Articles: brain-injuries.
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To study sequential changes in heart rate, respiratory rate, blood pressure, heart rate power spectra, and plasma catecholamine concentrations in patients with acute brain injury and correlate these variables with the severity of neurologic dysfunction and patient outcome. ⋯ Our results imply that autonomic nervous system control of heart rate is disrupted in proportion to the degree of neurologic insult in children after acute brain injury. Thus, heart rate power spectral analysis and plasma catecholamine concentrations may prove to be useful adjuncts in determining severity of neurologic injury and prognosis for recovery in children suffering from brain injury. In addition, these techniques may aid in the determination of brain death.
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Arch Phys Med Rehabil · Feb 1996
Association between injury indices and outcome after severe traumatic brain injury in children.
(1) To determine whether indices of traumatic brain injury (TBI) in children are associated with outcome at hospital discharge and 5 to 7 years later; (2) to describe persisting disabilities. ⋯ Early and late outcome after severe TBI are related to variables measured at and after injury. Subjects had long-term educational and vocational problems but often did not utilize the medical model of neurorehabilitation.
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Early neurological rehabilitation means starting rehabilitation of brain damaged patients already during the acute phase of the trauma or illness. It meanwhile is commonly accepted that early onset of specific neurological rehabilitation interventions will enhance medical improvement and social reintegration potential. On the other hand, the number of treatment places required for adequate early neurological rehabilitation remains a controversial, and as yet unresolved, issue in Germany. ⋯ A total of 146 early rehabilitation treatments was found, which is equivalent to 80 treatments a year. These results are compared with the figures and recommendations given by Kuratorium ZNS. Also, our findings document the apparent deficits in neurological rehabilitation at the time in the Land Bremen, which undoubtedly jeopardize our daily objectives, the progress and successes achieved in early intensive care.
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Review Comparative Study
Cellular and molecular correlates to plasticity during recovery from injury in the developing mammalian brain.
In summary, our studies indicate that the perinatal mammalian brain shows considerable plasticity in response to trauma. Studies carried out both in vivo in the perinatal mouse brain and in vitro in cell line culture and organotypic slice cultures of developing brain tissue, indicate that the cytokine, interleukin-1 beta (IL-1 beta) regulates early healing responses that restore the integrity of the damaged structure and create conditions conducive to the sprouting of new connections involved in plasticity. In response to a lesion placed in the cerebral cortex in a late third trimester embryo, astrocytes form a line that delimits damaged tissue being removed by phagocytic macrophages from tissue that will remain part of the neural parenchyma. ⋯ Similar sprouting occurred in vitro in organotypic slice culture of deafferented hippocampus. In culture, sprouting was first observed at the time of onset of astrocyte hypertrophy, indicating that astrocyte derived factors may play a role in regulating circuit reorganization. Viewed together, in vivo and in vitro studies indicate that IL-1 beta upregulation in neural tissue correlates with glial activities that underlie rapid healing and repair in the perinatal brain, and that glial activities associated with deafferentation may play a role in inducing compensatory neurite sprouting and cicuit reorganization.
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The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify the head injured patients who will eventually undergo tracheotomy. Authors' present retrospective study reveals that the likelihood of tracheotomy is significantly greater in patients with a GCS rating < 7 than in those with a GCS rating > 7 (p < 0.01). In order to minimize complications and make tracheotomy patients feeling more comfortable and communicable, this study argues for early tracheotomy in patients with a GCS score < 7, but never before 72 hours after injury, because it is a time necessary for patient stabilization and elimination of any illicit drugs or alcohol used prior to head injury.