Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2005
ReviewAssessment of health-related quality of life in persons after traumatic brain injury--development of the Qolibri, a specific measure.
Health-related quality of life (HRQOL) associated or not with the measurement of neuropsychological functioning is a relatively new outcome variable in the field of traumatic brain injury (TBI). In both cases, accuracy and precision are increased in outcome estimation. Validation of generic, cross-culturally (cc) administered HRQOL measures in persons after TBI is not yet well established. Disease-specific HRQOL instruments do not exist in an international context. The objective here is to present the TBI consensus group's (QOLIBRI-Group) approach in cc development of a specific HRQOL measure--the QOLIBRI (Quality of Life after Brain Injury). ⋯ In TBI patients, generic and disease-specific aspects of HRQOL need to be assessed with measures of adequate psychometric quality, applicable across different populations and cultural conditions. The QOLIBRI is a promising instrument for sensitive patient-centered specific outcome evaluation after TBI.
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In neurorehabilitation, transcranial magnetic stimulation (TMS) offers information regarding prognosis and pathophysiology and could also be useful for therapeutic purposes. Numerous studies have indicated that, after stroke, the absence of motor evoked potentials is associated with a poor motor recovery. In contrast, MEPs obtained in the paretic muscle with low stimulus intensities suggest a good restitution of motor function. ⋯ Stroke patients participating in a Constraint-induced movement therapy show an enlargement of the motor output area in the affected hemisphere after therapy. This enhancement of motor excitability is associated with an improvement of motor function. Some evidence is emerging that the application of low frequency repetitive TMS over the non-lesioned hemisphere improves neglect phenomena by down-regulation of the excitability of the non-lesioned hemisphere.
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Acta Neurochir. Suppl. · Jan 2005
ReviewMicrodialysis in traumatic brain injury--methodology and pathophysiology.
The application of clinical microdialysis to monitor changes in cerebral extracellular chemistry is now well established in several neurosurgical units worldwide. In neuro-intensive care the technique has been predominantly applied to patients with traumatic brain injury and subarachnoid haemorrhage. ⋯ This involves establishing the relationship between microdialysis and outcome, and the effect of therapeutic manoeuvres on the chemistry. This manuscript describes the place of microdialysis in traumatic brain injury in terms of the fundamental principles, methodology, pathophysiology and clinical application.
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Acta Neurochir. Suppl. · Jan 2005
ReviewNear infrared spectroscopy in brain injury: today's perspective.
The technique of near infrared spectroscopy (NIRS) is based on the principle of light attenuation by the chromophores oxyhaemoglobin (HbO2), deoxyhaemoglobin (Hb) and cytochrome oxidase. Changes in the detected light levels can therefore represent changes in concentrations of these chromophores. Clinical use of NIRS in the brain has been well established in neonates where transillumination is possible. ⋯ Recent technical advances have led to the development of compact, portable instruments that detect changes in optical attenuation of several wavelengths of light. Near infrared spectroscopy is an evolving technology that holds significant potential for technical advancement. In particular, NIRS shows future promise as a clinical tool for bedside cerebral blood flow measurements and as a cerebral imaging modality for mapping structure and function.
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Acta Neurochir. Suppl. · Jan 2005
ReviewPhenomenological aspects of consciousness--its disturbance in acute and chronic stages.
The meaning of a disturbance of consciousness is completely different in an acute as opposed to a chronic stage. In the acute stage, the grade of arousal is the most essential component in order to assess the changes of the level of intracranial pressure in neurosurgical emergency room. ⋯ We propose the difference in conception between consciousness and mind; that is, consciousness consists of psycho-sensory afferent system, mind of psycho-motor efferent and afferent system, and memory and language as liaison officers between them. This proposal would play a role to understand mental change in the natural aging processes, when memory and cognition are deteriorating gradually, but is still in evolution in the field of culture.