Traumatic brain injury (TBI) causes two injury types: primary and secondary. In infants and young children, nonaccidental TBI is an important etiology of brain injury and is commonly a repetitive insult. TBI is by far the most common cause of acquired brain injury (ABI) in children and is the most common cause of death in cases of childhood injury. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) issued validated prediction rules to identify children at very low risk of clinically important TBI, which is defined as TBI requiring neurosurgical intervention or leading to death. The range of outcomes in pediatric TBI is very broad, from full recovery to severe physical and/or intellectual disabilities. Children and adolescents who have suffered a TBI are at increased risk of social dysfunction. Studies show that these patients can have poor self-esteem, loneliness, maladjustment, reduced emotional control, and aggressive or antisocial behavior.
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The electrical discharge of neurons associated with seizure activity stimulates a marked rise in cerebral metabolic activity. Estimates from animal experiments indicate that energy utilization during seizures increases by more than 200", while tissue adenosine triphosphate (ATP) levels remain at more than 95" of control, even during prolonged status epilepticus. The brain generally withstands the metabolic challenge of seizures quite well because enhanced cerebral blood flow delivers additional oxygen and glucose. Mild to moderate degrees of hypoxemia that commonly accompany seizures are usually harmless. However, severe seizures and status epilepticus can sometimes produce an imbalance between metabolic demands and cerebral perfusion, especially if severe hypotension or hypoglycemia is present. A marked increase in glutamate release, which occurs during a prolonged seizure, is likely to result in the activation of all types of glutamate receptors. Although kainic acid produces seizures in the immature brain, it produces little cytotoxicity.
Recent advancements in molecular genetics have expanded our understanding of the etiology of many neurological diseases and neurodevelopmental abnormalities. Having a comprehensive understanding of genetics is essential in treating patients with metabolic epilepsies. Genetic counseling has been defined as a process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. Some of the components of a genetic counseling interaction include interpretation of family and medical histories to assess the chance of disease occurrence or recurrence; education about inheritance, testing, management, prevention, resources, and research; and counseling to promote informed choices and adaptation to the risk or condition. The genetic counselor may also educate patients and their families about the underlying genetics of their epilepsy and the relevance of a genetic cause of epilepsy for family members, including recurrence risk, reproductive options and the possible teratogenic effect of antiepileptic drugs.Source:
This chapter presents a brief review of the enzymes, transporters, and cofactor producers of the urea cycle. Seizures have long been associated with urea cycle disorders (UCDs), thought to be caused by high levels of ammonia. Furthermore, the brain damage obtained during metabolic crisis has been thought to damage critical structures, leading to epilepsy after the conclusion of the crisis. The first and most critical step of successful treatment of UCDs is recognition. Neurologic monitoring is an essential part of the emergency management of UCDs. The neurological abnormalities observed in patients with urea cycle defects are vast. Controlling ammonia levels by dialysis and complementary medication are needed. EEG monitoring should be initiated early, as this may be very useful for clinical management and indication of untreated metabolic crises. Furthermore, aggressive treatment of clinical and subclinical seizure activity may be helpful in optimizing outcomes for these patients.Source:
Clinical neurophysiology (CNP) is a time-honored medical specialty that continues to make great strides, bolstered by rapid advances in neuroscience, biomedical engineering, and computer technology. It encompasses a wide range of methods and techniques for recording, presenting, and analyzing neurophysiologic signals in order to diagnose sensory, motor, autonomic, and central nervous system disorders. Testing performed in CNP or procedures used in current neurological practice include a variety of modality-specific and mixed-modality tests. Modality-specific CNP tests are performed to assess specific functional modalities using biomedical instruments that measure changes in neurophysiologic signals that occur spontaneously or with activation. Mixed-modality CNP tests utilize two or more test modalities to assess complex states (e.g., sleep, coma), to track multiple physiologic parameters, or to obtain more accurate results. CNP tests are classified based on functional anatomy or neural pathway tested. This chapter discusses artifact recognition and presents sources of artifacts in clinical neurophysiologic testing.
- Go to chapter: Neurodevelopmental Disabilities: Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder
Neurodevelopmental Disabilities: Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder
This chapter defines neurodevelopmental disorders, and examines the medical, psychosocial, and vocational aspects of two neurodevelopmental disorders that are increasing in the U.S. population: autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). It provides populations at risk of being diagnosed with ASD or ADHD, and distinguishes key considerations for outreach, eligibility determination, and rehabilitation assessment and planning. The chapter considers services to be included in the rehabilitation plan to facilitate goal achievement for consumers with ASD or ADHD, and examines evidence-based practices in job development, placement, and retention. Both ASD and ADHD can be accompanied by co-occurring psychiatric disabilities. Counseling and guidance are always individualized to the unique characteristics, rehabilitation needs, and preferences of each rehabilitation consumer. Rehabilitation counselors must also take into consideration the importance of family involvement in the transition and rehabilitation of youths with ASD and ADHD.
This chapter describes changes in the age demographic of the American populace that will steadily increase the number of elderly people in the United States for the next 30 years, and examines the relationship among aging, health, and disability. It provides the characteristics and needs of people who have frequently occurring aging-related disabling conditions such as dementia, rheumatoid arthritis, and stroke. The most common chronic health conditions for people over the age of 65 include arthritis, hypertensive disease, heart disease, hearing impairments, musculoskeletal impairments, chronic sinusitis, diabetes, and visual impairments. It is important for rehabilitation counselors to understand the impact that population aging has had and will continue to have on family interaction and socialization, the American economy, and human health care and social service systems. In providing counseling and guidance services to individuals with age-related disabilities, the issue of chronicity is often of paramount concern.
This chapter promotes a better understanding of women’s experience of abuse. It articulates strategies used in victim advocacy, and addresses the experiences and needs of female victims of intimate partner violence. The chapter examines common practices used and issues faced by victim advocates–who are often trained social workers–who work with women who have been victimized by a male intimate partner. It also highlights firsthand experiences of a victim advocate for female victims of intimate partner violence. Many women continue to be victims of intimate partner violence, and the work of victim advocates who serve these women is challenging. Advocates must be able to assess the needs of victims, refer them to appropriate services, protect their rights, empower them, and help them navigate the criminal and civil justice systems. These responsibilities require advocates to possess various personal and professional skills and to collaborate with many different professionals.
This chapter examines the roles that lifestyle factors and climate change play in the onset and exacerbation of emerging disabilities, and provides examples of chronic illnesses and disabilities linked to lifestyle and climate change that are increasing in the population. It considers the medical, psychosocial, and vocational characteristics of emerging disabilities associated with lifestyle and climate change, and explores characteristics of populations at risk of acquiring disabilities and chronic illnesses associated with lifestyle and climate change. The respective incidences of diabetes, asthma, and heart disease have reached epidemic proportions in the United States. The chapter presents an overview of the health impacts of extreme heat, extreme weather events, air pollution, and vector-borne diseases. Temperature increases, changing precipitation patterns, and extreme weather events have resulted in the increased spread of vector-borne diseases. Health promotions services may be especially beneficial to individuals with lifestyle disabilities to assist them with changing health-related behaviors.
This chapter examines the medical, psychosocial, and vocational characteristics, challenges, and rehabilitation needs of emerging populations of individuals with psychiatric disabilities, and introduces a recovery-oriented approach to providing responsive services to individuals with psychiatric disabilities. It explores integrated, evidence-based, and emerging practices to facilitate better recovery and rehabilitation outcomes for these populations. The onset of psychiatric disabilities occurs during critical years when major changes are occurring in the areas of identity formation and cognitive, psychosocial, psychosexual, and career development. Many individuals with psychiatric disabilities receive their health care in emergency departments and intensive care units and not until their secondary conditions create medical crises. Substance use disorders (SUDs) often co-occur with psychiatric disabilities. The principles of recovery align with the core values and principles of rehabilitation counseling. Illness management and recovery (IMR) is an evidence-based practice for equipping individuals with the knowledge and skills they need to self-manage their disabilities.