The influence of memory beliefs in individuals with traumatic brain injury.

Objective: To explore metamemory (memory beliefs) and affective functioning in individuals with traumatic brain injury (TBI). Participants: Twenty-six individuals with mild TBI (MTBI), 16 individuals with severe TBI (STBI), and 42 uninjured adults. Outcome Measures: Metamemory in Adulthood questionnaire, Postconcussion Syndrome Checklist, Perceived Stress Scale, Beck Depression Inventory (2nd ed.), Beck Anxiety Inventory. Results: The control group endorsed higher memory self-efficacy, fewer depressive symptoms, fewer memory strategies, and fewer postconcussion symptoms than the MTBI or STBI group. The MTBI group placed high importance on success in memory tasks. Memory self-efficacy and memory-strategies use mediated the relation between TBI and depression. Conclusion: Individuals with brain injury hold negative beliefs about their memory functioning, and such beliefs contribute to depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analysis of facial affect recognition difficulties after traumatic brain injury.

Objective: Difficulties in communication and social relationships present a formidable challenge for many people after traumatic brain injury (TBI). These difficulties are likely to be partially attributable to problems with emotion perception. Mounting evidence shows facial affect recognition to be particularly difficult after TBI. However, no attempt has been made to systematically estimate the magnitude of this problem or the frequency with which it occurs. Method: A meta-analysis is presented examining the magnitude of facial affect recognition difficulties after TBI. From this, the frequency of these impairments in the TBI population is estimated. Effect sizes were calculated from 13 studies that compared adults with moderate to severe TBI to matched healthy controls on static measures of facial affect recognition. Results: The studies collectively presented data from 296 adults with TBI and 296 matched controls. The overall weighted mean effect size for the 13 studies was ?1.11, indicating people with TBI on average perform about 1.1 SD below healthy peers on measures of facial affect recognition. Based on estimation of the TBI population standard deviation and modeling of likely distribution shape, it is estimated that between 13% and 39% of people with moderate to severe TBI may have significant difficulties with facial affect recognition, depending on the cut-off criterion used. Conclusion: This is clearly an area that warrants attention, particularly examining techniques for the rehabilitation of these deficits. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Fatigue following traumatic brain injury: Frequency, characteristics, and associated factors.

Objectives: To document the frequency, characteristics, and factors associated with fatigue following traumatic brain injury (TBI). Design: Survey methodology and multivariate statistical design. Setting: Rehabilitation center and community. Participants: 452 participants aged 16 years and over with minor to severe TBI who answered a questionnaire measuring diverse aspects of fatigue as well as different dimensions of psychological distress, pain, and sleep quality. Measures: Proportion of participants reporting being significantly fatigued. Validated measures of fatigue, sleep quality, and psychological distress. Results of a logistic regression analysis. Results: Significant fatigue was reported by 68.5% of participants. Mental fatigue was the most prominent type of fatigue, followed by physical fatigue. Fatigue was present even several years following the accident and had many perceived impacts on day-to-day function. Factors associated with fatigue were a shorter time since injury; being on long-term disability leave; and higher levels of sleep problems, cognitive disturbances, and anxiety. Conclusion: Fatigue is a prevalent problem after TBI that requires more clinical and scientific attention because it probably has important repercussions on the quality of rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and functional outcome following traumatic brain injury.

Objective: To investigate pre- to postinjury personality change in relation to outcomes following traumatic brain injury (TBI). Design: Prospective analysis of personality ratings, depression, and outcome using multiple regression analyses. Participants: Cohort of 3 clinical trauma groups (mild TBI, moderate-severe TBI, orthopedic injury) and their significant others (SO). Outcome Measures: Independent Living Scale, Vocational Independence Scale, and Mayo-Portland Adaptability Inventory, 1-2 years postinjury. Predictor Variables: Posttraumatic amnesia (PTA); patient and SO NEO Personality Inventory-Revised ratings of preinjury personality taken at 1-2 months postinjury. Results: Personality function was normal for all groups (regardless of rating source) and stable over time. Neuroticism, and specifically depression, accounted for small proportions of variance in functional outcome, beyond PTA. Conclusions: There is little empirical evidence for significant personality disturbance or change up to 2 years post-TBI. Personality and depression contribute modestly to functional outcomes. Results support a distinction between "personality change" and behavior change following TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of the Neuropsychiatric Inventory in traumatic brain injury: A pilot investigation.

Objective: The goal of this investigation was to pilot the Neuropsychiatric Inventory (NPI) among individuals with traumatic brain injury (TBI) and their caregivers, assessing its screen-metric approach. Design and Participants: Using the NPI, caregivers rated neurobehavioral disturbances in 51 individuals with moderate-to-severe TBI. The NPI was completed 1 or 2 years after the individuals were injured. Results: Caregivers reported the highest symptom levels for participants on Irritability/Lability, Apathy, and Agitation/Aggression, and rated greater levels of distress tied to those domains and to Dysphoria. Caregivers endorsing domain screening items endorsed significantly more metric items (vs. screen non-endorsers) within that domain, as would be expected if the screen accurately measured the psychopathology under consideration. In addition, the screen-metric yielded extremely low false-positive rates, although 5 of the 12 domains had elevated false-negative rates. Conclusions: Findings provide preliminary support for the accuracy of the NPI's screen-metric in this population and are consistent with prior work detailing common problematic neurobehavioral consequences of TBI. These results lay groundwork for research and clinical use of this measure in populations with TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of changes in spatial distance on emotional responses.

Drawing on motivational approaches to emotion, the authors propose that the perceived change in spatial distance to pictures that arouse negative emotions exerts an influence on the significance of these pictures. Two experiments induced the illusion that affective pictures approach toward the observer, recede from the observer, or remain static. To determine the motivational significance of the pictures, emotional valence and arousal ratings as well as startle responses were assessed. Approaching unpleasant pictures were found to exert an influence on both the valence and the arousal elicited by the pictures. Furthermore, movement of pleasant or neutral pictures did not influence startle responses, while the second experiment showed that approaching unpleasant pictures elicited enhanced startle responses compared to receding unpleasant pictures. These findings support the view that a change of spatial distance influences motivational significance and thereby shapes emotional responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Post-concussive symptoms in children with mild traumatic brain injury.

To investigate postconcussive symptoms (PCS) following pediatric mild traumatic brain injury (mTBI), 8- to 15-year-old children with mTBI (n = 186) and a comparison group with uncomplicated orthopedic injuries (OI, n = 99) were recruited from two emergency departments. Parent and child ratings of PCS and symptom counts were obtained within 3 weeks after injury (baseline) and at 1, 3, and 12 months postinjury. The mTBI group also completed magnetic resonance imaging at baseline. Group differences were examined using growth modeling, controlling for age at injury, sex, socioeconomic status, and (for parent-based measures) preinjury symptom levels. Relative to the OI group, the mTBI group had higher ratings of somatic PCS and parent counts of PCS at the initial assessments, but higher parent ratings of cognitive PCS and child counts of PCS throughout follow-up. Higher levels of PCS in the mTBI group were associated with motor-vehicle-related trauma, loss of consciousness, neuroimaging abnormalities, and hospitalization. The findings validate both transient and persistent PCS in children with mTBI and document associations of symptoms with injury and noninjury factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors contributing to attentional impairments after traumatic brain injury.

The aim of the present study was to investigate the contribution of impaired information processing speed and strategic control of attention to performance on attentional tasks after traumatic brain injury (TBI). Forty moderately to severely injured rehabilitation inpatients and 40 healthy controls completed a selection of attentional tasks. Slowed processing speed in the TBI group was identified on the Symbol Digit Modalities Test (SDMT), 2&7 Selective Attention Test (2&7), Selective Attention (SAT), and Four Choice Reaction Time (4CRT) tasks. Impaired working memory was evident on the Letter Number Sequencing (LNS) task. Structural equation modeling revealed that the group difference in RT on the complex SAT was accounted for by slowed speed of processing on the simple SAT, and not working memory. TBI participants made more errors and missed responses on the complex version of the SAT, suggesting impairment in some aspects of strategic control of attention, and appeared unable to benefit from the automatic condition of the 2&7 Test. There was little evidence of deficit on the Sustained Attention to Response Task (SART). The present study provides evidence for a significant contribution of slowed processing speed to impaired performance on attentional tasks after TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The psychological effects of employment after traumatic brain injury: Objective and subjective indicators.

Objectives: This study examines the effects of objective (level of engagement) and subjective (discrepancy between importance of work and the degree to which work needs are met) indicators of employment on self-reported psychological well-being, quality of life (QoL), and depression for individuals with traumatic brain injury (TBI). Design: Cross-sectional. Setting: Community-based research and training center. Participants: 317 individuals with self-reported TBI under the age of 65 were included in analysis. Main Outcome Measures: Living Life After Traumatic Brain Injury (LLATBI; 1998), Flanagan Scale of Needs (J. C. Flanagan, 1982), Beck Depression Inventory-II (BDI-II; A. T. Beck, R. Steer, & G. Brown, 1996). Results: Only 21% of the present sample experienced similar levels of pre- and postinjury employment. Multiple regressions revealed significant relationships between demographic, objective, and subjective employment indicators and perceived QoL and depression. In addition, significant increments in QoL and depression variance were accounted for by subjective indicators of employment per se. Conclusions: Subjective indicators are additional important measures when assessing the rehabilitation needs and planning treatment for individuals with TBI, as they contribute to further improvements in their QoL and mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional Response in Patients With Frontal Brain Damage: Effects of Affective Valence and Information Content.

The authors investigated the role of the frontal lobes in the emotional response in 19 patients with brain damage and 23 control subjects. They studied the modulation of the startle blink reflex by affective pictures, and other autonomic responses. Patients showed a dissociation between the startle reflex and the affective valence ratings of the pictures, as a result of a low inhibition of the startle reflex by pleasant pictures. Pictures elicited lower skin conductance responses (SCRs) in patients than in controls, whereas the groups did not differ in the SCRs prompted by less significant acoustic stimuli. The findings point to the frontal lobe as a structure involved in the emotional response and in the physiological emotional arousal related to the complexity of the stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of age on long-term cognitive function after traumatic brain injury.

Objective: To examine the association of age and time postinjury with cognitive outcome 5–22 years following traumatic brain injury (TBI), in relation to matched uninjured controls. Methods: One hundred twelve participants with mild to very severe TBI, aged 16–81 years at the time of injury, were cognitively assessed on measures of processing speed and attention, verbal and visual memory, executive function, and working memory. Results were compared with those of 112 healthy controls individually matched for current age, gender, education, and estimated IQ. Results: Older injured individuals performed worse than did younger injured individuals across all cognitive domains, after controlling for the performance of controls. In relation to matched controls, long-time survivors performed disproportionately worse than did more recently injured individuals, irrespective of age. Conclusions: After maximum spontaneous recovery from TBI, poorer cognitive functioning appears to be associated with both older age at the time of injury and increased time postinjury. These findings have implications for prognosis, early treatment recommendations, and long-term issues of differential diagnosis and management planning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive functioning ten years following traumatic brain injury and rehabilitation.

Many previous studies investigating long-term cognitive impairments following traumatic brain injury (TBI) have focused on extremely severely injured patients, relied on subjective reports of change and failed to use demographically relevant control data. The aim of this study was to investigate cognitive impairments 10 years following TBI and their association with injury severity. Sixty TBI and 43 control participants were assessed on tests of attention, processing speed, memory, and executive function. The TBI group demonstrated significant cognitive impairment on measures of processing speed (Symbol Digit Modalities Test [SDMT], Smith, 1973; Digit Symbol Coding, Wechsler, 1997), memory (Rey Auditory Verbal Learning Test [RAVLT]; Rey, 1958; Lezak, 1976), Doors and People tests; Baddeley, Emslie & Nimmo-Smith, 1994) and executive function (Hayling C [Burgess & Shallice, 1997] and SART errors, Robertson, Manly, Andrade, Baddeley & Yiend, 1997). Logistic Regression analyses indicated that the SDMT, Rey AVLT and Hayling C and SART errors most strongly differentiated the groups in the domains of attention/processing speed, memory and executive function, respectively. Greater injury severity was significantly correlated with poorer test performances across all domains. This study shows that cognitive impairments are present many years following TBI and are associated with injury severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring sandplay therapy: Application to individuals with traumatic brain injury.

Adolescents with traumatic brain injury (TBI) often experience social, emotional, and behavioral challenges requiring intervention. Although sandplay techniques have been used with targeted populations, there are no published accounts of sandplay applications with children or adolescents with TBI. This article explores the merits of sandplay approaches for clients with TBI with respect to key features of TBI, including language, communication, psychosocial, and executive function impairments. Two case examples of adolescents with TBI treated with sandplay therapy are presented, followed by discussion and recommendations for further study in the application of this technique with individuals experiencing emotional or behavioral difficulties associated with TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of traumatic brain injury on working memory-related brain activation in adolescents.

Eight adolescents (ages 13-18 years) who sustained traumatic brain injury (TBI) and eight gender- and age-matched typically developing (TD) adolescents underwent event-related functional MRI (fMRI) while performing a Sternberg letter recognition task. Encoding, maintenance, and retrieval were examined with memory loads of one or four items during imaging. Both groups performed above a 70% accuracy criterion and did not differ in performance. TD adolescents showed greater increase in frontal and parietal activation during high-load relative to low-load maintenance than the TBI group. The TBI patients showed greater increase in activation during high-load relative to low-load encoding and retrieval than the TD group. Results from this preliminary study suggest that the capability to differentially allocate neural resources according to memory load is disrupted by TBI for the maintenance subcomponent of working memory. The overrecruitment of frontal and extrafrontal regions during encoding and retrieval following TBI may represent a compensatory process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family satisfaction predicts life satisfaction trajectories over the first 5 years after traumatic brain injury.

Objectives: Examined the influence of functional impairment, stable marital status, and family satisfaction on life satisfaction trajectories for 609 individuals (435 men, 174 women) over the first 5 years after traumatic brain injury (TBI). Measures: Participants completed the Family Satisfaction Scale (FSS), Functional Independence Measure (FIM), and the Life Satisfaction Index (LSI) at years 1, 2, 4, and 5 after sustaining a TBI. Results: Trajectory modeling revealed that higher family satisfaction was associated with increases in life satisfaction for individuals with less functional impairment. Stable marital status was not significantly associated with life satisfaction trajectories. Implications: Family satisfaction appears to have pronounced beneficial effects on life satisfaction for persons with less functional impairment after TBI regardless of marital status. In contrast, a stable marriage appears to have no apparent benefits to self-reported life satisfaction over the first 5 years post-TBI. Theoretical and clinical implications of these results are discussed. (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)     

Neuropsychological impairments after spinal cord injury: A comparative study with mild traumatic brain injury.

Objective: To determine if individuals with mild traumatic brain injury (MTBI) perform differently on neuropsychological measures than individuals with spinal cord injury (SCI) having no loss of consciousness. Design and Participants: Data were collected prospectively on 33 matched pairs of individuals with SCI or MTBI. Independent t tests were performed to identify differences between the SCI and MTBI groups. Results: Although those with SCI generally outperformed individuals with MTBI, no meaningful between-groups differences were noted on 5 of the 10 neuropsychological tests administered. Greater than 40% of the SCI patients were identified as having impairments in processing speed, motor speed, and verbal learning. Conclusions: Treatment planning after SCI should include procedures to identify cognitive deficits that may complicate adjustment to disability and delay acquisition of new skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self and parent ratings of executive functioning after adolescent traumatic brain injury.

Objective: To examine the level of agreement between adolescents with traumatic brain injury (TBI) and their parents in standardized ratings of executive functioning, and to determine correlates of discrepancies between those ratings. Participants: Ninety-eight 11- to 16-year-old adolescents with TBI and their parents, and 97 neuropsychologically healthy controls. Method: Five-year consecutive series of rehabilitation referrals for TBI. Measures: Behavior Rating Inventory of Executive Function–Self Report (BRIEF–SR) and Behavior Rating Inventory of Executive Function (BRIEF) parent report versions. Results: Self and parent ratings were moderately positively correlated in both the TBI group and the control group, but parents generally identified more executive dysfunction than did the adolescents. Parent-adolescent discrepancies were statistically significantly greater in the TBI group than in the control group on the Metacognitive index but not the Behavioral Regulation index. The degree of the former discrepancy was predicted by duration of coma in the TBI group. Conclusions: Adolescents with more severe TBI may underestimate their own degree of executive dysfunction in daily life, particularly aspects of metacognitive abilities, possibly, in part, because of an organic-based lack of deficit awareness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Driving, aging, and traumatic brain injury: Integrating findings from the literature.

Objective: In order to address the potential compounded risk in the population of aging traumatic brain injury (TBI) survivors who continue to drive, the authors synthesized literatures regarding the impact of aging or TBI on driving. Study Design: PubMed searches were conducted utilizing combinations of the following terms: driving, aging, elderly, TBI, cognition, seizures, vision, hearing, rehabilitation, sleep, fatigue, and assessment. Additional sources were also identified from the bibliographies of articles obtained and the Transportation Research Information Service electronic database. Clinically relevant human studies written in English were reviewed. Results: Using a conceptual framework developed by W. H. Brouwer and F. K. Withaar (1997), the authors of the current review highlight driving-related obstacles for TBI survivors and aging adults and suggest that individuals aging with TBI may be at increased risk for driving-related problems. Implications: Areas for clinical consideration include seizures, sleepiness and fatigue, vision, cognition, driving assessment, and caregiver involvement. The need for further study of postacute driving assessment and rehabilitation is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A stress process model of caregiving for individuals with traumatic brain injury.

Objective: To test a stress process model of caregiving for persons with traumatic brain injury. Design: A correlational study using path analysis. Participants: One hundred eight caregivers affiliated with community- or Web-based support groups. Main Outcome Measures: The Modified Caregiver Appraisal Scale, the World Health Organization Quality of Life-Brief Version, the Interpersonal Support Evaluation List, and the COPE. Results: The normed fit index, comparative fit index, and parsimony ratio indicated a good fit for the model, suggesting that coping, social support, and caregiving appraisal contribute to quality of life. A more parsimonious model was respecified and achieved a better fit with fewer paths and variables. Conclusions: Empirical support was found for the proposed caregiving stress process model, which appears to provide useful information for future research and clinical interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)