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Recognizing encephalopathy and delirium in the cardiopulmonary rehabilitation setting

Waked, William J; Gordon, Robert M; Whiteson, Jonathan H; Baron, Erika M
OBJECTIVE: This article reviews the prevalence, underlying mechanisms, and challenges of treating encephalopathy and delirium in the postsurgical and medically compromised cardiopulmonary patient receiving services on an acute inpatient rehabilitation unit. Additionally, pertinent information is provided on conducting an evaluation to assess for neurocognitive sequelae of the above-mentioned conditions to help achieve better treatment outcomes. METHOD: Review of the medical and neuropsychology literature is provided along with 2 case reports to illustrate evaluation of a persisting toxic-metabolic encephalopathy and a resolving delirium and the treatment team's effectiveness in producing a more optimal treatment outcome. The unique role of the rehabilitation psychologist, special treatment considerations, and the importance of integrated follow-up neurorehabilitation services for the cardiopulmonary patient and caregivers also are emphasized. RESULTS: Encephalopathy and delirium are 2 related, but somewhat different, conditions that can emerge postoperatively, any time during acute care hospitalization, and often enough, during impatient or subacute-care rehabilitation. Their association with long-term harm and poor outcome warrant early identification and immediate medical intervention. IMPLICATIONS: Encephalopathy and delirium can significantly affect rehabilitation outcomes and, as such, rehabilitation psychologists are encouraged to systematically screen for the presence of delirium and encephalopathy in the cardiopulmonary rehabilitation setting so to enhance treatment efficacy and quality of life in affected individuals. (PsycINFO Database Record
PMID: 26120746
ISSN: 1939-1544
CID: 1650332

Organizational strategy influence on visual memory performance after stroke: cortical/subcortical and left/right hemisphere contrasts

Lange, G; Waked, W; Kirshblum, S; DeLuca, J
OBJECTIVE: To examine how organizational strategy at encoding influences visual memory performance in stroke patients. DESIGN: Case control study. SETTING: Postacute rehabilitation hospital. PARTICIPANTS: Stroke patients with right hemisphere damage (n = 20) versus left hemisphere damage (n = 15), and stroke patients with cortical damage (n = 11) versus subcortical damage (n = 19). MAIN OUTCOME MEASURES: Organizational strategy scores, recall performance on the Rey-Osterrieth Complex Figure (ROCF). RESULTS: Results demonstrated significantly greater organizational impairment and less accurate copy performance (i.e., encoding of visuospatial information on the ROCF) in the right compared to the left hemisphere group, and in the cortical relative to the subcortical group. Organizational strategy and copy accuracy scores were significantly related to each other. The absolute amount of immediate and delayed recall was significantly associated with poor organizational strategy scores. However, relative to the amount of visual information originally encoded, memory performances did not differ between groups. CONCLUSIONS: These findings suggest that visual memory impairments after stroke may be caused by a lack of organizational strategy affecting information encoding, rather than an impairment in memory storage or retrieval
PMID: 10638882
ISSN: 0003-9993
CID: 70834

Strauss and Carpenter outcome criteria--revised

Tucker, L; Wagner, S; Sher, I; Mujica, E; Waked, W
Poor inter-rater reliability of the Strauss and Carpenter Outcome Criteria in hospital outcome study was attributed to lack of operational definition. A revision aimed at remedying this problem was used to rate a portion of the original sample of subjects. The revised form proved superior in interrater reliability for seven of the nine categories, suggesting that this more explicitly behavioral version may improve hospital outcome research
PMID: 10282450
ISSN: 0885-7717
CID: 70835

Learning style and intelligence of reading disabled students

Sinatra, R; Primavera, L; Waked, W J
This study examined the relationship between elements of the Learning Style Inventory and various scales of the WISC-R for reading disabled students. Previous research generally suggests that reading disabled students have preferences that tap the visual-spatial domain and have higher WISC-R Performance Scale and subtest scores than Verbal Scale and subtest scores. Subjects with IQs of 90 or better on either the Verbal or Performance Scales of the WISC-R and a consistency score of 75 or better on the inventory were selected. Contrary to what might be expected, data generally showed a nonmeaningful pattern of correlations between scales of the Learning Style Inventory and WISC-R Performance-type functioning. However, as an important part of the validation of the inventory, lack of association between the two can be interpreted as support for its construct validity
PMID: 3808899
ISSN: 0031-5125
CID: 70836