Christian G. Zimmerman

Brain injury: quality of life's greatest challenge

The objectives of this investigation were to (1) identify elements that comprise an acceptable quality of life (Q-L) post-traumatic brain injury (TBI) from the perspectives of patients and families, and (2) explore patient and family satisfaction with treatment decisions relevant to QoL. The authors created, tested, and administered two forms (patient; family) of a 35-question interview to 33 participants in a longitudinal TBI study (14 women, 19 men) and 33 associated family members. Men associated ratings of QoL with numerous variables, while womens responses revealed no significant relationships shared by QoL and other variables. Women reported a poorer QoL than did men. Older patients reported a better QoL than did younger patients. Families emphasized the family relationship, emotional control, and ability to concentrate when considering overall QoL. Patients did not. The majority of patients and families expressed satisfaction with decisions made about acute treatment. QoL research is essential to illuminate best practice models.

Cranio-cervical stabilization of traumatic atlanto-occipital dislocation with minimal resultant neurological deficit

SummaryOur purpose is to describe a case of atlanto-occipital dislocation and discuss treatment approaches to minimize subsequent neurological deficits. Traumatic atlanto-occipital dislocation, has traditionally been considered rare and lethal, due to resulting high levels of spinal cord injury. Outcomes are generally expected to be poor. However, recent case reports indicate that survival is increasing. Of patients who survive cranio-cervical dislocation, many endure resulting neurological deficits.We present a rare case of a 23-year-old male, who sustained an atlanto-occipital dislocation in a motor vehicle accident. The patient presented with a Glasgow Coma Scale (GCS) of 11T. Lateral C-spine x-ray and thin-section slices CT delineated a C1 ring fracture on the left side with approximately 1 cm anterior and superior subluxation of the occipital condyles of the cranium in reference to C1. The patient was completely awake, alert, and was following commands.The patient underwent a cranio-cervical stabilization from occiput to C3, using lateral mas screws (C1–C3) and transarticular screws (C2–C3). The Vertex (Medtronics) system used included longitudinal bars connected to the lateral mas plating system, which was subsequently used to place screws within the keel of the occipital bone. Motor strength and sensation remained intact following surgery. One-week post-operation, the patient was ambulating 140 feet, conversationally appropriate, and had a GCS of 15. This case illustrates the possibility for neurosurgical intervention of cranio-cervical dislocations to achieve optimal outcome and demonstrates that survival from this injury is not only conceivable, but recovery of function is also possible.

Case Study Music and the Brain: The Impact of Music on an Oboist's Fight for Recovery

A 20-year-old female, alias Sara, was an aspiring professional oboist who studied music performance at college level. While wading across a river she lost her balance, was swept down river, and suffered profound injuries including severe hypothermia, cardiac arrest, and hypoxic brain injury. While recovering, her family and friends surrounded Sara with music. Her oboe teacher placed Saras oboe in her hand and played tapes of Saras past performances. Her mother played recordings of her favourite music in hopes that the music would remind her of her lifes passion and, thus, stimulate her mind and soul while she recovered. Two years post-injury, Sara continues to strive to improve her quality of life. In this case study, Saras musical and medical recovery is detailed using quantitative and qualitative data. This data gathered allows one to provide an analysis of the powerful role of music in Saras fight to recover.A 20-year-old female, alias Sara, was an aspiring professional oboist who studied music performance at college level. While wading across a river she lost her balance, was swept down river, and suffered profound injuries including severe hypothermia, cardiac arrest, and hypoxic brain injury. While recovering, her family and friends surrounded Sara with music. Her oboe teacher placed Saras oboe in her hand and played tapes of Saras past performances. Her mother played recordings of her favourite music in hopes that the music would remind her of her lifes passion and, thus, stimulate her mind and soul while she recovered. Two years post-injury, Sara continues to strive to improve her quality of life. In this case study, Saras musical and medical recovery is detailed using quantitative and qualitative data. This data gathered allows one to provide an analysis of the powerful role of music in Saras fight to recover.

Sleeping through the Ages: An Examination of Sleep in Older Adults

It is widely recognized that sleep disorders (SD) are highly prevalent, despite being under diagnosed and under treated in practice. SDs occurs at all ages, although presentation and subsequent consequences for an individuals health varies throughout the lifespan. Currently, evaluation of SDs are inadequate across all age ranges, and for both sexes, as they are compromised by under reporting and relying on self-report, rather than professional sleep studies (i.e., nocturnal polysomnography (NPS) and multiple sleep latency tests (MSLT)). Moreover, there is a paucity of data specific to the elderly; many older individuals report dissatisfaction with quality of sleep. Indeed, literature has shown that geriatric populations spend less time in slow-wave sleep and rapid eye movement (REM) sleep and have more difficulties maintaining sleep. Their dissatisfaction may occur from changes in sleep architecture associated with the aging process; however, it has been suggested that it largely stems from comorbid illness, social problems, hormonal effects, altered circadian rhythms, or side effects of medications that are common in the elderly. Further, geriatric sleep is related to depression, impaired health and functioning, and weaker/ less synchronized circadian rhythms. In response, we utilized a 111-item questionnaire in conjunction with NPS, MSLT, the Epworth Sleepiness Scale (ESS) and medical chart reviews of individuals referred for SD evaluation to compare sleep in geriatrics with adults. Analysis revealed numerous differences between adult and geriatric groups, with the elderly experiencing more SDs, longer sleep latencies, and fewer sleep complaints. Based on the outcomes of this investigation, we posit further consideration to SDs across the age groups to achieve the best health care and quality of life for all.