The effectiveness and safety of botulinum toxin treatment for sialorrhea due to severe brain injury.

Introduction: Sialorrhea may be a consequence of severe acquired brain injury (ABI). Salivary gland botulinum neurotoxin (SG-BoNT) injections can reduce saliva production, but there is limited evidence for their use in ABI.We reviewed the effectiveness, impact on chest infection frequency, and safety of SG-BoNT for sialorrhea in a cohort of patients with severe ABI.

The impact of delays in transfer to specialist rehabilitation on outcomes in patients with acquired brain injury.

Objective: To determine the effect of time waiting for admission to inpatient neurorehabilitation following acquired brain injury on rehabilitation outcomes.

Design: A retrospective observational case series.

Setting: A specialist brain injury inpatient rehabilitation service.

Non-medical prescribing in critical care: A mixed methods study.

Background: Little is known about non-medical prescribers in critical care in the United Kingdom. In 2007, a small survey identified few non-medical prescribers; however, in the intervening years, there have been many changes to the Medicine Act 1968. It is likely that prescribing within the non-medical workforce in critical care has changed significantly.

The circular paradox of including people with severe brain injuries and reduced decisional capacity in research: A feasibility study exploring randomized research, consent-based recruitment biases, and the resultant health inequities.

Background: People with severe brain injuries (PSBI) and reduced capacity to consent (CTC) frequently develop muscle contractures. Standard care includes prolonged stretch (PS) but there is limited condition-specific evidence from randomized controlled trials (RCTs).

Purpose: Identify factors affecting the inclusion of PSBI and reduced CTC in a PS RCT and methodologies more capable of generating condition-specific outcomes.

A consensus process to agree best practice for managing physical wellbeing in people with a prolonged disorder of consciousness.

Background: Current practice for physical wellbeing of people in a Prolonged Disorder of Consciousness (PDOC) is variable. A scoping literature review identified no agreed standard of care for physical management of those in a PDOC. This study addressed this deficit using a consensus process applied using nominal group technique.

Assessing emergence from a prolonged disorder of consciousness: Current opinion and practice in the UK.

Background: A patient in PDOC must demonstrate functional object use or functional communication to confirm they have emerged from this state. A range of tasks and stimuli are used and patients must achieve 100% accuracy. As consciousness occurs along a continuum, determining emergence is not straightforward.

The assessment of language and the emergence from disorders of consciousness.

In order to demonstrate emergence from a disorder of consciousness (DoC) an individual is currently required to demonstrate functional object use of two objects, or functional communication defined as accurately answering six yes/no questions on two consecutive occasions (Giacino et al., 2002). In practice, experienced speech and language therapists (SLTs) working with this group often focus on facilitating object use or employ other language tasks, since achieving a 100% accurate yes/no response can be difficult for patients following an extensive brain injury due to language and/or cognitive impairments.

Psychological needs of patients in low awareness states, their families, and health professionals.

Patients who have emerged from low awareness states may present with psychological needs that can be addressed via adapted formal clinical psychological interventions, or by behavioural techniques. Families of these patients may experience similar psychological reactions to relatives of any patients with severe brain injury, but there are also additional factors that are unique to patients in low awareness states. These sources of psychological distress for relatives are discussed.

Clinical approaches to the withdrawal of nutrition and hydration.

The request for withdrawal of nutrition and hydration from the vegetative patient is rare, but when it occurs it causes considerable anxiety for the clinical team. This anxiety is exacerbated by the need to seek a declaration from court that withdrawal of treatment would be legal. This paper discusses the process from the time of the request to the withdrawal of the tube feeding, and the actions the clinical team needs to take.

Managing faecal retention and incontinence in neurodisability.

The large number of patients with faecal retention and/or incontinence in continuing care wards and rehabilitation units presents a considerable challenge. In order to maintain dignity and minimize the unpleasant odour so commonly associated with these wards and units, effective bowel management should be planned for individual patients. For an effective bowel management regime a team approach should be adopted, involving, where possible, the patient and carer as well as all the health professionals administering the care.

Future research directions in laterality.

This paper considers the current conceptual state of research into neuropsychological laterality and considers some issues which might appropriately be considered for the forward development of the field. It considers the biological context which has been adopted for these studies and the psychological significance of performance asymmetries. A principal emphasis of the paper is the degree to which inferences, rather than direct methodological deductions, can be drawn from the research undertaken.

Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit.

Objective: To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics.

Design: Retrospective study of the clinical records of the medical, occupational therapy, and clinical psychology departments.

Setting: 20 bed unit specialising in the rehabilitation of patients with profound brain damage, including the vegetative state.