scholarly journals Differential Diagnosis and Management of Incomplete Locked-In Syndrome after Traumatic Brain Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Lauren Surdyke ◽  
Jennifer Fernandez ◽  
Hannah Foster ◽  
Pamela Spigel
Keyword(s):  
Traumatic Brain Injury ◽  
Differential Diagnosis ◽  
Brain Injury ◽  
Treatment Plan ◽  
Inpatient Rehabilitation ◽  
Individualized Treatment ◽  
Rehabilitation Team ◽  
Lower Cranial Nerve ◽  
Nerve Paralysis ◽  
Comprehensive Therapy

Locked-in syndrome (LIS) is a rare diagnosis in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. It is clinically difficult to differentiate from other similarly presenting diagnoses with no standard approach for assessing such poorly responsive patients. The purpose of this case is to highlight the clinical differential diagnosis process and outcomes of a patient with LIS during acute inpatient rehabilitation. A 32-year-old female was admitted following traumatic brain injury. She presented with quadriplegia and mutism but was awake and aroused based on eye gaze communication. The rehabilitation team was able to diagnose incomplete LIS based on knowledge of neuroanatomy and clinical reasoning. Establishing this diagnosis allowed for an individualized treatment plan that focused on communication, coping, family training, and discharge planning. The patient was ultimately able to discharge home with a single caregiver, improving her quality of life. Continued evidence highlights the benefits of intensive comprehensive therapy for those with acquired brain injury such as LIS, but access is still limited for those with a seemingly poor prognosis. Access to a multidisciplinary, specialized team provides opportunity for continued assessment and individualized treatment as the patient attains more medical stability, improving long-term management.

scholarly journals A Pilot Project of Early Integrated Traumatic Brain Injury Rehabilitation in Singapore

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Siew Kwaon Lui ◽  
Yee Sien Ng ◽  
Annie Jane Nalanga ◽  
Yeow Leng Tan ◽  
Chek Wai Bok
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcomes ◽  
Inpatient Rehabilitation ◽  
Epidemiological Data ◽  
Pilot Project ◽  
Functional Improvement ◽  
Early Screening ◽  
Neurosurgical Department ◽  
Rehabilitation Team

Objective.Document acute neurosurgical and rehabilitation parameters of patients of all traumatic brain injury (TBI) severities and determine whether early screening along with very early integrated TBI rehabilitation changes functional outcomes.Methods. Prospective study involving all patients with TBI admitted to a neurosurgical department of a tertiary hospital. They were assessed within 72 hours of admission by the rehabilitation team and received twice weekly rehabilitation reviews. Patients with further rehabilitation needs were then transferred to the attached acute inpatient TBI rehabilitation unit (TREATS) and their functional outcomes were compared against a historical group of patients. Demographic variables, acute neurosurgical characteristics, medical complications, and rehabilitation outcomes were recorded.Results.There were 298 patients screened with an average age of61.8±19.1years. The most common etiology was falls (77.5%). Most patients were discharged home directly (67.4%) and 22.8% of patients were in TREATS. The TREATS group functionally improved (P<0.001). Regression analysis showed by the intervention of TREATS, that there was a statistically significant FIM functional gain of 18.445 points (95% CI −30.388 to −0.6502,P=0.03).Conclusion.Our study demonstrated important epidemiological data on an unselected cohort of patients with TBI in Singapore and functional improvement in patients who further received inpatient rehabilitation.

Clinical Implications of the Center of Balance for a Veteran with Traumatic Brain Injury

2015 ◽  
pp. 280-289
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Benign Paroxysmal Positional Vertigo ◽  
Medical Center ◽  
Treatment Plan ◽  
Successful Outcome ◽  
Model Case ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Background: It is known that traumatic brain injury (TBI), even of the mild variety, can cause diffuse multisystem neurological damage. Coordination of sensory input from the visual, vestibular and somatosensory pathways is important to obtain proper balance and stabilization in the visual environment. This coordination of systems is potentially disrupted in TBI leading to visual symptoms and complaints of dizziness and imbalance. The Center of Balance (COB) at the Northport Veterans Affairs Medical Center (VAMC) is an interprofessional clinic specifically designed for patients with such complaints. An evaluation entails examination by an optometrist, audiologist and physical therapist and is concluded with a comprehensive rehabilitative treatment plan. The clinical construct will be described and a case report will be presented to demonstrate this unique model. Case Report: A combat veteran with a history of a gunshot wound to the skull, blunt force head trauma and exposure to multiple explosions presented with complaints of difficulty reading and recent onset dizziness. After thorough evaluation in the COB, the patient was diagnosed with and treated for severe oculomotor dysfunction and benign paroxysmal positional vertigo. Conclusion: Vision therapy was able to provide a successful outcome via improvement of oculomotor efficiency and control. Physical therapy intervention was able to address the benign paroxysmal positional vertigo. The specific evaluation and management as pertains to the aforementioned diagnoses, as well as the importance of an interprofessional rehabilitative approach, will be outlined.

Mortality following Traumatic Brain Injury Inpatient Rehabilitation

2015 ◽  
Vol 32 (16) ◽  
pp. 1272-1280 ◽  
Author(s):  
Gershon Spitz ◽  
Marina G. Downing ◽  
Dean McKenzie ◽  
Jennie L. Ponsford
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Inpatient Rehabilitation

Outcomes for Traumatic Brain Injury in Inpatient Rehabilitation by Facility Volume

2015 ◽  
Vol 96 (10) ◽  
pp. e62
Author(s):  
Amol M. Karmarkar ◽  
Kshitija Kulkarni ◽  
James Graham ◽  
Amit Kumar ◽  
Timothy Reistetter ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Inpatient Rehabilitation
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