Rehabilitation of the Adult and Child With Traumatic Brain Injury

by Rosenthal, Mitchell

• ISBN13: 9780803603912
• ISBN10: 0803603916
• Edition: 3rd
• Format: Hardcover
• Copyright: 1999-01-01
• Publisher: DAVIS F A COMPANY

Summary

Wayne State Univ., Detroit, MI. Text for physical medicine and rehabilitation physicians and rehab teams. This edition includes new chapters on the low-level patient, older adult, life care plan- ning, advances in neuroradiology, functional assessment, psychotherapy, psychopharmacology, and ethical issues. Previous edition: c1990. DNLM: Brain Injuries--rehabilitation.

Table of Contents

SECTION I Acute Aspects of Brain Injury	1	(86)
BRIAN PENTLAND, MB, CHB, FRCP, FRCSLT
CHAPTER 1 Incidence and Prevalence of, and Costs Associated with, Traumatic Brain Injury	3	(16)
JESS F. KRAUS, MPH, PHD
DAVID L. McARTHUR, PHD, MPH
Objectives and Glossary	3	(2)
Scope, Limitations, and Technical Concerns	3	(1)
Epidemiological Terms and Meanings	3	(2)
Estimates of Incidence and Prevalence	5	(3)
Fatal Incidence	5	(1)
Nonfatal Incidence	5	(3)
Prevalence	8	(1)
Risk Factors for Traumatic Brain Injury	8	(4)
High-Risk Groups	8	(1)
High-Risk Exposures	9	(3)
Outcomes of Traumatic Brain Injury	12	(4)
Gross Measures	12	(1)
Implications of Risk Markers on Outcomes	13	(3)
Costs	16	(3)
CHAPTER 2 Pathophysiological Aspects of Injury and Mechanisms of Recovery	19	(23)
D.I. GRAHAM, MB, BCH, PHD, FRCPATH
Classification and Mechanisms of Brain Damage	19	(1)
Brain Damage in Fatal (Blunt) Nonmissile Head Injury	20	(14)
Focal Brain Injury	20	(6)
Diffuse Brain Injury	26	(8)
Experimental Models of Focal and Diffuse Traumatic Brain Injury	34	(1)
Models of Focal Traumatic Brain Injury	35	(1)
Models of Diffuse Traumatic Brain Injury	35	(1)
Outcome after Blunt Head Injury	35	(7)
Severe Disability and Vegetative State	36	(1)
Hydrocephalus	36	(1)
Progressive Neurological Disease	36	(6)
CHAPTER 3 Acute Management of Brain Injury	42	(11)
BRIAN PENTLAND, MB, CHB, FRCP, FRCSLT
IAN R. WITTLE, MD, PHD, FRACS, FRCSE
Assessment of Brain Injury	42	(5)
Diagnosis	42	(1)
Clinical Evaluation	42	(4)
Radiological Evaluation	46	(1)
Acute Treatment of Brain Injury	47	(4)
Early Measures at the Scene of the Accident and in Transit	47	(1)
Management in the Emergency Department	47	(1)
Operative Management of Brain Injury	48	(1)
Nonoperative Management of Severe Head Injury	49	(2)
Drug Treatment in the Acute Stage	51	(1)
The Family During the Acute Stage	51	(2)
CHAPTER 4 Medical and Orthopedic Complications	53	(21)
FLORA M. HAMMOND, MD
JAMES T. McDEAVITT, MD
Complications by Organ System	53	(18)
Integument	53	(1)
Head, Ears, Eyes, Nose, and Throat	53	(2)
Gastrointestinal	55	(1)
Cardiovascular	56	(1)
Hypertension	56	(2)
Genitourinary System	58	(1)
Endocrine	59	(3)
Musculoskeletal	62	(4)
Central Nervous System	66	(5)
Summary	71	(3)
CHAPTER 5 Cognitive and Behavioral Effects of Brain Injury	74	(13)
WILLIAM W. McKINLAY, PHD
ANNA J. WATKINS, BSC
Early Effects	74	(3)
Retrograde Amnesia	74	(1)
Post-Traumatic Amnesia	75	(1)
Recall of the Injury and Post-Traumatic Stress Disorder	76	(1)
Emergence of Further Deficits: Agitation and Restlessness	76	(1)
Cognitive Deficits	77	(2)
Emergence of Cognitive Deficits	77	(1)
Language and Communication Difficulties	77	(1)
Intellectual Deficits	77	(1)
Memory and Learning Deficits	78	(1)
Attentional Deficits	78	(1)
Executive Function	79	(1)
Adjusting to the Effects of Brain Injury	79	(1)
Insight and Denial	79	(1)
Emotional and Behavioral Changes	80	(2)
Lack of Insight	81	(1)
Undercontrol	81	(1)
Apathy and Tiredness	81	(1)
Depressed and Anxious Mood	81	(1)
Social Behavior	82	(1)
Psychiatric Diagnoses	82	(1)
Mediating Factors	82	(1)
Severity	82	(1)
Age at Injury and Premorbid Factors	83	(1)
Implications for Future Adjustment	83	(1)
Return to Work	83	(1)
Family Burden and Social Isolation	83	(1)
Conclusions	83	(4)
SECTION II Specialized Assessment Techniques	87	(130)
JEFFREY S. KREUTZER, PHD
CHAPTER 6 Neurological and Neuroradiological Evaluation	89	(28)
DOUGLAS I. KATZ, MD
SANDRA E. BLACK, MD, FRCP(C)
Purpose of the Neurological Evaluation	89	(1)
Neurological Evaluation and Team Management	89	(1)
Neuropathologically Based Diagnosis	90	(4)
Natural History	91	(3)
Elements of the Neurological Assessment	94	(6)
History	94	(1)
The Neurological Examination of the Patient with Traumatic Brain Injury	95	(5)
Neuroimaging in Traumatic Brain Injury	100	(10)
Contribution of Computed Tomography	101	(4)
Contribution of Magnetic Resonance Image Scanning	105	(3)
Contribution of Single-Photon Emission Computed Tomography Imaging	108	(2)
Electrophysiological Evaluation	110	(1)
Diagnosis and Prognosis	110	(3)
1. Diffuse Brain Injury	110	(1)
2. Focal Brain Injury	110	(1)
3. Secondary Injury	110	(2)
4. Late Secondary Complications	112	(1)
5. Seizures	112	(1)
6. Medical Comorbidities	112	(1)
7. Noninjury Factors	112	(1)
Conclusion	113	(4)
CHAPTER 7 Physiatric Assessment in Traumatic Brain Injury	117	(14)
NATHAN D. ZASLER, MD, FAAPM&R, FAADEP, CIME
Role of the Physiatrist	117	(1)
Clinical Assessment Issues	117	(5)
Nomenclature	117	(1)
Use of Outcome Measures	118	(1)
Standardization of Assessment and Treatment Protocols	118	(1)
Assessment Overview	118	(2)
History	120	(1)
Physical Examination	120	(1)
Other Assessment Issues	121	(1)
Role of Diagnostic Exams in Assessment	122	(1)
Prognostication Issues in Assessment	122	(3)
Preinjury Parameters	123	(1)
Injury Parameters	123	(1)
Postinjury Parameters	124	(1)
Differential Diagnostic Issues in Physiatric Assessment	125	(2)
Causality Determination	127	(1)
Physiatrist Interactions with Patients and Families	128	(1)
Conclusions	129	(2)
CHAPTER 8 Functional Assessment in Traumatic Brain Injury	131	(16)
KARYL M. HALL, EDD
Considerations in Choosing Measures	131	(3)
Validity	132	(1)
Reliability	132	(1)
Sensitivity or Precision	132	(1)
Time Required to Complete the Measure (Brevity)	132	(1)
Expertise Required to Complete the Measure	133	(1)
Comparability	133	(1)
Continuity	133	(1)
Phone Capability	133	(1)
Standardization	133	(1)
Supportive Documentation	133	(1)
Age Limitations	133	(1)
Comprehensiveness	134	(1)
Availability of Tool	134	(1)
Indices of Impairment: Severity of Injury	134	(1)
Coma Measures	134	(1)
Other Indicators of Severity of Injury	135	(1)
Indices of Disability	135	(3)
Functional Assessment Measures	135	(3)
Single-Concept Measures	138	(1)
Client Satisfaction with Services	138	(1)
Indices of Handicap	138	(4)
Community Integration	139	(1)
Single-Concept Handicap Measures	139	(1)
Psychosocial and Behavioral Adjustment	140	(1)
Mild Brain Injury (MBI) Assessment	140	(2)
Summary of Recommendation by Type of Program	142	(1)
A Minimal Data Set for Traumatic Brain Injury	142	(1)
Concept of a Minimal Uniform Data Set	142	(1)
Content of the Data Set	143	(1)
Summary	143	(4)
CHAPTER 9 Neuropsychological Examination of the Patient with Traumatic Brain Injury	147	(20)
STEVEN H. PUTNAM, PHD
NORMAN L. FICHTENBERG, PHD
Assessment	148	(1)
The Neuropsychological Examination	148	(1)
Complimentary Inferential Approaches to the Interpretation of Neuropsychological Test Data	149	(2)
Level of Performance	149	(1)
Comparison of Performance Between the Two Sides of the Body	149	(1)
Pathognomonic Signs	150	(1)
Analysis of Configurations and Relationships of Performance	150	(1)
Preparing the Patient for Neuropsychological Examination	151	(1)
Examination of Patients with Special Needs	152	(1)
Estimation of Status Before Traumatic Brain Injury	153	(1)
Practice Effects Associated with Retesting	154	(1)
Traumatic Brain Injury and Litigation	155	(1)
Demographic Adjustments, Base Rates, and the Sensitive-Specificity Issue	155	(2)
Neuropsychological Test Findings Associated with Traumatic Brain Injury	157	(3)
Neuropsychological Examination and Outcome Prediction	160	(1)
Vocational Outcome	160	(1)
Psychosocial Outcome	161	(1)
Treatment Recommendations	162	(1)
Cognitive Rehabilitation	162	(1)
Psychotherapy	163	(1)
Conclusions	163	(4)
CHAPTER 10 Emotional, Behavioral, and Personality Assessment after Traumatic Brain Injury	167	(16)
ADRIENNE D. WITOL, PSYD
JEFFREY S. KREUTZER, PHD
ANGELLE M. SANDER, PHD
An Overview of Research on Neurobehavioral Functioning	167	(1)
A Comprehensive Approach to Neurobehavioral Assessment	168	(12)
Clarifying the Referral Question	168	(1)
Records Review	169	(1)
Behavioral Observation	170	(1)
Clinical Interview	171	(1)
Quantitative Assessment Approaches	172	(1)
A Review of Assessment Tools	173	(6)
Diagnosis	179	(1)
Summary	180	(3)
CHAPTER 11 Evaluation of Communication and Swallowing Disorders	183	(16)
MICHAEL E. GROHER, PHD
LINDA PICON-NIETO, MCD, CCC
Communication Disorders	183	(10)
The Importance of Assessment	183	(1)
Neurogenic Communication Disorders	183	(1)
Characteristics of Communication Deficits	184	(1)
The Process of Evaluation	184	(1)
The Initial Evaluation	184	(2)
The Comprehensive Evaluation	186	(1)
The Minimally Responsive Patient	186	(3)
The Confused Patient	189	(1)
The Purposeful and Appropriate Patient	190	(3)
Swallowing Disorders	193	(3)
The Importance of Swallowing	193	(1)
Categories of Impairment	193	(1)
Cognitive Controls	194	(1)
Neuromuscular Controls	194	(1)
Iatrogenic Causes	194	(1)
Assessment Approaches	195	(1)
Summary	196	(3)
CHAPTER 12 A Holistic Approach to Family Assessment after Brain Injury	199	(18)
ANGELLE M. SANDER, PHD
JEFFREY S. KREUTZER, PHD
Common Emotional Reactions of Family Members	199	(2)
Depression	200	(1)
Guilt	200	(1)
Anxiety	200	(1)
Anger	201	(1)
Prolonged Emotional Distress	201	(1)
Role Changes	201	(1)
Common Family Role Changes	201	(1)
Coping	202	(1)
Family Needs Research	203	(1)
Assessment	204	(9)
Assessment Techniques	204	(2)
Assessment Content Areas	206	(7)
Special Issues and Challenges	213	(1)
Cultural, Ethnic, and Personal Differences	213	(1)
Overlooking the Patient's Point of View	213	(1)
Sources of Stress Not Related to Injury	213	(1)
Summary and Conclusions	213	(4)
SECTION III Treatment Approaches	217	(126)
MITCHELL ROSENTHAL, PHD
CHAPTER 13 Strategies to Enhance Mobility in Traumatic Brain Injured Patients	219	(23)
SARAH BLANTON, MPT
LISA PORTER, MOT, OTR
DONNA SMITH, PT
STEVEN L. WOLF, PHD, PT, FAPTA
Recovery and Outcomes	220	(1)
Determining Goals and the Course of Management	220	(10)
Assessment	221	(1)
Establishing Therapeutic Goals	222	(2)
Prevention of Secondary Complications	224	(1)
Stages of Management	225	(4)
Choosing a Treatment Strategy	229	(1)
Therapeutic Environment	230	(4)
Patient Involvement with the Environment	230	(1)
Social Environment	230	(1)
Transportation Equipment	231	(1)
The Environmental Surround	231	(1)
Treatment Settings	232	(1)
Nature of Treatment	232	(1)
Family Involvement	232	(2)
Efficacy of Treatment	234	(2)
Historical Background of Therapeutic Approaches	234	(1)
Motor Control Perspective	235	(1)
Treatment Considerations	236	(1)
Strategies	237
Examination of Deficits	236	(1)
Motor Learning Principles	236	(1)
Case Studies	237	(3)
Summary	240	(2)
CHAPTER 14 Activities of Daily Living	242	(12)
ROBIN McNENY, OTR
Effects of Brain Injury on Activities of Daily Living	242	(1)
Assessment and Definition of Functional Level	243	(2)
Discipline-Specific Evaluation	243	(1)
Interdisciplinary Assessment	243	(1)
Elements Critical to Effective Assessment	243	(2)
Considerations in Retraining Activities of Daily Living Performance	245	(1)
Treatment for Defects in Activities of Daily Living	245	(2)
Feeding	245	(1)
Dressing	246	(1)
Grooming and Hygiene	247	(1)
Treating Deficits in Instrumental Activities of Daily Living	247	(3)
Communication Tasks	248	(1)
Time Management	248	(1)
Social Skills	249	(1)
Homemaking	249	(1)
Financial Management	250	(1)
Use of Group Treatment in Retraining Activities of Daily Living	250	(1)
Driving	251	(1)
Conclusion	251	(3)
CHAPTER 15 Cognitive Rehabilitation	254	(17)
CATHERINE A. MATEER, PHD
SARAH RASKIN, PHD
Approaches to Cognitive Rehabilitation	254	(2)
Environmental Modifications	254	(1)
Compensatory Approaches	254	(1)
Direct Interventions	255	(1)
Factors Important to the Selection of a Treatment Approach	255	(1)
Measurement of Generalization	255	(1)
Dealing with the Emotional Consequences of Cognitive Loss	256	(1)
Approaches to Managing Attention Disorders	256	(3)
Understanding Attentional Disorders in Traumatic Brain Injury	256	(1)
The Assessment of Attention	256	(1)
Specific Intervention Approaches for Individuals with Attentional Disorders	257	(2)
Remediation and Management of Memory Disorders	259	(4)
Externally Focused Approaches to Managing Memory Impairment	259	(1)
Strategies for Teaching Individuals with Memory Impairment	259	(1)
Internally Focused Approaches for Managing Memory Impairment	260	(2)
Training Compensatory Systems for Managing Memory Impairment	262	(1)
Management of Executive Function Disorders	263	(3)
Functions of the Frontal Lobe	263	(1)
Evaluation of Frontal Lobe Functioning	263	(1)
Rehabilitation of Impairments in Executive Function	264	(2)
Summary and Conclusions	266	(5)
CHAPTER 16 Psychotherapy and Psychotherapeutic Interventions in Brain Injury Rehabilitation	271	(13)
GEORGE P. PRIGATANO, PHD
YEHUDA BEN-YISHAY, PHD
"Formal" Psychotherapy and Neuropsychological Rehabilitation	272	(3)
Kurt Goldstein's Insights	272	(1)
Lost Normality and the Fear of Losing One's Existence after Brain Injury	273	(1)
Why Do Some Brain Dysfunctional Patients Not Benefit from Psychotherapy or Psychoterapeutic Intervention?	273	(1)
The Problem of Transference in Psychotherapy with Brain Dysfunctional Patients	274	(1)
Psychotherapeutic Interventions Throughout the Rehabilitation Day	275	(6)
Learning that the Goal of Neuropsychological Rehabilitation Is Not Happiness but Independence	275	(1)
Learning To Show Love for a Spouse in Different Ways after Brain Injury Helps the Adjustment Process	276	(1)
Learning that Returning to a Previous Level of Employment after Brain Injury Is Not Necessary To Derive Meaning and Satisfaction from Work	276	(1)
Psychotherapeutic Interventions after the Yom Kippur War	276	(5)
Empirical Observations about Neuropsychological Rehabilitation that Incorporates Psychotherapeutic Interventions	281	(1)
Productivity Studies	281	(1)
Studies on Control of Negative Emotional Reactions	281	(1)
Summary and Conclusions	282	(2)
CHAPTER 17 Treatment Approaches for Communication Disorders	284	(13)
KATHRYN M. YORKSTON, PHD
MARY R. T. KENNEDY, PHD
Model of Chronic Disease	284	(1)
Cognitive-Communicative Dysfunction	285	(6)
Definitions	285	(1)
Treatment Issues	285	(3)
Management Approaches	288	(1)
Treating the Impairment	289	(1)
Treating the Functional Limitation	289	(1)
Treating the Disabilities	290	(1)
Dysarthria	291	(4)
Description and Characteristics	291	(1)
Treating the Impairment	292	(1)
Treating the Functional Limitation	293	(1)
Treating the Disability	294	(1)
Future Needs	295	(2)
CHAPTER 18 Behavior Analysis and Brain Injury Rehabilitation	297	(15)
HARVEY E. JACOBS, PHD
Cycles of Behavioral Intervention	297	(1)
What is Behavioral?	297	(1)
What is Behavior?	298	(1)
What is Applied Behavior Analysis?	298	(4)
Applied	298	(1)
Behavioral	298	(2)
Analytic	300	(1)
Technological	300	(1)
Conceptual Systems	301	(1)
Effective	301	(1)
Generality	301	(1)
Topical Behavioral Applications in Brain Injury Rehabilitation	302	(6)
Aggression and Agitation	302	(1)
Compliance	303	(1)
Skills Training	304	(3)
Other Clinical Challenges	307	(1)
Staff Management	307	(1)
Medication and Behavior Change	308	(1)
Limitations of Behavior Analysis	309	(1)
Summary	309	(3)
CHAPTER 19 Community Integration and Quality of Life of Individuals with Traumatic Brain Injury	312	(14)
WAYNE A. GORDON, PHD
MARY R. HIBBARD, PHD
MARGARET BROWN, PHD
STEVEN FLANAGAN, MD
MAUREEN CAMPBELL KORVES
Previous Studies of Individuals with Traumatic Brain Injury Living in the Community	313	(1)
A Community-Based Study of Individuals with Traumatic Brain Injury: Who Are They and How Do They Fare in Life?	313	(8)
The Quality of Life Study Sample	313	(3)
The Study Interview	316	(1)
Results	316	(4)
Discussion	320	(1)
Individuals with Traumatic Brain Injury in the Community: Service Delivery and Public Policy Challenge	321	(2)
Individuals with Traumatic Brain Injury: The Challenge of Managed Care	323	(1)
Conclusion	324	(2)
CHAPTER 20 Vocational Rehabilitation for Individuals with Traumatic Brain Injury	326	(17)
PAUL WEHMAN, PHD
MICHAEL WEST, PHD
ANGELA JOHNSON, MED
DAVID X. CIFU, MD
Individual Choice	327	(2)
Choosing a Career	327	(1)
Selecting a Counselor	327	(1)
Participation in Decisions on Training Methods	327	(1)
Deciding to Keep a Job	328	(1)
Models and Processes of Vocational Rehabilitation	329	(4)
Supported Employment	329	(1)
Natural Supports	330	(1)
Job Clubs	331	(1)
Vocational Rehabilitation Counseling	332	(1)
Independent Living Centers	333	(1)
Training and Employment Issues	333	(7)
Career Planning	333	(1)
Assistive Technology	334	(2)
Compensatory Strategies	336	(1)
Learning the Job	336	(1)
Performing the Job	337	(1)
Determining the Individual's Current Production Rate	338	(1)
Keeping the Job	338	(1)
Advocacy for the Worker	339	(1)
Conclusion	340	(3)
SECTION IV Rehabilitation of the Child with Traumatic Brain Injury	343	(68)
ERNEST R. GRIFFITH, MD
CHAPTER 21 Specific Problems Associated with Pediatric Brain Injury	345	(11)
LINDA J. MICHAUD, MD
ANN-CHRISTINE DUHAIME, MD
KENNETH M. JAFFE, MD
Functional Consequences of Specific Brain Injury Categories	345	(2)
Diffuse Axonal Injury	345	(1)
Focal Parenchymal Injuries	346	(1)
Epidural Hematoma	346	(1)
Subdural Hematoma	347	(1)
Gunshot Wounds	347	(1)
Neurological and Neurosurgical Complications	347	(3)
Infections	347	(1)
Growing Fractures	348	(1)
Hydrocephalus and Extra-axial Collections	348	(1)
Post-Traumatic Seizures	348	(1)
Auditory and Vestibular Disorders	349	(1)
Visual Impairment	349	(1)
Spinal Cord Injury	350	(1)
Peripheral Nerve Injury	350	(1)
Medical and Surgical Problems	350	(4)
Nutrition and Feeding Problems	350	(1)
Respiratory Problems	351	(1)
Gastrointestinal Problems	351	(1)
Genitourinary Problems	352	(1)
Musculoskeletal Disorders	352	(1)
Endocrine Disorders	353	(1)
Fever and Infection	354	(1)
Dermatologic Problems	354	(1)
Summary	354	(2)
CHAPTER 22 Traumatic Brain Injury in Children and Adolescents: Assessment and Rehabilitation	356	(37)
MARK YLVISAKER, PHD
ANNA J. L. CHORAZY, MD
TIMOTHY J. FEENEY, PHD
MARY LOUISE RUSSELL, MD
A Long-Term Developmental Perspective	356	(4)
Delayed Developmental Consequences	357	(3)
Executive Functions, Cognition, Communication, and Behavior: An Integrated Approach to Rehabilitation	360	(22)
Functional Assessment	362	(5)
Functional, Everyday, Routine-Based Intervention	367	(15)
Sensorimotor Assessment and Intervention	382	(6)
Critical Aspects of Pediatric Physical Rehabilitation	382	(2)
Assessment: Measurement of Outcome	384	(1)
Assessment: Identifying Impairment and Planning Intervention	384	(1)
Intervention: Acute Care	384	(1)
Intervention: Inpatient Rehabilitation	385	(3)
Rehabilitative Medical Assessment and Management	388	(1)
Summary	389	(4)
CHAPTER 23 Managing Transitions for Education	393	(18)
ROBERTA DePOMPEI, PHD
JEAN L. BLOSSER, EDD
Question 1: "What Basic Information Do We Need?"	393	(2)
Laws, Rules, and Regulations	393	(2)
Question 2: "What Systems Can Help?"	395	(1)
The Networking Process	395	(1)
Planning Multiple Transitions for the Child or Adolescent	395	(1)
Question 3: "Where Is This Child or Adolescent Now?"	396	(2)
Developmental Issues Affect Learning	396	(1)
Assessment Provides Planning and Placement Information	397	(1)
Applying Information about Performance Levels to Classroom Expectations	397	(1)
Question 4: "Where Do We Want the Youngster to Go?"	398	(1)
Question 5: "When Do We Want the Child to Get There?"	398	(1)
Question 6: "Who Do We Want and Need to Help?"	398	(1)
Question 7: "How Do We Want to Proceed?"	399	(3)
Class Placement and Special Education Services	399	(1)
Special Modifications	400	(1)
Instructional Methods	400	(1)
School to Work	401	(1)
Question 8: "How Much Will the Trip Cost?"	402	(1)
Question 9: "How Will We Know When the Goal Has Been Reached?"	402	(1)
Question 10: "How Can Families Help Their Child?"	402	(2)
Summary	404	(7)
SECTION V Special Topics	411	(188)
ERNEST R. GRIFFITH, MD
JEFFREY S. KREUTZER, PHD
CHAPTER 24 Ethical Dimensions of Severe Traumatic Brain Injury	413	(22)
JOHN D. BANJA, PHD
Ethical Implications of the Disrupted Self	413	(2)
Brain Injury and the Disrupted Self	414	(1)
Moral Accountability and the Disrupted Self	414	(1)
Moral Aspects of Families with Severely Brain Injured Members	415	(4)
The Family's Right to Information	416	(1)
Ethnographic Considerations	417	(1)
Conflicts Involving Familial Values	417	(2)
Decision-Making Ability and Competence	419	(4)
The Competency Construct	420	(1)
The Reliability of Competency Evaluations	421	(2)
Competence and the Ability to Manage Risk	423	(1)
Profoundly Diminished Consciousness and the Withholding or Discontinuation of Life-Prolonging Treatment	423	(5)
The Ethical Propriety of Withholding or Discontinuing Life-Prolonging Treatment	424	(1)
Ethically Challenging Aspects of Withholding or Discontinuing Life-Prolonging Treatment	425	(2)
The Tragedy of Michael Martin	427	(1)
Who Should Pay for Care?	428	(3)
Marketplace Economics and Allocation of Care	429	(1)
Determining When Rehabilitation Is "Successful"	429	(1)
Determining a "Decent Minimum" of Rehabilitation	430	(1)
Conclusion	431	(4)
CHAPTER 25 Assessment and Treatment of the Vegetative and Minimally Conscious Patient	435	(18)
JOHN WHYTE, MD, PHD
ANDREA LABORDE, MD
MADELINE C. DIPASQUALE, PHD
Medical Assessment	437	(14)
Rationale	437	(1)
Tachycardia	437	(1)
Fever	437	(1)
Hypertension	437	(1)
Medications	437	(1)
Post-Traumatic Epilepsy	438	(1)
Post-Traumatic Hydrocephalus	438	(1)
Heterotopic Ossification	439	(1)
Hypertonia and Motor Control	440	(1)
Decannulation	441	(1)
Feeding	441	(1)
Bruxism	442	(1)
Sensory and Cognitive Issues	442	(1)
Methods of Assessment and Evaluation	442	(1)
Visual Function	443	(1)
Auditory Function	444	(1)
Following Commands	445	(1)
Establishing a Communication System	445	(2)
Psychopharmacology	447	(1)
Assessing Change	448	(1)
Psychosocial and Ethical Issues	449	(2)
Summary	451	(2)
CHAPTER 26 The Older Adult with Traumatic Brain Injury	453	(18)
JEFFREY ENGLANDER, MD
DAVID X. CIFU, MD
Demographics of Aging	453	(1)
Disability in the Older Adult	453	(1)
Geriatric Rehabilitation	453	(1)
Injury Prevention	454	(1)
Epidemiology	454	(1)
Mechanism and Pathology of Injury	455	(1)
Mortality	455	(1)
Morbidity	456	(1)
Multiple Trauma and Hypotension	456	(1)
Fractures	456	(1)
Medical Complications	456	(1)
Factors Affecting Outcome	457	(1)
Age	457	(1)
Injury Severity	458	(1)
Rehabilitation	458	(3)
Assessment	458	(1)
Settings	458	(3)
Management of the Older Individual with Traumatic Brain Injury	461	(1)
Medical Issues	461	(1)
Medication Management	461	(1)
Pain	461	(1)
Seizure Risk	462	(1)
Deep Venous Thrombosis and Pulmonary Embolism Risk	462	(1)
Nutrition and Swallowing	462	(1)
Substance Abuse	463	(1)
Continence	463	(1)
Bladder	463	(1)
Bowel	464	(1)
Sensory Health	464	(1)
Vision	464	(1)
Hearing	464	(1)
Smell	464	(1)
Taste	464	(1)
Touch, Vibration, and Joint Position Sense	464	(1)
General Medical Health	465	(1)
Behavior and Cognition	465	(1)
Attention	465	(1)
Agitation	465	(1)
Alteration in Mood	465	(1)
Sleep-Wake Disturbance	466	(1)
Motivation	466	(1)
Memory	466	(1)
Safety Judgment	466	(1)
Competence and Capacity	466	(1)
Language	467	(1)
Sexuality	467	(1)
Self-Care	467	(1)
Mobility	467	(1)
Driving	467	(1)
Recreation and Vocation	468	(1)
Conclusion	468	(3)
CHAPTER 27 Mild Head Injury: Current Research and Clinical Issues	471	(8)
JEFFREY T. BARTH, PHD
STEPHEN N. MACCIOCCHI, PHD
PAUL T. DIAMOND, MD
Definition	471	(1)
Physiogenic versus Psychogenic	472	(3)
Variability in Outcome	475	(1)
Malingering	475	(1)
Treatment	476	(3)
CHAPTER 28 Sexuality and Sexual Dysfunction	479	(24)
AMY HERSTEIN GERVASIO, PHD
ERNEST R. GRIFFITH, MD
Prevalence and Types of Sexual Dysfunction after Traumatic Brain Injury	479	(6)
Definitions	479	(1)
Prevalence of Sexual Dysfunction	480	(1)
Primary Sexual Dysfunction	480	(3)
Secondary Sexual Dysfunctions after TBI	483	(2)
Assessment of Sexual Dysfunction	485	(2)
The Interview and Sexual History	486	(1)
Self-Report Inventories	486	(1)
Medical Examination and Diagnostic Studies	487	(1)
Management and Treatment of Sexual Problems	487	(7)
Research on Sexuality Education and Disability	488	(1)
Educating the Rehabilitation Professional about Sexual Issues	488	(1)
Treatment Roles of Staff	489	(1)
Varieties of Treatment	489	(4)
Appropriateness of the Setting	493	(1)
Sexuality Across the Lifespan	494	(4)
Childhood Sexuality	494	(1)
Puberty and Adolescence	494	(1)
Young Adulthood	495	(1)
Middle Age	496	(1)
Old Age	497	(1)
Special Topics in Sexuality	498	(3)
Homosexuality	498	(1)
Sexually Transmitted Diseases	499	(1)
Sexual Abuse	499	(1)
Sexuality in Institutions: A Dilemma	500	(1)
Summary and Conclusions	501	(2)
CHAPTER 29 Limbs with Restricted or Excessive Motion after Traumatic Brain Injury	503	(33)
NATHANIEL H. MAYER, MD
MARY ANN E. KEENAN, MD
ALBERTO ESQUENAZI, MD
Principles and Considerations Regarding Recovery from Brain Injury	504	(1)
The Period of Acute Injury	504	(1)
The Period of Motor Recovery	505	(1)
The Period of Functional Adaptation to Residual Motor Deficits	505	(1)
Principles of Evaluation	505	(4)
Sensory Evaluation	506	(1)
Kinesiological Considerations Underlying Functional Examination	506	(1)
Laboratory Studies	507	(1)
Treatment Considerations	507	(2)
Limbs with Excessive Motion: Specific Clinical Conditions and Approaches	509	(5)
Cerebellar Pathway Ataxia	509	(1)
Brain Stem Syndrome	510	(1)
Clonus	510	(1)
Hemiballismus	511	(1)
Chorea	511	(1)
Tremor	512	(1)
Myoclonus	512	(1)
Tics	512	(1)
Capsular and Ligamentous Laxity	513	(1)
Sensory Disturbance	514	(1)
Limbs with Restrictive Motion: Specific Clinical Conditions and Approaches	514	(20)
Spasticity, Stiffness, and Contracture	514	(4)
Patterns of Upper Motor Neuron Dysfunction	518	(13)
Heterotopic Ossification	531	(1)
Bony Malalignment of Fracture Malunion	531	(1)
Pain Syndromes	531	(1)