Download PDF Vision Rehabilitation: Multidisciplinary Care of the Patient Following Brain Injury

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Includes a foreword by Dr. Sue Barry. Because post-brain injury rehabilitation works best in a team setting where the entire person can be treated, this text has been carefully designed as a multidisciplinary resource with an emphasis on models for working with the rehabilitation team. The book covers a myriad of topics such as post-brain injury vision rehabilitation; eye movements; binocular dysfunction; visual field loss; visual-spatial neglect; shifts in visual egocenter affecting balance and coordination; visual-vestibular interactions; central vs.

The book details models that vision specialists working with the rehabilitation team can use to achieve the best success for the patient in rehabilitation; vision rehabilitation concepts and the science from which they have been developed; examples of therapeutic exercises; practice management information for the post-brain injury vision rehabilitation practice; and information on the legal process in which one frequently becomes involved in this type of work. Edited by eminent clinicians, the book highlights the work of contributors who are well-respected academicians and researchers, bringing together the clinical information that enables everyone involved in a brain injury case to grasp the diagnostic and therapeutic strategies.

Penelope S. Suter, O. Bragg, California, USA. This is a retrospective case series study, based on the analysis of data from charts of patients admitted in the first half of Motor impairment, mobility aid, changes in memory and communication were associated with the presence of anal incontinence. The prevalence of bowel dysfunction is high in this population.

Early identification of the symptoms and its related factors promoting bowel retraining, may help to improve the quality of life of patients with bowel dysfunction. Descriptors: Constipation. Fecal incontinence.

Brain Injury | Treatment and Recovery | Mischer Neurosciences | Houston, TX

Traumatic brain injury. Incontinencia fecal. Accidente cerebrovascular. Intestinal constipation is a condition in which individuals present symptoms that prevent them from having a satisfactory intestinal elimination. It can be associated with fecal consistency, evacuation frequency, effort to reach a satisfactory elimination and sensation of incomplete evacuation. Fecal loss through the anal sphincter is another condition that restricts individuals' social interaction.

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It is estimated that between 0. The central nervous system controls the defecation mechanism. Injuries in the brain and its connections can alter individuals' intestinal functioning. Factors associated with the brain injury can alter fecal peristalsis and elimination. Immobility, spasticity, muscle weakness, loss of independence to use the bathroom and the use of some drugs can contribute to bowel dysfunction. In literature, there is a lack of information on intestinal dysfunction in patients with sequelae caused by CVA and TBI.

The prevalence of intestinal constipation in patients with brain injury secondary to CVA ranges between The prevalence of anal incontinence was not investigated in the same study. The prevalence of bowel dysfunction in patients with sequelae due to CVA and TBI is higher than in the general population.

Little literature has been published about bowel alterations and, in Brazil, the dimension of this problem is not very well known. These complaints are common in individuals with sequelae due to CVA and TBI and lead to constraints and quality of life problems, often hampering patients' effective return to daily and social activities. Thus, the aim of this study was to investigate the prevalence of bowel dysfunction intestinal constipation and anal incontinence in patients admitted for rehabilitation at a neurologic rehabilitation ward.

This retrospective case series study was based on the analysis of electronic data charts related to hospitalizations that took place in the first semester of at a neurological rehabilitation ward, where patients are admitted for diagnostic investigation and rehabilitation.

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All adult patients with brain injury deriving from CVA and TBI were included, independently of the time with brain injury and neurological damage, hospitalized during the abovementioned period. All patient admission evolutions by nurses, physicians and physiotherapists were analyzed.


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Based on the analysis of each patient's chart, symptoms of intestinal constipation and anal incontinence were registered, as well as the following alterations: memory disorder and communication impairment, motor problems, use of mobility aid and demographic characteristics. The intestinal constipation symptom was defined in the presence of at least one of the following criteria: evacuation frequency less than three times per week, use of laxatives, intestinal wash and use of suppositories.

These definitions had also been used in other studies. Patients who were unable to inform their desire to evacuate were also considered incontinent. The presence or absence of cognitive impairment memory and communication was registered. To classify the use of mobility aids, the aid used more frequently was considered.

Motor problems were classified according to the professionals' evaluations, as follows: tetraplegia, tetraparesis, hemiplegia, hemiparesis and no motor problem. Besides calculating bowel dysfunction prevalence rates, the relation between intestinal constipation and anal incontinence and the following variables was assessed: memory disorder, communication impairment, motor problem, use of mobility aid, age and gender. Data were collected directly from the electronic file and stored in a Microsoft Access database. Descriptive and inferential analyses were developed.

The project received previous approval from the research ethics committee at the institution, approval letter As observed in table 1 , patients with ischemic injuries were predominant. The mean age in the total patient group was In the group of patients with brain injury due to a stroke, the mean age was The mean time with the brain injury in the sample was 4. In table 1 , the clinical sample characteristics are displayed. According to table 2 , no statistically significant difference was found between stroke and traumatic brain injury patients, neither with regard to the prevalence of anal incontinence nor intestinal constipation.

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The mean time with the injury among constipated patients equaled 4. Also regarding table 2 , anal incontinence was associated with motor problems, use of mobility aid, memory disorder and communication impairment. No association was found between bowel dysfunction and gender, age and injury type. In other studies in the general population, undertaken in Latin America, intestinal constipation is more common in women. This can be explained by the fact that this sample contains far more men than women, although no statistical significance between these variables was found.

In this study, the mean age among constipated patients was lower than in similar studies, which can be justified by the presence of patients with brain injury due to TBI, who tend to be younger. Similar results were found in a study of patients after stroke, TBI and other brain injuries, in which the TBI population was significantly younger and predominantly male.

Thus, in the literature, the prevalence of intestinal constipation in patients suffering from stroke sequelae can range between In some cases, prevalence rates were investigated in more acute patients or after a recent injury ,19 and in others with chronic patients. In another prospective study in which a standardized instrument was used, developed in Brazil, 13 this prevalence was higher, which underlines differences in study designs according to the definitions of intestinal constipation adopted.

The stroke can result in paresis and speech alterations, besides cognitive impairment, object agnosia, visual-spatial disorientation, attention deficits, which can compromise evacuation at socially acceptable times and places, and also in intestinal constipation.

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A stroke can affect all aspects of personal life and enhance risk factors for bowel problems like: reduced physical mobility; decreased fluid intake, as the individual can present difficulties to swallow and reach fluids or reduce fluid intake in the attempt to control urinary incontinence; reduced fiber intake, due to swallowing difficulties; dependence on others to use the bathroom; reduction or absence of feeling the need to defecate; cognitive impairment and use of medicines that can affect the bowel function.

Bowel dysfunction is a common and anguishing condition after a stroke, but there are practically no intervention studies in this clinical area. On the one hand, the neurological disorders leading to urinary and anal-rectal sphincter disorders. On the other, the general consequences of hemiplegia, including dependence, modification of dietary regimen and defecation conditions.

This may be related to the way data were collected, as anal incontinence was identified through diaper use and patients' lack of request to evacuate in an appropriate place, according to a relative or the patient's own report during hospitalization. Another aspect is the fact that the sample in the above mentioned study included more patients with neurological injuries. Another important factor that should be taken into account in data analysis is patients' time with the brain injury. Regarding mobility aid and motor problems, according to the literature, immobility can be a risk factor for intestinal constipation, as it leads to deconditioning, which results in an inappropriate abdominal press strength for defecation, 20 so that physical mobility plays an important role in bowel dynamics.