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Closed Head Injury Psychological, social, and family consequences
... Given the short time frame of the study, however, there is at least one alternative interpretation. The greatest functional recovery is within the first 6 months after trauma (Brooks, 1984), and relatives were possibly less distressed because they expected good recovery rates to continue. Also, if the clinical caseness cutoff point for anxiety on the STAI had been set at the 80th percentile, the percentage of relatives reporting anxiety (27%) would be comparable to both Oddy's and Livingston's samples of relatives at approximately 3 months post-TBI (Livingston et al., 1985a; Oddy, Humphrey, & Uttley, 1978a). ...
... Another factor contributing to relatives' stress was their perception that their needs were not being met (Brooks et al., 1987), and that negative personality and behavioral changes were consistently more distressing to relatives (Livingston & Brooks, 1988). The Glasgow team also explored the relationship between the characteristics of relatives and their reporting of distress (McKinlay & Brooks, 1984). McKinlay and Brooks found a strong relationship between high neuroticism and high burden in relatives. ...
... McKinlay and Brooks found a strong relationship between high neuroticism and high burden in relatives. However, their measure of neuroticism was based on a truncated version of Eysenck's Personality Questionnaire (Eysenck & Eysenck, 1975), in which the respondent scoring high on neuroticism was described as "anxious, depressed, overly emotional and inclined to over-react; in short 'a worrier' " (McKinlay & Brooks, 1984, p. 93), a description that could easily apply to someone scoring high on trait anxiety. Because anxiety is a common signpost for stress (Smith & Allred, 1989), the supposedly strong relationship between neuroticism and relatives' stress may indicate that they are similar constructs rather than the personality trait of neuroticism being an indicator of vulnerability to stress. ...
Presents a critical overview of the literature of family psychosocial outcome after traumatic brain injury (TBI). Thirty-seven family outcome studies were reviewed. Most of the data presented were on psychosocial outcome of primary caregivers, most often parents and spouses. A smaller amount of outcome literature on siblings and children of a parent with TBI was also considered. In the studies reviewed, 23 different standardized psychosocial outcome measures were used in addition to semistructured, in-depth interviews and indexes such as medication usage and counseling uptake. A clear bias was evident in the literature whereby family outcome was likely to be viewed by researchers in terms of stress and burden on relatives. Recommendations were made for future family outcome research to develop a more theoretically coherent framework of family adaptation post-TBI to expand our understanding of relatives' psychosocial outcome and to shift the research focus to the resilience of families and their ability to work toward positive outcomes. There is a need to use standardized, TBI-specific measures with cross-cultural validity to have less variability in outcome measurement and more consensus in operationalizing outcome in order to enhance comparability between studies. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Some of the war-related sources of stress for women include: providing care for the disabled veterans, looking after children, managing the household, and finally putting up with their husbands’ PTSD. Studies suggest that wives of injured men experience more distress than mothers and that the impact of a traumatic injury upon a marriage partnership is different from the impact upon a parent-child relationship (16–19). ...
... Partners are keenly aware of cues that precipitate symptoms of PTSD, and partners take an active role in managing and minimizing the effects of these precipitants.Many researchers concluded that there were high levels of caregiver burden included psychological distress, dysphoria, and anxiety(13–15). Studies also suggest that wives of injured men experience more distress than mothers (16–19). A more specific study was carried out by Solomon et al. (12) on 205 wives of Israeli combat veterans of the 1982 Lebanon war providing further evidence of heightened emotional distress among wives of PTSD veterans. ...
This study was conducted to compare the personal well-being among the wives of Iranian veterans living in the city of Qom.
A sample of 300 was randomly selected from a database containing the addresses of veteran's families at Iran's Veterans Foundation in Qom (Bonyad-e-Shahid va Omoore Isargaran). The veterans' wives were divided into three groups: wives of martyrs (killed veterans), wives of prisoners of war, and wives of disabled veterans. The Persian translation of Personal Well-being Index and Stress Symptoms Checklist (SSC) were administered for data collection. Four women chose not to respond to Personal Well-being Index. Data were then analyzed using linear multivariate regression (stepwise method), analysis of variance, and by computing the correlation between variables.
Results showed a negative correlation between well-being and stress symptoms. However, each group demonstrated different levels of stress symptoms. Furthermore, multivariate linear regression in the 3 groups showed that overall satisfaction of life and personal well-being (total score and its domains) could be predicted by different symptoms.
Each group experienced different challenges and thus different stress symptoms. Therefore, although they all need help, each group needs to be helped in a different way.
... Cognitive changes are troublesome to families of TBI patients, but " of much greater worry to relatives was the change in personality in the patient which, the relatives felt, overshadowed all other changes " (Brooks, 1984, p. 126). Therefore, just as the neurobehavioral symptoms of TBI exert a disproportionate effect on recovery for the braininjured individual, so too these symptoms exert a disproportionate effect on family adjustment to injury (Brooks, 1984; Cavallo, Kay, & Ezrachi, 1992; Hall et al., 1994; Stambrook, Peters, & Moore, 1989; Thomsen, 1984). ...
... Cognitive changes are troublesome to families of TBI patients, but " of much greater worry to relatives was the change in personality in the patient which, the relatives felt, overshadowed all other changes " (Brooks, 1984, p. 126). Therefore, just as the neurobehavioral symptoms of TBI exert a disproportionate effect on recovery for the braininjured individual, so too these symptoms exert a disproportionate effect on family adjustment to injury (Brooks, 1984; Cavallo, Kay, & Ezrachi, 1992; Hall et al., 1994; Stambrook, Peters, & Moore, 1989; Thomsen, 1984). This belief has come to be so widely held by researchers that a maxim has developed: Family members find the behavioral and emotional changes associated with TBI most distressing. ...
Traumatic brain injury (TBI) often results in a myriad of symptoms across physical, cognitive, and neurobehavioral domains. Despite inherent limitations associated with physical or cognitive impairments, the extant literature suggests that neurobehavioral symptoms tend to be the most distressing symptoms for the family and are more strongly related to poor outcome for the patient. The Neuropsychology Behavior and Affect Profile (NBAP) along with the General Functioning subscale of the Family Assessment Device (FAD-GF) and the Perceived Stress Scale were administered to 153 family members of persons who had sustained a TBI. The results provide new normative data and statistical support for the NBAP as a promising measure of neurobehavioral symptomatology following TBI. The correlation of.54 (p <.01) between FAD-GF and Full Scale NBAP scores provides powerful support for the hypothesis that family dysfunction is related to the presence of neurobehavioral symptoms in the patient. NBAP domains of Depression, Inappropriateness, Pragnosia, and Indifference appear most strongly related to family functioning and also bear a significant relationship to caregiver stress level and patient unemployment, whereas injury severity had little impact on either family functioning or neurobehavioral symptoms. The findings reinforce the significance of neurobehavioral symptoms and fortify their proposed link to family dysfunction post-TBI.
... Cognitive changes are troublesome to families of TBI patients, but " of much greater worry to relatives was the change in personality in the patient which, the relatives felt, overshadowed all other changes " (Brooks, 1984, p. 126 ). Therefore, just as the neurobehavioral symptoms of TBI exert a disproportionate effect on recovery for the braininjured individual, so too these symptoms exert a disproportionate effect on family adjustment to injury (Brooks, 1984; Cavallo, Kay, & Ezrachi, 1992; Hall et al., 1994; Stambrook, Peters, & Moore, 1989; Thomsen, 1984). This belief has come to be so widely held by researchers that a maxim has developed: Family members find the behavioral and emotional changes associated with TBI most distressing. ...
Traumatic brain injury (TBI) often results in a myriad of symptoms across physical, cognitive, and neurobehavioral domains. Despite inherent limitations associated with physical or cognitive impairments, the extant literature suggests that neurobehavioral symptoms tend to be the most distressing symptoms for the family and are more strongly related to poor outcome for the patient. The Neuropsychology Behavior and Affect Profile (NBAP) along with the General Functioning subscale of the Family Assessment Device (FAD-GF) and the Perceived Stress Scale were administered to 153 family members of persons who had sustained a TBI. The results provide new normative data and statistical support for the NBAP as a promising measure of neurobehavioral symptomatology following TBI. The correlation of .54 (p < .01) between FAD-GF and Full Scale NBAP scores provides powerful support for the hypothesis that family dysfunction is related to the presence of neurobehavioral symptoms in the patient. NBAP domains of Depression, Inappropriateness, Pragnosia, and Indifference appear most strongly related to family functioning and also bear a significant relationship to caregiver stress level and patient unemployment, whereas injury severity had little impact on either family functioning or neurobehavioral symptoms. The findings reinforce the significance of neurobehavioral symptoms and fortify their proposed link to family dysfunction post-TBI.
... Ernstige hersenkneuzingen met langere PTA-duren komen veel minder vaak voor (Minderhoud & Van Zomeren, 1984; Van der Naalt, 2000; Russell, 1971). Een middelzware contusio cerebri kan fysieke stoornissen tot gevolg hebben, zoals paresen of coördinatieproblemen, maar cognitieve, emotionele en sociale gevolgen komen veel meer voor en hebben over het algemeen meer beperkende gevolgen voor het functioneren van de patiënt (Brooks, 1984; Minderhoud & Van Zomeren, 1984; Richardson, 2000). De cognitieve stoornissen die het frequentst optreden liggen op het gebied van geheugen en aandacht. ...
Na een traumatisch hersenletsel, een veel voorkomende neurologische aandoening, heeft een groot deel van de patiënten cognitieve
klachten, met name op het gebied van aandacht. In de literatuur is er consensus over een vertraagd tempo van informatieverwerking
als blijvend restverschijnsel, maar als het gaat om stoornissen in aandacht en executieve functies lopen de bevindingen uiteen.
In dit artikel wordt een promotieonderzoek beschreven dat erop gericht was dergelijke stoornissen, eventueel herstel, en de
gevolgen ervan voor het dagelijks leven in kaart te brengen. Tevens werden theoretische vragen beantwoord over de onderlinge
relatie van de begrippen ‘tempo’, ‘selectieve aandacht’ en ‘executieve controle’, en de meetbaarheid hiervan op testniveau.
... A probable cause for the experienced fatigue may be found in this light. Cognitive deficits may temporarily be compensated for by exerting increased mental effort, which then may cause fatigue [40]. Indeed, widespread brain activity has been shown in patients with unilateral lesions of one cerebral hemisphere trying to perform a unimanual task with their affected hand [41]. ...
Objective. To obtain a psychosocial profile of patients with poststroke fatigue (PSF), which could aid in optimizing treatment strategies. Methods. Eighty-eight outpatients with severe PSF measured with the Checklist Individual Strength-fatigue subscale (CIS-f) and the Fatigue Severity Scale (FSS) were selected. Depression and anxiety, psychological distress, coping, social support, and self-efficacy of this group were compared to reference groups of healthy controls and patients with other chronic diseases. Associations between psychosocial characteristics and fatigue were calculated. Results. Compared to healthy controls, patients with PSF reported more psychological distress, less problem-focused coping, and more positive social support. Minor or no differences were found in comparison with other chronic patients. The CIS-f correlated with somatic complaints and the FSS with cognitive complaints. Conclusion. Patients with PSF show a psychosocial profile comparable to patients with other chronic disease. Implications for diagnosis and treatment are discussed.
... Behavioural dysfunction following frontal lobe damage is one of the obstacles to the rehabilitation and the social and occupational reintegration of these patients (Bond & Godfrey, 1997). Among the dysfunctions (see Fuster, 1999), we find personality disorders, motor and attention deficits (Brooks, 1984; Eslinger & Damasio, 1985), and language impairment (Prigatano, Roueche & Fordyce, 1985). Wapner, Hamby and Gardner (1981) and Kaczmarek (1984) showed that phonological and syntactic abilities remain globally intact. ...
This paper is about communication deficits in an interview setting among adolescents with frontal lobe damage. One of the predominant characteristics of these patients is difficulty taking the context into account. Pragmatic theories, which attempt to clarify the link between the formal structure of language and the extra-linguistic context (such as the interlocutor's characteristics or strategies), may help provide insight into the difficulties of these patients. An interview setting, viewed here as a communication situation, is governed by an interaction format based on specific cooperative principles. In this study, the results of subjects with frontal lobe damage (in the role of interviewee) were first compared with those of normal subjects in an interview situation. Three pragmatic indexes were considered: the number of utterances per speaking turn (speech quantity), amount of digression (keeping to the topic or predefined subject of conversation shared by the interlocutors) and prevalence of within-subject contingency speaking turns without an intervening remark by the interviewer (topic development). Secondly, we attempted to determine whether the patients' discourse was dependent upon the interviewer's conversational strategy (structured, non-structured, or alternating). The results clearly point out the extent of the difficulty frontal lobe patients have conforming to the rules of the interview situation, whether regarding the amount of speech they produce or their ability to keep within and/or development of the topic of conversation. The data also indicated that the patients' linguistic productions varied with the interviewer's strategy. The structured strategy did not always give rise to the best performance: while the unstructured and alternating strategies allowed patients to produce more utterances per speaking turn, the alternating strategy enabled better development of the interview topic. These results suggest that such variations could be put to fruitful use in remedial techniques.
The caregivers of 22 severely head-injured individuals were interviewed at 6 and 12 months post injury to obtain information about the extent of their distress and to in vestigate the relationship between their distress and two aspects of burden: caregivers' perceptions of the head-injured person's problems and an objective assessment of func tional independence. Caregivers reported high levels of distress. The factors associated with caregiver distress included the number of perceived problems at 6 months post injury, the overall level of disability, and certain aspects of functional independence at both 6 and 12 months, particularly if the person required assistance with self-care and home-based tasks. Implications for rehabilitation of both the head-injured indi vidual and his or her caregivers are examined, especially with reference to issues sur rounding return to the community. Key Words: Caregivers—Head injury—Psycho logical distress—Functional outcome—Newcastle Independence Assessment Form (N1AF)—GHQ-28
Objectives:
To determine (1) alexithymia, affect recognition, and empathy differences in participants with and without traumatic brain injury (TBI); (2) the amount of affect recognition variance explained by alexithymia; and (3) the amount of empathy variance explained by alexithymia and affect recognition.
Participants:
Sixty adults with moderate-to-severe TBI; 60 age and gender-matched controls.
Procedures:
Participants were evaluated for alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking); facial and vocal affect recognition; and affective and cognitive empathy (empathic concern and perspective-taking, respectively).
Results:
Participants with TBI had significantly higher alexithymia; poorer facial and vocal affect recognition; and lower empathy scores. For TBI participants, facial and vocal affect recognition variances were significantly explained by alexithymia (12% and 8%, respectively); however, the majority of the variances were accounted for by externally-oriented thinking alone. Affect recognition and alexithymia significantly accounted for 16.5% of cognitive empathy. Again, the majority of the variance was primarily explained by externally-oriented thinking. Affect recognition and alexithymia did not explain affective empathy.
Conclusions:
Results suggest that people who have a tendency to avoid thinking about emotions (externally-oriented thinking) are more likely to have problems recognizing others' emotions and assuming others' points of view. Clinical implications are discussed.
The application of techniques for reducing verbal and physical aggression can be problematic when the procedures are applied to high functioning adults who have sustained a traumatic head injury. In this investigation, the effect of a ‘cool down’ training procedure on two adult males with brain injuries was examined using the same strategy, which was simultaneously applied to both behaviors for 1 subject and applied only to verbal aggression for a second subject. The cool down training procedure included 2 training sessions per week, plus implementation of a modified training program in the test situation. Results revealed that the cool down training program was effective in reducing both verbal and physical aggression and therefore provides an alternative treatment for adults with head injuries.
Survivors from a coma due to severe traumatic brain injury (TBI) frequently suffer from long-lasting disability, which is mainly related to cognitive deficits. Such deficits include slowed information processing, deficits of learning and memory, of attention, of working memory, and of executive functions, associated with behavioral and personality modifications. This review presents a survey of the main neuropsychological studies of patients with remote severe TBI, with special emphasis on recent studies on working memory, divided attention (dual-task processing), and mental fatigue. These studies found that patients have difficulties in dealing with two simultaneous tasks, or with tasks requiring both storage and processing of information, at least if these tasks require some degree of controlled processing (i.e., if they cannot be carried out automatically). However, strategic aspects of attention (such as allocation of attentional resources, task switching) seem to be relatively well preserved. These data suggest that severe TBI is associated with a reduction of resources within the central executive of working memory. Working memory limitations are probably related to impaired (i.e., disorganized and augmented) activation of brain executive networks, due to diffuse axonal injury. These deficits have disabling consequences in everyday life.
A retrospective study examined predictors of MMPI responses for a sample of 66 post-acute traumatic brain-injured patients. Years of education was found to be correlated to four clinical scales and two validity scales with the more educated subjects reporting less psychopathological symptoms. Those with higher Verbal IQs tended to score higher on the Hysteria scale and the Repression scale. Those with higher Performance IQs were found to be endorsing more items on the Hypochondriasis, Hysteria and Organic Symptoms scales. The Verbal-Performance (V-P) difference score was not found to be significantly predictive of indices of defensiveness. Depression was found to vary over time peaking between 1 and 3 years after injury. The results were discussed in terms of their implications for clinicians.
One hundred and two consecutive head injured patients were studied at 1 and 12 months after injury. Their performances were compared with a group of uninjured friends. The results indicate that impairment in memory depends on the type of task used, time from injury to testing, and on the severity of head injury (that is, degree of impaired consciousness). Head injury severity indices are more closely related to behavioural outcome early as compared with later after injury. At 1 year, only those with deep or prolonged impaired consciousness (as represented by greater than 1 day of coma, Glasgow Coma Scale of 8 or less, and post traumatic amnesia of 2 weeks or greater) are performing significantly worse than comparison subjects.
Twenty four patients with severe brain injury who had disturbed behaviours preventing rehabilitation or care in ordinary settings were treated in a token economy. This long-term follow-up study indicates that post-traumatic behaviour disorders can be lastingly improved, and that lengthy rehabilitation can have surprisingly good effects.
Covert orientation of visual attention was studied in eight closed head injury (CHI) subjects who fixated warning cues and pressed a button at peripheral target onset. Directional cues (arrows) indicated the most probable (p = 0.8) side of target occurrence while neutral cues (crosses) gave no directional information. A NoGo cue (vertical bar) indicated no response was required. Compared to eight matched controls the CHI subjects displayed slowed processing of all cues (increased P2, N2 and P3 latencies). Also, evidence was found for very early impairment (increased P2 amplitude) in directing attention. Further, the CHI group did not show the normal attenuated CNV after NoGo signals, suggesting perseverative behaviour. Finally, the amplitude and latency of the P3 component (post-cue and post-target) approached normal as time since injury increased.
This study sought to identify combinations of early neurological variables which best predict cognitive outcome 12 months after severe head injury. At the time of admission patients were assessed on seven neurological indices. Twelve months later a battery of neuropsychological tests examining recent memory functioning and speed of information processing was administered. Recent memory functioning was best predicted by a combination of post-coma disturbance (PCD; i.e. the duration of post-traumatic amnesia, PTA, minus the duration of coma) and presence of subarachnoid haemorrhage (multiple r = 0.54, p < 0.001). Speed of information processing was best predicted by the duration of PTA (r = 0.35, p < 0.01). However, these conclusions were based on square root transformation of PCD and PTA variables. The success of this transformation in assisting prediction confirms suggestions that the relationship between PTA and cognitive outcome is nonlinear.
This study examined the relationship of patient variables to caregiver distress and family functioning after TBI in 62 families. An extension of Kreutzer et al. 1994 (in press), the present investigation used four categories of predictor variables: indices of injury severity, neuropsychological tests, neurobehavioural problem checklist scales, and kinship of caregiver (i.e. spouse vs. parent). Caregiver distress and family functioning were measured by the Brief Symptom Inventory (BSI) and Family Assessment Device (FAD), respectively. Regression analyses revealed that indices of injury severity did not predict BSI scores. Time post-injury predicted several FAD subscales. The number of the patient's neurobehavioural problems predicted BSI subscale scores most consistently, particularly the Global Severity Index, Somatic, Obsessive-Compulsive and Depression scales. Scores on the behaviour problem subscale predicted BSI scores better than other kinds of problems, and also had some relation to several FAD subscales. Of the 10 neuropsychological test scores, those which measured verbal abilities were more predictive of caregiver's BSI scores. Kinship (i.e. being a spouse) predicted Depression scores, even when other variables were partialled out. Research findings are integrated with European studies and clinical implications for understanding caregiver distress are discussed.
This study addresses the possibility that cognitive sequelae--albeit of a transient or minor character--can be associated with mild head injury. Twenty men (aged 16-30 years of age), whose post-traumatic amnesia did not exceed eight hours, were examined within 48 hours of their accident and again one month later. This unselected sample had no previous history of head injury. A control group of 20 men of similar socioeconomic background, was selected from medical wards (where they had been admitted for orthopaedic treatment or a minor operation). They were also retested one month after the first examination. Neuropsychological tests were selected to measure abilities often compromised after significant head injury, namely memory and attention. The experimental component consisted of the fractionation of a complex skill (paced addition) to probe for deficits at different stages of information processing: perception and input into storage; search for and retrieval of information from working memory; and paced and unpaced addition. In general, no significant difference was found between the experimental and control groups, with the possible exception of an initial decrement on two working memory tasks: probe digits and a keeping track task (where the subject has to keep in mind and update a number of variables at the same time). The keeping track paradigm, ostensibly of ecological relevance, may well be worth further exploration in memory research, and in studies of more severely head-injured patients. It is further suggested that the appropriate management and counselling of mildly head-injured patients may help to avert symptoms that are of psychological rather than pathophysiological origin.
To establish efficacy of a coordinated multidisciplinary rehabilitation service for severe head injury, provided at Hunters Moor Regional Rehabilitation Centre.
A quasi-experimental design to compare treatment effects between two groups. The first group received a coordinated, multidisciplinary regional rehabilitation service; the other, a single discipline approach provided by local, district hospitals. Follow-up was for 2 years postinjury.
Fifty-six consecutive severe head injury admissions, with an identified main caregiver, referred for rehabilitation within 4 weeks of their injury.
The Barthel index, the Functional Independence Measure (FIM), and the Newcastle Independence Assessment Form (NIAF), a newly developed, real-life, comprehensive measure. In addition, caregivers completed the General Health Questionnaire.
The group that received coordinated multidisciplinary rehabilitation not only demonstrated significant gains throughout the study period but also maintained treatment effect after input ended. Furthermore, caregivers of this group had significantly reduced levels of distress. The comparison group, despite initial lower injury severity and shorter hospital stay, did not demonstrate equivalent gains or any posttreatment effect.
The results show the efficacy of a comprehensive, specialist multidisciplinary regional service. There are significant implications for service provision for people with severe traumatic head injury.
Although the negative effect of epilepsy on patient's psychosocial well-being has been increasingly documented in the last decade, the influence of the condition on the family has attracted much less interest. This paper reviews the present state of family research, examining the influence of both childhood and adulthood epilepsy on the psychological and social well-being of family members. Studies indicate that epilepsy may cause high levels of psychosocial difficulties for all family members, including stigmatization, stress, psychiatric morbidity, marital problems, poor self esteem and restriction of social activities. Studies also suggest that the family environment may be an important intervening factor between the condition and the outcome for the family unit, and a number of family factors are reviewed which have been suggested to mediate this relationship, with recommendations being made for their use in intervention studies. Shortcomings of the family studies to date are discussed and these include: concentration on examination of issues around family life, studies being based on reports from single members of the family and the selection of subjects from clinical populations. Recommendations are made concerning methodological and conceptual issues that need addressing for future research.
This study suggests that perceptually based implicit learning may either be preserved following a severe closed-head injury (CHI) or recover within the 1st year. Nineteen severe CHI patients and 19 controls searched visual matrices and indicated the quadrant location of a target. Participants were exposed to the following covariation pattern: AAAABAAA. For Covariation A blocks, the matrices systematically co-occurred with a unique location of the target. This relationship was altered for the B block. Despite CHI participants' overall slower response times (RTs), both groups demonstrated the expected decline in RTs across the first 4 Covariation A blocks followed by an increase when the covariation changed. Both groups also exhibited retention of their learning after a 20-min delay. Explicit knowledge tests indicated that participants lacked awareness for the covariation.
The assessment of memory typically includes tests for both audioverbal and visuospatial processing, while measurements of
learning have primarily utilized the audioverbal mode. However, there exists no compelling reason why learning should not
also be assessed in the visuospatial mode. The Ruff Light Trail Learning Test (RULIT) represents such an option. Normative
values utilizing 307 volunteers indicated neither significant gender nor educational differences. However, an age effect for
those subjects 55 and older was demonstrated, and our data suggest that the major reason for the inferior learning in this
older subgroup was their reduced memory capacities rather than their slowed visuospatial processing. Multiple components including
learning curves, error analysis, and delayed recall are presented. Test-retest data also indicate an adequate reliability.
The validity was compared to concurrently administered neuropsychological tests, and, finally, the potential for neuropsychological
application of this new test is discussed.
Impaired deficit awareness is common following traumatic brain injury (TBI) and is a major obstacle to rehabilitation. We have previously confirmed the presence of impaired error awareness in TBI using a highly discriminating go/no-go procedure. In the present study, we extend this work to try to identify more closely the nature of the error awareness deficit using measures of electrodermal activity (EDA). Sixteen participants with TBI and sixteen age-, sex-, and education-matched controls performed the Sustained Attention to Response Task (SART), while EDA was recorded. TBI detected significantly fewer errors compared to controls. EDA was significantly attenuated for TBI participants even to errors of which they were aware; error detection rates and EDA amplitude were also correlated. These findings suggest that poor insight following TBI may result, in part, from impaired error processing abilities.
To examine the contributions of injury severity, physical and cognitive disability, child and family function to outcome 30 months after traumatic brain injury (TBI) in children.
A prospective, longitudinal, between group design, comparing function before and after injury across three levels of injury severity.
One hundred and fifty children, 3.0-12.11 years old, admitted to hospital with a diagnosis of TBI. The sample was divided according to injury severity: mild (n = 42), moderate (n = 70), severe (n = 38). Children with a history of neurological, developmental, and psychiatric disorders were excluded from participation.
Post injury physical function, cognitive ability (incorporating intellect, memory, and attention), behavioural and family functioning, and level of family burden.
A dose-response relation was identified for injury severity and physical and cognitive outcome, with significant recovery documented from acute to six months after TBI. Behavioural functioning was not related to injury severity, and where problems were identified, little recovery was noted over time. Family functioning remained unchanged from preinjury to post injury assessments. The level of family burden was high at both six and 30 months after injury, and was predicted by injury severity, functional impairment, and post injury child behavioural disturbance.
These results suggest ongoing problems for the child and significant family burden 30 months after TBI. The nature and severity of the physical and cognitive problems are closely related to injury severity, with child and family function predicted by psychosocial and premorbid factors.
Primary objective:
To examine the moderating effect of wives' coping flexibility on the relation between time since husband's traumatic brain injury (TBI) and wives' perceived burden and the hypotheses that wives of long duration TBI men and wives with less coping flexibility will express more burden than wives of short duration burden men and wives with more coping flexibility.
Research design:
Forty-four wives whose husbands had sustained brain injury were interviewed 1 year or more after hospital discharge.
Methods and procedures:
The Relatives' Burden Questionnaire and Ways of Coping Questionnaire for each of four different problem vignettes were administered to the wives.
Main findings and conclusions:
No statistically significant effects were found for TBI duration or for wives' coping flexibility, although longer duration TBI wives reported a statistically significant higher level of burden than short duration TBI wives, only if the wives were characterized by low coping flexibility.
A test of whether patients suffering from a severe closed-head injury (CHI) were affected by disproportionate dual-task costs compared to those of healthy control participants was carried out through a direct comparison of CHI effects on dual-task (psychological refractory period, or PRP) performance and on single-task performance. In the dual-task condition of the present experiment, independent choice-responses were required to two sequential stimuli presented at a variable stimulus onset asynchrony (SOA). A significant delay of the reaction time (RT) to the second stimulus was reported by both CHI patients and controls at short (SOA) compared to long SOA, i.e., a PRP effect. The PRP effect was more pronounced for CHI patients than controls. In the single-task condition, a single choice-response was required to a stimulus presented in isolation. The RT produced by CHI patients in the single-task paradigm was longer than the RT produced by controls. CHI effects on dual-task performance and on single-task performance were compared following (1) their transformation into Cohen's ds, and (2) the application of a correction algorithm taking into account the different reliability of single-task and dual-task measures. The analysis of Cohen's ds revealed that CHI effects on performance were, if anything, smaller in the dual-task condition than in the single-task condition. The results imply that CHI patient's slower responding in single- and dual-task performance reflects a single common cause--slowing of the central processing.
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