ABSTRACT
Anti-N-methyl-D-aspartate（NMDA）receptor（NMDAR）encephalitis is an autoimmune disorder typically involving ovarian teratomas and a severe neuropsychiatric disorder involving prominent memory and behavioral deficits. The purpose of this study was to evaluate the clinical symptoms and outcomes of six patients（one male, five female；age：20 to 47 years）with autoantibody-associated NMDAR encephalitis, who underwent comprehensive rehabilitation in our hospital. The five female patients underwent ovarian teratoma removal. At the beginning of rehabilitation, the mean score on the Rivermead Behavioural Memory Test was 16.7, and prospective memory was preserved in two patients and was recovered in two patients. The mean Wechsler Memory Scale-Revised score of the six patients significantly increased after rehabilitation, which suggested good recovery, compared to that in the patients with herpes encephalitis. However, in the chronic state, two patients showed persistent short-term memory disturbances that required a compensatory approach and employment assistance. Four patients who were treated with convalescent cognitive rehabilitation 4.5 months after onset improved in 4 months and showed good prognoses. Three returned to work, one returned to school, and two lived independently. Patients with anti-NMDAR encephalitis respond to immunotherapy, but they exhibit persistent cognitive deficits that are related to the distribution and functional role of NMDARs in the human brain. Early intervention for the short-term memory disturbances in convalescent rehabilitation, chronic interventions for the persistent memory disturbances, and preservation of perceptive memory are important to facilitate future employment.
ABSTRACT
The purpose of this study was to estimate the effect of our post-acute comprehensive intensive inpatient treatment (Program A) on persons with acquired brain injury in the hospital. Program A, designed for work or school, consists of daily six hours sessions for three months, personal and group sessions, and family support. It was designed to build cognitive and behavioral skills through a transdisciplinary approach and 17 patients with acquired brain injury were enrolled in the program. Seventeen program non-participants were selected as our control. Cognitive functions were measured with FIM, WAIS-III, RBMT, and TMT before and after the program. Significant cognitive improvements (especially attention) and increased societal participation were obtained for the Program A participants compared with non-participants. Considering that Program A improved both the cognitive function and level of social participation in program participants, we suggest that it is valuable to perform intensive treatment programs in an inpatient condition for acquired brain injury patients.
ABSTRACT
The purpose of this study was to evaluate the effectiveness of therapeutic intervention via liaison-psychiatry by a psychiatrist to the team rehabilitation for spinal cord-injured patients with mental disorders. Out of 652 spinal cord-injured patients who underwent rehabilitation during post-acute stages in our hospital from April 2000 to March 2006, 82 patients aged from 19 to 65 with mental disorders according to the diagnostic criteria of DSM-IV-TR were selected. In order to assess the effectiveness of this comprehensive team approach, the outcomes of these 82 patients were compared with the outcomes of 82 control patients without mental disorders. As a result, there were no significant differences of the acquired BI (Barthel Index), FIM (Functional Independence Measure), and abilities of transfer between the two groups. In addition, 35 out of 82 patients went back to their home. These results demonstrate the effectiveness of liaison psychiatry in conducting the comprehensive team rehabilitation for spinal cord-injured patients with mental disorders.