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Purpose. To determine outcomes for persons with traumatic brain injury (TBI) in terms of employment status, income and public assistance received at 2 years after injury. Method. This study was part of a non-experimental, longitudinal survey. Participants included 49 persons with new TBI from one US national Traumatic Brain Injury Model Systems centre. Main outcome measures included employment status, earned monthly income and monthly income from public sources, at the time of injury and at 2-years follow-up. Results. At 2-year follow-up, individuals with TBI reported higher levels of employment and earned income than was previously reported for 1-year post-injury, but continued to experience declines relative to pre-injury baseline. Frequency and amount of major public agency payments continued to be increased relative to baseline. Conclusions. The costs associated with brain injury remain high for individuals, families and society, as those with TBI move into the more chronic phase of recovery. [ABSTRACT FROM AUTHOR]

Purpose. The current articles reviews the epidemiology of disability in Ireland, discusses the political and social factors which have increased focus on disability issues and offers training guidelines for rehabilitation psychology based on those of the APA's Rehabilitation Psychology Division. Rationale. With the growing number of individuals with acquired (vs developmental) disabilities in Ireland, there is increased recognition of the need to train psychologists to assist persons with acquired disabilities (e.g. spinal cord injury, acquired brain injury, stroke, etc.) in adjusting to their impairments, reintegrating back into their communities and reducing the long-term financial costs associated with disability. Conclusion. Social and political factors suggest that the time is right to develop rehabilitation psychology as a specialty in Ireland given the increased focus on disability in Ireland, including recently passed disability legislation (i.e. 2005 Disability Bill), international events (e.g. 2003 Dublin World Special Olympics) and increases in rehabilitation training programmes (i.e. medicine; physio, occupational and speech therapy). [ABSTRACT FROM AUTHOR]

The primary aim of this randomized, controlled trial was to assess the effectiveness of botulinum toxin A (BoNT-A) injections into the submandibular and parotid glands on drooling in children with cerebral palsy (CP) and other neurological disorders. Secondary aims were to ascertain the duration of any such effect and the timing of maximal response. Of the 48 participants (27 males, 21 females; mean age 11y 4mo [SD 3y 3mo], range 6-18y), 31 had a diagnosis of CP and 15 had a primary intellectual disability; 27 children were non-ambulant. Twenty-four children randomized to the treatment group received 25 units of BoNT-A into each parotid and submandibular gland. Those randomized to the control group received no treatment. The degree and impact of drooling was assessed by carers using the Drooling Impact Scale questionnaire at baseline and at monthly intervals up to 6 months postinjection/baseline, and again at 1 year. Maximal response was at 1 month at which time there was a highly significant difference in the mean scores between the groups. This difference remained statistically significant at 6 months. Four children failed to respond to the injections, four had mediocre results, and 16 had good results. While the use of BoNT-A can help to manage drooling in many children with neurological disorders, further research is needed to fully understand the range of responses. [ABSTRACT FROM AUTHOR]

Primary Objective: to determine the relationships that exist among level of spirituality, psychological coping strategies, and community integration for persons with traumatic brain injury (TBI). Research Design: non-experimental, prospective study. Methods and Procedures: Participants were 26 individuals with non-acute TBI (18 males, 8 females; 25 Caucasian, 1 Hispanic; average time since injury = 41 months). Participants completed a measure of spirituality (i.e., INSPIRIT; Kass et al., 1991); a measure of psychological coping (i.e., a revised Ways of Coping Scale (WAYSS); Felton, Revenson, & Hinrichson, 1984); and a measure of community integration (i.e., Community Integration Questionnaire (CIQ); Corrigan & Deming, 1995). Main Outcomes and Results: Spearman correlational analyses indicated statistically significant positive relationships between spirituality and 'positive' psychological coping strategies (i.e., WAYSS Cognitive Restructuring, Information Seeking, and Emotional Expression scales), but not with 'negative' psychological coping strategies (i.e., WAYSS Wish Fulfilling Fantasy, Self Blame, or Threat Minimization scales) or with the CIQ. Conclusion: Increased spirituality is associated with positive (but not negative) psychological coping strategies, but spirituality is not necessarily related to improved functional capabilities. These results underscore the need for rehabilitation professionals to consider spiritual coping as a component of recovery for TBI survivors. [ABSTRACT FROM AUTHOR]

Purpose. This article (i) reviews existing research on the relationships that exist among spirituality, religion, and health for persons with disabilities; and (ii) compares different theoretical coping models (i.e., spiritual vs. psychoneuroimmunological). Background. Over the past decade interest has increased in relationships among spirituality, religion, and health in both the mainstream media (e.g., Newsweek) and scientific literature (e.g., Koenig). In general, research has concluded that religion and spirituality are linked to positive physical and mental health outcomes. Most religion and health research has focused on populations with life-threatening diseases (e.g., cancer, cardiovascular disorders, AIDS) with minimal attention to persons with chronic, life-long disabling conditions such as brain injury, spinal cord injury, and stroke. However, religion is used by many individuals with disabilities to help them adjust to their impairments and to give new meaning to their lives. Conclusions. Religion and spirituality are important coping strategies for persons with disabilities. Practical suggestions for rehabilitation professionals are provided regarding: (a) strategies to enhance religious coping; (b) methods to train rehabilitation professionals about religious issues; and (c) issues to consider regarding future research on rehabilitation and religion. [ABSTRACT FROM AUTHOR]

Although there is considerable research on the vocational outcomes of individuals with traumatic brain injuries (TBI), there has been minimal research on the characteristics of persons with TBI who seek services from state vocational rehabilitation services. Such research is deemed critical given the significant number of individuals who request such services, as well as the significant federal and state costs associated with these programs. The current article reviews a series of studies completed collaboratively between the University of Missouri-Columbia and Missouri Division of Vocational Rehabilitation (DVR). Information is reported regarding the typical demographic, injury severity, and neuropsychological characteristics of DVR clients with TBI, as well as the most common DVR services provided to them and their vocational outcomes (i.e., successful, unsuccessful). Studies are reviewed which indicate that the provision of specific DVR services predict successful vocational outcomes, although traditional medical and neuropsychological variables do not. Additional studies are reviewed which examine the impact of gender, race, age, geographic location (i.e., rural vs. urban), and concomitant disabilities on vocational outcomes. Results indicate the importance of considering environmental and social factors when providing vocational rehabilitation services to clients with TBI, and that specific DVR services can lead to successful vocational outcomes regardless of TBI severity. Implications for future clinical services and research are presented. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of traumatic brain injury (TBI) and concomitant disabilities on vocational outcomes. Design: Non-experimental, prospective analysis of adults who qualified for services with the Missouri Division of Vocational Rehabilitation (MDVR) based on a history of TBI. Participants: 139 MDVR clients with non-acute TBI, followed from enrollment until case closure, who were divided into 5 groups (TBI only; TBI + orthopedic injury; TBI + seizure; TBI + psychological disorder; TBI + learning disability). Main outcome measures: Demographic characteristics; injury severity; neuropsychological functioning; and employment status at case closure. Analyses: Multivariate analysis of variance and non-parametric methods were used to evaluate differences in outcome variables between the TBI Only and other 4 groups. Results: Statistically non-significant trends between the groups suggested less successful employment outcomes for persons with TBI and concomitant psychological disorders (11%) and learning disabilities (8%) vs. persons with orthopedic injuries (23%), seizure disorders (32%), or TBI only (26%). Conclusions: Concomitant psychological and learning disabilities, compared to concomitant physical disabilities, are associated with greater employment difficulties for persons with TBI. VR clients with psychological and learning disorders may require additional services/interventions to enhance their vocational outcomes. [ABSTRACT FROM AUTHOR]

Persons with epilepsy experience numerous problems securing and retaining employment, and may require the assistance of state Vocational Rehabilitation (VR) services. Unfortunately, very little is known about VR clients with epilepsy, including their typical characteristics, the VR services they receive, the relative success of VR programs, and how VR services impact their ability to financially support themselves (i.e. income and insurance). This study collected data retrospectively to determine the demographic characteristics of state VR clients with epilepsy, their employment/financial outcomes, the type and frequency of VR services they receive, and the best predictors of successful employment for VR clients. The main outcome measures included demographic indices, financial/insurance status at case referral/closure, VR services offered, and vocational status at time of case closure (i.e., successful, unsuccessful, etc.). Study participants were 156 VR clients with epilepsy from Missouri who requested services between 2000 and 2001. Demographically, the participants were primarily Caucasian (81%), male (53%), and of limited education (i.e., 79% with a high school degree or less). Twenty percent of the participants were successfully employed at case closure, compared to 42% who were closed as unsuccessful, 14% who had services interrupted, 5% who had no services provided after referral, and 19% who were closed for 'other reasons'. The most common VR services offered were assessment, transportation, maintenance, job services, and training. Stepwise logistic regression indicated that the delivery of VR services (i.e., on-the-job training, etc.) were the only significant predictors of positive employment outcome. It was concluded that state VR programs can assist persons with epilepsy in becoming successfully employed, increasing personal income, and decreasing reliance on government support. [ABSTRACT FROM AUTHOR]

The Wechsler Memory Scale-Revised (WMS-R) is a frequently used memory measure that has endured numerous criticisms, particularly related to the variability of results of factor analytic studies The instrument relies on conglomerate Index scores to represent performance, in spite of tenuous empirical support This study provides evidence that valuable information about memory abilities for individuals sustaining traumatic brain injury can be gained by investigating individual WMS-R subtest performance The WMS-R was administered to a total of 54 subjects 36 individuals with moderate to severe TBI, and 18 normal controls Results suggested that Index scores do not necessarily accurately represent performance on each of the individual Index subtests Development of percentile scores for all subtests is strongly recommended, and implications for rehabilitation planning are discussed. [ABSTRACT FROM AUTHOR]

The current study attempted to determine 1) if frontal lobe TBI produces specific long-term cognitive deficits that are measurable on objective testing, and 2) which tests are most appropriate for assessing frontal deficits The study revolved 41 patients 10 sustaining TBI with frontal lesions on CT, 11 sustaining TBI without frontal lesions, and 20 controls TBI subjects were included only if they were evaluated as outpatients to ensure that their cognitive deficits were stable, and not due to acute injury The results suggest that 1) frontal lobe TBI produces a specific profile of cognitive deficits (characterized as inflexibility), with relative deficits on the Trail Making Test Part B and Rey AVLT that 6 (not trials 1-5), but generally intact performance on other cognitive measures and 2) tests useful in evaluating global cognitive dysfunction (i e, Rey AVLT) may need to be used differently for the specific evaluation of frontal lobe dysfunction. [ABSTRACT FROM AUTHOR]

We have used Transition Region and Coronal Explorer 1600 Å images and Global Oscillation Network Group (GONG) magnetograms to compare ultraviolet (UV) emissions from the chromosphere to longitudinal magnetic field changes in the photosphere during four X-class solar flares. An abrupt, significant, and persistent change in the magnetic field occurred across more than 10 pixels in the GONG magnetograms for each flare. These magnetic changes lagged the GOES flare start times in all cases, showing that they were consequences and not causes of the flares. Ultraviolet emissions were spatially coincident with the field changes. The UV emissions tended to lag the GOES start times for the flares and led the changes in the magnetic field in all pixels except one. The UV emissions led the photospheric field changes by 4 minutes on average with the longest lead being 9 minutes; however, the UV emissions continued for tens of minutes, and more than an hour in some cases, after the field changes were complete. The observations are consistent with the picture in which an Alfvén wave from the field reconnection site in the corona propagates field changes outward in all directions near the onset of the impulsive phase, including downward through the chromosphere and into the photosphere, causing the photospheric field changes, whereas the chromosphere emits in the UV in the form of flare kernels, ribbons, and sequential chromospheric brightenings during all phases of the flare. [ABSTRACT FROM AUTHOR]

Purpose To evaluate children with obstetric brachial plexus palsy treated with botulinum toxin A (Botox)injections to assist with the management of contracted muscles and joints as well as co-contraction. Methods Since September 2004, 20 children have been treated. The median age at treatment was 2.1 years (range 7 months to 11 years). As experience was gained, the total dose of Botox increased from 4 to 10 units per kg. Results 12 patients were treated primarily for restriction of passive external rotation at the shoulder at an average age of 24 months (range 7 to 42 months). This group had the most impressive gains which became apparent within a week of injection. There was a high level of parental satisfaction with an improvement in passive range and increased ease of physiotherapy. Six had excellent and 4 had good results. The two patients who had little improvement had clear indications for surgery. Seven (58%) of these 12 patients went on to have a repeat injection , in 2 cases with a higher dose, aiming to achieve further gains. Five patients were treated for co-contraction of the latissimus dorsi and/or teres major were aged 8 months and from 8 to 11 years. They reported minor gains.All five patients who had triceps injections had improved elbow flexion. One patient had an over active biceps injected with minor benefit. Conclusion It is hoped that persistent physiotherapy assisted by botulinum toxin A injections targeting internal rotators can reduce gleno-humoral joint dysplasia, posterior subluxation and the need for open procedures. Shoulder subluxation identified by ultrasound should be further imaged with CT or MRI and be considered for an open procedure. [ABSTRACT FROM AUTHOR]

Purpose To evaluate patients with cerebral palsy treated with botulinum toxin A injections to assist with the management of contracted muscles and joints as well as co-contraction. Methods Since 1998, 40 limbs have been treated. The average age was 14 years (range 4 to 33 years) and the average dose given was 107 units (range 50 to 200 units). Digital flexors were injected in 26 limbs, elbow flexors in 18, wrist flexors in 17, thumb adductors in 13, pronator teres in 9, intrinsics in 3, shoulder abductors in 2 and ECU in one limb. All patients were injected under a general anaesthetic, allowing for an assessment of fixed contractures. Padded plaster casts were applied, putting the injected muscles on full stretch before the reversal of anaesthesia and were maintained for approximately 3 weeks. Thermoplastic splits were then wore 23 hrs per day for a further three weeks. Splints were serially modified to achieve progressively more extension as the flexion contractures were corrected. Simultaneous surgical procedures such as tendon lengthening and transfers were performed in 14 limbs. Results The results in the elbow flexors were disappointing. The finger, thumb and wrist flexors have responded extremely well, despite fixed flexion deformities being documented under anaesthesia in the majority of patients. Conclusion It is estimated that the muscle bellies have been elongated by 3 to 4 cm either by the lengthening of, or addition to the sarcomeres. The results in these patients are vastly superior to that which could be obtained surgically. [ABSTRACT FROM AUTHOR]

Duplicate thumb is a common congenital difference with complex management. Surgical treatment includes reconstruction of the collateral ligaments to optimise future function and cosmesis. We present the use of the "U-ligament" to further refine collateral ligament reconstruction. We have found it to be a simple and reliable technique. [ABSTRACT FROM AUTHOR]

PRIMARY OBJECTIVE: To determine if short forms (i.e. 15 item) of the Judgment of Line Orientation (JOLO) test are equivalent to the full JOLO (i.e. 30 item). RESEARCH DESIGN: Retrospective analysis of JOLO test performance. Methods and procedures: Seventy-two persons with TBI evaluated at a Midwestern University neuropsychology laboratory were administered the JOLO test, Form V, as part of a larger battery of neuropsychological tests. Short forms (i.e. odd and even number short forms) were correlated with the 30 item to determine equivalency of forms. The Statistical Package for the Social Sciences (version 10) was used for the data analyses (SPSS). MAIN OUTCOMES AND RESULTS: Pearson's correlations indicate that the JOLO odd and even short forms are significantly correlated with the full JOLO score (r = 0.90 and 0.93, respectively), and that 100% of the participants' estimated JOLO full score fell within 2 points of the actual full JOLO score. CONCLUSIONS: The results confirm the validity of the short forms of the JOLO for persons with TBI and that gender effects were not significant. [ABSTRACT FROM AUTHOR]

Abstract: There is currently very limited effective pharmacological treatment for amyotrophic lateral sclerosis. Recent evidence suggests that caffeic acid phenethyl ester has strong anti-inflammatory, anti-oxidative, and anti-neuronal death properties; thus, the present study tested the effects of caffeic acid phenethyl ester in mice expressing a mutant superoxide dismutase (SOD1G93A) linked to human amyotrophic lateral sclerosis. Administration of caffeic acid phenethyl ester after symptom onset significantly increased the post-onset survival and lifespan of SOD1G93A mice. Moreover, immunohistochemical analysis detected less activation of microglia and astrocytes and higher motor neuron counts at an early symptomatic stage (7 days following onset) in the spinal cords of SOD1G93A mice given caffeic acid phenethyl ester treatment. Additionally, lower levels of phosphorylated p38, a mitogen-activated protein kinase that is involved in both inflammation and neuronal death, were observed in the spinal cords of SOD1G93A mice treated with caffeic acid phenethyl ester for 7 days. These results indicate that caffeic acid phenethyl ester may represent a novel and effective therapeutic for the treatment of amyotrophic lateral sclerosis, and these significant neuroprotective effects observed in a commonly used amyotrophic lateral sclerosis mouse model validate the therapeutic potential of caffeic acid phenethyl ester for slowing disease progression by attenuating the neuroinflammation and motor neuron cell death associated with clinical amyotrophic lateral sclerosis pathology. [Copyright &y& Elsevier]

The prevalence of tuberculosis (TB) continues to rise worldwide. Current migration patterns and increased travel to high-prevalence TB countries will result in more frequent presentations of less common forms of TB. Tuberculous dactylitis, a form of tuberculous osteomyelitis, is well recognised in countries with a high prevalence of TB. We provide a systematic review of all published cases of tuberculous dactylitis in children and adolescents and describe a case to illustrate the typical features of the disease. Our review revealed 37 cases of tuberculous dactylitis in children and adolescents, all reported in the last 17 years. Children less than 10 years of age are most frequently affected and the hand is the most commonly affected site. Concurrent pulmonary TB is present in a fifth of cases and systemic symptoms are usually absent. Positive TST and IGRA support the presumptive diagnosis, but cannot be used as rule-out tests. The definitive diagnosis relies on the detection M. tuberculosis by PCR or culture. Treatment should comprise of a standard three to four drug anti-tuberculous regimen. The optimal treatment duration remains unknown. Surgery has a limited role in the treatment in general but may play a supportive role, and curettage of the cavity has been recommended for avascular lesions. [ABSTRACT FROM AUTHOR]

Background: There is no ideal treatment for end-stage degenerative wrist disorders and subsequent carpal collapse. The purpose of this study was to investigate whether autologous cartilage constructs tissue-engineered from bone-marrow-derived mesenchymal stem cells can be effective for carpal bone reconstruction.Methods: Total lunate excision was performed in twenty-seven adult New Zealand White rabbits. Mesenchymal stem cells were isolated from marrow and then were culture-expanded. Group-1 rabbits underwent excision only. Group-2 animals underwent excision followed by implantation of a scaffold consisting of gelatin and hyaluronan. Group-3 animals underwent excision followed by implantation of a mesenchymal stem cell-seeded scaffold that had been preincubated in chondrogenic medium. The group-1 animals were killed at six weeks, whereas the group-2 and group-3 animals were killed at six or twelve weeks. Tissues were harvested for radiographic and histologic analysis.Results: Significant carpal collapse (a 5.4% +/- 2.8% reduction in the carpometacarpal index, p < 0.05) was observed in the group-1 animals by six weeks. In contrast, the carpal height was maintained in the group-2 and 3 animals. There was no radiographic evidence of ossification in the group-1 or 2 animals, whereas there was radiographic evidence of ossification in all six group-3 rabbits killed at the twelve-week time-point. Histologic sections from the group-3 animals showed filling of the lunate space with islands of cartilage with interspersed bone ossicles at six weeks. At twelve weeks, there was abundant bone formation as well as evidence of neovascularization. Osseous tissue was present in the central portions of the constructs while the periphery was lined with cartilage. In groups 1 and 2, the lunate space was filled with poorly organized fibrous tissue.Conclusions: Cartilaginous implants preformed from autologous mesenchymal stem cells seeded onto biodegradable scaffold can prevent carpal collapse. The newly formed osteochondral tissue appears to function as an adequate biologic lunate spacer for at least twelve weeks in this animal model. [ABSTRACT FROM AUTHOR]

Research has suggested that sustaining a traumatic brain injury (TBI) may increase one's risk of developing Dementia of the Alzheimer's Type (DAT) later in life. Several neuropathological models have been proposed to explain the association between TBI and DAT and studies using a neuropsychological deficit profile methodology suggest that the pattern and extent of cognitive decline associated with these conditions are similar. This paper presents a new conceptual model, derived from deficit profile methodology, regarding the relationship between TBI and DAT. This model proposes that, for some individuals, TBI may not lead to true DAT neuropathology, but rather produces a profile of neuropsychological deficits similar to DAT, which increasingly mimics the symptoms of true DAT as the TBI survivor ages. Understanding how TBI may contribute to the development of DAT has important social and medical implications, influencing the direction of prevention efforts and contributing to one's understanding of DAT. [ABSTRACT FROM AUTHOR]

Much attention has been given to the influences of bioactive factors on mesenchymal progenitor cell differentiation and proliferation, but few studies have examined the effect of mechanical factors on these cells. This study examined the effects of cyclic hydrostatic pressure on human bone marrow-derived mesenchymal progenitor cells undergoing chondrogenic differentiation. Aggregates of bone marrow-derived mesenchymal progenitor cells were cultured in a defined chondrogenic medium and were subjected to cyclic hydrostatic pressure. Aggregates were loaded at various time points: single (day 1 or 3) or multiple (days 1–7). At 14 and 28 days, aggregates were harvested for histology, immunohistochemistry, and quantitative DNA and matrix macromolecule analysis. The aggregates loaded for a single day did not demonstrate significant changes in proteoglycan and collagen contents compared with the non-loaded controls. In contrast, for the multi-day loaded aggregates, statistically significant increases in proteoglycan and collagen contents were found on both day 14 and day 28. Aggregates loaded for seven days were larger and histological staining indicated a greater matrix/cell ratio. This study indicates that hydrostatic pressure enhances the cartilaginous matrix formation of mesenchymal progenitor cells differentiated in vitro, and suggests that mechanical forces may play an important role in cartilage repair and regeneration in vivo. [Copyright &y& Elsevier]

Bone marrow stromal cells isolated from a model of osteogenesis imperfecta (oim) mice, were transduced with a retrovirus (BAG) carrying the LacZ and neor genes after passage 21. The transduced cells retained the ability to express alkaline phosphatase activity in vitro when treated with recombinant human bone morphogenetic protein two (rhBMP-2), formed cartilage in vitro in aggregate cultures and formed bone in ceramic cubes after 6 weeks of implantation in nude mice. X-gal staining of ceramic cubes seeded with the transduced cells demonstrated the presence of LacZ-positive cells on the edges of bone and also in the lacunae of the newly formed bone 6 weeks after implantation. After infusion into femurs of oim mice, the transduced cells were detected in the marrow cavity and on the edges of the trabecular bone of the injected and contralateral femurs by X-gal staining and PCR analysis at 4, 10, 20, 30 and 40 days after injection. The LacZ gene was also detected in the lung and liver of the recipient mice at 4 and 10 days after injection but not at later time-periods. The present findings suggest that long-term cultured bone marrow stromal cells from osteogenesis imperfecta (OI) animals have the potential to traffic through the circulatory system, home to bone, form bone and continue to express exogenous genes. These findings open the possibility of using these cells as vehicles to deliver normal genes to bone as an alternative approach for the treatment of some forms of OI and certain other bone acquired and genetic diseases. [ABSTRACT FROM AUTHOR]