BEHAVIORAL TREATMENT FOR PATHOLOGICAL GAMBLING IN PERSONS WITH ACQUIRED BRAIN INJURY

The present investigation examined a behavior‐analytic clinical treatment package designed to reduce the pathological gambling of 3 individuals with acquired brain injury. A prior history of pathological gambling of each patient was assessed via caregiver report, psychological testing, and direct observation of gambling behavior. Using an 8‐week one‐on‐one client—patient format, a treatment program was developed in which the patient learned about the antecedents, consequences, and motivating operations that controlled the emission of gambling behavior. Data were collected on both self‐report of gambling urges and behavior following therapy and during in situ gambling opportunities. The therapy program reduced urges to gamble and actual gambling for all patients. The potential of behavior‐analytic therapy for reducing the pathological gambling of patients with and without brain injury is discussed.     

Attention Bias for Threatening Information in Children Following a Distressing Medical Procedure

Attention bias is common in adults with post‐traumatic stress disorder (PTSD) but is less studied in children. Children (n = 22) who experienced a potentially distressing procedure in an outpatient clinic (removal of K‐wires from orthopaedic fractures) and a group of medically unwell children (illness group; n = 27) were compared with healthy controls (n = 32). Children's baseline level of PTS symptoms were indexed prior to the medical procedure, and again at 1‐week follow‐up. Immediately after the K‐wire removal, children completed a dot probe task using two categories of target words (medical threatening and emotionally threatening). While K‐wire children showed an overall bias away from negative words relative to healthy controls, the illness group did not significantly differ from healthy controls. Attention bias in K‐wire and illness groups was unrelated to later PTS symptoms.     

肝血管瘤外科治疗方案的选择

肝海绵状血管瘤是肝脏最常见的良性肿瘤,一直以来,手术切除是其治疗的首选方法,但手术指征存在着很大争议,近年来,腹腔镜的广泛使用使手术指征有放宽的趋势。而介入治疗的发展为肝海绵状血管瘤的治疗提供了新的、更具有优势的选择。通过运用治疗方法决策的利弊论,站在使患者利益最大化的角度分析两种方法的利弊,选择合适的治疗方法对,临床工作具有重要意义,通过对比,笔者认为介入治疗应成为肝海绵状血管瘤的首选治疗方法。但对于每一个患者个体必须充分考虑其生理、心理、社会方面的特殊性,运用矛盾的普遍性和特殊性原理,选择恰当的方法。     

Time perception in severe traumatic brain injury patients: A study comparing different methodologies

In this study, we investigated time perception in patients with traumatic brain injury (TBI). Fifteen TBI patients and 15 matched healthy controls participated in the study. Participants were tested with durations above and below 1 s on three different temporal tasks that involved time reproduction, production, and discrimination tasks. Data variables analyzed included amount of errors, relative errors, and coefficient of variation. Both groups completed a neuropsychological battery that included measures of attention, working memory, and executive functions. Results revealed significant differences between groups on the time reproduction and discrimination tasks, whereas groups showed similar performance on the time production task. Correlation analyses showed involvement of attention, working memory and executive functions on the time reproduction and time discrimination tasks, but there was no involvement on the time production task. These findings suggest that TBI does not impact specific temporal function. Rather, impairments in attention, working memory and executive function abilities may explain lower temporal performance in people with TBI.     

Regional cortical volume and cognitive functioning following traumatic brain injury

There has been limited examination of the effect of brain pathology on subsequent function. The current study examined the relationships between regional variation in grey matter volume, age and cognitive impairment using a semi-automated image analysis tool. This study included 69 individuals with mild-to-severe TBI, 41 of whom also completed neuropsychological tests of attention, working memory, processing speed, memory and executive functions. A widespread reduction in grey matter volume was associated with increasing age. Regional volumes that were affected also related to the severity of injury, whereby the most severe TBI participants displayed the most significant pathology. Poorer retention of newly learned material was associated with reduced cortical volume in frontal, parietal, and occipital brain regions. In addition, poorer working memory and executive control performance was found for individuals with lower cortical volume in temporal, parietal, and occipital regions. These findings are largely in line with previous literature, which suggests that frontal, temporal, and parietal regions are integral for the encoding of memories into long-term storage, memory retrieval, and working memory. The present study suggests that automated image analysis methods may be used to explore the relationships between regional variation in grey matter volume and cognitive function following TBI.     

舒芬太尼和七氟烷不同剂量组合对创伤患者心肌损伤的协同保护作用

创伤失血性休克患者在接受液体复苏和输血治疗时,由于再灌注可导致心肌和心脏功能进一步受损.在再灌注前应积极采取临床措施以保护心脏.阿片类药物和吸入麻醉药物后处理对创伤失血性休克患者心肌缺血-再灌注损伤具有良好的保护作用.此研究中,笔者将不同剂量的舒芬太尼和七氟烷联合应用,通过对患者心肌酶检测相比较,发现两种药物组对后处理是否对失血性休克患者心肌缺血-再灌注损伤具有协同保护作用.     

Ethical considerations in the management of military related concussion

Since the year 2000 over 300,000 military service members have been diagnosed with mild traumatic brain injury/concussion. Consequently, this injury has become the subject of increased awareness and study within the military healthcare environment. Although single and/or isolated concussions typically heal in a relatively rapid fashion with limited to no long-term sequelae, there is debate in the field about the impact of repeat concussion. To this end, various ethical challenges arise when managing patients with such injuries. Several papers outlining these issues with regard to athletes have been published in the sports medicine literature. However, because providers caring for military service members must make return-to-duty-decisions, practice within the military setting results in a number of unique ethical considerations. More specifically, management of service members with a history of repeat concussion and increasingly complicated recoveries, as well as the potential for premature return-to-duty are topics of concern for military health care providers. Using the American Psychological Association ethical principles and standards, the current article outlines various ethical challenges to concussion management in the military setting. The ethical principles of Beneficence and Nonmaleficence and Respect for People’s Rights and Dignity, as well as the 3 related ethical standards of Competence, Avoiding Harm, and Conflict of Interest are discussed. Policy changes are highlighted as a proximal solution to these ethical challenges.     

Depressive Symptomatology Mediates Associations With Community Reintegration in Veterans With TBI

Community reintegration (CR) is a challenge for military veterans with traumatic brain injury (TBI). Posttraumatic stress disorder (PTSD), depression, bodily pain, and limitations in physical functioning—common comorbidities with TBI in veterans—have all been associated with problems in CR, but their interrelationships are unclear. The role of depression as a possible mediator of effects on CR has not been examined. We tested depressive symptoms as a possible mediator of CR’s associations with physical limitations, PTSD, and bodily pain. This cross-sectional study used baseline data from a larger randomized controlled trial that evaluated the impact of an in-home intervention for veterans with TBI and their families. Eighty-three military veterans with TBI recruited from a medical rehabilitation service at an urban U.S. Department of Veterans Affairs medical center participated in the study. Interview instruments measured CR, depressive symptoms, physical limitations (limitations in physical functioning), bodily pain, quality of the relationship with key family members, and sociodemographic characteristics. PTSD was determined through review of the electronic medical record. Interview data were collected in veterans’ homes. Depressive symptoms totally mediated the association between physical limitations and CR and the association between PTSD and CR. The bodily pain–CR association was not significant after quality of relationship had been entered into the regression models. Findings suggest that interventions to increase CR of veterans with TBI should address depression, a treatable condition. Replication of our mediation findings in larger veteran and civilian samples with TBI is needed.     

Applying a traumatic stress approach to understanding PCS following pediatric mild TBI

Pediatric traumatic brain injury is a significant public health concern affecting hundreds of thousands of children each year. The majority of children who sustain traumatic brain injuries are classified as having a mild traumatic brain injury, and a subset of these children go on to experience persistent physical, cognitive, and emotional symptoms. These symptoms, known as postconcussive symptoms, can endure for months and even years after injury. The outcomes of mild traumatic brain injury are variable and not well understood for a small percentage of children who experience persistent symptoms. The current article explores the potential influence of children’s posttraumatic stress symptoms on persistent postconcussive symptoms. Despite the high incidence of posttraumatic stress symptoms after pediatric accidental injury, they have not yet been identified as an important factor for consideration in the understanding of pediatric postconcussive outcomes. The article will review the literature on posttraumatic stress and postconcussive symptoms after pediatric injury and consider neurobiological and cognitive factors to propose a model explaining a pathway through which posttraumatic stress reactions may serve as the mechanism for the expression and maintenance of postconcussive symptoms after mild traumatic brain injury. The clinical implications for the proposed relationship between posttraumatic stress symptoms and postconcussive symptoms are considered prior to the conclusion of the article, which acknowledges limitations in the current literature and provides suggestions for future research.     

Using a Computer as an Environmental Facilitator to Promote Post-Head Injury Social Role Resumption

Abstract

The purpose of this case study was to determine if an adult man with traumatic brain injury could use a computer as an environmental facilitator to assume adult social roles post-injury. The participant received four months of intervention in which (a) modifications to the computer's internal system, monitor, and keyboard were made, (b) the participant received instruction in adapted word processing and e-mail packages, and (c) the participant was provided with computer-related activities that were designed to enhance his participation in desired social roles. Participant observation and qualitative interview methods were used as data collection and analysis processes. As a result of his participation in the intervention, the participant was able to (a) re-establish his roles as a brother and an adult son, (b) develop and maintain an extended family of others beyond his family of origin, and (c) create a more satisfying adult work role that has brought greater meaning to his post-injury life.