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.     

STIMULUS FADING AS TREATMENT FOR OBSCENITY IN A BRAIN-INJURED ADULT

Obscene verbalizations of a person with traumatic brain injury were treated using stimulus fading as the singular form of intervention. Results of a functional assessment revealed that obscenity was maintained by negative reinforcement. Stimulus fading (initial elimination of instructional demands followed by their gradual reintroduction) produced immediate and substantial reductions in obscenity that were maintained as the frequency of demands increased to baseline levels. Potential applications of the use of antecedent treatment strategies are discussed.     

A GROUP-ORIENTED CONTINGENCY TO INCREASE LEISURE ACTIVITIES OF ADULTS WITH TRAUMATIC BRAIN INJURY

An interdependent group-oriented contingency and graphic feedback were used to increase the activity levels of residents of a group home for persons with traumatic brain injury. Results showed that the intervention was effective for 4 of the 6 subjects. Individual performances must be examined when implementing group contingencies because all subjects may not respond.     

Cognitive deficits related to major organ failure: The potential role of neuropsychological testing

Until recently, little attention has been paid to the possibility of cognitive deficits in patients with disease or failure of major organs such as the liver, kidney, or heart. However, there is a growing awareness that major organ failure often has neuropsychological sequelae. These sequelae may at times be quite subtle and not detectable under gross. examination. Nevertheless, even subtle deficits may have a major impact on adherence to medical regimens, psychosocial adjustment, and quality of life of patients. Neuropsychological assessment has a potentially valuable role to play both in research and in clinical work. It can be useful in adding to our knowledge of the cognitive effects of various types, severity and duration of major organ disease, as well as sequelae associated with treatment. It also is a potentially valuable clinical tool for identifying cognitive deficits that will affect the quality of life and probability of survival for organ failure patients.     

EMPIRICALLY DERIVED INJURY PREVENTION RULES

This study describes a set of empirically derived safety rules that if followed, would have prevented the occurrence of minor injuries. Epidemiologists have criticized behavioral interventions as increasing “safe” behavior but failing to demonstrate a decrease in injury. The present study documents retrospectively the link between safe behavior and injury. It demonstrates that these empirically derived rules are very similar to rules for the prevention of serious injury. The study also shows that these rules are not widely accepted and implemented by parents. Suggestions for future research in this area are advanced.     

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.     

Reducing risk of head injury in youth soccer: An extension of behavioral skills training for heading

Recently, concerns regarding sport-related concussions have increased within the research literature, the media, and popular culture. One potential source of soccer-related concussions involves the purposeful striking of the ball with one's head (i.e., heading). There is currently limited research on an effective teaching method to improve safe heading technique. In the current study, Behavior Skills Training (BST) was evaluated as a method to teach correct heading techniques to youth soccer players. BST increased the percentage of correct steps for each player based on a task analysis of heading. Based on social validity questionnaires administered to players and the coach, BST was rated as an acceptable form of training. After the final training session, experienced coaches rated each player as having improved from baseline to training.     

The effects of video feedback on running form

Correct running form is important for injury prevention; as such, correct form promotes continued engagement in running as a long-term form of exercise. Researchers have shown video feedback to be an effective strategy to improve athletic form for a variety of sports, but it has not been evaluated in any behavior analytic research as a method for improving running form. The purpose of this study is to evaluate the effectiveness of video feedback to improve running form for regular runners. During baseline, each participant was video recorded while running without any feedback (verbal or video). During intervention, the researcher recorded the participant, then showed them the video and provided feedback on correct or incorrect form, according to a 9-step task analysis. Results show that all three participants achieved 100% correct steps on the task analysis when video feedback was used to maintain their form during follow-up.     

活体肝移植的伦理学问题

目前,肝移植已成为治疗终末期肝病的有效手段,活体肝移植术部分解决了供肝短缺的问题,10多年来其发展迅速,并取得了良好的疗效,由于活体肝移植需从活的供体身上切取部分肝脏,且供体多为患者家属,故存在着供体的选择,供体的贡献与代价,患者的家庭,心理,社会等伦理等问题。因此在提高活体肝移植技术水平的同时,必须充分考虑活体肝移植的伦理学问题,遵守伦理原则,使活体肝移植不但能从技术上达到,在伦理学方面也是可行的。     

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.