Axone (Dartmouth, N.S.)最新文献

The causes and consequences of severe traumatic brain injury are reviewed, including mechanical injury and neurochemical changes following focal and diffuse injuries. A discussion of terminology seeks to clarify current nomenclature and descriptions of behaviours during emergence from coma. Theories of recovery following severe brain injury are reviewed including diaschisis, plasticity and compensation, redundancy, environmental regulation, and excess disability. Several assessment tools that have been recommended for use with this population of individuals in an altered state of consciousness following coma are discussed and critiqued. They include the Glasgow Coma Scale, Ranchos Los Amigos Levels of Cognitive Functioning Assessment Scale, Western Neuro Sensory Stimulation Profile, Coma Near Coma Scale, Freeman Questionnaire, and the Sensory Modality Assessment Rehabilitation Technique.

Brain injury is a major cause of injury death and long-term neurological impairment in children often requiring long-term support. Despite the significance and frequency of such injuries, very little is known about the circumstances of these injuries, the long-term outcomes and family support needs. In this pilot study of 10 families of children with traumatic brain injury, participants described a variety of factors which contributed to their child's injury (inattentiveness, unfamiliarity, developmental level, lack of protective gear, invulnerability, peer pressure, environmental hazards and lack of supervision). As a result of their child's injury, family members described fundamental shifts in how they view life and that the roles and responsibilities of family members changed drastically. Study families experienced sustained uncertainty and described the impact on family relationships. While social support was clearly a mediating factor, families described the need for ongoing support and services to help them adapt to new roles, cope with new challenges, and manage sequellae such as post-traumatic headaches, epilepsy, learning difficulties and behavioural problems. The study findings represent an initial attempt to develop knowledge upon which focussed injury prevention interventions can be developed. Furthermore, this information will assist in the determination of appropriate health, rehabilitative, and educational support services for children with brain injuries. Involving families in this way will enhance the implementation of practical and useful support services for families of children with brain injuries.

In May of 1997 a drug inadvertently injected intrathecally caused severe neurological damage and death to a child. This event rendered a family grief-stricken and numerous health care providers forever changed. As Paget (1988) says, "The sorrow of mistakes is sometimes very diffuse and sometimes very pointed. It is sometimes the sorrow of failed action and sometimes the sorrow of failed conduct. The sorrow of mistakes has been expressed as the too-lateness of human understanding as it lies along the continuum of time, and as a wish that it might have been different, both then and now" (p.149). The reports of this tragic event in the media horrified a mother in another province. The same error had led to the death of her child five years earlier. In fact, this error has taken place a number of times in North America in the preceding decade. However, we did not know of the previous tragedies nor had we fully understood how critical examination of some of our own earlier near misses could have made such a tragic mistake less likely to occur.

Guillain-Barré Syndrome (GBS) is an illness characterized by acute neuromuscular paralysis. A review of the history, course of the disease, current treatments, and nursing interventions, as well as excerpts from a patient teaching guide developed by the author for patients with GBS is included in this paper. The objectives are to present information about GBS, first at a level of understanding appropriate for patients and their families, and then to provide a more indepth discussion for health care providers. Despite the potential severity of GBS, the expected outcomes are encouraging. GBS affects 1-2.73 individuals per 100,000/year (Hahn, 1998). The symptoms can range from numbness and tingling with mild weakness to total paralysis requiring mechanical ventilation. Once diagnosed, patients are usually treated with intravenous immune globulin (i.v. IG), which significantly reduces the duration of the illness (Hughes, 1997; Guillain-Barré Syndrome Study Group, 1985). Neuroscience nurses can make a difference in the recovery of their patients by anticipating potential complications and attending to their special needs during the acute and recovery phases of their illness. Aside from physical care, being able to support and teach the patient and family about GBS is crucial. Use of a patient and family teaching guide is one strategy for providing education and support.

Over the past three decades, there has been an increasing interest in cases of profound muscle weakness in critically ill, mechanically ventilated patients. Potential causes for these acute weakness syndromes are multiple and include disorders of the peripheral nerves, the neuromuscular junction, and muscle (Sliwa, 2000). This article will provide an overview of one potential cause of an acute weakness syndrome affecting peripheral nerves, critical illness polyneuropathy (CIP). A case study concerning a 32-year-old male who suffered multiple traumatic injuries, and who was treated for more than two years, is presented to illustrate the course of the syndrome. He required extensive interdisciplinary involvement to achieve independence in spite of ongoing neurological impairments.

The presence of a chronic illness such as multiple sclerosis (MS) represents not only overwhelming demands on male caregivers, but ambivalence for men with respect to their masculinity. Men as sole caregivers for spouses with MS feel caught between a rock and a hard place, given their gender socialization and the pressing demands of caring for a dependent and vulnerable spouse. Regular chapter visits within the MS Society in Ontario confirmed the assumption that male caregivers have to contend with a predominant bias among professional female caregivers that men are really not capable of caring for someone with a chronic illness and subsequently cannot be trusted with such responsibility. This bias actually works to undermine men's perceived capability and predisposition to caring for a vulnerable family member with a chronic illness or disability.

Although concurrent spinal cord injury (SCI) and traumatic brain injury (TBI) are recognized, there is little acknowledgement of SCI/TBI as a contributor to psychological distress and family burden. By mail-out questionnaire, we evaluated psychological distress and family burden in a married group (n = 12) with traumatic SCI who had not been identified as having concurrent TBI on referral to the Canadian Paraplegic Association. Both the person with SCI and the partner completed the Brief Symptom Inventory (BSI), the Adjective Checklist, and a Likert strain scale to measure the perception of the partner's strain. The partner also completed the Zarit Burden Interview. Despite screening criteria designed to selectively recruit individuals without TBI, seven individuals described post-traumatic amnesia (PTA) > or = 3 days. Subsequently, participants' reports were divided into two groups--"longer PTA" and "shorter PTA". On the Brief Symptom Inventory, the two SCI groups did not differ, but the partners of individuals with "longer PTA" had significantly elevated Global Severity Index scores compared to the other partners. The "longer PTA" partner group demonstrated more strain and more burden (as measured by the Likert strain scale and the Zarit Burden Interview). Given the size of the groups (n = 7, n = 5), these findings are presented to illustrate trends and to stimulate further research.