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Biomedical subjects

R L Bruno

Publications and source records attributed to R L Bruno.

At least 19 recordsLinked to original sources
PubMed1994

Predicting physical and verbal aggression on a brain trauma unit.

Brain injury often results in cognitive impairments and neurobehavioral deficits that effect recovery, rehabilitation, and general adjustment. Aggressive behaviors and agitation, well-known consequences of cerebral damage, are the most difficult for caregivers to evaluate and manage and the most stressful for patients and families. This study was designed to determine the efficacy of an observational protocol (Cognitive Behavioral Rating Scale, CBRS) in evaluating cognition and its usefulness with demographic, medical, and psychological information in predicting aggressive behaviors of cerebrally damaged patients. Twenty-eight brain-injured patients consecutively admitted to a brain injury unit were evaluated by nurses who used the CBRS after first establishing interrater reliability in using the instrument. Relationships were determined between results of the CBRS, demographic information, medical and psychological information; the variable in each category that was most highly correlated with aggressive behaviors was then used in a multiple linear regression to predict the frequency of aggressive behaviors. Discussion focused on disorientation to place and time as the most significant predictors of aggressive behaviors, as well as the prescriptive use of antiseizure medications and the number of medical comorbidities.

Adult↗
PubMed1994

The neuroanatomy of post-polio fatigue.

Fatigue is the most commonly reported, most debilitating, and most poorly understood Post-Polio Sequelae (PPS). Postmortem studies of 50 years ago documented frequent and severe poliovirus-induced lesions within the Reticular Activating System (RAS). Recently, neuropsychological testing has documented marked attention deficits in polio survivors reporting severe fatigue. However, neither of these findings has yet been related to the pathophysiology of post-polio fatigue. Magnetic resonance imaging of the brain was performed in 22 polio survivors carefully screened to eliminate the effect of comorbidities. Subjects rated the severity of their daily fatigue and subjective problems with attention, cognition, and memory. Small discrete or multiple punctate areas of hyperintense signal (HS) in the reticular formation, putamen, medial leminiscus, or white matter tracts were imaged in 55% of the subjects reporting high fatigue and in none of those reporting low fatigue. The presence of HS significantly correlated with fatigue severity and subjective problems in attention, concentration, staying awake, recent memory, and thinking clearly. The lack of significant correlations between HS or fatigue severity and age, severity of the acute polio, depressive symptoms, or difficulty sleeping militates against these factors as either causing HS or producing fatigue. These preliminary findings suggest that poliovirus-induced lesions in the Brain Activating System may underlie the subjective fatigue and attention deficits reported by polio survivors.

Adult↗
PubMed1993

The neuropsychology of post-polio fatigue.

To test the hypothesis that post-polio fatigue and its concomitant cognitive deficits are associated with an impairment of attention and not of higher-level cognitive processes, six carefully screened polio survivors were administered a battery of neuropsychological tests. Only subjects reporting severe fatigue, and not those with mild fatigue, demonstrated clinically significant deficits on all tests of attention, concentration, and information processing speed while showing no impairments of cognitive ability or verbal memory. These findings suggest that an impaired ability to maintain attention and rapidly process complex information appears to be a characteristic in polio survivors reporting severe fatigue, because these deficits were documented even when their subjective rating of fatigue was low. This finding supports the hypothesis that a polio-related impairment of selective attention underlies polio survivors' subjective experience of fatigue and cognitive problems.

Adult↗
PubMed1993

Predicting length of stay, functional outcome, and aftercare in the rehabilitation of stroke patients. The dominant role of higher-order cognition.

BACKGROUND AND PURPOSE: Research in recent years has revealed factors that are important predictors of physical and functional rehabilitation: demographic variables, visual and perceptual impairments, and psychological and cognitive factors. However, there is a remaining uncertainty about prediction of outcome and a need to clinically apply research findings. This study was designed to identify the relative importance of medical, functional, demographic, and cognitive factors in predicting length of stay in rehabilitation, functional outcome, and recommendations for postdischarge continuation of services. METHODS: The influence of these factors was determined by comparing diagnostic, medical, demographic, functional, and neuropsychological information that was retrospectively obtained by reviewing the records of 86 patients admitted for comprehensive rehabilitation due to stroke (n = 36) or orthopedic injury (n = 50). Multiple linear regression with statistical adjustment to control for overprediction of variance was used to predict outcomes. RESULTS: The study revealed the primary importance of higher-order cognitive impairments (comprehension, judgment, short-term verbal memory, and abstract thinking) in extending length of stay and increasing referrals for outpatient therapies and home services after discharge for the cerebrovascular accident patients in comparison with orthopedic cohorts. CONCLUSIONS: The need is discussed for early, comprehensive assessment of deficits in cognition that affect a stroke survivor's ability to participate in a rehabilitation program and remediation that facilitates functional improvement by building on residuals of impaired abilities or teaching compensatory behaviors.

Aged↗
PubMed1992

Driving after cerebral damage: a model with implications for evaluation.

Evaluation of the ability of cerebrally injured patients to return to driving is an important task for rehabilitation specialists. These evaluations require predictively valid methods of assessment based on identification of relevant skills and abilities. The present study tested a hypothetical model for driving after cerebral injury and determined its use in evaluating fitness to drive. Thirty-five patients with cerebral damage due to head injury or cerebrovascular accident participated in the study. All were administered (a) a predriver evaluation, that is, a battery of neuropsychological tests chosen a priori to test the model, (b) a simulator evaluation, and (c) a behind-the-wheel evaluation consisting of driving on a protected course and in traffic. The results showed that 93% of the driving outcome in traffic was explained cumulatively by findings from the predriver and simulator evaluations as well as from behavioral and operational measures during evaluation on the protected lot. These results supported the predictive validity of the model and are discussed in terms of methodology for evaluation of return to driving.

Adolescent↗
PubMed1991

The psychology of polio as prelude to post-polio sequelae: behavior modification and psychotherapy.

Even as the physical causes and treatments for post-polio sequelae (PPS) are being identified, psychological symptoms--chronic stress, anxiety, depression, and compulsive, Type A behavior--are becoming evident in polio survivors. Importantly, these symptoms are not only causing marked distress but are preventing patients from making the lifestyle changes necessary to treat their PPS. Neither clinicians nor polio survivors have paid sufficient attention to the acute polio experience, its conditioning of life-long patterns of behavior, its relationship to the development of PPS, and its effect on the ability of individuals to cope with and treat their new symptoms. We describe the acute polio and post-polio experiences on the basis of patient histories, relate the experience of polio to the development of compulsive, Type A behavior, link these behaviors to the physical and psychological symptoms reported in the National Post-Polio Surveys, and present a multimodal behavioral approach to treatment.

Activities of Daily Living↗
PubMed1991

Polioencephalitis, stress, and the etiology of post-polio sequelae.

Post-mortem neurohistopathologies that document polio virus-induced lesions in reticular formation and hypothalamic, thalamic, peptidergic, and monoaminergic neurons in the brain are reviewed from 158 individuals who contracted polio before 1950. This polioencephalitis was found to occur in every case of poliomyelitis, even those without evidence of damage to spinal motor neurons. These findings, in combination with data from the 1990 National Post-Polio Survey and new magnetic resonance imaging studies documenting post-encephalitis-like lesions in the brains of polio survivors, are used to present two hypotheses: 1) polioencephalitic damage to aging reticular activating system and monoaminergic neurons is responsible for post-polio fatigue, and 2) polioencephalitic damage to enkephalin-producing neurons is responsible for hypersensitivity to pain in polio survivors. In addition, the antimetabolic action of glucocorticoids on polio-damaged, metabolically vulnerable neurons may be responsible for the fatigue and muscle weakness reported by polio survivors during emotional stress.

Brain↗
PubMed1990

An assessment of measures to predict the outcome of driving evaluations in patients with cerebral damage.

The evaluation of the ability of patients to return to driving after cerebral damage stands out as one of the most important tasks confronted by rehabilitation professionals. The present study was designed to critically assess evaluations that were developed at one facility to determine fitness to drive: an offroad, predriver evaluation of skills regarded as important in driving and an on-road, behind-the-wheel evaluation of abilities needed to drive in actual traffic situations. The evaluation results of 3-patients with cerebral damage due to traumatic head injury or cerebrovascular accident were studied retrospectively. Only 4 out of 21 items on the predriver evaluation significantly predicted the outcome of the predriver evaluation and none of the predriver evaluation items predicted the outcome of the behind-the-wheel evaluation. Only 6 of the 26 tasks on the behind-the-wheel evaluation significantly predicted the outcome of the behind-the-wheel evaluation. None of the items on the predriver evaluation or the behind-the-wheel evaluation explained a significant portion of variance related to outcome. The lack of internal and predictive validity of driver evaluations is discussed in light of these findings, and recommendations are given for improving the predictive power of driving evaluations.

Adolescent↗
PubMed1985

Vasomotor abnormalities as post-polio sequelae: functional and clinical implications.

Persons who had poliomyelitis report cold and discolored extremities and decreased muscle strength when exposed to mildly cool ambient temperatures. Bilateral digital cutaneous blood flow, skin temperature and median nerve latencies and amplitudes were measured at 30 degrees C, 25 degrees C and 20 degrees C in five post-polio subjects and age-matched controls. Cutaneous blood flow was lowest on the more affected side in the post-polio subjects but vasoconstriction with decreasing Ta was equal bilaterally in both groups. With decreasing Ta, median motor nerve latencies became clinically abnormal and "giant" sensory nerve potential amplitudes were seen in a majority of the post-polio subjects. It is concluded that an impairment of sympathetic vasoconstrictor outflow in post-polios allows passive dilatation and engorgement of the cutaneous venous capacitance beds. This promotes uncontrolled heat loss and causes cooling of nerve and muscle that is responsible for the impairment of muscle functioning and the abnormal electrophysiological findings.

Adult↗
PubMed1983

Differential left hemisphere activation during the voluntary control of skin resistance level.

Sixteen dextral subjects were presented auditory feedback (FBK) in the form of clicks, the frequency of which was inversely proportional to the sum of the skin resistance levels (SRLs) of the two hands. The FBK was presented in a two-ear changeover paradigm: FBK was presented for 10 minutes to one ear while a white noise masking stimulus was presented to the other; the ears of FBK and masking stimulus presentation were then reversed. Subjects were instructed to decrease the frequency of the clicking. An increase in the SRL of each hand was used as a measure of the activation of the contralateral hemisphere. Significant increases in right-hand SRL (on the order of 40% of baseline) were seen following FBK and obtained regardless of the ear to which FBK was presented, the order of FBK presentation, or the sex of the subjects. Also seen were small-magnitude changes in left-hand SRL, which were not statistically significant. These findings indicate that the left hemisphere was differentially active during acquisition of inhibitory control of SRL in dextrals receiving auditory FBK. Clinical implications of this finding are discussed.

Adult↗
PubMed1983

A correlational study of cardiovascular autonomic functioning and unipolar depression.

Cardiovascular autonomic functioning was assessed in 22 drug-free inpatients diagnosed by DSM-III criteria as having a unipolar depression. Sympathetic cholinergic, alpha- and beta-adrenergic activity were assessed via the measurement of forearm blood flow (FBF), digital blood flow (DBF), and the cardiac pre-ejection period (PEP), respectively. These parameters were correlated with total Hamilton score (HT) (using partial correlations to control for extraneous autonomic variables) to identify the specific autonomic correlates of unipolar depression. Significant negative correlations were found between HT and supine FBF and significant positive correlations between HT and PEP. Large effect-size, negative correlations (which approached significance) were found between HT and DBF. It is concluded that there is a specific autonomic profile of unipolar depression, characterized by a decrease in central sympathetic cholinergic outflow, coupled with increases in alpha-adrenergic and decreases in beta-adrenergic activity. Further, this profile is not merely a static hallmark of depression but covaries with the severity of the depression, independent of other autonomic activity.

Aged↗
PubMed1982

Factors related to orthostatic hypotension associated with tricyclic antidepressants.

A group of 45 depressed patients treated with imipramine hydrochloride were examined in an attempt to identify factors that might influence the risk of developing orthostatic hypotension. Although the literature suggests that age and/or heart disease influences the occurrence of orthostatic hypotension, these conclusions are controversial. To pursue this issue, a sample of older depressed patients, many with severe cardiovascular disease, was chosen. The incidence of orthostatic hypotension rose dramatically among those with severe heart disease. There was a significant association between symptomatic orthostatic hypotension and cardiac medication (p less than .01), and trends between orthostatic hypotension and both ejection fraction (p = .11) and baseline forearm resistance (p = .16). The sample is too small to permit determination of the relative independent importance of these variables or the contribution of specific cardiovascular drugs among these sicker cardiac patients.

Aged↗