Admission examination factors predicting cognitive improvement during acute brain injury rehabilitation.

In this study 46 brain-injured patients admitted to a brain injury inpatient rehabilitation programme after acute care were evaluated at the bedside with a comprehensive mental status examination and physical evaluation. Using multiple regression analysis, elements of the cognitive and physical examinations were studied to determine if any of these items, individually or collectively, had predictive value for discharge functional status. A principal-components analysis identified meaningful clusters of items. Factor I, Simple Cognitive Operations, consisted of word repetition, naming and comprehension of simple commands. Factor IV, Higher Cognitive Operations, consisted of interpretation of similarities and reverse digit span. Other items, including elements of the physical examination such as eye movements, hearing and ambulatory function, were also clustered into factors. Stepwise multiple regression analysis led to a conclusion that only factor IV was a significant predictor of Discharge Rancho Level, with the predictive power of factor I and Admission Rancho Level subsumed by factor IV. This model, using a few items from a bedside mental status examination, accounted for 27% of the variance in Discharge Rancho Level in patients admitted to a brain injury rehabilitation unit after injury. We conclude that a brief mental status examination in a rehabilitation inpatient setting can be useful in predicting outcome in patients with brain injuries. More research is needed to identify additional test items that will add prognostic power to the initial evaluation of patients with brain injuries admitted to a rehabilitation unit.

Effects of intensity of treatment and length of stay on rehabilitation outcomes.

The combined effects of intensity of treatment and length of stay during inpatient rehabilitation hospitalization on the outcomes of 95 traumatic brain injury patients were examined. Outcome was assessed using the Rancho Scale and three measures of functional status--physical performance, higher-level cognitive skills, and cognitively mediated physical skills. The effects of intensity of treatment and length of stay were assessed using 2 x 2 analyses of variance with repeated measures. The results showed clearly that both length of stay and intensity of treatment affect outcomes. Patients in the long length of stay group consistently made more progress across all outcome variables than patients in the short length of stay group. However, the greater progress of the long length of stay patients was from a point significantly more disabled than that of the short length of stay patients, with improvement at discharge to the point at which the groups were now equal. The effect of intensity of treatment was significant or closely approached significance for higher-level cognitive skills and Rancho Level. In the long length of stay group, the two intensity groups were initially equivalent, but at discharge the high-intensity group surpassed the low-intensity group. The practical implications of the results are discussed.

Time of rehabilitation admission and severity of trauma: effect on brain injury outcome.

Outcome after traumatic brain injury, defined by the Glasgow Outcome Scale (GOS) and length of stay in acute rehabilitation, was measured in 59 patients admitted to an intensive rehabilitation program to examine the effects of severity of the initial brain injury, severity of multiple trauma, and length of stay in the acute care hospital. Severity of initial brain injury, best measured by length of coma, was the most significant predictor of GOS outcome. Length of acute hospitalization was a small, but significant, predictor of GOS. Severity of initial brain injury, length of acute hospitalization, and gender emerged as predictors of length of rehabilitation hospital stay. Although length of acute hospitalization is apparently affected by severity of brain injury, it adds significantly--more than severity of brain injury--to the prediction of length of rehabilitation.

Evaluation of the vasodilator vs inotropic effect of milrinone using an animal model of left ventricular failure: reversal of disopyramide depression of the myocardium with milrinone.

Milrinone (M) has been shown to improve left ventricular (LV) performance in animal and human studies. M has strong vasodilator action, and whether increased LV performance is due primarily to vasodilation or to a direct positive inotropic effect is unclear. Ten mongrel dogs were studied. Disopyramide caused a significant and sustained decrease in LV function and was a good model for myocardial depression. At equal reduction in systemic vascular resistance (SVR), M reversed this LV depression to a significantly greater degree than nitroprusside (NP) did. At equal levels of vasodilation, M produced significantly greater improvement in indices of LV function than NP did in our model of disopyramide-induced LV failure. This suggest that its effect on LV function is not due entirely to afterload reduction, or to reflex sympathetic stimulation, but has a substantial component of direct inotropic stimulation. This study also demonstrated a reversal of disopyramide-induced LV dysfunction by M, which may be clinically useful since, as in many antiarrhythmics, myocardial depression may be a limiting factor in its use.

Marks and classroom adjustment as early indicators of mental health at age twenty.

The data are derived from a 15-year longitudinal study of 659 urban children who entered kindergarten in 1968, 371 who were interviewed at the age of 20. Analyses related school adjustment and academic performance in the early primary grades, early adolescence, and middle adolescence to mental health outcomes based on responses to a short form of the MMPI at age 20. The results suggest that poor marks, absence of positive coping behaviors, and presence of negative coping behaviors are indicators of later mental health problems, that the absence of positive coping behaviors may be more indicative of later problems than the presence of negative coping behaviors, and that there are sex differences in the time periods at which indicators of school productivity are important.

Interpersonal problem-solving in young children: a cognitive approach to prevention.

An interpersonal cognitive problem-solving (ICPS) intervention, designed to reduce and prevent impulsive and inhibited behaviors in black low socioeconomic status (SES) 4- and 5-year-olds, was implemented by teachers and evaluated over a 2-year period. In the first year, 113 children were trained and 106 were not. The 131 still-available in kindergarten were divided into four groups: Twice-trained (n = 39); Once-trained, Nursery (n = 30); Once-trained, Kindergarten (n = 35), and Never-trained controls (n = 27). Findings showed that (a) ICPS impact on behavior lasted at least 1 full year, (b) training was as effective in kindergarten as in nursery, and (c) for this age and SES group, 1 year of intervention had the same immediate behavior impact as 2. Further, well-adjusted children trained in nursery were less likely to begin showing behavioral difficulties over the 2-year period than were comparable controls, highlighting implications of the ICPS approach for primary prevention.

The long-term patient in the community: life style patterns and treatment implications.

A sample of 99 long-term patients at an urban community mental health-mental retardation center were interviewed to determine how they spent their time and their degree of happiness with their lives and the services they received at the center. More than half the patients were considered by center staff to be only mildly or moderately impaired, but as a group they were distinguished by low levels of educational, financial, and vocational achievement; only 13 per cent were working more than half time. Most of the patients considered themselves happy, but their life style was oriented toward health and social relationships and lacked a work-task orientation. The authors conclude that the patients' life style meshes closely with the orientation of the treatment system; neither places emphasis on achievement of noninterpersonal tasks or enhancement of a work orientation. The authors believe that many chronic users of community mental health services have the potential to work and that practically all could benefit from the ego-enhancing experiences resulting from the successful accomplishment of tasks and development of skills. Therefore they feel programming for long-term patients should address deficits in work and achievement motivation.

An investigative study of the Bender-Gestalt: clinical validation of its use with a reading disabled population.

Investigated usefulness of the Bender-Gestalt in differentiating between primary and secondary reading disability. Research with 50 reading disabled Ss was carried out. The Ss were classified as having a primary or secondary reading disability according to selected criteria; then their Bender protocols were scored. It was hypothesized that developmental scores would differentiate the two diagnostic groups. A second hypothesis was that specific signs would differentiate between primary and secondary reading disabled children. The results supported the latter hypothesis, but not the former. Results also showed that those in the primary group were more reading retarded than secondary reading disability Ss and that Bender-Gestalt scores are not significantly related to reading level in such a group of reading disabled children.

What residents do after graduation.

This article reports the results of an investigation of the professional activities of graduates of National Institute of Mental Health-supported residency programs, spanning the five-year period 1968 to 1972. The results explode the mythical notion that the majority of such trainees enter straightway into the private practice careers. In fact, the majority devote at least half-time to some type of public-service psychiatry, with no less than 43% in full-time public service.

Differing perspectives on mental health evaluation.

Small-group workshops of nonevaluators with differing interests in mental health discussed evaluation priorities for community mental health centers. Participants included center professionals, concerned citizens, and funders. A majority of the participants placed high value on accountability from a consumer standpoint and relatively low value on center management issues and cost or equity of service delivery. Center staff were more interested in efficiency and effectiveness, while outsiders with vested interests were more concerned with community involvement. The authors summarize seven role perspectives and discuss their implications for the establishment of evaluation priorities within a center.

An instrument to assess staff time utilization in a community mental health center.

The Daily Staff Log is an empirically refined instrument to assess staff hours spent in direct patient and collateral contact, clinical backup time, consultation, education, and administration. Its primary uses as a management tool include description of staff activities, comparisons by discipline or clinic, pre- and postcomparisons following administrative policy change, and cost-effectiveness studies. Conditions for successful use include a firmly committed administrative interest, in-service education on the value of log data for decisionmaking to improve delivery of care, and positive feedback when logs indicate service goals are being met. Following the introduction of logging it was possible to document improvements in clinical and financial efficiency.