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Ganesh A, Al-Shamli S, Mahadevan S, Chan MF, Burke DT, Al Rasadi K, Al Saadoon M, Al–Adawi S. The Frequency of Neuropsychiatric Sequelae After Traumatic Brain Injury in the Global South: A systematic review and meta-analysis. Sultan Qaboos Univ Med J 2024; 24:161-176. [PMID: 38828247 PMCID: PMC11139369 DOI: 10.18295/squmj.12.2023.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 06/05/2024] Open
Abstract
This study aimed to assess the prevalence of neuropsychiatric sequelae following traumatic brain injury (TBI) among the Western Asian, South Asian and African regions of the global south. All studies on psychiatric disturbances or cognitive impairment following TBI conducted (until August 2021) in the 83 countries that constitute the aforementioned regions were reviewed; 6 databases were selected for the literature search. After evaluating the articles using the Joanna Briggs Institute guidelines, the random effects model was used to estimate the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), TBI-related sleep disturbance (TBI-SD), obsessive-compulsive disorder (OCD) and cognitive impairment. Of 56 non-duplicated studies identified in the initial search, 27 were eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in 1,882 samples was 35.35%, that of anxiety in 1,211 samples was 28.64%, that of PTSD in 426 samples was 19.94%, that of OCD in 313 samples was 19.48%, that of TBI-SD in 562 samples was 26.67% and that of cognitive impairment in 941 samples was 49.10%. To date, this is the first critical review to examine the spectrum of post-TBI neuropsychiatric sequelae in the specified regions. Although existing studies lack homogeneous data due to variability in the diagnostic tools and outcome measures utilised, the reported prevalence rates are significant and comparable to statistics from the global north.
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Affiliation(s)
- Aishwarya Ganesh
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | - Sangeetha Mahadevan
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Moon Fai Chan
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - David T. Burke
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Khalid Al Rasadi
- Medical Research Center, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Muna Al Saadoon
- Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Samir Al–Adawi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Crumlish L, Wallace SJ, Copley A, Rose TA. Exploring the measurement of pediatric cognitive-communication disorders in traumatic brain injury research: A scoping review. Brain Inj 2022; 36:1207-1227. [PMID: 36303459 DOI: 10.1080/02699052.2022.2111026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To synthesize information about the constructs measured, measurement instruments used, and the timing of assessment of cognitive-communication disorders (CCDs) in pediatric traumatic brain injury (TBI) research. METHODS AND PROCEDURES Scoping review conducted in alignment with Arksey and O'Malley's five-stage methodological framework and reported per the PRISMA extension for Scoping Reviews. Inclusion criteria: (a) cohort description, case-control, and treatment studies; (b) participants with TBI aged 5-18 years; (c) communication or psychosocial outcomes; and (d) English full-text journal articles. The first author reviewed all titles, abstracts, and full-text articles; 10% were independently reviewed. OUTCOMES AND RESULTS Following screening, a total of 687 articles were included and 919 measurement instruments, measuring 2134 unique constructs, were extracted. The Child Behavior Checklist was the most used measurement instrument and 'Global Outcomes/Recovery' was the construct most frequently measured. The length of longitudinal monitoring ranged between ≤3 months and 16 years. CONCLUSIONS AND IMPLICATIONS We found considerable heterogeneity in the constructs measured, the measurement instruments used, and the timing of CCD assessment in pediatric TBI research. A consistent approach to measurement may support clinical decision-making and the efficient use of data beyond individual studies in systematic reviews and meta-analyses.
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Affiliation(s)
- Lauren Crumlish
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Queensland Aphasia Research Centre, Australia
| | - Anna Copley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Queensland Aphasia Research Centre, Australia
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Abstract
Executive functions (EFs) include high-order cognitive abilities such as working memory, inhibitory control, cognitive flexibility, planning, reasoning, and problem solving. EFs enable humans to achieve goals, adapt to novel everyday life situations, and manage social interactions. Traditionally EFs have been associated with frontal lobe functioning. More recent evidence shows that posterior and subcortical regions also play a crucial role in EF processing, especially in the integration of sensory information and emotion. This chapter reviews the variety of EFs and their neural underpinning, based on lesion mapping and neuroimaging studies, as well as the evidence for rehabilitation interventions, neuropsychological assessment based on standard and ecologically valid tests, development, and genetic predisposition for recovery of executive functions after brain injury. Taken together, the EFs are critical for unique human abilities and more careful analyses of their subcomponents may help the development of targeted translational interventions to improve them.
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Nolan A, Hennessy E, Krukowski K, Guglielmetti C, Chaumeil MM, Sohal VS, Rosi S. Repeated Mild Head Injury Leads to Wide-Ranging Deficits in Higher-Order Cognitive Functions Associated with the Prefrontal Cortex. J Neurotrauma 2018; 35:2425-2434. [PMID: 29732949 DOI: 10.1089/neu.2018.5731] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) has long been identified as a precipitating risk factor for higher-order cognitive deficits associated with the frontal and prefrontal cortices (PFC). In addition, mild repetitive TBI (rTBI), in particular, is being steadily recognized to increase the risk of neurodegenerative disease. Thus, further understanding of how mild rTBI changes the pathophysiology of the brain to lead to cognitive impairment is warranted. The current models of rTBI lack knowledge regarding chronic higher-order cognitive functions and the underlying neuronal physiology, especially functions involving the PFC. Here, we establish that five repeated mild hits, allowing rotational acceleration of the head, lead to chronic deficits in PFC-dependent functions such as social behavior, spatial working memory, and environmental response with concomitant microgliosis and a small decrease in the adaptation rate of layer V pyramidal neurons in the medial PFC (mPFC). However, structural damage is not seen on in vivo T2-weighted magnetic resonance imaging (MRI), and extensive intrinsic excitability changes in layer V pyramidal neurons of the mPFC are not observed. Thus, this rTBI animal model can recapitulate chronic higher-order cognitive impairments without structural damage on MR imaging as observed in humans.
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Affiliation(s)
- Amber Nolan
- 1 Brain and Spinal Injury Center, University of California , San Francisco, San Francisco, California.,2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California.,3 Department of Anatomic Pathology, University of California , San Francisco, San Francisco, California
| | - Edel Hennessy
- 1 Brain and Spinal Injury Center, University of California , San Francisco, San Francisco, California.,2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California
| | - Karen Krukowski
- 1 Brain and Spinal Injury Center, University of California , San Francisco, San Francisco, California.,2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California
| | - Caroline Guglielmetti
- 2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California.,4 Surbeck Laboratory of Advanced Imaging, Department of Radiology and Biomedical Imaging, University of California , San Francisco, San Francisco, California
| | - Myriam M Chaumeil
- 2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California.,4 Surbeck Laboratory of Advanced Imaging, Department of Radiology and Biomedical Imaging, University of California , San Francisco, San Francisco, California
| | - Vikaas S Sohal
- 5 Department of Psychiatry, University of California , San Francisco, San Francisco, California
| | - Susanna Rosi
- 1 Brain and Spinal Injury Center, University of California , San Francisco, San Francisco, California.,2 Department of Physical Therapy and Rehabilitation Science, University of California , San Francisco, San Francisco, California.,6 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California.,7 Weill Institute for Neuroscience, University of California , San Francisco, San Francisco, California.,8 Kavli Institute of Fundamental Neuroscience, University of California , San Francisco, San Francisco, California
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5
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A Survey of Clinicians Working in Brain Injury Rehabilitation: Are Social Cognition Impairments on the Radar? J Head Trauma Rehabil 2017; 32:E55-E65. [DOI: 10.1097/htr.0000000000000269] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Abstract
OBJECTIVES The negative effect of changes in social behavior following traumatic brain injury (TBI) are known, but much less is known about the neuropsychological impairments that may underlie and predict these changes. The current study investigated possible associations between post-injury behavior and neuropsychological competencies of emotion recognition, understanding intentions, and response selection, that have been proposed as important for social functioning. METHODS Forty participants with TBI and 32 matched healthy participants completed a battery of tests assessing the three functions of interest. In addition, self- and proxy reports of pre- and post-injury behavior, mood, and community integration were collected. RESULTS The TBI group performed significantly poorer than the comparison group on all tasks of emotion recognition, understanding intention, and on one task of response selection. Ratings of current behavior suggested significant changes in the TBI group relative to before the injury and showed significantly poorer community integration and interpersonal behavior than the comparison group. Of the three functions considered, emotion recognition was associated with both post-injury behavior and community integration and this association could not be fully explained by injury severity, time since injury, or education. CONCLUSIONS The current study confirmed earlier findings of associations between emotion recognition and post-TBI behavior, providing partial evidence for models proposing emotion recognition as one of the pre-requisites for adequate social functioning. (JINS, 2017, 23, 400-411).
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Yeates G, Rowberry M, Dunne S, Goshawk M, Mahadevan M, Tyerman R, Salter M, Hillier M, Berry A, Tyerman A. Social cognition and executive functioning predictors of supervisors’ appraisal of interpersonal behaviour in the workplace following acquired brain injury. NeuroRehabilitation 2016; 38:299-310. [DOI: 10.3233/nre-161321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Giles Yeates
- Working Out Programme, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, UK
| | | | - Stephen Dunne
- Momentum Skills Brain Injury Vocational Rehabilitation, UK
| | | | - Mythreyi Mahadevan
- Working Out Programme, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, UK
| | - Ruth Tyerman
- Working Out Programme, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, UK
| | - Mandy Salter
- Working Out Programme, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, UK
| | - Martin Hillier
- Working Out Programme, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, UK
| | - Alister Berry
- Momentum Skills Brain Injury Vocational Rehabilitation, UK
| | - Andy Tyerman
- Working Out Programme, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, UK
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Zgaljardic DJ, Seale GS, Schaefer LA, Temple RO, Foreman J, Elliott TR. Psychiatric Disease and Post-Acute Traumatic Brain Injury. J Neurotrauma 2015; 32:1911-25. [DOI: 10.1089/neu.2014.3569] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dennis J. Zgaljardic
- Transitional Learning Center, Galveston, Texas
- University of Texas Medical Branch, Galveston, Texas
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9
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Meulenbroek P, Turkstra LS. Job stability in skilled work and communication ability after moderate-severe traumatic brain injury. Disabil Rehabil 2015; 38:452-61. [PMID: 25958999 PMCID: PMC5308217 DOI: 10.3109/09638288.2015.1044621] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Communication deficits may play a critical role in maintaining employment after traumatic brain injury (TBI), but links between specific communication deficits and employment outcomes have not been determined. This study identified communication measures that distinguished stably employed versus unstably employed adults with TBI. METHODS Participants were 31 adults with moderate-severe TBI who were employed full-time for at least 12 consecutive months before injury in skilled jobs and had attempted return to skilled jobs after injury. Sixteen had achieved stable employment (SE) post-injury, defined as full-time employment for ≥12 consecutive months; and 15 had unstable employment (UE). Participants completed a battery of communication tests identified in a prior qualitative study of communication skills required for skilled work. RESULTS Measures of spoken language comprehension, verbal reasoning, social inference, reading and politeness in spoken discourse significantly discriminated between SE and UE groups. Two nested models were completed and compared. The first model excluded discourse data because of missing data for two UE and one SE participant. This model revealed that measures of verbal reasoning speed (β = -0.18, p = 0.05) and social inference (β = 0.19, p = 0.05) were predictive independent of the overall model. The second model included discourse politeness data and was a better overall predictor of group membership (Likelihood ratio test, Model 1: 3.824, Model 2: 2.865). CONCLUSION Communication measures were positively associated with SE in skilled jobs after TBI. Clinicians should include assessment of communication for adults attempting return to work after TBI, paying specific attention to social inference and speed of verbal reasoning skills. IMPLICATIONS FOR REHABILITATION Traumatic brain injury (TBI) often results in communication impairments associated with the cognitive skills underlying interpersonal skills. Communication impairment after TBI has been anecdotally associated with job instability. This research associate communication functioning with work stability after TBI in skilled jobs. These findings indicate that communication impairment should be assessed in persons with TBI returning to skilled employment after injury.
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Affiliation(s)
- Peter Meulenbroek
- Northwestern University, Department of Physical Medicine and Rehablitation, Feinberg School of Medicine, Chicago, IL, USA
- The Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Lyn S. Turkstra
- University of Wisconsin – Madison, Department of Communication Sciences and Disorders, Madison, WI, USA
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10
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Abstract
Traumatic brain injury (TBI) is a major cause of death and disability, and therefore an important health and socioeconomic problem for our society. Individuals surviving from a moderate to severe TBI frequently suffer from long-lasting cognitive deficits. Such deficits include different aspects of cognition such as memory, attention, executive functions, and awareness of their deficits. This chapter presents a review of the main neuropsychological and neuroimaging studies of patients with TBI. These studies found that patients evolve differently according to the severity of the injury, the mechanism causing the injury, and the lesion location. Further research is necessary to develop rehabilitation methods that enhance brain plasticity and recovery after TBI. In this chapter, we summarize current knowledge and controversies, focusing on cognitive sequelae after TBI. Recommendations from the Common Data Elements are provided, with an emphasis on diagnosis, outcome measures, and studies organization to make data more comparable across studies. Final considerations on neuroimaging advances, rehabilitation approaches, and genetics are described in the final section of the chapter.
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Affiliation(s)
- Irene Cristofori
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
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11
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Poncet F, Swaine B, Taillefer C, Lamoureux J, Pradat-Diehl P, Chevignard M. Reliability of the Cooking Task in adults with acquired brain injury. Neuropsychol Rehabil 2014; 25:298-317. [PMID: 25384200 DOI: 10.1080/09602011.2014.971819] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Acquired brain injury (ABI) often leads to deficits in executive functioning (EF) responsible for severe and long-standing disabilities in daily life activities. The Cooking Task is an ecological and valid test of EF involving multi-tasking in a real environment. Given its complex scoring system, it is important to establish the tool's reliability. The objective of the study was to examine the reliability of the Cooking Task (internal consistency, inter-rater and test-retest reliability). A total of 160 patients with ABI (113 men, mean age 37 years, SD = 14.3) were tested using the Cooking Task. For test-retest reliability, patients were assessed by the same rater on two occasions (mean interval 11 days) while two raters independently and simultaneously observed and scored patients' performances to estimate inter-rater reliability. Internal consistency was high for the global scale (Cronbach α = .74). Inter-rater reliability (n = 66) for total errors was also high (ICC = .93), however the test-retest reliability (n = 11) was poor (ICC = .36). In general the Cooking Task appears to be a reliable tool. The low test-retest results were expected given the importance of EF in the performance of novel tasks.
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Affiliation(s)
- Frédérique Poncet
- a APHP, Service de Médecine Physique et de Réadaptation . Hôpital Pitié-Salpêtrière , Paris , France
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Montani V, De Filippo De Grazia M, Zorzi M. A new adaptive videogame for training attention and executive functions: design principles and initial validation. Front Psychol 2014; 5:409. [PMID: 24860529 PMCID: PMC4026745 DOI: 10.3389/fpsyg.2014.00409] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 04/18/2014] [Indexed: 11/21/2022] Open
Abstract
A growing body of evidence suggests that action videogames could enhance a variety of cognitive skills and more specifically attention skills. The aim of this study was to develop a novel adaptive videogame to support the rehabilitation of the most common consequences of traumatic brain injury (TBI), that is the impairment of attention and executive functions. TBI patients can be affected by psychomotor slowness and by difficulties in dealing with distraction, maintain a cognitive set for a long time, processing different simultaneously presented stimuli, and planning purposeful behavior. Accordingly, we designed a videogame that was specifically conceived to activate those functions. Playing involves visuospatial planning and selective attention, active maintenance of the cognitive set representing the goal, and error monitoring. Moreover, different game trials require to alternate between two tasks (i.e., task switching) or to perform the two tasks simultaneously (i.e., divided attention/dual-tasking). The videogame is controlled by a multidimensional adaptive algorithm that calibrates task difficulty on-line based on a model of user performance that is updated on a trial-by-trial basis. We report simulations of user performance designed to test the adaptive game as well as a validation study with healthy participants engaged in a training protocol. The results confirmed the involvement of the cognitive abilities that the game is supposed to enhance and suggested that training improved attentional control during play.
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Affiliation(s)
- Veronica Montani
- Department of General Psychology, University of Padova Padova, Italy
| | | | - Marco Zorzi
- Department of General Psychology, University of Padova Padova, Italy ; Center for Cognitive Neuroscience, University of Padova Padova, Italy ; IRCCS San Camillo Neurorehabilitation Hospital Venice Lido, Italy
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Cullen N, Krakowski A, Taggart C. Early neuropsychological tests as correlates of return to driving after traumatic brain injury. Brain Inj 2013; 28:38-43. [DOI: 10.3109/02699052.2013.849005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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The Development and Validation of a Neuropsychological Assessment for Mild Cognitive Impairment of Filipino Older Adults. AGEING INTERNATIONAL 2013. [DOI: 10.1007/s12126-012-9145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Andrewes D. Duncan's Spearman's “G” — A New Measure of Executive Function? BRAIN IMPAIR 2012. [DOI: 10.1375/brim.3.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractDuncan's theory allows that executive function may be represented by a central and general construct of intelligence which was originally described by Spearman (Spearman, 1946). This theoretical critique discusses the three planks of evidence which appear to support this proposal: (1), the finding that intra correlations between “executive” tests are low and in one study equivalent to those with non-executive tasks, (2), that tests which are seen as most representative of Spearman's G may be used to identify patients with frontal lobe lesions and executive dysfunction and (3), the finding that functional neuroimaging studies which have used disparate tasks may show a similar region of activation within the prefrontal cortex. The evidence for these three findings is discussed in terms of their ability to support Duncan's theory.
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Long E, McDonald S, Tate R, Togher L, Bornhofen C. Assessing Social Skills in People With Very Severe Traumatic Brain Injury: Validity of the Social Performance Survey Schedule (SPSS). BRAIN IMPAIR 2012. [DOI: 10.1375/brim.9.3.274] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe current study was designed to determine whether the Social Performance Survey Schedule (SPSS; Lowe & Cautela, 1978) is a useful measure of social skills in people with traumatic brain injuries (TBI). Forty-nine adults with TBI were compared on the SPSS to 190 adults without injuries. The validity of the SPSS was also investigated in relation to another measure of social performance, the first scale of the Katz Adjustment Scale (KAS-R1; Katz & Lyerly, 1963) and a broad measure of social function (the SPRS; Tate, Hodgkinson, Veerabangsa, & Maggiotto, 1999). Individuals with TBI had significantly lower scores on the positive scale of the SPSS than nonbrain-injured individuals. They did not have lower scores on the SPSS negative scale relative to the normative sample. Significant correlations with the KAS-R1 and SPRS provided evidence for the construct and criterion validity of SPSS within this population. In conclusion, this study suggests that where an appropriate normative sample is used, the positive subscale of the SPSS is a sound measure for detecting the extent and nature of deficits in prosocial behaviour seen in TBI, but raises the question as to how we define negative behaviours in the 21st century on scales such as the SPSS.
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Nightingale EJ, Soo CA, Tate RL. A Systematic Review of Early Prognostic Factors for Return to Work After Traumatic Brain Injury. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.8.2.101] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis article presents a systematic review identifying variables and their prognostic value for return to work (RTW) after traumatic brain injury (TBI). RTW has been identified as being a key goal following TBI, with estimates ranging from 10% to 70%. Prediction of postinjury employment is important for planning rehabilitation and structuring individualised vocational services. Studies examining prognostic factors were identified by searching four electronic databases, until June 2006. Searches yielded 1948 studies of which 55 met inclusion criteria and were subsequently rated for methodological quality. Mean methodological score for included studies was 3.9/6 (SD0.9, range 1–6). Analysis focused on a subset of 27 studies which provided sampling from all three domains of preinjury, injury and early postinjury variables. Few studies considered preinjury variables, apart from simple demographics. Only five studies considered preinjury employment, which was a significant predictor in each case. Severity of injury variables were invariably examined, but were significant predictors in only 8/27 studies (30%). For early postinjury variables, 14/27 studies entered cognitive variables with 12/14 (86%) identifying them as significant predictors; 3/27 studies examined neurophysical variables, with 2/3 (67%) studies finding them significant; and 12/27 studies examined multidimensional/participation variables which were statistically significant individual predictors in 8/12 (67%) cases. The results are discussed in the context of methodological issues encountered during the course of the review that require addressing in future studies.
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18
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Tate RL, Broe GA, Cameron ID, Hodgkinson AE, Soo CA. Pre-Injury, Injury and Early Post-Injury Predictors of Long-Term Functional and Psychosocial Recovery After Severe Traumatic Brain Injury. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.2005.6.2.75] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground: Findings from prognostic studies of functional and psychosocial recovery after traumatic brain injury (TBI) reported to date have been limited by the restricted timeframe for prediction, generally within the first 5 years post-trauma. This investigation examined prediction of functional and psychosocial recovery in the medium-term (6 years post-trauma; Time 1) and long-term (23 years post-trauma; Time 2). Methods: The participants comprised a consecutive series of the first 100 patients with severe TBI receiving their primary rehabilitation at a regionally based unit. At the 23-year follow-up, 91% of the sample was traced: 17 had died, 5 declined participation, and 69 were interviewed, with 68 participating at both Time 1 and Time 2. Five outcome domains were examined: mobility, self-care, employability, relationships and living skills. Results: Very few of seven pre-injury variables were significantly correlated with any of the outcome variables. A series of logistic regression analyses successfully predicted levels of recovery in all domains using four predictor variables: pre-injury occupational status, duration of post-traumatic amnesia, and physical and neuropsychological disability at rehabilitation discharge. At Time 1, 60% or more of the variance was accounted for in four of the five domains, and at Time 2, more than 40% of the variance was accounted for in all domains. Sensitivity ranged from 62% (self-care) to 90% (mobility). With a single exception (employability at Time 2), specificity was also high, ranging from 80% (relationships) to 98% (mobility). Comparable accuracy rates were also found for positive and negative predictive power. Conclusions: These results demonstrate impressive predictive capacity of early post-trauma variables for the very long-term levels of recovery. They provide guidance for the tailoring of individual rehabilitation programs and the identification of people who may require special supports after rehabilitation discharge.
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Spikman JM, Timmerman ME, Milders MV, Veenstra WS, van der Naalt J. Social Cognition Impairments in Relation to General Cognitive Deficits, Injury Severity, and Prefrontal Lesions in Traumatic Brain Injury Patients. J Neurotrauma 2012; 29:101-11. [DOI: 10.1089/neu.2011.2084] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jacoba M. Spikman
- Department of Clinical and Developmental Neuropsychology, and University of Groningen, the Netherlands
- Department of Neurology, University Medical Center Groningen, the Netherlands
| | - Marieke E. Timmerman
- Department of Psychometrics and Statistics, and University of Groningen, the Netherlands
| | | | - Wencke S. Veenstra
- Department of Neurology, University Medical Center Groningen, the Netherlands
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20
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Tonks J, Williams WH, Yates P, Slater A. Cognitive correlates of psychosocial outcome following traumatic brain injury in early childhood: comparisons between groups of children aged under and over 10 years of age. Clin Child Psychol Psychiatry 2011; 16:185-94. [PMID: 21571762 DOI: 10.1177/1359104511403583] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with traumatic brain injuries (TBI) commonly present with socioemotional difficulties, as well as accompanying multiple cognitive impairments. Often difficulties worsen at around 10 years old. This change is associated with frontal system changes, and tests of executive function (EF) predict outcome. However, children with TBI sometimes present with socioemotional difficulties despite apparent cognitive recovery. Our aims were to explore potential cognitive and socioemotional effects following childhood TBI, before and after the age of 10 years. We also wanted to identify cognitive correlates of psychosocial dysfunction. Measures of cognitive function and socioemotional disturbance administered to 14 children with TBI aged 8-10 years, and 14 children with TBI aged 10-16 years, were compared to control data from 22 non-injured 8- to 10 year-olds and 67 non-injured 10- to 16-year-olds. Results indicated that only the older group of children with TBI were impaired in tests of EF, but significant socioemotional difficulties were commonly evident in both groups. Processing speed (as well as EF) was found to correlate with socioemotional disturbance. We conclude that poor processing speed may also index the risk of socioemotional difficulties, but our general findings indicate that cognitive functions relevant to socioemotional functioning are not readily testable in younger children and are not strongly associated with such outcomes as they may be in adults.
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Affiliation(s)
- James Tonks
- School of Psychology, University of Exeter, UK.
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Rochat L, Ammann J, Mayer E, Annoni JM, Linden M. Executive disorders and perceived socio-emotional changes after traumatic brain injury. J Neuropsychol 2010; 3:213-27. [DOI: 10.1348/174866408x397656] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Crepeau F, Peter Scherzer B, Belleville S, Desmarais G. A Qualitative Analysis of Central Executive Disorders in a Real-life Work Situation. Neuropsychol Rehabil 2010. [DOI: 10.1080/713755525] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Boelen DHE, Spikman JM, Rietveld ACM, Fasotti L. Executive dysfunction in chronic brain-injured patients: Assessment in outpatient rehabilitation. Neuropsychol Rehabil 2009; 19:625-44. [DOI: 10.1080/09602010802613853] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Himanen L, Portin R, Tenovuo O, Taiminen T, Koponen S, Hiekkanen H, Helenius H. Attention and depressive symptoms in chronic phase after traumatic brain injury. Brain Inj 2009; 23:220-7. [PMID: 19205958 DOI: 10.1080/02699050902748323] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study whether attention deficits differ between TBI (traumatic brain injury) patients with and without depressive symptoms. METHOD The study group (n = 61, mean age = 59 years) consisted of symptomatic TBI patients injured on average 30 years earlier. They were studied with a broad range of attention tasks including computerized methods. The patients were divided into those with depressive symptoms (n = 32) and those without (n = 29), according to the short form of the Beck depression scale with a cut-off score of 5. In addition, a diagnosis of major depression was applied according to the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) (n = 6). The groups with depression or depressive symptoms were compared with the non-depressed TBI patients and with an age- and education-matched healthy control group (n = 31). RESULTS Cognitive methods that require flexibility (Trail making B, Card sorting, Word fluency) and working memory (Subtraction test) were sensitive to discriminate TBI patients without depressive symptoms from the control subjects (p < 0.001). Only a few methods were able to discriminate the TBI patients with depressive symptoms from those without (p < 0.001 for Simple reaction time, p < 0.003 for Vigilance test). The depressed TBI patients (assessed by SCAN) did not differ from the non-depressed TBI patients in attention functions. CONCLUSIONS The results suggest that problems in complex attention processing are more specific to TBI, while slowness in simple psychomotor speed and impaired sustained attention may be mostly related to depressive symptoms in patients with chronic TBI sequelae.
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Affiliation(s)
- Leena Himanen
- Department of Neurology, Turku University Hospital, Turku, Finland.
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Ownsworth T, McKenna K. Investigation of factors related to employment outcome following traumatic brain injury: a critical review and conceptual model. Disabil Rehabil 2009; 26:765-83. [PMID: 15371049 DOI: 10.1080/09638280410001696700] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this article is to critically review the literature to examine factors that are most consistently related to employment outcome following traumatic brain injury (TBI), with a particular focus on metacognitive skills. It also aims to develop a conceptual model of factors related to employment outcome. METHOD The first stage of the review considered 85 studies published between 1980 and December 2003 which investigated factors associated with employment outcome following TBI. English-language studies were identified through searches of Medline and PsycINFO, as well as manual searches of journals and reference lists. The studies were evaluated and rated by two independent raters (Kappa=0.835) according to the quality of their methodology based upon nine criteria. Fifty studies met the criteria for inclusion in the second stage of the review, which examined the relationship between a broad range of variables and employment outcome. RESULTS The factors most consistently associated with employment outcome included pre-injury occupational status, functional status at discharge, global cognitive functioning, perceptual ability, executive functioning, involvement in vocational rehabilitation services and emotional status. CONCLUSIONS A conceptual model is presented which emphasises the importance of metacognitive, emotional and social environment factors for improving employment outcome.
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Affiliation(s)
- Tamara Ownsworth
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia.
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Himanen L, Portin R, Isoniemi H, Helenius H, Kurki T, Tenovuo O. Cognitive functions in relation to MRI findings 30 years after traumatic brain injury. Brain Inj 2009; 19:93-100. [PMID: 15841753 DOI: 10.1080/02699050410001720031] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of the study was to relate cognitive effects of a remote traumatic brain injury (TBI) to MRI findings and severity of injury. METHOD Sixty-one patients were assessed on average 30 years after a TBI of variable severity. A comprehensive cognitive test battery was used to evaluate memory, executive functions and cognitive overall impairment. Multiple regression analyses were used to examine the relationships between cognitive variables and MRI volumetric findings (the volumes of the hippocampus and the lateral ventricles) and local contusions on MRI. Also, the effect of injury severity on cognitive outcome was evaluated. RESULTS Reductions in hippocampal volumes and lateral ventricular enlargement were significantly associated with impaired memory functions, memory complaints and executive functions. Of the MRI parameters used, the best predictor for cognitive outcome was the volume of the lateral ventricle. There was only a modest relationship between severity of injury and cognitive performance. CONCLUSIONS The results show that long-term memory impairments after TBI are associated with MRI volumetric measures. This suggests that the degree of diffuse injury leading to atrophic changes is prognostically more important than the initial severity of TBI.
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Affiliation(s)
- Leena Himanen
- Department of Neurology, Turku University Central Hospital, Turku, Finland.
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Cyr AA, Stinchcombe A, Gagnon S, Marshall S, Hing MMS, Finestone H. Driving difficulties of brain-injured drivers in reaction to high-crash-risk simulated road events: A question of impaired divided attention? J Clin Exp Neuropsychol 2009; 31:472-82. [DOI: 10.1080/13803390802255627] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Sylvain Gagnon
- a University of Ottawa , Ottawa, ON, Canada
- b Elisabeth Bruyère Research Institute , Ottawa, ON, Canada
| | - Shawn Marshall
- b Elisabeth Bruyère Research Institute , Ottawa, ON, Canada
- c The Rehabilitation Centre of the Ottawa General Hospital , Ottawa, ON, Canada
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Wells R, Minnes P, Phillips M. Predicting social and functional outcomes for individuals sustaining paediatric traumatic brain injury. Dev Neurorehabil 2009; 12:12-23. [PMID: 19283530 DOI: 10.1080/17518420902773109] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the efficacy of models employing the classification of severity of injury, based on either GCS scores or clinical findings using standardized test scores for Occupational Therapy, Physiotherapy and Psychology in predicting outcomes associated with paediatric traumatic brain injury (TBI). METHOD Medical records were reviewed to obtain GCS scores and standardized tests used in the clinically based classification of severity of injury for 30 individuals who sustained a paediatric TBI and were patients of a brain injury treatment programme. Interviews were conducted with parents to obtain current data on social participation, cognitive functioning and environmental factors. RESULTS Three variables emerged as significant predictors of outcome: age at injury, clinical ratings of injury severity and environmental factors. CONCLUSION Findings offer preliminary support for the idea that a combination of factors, including age at injury, clinical expertise and the environment, provide the best estimate of long-term outcome.
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Affiliation(s)
- Rebecca Wells
- University of Waterloo, Psychology, Waterloo, Ontario, Canada.
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Rasmussen IA, Xu J, Antonsen IK, Brunner J, Skandsen T, Axelson DE, Berntsen EM, Lydersen S, Håberg A. Simple dual tasking recruits prefrontal cortices in chronic severe traumatic brain injury patients, but not in controls. J Neurotrauma 2008; 25:1057-70. [PMID: 18729718 DOI: 10.1089/neu.2008.0520] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The ability to carry out two tasks simultaneously, dual tasking, is specifically impaired after traumatic brain injury (TBI). The aim of the present study was to investigate the neuronal correlates to this increased dual cost in chronic severe TBI patients (n = 10) compared to healthy controls (n = 11) using functional magnetic resonance imaging (fMRI) at 3 Tesla (T). The tasks were a visual search and a simple two-fingers button press motor task. Performance data demonstrated similar and significant dual task interference in both TBI patients and controls using a linear mixed model. However, principal component analysis showed that TBI patients and controls could be classified into different categories based on motor activity in the single compared to the dual task condition, thus reflecting the increased variability in the performance in the TBI group. Random effects between-group analysis demonstrated significantly reduced activation in the TBI group in both single task conditions in the occipital and posterior cingulate cortices, and for the visual task also in the thalami. This pattern was reversed in the dual task condition with significantly increased activation of a predominantly left lateralized prefrontal-anterior midline-parietal network in the TBI group compared to the controls. The increase in activation occurred within regions described to be engaged in healthy volunteers as dual task cost increases. This finding points to substitution, functional reorganization within the primary network subserving the task, following TBI, and demonstrates more effortful processing. Recruitment of these additional prefrontal resources may be connected to serial rather than parallel processing in low level dual tasking in TBI. Thus, in severe TBI, low level dual task performance depends on increased attentional and executive guidance.
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Affiliation(s)
- Inge-André Rasmussen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Green RE, Colella B, Hebert DA, Bayley M, Kang HS, Till C, Monette G. Prediction of Return to Productivity After Severe Traumatic Brain Injury: Investigations of Optimal Neuropsychological Tests and Timing of Assessment. Arch Phys Med Rehabil 2008; 89:S51-60. [DOI: 10.1016/j.apmr.2008.09.552] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 09/03/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
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Chevignard MP, Taillefer C, Picq C, Poncet F, Noulhiane M, Pradat-Diehl P. Ecological assessment of the dysexecutive syndrome using execution of a cooking task. Neuropsychol Rehabil 2008; 18:461-85. [PMID: 18576272 DOI: 10.1080/09602010701643472] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with a dysexecutive syndrome often have severe disabilities in daily life activities. The aims of this study were to use a naturalistic experimental task to assess patients' disabilities, and to study the nature of the cognitive disorders underlying them. Execution of a cooking task involving multi-tasking (Chevignard et al., 2000) was studied in 45 patients with a dysexecutive syndrome following acquired brain injury. Patients made significantly more errors and were slower than controls; more than half of the patients did not achieve the goal and demonstrated dangerous behaviours. Those results were significantly correlated to the results of the Six Elements Task and to a behavioural questionnaire. They were also correlated to brain injury severity and to patients' cooking habits. This naturalistic assessment is clinically relevant to better assess patients' dysexecutive impairments in complex activities of daily living. Correlations of the results in the cooking task with the neuropsychological assessment highlighted the role of the dysexecutive syndrome in patients' disabilities, indicating control alterations rather than planning disorders, difficulty in dealing with the environment, and inhibiting inappropriate actions. The role of attention and prospective memory was also underlined, whereas other cognitive functions did not influence task performance.
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Affiliation(s)
- M P Chevignard
- Department of Rehabilitation for Children with Acquired Brain Injury, Hopital National de Saint Maurice, France.
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Chevignard M, Taillefer C, Poncet F, Picq C, Pradat-Diehl P. [The effect of age on executive functioning after acquired brain injury in adults]. Rev Neurol (Paris) 2008; 164:1018-27. [PMID: 18808778 DOI: 10.1016/j.neurol.2008.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 01/15/2008] [Accepted: 04/02/2008] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Executive functioning deficits have often been described in normal aging. They are also known to be a frequent sequel of traumatic brain injury, where patients may exhibit severe long-standing impairments in instrumental activities of daily living. One could therefore expect that cerebral lesions affecting executive functioning would result in more severe impairments in older patients. We previously developed an ecological assessment of executive functions, consisting of a cooking task, requiring multitasking abilities and known to be sensitive to a dysexecutive syndrome [Cortex 36 (2000) 649-669]. The aim of this study was to analyze the effect of age on the cognitive and ecological assessments of executive functions in a group of patients with acquired brain injury (ABI) resulting in a dysexecutive syndrome. Studies in this area usually focus on patients older than 60 or 65, but we chose to analyze the effect of age in a younger population. We hypothesized that older patients would have poorer performances on the cognitive and ecological tests of executive functioning, when compared to younger patients. METHODS Forty-five patients with ABI resulting in frontal lesions and a dysexecutive syndrome participated in this study. Patients underwent a comprehensive battery of cognitive tests assessing executive functioning, as well as the cooking task. We also studied a group of 12 control subjects who performed the cooking task. RESULTS No effect of age was found on performance in the cooking task in the control group. Age was not related to demographic parameters or injury severity in the ABI group. Although the ABI group was relatively young (mean age: 40.3 years (S.D.=12.5), ranging from 17 to 63), results indicated a significant deleterious effect of age on the cognitive tests of executive functioning in the ABI group. We also highlighted a significant worsening of patients' performance in the cooking task with age, and this effect was found on several variables of task analysis: the number of errors and occurrence of dangerous behaviors. CONCLUSION Our study demonstrates the deleterious effect of aging on cognitive and ecological assessment of executive functioning after ABI. The strength of this study is that it deviated from the traditional age considered in studies of elderly populations and focused on younger patients. It is therefore important to consider the implication that this may have on a patient's rehabilitation program and postinjury discharge.
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Affiliation(s)
- M Chevignard
- Service de rééducation des pathologies neurologiques acquises de l'enfant, hôpital national de Saint-Maurice, 14, rue du Val-d'Osne, 94410 Saint-Maurice, France
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Social behavior following traumatic brain injury and its association with emotion recognition, understanding of intentions, and cognitive flexibility. J Int Neuropsychol Soc 2008; 14:318-26. [PMID: 18282329 DOI: 10.1017/s1355617708080351] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 11/08/2007] [Accepted: 11/08/2007] [Indexed: 11/07/2022]
Abstract
Although the adverse consequences of changes in social behavior following traumatic brain injury (TBI) are well documented, relatively little is known about possible underlying neuropsychological deficits. Following a model originally developed for social behavior deficits in schizophrenia, we investigated whether impairments in emotion recognition, understanding of other people's intentions ("theory of mind"), and cognitive flexibility soon after first TBI or 1 year later were associated with self and proxy ratings of behavior following TBI. Each of the three functions was assessed with two separate tests, and ratings of behavior were collected on three questionnaires. Patients with TBI (n = 33) were impaired in emotion recognition, "theory of mind," and cognitive flexibility compared with matched orthopedic controls (n = 34). Proxy ratings showed increases in behavioral problems 1 year following injury in the TBI group but not in the control group. However, test performance was not associated with questionnaire data. Severity of the impairments in emotion recognition, understanding intention, and flexibility were unrelated to the severity of behavioral problems following TBI. These findings failed to confirm the used model for social behavior deficits and may cast doubt on the alleged link between deficits in emotion recognition or theory of mind and social functioning.
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[Ecological assessment of executive functions in a patient with acquired brain injury]. ACTA ACUST UNITED AC 2007; 51:74-83. [PMID: 18192053 DOI: 10.1016/j.annrmp.2007.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 10/15/2007] [Indexed: 11/20/2022]
Abstract
UNLABELLED Dysexecutive syndrome is one of the most frequent sequel of severe traumatic brain injury. It causes severe disabilities and it is incompletely assessed by the classical "paper and pencil" neuropsychological tests. We developed an ecological assessment conducted in a naturalistic situation, consisting of a cooking task, and we described a classification of errors. This assessment is very sensitive, even to a mild dysexecutive syndrome. OBJECTIVE To describe the disabilities in activities of daily living of a traumatic brain-injured patient and to demonstrate the sensitivity of an ill-structured ecological assessment. METHOD We report a single case study illustrating how the ecological assessment by the cooking task helped better understand and characterize the patient's disabilities. RESULTS The patient presented severe disabilities in daily life activities, which were well described by his family. His cognitive disorders were mild in the cognitive tests, even those supposed to be more ecological, such as the Six Elements Task or script generation. He exhibited very severe disorders in the cooking task, with a very high number of errors. Moreover, duration of the cooking task was very long; he did not achieve the goal and exhibited dangerous behaviour. DISCUSSION AND CONCLUSION The cooking task involves abilities to deal with multitasking, which particularly involve executive functions. The most severe disorders were observed during the patient's interaction with the environment while conducting a complex goal-directed action plan, indicating control disorders. This type of naturalistic assessment provides very useful information to help patients organise their familial, social or professional reintegration.
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Rabin LA, Burton LA, Barr WB. Utilization Rates of Ecologically Oriented Instruments Among Clinical Neuropsychologists. Clin Neuropsychol 2007; 21:727-43. [PMID: 17676540 DOI: 10.1080/13854040600888776] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The ecological validity of neuropsychological instruments has become an important topic in recent decades, as neuropsychologists are asked to address real-world outcomes with increasing frequency. Although novel instruments that tap skills required for everyday functioning have been developed, it is unclear whether these instruments are migrating from research laboratories into the applied settings of clinical neuropsychologists. The current study surveyed assessment practices of neuropsychologists with regard to their utilization of instruments designed with ecological concerns in mind. Respondents included 747 North American, doctorate-level psychologists (40% usable response rate) affiliated with Division 40 of the American Psychological Association, National Academy of Neuropsychology, or the International Neuropsychological Society. Results indicated that approximately one-third of respondents reported use of ecologically oriented instruments (EOIs), and these instruments were generally utilized with much less frequency than traditional measures. Additionally, certain practice demographics affected usage rates of EOIs. Study findings are interpreted in the context of a growing body of literature that calls attention to the importance of developing and utilizing instruments that are able to handle the complex, real-world issues increasingly addressed during the neuropsychological assessment process.
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Affiliation(s)
- Laura A Rabin
- Brooklyn College/City University of New York, Department of Psychology, Brooklyn, NY 11201, USA.
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Sarajuuri JM, Koskinen SK. Holistic neuropsychological rehabilitation in Finland: The INSURE program—a transcultural outgrowth of perspectives from Israel to Europe via the USA. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2006. [DOI: 10.1080/01650250500346103] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Havet-Thomassin V, Allain P, Etcharry-Bouyx F, Le Gall D. What about theory of mind after severe brain injury? Brain Inj 2006; 20:83-91. [PMID: 16403703 DOI: 10.1080/02699050500340655] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Behavioural changes are often reported after a severe traumatic brain injury (TBI). These changes are usually a greater burden for relatives than physical or cognitive impairments. This study investigated social cognition in TBI patients using two theory of mind (TOM) tasks. METHOD The performances of 17 patients with severe TBI and 17 matched controls were compared on two tasks designed to investigate understanding of other people's mental states: The 'Reading the Mind in the Eyes' test (RME) and the 'Character Intention Task' (CIT). TBI patients and controls were also given several executive function tasks. RESULTS Compared to healthy controls, patients were impaired in most executive tests and in both TOM tasks. No relationship was found between TOM and executive measures. This is consistent with Rowe's position, who suggested an independence between executive functioning and social cognition. These data suggest that TBI patients may have specific social intelligence disturbances. CONCLUSION Future work should employ additional tests of TOM and behavioural ratings and recruit more patients in order to complete analysis.
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Affiliation(s)
- V Havet-Thomassin
- Department of Psychology, University and Hospital Center of Angers, France
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Le Gall C, Lamothe G, Mazaux JM, Muller F, Debelleix X, Richer E, Joseph PA, Barat M. [Outcome of the Aquitaine Unit for Evaluation, Training and Social and Vocational Counselling (UEROS) at 5-year follow-up in young adults with brain damage]. ACTA ACUST UNITED AC 2006; 50:5-13. [PMID: 16945446 DOI: 10.1016/j.annrmp.2006.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2006] [Accepted: 06/28/2006] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Difficulties in social and vocational adjustment are common in adults with brain damage. A French government-funded program, UEROS (Unit for Evaluation, Training and Social and Vocational Counselling), was developed to improve cognitive adjustment, social autonomy and return to work for these people. OBJECTIVES To describe the outcome and satisfaction with life after 5 years for patients who participated in the UEROS-Aquitaine network program. MAIN OUTCOME MEASURES EBIS Document to evaluate people with traumatic brain injury. RESULTS Seventy-five of the 102 patients participating in UEROS from 1997 to 1999 were assessed during a phone-structured interview based on the EBIS Document. The sample consisted of young adults (mean age 28.5 years), most (65, 85%) with brain injury and moderate disability (Glasgow Outcome Scale 2: 57%) or severe disability (Glasgow Outcome Scale 3: 42%). On entering the program, 33% of the subjects needed no help physically or cognitively. None were employed. At the end of the program, 9% were students or were learning a job, 8% worked full-time, 16% were in sheltered conditions, and 13% had volunteer activities. At 5-year follow-up, 50% of the subjects were independent, 4% were in school, 10.6% worked full-time, and 26.7% were in sheltered conditions. Playing sports was associated with good social adjustment. The professional status at 5 years was significantly correlated with following the UEROS program (r=0.30, P<0.01) and status at the end of the program (r=0.29, P<0.05). However, 41.3% of the subjects were still unsatisfied with their conditions of life. DISCUSSION-CONCLUSION In patients with brain damage, the UEROS-Aquitaine network program improves independence in daily living and allows for nearly one inactive adult in two (42%) to be engaged in an activity or a job.
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Ownsworth T, Fleming J, Desbois J, Strong J, Kuipers P. A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: a single-case experimental design. J Int Neuropsychol Soc 2006; 12:54-63. [PMID: 16433944 DOI: 10.1017/s135561770606005x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 09/07/2005] [Accepted: 09/08/2005] [Indexed: 11/07/2022]
Abstract
Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home; and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional outcome in real life settings.
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Affiliation(s)
- Tamara Ownsworth
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia.
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Odhuba RA, van den Broek MD, Johns LC. Ecological validity of measures of executive functioning. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2005; 44:269-78. [PMID: 16004660 DOI: 10.1348/014466505x29431] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study aimed to ascertain the ecological validity of the Hayling and Brixton tests of executive functioning, by investigating whether cognitive 'impairment' detected by these measures was associated with assessment of 'disability' and 'handicap'. DESIGN AND METHOD A correlational design was employed to evaluate the degree of association between the executive test results, and behavioural and community integration measures. Participants were 53 people with brain injuries participants who were selected from neuropsychology patient lists and their 'significant other'. The brain-injured participant was given the executive tests, together with behavioural and community integration questionnaires, while their 'significant other' was given an equivalent behavioural questionnaire and structured interview. RESULTS There were moderate relationships between scores on the tests and measures of everyday functioning, suggesting that the tests have modest ecological validity. CONCLUSIONS The tests contribute to understanding the impact of executive impairment on everyday functioning, but they should be interpreted in combination with other measures of executive functioning.
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Wallesch CW, Marx P, Tegenthoff M, Unterberg A, Schmidt R, Fries W. Leitlinie “Begutachtung nach gedecktem Schädel-Hirntrauma”. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2005. [DOI: 10.1024/1016-264x.16.3.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Die wichtigsten Empfehlungen auf einen Blick: 1. Begutachtung: 1.1. Die Kenntnis der Leitlinie “Allgemeine Grundlagen neurologischer Gutachten” ist Voraussetzung zur Anwendung dieser Leitlinie. 1.2. Klinische Befunde, auf die früher die Diagnose einer substanziellen Hirnschädigung gestützt wurde, können auch weiterhin für die gutachterliche Anerkennung eines Zusammenhangs zwischen Beschwerden und Trauma herangezogen werden, ihr Fehlen rechtfertigt jedoch nicht die Ablehnung eines Zusammenhangs. Angesichts der großen Bedeutung der Initialbefunde sollte der Gutachter sicherstellen, dass diese ihm vollständig vorliegen. 1.3. Die Arbeitsgruppe hält die Durchführung (oder Heranziehung) einer MR-Bildgebung in jedem Fall einer kausalen Begutachtung zu den Folgen eines Schädel-Hirntraumas, in dem die vorliegende Bildgebung keinen eindeutig positiven Hinweis ergibt, für notwendig. Diese sollte T2*-gewichtete Sequenzen enthalten. 1.4. Monate und Jahre nach SHT dominieren Störungen des Gedächtnisses, von Aufmerksamkeitsfunktionen, Antrieb und psychomotorischer Geschwindigkeit sowie frontal exekutive Defizite die neuropsychologische Symptomatik (↑). Nach diesen ist gezielt zu fragen. Da für die gutachterliche Beurteilung das Ausmaß der kognitiven Funktionsstörungen hinreichend reliabel und valide quantifiziert sein muss, ist zur Beurteilung der Wahrscheinlichkeit des Zusammenhangs hinsichtlich des Defizitprofils und zur Quantifizierung der Defizite eine neuropsychologische Untersuchung (↑), in der Regel als neuropsychologisches Zusatzgutachten, notwendig. 1.5. So genannte “Kurztests” (z. B. Syndrom-Kurztest, Benton-Test, Mehrfachwahl-Wortschatztest) sind für die Begutachtung in keinem Fall ausreichend, ihre Validität in Bezug auf die Fragestellung ist nicht belegt (↓↓). 1.6. Eine verlässliche Fremdanamnese unterstützt die Beurteilung und Bewertung von Auswirkungen im Alltag. 1.7. Bei sehr schwerer Gewalteinwirkung treten Schädigungen von Mittelhirn- und Hirnstammstrukturen hinzu, die wesentliche pathologische Korrelate für psychomotorische Verlangsamung, aber auch Tetraspastik, Ataxie und Hypokinese darstellen. Die gutachterliche Bewertung wirft selten Probleme auf. 1.8. Kopfschmerz ist als Verletzungsfolge nach SHT ohne Hirnhautnarbe vermutlich selten (aber im ICD vorgesehen). Bei relevantem Trauma, belastender Symptomatik und glaubhafter Schilderung (und nur dann) empfehlen wir pragmatische Anerkennung im Sinne eines Spannungskopfschmerzes bei beeinträchtigungsbedingter Überlastung und evtl. Stressintoleranz. 1.9. An psychiatrischen Diagnosen sind Depressionen und Angststörungen besonders häufig. Auch posttraumatische Belastungsstörungen kommen trotz Amnesie für das Geschehen nach SHT vor. 2. Optimierung der Versorgung im Hinblick auf die Erfordernisse einer späteren Begutachtung: 2.1. Eine qualifizierte neurologische und verhaltensneurologische Untersuchung einschließlich EEG sollte bei allen Patienten nach Schädel-Hirntrauma in den ersten 14 Tagen angestrebt werden (½).
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Affiliation(s)
| | - Peter Marx
- Universitätsklinikum Benjamin Franklin, Berlin
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Nybo T, Sainio M, Müller K. Stability of vocational outcome in adulthood after moderate to severe preschool brain injury. J Int Neuropsychol Soc 2004; 10:719-23. [PMID: 15327719 DOI: 10.1017/s1355617704105109] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2003] [Revised: 03/05/2004] [Indexed: 11/07/2022]
Abstract
We studied how moderate to severe childhood traumatic brain injury (TBI) affects vocational outcome with time. This is the second follow-up of patients who were injured as preschoolers in traffic accidents. In the first follow-up the mean age was 23 years and in the present study the average age of the 27-patient cohort was 40 years. Twenty-two patients were assessed clinically by a neuropsychologist, neurologist and a social worker. Five patients, although not able or willing to participate in the clinical study, were contacted by telephone and interviewed on their vocational outcome. Compared to the first follow-up, 20/27 patients in total had no change in their vocational status. Nine out of the 27 patients were working full-time, two had subsidized jobs and 16 were not working. Twenty-four of 27 patients were independent in daily living. In the neuropsychological tests of executive functions, preserved flexibility associated with full-time work status. In conclusion, 1/3 of the patients were still employed full-time over 30 years after the TBI. This suggests that favorable vocational outcome, reached by young adulthood, is maintained at least until middle age.
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Affiliation(s)
- Taina Nybo
- Finnish Institute of Occupational Health, Helsinki, Finland.
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McDonald S, Flanagan S. Social Perception Deficits After Traumatic Brain Injury: Interaction Between Emotion Recognition, Mentalizing Ability, and Social Communication. Neuropsychology 2004; 18:572-579. [PMID: 15291735 DOI: 10.1037/0894-4105.18.3.572] [Citation(s) in RCA: 185] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Thirty-four adults with severe traumatic brain injuries (TBI) and 34 matched control participants were asked to interpret videotaped conversational exchanges. Study participants were asked to judge the speakers' emotions, the speakers' beliefs (first-order theory of mind), what the speakers intended their conversational partners to believe (second-order theory of mind), and what they meant by remarks that were sincere or literally untrue (i.e., a lie or sarcastic retort). The TBI group had marked difficulty judging most facets of social information. They could recognize speaker beliefs only when this information was explicitly provided. In general, emotion recognition and first-order theory of mind judgments were not related to the ability to understand social (conversational) inference, whereas second-order theory of mind judgments were related to that ability.
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Azouvi P, Couillet J, Leclercq M, Martin Y, Asloun S, Rousseaux M. Divided attention and mental effort after severe traumatic brain injury. Neuropsychologia 2004; 42:1260-8. [PMID: 15178177 DOI: 10.1016/j.neuropsychologia.2004.01.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Revised: 01/05/2004] [Accepted: 01/07/2004] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess dual-task performance in TBI patients, under different experimental conditions, with or without explicit emphasis on one of two tasks. Results were compared with measurement of the subjective mental effort required to perform each task. Forty-three severe TBI patients at the subacute or chronic phase performed two tasks under single- and dual-task conditions: (a) random generation; (b) visual go-no go reaction time task. Three dual-task conditions were given, requiring either to consider both tasks as equally important or to focus preferentially on one of them. Patients were compared to matched controls. Subjective mental effort was rated on a visual analogic scale. TBI patients showed a disproportionate increase in reaction time in the go-no go task under the dual-task condition. However, they were just as able as controls to adapt performance to the specific instructions about the task to be emphasised. Patients reported significantly higher subjective mental effort, but the variation of mental effort according to task condition was similar to that of controls. These results suggest that the divided attention deficit of TBI patients is related to a reduction in available processing resources rather than an impairment of strategic processes responsible for attentional allocation and switching. The higher level of subjective mental effort may explain why TBI patients frequently complain of mental fatigue, although this subjective complaint seems to be relatively independent of cognitive impairment.
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Affiliation(s)
- Philippe Azouvi
- Service de Rééducation Neurologique, Formation de Recherche Claude Bernard, Faculté de Médecine Paris-Ile de France Ouest, Université de Versailles-Saint Quentin, Hôpital Raymond Poincaré, Garches 92380, France.
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Abstract
Abstract: Many TBI patients suffer from cognitive impairments, affecting their abilities to function on a previous level. However, some patients exhibit personality changes, manifesting themselves in inadequate or inappropriate social behavior, which are considered to have even more debilitating consequences on successful social and vocational rehabilitation. The term “impaired social attention” was put forward by Dr. van Zomeren as a description of a part of these problems: Patients' analysis of social situations seems incomplete, and they seem to lack awareness of consequences of their actions. In this paper the concept of social attention will be explored, whereby it is hypothesized that impaired social attention results from underlying emotional impairments. Two aspects of emotional behavior are considered essential prerequisites for intact social attention: The ability to perceive emotional expressions of others, and the ability to form a Theory of Mind (ToM). The literature will be reviewed in order to find out whether these aspects are impaired in TBI patients.
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Affiliation(s)
- Jacoba M. Spikman
- Department of Neurology, Neuropsychology Unit, Academic Hospital Groningen, The Netherlands
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Sherer M, Sander AM, Nick TG, High WM, Malec JF, Rosenthal M. Early cognitive status and productivity outcome after traumatic brain injury: findings from the TBI model systems. Arch Phys Med Rehabil 2002; 83:183-92. [PMID: 11833021 DOI: 10.1053/apmr.2002.28802] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the contribution of early cognitive assessment to the prediction of productivity outcome after traumatic brain injury (TBI) adjusted for severity of injury, demographic factors, and preinjury employment status. DESIGN Inception cohort. SETTING Six inpatient brain injury rehabilitation programs. PARTICIPANTS A total of 388 adults with TBI whose posttraumatic amnesia (PTA) resolved before discharge from inpatient rehabilitation. INTERVENTIONS Administered neuropsychologic tests during inpatient stay on emergence from PTA. Follow-up interview and evaluation. Predictor measures also determined. MAIN OUTCOME MEASURE Productivity status at follow-up 12 months postinjury. RESULTS Multiple logistic regression analysis revealed that preinjury productivity status, duration of PTA, education level, and early cognitive status each made significant, independent contributions to the prediction of productivity status at follow-up. When adjusted for all other predictors, persons scoring at the 75th percentile on early cognitive status (less impaired) had 1.61 times greater odds (95% confidence interval [CI], 1.07-2.41) of being productive follow-up than those scoring at the 25th percentile (more impaired). Without adjustment, persons scoring at the 75th percentile had 2.46 times greater odds (95% CI, 1.77-3.43) of being productive at follow-up. CONCLUSIONS Findings support the utility of early cognitive assessment by using neuropsychologic tests. In addition to other benefits, early cognitive assessment makes an independent contribution to prediction of late outcome. Findings support the clinical practice of performing initial neuropsychologic evaluations after resolution of PTA.
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Affiliation(s)
- Mark Sherer
- Methodist Rehabilitation Center, Jackson, MS 39216, USA.
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Spikman JM, Kiers HA, Deelman BG, van Zomeren AH. Construct validity of concepts of attention in healthy controls and patients with CHI. Brain Cogn 2001; 47:446-60. [PMID: 11748900 DOI: 10.1006/brcg.2001.1320] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study aimed to examine the construct validity of three aspects of attention, namely focused, divided, and supervisory control of attention. Factor-analytic techniques were applied to scores of healthy subjects on a series of neuropsychological tests tapping these aspects of attention. The two components found did not match the hypothesized aspects and were labeled as Memory-driven Action and Stimulus-driven Reaction. The second question was whether the same components could be found in a group of patients with CHI. The pattern of attentional functions found in healthy subjects had changed qualitatively in patients with CHI. A possible explanation for this result in terms of a shift from automatic to controlled processing is discussed.
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Affiliation(s)
- J M Spikman
- Department of Neuropsychology, Groningen State University, The Netherlands.
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McCauley SR, Levin HS, Vanier M, Mazaux JM, Boake C, Goldfader PR, Rockers D, Butters M, Kareken DA, Lambert J, Clifton GL. The neurobehavioural rating scale-revised: sensitivity and validity in closed head injury assessment. J Neurol Neurosurg Psychiatry 2001; 71:643-51. [PMID: 11606677 PMCID: PMC1737597 DOI: 10.1136/jnnp.71.5.643] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the factor structure and psychometric properties of the neurobehavioural rating scale-revised (NRS-R) and to determine its usefulness in clinical trials. METHODS A consecutive series of patients sustaining severe closed head injury were evacuated to one of 11 large regional North American trauma centres and entered into a randomised, phase III, multicentre clinical trial investigating the therapeutic use of moderate hypothermia. Acute care personnel were blinded to outcome and outcome personnel were blinded to treatment condition. The Glasgow outcome scale (GOS) was the primary outcome measure. Secondary outcome measures included the disability rating scale (DRS) and the NRS-R. RESULTS Exploratory factor analysis of NRS-R data collected at 6 months after injury (n=210) resulted in a five factor model including: (1) executive/cognition, (2) positive symptoms, (3) negative symptoms, (4) mood/affect, and (5) oral/motor. These factors showed acceptable internal consistency (0.62 to 0.88), low to moderate interfactor correlations (0.19 to 0.61), and discriminated well between GOS defined groups. Factor validity was demonstrated by significant correlations with specific neuropsychological domains. Significant change was measured from 3 to 6 months after injury for the total score (sum of all 29 item ratings) and all factor scores except mood/affect and positive symptoms. The total score and all factor scores correlated significantly with concurrent GOS and DRS scores. CONCLUSIONS The NRS-R is well suited as a secondary outcome measure for clinical trials as its completion rate exceeds that of neuropsychological assessment and it provides important neurobehavioural information complementary to that provided by global outcome and neuropsychological measures.
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Affiliation(s)
- S R McCauley
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, 6560 Fannin, Ste 1144, Houston, TX 77030, USA
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Rapoport MJ, Feinstein A. Outcome following traumatic brain injury in the elderly: a critical review. Brain Inj 2000; 14:749-61. [PMID: 10969893 DOI: 10.1080/026990500413777] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The elderly are at risk for traumatic brain injury (TBI), but their outcome following these injuries remains unclear. OBJECTIVE This paper critically reviews research done to date on cognitive and functional outcome following TBI in the elderly. METHODS MEDLINE and PSYCHLIT databases going back to 1965 were searched. RESULTS Studies suggest that TBI results in adverse cognitive and functional outcomes in the elderly. There is uncertainty as to whether TBI is a significant risk factor for Alzheimer's disease (AD). Methodological problems in these studies include selection bias, small samples, retrospective analyses, and, particularly, the failure to address the role of pre-morbid functioning. These problems limit the strength of the outcome studies, and may account for the equivocal findings on AD risk. CONCLUSIONS It is premature to conclude from the published research to date that the elderly have a uniformly poor outcome following TBI. Directions for further research are suggested.
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Affiliation(s)
- M J Rapoport
- University of Toronto, Sunnybrook and Women's Health Sciences Centre, Ontario, Canada
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