Biomedical subjects

W J Mysiw

Publications and source records attributed to W J Mysiw.

30 records · Page 2Linked to original sources

PubMed1989

Orientation Group Monitoring System: an indicator for reversible impairments in cognition during posttraumatic amnesia.

During posttraumatic amnesia (PTA), confusion, attention deficits, impaired memory, disorientation, and inability to process external stimuli often preclude accurate assessment of subtle neurologic changes. The Orientation Group Monitoring System (OGMS) has proven to be a simple, useful strategy for assessing cognitive status. Retrospective analysis of weekly aggregate OGMS scores indicated that a decline in performance of 0.23 or greater is clinically significant. Over a one-year period, 27 patients demonstrated significant decrements in OGMS performance, and in 93% of these instances, the decrease was attributable to a medical problem. Adverse effects of medication was the most common etiology of decreased performance (n = 13). Overwhelmingly, the decline in the OGMS score was the first indication of impaired cognition. This monitoring device is therefore useful as an indicator during PTA of declining cognitive function, warranting further medical evaluation.

Adult↗

PubMed1988

Amitriptyline for post-traumatic agitation.

Agitated behavior is exhibited in up to 30% of patients recovering from a traumatic brain injury. Past treatment protocols have included proactive behavioral management and major tranquilizers. We now report the use of amitriptyline for control of agitation. For a period of over 2 years, 43 male and 15 female patients with a "recent" severe brain injury were admitted for inpatient rehabilitation and subjected to traditional structured programming for treatment of post-traumatic amnesia (PTA). In 20 patients, 18 men and 2 women, where agitation persisted sufficiently to impede rehabilitation despite initiation of structure, amitriptyline was instituted. These patients were of a comparable age (29.4 years for the agitated group versus 25.6 years for the nonagitated group), but the agitated patients had a lower median Rancho Los Amigos Hospital Level of Cognitive Functioning in a comparison to nonagitated patients (V versus VI). All patients were monitored for cognitive performance by the Orientation Group Monitoring System, and a daily account of frequency, severity and type of agitation was recorded. Within 7 days of initiation of therapy, 12 of 17 patients within PTA had dramatic decrease in agitation (5/5 patients at Rancho IV; 4/8 at Rancho V; 3/4 at Rancho VI). Two of the three patients at Rancho VII had agitation that was unresponsive to amitriptyline. The amitriptyline-responsive patients were maintained on the drug through PTA, and the Orientation Group Monitoring System scale demonstrated no impedance in cognitive recovery. Thus, amitriptyline appears most useful as an adjunct for treatment of nondirected agitation; it also has a role in reducing the severity of the directed agitation that is seen during but not after PTA.

Adolescent↗

PubMed1988

Electrophysiologic study of the anterior interosseous nerve.

Nerve conduction studies of the anterior interosseous nerve were performed on 26 healthy subjects (6 women and 20 men, aged 24 to 63 years). The compound muscle action potential from the pronator quadratus muscle was obtained by using surface electrodes placed over the dorsal aspect of the distal forearm and median nerve stimulation at the elbow. The latency of the evoked potential was determined over distances that ranged from 17.5-28 cm from the elbow to the pronator quadratus muscle; this resulted in latencies of 3.5 ms (+/- 0.4) and 3.6 ms (+/- 0.4) for the left and right extremities, respectively, with a side-to-side difference of 0.1 ms (+/- 0.1). The amplitude of the potentials recorded was 3.1 mV (+/- 0.8); a difference in amplitude of 11.4% (+/- 7.7%) between extremities was seen. Although duration measurements were obtained, the frequent presence of biomodal peaks made interpretation difficult. This bimodal pattern was felt to represent either two heads of the pronator quadratus or another muscle innervated by the anterior interosseous nerve. The technique in the present study is easy to perform, allows better assessment of the compound muscle action potentials obtained and provides for side-to-side comparisons of latency and amplitude. This technique aids the electromyographer in evaluation of suspected cases of injury to the anterior interosseous nerve, particularly in unilateral cases.

Adult↗

PubMed1988

Agitation following traumatic head injury: equivocal evidence for a discrete stage of cognitive recovery.

Agitation and confusion appear to be associated in the early period of recovery from traumatic head injury. Eighteen severely head-injured patients were assessed during acute rehabilitation for both the extent of agitation and level of cognitive functioning. Agitation was measured by the Agitated Behavior Scale developed by Corrigan. Simultaneous independent measurements of cognitive functioning were obtained from the Orientation Group Monitoring System and Mini-Mental State. Agitation was significantly correlated with both measures of cognitive functioning, indicating that as cognition improved, agitation diminished. Agitation was partitioned into high and low levels, and cognitive functioning was partitioned into low, middle, and high levels for each of the two measures of cognitive functioning. Chi-square analysis of the distribution of agitation and cognition indicated significant differentiation, with high agitation prevalent in low levels of cognition, and low agitation prevalent in high levels of cognition. Patients in the middle level of cognition were equally likely to demonstrate high and low agitation. Further descriptive analysis indicated that improvement from low levels of cognition preceded improved agitation, and improved agitation preceded clearing from posttraumatic amnesia. These results provide equivocal support for the long-held clinical observation that a period of pronounced confusion and agitation represents a discrete stage of recovery from traumatic head injury.

Adolescent↗

PubMedDate not supplied

Effect of stimulus parameters on characteristics of the F-response in normal subjects.

The F-response is a valuable tool for evaluating the functional integrity of proximal nerve segments. Although many studies have focused on the various F-response characteristics observed (e.g., latency, amplitude, duration, persistence, etc.), few have examined the significance of stimulus parameters on the resultant F-response. In this study, we examined the F-responses obtained in 25 healthy subjects when using various stimulus parameters. The stimulus parameters used were: 1) 0.5 Hz, 25% supramaximal intensity at 0.05 ms duration; 2) 0.5 Hz, 25% supramaximal intensity at 0.1 ms duration; 3) 0.5 Hz, 25% supramaximal intensity at 0.2 ms duration; 4) 0.5 Hz, 50% supramaximal intensity at 0.1 ms duration; 5) 3.0 Hz, 25% supramaximal intensity at 0.1 ms duration. No significant differences in F-response latency, amplitude, duration or persistence were seen when duration or intensity of stimuli was altered. However, changing stimulus frequency resulted in a significant decrease in latency and a significant increase in persistence and amplitude. Care should be taken in controlling for stimulus frequency to enhance the reproducibility of F-response determinations.

Adult↗

PubMedDate not supplied

Defining sleep disturbance after brain injury.

Sleep disorders are a relatively common occurrence after brain injury. Sleep disturbances often result in a poor daytime performance and a poor individual sense of well-being. Unfortunately, there has been minimal attention paid to this common and often disabling sequela of brain injury. This study attempts to define and to correlate the incidence and type of sleep disturbances that occur after brain injury. Consecutive admissions to a rehabilitation unit were used to create a longitudinal database designed to predict long-term outcomes for individuals who suffered a brain injury. Fifty percent of subjects had difficulty sleeping. Sixty-four percent described waking up too early, 25% described sleeping more than usual, and 45% described problems falling asleep. Eighty percent of subjects reporting sleep problems also reported problems with fatigue. Logistic regression analysis revealed the following: the more severe the brain injury the less likely the subject would be to have a sleep disturbance; subjects who had sleep disturbances were more likely to have problems with fatigue; females were more likely to have trouble with sleep. This study demonstrates the substantial prevalence of sleep disturbances after brain injury. It underscores the relationship between sleep disorders and perception of fatigue. It also underscores the need for clinicians to strive for interventional studies to look at the treatment of sleep and fatigue problems after brain injury.

Adult↗

PubMedDate not supplied

Vocational evaluation of traumatic brain injury patients using the functional assessment inventory.

Impaired work capacity is one of the most common residual impairments encountered after either a severe or moderate traumatic brain injury (TBI), yet no instrument is available for screening TBI victims regarding their readiness to participate in more comprehensive vocational planning and evaluation. In the study reported here, the Functional Assessment Inventory (FAI) was administered to 76 subjects who suffered a moderate or severe TBI and the results obtained were compared to the Rancho Los Amigos Hospital Levels of Cognitive Functioning, the Mini-Mental State and the Glasgow Outcome Scale for sensitivity in discerning vocational readiness. The results obtained indicated that the FAI composite score has the greatest discriminating power in screening the vocational readiness of this population, followed by the Glasgow Outcome Scale. In addition, the FAI cluster scores demonstrated reasonable discriminative ability, which may prove useful in directing ongoing remediation.

Adolescent↗

PubMedDate not supplied

Relationship of new-onset systemic hypertension and normal pressure hydrocephalus.

Communicating normal pressure hydrocephalus (NPH) is an important remote complication of traumatic brain injury (TBI). The diagnosis of this hydrocephalus depends largely on clinical signs and symptoms, including cognitive deterioration, gait changes and incontinence. However, many of these signs are also seen during post-traumatic amnesia, making early recognition of this syndrome difficult. A case study of one man post-TBI, who presented with new-onset hypertension as a sign of NPH, prompted a retrospective chart review of all patients admitted over a 2-year period with a diagnosis of NPH. Ninety per cent of patients had one or more of the classic triad of NPH and 25% of patients had symptoms suggestive of raised intracranial pressure (unexplained nausea, headache and visual disturbance). Mean systolic and diastolic blood pressures among the 20 subjects for six consecutive days pre-operatively compared with those for days 8-14 and 15-21 post-operatively showed no significant differences; a subgroup of five patients (25%), however, demonstrated a significant change in blood pressure temporally related to shunting. We suggest that demonstration of new-onset systemic hypertension may also be a clinical sign suggestive of NPH useful in the evaluation of the TBI patient.

Adolescent↗

PubMedDate not supplied

The ataxic subgroup: a discrete outcome after traumatic brain injury.

We have observed five individuals who appear to represent a unique subgroup of patients with traumatic brain injury (TBI). Because of the prominence of severe ataxia, this group has been labelled the 'ataxic subgroup'. These individuals are distinguished by both clinical course and outcome, including severe ataxia, prolonged coma and prolonged post-traumatic amnesia (PTA). They distinguish themselves from other severely impaired TBI patients in that they spend a relatively longer length of time prior to the establishment of volition, but progress rapidly through the period of confusion. We hypothesized that this group is unique in that they have suffered Grade III diffuse axonal injury (DAI) with no or minimal complications due to other primary or secondary brain damage. In order to investigate these hypotheses, a retrospective file review of a selected group of 72 patients was undertaken to determine the specificity and sensitivity of two diagnostic criteria. The existence of severe Grade III DAI without other primary or secondary brain damage was presumed if severe ataxia was present in conjunction with normal CT scans. Results of this review indicated that 33% of the population demonstrated severe ataxia, although only 11% also had normal CT scans. These dual criteria were neither adequately sensitive nor specific to define the five patients who comprised the 'ataxic subgroup'. When rate of clearing the confused period of PTA was added to the diagnostic criteria, specificity improved. Although this attempt to define this subgroup empirically was not entirely successful, further attempts to delineate this group are important in that prognosis for clearing PTA is good despite early indicators of poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Fever of unknown origin following traumatic brain injury.

Fever is a common complication of a traumatic brain injury, occurring during both the acute-care phase and the rehabilitation phase of recovery. The aetiology of fever in this population may remain obscure because of the presence of cognitive confusion associated with post-traumatic amnesia interfering with history taking and the difficult physical examination. We present a case where recovery from a traumatic brain injury was complicated by a fever of unknown origin that proved to be secondary to lateral sinus thrombophlebitis. This case emphasises the importance of a thorough knowledge of the differential diagnosis for fever that is unique to the traumatic brain injury population.

Adult↗

PubMedDate not supplied

Agitation, cognition and attention during post-traumatic amnesia.

During the early phases of recovery from traumatic head injury, the level of functional cognition and the presence of agitation in patients appear to co-vary. However, it has been observed that there appears to be some temporal disassociation in the recovery of cognition and agitation. The purpose of this study was to investigate the degree to which attention accounts for the co-variation previously observed. Over a 1-year period, 130 patient-weeks of independent monitoring of cognition, agitation and attention were obtained from 20 head-injured patients in the acute phase of recovery. Weekly scores for measures of cognition, agitation and attention were each found to share approximately 50% of the variance when paired with one of the other two. When attention was extracted, only 7% of the variation in cognition was accounted for by agitation, and 40% of the variance could not be accounted for by either agitation or attention. These results support previous findings that cognition and agitation co-vary with most of the co-variance due to the effect of attention on each. Concomitantly, these results allow that significant portions of the variance in cognition and agitation may be temporally dissociated during the acute phases of recovery from traumatic head injury.

Adolescent↗

PubMedDate not supplied

Hyponatremia-associated cognitive impairment in traumatic brain injury.

The case of a traumatic brain injury (TBI) patient with dramatic cognitive deterioration in the absence of medical aetiology other than simultaneous decline in serum sodium led to an investigation of the association between declines in sodium levels and cognitive status. In a population of 50 persons undergoing TBI rehabilitation, 12 (24%) had relative (3 mEq/L) decreases in serum sodium while five (10%) experienced absolute hyponatremia (136 mEq/L). Correlation with cognitive status was significant when the absolute hyponatremia group was compared with those whose sodium levels remained above 136 mEq/L. A case-matched study of the relative hyponatremia group yielded no significant association between sodium-level decreases and cognitive status. These data support previous conclusions indicating wide variation in individual responses to changes in serum sodium. The threshold for significant effects of hyponatremia may be higher in patients with TBI than in populations studied previously.

Bicycling↗