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)     

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)     

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.     

Visual selective attention after severe closed head injury

This study investigated the nature of selective attention deficits after severe closed head injury (CHI). Twenty participants with severe CHI (greater than 1 year postinjury) and 20 matched controls completed search and nonsearch visual selective attention tasks under conditions of low (Experiment 1) and high (Experiment 2) target-distractor similarity. In the search situations, participants searched visual displays that contained 1, 4, or 8 items for the targets. In the nonsearch situations, the location of the targets was visually cued with a peripheral arrow. The results revealed that in both the low and high target-distractor similarity search conditions. CHI participants required a longer time than controls to locate and identify the target. In contrast, in the nonsearch condition, CHI participants were able to successfully ignore irrelevant task information when target-distractor similarity was low. However, when target-distractor similarity was high, CHI participants had more difficulty than controls ignoring the irrelevant information. These results suggest that, in comparison to controls, CHI participants may be at a disadvantage in selective attention situations when visual search is required and when the discriminability between targets and distractors is difficult.     

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.     

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.     

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.     

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)     

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.     

Affective state and awareness of sensory and cognitive effects after closed head injury.

Found that emotional dysphoria was significantly and positively correlated with awareness of sensory and cognitive change in 42 Ss with closed head injury (CHI). Compared with their rehabilitation therapists, Ss tended to underestimate the sensory and cognitive effects of their injury, but agreement between Ss and therapists was highest for those sensory and cognitive functions that Ss could accurately define. S awareness of the sensory and cognitive effects of CHI may be formed from an interaction among at least 4 variables: the assessment measure used, the S's preinjury awareness, motivational influences (e.g., denial), and damage to the frontal lobes. (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)     

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)     

Major depression in patients with closed head injury.

Interviewed 120 patients with closed head injury (CHI) with regard to depressive symptoms at least 2 yrs after the date of injury. 92 Ss met Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for major depressive disorder. Half of the depressed CHI Ss did not manifest depressive symptoms until at least 6 mo after being injured. Bipolar affective disorder and schizophrenia were uncommon following CHI. CHI patients may be at increased risk for development of major depressive disorder. CHI patients should be screened for depressive symptoms after they appear to have made a "full" recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Use of elaborative encoding to facilitate verbal learning after adolescent traumatic brain injury

OBJECTIVE: To investigate the effectiveness of elaborative encoding in learning and remembering word definitions after traumatic brain injury (TBI). DESIGN: Two case studies. SETTING: University outpatient clinic. Participants: Two adolescents with severe memory impairments after TBI who needed specific vocabulary for school. INTERVENTIONS: A series of individual speech-language therapy sessions incorporating clinician- and subject-generated strategies to facilitate elaborative encoding. Target words were based on school requirements and pretreatment test results and were assigned randomly to treatment or control groups. MAIN OUTCOME MEASURE: Accuracy of free-recalled definitions at the conclusion of therapy and after 1 month with no therapy. RESULTS: Significant improvement in expressed word knowledge at the conclusion of therapy, with improvement on treated words maintained at 1 month for both subjects. CONCLUSIONS: Elaborative encoding was an effective tool for teaching specific information required for school. Patterns of response differed substantially from those of normally developing children. Generalization to classroom use was planned for and should be measured in future research.     

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)     

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.     

Contributions of neuroimaging to neuropsychological research on closed head injury.

Reviews the contributions of neuroimaging to research on neuropsychological outcome of closed head injury. Studies quantifying cerebral atrophy and investigations of focal brain lesions are discussed. Use of magnetic resonance imaging (MRI) to characterize the location, size, and depth of focal brain lesions is reviewed. The disparities between the findings of computerized tomography (CT) and MRI are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnosis and verbal learning.

Rigidly standardized hypnotic procedures were used in a double-blind experiment which examined the acquisition ability of Ss who differed in hypnotic susceptibility for the learning of both meaningful (poems) and meaningless (nonsense syllables) material when hypnotized and when unhypnotized. Regression analyses indicated that: (a) Differences in relative degree of hypnotic susceptibility among Ss did not influence the learning of nonsense syllables or poems; (b) S's degree of manifest anxiety and verbal intelligence did not contribute significantly to performance scores; and most important, (c) the application of hypnosis did not significantly influence performance on either nonsense syllables or poems when compared to performance in the unhypnotized treatment. (22 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety and verbal learning.

3 groups, differing in anxiety, learned 2 different types of paired-associate materials and then half of each anxiety group were tested under "immediate" and half under "delay" conditions of intertrial spacing. The first 2 groups were college students selected from extreme scorers on the Taylor Manifest Anxiety Scale and the third group was composed of hospitalized anxious patients. "Among the students, the high and low groups, tested under both delay and immediate conditions, showed no significant differences in their learning of the word-associate material. With the more novel and difficult false equations, however, the high anxiety Ss learned significantly less over all and showed a somewhat slower rate of learning from trial to trial. Among the patients, those tested under the delay condition performed about as well as the high-anxiety students, while those under the immediate condition learned a lesser amount both of the word and equation materials." 19 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)