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Biomedical subjects

T Najenson

Publications and source records attributed to T Najenson.

At least 55 records · Page 3Linked to original sources

A description of an intensive treatment project for the rehabilitation of severely brain-injured soldiers.

Thirteen severely brain-injured veterans are currently participating in an intensive rehabilitation project. This is a one-year vocational rehabilitation project conducted 30 hours weekly in a therapeutic workshop environment, in which all aspects of the patient's rehabilitation needs are dealt with. The three major goals of this project are: (a) Changing and modifying the behavior of the individual through the use of psychotherapy, cognitive training, training in the use of prosthetic devices and vocational training; (b) creating a supportive environment within the project in which staff and patients live together for a few hours daily and where patients are treated in groups; (c) generalizing the therapeutic effects to the community at large. This includes work with the social environment of the patient: family, friends, employer and rehabilitation workers of the Ministry of Defense. Preliminary results indicate that considerable therapeutic gains could be achieved while the patient is in a sheltered therapeutic milieu. However, there is less success in generalizing these effects to the behavior of the patient outside the sheltered environment.

Adult↗

Recovery of communicative functions after prolonged traumatic coma.

Fifteen patients with prolonged coma after craniocerebral injury were observed for a year or more, and their communicative functions were evaluated. Nine of them showed a considerable degree of recovery, while 6 remained in a vegative state. Of the 9 with recovery, 6 showed complete recovery of semantic functions, while 3 remained with aphasic deficits. Eight out of these 9 remained dysarthric. Communicative recovery began as late as 5.7 months after injury, and it roughly paralleled recovery in locomotion and A.D.L. Restlessness and sweating were favorable prognostic factors. Excessive salivation, snout reflex, corneomandibular reflex, retractory nystagmus and stereotypic movements were unfavorable. The 8 patients who remained dysarthric showed marked diminution of their expiratory and inspiratory reserves, and of their forced vital capacity.

Adult↗

Eye movements in brain damaged patients.

Saccades, smooth movements and vergence were recorded in 28 patients with brain lesions using an infrared scleral reflexion technique. Large impairment in eye movement responses under visual feedback were recorded from the majority of the patients. The implication of these deficiencies on the vocational rehabilitation of the patients is discussed.

Brain Damage, Chronic↗

Pulmonary functions and responses to exercise of patients following cranio cerebral injury.

To assess the causes of excessive fatigue among patients who have recovered from cranio-cerebral injury (CCI) nineteen patients and fourteen healthy controls underwent pulmonary function testing at rest and cardiopulmonary evaluation during two submaximal exercise work-loads. Total lung capacity, vital capacity and forced expired volume were reduced by 25--40% among the patients. Functional residual capacity was normal. No improvement was elicited by inhalation of Ventolin and bronchoconstriction could thus be excluded. The above pattern may result from either decreased compliance of the chest wall or from weak (or non-coordinated) respiratory musculature. Exercise heart rate, minute ventilation and ventilatory equivalent were higher, and O2 pulse lower, among the CCI patients compared with the controls. This indicates lower circulatory and ventilatory efficiency during exercise among the patients, possibly due to habitual hypoactivity and detraining.

Adult↗

Dynamic features of standing and their correlation with neurological disorders.

Standing posture is a result of complex activity of the human control system. Irregularities of postural control may be expected to result in deviations from normal standing. In the present study a ballistic monitoring technique was employed to establish criteria for assessment of postural disorders. Two "Kistler" force plate dynamometers were used to measure changes in the weight bearing components of each foot and displacement of the center of pressure of each foot. The patterns were analysed separately, and it was found that each of the monitored parameters demonstrated three modes of oscillation--termed Tremor, Ataxia and Sway. Statistical analysis conducted on three groups of subjects (normals, post-C.V.A. hemiplegics and brain injured) revealed significant intergroup differences in movement patterns. Good agreement was found between the interpretation of the ballistic features and the clinical diagnosis.

Ataxia↗

FGP assessment of postural disorders during the process of rehabilitation.

Application of the newly developed footground pressure pattern (F.G.P.) method to a number of cranio-cerebral injured patients (C.C.I.) as well as to hemiplegics and normal subjects is made. The postural disorders in standing are assessed through modifications of the F.G.P. and different stages of the rehabilitation process may be followed up. Special parameters of the standing posture, which characterize its disorders, are presented; a diagonal pressure pattern is described. The visual qualitative analysis of the pressure pattern may also be directly useful in the physiotherapy treatment.

Biomedical Engineering↗

Tests of auditory perception in the assessment and management of patients with cerebral cranial injury.

Special listening tests have been applied to patients with cerebral cranial injury to determine whether such tests of auditory performance will provide functional evidence of lesions which are difficult to examine physically. There have been many reports in the literature on the apparent relationship between lesions affecting portions of the central auditory nervous system and results on tests of auditory perception for speech which is either distorted in some way or presented in competing arrangements to the two ears. The premise is that these tests require integrative function of the brain while reducing the effects of conditions of the peripheral organ of hearing and of basic language functions such as symbolization and memorization. Much of the previous literature has been concerned with infiltrative lesions, such as tumors. Our rehabilitation facility serves a number of patients whose lesions are the result of injuries rather than growths or vascular accidents. The present study was undertaken, therefore, to explore the contribution of information derived from such test procedures to diagnosis and to the planning of individual programs of rehabilitation. Preliminary findings are presented for a series of patients with cerebral cranial injury.

Auditory Perception↗

Effect of long-term co-trimoxazole therapy on renal function.

In order to study the effect of long-term administration of co-trimoxazole on renal function, creatinine clearance rates were measured in 18 patients with neurogenic hypotonia of the bladder due to paraplegia, quadriplegia, hemiplegia and cerebrocervical injuries. The duration of the prophylactic treatment was between 60 and 80 days. The initial average creatinine clearance rate of this group was 99-0 ml/min and the final one was 110-7 ml/min (P = 0-15, n.s.). In addition, in seven cases the prophylaxis was extended to a period of 330 to 430 days. In this group the initial average creatinine clearance rate was 104-4 ml/min and the final one was 94-7 ml/min (P greater than 0-3, n.s.). It is concluded, therefore, that prolonged administration of co-trimoxazole to patients with creatinine clearance above 50 ml/min does not cause any marked deterioration in the renal function.

Aged↗

Prognostic factors in rehabilitation after severe head injury. Assessment six months after trauma.

After initial neurosurgical treatment, 40 patients who regained consciousness 1 to 90 days after major cerebral trauma, were admitted for rehabilitation. Six months after their injury they were assessed in terms of: 1) Locomotor function, 2) Intellectual performance, 3) Communication disorder, and 4) behaviour disturbances. The usefulness of these parameters as prognostic factors in rehabilitation is discussed. Eight patients without significant disabilities in all 4 parameters returned to normal life. Patients who showed locomotor, communicative and behaviour impairment but no gross intellectual deficits, were considered capable of being retrained. The poorest prospects for social and vocational rehabilitation were found in 15 patients with cognitive defects.

Adult↗

Periarticular new bone formation in patients suffering from severe head injuries.

A total of 35 cases of periarticular new bone formation (PNBF) was observed among 160 patients with coma following severe craniocerebral trauma. All cases were associated with blunt trauma and none with penetrating wounds. Only 6 of 500 cases of acute non-traumatic hemiplegia developed PNBR, and all 6 of them followed craniotomy, brain surgery and coma. New bone formation first appeared mainly between 50 and 120 days after craniocerebral injury with prolonged coma. Three-quarters of the patients with PNBF showed involvement of the shoulder joint, but this was not associated with previous subluxation. Metabolic studies were done in some patients; no disturbances were found in the metabolism of calcium, phosphorus or alkaline phosphatase. The pathologic process of PNBF seemed to stabilize some 6 to 8 months following trauma, and surgery after this period produced functional improvement in the 3 patients in whom it was tried. No satisfactory pathophysiological explanation has been found for the phenomenon of PNBR. Prolonged coma is common to all patients who suffered from PNBF and is probably an etiologic factor. The absence of PNBF in cases of cerebrovascular accident with subluxations of the gleno-humeral joint and intensive physiotherapy seems to contradict the suggestion of microtrauma as an etiological factor.

Adult↗

Acidophilic adenoma of the pituitary with polyneuropathy.

An acromegalic man aged 70 developed progressive polyneuropathy affecting mainly the extremities. The peripheral nerves showed hypertrophic neuropathy and accumulation of acid mucopolysaccharides in the nerve without `onion bulb' formation. The myelin showed a lamellar disintegration and vesicular formation. It is suggested that the association of these findings represents a pathological entity, acromegalic polyneuropathy.

Acromegaly↗