Direct clinician-delivered versus indirect family-supported rehabilitation of children with traumatic brain injury: a randomized controlled trial.

PRIMARY OBJECTIVES: To explore the relative effectiveness of clinician-delivered vs family-supported interventions for children with chronic impairment after TBI. RESEARCH DESIGN: Randomized controlled clinical trial. METHODS AND PROCEDURES: Children aged 5-12 years in the chronic phase of their recovery were randomly assigned to the clinician-delivered or to the family-supported intervention group; both samples received intensive services for 1 year; physical outcome was measured by the SARAH scales, cognitive outcome by the WISC-III. MAIN OUTCOMES AND RESULTS: Parents in the family-supported intervention sample efficiently acquired the skills needed to deliver physical and cognitive interventions within the context of everyday routines of the child's life at home; family education level was not a factor. Although both groups demonstrated improvements, only the children in the family-supported intervention group demonstrated statistically significant--and clinically important--improvements on both outcome measures. CONCLUSIONS: This RCT provides compelling evidence for organizing cognitive and physical interventions and supports for children with TBI around the everyday routines of their lives, with intensive supports for their families.

A preliminary functional brain study on amputees.

The purpose of this study was to verify whether brain activation could be used to modulate the movements of an artificial limb. This approach was begun 20 years ago with the fitting of prostheses immediately following lower-limb amputations. We studied 9 unilateral amputees and 9 control participants using functional MRI, electroneuromyography, gait laboratory, and neuropsychological assessments. The results demonstrated that brain activation is analogous when participants in the control group are asked to mentally move a foot, compared with amputees who are asked to move a nonexistent foot. The brain has not been damaged and maintains its areas of command. This can be applied in rehabilitation.

Traumatic injury to the spinal cord. Prevalence in Brazilian hospitals.

Traumatic spinal cord lesions have a worldwide high morbidity and mortality, and in many developed countries the problem has received special attention, based on epidemiological studies. In Brazil these studies have been restricted to institutional data. In 1988 a survey conducted by the Integrated System of Traumatology and Orthopaedics, covering 36 public hospitals from 7 Brazilian capitals, revealed a point prevalence of 8.6% (108 patients) with spinal cord injury, aged from 6-56 years; 81% were men. The most frequent causes were traffic accidents (42%), firearms (27%) and falling from heights (15%). The main complications were pressure ulcers (54%) and urinary infections (32%).