George: Learning to live independently with NeuroPage?.

The authors report the case of George, a young man with very severe memory impairments after a head injury sustained in a road traffic accident several years earlier. George was one of 200 participants in a study evaluating NeuroPage?, an electronic memory aid. Like many other participants in the study, he responded well to NeuroPage? and was able to live independently with the new memory aid. Using an ABAB single-case experimental design, the authors show his response to the pager, describe his feelings about it, and consider reasons for its efficacy. It would appear that NeuroPage? is effective because it is easy for patients with brain injuries to use, the messages are relevant, the prompts appear at the time needed, and using a pager is prestigious. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The validity of the Katz Adjustment Scale among people with traumatic brain injury.

Deficits in self- and social awareness can impair adjustment following traumatic brain injury (TBI) and draw into question the accuracy of self-report measures of adjustment. This study evaluates the validity of Katz Adjustment Scale (KAS) factor components identified by R. J. Fabiano and D. A. Goran (1992). The KAS is an observer rating scale often used to assess the social adjustment of people with traumatic brain injury. The responses of 105 individuals with TBI to the Symptom Checklist 90—Revised (SCL-90–R; L. R. Derogatis, 1983), a self-report measure of distress, were correlated with observer ratings on the KAS. Results support the use of observer ratings and self-report to assess adjustment and social behavior following TBI. Each contributes valuable information that can guide treatment and enhance adaptive functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aging and adjustment after spinal cord injury: The roles of chronologic age, time since injury, and environmental change.

The purpose of this study was to identify relationships between aging and long-term adjustment after spinal cord injury (SCI). A time-sequential design was utilized to isolate the influence of three confounded factors related to aging: (1) chronologic age, (2) time since injury, and (3) time of measurement—environmental change. A total of 394 individuals from 2 distinct participant samples completed the Life Situation Questionnaire (LSQ). Sample 1 (n?=?193) completed the LSQ in 1985; Sample 2 (n?=?201) completed the LSQ in 1994. The multivariate analysis of covariance with univariate follow-up tests was used to identify time-lagged differences in adjustment between 1985 and 1994 (an environmental factor), while simultaneously analyzing the role of chronologic age and time since injury. As with previous studies, time since injury was positively correlated, and age was negatively correlated with multiple adjustment outcomes. However, in contrast to previous research, environmental change between 1985 and 1994 was associated with a deterioration in subjective well-being. The results of the study suggest that the way people adjust as they age with SCI is significantly influenced by the nature of changes in their environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients with traumatic brain injury referred to a rehabilitation and re-employment programme: social and professional outcome for 508 Finnish patients 5 or more years after injury

We studied influence of age and educational level before injury on the social and vocational outcome among a group of traumatic brain injury (TBI) patients with post-injury problems in their education and employment. Patients with TBI, followed up for at least 5 years, and who were admitted to a rehabilitation and re-employment programme, were selected for evaluation of long-term outcome. We used the Glasgow Coma Scale (GCS) scores at the time of emergency admission to the hospital to measure brain injury severity. Age at the time of TBI and educational status before TBI were correlated with the outcome measures at the end of follow-up separately in each category of brain injury severity. The study was carried out at the Kauniala outpatient neurological clinic, which specializes in brain injuries in Finland; it works closely with the Departments of Neurology and Neurosurgery at the Helsinki University Central Hospital. Main outcome measures were functional outcome measured by the Glasgow Outcome Scale (GOS), the educational level reached, and post-injury occupation, as well as the incapacity for work at the end of follow-up. In the severe category of brain injuries, children 7 years or younger at the time of injury suffered severe disability as measured by the GOS scores more often than did the older age groups (p = 0.010, chi 2). They were less often capable of independent employment (p = 0.011, chi 2) than the children injured at the age of 8-16. Patients with a higher education usually had a better outcome. In the category of mild brain injuries the majority of the patients, regardless of age, recovered well according to the GOS, and were capable of independent employment at the end of follow-up. Our patients were selected from the TBI population as survivors with problems in education and re-employment. Those with severe injury sustained early in life (childhood and early teens) coupled with poor educational attainment had relatively worse social and vocational outcome; better outcomes were enjoyed by those severely injured individuals whose injuries were sustained later (late teens or early adulthood). In the groups of patients with moderate and mild brain injuries such a relationship was not found between age or pre-injury education and outcome.     

Brain activation while thinking about the self from another person’s perspective after traumatic brain injury in adolescents.

Deficits in self awareness and taking the perspective of others are often observed following traumatic brain injury (TBI). Nine adolescents (ages 12–19 years) who had sustained moderate to severe TBI after an average interval of 2.6 years and nine typically developing (TD) adolescents underwent functional MRI (fMRI) while performing a perspective taking task (D’Argembeau et al., 2007). Participants made trait attributions either from their own perspective or from that of the significant other. The groups did not differ in reaction time or on a consistency criterion. When thinking of the self from a third-person perspective, adolescents with TBI demonstrated greater activation in posterior brain regions implicated in social cognition, the left lingual gyrus (BA 18) and posterior cingulate (BA 31), extending into neighboring regions not generally associated with social cognition, that is, cuneus (BA 31) and parahippocampal gyrus, relative to TD adolescents. We postulate that adolescents with moderate to severe TBI recruited alternative neural pathways during perspective-taking because traumatic axonal injury disrupted their fronto-parietal networks mediating social cognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual patient prediction of seizure lateralization in temporal lobe epilepsy: a comparison between neuropsychological memory measures and the Intracarotid Amobarbital Procedure

The factors associated with involvement in sport were surveyed in a sample of 121 adults (aged 16 to 60 years) with spinal cord injury. The subjects responded to a questionnaire requesting data on personal characteristics and injury variables, and completed measures of depression (Centre for Epidemiological Studies Depression Scale) and trait anxiety (Spielberger's State Trait Anxiety Inventory). Univariate analysis showed that although sport participants (n = 67) did not differ significantly from nonparticipants (n = 54) on any of the psychometric measures, they were younger, had sustained their injury at an earlier stage, reported higher incomes, and were less likely to have sustained cervical-level damage. A hierarchical discriminant function analysis revealed that the significant predictors discriminating sport participants from nonparticipants were age and income. These findings suggested that, at least for this sample of individuals with spinal cord injury, post-injury involvement in sport was not specifically associated with indices of psychological adjustment.     

Cognitive outcome in children and adolescents following severe traumatic brain injury: influence of psychosocial, psychiatric, and injury-related variables

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N = 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group who sustained an orthopedic injury. Standardized intellectual, memory, psychiatric, family functioning, family psychiatric history, neurological, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic injury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that showed significant (p < .05) bivariate correlations with the outcome measures yielded a neuropsychiatric factor encompassing severity of TBI indices and postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added significantly to severity indices and family functioning and family psychiatric history added significantly to socioeconomic status in explaining several specific cognitive outcomes. These results may help to define subgroups of children who will require more intensive services following their injuries.     

Social outcomes in childhood brain disorder: A heuristic integration of social neuroscience and developmental psychology.

The authors propose a heuristic model of the social outcomes of childhood brain disorder that draws on models and methods from both the emerging field of social cognitive neuroscience and the study of social competence in developmental psychology/psychopathology. The heuristic model characterizes the relationships between social adjustment, peer interactions and relationships, social problem solving and communication, social-affective and cognitive-executive processes, and their neural substrates. The model is illustrated by research on a specific form of childhood brain disorder, traumatic brain injury. The heuristic model may promote research regarding the neural and cognitive-affective substrates of children's social development. It also may engender more precise methods of measuring impairments and disabilities in children with brain disorder and suggest ways to promote their social adaptation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obituary: Daniel Katz (1903–1998).

Memorializes Daniel Katz, known for his work in the field of social psychology. He was among the earliest users of survey methods to study social psychological problems, and he improved the methods with which he worked. His early studies on racial stereotypes illuminated the nature and extent of prejudice, and his later cross-cultural research revealed the various forms of nationalism. His theoretical research on attitude formation and change linked methods of change to the different motivational bases of attitudes themselves. Finally, his sustained interest in formal organizations reflected his conviction that these massively influential factors in modern life were a necessary part of a comprehensive social psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of music therapy on mood and social interaction among individuals with acute traumatic brain injury and stroke.

Objective: To investigate the efficacy of music therapy techniques as an aid in improving mood and social interaction after traumatic brain injury or stroke. Design: Eighteen individuals with traumatic brain injury or stroke were assigned either standard rehabilitation alone or standard rehabilitation along with music therapy (3 treatments per week for up to 10 treatments). Measures: Pretreatment and posttreatment assessments of participant self-rating of mood, family ratings of mood and social interaction, and therapist rating of mood and participation in therapy. Results: There was a significant improvement in family members' assessment of participants' social interaction in the music therapy group relative to the control group. The staff rated participants in the music therapy group as more actively involved and cooperative in therapy than those in the control group. There was a trend suggesting that self-ratings and family ratings of mood showed greater improvement in the music group than in the control group. Conclusions: Results lend preliminary support to the efficacy of music therapy as a complementary therapy for social functioning and participation in rehabilitation with a trend toward improvement in mood during acute rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do neurocognitive ability and personality traits account for different aspects of psychosocial outcome after traumatic brain injury?

Objective: To examine the contributions of demographic, injury, cognitive, and personality characteristics to psychosocial outcome 8 years after traumatic brain injury (TBI). Design: Multiple regression analyses were used to estimate the variance explained by putative "predictors" of psychosocial outcome. Participants: Thirty-nine TBI survivors and 39 family member informants. On the basis of Glasgow Coma Scale scores and Accident Injury Severity (head) ratings, the patients' brain injuries ranged from mild to critical in severity. Main Outcome Measures: One self-report measure combined putative markers of social role engagement, such as marital status and earned income. Another, based on informant ratings using the Katz Adjustment Scale, was conceptualized as reflecting behavioral adjustment. Results: Whereas cognitive functioning explained significant unique variation in social role engagement, it did not account for variance in behavioral adjustment. Conversely, whereas 3 personality trait ratings explained significant incremental variance in behavioral stability, only 1 did the same with respect to social role engagement. Conclusions: Social role engagement and behavioral adjustment appear to represent 2 related but distinguishable aspects of TBI outcome that are associated with different patient characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic gas-containing brain abscess caused by Clostridium perfringens with unique simultaneous fungal suppuration by Myceliophthora thermophila: case report

OBJECTIVE AND IMPORTANCE: Gas-containing brain abscesses are rare, and the vast majority are caused by Clostridium perfringens. Significant simultaneous fungal infection in a bacterial abscess is even rarer. We present such a case and review the literature. CLINICAL PRESENTATION: A 21-month-old male patient sustained a penetrating head injury in a barnyard, developed a gas-containing left parietal brain abscess, and presented with high fever, galeal swelling, and seizure. INTERVENTION: The patient initially underwent debridement of his wound and then repeated aspirations. The initial cultures revealed pure growth of Clostridium perfringens. Despite appropriate antibiotic therapy, serial neuroimaging did not demonstrate a decrease in the size of the cavity. An excision had to be undertaken 6 weeks after the injury. The culture from the excised specimen revealed an unexpected growth of a saprophytic and opportunistic fungus, Myceliophthora thermophila. Antifungal treatment consisting of the administration of liposomal amphotericin B and itraconazole was then performed. The child was well and neurologically intact 6 months after the excision. CONCLUSION: Our review revealed 38 cases of clostridial brain abscess in the literature. Despite the reputation of the organism, the outcome with clostridial brain abscesses was relatively benign. The main characteristics of clostridial brain abscesses are highlighted, with reference to their optimal treatment. Our review also revealed that fungal infection after a penetrating head injury is extremely rare and often fatal. Our case seems to be the first in the medical literature with growth of M. thermophila as a causative agent for intracranial suppuration.     

Rehabilitation and outcome of right-hemisphere stroke patients: Challenges to traditional diagnostic and treatment methods.

Examined 3 case studies involving right-hemisphere brain injury in terms of vocational, behavioral, and social outcomes following the rehabilitation process. Results indicate that standard neuropsychological tests and other measures of cognitive and speech and language function tend to underestimate the impact of right-hemisphere syndrome on a patient's judgment and social skills, relationship to the family system, ability to perform functional living activities, and ultimate ability to return to productive work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Initial disturbances of consciousness and resultant impaired awareness in Spanish patients with traumatic brain injury

The purpose of this prospective, between-subjects study was to look at impaired awareness cross-culturally in patients with traumatic brain injury (TBI) and to relate impaired awareness after injury to the initial estimates of disturbed consciousness at time of injury. The study was conducted in community and inpatient and outpatient rehabilitation centers in Barcelona and Madrid. Participants were 30 persons with primarily moderate to severe TBI who could complete a written questionnaire concerning their functioning and 28 age- and gender-matched controls. A Spanish translation of the Patient Competency Rating Scale (PCRS) was administered to each participant. Relatives or significant others also completed this scale on each participant using the relative's version (PCRS-R). Difference scores, obtained by subtracting PCRS-R from PCRS-P (PCRS-P minus PCRS-R), were used as a marker of impaired awareness. Individuals with TBI were rated (by self and significant others) as being less competent than controls. Forty percent of Spanish patients with TBI who suffered severe injuries tended to overestimate their behavioral competencies. The PCRS-P minus the PCRS-R difference scores tended to correlate with admitting Glasgow Coma Scale (GCS) scores and retrospective estimates of posttraumatic amnesia (PTA). Initial disturbances of consciousness, one measure of severity of brain injury, appeared to relate to later measures of impaired self-awareness in Spanish patients with TBI. Non-brain-injured controls did not tend to report levels of competency that differed from their relatives' reports.     

Clinical utility of the Category Test as a multidimensional instrument.

The construct and criterion validities of the Category Test (CT) were evaluated in 162 participants who had sustained traumatic brain injury and had been screened carefully for confounding factors. Maximum likelihood factor analysis identified 2 latent constructs, consistent with previous research. However, only subtests associated with the Proportional Reasoning factor (Subtests V and VI) demonstrated consistent criterion validity in terms of sensitivity to injury severity. Performance of Subtest III, associated with the Spatial Positioning factor, was in the range of chance for more than a third of the sample, without any relationship to injury variables. It was concluded that the CT has construct validity as a multidimensional instrument but that only the Proportional Reasoning factor has criterion validity in the evaluation of sequelae of traumatic brain injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Qualitative analysis of the peer-mentoring relationship among individuals with spinal cord injury.

Objectives: To identify salient dimensions and outcomes of the peer-mentoring relationship among individuals with spinal cord injury (SCI). To understand from the perspective of the mentee how the mentoring relationship differs from other supportive relationships. Study Design: Qualitative. Participants: Convenience sample of 7 mentees from a hospital-based SCI peer-mentoring project. Method: Telephone interviews with mentees were conducted 1-4 months postdischarge, and results were coanalyzed with grounded theory methodology. Results: Mentees emphasized the impact of the mentor in terms of his or her practical, emotional, and identity-changing influence. Relationship quality was influenced by multiple factors (e.g., age, friendliness). Five components of the relationship (credibility, equitability, mutuality, acceptance, normalization) differentiated mentoring from other supportive relationships. Conclusions: Peer mentors provide a unique combination of supportive elements not replicated by other relationships. Mentoring programs are useful interventions for facilitating adjustment after SCI. Recommendations for implementing a mentoring program are provided on the basis of participant suggestions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multimodal behavior therapy: Use of professional and paraprofessional resources.

Presents a case study of an 18-yr-old obsessive, phobic male who was socially isolated and depressed. Some of the interventions were conducted by the professional therapist in his office, while the paraprofessional worked in the client's social environment using participant modeling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-Enhancement Among High-Exposure Survivors of the September 11th Terrorist Attack: Resilience or Social Maladjustment?

The authors examined self-enhancing bias as a predictor of adjustment among individuals in or near the World Trade Center during the September 11, 2001, terrorist attacks. Resilience was defined from categorical and continuous analyses of both participant self-report and friend and relative ratings of adjustment. Self-enhancement was associated with a resilient outcome, ratings of better adjustment prior to September 11th, greater positive affect, and reduced perceptions of social constraints. Additional analyses indicated that self-enhancers' reduced symptom levels were fully mediated by their low perceived social constraints. However, consistent with previous evidence suggesting a social cost to self-enhancement, at 18 months post-September 11th, self-enhancers' friends and relatives also rated them as decreasing in social adjustment and as being less honest. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of traumatic brain injury for survivors of sexual abuse: A preliminary report of findings.

The authors' purpose for presenting these cases is to report on some clinical observations that may have relevance for a subgroup of individuals recovering from a traumatic brain injury. Specifically, the authors observe that a group of patients who reported histories of childhood sexual trauma and then sustained a TBI as adults are experiencing a reemergence of intrusive recollections and other symptoms related to the abuse. Further, the appearance of these posttraumatic stress-type symptoms—sometimes after years of nonoccurrence—frequently proves disruptive to the patient's rehabilitation process. Possible structural, chemical, and phenomenological factors are discussed. The authors' observations raise the possibility that individuals who have made the best recoveries from childhood sexual trauma are the most vulnerable to the reemergence of posttraumatic stress disorder symptoms subsequent to the TBI. These provisory observations would suggest that sensitive inquiry regarding abuse history should be considered as part of any clinical interview with patients who have sustained neurological trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)