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MANY HEALTH CARE consumers of the 21st century are becoming more demanding of their providers as they are actively involved in making choices about the health care they receive. Three [...]

To determine the functional outcome following acute rehabilitation for anoxic en cephalopathy using the Functional Independence Measure (FIM). Background: Patients with anoxic encephalopathy are reported in the literature to have poor functional outcome. However, there are few existing studies that use stan dardized functional measures to assess functional gains in anoxic patients during in patient rehabilitation.Methods: We retrospectively reviewed charts of 34 consecutive patients with the primary diagnosis of cerebral anoxia admitted to an inpatient rehabilitation unit. The criteria for admission to the rehabilitation unit were wakefulness and ability to follow one step commands. Outcome measures included discharge residence and the FIM score.Results:Of 34 patients, 26 had sufficient data for inclusion. Discharge FIM scores were significantly improved over admission FIM (p = < 0.0001) for all categories. FIM efficiency score was 0.45 (mean [FIMdisFIMadm]/mean LOS). Seventy-six per cent (20 patients) were discharged home, four patients were transferred ,to nursing home care, one patient was transferred to an acute, hospital for unrelated medical ill ness, and one patient was sent to long-term rehabilitation.Conclusion:Patients with anoxic encephalopathy experience significant functional improvement during inpatient rehabilitation. These results are compared to other brain injury populations, and clinical implications are discussed.

BONEKAT, H. W., M. L. DOMBOVY, and B. A. STAATS. Progesterone-induced changes in exercise performance and ventilatory response. Med. Sci. Sports Exerc, Vol. 19, No. 2, pp. 118–123, 1987. To further study the relationship between ventilatory response (VR) and exercise performance, and to investigate to what extent progesterone is responsible for ventilatory changes in the luteal phase of the menstrual cycle, we administered medroxyprogesterone acetate (MPA) to 10 normal males (20 mg three times a day for 5 doses) and compared results with those obtained in a similar study of females. With MPA, there was an increase in the resting VR to hypercapnia; the resting VR to hypoxia was not changed. There was a respiratory alkalosis at rest. During exercise, the PaCO2remained lower but the pHawas not different because of a tendency toward lower bicarbonate concentration with MPA. Ventilation, when related to CO2output, was increased at all exercise loads, indicating increased VR to endogenous CO2. However, ventilation was only minimally (3) increased when related to oxygen uptake or workload. This apparent disparity is because of slightly lower CO2output at a given oxygen uptake with MPA. As in females, maximal duration of exercise and maximal oxygen uptake were unchanged. Except for degree, MPA induced all the ventilatory changes seen in the menstrual cycle. Increased VR does not adversely affect exercise performance.

This book is based on invited review lectures given at the European Brain and Behavior Society's Workshop on Recovery of Function Following Brain Damage, London, England, in April 1991. There are 11 chapters covering both basicand human research. The chapters vary in quality and ease of reading.The first chapter, by D. Stein and M. Glasier, provides an excellent overview of the history of and developments in research on recovery from brain injury as well as succinctly describing the problems facing current researchers (eg, the definition of "recovery of function," distinguishing between "restitution" and "substitution"). This chapter provides information that all neurologists would find useful and interesting. The final chapter (by the editors) serves a similar purpose, is also quite well done, and argues for better collaboration between researchers in the field.Of the remaining chapters, the chapter by L. Diller, "Neuropsychological Rehabilitation," and the one by B. Kolls, "Mechanisms

This new and timely text provides an excellent integration of research and clinical aspects of severe traumatic brain injury.The first 3 chapters cover clinical features and epidemiology in a comprehensive fashion that leaves the reader with a clear concept of the findings, prognosis, and still remaining controversies regarding severe traumatic brain injury and persistent vegetative state.Chapter 4 summarizes recent contributions of single photon emission computed tomography and positron emission tomography to prediction of outcome.Chapter 5 on medical problems seems somewhat out of place and superficial. In general, selected medical problems are briefly discussed, but few practical recommendations are given for treatment.Chapter 6 covering pharmacological treatment is excellent and gives practical, usable information to clinicians who are faced with choosing the appropriate medication.Chapter 7 on cognitive and linguistic outcomes seems misplaced and does not cover cognitive deficits in any depth, nor does it incorporate new concepts

Medical Rehabilitation of Traumatic Brain Injury is a new text attempting to comprehensively address medical and rehabilitation issues following traumatic brain injury (TBI), but falls far short of this goal. The target audience and purposes are not clearly outlined in the preface and the book suffers from overall organizational problems: the chapters do not appear in a logical order (except for the first 3) and the section headings do not accurately describe the chapters that follow.Chapter 1 on epidemiology begins with a historical and rather wordy discussion on the appropriate definition of TBI, but does contain a nice detailed discussion of epidemiology and primary prevention. Chapter 2 contains misinformation on the pathology of TBI (axons are likely not truly "sheared," as axonal separation and retraction bulb formation take approximately 12 hours to appear) and mild TBI (the pathology is known: it is diffuse axonal injury, simply less of it