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EVALUATION AND MANAGEMENT OF THE BRAIN-DAMAGED PATIENT

Jerome S. Tobis, M.D.; Milton Lowenthal, M.D.; Simon Maringer, M.D.
JAMA. 1957;165(16):2035-2041. doi:10.1001/jama.1957.02980340001001.
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Neurological examination of a braindamaged patient precisely defines the mechanism underlying his deficits, but it must be supplemented by measurement of integrated neuromuscular functions such as capacity for walking, feeding, and self-care and by evaluation of psychological and emotional capacities. Sensory deficits often make movement futile even when true paralysis is absent. Paralyses often lead to severe secondary emotional reactions. Disabilities due to either exaggerated or restricted motion can be reduced by a variety of medical, surgical, and physiotherapeutic means. Techniques for rehabilitating the brain-damaged patient include especially those intended to improve musculoskeletal function and those intended to improve psychological function. The danger of deconditioning in unsympathetic, desolate environments is real; it must be offset by the reassuring effects of regularity of care, the presence of familiar persons and objects, and the gradual resumption of limited activities and responsibilities. Many of these conditions can be assured only by the attentions of a physician who is thoroughly conversant with all aspects of the problem.

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