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The debate about the causal role of the motor system in speech perception has been reignited by demonstrations that motor processes are engaged during the processing of speech sounds. Here, we evaluate which aspects of auditory speech processing are affected, and which are not, in a stroke patient with dysfunction of the speech motor system. We found that the patient showed a normal phonemic categorical boundary when discriminating two non-words that differ by a minimal pair (e.g., ADA–AGA). However, using the same stimuli, the patient was unable to identify or label the non-word stimuli (using a button-press response). A control task showed that he could identify speech sounds by speaker gender, ruling out a general labelling impairment. These data suggest that while the motor system is not causally involved in perception of the speech signal, it may be used when other cues (e.g., meaning, context) are not available. [ABSTRACT FROM AUTHOR]

Background and purpose: Subarachnoid haemorrhage SAH accounts for 5-10 of all strokes, strikes at a mean age of 50 years and results in a pattern of deficits similar to that of traumatic brain injury. This study is an extension of a previous study which described outcome at discharge from inpatient rehabilitation. The purpose of this follow up study was to describe long term functional, cognitive and psychosocial outcome in a cohort of SAH survivors who received inpatient rehabilitation. Methods: Subjects were interviewed by telephone. Functional status was assessed using the Functional Independence Measure FIM and cognitive status with the Telephone Interview for Cognitive Status TICS. Social function was determined via a brief questionnaire. Results: Thirty two out of 80 subjects who received inpatient rehabilitation participated in the study. The 32 did not differ from the original group of 80 on any demographic or clinical criteria. The mean time from onset of SAH to follow up was 28 months. Total FIM scores improved significantly between discharge and follow up p<0.0001 and most subjects functioned at a physically indepen dent level. However, almost 40 scored in the cognitively impaired range on the TICS. Between 40 and 50 required help with common household activities, and none returned to full time work. Functional and cognitive outcome was not related to any demographic or clinical characteristics at SAH onset. Conclusion: The majority of SAH survivors who received inpatient rehabilitation attain physical independence, but many continue to have cognitive impairments which result in social and vocational disabilities. [ABSTRACT FROM AUTHOR]

The objective of the current study was to determine the efficacy of amantadine in improving cognitive and behavioural performance in a traumatic brain injury (TBI) rehabilitation sample. The design was a prospective, randomized, double-blind, placebo-controlled, crossover design. Subjects were 10 adult traumatic brain injury patients in an acute brain injury rehabilitation unit. Subjects received a 2-week trail of amantadine or placebo, followed by a 2-week washout, then a 2-week trail of the alternative (placebo or amantadine). Neuropsychological outcome measures included orientation, attention, executive function, memory, orientation, behaviour, and a composite variable. Results of repeated measures ANOVA and regression analysis of slope/change showed a main effect of time, but no significant difference for amantadine versus placebo. In conclusion, although patients generally improved, this initial exploratory study found no differences in rate of cognitive improvement between subjects given amantadine versus those given placebo. However, the small sample size, heterogeneous population, acute time course, and large number of dependent variables limit power and generalizability. Implications are discussed for further research to better answer questions regarding efficacy of amantadine post-TBI. [ABSTRACT FROM AUTHOR]

Objective : To determine if clinical variables or neurobehavioural test (NBT) scores obtained in the ED within 24 hours of minor head injury (MHI) predict the development of postconcussive syndrome (PCS). Methods : Prospective, observational study of 71 MHI patients and 60 orthopaedic controls. MHI defined as loss of consciousness < 10 minutes or amnesia, GCS 15, no skull fracture or new neurologic focality on PE, and no brain injury on CT (if done). All patients received a seven part NBT battery in the ED. Telephone follow-up was done at 1, 3 and 6 months to determine if patients met the DSM IV definition of PCS. Analysis : Stepwise, multivariate, logistic regression. Results : Predictors of PCS at 1 month were female gender (OR 7.8; 95% CI 41.6, 1.98), presence of both retrograde and anterograde amnesia (OR 0.055; CI 0.002, 0.47), Digit Span Forward Scores (OR 0.748; CI 0.52, 1.03) and Hopkins Verbal Learning A scores (OR 0.786; CI 0.65, 0.91); at 3 months, presence of both retrograde and anterograde amnesia (OR 0.13; CI 0.0, 0.93), Digit Span Forward Scores (OR 0.744; CI 0.58, 0.94). No variables fit the model at 6 months. 92% of males scoring > 25 on Hopkins Verbal Learning A did not have PCS at 1 month, and 89% of females scoring < 9 on Digit Span Forward did have PCS at 1 month. Conclusions : Gender and two NBTs can help predict PCS after MHI. [ABSTRACT FROM AUTHOR]

Background: Encephalitis is an uncommon clinical entity compared to traumatic brain injury, and stroke. Many encephalitis survivors have disabling seqeulae. There is scant information in the literature addressing outcome following inpatient rehabilitation for encephalitis. Further, it is unclear which of these patients will benefit from acute in-patient rehabilitation. Purpose: The purposes of this study are to (1) describe the outcome following in-patient rehabilitation in a cohort of patients with encephalitis, and (2) develop preliminary criteria to guide the selection of patients with encephalitis who may benefit from inpatient rehabilitation. Method: The demographic, clinical, functional (functional independence measure-FIM) and neuropsychological data were retrospectively abstracted for eight subjects with a clinical diagnosis of encephalitis aged 5 to 75 years, who were admitted to a brain injury rehabilitation unit between 1990 and 1997. Results: In the eight subjects, the mean age was 38 years, mean acute hospital stay (ALOS) was 40.3 days, and mean rehabilitation length of stay (RLOS) was 75.9 days. Mean admission FIM (AFIM) was 40.1, mean discharge FIM (DFIM) was 69.9. Mean FIM gain was 29.8 and mean FIM efficiency was 0.39. Adult subjects with an AFIM > 30 at 5 weeks from onset of illness (n 4) had a FIM LOS efficiency of 0.64 and all four were discharged home. None of the adult subjects with an AFIM < 30 at 5 weeks from onset of illness (n 3, FIM efficiency 0.14) were discharged home. A child with an AFIM < 30 (n 1) had a FIM LOS efficiency of 1.24, made good recovery and was discharged home. FIM LOS efficiency of 0.64 in encephalitis is less, as compared to traumatic brain injury (TBI 1.27) and stroke (1.06). Conclusions: The results of this study showed that, although subjects with encephalitis make functional gains in rehabilitation, the rate of recovery varies and is generally less than that for TBI and stroke. The study also suggests that FIM scores can be used for screening adult patients after encephalitis for admission to inpatient rehabilitation. Adult patients with an AFIM > 30, 5 weeks post onset of illness are likely to make reasonable progress and be discharged home. If replicated, these results suggest that despite low AFIM scores at 5 weeks from onset of illness (AFIM < 30), children may still make good progress and should be given a trial of in-patient rehabilitation. [ABSTRACT FROM AUTHOR]

Background and purpose : Although subarachnoid haemorrhage SAH is a subtype of stroke, functional outcome following rehabilitation for SAH must be considered distinct from that of cerebral infarction because of the younger age and the difference in pathology and resultant neurologic deficits. The purposes of this study were to: 1 describe the demographic and clinical characteristics of SAH patients receiving rehabilitation; 2 describe functional outcomes following inpatient rehabilitation; and 3 investigate possible relationships between patient characteristics and functional outcomes. Methods : Retrospective chart review of SAH patients admitted to inpatient rehabilitation. Functional Outcomes rated by the Functional Independence Measures FIM . Analysis with descriptive and nonparametric statistics. Results : Eighty patients with SAH admitted to a rehabilitation unit with a mean age of 54 years. Fifty seven had identified aneurysms as a cause of SAH. Seventy four subjects 93 presented with Hunt and Hess grades of 3-5. The median length of stay was 26 days in acute care and 49 days in rehabili tation. Seventy patients 88 were discharged home. The mean admission FIM was 59.5 and mean discharge FIM 91.0. The FIM efficiency aggregate change in FIM day was 0.62 day and the average rate of FIM gain 0.97 points day. Hydrocephalus negatively influenced outcome p=0.05 . There was a trend for subjects with worse Hunt and Hess scores at onset to have poorer discharge FIM scores. Conclusion : SAH patients receiving inpatient rehabilitation make functional gains, although the rate of gain is less than for TBI or stroke. These SAH patients represent a subgroup with more severe SAH at onset than the total population of SAH survivors. The presence of hydrocephalus negatively impacts on outcome. Further detailed study of functional and neuropsychological outcome in SAH survivors is needed. [ABSTRACT FROM AUTHOR]