The Sensory Stimulation Assessment Measure (SSAM): a tool for early evaluation of severely brain-injured patients.

There has been little definitive research ono the efficacy of sensory stimulation, yet many brain-injury rehabilitation programmes offer some form of it as treatment for severely injured patients. In general, however, sensory stimulation programmes and outcome studies alike lack precise definitions of terms, consistent criteria of patient selection, and valid and reliable measures of response to treatment. The Sensory Stimulation Assessment Measure (SSAM) was developed as a neuropsychological approach that provides a reliable and valid measure of responsiveness in patients who can neither communicate nor consistently follow commands. Patient responses are divided into three six-point behavioural scales (Eye Opening, Motor, and Vocalization) that require little evaluator subjectivity or inference. The measure may be used in treatment planning and is designed to address the rigorous demands of scientific research. Validity, reliability, and normative data are presented.

Chlorpromazine-induced psychosis after brain injury.

Antipsychotic agents, most often used for treatment of schizophrenia, are sometimes prescribed for the agitated patient with an organic brain disorder. We report the case of a brain-injured patient who was prescribed chlorpromazine for agitation and who developed a delusional state while taking this antipsychotic agent. The emergence of this delusional state coincided with the exacerbation of certain cognitive deficits. Possible mechanisms for this phenomenon are discussed. Caution is advised when prescribing neuroleptics for patients with traumatic brain injury, especially those agents with significant cognitive side-effects or with a significant potential to precipitate seizures.

Sensory stimulation of severely brain-injured patients.

The research reported here consisted of a series of three studies of the use of a sensory stimulation protocol and assessment scale with brain-injured patients at either Level II or Level III on the Ranchos Los Amigos Cognitive Scale. In the first study, a pilot project with six patients addressed the hypotheses that: (1) immediate changes in responsiveness occur as a result of sensory stimulation; (2) variables such as positioning and level of contact have an effect on responsiveness; and (3) these changes can be measured. The second study established acceptable concurrent validity (n = 20), test-retest (n = 20) reliability and inter-rater reliability (n = 19) values for the procedures. The third study assessed whether change in responsiveness occurs over time secondary to sensory stimulation. General Responsiveness measures for 19 patients were obtained and then remeasured after 3 months. No significant differences in mean General Responsiveness values were found using the t-test for related measures procedure. Relationships were reviewed between General Responsiveness and amount of treatment per day, frequency of family visits, pre-morbid education, age, time since injury and neurological status. No differences were found between those patients who improved and those who did not improve.