Post-coma paraschizophrenia and quality of life in patients with closed-head injuries.

Background. Organic brain damage is traditionally an excluding criteria for a psychiatric diagnosis of mental illness. In fact, however, the neurobehavioral disturbances exhibited by many CHI patients, especially those who have been comatose for more than a month, are strikingly similar to the symptoms of Type II schizophrenia. The authors propose to use the term "post-coma paraschizophrenia" to describe these disturbances and discuss their negative impact on the quality of life of CHI patients.
Material and methods. The experimental group (Group CHI) consisted of 15 CHI patients, 7 males and 8 females, ranging in age from 17 to 58, treated in the Department of Medical Rehabilitation at the Cracow Rehabilitation Center and the Rehabilitation Clinic at the Bydgoszcz Medical University. All these patients had incurred a closed-head injury resulting in a coma lasting at least one month. He control group (Group SCHI) consisted of 15 patients diagnosed with Type II schizophrenia, matched by age, sex, and level of education to the patients in Group CHI, under treatment in the Psychiatry Department at the Wroclaw Medical University and the Bydgoszcz Medical University. The data reported were based on clinical observation, patient and family interviews, standard neuropsychological tests, the Frontal Behavioral Inventory, and the Quality of Life Scale for Patients with Traumatic Brain Injuries.
Results. Standard neuropsychological tests showed similar dysfunctions in general intelligence and memory, with a tendency in both groups to lower scores in non-verbal parameters. Some interesting qualitative differences in performance are presented. All the CHI patients showed significant signs of frontal syndrome, with a profile resembling fronto-temporal dementia, while the test results from the SCHI patients were more similar to those associated with severe clinical depression. All of the patients in the CHI group exhibited at least some of the symptoms traditionally regarded as indicative of schizophrenia. Positive (formative) symptoms of schizophrenia were found much more often in the patients from Group SCHI, whereas the percentages for the occurrence of particular negative (defective) symptoms are quite similar in both groups.
Conclusions. Patients with closed-head injuries may present with quasi-psychotic symptoms, here termed "post-coma paraschizophrenia". Among the most significant common features of the two syndromes are disorganized behavior, apathy, and disturbances of executive functions. Post-coma paraschizophrenia, which mostly remains untreated because of the lack of neuropsychiatric diagnosis, has a significant negative on the quality of life of CHI patients, and should receive further attention in both theoretical research and clinical practice.

"Towards a Better Life": a program of comprehensive rehabilitation for elderly patients following revision hip arthroplasty.

Introduction. The aim of the research was to evaluate the quality of life of patients recovering from revision hip arthroplasty, who underwent rehabilitation under the "Towards a Better Life" program (TBL). In the TBL Program, appropriate physical exercises, relaxation techniques, seminars, and panel discussions are combined to support general improvement in both physical and psychological condition, thus improving the patients' quality of live.
Material and methods. The effectiveness of the TBL approach was evaluated in a clinical experiment involving 36 patients recovering from revision hip arthroplasty, treated under the standard rehabilitation program in general use at the centers represented by the authors. The patients were divided into two equal groups, matched by age and sex: an experimental group E (n = 18), with patients who received additionally the "Towards a Better Life" Program, and a control group K (n = 18), consisting of patients who did not receive this program. The methods used to evaluate the outcome of rehabilitation included clinical interview and observation, the Medical Outcomes Study (MOS-100) and the Self-Evaluating Quality of Life Scale (QOL). The patients were tested before rehabilitation commenced and re-tested two months later.
Analysis of results. On the Physical Index of the MOS-100 scale considerably greater progress was observed in patients from Group E in terms of reduced pain, increased coordination and fluency of movement, improved respiratory capacity, regulation of blood pressure and pulse, functioning of the digestive system, reduced body weight, and improved walking distance. In this group somewhat greater improvements were noted on the Psychological Index of the MOS-100, especially in cognitive functions (perception and attention) and emotional factors (increased satisfaction with life, reduced anexiety, depression, and irritability). The QOL parameters most sensitive to the difference between the TBL Program and the standard program were pain management, independence and self-care, and especially improved self-image and reduced anxiety. The improvements noted by Group E were in many subtest two or three times higher than in Group K.
Conclusions. The greater improvements recorder by patients participating in the "Towards a Better Life" Program in all measured parameters indicates that the program is highly effective in comparison to the standard model. The patients from Group E were much more satisfied with the results they had achieved in rehabilitation, and attained a higher degree of independence and self-determination. The TBL Program can be used to improve the quality of life of patients recovering from revision hip arthroplasty.

Adolescents' attitudes toward peers who wear visible hearing aids.

The purpose of this study was to determine how adolescents are likely to react to peers who wear visible hearing aids. Forty high school juniors and seniors rated a photograph of a male peer on an 81-scale semantic differential. One-half rated a copy of the photograph in which a hearing aid was visible and the others rated a copy in which one was not visible. Analyses of the ratings suggest that adolescents are likely to react negatively to peers who wear visible hearing aids. Clinical implications are discussed.

Dimensions of improvement in stuttering.

This paper presents a first approximation of the dimensional structure of stuttering improvement and its hierarchical organization. A set of 288 statements obtained from stutterers, indicating ways in which they felt their stuttering problems had improved, were assigned to dimensions by three clinicians who had considerable experience in the area of stuttering. They also were rated for the amount of improvement the changes reported usually represent by 26 clinicians who were regarded as authorities in the area of stuttering. The statements are ordered on the improvement continuum, by dimension, based upon the medians of the ratings assigned to them. The ordering of the statement set appears to be highly reliable.

The stuttering problem profile: a task that assists both client and clinician in defining therapy goals.

This report describes a paper and pencil task, the Stuttering Problem Profile, which provides qualitative data that can be useful when identifying goals for stuttering therapy. Specific ways in which the task has been used are indicated. A copy of the Stuttering Problem Profile is included.

Criteria for assessing therapy outcome in speech pathology and audiology.

Speech pathologists and audiologists function as both producers and consumers of information concerning therapy outcome. In both roles they have to know the questions that need to be answered to adequately evaluate a therapy method and the factors that have to be considered when interpreting answers to such questions. An approach (in the form of a work sheet) is described here that can be used for both identifying and systematically evaluating the validity, reliability, and generality of information regarding impacts of therapy methods on persons who have communicative disorders and for identifying additional information needed to complete such an evaluation. The approach is used to assess the impacts of a therapy method.

The stutterer as a character in contemporary literature: a bibliography.

This 27-item bibliography includes contemporary novels, biographies, short stories, and plays in which there are characters who stutter. Several aspects of how stutterers are depicted in these works are described.

Effect of threat of shock for being disfluent of fluency of normal speakers.

Each of 20 adult nonstutterers read a 330-word passage six times with a one minute pause between readings. Between the third and fourth reading or the fifth and sixth reading (determined by a table of random numbers) Ss were informed that at the conclusion of the next reading an electric shock would be administered for each instance of disfluency detected by E during that reading. Ss did not become less fluent as a consequence of the experimental condition. Their mean disfluency frequency during the threat-of-shock reading was lower than during the preceding one. Thus, threat of shock for being disfluent may be a condition which differentiates stutterers from nonstutterers since stutterers have been reported to become less fluent under this condition.