NeuroRehabilitation - Volume 32, issue 4

Authors: Wood, Rodger Ll.

Article Type: Editorial

DOI: 10.3233/NRE-130894

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 697-698, 2013

Authors: Wood, Rodger Ll.

Article Type: Research Article

Abstract: Background: Neurobehavioural disability often leads to serious social handicap. Many individuals never recover full social independence and will remain largely dependent upon family support, imposing a significant and potentially life-long psychological burden on those who care for injured relatives. Close relationships are at risk and many partnerships break down, increasing the risk of social isolation and subsequent psychological distress to the survivor. Objectives: The aim of this paper is to examine the nature of some cardinal features of neurobehavioural disability that contribute to poor psychosocial outcome; consider their organic origins, and problems associated with standardised methods of assessment. …Methods: A review of clinical literature addressing neurobehavioural disability after TBI. Results: Many forms of neurobehavioural disability are subtle but have a pervasive impact on psychosocial outcome in general and relationships in particular. Conclusions: Caution is recommended when employing standardised tests to identify the complex and often subtle nature of neurobehavioural disorders. More work is needed to define the nature and impact of different forms of neurobehavioural disorders that comprise this complex form of disability. Show more

Keywords: Neurobehavioural, disability, traumatic brain injury, assessment

DOI: 10.3233/NRE-130895

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 699-706, 2013

Authors: Bigler, Erin D. | Yeates, Keith Owen | Dennis, Maureen | Gerhardt, Cynthia A. | Rubin, Kenneth H. | Stancin, Terry | Taylor, H. Gerry | Vannatta, Kathryn

Article Type: Research Article

Abstract: Background: Neuroimaging studies identified either focal and/or non-specific frontotemporolimbic damage resulting from mild-complicated to severe traumatic brain injury (TBI) in a subset of 12 children 8–12 years of age who were part of the Social Outcomes of Brain Injury in Kids (SOBIK) study. The influence of identifiable damage on social behavior was examined. Methods: Magnetic resonance imaging was obtained on average 2.5 years post injury wherein cases with distinct abnormalities were selected. Various direct, performance-based measures of cognitive-social-emotional functioning were obtained along with data regarding peer relations and friendships in the classroom. Results: Overall, children …with TBI were impaired on tasks of social-emotional processing compared to children with orthopedic injury (OI). Ten of the 12 children with TBI had multiple areas of impaired social-emotional functioning in comparison to OI controls. With regards to friendships, four of the nine children with TBI who had classroom data had no mutual friends, four also received low peer acceptance ratings, and two were perceived by peers as having high levels of rejection/victimization in the classroom. Conclusions: Children with frontotemporolimbic or diffuse damage demonstrated variable social outcomes from their TBI. Results are discussed in terms of the heterogeneity of TBI-related abnormalities and their relationship to social behavior. Show more

Keywords: Traumatic brain injury, social brain, neuroimaging, theory of mind, frontotemporolimbic damage

DOI: 10.3233/NRE-130896

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 707-720, 2013

Authors: Krpan, Katherine M. | Anderson, Nicole D. | Stuss, Donald T.

Article Type: Research Article

Abstract: Background: Coping has been suggested as the final common pathway related to outcome after traumatic brain injury (TBI). Different types of coping have been related to either positive or negative psychosocial outcomes. As a result, a small set of studies have attempted to remediate coping through intervention, but the effectiveness of these studies has been modest. Conclusion: We propose that three primary factors are limiting our ability to effectively remediate coping following TBI through intervention TBI: 1) limited understanding of inter-patient variability following TBI; 2) limited understanding of the mechanisms underlying coping following TBI; and 3) reliance …on self-report measures of coping. We discuss these obstacles in the context of a model of frontal lobe function, and in light of recent behavioural work on coping. Show more

Keywords: Traumatic brain injury, coping, rehabilitation, inter-patient variability, mechanisms

DOI: 10.3233/NRE-130897

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 721-728, 2013

Authors: Tate, Robyn L. | Godbee, Kali | Sigmundsdottir, Linda

Article Type: Review Article

Abstract: Background and aims: Good assessment is an essential component of effective patient management. Yet the sheer volume of available assessment instruments presents a barrier for the clinician or researcher to (a) be knowledgeable about suitable measures and (b) keep up-to-date with new measures that are published. In order to create a resource of currently-used measures, we conducted a systematic review of assessment tools used in the research literature on traumatic brain injury (TBI). Methods: We used two electronic databases (Medline and PsycINFO) to identify full-length, English-language articles published between 2000 and 2012 in which outcome in adults with …TBI was assessed with behavioural tests or questionnaires. Results: The searches yielded 5,735 articles and after deletion of duplicates (n = 1,383) and articles not meeting selection criteria (n = 1,759), 2,593 articles were further examined. The articles contained 910 behavioural instruments, with a final set of 728 unique instruments. Each instrument was classified against the International Classification of Functioning, Disability and Health (ICF). Half of the instruments (n = 370, 50.8%) evaluated the mental functions domain of the ICF body functions component, with a substantially smaller proportion (n = 64, 8.8%) examining specific motor-sensory and other body functions. Instruments also covered domains of activities/participation (n = 109, 15.0%), environmental factors (n = 22, 3.0%) and personal factors (n = 36, 4.9%). A substantial number of scales (n = 93, 12.8%) were multidimensional across the body function domains (n = 32), as well as the functioning and disability part of the ICF (n = 60). The remaining 5% of instruments addressed concepts not covered by the ICF, including quality of life (n = 19, 2.6%) and rehabilitation process tools (such as therapeutic alliance). The 728 instruments were listed and more than 70 of the most common, spread across 20 domains, were highlighted. Conclusion: These data provide a comprehensive and up-to-date resource that gives the researcher or clinician a very large selection of assessment instruments covering the major areas of function pertinent to TBI. Show more

Keywords: Traumatic brain injury, cognition disorders, ICF, International Classification of Functioning, Disability and Health, neurobehavioral functioning, measurement, questionnaires, tests

DOI: 10.3233/NRE-130898

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 729-750, 2013

Authors: Prigatano, George P.

Article Type: Review Article

Abstract: Background: Holistic approaches to neuropsychological rehabilitation have progressively been recognized as an important form of rehabilitative care for persons who have a history of moderate to severe traumatic brain injury. OBJECTIVE: After providing historical and contemporary perspectives, identify challenges and opportunities facing the field of neuropsychological rehabilitation. Methods: Selective literature review from neuropsychological rehabilitation, neurosciences, learning theory, cognitive neuropsychology, and psychotherapy that highlight challenges to the development of holistic neuropsychological rehabilitation. Results: Ten challenges and associated opportunities that face the field of holistic neuropsychological rehabilitation are identified. Illustrations of these challenges and opportunities are provided. …Conclusions: Effectively addressing the challenges that face holistic neuropsychological rehabilitation will result in greater advances for this field of care for both children and adults. Show more

Keywords: Neuropsychological rehabilitation, holistic approaches, traumatic brain injury, adults, children, challenges and opportunities

DOI: 10.3233/NRE-130899

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 751-759, 2013

Authors: Alderman, Nick | Wood, Rodger Ll.

Article Type: Review Article

Abstract: Background: Neurobehavioural disability (NBD) following acquired brain injury undermines capacity for independent social behaviour and results in serious long-term social handicap. The presence of challenging behaviour as a feature of NBD has obvious implications for rehabilitation and community reintegration. Objectives: Behavioural approaches are seen by many as fundamental to the successful rehabilitation of challenging behaviour. This paper will a) define the nature of neurobehavioural rehabilitation; b) explore the characteristics of cases referred, and c) the outcomes achieved. Strengths, limitations and future developments of neurobehavioural approaches for challenging behaviour will be considered along with potential factors that limit generalisation …and longevity of treatment gains. Methods: Literature review. Results: Neurobehavioural services are distinguishable from other forms of neurorehabilitation. There is considerable evidence supporting the central role of both positive behaviour supports and contingency management approaches in creating conditions that minimise neurocognitive impairment, facilitate new learning, and ensure a positive social climate in both specialised inpatient units and community settings. Possible limitations include over-reliance on evidence from successful accounts of single cases and lack of knowledge regarding generalisation. Conclusions: Neurobehavioural rehabilitation is effective and can save care costs in the long term. More evidence regarding maintenance of gains is required. Show more

Keywords: Challenging behaviour, aggression, operant learning theory, rehabilitation

DOI: 10.3233/NRE-130900

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 761-770, 2013

Authors: Ruff, Ronald

Article Type: Research Article

Abstract: Background: When traditional psychotherapy is provided to patients with traumatic brain injuries (TBIs), the primary focus is on treating mood changes such as depression, anxiety or anger. However, traditional psychotherapeutic methods developed specifically for mood changes fall short when treating most TBI patients. In large part, this is because the psychological adjustment difficulties that most TBI patients face are linked to life-altering changes that are interwoven with permanent physical, cognitive, and social sequelae. In addition, mood changes in TBI patients are also caused by vocational and financial losses. Objective: The sudden onset of these unfamiliar and interdependent problems …necessitates a psychotherapeutic approach that acknowledges the inherent challenges of coping with multiple life-altering changes. For patients who experience a shattered sense of self, interventions need to be explored to make life meaningful following a TBI. Methods: An existentially-oriented approach is introduced in the following steps: (1) identifying pre-injury future expectations, (2) examining how the TBI has altered these expectations, (3) grieving the loss of the expected future, and (4) developing a realistic future that is existentially meaningful. Results: Pivotal gains are achieved when patients rebuild their lives according to their own core values. Conclusion: TBI patients can benefit from existential psychotherapy. Show more

Keywords: Psychotherapy, emotional problems, traumatic brain injury, acquired brain damage, existential approach

DOI: 10.3233/NRE-130901

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 771-779, 2013

Authors: Oddy, Michael | da Silva Ramos, Sara

Article Type: Research Article

Abstract: Background: The long term support of people with neurobehavioural disorders following a severe traumatic brain injury (TBI) can amount to a lifetime cost of several million dollars. Such costs are often obtained from personal injury compensation. However, those not eligible for such awards often depend on their families to provide support and care at no direct financial cost, but with indirect financial and human costs in terms of loss of productivity, and increased stress and health problems. Objectives: The aim of this paper is to examine the role of support workers in the long-term care of those with …neurobehavioural deficits following severe TBI and to discuss the feasibility of meeting some aspects of their role with technological solutions. Methods: This critical review uses observational and cost-analysis methodologies to establish the roles and costs associated with staff supporting people with neurobehavioural disorders resulting from severe TBI. Results: The role of support workers is varied and includes prompting to initiate and guide simple or complex activities, promoting social behaviour and managing emotional reactions. Some of these roles can be fulfilled by existing technology. Conclusions: Cost effective care of those with long-term neurobehavioural disorders can be provided by a combination of human support and existing technology. Show more

Keywords: Traumatic brain injury, neurobehavioural disorder, community based rehabilitation, cost-effectiveness, technology, review

DOI: 10.3233/NRE-130902

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 781-790, 2013

Authors: McMillan, T.M.

Article Type: Research Article

Abstract: Background: The evidence base on neurobehavioural disorders and their rehabilitation has been growing for four decades. Over that time understanding of the need for effective interventions for a range of handicaps in personal, interpersonal and employment spheres has developed. There is a continuing need to demonstrate whether interventions, are effective and cost-sensitive. Moreover, in pursuing effectiveness, clinicians need to be able to predict which individuals are likely to benefit from a programme and here, clinical experience needs to be informed by research evidence. Objective: To review the outcome of rehabilitation for neurobehavioural disorders. Methods: This review …initially considers the background to neurobehavioural rehabilitation and discusses methodological issues. It reviews the evidence for neurobehavioural interventions for severe head injury with emphasis on holistic models of care, behavioural treatments, interventions in non-specialist settings and for emotion perception and self-awareness. Results: In general, there is a need for further high quality studies with longer follow-ups and evidence for generalisation in the community. However, there is a growing consensus that intensive holistic rehabilitation programmes can improve community reintegration and self-efficacy. For behaviour disturbance the evidence base largely comprises studies with weaker (single group or single case) designs. Overall studies here provide limited evidence in support of behavioural approaches for externalised behaviour such as aggression. Further RCT or group comparison studies are needed. In terms of negative behaviours such as apathy, there are few studies on head injury and conclusions cannot be made with confidence. Self awareness is a key issue associated with good outcome in general and research to date supports use of interventions that focus in on-task behaviour and education. The correct perception of emotions in others is a precursor to successful social interaction, and here there is very little evidence although early studies are encouraging. Conclusion: There is mounting evidence to support the effectiveness of non-pharmacological interventions for neurobehavioural disorders. Successful outcomes are often associated with intensive and prolonged interventions involving multidisciplinary working. Show more

Keywords: Neurorehabilitation, neurobehavioural, holistic rehabilitation, traumatic brain injury

DOI: 10.3233/NRE-130903

Citation: NeuroRehabilitation, vol. 32, no. 4, pp. 791-801, 2013