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Fedele B, Williams G, McKenzie D, Giles R, McKay A, Olver J. Sleep Disturbance During Post-Traumatic Amnesia and Early Recovery After Traumatic Brain Injury. J Neurotrauma 2024; 41:e1961-e1975. [PMID: 38553904 DOI: 10.1089/neu.2023.0656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
After moderate to severe traumatic brain injury (TBI), sleep disturbance commonly emerges during the confused post-traumatic amnesia (PTA) recovery stage. However, the evaluation of early sleep disturbance during PTA, its recovery trajectory, and influencing factors is limited. This study aimed to evaluate sleep outcomes in patients experiencing PTA using ambulatory gold-standard polysomnography (PSG) overnight and salivary endogenous melatonin (a hormone that influences the sleep-wake cycle) assessment at two time-points. The relationships between PSG-derived sleep-wake parameters and PTA symptoms (i.e., agitation and cognitive disturbance) were also evaluated. In a patient subset, PSG was repeated after PTA had resolved to assess the trajectory of sleep disturbance. Participants with PTA were recruited from Epworth HealthCare's inpatient TBI Rehabilitation Unit. Trained nurses administered overnight PSG at the patient bedside using the Compumedics Somté portable PSG device (Compumedics, Ltd., Australia). Two weeks after PTA had resolved, PSG was repeated. On a separate evening, two saliva specimens were collected (at 24:00 and 06:00) for melatonin testing. Results of routine daily hospital measures (i.e., Agitated Behavior Scale and Westmead PTA Scale) were also collected. Twenty-nine patients were monitored with PSG (mean: 41.6 days post-TBI; standard deviation [SD]: 28.3). Patients' mean sleep duration was reduced (5.6 h, SD: 1.2), and was fragmented with frequent awakenings (mean: 27.7, SD: 15.0). Deep, slow-wave restorative sleep was reduced, or completely absent (37.9% of patients). The use of PSG did not appear to exacerbate patient agitation or cognitive disturbance. Mean melatonin levels at both time-points were commonly outside of normal reference ranges. After PTA resolved, patients (n = 11) displayed significantly longer mean sleep time (5.3 h [PTA]; 6.5 h [out of PTA], difference between means: 1.2, p = 0.005). However, disturbances to other sleep-wake parameters (e.g., increased awakenings, wake time, and sleep latency) persisted after PTA resolved. This is the first study to evaluate sleep disturbance in a cohort of patients as they progressed through the early TBI recovery phases. There is a clear need for tailored assessment of sleep disturbance during PTA, which currently does not form part of routine hospital assessment, to suggest new treatment paradigms, enhance patient recovery, and reduce its long-term impacts.
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Affiliation(s)
- Bianca Fedele
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Gavin Williams
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Dean McKenzie
- Research Development and Governance Unit, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert Giles
- Sleep Unit, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
| | - Adam McKay
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - John Olver
- Department of Rehabilitation, Department of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
- Department of Rehabilitation, Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
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Mitchell G, Taylor J, Jin G, Snelling R. A review of minor traumatic brain injury presentations and their management in Brisbane emergency departments. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211006551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective A retrospective audit of minor traumatic brain injury presentations to three Brisbane emergency departments aiming to assess rates of CT scans and compliance with the Canadian CT Head Rule (CCTHR), as well as reviewing the demographics of patients and their management. Method Minor traumatic brain injury presentations to the Emergency departments of the Royal Brisbane and Women’s Hospital, Redcliffe Hospital and Queen Elizabeth II Hospital between July 1st and August 30th, 2019 were identified via diagnosis searches in patient tracking systems. Data collected included patient demographics, use of CT scans and Abbreviated Westmead Post Traumatic Amnesia Scale assessment, length of stay and discharge advice regarding return to sport. Results 200 minor traumatic brain injury presentations were included. 75% of patients received a CT head with only 9% of these found to be non-compliant with the CCTHR. The most common indications for CTs were age >65, GCS <15 at 2 hours post injury and anticoagulation. Only 40% of patients that qualified for A-WTPAS received the assessment. 18% of presentations were due to sporting injuries and 69% were not given return to play advice. The average length of stay was 250 minutes with 41.5% of presentations longer than 4 hours. 99% of the patients were discharged home from the ED with 1% admitted. Conclusion The study characterised minor traumatic brain injury management across three emergency departments and showed that most patients received CT head scans that were indicated. However, other areas of management such as A-WPTAs and return to play advice must be improved.
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Affiliation(s)
- Gary Mitchell
- Royal Brisbane and Women's Hospital Emergency and Trauma Centre, Herston QLD, Australia
| | - Jack Taylor
- Royal Brisbane and Women's Hospital Emergency and Trauma Centre, Herston QLD, Australia
| | - Gilbert Jin
- Redcliffe Hospital Emergency Department, Redcliffe QLD, Australia
| | - Rahul Snelling
- Royal Brisbane and Women's Hospital Emergency and Trauma Centre, Herston QLD, Australia
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Chen NYC, Batchelor J. Length of post-traumatic amnesia and its prediction of neuropsychological outcome following severe to extremely severe traumatic brain injury in a litigating sample. Brain Inj 2019; 33:1087-1096. [PMID: 31046471 DOI: 10.1080/02699052.2019.1610797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary Objective: The aim of the current study was to examine the relationship between duration of post-traumatic amnesia (PTA) and neuropsychological outcome at one or more years following severe to extremely severe traumatic brain injury (TBI) in a litigating sample. Research Design: Retrospective study design, using data collected from 2010 to 2017. Methods and Procedures: Data from 41 cases obtained from a private medicolegal neuropsychological database was examined. The database comprised information pertaining to TBI etiology, TBI severity parameters, demographic variables, neuropsychological test results and scores on psychological questionnaires. PTA duration was examined as a continuous variable. All cases that demonstrated non-credible effort were excluded. Main Outcomes and Results: Continuous PTA duration was not found to be a significant predictor of cognitive impairment across domains of verbal intellect, non-verbal intellect, working memory, information processing speed, immediate memory, delayed memory, and executive functioning. Conclusions: The predictive relationship between duration of PTA and cognitive impairment that has been reported in non-litigating populations did not exist in a litigating TBI sample. Findings illustrate the importance of investigating the relationships between injury variables and cognitive outcome in a population undergoing litigation, to provide better understanding of outcome in this subgroup of patients with TBI.
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Hayter C, Meares S, Shores EA. The Abbreviated Westmead Post-traumatic Amnesia Scale and Pocket Concussion Recognition Tool: Data from amateur sports players in live-match conditions. APPLIED NEUROPSYCHOLOGY-ADULT 2016; 24:30-41. [DOI: 10.1080/23279095.2015.1081200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Comparing Prospectively Recorded Posttraumatic Amnesia Duration With Retrospective Accounts. J Head Trauma Rehabil 2016; 31:E71-7. [DOI: 10.1097/htr.0000000000000154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Königs M, Engenhorst PJ, Oosterlaan J. Intelligence after traumatic brain injury: meta-analysis of outcomes and prognosis. Eur J Neurol 2015; 23:21-9. [PMID: 25919757 DOI: 10.1111/ene.12719] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/26/2015] [Indexed: 11/29/2022]
Abstract
Worldwide, 54-60 million individuals sustain traumatic brain injury (TBI) each year. This meta-analysis aimed to quantify intelligence impairments after TBI and to determine the value of age and injury severity in the prognosis of TBI. An electronic database search identified 81 relevant peer-reviewed articles encompassing 3890 patients. Full-scale IQ (FSIQ), performance IQ (PIQ) and verbal IQ (VIQ) impairments were quantified (Cohen's d) for patients with mild, moderate and severe TBI in the subacute phase of recovery and the chronic phase. Meta-regressions explored prognostic values of age and injury severity measures for intelligence impairments. The results showed that, in the subacute phase, FSIQ impairments were absent for patients with mild TBI, medium-sized for patients with moderate TBI (d = -0.61, P < 0.001) and large for patients with severe TBI (d = -1.09, P < 0.001). In the chronic phase, FSIQ impairments were small for patients with mild or moderate TBI (d = -0.37 and -0.19, P ≤ 0.008) and large for patients with severe TBI (d = -0.80, P < 0.001). Adults with mild TBI had larger PIQ and VIQ impairments in the chronic phase than children (both Q ≥ 5.21, P ≤ 0.02), whilst children with severe TBI had larger FSIQ and VIQ impairments than adults (both Q ≥ 4.40, P ≤ 0.04). Glasgow Coma Scale score, duration of loss of consciousness and post-traumatic amnesia duration moderately to strongly predicted FSIQ, PIQ and VIQ impairments (0.41 ≤ r ≤ 0.82, P ≤ 0.02), but no differences in predictive value were observed. In conclusion, TBI causes persisting intelligence impairments, where children may have better recovery from mild TBI and poorer recovery from severe TBI than adults. Injury severity measures predict intelligence impairments and do not outperform one another.
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Affiliation(s)
- M Königs
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - P J Engenhorst
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - J Oosterlaan
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands.,Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
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Testing a Reality Orientation Program in Patients With Traumatic Brain Injury in a Neurointensive Care Unit. J Neurosci Nurs 2015; 47:E2-10. [DOI: 10.1097/jnn.0000000000000106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in both children and adults. TBI is complex, as it involves injury to multiple brain areas caused by both the initial injury and secondary events. The most persistent sequelae of TBI are cognitive and behavioral, reflecting the fact that the preponderance of damage is to the frontal lobes. Although the sequence of recovery follows a pattern, TBI is a heterogeneous disorder and rehabilitation programs must be tailored to the needs of the individual and his or her social situation. Specific therapy approaches, environmental structure, and medications all play a role. Many of the emerging approaches to facilitating CNS plasticity can be applied.
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Fernando K, Eaton L, Faulkner M, Moodley Y, Setchell R. Development and Piloting of the Starship Posttraumatic Amnesia Scale for Children Aged Between Four and Six Years. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.3.1.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe aim of this study was to develop and pilot a posttraumatic amnesia scale (PTA) scale for children aged between four and six years. The scale consists of seven orientation questions and five memory items modelled on the Westmead PTA Scale which assesses posttraumatic amnesia in children from eight years onwards and adults. The sample consisted of 45 four-year-olds, 82 five-year-olds and 49 six-year-old children from a variety of cultural and socioeconomic backgrounds. Children were recruited from hospitals, kindergartens and schools. Results were analysed across age groups using means and standard deviations. The orientation and memory items were analysed separately as well as in combination. Early analyses indicate that the majority of normal children in the four to 6 year age group can answer most of the orientation questions correctly and remember the memory stimuli from day to day. The results indicate that the Starship PTA Scale is suitable for young children aged 4 to 6 years. It is simple and quick to administer and utilises an operational definition of posttraumatic amnesia in terms of measuring continuous memory.
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Thickpenny-Davis KL, Ogden JA, Fernando K. The Starship Post-Traumatic Amnesia Scale: Does It Predict Outcome After Mild to Moderate Traumatic Brain Injury in Children Aged 3 to 7 Years? BRAIN IMPAIR 2012. [DOI: 10.1375/brim.2005.6.2.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis study assesses whether the Starship Post-Traumatic Amnesia scale, developed for children aged 3 to 7 years, can predict neuropsychological impairment and behavioural outcome following mild to moderate traumatic brain injury. Participants are 19 children aged from 3 to 7 years with a GCS score of >13, and a PTA of 0–3 days. Neuropsychological outcome is measured by the NEPSY, and behavioural outcome by the Child Behaviour Checklist (CBCL) two months after the TBI. The duration of PTA contributed to the prediction of scores on the NEPSY memory and learning domain. In all cases the longer the duration of PTA, the poorer the memory scores were. The duration of PTA did not contribute to the prediction of NEPSY visuospatial processing or attention and executive functions domain scores, or to any of the CBCL scores. This preliminary study suggests that the Starship PTA scale has good sensitivity for this very young age group, even when the TBI is mild.
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Langhorn L, Sorensen JC, Pedersen PU. A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care. J Clin Nurs 2011; 19:2959-69. [PMID: 21040002 DOI: 10.1111/j.1365-2702.2010.03330.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To identify the effect of early rehabilitation of patients with post-traumatic amnesia in patients with traumatic brain injury, to review and critically assess evidence related to the timing of intervention and to identify the effect on outcome of a specific neurological rehabilitation in acute care. BACKGROUND Up to 70% of patients with traumatic brain injury will experience post-traumatic amnesia. Although duration of post-traumatic amnesia is correlated negatively with outcome for patients with traumatic brain injury, there is limited evidence relating to what influence timing and effect may have on enhancing early rehabilitation patient outcomes. DESIGN A critical literature review. METHODS Searches for systematic reviews were undertaken in Medline, CINAHL, Cochrane, PSYC INFO and Neurotraume databases. The efficacy of intervention and timing was classified based on a hierarchy of study designs for questions about health care interventions based on soundness of design. RESULTS Six reviews and 11 original studies were included and comprised the review. Many studies used weak designs and small sample size, thus limiting their ability to control confusing variables and outcomes. Few studies included papers with the information about timing and effect of early post-traumatic amnesia intervention. Only one study showed an effect of a reality orientation programme in acute care. Although there was no significant detail reported on the possibility of reducing the post-traumatic amnesia period, the study showed clinical relevance. CONCLUSION This review highlights the limited evidence of the effect of early rehabilitation of patients with post-traumatic amnesia. Future research should be conducted to identify the effectiveness of early intervention. RELEVANCE TO CLINICAL PRACTICE Although nurses are treating patients with post-traumatic amnesia without systematic assessment, the limited evidence available does little to direct nurses as to the best approach to start early rehabilitation of post-traumatic amnesia to promote good outcomes.
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Affiliation(s)
- Leanne Langhorn
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
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Abstract
O trauma crânio-encefálico contuso (TCEC) é freqüentemente seguido pela amnésia pós-traumática (APT), caracterizada como um estado transitório de confusão e desorientação. Sua duração tem sido utilizada para quantificar a gravidade do TCEC e prever distúrbios nas funções cognitivas, assim como para antever as alterações na capacidade funcional das vítimas pós-trauma. O Galveston Orientation Amnesia Test (GOAT) é o primeiro instrumento sistematizado criado e o mais amplamente utilizado para avaliar a APT. Este artigo apresenta esse instrumento, as bases conceituais para seu desenvolvimento e a adaptação e validação do GOAT para cultura brasileira. Além disso, descreve sua aplicação e comenta as restrições do seu uso. Resultados de pesquisas realizadas em nosso meio contribuíram para as evidências sobre a validade do GOAT. Também apontaram os indicadores do momento pós-trauma em que o GOAT deve ser aplicado e destacaram as dificuldades no uso desse instrumento.
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Ponsford J, Willmott C, Rothwell A, Kelly AM, Nelms R, Ng KT. Use of the Westmead PTA scale to monitor recovery of memory after mild head injury. Brain Inj 2009; 18:603-14. [PMID: 15204340 DOI: 10.1080/02699050310001646152] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE Duration of post-traumatic amnesia (PTA) is an important index of severity of head injury. Retrospective assessment of PTA duration is arguably unreliable. Existing objective measures of PTA duration are designed for use over a 24-hour timeframe and, therefore, are not useful for assessing PTA following mild head injury (MHI). A revised version of the Westmead PTA scale was developed for assessing patients with MHI in the Emergency Department (ED) at hourly intervals. The objective of this study was the field testing of this scale in EDs and assessment of validity and reliability of test items. METHODS The scale contained 12 items, assessing orientation, memory for a face and name in a photograph and three pictures of objects. This revised scale, administered by nursing staff, was completed at least four times at hourly intervals by 147 adults with MHI in the ED and again at follow-up 1 week later. It was also completed by 109 demographically similar controls. Results were compared with Glasgow Coma scores and retrospective estimates of PTA duration based on patient report and medical records. RESULTS Thirty-six per cent of MHI participants made errors on the scale in the ED, a significantly greater proportion than in MHI or controls at follow-up. Removal of the items 5 (day of week) and 9 (recall of name of face in photograph) improved the validity of the measure significantly. Scores correlated significantly with Glasgow Coma Scale scores and estimated duration of PTA. CONCLUSION The Westmead Scale (minus items 5 and 9) is a valid measure of PTA duration in adult patients with MHI in ED. Its use will allow for more appropriate timing of discharge and accurate prognostic information.
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Sharp DJ. Cognitive impairment after mild traumatic brain injury--the value of memory testing. NATURE CLINICAL PRACTICE. NEUROLOGY 2008; 4:420-421. [PMID: 18648347 DOI: 10.1038/ncpneuro0866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 06/10/2008] [Indexed: 05/26/2023]
Affiliation(s)
- David J Sharp
- Cognitive Neuroimaging Group, MRC Clinical Sciences Centre, The Hammersmith Hospital, Du Cane Road, London W12 0NN, UK.
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O’Dell MW, Noren T. Principles of Surgical Rehabilitation. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Moreau J, Laurent-Vannier A, De Agostini M. [Standardization of the Children's Orientation and Amnesia Test, French version, to evaluate post-traumatic amnesia in children]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2008; 51:24-30. [PMID: 17765352 DOI: 10.1016/j.annrmp.2007.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 07/02/2007] [Indexed: 05/17/2023]
Abstract
INTRODUCTION The duration of post-traumatic amnesia (PTA), the period of altered memory that often follows traumatic brain injury (TBI), is a useful index of severity of TBI and a predictor of outcome after TBI. Yet, evaluating PTA in French-speaking brain-injured children is not standardized. OBJECTIVE We aimed to translate into the French language and standardize the Children's Orientation and Amnesia Test (COAT), inspired by the Galveston Orientation and Amnesia Test (GOAT), which estimates PTA duration in adults. METHOD Development of a French version of the COAT (COAT-VF) with 16 items: 7 of general orientation, 5 temporal orientation and 4 memory. Normative data were collected for 137 children aged 4, 6, 8 and 10 years who were attending school. RESULTS Performance on the COAT-VF was influenced by age and sociocultural factors but not sex. CONCLUSION The COAT-VF, short and simple to administer, allows for an accurate evaluation of PTA duration in French children.
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Affiliation(s)
- J Moreau
- Centre médicopsychologique, 94500 Champigny-sur-Marne, France.
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Marschark M, Richtsmeier LM, Richardson JT, Crovitz HF, Henry J. Intellectual and emotional functioning in college students following mild traumatic brain injury in childhood and adolescence. J Head Trauma Rehabil 2000; 15:1227-45. [PMID: 11056405 DOI: 10.1097/00001199-200012000-00004] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether college students with a history of mild traumatic brain injury (TBI) in childhood or adolescence show residual deficits in intellectual functioning, approaches to studying, or emotional stability. DESIGN Participants with a history of mild TBI and two control groups. SETTING Volunteers were recruited from students taking an introductory psychology course. PARTICIPANTS 79 students with a history of mild TBI, 75 students with a history of general anesthesia, and 93 students with no history of either TBI or general anesthesia. MAIN OUTCOME MEASURES Participants carried out tests of verbal memory, nonverbal memory, verbal fluency, and nonverbal fluency; in addition, they completed a short form of the Approaches to Studying Inventory and the Symptom Checklist-90-Revised (SCL-90-R). RESULTS In comparison with the two control groups, the students with a history of mild TBI produced similar scores on the cognitive tests and similar orientations to studying. However, they showed a significantly higher level of emotional distress on the SCL-90-R. CONCLUSION College students with a history of mild TBI in childhood or adolescence are intellectually unimpaired and approach their studying in a similar manner to their uninjured classmates. Nevertheless, they report more severe distress in terms of their general personal and emotional functioning.
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Affiliation(s)
- M Marschark
- Professor, Center for Research, Teaching, and Learning, National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York, USA
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Ahmed S, Bierley R, Sheikh JI, Date ES. Post-traumatic amnesia after closed head injury: a review of the literature and some suggestions for further research. Brain Inj 2000; 14:765-80. [PMID: 11030451 DOI: 10.1080/026990500421886] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Post-traumatic amnesia (PTA) is a transient sequela of closed head injury (CHI). The term PTA has been in clinical use for over half a century, and generally refers to the subacute phase of recovery immediately after unconsciousness following CHI. The duration of PTA predicts functional outcome after CHI, but its pathophysiological mechanism is not known. This paper compares current methods of determining the duration of PTA, summarizes reports on neuropsychological deficits in PTA, reviews available data that allow inferences about its mechanism, and suggests methods for further exploration of its pathophysiology.
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Affiliation(s)
- S Ahmed
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA.
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Samuel C, Louis-Dreyfus A, Couillet J, Roubeau B, Bakchine S, Bussel B, Azouvi P. Dysprosody after severe closed head injury: an acoustic analysis. J Neurol Neurosurg Psychiatry 1998; 64:482-5. [PMID: 9576539 PMCID: PMC2170057 DOI: 10.1136/jnnp.64.4.482] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Neurological speech disorders (dysarthria and dysprosody) are known to be frequent sequelae after severe closed head injury. These disorders may dramatically alter communicative intent and accentuate social isolation. The aim was to provide an instrumental evaluation for prosodic production in a group of patients with severe closed head injury and to determine the correlations between prosodic production and neurobehavioural status. METHODS Fifteen patients, at the subacute stage after severe closed head injury, were studied and compared with 11 controls, matched for age, sex, and duration of education. Each subject was required to read aloud a French sentence "Je m'en vais samedi matin" (I am leaving saturday morning) under six different prosodic intonations (neutral, affirmation, interrogation, happiness, sadness, anger). The recorded sentences were analysed using a sound signal analysis software (Signalyse) allowing the measurement of signal intensity and fundamental frequency. Statistical analyses were carried out using repeated measures analysis of variance (ANOVA). RESULTS Patients with closed head injury were significantly less able than controls to modulate speech output (pitch and intensity) according to prosodic context. This deficit was particularly pronounced for the intonation feature of anger, question, and statement. No consistent correlations could be found between prosodic production and cognitive or behavioural data. CONCLUSIONS Acoustic analysis of pitch and intensity may show impairments of prosodic production after severe closed head injury, which may be useful in rehabilitation planning. This impairment does not seem to reflect the eventual cognitive and behavioural deficits of the patients, but rather a specific disorder of modulation of speech output.
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Affiliation(s)
- C Samuel
- Service de Rééducation Neurologique, Hôpital Raymond Poincaré (AP-HP), Université Paris V, Garches, France
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