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BACKGROUND AND PURPOSE: Inpatient rehabilitation facilities play an integral role in patient progress post-stroke. Cerebellar hemorrhages are an infrequent type of stroke and are therefore less discussed in the literature; however, inpatient rehabilitation continues to be an integral part of patient recovery. The purpose of this case report is to discuss the physical therapy interventions, challenges, and successes for a complex patient with a large cerebellar hemorrhage with obstructive hydrocephalus. Case Description: The patient is a 32-year-old male admitted to an inpatient rehabilitation facility. Prior to admission, the patient spent 1 month at a local hospital following a complicated recovery status post cerebellar hemorrhage with obstructive hydrocephalus. Interventions: The patient participated in at least 3 hours of combined therapy a day, split into 30- and 60-min sessions, and divided between physical, occupational, and speech therapy. Physical therapy interventions focused on various gait and coordination activities. Outcomes: The patient spent 47 days in an inpatient rehabilitation facility and demonstrated improvements in all aspects of the Functional Independence Measure®. The patient improved from an 18 to a 90 on the total FIM® score, allowing the patient to ultimately be discharged home with family able to provide 24/7 supervision.
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Doenças Cerebelares/reabilitação , Hidrocefalia/reabilitação , Hemorragias Intracranianas/reabilitação , Modalidades de Fisioterapia , Reabilitação do Acidente Vascular Cerebral , Adulto , Humanos , Masculino , Terapia Ocupacional , Recuperação de Função Fisiológica , Centros de Reabilitação , FonoterapiaRESUMO
BACKGROUND/OBJECTIVE: Early mobilization of critically ill patients has been shown to improve functional outcomes. Neurosurgery patients with an external ventricular drain (EVD) due to increased intracranial pressure often remain on bed rest while EVD remains in place. The prevalence of mobilizing patients with EVD has not been described, and the literature regarding the safety and feasibility of mobilizing patients with EVDs is limited. The aim of our study was to describe the outcomes and adverse events of the first mobilization attempt in neurosurgery patients with EVD who participated in early functional mobilization with physical therapy or occupational therapy. METHODS: We performed a single-site, retrospective chart review of 153 patients who underwent placement of an EVD. Hemodynamically stable patients deemed appropriate for mobilization by physical or occupational therapy were included. Mobilization and activity details were recorded. RESULTS: The most common principal diagnoses were subarachnoid hemorrhage (61.4%) and intracerebral hemorrhage (17.0%) requiring EVD for symptomatic hydrocephalus. A total of 117 patients were mobilized (76.5%), and the median time to first mobilization after EVD placement in this group of 117 patients was 38 h. Decreased level of consciousness was the most common reason for lack of mobilization. The highest level of mobility on the patient's first attempt was ambulation (43.6%), followed by sitting on the side of the bed (30.8%), transferring to a bedside chair (17.1%), and standing up from the side of the bed (8.5%). No major safety events, such as EVD dislodgment, occurred in any patient. Transient adverse events with mobilization were infrequent at 6.9% and had no permanent neurological sequelae and were mostly headache, nausea, and transient diastolic blood pressure elevation. CONCLUSION: Early progressive mobilization of neurosurgical intensive care unit patients with external ventricular drains appears safe and feasible.
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Hemorragia Cerebral/terapia , Deambulação Precoce/estatística & dados numéricos , Hidrocefalia/terapia , Hemorragia Subaracnóidea/terapia , Ventriculostomia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/complicações , Hemorragia Cerebral/reabilitação , Hemorragia Cerebral/cirurgia , Deambulação Precoce/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/reabilitação , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/reabilitação , Hemorragia Subaracnóidea/cirurgia , Ventriculostomia/efeitos adversos , Adulto JovemRESUMO
PURPOSE: Endoscopic Third Ventriculostomy (ETV) and Choroid Plexus Cautery (CPC) are low-cost, safe, and promising interventions for spina bifida-associated hydrocephalus (SBHCP). The purpose of this review was to explore and describe these efforts in Africa in order to upscale surgical training and rehabilitation services. METHODS: A PubMed search for articles on ETV and CPC as management of SBHCP in Africa was performed. Two authors appraised the results for key themes in content: indications, technique, outcomes, complications, education, and rehabilitation. RESULTS: Twenty of 47 articles identified were included for appraisal. Twelve described indications, ten and seven outlined technique and complications, respectively, and four described predictors of operative success. Fourteen studies describe outcomes, including operative and neurodevelopmental outcomes. Only two outlined educational efforts. Half of the literature stems from a single site in Uganda; in total, only six countries were represented. No articles described significant post-operative rehabilitation services or related training. CONCLUSION: The experience of ETV and CPC in Africa is promising, however, efforts to train and empower local staff in surgical technique and methods to upscale post-operative community-based rehabilitation services remain as a key to long-term success.
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Endoscopia/métodos , Hidrocefalia/cirurgia , Disrafismo Espinal/complicações , Ventriculostomia/métodos , África , Serviços de Saúde Comunitária , Humanos , Hidrocefalia/etiologia , Hidrocefalia/reabilitação , Cuidados Pós-Operatórios/métodos , Disrafismo Espinal/reabilitação , Ventriculostomia/educação , Ventriculostomia/reabilitaçãoRESUMO
Errorless learning has demonstrated efficacy in the treatment of memory impairment in adults and older adults with acquired brain injury. In the same population, use of elaborative encoding through supported self-generation in errorless paradigms has been shown to further enhance memory performance. However, the evidence base relevant to application of both standard and self-generation forms of errorless learning in children is far weaker. We address this limitation in the present study to examine recall performance in children with brain injury (n = 16) who were taught novel age-appropriate science and social science facts through the medium of Skype. All participants were taught these facts under conditions of standard errorless learning, errorless learning with self-generation, and trial-and-error learning after which memory was tested at 5-minute, 30-minute, 1-hour and 24-hour delays. Analysis revealed no main effect of time, with participants retaining most information acquired over the 24-hour testing period, but a significant effect of condition. Notably, self-generation proved more effective than both standard errorless and trial-and-error learning. Further analysis of the data revealed that severity of attentional impairment was less detrimental to recall performance under errorless conditions. This study extends the literature to provide further evidence of the value of errorless learning methods in children with ABI and the first demonstration of the effectiveness of self-generation when delivered via the Internet.
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Lesões Encefálicas/reabilitação , Aprendizagem , Transtornos da Memória/reabilitação , Reabilitação Neurológica , Telecomunicações , Adolescente , Lesões Encefálicas/psicologia , Lesões Encefálicas Traumáticas/psicologia , Lesões Encefálicas Traumáticas/reabilitação , Neoplasias Encefálicas/psicologia , Neoplasias Encefálicas/reabilitação , Hemorragia Cerebral/psicologia , Hemorragia Cerebral/reabilitação , Infarto Cerebral/psicologia , Infarto Cerebral/reabilitação , Criança , Encefalite/psicologia , Encefalite/reabilitação , Feminino , Humanos , Hidrocefalia/psicologia , Hidrocefalia/reabilitação , Masculino , Transtornos da Memória/psicologia , Rememoração Mental , Leucemia-Linfoma Linfoblástico de Células Precursoras/psicologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/reabilitaçãoRESUMO
These are challenging times in the NHS,' says RCN north west regional director Estephanie Dunn. 'We are endeavouring to safeguard already diminishing budgets and services while there are increasing pressures on staff.
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Recursos Humanos de Enfermagem , Medicina Estatal/organização & administração , Inglaterra , Hidrocefalia/enfermagem , Hidrocefalia/reabilitação , Hidrocefalia/terapia , TriagemRESUMO
Objective Our aims were (1) to test whether diffusion tensor imaging (DTI) could detect underlying white matter (WM) changes after a 6-week iPad application-based occupational therapy (OT) intervention in children with surgically treated hydrocephalus (HCP); and (2) to explore the association between WM changes and performance outcomes. Methods Five children (age range: 6.05-9.10 years) with surgically treated HCP completed an intensive iPad-based OT intervention targeting common domains of long-term deficits in children with HCP. The intervention included 6 weekly sessions in an OT clinic supplementing home-based program (1 hour/day, 4 days/week). DTI and neuropsychological assessments were performed before and after the intervention. Observation After the therapy, significant increases in fractional anisotropy (FA) and/or decreases in radial diffusivity were found in extensive WM areas. All participants demonstrated an increased perceptual reasoning index (PRI, Wechsler Abbreviated Scale of Intelligence: 2nd edition, PRI gains = 14.20 ± 7.56, p = 0.014). A significant positive correlation was found between PRI increase and the increase of FA in the right posterior limb of the internal capsule and the right external capsule (both p < 0.05). Conclusion This study provides initial evidence of DTI's sensitivity to detect subtle WM changes associated with performance improvements in response to a 6-week OT intervention in children with HCP.
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Computadores de Mão , Hidrocefalia/reabilitação , Terapia Ocupacional , Substância Branca/diagnóstico por imagem , Anisotropia , Pedúnculo Cerebral/diagnóstico por imagem , Criança , Corpo Caloso/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Imagem de Tensor de Difusão , Cápsula Externa/diagnóstico por imagem , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Cápsula Interna/diagnóstico por imagem , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Procedimentos Neurocirúrgicos , Projetos PilotoRESUMO
BACKGROUND: Post traumatic hydrocephalus (PTH) is a frequent complication during rehabilitation following severe TBI. However, the diagnosis of PTH is not straightforward and despite shunting recovery may be delayed. OBJECTIVE: To study the influence of PTH on recovery and outcome during rehabilitation. METHODS: We studied 417 patients with severe TBI admitted consecutively to a single hospital-based neurorehabilitation department serving Eastern Denmark between 2000 and 2010. Demographics (age and gender) and clinical characteristics (length of acute treatment, post traumatic amnesia (PTA), level of consciousness, injury severity (ISS), and admission FIM™), and PTH were related to recovery (discharge FIM™), outcome (GOS), and length of rehabilitation stay. RESULTS: Patients with PTH were older, brain injury more severe, and acute treatment was longer. At discharge they had more disability, longer rehabilitation stays, and unfavorable outcome. However, after adjusted multiple regression analyses PTH was not associated with disability at discharge or outcome. Instead, PTH was associated with longer stay for rehabilitation. CONCLUTIONS: Shunting for PTH does not affect recovery and outcome per se, but prolongs lengths of stay by almost 3 weeks. Therefore, patients treated for PTH are as likely to benefit from rehabilitation as patients without, but require longer rehabilitation stays.
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Lesões Encefálicas/reabilitação , Hidrocefalia/reabilitação , Adulto , Idoso , Lesões Encefálicas/complicações , Estado de Consciência , Feminino , Humanos , Hidrocefalia/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Recuperação de Função Fisiológica , Análise de Regressão , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI). BACKGROUND: Posttraumatic hydrocephalus (PTH) may lead to clinical deterioration and poor outcome if untreated. However, PTH can be successfully treated if detected. Nevertheless, PTH is easily overlooked during rehabilitation, particularly in severe cases. METHOD: We prospectively followed all patients (n = 444) in Eastern Denmark (population 2.5 mill) sustaining severe TBI, who required lengthy rehabilitation between 2000 and 2010. All patients with PTH were tracked retrospectively. Demographics, surgery, injury severity, consciousness level, and disability were compared for patients with versus without PTH. Independent predictors of PTH during rehabilitation were identified through multiple logistic regression models. RESULTS: PTH occurred in 14.2% and 3/4 emerged during rehabilitation. Patients with PTH were older, had more severe brain injuries, were more frequently in vegetative state, and needed longer rehabilitation stays. After adjusted analyses, however, only older age and low level of consciousness were independently associated with PTH. CONCLUSION: Most cases of PTH emerge during rehabilitation. Therefore, attention towards this complication should be present also beyond the acute stage after TBI, particularly among older patients and patients with severe disordered consciousness.
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Lesões Encefálicas/complicações , Hidrocefalia , Adolescente , Adulto , Idoso , Lesões Encefálicas/epidemiologia , Avaliação da Deficiência , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Hidrocefalia/epidemiologia , Hidrocefalia/etiologia , Hidrocefalia/reabilitação , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To determine which clinical (health status) and nonclinical (demographic) factors may affect perceptions of quality of life in children with spina bifida and their parents. DESIGN: A prospective study by using a validated questionnaire. SETTING: A multidisciplinary spina bifida clinic at a pediatric tertiary referral center. PATIENTS: Thirty-three children with spina bifida aged 5-18 years and 41 parents of children with spina bifida aged 2-18 years completed questionnaires after informed consent was obtained. METHODS: The Peds QL 4.0 Short Form 15 questionnaire was administered to children with spina bifida and their parents. Additional data were collected, including socioeconomic status, self-reported ethnicity, insurance status, ambulatory status, presence of shunted hydrocephalus, and continence. All completed questionnaires were included in the final analysis. RESULTS: Self-reported physical and psychosocial health scores for patients in our study were lower than previously published scores from healthy children. Patients with a shunted hydrocephalus had significantly lower self-reported physical health scores compared with those without shunted hydrocephalus (61.4 versus 39.3; P = .015). Self-reported physical health score in those with shunted hydrocephalus improved with age (Spearman ρ = 0.42; P = .017). Shunted hydrocephalus remained significant on multivariate analysis. Ethnicity, insurance, socioeconomic status, ambulatory status, and urinary and fecal continence were not associated with self-reported physical or psychosocial scores. Parent-reported scores were not associated with any of the variables of interest. There was excellent correlation between parent-reported and self-reported psychosocial health scores (Spearman ρ = 0.636; P < .001) but not physical health scores (Spearman ρ = 0.023; P = .905). CONCLUSIONS: Shunted hydrocephalus has a negative impact on the perception of quality of life, an effect that may be attenuated by age. Further study and more-specific measurement tools are needed to better understand health-related quality of life in children with spina bifida.
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Nível de Saúde , Hidrocefalia/reabilitação , Qualidade de Vida , Disrafismo Espinal/reabilitação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/complicações , Masculino , Análise Multivariada , Estudos Prospectivos , Disrafismo Espinal/complicações , Inquéritos e QuestionáriosRESUMO
Introduction: Dandy Walker Syndrome is a congenital abnormality in the central nervous system, characterized by a deficiency in the development of middle cerebelar structures, cystic dilatation of the posterior pit communicating with the fourth ventricle and upward shift of the transverse sinuses, tentorium and dyes. Among the clinical signs are occipital protuberances, a progressive increase of the skull, bowing before the fontanels, papilledema, ataxia, gait disturbances, nystagmus, and intellectual impairment. Objectives: To describe a case of female patient, 13 years old with a diagnosis of this syndrome and bilateral hearing loss underwent cochlear implant surgery under local anesthesia and sedation. Case Report: CGS, 13 years old female was referred to the Otolaryngological Department of Otolaryngology Institute of Parana with a diagnosis of "Dandy-Walker syndrome" for Otolaryngological evaluation for bilateral hearing loss with no response to the use of hearing aids. Final Comments: The field of cochlear implants is growing rapidly. We believe that the presence of Dandy-Walker syndrome cannot be considered a contraindication to the performance of cochlear implant surgery, and there were no surgical complications due to neurological disorders with very favorable results for the patient who exhibits excellent discrimination. It has less need for lip reading with improvement in speech quality...
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Humanos , Feminino , Adolescente , Audiometria , Hidrocefalia/reabilitação , Implantes Cocleares/tendências , Perda Auditiva Bilateral/reabilitação , Qualidade de Vida , Sistema Nervoso Central/anormalidades , SíndromeRESUMO
The objective of this study was to determine the incidence of posttraumatic hydrocephalus (PTH) among patients in our rehabilitation unit for traumatic brain injury. Furthermore, we aimed to assess the effect of shunt implantation and to identify the postoperative complication rate. This is a retrospective cohort study, in which between 2000 and 2009, data were collected from inpatients with traumatic brain injury complicated by PTH. During this period, 55 patients in our unit presented with PTH; all of these patients underwent ventricular shunt implantation. The incidence of PTH treated with shunt implantation was 4.8%. The mean age of the patients was 32 years (range 14-75 years). In 22 cases, the hydrocephalus was diagnosed in our rehabilitation unit (40%). Other patients were diagnosed and shunted before being transferred to our department. The median time of shunting was 80 days (range 20-270 days) after brain trauma. On the basis of scores of the functional independence measure, improvement could be observed in 43 cases (78%), the mean score improvement was 40 (2-81). Postoperative complications were seen in 10 patients (18%): four due to infections and six due to shunt failure. Revision was necessary in all 10 cases. Almost half of the diagnoses of PTH were established in the postacute rehabilitation unit, and all complications after shunt implantation were also recognized there. Precise clinical observation is necessary for diagnosis of PTH. Early diagnosis and treatment are important to prevent secondary complications. Teamwork and good cooperation between acute and postacute care are necessary for successful rehabilitation of patients with traumatic brain injury.
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Lesões Encefálicas/reabilitação , Hidrocefalia/reabilitação , Adolescente , Adulto , Idoso , Lesões Encefálicas/complicações , Derivações do Líquido Cefalorraquidiano/reabilitação , Avaliação da Deficiência , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/reabilitação , Adulto JovemRESUMO
BACKGROUND: We sought to describe the design of the Active Lifestyle and Sports Participation (ALSP) intervention for adolescents and young adults with physical disabilities, and to present the first 2 cases. METHODS: A 17-year-old boy with myelomeningocele and hydrocephalus and a 23-year-old woman with unilateral cerebral palsy were enrolled into the ALSP intervention, a personalized intervention designed to improve physical activity and fitness levels. Main outcome measures were self-reported physical activity and aerobic fitness. Fitness was determined by submaximal 6-minute walk or wheel test and by maximal cycle or arm ergometer-exercise test. Participants rated satisfaction with the intervention on a Likert-type numeric scale from 1 to 10. RESULTS: Improvements in self-reported physical activity were 51% and 75% for the male and female participant, respectively. Respective improvements in submaximal exercise were 16% and 9%. Maximal exercise increased 39% in the male participant but did not increase in the female participant. Satisfaction with the intervention was rated moderate-good to excellent. CONCLUSION: Data for the first 2 cases suggested that ALSP intervention seemed feasible to offer in an outpatient rehabilitation department, and the effectiveness may be promising. Future studies should determine the short- and long-term effectiveness of the intervention.
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Paralisia Cerebral/psicologia , Pessoas com Deficiência/psicologia , Promoção da Saúde , Hidrocefalia/psicologia , Meningomielocele/psicologia , Atividade Motora , Adolescente , Fatores Etários , Paralisia Cerebral/reabilitação , Participação da Comunidade , Aconselhamento , Teste de Esforço , Feminino , Humanos , Hidrocefalia/reabilitação , Estilo de Vida , Masculino , Meningomielocele/reabilitação , Consumo de Oxigênio , Autorrelato , Inquéritos e Questionários , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVE: In clinical practice, it is often necessary to judge the probability of clinical benefit of invasive ancillary tests given to patients with chronic hydrocephalus before they are performed. The aim of the current study was to establish a screening tool for such prediction. MATERIAL AND METHODS: A total of 125 patients with chronic hydrocephalus were assessed using a clinical (HHS) and comorbidity (CMI) grading. These patients were shunted and followed-up for at least one year. The statistical tools of ANOVA, CHI-squared, Spearman, Kuskal-Wallis, and Wilcoxen-U-Test were applied. RESULTS: The variables discovered to be of use in prediction were age (p = 0.02), anamnesis duration (p = 0.04), CMI (p < 0.000) and HHS (p = 0.001). A decision tree using solely HHS and CMI was established allowing outcome prediction of sufficient power. Interestingly, in patients who had favourable preconditions, older age impeded not a favourable prognosis. CONCLUSION: With our proposed decision tree, a minimum of data allow a clinician to sufficiently judge whether shunting will be of benefit to a patient, which may help to decide whether invasive ancillary tests are justified.
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Algoritmos , Derivações do Líquido Cefalorraquidiano/métodos , Hidrocefalia/diagnóstico , Hidrocefalia/reabilitação , Seleção de Pacientes , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Doença Crônica , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesAssuntos
Lesões Encefálicas/complicações , Hidrocefalia/complicações , Siringomielia/etiologia , Bombas (Dispositivos Explosivos) , Humanos , Hidrocefalia/etiologia , Hidrocefalia/reabilitação , Imageamento por Ressonância Magnética , Masculino , Fraturas Cranianas/complicações , Siringomielia/patologia , GuerraRESUMO
BACKGROUND AND PURPOSE: Foot orthoses may lead to improved function when used to control faulty foot biomechanics. The purpose of this case report was to describe the influence of modified stabilizing foot splints (SFSs) on the function of a child with developmental delay. CASE DESCRIPTION: The participant was a 19-month-old girl with hypotonia and developmental delay due to hydrocephalus and congenital absence of the corpus callosum. INTERVENTION: Modified SFSs were created with the child's feet held in a subtalar neutral position. OUTCOMES: Five items from the Peabody Developmental Motor Scale II (rise to stand, standing, lowering, cruising, and stepping forward) were tracked over three weeks, under three conditions: with shoes and orthoses, shoes only, and barefoot. The ability to perform these items was improved when wearing shoes and orthoses. CONCLUSION: The outcomes indicate that future study of the modified SFS as an intervention is warranted.
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Deficiências do Desenvolvimento/reabilitação , Deformidades Adquiridas do Pé/reabilitação , Pé , Aparelhos Ortopédicos , Contenções , Feminino , Humanos , Hidrocefalia/fisiopatologia , Hidrocefalia/reabilitação , Lactente , Destreza Motora , Equilíbrio PosturalRESUMO
The many concerns of parents of children with hydrocephalus have not previously been assessed using a reliable, quantitative measurement. The development and preliminary use of a questionnaire to measure the concerns of these parents is reported. A general health status measure for hydrocephalus was developed concurrently. Items were generated primarily from parent focus groups resulting in a comprehensive list of 22 unique parental concern items. The most important of these items, as selected by another sample of parents of 60 children (27 females, 33 males; mean age 8y 4mo, [SD 4y 6mo]) were retained for the final questionnaire. This 9-item parental concerns questionnaire was tested for reliability and construct validity (by assessing correlations with various independent measures of health status, including Health Utilities Index-2 and Impact-on-Family Scale) using a cohort consisting of the parents of 80 children (39 females, 41 males; mean age 10y, [SD 3y 6mo]). An exploratory analysis was performed to determine which patient variables were associated with greater parental concern. The parental concerns questionnaire demonstrated excellent test-retest reliability (0.86, 95% CI 0.77-0.92) and internal consistency (Cronbach's alpha=0.89). As expected, interrater reliability was somewhat lower (0.67, 95% CI 0.49-0.79). Construct validity was demonstrated by consistently moderate Pearson's correlations with several independent measures of the child's health. The presence of epilepsy and younger patient age appeared to be significantly associated with greater parental concern. This new questionnaire has demonstrated very good psychometric properties. It can be used to broaden the scope of future clinical research in pediatric hydrocephalus to include the impact on parents.
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Hidrocefalia/reabilitação , Relações Pais-Filho , Inquéritos e Questionários , Adulto , Idade de Início , Cuidadores/psicologia , Criança , Epilepsia , Saúde da Família , Feminino , Grupos Focais , Nível de Saúde , Humanos , Masculino , Prognóstico , Psicometria , Estresse PsicológicoRESUMO
INTRODUCTION: The routine surgical procedure for placement of the ventricular shunt catheter is straightforward. However, the topography of the ventricular system in complex hydrocephalus is so distorted that orientation on the basis of standard external topographic points does not ensure satisfactory positioning of the drain. AIMS: 1. To test the clinical efficiency of endoscope-guided placement of the ventricular catheter in cases of complex hydrocephalus. 2. To present and popularize the surgical technique of endoscope-guided placement of the ventricular shunt catheter which hitherto was not published in the Polish literature. MATERIAL AND METHODS: This study was done in 38 patients aged 2 days to 45 years (mean 7 years and 5 months). Multiloculated hydrocephalus was found in 7, lateral ventricle isolation in 14, fourth ventricle isolation in 3, intraventricular cyst accompanied hydrocephalus in 6, and adherent ventricular catheter of the shunt implanted previously in 8 cases. Endoscopy was performed through coronal or occipital burr hole. Peelaway sheath was used for placement of the catheter in the desired position. Computerized tomography was performed within 24 hours after surgery, after 6 months, and subsequently every 12 months during follow-up. The time of follow-up ranged from 1 to 5 years (mean 27 months). There were eight cases (15.78%) of postoperative occlusion of the ventricular catheter. In two of them, occlusion was caused by catheter tip displacement. In the remaining cases, occlusion was caused by growing membranes of the multiloculated hydrocephalus (four cases) or by infection (two cases) and was not related to the catheter position. There were no cases of catheter position change during follow-up. DISCUSSION: In complex hydrocephalus, proper placement of the ventricular catheter without direct visual control is very difficult if not impossible. Therefore, use of the endoscope facilitates proper catheter placement in multiloculated hydrocephalus, hydrocephalus complicated by isolation of the ventricle or intraventricular cyst. CONCLUSIONS: 1. The technique of endoscope-guided placement of the ventricular catheter is relatively simple and useful for reliable positioning of the drain in the right location. 2. Our cases show that the method is clinically effective. However, comparison with the conventional method will require a controlled and matched trial.
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Endoscopia/métodos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/reabilitação , Derivação Ventriculoperitoneal/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
The purpose of this report is to analyse the long-term outcome in hydrocephalic children treated by shunt insertion, in particular their psycho-intellectual development and quality of life. We studied 46 patients aged 3 - 21, who had been operated on in the Department of Paediatric Surgery of the Medical University of Bialystok between 1982 - 2000 and had had ventriculo-peritoneal shunts inserted during their first year of life. Data from anamnesis and medical documentation were analysed. Age-appropriate psychomotor development and IQ tests were carried out: Wechsler Intelligence Scale for Children, Revised (WISC-R) (for children between the ages of 6 and 16), Wechsler Adult Intelligence Scale, Revised (WAIS-R PL) (for adults), Brunet-Lezine psychometric scale (early childhood), and Terman-Merril intelligence scale (children younger than 3). The final IQs were above 90 in 30 % of children, between 70 and 90 in 24 %, between 50 and 70 in 26 %, and lower than 50 in 20 %. 69 % of patients presented with neurological deficits and visual or auditory deficits were found in 22 %. Integration into normal schools was possible for 58.7 % of the children, one of whom is now a second year medical student. A relationship between shunt malfunction and the children's development was observed. An essential aspect of caring for hydrocephalic children is their rehabilitation and integration into society. Early physical rehabilitation, stimulation of psychological development, and continued monitoring by a paediatric surgeon to ensure proper functioning of the shunts will improve the independence of such children in their families and among their peers.
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Hidrocefalia/cirurgia , Qualidade de Vida , Derivação Ventriculoperitoneal , Adolescente , Adulto , Criança , Pré-Escolar , Educação Inclusiva , Humanos , Hidrocefalia/reabilitação , Masculino , Desempenho PsicomotorRESUMO
This study investigated the effectiveness of a behavioural intervention programme in reducing disruptive behaviours in children with brain injury. The behavioural package included programme rules, a token economy with response cost and mystery motivators. Participants were three male patients in an after-school programme at a rehabilitation hospital who were identified as having both a brain injury and disruptive behaviours in the classroom setting. Two control composites were formed, one with children who behaved appropriately and one with children who behaved in a disruptive manner. This study employed a multiple baseline design across individuals. The participants' disruptive behaviour decreased during the intervention phase by an average of 69%; the effect size of each participant's improvement was 'large'. The comparisons' disruptive behaviour was unchanged. This pronounced decrease in disruptive behaviours for the three participants was maintained in the follow-up phase. This short-term, easily implemented package altered important programme and social behaviours positively, were well received by children and staff and resulted in long-term improvements to behavioural deficits secondary to brain injury. These results are discussed in terms of theoretical disagreements, methodological issues and practical community-based interventions in brain-injured children.
Assuntos
Terapia Comportamental , Encefalopatias/reabilitação , Lesões Encefálicas/complicações , Transtornos do Comportamento Infantil/reabilitação , Adolescente , Encefalopatias/complicações , Lesões Encefálicas/reabilitação , Criança , Transtornos do Comportamento Infantil/etiologia , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/reabilitação , Masculino , Comportamento SocialRESUMO
PURPOSE: We sought to detect the incidence and the risk factors of posttraumatic epilepsy (PTE) in rehabilitation patients; to define the influence of PTE for late clinical and functional outcome; and to assess the cognitive and behavioral features of the patients with PTE. METHODS: Patients were examined with (a) cognitive and behavioral examinations, which included a clinical interview and psychometric tests performed by an expert clinical psychologist; (b) single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI); and (c) functional evaluation including the Glasgow Outcome Scale (GOS) and the Functional Independence Measure (FIM). RESULTS: Of the 143 patients examined in this study, in 27 (19%), seizures developed after a mean time from trauma of 11.9 +/- 8.6 months. The occurrence of PTE was significantly correlated with the hypoperfusion in temporal lobes (p < 0.004), the degree of hydrocephalus (p < 0.04), the evidence of intracerebral hematoma (p < 0.01), and operative brain injury (p < 0.001). Patients with epilepsy showed a significantly higher incidence of personality disorders than did patients without epilepsy. The uninhibited behavior, irritability, and agitated and aggressive behavior were significantly more frequent and severe in PTE patients. The psychometric tests intended to explore memory, language, intelligence, attention, and spatial cognition did not show any significant difference between those with and without epilepsy. PTE also was significantly correlated with a worse functional outcome 1 year after the trauma. CONCLUSIONS: The degrees of hydrocephalus and of hypoperfusion in the temporal lobes are significant risk factors for late PTE. Another main finding of our study is the absence of influence of epilepsy on cognitive disorders; its influence on neurobehavioral disorders and functional outcome is discussed.