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Sansonetti D, Fleming J, Patterson F, De Lacy L, Lannin NA. Factors associated with self-awareness impairment in an inpatient brain injury rehabilitation cohort. Brain Inj 2024; 38:699-707. [PMID: 38634476 DOI: 10.1080/02699052.2024.2344096] [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: 01/29/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Self-awareness impairment is common following acquired brain injury and can impact rehabilitation outcomes. Knowledge of factors associated with impaired self-awareness may assist with rehabilitation planning. OBJECTIVES To identify factors associated with self-awareness and determine predictors of self-awareness impairment for adults with traumatic brain injury (TBI) and stroke. DESIGN AND METHODS A retrospective cohort study of rehabilitation inpatients was conducted by medical record audit. Self-awareness was measured using the Self-awareness of Deficits Interview (SADI). Relationships between SADI scores and demographic and clinical variables were identified with non-parametric statistics. Predictors of SADI scores were identified using ordinal regression analyses for TBI and stroke groups. RESULTS Participants were 149 adults (18-70 years) with TBI (n = 110) and stroke (n = 39). For TBI, longer post-traumatic amnesia (PTA), lower functional cognition/communication, and behaviors of concern (BoC) were significantly associated with higher SADI scores (i.e. impaired self-awareness). For stroke, lower functional cognition/communication and motor scores were associated with higher SADI scores. Impaired self-awareness was predicted by PTA duration, acute length of stay and presence of BoC for the TBI group, and by functional cognition/communication for the stroke group. CONCLUSION Different factors were associated with impaired self-awareness for individuals with TBI and stroke during inpatient rehabilitation.
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Affiliation(s)
- Danielle Sansonetti
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Freyr Patterson
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Laura De Lacy
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia
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Potvin MJ, Tétreault G, Audy J, Roy SJ, Rouleau I. Factors Influencing Objective and Subjective Prospective Memory Measures in Traumatic Brain Injury. Arch Clin Neuropsychol 2024:acae048. [PMID: 38915139 DOI: 10.1093/arclin/acae048] [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: 07/06/2023] [Revised: 05/03/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVE To accurately assess prospective memory (PM) functioning in patients who sustained a traumatic brain injury (TBI), it is important to use both subjective (questionnaires) and objective (tests) measures. However, which factors have the most significant effect on each PM measure remains unknown. This observational study aims to verify whether TBI severity or psychological status has the most influence on patients' objective and subjective PM measures. METHOD Fifteen healthy control (HC) participants (n = 15), 19 patients with a mild TBI (n = 19) and 30 patients with a moderate-to-severe TBI (n = 30) were recruited during the post-acute phase. For almost every participant, a relative was also recruited (n = 62). The Test écologique de mémoire prospective (TEMP), an objective computerized PM measure consisting of naturalistic stimuli, was administered to all participants along with anxiety (BAI) and depression inventories (BDI). Participants and their relatives also completed a questionnaire, the comprehensive assessment of PM (CAPM), a subjective PM measure assessing everyday failures. RESULTS Results on the objective PM measure were predicted by TBI severity, while psychological symptoms (BAI and BDI) predicted scores on the subjective PM measure. In addition, relatives in the moderate-to-severe TBI group reported more PM failures on the subjective measure and their perception was significantly correlated with results on the objective PM measure, which was not the case for the other two groups of relatives. CONCLUSIONS Objective PM measures are related to TBI severity and appear more robust against the influence of psychological factors than subjective PM measures.
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Affiliation(s)
- Marie-Julie Potvin
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
- Traumatology Program, Montreal Sacré-Coeur Hospital, CIUSSS Nord-de-l'île-de-Montréal, 5400 Boulevard Gouin West, Montreal, Quebec, H4J 1C5, Canada
| | - Gabrielle Tétreault
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
| | - Julie Audy
- Regional Geriatric Ambulatory Program, CISSS de Laval, 1515 Chomedey Boulevard, Laval, Quebec, H7V 3Y7, Canada
| | - Sarah-Jade Roy
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
| | - Isabelle Rouleau
- Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street West, Montreal, Quebec, H2X 3P2, Canada
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O'Loghlen J, Geraghty T, Kendall M, Nielsen M, Jones R, McLennan V, Watter K, Ownsworth T. Perceived vocational support needs and return-to-work outcomes in the first 12-months post-discharge in individuals with acquired brain injury and spinal cord injury: A retrospective cohort study. Work 2024; 77:275-293. [PMID: 37638466 DOI: 10.3233/wor-230090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Return-to-work (RTW) is often viewed as an important outcome following acquired brain injury (ABI) and spinal cord injury (SCI), although not all individuals have vocational goals and many experience barriers to RTW. OBJECTIVE This study investigated the relationship between RTW and psychosocial functioning at 12-months post-discharge after ABI and SCI and examined patterns of RTW according to perceived need for and receipt of vocational support. METHODS A file audit was conducted for 69 participants with ABI (n = 44) and SCI (n = 25). Data on employment status and perceived vocational support at 3- and 12-months post-discharge, home and community participation, psychological distress, and health-related quality of life were extracted. RESULTS Individuals in paid employment at 12-months post-discharge (22%, n = 15) reported significantly better psychosocial functioning at this timepoint compared to those not employed (78%; n = 54). For those not employed, three subgroups were identified: 1) Did not perceive the need for or receive vocational support (50%; n = 27); 2) Perceived vocational support needs were unmet (19%; n = 10); and 3) Perceived and received vocational support (31%; n = 17). Psychological distress was highest for those who perceived and received vocational support but were not employed. CONCLUSION RTW was associated with better psychosocial functioning after acquired neurological injury. The findings highlight the need for clinicians to explore and revisit individuals' perceived need for and preferences for vocational support and monitor the psychological well-being of those with RTW goals that are not yet successful.
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Affiliation(s)
- Jessica O'Loghlen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Melissa Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Mandy Nielsen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Rachel Jones
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Vanette McLennan
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kerrin Watter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Tamara Ownsworth
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Carmichael J, Hicks AJ, Gould KR, Spitz G, Ponsford J. Network analysis of anxiety and depressive symptoms one year after traumatic brain injury. Psychiatry Res 2023; 326:115310. [PMID: 37356251 DOI: 10.1016/j.psychres.2023.115310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
We used network analysis to explore interrelationships between anxiety and depressive symptoms after traumatic brain injury (TBI). At one year post-injury, 882 adult civilians who received inpatient rehabilitation for moderate-severe TBI self-reported anxiety and depressive symptoms (Hospital Anxiety and Depression Scale). The severity of TBI was characterized acutely by the duration of post-traumatic amnesia (PTA), and TBI-related functional disability was rated by an examiner at one year post-injury using a structured interview (Glasgow Outcome Scale - Extended). We estimated two cross-sectional, partial correlation networks. In the first network, anxiety and depressive symptoms were densely interconnected yet formed three distinct, data-driven communities: Hyperarousal, Depression, and General Distress. Worrying thoughts and having difficulty relaxing were amongst the most central symptoms, showing strong connections with other symptoms within and between communities. In the second network, TBI severity was directly negatively associated with hyperarousal symptoms but indirectly positively associated with depressive symptoms via greater functional disability. The results highlight the potential utility of simultaneous, transdiagnostic assessment and treatment of anxiety and depressive symptoms after moderate-severe TBI. Worrying thoughts, having difficulty relaxing, and the experience of disability may be important targets for treatment, although future studies examining symptom dynamics within individuals and over time are required.
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Affiliation(s)
- Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia; Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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Luo L, Langley C, Moreno-Lopez L, Kendrick K, Menon DK, Stamatakis EA, Sahakian BJ. Depressive symptoms following traumatic brain injury are associated with resting-state functional connectivity. Psychol Med 2023; 53:2698-2705. [PMID: 37310305 PMCID: PMC10123829 DOI: 10.1017/s0033291721004724] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND To determine whether depressive symptoms in traumatic brain injury (TBI) patients were associated with altered resting-state functional connectivity (rs-fc) or voxel-based morphology in brain regions involved in emotional regulation and associated with depression. METHODS In the present study, we examined 79 patients (57 males; age range = 17-70 years, M ± s.d. = 38 ± 16.13; BDI-II, M ± s.d. = 9.84 ± 8.67) with TBI. We used structural MRI and resting-state fMRI to examine whether there was a relationship between depression, as measured with the Beck Depression Inventory (BDI-II), and the voxel-based morphology or functional connectivity in regions previously identified as involved in emotional regulation in patients following TBI. Patients were at least 4 months post-TBI (M ± s.d. = 15.13 ± 11.67 months) and the severity of the injury included mild to severe cases [Glasgow Coma Scale (GCS), M ± s.d. = 6.87 ± 3.31]. RESULTS Our results showed that BDI-II scores were unrelated to voxel-based morphology in the examined regions. We found a positive association between depression scores and rs-fc between limbic regions and cognitive control regions. Conversely, there was a negative association between depression scores and rs-fc between limbic and frontal regions involved in emotion regulation. CONCLUSION These findings lead to a better understanding of the exact mechanisms that contribute to depression following TBI and better inform treatment decisions.
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Affiliation(s)
- Lizhu Luo
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, PR China
| | - Christelle Langley
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Laura Moreno-Lopez
- Division of Anaesthesia, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Keith Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, PR China
| | - David K. Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Emmanuel A. Stamatakis
- Division of Anaesthesia, University of Cambridge, Cambridge, CB2 0QQ, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
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Fisher LB, Curtiss JE, Klyce DW, Perrin PB, Juengst SB, Gary KW, Niemeier JP, Hammond FM, Bergquist TF, Wagner AK, Rabinowitz AR, Giacino JT, Zafonte RD. Using Machine Learning to Examine Suicidal Ideation After Traumatic Brain Injury: A Traumatic Brain Injury Model Systems National Database Study. Am J Phys Med Rehabil 2023; 102:137-143. [PMID: 35687765 PMCID: PMC9729434 DOI: 10.1097/phm.0000000000002054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of the study was to predict suicidal ideation 1 yr after moderate to severe traumatic brain injury. DESIGN This study used a cross-sectional design with data collected through the prospective, longitudinal Traumatic Brain Injury Model Systems network at hospitalization and 1 yr after injury. Participants who completed the Patient Health Questionnaire-9 suicide item at year 1 follow-up ( N = 4328) were included. RESULTS A gradient boosting machine algorithm demonstrated the best performance in predicting suicidal ideation 1 yr after traumatic brain injury. Predictors were Patient Health Questionnaire-9 items (except suicidality), Generalized Anxiety Disorder-7 items, and a measure of heavy drinking. Results of the 10-fold cross-validation gradient boosting machine analysis indicated excellent classification performance with an area under the curve of 0.882. Sensitivity was 0.85 and specificity was 0.77. Accuracy was 0.78 (95% confidence interval, 0.77-0.79). Feature importance analyses revealed that depressed mood and guilt were the most important predictors of suicidal ideation, followed by anhedonia, concentration difficulties, and psychomotor disturbance. CONCLUSIONS Overall, depression symptoms were most predictive of suicidal ideation. Despite the limited clinical impact of the present findings, machine learning has potential to improve prediction of suicidal behavior, leveraging electronic health record data, to identify individuals at greatest risk, thereby facilitating intervention and optimization of long-term outcomes after traumatic brain injury.
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Affiliation(s)
- Lauren B. Fisher
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Joshua E. Curtiss
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Daniel W. Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA; Sheltering Arms Institute, Richmond, VA; Virginia Commonwealth University Health System, Richmond, VA
| | - Paul B. Perrin
- Central Virginia Veterans Affairs Health Care System, Richmond, VA; Department of Psychology and Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA
| | - Shannon B. Juengst
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX
| | - Kelli W. Gary
- Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond, VA
| | | | - Flora McConnell Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
| | | | - Amy K. Wagner
- Departments of Physical Medicine & Rehabilitation and Neuroscience, Center for Neuroscience, Safar Center for Resuscitation Research, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh PA
| | | | - Joseph T. Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Ross D. Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA; Massachusetts General Hospital, Boston, MA; Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Fahey AM, Bain KM, Critchfield EA. "I Couldn't Be Better": Assessing Self-Awareness With the Mayo-Portland Adaptability Inventory-4 Following TBI. J Head Trauma Rehabil 2021; 36:E373-E380. [PMID: 33782347 DOI: 10.1097/htr.0000000000000670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION/OBJECTIVE To describe level of awareness, as assessed by the Mayo-Portland Adaptability Inventory-4 (MPAI-4), across physical, cognitive, functional, and emotional domains in individuals with mild, moderate, and severe traumatic brain injury (TBI) participating in a residential rehabilitation program. In addition, this study aimed to examine the relationship between time since injury and awareness. A novel way the MPAI-4 can be used to measure self-awareness is also presented. METHOD Retrospective analysis of existing data. The MPAI-4 was completed by the patient on admission, as well as by provider consensus within 2 weeks of admission. Level of awareness was determined by discrepancy scores, computed as MPAI-4 provider consensus score minus self-report MPAI-4 score, for the total score and for each index score: Ability, Adjustment, and Participation. PARTICIPANTS A total of 101 military veterans and active duty service members admitted to a Veterans Affairs community reintegration rehabilitation program. RESULTS Discrepancies between patient and provider reports of functioning were found among all severities of TBI across the MPAI-4 total score and index domains measuring Ability, Adjustment, and Participation. Interestingly, those with mild TBI endorsed greater impairments than their providers, while those with moderate and severe TBI reported less impairment on the MPAI-4 than providers. The effect of time varied across domains, and those who were more than 1 year postinjury displayed greater self-awareness. CONCLUSION This study highlights the importance of measuring awareness of functional ability over time and across TBI severity and introduces a novel method for doing so, using the MPAI-4 for comparison between staff and patient reports.
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Affiliation(s)
- Amber M Fahey
- Psychology Service, South Texas Veterans Health Care System, San Antonio
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Dromer E, Kheloufi L, Azouvi P. Impaired self-awareness after traumatic brain injury: A systematic review. Part 2. Consequences and predictors of poor self-awareness. Ann Phys Rehabil Med 2021; 64:101542. [PMID: 34029754 DOI: 10.1016/j.rehab.2021.101542] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Impaired self-awareness (ISA) has frequently been found both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI). OBJECTIVES This is the second of a two-part systematic review on ISA after TBI, focusing on the consequences and predictors of ISA after TBI. METHODS Following the PRISMA guidelines, 95 articles meeting the inclusion criteria were included; 46 were specifically related to this second part of the review. RESULTS Among 16 studies that investigated the effect of ISA on outcome, most (n=13) found poor self-awareness associated with poor rehabilitation, functional, social and vocational outcome and with increased burden on relatives. Multiple factors have been found associated with increased frequency of ISA. ISA was found significantly related to injury severity in 8 of 10 studies, impaired executive functions in 12 of 15 studies, and poor social cognition in 3 studies, but paradoxically inverse associations were repeatedly found between self-awareness and emotional status (11 of 12 studies). Finally, although research in the field is still scarce, ISA seems associated with a dysfunction within brain networks involving the anterior cingulate cortex, anterior insula and fronto-parietal control network. CONCLUSIONS ISA is a complex and multifaceted disorder associated with poor rehabilitation outcome, severe injuries, and deficits of executive functions and social cognition but has an inverse association with mood impairments.
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Affiliation(s)
- Emilie Dromer
- AP-HP, GHU Paris-Saclay, Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
| | - Lyes Kheloufi
- AP-HP, GHU Paris-Saclay, Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
| | - Philippe Azouvi
- AP-HP, GHU Paris-Saclay, Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France.
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Brown L, Fish J, Mograbi DC, Bellesi G, Ashkan K, Morris R. Awareness of deficit following traumatic brain injury: A systematic review of current methods of assessment. Neuropsychol Rehabil 2021; 31:154-188. [PMID: 31642719 DOI: 10.1080/09602011.2019.1680393] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
Background: Awareness of deficit plays an important role in adjustment following a brain injury and has been noted to impact on engagement with and outcome of rehabilitation. However, there are challenges associated with the assessment of awareness. Aim: To systematically review all instruments used to assess intellectual awareness of deficits following Traumatic Brain Injury (TBI) in adults, and evaluate instrument characteristics (e.g., the format and focus of measures of awareness) and assessment methods adopted. Results: Thirty-four studies, all rated as fair to good quality, were identified and within these twenty-three different assessment tools were adopted. The most common method of assessment was patient-proxy discrepancy, with three frequently used instruments employed in a total of 22 of the 34 studies. Across studies, variability was noted regarding the type of assessment method dependent on various sample demographics (e.g., age of sample) and injury characteristics (e.g., time post injury). Conclusions: There is no consensus on the preferred instrument to assess intellectual awareness of deficits after TBI. Continued instrument development should attempt to incorporate multiple perspectives and assessment should take into account demographic and injury-related factors. An insightful avenue for future research would be to determine which factors are likely to impact awareness measurement.
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Affiliation(s)
- Laura Brown
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Jessica Fish
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Daniel C Mograbi
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janerio, Brazil
| | - Giulia Bellesi
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | - Robin Morris
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
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10
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Establishing 'proof of concept' for a social cognition group treatment program (SIFT IT) after traumatic brain injury: two case studies. Brain Inj 2020; 34:1781-1793. [PMID: 33180565 DOI: 10.1080/02699052.2020.1831072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Social cognitive deficits are prevalent after traumatic brain injury (TBI). Despite this, few remediation studies exist. This study aimed to demonstrate 'proof of concept' for a novel group treatment that comprehensively targeted the core processes of social cognition. DESIGN Pre-post case study with two participants, "Greg" and "Aaron", living with severe TBI, with three assessment time points. METHOD Participants were screened at baseline to confirm social cognitive deficits: Greg exhibited difficulties with emotion perception and detecting hints; Aaron with detecting sarcasm and hints. Both reported everyday social problems. Participants then completed the 14-week group treatment program (SIFT IT). Feasibility and outcome measures were repeated post-group and at three-month follow-up. RESULTS The study procedure was implemented with 100% assessment and 89% SIFT IT session attendance, albeit with a lack of proxy-report measures. Both participants described procedures as acceptable, although suggested more group participants could be beneficial. They both demonstrated reliable improvements (RCI > 1.96) on relevant social cognitive measures. Qualitative feedback corroborated findings: Greg reported generalization of therapeutic gains, Aaron reported increased self-awareness but nominal generalization. CONCLUSION Feasibility and limited efficacy outcomes established 'proof of concept' of SIFT IT. Findings will inform the study protocol for a larger randomized-controlled trial.
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11
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The Discrepancy Between Cognitive Complaints and Neuropsychological Test Findings in Persons With Traumatic Brain Injury. J Head Trauma Rehabil 2020; 35:E382-E392. [PMID: 32108707 DOI: 10.1097/htr.0000000000000557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To better identify variables related to discrepancies between subjective cognitive complaints and objective neuropsychological findings in persons with traumatic brain injury (TBI). SETTING Three rehabilitation centers in the United States. PARTICIPANTS In total, 504 community-dwelling adult survivors of TBI following discharge from inpatient rehabilitation. DESIGN Prospective cohort observation study. MAIN MEASURES Wechsler Adult Intelligence Scale, Fourth Edition, Digit Span; Rey Auditory Verbal Learning Test; Trail Making Test, Part B; Word Memory Test; Patient Health Questionnaire-9; Neurobehavioral Symptom Inventory; TBI-Quality of Life item bank. RESULTS Statistical analyses revealed multiple factors associated with subjective-objective discrepancies in attention, memory, and executive functions. Depression was consistently associated with underestimation of cognitive abilities. However, subjective-objective discrepancies varied by cognitive domains in regard to other factors related to underestimation and overestimation of abilities. CONCLUSIONS Reconciling and interpreting subjective-objective discrepancies regarding cognitive functions following TBI are important tasks for case conceptualization and treatment planning. Depression is an important patient characteristic to consider when discrepancy patterns indicate underestimation of cognitive abilities. This study highlights the importance of assessing mood, a modifiable patient characteristic, with self-report symptom inventories. Future studies are needed to connect these findings with TBI outcomes.
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Yeo YX, Pestell CF, Bucks RS, Allanson F, Weinborn M. Metacognitive knowledge and functional outcomes in adults with acquired brain injury: A meta-analysis. Neuropsychol Rehabil 2019; 31:453-478. [PMID: 31876262 DOI: 10.1080/09602011.2019.1704421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pronounced difficulties in functional outcomes often follow acquired brain injury (ABI), and may be due, in part, to deficits in metacognitive knowledge (being unaware of one's cognitive strengths and limitations). A meta-analytic review of the literature investigating the relationship between metacognitive knowledge and functional outcomes in ABI is timely, particularly given the presence of apparently inconsistent findings. Twenty-two articles revealed two distinct methods of measuring metacognitive knowledge: (1) absolute (the degree of inaccurate self-appraisal regardless of whether the error tends towards under- or over-confident estimations) and (2) relative (the degree and the direction of the inaccuracy) discrepancy. Separate meta-analyses were conducted for absolute and relative discrepancy studies to assess the relationship between metacognitive knowledge and functional outcomes (affect-related quality of life, family and community integration, and work outcomes). The pattern of results found suggested that better metacognitive knowledge is related to better overall functional outcomes, but the relationship may differ depending on the outcome domain. These findings generally support the importance of focusing on metacognitive knowledge to improve outcomes following ABI. Nonetheless, the relatively small effect sizes observed suggest that other predictors of functional outcome should be investigated, including other subdomains of metacognition.
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Affiliation(s)
- Yong Xiang Yeo
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Carmela F Pestell
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Fiona Allanson
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, Perth, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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Juengst SB, Nabasny A, Terhorst L. Neurobehavioral Symptoms in Community-Dwelling Adults With and Without Chronic Traumatic Brain Injury: Differences by Age, Gender, Education, and Health Condition. Front Neurol 2019; 10:1210. [PMID: 31849805 PMCID: PMC6879460 DOI: 10.3389/fneur.2019.01210] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Neurobehavioral symptoms after Traumatic Brain Injury (TBI) are prevalent, persist for many years, and negatively affect long-term health, function, and quality of life. Symptoms may differ based on age, gender, education, race, ethnicity, and injury severity. To better understand neurobehavioral functioning after TBI, we need a comprehensive picture of emotional, cognitive, and behavioral symptoms in the context of personal factors that may affect these symptoms. We also need to understand the extent to which these symptoms are specific to TBI, shared across other neurological conditions, or attributable to factors outside of the injury itself. We collected neurobehavioral symptoms via the self-reported Behavioral Assessment Screening Tool (BAST) in a National Cohort of English (n = 2,511) and Spanish speaking (n = 350) community-dwelling adults with and without chronic TBI and other neurological and mental health conditions. The primary focus of the present study was to comprehensively describe neurobehavioral symptoms in adults with and without TBI, broken down by gender and health conditions and then further by age group or educational attainment. As expected, participants with TBI reported more symptoms than Healthy Controls. Regardless of condition, women reported more fatigue, while men reported more substance abuse and impulsivity. Hispanic participants reported more neurobehavioral symptoms than non-Hispanic participants did across health conditions, though primarily Spanish-speakers reported fewer symptoms than English-speakers, suggesting that level of acculturation may contribute to symptom reporting. These data provide a comprehensive characterization of neurobehavioral symptoms in adults with TBI and adults without TBI (healthy controls, adults with other neurological conditions, and adults with mental health conditions).
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Affiliation(s)
- Shannon B Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Andrew Nabasny
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, United States
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14
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Predictors of Homework Engagement in CBT Adapted for Traumatic Brain Injury: Pre/post-Injury and Therapy Process Factors. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Bivona U, Costa A, Contrada M, Silvestro D, Azicnuda E, Aloisi M, Catania G, Ciurli P, Guariglia C, Caltagirone C, Formisano R, Prigatano GP. Depression, apathy and impaired self-awareness following severe traumatic brain injury: a preliminary investigation. Brain Inj 2019; 33:1245-1256. [PMID: 31304792 DOI: 10.1080/02699052.2019.1641225] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary Objective: The primary aim of this study was to determine the frequency of severe impaired self-awareness (ISA) in patients with severe traumatic brain injury (TBI) and the correlates of selected clinical, neuropsychiatric and cognitive variables. The secondary aim of the study was to assess depression and apathy on the basis of their level of self-awareness. Methods: Thirty patients with severe TBI and 30 demographically matched healthy control subjects (HCs) were compared on measures of ISA, depression, anxiety, alexithymia, neuropsychiatric symptoms and cognitive flexibility. Results: Twenty percent of the patients demonstrated severe ISA. Severe post-acute ISA was associated with more severe cognitive inflexibility, despite the absence of differences in TBI severity, as evidenced by a Glasgow Coma Scale (GCS) score lower than 9 in all cases in the acute phase. Patients with severe ISA showed lower levels of depression and anxiety but tended to show more apathy and to have greater difficulty describing their emotional state than patients with severe TBI who showed minimal or no disturbance in self-awareness. Conclusion: These findings support the general hypothesis that severe ISA following severe TBI is typically not associated with depression and anxiety, but rather with apathy and cognitive inflexibility.
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Affiliation(s)
- U Bivona
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - A Costa
- b Unicusano University , Rome , Italy
| | - M Contrada
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - D Silvestro
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - E Azicnuda
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - M Aloisi
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - G Catania
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - P Ciurli
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - C Guariglia
- a IRCCS, Santa Lucia Foundation , Rome , Italy.,c Sapienza University , Rome , Italy
| | - C Caltagirone
- a IRCCS, Santa Lucia Foundation , Rome , Italy.,d Tor Vergata University , Rome , Italy
| | - R Formisano
- a IRCCS, Santa Lucia Foundation , Rome , Italy
| | - G P Prigatano
- e Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center , Phoenix , AZ , USA
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16
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Powell MR, Brown AW, Klunk D, Geske JR, Krishnan K, Green C, Bergquist TF. Injury Severity and Depressive Symptoms in a Post-acute Brain Injury Rehabilitation Sample. J Clin Psychol Med Settings 2019; 26:470-482. [PMID: 30690670 DOI: 10.1007/s10880-019-09602-w] [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: 10/27/2022]
Abstract
This study explored the relationship between injury severity and depressive symptoms for treatment-seeking individuals with traumatic brain injury (TBI). The Mayo Classification System was used to classify TBI severity in 72 participants who completed the Patient Health Questionnaire at admission and at dismissal from rehabilitation. Patients with mild TBI reported more depressive symptoms than those with moderate or severe TBI at admission and at dismissal. Although injury severity groups differed by gender composition, gender had no effect on severity of depressive symptoms. All participants reported fewer depressive symptoms at dismissal from rehabilitation, including lower endorsement of dysphoria by discharge. Participants with mild TBI, however, continued to report depressive symptoms of a mild severity at dismissal, with residual problems with anhedonia. These findings underscore the benefit of interdisciplinary post-acute rehabilitation services for persons with TBI of any severity, including those with mild injury.
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Affiliation(s)
- Matthew R Powell
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. .,Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Allen W Brown
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Danielle Klunk
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jennifer R Geske
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Kamini Krishnan
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,Cleveland Clinic, Cleveland, OH, USA
| | - Cassie Green
- Kirk Neurobehavioral Health, Louisville, CO, USA
| | - Thomas F Bergquist
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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17
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Singh R, Mason S, Lecky F, Dawson J. Comparison of early and late depression after TBI; (the SHEFBIT study). Brain Inj 2019; 33:584-591. [DOI: 10.1080/02699052.2019.1566837] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Rajiv Singh
- Osborn Neurorehabilitation Unit, Department of Rehabilitation Medicine, Sheffield Teaching Hospitals, Sheffield, UK
- Emergency Medicine Research in Sheffield (EMRiS), School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Suzanne Mason
- Emergency Medicine Research in Sheffield (EMRiS), School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Fiona Lecky
- Emergency Medicine Research in Sheffield (EMRiS), School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Jeremy Dawson
- Institute of Work Psychology, Sheffield University Management School, Sheffield, UK
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18
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Ouellet MC, Beaulieu-Bonneau S, Sirois MJ, Savard J, Turgeon AF, Moore L, Swaine B, Roy J, Giguère M, Laviolette V. Depression in the First Year after Traumatic Brain Injury. J Neurotrauma 2018; 35:1620-1629. [PMID: 29566597 DOI: 10.1089/neu.2017.5379] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aims of this study were to document the frequency of major and minor depressive episodes in the first year after traumatic brain injury (TBI), taking into account TBI severity and pre-morbid history of major depression, and to describe trajectories of depressive episodes. Participants were 227 adults who were hospitalized post-TBI (76% male; mean age = 41 years; 50% mild, 33% moderate, and 17% severe TBI). Major and minor depressive episodes were assessed with the Mini International Neuropsychiatric Interview at three time points (4, 8, and 12 months after TBI). Overall, 29% of participants had a major depressive episode in at least one of the three assessments, with fairly stable rates across assessments. Participants with mild TBI were more likely than those with moderate/severe TBI to be diagnosed with major depression, as were individuals with a positive pre-morbid history of depression compared to those without such history. In addition, 13% of participants had a minor depressive episode in at least one of the three assessments. Rates of minor depression significantly decreased from 4 to 8-12 months post-injury. Results also revealed a wide variety of trajectories of depressive episodes across assessments. Of note, 52% of major depression cases still fulfilled diagnostic criteria 4 months later, whereas 38% of minor depression cases deteriorated to major depression at the following assessment. These findings suggest that depression is highly prevalent after TBI, and monitoring of patients with subthreshold depressive symptoms is warranted in order to prevent the development of full-blown major depressive episodes.
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Affiliation(s)
- Marie-Christine Ouellet
- 1 Centre interdisciplinaire de recherche en réadaptation et intégration sociale , Québec City, Québec, Canada .,2 École de psychologie, Université Laval , Québec City, Québec, Canada .,3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada
| | - Simon Beaulieu-Bonneau
- 1 Centre interdisciplinaire de recherche en réadaptation et intégration sociale , Québec City, Québec, Canada .,2 École de psychologie, Université Laval , Québec City, Québec, Canada
| | - Marie-Josée Sirois
- 3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada
| | - Josée Savard
- 2 École de psychologie, Université Laval , Québec City, Québec, Canada .,3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada
| | - Alexis F Turgeon
- 3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada .,4 Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval , Québec City, Québec, Canada
| | - Lynne Moore
- 3 Centre de recherche du CHU de Québec-Université Laval , Axe Santé des populations et Pratiques optimales en santé, Québec City, Québec, Canada
| | - Bonnie Swaine
- 5 École de réadaptation, Faculté de médecine, Université de Montréal , Montréal, Québec, Canada .,6 Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain , Montréal, Québec City, Québec, Canada
| | - Joanne Roy
- 7 CHU de Québec-Université Laval , Québec City, Québec, Canada
| | - Myriam Giguère
- 1 Centre interdisciplinaire de recherche en réadaptation et intégration sociale , Québec City, Québec, Canada
| | - Valérie Laviolette
- 1 Centre interdisciplinaire de recherche en réadaptation et intégration sociale , Québec City, Québec, Canada .,2 École de psychologie, Université Laval , Québec City, Québec, Canada
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Han K, Martinez D, Chapman SB, Krawczyk DC. Neural correlates of reduced depressive symptoms following cognitive training for chronic traumatic brain injury. Hum Brain Mapp 2018; 39:2955-2971. [PMID: 29573026 PMCID: PMC6055759 DOI: 10.1002/hbm.24052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/12/2018] [Accepted: 03/09/2018] [Indexed: 12/24/2022] Open
Abstract
Depression is the most frequent comorbid psychiatric condition among individuals with traumatic brain injury (TBI). Yet, little is known about changes in the brain associated with reduced depressive symptoms following rehabilitation for TBI. We identified whether cognitive training alleviates comorbid depressive symptoms in chronic TBI (>6 months post-injury) as a secondary effect. Further, we elucidated neural correlates of alleviated depressive symptoms following cognitive training. A total of seventy-nine individuals with chronic TBI (53 depressed and 26 non-depressed individuals, measured using the Beck Depressive Inventory [BDI]), underwent either strategy- or information-based cognitive training in a small group for 8 weeks. We measured psychological functioning scores, cortical thickness, and resting-state functional connectivity (rsFC) for these individuals before training, immediately post-training, and 3 months post-training. After confirming that changes in BDI scores were independent of training group affiliation, we identified that the depressive-symptoms group showed reductions in BDI scores over time relative to the non-depressed TBI controls (p < .01). Within the depressive-symptoms group, reduced BDI scores was associated with improvements in scores for post-traumatic stress disorder, TBI symptom awareness, and functional status (p < .00625), increases in cortical thickness in four regions within the right prefrontal cortex (pvertex < .01, pcluster <.05), and decreases in rsFC with each of these four prefrontal regions (pvertex < .01, pcluster < .0125). Overall, these findings suggest that cognitive training can reduce depressive symptoms in TBI even when the training does not directly target psychiatric symptoms. Importantly, cortical thickness and brain connectivity may offer promising neuroimaging markers of training-induced improvement in mental health status in TBI.
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Affiliation(s)
- Kihwan Han
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas
| | - David Martinez
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas
| | - Sandra B Chapman
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas
| | - Daniel C Krawczyk
- Center for BrainHealth, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas.,Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
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20
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Depressive Symptomatology Mediates Associations With Community Reintegration in Veterans With TBI. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Singh R, Mason S, Lecky F, Dawson J. Prevalence of depression after TBI in a prospective cohort: The SHEFBIT study. Brain Inj 2017; 32:84-90. [DOI: 10.1080/02699052.2017.1376756] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rajiv Singh
- Osborn Neurorehabilitation Unit, Department of Rehabilitation Medicine, Sheffield Teaching Hospitals, Sheffield, UK
- Emergency Medicine Research in Sheffield (EMRiS), Health Services Research, School of Health and Related Research (ScHARR) University of Sheffield, UK
| | - Suzanne Mason
- Emergency Medicine Research in Sheffield (EMRiS), Health Services Research, School of Health and Related Research (ScHARR) University of Sheffield, UK
| | - Fiona Lecky
- Emergency Medicine Research in Sheffield (EMRiS), Health Services Research, School of Health and Related Research (ScHARR) University of Sheffield, UK
| | - Jeremy Dawson
- Institute of Work Psychology, Sheffield University Management School, Sheffield, UK
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22
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Geytenbeek M, Fleming J, Doig E, Ownsworth T. The occurrence of early impaired self-awareness after traumatic brain injury and its relationship with emotional distress and psychosocial functioning. Brain Inj 2017; 31:1791-1798. [DOI: 10.1080/02699052.2017.1346297] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Megan Geytenbeek
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, The Princess Alexandra Hospital, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, The Princess Alexandra Hospital, Brisbane, Australia
| | - Emmah Doig
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia
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23
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Self-Awareness and Self-Ratings of On-Road Driving Performance After Traumatic Brain Injury. J Head Trauma Rehabil 2017; 32:E50-E59. [DOI: 10.1097/htr.0000000000000212] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Weddell RA, Wood RL. Exploration of correlates of self-reported personality change after moderate-severe traumatic brain injury. Brain Inj 2016; 30:1362-1371. [PMID: 27541376 DOI: 10.1080/02699052.2016.1195921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Individuals with traumatic brain injury (TBI) often express concern that their personality has changed. Factors generating that conclusion are rarely explored quantitatively. Accordingly, this study examines neurobehavioural correlates of self-reported personality change. METHODS Seventy-one participants and informants were interviewed M = 57.9 (SD = 46.9) months after a moderate-severe TBI. The degree of self-reported personality change was correlated with scores on measures of general cognitive functioning, executive functioning, olfaction, social-emotional behaviour, emotional distress and the Expressed Emotion close informants directed towards them. RESULTS As expected, self-reported personality change correlated with dysexecutive symptoms and depression. Although anosmia (a putative index of ventral frontal damage) correlated with reduced self-reported emotional recognition and empathy, against prediction, the latter measures did not correlate with self-reported personality change. Neither were the predicted positive correlations found between high Expressed Emotion (criticism and emotional over-involvement) and self-reported personality change. DISCUSSION These findings are discussed in the context of previous work. A need to replicate and extend the present findings is suggested. A strategy to further clarify the relationships perceived personality change have with (a) self-reported change in specific behaviours and (b) identity change is advocated. Implications for intervention are suggested.
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Affiliation(s)
- Rodger A Weddell
- a Neuropsychology Department , Morriston Hospital , Swansea , UK.,b Brain Injury Research Group , Swansea University , Swansea , UK
| | - Rodger L Wood
- b Brain Injury Research Group , Swansea University , Swansea , UK
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25
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Awareness of Subjective Fatigue After Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:E60-8. [DOI: 10.1097/htr.0000000000000161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Disrupted Intrinsic Connectivity among Default, Dorsal Attention, and Frontoparietal Control Networks in Individuals with Chronic Traumatic Brain Injury. J Int Neuropsychol Soc 2016; 22:263-79. [PMID: 26888622 PMCID: PMC4763346 DOI: 10.1017/s1355617715001393] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Individuals with chronic traumatic brain injury (TBI) often show detrimental deficits in higher order cognitive functions requiring coordination of multiple brain networks. Although assessing TBI-related deficits in higher order cognition in the context of network dysfunction is promising, few studies have systematically investigated altered interactions among multiple networks in chronic TBI. METHOD We characterized disrupted resting-state functional connectivity of the default mode network (DMN), dorsal attention network (DAN), and frontoparietal control network (FPCN) whose interactions are required for internally and externally focused goal-directed cognition in chronic TBI. Specifically, we compared the network interactions of 40 chronic TBI individuals (8 years post-injury on average) with those of 17 healthy individuals matched for gender, age, and years of education. RESULTS The network-based statistic (NBS) on DMN-DAN-FPCN connectivity of these groups revealed statistically significant (p NBS2.58) reductions in within-DMN, within-FPCN, DMN-DAN, and DMN-FPCN connectivity of the TBI group over healthy controls. Importantly, such disruptions occurred prominently in between-network connectivity. Subsequent analyses further exhibited the disrupted connectivity patterns of the chronic TBI group occurring preferentially in long-range and inter-hemispheric connectivity of DMN-DAN-FPCN. Most importantly, graph-theoretic analysis demonstrated relative reductions in global, local and cost efficiency (p<.05) as a consequence of the network disruption patterns in the TBI group. CONCLUSION Our findings suggest that assessing multiple networks-of-interest simultaneously will allow us to better understand deficits in goal-directed cognition and other higher order cognitive phenomena in chronic TBI. Future research will be needed to better understand the behavioral consequences related to these network disruptions.
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27
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Han K, Chapman SB, Krawczyk DC. Altered Amygdala Connectivity in Individuals with Chronic Traumatic Brain Injury and Comorbid Depressive Symptoms. Front Neurol 2015; 6:231. [PMID: 26581959 PMCID: PMC4631949 DOI: 10.3389/fneur.2015.00231] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/19/2015] [Indexed: 01/04/2023] Open
Abstract
Depression is one of the most common psychiatric conditions in individuals with chronic traumatic brain injury (TBI). Though depression has detrimental effects in TBI and network dysfunction is a "hallmark" of TBI and depression, there have not been any prior investigations of connectivity-based neuroimaging biomarkers for comorbid depression in TBI. We utilized resting-state functional magnetic resonance imaging to identify altered amygdala connectivity in individuals with chronic TBI (8 years post-injury on average) exhibiting comorbid depressive symptoms (N = 31), relative to chronic TBI individuals having minimal depressive symptoms (N = 23). Connectivity analysis of these participant sub-groups revealed that the TBI-plus-depressive symptoms group showed relative increases in amygdala connectivity primarily in the regions that are part of the salience, somatomotor, dorsal attention, and visual networks (p voxel < 0.01, p cluster < 0.025). Relative increases in amygdala connectivity in the TBI-plus-depressive symptoms group were also observed within areas of the limbic-cortical mood-regulating circuit (the left dorsomedial and right dorsolateral prefrontal cortices and thalamus) and the brainstem. Further analysis revealed that spatially dissociable patterns of correlation between amygdala connectivity and symptom severity according to subtypes (Cognitive and Affective) of depressive symptoms (p voxel < 0.01, p cluster < 0.025). Taken together, these results suggest that amygdala connectivity may be a potentially effective neuroimaging biomarker for comorbid depressive symptoms in chronic TBI.
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Affiliation(s)
- Kihwan Han
- Center for BrainHealth®, School of Behavioral and Brain Sciences, University of Texas at Dallas , Dallas, TX , USA
| | - Sandra B Chapman
- Center for BrainHealth®, School of Behavioral and Brain Sciences, University of Texas at Dallas , Dallas, TX , USA
| | - Daniel C Krawczyk
- Center for BrainHealth®, School of Behavioral and Brain Sciences, University of Texas at Dallas , Dallas, TX , USA ; Department of Psychiatry, University of Texas Southwestern Medical Center , Dallas, TX , USA
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28
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Lloyd O, Ownsworth T, Fleming J, Zimmer-Gembeck MJ. Awareness Deficits in Children and Adolescents After Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:311-23. [DOI: 10.1097/htr.0000000000000113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Meulenbroek P, Turkstra LS. Job stability in skilled work and communication ability after moderate-severe traumatic brain injury. Disabil Rehabil 2015; 38:452-61. [PMID: 25958999 PMCID: PMC5308217 DOI: 10.3109/09638288.2015.1044621] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Communication deficits may play a critical role in maintaining employment after traumatic brain injury (TBI), but links between specific communication deficits and employment outcomes have not been determined. This study identified communication measures that distinguished stably employed versus unstably employed adults with TBI. METHODS Participants were 31 adults with moderate-severe TBI who were employed full-time for at least 12 consecutive months before injury in skilled jobs and had attempted return to skilled jobs after injury. Sixteen had achieved stable employment (SE) post-injury, defined as full-time employment for ≥12 consecutive months; and 15 had unstable employment (UE). Participants completed a battery of communication tests identified in a prior qualitative study of communication skills required for skilled work. RESULTS Measures of spoken language comprehension, verbal reasoning, social inference, reading and politeness in spoken discourse significantly discriminated between SE and UE groups. Two nested models were completed and compared. The first model excluded discourse data because of missing data for two UE and one SE participant. This model revealed that measures of verbal reasoning speed (β = -0.18, p = 0.05) and social inference (β = 0.19, p = 0.05) were predictive independent of the overall model. The second model included discourse politeness data and was a better overall predictor of group membership (Likelihood ratio test, Model 1: 3.824, Model 2: 2.865). CONCLUSION Communication measures were positively associated with SE in skilled jobs after TBI. Clinicians should include assessment of communication for adults attempting return to work after TBI, paying specific attention to social inference and speed of verbal reasoning skills. IMPLICATIONS FOR REHABILITATION Traumatic brain injury (TBI) often results in communication impairments associated with the cognitive skills underlying interpersonal skills. Communication impairment after TBI has been anecdotally associated with job instability. This research associate communication functioning with work stability after TBI in skilled jobs. These findings indicate that communication impairment should be assessed in persons with TBI returning to skilled employment after injury.
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Affiliation(s)
- Peter Meulenbroek
- Northwestern University, Department of Physical Medicine and Rehablitation, Feinberg School of Medicine, Chicago, IL, USA
- The Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Lyn S. Turkstra
- University of Wisconsin – Madison, Department of Communication Sciences and Disorders, Madison, WI, USA
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30
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Moriarty H, Winter L, Robinson K, True G, Piersol C, Vause-Earland T, Iacovone DB, Holbert L, Newhart B, Fishman D, Short TH. Exploration of Individual and Family Factors Related to Community Reintegration in Veterans With Traumatic Brain Injury. J Am Psychiatr Nurses Assoc 2015; 21:195-211. [PMID: 26156059 DOI: 10.1177/1078390315591879] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Community reintegration (CR) poses a major problem for military veterans who have experienced a traumatic brain injury (TBI). Factors contributing to CR after TBI are poorly understood. OBJECTIVE To address the gap in knowledge, an ecological framework was used to explore individual and family factors related to CR. DESIGN Baseline data from an intervention study with 83 veterans with primarily mild to moderate TBI were analyzed. Instruments measured CR, depressive symptoms, physical health, quality of the relationship with the family member, and sociodemographics. Posttraumatic stress disorder and TBI characteristics were determined through record review. RESULTS Five variables that exhibited significant bivariate relationships with CR (veteran rating of quality of relationship, physical functioning, bodily pain, posttraumatic stress disorder diagnosis, and depressive symptoms) were entered into hierarchical regression analysis. In the final analysis, the five variables together accounted for 35% of the variance, but only depression was a significant predictor of CR, with more depressed veterans exhibiting lower CR. CONCLUSIONS Efforts to support CR of Veterans with TBI should carefully assess and target depression, a modifiable factor.
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Affiliation(s)
- Helene Moriarty
- Helene Moriarty, PhD, RN, Nursing Service, Philadelphia Veterans Affairs (VA) Medical Center, Philadelphia, PA, USA; Villanova University College of Nursing, Villanova, PA, USA
| | - Laraine Winter
- Laraine Winter, PhD, Nursing Service, Philadelphia VA Medical Center, Philadelphia, PA, USA; Philadelphia Research and Education Foundation, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Keith Robinson
- Keith Robinson, MD, Polytrauma Service, Philadelphia VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gala True
- Gala True, PhD, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine Piersol
- Catherine Piersol, PhD, OTR/L, Thomas Jefferson University, School of Health Professions, Philadelphia, PA, USA
| | - Tracey Vause-Earland
- Tracey Vause-Earland, MS, OTR/L, Thomas Jefferson University, School of Health Professions, Philadelphia, PA, USA
| | - Dolores Blazer Iacovone
- Dolores Blazer Iacovone, MS, OTR/L, CDRS, Polytrauma Service, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Laura Holbert
- Laura Holbert, MSW, Philadelphia Research and Education Foundation, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Brian Newhart
- Brian Newhart, MSW, Polytrauma Service, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Deborah Fishman
- Deborah Fishman, RN, MSN, Nursing Service, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Thomas H Short
- Thomas H. Short, PhD, PStat®, John Carroll University, Department of Mathematics and Computer Science, University Heights, OH, USA
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Llorens R, Noé E, Ferri J, Alcañiz M. Videogame-based group therapy to improve self-awareness and social skills after traumatic brain injury. J Neuroeng Rehabil 2015; 12:37. [PMID: 25889914 PMCID: PMC4404289 DOI: 10.1186/s12984-015-0029-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/27/2015] [Indexed: 11/28/2022] Open
Abstract
Background This study determines the feasibility of different approaches to integrative videogame-based group therapy for improving self-awareness, social skills, and behaviors among traumatic brain injury (TBI) victims and retrieves participant feedback. Methods Forty-two adult TBI survivors were included in a longitudinal study with a pre- and post-assessments. The experimental intervention involved weekly one-hour sessions conducted over six months. Participants were assessed using the Self-Awareness Deficits Interview (SADI), Patient Competency Rating Scale (PCRS), the Social Skills Scale (SSS), the Frontal Systems Behavior Scale (FrSBe), the System Usability Scale (SUS). Pearson's chi-squared test (χ2) was applied to determine the percentage of participants who had changed their clinical classification in these tests. Feedback of the intervention was collected through the Intrinsic Motivation Inventory (IMI). Results SADI results showed an improvement in participant perceptions of deficits (χ2 = 5.25, p < 0.05), of their implications (χ2 = 4.71, p < 0.05), and of long-term planning (χ2 = 7.86, p < 0.01). PCRS results confirm these findings (χ2 = 5.79, p < 0.05). SSS results were also positive with respect to social skills outcomes (χ2 = 17.52, p < 0.01), and FrSBe results showed behavioral improvements (χ2 = 34.12, p < 0.01). Participants deemed the system accessible (80.43 ± 8.01 out of 100) and regarded the intervention as interesting and useful (5.74 ± 0.69 out of 7). Conclusions Integrative videogame-based group therapy can improve self-awareness, social skills, and behaviors among individuals with chronic TBI, and the approach is considered effective and motivating.
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Affiliation(s)
- Roberto Llorens
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain. .,Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain.
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain.
| | - Joan Ferri
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain.
| | - Mariano Alcañiz
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain. .,Ciber, Fisiopatología Obesidad y Nutrición, CB06/03 Instituto de Salud Carlos III, Univesity of Jaume I, Av. Sos Baynat s/n, 12071, Castellón, Spain.
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Kennedy JE, Cooper DB, Reid MW, Tate DF, Lange RT. Profile analyses of the Personality Assessment Inventory following military-related traumatic brain injury. Arch Clin Neuropsychol 2015; 30:236-47. [PMID: 25857403 DOI: 10.1093/arclin/acv014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/12/2022] Open
Abstract
Personality Assessment Inventory (PAI) profiles were examined in 160 U.S. service members (SMs) following mild-severe traumatic brain injury (TBI). Participants who sustained a mild TBI had significantly higher PAI scores than those with moderate-severe TBI on eight of the nine clinical scales examined. A two-step cluster analysis identified four PAI profiles, heuristically labeled "High Distress", "Moderate Distress", "Somatic Distress," and "No Distress". Postconcussive and posttraumatic stress symptom severity was highest for the High Distress group, followed by the Somatic and Moderate Distress groups, and the No Distress group. Profile groups differed in age, ethnicity, rank, and TBI severity. Findings indicate that meaningful patterns of behavioral and personality characteristics can be detected in active duty military SMs following TBI, which may prove useful in selecting the most efficacious rehabilitation strategies.
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Affiliation(s)
- Jan E Kennedy
- Defense and Veterans Brain Injury Center, San Antonio Military Medical Center, Ft Sam Houston, TX, USA
| | - Douglas B Cooper
- Defense and Veterans Brain Injury Center, San Antonio Military Medical Center, Ft Sam Houston, TX, USA
| | - Matthew W Reid
- Defense and Veterans Brain Injury Center, San Antonio Military Medical Center, Ft Sam Houston, TX, USA
| | - David F Tate
- Defense and Veterans Brain Injury Center, San Antonio Military Medical Center, Ft Sam Houston, TX, USA
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA University of British Columbia, Vancouver, Canada
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Staccini L, Tomba E, Grandi S, Keitner GI. The evaluation of family functioning by the family assessment device: a systematic review of studies in adult clinical populations. FAMILY PROCESS 2015; 54:94-115. [PMID: 25154959 DOI: 10.1111/famp.12098] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self-report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test-retest and concurrent reliability, and modest sensitivity to change after treatment. FAD-dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop-out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.
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Affiliation(s)
- Laura Staccini
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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35
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Dahm J, Ponsford J. Comparison of long-term outcomes following traumatic injury: what is the unique experience for those with brain injury compared with orthopaedic injury? Injury 2015; 46:142-9. [PMID: 25123975 DOI: 10.1016/j.injury.2014.07.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/11/2014] [Accepted: 07/11/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Whilst it has been well-demonstrated that traumatic brain injury (TBI) results in long-term cognitive, behavioural and emotional difficulties, less is understood about how these outcomes differ from those following traumatic orthopaedic injury (TOI). The aim of this study was to compare self-reported outcomes at 5-10 years post-injury for those with TBI, TOI, and uninjured controls. It was hypothesised that participants with TBI would have greater cognitive difficulties; participants with TOI and TBI would have similar functional and physical outcomes, both being poorer than controls; and participants with TBI would have poorer psychosocial outcomes than those with TOI. PARTICIPANTS AND METHODS Eighty-eight individuals with complicated mild to severe TBI and 96 with TOI recruited during inpatient rehabilitation were followed up 5-10 years post-injury, together with 48 controls followed over a similar period. Self-report measures of global functioning (GOS-E), quality of life (SF-36), psychological wellbeing (SCL-90-R, HADS, PCL-S), psychosocial difficulties (SIP), cognitive difficulties (SF-36 COG), pain (BPI), and fatigue (FSS) were administered. RESULTS Outcomes for individuals with TBI and TOI differed significantly from controls, with poorer global functioning, and greater psychological distress and interference from pain. Only participants with TBI reported greater cognitive difficulties and anxiety than controls, and were less likely to be employed or in a relationship. Participants with TBI reported greater anxiety, PTSD, psychological distress and psychosocial difficulties than those with TOI. CONCLUSIONS Both TOI and TBI cause long-term disability, interference from pain, and psychological distress. However, cognitive impairments, unemployment, lack of long-term relationships, anxiety and PTSD are more substantial long-term problems following TBI. Findings from this study have implications for managing risks associated with these injury groups and tailoring rehabilitation to improve long-term outcomes.
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Affiliation(s)
- Jane Dahm
- School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia.
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia
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36
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Osborn A, Mathias J, Fairweather-Schmidt A. Depression following adult, non-penetrating traumatic brain injury: A meta-analysis examining methodological variables and sample characteristics. Neurosci Biobehav Rev 2014; 47:1-15. [DOI: 10.1016/j.neubiorev.2014.07.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 06/16/2014] [Accepted: 07/08/2014] [Indexed: 11/25/2022]
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37
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Richardson C, McKay A, Ponsford JL. The trajectory of awareness across the first year after traumatic brain injury: The role of biopsychosocial factors. Brain Inj 2014; 28:1711-20. [DOI: 10.3109/02699052.2014.954270] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mindfulness-Based Cognitive Therapy Reduces Symptoms of Depression in People With a Traumatic Brain Injury. J Head Trauma Rehabil 2014; 29:E13-22. [DOI: 10.1097/htr.0b013e3182a615a0] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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39
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Svoboda E, Richards B, Yao C, Leach L. Long-term maintenance of smartphone and PDA use in individuals with moderate to severe memory impairment. Neuropsychol Rehabil 2014; 25:353-73. [DOI: 10.1080/09602011.2014.927368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Schönberger M, Ponsford J, McKay A, Wong D, Spitz G, Harrington H, Mealings M. Development and predictors of psychological adjustment during the course of community-based rehabilitation of traumatic brain injury: A preliminary study. Neuropsychol Rehabil 2014; 24:202-19. [DOI: 10.1080/09602011.2013.878252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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41
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Goverover Y, Chiaravalloti N. The impact of self-awareness and depression on subjective reports of memory, quality-of-life and satisfaction with life following TBI. Brain Inj 2013; 28:174-80. [PMID: 24304140 DOI: 10.3109/02699052.2013.860474] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the relationship between self-awareness and depressive symptomatology with self-reports of memory, Quality-of-Life (QoL) and satisfaction with life in individuals with traumatic brain injury (TBI). METHODS Cross-sectional survey of 30 community dwelling adults, who sustained a TBI at least 1 year prior to study enrolment. Participants completed questionnaires to assess the constructs of depression, self-awareness, QoL, satisfaction with life and memory. RESULTS Symptoms of depression were significantly associated with self-reports of poor memory abilities, lower QoL and lower satisfaction with life. Additionally, higher levels of self-awareness were associated with lower ratings of QoL and reduced memory abilities and better strategy use regarding memory. However, when examining the contribution of each construct individually, depressive symptomatology, and not self-awareness, was significantly associated with subjective self-reports of memory, QoL and satisfaction with life. CONCLUSIONS This pattern of relationships illustrates that, when a person has a low level of depressive symptoms, his/her reports of QoL, memory and satisfaction with life will be more positive; however, he/she will demonstrate more difficulty with self-awareness. Thus, psychological aspects of recovery must, therefore, be taken into account when using self-reported measures in the evaluation of persons who have sustained TBI.
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Affiliation(s)
- Yael Goverover
- Department of Occupational Therapy, New York University , New York, NY , USA
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42
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Self-Awareness and Health-Related Quality of Life After Traumatic Brain Injury. J Head Trauma Rehabil 2013; 28:464-72. [DOI: 10.1097/htr.0b013e318263977d] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Waldron B, Casserly LM, O'Sullivan C. Cognitive behavioural therapy for depression and anxiety in adults with acquired brain injury. What works for whom? Neuropsychol Rehabil 2013; 23:64-101. [DOI: 10.1080/09602011.2012.724196] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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44
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Senra H, Vieira CR, Nicholls EG, Leal I. Depression and experience of vision loss in group of adults in rehabilitation setting: Mixed-methods pilot study. ACTA ACUST UNITED AC 2013; 50:1301-14. [DOI: 10.1682/jrrd.2012.08.0138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 03/18/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | - Isabel Leal
- ISPA, Instituto Universitário, Uipes - I&D, Lisbon, Portugal
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45
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Cotton GS. Occupational identity disruption after traumatic brain injury: an approach to occupational therapy evaluation and treatment. Occup Ther Health Care 2012; 26:270-282. [PMID: 23899201 DOI: 10.3109/07380577.2012.726759] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
People with traumatic brain injury (TBI) represent a significant population for occupational therapy practitioners. The long-term physical, cognitive, behavioral, and psychosocial symptoms of TBI can contribute to the experience of occupational identity disruption and affect participation outcomes in community living. Although occupational therapy scholars have studied the topic of identity, there appears to be a gap in the education and research literature regarding the topic of post-TBI occupational identity disruption. This article describes theoretical perspectives on identity, summarizes evidence regarding post-TBI identity disruption and the transition process, and examines the role of occupational therapy in evaluating and treating identity disruption.
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Affiliation(s)
- Glen S Cotton
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA.
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46
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Davis LC, Sherer M, Sander AM, Bogner JA, Corrigan JD, Dijkers MP, Hanks RA, Bergquist TF, Seel RT. Preinjury Predictors of Life Satisfaction at 1 Year After Traumatic Brain Injury. Arch Phys Med Rehabil 2012; 93:1324-30. [DOI: 10.1016/j.apmr.2012.02.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/21/2012] [Accepted: 02/22/2012] [Indexed: 11/30/2022]
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Association of depressive symptoms with functional outcome after traumatic brain injury. J Head Trauma Rehabil 2012; 27:87-98. [PMID: 22411107 DOI: 10.1097/htr.0b013e3182114efd] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test whether improved functional status correlates with more depressive symptoms after traumatic brain injury (TBI). This is based on the concept that increasing awareness of deficits may exacerbate depression, even while survivors are making functional improvements. PARTICIPANTS A total of 471 individuals with TBI (72% white; 71% men; median Glasgow Coma Scale (GCS) score = 11) enrolled during acute care or inpatient rehabilitation and followed up at a median of 6 months. MAIN MEASURE Beck Depression Inventory-II (BDI-II), Glasgow Outcome Scale-Extended, and Functional Status Examination (FSE). RESULTS We found significant Spearman rank order correlations between BDI-II scores and the total FSE as well as all domains of the FSE. Lower functional levels correlated with more depressive symptoms. Modeling of predictive factors, including subject characteristics, injury-related characteristics, and outcome measures, resulted in 2 models, both containing age and GCS along with other factors. CONCLUSION The relation between depressive symptoms and functional outcomes is complex and a fertile area for further research. The authors would encourage clinicians to monitor patients for depressive symptoms to help to prevent the detrimental impact on recovery.
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de Guise E, LeBlanc J, Tinawi S, Lamoureux J, Feyz M. Acute Relationship between Cognitive and Psychological Symptoms of Patients with Mild Traumatic Brain Injury. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/147285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective. The goal of this study was to explore the relationship between acute psychological reactions and cognition as well as postconcussive symptoms in patients with MTBI. Research Methods. Sociodemographic and medical history data were gathered for 59 patients diagnosed with MTBI. Validated and standardized tools were used to assess anxiety, depression, and cognitive function two weeks after trauma. Postconcussive symptoms were assessed with the Rivermead postconcussive questionnaire. Results. Despite the absence of significant neuropsychological deficits, a very high level of anxiety and depression was observed in our cohort. Level of anxiety and depression were positively related to cognitive performances and to postconcussive symptoms. Moreover, patients with preexisting alcohol and psychological problems were more likely to present with acute depression after MTBI. Conclusions. Early psychological rehabilitation should be provided to decrease the intensity and frequency of postconcussive symptoms and diminish the risk of these problems becoming chronic.
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Affiliation(s)
- Elaine de Guise
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, QC, Canada H3G 1A4
- Neurology and Neurosurgery Department, McGill University, Montreal, QC, Canada H3G 1A4
| | - Joanne LeBlanc
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, QC, Canada H3G 1A4
| | - Simon Tinawi
- Rehabilitation Medicine Department, McGill University Health Centre-Montreal General Hospital, Montreal, QC, Canada H3G 1A4
| | - Julie Lamoureux
- Social and Preventive Medicine Department, University of Montreal, Montreal, QC, Canada H3C 3J7
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, QC, Canada H3G 1A4
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Senra H, Oliveira RA, Leal I. From self-awareness to self-identification with visual impairment: a qualitative study with working age adults at a rehabilitation setting. Clin Rehabil 2011; 25:1140-51. [DOI: 10.1177/0269215511410729] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To explore the experience of vision loss, focusing on working age patients' self-awareness of impairment and self-identification with the impairment. Design: A cross-sectional and qualitative study, using semi-structured interviews. Setting: A specialized rehabilitation centre and a low vision unit at a public hospital. Participants: A convenience sample of 38 patients between the ages of 20 and 65, with sight loss caused by a serious ophthalmological condition acquired after the age of 18, and doing their rehabilitation. Main outcome measures: A semi-structured interview, addressing three core areas: the emotional impact of vision loss; adjustment; and social support. Interviews were transcribed, coded and analysed by two independent researchers. Results: Seven themes emerged from interviews. Changes in patients' identity, achievement and future life projection arose as being the main transformations caused by vision loss. Self-awareness of impairment appeared associated with the patients' first contact with their loss, while self-identification with the impairment arose connected with the later embodiment process of the vision loss. Conclusions: Patients’ self-awareness and self-perceptions of impairment appear to be two important milestones in the adjustment process to vision loss. Their assessment and monitoring over the rehabilitation period might help to promote impairment acceptance and rehabilitation outcomes.
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Affiliation(s)
- Hugo Senra
- High Institute of Applied Psychology (ISPA), Psychology and Health Research Unit, Lisbon, Portugal
| | - Rui Aragão Oliveira
- High Institute of Applied Psychology (ISPA), Psychology and Health Research Unit, Lisbon, Portugal
| | - Isabel Leal
- High Institute of Applied Psychology (ISPA), Psychology and Health Research Unit, Lisbon, Portugal
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Hudak A, Warner M, de la Plata CM, Moore C, Harper C, Diaz-Arrastia R. Brain morphometry changes and depressive symptoms after traumatic brain injury. Psychiatry Res 2011; 191:160-5. [PMID: 21310594 PMCID: PMC3053081 DOI: 10.1016/j.pscychresns.2010.10.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
Abstract
Traumatic brain injury (TBI) is associated with an increased risk of depressive symptoms. Recent imaging studies on spontaneous depression have implicated several brain structures; however, few studies have done the same for post-TBI depression. We report on a pilot observational study correlating atrophy of brain regions of interest in subjects after TBI with depressive symptoms measured by the Beck Depression Inventory-II. Regional brain volumes were calculated on both acute and 6-month MRI using an automated segmentation algorithm (FreeSurfer). Percent volume changes in brain regions were correlated with BDI-II scores using Spearman's rank order correlation coefficient. Correction for multiple comparisons was performed using the false discovery rate (FDR). Three regions of interest (left rostral anterior cingulate and bilateral orbitofrontal cortex) were found to be significantly correlated with depressive symptoms (FDR 0.05). With FDR 0.1, six regions were significantly correlated. The use of volumetric analysis of brain regions of interest to study post-TBI depression is worthy of further study. Regions associated with depressive symptoms in this pilot study were similar to those implicated in study of spontaneous depression.
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Affiliation(s)
- Anne Hudak
- Dept. of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9055, USA.
| | - Matthew Warner
- Dept. of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9036, USA
| | - Carlos Marquez de la Plata
- University of Texas at Dallas, Center for Brain Health, Frances and Mildred Goad Bldg., 2200 West Mockingbird Lane, Rm. 3.252, Dallas, TX 75235, USA
| | - Carol Moore
- Dept. of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9036, USA
| | - Caryn Harper
- Dept. of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9036, USA
| | - Ramon Diaz-Arrastia
- Dept. of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9036, USA
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