ABSTRACT
We report a case of a 67-year-old man with left thalamic hemorrhage. He had right hemiplegia, aphasia, and higher brain dysfunction. The hemiplegia and aphasia improved with rehabilitation treatment；however, he was unable to perform activities of daily living. Visual and tactile agnosia was suspected using the visual perception test for agnosia 1 month after the hemorrhage. The patient was able to recognize common objects, such as chopsticks and a shaver, by labeling them with their names because he could read words. He was able to use these objects as a result. Multimodal agnosia with combined visual-tactile agnosia usually occurs as lesions in and around the left lateral occipital complex where the ventral stream of somatosensory information processing merges with that of visual information processing. Concurrently, the present case seems very unusual because multimodal agnosia was likely to have occurred as a lesion of the left thalamus. The compensatory strategy to put objects into words was effective in this case. We repeatedly assessed and analyzed his higher brain dysfunction in detail, which led to effective rehabilitation treatment. The present case highlights the importance of planning an appropriate treatment based on detailed evaluation and accurate diagnosis of the higher brain dysfunction in patients with neurological deficits.
ABSTRACT
We report a case of a 67-year-old man with left thalamic hemorrhage. He had right hemiplegia, aphasia, and higher brain dysfunction. The hemiplegia and aphasia improved with rehabilitation treatment；however, he was unable to perform activities of daily living. Visual and tactile agnosia was suspected using the visual perception test for agnosia 1 month after the hemorrhage. The patient was able to recognize common objects, such as chopsticks and a shaver, by labeling them with their names because he could read words. He was able to use these objects as a result. Multimodal agnosia with combined visual-tactile agnosia usually occurs as lesions in and around the left lateral occipital complex where the ventral stream of somatosensory information processing merges with that of visual information processing. Concurrently, the present case seems very unusual because multimodal agnosia was likely to have occurred as a lesion of the left thalamus. The compensatory strategy to put objects into words was effective in this case. We repeatedly assessed and analyzed his higher brain dysfunction in detail, which led to effective rehabilitation treatment. The present case highlights the importance of planning an appropriate treatment based on detailed evaluation and accurate diagnosis of the higher brain dysfunction in patients with neurological deficits.
ABSTRACT
<b>Objectives</b>: To optimize the treatment of patients on tube feeding, it is important to ascertain whether medicines are appropriate for administration by gastrostomy and nasogastric tubes. In this study, we evaluated the drug information services provided to medical staff by clinical pharmacists related to 109 patients administered medication via a feeding tube in a neurological ward.<br><b>Design and Methods</b>: We analyzed the records of drug information services provided to medical staff from January 2006 to December 2007 at the Higashi Nagoya Hospital. We classified drug information services for avoiding obstruction of the feeding tube and chemical changes into four categories: ‘formulation changes’, ‘medication changes’, ‘incompatibilities’ and ‘administration method’, and evaluated the acceptance rate of the pharmacists’ recommendations for drug therapy via feeding tube.<br><b>Results</b>: Drug information related to formulation and medication changes accounted for 130 and 88 cases, respectively. Information related to incompatibilities accounted for 19 cases, involving anticipated chemical changes related to concurrent administration of drugs. Information related to administration methods accounted for 24 cases. The acceptance rate for information by medical staff was 92.0%.<br><b>Conclusions</b>: Drug information to medical staff by pharmacists contributes to improved safety for patients administered medication via feeding tubes. The acceptance rate for drug information was high, and the provision of drug information by pharmacists in the neurological ward was considered useful.
ABSTRACT
The purpose of this study is to investigate stroke patients in a convalescent rehabilitation ward of an acute stroke center. We collected data on 314 stroke patients discharged from the convalescent rehabilitation ward between January 2004 and December 2005. In total, 108 patients were classified as our regional inter-hospital referral model group. Alternately, 206 patients were classified as our intra-hospital referral model group. The regional inter-hospital referral model group took a longer time for transferring and discharging as compared with the intra-hospital referral model group. There was a significant difference in the days between onset of stroke and transfer, and the days between onset of stroke and discharge returned home. In conclusion, we should have a better opinion of the intra-hospital referral model in order to improve the quality of rehabilitation medicine.