Psychological management of acute paraplegia in adolescence

Important management principles regarding emotional needs of the teenager with acute paraplegia during early hospitalization are discussed. One illustrative case is presented. Mourning reaction of the patient and family to this severe loss of bodily function is reviewed. Reaction of medical caretakers to this catastrophe is also discussed. It is emphasized that these concepts be applied by pediatricians in managing adolescent paraplegics.

A follow-up study of paraplegics and tetraplegics discharged from hospital

A study was conducted to investigate to what extent 76 paraplegics and tetraplegics were able to cope with their environment after discharge from hospital. The results showed that automobile accidents were responsible for most cases of paraplegia and tetraplegia; most patients died within one year of discharge from hospital; there was a significant differential in the survival rate between the upper and lower class patients in favour of the former; the younger the patient the longer was his chances of survival; the higher the lesion the greater were the chances of wife desertion among subjects and the lesser was the chance of survival; and finally none of the subjects except one was employed after discharge from hospital.

The high-level tetraplegic: psychological survival and adjustment

From the date of injury tetraplegics with spinal cord lesions of C4 and above are faced with unparalleled social and psychological adjustment. The individual will be involved in a process of re-establishing his identity by learning to develop and adapt his only remaining resources, his mind and his ability to communicate. This patient population is absolutely dependent in all aspects of meeting basic needs during the initial stages of the injury. If we attempt to return the patient to an active role in society, the rehabilitation team must be aware of the dynamics by which the patient achieves control of both himself and his environment. He will undergo a marked regression of his physical and emotional being and will face the turmoil of realigning ego parameters. The focal point of patient, family and staff interaction is the months of rehabilitation, where the team deals with the problem of social reintegration. Family involvement is essential from the beginning and reaches a high point at discharge and home planning. The scope of the paper will be to trace the psycho-social development of the patient with cervical lesion of C4 and above through the initial, rehabilitation and discharge phases of the injury. Our aim is to develop sufficient insight to the problems facing our patient population that we may aid in their search for meaningful lives.

Neurological and intellectual sequelae of Reye's syndrome

Eleven survivors of Reye's syndrome ranging in age from 9 months to 12 years were evaluated for neurological and psychoeducational sequelae. Seven children showed significant neuropsychological sequelae, ranging from severe global psychomotor retardation to mild specific perceptual and/or language impairments and from spastic quadriplegia and decorticate posturing to mild dysarthria. The severity of sequelae was inversely related to age of the child at onset of the disease. Whereas those children developing the syndrome when they were less than 1 year of age were seriously impaired, 3 children developing it in late childhood sustained no sequelae. Biochemical and neurological status at disease onset did not predict neuropsychological outcome. The results parallel the pattern of sequelae for other encephalopathies and suggest the importance for both child and family of early developmental evaluation following recovery from the disease.

Lottery winners and accident victims: Is happiness relative?

Adaptation level theory suggests that both contrast and habituation will operate to prevent the winning of a fortune from elevating happiness as much as might be expected. Contrast with the peak experience of winning should lessen the impact of ordinary pleasures, while habituation should eventually reduce the value of new pleasures made possible by winning. Study 1 compared a sample of 22 major lottery winners with 22 controls and also with a group of 29 paralyzed accident victims who had been interviewed previously. As predicted, lottery winners were not happier than controls and took significantly less pleasure from a series of mundane events. Study 2 indicated that these effects were not due to preexisting differences between people who buy or do not buy lottery tickets or between interviews that made or did not make the lottery salient. Paraplegics also demonstrated a contrast effect, not by enhancing minor pleasures but by idealizing their past, which did not help their present happiness.