Quality of life 10 years after a very severe traumatic brain injury (TBI): the perspective of the injured and the closest relative

This study is a further follow-up of a group of 15 very severely injured TBI patients who have earlier been followed-up 5 years after the injury, and their closest relatives. The aim of this study was to evaluate the factors related to the quality of life of the injured and the strain felt by the relatives. The information was gathered by questionnaires for the injured and the relative and clinical ratings based on the observations of a clinician. The self-reported quality of life of both the injured and their closest relatives was rather high in spite of the various physical, cognitive and emotional/behavioral disturbances. However, the strain felt by many of the relatives was still high 10 years after the injury although it had decreased over the years. The neurobehavioral and emotional disturbances had the most significant effect on the quality of life of the injured and strain felt by the relative. The relationship between the quality of life of the injured and strain felt by the relative was not linear. The implications of the findings for developing different forms of rehabilitation and support systems is discussed.     

Are the subjective complaints of traumatically brain injured patients reliable?

The present study was designed to compare the subjective complaints of 50 traumatically brain injured (TBI) patients with the observations of their significant others. The complaints of the TBI patients and their significant others were contrasted according to the severity of the TBI and the type of complaint (physical, cognitive/behavioural and emotional). While no differences were found in physical complaints, the cognitive/behavioural and emotional complaints of TBI patients, regardless of the severity of the initial TBI, were significantly under-reported in comparison to the observations of their significant others. The data suggests that while this finding was most likely due to the TBI patients' poor awareness, it was unlikely to be the result of psychological denial since all of these individuals were evaluated in the context of being a plaintiff in personal injury litigation or a claimant in a Workers' Compensation claim. The data suggests that the cerebral trauma these patients sustained played a major role in their ability to recognize their cognitive, behavioural and emotional symptoms. Finally, the data suggests that clinicians should obtain information about the TBI patients' cognitive/behavioural and emotional functioning from their significant others, rather than rely entirely on the TBI patients' subjective assessment of these problems.     

Spontaneous complaints of long-term traumatic brain injured subjects and their close relatives

Long-term consequences of head injury for patients and families are not well known, given the complexity of variables that have to be studied. Subject's self-experience is one of these less studied aspects. The purpose of this study is to examine the spontaneous complaints of long-term brain injured adult subjects to be compared to the impression of their relatives. A total of 48 chronic head trauma subjects were studied more than 6 years after injury together with a relative, usually a mother or wife. At the beginning of the interview the participants were asked to freely refer their present complaints. In general, relatives referred more complaints about the injured subjects than the injured subjects referred about themselves. This occurred in several domains: somatic, physical, cognitive, and behavioural. Memory problems were highly reported by both groups. Somatic complaints were more frequently reported by patients and behavioural problems were more often reported by relatives. Mothers and wives had different profiles or responses. Mothers' opinions were identical to those of their TBI sons in all domains. These different results must be taken into consideration so that the real needs of patients and relatives can be addressed.     

Changes in ocular dimensions and refraction with accommodation

We assessed the accuracy of the family history (FH-RDC) and family study (SADS-L) methods for obtaining information about the presence of psychopathology in 274 first-degree relatives of patients with psychotic disorders. The family history method had only modest sensitivity, 40.8% for affective disorders and 58.6% for psychotic disorders, but high specificity, 94.1% for affective disorders and 98.7% for psychotic disorders. For both disorders, sensitivity was higher for relatives who had had previous psychiatric admissions. However, with the family study method, we found that relatives with affective disorder were more likely to be interviewed than those relatives with other disorders. Hence, the family study method may be prone to selection bias that distorts morbid risk estimates. We conclude that the best way of collecting information regarding family psychopathology is to interview directly as many relatives as possible and to collect supplementary family history information on unavailable relatives.     

Bring it up in milieu: Toward effective traumatic brain injury rehabilitation interaction.

Reviews the emotional and motivational problems faced by the rehabilitation therapist dealing with traumatic brain injury (TBI) patients and describes a neuropsychologically oriented method to help rehabilitation team members improve their effectiveness in returning post-TBI patients to work. A clinical vignette describing the use of milieu therapy is presented. Topics that rehabilitation team members need to be taught about cognitive and personality problems of TBI patients are discussed, focusing on teaching staff to give feedback in milieu. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Loss of emotional experience after traumatic brain injury: Findings with the startle probe procedure.

The authors used affective modulation of the eyeblink startle response to examine the impact of traumatic brain injury (TBI) on emotional reactions to pictures. Participants were 13 individuals with severe TBI and 24 controls. Participants were presented with pictures that differed in affective valence (e.g., mutilated bodies, erotic couples, and household objects) while the eyeblink startle response to an acoustic probe was measured. Startle amplitude was used to assess valence of emotional response, and startle latency was used to index interest in the pictures. Subjective ratings of the affect and arousal elicited by the various pictures were also obtained. TBI impaired startle potentiation to unpleasant pictures but not startle attenuation to pleasant pictures. Further, subjective ratings indicated that TBI participants found unpleasant pictures less arousing than did controls. The results are consistent with recent evidence of differential impairment in negative versus positive emotions after TBI and are discussed in relation to 2 competing explanations of startle modulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blame attribution in intentional and unintentional traumatic brain injury: Longitudinal changes and impact on subjective well-being.

Objective: Examine longitudinal changes in attribution of blame to self and others, and concern over cause of injury, in both intentional (violence-related) and unintentional (accidental) traumatic brain injury (TBI); investigate the relation of these factors to subjective well-being outcomes at 1 year post-TBI. Study Design: Prospective, multicenter, observational study with longitudinal component. Participants: 99 men with unintentional TBI and 25 men with intentional TBI who sustained moderate to severe injuries, received inpatient rehabilitation, and provided data in both acute rehabilitation and 1-year follow-up. Measures: Blame Attribution Questionnaire, General Health Questionnaire-30, Neurobehavioral Functioning Inventory-Revised Depression Scale, Satisfaction With Life Scale, community participation measures. Results: At both time points, participants with intentional TBI blamed others more while those with unintentional TBI blamed themselves more (trend). Other-blame at 1 year predicted depression but not life satisfaction. Self-blame was not a significant predictor of depression or life satisfaction. Increasing concern over cause/blame for injury from acute rehabilitation to follow-up was associated with high levels of emotional distress. Conclusion: Blame attribution issues may be markers of TBI-related emotional distress regardless of injury etiology, particularly when others are blamed for the injury and/or concerns over cause of injury do not resolve over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of fine-needle aspiration cytology and flow cytometry in the diagnosis and subclassification of primary and recurrent lymphoma

The aim of this study was to assess and compare spinal cord injured (SCI) and traumatic brain injured (TBI) persons and people from the general population concerning partner relationships, functioning, mood and global quality of life. One hundred and sixty seven SCI persons, 92 TBI persons and 264 controls participated in the study. The median age was: SCI persons 33 years (range 19 to 79 years), TBI persons 40 years (range 20 to 70 years), and controls 31 years (range 19 to 79 years). Age at injury ranged among SCI persons from 14 to 76 years (Md 28 years), and among TBI persons from 16 to 56 years (Md 32 years). Half of the SCI group (51%), 58% of the TBI group and 59% of the controls had a stable partner relationship at the time of the investigation. Many of these SCI and TBI relationships (38% and 55% respectively) were established after injury. Both SCI and TBI persons showed significantly more depressive feelings compared with the controls. Perceived quality of life (global QL rating) was significantly lower in the SCI group compared with the controls, whereas the ratings of TBI persons and controls did not differ significantly. SCI and TBI persons did not differ significantly in level of education, perceived quality of life or distress. In all three groups, global quality-of-life ratings were significantly lower among single persons compared to those with a partner relationship. It was concluded that both SCI and TBI appear to affect overall quality of life and mental well-being negatively. The number of partner relationships contracted after injury among both SCI and TBI persons indicates, however, that the injury is not a major barrier to establishing close partner relationships. Being in good spirits, that is, lack of depressive feelings has a profound impact on the perception of a high quality of life in all three groups. For the SCI and TBI persons, a high level of physical and social independence were further positive determinants of a perceived high quality of life.     

The role of the family for behavioral outcome in children and adolescents following traumatic brain injury.

This study assessed the behavioral outcome of 51 children with traumatic brain injury (TBI) up to 2 years following injury. Children with severe injuries, but not those with mild or moderate injuries, were reported by parents to have a greater incidence of behavior problems following TBI. Regression analyses indicated that the presence of a partner for the primary caregiver of the child and the acute emotional reaction of the parent to the injury were both predictive of child behavioral outcome, although not by 2-year follow-up. These findings suggest that parental coping resources may impact on the development of child behavioral sequelae following TBI, emphasizing the role of the family in the child's response and the importance of supportive intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The enigma of "hidden" traumatic brain injury

OBJECTIVE: To examine individuals with "hidden" traumatic brain injury (TBI), defined in this study as those who sustained a blow to the head, with altered mental status, and experienced a substantial number of the cognitive, behavioral, and emotional sequelae typically associated with brain injury but did not make the causal connection between the injury and its consequences. DESIGN: Comparison of four groups of individuals matched for age, gender, years of education, and duration of loss of consciousness. SETTING: This study of hidden TBI followed the identification of 143 individuals who, within a larger study of people with TBI who live in the community, identified themselves as "nondisabled" (they were to be part of the comparison sample) but who had experienced a blow to the head that left them at minimum dazed and confused. PARTICIPANTS: 21 of these 143 individuals also reported large numbers of symptoms (eg, headaches, memory problems) associated with TBI. This group (Hidden TBI-High Symptoms group) was compared to three other matched samples: one with known TBI (Known Mild TBI group) and one with no disability (No Disability group) (both of which were drawn from the larger study), and one group of individuals who identified themselves as having no disability but who had experienced a blow to the head that resulted in a few symptoms (Head Trauma-Low Symptoms group). MAIN OUTCOME MEASURES: All study participants were administered an interview that incorporated several existing instruments documenting levels of reported symptoms, emotional well-being/distress, and vocational/social handicaps. RESULTS: The Hidden TBI-High Symptoms group was found to be similar to the Known Mild TBI group in terms of the number and types of symptoms experienced, whereas the Head Trauma-Low Symptoms group was similar in this respect to the No Disability group. The two former groups also evidenced high levels of emotional distress, whereas the two latter groups did not. However, on measures of handicap, the Hidden TBI-High Symptoms and Head Trauma-Low Symptoms groups were similar to the No Disability group and dissimilar from the Known Mild TBI group in that the last group experienced vocational handicap, in particular, whereas the other groups did not. Conclusions: We conclude that hidden TBI occurs at a nontrivial level (7% of our nondisabled sample). Also, individuals with hidden TBI (with persistent symptoms), unlike those with known mild TBI, are likely to experience emotional distress but not vocational handicap following injury.     

The effects of parental traumatic brain injury on the behaviour of parents and children

Little is known about the effects of a parent's brain injury and subsequent disabilities on the children in the family. This study examines 24 families in which one parent is brain injured. In each family the children were born before the parent's injury and still lived at home at the time of interview. Reports of the uninjured parent indicate that most of the children experienced some degree of negative behavioural change after the parent's injury. In 10 of the families, significant and problematic changes occurred. Types of problems included poor relationship with the injured parent, acting-out behaviour and emotional problems. Correlates of poor outcomes for the children were: (1) injured parent's gender, (2) compromised parenting performance of the injured parent, (3) compromised parenting performance of the uninjured parent and (4) depression in the uninjured parent. This study points to the importance of recognizing traumatic brain injury as a major family stressor.     

Social and emotional loneliness: An examination of Weiss's typology of loneliness.

Examined R. S. Weiss's (1973) conceptualization of social and emotional loneliness, using survey data on 505 college students that included the UCLA Loneliness Scale—Revised. Social and emotional loneliness, Ss' affective and behavioral reactions to loneliness, Ss' social relationships, and their judgments of the degree to which their relationships supply the 6 social provisions described by Weiss were measured. There were differences in the subjective experiences of social and emotional loneliness, although both forms of loneliness were also characterized by a common core of experiences. Results generally support Weiss's ideas concerning the determinants of social and emotional loneliness. Predictions concerning the affective and behavioral consequences associated with each type of loneliness, however, were only partly supported, although the 2 forms of loneliness were associated with different affective reactions and coping behaviors. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapeutic interventions with traumatically brain-injured patients.

Reviews personality disturbances that can occur after traumatic brain injury (TBI), including neuropsychologically based personality changes, emotional reactions to injury, and preexisting characterological styles. Denial, based in either psychological defensiveness or organic lack of awareness, presents a special rehabilitation problem that may be amenable to therapy. Psychotherapy following TBI is described, focusing on the use of the psychotherapeutic relationship, setting, rationale, and procedures. Psychotherapeutic techniques appropriate for working with TBI patients are noted, including cognitive-behavioral interventions, self-instructional training, dynamically oriented psychotherapies, and group psychotherapy. A comment by M. Rosenthal follows. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concordance of patients' and family members' ratings of neurobehavioral functioning after traumatic brain injury

OBJECTIVE: To examine differences in family and patient evaluation of neurobehavioral functioning in adults with traumatic brain injury (TBI). DESIGN: Differences were examined by conducting 70 paired sample t tests on scale items and 6 paired sample t tests on scale scores from a neurobehavioral inventory. SETTING: Medical center outpatient clinic. PARTICIPANTS: Three hundred one consecutive adult patients with TBI and 301 informants, primarily family members, completed the neurobehavioral inventory. MAIN OUTCOME MEASURE: Neurobehavioral Functioning Inventory (NFI) comprised of six scales with items describing symptoms and daily living problems. RESULTS: Paired t test analyses of the six scales indicated that patients reported a significantly greater level of communication problems than did their matched family members. No differences were found for the other five scales. Paired t test analyses of the 70 scale items revealed significant differences in patient and family ratings for only 13 items. In all 13 instances, patients reported greater levels of dysfunction than were reported by their family members. Analysis of variance (ANOVA) indicated a main effect of injury severity for only the Communication and Memory/Attention scales. CONCLUSIONS: Findings indicate general agreement between family members and patients regarding patients' everyday problems. Results do not support contentions that patients tend to underestimate difficulties. Agreement levels appear related to injury severity, item specificity, and item content. More research is needed to identify other variables relating to agreement levels, including age, injury severity, and amount of contact between patients and family members.     

The cost-effectiveness of the diagnosis of renal artery stenosis

Variables were studied which predict at the acute stage the functional and occupational long-term outcome for patients with traumatic brain injury (TBI). Glasgow Coma Scale (GCS) score on hospital admission, length of coma (LOC) and duration of post-traumatic amnesia (PTA) were studied in a group of 508 TBI rehabilitation patients, age 0.8-71, mean age 19, followed up between five and over 20 years, mean of 12 years. Information from hospital charts and all data available before and after the injury were gathered and reviewed. The study was carried out among a consecutive sample of Finnish patients with TBI referred to a rehabilitation programme at the out-patient neurological clinic of Kauniala Hospital, which specializes in brain injuries in Finland. The patients came from various hospital districts in the country for an evaluation of their educational and vocational problems. Main outcome measures were functional outcome, as measured by the Glasgow Outcome Scale (GOS) at the end of follow-up, and post-injury occupational outcome. The patients' reemployment on the open job marklet, subsidized employment or inability to work was noted. The GCS score on hospital admission correlated clearly with the functional outcome of the patients at the end of follow-up. Length of coma and duration of post-traumatic amnesia correlated specifically with the patient's work history after the brain injury and with functional outcome measured by the GOS. Outcomes varied among age groups and seemed to be affected by age at injury. Accordingly, the extent of recovery and quality of life for rehabilitation patients with TBI can be estimated early on by prognostic factors reflecting injury severity in the acute phase. The results suggest that the GCS score, LOC and duration of PTA all have a strong predictive value in assessing functional or occupational outcome for TBI patients.     

Cancer chemotherapy in patients of advanced age (over 75)

The changes occurring within Korean society provide an opportunity for studying the influence of family structure on children's emotional and behavioural problems. Children aged 7-13 years from two Korean cities were assessed for emotional and behavioural problems in school by their teachers, using the Children's Behaviour Questionnaire. In Study 1, 326 children from extended families were compared with demographically matched nuclear family children in the same school classes. In Study 2, a further sample of 204 extended family children was compared with pair-matched nuclear family children, in order to replicate the findings. Children from Study 1 were followed up 2.5 years later. Children from extended families had lower behaviour problems scores and the prevalence of serious problems was lower in extended family children. These differences were most marked in relation to externalising behaviour problems and were stable over the studies and time. Grandparents in extended families may increase children's resiliency by providing sources of attachment, affection, and knowledge, as well as having indirect effects through their support of parents. Consistent with recent ideas about the cognitive bases for behaviour problems, it may be that rules for behaviour derived from traditional cultural beliefs and values are internalised by children from extended families and generalise to prevent behaviour problems in school.     

Pharmacotherapy for postacute traumatic brain injury: A literature review for guidance in psychological practice.

Objectives: The purpose of this review is to educate and guide the actions of rehabilitation psychologists by providing a summary of the current literature on pharmacotherapies and treatment effectiveness for the chronic sequelae associated with severe traumatic brain injury (TBI). A number of medications are reviewed for use in treating deficits in arousal, cognition, function, and other problems associated with TBI. Findings for their use in this population are summarized. Cautions, limitations, and directions for future research are discussed. Conclusions: Pharmacological management of chronic symptoms of TBI is commonplace in rehabilitation practice. Clear clinical guidelines for the use of pharmacotherapy in TBI are lacking, however, because of the few conclusive findings regarding the effectiveness of any particular agent. Rehabilitation psychologists frequently encounter patients treated with numerous medications and, therefore, need to be aware of potential effects on cognitive and functional abilities. Additionally, rehabilitation psychologists should be aware of available and empirically supported pharmacotherapies as they are in a position to comprehensively assess the patient and provide requested consultation to the treating physician concerning the patient's need for and likelihood of benefiting from various pharmacological agents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The long term effects of traumatic brain injury on the roles of caregivers

This study was conducted to identify the long term effects of traumatic brain injury (TBI) on the roles of caregivers. The subjects consisted of 155 caregivers of survivors with TBI who were randomly selected from 15 midwestern state brain injury association databases. A questionnaire was developed by the researchers to determine factors affecting role changes of caregivers. The Role Checklist, by Barris, Oakley and Kielhofner, was also included with the questionnaire. Both were mailed to each selected caregiver and used for data gathering. The data obtained were analysed to determine existing trends in the data. Graphs were utilized to depict the trends that was identified. The following trends and conclusions established by this research include: (a) behavioural effects of the survivor with a TBI are associated with the number of role changes experienced by caregivers; (b) participation in support systems is associated with the number of role changes experienced by caregivers; and (c) caregivers who care for a person with a TBI in the home will show a larger number of role changes than those who do not provide direct care for a person with a TBI.     

Neurochemical changes and current pharmacological approaches in craniocerebral trauma

In recent years, our knowledge concerning pathophysiological changes in brain metabolism after traumatic brain injury (TBI) has greatly expanded. This, in turn, has enabled the development of specific pharmacological strategies for the supplementary treatment of brain-injured patients with the aim of reducing secondary brain damage. The present article focuses on the pathophysiology of TBI and the possibilities for pharmacological intervention. While some of the substances reviewed and presently used in the treatment of TBI, others are under experimental and clinical evaluation at different stages.     

Impact of traumatic brain injury on the family: A critical review.

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) 2010 APA, all rights reserved)