NeuroRehabilitation - Volume 17, issue 4

Authors: McAllister, Thomas W.

Article Type: Introduction

DOI: 10.3233/NRE-2002-17401

Citation: NeuroRehabilitation, vol. 17, no. 4, pp. 263-264, 2002

Authors: McAllister, Thomas W. | Arciniegas, David

Article Type: Research Article

Abstract: Postconcussive symptoms such as headache, dizziness, irritability, and difficulties with memory and attention are reported frequently after traumatic brain injuries (TBI) of all severities. The etiology of these symptoms in individuals with mild TBI has been a subject of some controversy with theories ranging from neural damage to malingering. Furthermore, although the term postconcussive syndrome is commonly used clinically and in the scientific literature, it is not clear that postconcussive symptoms constitute a syndrome per se. Instead, it may be the case that the various symptoms that commonly co-occur after TBI are relatively independent consequences of a single neurological …event. In other words, because the locations and severity of injury vary between individuals despite ostensibly similar injuries, it follows that there should be variations in symptom type and severity between individuals as well. This article reviews the sequelae and natural course of recovery from mild TBI, the evidence regarding both persistent postconcussive symptoms and the postconcussive syndrome, and outlines an approach to the assessment and treatment of individuals with these symptoms after TBI. Show more

Keywords: postconcussion syndrome, mild traumatic brain injury, postconcussive symptoms

DOI: 10.3233/NRE-2002-17402

Citation: NeuroRehabilitation, vol. 17, no. 4, pp. 265-283, 2002

Authors: Flashman, Laura A. | McAllister, Thomas W.

Article Type: Research Article

Abstract: Research suggests that up to 45% severe TBI demonstrate reduced awareness or complete lack of awareness of their deficits. We describe dimensions and distinctions within the concept of lack of awareness – including whether an individual has knowledge of a specific deficit, the emotional response an individual manifests to a specific deficit, the ability to comprehend the impact or consequences of the deficit on day to day life, and how an individual explains or accounts for any deficits – and various methods of assessing for lack of awareness in this population. Finally, a review of the literature studying lack of …awareness in TBI, its relationship to injury severity, the impact of lack of awareness on outcome, and intervention approaches is presented. Show more

Keywords: unawareness, lack of insight, traumatic brain injury, frontal-parietal circuitry

DOI: 10.3233/NRE-2002-17403

Citation: NeuroRehabilitation, vol. 17, no. 4, pp. 285-296, 2002

Authors: Kim, Edward

Article Type: Research Article

Abstract: Traumatic brain injury (TBI) is frequently complicated by disinhibition and aggression. These often profound changes in personality, present obstacles to rehabilitative treatments and community reentry. Syndromal presentations may involve a loss of impulse control, spontaneous aggression, and dysphoric bipolar states. Common neuropathological findings of inferior frontal lobe dysfunction support both disinhibition and kindling models of TBI-induced aggression. Assessment of these highly disruptive symptoms requires detailed historical, clinical, and neuropsychological information to formulate appropriate strategies. Management of TBI-related aggression may involve pharmacological, environmental, and psychotherapeutic strategies that incorporate caregiver training and support.

Keywords: brain injury, aggression, agitation, behavior

DOI: 10.3233/NRE-2002-17404

Citation: NeuroRehabilitation, vol. 17, no. 4, pp. 297-310, 2002

Authors: Jorge, Ricardo | Robinson, Robert G.

Article Type: Research Article

DOI: 10.3233/NRE-2002-17405

Citation: NeuroRehabilitation, vol. 17, no. 4, pp. 311-324, 2002

Authors: Kant, Ravi | Smith-Seemiller, Laura

Article Type: Research Article

Keywords: apathy, head injury, motivation, brain injury

DOI: 10.3233/NRE-2002-17406

Citation: NeuroRehabilitation, vol. 17, no. 4, pp. 325-331, 2002

Authors: McDonald, Brenna C. | Flashman, Laura A. | Saykin, Andrew J.

Article Type: Research Article

Abstract: Executive dysfunction is among the most common and disabling aspects of cognitive impairment following traumatic brain injury (TBI), and may include deficits in reasoning, planning, concept formation, mental flexibility, aspects of attention and awareness, and purposeful behavior. These impairments are generally attributed to frontal systems dysfunction, due either to direct insult to the frontal lobes or to disruption of their connections to other brain regions. Evaluation of executive deficits typically includes neuropsychological assessment, though adjunctive interviews can be critical in detecting subtle dysexecutive symptoms that may not be apparent on standardized testing. Rehabilitation programs emphasizing cognitive-behavioral approaches to the …retraining of planning and problem-solving skills can be effective in ameliorating identified executive deficits. In addition, pharmacological approaches may be useful in addressing aspects of executive dysfunction. This review summarizes the nature of executive deficits following TBI, their neuroanatomical substrates, selected assessment and treatment strategies, and recent research findings and trends. Show more

Keywords: executive functions, traumatic brain injury, TBI, assessment, treatment

DOI: 10.3233/NRE-2002-17407

Citation: NeuroRehabilitation, vol. 17, no. 4, pp. 333-344, 2002

Authors: Hiott, D. Walter | Labbate, Lawrence

Article Type: Research Article

Abstract: Anxiety disorders are common in the general population and may be even more common in people with traumatic brain injuries. This article presents a review of the literature on anxiety disorders as a result of traumatic brain injury, specifically post-traumatic stress disorder, generalized anxiety disorder, obsessive compulsive disorder, and panic disorder. Our current understanding suggests that the increased frequency of anxiety disorders after TBI may reflect an overlap between brain regions vulnerable to traumatic brain injury, and the neural circuitry of these disorders. Issues regarding treatment are largely anecdotal, and much remains unsettled. More research is needed, both in terms …of diagnosis and treatment. Show more

Keywords: traumatic brain injury, obsessive compulsive disorder, posttraumatic stress disorder, panic disorder, generalized anxiety disorder

DOI: 10.3233/NRE-2002-17408

Citation: NeuroRehabilitation, vol. 17, no. 4, pp. 345-355, 2002

Authors: McAllister, Thomas W. | Ferrell, Richard B.

Article Type: Research Article

Abstract: A review of research studies to date suggests that psychosis is a relatively rare, but serious, complication of traumatic brain injury (TBI). Psychotic syndromes occur more frequently in individuals who have had a TBI than in the general population. Onset of symptoms can be early or late. Psychosis can occur during the period of post-traumatic amnesia, in association with post-traumatic epilepsy, in association with TBI-related mood disorders, and as a chronic, schizophrenia-like syndrome. TBI can interact with genetic vulnerability to increase the risk of developing illnesses such as schizophrenia. Thorough diagnostic assessment is the foundation of rational and effective …pharmacotherapy for psychosis after TBI. Atypical antipsychotic drugs have emerged as first line drugs for treatment of psychotic disorders from all causes, including TBI. Anticonvulsant, antidepressant or other drugs may also be needed in some cases. Medication approaches must be adjusted for the particular characteristics and vulnerabilities of the patient with a TBI. Show more

DOI: 10.3233/NRE-2002-17409

Citation: NeuroRehabilitation, vol. 17, no. 4, pp. 357-368, 2002