Neuropsychological issues in litigation following traumatic brain injury.

Provides information about issues confronting neuropsychologists involved in brain injury litigation. Neuropsychologists are often involved as experts in the litigation process because of their unique role in assessment and treatment of brain injury sequelae. Focus is on evaluation, preparation of reports, testimony, professional credibility, ethics, and responsibilities to the patient. Criteria for evaluating the expertise and credentials of psychologists hired by attorneys are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation after traumatic brain injury in adults

PURPOSE: Traumatic brain injury (TBI) stands as a major public health problem and one of the most important challenges for neurological rehabilitation. This review discusses advances that have occurred in the past 10 years in rehabilitation after severe TBI in adults. METHOD: First, theoretical concepts, goals of rehabilitation and organization of resources are reviewed. Then specific questions that arise in the rehabilitation of severe TBI patients are considered. RESULTS: Three phases are distinguished in post-traumatic evolution. Acute rehabilitation takes place during coma and arousal states. Specific aims are to prevent orthopaedic and visceral complications, and to provide sensory stimulations with the hope of accelerating arousal. Secondly subacute (generally inpatient) rehabilitation is designed to facilitate and accelerate recovery of impairments, and to compensate for disabilities. Motility, cognition, behaviour, personality and affect should be simultaneously addressed in an holistic approach. Physical as well as psychological independence and self-awareness are the major goals to emphasize. A third, post-acute rehabilitation phase includes outpatient therapy for achieving physical, domestic and social independence, reduction of handicaps and re-entry into the community. CONCLUSIONS: Problems with returning home, obtaining financial independence, driving, returning to work, participating in social relationships and leisure activities, and the importance of psychosocial adjustment and self-acceptance, are outlined. Questions about economic aspects and rehabilitation in the future are addressed.     

Reduplicative paramnesia: Rehabilitation of content-specific delusion after brain injury.

ABSTRACT. Reduplicative paramnesia (RP) is one of several rare content-specific delusions that may be associated with specific central nervous system lesions and disease. RP involves the assertion that a geographic location exists simultaneously in more than one place. Correct identification of this syndrome and its neurological etiology is essential because misdiagnosing RP as a psychiatric disorder may lead to unnecessary use of neuroleptics and an increased risk of iatrogenic complications. The rehabilitation psychologist has an important role in treating the patient with RP, as well as educating family and other treating professionals regarding this syndrome. A case of RP arising from subarachnoid hemorrhage is presented with discussion of the rehabilitation course leading to the resolution of the RP. The neuropsychological and psychological underpinnings of RP are discussed, in addition to recommendations for rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anosognosia and denial: Their relationship to coping and depression in acquired brain injury.

Objective: To evaluate relations among denial, anosognosia, coping strategies, and depression in persons with brain injury. Study Design: Correlational. Setting: A Midwest residential, post-acute brain injury rehabilitation center. Participants: Twenty-seven adults with brain injury. Measures: Clinician's Rating Scale for Evaluating Impaired Self-Awareness and Denial of Disability After Brain Injury, COPE, Beck Depression Inventory-I. Results: Denial and anosognosia were related and co-occurred. Use of process coping strategies was associated with greater use of problem-focused coping strategies. Higher levels of denial were associated with greater use of avoidant coping strategies, and greater use of these coping strategies was related to higher levels of depression. Conclusions: Individuals primarily in denial and individuals primarily anosognosic differ in the coping strategies they institute. Avoidant coping strategies are used more frequently by individuals in denial, and use of these strategies is associated with higher levels of clinical depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology: Exploring issues.

Rehabilitation Psychology has several goals. One of its primary functions is to disseminate information that promotes the effective use of knowledge. While really new and current developments in rehabilitation interventions having psychological components may be known to the reader long before discussion of them appears in Rehabilitation Psychology, few "new findings" are dealt with to everyone's complete satisfaction. Many opinions exist about the efficacy of most innovative strategies; these conflicting views often are diverse, if not controversial. Therefore, it is helpful to provide professionals a forum in which they can discuss a problem and offer different viewpoints and perspectives that promote its resolution. I hope to make the journal such a forum within which these varying viewpoints can be heard. As Editor, I view Rehabilitation Psychology as being the single most significant organ through which the field can acquire additional clarity and identity. I view the role of Editor as being similar to that of a gatekeeper. The role entails major responsibility for ensuring that clinicians and academicians have an opportunity to present their findings and their opinions about critical issues facing the field. It is a role I hope to fulfill with competence and sensitivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of attention rehabilitation after an acquired brain injury: A meta-analysis.

The efficacy of attention rehabilitation after an acquired brain injury was examined meta-analytically. Thirty studies with a total of 359 participants met the authors' selection criteria. Studies were categorized according to whether training efficacy was evaluated by comparing pre- and posttraining scores only or included a control condition as well. Performance improved significantly (using the d+ statistic) after training in pre-post only studies but not in pre-post with control studies. Further analyses showed that specific-skills training significantly improved performance of tasks requiring attention but that the cognitive-retraining methods included in the meta-analysis did not significantly affect outcomes. These findings demonstrate that acquired deficits of attention are treatable using specific-skills training. Implications of these results for rehabilitation theory and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive remediation in traumatic brain injury: update and issues

Cognitive Remediation (CR) is a relatively new treatment technique for alleviating residual cognitive deficits following traumatic brain injury. This is a promising yet still changing technique. The future of CR as a rational and systematic endeavor requires the incorporation of important new ideas that have been emerging in allied fields. For example, the emerging field of instructional psychology has contributed relevant concepts such as scaffolding, metacognition, and generalization. It is furthermore argued that the issues of awareness, self-concept, and self-efficacy are vital to the process of CR intervention, and an integrative (holistic) approach to the remedial endeavor is thus indicated.     

Group psychotherapy focusing on self-concept change following acquired brain injury: A pilot investigation.

Objective: The current study explored the effectiveness of a group therapy intervention that was focused specifically on self-concept changes following acquired brain injury (ABI). Method: Eighteen individuals in the postacute phase of recovery underwent a 6-week group therapy intervention and were administered a self-concept measure before and after the intervention. Results: Group members showed a significant increase (improvement) in self-concept ratings at the end of the group intervention. Conclusions: Although the results of this study suggest that this intervention may be helpful in improving self-concept following ABI, further exploration is clearly warranted. Future research is needed to investigate the impact of self-concept on emotional adjustment, participation in rehabilitation activities, and functional outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Educating about gender and sexuality issues in graduate training: Introduction.

The topic of gender issues and sexuality has been a concern in counseling and psychotherapy since the days of Freud. The purpose of the next four articles is to provide an overall understanding of issues related to sex roles and gender that need to be addressed in graduate education and to suggest the direction that this education might take. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer group training of pragmatic skills in adolescents with acquired brain injury

OBJECTIVE: To empirically evaluate a method of treating adolescents with cognitive communication disorders, including pragmatic deficits, secondary to acquired brain injury (ABI) in a group setting by objectively measuring outcomes before treatment and immediately after treatment and at 6 months posttreatment. DESIGN: A before-after trial with follow-up in a consecutive sample, with no control group. SETTING: Inpatient and outpatient pediatric rehabilitation center. SUBJECTS: Adolescents who demonstrated pragmatic deficits and scored a rating of 3 or less on each subdomain of the Rehabilitation Institute of Chicago Rating Scale of Pragmatic Communication Skills (RICE-RSPCS) were eligible for the study. Eight subjects were recruited into the study, and two subjects were lost to follow-up. Thus, six of the eight completed the study. MAIN OUTCOME MEASURES: RICE-RSPCS, Communication Performance Scale (CPS). Results: Clinically relevant and statistically significant (P <.01) changes occurred during the treatment and were maintained at follow-up for the four RICE-RSPCS subscales and the CPS. CONCLUSION: These results suggest that the potential and often typical long-term pragmatic and subsequent social difficulties associated with ABI can possibly be lessened through effective intervention.     

A service mapping approach to the analysis of service use for people with acquired brain injury

This research study is a retrospective study which uses a novel graphical approach to visually present information about the duration and types of services provided to people with acquired brain injury in a university teaching hospital. It illustrates a method for using practitioners' knowledge of this client group and requisite interventions to develop a method of documenting the intensity and extensiveness of social work intervention. It provides a useful tool for social work, particularly in interdisciplinary settings, where the social work role in areas such as case management and counselling is rendered less visible by factors such as exception-based reporting which discourages detailed documentation of practice processes and outcomes.     

Neuropsychological evaluation of a case of organic personality disorder due to penetrating brain injury

In this paper, an organic personality disorder case by penetrating brain injury, predominantly localized in the right frontal lobe, is presented. Neuropsychological and neuroimaging (CT scan studies) were performed. We assessed the main cognitive aspect: orientation, attention, memory, intelligence, language, visual-spatial functioning, motor functioning, executive functioning and personality. The results obtained, point out disorders in the patient's behavior and in the executive functions. Likewise, other cognitive functions as: attention, memory, language and visual-spatial functioning, show specific deficits.     

Multifamily group treatment for veterans with traumatic brain injury.

A common clinical problem encountered by clinicians treating veterans who incurred traumatic brain injury (TBI) while serving in Afghanistan in support of Operation Enduring Freedom (OEF) or in Iraq in support of Operation Iraqi Freedom (OIF) is lack of knowledge about TBI on the part of the veterans' family members. Insufficient information can exacerbate marital or family conflict and lead to psychological distress and social isolation for the veteran and family, and suboptimal illness management for the veteran. To address this problem, we adapted Multifamily Group Treatment (MFGT), an evidence-based practice for treatment of serious mental illness (SMI), for treatment of OEF/OIF veterans with TBI and their families. We have implemented the adapted treatment (MFG-TBI) in four groups of veterans and families (N = 20 veterans and 20 family members) across two sites: the Durham VA Medical Center (VAMC) in North Carolina and the JJ Peters VAMC in the Bronx, New York. Adaptations focused on contents and format of the educational components, specification of a protocol for conjugal couples, and the addition of an ecomap to identify support systems during the joining (i.e. assessment) phase, a shorter (9 months) intervention duration, and a more active clinician role including use of motivational enhancement, intersession support, and coordination with other service providers. Biweekly group sessions were supervised and rated for adherence. We illustrate how MFG-TBI both educates and builds problem-solving skills with clinical examples. Suggestions for effective use of problem-solving skills with this population are offered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychometric properties of the rehabilitation therapy engagement scale when used among individuals with acquired brain injury.

Objective: To examine the properties of the Rehabilitation Therapy Engagement Scale (RTES), a new scale developed to assess patient engagement in physical and occupational therapies in the acute rehabilitation setting quantitatively. Design: Psychometric analysis to test the reliability and validity of the RTES in a Midwestern acute rehabilitation facility. Participants: 75 individuals with acquired brain injury admitted to an acute rehabilitation program in a Midwestern urban setting. Main Outcome Measures: Physical therapists (PTs) and occupational therapists (OTs) completed a rating scale designed to measure each patient's level of engagement, or involvement, in therapy. Functional status at admission and discharge was measured with the Motor and Cognition scales of the Functional Independence Measure (FIM; J. M. Linacre, A. W. Heinemann, B. D. Wright, C. V. Granger, B. B. Hamilton, 1994). Results: The RTES showed high internal consistency in both physical therapy and occupational therapy settings, as well as significant correlation across those settings (r = .56, p = .001). Conclusions: The RTES appears to be a reliable and relatively unidimensional measure to identify and describe issues affecting patient engagement in rehabilitation therapies. Additional research is suggested to better understand and define the construct of engagement and to provide additional evidence of convergent and discriminant validity in the RTES. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation following electrical injury to the upper extremity

This review emphasizes two of the difficult problems associated with electrical injury to the hand and forearm. Early wound closure to preserve important vascular, nerve, and tendon structures in the hand must be considered, recognizing the tendency for continued necrosis of tissue in this type of injury. Tissue fibrosis, even in areas of the hand not grossly injured, may develop, progressively compromising function. Five patients are presented to illustrate the early care and rehabilitation of these patients.     

Splenic injury due to indirect torsion

A patient with subcapsular rupture of the spleen in association with indirect torsion trauma is reported. The spleen was surrounded by bands and adherent organs. The injury was considered to have been caused by a stretched band. In patients with hemoperitoneum, celiac angiography is advocated for diagnosis when immediate surgery is not indicated.     

Introduction to the special section on contemporary issues in human sexuality: research and practice

Critical issues in human sexuality have changed markedly during the past decade and so have the contributions of psychology to the evaluation and treatment of sexual behavior problems. Some of the greatest challenges facing psychologists today include the increasing emphasis on medical interventions for the male sexual disorders and the relative decline of traditional behavioral sex therapies, the recalcitrance of sexual desire disorders, the prevention of "unsafe" sexual behavior, and the limited understanding of female sexuality. This overview introduces a series of 5 articles that examine these selected critical issues in human sexuality. Guidelines for clinical practice and directions for future research are highlighted.