Christopher D Ward

Transient feelings of compulsion caused by hemispheric lesions: three cases.

There was strong evidence of a neurological explanation for transient feelings of compulsion reported by three patients. In at least two cases the mechanism was epileptic. The frontal lobe was implicated in all three. A feeling of compulsion, divorced from action, has rarely if ever been reported in epilepsy or other neurological disorders.

Asymmetrical trunk posture, unilateral neglect and motor performance following stroke

It has been observed that some patients, often with unilateral neglect, have difficulty sitting with their trunk symmetrically and tend to lean towards their affected side. The aim of the study was to see whether this inability to achieve midline sitting existed, and if it did whether there was any relationship with motor function and unilateral neglect. The sample consisted of 38 stroke patients assessed at one, three and six weeks post stroke. Of these 17 had a right hemiplegia and 21 a left hemiplegia. Data were collected using the Rivermead Motor Assessment (RMA), star cancellation tests and a measure of midline position. By six weeks most (28) of the subjects sat with their trunk in the midline or towards their unaffected side (group A). Nine subjects sat with their trunk leaning to their affected side (group B). Most of this group (eight) showed signs of unilateral neglect. Chi-square statistics showed that there were more subjects with unilateral neglect in group B than group A (p <0.001). In the gross function section of the RMA Mann-Whitney statistics showed that group B scored significantly worse than group A at three and six weeks post stroke (p = 0.029, p = 0.008). There were no differences in the groups in terms of leg/trunk or arm scores. The findings suggest that there is a group of stroke patients who tend to sit with their trunk leaning towards their affected side and that these patients tend to have unilateral neglect and a poorer functional outcome.

Neuropsychological treatment after brain injury

1. Introduction.- I. Theory and Intervention.- 2. Brain Injury: A Pathophysiological Basis for Neuropsychological Dysfunction.- 3. Issues in Behavioral Neurology and Brain Injury.- 4. Psychopharmacological Agents in the Treatment of Brain Injury.- 5. Traumatic Brain Injury and the Rehabilitation Process: A Psychiatric Perspective.- 6. The Neuropsychological Investigation as a Therapeutic and Rehabilitative Technique.- II. Rehabilitation Programs: Application of Theory.- 7. Interventions in the Inpatient Setting.- 8. Residential Treatment.- 9. Concepts in Day Programming.- III. Neuropsychological Rehabilitation Techniques.- 10. Neuropsychotherapy.- 11. Structured Group Treatment for Brain-Injury Survivors.- 12. Long-Term Family Intervention.- 13. Management of Aggressive Behavior Following Traumatic Brain Injury.- IV. Professional and Legal Issues.- 14. Professional Issues in Neuropsychological Rehabilitation.- 15. Legal Issues that Commonly Confront Brain-Injury Survivors and Their Families.

Rehabilitation in Parkinson's disease

Rehabilitation can be described either as a set of technologies, akin to drug treatment, or as a person-centered process. We will use both frames of reference in this review. Our orientation in Part 1 will be technological, with initial consideration of the pathophysiology of parkinsonian impairments, before examining the rationale for non-drug interventions in Parkinsons disease (PD). In Part 2 we describe how the process of rehabilitation can be applied in a progressive disease such as PD.

Development of a disability team in general practice

On the assumption that team-work, follow-up monitoring and the involvement of a neurologist would contribute to the management of chronic disabling conditions, a project to promote these aims was operated for two years in four general practices serving a rural population of 35 000. Physically disabled adults posing management problems were discussed (in their absence) at meetings attended by general practitioners, nurses, therapists, social workers and district- based staff including a neurologist. The majority of the 138 patients reviewed had neurological diagnoses. Team-work and routine surveillance of patients were generally favoured by therapists, health visitors and others more than by GPs and district nurses. Nevertheless, the project demonstrated how a community disability team can function at minimal cost, with potential benefits to patients.

Commentary on “Alzheimer's disease may begin in the nose and may be caused by Aluminosilicates”

Abstract The suggestion that the nose is the portal of entry for aluminosilicates is considered to be implausible, but readily testable. The proposed mode of action of aluminosilicates in triggering changes in the structure and function of cerebral proteins is interesting but there are few convincing data supporting the model.

Cognitive neurorehabilitation: Edited by Donald T Stuss, Gordon Winocur, and Ian H Robertson (Pp 385, £64.95). Published by Cambridge University Press, Cambridge, 1999. ISBN 0 521 58102 8

As the French term “re-education” implies, learning is a key process in rehabilitation. Nothing might seem more challenging than to effect useful learning in people with cognitive impairments. Until recently, a cloud of pessimism hung over cognitive deficits, but the later sections of this useful book provide authoritative evidence that interventions can produce positive changes in people with impairments in memory, in attention, …

Brain Injury Rehabilitation—Clinical Considerations

All titles reviewed here are available from the BMJ Bookshop, PO Box 295, London WC1H 9TE. Prices include postage in the United Kingdom and for members of the British Forces Overseas, but overseas customers should add C2 per item for postage and packing. Payment can be made by cheque in sterling drawn on a United Kingdom bank, or by credit card (Mastercard, Visa or American Express) stating card number, expiratory date, and your full name.

Aging with a Disability

book are more useful but I am surprised by Yamada et al on bilateral stimulation for the fact that a table is produced showing the SEPs and Blumhardt on the VEP and visual assessment of risk of development of bed field defects, to choose a few at random. sores without any mention being made of There is much of interest in all eight the various clinical assessments of severity sections-perhaps that termed Anatomy has or recovery of stroke. the most to offer for the clinician apart from The photographs in the book are well the obviously clinical sections, with, for produced but the volume cannot be recomexample, M0ller and Jannetta on the BAEP, mended to physicians involved in the care of followed in sequence by Desmedt, Kimura patients with stroke and nor can I see it and colleagues, and Burke and Gandevia on being used by paramedical personnel various SEP aspects. The section entitled because the language used in the text is inapDifferential Diagnosis is generally good and propriately complicated. contains a real gem of a short chapter by DAVID BATES Picton, classifying BAEP abnormalities. Surprisingly the smallest section is that on surgical monitoring, with only two contributors, both on the SEP, and no mention Evoked Potentials Frontiers of Clinical of BAEP monitoring or the more probNeuroscience Vol 3. Edited by Roger Q lematical VEP. Cracco, Ivan Bodis-Wollner. (Pp 564 The arrival of this work is timely since £70-00.) New York: Alan R Liss Inc, 1986. certain aspects of the EP field seem likely to undergo critical reappraisal in the near This book, volume 3 in the series, is of a future. In the USA if not yet in Britain, the different generation and has an aim very rapid increase in availability of magnetic different from the standard works on clinical resonance imaging is bound to be accomevoked potentials, such as Hallidays and panied by a decrease in the use of EPs for Chiappas volumes, published a few years diagnosis of multiple sclerosis. Event related ago. The authors of this work have potentials, for years a candidate for growth, attempted, largely successfully, to select have still to establish a clinical role, and what is relevant, interesting and important though there has been a remarkable recent in the field, whether basic or clinical. The increase in commercial averagers with facilibook is not intended to be all-encompassing ties for topographical display of EPs, and but a great deal is covered in the 49 chapters, thus for generation of pretty pictures, there by no less than 99 contributors. The great are many who have reservations about the majority of the contributors are from North true value of this technique. This book is America, with Italy and Israel particularly packed with interesting material and is in well represented among the rest. All the congeneral well produced; the price is reasontributors are well known for their work on able. It will be of great value to clinical neuthe aspects of EPs which they here review, rophysiologists wishing to improve their describe or discuss according to their understanding of basic mechanisms, ponpreference. dering new ideas for research or aiming to There are eight sections in the book: improve their routine clinical service. methodology, animal models, anatomy, bioNMF MURRAY chemistry and pharmacology, differential diagnosis, surgical monitoring, paediatrics, and cognitive disorders. Though the reason for placing some contributors in their particular section seems somewhat arbitrary at Magnetic Resonance Imaging of the Central times, this arrangement works reasonably Nervous System. Edited by Michael well on the whole. I certainly found, when Brandst-Zawadzki, David Norman. (Pp searching for a particular chapter that my 300;

Retrieval from semantic and letter-initial categories in patients with Parkinson's disease

103.00.) New York: Raven Press, attention was frequently caught by an inter1986. esting or relevant page or illustration in one of the adjacent chapters. As might be expected with a multiauthor Most of the workers whom one would book this one suffers from a certain amount hope to find in a major work on clinical and of repetition. Although aimed at residents basic science of EPs are here and it is both a and practising radiologists there is more pleasure and a great convenience to have in than enough technical detail in the first nine a single volume such diverse workers as chapters, which occupy over one third of the Lehmann on spatial analysis, Kaufmann book, to satisfy any other than someone and Williamson on the neuromagnetic field, who has to devote much of his practise to Maffei and Fiorentini on the pattern ERG, MRI. However, these chapters are well writBook reviews