Relationship between narcissistic tendencies and psychiatric conditions in patients undergoing physical rehabilitation

This study examined the relationship between psychiatric conditions and narcissism in 78 patients with physical rehabilitation for illnesses such as cerebrovascular disease. The frequency of psychiatric disorders (Major Depression and Adjustment Disorder) was significantly higher for the patient group than for the healthy control group. The patients had significantly higher scores on measures of psychiatric symptoms including depression and lower scores on a narcissistic factor (Self-sufficiency) than the controls. In the patient group, the Self-sufficiency scores were significantly and positively correlated with Vigor scores. In the patient and control groups, although the correlation coefficient was not high and no significant difference was noted, the Self-sufficiency scores were negatively correlated with the Depression scores. These findings suggest that, in patients undergoing physical rehabilitation, poor Self-sufficiency is related to a decrease in vigor as a depressive symptom, perhaps due to the loss of physical functioning.

A neurological rehabilitation unit: audit of activity and outcome

A clinical audit was carried out to determine the impact of multidisciplinary rehabilitation in a specialist neurorehabilitation unit, and to demonstrate how outcome measurement can be incorporated into routine clinical audit. The study describes and interprets the results of one year's activity and outcome in a neurorehabilitation unit. A total of 138 patients were admitted to the 18 bedded unit between April 1994 and March 1995. The main outcome measures were: length of inpatient stay, admission and discharge destination, disability as measured by the Barthel Index and Functional Independence Measure, handicap as measured by the Environmental Status Scale and the Handicap Assessment Scale, and the time spent undertaking the audit. Improvement in disability was demonstrated in 112 (83%) patients and in handicap in 89 (66%) patients. The time taken to analyse the data on a quarterly basis was reduced from 20 hours for the first quarter to 4.5 hours for the last quarter. The results show that multidisciplinary inpatient neurorehabilitation leads to functional improvement in the majority of neurologically impaired patients. Outcome measurement and data collection can be incorporated into routine clinical practice once a sound methodology has been established.

Rehabilitation medicine

The nature of rehabilitation medicine is outlined in terms of its objectives, its methods, the patient groups which it seeks to help and its relationships to other specialties. Some major advances of recent years are discussed, such as the development of the impairment/disability/handicap framework. With particular emphasis upon neurological rehabilitation, the breadth of the specialty is then illustrated with examples of current preoccupations. These include recovery patterns of the damaged nervous system, testing the efficacy of existing therapies, applying new treatment techniques and developing quantitative measures of disability and handicap. Looking to the future, some key areas are identified where further advances might be sought.

Motor behavior research: implications for therapeutic approaches to central nervous system dysfunction

This article reviews the models and theories of motor behavior that are the foundation for the traditional approaches to central nervous system (CNS) dysfunction and presents a new theoretical model and approach that are beginning to influence practice. Reflex, hierarchical, and systems models of motor control and developmental and motor learning theories are discussed. The relationships of these models and theories to past, present, and future treatment approaches to CNS dysfunction are explored. The assumptions and limitations of the muscle reeducation, neurodevelopmental, and motor relearning approaches are discussed. A contemporary task-oriented approach based on the systems model is proposed and contrasted with traditional neurodevelopmental approaches.

[Home ventilation in neurologic diseases. Survey of 62 patients]

Home ventilation has developed as a sufficient and safe method in many neurological diseases afflicting respiratory functions. To achieve an overview of the situation of these patients in Germany, a questionnaire was distributed by the manufacturer of the most commonly used ventilator in Germany. The patients were asked to send the form back, even anonymous, to the Department of Neurology, RWTH Aachen. 65 of 110 questionnaires were answered, most of patients with muscle dystrophy's (n = 14), Polio (n = 14) and spinal cord injuries (n = 11). Home ventilation in ALS was performed in 3 cases only. The majority of patients (n = 30) was aged between 20 and 49 years, but here were also 5 children younger than 10 years. Most patients were ventilated not more than 4 years, but there were also 5 patients ventilated for over 20 years, all of them Polio-patients. 70% of all lived at home with their relatives, who take care for them. Nevertheless, 13 were full- or part-time working.

[Maternal personality and role in the rehabilitation of physically handicapped subjects]

The paper focuses on the importance of affective relations within the handicapped child's family during rehabilitation. In particular, the personality of the mother, as expressed for example through her pedagogical approach and emotive attitude, is correlated to the degree of success of the re-educational programme. Twelve children with neurological handicaps were monitored during a programme of rehabilitative physiotherapy. The mother-child relations were studied, focusing on the mother's difficulty in accepting her child's situation and adequately responding to the child's requirements, with the aim of identifying those instruments which promote, as far as possible, "separation" and autonomy. The study underlines the need for a medical team with which the parents can communicate both to obtain correct information and to diminish their anxiety in order to facilitate therapy and also establish a more satisfactory relationship with the handicapped child.

Toronto clinic takes new approach to neurologic injury, damage

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[Neurology of behavior as basis in neuro-rehabilitation]

Based on phylogenetic and ontogenetic aspects of sensorimotor development, human behaviour may be differentiated on three levels: (1) visceration as movements within the organism itself; (2) expression of inner states in posture, language and gesture by which only other living organisms can be influenced (socioverse activity); and (3) effectuation, which leads to changes of the living and material environment by direct contact (materioverse activity). These levels of behaviour are organized in different, cooperating structures of the central nervous system. Knowledge of them, and their practical applicability, form the basis of neurorehabilitation.

VOJTA neurophysiologic therapy

The reflexlocomotion acc. to VOJTA is a neurophysiologic facilitation system for the whole CNS and neuromuscular apparatus. It consists of all components, in a reciprocal manner of locomotion: (i) automatic control of posture, (ii) uprighting, (iii) aimed movements. Consequently the indications for this type of kinesiologic facilitation are really extensive. In this article the following complete list of indications is described: CCD (central coordination disorder), CP (cerebral palsy), peripheral paresis, Spina bifida (MMC), Myopathies, congenital malformations, orthopaedic problems, traumatic cross sections, neuromuscular dysfunctions etc. Further the experiences of the treatment in each disease are discussed. Even EMG-detections have shown the effect of the therapy in peripheral and central damage. Therefore a good prognosis for improvement and rehabilitation can be given in a large number of disorders, irrespective of age.

Opportunities and challenges for the clinical utilization of functional electrical stimulation

Clinical applications of electrical stimulation for effecting change in the damaged or disabled nervous system are in their infancy. This technique is extremely powerful, because any neural structure that is electrically excitable can potentially be affected. Although early attempts to apply electrical stimulation were limited by insufficient physiological knowledge and undeveloped technology, developments over the past two decades now provide a strong base for clinical applications. Clinical systems for bladder control and respiration have been in use for many years. Some applications of FES to restore hand function and walking are in multicenter testing, whereas many others are being studied for clinical feasibility at single sites. Applications are focusing on safety and efficacy, as well as on clinical outcome measures to address the issues posed by the regulatory and reimbursement processes. As clinical systems become more routine, issues of multiple system applications will need to be addressed. Present and future applications of functional electrical stimulation may be expected to significantly enhance independence and improve the quality of life for individuals with central nervous system dysfunction.

Joint mobilization for children with central nervous system disorders: indications and precautions

Because clinicians are introducing joint mobilization into treatment programs for children with cerebral palsy, we felt that a review of the procedure and its scientific basis would be timely. The goals of the introductory section of this article are to define joint mobilization as it has been used for adults with musculoskeletal disabilities, to discuss various rationales for its effects, to describe contraindications and precautions for its use, and to discuss its efficacy as reported in the research literature. The latter part of the article deals with the use of joint mobilization for children with central nervous system (CNS) disorders. In an effort to understand precautions for the use of joint mobilization in children, musculoskeletal development will be described both for typically developing children and for children with spastic cerebral palsy. Indications for using joint mobilization techniques in children with spasticity will be outlined. Specific neurodevelopmental disabilities for which joint mobilization would be strongly contraindicated will be listed. Finally, future research directions in evaluating reliability of assessment of joint dysfunction and efficacy of joint mobilization in children will be discussed.

Development of a clinical measure of postural control for assessment of adaptive seating in children with neuromotor disabilities

The primary purposes of this article are to review the literature on seating assessment and to describe the development of a clinical evaluation scale, the Seated Postural Control Measure (SPCM), for use with children requiring adaptive seating systems. The SPCM is an observational scale of 22 seated postural alignment items and 12 functional movement items, each scored on a four-point, criterion-referenced scale. A secondary purpose of this article is to report the reliability of the seven-point Level of Sitting Scale (LSS). Interrater and test-retest reliability of the SPCM items and the one-item LSS were evaluated on a sample of 40 children with developmental disabilities who sat with and without their seating systems. Kappa values of .75 or higher were considered excellent, .40 to .74 as fair to good, and less than .40 as poor. The interrater reliability tests for the two seated conditions and the two test sessions conducted 3 weeks apart yielded overall item Kappa coefficient means of .45 for the alignment section and .85 for the function section. Test-retest results for the SPCM items were less satisfactory, with item Kappa coefficient means for the two seating conditions and raters of .35 and .29 for alignment and function, respectively. Reliability results did not appear to be consistently better among seating conditions, raters, or test sessions. Kappa coefficients for the LSS were fair to good for both interrater and test-retest reliability. Plans for future development of the SPCM and LSS are discussed.

Joint mobilization principles. Considerations for use in the child with central nervous system dysfunction

The purpose of this article is to explore the use of mobilization in the treatment of capsular dysfunction of the shoulder joint in children with central nervous system dysfunction. A review of functional anatomy and of normal and abnormal development of the shoulder is presented. Basic mobilization principles and application of joint mobilization techniques to children with long-standing shoulder hypomobility and spasticity are discussed. Research to determine the benefits and risks of mobilization of joints in children with spasticity is recommended.

Focus on rehabilitation in the acute care setting: the role of the neuro clinical nurse specialist

Establishment of an early rehabilitation program for patients with neurological/neurosurgical illness or injury is the focus of this article. The Neuroscience Clinical Nurse Specialist (NCNS) is identified as having a major responsibility in initiating early rehabilitation in the acute care setting. Development of the rehabilitation program is discussed through the NCNS's roles as educator, clinician, consultant, and researcher. Implementation of the rehabilitation program emphasizes the use of the nursing process, the role of the staff nurse, active patient and family participation, and use of the interdisciplinary team approach. General concepts rather than specific practices are used in order to present an overview of the role.

Rehabilitation following brain damage: some neurophysiological mechanisms. Functional recovery in the visual and vestibular pathways

The visual and labyrinthine sensing systems are often neglected in the rehabilitation process of patients with central nervous system (CNS) lesions. Nevertheless, their integrity is essential for the construction of motor tasks ranging from accurate reaching to the co-ordinated behaviours of posture and locomotion. This tasks may be influenced considerably by the roles of the visual and vestibular systems in the perceptual analysis of localizing objects in space ("egocentric localization") and of spatial orientation of the body ("ego-orientation") and in controlling oculomotor and postural stability. The anatomy, physiology, clinical relevance and patterns of recovery of function of two specific visual-vestibular related behaviours is addressed, namely ocular stability and egocentric localization. Emphasis is placed upon such issues as (a) motor learning in complete and incomplete lesions as adjudged from observations of peripheral vestibular nerve disorders; (b) the role of the cerebellum in calibrating motor performance with particular reference to the modifiability of the vestibulo-ocular reflex to attain ocular stability; (c) the use of redundant or complementary structures as assumed from evidence of recovery from chronic visual field deficits; and (d) specified behavioural tactics as a mechanism for adaptation.

Rehabilitation following brain damage: some neurophysiological mechanisms. The effects of repetitive stimulation in recovery from damage to the central nervous system

There is a growing body of evidence that the central nervous system (CNS), even in the adult animal, is capable of adaptation and reorganization not only as a result of partial damage to the CNS but also in response to stimulation. Environmental stimulation produces changes including expansion of visual cortex, increases in dendritic branching, glia and cholinesterase. Environmental stimulation also produces behavioural changes. Experimental electrical stimulation produces changes in synapse size, synaptic vesicle change, dendritic branching and changes in synaptic transmission. In man, repetitive electrical stimulation via epidural electrodes increases plasma levels of norepinephrine, epinephrine, and dopamine, and CSF levels of norepinephrine. Repetitive electrical stimulation in man dates back to 1967 and has been used for the control of pain, to improve spasticity, bladder control, motor deficit and the autonomic hyperreflexia of spinal cord injury. In addition, improvement has been reported in epilepsy, cerebral palsy, torticollis and peripheral vascular diseases. The best controlled studies are in multiple sclerosis and peripheral vascular disease, and these results will be presented in more detail.

Rehabilitation following brain damage: some neurophysiological mechanisms. A therapeutic approach based on theories of motor control

Rehabilitation programmes concerned with functional recovery of patients with central nervous system (CNS) lesions may be in need of developing processes more consistent with prevailing concepts of motor control and of behavioural requirements by the CNS for motor learning. Both central and peripheral factors can play important roles in providing for finely orchestrated and relatively accurate learned motor performance. The relative influence of each of these factors on motor recovery is determined, in part, by the actions observed, i.e. control of body ("mid-line") and/or limb ("peripheral") position, by the interaction between two principal features of the control system, fixation (stability) and motion, by the inherent plasticity of structures, and by the ability of cerebral mechanisms to code, store and recall information with minimal error and time delay. A functional theory for governing spatial and temporal components of motor performance is presented; this is based upon three attributes: (a) attainment of control of fixation and motion of midline (eye-head-trunk) and peripheral structures in developmental order; (b) organization of serial fixation-motion steps in the guidance-manipulation functions of limbs, and (c) provision for coding spatial and temporal information related to both fixation and motion.

Rehabilitation following brain damage: some neurophysiological mechanisms. Determinants of recovery

General theories of recovery are outlined. The effect of a partial lesion in the central nervous system (CNS) is described with the emphasis on the reaction of the intact and undamaged CNS. The reaction of the CNS includes sprouting of new terminals and the unmasking of synapses. The role of neuroglia is discussed in relation to the dynamic changes following partial damage and consequent reorganization of the CNS. The effect of this reaction, sprouting and unmasking of synapses, is to produce an altered nervous system and it is this altered nervous system, as well as the lesion responsible, which produces the clinical picture in human chronic neurological damage. Although much remains unanswered, the known facts of CNS reorganization (and possible regeneration?) in the experimental animal have definite implications for management of neurological deficit in man; in particular, that the adult nervous system is capable of considerable reorganization and therapeutic procedures may be based on active environmental and artificial stimulation.

Rehabilitation following brain damage: some neurophysiological mechanisms. Animal models of recovery with training after central nervous system lesions

Animal studies revealed that training with techniques of instrumental conditioning produces another phase of functional recovery beyond spontaneous recovery after CNS lesions. Such conditioned behaviour is difficult to transfer to an unconditioned or another conditioned response. Conditioned and unconditioned behaviours are mediated through different pathways and mechanisms. Conditioned behaviour requires less specific pathways and can probably be achieved as long as the basic spinal mechanisms are activated. Other studies showed that reflex recovery can be maximized through non-specific training, probably by protecting the neuromuscular system from deterioration. However, such a programme does not appear to improve the reflexes beyond the level attributable to spontaneous recovery, nor to facilitate the rate of recovery. If the training is specifically directed towards augmentation of a particular reflex, the reflex can be improved beyond that seen with spontaneous recovery but may be exaggerated to a functional disadvantage. These findings have significant clinical implications.

Rehabilitation following brain damage: some neurophysiological mechanisms. Physiological correlates of clinically observed changes in posture and tone following lesions of the central nervous system

Extensive investigation of the role of the fusimotor system in the production of hypotonic and hypertonic disorders of posture and tone has been undertaken in humans and experimental animals. The data from human studies have usually been from indirect assessment of the fusimotor system, and results are often contradictory. Results are now available from animal studies utilizing direct recording of muscle spindle afferent discharge in a number of models of human disorder. Conditions resulting in hypotonia, e.g. cerebellar ablations, medullary pyramidotomy, VL nucleus, thalamotomy, acute spinal cord transection, and acute motor cortex ablation uniformly result in a depression of muscle spindle primary afferent discharge. Conditions resulting in hypertonia, e.g. chronic spinal cord transection and chronic motor cortex ablation, fail to show heightened muscle spindle afferent discharge, however. Rather the spindle afferent discharge returns to control levels in the models. Recovery from the hypotonic to the hypertonic state is, however, associated with significant recovery of spindle afferent function.

Central nervous system lesions: sprouting and unmasking in rehabilitation

Recovery of function following a central nervous system lesion can continue for months or years following the injury. Considerable experimental evidence supports the conclusion that the plasticity of the brain is of importance to the functional recovery. A number of neural mechanisms may be involved in the functional recovery. Two of the mechanisms of neuroplasticity considered particularly likely to play a role, are the following: 1) Collateral sprouting from intact cells to a denervated region after some or all of its normal input has been destroyed, and 2) The unmasking of neural pathways and synapses which are not normally used for the particular function under study but which can be called upon when the ordinarily of dominant system fails. The process of unmasking is extensively discussed in the context of the role of rehabilitation in obtaining maximum recovery of function.

Current neuropsychological approaches in assessment, rehabilitation, and clinical research of central nervous system disorders

A current review of selected clinical neuropsychological approaches in the assessment, rehabilitation, and clinical research of central nervous system (CNS) disorders is presented. Clinical neuropsychology occupies a unique place among the sciences of the human nervous system. Over the past 50 years it has been concerned mainly with brain systems involving human psychological activity and its organization and how these systems are altered upon disturbances in brain-behavior functions. The field of clinical neuropsychology differs from other groups of neurological disciplines in that its major goal to introduce selected neuropsychological functions involving the higher cortex, to discriminate between functional and structural disorders, to standardize the collection of base line information needed in assessment of the efficacy of rehabilitation techniques, and to define the role of neuropsychology in building conceptual models of the brain's functional organizaton from research. The topics covered are neuropsychological test batteries, the systems of Luria and Halstead-Reitan, implications for rehabilitation planning, and current research and its application for the future use of neuropsychoclogical test batteries.