Showing papers in "Brain Injury in 1996"
TL;DR: The 1991 National Health Interview Survey was analysed to describe the incidence of mild and moderate brain injury in the United States and found the risk of medically attended brain injury was highest among three subgroups: teens and young adults, males, and persons with low income who lived alone.
Abstract: The 1991 National Health Interview Survey was analysed to describe the incidence of mild and moderate brain injury in the United States. Data were collected from 46761 households and weighted to re...
595Â citations
TL;DR: The findings suggest the need for intermittent lifelong intervention following TBI, and systems of rehabilitation need to be adapted to provide this.
Abstract: This study examined long-term outcome in traumatically brain-injured individuals following discharge from a comprehensive rehabilitation programme. Of 254 traumatic brain injury (TBI) patients reviewed at 2 years, 103 have been followed up at 5 years using a structured interview format detailing neurological symptoms, mobility, independence in ADL, productivity status, relationship issues, communication and the presence of cognitive, behavioural and emotional changes. Visual difficulties, headache and fatigue were persistent in a significant number of patients. Between 2 and 5 years there was increased independence in personal, domestic and community ADL and the use of transport. Ten more patients had returned to driving. On the other hand there was a slightly higher incidence of cognitive, behavioural and emotional changes reported at 5 years. Thirty-two per cent of those working at 2 years were not employed at 5 years. Many students had also become unemployed. These findings suggest the need for intermittent lifelong intervention following TBI. Systems of rehabilitation need to be adapted to provide this.
510Â citations
TL;DR: An approach which makes use of multiple measures to evaluate self-awareness of deficits is recommended, and an interviewer-rated semi-structured interview is proposed (the Self-Awareness of Deficits Interview).
Abstract: Some method of assessing self-awareness of deficits in patients with traumatic brain injury (TBI) is required to increase our understanding of the phenomenon, and to then evaluate strategies for clinical intervention with patients who lack such self-awareness. Options for the assessment of self-awareness of deficits following TBI are reviewed. The most commonly used method is comparison of patients' self-ratings on questionnaires of functional abilities with ratings by relatives or staff on the same questionnaires. An additional method of assessment, an interviewer-rated semi-structured interview is proposed (the Self-Awareness of Deficits Interview), and some preliminary inter-rater reliability data are presented. However, quantitative methods of evaluating self-awareness have shortcomings, and qualitative research may be more appropriate in some circumstances. An approach which makes use of multiple measures to evaluate self-awareness of deficits is recommended.
342Â citations
TL;DR: Emotional risk factors are explored in four case studies, each of whom had sustained a mild traumatic brain injury (MTBI) and selected pre-existing personality traits that compounded the symptom presentation included over-achievement, dependency, grandiosity and borderline personality traits.
Abstract: Emotional risk factors are explored in four case studies, each of whom had sustained a mild traumatic brain injury (MTBI). Selected pre-existing personality traits that compounded the symptom presentation included over-achievement, dependency, grandiosity and borderline personality traits. Premorbid risk factors are described and their influence on co-morbid and post-morbid difficulties is discussed. We also touched upon the therapeutic issues involved in our cases. General treatment considerations are highlighted for dealing with grandiosity, narcissistic features and borderline traits. Over-achievement and perfectionism are discussed in the context of providing treatment for stress management. Finally, the effect of pre-existing emotional trauma combined with the MTBI is discussed.
256Â citations
TL;DR: The study supports the association between TBI and psychiatric disorder, and suggests the need for monitoring, for prevention, and for treatment of psychiatric disorders after TBI.
Abstract: Substantial psychological and neurobehavioural evidence is available to support the hypothesis that traumatic brain injury (TBI) is a risk factor for subsequent psychiatric disorders. However, studies utilizing established psychiatric diagnostic schemes to study these outcomes after TBI are scarce, and no studies have included an assessment of personality disorders in addition to the major psychiatric disorders. This study utilizes structured psychiatric interviews to measure the prevalence of DSM-III(R) disorders in a sample of 18 subjects derived from a TBI rehabilitation programme. Results revealed high rates for major depression, bipolar affective disorder, generalized anxiety disorder, borderline and avoidant personality disorders. Co-morbidity was also high. A preliminary study of postulated predictive factors revealed possible roles for sex and for initial severity of injury. The study supports the association between TBI and psychiatric disorder, and suggests the need for monitoring, for prevention, and for treatment of psychiatric disorders after TBI.
203Â citations
TL;DR: The nature of attentional disturbance after MTBI is examined using an extended version of the 2 and 7 Test, which introduced two conditions reflecting patients' subjective complaints: the ability to perform with background 'noise', and while simultaneously attending to a secondary task.
Abstract: Attention deficits are a prominent aspect of cognitive dysfunction after mild traumatic brain injury (MTBI). Patients frequently complain of distractibility and difficulty attending to more than one thing at a time, and several neuropsychological studies have found evidence for a specific attention deficit without general neuropsychological impairment. The present study examined the nature of attentional disturbance after MTBI using an extended version of the 2 and 7 Test, which introduced two conditions reflecting patients' subjective complaints: the ability to perform with background 'noise', and while simultaneously attending to a secondary task. The dual task demands produced a significant slowing in processing speed for both the MTBI patients and control subjects. However, the relative decline in processing speed appeared much greater for the patients with MTBI, and they differed from control subjects only in this condition. The results are consistent with findings that patients with MTBI exhibit relatively subtle cognitive deficits which are apparent primarily under conditions which require effortful or controlled cognitive processing and exceed their available cognitive resources. Thus, the attentional deficits apparent during dual task demands may represent decreased cognitive, and perhaps neural, efficiency which reflects MTBI patients' subjective complaints and functional impairments.
199Â citations
TL;DR: In minor and moderate HI patients, most disabilities were related to associated injuries, and the long-term management of certain patients needs improvement because these impairments are misunderstood.
Abstract: To determine what consequences cognitive, behavioural or somatic impairments had on disabilities and recovery after a head injury (HI), a population-based sample of 231 adult patients was studied 5 years after an HI. Eighty lower-limb-injured (LLI) patients were considered as controls. Sixty-four LLI and 176 HI patients were reviewed (114 minor, 35 moderate, and 27 severe HI). Prevalence values of headaches (44-54%), dizziness (26-37%), and anxiety (47-63%) were not significantly different in the three HI severity groups, but were significantly lower in patients with an isolated limb injury (12-15%). Memory problems and depressive mood increased with injury severity. Mental impairments were frequent in severe HI patients (18-40% of patients). In minor and moderate HI patients, most disabilities were related to associated injuries. According to the Glasgow Outcome Scale (GOS), recovery was not considered as good because of somatic, behavioural or cognitive complaints in 2.5%, 5.7% and 59.2% of surviving patients in each of the above HI groups. Somatic or behavioural complaints may have considerable consequences in some minor HI patients, and the long-term management of certain patients needs improvement because these impairments are misunderstood.
147Â citations
TL;DR: Investigating the interrelationships between subjective memory reports, performance on traditional memory tests, and performance on tests of prospective memory provided preliminary evidence that prospective memory tests are sensitive to TBI-related neurological impairment and, in comparison to traditional tests, may be better indicators of functional memory capacity.
Abstract: Residual memory deficits may represent a problem to the everyday functioning of a large number of people, including those who have sustained traumatic brain injury (TBI). The present exploratory study sought to investigate the interrelationships between subjective memory reports, performance on traditional memory tests, and performance on tests of prospective memory. These interrelationships were contrasted between a group of 24 adults who had sustained TBI and a group of 24 matched control subjects. Prospective memory was hypothesized to be indicative of everyday memory functioning. The results provided preliminary evidence that prospective memory tests are sensitive to TBI-related neurological impairment and, in comparison to traditional tests, may be better indicators of functional memory capacity. This pattern was particularly true for control subjects, possibly because TBI subjects had difficulties in evaluating their memory functioning.
132Â citations
TL;DR: It is suggested that neuropsychological deficits are detectable after resolution of neurological symptoms in the early stages following mild concussive injury.
Abstract: The term 'concussion' has been applied to head injuries of varying severity. Most studies have examined subjects suffering concussion of a severity requiring hospital observation, usually as a consequence of motor vehicle accidents. Milder concussive injuries such as those resulting from contact sport are often not reported in hospital-based studies. In this study, subjects with mild concussive injuries were studied with the aim of determining if neuropsychological sequelae are detectable. The subjects received their injuries while playing Australian Rules Football. Baseline (pre-injury) measures on the Paced Auditory Serial Addition Test (PASAT), Digit Symbol Substitution Test (DSST) and Four-Choice Reaction time, involving measures of decision time (DT) and movement time (MT), were obtained in a sample of 130 players. Ten players subsequently concussed were re-tested at 5 days post-injury. A control group of age-matched umpires were assessed on two corresponding occasions. Analyses of covariance showed poorer performances following concussion on the DSST and DT measures. The results suggested that neuropsychological deficits are detectable after resolution of neurological symptoms in the early stages following mild concussive injury.
130Â citations
TL;DR: The joint distribution of motor and cognitive items suggests that, for a given level of cognitive function, the addition of a motor limitation will result in greater injury-related FTR TW, and as motor function declines, FTRTW is further increased.
Abstract: About 63% of all traumatic brain injuries (TBI) occur in teenagers and adults aged 15-64 years, the primary working population. Since reports of failure to return to work (FTRTW) vary, understanding the factors that influence FTRTW is key to improving work outcomes for this primarily working-age population. Our study sample consists of 343 previously employed persons who were hospitalized following TBI and had either returned to work at 1 year or had failed to return to work because of their injury (injury-related FTRTW). Medical records were reviewed and participants were interviewed by telephone at 1 year post-discharge. Individuals with injury-related FTRTW were far more likely to report dependence or modified independence on the Functional Independence Measure (FIM) than those who were employed at 1 year. The joint distribution of motor and cognitive items suggests that, for a given level of cognitive function, the addition of a motor limitation will result in greater injury-related FTRTW. In addition as motor function declines, FTRTW is further increased. Injury-related FTRTW is also associated with being unmarried and not completing high school. While the importance of behavioural, economic, and psychosocial factors should not be minimized, services aimed at improving function can be expected to have an impact on RTW after TBI.
130Â citations
TL;DR: Overall, measures of severity of injury (PTA), residual neurobehavioural function, and adequacy of social support for caregivers proved to be reliable and significant indicators of family functioning.
Abstract: This study investigated the degree of association between four sets of predictor variables (demographic, injury-related, patient functioning, and caregiver functioning variables) and the criterion ...
TL;DR: A review of the literature reveals that, while considerable research has been done on minor head injury, there remain several major sources of confusion as discussed by the authors, which leads to individuals being categorized as having sustained a mild TBI despite minimal or no neurological damage being present.
Abstract: Traumatic brain injury (TBI) refers to a broad range of neurological, cognitive and emotional factors that result from the application of a mechanical force to the head. Mechanical force can be applied on a continuum from none to very severe, and the extent of brain injury is related to the severity of this force. A review of the literature reveals that, while considerable research has been done on minor head injury, there remain several major sources of confusion. First, one of the most noticeable problems relates to the fact that the mild head injury has lower limits which are vaguely defined. This leads to individuals being categorized as having sustained a mild TBI despite minimal or no neurological damage being present. A second source of confusion in the literature is related to the failure to differentiate between cognitive consequences of TBI and post-concussion symptoms (PCS). Since PCS can occur in the absence of head injury, and are often present beyond the period of cognitive recovery from mild TBI, the two clearly result from different factors. Researchers have often failed to separate these two factors when studying recovery of function, and this has led to varying findings on outcome. Finally, many pre-injury factors (age, education, emotional adjustment) and post-injury factors (pain, family support, stress) interact with cognitive functioning and significantly affect recovery from TBI. These problems are reviewed and discussed.
TL;DR: The purpose of the current study is to evaluate the prevalence of post-traumatic stress disorder (PTSD) and explore the clinical picture among TBI patients, finding that PTSD following TBI is somewhat distinguished from those following other traumatic events.
Abstract: In the absence of the recognition of the emotional sequelae following traumatic brain injury (TBI), many patients are deprived of adequate treatment. The purpose of the current study is to evaluate the prevalence of post-traumatic stress disorder (PTSD) and explore the clinical picture among TBI patients. Twenty-four outpatients with diagnosed head injuries following various traumas filled out standardized questionnaires, assessing post-traumatic residuals. Thirty-three per cent of these patients met criteria for PTSD diagnosis. The clinical picture of PTSD following TBI is somewhat distinguished from those following other traumatic events. Issues concerning the specific nature of the syndrome following TBI, and the difficulties in differentiating between PTSD and postconcussive syndrome, are discussed.
TL;DR: In this article, the International Working Party on the Management of the Vegetative State presented a summary report on brain injury and brain injury management in the context of brain injury in humans.
Abstract: (1996). International Working Party on the Management of the Vegetative State: summary report. Brain Injury: Vol. 10, No. 11, pp. 797-806.
TL;DR: Speed of processing is more sensitive to task complexity in individuals with head injury, but only when age at injury is considered, and recovery of consistency in performance can be expected more than 5 years after a TBI.
Abstract: Improvement in performance can occur up to 10 years after traumatic brain injury (TBI). Few previous studies have examined the long-term effects of TBI on information processing. This study used reaction time (RT) tasks of increasing complexity with 10-year post-injury, 5-year post-injury, and control groups to assess any such effects. There were no significant group differences in mean RT; however, in the groups of persons with head injury only, response latency was related to age and to task demands. Older members of the groups of persons with head injury were slower than controls. The variability in performance was significantly higher in the 5-year post-injury group than in both the 10-year group and the control group. There were no significant differences among the groups in their ability to inhibit the processing of redundant information. There were no correlations between any dependent measure and severity of injury. Speed of processing is more sensitive to task complexity in individuals with head injury, but only when age at injury is considered. Most importantly, for rehabilitation purposes, recovery of consistency in performance can be expected more than 5 years after a TBI.
TL;DR: Four tasks designed to tap various aspects of pragmatic communication ability were administered to three brain-injured adolescents and 36 of their uninjured peers aged 15-18 years, and the ability to negotiate, hint, describe a simple procedure, and understand sarcasm was found to tap distinct aspect of pragmatic ability in control subjects.
Abstract: Deficits in pragmatic communication ability have a significant impact on functional outcome from traumatic brain injury (TBI), particularly during adolescence, when sophisticated social communication skills are developing. There are few published tests designed to assess pragmatic skills in this age group. In the present study, four tasks designed to tap various aspects of pragmatic communication ability were administered to three brain-injured adolescents and 36 of their uninjured peers aged 15-18 years. The tasks evaluated the ability to negotiate, hint, describe a simple procedure, and understand sarcasm. The four tasks were found to tap distinct aspects of pragmatic ability in control subjects. Further, within the control group, task performance was related more to non-verbal reasoning ability than vocabulary skills. Scores for two of the three TBI subjects were poorer than those of their peers, while a third mildly injured subject performed within normal limits. Pragmatic task scores were consistent with the results of neuropsychological testing in the three TBI subjects. Implications for clinical management and recommendations for future research are discussed.
TL;DR: There was little quantitative or qualitative difference between the two groups in sources, utilization of and satisfaction with social support, and positive correlations were found between stress and role change and stress and health problems.
Abstract: There is general agreement between researchers and clinicians alike that relatives of people with head injuries experience heightened stress as a result of the injury and its consequences. In the present study a single structured interview, including both verbally administered and written response questionnaires, was completed by 18 parents and 11 partners. Measures included the Daily Hassles and Uplifts Scale, the Arizona Social Support Interview Schedule and questions regarding role change and health problems. The combined parents and partners group indicated that they experienced moderate levels of stress and role change. A relatively small proportion of participants reported experiencing health problems. Partners indicated a slightly higher degree of stress and a greater degree of role change than parents, and a larger proportion of partners indicated the presence of health problems. Qualitative differences between the two groups were found in terms of sources of stress. There was little quantitative ...
TL;DR: The activity setting influenced outcome such that it appeared to be most difficult to return to work, suggesting the necessity of adequate vocational assistance, and cognitive and demographic variables accounted for less than 30% of the total variance in outcome.
Abstract: Neuropsychological assessment is a standard component of traumatic brain injury rehabilitation programmes; however, the relationship between neuropsychological test scores and functional abilities is not clear. The current study compared serial neuropsychological test data with functional outcomes for 152 subjects. Outcome was operationally defined for three activity settings (home, school, work) with six levels of productivity for each. Productivity was defined as one's ability to function at increasing levels of independence. Demographic and caseload variables were analysed utilizing correlation and stepwise multiple regression analyses. Significant relationships to outcome were found between certain neuropsychological test scores, and certain demographic variables. Positive outcomes were related in part to patient's speed of information processing, memory skills, and simultaneous processing abilities. Also related to positive outcomes were mechanism of injury, level of insurance funding, premorbid educational level, and negative history of substance abuse. The activity setting influenced outcome such that it appeared to be most difficult to return to work, suggesting the necessity of adequate vocational assistance. However, cognitive and demographic variables accounted for less than 30% of the total variance in outcome. Therefore, brain injury rehabilitation must be multifaceted.
TL;DR: Sexual functioning in 52 outpatients with a history of traumatic brain injury indicated a reduction below levels within non-injured populations, but only to statistically significant levels on two scales of the Derogatis Interview of Sexual Function: Orgasm and Drive/Desire.
Abstract: In this study we investigated sexual functioning in 52 outpatients with a history of traumatic brain injury to determine: (1) the prevalence of reported sexual dysfunction; and (2) the relationship between sexual functioning and age, severity and locus of injury, time since injury, and physical and cognitive function. Reports of sexual functioning indicated a reduction below levels within non-injured populations, but only to statistically significant levels on two scales of the Derogatis Interview of Sexual Function (DISF): Orgasm and Drive/Desire. Location of injury was related to sexuality in that patients with frontal lobe lesions reported an overall higher level of sexual satisfaction and functioning than those individuals without frontal lobe lesions. Time since injury was inversely related to reports of levels of sexual arousal; that is, patients with more recent injuries reported greater levels of arousal than those not recently injured. Right hemisphere injuries also correlated with higher scores ...
TL;DR: Rec rehabilitation achieved improvements in functional skills and social behaviour that lastingly affected the type of placement possible, and thus improved quality of life and in most cases where improvements were seen during rehabilitation, further improvements occurred after discharge.
Abstract: Fifty-five brain-injured adults (of 64 discharged) were followed up from 19 to 101 months after discharge from a rehabilitation unit. Change was assessed in terms of discharge and current placement, as compared with pre-admission placement. The results demonstrate that rehabilitation achieved improvements in functional skills and social behaviour that lastingly affected the type of placement possible, and thus improved quality of life. In most cases where improvements were seen during rehabilitation, further improvements occurred after discharge. The findings also have implications for the timing of rehabilitation and for discharge and resettlement planning.
TL;DR: It is concluded that the PFIC is a useful measure for the identification of specific communication impairments in clinical practice.
Abstract: This article describes the construction of the Profile of Functional Impairment in Communicaton (PFIC), a scale designed for the assessment of communication impairments following traumatic brain injury The measure comprises 10 feature summary scales, assessing severity of impairment, and 84 specific behaviour items, assessing the frequency of specific communication impairments To assess the psychometric properties of the scale, videotaped dyadic social interactions of 20 patients with traumatic brain injury were rated by eight trained raters The feature summary scales were found to have acceptable inter-rater reliabilities, and high concurrent validity and internal consistency Four case descriptions are presented to illustrate the clinical application of the PFIC It is concluded that the PFIC is a useful measure for the identification of specific communication impairments in clinical practice
TL;DR: A retrospective analysis of the results of a neuropsychological rehabilitation programme for 20 patients with MTBI found that there may be significant variability in recovery and response to treatment after MTBI.
Abstract: A significant minority of patients who have sustained a mild traumatic brain injury (MTBI) may exhibit persistent disability. There have been few attempts to describe and evaluate the effectiveness of neurorehabilitation for these patients. We conducted a retrospective analysis of the results of a neuropsychological rehabilitation programme for 20 patients with MTBI. Based upon the ability to resume productive functioning after treatment, 10 patients were determined to exhibit a good outcome and 10 patients were considered to exhibit a poor outcome. Patients with good outcome exhibited significant pre-post-treatment improvements on both neuropsychological measures of cognitive functioning and self-reported post-concussive symptoms. Patients with poor outcome demonstrated little improvement in either area, and in some cases showed a decline in functioning. The results are consistent with the view that there may be significant variability in recovery and response to treatment after MTBI. There is a continued need to identify which patients may benefit from neurorehabilitation, develop specially tailored interventions, and conduct controlled, prospective studies in this area.
TL;DR: Patients displaying pathological laughter and crying had a greater severity of injury than patients without the syndrome; they also had other associated neurological features compatible with pseudobulbar palsy.
Abstract: We report on the clinical and radiological features in 16 adult patients who suffered a traumatic brain injury and subsequently developed pathological laughter and crying. Patients with pathological laughter and crying were identified from among 301 consecutive brain-injured admissions to a trauma centre and subsequently to a rehabilitation facility. Patients displaying pathological laughter and crying had a greater severity of injury than patients without the syndrome; they also had other associated neurological features compatible with pseudobulbar palsy. Pathological laughter alone, or combined with crying, was more frequent than crying alone. An attempt to correlate clinical features with focal lesions on neuroimaging studies yielded inconsistent results. The theoretical anatomical substrate for pathological laughter and crying in patients with traumatic brain injury is discussed.
TL;DR: The cognitive functioning of the 18 patients was variable, with the greatest number showing deficits of memory and executive functioning, and the remaining four patients were very severely impaired intellectually (VSI), with widespread cognitive deficits precluding the use of neuropsychological assessment procedures designed for adults.
Abstract: What should clinical neuropsychologists look out for when asked to assess someone with hypoxic brain damage? To determine whether there are typical cognitive profiles of hypoxic patients, all referrals for a neuropsychological assessment made to the author over a period of 16 years were scanned to identify those with a primary diagnosis of cerebral hypoxia as recorded in the hospital notes. From a total sample of 567 patients, 18 (3.17%) had sustained primary cerebral hypoxia from a variety of causes including carbon monoxide poisoning, cardiac arrest, anaesthetic accident, respiratory failure following a pulmonary embolus, hanging and drowning. Not surprisingly, in view of the different degrees of brain damage, the cognitive functioning of the 18 patients was variable, with the greatest number showing deficits of memory and executive functioning (n = 6). Three presented with an amnesic syndrome; two with memory, executive and visuospatial deficits; and three with visuospatial or visuoperceptual problems without severe memory impairments. The remaining four patients were very severely impaired intellectually (VSI), with widespread cognitive deficits precluding the use of neuropsychological assessment procedures designed for adults.
TL;DR: Results reveal that agreement differs across instruments and subscales, with greatest response comparability on the productivity CIQ subscale, followed by the motor FIM, social integration CIQ, cognitive F IM, and home integrationCIQ.
Abstract: This paper examines the inter-rater reliability of 148 persons with traumatic brain injury (PwTBI) and their significant others (SO) on the Functional Independence Measure (FIM), and the Community Integration Questionnaire (CIQ). Results reveal that agreement differs across instruments and subscales, with greatest response comparability on the productivity CIQ subscale, followed by the motor FIM, social integration CIQ, cognitive FIM, and home integration CIQ. These findings have important implications for the future of TBI outcomes studies.
TL;DR: A wide spectrum of disorders was observed: cerebral personality disorder, persistent altered consciousness, post-traumatic stress, psychodynamic reactions to impairment, and complex reactions expressing neurological, somatic, and psychological dysfunctions.
Abstract: This is a systematic presentation of the emotional and personality disorders of 33 patients who incurred minor traumatic brain injury (MTBI) in a vehicular accident. A wide spectrum of disorders wa...
TL;DR: It is argued that a continuum of experience is not necessary for PTSD to occur, but that a "window' of real or imagined experience which results from loss of consciousness and post-traumatic amnesia after closed head injury need not prevent the symptoms of PTSD from arising, although they may make them less likely.
Abstract: Post-traumatic stress disorder (PTSD) was found to occur after minor or severe closed head injury in 10 single cases which are reported in detail. They were drawn from 312 cases of closed head injury who were referred for neuropsychological assessment or neurorehabilitation. All cases which had been given both diagnoses are presented. Information was collected retrospectively from case notes and reports. It is argued that a continuum of experience, which represents the entirety of an event, is not necessary for PTSD to occur, but that a 'window' of real or imagined experience which results from loss of consciousness and post-traumatic amnesia after closed head injury need not prevent the symptoms of PTSD from arising, although they may make them less likely and the phenomenon of the dual diagnoses relatively rare. The issue of whether PTSD found following closed head injury is a sub-classification of PTSD is raised.
TL;DR: A chart review of dextroamphetamine treatment in 27 traumatic brain injury patients during rehabilitation therapy suggests that amphetamine treatment enhanced the recovery and functional status of 15 patients.
Abstract: A chart review of dextroamphetamine treatment in 27 traumatic brain injury patients during rehabilitation therapy suggests that amphetamine treatment enhanced the recovery and functional status of 15 patients.
TL;DR: Age at the time of TBI and educational status before TBI were correlated with the outcome measures at the end of follow-up separately in each category of brain injury severity; in the groups of patients with moderate and mild brain injuries such a relationship was not found between age or pre-injury education and outcome.
Abstract: We studied influence of age and educational level before injury on the social and vocational outcome among a group of traumatic brain injury (TBI) patients with post-injury problems in their education and employment. Patients with TBI, followed up for at least 5 years, and who were admitted to a rehabilitation and re-employment programme, were selected for evaluation of long-term outcome. We used the Glasgow Coma Scale (GCS) scores at the time of emergency admission to the hospital to measure brain injury severity. Age at the time of TBI and educational status before TBI were correlated with the outcome measures at the end of follow-up separately in each category of brain injury severity. The study was carried out at the Kauniala outpatient neurological clinic, which specializes in brain injuries in Finland; it works closely with the Departments of Neurology and Neurosurgery at the Helsinki University Central Hospital. Main outcome measures were functional outcome measured by the Glasgow Outcome Scale (GOS), the educational level reached, and post-injury occupation, as well as the incapacity for work at the end of follow-up. In the severe category of brain injuries, children 7 years or younger at the time of injury suffered severe disability as measured by the GOS scores more often than did the older age groups (p = 0.010, chi 2). They were less often capable of independent employment (p = 0.011, chi 2) than the children injured at the age of 8-16. Patients with a higher education usually had a better outcome. In the category of mild brain injuries the majority of the patients, regardless of age, recovered well according to the GOS, and were capable of independent employment at the end of follow-up. Our patients were selected from the TBI population as survivors with problems in education and re-employment. Those with severe injury sustained early in life (childhood and early teens) coupled with poor educational attainment had relatively worse social and vocational outcome; better outcomes were enjoyed by those severely injured individuals whose injuries were sustained later (late teens or early adulthood). In the groups of patients with moderate and mild brain injuries such a relationship was not found between age or pre-injury education and outcome.
TL;DR: In this article, a 24-year-old woman who exhibited dense amnesia secondary to status epilepticus following a motor vehicle accident was treated with a multidisciplinary comprehensive program of external cueing.
Abstract: This case study describes rehabilitation efforts with a 24-year-old woman who exhibited dense amnesia secondary to status epilepticus following a motor vehicle accident. She was 20 months post-injury upon entry into our day treatment programme. The functional severity of her amnesia was reflected in numerous ways, including no recall of what she wore from day to day and an inability to find the toilet after 2 weeks in the programme. A multidisciplinary comprehensive programme of external cueing was established to exploit her preserved procedural memory. Objective measures of functional compliance were gathered over time and contrasted with both standard neuropsychological test scores and early levels of functioning in rehabilitation. Results demonstrated enhanced functioning via utilization of procedural memory. In addition, the patient actually demonstrated increased independent generalization of strategies and techniques over time. Practical treatment implications are reviewed and discussed.