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Tanna V, Parry L, Brookes N, Epps A, Lah S. Post-traumatic amnesia: a scoping review & content analysis of behavioral disturbances. Brain Inj 2024; 38:142-149. [PMID: 38328966 DOI: 10.1080/02699052.2024.2304865] [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] [Received: 03/08/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE The aim of this scoping review was to identify behavioral disturbances exhibited by patients in post-traumatic amnesia (PTA). While behavioral disturbances are common in PTA, research into their presentation and standardized measures for their assessment are limited. DESIGN The study protocol was registered with PROSPERO (CRD42021268275). A scoping review of databases was performed according to pre-determined criteria on 29 July 2021 and updated on 13 July 2022. A conventional content analysis was used to examine and categorize behavioral disturbances. RESULTS Thirty papers met the inclusion criteria, of which 27 reported observations and/or scores obtained on behavioral scales, and 3 on clinician interviews and surveys. None focused exclusively on children. Agitation was the most frequently assessed behavior, and Agitated Behavior Scale was the most used instrument. Content analysis, however, bore eight broad behavioral categories: disinhibition, agitation, aggression, lability, lethargy/low mood, perceptual disturbances/psychotic symptoms, personality change and sleep disturbances. CONCLUSION Our study revealed that while standardized assessments of behavior of patients in PTA are often limited to agitation, clinical descriptions include a range of behavioral disturbances. Our study highlights a significant gap in the systematic assessment of a wide range of behavioral disturbances observed in PTA.
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Affiliation(s)
- Victoria Tanna
- School of Psychology, University of Sydney, Sydney, Australia
| | - Louise Parry
- Rehab2Kids Rehabilitation Unit, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Naomi Brookes
- Rehab2Kids Rehabilitation Unit, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Adrienne Epps
- Rehab2Kids Rehabilitation Unit, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, Australia
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2
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Segev S, Silberg T, Bar O, Erez N, Ahonniska-Assa J, Brezner A, Landa J. Prolonged duration of post-traumatic amnesia: A sensitive classification for predicting cognitive outcomes in children recovering from traumatic brain injury. J Int Neuropsychol Soc 2023; 29:831-838. [PMID: 36781415 DOI: 10.1017/s1355617723000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE A paucity of data exists regarding the duration of post-traumatic amnesia (PTA) as a predictor of cognitive functioning among children after traumatic brain injury (TBI). The study aimed to assess the relationship between PTA duration and areas of neurocognitive function among the pediatric population in the sub-acute phase of recovery and rehabilitation. METHODS Data were collected from medical files on 103 children aged 5.5-16.5 hospitalized at a pediatric rehabilitation department with a diagnosis of moderate-severe TBI (msTBI) between the years 2004-2019. The Children Orientation and Amnesia Test was used to evaluate PTA duration. Measures of high-order cognitive abilities of attention and executive function were collected using the Test of Everyday Attention-Child version (TEA-Ch). RESULTS Three PTA duration groups were assembled out of a cluster analysis: "Long PTA" (M = 21 days), "Very Long PTA" (M = 47 days), and "Extremely Long PTA" (M = 94 days). Analyses revealed that the "Long PTA" group preformed significantly better than the "Very Long PTA" and "Extremely Long PTA" groups on all TEA-Ch measures, that is, Selective Attention, Attentional Control Switching, and Sustained Attention. CONCLUSIONS This study is the first to demonstrate that PTA duration is a useful predictor of high-order cognitive functions among children with msTBI in the sub-acute phase of recovery and rehabilitation. The findings emphasize the importance of using a more sensitive classification of prolonged PTA durations to improve outcome prediction and allocation of resources to those who can benefit most after severe brain injuries.
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Affiliation(s)
- Shira Segev
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Orly Bar
- Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Neta Erez
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jaana Ahonniska-Assa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
- The School of Behavioral Sciences, The Academic College of Tel Aviv Yaffo, Tel Aviv-Yafo, Israel
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jana Landa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan, Israel
- The Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Factor Structure of the Agitated Behavior Scale in Traumatic Brain Injury During Posttraumatic Amnesia. J Head Trauma Rehabil 2023; 38:E56-E64. [PMID: 36594864 DOI: 10.1097/htr.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate the factor structure of the Agitated Behavior Scale (ABS) in patients with traumatic brain injury (TBI) in posttraumatic amnesia (PTA). SETTING Inpatient TBI rehabilitation ward in Victoria, Australia. PARTICIPANTS A total of 364 patients aged 16 to 92 years meeting diagnostic criteria for TBI and PTA admitted between September 2013 and October 2020. DESIGN Retrospective cohort study utilizing electronic medical record data. MAIN MEASURES The ABS and the Westmead Post-Traumatic Amnesia Scale (WPTAS). RESULTS Exploratory factor analysis uncovered 2 moderately correlated underlying factors (0.52), labeled Restlessness and Aggression/Lability. Two items failed to demonstrate sufficiently large loadings on either factor. Both factors demonstrated adequate reliability (Cronbach α = 0.87 and 0.81 for Restlessness and Aggression/Lability, respectively). Linear regression indicated that higher WPTAS scores were associated with lower levels of Restlessness (β = -.14, P < .001), supporting construct validity. Conversely, WPTAS scores were not significantly associated with Aggression/Lability (β = -.12, P = .08). Subgroup analysis indicated that a history of mood disorder was associated with greater severity of Aggression/Lability (P = .02). Confirmatory factor analysis indicated superior fit of the identified 2-factor solution when compared with previously explored 1-, 2-, 3-, and 4-factor structures. CONCLUSION This study suggests that the latent structure of the ABS is best explained by a single construct of agitation with 2 discrete facets reflecting Restlessness and Aggression/Lability. These subscales may be used in clinical practice to evaluate the severity of different aspects of agitated behavior, inform treatment decisions, and judge the efficacy of interventions over time. Further research is required to explain low factor loadings demonstrated by 2 items.
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Phyland RK, McKay A, Olver J, Walterfang M, Hopwood M, Ponsford M, Ponsford JL. Use of Olanzapine to Treat Agitation in Traumatic Brain Injury: A Series of N-of-One Trials. J Neurotrauma 2023; 40:33-51. [PMID: 35833454 DOI: 10.1089/neu.2022.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Agitation is common during post-traumatic amnesia (PTA) following traumatic brain injury (TBI) and is associated with risk of harm to patients and caregivers. Antipsychotics are frequently used to manage agitation in early TBI recovery despite limited evidence to support their efficacy, safety, and impact upon patient outcomes. The sedating and cognitive side effects of these agents are theorized to exacerbate confusion during PTA, leading to prolonged PTA duration and increased agitation. This study, conducted in a subacute inpatient rehabilitation setting, describes the results of a double-blind, randomized, placebo-controlled trial investigating the efficacy of olanzapine for agitation management during PTA, analyzed as an n-of-1 series. Group comparisons were additionally conducted, examining level of agitation; number of agitated days; agitation at discharge, duration, and depth of PTA; length of hospitalization; cognitive outcome; adverse events; and rescue medication use. Eleven agitated participants in PTA (mean [M] age = 39.82 years, standard deviation [SD] = 20.06; mean time post-injury = 46.09 days, SD = 32.75) received oral olanzapine (n = 5) or placebo (n = 6) for the duration of PTA, beginning at a dose of 5 mg/day and titrated every 3 to 4 days to a maximum dose of 20 mg/day. All participants received recommended environmental management for agitation. A significant decrease in agitation with moderate to very large effect (Tau-U effect size = 0.37-0.86) was observed for three of five participants receiving olanzapine, while no significant reduction in agitation over the PTA period was observed for any participant receiving placebo. Effective olanzapine dose ranged from 5-20 mg. Response to treatment was characterized by lower level of agitation and response to treatment within 3 days. In group analyses, participants receiving olanzapine demonstrated poorer orientation and memory during PTA with large effect size (olanzapine, mean = 9.32, SD = 0.69; placebo, M = 10.68, SD = 0.30; p = .009, d = -2.16), and a trend toward longer PTA duration with large effect size (olanzapine, M = 71.96 days, SD = 20.31; placebo, M = 47.50 days, SD = 11.27; p = 0.072, d = 1.26). No further group comparisons were statistically significant. These results suggest that olanzapine can be effective in reducing agitation during PTA, but not universally so. Importantly, administration of olanzapine during PTA may lead to increased patient confusion, possibly prolonging PTA. When utilizing olanzapine, physicians must therefore balance the possible advantages of agitation management with the possibility that the patient may never respond to the medication and may experience increased confusion, longer PTA and potentially poorer outcomes. Further high-quality research is required to support these findings and the efficacy and outcomes associated with the use of any pharmacological agent for the management of agitation during the PTA period.
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Affiliation(s)
- Ruby K Phyland
- Monash Epworth Rehabilitation Research Center, Melbourne, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne Australia
| | - Adam McKay
- Monash Epworth Rehabilitation Research Center, Melbourne, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne Australia.,Division of Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Australia
| | - John Olver
- Department of Rehabilitation Medicine, Epworth HealthCare, Melbourne, Australia.,Epworth Monash Rehabilitation Medicine Research Unit, Epworth HealthCare, Melbourne, Australia
| | - Mark Walterfang
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Melbourne, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Albert Road Clinic Professorial Psychiatry Unit, University of Melbourne, Melbourne, Australia
| | - Michael Ponsford
- Department of Rehabilitation Medicine, Epworth HealthCare, Melbourne, Australia.,Epworth Monash Rehabilitation Medicine Research Unit, Epworth HealthCare, Melbourne, Australia
| | - Jennie L Ponsford
- Monash Epworth Rehabilitation Research Center, Melbourne, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne Australia
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Lannin NA, Galea C, Coulter M, Gruen R, Jolliffe L, Ownsworth T, Schmidt J, Unsworth C. Feasibility of modifying the hospital environment to reduce the length of amnesia after traumatic brain injury: a pilot randomized controlled trial. Int J Qual Health Care 2021; 33:6162463. [PMID: 33693639 DOI: 10.1093/intqhc/mzab044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/21/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Reorientation programmes have been an important component of neurotrauma rehabilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI); however, research testing the efficacy of acute programmes is limited. OBJECTIVE This study aimed to determine if it is feasible to provide a standardized environmental reorientation programme to adults suffering from PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial. METHODS We conducted a randomized controlled trial with concealed allocation and intention-to-treat analysis. A total of 40 participants suffering from PTA after TBI were included. The control group received usual care; the experimental group received usual care plus a standardized orientation programme inclusive of environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA Scale, assessed daily from hospital admission or on regaining consciousness. RESULTS Adherence to the orientation programme was high, and there were no study-related adverse responses to the environmental orientation programme. Although there were no statistically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardized reorientation programme (9.0 (6.4-11.6) versus 13.0 (4.5-21.5) days). Multivariate analysis showed that the Glasgow Coma Scale (GCS) at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors contributing to the longer length of PTA. CONCLUSION Providing an orientation programme in acute care is feasible for adults suffering from PTA after TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and a power of 80%.
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Affiliation(s)
- Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia
| | - Claire Galea
- Melanoma Institute Australia, Sydney, NSW, Australia
| | - Megan Coulter
- Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia
| | - Russell Gruen
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Laura Jolliffe
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia
| | - Tamara Ownsworth
- Menzies Health Institute Queensland, Griffith University, Mount Gravatt, QLD, Australia
| | - Julia Schmidt
- University of British Columbia, Vancouver, BC, Canada
| | - Carolyn Unsworth
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Federation University, Mount Helen, VIC, Australia
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Coelho P, Schön M, Alves PN, Fonseca AC, Pinho E Melo T. An image is not always worth a thousand words: an image mimic of transient global amnesia. Neurol Sci 2021; 42:2515-2517. [PMID: 33462633 DOI: 10.1007/s10072-021-05050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Transient global amnesia (TGA) is a neurological syndrome with rather distinctive brain MRI features, namely hyperintense lesion in hippocampus on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences. Post-traumatic amnesia is another amnestic syndrome which can also show hyperintense lesions in brain MRI due to cytotoxic oedema caused by traumatic brain injury. We present a case of a patient with post-traumatic amnesia with a brain MRI image mimic of TGA.
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Affiliation(s)
- Pedro Coelho
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Miguel Schön
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal
| | - Pedro Nascimento Alves
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.,Language Research Laboratory, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Teresa Pinho E Melo
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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7
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Phyland RK, McKay A, Olver J, Walterfang M, Hopwood M, Hicks AJ, Mortimer D, Ponsford JL. Use of olanzapine to treat agitation in traumatic brain injury: study protocol for a randomised controlled trial. Trials 2020; 21:662. [PMID: 32690072 PMCID: PMC7370410 DOI: 10.1186/s13063-020-04553-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Agitation is common in the early stages of recovery from traumatic brain injury (TBI), when patients are in post-traumatic amnesia (PTA). Agitation is associated with risk of harm to patients and caregivers. Recent guidelines recommend that agitation during PTA is managed using environmental modifications. Agitation is also frequently treated pharmacologically, with the use of atypical antipsychotics such as olanzapine among the most common. This is despite a lack of well-designed studies to support the use of antipsychotics within this context. This study will be a double-blind, placebo-controlled randomised controlled trial. We will examine the efficacy, safety, cost-effectiveness and outcomes associated with the use of olanzapine for reducing agitation in patients in PTA following TBI over and above recommended environmental management. Methods Fifty-eight TBI rehabilitation inpatients who are in PTA and are agitated will receive olanzapine or placebo for the duration of PTA. All participants will additionally receive optimal environmental management for agitation. Measures of agitation, PTA and health will be undertaken at baseline. Treatment administration will begin at a dose of 5 mg daily and may be escalated to a maximum dose of 20 mg per day. Throughout the treatment period, agitation and PTA will be measured daily, and adverse events monitored weekly. Efficacy will be assessed by treatment group comparison of average Agitated Behaviour Scale scores during PTA. Participants will cease treatment upon emergence from PTA. Agitation levels will continue to be monitored for a further 2 weeks, post-treatment measures of health will be undertaken and cognitive and functional status will be assessed. Level of agitation and functional health will be assessed at hospital discharge. At 3 months post-discharge, functional outcomes and health service utilisation will be measured. Discussion This trial will provide crucial evidence to inform the management of agitation in patients in PTA following TBI. It will provide guidance as to whether olanzapine reduces agitation over and above recommended environmental management or conversely whether it increases or prolongs agitation and PTA, increases length of inpatient hospitalisation and impacts longer term cognitive and functional outcomes. It will also speak to the safety and cost-effectiveness of olanzapine use in this population. Trial registration ANZCTR ACTRN12619000284167. Registered on 25 February 2019
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Affiliation(s)
- Ruby K Phyland
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia. .,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia. .,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia.
| | - Adam McKay
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia.,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia.,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia.,Department of Psychology, Epworth HealthCare, 29 Erin Street, Richmond, Victoria, 3121, Australia
| | - John Olver
- Rehabilitation Medicine, Epworth HealthCare, 89 Bridge Rd, Richmond, Victoria, 3121, Australia
| | - Mark Walterfang
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North Block, Grattan Street, Parkville, Victoria, 3052, Australia.,Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, 30 Royal Parade, Parkville, Victoria, 3052, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North Block, Grattan Street, Parkville, Victoria, 3052, Australia.,Albert Road Clinic Professorial Psychiatry Unit, University of Melbourne, 31 Albert Rd, Melbourne, Victoria, 3004, Australia
| | - Amelia J Hicks
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia.,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia.,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Building H, Level 5, Caulfield Campus, Clayton, Victoria, 3145, Australia
| | - Jennie L Ponsford
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia.,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia.,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia
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8
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How Much Is Enough? Trauma Recall and the Exposure Therapy Process. J Nerv Ment Dis 2020; 208:215-221. [PMID: 31904667 DOI: 10.1097/nmd.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Theoretical models of posttraumatic stress disorder (PTSD) as well as exposure therapy (EXP) methodology suggest that trauma recall is crucial to altering the conditioned fear response associated with PTSD. However, it is unclear whether limited recall of the trauma event attenuates treatment outcomes. This study examined whether the extent of difficulty recalling aspects of a traumatic event affected fear activation, habituation, number of sessions, session length, and diagnostic outcomes in 166 Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans. Extent of trauma recall difficulty neither attenuated veterans' ability to achieve fear activation and habituation nor affected treatment outcomes. Findings suggest that even veterans who reported greater difficulty recalling their trauma event can engage successfully and benefit from EXP. This research is the first to examine trauma event recall in the context of the EXP process and contributes to the current body of literature that aims to address the question: "For whom do treatments work?"
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The Progression of Memory Loss Secondary to TBI-Induced White Matter Attenuation: a Review of the Literature and Case Exemplar. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2019. [DOI: 10.1007/s40817-018-0050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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Quach NT, Ehsanian R, Dirlikov B, Sechrist S, Mohole J, McKenna S, Isaac L, Duong TT. Burden of Care Implications and Association of Intracranial Hypertension With Extremely Severe Post-traumatic Amnesia After Traumatic Brain Injury: A 5-Year Retrospective Longitudinal Study. Front Neurol 2019; 10:34. [PMID: 30761071 PMCID: PMC6361805 DOI: 10.3389/fneur.2019.00034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/10/2019] [Indexed: 11/30/2022] Open
Abstract
Post-traumatic amnesia (PTA) is characterized by a state of disorientation and confusion following traumatic brain injury (TBI). Few studies have looked at the effect of prolonged PTA on the functional outcomes beyond 1 year post-injury. This study aims to evaluate the burden of care in individuals with extremely severe PTA (esPTA; PTA >28 days) from acute inpatient rehabilitation admission to 5 years post-injury as well as the association between intracranial hypertension (ICH; Intracranial pressure (ICP) ≥20 mmHg) and esPTA status. Three hundred and forty-two individuals with moderate to severe TBI enrolled in the Northern California TBI Model System (TBIMS) of Care were included in this study. The FIM® instrument was chosen as the outcome measurement as it is a widely used functional assessment in the rehabilitation community. Repeated measure ANOVA revealed greater burden of care based on FIM® total scores (p < 0.001) from admission to 5-year follow-up for the esPTA group compared to the non-esPTA group (PTA ≤ 28 days). Unlike the non-esPTA group where FIM® total score plateaued 1 year post-injury, FIM® total score continued to improve up to 2 years post-injury for the esPTA group. The odds of developing esPTA was ~3 times higher for individuals with ICH vs. individuals without ICH (p < 0.001). In conclusion, individuals with esPTA have increased short- and long-term burden of care and the presence of ICH during hospitalization increased the odds of experiencing esPTA. These results may help the rehabilitation team and family in planning care post rehabilitation discharge.
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Affiliation(s)
- Nhung T. Quach
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Reza Ehsanian
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Samantha Sechrist
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Jyodi Mohole
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Stephen McKenna
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
- Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, United States
| | - Linda Isaac
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Thao T. Duong
- Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, United States
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11
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Hicks AJ, Clay FJ, Hopwood M, James AC, Jayaram M, Batty R, Perry LA, Ponsford JL. Efficacy and Harms of Pharmacological Interventions for Neurobehavioral Symptoms in Post-Traumatic Amnesia after Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2018; 35:2755-2775. [PMID: 29969935 DOI: 10.1089/neu.2018.5738] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Many individuals in post-traumatic amnesia (PTA) following traumatic brain injury (TBI) experience neurobehavioral symptoms (NBS) in addition to disorientation and amnesia. These symptoms are associated with low rehabilitation engagement, self-inflicted harm, and risk of violence. The aim of this systematic review was to evaluate the efficacy and harms of pharmacological interventions for NBS in PTA following TBI in adults. Studies in English published before December 2017 were reviewed. Six databases were searched, with additional hand searching of key journals, clinical trials registries, and international drug regulators. Evidence quality was assessed using Joanna Briggs Institute Critical Appraisal Instruments. Thirteen studies were identified: three randomized controlled trials (RCTs), three cohort studies, and seven case series. In the RCTs, neither amantadine nor sertraline reduced NBS. Less rigorous studies reported reduced NBS in patients administered haloperidol, ziprasidone, carbamazepine, amitriptyline, desipramine, and varied neuroleptics. There is a paucity of well-designed, adequately powered and controlled studies of pharmacological interventions for NBS in PTA. More research is needed to provide evidence-based treatment recommendations and improve care.
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Affiliation(s)
- Amelia J Hicks
- 1 Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Fiona J Clay
- 2 Department of Psychiatry, University of Melbourne, Melbourne, Australia .,3 Department of Forensic Medicine, Monash University, Southbank, Melbourne, Australia .,4 Professorial Psychiatry Unit, Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Malcolm Hopwood
- 2 Department of Psychiatry, University of Melbourne, Melbourne, Australia .,4 Professorial Psychiatry Unit, Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Amelia C James
- 1 Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Mahesh Jayaram
- 2 Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Rachel Batty
- 2 Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Luke A Perry
- 2 Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Jennie L Ponsford
- 1 Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
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Fotakopoulos G, Makris D, Tsianaka E, Kotlia P, Karakitsios P, Gatos C, Tzannis A, Fountas K. The value of the identification of predisposing factors for post-traumatic amnesia in management of mild traumatic brain injury. Brain Inj 2018; 32:563-568. [PMID: 29400569 DOI: 10.1080/02699052.2018.1432075] [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: 10/18/2022]
Abstract
OBJECT To identify the risk factors for post-traumatic amnesia (PTA) and to document the incidence of PTA after mild traumatic brain injuries. METHODS This was a prospective study, affecting mild TBI (mTBI) (Glasgow Coma Scale 14-15) cases attending to the Emergency Department between January 2009 and April 2012 (40 months duration). Patients were divided into two groups (Group A: without PTA, and Group B: with PTA, and they were assessed according to the risk factors. RESULTS A total of 1762 patients (males: 1002, 56.8%) were meeting study inclusion criteria [Group A: n = 1678 (83.8%), Group B: n = 84 (4.2%)]. Age, CT findings: (traumatic focal HCs in the frontal and temporal lobes or more diffuse punctate HCs, and skull base fractures), anticoagulation therapy and seizures were independent factors of PTA. There was no statistically significant correlation between PTA and sex, convexity fractures, stroke event, mechanism of mTBI (fall +/or beating), hypertension, coronary heart disease, chronic smokers and diabetes (p > 0.005). CONCLUSION CT findings: (traumatic focal HCs in the frontal and temporal lobes or more diffuse punctate HCs and skull base fractures), age, seizures and anticoagulation/antiplatelet therapy, were independent factors of PTA and could be used as predictive factors after mTBI.
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Affiliation(s)
- George Fotakopoulos
- a Department of Neurosurgery , University Hospital of Thessaly, University Hospital of Larissa , Thessaly , Greece
| | - Demosthenes Makris
- b Department of Head of Critical Care , University Hospital of Larissa , Larissa , Greece
| | - Eleni Tsianaka
- a Department of Neurosurgery , University Hospital of Thessaly, University Hospital of Larissa , Thessaly , Greece
| | - Polikceni Kotlia
- b Department of Head of Critical Care , University Hospital of Larissa , Larissa , Greece
| | - Paulos Karakitsios
- c Department of General Medicine , Public Health System of Palamas , Palamas , Greece
| | - Charalabos Gatos
- a Department of Neurosurgery , University Hospital of Thessaly, University Hospital of Larissa , Thessaly , Greece
| | - Alkiviadis Tzannis
- a Department of Neurosurgery , University Hospital of Thessaly, University Hospital of Larissa , Thessaly , Greece
| | - Kostas Fountas
- a Department of Neurosurgery , University Hospital of Thessaly, University Hospital of Larissa , Thessaly , Greece
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Hicks AJ, Clay FJ, Hopwood M, Jayaram M, Batty R, Ponsford JL. Efficacy and harms of pharmacological interventions for neurobehavioral symptoms in post traumatic amnesia after traumatic brain injury: a systematic review and meta-analysis protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2890-2912. [PMID: 29219873 DOI: 10.11124/jbisrir-2017-003430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
REVIEW OBJECTIVE/QUESTION The objective of this systematic review is to synthesize the best available evidence on the effectiveness and harms of pharmacotherapy as compared to all types of comparators for the management of neurobehavioral symptoms in post-traumatic amnesia in adults aged 16 years and over who have sustained a traumatic brain injury. This review forms part of a larger project which aims to gather the evidence for the pharmacological treatment of neurobehavioral symptoms post traumatic brain injury as a prelude to the development of a clinical guideline.
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Affiliation(s)
- Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Fiona J Clay
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Department of Forensic Medicine, Monash University, Southbank, Australia
- The Australian Centre for Evidence-Based Primary Health Care, Community Care: a Joanna Briggs Institute Centre of Excellence, Adelaide, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Professorial Psychiatry Unit, Albert Road Clinic, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Mahesh Jayaram
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Rachel Batty
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
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Steel J, Ferguson A, Spencer E, Togher L. Social communication assessment during post-traumatic amnesia and the post-acute period after traumatic brain injury. Brain Inj 2017; 31:1320-1330. [DOI: 10.1080/02699052.2017.1332385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Joanne Steel
- Deparment of Speech Pathology, The University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Moving Ahead, Sydney, Australia
| | - Alison Ferguson
- Deparment of Speech Pathology, The University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Brain Recovery, Moving Ahead, Sydney, Australia
| | - Elizabeth Spencer
- Deparment of Speech Pathology, The University of Newcastle, Newcastle, Australia
| | - Leanne Togher
- NHMRC Centre of Research Excellence in Brain Recovery, Moving Ahead, Sydney, Australia
- Deparment of Speech Pathology, The University of Sydney, Sydney, Australia
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De Simoni S, Grover PJ, Jenkins PO, Honeyfield L, Quest RA, Ross E, Scott G, Wilson MH, Majewska P, Waldman AD, Patel MC, Sharp DJ. Disconnection between the default mode network and medial temporal lobes in post-traumatic amnesia. Brain 2016; 139:3137-3150. [PMID: 27797805 PMCID: PMC5382939 DOI: 10.1093/brain/aww241] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/25/2016] [Accepted: 08/05/2016] [Indexed: 01/10/2023] Open
Abstract
See Bigler (doi:10.1093/aww277) for a scientific commentary on this article. Post-traumatic amnesia is very common immediately after traumatic brain injury. It is characterized by a confused, agitated state and a pronounced inability to encode new memories and sustain attention. Clinically, post-traumatic amnesia is an important predictor of functional outcome. However, despite its prevalence and functional importance, the pathophysiology of post-traumatic amnesia is not understood. Memory processing relies on limbic structures such as the hippocampus, parahippocampus and parts of the cingulate cortex. These structures are connected within an intrinsic connectivity network, the default mode network. Interactions within the default mode network can be assessed using resting state functional magnetic resonance imaging, which can be acquired in confused patients unable to perform tasks in the scanner. Here we used this approach to test the hypothesis that the mnemonic symptoms of post-traumatic amnesia are caused by functional disconnection within the default mode network. We assessed whether the hippocampus and parahippocampus showed evidence of transient disconnection from cortical brain regions involved in memory processing. Nineteen patients with traumatic brain injury were classified into post-traumatic amnesia and traumatic brain injury control groups, based on their performance on a paired associates learning task. Cognitive function was also assessed with a detailed neuropsychological test battery. Functional interactions between brain regions were investigated using resting-state functional magnetic resonance imaging. Together with impairments in associative memory, patients in post-traumatic amnesia demonstrated impairments in information processing speed and spatial working memory. Patients in post-traumatic amnesia showed abnormal functional connectivity between the parahippocampal gyrus and posterior cingulate cortex. The strength of this functional connection correlated with both associative memory and information processing speed and normalized when these functions improved. We have previously shown abnormally high posterior cingulate cortex connectivity in the chronic phase after traumatic brain injury, and this abnormality was also observed in patients with post-traumatic amnesia. Patients with post-traumatic amnesia showed evidence of widespread traumatic axonal injury measured using diffusion magnetic resonance imaging. This change was more marked within the cingulum bundle, the tract connecting the parahippocampal gyrus to the posterior cingulate cortex. These findings provide novel insights into the pathophysiology of post-traumatic amnesia and evidence that memory impairment acutely after traumatic brain injury results from altered parahippocampal functional connectivity, perhaps secondary to the effects of axonal injury on white matter tracts connecting limbic structures involved in memory processing.
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Affiliation(s)
- Sara De Simoni
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Patrick J Grover
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Peter O Jenkins
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | | | | | - Ewan Ross
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Gregory Scott
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Mark H Wilson
- 3 Traumatic Brain Injury Centre, Imperial College, St Mary's Hospital, London, UK
| | - Paulina Majewska
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
| | - Adam D Waldman
- 2 Department of Imaging, Charing Cross Hospital, London, UK
| | | | - David J Sharp
- 1 Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Division of Brain Sciences, Hammersmith Hospital, London, UK
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Friedland D, Swash M. Post-traumatic amnesia and confusional state: hazards of retrospective assessment. J Neurol Neurosurg Psychiatry 2016; 87:1068-74. [PMID: 26888959 DOI: 10.1136/jnnp-2015-312193] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/29/2016] [Indexed: 11/04/2022]
Abstract
Retrospective assessment of post-traumatic amnesia (PTA) must take into account factors other than traumatic brain injury (TBI) which may impact on memory both at the time of injury and subsequent to the injury. These include analgesics, anaesthesia required for surgery, and the development of acute or post-traumatic stress disorder. This is relevant in clinical and medicolegal settings. Repeated assessments of the post-injury state, involving tests for continuing amnesia, risk promoting recall of events suggested by the examiner, or generating confabulations. The PTA syndrome affects the categorical autobiographical memory, and is accompanied by confusion as an essential component; this should be suspected from the initial or early Glasgow Coma Scale score (13-14/15) if not directly recorded by clinical staff. PTA by itself is only one of several indices of severity of TBI. The nature of the head injury, including observers' accounts, clinical and neuroimaging data, the possible role of other external injuries, blood loss, acute stress disorder and the potential for hypoxic brain injury, must be taken into account as well as concomitant alcohol or substance abuse, and systemic shock. A plausible mechanism for a TBI must be demonstrable, and other causes of amnesia excluded.
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Affiliation(s)
| | - Michael Swash
- The London Independent Hospital, London, UK Barts and The London School of Medicine and Dentistry, QMUL at the Royal London Hospital, London, UK Institute of Neuroscience, University of Lisbon, Lisbon, Portugal
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Joubert PM, van Staden CW. Behaviour that underpins non-pathological criminal incapacity and automatism: Toward clarity for psychiatric testimony. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:10-16. [PMID: 27346664 DOI: 10.1016/j.ijlp.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 06/06/2023]
Abstract
Psychiatric expert testimony is challenging in cases of violence when the accused person submits a defence that he or she was so overwhelmed by emotions triggered by an upsetting event that his or her violent behaviour was an uncontrollable consequence of the emotions. This defence is usually presented in terms of an automatism particularly not attributed to a mental disorder. Clouding testimony in these cases is the various definitions of both automatism and mental disorder-definitions by which the jurisprudential distinction is made between a sane and an insane automatism, or pathological and non-pathological incapacity (NPCI). To avert testimony that is tainted from the very beginning by the lack of agreed definitions, this article proposes that psychiatrists focus in their assessment and testimony on particularly the behaviour as being distinct from the jurisprudential concerns whether that behaviour constitutes an automatism and whether it is (not) attributed to a mental disorder. This focus on the behaviour affords clarity by which the properties of the behaviour may be examined theoretically and clinically in terms of behaviour therapy, specifying accordingly its antecedents, consequences, topography, intensity, latency, duration, frequency, and quality. So informed, the behaviour that underpins NPCI and automatism is described here as emotionally triggered involuntary violent behaviour about which testimony may be given distinct from whether the behaviour is (not) causally attributed to a mental disorder, and from jurisprudential concerns with accountability.
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Affiliation(s)
- Pierre Mauritz Joubert
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Cornelius Werdie van Staden
- Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
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Steel J, Ferguson A, Spencer E, Togher L. Speech-language pathologists’ perspectives on cognitive communication assessment during post-traumatic amnesia. Brain Inj 2016; 30:1131-42. [DOI: 10.1080/02699052.2016.1174785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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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20
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Steel J, Ferguson A, Spencer E, Togher L. Language and cognitive communication during post-traumatic amnesia: A critical synthesis. NeuroRehabilitation 2015; 37:221-34. [DOI: 10.3233/nre-151255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joanne Steel
- Speech Pathology, The University of Newcastle, Newcastle, NSW, Australia
- NHMRC Clinical Centre of Research Excellence in Aphasia Rehabilitation, Brisbane, QLD, Australia
| | - Alison Ferguson
- Speech Pathology, The University of Newcastle, Newcastle, NSW, Australia
- NHMRC Clinical Centre of Research Excellence in Aphasia Rehabilitation, Brisbane, QLD, Australia
| | - Elizabeth Spencer
- Speech Pathology, The University of Newcastle, Newcastle, NSW, Australia
| | - Leanne Togher
- Speech Pathology, The University of Sydney, Sydney, NSW, Australia
- NHMRC Clinical Centre of Research Excellence in Aphasia Rehabilitation, Brisbane, QLD, Australia
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21
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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: 33] [Impact Index Per Article: 3.7] [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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Bower J, Catroppa C, Grocke D, Shoemark H. Music therapy for early cognitive rehabilitation post-childhood TBI: an intrinsic mixed methods case study. Dev Neurorehabil 2014; 17:339-46. [PMID: 23815784 DOI: 10.3109/17518423.2013.778910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The primary aim of this case study was to explore the behavioural changes of a paediatric patient in post-traumatic amnesia (PTA) during a music therapy session. A secondary objective was to measure the effect of the music therapy intervention on agitation. METHOD Video data from pre, during and post-music therapy sessions were collected and analysed using video micro-analysis and the Agitated Behaviour Scale. RESULTS The participant displayed four discrete categories of behaviours: Neutral, Acceptance, Recruitment and Rejection. Further analysis revealed brief but consistent and repeated periods of awareness and responsiveness to the live singing of familiar songs, which were classified as Islands of Awareness. Song offered an Environment of Potential to maximise these periods of emerging consciousness. The quantitative data analysis yielded inconclusive results in determining if music therapy was effective in reducing agitation during and immediately post the music therapy sessions. CONCLUSION The process of micro-analysis illuminated four discrete participant behaviours not apparent in the immediate clinical setting. The results of this case suggest that the use of familiar song as a music therapy intervention may harness early patient responsiveness to foster cognitive rehabilitation in the early acute phase post-TBI.
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Affiliation(s)
- Janeen Bower
- Music Therapy Department, The Royal Children's Hospital Melbourne , Flemington Rd, Parkville, VIC , Australia
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Ponsford JL, Downing MG, Olver J, Ponsford M, Acher R, Carty M, Spitz G. Longitudinal follow-up of patients with traumatic brain injury: outcome at two, five, and ten years post-injury. J Neurotrauma 2014; 31:64-77. [PMID: 23889321 DOI: 10.1089/neu.2013.2997] [Citation(s) in RCA: 393] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The deleterious consequences of traumatic brain injury (TBI) impair capacity to return to many avenues of pre-morbid life. However, there has been limited longitudinal research examining outcome beyond five years post-injury. The aim of this study was to examine aspects of function, previously shown to be affected following TBI, over a span of 10 years. One hundred and forty one patients with TBI were assessed at two, five, and 10 years post-injury using the Structured Outcome Questionnaire. Fatigue and balance problems were the most common neurological symptoms, with reported rates decreasing only slightly during the 10-year period. Mobility outcomes were good in more than 75% of patients, with few participants requiring aids for mobility. Changes in cognitive, communication, behavioral, and emotional functions were reported by approximately 60% of the sample at all time points. Levels of independence in activities of daily living were high during the 10-year period, and as many as 70% of subjects returned to driving. Nevertheless, approximately 40% of patients required more support than before their injury. Only half the sample returned to previous leisure activities and fewer than half were employed at each assessment time post-injury. Although marital status remained stable over time, approximately 30% of participants reported difficulties in personal relationships. Older age at injury did not substantially alter the pattern of changes over time, except in employment. Overall, problems that were evident at two years post-injury persisted until 10 years post-injury. The importance of these findings is discussed with reference to rehabilitation programs.
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Affiliation(s)
- Jennie L Ponsford
- 1 School of Psychology and Psychiatry, Monash University , Melbourne, Australia
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Ponsford J, Janzen S, McIntyre A, Bayley M, Velikonja D, Tate R. INCOG Recommendations for Management of Cognition Following Traumatic Brain Injury, Part I. J Head Trauma Rehabil 2014; 29:307-20. [DOI: 10.1097/htr.0000000000000074] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Holli-Helenius K, Luoto TM, Brander A, Wäljas M, Iverson GL, Ohman J. Structural integrity of medial temporal lobes of patients with acute mild traumatic brain injury. J Neurotrauma 2014; 31:1153-60. [PMID: 24579770 DOI: 10.1089/neu.2013.2978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Post-traumatic amnesia (PTA) is an acute characteristic of traumatic brain injury (TBI) and the duration of PTA is commonly used to estimate the severity of brain injury. In the context of mild traumatic brain injury (MTBI), PTA is an essential part of the routine clinical assessment. Macroscopic lesions in temporal lobes, especially hippocampal regions, are thought to be connected to memory loss. However, conventional neuroimaging has failed to reveal neuropathological correlates of PTA in MTBI. Texture analysis (TA) is an image analysis technique that quantifies the minor MRI signal changes among image pixels and, therefore, the variations in intensity patterns within the image. The objective of this work was to apply the TA technique to MR images of MTBI patients and control subjects, and to assess the microstructural damage in medial temporal lobes of patients with MTBI with definite PTA. TA was performed for fluid-attenuated inversion recovery (FLAIR) images of 50 MTBI patients and 50 age- and gender-matched controls in the regions of the amygdala, hippocampus, and thalamus. It was hypothesized that 1) there would be statistically significant differences in TA parameters between patients with MTBIs and controls, and 2) the duration of PTA would be related to TA parameters in patients with MTBI. No significant textural differences were observed between patients and controls in the regions of interest (p>0.01). No textural features were observed to correlate with the duration of PTA. Subgroup analyses were conducted on patients with PTA of>1 h, (n=33) and compared the four TA parameters to the age- and gender-matched controls (n=33). The findings were similar. This study did not reveal significant textural changes in medial temporal structures that could be related to the duration of PTA.
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Affiliation(s)
- Kirsi Holli-Helenius
- 1 Medical Imaging Centre and Hospital Pharmacy, Department of Radiology, Tampere University Hospital , Tampere, Finland
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Marshman LA, Jakabek D, Hennessy M, Quirk F, Guazzo EP. Post-traumatic amnesia. J Clin Neurosci 2013; 20:1475-81. [DOI: 10.1016/j.jocn.2012.11.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/11/2012] [Accepted: 11/17/2012] [Indexed: 10/26/2022]
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Carroll CP, Cochran JA, Guse CE, Wang MC. Are We Underestimating the Burden of Traumatic Brain Injury? Surveillance of Severe Traumatic Brain Injury Using Centers for Disease Control International Classification of Disease, Ninth Revision, Clinical Modification, Traumatic Brain Injury Codes. Neurosurgery 2012; 71:1064-70; discussion 1070. [DOI: 10.1227/neu.0b013e31826f7c16] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Silva SCFE, Settervall CHC, Sousa RMCD. Amnésia pós-traumática e qualidade de vida pós-trauma. Rev Esc Enferm USP 2012; 46 Spec No:30-7. [DOI: 10.1590/s0080-62342012000700005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/04/2012] [Indexed: 11/22/2022] Open
Abstract
Este estudo compara a qualidade de vida das vítimas que apresentaram amnésia pós-traumática de longa duração com as demais e analisa a relação entre qualidade de vida e duração da amnésia pós-traumática, computando ou não o período de coma. Estudo de coorte prospectivo, com coleta de dados durante a internação hospitalar e avaliação da qualidade de vida no período de estabilidade da recuperação pós-traumática. Participaram desta investigação vítimas de trauma crânio-encefálico contuso, maiores de 14 anos, sem antecedentes de demência ou trauma crânio-encefálico, internadas em hospital de referência para atendimento de trauma nas primeiras 12 horas pós-evento. Os resultados referentes à qualidade de vida foram mais desfavoráveis em três domínios do grupo com amnésia de longa duração. Correlações entre duração da amnésia e domínios de qualidade de vida foram mais expressivas quando excluído o período de coma, indicando que este tempo não deve ser computado na duração da amnésia pós-traumática.
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Abstract
AbstractIn the early stages of recovery after a traumatic brain injury, patients usually experience a period of posttraumatic amnesia (PTA) in which they are confused, amnesic for ongoing events, and frequently behaviourally agitated. Although a variety of procedures and instruments are available to measure the duration of PTA, their applications in clinical practice are far from ideal. This review paper describes retrospective and prospective measures of PTA and critically examines variations in item content and scoring procedures. In particular, methods currently available to measure the amnesia component of PTA are especially problematic. The limitations of PTA scales give rise to a number of difficulties that impact upon clinical practice. These include determining precisely when a patient has emerged from PTA, and distinguishing between patients in PTA and those with chronic amnesia. It is concluded that there is a need to revisit basic constructs comprising PTA, and develop an instrument with greater specificity. More focus should be placed on examining the confusional component of PTA, and validity of PTA tests would be improved by measuring attention and behaviour, in addition to orientation and memory.
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Spikman JM, Timmerman ME, Milders MV, Veenstra WS, van der Naalt J. Social Cognition Impairments in Relation to General Cognitive Deficits, Injury Severity, and Prefrontal Lesions in Traumatic Brain Injury Patients. J Neurotrauma 2012; 29:101-11. [DOI: 10.1089/neu.2011.2084] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jacoba M. Spikman
- Department of Clinical and Developmental Neuropsychology, and University of Groningen, the Netherlands
- Department of Neurology, University Medical Center Groningen, the Netherlands
| | - Marieke E. Timmerman
- Department of Psychometrics and Statistics, and University of Groningen, the Netherlands
| | | | - Wencke S. Veenstra
- Department of Neurology, University Medical Center Groningen, the Netherlands
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Abstract
OBJECTIVE To conduct a feasibility study to compare the effects of top-down Strategic Memory and Reasoning Training (SMART) versus information-based Brain Health Workshop (BHW, control) on gist-reasoning (ie, abstracting novel meaning from complex information), memory, executive functions, and daily function in adults with traumatic brain injury. PARTICIPANTS Twenty-eight participants (of the 35 recruited), 16 men & 12 women, aged 20 to 65 years (M = 43, SD = 11.34) at chronic stages posttraumatic brain injury (2 years or longer) completed the training. Fourteen participants that received SMART and 14 participants that completed BHW were assessed both pre- and posttraining. Thirteen of the SMART trained and 11 from BHW participated in a 6-month testing. DESIGN The study was a single blinded randomized control trial. Participants in both groups received a minimum of 15 hours of training over 8 weeks. RESULTS The SMART group significantly improved gist-reasoning as compared to the BHW group. Benefits of the SMART extended to untrained measures of working memory and participation in functional activities. Exploratory analyses suggested potential transfer effects of SMART on memory and executive functions. The benefits of the SMART program as compared to BHW were evident at immediately posttraining and 6 months posttraining. CONCLUSION This study provides preliminary evidence that short-term intensive training in top-down modulation of information benefits gist-reasoning and generalizes to measures of executive function and real life function at chronic stages of post-TBI.
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Grubenhoff JA, Kirkwood MW, Deakyne S, Wathen J. Detailed concussion symptom analysis in a paediatric ED population. Brain Inj 2011; 25:943-9. [PMID: 21749192 DOI: 10.3109/02699052.2011.597043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To examine the frequency of acute mild traumatic brain injury (mTBI) symptoms in children using a concussion symptom inventory and to identify which symptoms are most useful in identifying mTBI. It was hypothesized that symptoms associated with mTBI are more common in children with head injury than orthopaedic injury and certain symptoms are more useful than others in identifying mTBI. RESEARCH DESIGN Prospective case-control study conducted in a paediatric trauma centre emergency department. METHODS AND PROCEDURES Children of 6-18 years old with head injury or a minor extremity injury were enrolled. Symptoms were assessed using a graded symptom checklist. Symptom frequency was compared using a chi-square test. The association between individual symptoms with AMS was evaluated with logistic regression analysis. MAIN OUTCOMES AND RESULTS Children with head injury displayed more frequent symptoms than controls. Head-injured cases with altered mental status (AMS) demonstrated the most frequent and severe symptoms (median symptom scores: control = 1, cases without AMS = 5, cases with AMS = 10; p < 0.001). Headache, nausea, dizziness, blurred/double vision and not feeling 'sharp' were associated with AMS. CONCLUSIONS Symptoms associated with mTBI are more frequent in children with head injury. AMS magnifies this effect. A symptom inventory is integral to the evaluation of mTBI in children; a smaller set of dichotomized symptoms may be as useful as and more easily administered than lengthier symptom scales.
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Affiliation(s)
- Joseph A Grubenhoff
- University of Colorado School of Medicine, Department of Pediatrics, Section of Emergency Medicine, Aurora, CO, USA.
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Metting Z, Rödiger LA, de Jong BM, Stewart RE, Kremer BP, van der Naalt J. Acute cerebral perfusion CT abnormalities associated with posttraumatic amnesia in mild head injury. J Neurotrauma 2011; 27:2183-9. [PMID: 20939700 DOI: 10.1089/neu.2010.1395] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Posttraumatic amnesia (PTA) is a common symptom following traumatic brain injury. Although this transient memory deficit implies specific impairment of higher brain function, the actual pathophysiology of PTA is not well understood. The aim of this study was to assess regional cerebral hemodynamics with perfusion computed tomography (CT) in patients during PTA following mild head injury compared to patients with resolved PTA. A total of 74 patients with mild head injury without structural abnormalities on a non-contrast CT scan were included and compared to 25 healthy controls. Two patient groups were defined: (1) a PTA group that was scanned during the episode of PTA (n = 34), and (2) a post-PTA group scanned after resolution of PTA (n = 40). The PTA group had significantly reduced cerebral blood flow (CBF) in the frontal grey matter (41.78 [SD 7.4] versus 44.44 [SD 6.2] mL • 100 g⁻¹ • min⁻¹, p = 0.023), and caudate nucleus (44.59 [SD 6.2] versus 47.85 [SD 7.7] mL • 100 g⁻¹ • min⁻¹, p = 0.021), compared to the post-PTA group. Thus in patients with mild head injury, PTA is associated with cerebral perfusion abnormalities in specific cortical and subcortical regions.
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Affiliation(s)
- Zwany Metting
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands.
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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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Andriessen TMJC, Jacobs B, Vos PE. Clinical characteristics and pathophysiological mechanisms of focal and diffuse traumatic brain injury. J Cell Mol Med 2011; 14:2381-92. [PMID: 20738443 PMCID: PMC3823156 DOI: 10.1111/j.1582-4934.2010.01164.x] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Traumatic brain injury (TBI) is a frequent and clinically highly heterogeneous neurological disorder with large socioeconomic consequences. TBI severity classification, based on the hospital admission Glasgow Coma Scale (GCS) score, ranges from mild (GCS 13-15) and moderate (GCS 9-12) to severe (GCS ≤ 8). The GCS reflects the risk of dying from TBI, which is low after mild (∼1%), intermediate after moderate (up to 15%) and high (up to 40%) after severe TBI. Intracranial damage can be focal, such as epidural and subdural haematomas and parenchymal contusions, or diffuse, for example traumatic axonal injury and diffuse cerebral oedema, although this distinction is somewhat arbitrary. Study of the cellular and molecular post-traumatic processes is essential for the understanding of TBI pathophysiology but even more to find therapeutic targets for the development of neuroprotective drugs to be eventually used in human beings. To date, studies in vitro and in vivo, mainly in animals but also in human beings, are unravelling the pathological TBI mechanisms at high pace. Nevertheless, TBI pathophysiology is all but completely elucidated. Neuroprotective treatment studies in human beings have been disappointing thus far and have not resulted in commonly accepted drugs. This review presents an overview on the clinical aspects and the pathophysiology of focal and diffuse TBI, and it highlights several acknowledged important events that occur on molecular and cellular level after TBI.
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Nott MT, Chapparo C, Heard R, Baguley IJ. Patterns of agitated behaviour during acute brain injury rehabilitation. Brain Inj 2011; 24:1214-21. [PMID: 20715891 DOI: 10.3109/02699052.2010.506858] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To monitor daily shift-by-shift changes in agitated behaviour during adult brain injury rehabilitation. DESIGN A prospective, descriptive study. METHODS Eight participants were monitored daily for up to 28 days. The Agitated Behaviour Scale (ABS) evaluated behaviour during three nursing shifts (morning, afternoon, night). Severity of agitation, peak intensity and concomitant behaviours were calculated. Shift differences and patterns of behavioural changes were analysed. RESULTS Four hundred and seven recordings were taken with the ABS. All participants demonstrated multiple agitated behaviours (between 3-13 concomitant behaviours per person); the most common behaviours were representative of the ABS Disinhibition sub-scale. Weekly peak intensity ranged from 14-55 on the ABS. Mean ABS scores were highest during the afternoon shift and lowest at night. Improved cognition was associated with resolving agitated behaviour; while persistent agitated behaviour was associated with low levels of cognition. Minimal agitated behaviour was observed in participants who emerged from post-traumatic amnesia. CONCLUSIONS Agitated behaviour during acute brain injury rehabilitation has a complex clinical presentation. High levels of agitation observed during the afternoon shift may be associated with low levels of structured activities available at that time, higher levels of environmental stimuli during visiting times and increased cognitive fatigue. Lower cognitive ability was related to consistently higher levels of agitated behaviour and vice-versa.
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Affiliation(s)
- Melissa T Nott
- Brain Injury Rehabilitation Service, Westmead Hospital, Wentworthville, NSW, Australia.
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Abstract
OBJETIVO: Identificar fatores relacionados à amnésia pós-traumática de longa duração. MÉTODO: Estudo prospectivo, longitudinal, com 187 vítimas de trauma cranioencefálico contuso, idade >14 anos, atendidos em hospital de referência para trauma. As variáveis independentes foram: idade, sexo, gravidade do trauma cranioencefálico, local e tipo de lesão, número de lesões encefálicas e uso de medicação com atividade em sistema nervoso central ou corticoides. RESULTADO: O modelo de regressão logística múltipla ajustado pela variável área de lesão (intra/extra axial) evidenciou: Escala de Coma de Glasgow inicial <12 (OR=20,17); Maximum Abbreviated Injury Scale/cabeça >3 (OR=2,80) e uso de Fenitoína (OR=2,60), Midazolan (OR=2,83) ou ambas as drogas (OR=3,83). CONCLUSÃO: O uso do Midazolan e da Fenitoína, além da gravidade do trauma cranioencefálico, destacaram-se como fatores relacionados à amnésia de longa duração.
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Grubenhoff JA, Kirkwood M, Gao D, Deakyne S, Wathen J. Evaluation of the standardized assessment of concussion in a pediatric emergency department. Pediatrics 2010; 126:688-95. [PMID: 20819901 DOI: 10.1542/peds.2009-2804] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The Standardized Assessment of Concussion (SAC) is a validated tool for identifying the effects of mild traumatic brain injury (mTBI). Previous research focused on sport-related sideline evaluation of adolescents and adults. Our goal was to evaluate performance of the SAC among subjects with and without head injury in a pediatric emergency department (ED). METHODS This was an observational study of children 6 to 18 years of age who presented to an ED with blunt head injury (case-patients) or minor extremity injury (controls). SAC and graded-symptom-checklist scores were compared. American Academy of Neurology concussion grades, presence of loss of consciousness and posttraumatic amnesia were also compared with SAC and graded-symptom-checklist scores among case-patients. RESULTS Three hundred forty-eight children were enrolled. SAC scores trended lower (greater cognitive deficits) for case-patients compared with controls but did not reach significance. Graded-symptom-checklist scores were significantly higher among case-patients. Presence of altered mental status magnified this effect. There was no correlation between SAC scores and other indicators of mTBI. There was a positive correlation between graded-symptom-checklist scores and posttraumatic amnesia and American Academy of Neurology concussion grade. CONCLUSIONS The graded symptom checklist reliably identified mTBI symptoms for all children aged 6 years and older. SAC scores tended to be lower for case-patients compared with controls but did not reach significance. Patients with altered mental status at the time of injury manifest an increased number and severity of symptoms. Additional research into strategies to identify cognitive deficits related to mTBI and classify mTBI severity in children is needed.
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Affiliation(s)
- Joseph A Grubenhoff
- Department of Pediatrics, University of Colorado School of Medicine, and Clinical Translational Research Center, Children's Hospital Denver, 13123 E 16th Ave, B-251, Aurora, CO 80045, USA.
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Stulemeijer M, Vos PE, van der Werf S, van Dijk G, Rijpkema M, Fernández G. How Mild Traumatic Brain Injury May Affect Declarative Memory Performance in the Post-Acute Stage. J Neurotrauma 2010; 27:1585-95. [DOI: 10.1089/neu.2010.1298] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maja Stulemeijer
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Pieter E. Vos
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sieberen van der Werf
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Gert van Dijk
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Mark Rijpkema
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Guillén Fernández
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
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Lull N, Noé E, Lull JJ, García-Panach J, Chirivella J, Ferri J, López-Aznar D, Sopena P, Robles M. Voxel-based statistical analysis of thalamic glucose metabolism in traumatic brain injury: Relationship with consciousness and cognition. Brain Inj 2010; 24:1098-107. [DOI: 10.3109/02699052.2010.494592] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Collinson SL, Lam M, Hayes CJ. The utility and benefits of clinical neuropsychology in Asia. Asian J Psychiatr 2010; 3:50-4. [PMID: 23051189 DOI: 10.1016/j.ajp.2010.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 02/19/2010] [Accepted: 03/07/2010] [Indexed: 10/19/2022]
Abstract
Neuropsychological evaluation is the clinical practice of identifying and measuring impairments in mental functions in the context of a patient's mental strengths and preserved abilities for the purposes of diagnosis, rehabilitation planning, and long-term care. Best practice approaches to the medical management of neurodegenerative, neurological and psychiatric illness have lead to increasing demand for neuropsychological services. The simultaneous challenges of Asias' increasing adult and rapidly ageing population underscore the need for consideration of the role of neuropsychological services in day-to-day clinical practice. Here, we outline the clinical utility of neuropsychological assessment and indications for its use in general psychiatric practice.
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Affiliation(s)
- S L Collinson
- Department of Psychology, National University of Singapore, Singapore; Institute of Mental Health, Singapore; Department of Psychological Medicine, National University Hospital, Singapore
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Kosch Y, Browne S, King C, Fitzgerald J, Cameron I. Post-traumatic amnesia and its relationship to the functional outcome of people with severe traumatic brain injury. Brain Inj 2010; 24:479-85. [DOI: 10.3109/02699051003610417] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Bottari C, Dassa C, Rainville C, Dutil É. The criterion-related validity of theIADL Profilewith measures of executive functions, indices of trauma severity and sociodemographic characteristics. Brain Inj 2009; 23:322-35. [DOI: 10.1080/02699050902788436] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Andriessen TMJC, de Jong B, Jacobs B, van der Werf SP, Vos PE. Sensitivity and specificity of the 3-item memory test in the assessment of post traumatic amnesia. Brain Inj 2009; 23:345-52. [DOI: 10.1080/02699050902791414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McGhee H, Cornwell P, Addis P, Jarman C. Treating dysarthria following traumatic brain injury: Investigating the benefits of commencing treatment during post-traumatic amnesia in two participants. Brain Inj 2009; 20:1307-19. [PMID: 17132553 DOI: 10.1080/02699050601081851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE The aims of this preliminary study were to explore the suitability for and benefits of commencing dysarthria treatment for people with traumatic brain injury (TBI) while in post-traumatic amnesia (PTA). It was hypothesized that behaviours in PTA don't preclude participation and dysarthria characteristics would improve post-treatment. RESEARCH DESIGN A series of comprehensive case analyses. METHODS AND PROCEDURES Two participants with severe TBI received dysarthria treatment focused on motor speech deficits until emergence from PTA. A checklist of neurobehavioural sequelae of TBI was rated during therapy and perceptual and motor speech assessments were administered before and after therapy. MAIN OUTCOMES AND RESULTS Results revealed that certain behaviours affected the quality of therapy but didn't preclude the provision of therapy. Treatment resulted in physiological improvements in some speech sub-systems for both participants, with varying functional speech outcomes. CONCLUSIONS These findings suggest that dysarthria treatment can begin and provide short-term benefits to speech production during the late stages of PTA post-TBI.
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Affiliation(s)
- Hannah McGhee
- Division of Speech Pathology, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Wilde EA, Bigler ED, Pedroza C, Ryser DK. Post-traumatic amnesia predicts long-term cerebral atrophy in traumatic brain injury. Brain Inj 2009; 20:695-9. [PMID: 16809201 DOI: 10.1080/02699050600744079] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE To examine post-traumatic amnesia (PTA) and its relation to long-term cerebral atrophy in persons with traumatic brain injury (TBI) using objective indicators of PTA duration and Quantitative Magnetic Resonance Imaging (QMRI). It was hypothesized that longer PTA would predict later generalized atrophy (increased ventricle-to-brain ratio (VBR)). As a guide in assessing patients with TBI, this study determined the probability of developing chronic cerebral atrophy based on PTA duration. RESEARCH DESIGN Probability model using 60 adult patients with mild-to-severe TBI. MAIN OUTCOMES AND RESULTS A logistic regression model with a cut-off determined by normative QMRI data confirmed that longer PTA duration predicts increased VBR. A probability model demonstrated a 6% increase in the odds of developing later atrophy on neuroimaging with each additional day of PTA. CONCLUSIONS PTA has previously proven to be a good indicator of later cognitive recovery and functional outcome and also predicts long-term parenchymal change.
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Affiliation(s)
- Elisabeth A Wilde
- Baylor College of Medicine, Department of Physical Medicine and Rehabilitation, Houston, TX 77030, USA.
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McCarter RJ, Walton NH, Moore C, Ward A, Nelson I. PTA testing, the westmead post traumatic amnesia scale and opiate analgesia: A cautionary note. Brain Inj 2009; 21:1393-7. [DOI: 10.1080/02699050701793793] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Drake AI, McDonald EC, Magnus NE, Gray N, Gottshall K. Utility of Glasgow Coma Scale-Extended in symptom prediction following mild traumatic brain injury. Brain Inj 2009; 20:469-75. [PMID: 16716993 DOI: 10.1080/02699050600676370] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To examine the efficacy of the Glasgow Coma Scale-Extended (GCS-E) for the prediction of symptoms commonly associated with mild traumatic brain injury (TBI). METHOD Three hundred and sixty-one participants with a mild TBI were evaluated using the GCS-E and the Standardized Assessment of Concussion. A sub-group of 185 participants took part in a more extensive evaluation, which also included measures of depression and vestibular symptoms. All participants had a Glasgow Coma Scale score of 15, but experienced varying lengths of post-traumatic amnesia (PTA) as measured by the GCS-E. RESULTS Use of the GCS-E for assessment of PTA duration revealed that longer lengths of amnesia following mild TBI were associated with greater incidence of dizziness, depression and cognitive impairments during the first weeks after injury. CONCLUSION Results suggest that the GCS-E is a useful tool for the prediction of symptoms associated with mild TBI.
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Affiliation(s)
- Angela I Drake
- Department of Neurosciences, Naval Medical Center, San Diego, CA, USA
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Weir N, Doig EJ, Fleming JM, Wiemers A, Zemljic C. Objective and behavioural assessment of the emergence from post-traumatic amnesia (PTA). Brain Inj 2009; 20:927-35. [PMID: 17062424 DOI: 10.1080/02699050600832684] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PRIMARY OBJECTIVE To determine the profile of resolution of typical PTA behaviours and describe new learning and improvements in self-care during PTA. RESEARCH DESIGN Prospective longitudinal study monitoring PTA status, functional learning and behaviours on a daily basis. METHODS AND PROCEDURES Participants were 69 inpatients with traumatic brain injury who were in PTA. PTA was assessed using the Westmead or Oxford PTA assessments. Functional learning capability was assessed using a routine set of daily tasks and behaviour was assessed using an observational checklist. Data was analysed using descriptive statistics. MAIN OUTCOMES AND RESULTS Challenging behaviours that are typically associated with PTA, such as agitation, aggression and wandering resolved in the early stages of PTA and incidence rates of these behaviours were less than 20%. Independence in self-care and bowel and bladder continence emerged later during resolution of PTA. New learning in functional situations was demonstrated by patients in PTA. CONCLUSIONS It is feasible to begin active rehabilitation focused on functional skills-based learning with patients in the later stages of PTA. Formal assessment of typically observed behaviours during PTA may complement memory-based PTA assessments in determining emergence from PTA.
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Affiliation(s)
- Nicole Weir
- Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia.
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