Sustained attention after severe closed head injury.

Sustained attention was assessed in 20 patients with severe closed head injury (CHI) and 20 normal matched controls. Participants were presented with a visual continuous performance task (CPT) with 3 levels of complexity. Performance was assessed by examining response latencies and error rates. Across all levels of complexity, the CHI patients demonstrated a vigilance decrement, whereas the performance of the matched controls was stable across time. The vigilance decrement was not differentially affected by the manipulation of task complexity in the CHI patients. However, findings suggest that the overall vigilance performance of CHI patients was differentially affected by increasing the complexity of the task. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnosis and attention deficits after closed head injury

In a controlled study of patients attending a concussion clinic because of ongoing postconcussion symptoms, attention deficits were recorded in the head-injured group for the aspects of alertness, assessed by the Continuous Performance Test (CPT), and processing capacity, assessed by a version of the Paced Auditory Serial Addition Test (PASAT). Selective attention was intact. Hypnotizability was assessed by the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A), with normal means and standard deviations found in both the concussed and control groups. There was a significant correlation, however, between HGSHS:A scores and PASAT scores in the concussed group only. The results of this preliminary study suggest that slower processing capacity after a closed head injury may predict higher hypnotizability and that hypnosis could be an appropriate rehabilitation technique for these patients who present with postconcussion symptoms.     

Effects of divided attention on implicit and explicit memory performance following severe closed head injury.

This study investigated the relation between attentional limitations and memory impairments in patients with closed head injuries (CHI). Twenty-seven CHI participants ( > 1 year postinjury) and 27 matched controls rated their liking of target words under conditions of full and divided attention. Participants then completed an implicit test of tachistoscopic identification (TI) and an explicit test of recognition for the target words As expected, the results revealed impaired explicit memory but preserved perceptually driven implicit memory performance following a CHI. Contrary to what was hypothesized, a reduction in attention available at encoding did not disproportionately impair the recognition performance of the CHI patients. Finally, unlike controls, the CHI participants' priming scores on the TI task were significantly affected by dividing attention at encoding. However, this finding interacted with CHI participants perceptual processing rates, suggesting that nonmemory cognitive factors may influence measured performances on implicit memory tests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sagittal sinus thrombosis after closed head injury

We describe a patient with trisomy 8 mosaicism followed through a sixth pregnancy and discuss issues in phenotypic and genotypic variability, the risk for neoplasia, and reproductive risks.     

Automatic process development following severe closed head injury.

Automatic process development was investigated in a closed head injury (CHI) population. Ten severe CHI participants (>1 year postinjury) and 10 matched controls completed consistent mapping (CM) and varied mapping (VM) semantic-category memory search tasks. In VM search, despite a similar pattern of serial memory search, the CHI participants responded slower than controls and exhibited slower memory search rates throughout practice (1,800 trials). In CM search, after extensive practice (1,800 trials) both groups showed the performance characteristics indicative of automatic process development, that is, near-zero slopes and large reductions in response times. However, the CHI participants were slower to automatize the task. These results indicate that for memory-based search tasks the effects of a CHI may slow down the speed with which automatic processes develop but that CHI participants can acquire and use automatic processes in task performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory remediation after severe closed head injury: Notebook training versus supportive therapy.

Evaluated the effectiveness of a 9-wk memory notebook treatment for closed-head injured (CHI) participants with documented memory deficits. Eight participants who had sustained a severe CHI more than 2 yrs earlier were allocated to receive either notebook training or supportive therapy. The notebook training group reported significantly fewer observed everyday memory (EMF) failures on a daily checklist measure than the supportive therapy group. Although in the same direction, this finding no longer reached significance at follow-up. No significant treatment effects were found for the laboratory-based memory measures at posttreatment or follow-up. Although the present results are to be considered preliminary because of the small sample size, they suggest that notebook training has the potential to help individuals compensate for everyday memory problems and that the methods used to measure training efficacy are important. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interhemispheric transfer after spontaneous recovery in 43 cases of severe closed head injury.

Examined the possibility of frequent callosal disconnection following closed head injury. Interhemispheric transfer was evaluated in 43 severe closed-head-injured patients (aged 18–51 yrs) using a wide-ranging battery of untimed behavioral tasks, after the period of spontaneous recovery. Only 1 S showed signs of callosal disconnection. Much effective interhemispheric transfer occurred in closed-head-injured Ss after the period of spontaneous recovery. More frequent occurrence of the disconnection syndrome in its acute phase is a possibility that cannot be excluded. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discourse after closed head injury in young children

This study examined narrative discourse in 23 children, ages 6 to 8 years, who sustained a severe closed head injury (CHI) at least 1 year prior to assessment. Narratives were analyzed at multiple levels using language and information structure measures. Results revealed significant discourse impairments in the CHI group on all measures of information structure, whereas differences in the linguistic domain failed to reach significance. In addition, effects of age at injury and lateralization of lesion on discourse were considered. Although no significant differences were found according to age at injury, a consistent pattern of generally poorer discourse scores was found for the early injured group (< 5 years). With regard to lesion focus, the group findings were unimpressive. However, preliminary examination of individual CHI cases with relatively large lateralized lesions suggested that the late injured children may show the language-brain patterns reported in brain-injured adults, whereas early injured children may not.     

Long-term psychosocial adjustment following very severe closed head injury.

Examined the cognitive, psychological, and social functioning of 18 community-dwelling male patients who had experienced a severe closed head injury (CHI) at least 18 mo previously and still required contact with rehabilitation services. Results from Ss with CHI were compared with those from 27 normal control Ss. Information on Ss' behavior was also obtained from their significant others. Results show that Ss with CHI exhibited deficits in their cognitive and social functioning but showed no signs of emotional or psychiatric disturbance. Attempts to find a relationship between the cognitive impairment and social functioning of Ss with CHI were partially successful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Central executive aspects of attention in subacute severe and very severe closed head injury patients: Planning, inhibition, flexibility, and divided attention.

Central executive aspects of attention were investigated in a group of 20 closed head injury (CHI) patients with an average posttraumatic amnesia duration of 23.9 days, tested in the first half year after injury. Four aspects were distinguished: planning, inhibition, flexibility, and divided attention. Tasks allowed assessment of these with experimental or statistical control for the individual speed of information processing. This precaution appears necessary because slow information processing is a pervasive effect of CHI and may cause spurious effects on complex cognitive tasks under time pressure. Strong effects of CHI were shown on speed of information processing. Controlling this factor, central executive aspects of attention were normal, on average. A tentative analysis of the results in relation to severity indicated that less severely injured patients are better in this respect than controls, and more severely injured patients are worse. In comparison with the healthy control group, the performance of those with milder injuries appears to be characterized by greater cautiousness and increased mental effort. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral changes after closed head injury in children.

This study provides a longitudinal follow-up of the behavioral adjustment of 45 children with mild, moderate, and severe closed head injuries. Two measures of behavioral adjustment, the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales (VABS), were obtained from a parent at the time of injury and at 6 and 12 months postinjury. The severely injured children obtained significantly poorer VABS scores than children with mild and moderate injuries over the year-long follow-up. In addition, on the CBCL, severely injured children had more school problems and engaged in fewer social activities than mild and moderately injured children. These results show that severe head injury in children was associated with declines in adaptive functioning, whereas scores for children with mild and moderate injuries did not differ, nor did they deviate from average levels at any follow-up interval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of verbal learning after closed head injury.

Cluster analysis of the learning trials and delayed free-recall trials of 70 patients with closed head injury on the California Verbal Learning Test (CVLT) revealed 3 distinct patterns of memory performance. The clusters differed in the amount and rate of learning, retroactive interference, and the level of delayed recall. There was a significant positive relationship between performance on the CVLT and performance on concurrent measures of attention, semantic memory, and intellectual ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Imaging findings in diffuse axonal injury after closed head trauma

OBJECTIVE: We compared the activity and tolerance profile of a 0.05% retinaldehyde cream with a 0.05% retinoic acid cream and the retinaldehyde vehicle in patients with photodamaged skin of the face. METHODS: A silicone replica of the left crow's feet area was taken at baseline and at weeks 18 and 44. Skin replicas were then analyzed by means of an optical profilometry technique. Standard wrinkle and roughness features were then calculated and statistically analyzed. The tolerance profile of the test products was also clinically evaluated during the entire study. RESULTS: A total of 125 patients (40 in the retinoic acid group, 40 in the retinaldehyde group, and 45 in the vehicle group) were studied. At week 18, a significant reduction of the wrinkle and roughness features was observed with both retinaldehyde and retinoic acid. At week 44, a less pronounced reduction was demonstrated in both active groups. No statistically significant changes were observed with the retinaldehyde vehicle at any assessment point. A total of 135 patients constituted the safety population. Retinaldehyde was well tolerated during the entire study. In contrast, retinoic acid caused more local irritation, and affected compliance of the patients. CONCLUSION: Retinaldehyde was efficacious and well tolerated in patients with photodamage.     

Imaging of closed head injury

The endocrinology of late gestation and parturition in the mare has been described, but unlike other domestic animal species, the factors that initiate parturition in the mare have not been elucidated. In contrast to ruminant species, maternal estrogen and progesterone concentrations do not change markedly, and a well-defined fetal cortisol surge is not observed just prior to parturition in the mare. Parturition is associated with large increases in prostaglandin and oxytocin concentrations, which induce uterine contractions and delivery of the foal. There are many methods of inducing parturition in term mares, but the most popular and safest method is through the administration of low-dose oxytocin.     

Frontal lobe changes after severe diffuse closed head injury in children: a volumetric study of magnetic resonance imaging

In view of the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of < or = 8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). The patients ranged in age from 5 to 15 years at the time of their MRIs, which were acquired at least 3 months postinjury. MRI findings revealed no focal areas of abnormal signal in the frontal lobes. Volumetric analysis disclosed that the total prefrontal cerebrospinal fluid increased and the gray matter volume decreased in the patients with severe CHI, relative to the mildly injured comparison group. Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study.(ABSTRACT TRUNCATED AT 250 WORDS)     

Linguistic competence in paediatric closed head injury

The purpose of this investigation was to examine the effects of age at onset of traumatic brain injury on the linguistic competence of children and adolescents who sustained closed head injuries (CHI) that cause diffuse brain damage. The Test of Language Competence-Expanded Edition (TLC-E), a standardized test of subtle language abilities, was administered to 20 children who sustained severe CHI. The study determined whether 10 subjects who experienced CHI at a pre-adolescent age (4 to 11 years) and 10 subjects who experienced CHI at an adolescent age (13 to 18 years) showed quantitative differences in linguistic competence as measured by the TLC-E Test. The language abilities of children in both groups were compared to determine whether there were trends in performance relative to age of onset or type of subtest. In addition, experimental subjects' performance was compared to the normative population used to standardize the TLC-E. Hypotheses were constructed according to separate developmental and pathophysiological perspectives.     

Semantic priming after severe closed head trauma: Automatic and attentional processes.

The 2-process theory of semantic priming (J. H. Neely, 1977; M. I. Posner and C. R. Snyder, 1975) was used to determine the maintenance of automatic processes after severe closed head injury (CHI) and to determine whether processes that demand attention suffer a deficit. Ss with severe CHI (N?=?18,?>?2 yrs postinjury) and 18 matched control Ss completed a lexical decision task in which a category prime was followed by a target. Automatic and attentional priming were determined by orthogonally varying prime–target relatedness, expectancy, and stimulus onset asynchrony. Although the CHI Ss had slower reaction times (RTs) overall, there were no significant group differences in the magnitude of either the automatic or attentional component of semantic priming. The present results indicate the integrity of semantic processes and normal semantic priming in long-term patients with severe CHI. The results are discussed in relation to an attentional resource hypothesis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Event-related potentials as an index of cognitive function during recovery from severe closed head injury

OBJECTIVE: To evaluate the utility and neuropsychological correlates of serially performed recordings of event-related potentials (ERPs) in patients recovering from a severe closed head injury (CHI). DESIGN: Prospective longitudinal study. SETTING: Brain injury rehabilitation unit based in a national rehabilitation hospital. SUBJECTS: Sixteen patients with severe CHI (significant degree of impaired consciousness greater than 24 hours) subclassified into two severity groups according to initial Glasgow Coma Scale (GCS) score: those with initial GCS score < 9, consistent with a more severe injury; and those with initial GCS score > 8, indicating a less severe injury. METHODS: ERPs were elicited using the standard auditory P300 "oddball" detection paradigm. ERP recordings were carried out three times: 2 months after injury, 1 month later, and 2.5 months or more after the initial study. Parameters analyzed included latencies and amplitudes of the P3, N2, P2, and N1 components of the ERPs. Correlations between changes in these ERP parameters and specific neuropsychological test results were evaluated. RESULTS: Initial P3 latencies in the more severely injured group were significantly longer (P < .05) than those recorded in the less severely injured patients. In subsequent recordings, P3 latency was found to be significantly shorter compared with the initial P3 latency, and the difference in P3 latency between the two patient groups was no longer statistically significant by the time of the third recording. For the group as a whole, P3 latency decreased significantly on each repeated recording. N2 latency was found to be significantly shorter (P < .05) between the first and third recordings. Cognitive performance significantly improved between the first and third recordings. P3 latency shortening was correlated with improvement in neuropsychological test scores for short-term and long-term story recall and for word recall. N2 latency shortening was correlated with improvement in the neuropsychological test scores for word recall only. CONCLUSION: ERP recordings performed in the subacute stage after CHI may assist in evaluating injury severity. Moreover, serially performed recordings of P3 latency may be used as a physiologic index of brain activity that correlates with recovery from CHI.     

Actual versus self-reported scholastic achievement of litigating postconcussion and severe closed head injury claimants.

Psychologists typically rely on patients' self-report of premorbid status in litigated settings. The authors examined the fidelity between self-reported and actual scholastic performance in litigating head injury claimants. The data indicated late postconcussion syndrome (LPCS) and severe closed head injury litigants retrospectively inflated scholastic performance to a greater degree than nonlitigating control groups. The LPCS group showed the highest magnitude of grade inflation, but discrepancy scores did not significantly correlate with a battery of malingering measures or with objective cerebral dysfunction. These findings support previous studies, which showed self-report is not a reliable basis for estimation of preinjury cognitive status. Retrospective inflation may represent a response shift bias shaped by an adversarial context rather than a form of malingering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Naturalistic action impairment in closed head injury.

The authors sought to determine whether errors of action committed by patients with closed head injury (CHI) would conform to predictions derived from frontal lobe theories. In Study 1, 30 CHI patients and 18 normal controls performed routine activities, such as wrapping a present, under conditions of graded complexity. CHI patients committed more errors even on the simplest condition; but, except for a higher proportion of omitted actions, their error profile was very similar to that of controls. Study 2 involved a subset of patients whose performance in Study 1 was within normal limits. When these high functioning patients were asked to perform the routine tasks under still more taxing conditions, they, too, committed errors in excess of the control group. Accounts based on frontal mechanisms have a difficult time explaining the overall pattern of findings. An alternative based on limited-capacity resources is suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)