Rehabilitation and insurance relationships.

The ultimate goal of the health care process is to restore an individual to a maximal level of function within the constraints of the existing pathology. It is unfortunate, however, that this potential is often underestimated so that the individual is deprived of reintegration in society. Rehabilitation is the unfinished business of medicine. Reasonable goals need to be identified and clear cost benefit projections need to be established regarding any intervention. To decrease an individual's dependency means that the lifetime cost of care of the individual decreases dramatically. Physical independence and cognitive competency reestablish for the patient optimal levels of health care that need to be facilitated, and involve integrated, innovative insurance liaisons to assure achieving this goal.

Risks of restraints in head injury.

Confusion and disorientation occur as part of the process of recovery from head injury. Methods of management frequently include the use of restraints. A case is presented that illustrates how death or disability is possible from routine use of restraints. Awareness of the risk factors can reduce untoward complications.

Independent living programs: the role of the able-bodied professional.

The Independent Living Program movement was created by the disabled community. It has established a broad coalition of diverse disabilities functioning to provide services on a broader scale than has been traditionally offered by the rehabilitation community. The effectiveness and the strength of the movement lies in consumer control. The able-bodied professional can provide expertise, balance and a vital link with established rehabilitation programs. The integrity of the independent living program movement can only be maintained and developed if these basic concepts are respected.

Brain evoked potential use in a physical medicine and rehabilitation setting.

The objective of this effort was to explore the use of evoked potential (EP) procedure on a head injury unit in a Department of Physical Medicine and Rehabilitation. The method employed both auditory and visual stimulation presented bilaterally to various patients. Recordings of the brain's responses to such stimulation were obtained. Results permitted evaluation of brain stem, subcortical and cortical functioning, ipsilaterally, contralaterally, and bilaterally. EP data provided useful information for patient assessment and rehabilitation planning for head injured patients--particularly for those who were unable to cooperate in their own examination.

Evoked brain potentials and disability in brain-damaged patients.

Various measures of evoked brain potential abnormality (EPA) were correlated with disability ratings (DR) for 35 brain-damaged patients. EPA data consisted of judgements of abnormality of ipsilateral, contralateral and bilateral responses to auditory and visual stimuli reflecting activity in the brain stem, subcortex and cortex. DR data were obtained from a scale developed for this study to quantize and categorize patients with a wide range of disabilities from coma to normal functioning. EPA scores based on visual and auditory cortical responses showed significantly positive correlations with degree of disability. Visual response correlation was .49, auditory .38 and combined visual and auditory .51. It was concluded that EPA measures can reflect disability independently of clinical information. They are useful in assessing brain function in general and, specifically, in assessing impairment of sensory function. The evoked potential technique was particularly useful in patients who were not able to participate fully in their own examination. There were indications that the technique may also be valuable in monitoring progress and in predicting clinical outcome in brain-damaged patients.