Gender Differences in Cognitive and Emotional Adjustment to Traumatic Brain Injury

This study examined gender differences in cognitive and emotional status after traumatic brain injury (TBI) among 262 men and 140 women with TBI referred for neuropsychological evaluations. In this cross-sectional study, cognition was measured in terms of both absolute level of functioning (i.e., raw/standard scores) and estimated decline from premorbid levels expressed as z-deficit scores in the following domains: intelligence [Wechsler Adult Intelligence Scale—Revised (WAIS-R)], memory and attention [Wechsler Memory Scale—Revised (WMS-R)], processing speed (Trails A), and cognitive flexibility (Trails B). Emotional functioning was measured in terms of depression (Beck Depression Inventory) and general emotional distress (Brief Symptom Inventory). Kruskal–Wallis nonparametric one-way ANOVAs indicated that women and men differed significantly on 2 of 8 raw/standard cognitive scores [men demonstrated lower WMS-R General Memory (p < .05) and Trails B scores (p < .0001) and 4 of 8 relative decline scores [women demonstrated more estimated change in VIQ (Verbal IQ) [p < .0001], FSIQ (Full Scale IQ) [p < .01], and Attention (p < .01)]; men demonstrated greater estimated z-decline scores on Trails B (p < .01)]. Women reported significantly higher levels of depression (p < .01), but men endorsed significantly greater general psychological distress (p < .05). Research and assessment recommendations are suggested.     

Long‐Term Outcomes of Traumatic Brain Injury in Early Childhood

Mild traumatic brain injury (mTBI) is a leading cause of injury among children, with approximately 15% of children experiencing a TBI prior to 15 years of age. Acutely, mTBI has been associated with a range of cognitive, physical, emotional and behavioural impairments. However, few studies have examined outcomes beyond five years post injury, long before the developmental process is complete and the full extent of any deficits may manifest. Our group had the unique opportunity to use data from a longitudinal birth cohort of 1265 children (Christchurch Health and Development Study) to examine the long term outcomes of early injury (0–5 years). Information about these children, including mTBI events, had been collected at birth, 4 months and at yearly intervals until age 16, and again at ages 18, 21 and 25 years. We found that even after statistical control for a wide range of child and family confounds, children who had been hospitalized for an mTBI had increased inattention/hyperactivity and conduct as rated by mothers and teachers over ages 7–13 years. Increased rates of psychiatric disorders were over 14–16 years for those injured in the preschool, including symptoms consistent with Attention Deficit/Hyperactivity Disorder (ADHD), Odds Ratio = 4.6, Conduct Disorder (CD), Odds Ratio = 5.6 and Substance Abuse (Odds Ratio = 9.1). Over ages 21–25 ongoing behaviour problems were assessed using self‐reported arrests, violent offenses and property offenses. Compared to non‐injured individuals, mTBI groups were more likely to be arrested, involved in property, and violent offences. We controlled for a wide range of factors and there was still clear evidence of ongoing problems for individuals who had experienced a mTBI compared to their non injured counterparts. These findings provide compelling evidence of long term psychosocial and psychiatric outcomes following mTBI.     

Depression After Mild Traumatic Brain Injury: A Review of Current Research

Research pertaining to the occurrence of depression and/or depression symptomatology after a Mild Traumatic Brain Injury (MTBI) was reviewed. We found that methodological differences such as the criteria used to assess MTBI and depression, time that elapsed since brain injury, and control group variations confounded comparisons across studies. Nevertheless, the studies are consistent with at least a 35% prevalence of, and left frontal damage with depression after MTBI, an overlap of symptoms of depression and Postconcussion Syndrome (PCS), and indicate that depression can continue for many years following the injury. Our conclusion is that MTBI is the triggering event for a set of pathophysiological changes and a concomitant depressive episode in a vulnerable subset of the population. Due to a paucity of research, it cannot be definitively concluded that the underlying substrates of depression seen after MTBI and clinical depression are the same. Implications for future investigations are discussed.     

亚低温在重型颅脑损伤患者救治中的应用与思考

重型颅脑损伤是致死、致残的主要原因之一。亚低温（MHT）的应用为重型颅脑损伤患者的救治提供了新的思路和方法,国内外多个临床试验证实了其在救治中的有效性和实用性。本文结合国内外相关诊疗指南、循证医学证据和文献,辩证探讨了MHT在重型颅脑损伤患者救治中的适应证及机制、操作方法及时间窗、并发症及临床决策问题。     

重型颅脑损伤围术期亚低温治疗路径——循证医学指导下的治疗抉择

早期动物实验研究表明亚低温能减轻脑损伤后的继发性损害,促进神经功能恢复,然而对其临床疗效不同研究结果不完全一致。本文应用循证医学思想,检索和评价国内外文献,为重型颅脑损伤患者制定了围术期亚低温实施方案。随访结果表明,亚低温可改善患者预后。     

Depression Following Traumatic Brain Injury: The Validity of the CES-D as a Brief Screening Device

The validity, reliability, and factor structure of the Center for Epidemiological Studies-Depression Scale (CES-D) was examined with 253 patients seen for neuropsychological evaluation following traumatic brain injury (TBI). All patients completed the CES-D; 31 also completed the Beck Depression Inventory (BDI) and 17 completed the Minnesota Multiphasic Personality Inventory-II (MMPI-II). The CES-D demonstrated good concurrent, construct validity, significantly correlating with the BDI (r = .673, p < .0001) and the MMPI-II (Depression Scale T score r = .536, p = .027). The CES-D also demonstrated good internal consistency (coefficient alpha = .8195) and split-half reliability (Spearman–Brown r = .8284). Principal components factor analysis with varimax rotation resulted in a four-factor solution that accounted for 56.01% of the variance. The factor structure differed from the originally reported factor structure, and indicated that somatic difficulties were strongly associated with dysphoric affect in TBI patients. The CES-D is a valid and reliable screening instrument for use with TBI patients.     

Traumatic Brain Injury as a Risk Factor for Alzheimer's Disease: A Review

Accumulating epidemiological evidence implicates traumatic brain injury as a pathogenic agent in the development of Alzheimer's disease (AD). Considering the increase in the prevalence of both traumatic brain injury and AD in recent times, the possibility that brain trauma may provoke the early development of AD has important implications for health service planning, preventative efforts, and medico-legal compensation settlements. This paper evaluates the plausibility of the proposed link between traumatic brain injury and AD, largely by way of exploring a theoretical perspective advanced by Satz (1993) and considering recent contributions from the epidemiological, neuropathological, and biochemical literature that are pertinent to this issue. The literature reviewed provides sufficient support and empirical vindication to give credence to the proposed association between these two neuropsychological entities at the statistical, theoretical, and biological level.     

Women Living with Traumatic Brain Injury

Abstract

Women living with Traumatic Brain Injury (TBI) typically experience social and emotional sequelae that can be effectively addressed in the context of a psychotherapeutic relationship. Traumatic Brain Injuries can affect the full range of human functioning, from activities of daily living to experiencing a coherent sense of self. In this article, we focus on two issues, social isolation and emotional functioning, that encompass a number of key challenges facing women with TBI and are common and fruitful foci of psychotherapy. Social isolation includes marginalization in multiple communities, the invisibility of cognitive disabilities, difficulties in interpersonal relationships, and difficulties in employment and access to transportation. Emotional functioning includes posttraumatic stress symptoms, loss of self-esteem, anxiety, depression, anger, and shame. Two exemplary cases are used to illustrate the themes and underscore the complexities and realities of adjusting to TBI. Recommendations for therapists and consumers are woven throughout the paper.     

Adapting Cognitive Processing Therapy to Treat Co-Occurring Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: A Case Study

This case study aims to provide evidence for the effectiveness of adapting a particular manualized cognitive behavioral therapy intervention to treat co-occurring posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). This study presents the treatment of a woman who experienced co-occurring mTBI and PTSD following a motor vehicle accident, a dual diagnosis that was established through a flexible assessment approach involving interviews as well as standardized psychological, neuropsychological, and neurobehavioral testing. Treatment planning led to a-priori adaptation of Cognitive Processing Therapy (CPT) to treat both her PTSD symptoms and the sequelae associated with her mTBI. The therapist maintained fidelity to the manualized structure and content of CPT protocol, adapting portions of the treatment to add specific emphasis on issues of identity confusion and role loss in service of addressing these common functional impairments that can accompany mTBI. Discussion focuses on application of CPT for future treatment of comorbid PTSD and TBI amidst complicating factors, including role losses and medical and safety issues. This case study is especially relevant due to the prevalence of co-occurring PTSD and TBI across a variety of populations.     

Sports Media Representations of Concussions in the National Rugby League

Objective

Concussion is poorly understood by the general public who are regularly exposed to this type of injury via televised sports such as the National Rugby League (NRL). This study investigated media representations of concussion by examining the terminology used by the commentators during the 2010 and 2011 NRL seasons.

Method

Data was obtained through a surveillance design where commentary statements were recorded for each observable concussion.

Results

Dramatic terminology was the most frequently used followed by entertaining and humorous terminology. Commentators often portrayed the way the incident had occurred and the player's reaction to being concussed. However, information about a player sustaining an injury that required medical attention was rarely conveyed.

Conclusion

Media tend to trivialise concussion and this may have an impact on the public's knowledge of, and influence their response to, concussion.     

Depression After Traumatic Brain Injury: A Review of Evidence for Clinical Heterogeneity

Depression represents a major source of disability among individuals who have suffered a traumatic brain injury (TBI), with estimates of prevalence in this population ranging over 50%. In comparison with other sequelae of TBI, depression is often poorly conceptualized and treated among acute care and rehabilitation professionals. One reason for this is the lack of clear etiological models for the development of depression following TBI. This paper argues that post-TBI depression actually represents a heterogeneous category, with multiple etiologic pathways and clinical implications. The literature in this area is reviewed, with an emphasis on an appreciation of the diversity within this clinical population. Conclusions focus on suggestions for differential diagnosis and treatment options.     

Traumatic Brain Injury in School-Age Children Academic and Social Outcome

School-aged children with a traumatic brain injury (TBI) require extraordinary effort and energy from individuals in their school, home, and community. The purpose of this study was to examine the academic, behavioral, and social outcomes of a cohort of children and adolescents following TBI. A comprehensive assessment of cognitive functioning, achievement, and adaptive behavior was administered to 43 school-aged children 2 years after their TBI. Premorbid functioning for each participant was obtained from state-mandated test scores assessed prior to the TBI. The predictive utility of premorbid functioning, TBI severity, and age at injury were examined. Findings revealed that premorbid functions were significant predictors of reading and spelling achievement and adaptive functioning. Severity of injury was predictive of adaptive functioning. Implications of findings include program development, reintegration into school, and educating parents and teachers.     

Traumatic Brain Injury Outcome in Older Adults: A Critical Review of the Literature

This paper is a critical overview of the literature on older adults' outcome after traumatic brain injury (TBI). Eighteen outcome studies were reviewed. Results indicated that older patients demonstrated an increased risk for negative outcome following TBI when compared to younger patients with similar injury severity. Poorer outcome was characterized by higher mortality rates, decreased likelihood of returning to preinjury living arrangement, and declines in cognitive and affective functioning. In the studies reviewed, discharge destination, global outcome scales, and standardized neuropsychological tests were the primary measures of outcome from elderly TBI. Conceptual and methodological difficulties including variability in the definition of and inadequate measures of recovery from elderly TBI, inadequate control groups, and poor follow-up were discussed. Recommendations for future outcome research to increase uniformity in defining recovery in order to enhance comparability between studies and to tailor cognitive rehabilitation to the special needs of the older TBI patient were provided.     

128例重型颅脑损伤患者的临床治疗体会

探讨重型颅脑损伤的治疗方法与经验。观察128例重型颅脑损伤患者的脑部受伤情况,合并伤以及受伤到入院期间的病情变化。临床治愈113例,其中能生活自理者87例,留有后遗症者26例,死亡15例,病死率为11.72%。重型颅脑损伤病死率高,入院后重点合理的检查,积极有效的救治以及规范的康复护理是降低病死率、提高临床治愈率的关键。     

Neuroimaging Biomarkers in Mild Traumatic Brain Injury (mTBI)

Reviewed herein are contemporary neuroimaging methods that detect abnormalities associated with mild traumatic brain injury (mTBI). Despite advances in demonstrating underlying neuropathology in a subset of individuals who sustain mTBI, considerable disagreement persists in neuropsychology about mTBI outcome and metrics for evaluation. This review outlines a thesis for the select use of sensitive neuroimaging methods as potential biomarkers of brain injury recognizing that the majority of individuals who sustain an mTBI recover without neuroimaging signs or neuropsychological sequelae detected with methods currently applied. Magnetic resonance imaging (MRI) provides several measures that could serve as mTBI biomarkers including the detection of hemosiderin and white matter abnormalities, assessment of white matter integrity derived from diffusion tensor imaging (DTI), and quantitative measures that directly assess neuroanatomy. Improved prediction of neuropsychological outcomes in mTBI may be achieved with the use of targeted neuroimaging markers.     

Group Intervention Studies in the Cognitive Rehabilitation of Individuals with Traumatic Brain Injury: Challenges Faced by Researchers

There are many factors to consider in designing and interpreting group studies. These include both analytic considerations, such as the selection of valid and reliable outcome measures, and subjective considerations, such as the selection of outcomes that are perceived to be important to participants and researchers. In this paper, we review key issues to consider in the design of group studies in neurorehabilitation, using problem-solving studies in traumatic brain injury as an example.     

Agreement between Parents and Children on Ratings of Post-Concussive Symptoms Following Mild Traumatic Brain Injury

The level of parent-child agreement on post-concussive symptoms (PCS) was examined in children following mild traumatic brain injuries (TBI). As part of a larger longitudinal study, 186 children with mild TBI and 99 with orthopedic injuries (OI), from 8 to 15 years of age, were recruited prospectively. Parents and children completed the PCS Interview (PCS-I) and the Health and Behavior Inventory (HBI) at 2 weeks, 1 month, 3 months, and 12 months postinjury. Item-level correlations between child and parent ratings on both measures of PCS were significant but modest in both groups. Parent-child correlations for composite scales on the HBI and the total score on the PCS-I were significant in both groups, but somewhat higher in the OI group than in the mild TBI group. Mean symptom ratings tended to be significantly higher for children as compared to parents, especially for somatic symptoms. Parents and children display modest agreement when reporting PCS; their ratings correlate significantly, but children report higher mean levels of symptoms than parents.     

Resilience and Other Possible Outcomes After Mild Traumatic Brain Injury: a Systematic Review

The relation between resilience and mild traumatic brain injury (TBI) outcome has been theorized but empirical studies have been scarce. This systematic review aimed to describe the research in this area. Electronic databases (Medline, CINAHL, PsychINFO, SPORTdiscus, and PILOTS) were searched from inception to August 2015 for studies in which resilience was measured following TBI. The search terms included ‘TBI’ ‘concussion’ ‘postconcussion’ ‘resilience’ and ‘hardiness’. Inclusion criteria were peer reviewed original research reports published in English, human participants aged 18 years and over with brain injury, and an accepted definition of mild TBI. Hand searching of identified articles was also undertaken. Of the 71 studies identified, five studies were accepted for review. These studies were formally assessed for risk of bias by two independent reviewers. Each study carried a risk of bias, most commonly a detection bias, but none were excluded on this basis. A narrative interpretation of the findings was used because the studies reflected fundamental differences in the conceptualization of resilience. No studies employed a trajectory based approach to measure a resilient outcome. In most cases, the eligible studies assessed trait resilience with a scale and used it as a predictor of outcome (postconcussion symptoms). Three of these studies showed that greater trait resilience was associated with better mild TBI outcomes (fewer symptoms). Future research of the adult mild TBI response that predicts a resilient outcome is encouraged. These studies could yield empirical evidence for a resilient, and other possible mild TBI outcomes.     

脑损伤新生儿救治的选择

脑损伤是婴儿死亡、儿童残疾的主要原因之一。关于有严重脑损伤新生儿（包括脑瘫、智能精神发育落后等）是否该救治,牵涉到很多矛盾的思想观点。通过分析新生儿期脑损伤发生的高危因素,且提出相应的综合处置意见,认为要和谐地解决此矛盾,需要医院、家庭和社会有关部门的共同努力。     

Sawdust For Brains: Definition and Disconfirmation After Mild Traumatic Brain Injury

Abstract

Mild brain injury, despite its name, has lasting effects for many of its sufferers. This article is a firsthand account of one person's struggle with its onset and effects. Mot least of the symptoms is the sense of disconfirmalion and confusion that ensues because sufferers usually look “normal.” However, inside, their cognitive functioning and sense of self have changed markedly. Moreover, the effects often last longer than seem likely to medical professionals and laypeople alike, leading to evaluations of malingering or prior emotional distress. This first-person account is framed within the context of current literature on mild head injury.