Changes in coping strategies, social support, optimism and health-related quality of life following traumatic brain injury: a longitudinal study.

PRIMARY OBJECTIVE: To study longitudinal changes in psychological coping strategies, social support, life orientation and health-related quality of life in the late period after traumatic brain injury (TBI). SUBJECTS: Thirty-one patients with TBI who were first investigated on average 2.3 years after injury and were prospectively followed on average 5.7 years later. METHODS: Estonian versions of the COPE-D Test, the Brief Social Support Questionnaire, the Life Orientation Test and the RAND-36 questionnaire. RESULTS: During the late follow-up period health-related quality of life and resuming work did not improve significantly. Persons with TBI reported an increase in seeking social/emotional support (p<0.05), frequent use of avoidance-oriented styles and reduced use of task-oriented styles. This was accompanied by low social support and low satisfaction with support, both of which were associated with health-related quality of life and resuming work after TBI. Although the patients had become more optimistic (p<0.05), this did not correlate with their health status and social well-being. CONCLUSIONS: This prospective study revealed maladaptive changes in the profile of coping strategies and an increase in optimism. As social support, satisfaction with support and health-related quality of life did not improve, then rehabilitation, social and psychological support are continuously needed.

Coping strategies, social support, life orientation and health-related quality of life following traumatic brain injury.

OBJECTIVE: To study coping strategies, social support and life orientation in patients following moderate and severe traumatic brain injury (TBI) in relation to health-related quality of life. SUBJECTS: Eighty-five patients with moderate or severe TBI and 68 control persons. METHODS: Estonian versions of the COPE-D test, the Brief Social Support Questionnaire, the Life Orientation Test and the RAND-36 questionnaire. RESULTS: Persons with TBI reported using task-oriented and social/emotional support strategies less often and avoidance-oriented strategies more often than control persons (p < 0.05). The social support network, satisfaction with it and optimism as life orientation were lower in the patient group (p < 0.05). Task-oriented coping styles, satisfaction with social support and optimistic life orientation were associated with the majority of the domains of health-related quality of life and resuming work after TBI. CONCLUSIONS: To achieve effective rehabilitation and to enhance patients' well-being, it is important to improve the quality and amount of social support network, as well as to support patients' adequate coping efforts for promoting an active lifestyle.

Paradoxical facilitation of a free recall of nonwords in persons with traumatic brain injury.

Brain damage is usually associated with behavioral deficits. However, there is an increasing amount of evidence that lesions of some brain regions are associated with improvements instead of impairments of certain behaviors. We report the results of a study of free recall performance in subjects with traumatic brain injury. One-fourth of the subjects displayed above-normal performance in recall of nonwords. No such facilitation was found with nine lists of words.

The possible role of CSF hydrodynamic parameters following in management of SAH patients.

It is suggested that reduced intracranial compliance may be present even when measured ICP is normal and may precede clinical deterioration. Our findings reflect a decompensation of hydrodynamic parameters more pronounced 4-7 postictal days, when compliance is reduced not only in patients with poor clinical condition, but also in patients with Hunt-Hess grade I-III. Increased CSF outflow resistance in the first few days is not surprising; it is thought to be due to the blockage of flow of CSF through the basal subarachnoid cisterns and clogging of the arachnoid villi with erythrocytes and fibrin. Enlargement of ventricles seen on CT scan at the same time suggests the development of acute hydrocephalus. During the first days after SAH, our data reflects evidence of ventricular enlargement in patients presenting with both poor and better clinical condition. We conclude that the monitoring of ICP and dynamic measuring of CSF hydrodynamic parameters is important for longer than the generally accepted few days for selected cases after SAH.

Computerized tomography and prognosis in paediatric head injury.

The authors have analysed the computerized tomography (CT) findings and their correlation with the clinical state, early and late outcome in children and adolescents with head injuries (HI). This study represents clinical and CT data of 82 consecutive HI patients under 18 years of age. Among them 51 (62%) were boys and 31 (38%) girls. The application of CT to the evaluation of the morphologic manifestations of HI in children has shown some differences in forms and mechanisms of injury and in outcome compared to adults. In the paediatric HI the most frequent finding was diffuse brain swelling with CT evidence of ventricular and cisternal compression or obliteration. Prognostically the most unfavourable findings were shearing injury, intracerebral and subdural haematomas combined with brain swelling and parenchymal damage. According to the Lidcombe impairment scale, outcome from severe paediatric HI was determined in the 3rd and 6th months, one year and 2 years after the injury. The outcome two years after severe HI varied to a great extent and was better in children than in adults. Although there was long-term disruption of the patient's quality of life, our data show that as there are no predictors of individual outcomes in child HI, no child should be excluded from early and long-term rehabilitation.

Correlations between brain oedema volume on CT and CSF dynamics in severely head injured patients.

The CSF dynamics were studied in 18 patients with severe head injury who remained comatose over 6 hours after trauma (GCS less than 8). Amount of brain oedema was estimated by CT tomodensitometry. In addition, CSF parameters of PVI. Elastance (E), compliance (C) and resorption resistance (R) were calculated from serial bolus infusion tests. We observed a decrease in viscoelastic parameters as indexed by PVI, however, no increase in resistance to CSF outflow. It was noted that patients with lower PVI developed more severe brain oedema during the 3-5 day post traumatic period. From these data, we conclude that buffering capacity in severe head injury is mainly affected by the volume of brain oedema and not by the haematoma volume.

Quantitative analysis of CT visualized periventricular and perifocal brain oedema by means of CSF dynamics infusion test.

Brain oedema of different pathogenesis cannot be differentiated with CSF infusion tests. In cases with periventricular oedema the CSS viscoelastic parameters are changed more towards the decompensated state than in cases with perifocal oedema.

[Surgical treatment of patients with cranio-cerebral trauma and the role of neurological symptoms in the prognosis of its outcomes]. / Khirurgicheskoe lechenie bo'lnykh s cherepno-mozgovoi travmoi i ro'l nevrologicheskoi simptomatiki dlia prognozirovaniia iskhodov.

Under examination there were 411 patients with cranio-cerebral traumas. A unified method was used at different medical institutions in order to study questions of prognosis of the outcomes. Surgical treatment was used in 117 of them. The investigations have shown that the state of trance-coma both before operation and in the postoperative period is absolutely unfavourable prognostically. The state of trance-coma and the value of 15 scores and less should be taken into consideration as a contraindication for the solution of the question of operation in patients with cranio-cerebral traumas.

[Traumatic cerebral infarct]. / Travmaticheskii infarkt golovnogo mozga.

The clinical variants of traumatic cerebral infarction (TCI) were studied according to the results of computed tomography. It was found that TCI was encountered in 3.3% of patients with craniocerebral trauma. The localization and mechanism of the development of the ischemic lesion were determined by the character of the traumatic changes in the brain. Compression of the cerebral vessels and reduced perfusion pressure in intracranial three-dimensional processes are important in the pathogenesis of TCI. Computed tomographic studies must be repeated in order to establish the diagnosis of TCI.

[Surgical treatment of the carpal tunnel syndrome]. / Khirurgicheskoe lechenie sindroma zapiastnogo kanala.

The carpal tunnel syndrome was encountered in 2,727 patients, in 71% of them it was bilateral. Operations were conducted on 865 (18.6%) of the 4,663 affected hands. Operations for incision of the flexor retinaculum were conducted under local anesthesia, usually at out-patient hospitals. Additional interventions were performed in some patients: freeing the muscular branch of a nerve, resection of the edges of the flexor retinaculum, freeing the nerve from adhesions, endoneurolysis, resection of the tendon sheaths. Analysis of the results showed that manipulations on the nerve trunk are rarely indicated, while resection of the tendon sheaths is not justified. The working capacity was restored in 89.5% of patients in 25-45 days and in 7.4% - in the first 6 months. Early and late recurrences were observed in 3.1% of patients and called for a second operation.

[Surgical treatment of peripheral nerve compression syndromes]. / Khirurgicheskoe lechenie kompressionnykh sindromov porazheniia perifericheskikh nervov.

Among 12,476 patients with diseases of the peripheral nervous system 54.3% had radical syndromes, 16.3% had acute injuries of the nerves, 25.2% had entrapment syndromes, 3.8% suffered from polyneuropathies and other diseases. Entrapment syndromes were encountered in 3143 patients. Carpal, ulnar, and tarsal canal syndromes, thoracic outlet syndrome, and syndromes of entrapment of the radial and peroneal nerves prevailed. A total of 763 operations were performed for the entrapment syndromes. The distribution of the syndromes and operations is shown in the table. From 10 to 20% of patients with tunnel syndromes needed surgical treatment. From 12 to 34 upper extremities were operated on annually per 100,000 population for the carpal tunnel syndrome; 90% of the operations were performed at out-patient clinics. Interfascicular neurolysis by means of microsurgical techniques was conducted mainly in the cubital tunnel syndrome. Operations in entrapment lesions are marked by high efficacy.

[Structure of diseases of the peripheral nervous system]. / O strukture zabolevanii perifericheskoi nervnoi sistemy.

The structure of peripheral nervous system diseases is reviewed by analyzing 941 in- and outpatient case histories. Of this number, 57.34% of the patients had radicular syndromes, 16.17%, acute injuries of nerves and plexuses, and 22.66%, tunnel and other compression syndromes. Cases of polyneuropathy and other disorders accounted for only 3.83%. A total of 21.46 cases with nontraumatic mechanical damage to nerves are analyzed in detail. In 87.88%, these syndromes involved upper and in 12.12% lower extremities. Syndromes of the carpal canal (43.01%), ulnar canal (14.72%), cervical neurovascular compression (12.95%), and tarsal canal (5.08%) occurred most frequently. A wide variety of other syndromes made up only 24.24% of all compression syndromes.