Traumatic head injury: restlessness and agitation as prognosticators of physical and psychologic improvement in patients.

Eighty-seven traumatic head injury patients were followed from admission to post-discharge, spanning a period of 5 years or more. Using objective criteria, post-traumatic activity level (PTAL) was evaluated on admission and compared with cognitive and overall status at discharge. Further comparisons were made with follow-up data. Twelve patients were agitated., 32 restless, 17 appropriately active, 16 sluggish, and 10 immobile. Eighty-three percent of the agitated, 84.3% of the restless, 70.6% of the appropriately active, 18.8% of the sluggish, and 10% of the immobile patients showed improvement. At discharge, 41.6% of the agitated and 42.4% of the restless patients also needed supervision. Improvement was related to PTAL, with appropriately active restless patients demonstrating the greatest overall return of function. Rehabilitation of sluggish and immobile patients was not as dramatic. The majority of patients were able to return to the community; however, agitated patients showed a tendency to be committed for psychologic reasons to alternative medical facilities. Long-term improvement is also related to PTAL. At discharge, restlessness and agitation is related to improved physical functioning and inversely related to psychological adjustment. During follow-up, the appropriately active and the restless patients showed the greatest tendency to becoming cognitively functional.

Elderly patients with lower extremity amputations: three-year study in a rehabilitation setting.

Of the 112 mostly elderly patients with lower extremity amputations who were initially evaluated for this study, 86 were discharged as independent prosthetic ambulators after completion of both phases of a two-phase prosthetic rehabilitation program with a team approach. In four years of outpatient follow-up of the 86 patients who completed phase II, 14 died and contact was lost with 6. Sixty-six remain prosthetic ambulators. Six others who had unilateral amputations underwent amputation of the other limb; the initial procedure was above knee in one and below knee in five. All of the patients included in the study were originally referred to the Helen Hayes Hospital with a multitude of problems. The majority had emotional, social and financial difficulties, as well as medical problems. Many of the patients had undergone multiple surgical procedures prior to the first amputation. Psychological problems, particularly depression, were often severe in that group of patients.

Energy expenditure of ambulation in patients with above-knee amputations.

Oxygen consumption during ambulation was measured in nine middle-aged or elderly subjects having above-knee amputations, in an effort to determine the mode of ambulation and prosthetic prescription requiring the least energy expenditure. Studies revealed that crutch walking and prosthetic ambulation require the same energy expenditure; that there is no significant difference between the energy requirements of ambulating with knee locked or unlocked; and that 65 percent more energy is required at approximately one-half the normal speed of ambulation for above-knee amputees as compared to normal persons.