT, Ashwal S, Childs N, et al. The minimally conscious state: definition and diagnostic criteria. Neurology 22;58: Smith VH, Taylor CM, Lammi MH, Tate RL. Recovery profiles of cognitive-sensory modalities in patients in the minimally conscious state following traumatic brain injury. Brain Impair 21; 2: Lammi MH, Smith VH, Tate RL, Taylor CM. The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury. Arch Phys Med Rehabil 25; 86: Ansell BJ, Keenan JE, de la Rocha O. Western Neuro Sensory Stimulation Profile: a tool for assessing slow-to-recover headinjured patients. Tustin: Western Neuro Care Center; Malkmus D, Booth B, Kodimer C. Rehabilitation of the head-injured adult: comprehensive cognitive management. Downey: Professional Staff Association, Rancho Los Amigos Hospital; Owen AM, Coleman MR, Boly M, Davis MH, Laureys S, Pickard JD. Detecting awareness in the vegetative state. Science 26;313: Giacino JT, Whyte J. The vegetative and minimally conscious states: current knowledge and remaining questions. J Head Trauma Rehabil 25;2: Levin HS, O Donnell VM, Grossman RG. The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nerv Ment Dis 1979;167: Tate RL, Pfaff A. Problems and pitfalls in the assessment of posttraumatic amnesia. Brain Impair 2;1: Stuss DT, Binns MA, Carruth F, et al. The acute period of recovery from traumatic brain injury: posttraumatic amnesia or posttraumatic confusional state? J Neurosurg 1999;9: Tate RL, Pfaff A, Jurjevic L. Resolution of disorientation and amnesia during posttraumatic amnesia. J Neurol Neurosurg Psychiatry 2;68: Tate RL, Pfaff A, Baguley IJ, et al. A multicentre, randomised trial examining the effect of test procedures on emergence from post-traumatic amnesia. J Neurol Neurosurg Psychiatry 26;77: Arch Phys Med Rehabil Vol 88, April 27
The Minimally Conscious State and Recovery Potential: A Follow-Up Study 2 to 5 Years After Traumatic Brain Injury
746 The Minimally Conscious State and Recovery Potential: A Follow-Up Study 2 to 5 Years After Traumatic Brain Injury Michele H. Lammi, BAppSc, Vanessa H. Smith, BAppSc, Robyn L. Tate, MPsychol, PhD, Christine
More informationDISORDERS OF CONSCIOUSNESS: A MULTIDISCIPLINARY TREATMENT APPROACH
DISORDERS OF CONSCIOUSNESS: A MULTIDISCIPLINARY TREATMENT APPROACH Kathleen Crosskill, M.S., CCC-SLP, CBIS SLP Practice Leader, Brain Injury & Pediatrics, Spaulding Rehabilitation Hospital-Boston DISCLOSURE
More informationClinical Practice Guidelines for Managing Minimal Responsiveness after Blast-related Injury
Clinical Practice Guidelines for Managing Minimal Responsiveness after Blast-related Injury The Polytrauma Experience Linda M. Picon, MCD, CCC Speech-Language Pathologist James A. Haley Veterans Hospital
More informationMedical and Rehabilitation Innovations
Medical and Rehabilitation Innovations Disorders of Consciousness Programs 2017 2017. Paradigm Management Services, LLC ( Paradigm ). No part of this publication may be reproduced, transmitted, transcribed,
More informationAgitation Following TBI
Agitation Following TBI During the early phase of recovery from brain injury, many people undergo a period of agitation. Level IV of the Rancho Los Amigos Levels of Cognitive Functioning corresponds to
More informationCRS-R WORKSHOP. Coma Science Group GIGA Research Center University of Liège
CRS-R WORKSHOP Coma Science Group GIGA Research Center University of Liège January 19 th 2018 Coma Science Group GIGA Consciousness http://www.comascience.org/ OUTLINE Introduction What is «consciousness»?
More informationMOST PATIENTS RECOVERING from traumatic brain
42 ORIGINAL ARTICLE Effect of Severity of Post-Traumatic Confusion and Its Constituent Symptoms on Outcome After Traumatic Brain Injury Mark Sherer, PhD, Stuart A. Yablon, MD, Risa Nakase-Richardson, PhD,
More informationReview Evaluation of Residuals of Traumatic Brain Injury (R-TBI) Disability Benefits Questionnaire * Internal VA or DoD Use Only*
Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) Disability Benefits Questionnaire * Internal VA or DoD Use Only* Name of patient/veteran: SSN: Your patient is applying to the U. S. Department
More informationMultimodal Sensory Stimulation Treatment for an Individual with Chronic & Severe TBI
Multimodal Sensory Stimulation Treatment for an Individual with Chronic & Severe TBI Sakina S. Drummond & Melissa McDonough Southeast Missouri State University ASHA Convention, Chicago, IL 2008 Introduction:
More informationLet s s talk about behaviour
Let s s talk about behaviour Common Terms: Coma Restless Agitated Disoriented Confused Disinhibition Disrupted sleep cycle Amnestic Combative Inappropriate Vocalizing Some less accurate terminology Rude
More informationLearning Objectives 1. TBI Severity & Evaluation Tools. Clinical Diagnosis of TBI. Learning Objectives 2 3/3/2015. Define TBI severity using GCS
Learning Objectives 1 TBI Severity & Evaluation Tools Define TBI severity using GCS and PTA Describe functional prognosis after moderate to severe TBI using trends and threshold values Jennifer M Zumsteg,
More informationClinical Management of Confusion. Mark Sherer, Ph.D. Associate Vice President for Research
Clinical Management of Confusion Mark Sherer, Ph.D. Associate Vice President for Research Assessment of PTCS Confusion Assessment Protocol Authors: Mark Sherer, Risa Nakase-Richardson, Stuart Yablon Key
More informationDBQ Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI) Disability
DBQ Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI) Disability Name of patient/veteran: SSN: SECTION I 1. Diagnosis Does the Veteran now have or has he/she ever had a traumatic brain
More information3/23/2017 ASSESSMENT AND TREATMENT NEEDS OF THE INDIVIDUAL WITH A TRAUMATIC BRAIN INJURY: A SPEECH-LANGUAGE PATHOLOGIST S PERSPECTIVE
ASSESSMENT AND TREATMENT NEEDS OF THE INDIVIDUAL WITH A TRAUMATIC BRAIN INJURY: A SPEECH-LANGUAGE PATHOLOGIST S PERSPECTIVE MONICA STRAUSS HOUGH, PH.D, CCC/SLP CHAIRPERSON AND PROFESSOR COMMUNICATION SCIENCES
More informationConceptualization of Functional Outcomes Following TBI. Ryan Stork, MD
Conceptualization of Functional Outcomes Following TBI Ryan Stork, MD Conceptualization of Functional Outcomes Following Traumatic Brain Injury Ryan Stork, MD Clinical Lecturer Brain Injury Medicine &
More informationPost-traumatic Confusion Case Definition: Clinical Implications and Use in Research. Mark Sherer ACRM BI-ISIG DOC Task Force Confusion Group
Post-traumatic Confusion Case Definition: Clinical Implications and Use in Research Mark Sherer ACRM BI-ISIG DOC Task Force Confusion Group DISCLOSURES Dr. Sherer has no significant financial relationships
More informationLABETTE COMMUNITY COLLEGE BRIEF SYLLABUS. Please check with the LCC bookstore for the required texts for this class.
LABETTE COMMUNITY COLLEGE BRIEF SYLLABUS SPECIAL NOTE: This brief syllabus is not intended to be a legal contract. A full syllabus will be distributed to students at the first class session. TEXT AND SUPPLEMENTARY
More informationHandling Challenges & Changes after TBI
Handling Challenges & Changes after TBI Quick Facts about Traumatic Brain Injury (TBI) The CDC reports that roughly 2.5 million Americans have a TBI each year The most common causes are: falls, motor vehicle
More informationABSTRACT. n engl j med 362;7 nejm.org february 18,
The new england journal of medicine established in 1812 february 18, 2010 vol. 362 no. 7 Willful Modulation of Brain Activity in Disorders of Consciousness Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse,
More informationMedications to Expedite Rehabilitation of the Traumatic Brain Injury Patient
Medications to Expedite Rehabilitation of the Traumatic Brain Injury Patient Austin Trauma & Critical Care Conference May 31, 2018 Kristin Wong, MD, FAAPMR Assistant Professor, Physical Medicine & Rehabilitation
More informationPacific Assessment of Confabulation. Confabulation has been defined as unintentional verbal distortions or misinterpretations
Abstract This paper presents data on the Pacific Assessment of Confabulation (PAC), which was designed to accomplish two goals. First, the PAC is intended to quantify confabulation. Confabulation has been
More informationTHE ESSENTIAL BRAIN INJURY GUIDE
THE ESSENTIAL BRAIN INJURY GUIDE Outcomes Section 9 Measurements & Participation Presented by: Rene Carfi, LCSW, CBIST Senior Brain Injury Specialist Brain Injury Alliance of Connecticut Contributors Kimberly
More informationAcute Brain Injury. Definitions: Coma. Assessment and Rehabilitation of the Minimally Conscious Patient Jay H. Rosenberg, MD
Coma and Altered States of Consciousness: Intervention Strategies For Health Professionals The Neurology Center Staff Physician Scripps Memorial Hospital Encinitas The Rehabilitation Center Encinitas CA
More informationMeasuring Psychosocial Recovery After Brain Injury: Change Versus Competency
538 ARTICLES Measuring Psychosocial Recovery After Brain Injury: Change Versus Competency Robyn L. Tate, MPsychol, PhD, Anne Pfaff, MA, Ahamed Veerabangsa, MBBS, FAFRM, Adeline E. Hodgkinson, MBBS, FAFRM
More informationConcussions and the Athlete Child Neurology of Tulsa Page 1 of 5
Page 1 of 5 The Following information has been compiled from the American Academy of Neurology: This practice parameter is based on a background paper 1 written by James P. Kelly, MD, and Jay H. Rosenberg,
More informationJFK Johnson Rehabilitation Institute
AN OVERVIEW OF THE COMA RECOVERY SCALE- REVISED (CRS-R) Joseph T. Giacino, Ph.D. Director of Rehabilitation Neuropsychology Spaulding Rehabilitation Hospital Associate Professor Harvard Medical School
More informationDoes Treatment With Amantadine Increase the Rate of Improvement of Cognitive Function in Patients Suffering From Traumatic Brain Injury?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2014 Does Treatment With Amantadine Increase
More informationTRAUMATIC BRAIN INJURY. Moderate and Severe Brain Injury
TRAUMATIC BRAIN INJURY Moderate and Severe Brain Injury Disclosures Funded research: 1. NIH: RO1 Physiology of concussion 2016-2021, Co-PI, $2,000,000 2. American Medical Society of Sports Medicine: RCT
More informationDevelopment of the Sydney Falls Risk Screening Tool: phase two
Development of the Sydney Falls Risk Screening Tool: phase two Presented by Duncan McKechnie Coinvestigators Murray Fisher, Julie Pryor, Jhoven de Jesus, Melissa Bonser The University of Sydney Page 1
More informationPost-traumatic amnesia following a traumatic brain injury
Post-traumatic amnesia following a traumatic brain injury Irving Building Occupational Therapy 0161 206 1475 All Rights Reserved 2017. Document for issue as handout. Unique Identifier: NOE46(17). Review
More informationTable 3.1: Canadian Stroke Best Practice Recommendations Screening and Assessment Tools for Acute Stroke Severity
Table 3.1: Assessment Tool Number and description of Items Neurological Status/Stroke Severity Canadian Neurological Scale (CNS)(1) Items assess mentation (level of consciousness, orientation and speech)
More informationG. FUNCTIONAL MEMORY AND COGNITION ASSESSMENT 100
G. FUNCTIONAL MEMORY AND COGNITION ASSESSMENT 100 1. Check if any of the following exist: 1000 Learning disability 105 Communication, sensory or motor disabilities 110 Diagnosed Traumatic Brain Injury
More informationJens Bak Sommer, MSc 1,2,3, Anne Norup, PhD 1, Ingrid Poulsen, PhD 1 and Jesper Mogensen, PhD 3
J Rehabil Med 2013; 45: 778 784 ORIGINAL REPORT Cognitive activity limitations one year post-trauma in patients admitted to sub-acute rehabilitation after severe traumatic brain injury Jens Bak Sommer,
More informationFunctional Neuroanatomy and Traumatic Brain Injury The Frontal Lobes
Functional Neuroanatomy and Traumatic Brain Injury The Frontal Lobes Jessica Matthes, Ph.D., ABN Barrow TBI Symposium March 23, 2019 jessica.matthes@dignityhealth.org Outline TBI Mechanisms of Injury Types
More informationThe Vegetative and Minimally Conscious States: Diagnosis, Prognosis and Treatment
The Vegetative and Minimally Conscious States: Diagnosis, Prognosis and Treatment Ron Hirschberg, MD a,b,c, Joseph T. Giacino, PhD a,b,d, * KEYWORDS Consciousness Vegetative state Traumatic brain injury
More informationThe Extended Glasgow Coma Scale and Mtbi
The Extended Glasgow Coma Scale and Mtbi Michael J. Slater Slater Vecchio, Vancouver, B.C. December, 2001 Introduction In cases where a lawyer is attempting to prove that a plaintiff has suffered a mild
More informationPediatric Traumatic Brain Injury. Seth Warschausky, PhD Department of Physical Medicine and Rehabilitation University of Michigan
Pediatric Traumatic Brain Injury Seth Warschausky, PhD Department of Physical Medicine and Rehabilitation University of Michigan Modules Module 1: Overview Module 2: Cognitive and Academic Needs Module
More informationMOTOR SPEECH THERAPY AMNESIA (PTA)! IN POST TRAUMATIC. NSW TBI Evidence Based Practice Group Audrey McCarry - Royal Rehab Janine Mullay Royal Rehab
MOTOR SPEECH THERAPY IN POST TRAUMATIC AMNESIA (PTA)! NSW TBI Evidence Based Practice Group Audrey McCarry - Royal Rehab Janine Mullay Royal Rehab A BIT ABOUT OUR GROUP We are 3 years old We have 14 members
More informationAssessment of localisation to auditory stimulation in post-comatose states: use the patient s own name
Cheng et al. BMC Neurology 2013, 13:27 RESEARCH ARTICLE Open Access Assessment of localisation to auditory stimulation in post-comatose states: use the patient s own name Lijuan Cheng 1, Olivia Gosseries
More informationCanadian Stroke Best Practices Table 3.3A Screening and Assessment Tools for Acute Stroke
Canadian Stroke Best Practices Table 3.3A Screening and s for Acute Stroke Neurological Status/Stroke Severity assess mentation (level of consciousness, orientation and speech) and motor function (face,
More informationLanguage After Traumatic Brain Injury
Chapter 7 Language After Traumatic Brain Injury 10/24/05 COMD 326, Chpt. 7 1 1 10/24/05 COMD 326, Chpt. 7 2 http://www.californiaspinalinjurylawyer.com/images/tbi.jpg 2 TBI http://www.conleygriggs.com/traumatic_brain_injury.shtml
More informationNORTH AMERICAN BRAIN INJURY SOCIETY ANNUAL CONFERENCE
NORTH AMERICAN BRAIN INJURY SOCIETY ANNUAL CONFERENCE Acute and Long Term Clinical Issues in Disorders of Consciousness September 21, 2013 David Demarest, Ph.D., CBIST David Anders, MS, CCC-SLP, CBIST
More informationNeuropsychological Sequale of Mild Traumatic Brain Injury. Professor Magdalena Mateo. Megan Healy
Neuropsychological Sequale of Mild Traumatic Brain Injury Professor Magdalena Mateo Megan Healy Abstract: Studies have proven that mild traumatic brain injuries (MTBI), commonly known as concussions, can
More informationFinal Report of Activity February 21 st, 2006 to April 30 th, 2006 CHEO Grant 052
Final Report of Activity February 21 st, 2006 to April 30 th, 2006 CHEO Grant 052 1- Title of Study: The prevalence of neuropsychiatric disorders in children and adolescents on an inpatient treatment unit:
More informationThe significance of sensory motor functions as indicators of brain dysfunction in children
Archives of Clinical Neuropsychology 18 (2003) 11 18 The significance of sensory motor functions as indicators of brain dysfunction in children Abstract Ralph M. Reitan, Deborah Wolfson Reitan Neuropsychology
More informationobserved. In spite of the fact that D.H. demonstrated minimal definitive changes on the conversational measures selected, by the end of both
1 INTRODUCTION Decreased conversational skills negatively affect quality of life following brain injury because successful social, familial, academic, and/or vocational reintegration rests on the recovery
More informationCRITICALLY APPRAISED PAPER (CAP)
CRITICALLY APPRAISED PAPER (CAP) Couillet, J., Soury, S., Lebornec, G., Asloun, S., Joseph, P., Mazaux, J., & Azouvi, P. (2010). Rehabilitation of divided attention after severe traumatic brain injury:
More informationSession 15. Brain Death, Permanent Vegetative State, and Medical Futility
American Academy of Pediatrics Bioethics Resident Curriculum: Case-Based Teaching Guides Session 15. Brain Death, Permanent Vegetative State, and Medical Futility Ásdís Finnsdóttir Wagner, DO; Julio Quezada,
More informationQuality ID #293: Parkinson s Disease: Rehabilitative Therapy Options National Quality Strategy Domain: Communication and Care Coordination
Quality ID #293: Parkinson s Disease: Rehabilitative Therapy Options National Quality Strategy Domain: Communication and Care Coordination 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE:
More informationFact Sheet 8. DSM-5 and Autism Spectrum Disorder
Fact Sheet 8 DSM-5 and Autism Spectrum Disorder A diagnosis of autism is made on the basis of observed behaviour. There are no blood tests, no single defining symptom and no physical characteristics that
More informationScholarWorks at WMU. Western Michigan University. Caitlyn E. Bodine Western Michigan University,
Western Michigan University ScholarWorks at WMU Master's Theses Graduate College 5-2015 A Comparison Study of Diagnostic Outcomes between the Music Therapy Assessment Tool for Awareness in Disorders of
More informationhow reliable is it? measurement of post-traumatic amnesia may post-traumatic amnesia less than one hour; (Spearman's r 0.79), but the correlation
3838ournal of Neurology, Neurosurgery, and Psychiatry 1997;62:38-42 Oxford Head Injury Service, Rivermead Rehabilitation Centre, Abingdon Road, Oxford OX1 4XD, UK N S King S Crawford F J Wenden N E G Moss
More informationrelationship to brain damage after severe closed head injury
Jouirnal ofneurology, Neurosurgery, and Psychiatry, 1976, 39, 593-601 Wechsler Memory Scale performance and its relationship to brain damage after severe closed head injury From the D. N. BROOKS University
More informationEffect of Mobility on Community Participation at 1 year Post-Injury in Individuals with Traumatic Brain Injury (TBI)
Effect of Mobility on Community Participation at 1 year Post-Injury in Individuals with Traumatic Brain Injury (TBI) Irene Ward, PT, DPT, NCS Brain Injury Clinical Research Coordinator Kessler Institute
More informationTHE NEED TO PREDICT long-term functional outcome is
761 Using Early Neuropsychologic Testing to Predict Long-Term Productivity Outcome From Traumatic Brain Injury Corwin Boake, PhD, Scott R. Millis, PhD, Walter M. High Jr, PhD, Richard L. Delmonico, PhD,
More informationA Practice Parameter of the American Congress of Rehabilitation Medicine SPECIAL ARTICLE
1795 SPECIAL ARTICLE A Practice Parameter of the American Congress of Rehabilitation Medicine Assessment Scales for Disorders of Consciousness: Evidence- Based Recommendations for Clinical Practice and
More informationAge as a Predictor of Functional Outcome in Anoxic Brain Injury
Age as a Predictor of Functional Outcome in Anoxic Brain Injury Mrugeshkumar K. Shah, MD, MPH, MS Samir Al-Adawi, PhD David T. Burke, MD, MA Department of Physical Medicine and Rehabilitation, Spaulding
More informationInstructional Course #34. Review of Neuropharmacology in Pediatric Brain Injury. John Pelegano MD Jilda Vargus-Adams MD, MSc Micah Baird MD
Instructional Course #34 Review of Neuropharmacology in Pediatric Brain Injury John Pelegano MD Jilda Vargus-Adams MD, MSc Micah Baird MD Outline of Course 1. Introduction John Pelegano MD 2. Neuropharmocologic
More informationHarvard Medical School. Vice President Medical Affairs The Spaulding Rehabilitation Hospital Network Chief Physical Medicine and Rehabilitation
Interventions to Enhance Motor Neurorecovery: Lessons Learned and Opportunities AAPMR 2015 Boston, MA Ross Zafonte,DO. Earle P. and Ida S. Charlton Chair and Professor Department of Physical Medicine and
More informationFunctional Level During the First Year After Moderate and Severe Traumatic Brain Injury: Course and Predictors of Outcome
Original Article Elmer ress Functional Level During the First Year After Moderate and Severe Traumatic Brain Injury: Course and Predictors of Outcome Maria Sandhaug a, b, e, Nada Andelic c, Svein A Berntsen
More informationSchool of Hard Knocks! Richard Beebe MS RN NRP MedicThink LLC
School of Hard Knocks! Richard Beebe MS RN NRP MedicThink LLC Fall of a Teton How Bad is He Hurt? What REALLY happened inside Johnny s head? How common are these types of injuries? PONDER THIS What part
More informationAwareness of Behavioral, Cognitive, and Physical Deficits in Acute Traumatic Brain Injury
1450 Awareness of Behavioral, Cognitive, and Physical Deficits in Acute Traumatic Brain Injury Tessa Hart, PhD, Mark Sherer, PhD, John Whyte, MD, PhD, Marcia Polansky, ScD, Thomas A. Novack, PhD ABSTRACT.
More informationOUR BRAINS!!!!! Stroke Facts READY SET.
HealthSouth Rehabilitation Hospital Huntington Dr. Timothy Saxe, Medical Director READY SET. OUR BRAINS!!!!! Stroke Facts 795,000 strokes each year- 600,000 new strokes 5.5 million stroke survivors Leading
More informationA Healthy Brain. An Injured Brain
A Healthy Brain Before we can understand what happens when a brain is injured, we must realize what a healthy brain is made of and what it does. The brain is enclosed inside the skull. The skull acts as
More informationPatients with disorders of consciousness: how to treat them?
Patients with disorders of consciousness: how to treat them? Aurore THIBAUT PhD Student Coma Science Group LUCA meeting February 25 th 2015 Pharmacological treatments Amantadine Giacino (2012) 184 TBI
More informationCase reports. Computerised cognitive assessment of concussed Australian Rules footballers
354 Br J Sports Med 1;35:354 360 Case reports Centre for Sports Medicine Research Education, University of Melbourne, Parkville, Victoria, Australia M Makdissi P McCrory K Bennell Neuropsychology Laboratory,
More informationNew Mexico TEAM Professional Development Module: Deaf-blindness
[Slide 1] Welcome Welcome to the New Mexico TEAM technical assistance module on making eligibility determinations under the category of deaf-blindness. This module will review the guidance of the NM TEAM
More informationComa Management and Functional Assessment 17/9/2011
Coma Management and Functional Assessment 17/9/2011 CONSCIOUSNESS Consciousness is an ambiguous term, encompassing both wakefulness and awareness. INTRODUCTION Progress in intensive care has increased
More informationREFERENCES Blank, M., & Franklin, E. (1980). Dialogue with preschoolers: A cognitively-based system of assessment. Applied Psycholinguistics, 1,
1 INTRODUCTION Persisting deficits in conversational skills are a contributing factor to poor psychosocial adjustment and social isolation following closed-head injury (CHI). Therefore, conversational
More informationCognitive sequelae in relationship to early indices of severity of brain damage after severe blunt head injury
Journal of Neurology, Neurosurgery, and Psychiatry, 1980, 43, 529-534 Cognitive sequelae in relationship to early indices of severity of brain damage after severe blunt head injury D N BROOKS, M E AUGHTON,
More informationAssessment of minimally responsive patients: clinical difficulties of single-case design
BRAIN INJURY, 1999, VOL. 13, NO. 10, 829 ± 837 Assessment of minimally responsive patients: clinical difficulties of single-case design O L I V I E R P I G U E T {, A. C L A Y T O N K I N G { a n d D A
More informationDisorders of language and speech. Samuel Komoly MD PhD DHAS Professor and Chairman Department of Neurology
Disorders of language and speech Samuel Komoly MD PhD DHAS Professor and Chairman Department of Neurology http://neurology.pote.hu major categories disorders of language and speech cortical types aphasias
More informationOUTCOME PREDICTION is one of the most important
950 SPECIAL SECTION: ORIGINAL ARTICLE The Predictive Validity of a Brief Inpatient Neuropsychologic Battery for Persons With Traumatic Brain Injury Robin A. Hanks, PhD, Scott R. Millis, PhD, Joseph H.
More informationwhat do the numbers really mean? NIHSS Timothy Hehr, RN MA Stroke Program Outreach Coordinator Allina Health
what do the numbers really mean? NIHSS Timothy Hehr, RN MA Stroke Program Outreach Coordinator Allina Health NIHSS The National Institutes of Health Stroke Scale (NIHSS) is a tool used to objectively quantify
More informationCognitive Rehabilitation with Current Research and Transition of Care
Cognitive Rehabilitation with Current Research and Transition of Care Mike Dichiaro, MD Pediatric Rehabilitation Medicine Carin Rowan, MPT Pediatric Physical Therapy Financial Disclosures No relevant financial
More informationSensorimotor Functioning. Sensory and Motor Systems. Functional Anatomy of Brain- Behavioral Relationships
Sensorimotor Functioning Sensory and Motor Systems Understanding brain-behavior relationships requires knowledge of sensory and motor systems. Sensory System = Input Neural Processing Motor System = Output
More informationWe will look at the definition of Neuro-Rehabilitation as opposed to Palliative Care, What impairments patients have at diagnosis How good we are at
We will look at the definition of Neuro-Rehabilitation as opposed to Palliative Care, What impairments patients have at diagnosis How good we are at picking these up; What we need to do to change the system
More informationChanges, Challenges and Solutions: Overcoming Cognitive Deficits after TBI Sarah West, Ph.D. Hollee Stamper, LCSW, CBIS
Changes, Challenges and Solutions: Overcoming Cognitive Deficits after TBI Sarah West, Ph.D. Hollee Stamper, LCSW, CBIS Learning Objectives 1. Be able to describe the characteristics of brain injury 2.
More informationMai 2017 INDICATORS EXAMPLES
Mai 2017 INDICATORS EXAMPLES SECTIONS INDICATORS A. Key Components of TBI Rehabilitation Proportion of individuals with TBI who required and received rehabilitation services within two working days of
More informationAutism. Laura Schreibman HDP1 11/29/07 MAIN DIAGNOSTIC FEATURES OF AUTISTIC DISORDER. Deficits in social attachment and behavior
Autism Laura Schreibman HDP1 11/29/07 MAIN DIAGNOSTIC FEATURES OF AUTISTIC DISORDER Deficits in social attachment and behavior Deficits in verbal and nonverbal communication Presence of perseverative,
More informationNeuroimaging & Consciousness
Neuroimaging & Consciousness Georgios ANTONOPOULOS PhD student Coma Science Group GIGA Consciousness University & University Hospital Liège, Belgium Arousal & awareness Conscious Wakefulness Lucid Dreaming
More informationFUNCTIONAL STATUS. TBIFIM = Functional Status
TBIFIM = Functional Status FUNCTIONAL STATUS 1. CDE Variable TBIFIM = Functional Status 2. CDE Definition Functional status is to be collected within three calendar days after admission to inpatient rehabilitation
More informationMini Research Paper: Traumatic Brain Injury. Allison M McGee. Salt Lake Community College
Running Head: Mini Research Paper: Traumatic Brain Injury Mini Research Paper: Traumatic Brain Injury Allison M McGee Salt Lake Community College Abstract A Traumatic Brain Injury (also known as a TBI)
More informationHead Injury: Classification Most Severe to Least Severe
Head Injury: Classification Most Severe to Least Severe Douglas I. Katz, MD Professor, Dept. Neurology, Boston University School of Medicine, Boston MA Medical Director Brain Injury Program, HealthSouth
More informationDetecting Awareness in the Vegetative State
Detecting Awareness in the Vegetative State ADRIAN M. OWEN a AND MARTIN R. COLEMAN b a MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom b Impaired Consciousness Study Group, Wolfson Brain
More informationexamination in the initial assessment of overdose patients
Archives of Emergency Medicine, 1988, 5, 139-145 Use of abbreviated mental status examination in the initial assessment of overdose patients K. S. MERIGIAN,1 J. R. HEDGES,1 J. R. ROBERTS,1 R. A. CHILDRESS,'
More informationMaking Every Word Count for Nonresponsive Patients
Research Original Investigation Lorina Naci, PhD; Adrian M. Owen, PhD IMPORTANCE Despite the apparent absence of external signs of consciousness, a significant small proportion of patients with disorders
More informationVA/DoD Clinical Practice Guidelines for Management of Concussion/mTBI
VA/DoD Clinical Practice Guidelines for Management of Concussion/mTBI Ernest Degenhardt Chief, Evidence-Based Practice USA Medical Command Quality Management Division Office of Evidence-Based Practice
More informationSUPPLEMENTARY MATERIAL. Table. Neuroimaging studies on the premonitory urge and sensory function in patients with Tourette syndrome.
SUPPLEMENTARY MATERIAL Table. Neuroimaging studies on the premonitory urge and sensory function in patients with Tourette syndrome. Authors Year Patients Male gender (%) Mean age (range) Adults/ Children
More informationWhat is concussion? DR MARTIN RAFTERY CHIEF MEDICAL OFFICER NOVEMBER 2016
What is concussion? DR MARTIN RAFTERY CHIEF MEDICAL OFFICER NOVEMBER 2016 2 WHAT IS RUGBY? Short video CONCUSSION WHY IMPORTANT? 1. Can mimic more serious intra-cranial injury 2. Can lead to persistent
More informationGuideline Summary NGC-9701
Guideline Summary NGC-9701 Guideline T itle Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Bibliographic Source(s) American Congress
More informationRelationship between reaction time, mental processing speed and motor speed in individuals with mild to moderate brain injury
Relationship between reaction time, mental processing speed and motor speed in individuals with mild to moderate brain injury Kenneth NK FONG 1, PhD, Marko KL CHAN 2, BSc, Peggie PK NG 2, MSc 1 Department
More informationProgress Report. Date: 12/18/ :15 PM Medical Record #: DOB: 10/17/1940 Account #: Patient Information
Visits From SOC: Address: City, State, Zip: Occupation: Gender: Contact Person: 2 Primary Diagnosis: Other Diagnosis: 4614 Winstead Way Franklin, Tennessee 37065 Patient Information Healthcare - Medical
More informationAthena Demertzi. Coma Science Group Cyclotron Research Centre and Neurology Department University Hospital of Liège, BELGIUM
Coma Recovery Scale Revised workshop op Vienna, 22/09/2009 Athena Demertzi Neuropsychologist, o og st, PhD Student t Coma Science Group Cyclotron Research Centre and Neurology Department University Hospital
More informationApproximately five minutes after a terrible car accident
Report on Progress 2015 Disorders of Consciousness: Brain Death, Coma, and the Vegetative and Minimally Conscious States Thomas I. Cochrane M.D., MBA, Neurology, Brigham & Women s Hospital Michael A. Williams,
More informationSYLLABUS FOR PH.D ENTRANCE TEST IN SPEECH AND HEARING
SYLLABUS FOR PH.D ENTRANCE TEST IN SPEECH AND HEARING 1) ADVANCES IN SPEECH SCIENCE. a) Life span changes in speech mechanism including developmental milestones b) Physiology of Speech production: Respiratory
More informationDefinition: multiple personality disorder from The Hutchinson Unabridged Encyclopedia with Atlas and Weather Guide
Topic Page: dissociative identity disorder Definition: multiple personality disorder from The Hutchinson Unabridged Encyclopedia with Atlas and Weather Guide Psychiatric disorder wherein the patient exhibits
More informationRecent advances in paraclinical assessment of patients with disorders of consciousness
Recent advances in paraclinical assessment of patients with disorders of consciousness 11.9.2018 Camille Chatelle, PhD - neuropsychologist GIGA Consciousness, Coma Science Group, Liège 2 Who are we? Prof.
More informationPredicting the need for operation in the patient with an occult traumatic intracranial hematoma
J Neurosurg 55:75-81, 1981 Predicting the need for operation in the patient with an occult traumatic intracranial hematoma SAM GALBRAITH, M.D., F.R.C.S., AND GRAHAM TEASDALE, M.R.C.P., F.R.C.S. Department
More informationNew Mexico TEAM Professional Development Module: Autism
[Slide 1]: Welcome Welcome to the New Mexico TEAM technical assistance module on making eligibility determinations under the category of autism. This module will review the guidance of the NM TEAM section
More information