Electrical treatment of reduced consciousness: experience with coma and Alzheimer's disease.

The right median nerve can be stimulated electrically to help arouse the central nervous system for persons with reduced levels of consciousness. The mechanisms of central action include increased cerebral blood flow and raised levels of dopamine. There is 11 years of experience in the USA of using nerve stimulation for acute coma after traumatic brain injury. There is a much longer period of experience by neurosurgeons in Japan with implanted electrodes on the cervical spinal cord for persons in the persistent vegetative state (PVS). But the use of right median nerve electrical stimulation (RMNS) for patients in the subacute and chronic phases of coma is relatively new. Surface electrical stimulation to treat anoxic brain injury as well as traumatic brain injury is evolving. Novel applications of electrical stimulation in Amsterdam have produced cognitive behavioural effects in persons with early and mid-stage Alzheimer's disease employing transcutaneous electrical nerve stimulation (TENS). Improvements in short-term memory and speech fluency have also been noted. Regardless of the aetiology of the coma or reduced level of awareness, electrical stimulation may serve as a catalyst to enhance central nervous system functions. It remains for the standard treatments and modalities to retrain the injured brain emerging from reduced levels of consciousness.

Electrical treatment of coma via the median nerve.

The median nerve is a portal to interact with the injured comatose brain. Peripheral nerve electrical stimulation has a central nervous system effect. Two to three weeks of right median nerve stimulation (RMNS) can hasten awakening from deep coma by increasing the dopamine levels. Three cases of electrically treated GCS-4 teenagers with acute diffuse brain injuries from motor vehicle crashes are presented by video. Pilot studies of RMNS for acute post-traumatic coma states have been done over the last ten years at East Carolina University and the University of Virginia. The neurophysiological effects of RMNS have been well documented at several neurosurgical centers in Japan using neuroimaging and spinal fluid assays. RMNS is a safe, inexpensive, non-invasive therapy for neuro-resuscitation of coma patients. When employed early in the coma, the time in the ICU may be shortened and the quality of the final outcome may be enhanced.

Right median nerve electrical stimulation to hasten awakening from coma.

Electrical stimulation of the right median nerve may hasten the awakening of closed head injured, comatose patients. A series of 25 comatose patients have been treated. These patients made better recoveries than similar individuals reported in the literature. In a double-blind pilot project patients in the treated group scored better on interval Glasgow Coma Scale scores, spent fewer days in the intensive care unit, and showed better Glasgow Outcome Scores at 1 month post-injury. Peripheral electrical stimulation of the right median nerve, through activation of the ascending reticular activating system, may be sufficient to arouse the moderate to severely comatose patient.

HIV disease in pregnancy. Ethics, law, and policy.

Legal and ethical principles mandate that informed consent be an integral element of HIV-related education, counseling, testing, treatment, and intervention. Minimizing patient counseling and education (for economic reasons or otherwise) is likely to backfire. The presumption that a parent will act in her child's best interest, accepted in analogous contexts, should be foundational in the development of HIV policy in the obstetric and gynecologic setting. Most women, when provided with counseling, care, and confidentiality, consent to prenatal or perinatal testing and, most important, engage their families in HIV-related care and services. Because of the changing terrain of knowledge about and treatments of HIV disease, providers must thoroughly counsel women regarding the risks and benefits of available treatment and intervention.

Mandatory testing of pregnant women: a strategy for challenging the law.

AIDS: Legal arguments exist that can be used to challenge Federal legislation mandating the testing of all pregnant women for HIV. One argument is the constitutional right to privacy, encompassing bodily integrity, decisional privacy, and informational privacy. Because mandatory testing places an undue burden on women seeking pregnancy and delivery-related services, the constitutional right to privacy presents a strong legal claim. Other legal claims include the right to equal protection, the right to make decisions on behalf of one's children, and the right to informed consent. Mandatory counseling with the option to test is consistent with legal principles of informed consent, bodily integrity, decisional privacy, and informational privacy.^ieng

Treating fluency disordered adolescents.

This paper presents fluency disorders in three types of stuttering syndromes with etiological considerations. The syndromes consist of affective, behavioral and cognitive components useful for fluency assessment and establishment of therapy goals with adolescents who stutter. The ultimate goal of the treatment program is a feeling of fluency control rather than actual fluency. A therapy process for fluency disordered adolescents is suggested which outlines four stages with goals and objectives for each stage. Behavior techniques for eliciting a feeling of fluency control are also included. Finally, a case history illustrates the therapy process for an adolescent with a fluency disorder.

Spontaneous regression of small cell carcinoma of lung associated with severe neuropathy.

This is a case report of small cell lung cancer (SCLC) that underwent spontaneous regression. This was associated with severe neuropathy, which was unresponsive to therapy, including corticosteroids and plasmapheresis. We present here the case report and a brief review of the literature.

Thiazide-induced pulmonary edema: a case report.

A 42-year-old white female developed severe respiratory distress 30 minutes following the ingestion of hydrochlorothiazide. On her arrival at the emergency room, pulmonary edema was evident by physical examination and chest radiograph. She presented without evidence of a gallop, jugular venous distention, or history suggesting cardiac disease. Normal electrocardiogram (ECG) and echocardiogram, and a radionuclide ventriculogram showing normal systolic and diastolic functions supported the noncardiac origin. The patient responded to supportive treatment within hours although the radiographic abnormalities persisted for several days. A review of the literature revealed that at least 12 other cases have been described of this unusual but life threatening idiosyncratic reaction to hydrochlorothiazide.

Prevalence of communication disorders in students with learning disabilities.

The prevalence of communication disorders in a population of 242 children with learning disabilities between 8 and 12 years of age enrolled in a school system in Alabama was studied. The prevalence of articulation, language, voice, fluency, and hearing disorders was determined through an individual assessment program. A speech, language, or hearing problem was exhibited by 96.2% (233) of the 242 children studied. Language deficits were found in 90.5%, articulation deficits in 23.5%, voice disorders in 12%, and fluency disorders in 1.2% of the students with learning disabilities. Puretone hearing deficits were observed in 7.4% and middle ear function deficits were observed in 15.7% of the students. Only 6% of the children were receiving the services of a speech-language pathologist.

Speech-language clinician personality variables and clinical effectiveness.

The relationship between judged clinical effectiveness and personality variables as determined by the Minnesota Multiphasic Personality Inventory (MMPI) was studied in a population of 130 female graduate students in speech-language pathology from nine universities in six different states. An MMPI profile analysis for the total group indicated that the group was similar to other female graduate student populations and that the typical student, while being manifestly normal, might be described as being rather passive, compliant, stereotypically feminine, sensitive, anxious, highly imaginative, creative, and energetic. Although no single MMPI scale was found to differentiate between subject clinical effectiveness groups, the subjects' MMPI profiles were found to predict accurately the clinical effectiveness group to which the subjects were assigned.

Fundamental frequencies in the oral reading behavior of stuttering and nonstuttering male children.

The fundamental frequencies of the voices during oral reading of 12 stuttering and 12 nonstuttering 7-to-12-year-old males matched according to age, height, weight, and race were studied. No statistically significant differences were found between the stutterers and nonstutterers with respect to the mean fundamental frequency, the lowest fundamental frequency, the highest fundamental frequency, and the difference between the lowest and highest fundamental frequency values.

Parental attitudes toward and knowledge of stuttering.

Parenteral attitudes toward and knowledge of stuttering were studied in 50 parents of stutterers and 50 parents of nonstutterers following the development of the Parenteral Attitudes Toward Stuttering (PATS) Inventory and the Alabama Stuttering Knowledge (ASK) Test. Results indicated that the parents of nonstutterers displayed more desirable attitudes toward stuttering and more accurate knowledge of stuttering than did the parents of stutterers. Although the PATS Inventory and the ASK Test as presently constructed may be clinically useful particularly with respect to parental counseling, continued research appears warranted to enhance their usefulness as research and clinical instruments.