Bring it up in milieu: Toward effective traumatic brain injury rehabilitation interaction.

Reviews the emotional and motivational problems faced by the rehabilitation therapist dealing with traumatic brain injury (TBI) patients and describes a neuropsychologically oriented method to help rehabilitation team members improve their effectiveness in returning post-TBI patients to work. A clinical vignette describing the use of milieu therapy is presented. Topics that rehabilitation team members need to be taught about cognitive and personality problems of TBI patients are discussed, focusing on teaching staff to give feedback in milieu. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autonomic nervous system changes associated with a spider phobic reaction.

Tested the theory that autonomic nervous system arousal increases during a phobic reaction. 11 spider phobics and 11 nonphobics (female undergraduates) viewed spider, seascape, and surgical slides while several physiological responses were continuously recorded. Spider phobics showed significantly faster heart rate, greater heart-rate variability, and vasoconstriction during spider slide presentations than nonphobics. Spider phobics also showed more frequent phasic skin responses but not larger skin response amplitudes to spider slides. Respiration rate and respiration amplitude were not significantly different for the 2 groups. It appears that while a general autonomic nervous system arousal occurs during a spider-phobic reaction, the demand characteristics of the phobic situation seem to determine which physiological responses are most affected. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disturbances associated with traumatic brain injury.

Personality disturbances associated with traumatic brain injury are reviewed. The varied structural pathology of the brain in this patient group makes it difficult to specify how different brain lesions may result in specific emotional and motivational disturbances. However, an attempt to clarify terms and review empirical findings is made. Longitudinal prospective studies that utilize appropriate control groups are needed. Future research may especially benefit by considering the long-term effects of early agitation following traumatic brain injury as well as the problem of aspontaneity and impairment of self-awareness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Prigatano, Parsons, Wright, Levin, and Hawryluk.

Reports an error in the original article "Neuropsychological test performance in mildly hypoxemic patients with chronic obstructive pulmonary disease" by George P. Prigatano et al. (Journal of Consulting & Clinical Psychology, 1983[Feb.] Vol 51[1] 108-116). On page 116, the reference Rennick, P. M, should read as follows: Lewis, R. R., & Rennick, P. M. Manual for the Repeatable Cognitive-Perceptual- Motor Battery. Grosse Pointe Park, Mich.: Axon, 1979. (The following abstract of this article originally appeared in record 1983-13068-001) Previous research has demonstrated neuropsychological deficits in moderately to severely hypoxemic, chronic obstructive pulmonary disease (COPD) patients. The present article reports on the neuropsychological functioning of mildly hypoxemic COPD patients. 100 patients (mean age 61.5 yrs) and 25 controls (mean age 59.6 yrs) matched on relevant variables were given extensive neuropsychological tests including the WAIS, Wechsler Memory Scale, and Halstead-Reitan Neuropsychological Test Battery. Mild neuropsychological impairment was observed in the COPD Ss, with overall indexes of neuropsychological dysfunction correlating with resting partial pressure of oxygen. Depression and motivation to perform could not account for the results. Long-term reduced oxygen supply to the brain may account for these observed deficits. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methodological considerations in clinical neuropsychological research: 17 years later.

Research in clinical neuropsychology continues to flourish. Over the past 17 years, the field has embraced advances in structural and functional neuroimaging techniques, theoretical constructs, and statistical models in attempts to improve the quality and generalizability of its research efforts. With keen attention to methodological issues and careful consideration of broad hypotheses and underlying concepts, research in this field can continue to meet the needs of practicing clinicians and the rigorous requirements of scientific inquiry. (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.     

Methodological considerations in clinical neuropsychological research.

Discusses methodological problems and issues in clinical neuropsychological research for 4 types of neuropsychological studies: (a) differential diagnosis, (b) basic brain–behavior relationships, (c) effects of noxious agents or factors on brain–behavior relationships, and (d) rehabilitation of neuropsychological deficits. Five independent variables that may or may not affect such studies are discussed: age, education, sex, socioeconomic status, and experimenter or examiner characteristics. Recommendations for handling these methodological problems are made, and the characteristics of good case study reports are presented. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychological test performance in mildly hypoxemic patients with chronic obstructive pulmonary disease.

Previous research has demonstrated neuropsychological deficits in moderately to severely hypoxemic, chronic obstructive pulmonary disease (COPD) patients. The present article reports on the neuropsychological functioning of mildly hypoxemic COPD patients. 100 patients (mean age 61.5 yrs) and 25 controls (mean age 59.6 yrs) matched on relevant variables were given extensive neuropsychological tests including the WAIS, Wechsler Memory Scale, and Halstead-Reitan Neuropsychological Test Battery. Mild neuropsychological impairment was observed in the COPD Ss, with overall indexes of neuropsychological dysfunction correlating with resting partial pressure of oxygen. Depression and motivation to perform could not account for the results. Long-term reduced oxygen supply to the brain may account for these observed deficits. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speed of finger tapping and goal attainment after unilateral cerebral vascular accident

Forty children of 28 fathers who are Vietnam veterans with posttraumatic stress disorder (PTSD) completed the Minnesota Multiphasic Personality Inventory. Each of the fathers had at least one elevated clinical scale. Fathers averaged eight elevated clinical scales, and compared to more recent norms, fathers averaged seven elevated clinical scales. Seventy-eight percent of the children had at least one clinically elevated scale (averaging three elevated clinical scales). Compared to contemporary normal adolescents and adults, 65% of children had at least one clinically elevated scale (still averaging three elevated clinical scales). No consistent MMPI profile patterns emerged within or across the two groups. No gender differences were detected among child MMPI profiles. Forty percent of the children reported illegal drug use, and 35% reported behavior problems. Fifteen percent of children reported previous violent behavior. Eighty-three percent of the children reported elevated Cook-Medley hostility scores as compared to an age-matched national normative sample. Children with higher PK scores were also significantly more likely to report higher Cook-Medley hostility scores. Forty-five percent of children reported significant elevations on the PTSD/PK subscales.     

Diller lecture: Impaired awareness, finger tapping, and rehabilitation outcome after brain injury.

Speed of finger tapping after traumatic brain injury has been related to the problem of impaired self-awareness as well as to rehabilitation outcome. This article summarizes selected literature that documents the potentially rich information this "simple" task can provide. It supports Leonard Diller's emphasis on using developmentally sensitive tasks that allow for simple inferences to be applied to issues of diagnosis and rehabilitation after brain injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)