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Objective: To review the nutritional requirements of all new inpatient brain injury admissions presenting with Paroxysmal Sympathetic Hyperactivity (PSH) in the rehabilitation setting. Methods: RABIU is a 25-bed Regional facility in Northern Ireland which opened in 2006. All records of patients with a single episode non-progressive acquired brain injury admitted to RABIU from 2006 until the present were reviewed for evidence of PSH. Dietetic assessment and management was examined and recorded. Results: Four patients with persisting paroxysmal sympathetic hyperactivity were identified. All patients displayed dystonia and posturing and had clinically important percentage weight loss. All had nutrition and/or hydration requirements markedly above their estimated requirement for slow weight gain, despite adjustment for brain injury. All four had posture-related complications of their dystonia and nutrition. Conclusion: Careful monitoring of nutrition, hydration and mineral supplementation is paramount in patients presenting with paroxysmal sympathetic hyperactivity after brain injury. It is argued that morbidity may be reduced by aggressive and expert nutrition management. [ABSTRACT FROM AUTHOR]

Purpose: To analyse physiotherapy interventions and evaluate their effectiveness in the prevention and management of contracture with patients admitted in either vegetative or minimally conscious state in a UK Inpatient Regional Acquired Brain Injury Rehabilitation Service. Method: Retrospective audit of dependency levels and physiotherapy interventions in ten vegetative or minimally conscious state patients admitted over a 3-year period (2006-2009). Admission and discharge patient dependency status, Wessex Head Injury Matrix data and passive range of movement measurements on admission and discharge from physiotherapy were recorded. Results: All patients presented with hypertonicity including contractures and all initially received a manual stretching/passive movement programme. Casting/ splinting was employed in 8 cases and 7 received botulinum toxin injections. Standing regimes were initiated for 8 patients. No patient emerged out of either vegetative or minimally conscious state. Although they remained fully dependent for care needs, carer burden was reduced and all patients were able sustain a seating regimen. No minimal clinically important difference was observed in 85 out of 120 joint ranges measured (70.8%). Positive outcomes were observed in only 14 joints (11.7%) and negative outcomes in 21 joints (17.5%). Conclusion: At present, there is a paucity of evidence regarding physiotherapy efficacy to inform the management of patients in vegetative or minimally conscious state. Clearer agreed definitions of clinically important difference in passive range of movement are required to allow better interpretation of outcomes. Interventions should be aimed at minimising carer burden and developing individualised disability management programmes. Further research documenting the long-term outcomes in such patients is warranted. [ABSTRACT FROM AUTHOR]

Purpose: To compare long-term cognitive outcomes of patients treated with surgical clipping or endovascular coiling after subarachnoid haemorrhage (SAH). Method: Retrospective matched cohort study assessed neuropsychological functioning at least 12 months after aneurysmal SAH treatment. Fourteen patients treated by endovascular coiling and nine patients treated by surgical clipping participated. After gaining written consent, a comprehensive neuropsychological battery was completed. Standardised tests were employed to assess pre-morbid and current intellectual functioning (IQ), attention, speed of information processing, memory and executive function as well as psychosocial functioning and affect. Results: Treatment groups were not significantly different in terms of age, pre-morbid IQ, time from injury to treatment or time since injury. A significant effect of treatment on full-scale IQ score (p = 0.025), performance IQ (p = 0.045) and verbal IQ score (p = 0.029), all favouring the coiled group was observed. A medium effect size between groups difference in immediate memory (p = 0.19, partial η2 = 0.08) was also observed. No significant between group differences on attention, executive functioning and speed of information processing measures or mood and psychosocial functioning were noted. Both groups reported increased anxiety and memory, attention and speed of information processing deficits relative to normative data. Conclusions: Study findings indicate fewer cognitive deficits following endovascular coiling. Cognitive deficits in the clipped group may be due in part to the invasive nature of neurosurgical clipping. Further prospective research with regard to long-term cognitive and emotional outcomes is warranted. [ABSTRACT FROM AUTHOR]

Assessment of vegetative (VS) and minimally conscious state (MCS) patients presents clinicians with inherent difficulties (Royal College of Physicians, 2003) in terms of the reliable detection of potential signs of awareness given that all current assessment tools rely on observed behaviour. Recently developed measures such as SMART (Gill-Thwaites & Munday, 1999) and WHIM (Shiel et al., 2000), employing structured operational defined behavioural observations can facilitate the serial assessment of patient awareness, progress and appropriate goal setting particularly as one-off bedside assessments are more likely to be inaccurate. The use of sensitive tailored approaches involving experienced multidisciplinary teams is strongly advocated (Royal College of Physicians and British Society of Rehabilitation Medicine, 2003), notwithstanding clinicians should carefully consider potential confounding clinical factors, which may deleteriously influence patient arousal or ability to respond. Finally, areas for future development and recommendations regarding multidisciplinary assessment approaches with VS and MCS patients are outlined. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of two rehabilitation techniques for unilateral spatial neglect, contra-lesional limb activation and sustained attention training, on impaired activities of daily living. Methods: Two single case, time-series designs incorporating baseline, intervention and post-intervention phases. Results: Significant improvements were observed in both neuropsychological measures and in the independent performance of everyday activities coincident with the start of training. The benefits were well maintained during the post-training period. Conclusions: The results support the use of the two techniques in achieving functional goals for unilateral neglect patients. [ABSTRACT FROM AUTHOR]