Effects of Diffuse Axonal Injury on Speed of Information Processing Following Severe Traumatic Brain Injury.

To test the hypothesis that slowed information processing in traumatic brain injury is related to diffuse axonal injury (DAI), the authors compared 10 patients with predominant DAI (diffuse group) and minimal DAI (mixed injury group) on the Symbol Digit Modalities Test, simple and choice reaction time, Trail Making Tests A and B, and the Stroop Neuropsychological Screening Test. The diffuse group was slower than the mixed injury and control groups on basic speed of processing tasks. This difference was not apparent on complex speeded tasks once basic speed of processing was controlled for. The diffuse group's slower speed of processing was not accounted for by differences in injury severity, age, or time postinjury. The diffuse group showed greater recovery over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anoxic Versus Traumatic Brain Injury: Amount of Tissue Loss, Not Etiology, Alters Cognitive and Emotional Function.

Research in neuropsychology suggests that the etiology of a neurologic injury determines the neuropathological and neuropsychological changes. This study compared neuropsychological outcome in subjects who had traumatic brain injury (TBI) with subjects who had anoxic brain injury (ABI), who were matched for age, gender, and ventricle-to-brain ratio. There were no group differences for morphologic or neuropsychological measures. Both groups exhibited impaired memory, attention, and executive function, as well as slowed mental processing speed. Intelligence correlated with whole brain volume, and measures of memory correlated with hippocampal atrophy. There was no unique contribution of hippocampal atrophy on neuropsychological outcome between the groups. In the absence of localized lesions, the amount of neural tissue loss, rather than etiology, may be the critical factor in neuropsychological outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of Cognitive Abilities 1 Year Following Traumatic Brain Injury From Inpatient Rehabilitation Cognitive Screening.

Objective: To evaluate the ability of the Cognitive Log (Cog-Log) to predict neuropsychological outcome at 1 year after traumatic brain injury (TBI). Study Design: The Orientation Log (O-Log) and Cog-Log were administered during morning rounds, and a battery of neuropsychological tests was administered at 1 year postinjury. Setting: Acute rehabilitation hospital. Participants: Fifty rehabilitation inpatients. Main Outcome Measures: Composite scores for processing speed, attention, language, memory, executive functioning, and visuospatial abilities. Results: The Cog-Log was found to significantly predict 1-year outcome in attention, executive functioning, and visuospatial abilities. The O-Log contributed significantly to memory outcome. The Disability Rating Scale was not a significant predictor. Conclusions: The Cog-Log has utility as a predictor of neuropsychological outcome, particularly when used with its companion instrument, the O-Log. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Web-Based Assistive Technology Interventions for Cognitive Impairments After Traumatic Brain Injury: A Selective Review and Two Case Studies.

Objective: Assistive technology for cognition (ATC) is reviewed and 2 case studies presented. Participants: Study 1, a 19-year-old man, with topographical disorientation after traumatic brain injury (TBI); Study 2, a 71-year-old woman with cognitive declines associated with TBI and a pre-injury history of chronic ischemic changes. Design and Interventions: To assess ATC intervention, Study 1 used an ABA' design for a navigation task; Study 2 used a modified ABAB design for setting an alarm clock. Main Outcome Measures: Study 1, average errors per route; Study 2, average errors per task substep and number of substeps attempted. Results: For Study 1, navigation errors reduced with ATC; without ATC, partial improvement was maintained, with greater intertrial variability. For Study 2, performance errors reduced with ATC and all substeps were completed; without ATC, errors persisted, but declined across trials, suggesting learning. Conclusions: ATC interventions can facilitate functional performance and contribute to learning of specific adaptive skills. Wireless, interactive, Web-based interventions appear particularly suited to tasks in the home and community, permitting remote intervention and monitoring of task status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Impact of Patient-Centered Information on Patients' Treatment Satisfaction and Outcomes in Traumatic Brain Injury Rehabilitation.

Objective: To evaluate the effects on patients with traumatic brain injury (TBI) of detailed, personalized information about their injuries, acute care treatment, and rehabilitation progress. Participants: Twenty-eight former or present military personnel (mean age = 30 years) with moderate to severe TBI (mean of 29 days spent in intensive care before admission to TBI unit). Design: Two (personalized information vs. general information) × 2 (high- vs. low-patient preference for health care information) factorial design. Interpersonal behavior of patients, information providers, and health care staff were measured by the Impact Message Inventory. Outcome Measures: Rehabilitation Intensity of Therapy Scale, Functional Independence Measure, Treatment Satisfaction Questionnaire. Results: Patients given personalized information exerted greater effort in physical therapy, made greater improvement in functional independence, and were more satisfied with rehabilitation treatment. Patient preference for information and ratings of interpersonal behavior were largely unrelated to patient outcomes. Conclusion: Cognitively impaired TBI patients can benefit from interventions designed to enhance their sense of control and personal involvement in their own care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in Working Memory After Traumatic Brain Injury in Children.

The impact of traumatic brain injury (TBI) on working memory (WM) was studied in 144 children (79 with mild, 23 with moderate, and 42 with severe injuries) who underwent magnetic resonance imaging (MRI) at 3 months and were tested at baseline and at 3, 6, 12, and 24 months postinjury. An n-back WM task for letter identity was administered with memory load ranging from 1- to 3-back and a 0-back condition. A TBI Severity × Quadratic Tune interaction showed that net percentage correct (correct detections of targets minus false alarms) was significantly lower in severe than in mild TBI groups. The Left Frontal Lesions × Age interaction approached significance. Mechanisms mediating late decline in WM and the effects of left frontal lesions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective Attention Deficits Following Severe Closed Head Injury: The Role of Inhibitory Processes.

Heightened distractibility following severe closed head injury (sCHI) may result from a deficit in selective attention. The integrity of inhibitory processes involved in selective attention was assessed through use of a negative priming paradigm, allowing dissociation of inhibitory and episodic retrieval processes. In this task, inhibitory processes are elicited under intact stimulus conditions, whereas episodic retrieval is elicited when target stimuli are degraded. Despite inconsistent evidence of inhibitory deficits following sCHI in the literature, long-term survivors of sCHI showed no negative priming under intact stimulus conditions, providing evidence of compromised inhibitory processing. The sCHI participants' demonstration of negative priming when target stimuli were degraded provides evidence that automatic retrieval processes are intact following sCHI, results that are consistent with prior findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing Substance Abuse Treatment Compliance for Persons With Traumatic Brain Injury.

This study compared 3 methods of increasing participation in substance abuse treatment for clients with traumatic brain injury. Participants (N = 195) were randomly assigned to 4 conditions: (a) motivational interview, (b) reduction of logistical barriers to attendance, (c) financial incentive, and (d) attention control. Four interviewers conducted structured, brief telephone interventions targeting the timeliness of signing an individualized service plan. Participants assigned to the barrier reduction (74%) and financial incentive (83%) groups were more likely to sign within 30 days compared with the motivational interview (45%) and attention control (45%) groups. Similar results were observed for time to signing, perfect attendance at appointments, and premature termination during the following 6 months. Extent of psychiatric symptoms was the only significant covariate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case Management for Traumatic Brain Injury Survivors With Alcohol Problems.

Objective: To evaluate a community-based approach to substance abuse using comprehensive case management for persons with traumatic brain injury (TBI). Setting: Two programs that provide case management services (n=217): a comparison group was recruited that did not receive case management (n=102). Intervention: Comprehensive case management. Main Outcome Measures: Self-reported substance use, community integration, employment status, health-related quality of life. Results: For those receiving case management, employment at recruitment and early referral were associated with employment 9 months later. Community integration and physical well-being increased for both groups. Earlier program referral was associated with larger gains in physical well-being, employment, and community integration. Conclusions: Case management appears to have beneficial effects for adults with TBI and substance abuse problems in terms of life and family satisfaction as well as to have potential cost savings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Long-Term Educational Interventions After Traumatic Brain Injury in Children.

Objectives: To track educational interventions received by children with traumatic brain injury (TBI), examine factors associated with placement in special education, and explore the concordance of placement with children's needs. Methods: Interventions were monitored in 42 children with severe TBI, 42 with moderate TBI, and 50 with orthopedic injuries only (ORTHO group). A baseline assessment was completed soon after injury. Follow-up assessments were conducted 6 and 12 months after the baseline and at an extended follow-up about 4 years postinjury. Results: Rates of special education were higher in the severe TBI group than in the ORTHO. Predictors of special education included TBI severity, socioeconomic status, and measures of pre- and postinjury child status. Several children with TBI with residual deficits who were in regular education prior to injury did not receive special education at the extended follow-up. Conclusion: Although special education is frequently provided for several years after severe TBI, existing programs are of limited scope. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Base Rates of Traumatic Brain Injury History in Adults Admitted to State Psychiatric Hospitals: A 3-Year Study.

Objectives: To determine the base rate of traumatic brain injury (TBI) in adults admitted to state psychiatric hospitals. Participants: A total of 3,133 psychiatric patients between the ages of 18 and 60 years old from 7 state facilities were screened for TBI and associated sequelae during a 3-year study period. Method: Comprehensive medical chart/documentation review and treating psychiatrist assessment. Results: A total of 524 (16.73%) had a documented history of TBI, 195 (6.22%) held a previous diagnosis of organic mental disorder at time of admission, 57 (1.82%) had clinical symptoms considered to be consistent with TBI sequelae, and 201 (6.42%) were diagnosed with dysfunction of thinking secondary to TBI. Conclusions: Findings support specific assessment for TBI in these populations, especially in light of previous studies suggesting that psychiatric patients with a history of TBI may require more specialized treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preinjury Personality Traits and the Prediction of Early Neurobehavioral Symptoms Following Mild Traumatic Brain Injury.

Objective: To determine if preinjury personality predicts early outcome in mild traumatic brain injury (MTBI) compared with orthopedic injury (OI). Study Design: Participants and significant others (SO) completed preinjury personality and early postinjury symptom questionnaires. Setting: Inpatient hospital and outpatient follow-up. Subjects: Eighty-seven people with MTBI and 82 with OI. Outcome Measures: NEO Personality Inventory-Revised (NEO-PI-R); Neurobehavioral Functioning Inventory (NFI). Results: Personality ratings and symptom endorsement were within normal limits. Concordance between self- and SO ratings was moderate (r≥.50). In both groups, there were very modest associations between preinjury personality and early symptoms. Significant effects were primarily due to overlapping item content between the personality and symptom questionnaires. Conclusions: Preinjury personality holds limited predictive value for MTBI outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Explanatory Style and Perception of Recovery in Symptomatic Mild Traumatic Brain Injury.

Objective: To examine perception of injury and explanatory style in symptomatic mild traumatic brain injury (MTBI). Study Design: Cross-sectional comparisons. Setting: Outpatient brain injury rehabilitation clinic. Participants: Twenty-two adults with MTBI and 11 with moderate/severe traumatic brain injury (TBI). Measures: Questionnaires addressing self-perception of injury severity and recovery and explanatory style. Results: MTBI patients reported greater injury severity and poorer cognitive recovery and rated their brain injury as affecting more areas of life than the moderate/severe TBI group. Pessimistic explanatory style was associated with poorer perceived recovery. Conclusions: The results provide a stimulus for future research on self-perception and explanatory style as significant psychological variables and should be considered as relevant for interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Meta-Analytic Review of Verbal Fluency Performance in Patients With Traumatic Brain Injury.

A meta-analysis of 30 studies with 1,269 participants was conducted to investigate the sensitivity of tests of verbal fluency to the presence of traumatic brain injury (TBI). As has been found for patients with focal frontal lobe injuries (but not for patients with focal temporal lobe lesions), TBI patients were comparably impaired on tests of phonemic and semantic fluency. The phonemic fluency deficit could not be accounted for by patients' level of premorbid or current verbal IQ and was also substantially (although not significantly) in excess of the deficit on a measure of psychomotor speed. Phonemic fluency was also significantly more sensitive to the presence of TBI than was the Wisconsin Card Sorting Test (R. K. Heaton, 1981). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality Factors and Injury Severity in the Prediction of Early and Late Traumatic Brain Injury Outcomes.

Objective: To identify personality features predicting early and late outcome after traumatic brain injury (TBI). Design: Multiple regression analyses of data from an inception cohort. Participants: Sixty-nine persons with moderate to severe TBI and significant others (SOs). Outcome Measures: Rasch measure of supervision, independent living, and work (Participation and Independence Measure) at hospital discharge and at 1-year follow-up. Predictor Variables: Duration of posttraumatic amnesia (PTA) and NEO Personality Inventory-Revised completed by participants and SOs to describe participant's preinjury personality. Results: Overall personality variables were within normal limits. Only self-reported Neuroticism, specifically Depression, added significantly to PTA in predicting early outcome. Conclusions: Although self-reported depression negatively affects TBI outcome, other personality features reported by people with TBI and SOs during early recovery are normal and do not affect outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maladaptive Coping Strategies and Injury-Related Distress Following Traumatic Physical Injury.

Objectives: To identify coping strategies associated with injury-related distress in a mixed sample of physically injured adults. Study Design: Correlational. Setting: Level 1 trauma center. Participants: Orthopedic hand (n=22), multiple trauma (n=35), and burn-injured patients (n=11); ages 18-66; English speaking. Measures: Trauma Symptom Checklist-40 (TSC-40) and Brief Coping Orientations to Problems Experienced Scale. Results: Positive associations were found between 5 coping strategies and TSC-40 scores. Multiple regression revealed 3 strategies that explained significant variability in TSC-40 scores (R2=.36; emotional venting: β=.28, p=.02; behavioral disengagement: β=.25, p=.02; self-blame: β=.26, p=.05). Conclusions: Use of certain coping strategies was associated with injury-related distress among acutely injured adults. Psychosocial and educational interventions for coping in the immediate aftermath of traumatic physical injury may mediate and prevent injury-related distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Participation in Social and Recreational Activity in the Community by Individuals With Traumatic Brain Injury.

Objective: To compare the extent of engagement in social-recreational activity in individuals with traumatic brain injury (TBI) and with no disability (ND). Study Design: Between- and within-group comparisons. Participants: Samples (TBI, N=279; ND, N=224) recruited from community sources. Outcome Measures: A social-recreational measure based on items drawn from 3 measures of community integration. Results: The ND group was more active than the TBI group. For the latter, greater social-recreational activity was associated with being single, higher income, less depression, more vocational hours, and greater time since injury. Conclusions: Addressing depression, fatigue, and vocational engagement may promote entree to a fuller social-recreational life for individuals with TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of short- and long-term neuropsychological outcomes after traumatic brain injury in children.

Longitudinal neuropsychological outcomes of traumatic brain injury (TBI) were investigated in 53 children with severe TBI, 56 children with moderate TBI, and 80 children with orthopedic injuries only. Neuropsychological functioning was assessed at baseline, at 6- and 12-month follow-ups, and at an extended follow-up (a mean of 4 years postinjury). Mixed model analyses revealed persistent neuropsychological sequelae of TBI that generally did not vary as a function of time postinjury. Some recovery occurred during the first year postinjury, but recovery reached a plateau after that time, and deficits were still apparent at the extended follow-up. Further recovery was uncommon after the first year postinjury. Family factors did not moderate neuropsychological outcomes, despite their demonstrated influence on behavior and academic achievement after childhood TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Event-Based Prospective Memory Following Severe Closed-Head Injury.

Twenty-four severe closed-head injury (CHI) participants and 24 controls completed event-based prospective memory tasks concurrently with an ongoing working memory task. The event cue was either integrated with the ongoing working memory task (focal cue) or peripheral to it. Prospective remembering was poorer for the CHI group in both the focal- and peripheral-cue conditions. The groups did not differ on the ongoing task. The peripheral cue and the integrated focal cue also did not differ in ability to trigger prospective remembering. The results suggest that, even with highly salient event cues, severe CHI participants (> 1 year postinjury) are more likely than controls to exhibit prospective memory failures. The data revealed a link between CHI participants' prospective memory failures and momentary lapses of intention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)