Cognitive and psychosocial outcome following moderate or severe traumatic brain injury

The outcome of 96 consecutive adult patients with moderate to severe head injury was sequentially measured at 6, 12 and 24 months post-injury. In addition to global outcome using the Glasgow Outcome Scale (GOS) and a battery of neuropsychological tests of cognitive function, the Head Injury Symptom Checklist (HISC) and Relative's Questionnaire (RQ) were used. Although poorer GOS scores and severe cognitive impairments were typically associated with greater severity of initial injury, relatives reported similar functional problems irrespective of injury severity. This illustrates the legacy of moderate head injury in influencing many aspects of everyday life, supporting the argument that the needs of this group should not be overlooked.     

Early prediction of outcome following head injury in children

A retrospective survey of 166 children aged 15 years or less was made in an attempt to identify which clinical features presenting in the first 24 hours after a head injury might be helpful in predicting the eventual outcome as defined by the Glasgow Outcome Scale. In 88% of the children, the trend of Glasgow Coma Scale score over the first 24 hours was useful. This included children admitted with a score of 3 or 4 and those with a score of 5 or more who did not deteriorate within 24 hours of injury. In this group only 2% of the predictions would have been inaccurate and in only 0.7% would the outcome have been worse than the prediction. The presence of both abnormal plantar and pupillary light reflexes predicted death or significant disability in 99% of cases.     

Effects of acute injury characteristics on neuropsychological status and vocational outcome following mild traumatic brain injury

Despite recent attempts to define acute injury characteristics of mild traumatic brain injury (MTBI), neuropsychological outcome is often unpredictable. One hundred MTBI cases were prospectively collected, which were consecutive referrals to a concussion clinic, and the roles of various acute neurologic variables were examined in relation to neuropsychological status and vocational outcome. Significant differences were found between subgroups of patients classified by (1) mechanism of injury (i.e. acceleration/deceleration trauma in which the head strikes an object (HSO) versus acceleration/ deceleration trauma in which the head does not strike an object (HNSO) versus trauma in which an object strikes the head (OSH), and (2) type of injury (i.e. motor vehicle collision, fall, assault, motor vehicle-pedestrian collision, falling object, sports/recreation). There was no difference, with respect to neuropsychological status or vocational outcome, between patients who had positive findings on computerized tomography (CT) versus those who were CT negative. Additionally, there was no difference between patients who had suffered brief loss of consciousness (LOC) and those without LOC. These findings suggest that selective acute injury characteristics may be used to classify subtypes of MTBI patients.     

Episodic symptoms in dysfunctioning children and adolescents following mild and severe traumatic brain injury

The present investigation examines the phenomenology of episodic symptoms in dysfunctioning children and adolescents following mild (n = 25) or severe (n = 25) traumatic brain injury (TBI). TBI patients in both groups commonly endorsed symptoms such as staring spells, memory gaps, and temper outbursts. Anticonvulsant response in the 27 patients treated, reflected moderate to substantial improvement in 92%. A dose-response relationship between injury severity and number of episodic symptoms was not observed; however, patients in the severe TBI sample did produce significantly more defective performances on a dichotic word-listening task (DWLT) and lower IQ values. Defective DWLT performance was also significantly associated with greater number of episodic symptoms endorsed, but only in the mild TBI sample. Parallels with epilepsy spectrum disorder and clinical implications for paediatric TBI are discussed.     

Executive memory dysfunctions following mild traumatic brain injury

OBJECTIVES: To explore the contribution of executive dysfunctions to mnemonic problems in adults with mild traumatic brain injury (MTBI). DESIGN: Prospective quasiexperimental between-groups design. PARTICIPANTS: Ninety-nine persons with MTBI were compared to 90 control group participants matched for gender, age, and education. SETTING: Two Canadian brain injury rehabilitation programs. MAIN OUTCOME MEASURE: California Verbal Learning Test. RESULTS: Participants with MTBI showed a significant deficit in free recall on the California Verbal Learning Test but performed similarly to the comparison group on the recognition task. Furthermore, the participants with MTBI were less likely to use semantic clustering as a memorizing strategy and made more intrusion errors and false-positive errors on the recognition task. CONCLUSIONS: While the scores for the participants with MTBI are only slightly lower than the norm, they demonstrate that MTBI has a negative effect on mnemonic performance. The results are explained in terms of a deficit in registration/retrieval processes rather than a malfunction of the storage processes. This supports the initial hypothesis that executive dysfunctions are detrimental to the quality of mnemonic functions in patients with MTBI.     

Cognitive and affective sequelae in complicated and uncomplicated mild traumatic brain injury

This study examined cognitive and affective disturbances in patients with complicated (presence of space occupying lesion) vs uncomplicated (absence of space occupying lesion) mild traumatic brain injury (TBI). It was predicted that the complicated group would perform worse in both domains compared to the uncomplicated group. Participants were 28 patients admitted to an inpatient neurorehabilitation unit with mild TBI and assessed within 40 days of their injury. The complicated group (n = 14) was matched to the uncomplicated group (n = 14) on Glasgow Coma Scale score and compared to 14 normal controls on the BNI Screen for Higher Cerebral Functions (BNIS). The complicated group showed greater cognitive disturbances than the uncomplicated and control groups, while both TBI groups performed worse on affective measures. These findings document the role of affective disturbances in mild TBI. They also highlight the importance of early intervention strategies for improving affective communication in patients with mild TBI.     

Psychiatric treatment outcome following traumatic brain injury

The relationship between self-reported history of traumatic brain injury (TBI) and psychiatric treatment outcome was investigated. TBI was hypothesized to be frequent, associated with cognitive deficits on neuropsychological testing, and less amenable to standard psychiatric treatment. Subjects were 42 psychiatric patients with a self-reported history of TBI and 25 psychiatricpatients with no TBI history. Subjects received approximately 2 weeks of inpatient psychiatric treatment. Subjects received neuropsychological testing and completed the Brief Symptom Inventory weekly. TBI was frequent (66% of subjects); multiple injuries were common. Neuropsychological performance was generally average in both groups with few group differences. Subjects, on average, reported significantly decreased psychiatric symtoms on discharge. However, the TBI group appeared to improve less than the control group; group status was a significant predictor of treatment outcome. Implications of results for assessment and treatment of psychiatric disorders in patients with a history of TBI are discussed.     

Rehabilitation and outcome following pediatric traumatic brain injury

The long-term outcome for a child who has sustained a traumatic brain injury must be viewed in the context of ongoing development and maturation. Although neuronal plasticity provides the potential for neuronal reorganization in a child's brain, it is the behavioral demands of the environment that allow the child to take advantage of this potential and to maximize recovery. Pediatric rehabilitation is the setting that provides the necessary experiences for stimulating neuronal reorganization following TBI. However, neuronal reorganization has a cost to long-term development. The ultimate long-term impact of a TBI sustained in childhood depends on the child's ability to achieve developmental milestones following injury. Although injury-related and treatment-related factors are critical during the early stages of recovery, patient-related factors such as age-at-injury, developmental achievement at time of injury, maturation, and family involvement and resources impact the later stages of recovery. The process of pediatric rehabilitation following TBI is to provide an enriched, stimulating environment tailored to the needs of the child and based on real-word experiences. Early in the recovery process, pediatric rehabilitation is the setting that maximizes the potential for neuronal reorganization. Early rehabilitation also prepares the family for the child's long-term recovery and developmental needs. Involvement and training of family members early in the recovery process is critical for successful long-term outcome. Family members are the individuals best equipped to ensure treatment compliance and follow through with treatment recommendations, in maintaining treatment gains, and in generalizing treatment effects beyond the medical settings. Despite the life-long ramifications of childhood TBI, pediatric rehabilitation is the necessary step in promoting recovery and successful long-term outcome.     

Prevalence of abnormal CT-scans following mild head injury

Primary objective: The purpose of this study was to examine the prevalence of day-of-injury intracranial abnormalities in a large sample of patients with mild head injuries who were admitted to a Trauma Service. Methods and procedures: There were 912 patients who obtained admission Glasgow Coma Scale (GCS) scores of 13-15. Main outcomes and results: The base rate of complicated mild head injuries (i.e. abnormal CT scans) in this sample was 15.8%. However, nearly 25% of the sample, most of whom had very mild injuries, did not receive CT-scans. Therefore, the actual prevalence is more likely in the range 16-21%. There was a tremendous overlap in injury characteristics between patients with complicated and uncomplicated mild head injuries. None the less, there were modest, yet statistically significant, relationships between the presence of intracranial abnormalities and lower GCS scores, greater frequency of positive loss of consciousness, greater frequency of skull fractures, and lower GOAT scores.     

Cognitive orientation in rehabilitation and neuropsychological outcome after traumatic brain injury

This study evaluated the ability of the Orientation Log (O-Log) to predict cognitive outcome at rehabilitation discharge, as well as future neuropsychological outcome. The hypothesis was that patients who demonstrated better orientation upon admission would achieve superior functional cognitive outcome at discharge and on subsequent neuropsychological assessment. Sixty individuals receiving inpatient rehabilitation following a new-onset TBI participated. Orientation data was collected using the O-Log during morning bedside rounds. Outcome data was collected at 6 and 12 months post-injury. Significant correlations were found between the O-log and measures of memory, executive functioning, basic verbal skills, and estimated intellectual ability. When compared to the other predictor variables, step-wise multiple regression analyses revealed that the minimum O-Log score was the primary significant predictor of performance on six neuropsychological and functional outcome measures. Results of this study suggest that evaluating orientation with the O-Log during acute rehabilitation may reflect level of injury severity and aid in predicting cognitive outcome.     

Therapeutic effect of mild hypothermia on severe traumatic head injury

ldhypothermia (33 35℃ )isbeneficialforbrainprotectionandthusreducesthemortalityofthepatientswithseveretraumaticbraininjury (TBI) ,whichhasbeen provedbyclinicalandexperimentalevidences .1,2 However ,hypothermialeadstosuchcomplicationsasseveresecondaryinfectionsandshockduringrewarming .1InordertofurtherevaluatetheeffectofhypothermiaonsevereTBI ,wetreatedsuch patientswithmildhypothermiaandnormothermia ,respectively ,ananalyzedtheirclinicaleffectsprospectively .METHODSClinicaldataBetween 199…     

Stress, appraisal and coping following mild traumatic brain injury

Purpose: The present study tested a portion of the stress, appraisal and coping (SAC) model proposed by Godfrey, Knight and Partridge.

Methods: Using data gathered from 94 individuals who had sustained a traumatic brain injury, path analysis results indicated that a model based on Godfrey et al.'s SAC model did not fit the sample data. Based on relevant statistical output, previous research and theory, a re-specified model was tested.

Results: The final model was shown to meet common statistical measures for establishing model fit. The final model indicated that higher levels of perceived stress were predictive of higher levels of self-reported depression, higher levels of depression were predictive of lower levels of dispositional hope and dispositional hope was predictive of increased life satisfaction and work productivity.

Conclusions: The present findings hold implications for both research and for clinical practice. The findings do suggest the need for additional research to further clarify factors that contribute to emotional adjustment following traumatic brain injury.     

Cognitive moderators of outcome following traumatic brain injury: A conceptual model and implications for rehabilitation

This paper presents a conceptual model describing the relationships between quality of life outcomes following traumatic brain injury (TBI), coping patterns, and beliefs regarding self-efficacy to assist health-care professionals in understanding the complexity of social and psychological sequelae of TBI. The model hypothesizes that long-lasting cognitive, behavioural, emotional psychiatric, and interpersonal after-effects of TBI may create a real life 'learned helplessness' with consequent deficits in coping, and altered locus of control beliefs. As a result, TBI patients are at risk for developing self-limiting belief systems about their effectiveness in altering significant events that may result in over-generalizing the effects that TBI has in their day-to-day lives. Subsequently, a feedback loop may be set up where their beliefs in not being able to influence outcomes are not tested, life chances are further restricted, outcomes are suboptimal, and quality of life is reduced. The clinical and theoretical implications of this model are discussed, and an expanded model with future research directions is suggested.     

Predictors of acute stress following mild traumatic brain injury

The aim of this study was to investigate the predictors of acute stress disorder (ASD) following mild traumatic brain injury (MTBI). Patients who sustained MTBI following a motor vehicle accident (n = 48) were assessed with a structured interview within 18 days of the trauma for the presence of ASD and administered the Beck Depression Inventory (BDI), Coping Style Questionnaire, Dissociative Experiences Scale, and the Eysenck Personality Inventory. ASD was diagnosed in 14.6% of patients and 4.2% were diagnosed with sub syndromal ASD. BDI scores and avoidant coping were significant predictors of ASD and acute stress severity. This study provides further evidence that traumatic stress reactions occur following MTBI and highlights the possibility of identifying those who may benefit from early intervention.     

Functional outcome: a case for mild traumatic brain injury

The purpose of this case study was to demonstrate the successful incorporation of the strengths of process-specific and functional treatment approaches within a therapy programme for a patient with a MTBI. A patient with MTBI and deficits in attention, executive functioning, memory, reasoning and problem solving participated in a 4-month treatment programme. The interactions between the patient's cognitive deficits and problematic activities of daily living were identified. Treatment focused on teaching the patient compensatory strategies to offset the cognitive deficits following a cognitive framework within the context of hierarchically arranged activities of daily living. At the end of this programme, the patient consistently used his compensatory strategies to independently complete activities of daily living that were problematic prior to the receipt of treatment. Implications of this study for the treatment of patients with MTBI suggest that a combined approach is most beneficial in maximizing the recovery of these patients.