儿童缺血性脑病的诊治策略

结合国内外文献资料,从儿童缺血性脑病的病因、临床表现、影像学特点、治疗方式及疗效等方面着手,进行分析和比较,加深医患对儿童缺血性脑病的了解,同时为该类疾病的临床诊断与治疗思路提供借鉴。     

关于监测深低温停循环主动脉手术期间脊髓缺血性损伤的思考

脊髓缺血再灌注损伤（spinal cord ischemic reperfusion injury,SCIRI）是深低温停循环（deep hypothermic circulatoryarrest,DHCA）主动脉手术期间一种致命性的并发症,它对患者和其家属及医务人员带来严重的身心危害。在DHCA主动脉手术期间早期监测...     

The relation of learning disabilities to the long-term outcomes of concussion

ObjectiveThis study sought to cross-sectionally evaluate the relation between learning disorders (LD) and long-term concussion outcomes.MethodSeventy-three asymptomatic male university athletes (23 history of concussion with LD; 24 history of concussion no LD; 26 controls) completed the Beck Depression Inventory-2 (BDI-II), the Profile of Mood States (POMS), the Cogstate battery, and an Oddball task during which event-related brain potentials were recorded.ResultsConcussed athletes with LD exhibited greater depressive symptoms (BDI-II), greater total mood disturbance (POMS), decreased accuracy on the One-Card Learning and the N-back task (Cogstate), decreased accuracy on the Oddball task, and reduced ERN amplitude relative to both the concussed athletes without a LD and controls. Concussed athletes with LD also exhibited prolonged P3 latency relative to controls. Irrespective of LD, concussed athletes exhibited increased anger-hostility and decreased Pe amplitudes relative to controls. No differences were observed in P3a amplitude or latency.ConclusionHaving LD may be a significant factor moderating the neurophysiological, cognitive and psycho-affective outcomes of concussion, and may explain a significant portion of the persistent deficits observed by researchers and clinicians.     

Preference for progressive delays and concurrent physical therapy exercise in an adult with acquired brain injury

The purpose of this study was to increase self-control and engagement in a physical therapy task (head holding) for a man with acquired traumatic brain injury. Once impulsivity was observed (i.e., repeated impulsive choices), an experimental condition was introduced that consisted of choices between a small immediate reinforcer, a large fixed-delay reinforcer, and a large progressive-delay reinforcer. The participant showed a preference for the progressive-delay option, even when the duration of the delay exceeded that of the fixed delay. The results have implications for establishing optimal choice making and teaching life-enhancing skills.     

Teaching safety skills to children to prevent gun play: an evaluation of in situ training

This study evaluated behavioral skills training with added in situ training for teaching safety skills to prevent gun play. Following baseline, each child received two sessions of behavioral skills training and one in situ training session. Additional in situ training sessions were conducted until the child exhibited the safety skills (don't touch the gun, get away, and tell an adult). All children acquired and maintained the safety skills at a 3-month follow-up. In addition, of the 7 children assessed in a dyad situation, all exhibited the correct skills in the presence of another child.     

The scaling of postural adjustments during bimanual load-lifting in traumatic brain-injured adults

Previous postural studies of traumatic brain injury (TBI) patients have been limited to identifying deficits in static and quasi-dynamic postural control tasks such as weight shifting. In this study, we examined whether or not patients with TBI are able to scale adequately their postural adjustments during the performance of the dynamic task of bimanual load-lifting. An age matched group of healthy adults served as controls. We used the Tetrax posturography system that calculates a stability score (ST) based on fluctuations in vertical ground reaction forces, normalized for body weight. During quiet standing, the ST scores of the TBI group were significantly higher than the control group. Forward weight shift and percentage change in the vertical ground reaction forces (lift postural adjustment (LPA) and post-lift postural adjustment (PLPA) scores) linearly increased with increasing load weight in both healthy and TBI subjects. Group differences were found in the magnitude of forward weight shift but not in the relative increase of the LPA and PLPA scores during the lifting and post-lifting phases respectively. The forward weight shift of the TBI group was lower-than-normal and asymmetrical--there was significantly less forward weight shift on the more affected than on the less affected limb. In addition, a significant amplitude coupling was found between the scaling of the weight shift of the heel and forefoot of each limb. However, no coupling was found between the weight shift amplitudes of homologous parts of both limbs in the TBI group. The results showed that scaling based on prior experience was preserved in the TBI group, though some TBI subjects demonstrated absent scaling in either the more affected or less affected heel or forefoot. The differences between the normal and TBI groups in postural adjustments are not necessarily a sign of pathology; rather they may represent a deliberate choice of the central nervous system to counteract predictable disturbances.     

Depression After Traumatic Brain Injury: A Review of Evidence for Clinical Heterogeneity

Depression represents a major source of disability among individuals who have suffered a traumatic brain injury (TBI), with estimates of prevalence in this population ranging over 50%. In comparison with other sequelae of TBI, depression is often poorly conceptualized and treated among acute care and rehabilitation professionals. One reason for this is the lack of clear etiological models for the development of depression following TBI. This paper argues that post-TBI depression actually represents a heterogeneous category, with multiple etiologic pathways and clinical implications. The literature in this area is reviewed, with an emphasis on an appreciation of the diversity within this clinical population. Conclusions focus on suggestions for differential diagnosis and treatment options.     

STIMULUS FADING AS TREATMENT FOR OBSCENITY IN A BRAIN-INJURED ADULT

Obscene verbalizations of a person with traumatic brain injury were treated using stimulus fading as the singular form of intervention. Results of a functional assessment revealed that obscenity was maintained by negative reinforcement. Stimulus fading (initial elimination of instructional demands followed by their gradual reintroduction) produced immediate and substantial reductions in obscenity that were maintained as the frequency of demands increased to baseline levels. Potential applications of the use of antecedent treatment strategies are discussed.     

A GROUP-ORIENTED CONTINGENCY TO INCREASE LEISURE ACTIVITIES OF ADULTS WITH TRAUMATIC BRAIN INJURY

An interdependent group-oriented contingency and graphic feedback were used to increase the activity levels of residents of a group home for persons with traumatic brain injury. Results showed that the intervention was effective for 4 of the 6 subjects. Individual performances must be examined when implementing group contingencies because all subjects may not respond.     

EMPIRICALLY DERIVED INJURY PREVENTION RULES

This study describes a set of empirically derived safety rules that if followed, would have prevented the occurrence of minor injuries. Epidemiologists have criticized behavioral interventions as increasing “safe” behavior but failing to demonstrate a decrease in injury. The present study documents retrospectively the link between safe behavior and injury. It demonstrates that these empirically derived rules are very similar to rules for the prevention of serious injury. The study also shows that these rules are not widely accepted and implemented by parents. Suggestions for future research in this area are advanced.