Items in AFP with MESH term: Brain Injuries
Evaluation of Clumsiness in Children - Article
ABSTRACT: Parents and physicians often dismiss seemingly minor motor difficulties in children. Approximately 6 percent of school-aged children have coordination problems serious enough to interfere with academic performance and social integration. These problems often arise during the early school years and manifest in difficulties with such simple motor tasks as running, buttoning, or using scissors. Increasing evidence shows that rather than improving over time, these motor difficulties remain stable throughout adolescence and adulthood. While these children are initially singled out for motor difficulties, their problems are rarely limited to poor motor coordination. Many of them have a range of associated deficits, such as attention-deficit/hyperactivity disorder, learning disabilities, poor handwriting and drawing skills, and emotional immaturity. Associated problems magnify with time, and as teenagers, these children have higher rates of educational, social, and emotional problems. Diagnosis is determined by taking a careful history that includes a review of fine motor, visual, adaptive, and gross motor milestones, and performing a physical examination. Formal standardized testing may be indicated. Referral to occupational therapy that is appropriately individualized to the needs of each child appears to be effective. To aid in management, the family physician must be aware of this condition, as well as the associated coexisting deficits.
Care of the Returning Veteran - Article
ABSTRACT: Of the 23.8 million military veterans living in the United States, approximately 3 million have served in Operation Enduring Freedom or Operation Iraqi Freedom. The injuries and illnesses that affect veterans returning from combat are predictable. Blast injuries are common and most often present as mild traumatic brain injury, which is synonymous with concussion. Family physicians caring for returning veterans will also encounter conditions such as posttraumatic stress disorder at rates higher than those in the general population. The symptoms associated with posttraumatic stress disorder and mild traumatic brain injury often overlap and can present concurrently. Treatment of traumatic brain injury should be based on symptoms and guided by clinical practice guidelines from the U.S. Department of Veterans Affairs and Department of Defense. Family physicians should understand the range of post-war health concerns and screen returning service members for posttraumatic stress disorder, substance abuse, suicidality, and clinical depression. Family physicians are well positioned to offer continuity of care for issues affecting returning service members and to coordinate the delivery of specialized care when needed. (Am Fam Physician. 2010;82(1):43-49. Copyright © 2010 American Academy of Family Physicians.)
ABSTRACT: Referring a patient to a neuropsychologist for evaluation provides a level of rigorous assessment of brain function that often cannot be obtained in other ways. The neuropsychologist integrates information from the patient’s medical history, laboratory tests, and imaging studies; an in-depth interview; collateral information from the family and other sources; and standardized assessment instruments to draw conclusions about diagnosis, prognosis, and response to therapy. Family physicians can use this information in the diagnosis and treatment of patients with depression, dementia, concussion, and similar conditions, as well as to address concerns about decision-making capacity. Certain assessment instruments, such as the Mini-Mental State Examination and Patient Health Questionnaire–9, are readily available and easily performed in a primary care office. Distinguishing among depression, dementia, and other conditions can be challenging, and consultation with a neuropsychologist at this level can be diagnostic and therapeutic. The neuropsychologist typically helps the patient, family, and primary care team by establishing decision-making capacity; determining driving safety; identifying traumatic brain injury deficits; distinguishing dementia from depression and other conditions; and detecting malingering. Neuropsychologists use a structured set of therapeutic activities to improve a patient’s ability to think, use judgment, and make decisions (cognitive rehabilitation). Repeat neuropsychological evaluation can be invaluable in monitoring progression and treatment effects.
Hypothermia for Neuroprotection in Adults After Cardiopulmonary Resuscitation - Cochrane for Clinicians
NIH Issues Consensus Statement on the Rehabilitation of Persons with Traumatic Brain Injury - Special Medical Reports
AHRQ Releases Evidence Report on Brain Injury in Children - Practice Guidelines