Traumatic brain injury: Implications for practice

This article presents a brief overview of the prevalence and history of traumatic brain injury (TBI), discusses the multidimensional effects of TBI, describes the current focus of TBI rehabilitation, and summarizes outcomes from (re)habilitation work with individuals with traumatic brain injury. The importance of this critical area to rehabilitation personnel is discussed, along with suggestions for future research and evaluation studies.     

Traumatic brain injury: Implications for practice

This article presents a brief overview of the prevalence and history of traumatic brain injury (TBI), discusses the multidimensional effects of TBI, describes the current focus of TBI rehabilitation, and summarizes outcomes from (re)habilitation work with individuals with traumatic brain injury. The importance of this critical area to rehabilitation personnel is discussed, along with suggestions for future research and evaluation studies.     

Does multitasking mediate the relationships between episodic memory,attention, executive functions and apathetic manifestations in traumatic brain injury?

Apathy is frequently described in patients with traumatic brain injury (TBI); its negative consequences particularly affect functional independence. Among apathetic manifestations, lack of initiative and lack of interest have mainly been associated with cognitive impairments. However, few studies have been conducted to precisely identify the underlying cognitive processes. Our aims were (1) to determine the best predictor of apathy from among several cognitive processes, including episodic memory and attention/executive mechanisms and multitasking, and (2) to examine to what extent multitasking could mediate the relationships between specific cognitive processes and lack of initiative/interest. Seventy participants (34 patients with TBI matched with 36 control participants) were given a questionnaire to assess anxio‐depressive symptoms, four tasks to assess specific cognitive processes, and one task to assess real‐life multitasking. Participants’ relatives completed an apathy questionnaire. Multitasking, as assessed by the number of goals not achieved, was the only significant predictor of apathetic manifestations. In addition, the mediation analyses revealed that multitasking performance mediated the relationships between verbal episodic memory and lack of initiative/interest, whereas executive and attentional functions were only indirectly related to lack of initiative/interest due to their significant impacts on multitasking. These results shed new light on the aetiology of apathetic manifestations in patients with TBI, indicating how specific cognitive deficits are expressed in real‐life multitasking, and consequently, how they may lead to the development and/or maintenance of apathetic manifestations.     

Is there a trade-off between cognitive and motor recovery after traumatic brain injury due to competition for limited neural resources?

The status of neurorehabilitation for traumatic brain injury (TBI) is under active debate because of a dearth of research findings demonstrating effectiveness. This may be due, in part, to limitations in our understanding of basic mechanisms of cognitive and motor recovery,including those that might impede recovery. In this regard, we examined whether overall recovery following TBI might be undermined by competition between cognitive and motor functions for finite neural resources during recovery. In this preliminary study, 21 moderately and severely impaired patients were administered cognitive and motor assessments at 1, 4, and 12 months post-TBI, and recovery of cognitive and motor functions was measured using regression residuals. Negative correlations between recovery of cognitive versus motor functions were used as the index of competition. We found suggestive evidence that there may indeed be a trade-off between the recovery of cognitive and motor functions after TBI. Implications for rehabilitation are discussed.     

Attention After Pediatric Traumatic Brain Injury: A Multidimensional Assessment

Attentional disturbance is a common complaint after TBI in children and adolescents, however, few studies have assessed post-traumatic attentional functions. The attentional constructs proposed by Mirsky, Anthony, Duncan, Ahearn, and Kellam (1991) provided a multidimensional framework for prospective assessment of late attentional disturbance after mild-moderate (n = 34) and severe (n = 57) traumatic brain injury (TBI). Attention was evaluated from 5 to 8 years after TBI in children ages 0 to 15 years at the time of injury. Children with severe TBI performed more poorly than children with mild-moderate TBI on tests comprising the focus/execute and shift constructs. Younger children scored below older children irrespective of injury severity on the Digit Span subtest and interstimulus interval scores from an adaptive rate continuous performance test reflecting the encode and sustain constructs of Mirsky et al. (1991). Age × Severity interaction effects were found for speeded perceptual-motor tests; scores were reduced following mild-moderate and severe TBI in younger children and following severe TBI in older patients. Results are discussed in terms of the vulnerability of skills in a rapid stage of development to disruption by acquired brain injury.     

Reward anticipation enhances brain activation during response inhibition

The chance to achieve a reward starts up the required neurobehavioral mechanisms to adapt our thoughts and actions in order to accomplish our objective. However, reward does not equally reinforce everybody but depends on interindividual motivational dispositions. Thus, immediate reward contingencies can modulate the cognitive process required for goal achievement, while individual differences in personality can affect this modulation. We aimed to test the interaction between inhibition-related brain response and motivational processing in a stop signal task by reward anticipation and whether individual differences in sensitivity to reward (SR) modulate such interaction. We analyzed the cognitive–motivational interaction between the brain pattern activation of the regions involved in correct and incorrect response inhibition and the association between such brain activations and SR scores. We also analyzed the behavioral effects of reward on both reaction times for the “go” trials before and after correct and incorrect inhibition in order to test error prediction performance and postinhibition adjustment. Our results show enhanced activation during response inhibition under reward contingencies in frontal, parietal, and subcortical areas. Moreover, activation of the right insula and the left putamen positively correlates with the SR scores. Finally, the possibility of reward outcome affects not only response inhibition performance (e.g., reducing stop signal reaction time), but also error prediction performance and postinhibition adjustment. Therefore, reward contingencies improve behavioral performance and enhance brain activation during response inhibition, and SR is related to brain activation. Our results suggest the conditions and factors that subserve cognitive control strategies in cognitive motivational interactions during response inhibition.     

A review of social disinhibition after traumatic brain injury

Acquired social disinhibition refers to a debilitating behavioural syndrome commonly reported after a severe traumatic brain injury (TBI) and is characterized by inappropriate social behaviour, often described as immaturity and insensitivity towards others. These behaviours can have enduring effects on the social capability of the individual and their relationships with others. However, research into socially disinhibited behaviour after TBI has been thwarted by a lack of consensus in the literature on definition and measurement. This review provides an overview of our current understanding of the definition, measurement, prevalence, associated outcomes, neuropathology, and underlying mechanisms of social disinhibition after TBI. In addition, suggestions are made for future research to further our understanding of this syndrome with the eventual aim of rehabilitating problematic behaviours. It is concluded that an improved understanding of what causes disinhibited behaviour after TBI will be necessary for the development of effective treatment strategies aimed at the rehabilitation of underlying impairments.     

Local and global effects of motivation on cognitive control

Motivation has been found to enhance cognitive control, but the mechanisms by which this occurs are still poorly understood. Cued motivational incentives (e.g., monetary rewards) can modulate cognitive processing locally??that is, on a trial-by-trial basis (incentive cue effect). Recently, motivational incentives have also been found to produce more global and tonic changes in performance, as evidenced by performance benefits on nonincentive trials occurring within incentive blocks (incentive context effect). In two experiments involving incentivized cued task switching, we provide systematic evidence that the two effects are dissociable. Through behavioral, diffusion-modeling, and individual-differences analyses, we found dissociations between local and global motivational effects that were linked to specific properties of the incentive signals (i.e., timing), while also ruling out alternative interpretations (e.g., practice and speed??accuracy trade-off effects). These results provide important clues regarding the neural mechanisms by which motivation exerts both global and local influences on cognitive control.     

Assessment of apathy in neurological patients using the Apathy Motivation Index caregiver version

Apathy is a common, disabling neuropsychiatric syndrome that occurs across many brain disorders and may be associated with diminished motivation in behavioural, cognitive, emotional and social domains. Assessment is complicated by the variability of symptoms across apathy domains and self-report from patients, which can be misleading due to their lack of insight. Independent evaluation by clinicians also has limitations though if it has to be performed with limited time. Caregiver reports are a viable alternative, but current assessments for them either do not distinguish between different apathy domains or are interview-based and take long to administer. In this study, we developed a brief caregiver questionnaire version of the recently developed Apathy Motivation Index (AMI), which is a self-report tool. We confirmed three apathy factors in this new caregiver measure (AMI-CG) that were also present in the AMI: Behavioural Activation, Emotional Sensitivity and Social Motivation. Furthermore, we validated the scores against more extensive caregiver interviews using the established Lillle apathy rating scale as well as patient self-reports of apathy, measures of depression, anhedonia, cognition, activities of daily living and caregiver burden across four different neurological conditions: Parkinson's disease, Alzheimer's disease, subjective cognitive impairment and limbic encephalitis. The AMI-CG showed good internal reliability, external validity and diagnostic accuracy. It also uncovered cases of social apathy overlooked by traditional instruments. Crucially, patients who under-rated their apathy compared to informants were more likely to have difficulties performing everyday activities and to be a greater burden to caregivers. The findings provide evidence for a multidimensional conceptualization of apathy and an instrument for efficient detection of apathy based on caregiver reports for use in clinical practice.     

空间导航的脑网络基础和调控机制

空间导航在生活中时刻发生,空间能力衰退是阿尔兹海默症的重要早期表现。早期关于空间导航神经机制的研究主要关注单个脑区的特异性功能,但这些脑区如何交互以整合不同模态的信息支持复杂导航行为尚不清楚。脑成像技术、脑网络建模方法和神经调控手段的发展,为在脑网络水平理解人类空间导航的认知神经机制提供了重要研究手段。本研究试图融合空间导航认知神经机制研究的最新进展,借助脑网络建模、大数据分析、微电流刺激等前沿研究手段,研究空间导航脑网络的关键拓扑属性特征(如模块化、核心节点等),探寻该功能特异性神经网络的重要影响因素和调控机制,并构建空间导航的脑网络理论模型。研究成果将有利于理解人类复杂导航行为的脑网络基础,为阿尔兹海默症等相关认知障碍脑疾病的筛查和诊断提供重要参考。     

Effects and mechanisms of working memory training: a review

Can cognitive abilities such as reasoning be improved through working memory training? This question is still highly controversial, with prior studies providing contradictory findings. The lack of theory-driven, systematic approaches and (occasionally serious) methodological shortcomings complicates this debate even more. This review suggests two general mechanisms mediating transfer effects that are (or are not) observed after working memory training: enhanced working memory capacity, enabling people to hold more items in working memory than before training, or enhanced efficiency using the working memory capacity available (e.g., using chunking strategies to remember more items correctly). We then highlight multiple factors that could influence these mechanisms of transfer and thus the success of training interventions. These factors include (1) the nature of the training regime (i.e., intensity, duration, and adaptivity of the training tasks) and, with it, the magnitude of improvements during training, and (2) individual differences in age, cognitive abilities, biological factors, and motivational and personality factors. Finally, we summarize the findings revealed by existing training studies for each of these factors, and thereby present a roadmap for accumulating further empirical evidence regarding the efficacy of working memory training in a systematic way.     

An integrative analysis of intrinsic and extrinsic motivation in sport

Abstract

The purpose of this paper is to propose a motivational sequence that integrates much of the intrinsic and extrinsic motivation literature in sport. The proposed motivational sequence: “Social Factors → Psychological Mediators → Types of Motivation → Consequences” is in line with self-determination theory (Deci & Ryan. 1985. 1991) and the Hierarchical model of intrinsic and extrinsic motivation (Vallerand, 1997). Using the sequence, it is first shown that the motivational impact of social factors inherent in sport, such as competition/cooperation, success/failure, and coaches' behaviors toward athletes, takes place through their influence on athletes' perceptions of autonomy, competence, and relatedness (i.e., the psychological mediators). Second, recent results are provided with respect to a new multidimensional measure (i.e., the Sport Motivation Scale; Pelletier et al., 1995) to assess the different types of athletes' motives. Third, we review findings that suggest that such sport motives lead to various consequences for the athlete e.g.     

The effects of stereotype activation on behavior: a review of possible mechanisms.

Considerable recent research has examined the effects that activated stereotypes have on behavior. Research on both self-stereotype activation and other-stereotype activation has tended to show that people behave in ways consistent with the stereotype (e.g., walking more slowly if the elderly stereotype is activated). Interestingly, however, the dominant account for the behavioral effects of self-stereotype activation involves a hot motivational factor (i.e., stereotype threat), whereas the dominant account for the behavioral effects of other-stereotype activation focuses on a rather cold cognitive explanation (i.e., ideomotor processes). The current review compares and contrasts the behavioral research on self- and other-stereotype activation and concludes that both motivational and cognitive explanations might account for effects in each domain.     

An attempt towards differentiating attentional deficits in traumatic brain injury

Attentional deficits in patients suffering traumatic brain injury (TBI) can occur with minor to severe impact to the brain. Based on reviews of both the cognitive and neurobehavioral literature, the following three concepts of attention are addressed: (a) arousal/alertness, (b) selective attention, and (c) energetic aspects of attention, which include such components as effort, resource allocation, and speed of processing. Within each concept, definitions are proposed, the underlying brain mechanisms are identified, and the specific deficits associated with TBI are explored. This review combines theoretical perspectives and clinical findings with the objective of leading toward a diagnostic differentiation that in turn will benefit treatment planning.     

Cognitive Sequelae of Blast-Induced Traumatic Brain Injury: Recovery and Rehabilitation

Blast-related traumatic brain injury (bTBI) poses a significant concern for military personnel engaged in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Given the highly stressful context in which such injury occurs, psychiatric comorbidities are common. This paper provides an overview of mild bTBI and discusses the cognitive sequelae and course of recovery typical of mild TBI (mTBI). Complicating factors that arise in the context of co-morbid posttraumatic stress disorder (PTSD) are considered with regard to diagnosis and treatment. Relatively few studies have evaluated the efficacy of cognitive rehabilitation in civilian mTBI, but we discuss cognitive training approaches that hold promise for addressing mild impairments in executive function and memory, akin to those seen in OEF/OIF veterans with bTBI and PTSD. Further research is needed to address the patient and environmental characteristics associated with optimal treatment outcome.     

Cerebral palsy in very preterm infants: new epidemiological insights

The focus of this review is on new insights from recent epidemiological research on cerebral palsy in preterm infants. These include: 1) a better understanding of issues related to diagnosis and classification; 2) new information about the brain abnormalities underlying cerebral palsy in preterm infants; and 3) a better understanding of biological mechanisms that may underlie previously described epidemiological associations. Ongoing efforts to improve the diagnosis and classification of cerebral palsy have been enhanced by findings from serial examinations of cohorts of very preterm infants. Cranial ultrasonography through the anterior fontanelle of very preterm infants has provided information about grossly evident brain damage, found in about one-half of preterm infants who develop cerebral palsy. Insights into the pathophysiologic basis for certain epidemiologic associations have come from studies of experimental brain damage in animals and clinical studies of neurologic disorders in adults. Much of the current epidemiological research into the causes of cerebral palsy in preterm infants has focused on two potential mechanisms of brain damage. One mechanism involves insufficient cerebral perfusion; the other, cytokine-mediated damage, potentially triggered by events such as maternal infection (e.g., intrauterine or periodontal infection), neonatal infection (e.g., sepsis and necrotizing enterocolitis), and neonatal oxygen- or ventilator-induced lung injury. In addition to the preterm infant's increased exposure to such damaging factors, the high frequency of cerebral palsy in these infants might be due, in part, to insufficient levels of developmentally regulated protective substances, such as thyroid hormone and glucocorticoids. Models of causation currently are being investigated using recently developed methods for quantifying, with small quantities of blood, biomolecules that are suspected to either promote or protect against brain damage in the neonate. Clinical investigations now under way can be expected to identify strategies to be tested in clinical trials that could lower the risk of cerebral palsy in very preterm infants.     

Treatment readiness in violent offenders: The influence of cognitive factors on engagement in violence programs

Advances in offender rehabilitation theory have led to the development of a clear framework of the factors that need consideration for an offender to be ready for therapy and thus gain maximum benefits. Here, we examine in greater detail the role of cognition in readiness for rehabilitation in violent offenders. We assess how cognitive processes and distortions common in violent offenders may affect and hamper rehabilitation readiness. Methods for remediation of cognitive factors that diminish readiness, including motivational interviewing, are discussed. We conclude that cognitive factors are critical in the assessment of readiness in violent offenders and therapeutic efforts to enhance engagement.     

Imitation: definitions, evidence, and mechanisms

Imitation can be defined as the copying of behavior. To a biologist, interest in imitation is focused on its adaptive value for the survival of the organism, but to a psychologist, the mechanisms responsible for imitation are the most interesting. For psychologists, the most important cases of imitation are those that involve demonstrated behavior that the imitator cannot see when it performs the behavior (e.g., scratching one's head). Such examples of imitation are sometimes referred to as opaque imitation because they are difficult to account for without positing cognitive mechanisms, such as perspective taking, that most animals have not been acknowledged to have. The present review first identifies various forms of social influence and social learning that do not qualify as opaque imitation, including species-typical mechanisms (e.g., mimicry and contagion), motivational mechanisms (e.g., social facilitation, incentive motivation, transfer of fear), attentional mechanisms (e.g., local enhancement, stimulus enhancement), imprinting, following, observational conditioning, and learning how the environment works (affordance learning). It then presents evidence for different forms of opaque imitation in animals, and identifies characteristics of human imitation that have been proposed to distinguish it from animal imitation. Finally, it examines the role played in opaque imitation by demonstrator reinforcement and observer motivation. Although accounts of imitation have been proposed that vary in their level of analysis from neural to cognitive, at present no theory of imitation appears to be adequate to account for the varied results that have been found.     

Functional Neuroimaging Studies of Cognitive Recovery After Acquired Brain Damage in Adults

The first two decades of cognitive neuroimaging research have provided a constant increase of the knowledge about the neural organization of cognitive processes. Many cognitive functions (e.g.working memory) can now be associated with particular neural structures, and ongoing research promises to clarify this picture further, providing a new mapping between cognitive and neural function. The main goal of this paper is to outline conceptual issues that are particularly important in the context of imaging changes in neural function through recovery process. This review focuses primarily on studies made in stroke and traumatic brain injury patients, but most of the issues raised here are also relevant to studies using other acquired brain damages. Finally, we summarize aset of methodological issues related to functional neuroimaging that are relevant for the study ofneural plasticity and recovery after rehabilitation. Deceased