Coping and family functions after closed head injury

Relationship between learning and memory deficits and Arp2 expression in the hippocampus in rats with traumatic brain injury

OBJECTIVE

To investigate the learning and memory impairments at acute phase after mild traumatic brain injury (TBI) in Sprague-Dawley rats and its relationship with the expression of Arp2.

METHODS

Hundred adult male Sprague-Dawley rats were randomly assigned into a TBI group or a control group. TBI was produced by using an impact acceleration model. Learning and memory function was assessed using Morris Water Maze test after different injury intervals, and synaptic function was investigated after TBI treatment by using field excitatory postsynaptic and long-term potentials. Western blot, immunochemistry, and polymerase chain reaction (PCR) were used to detect the mRNA and protein expression of actin-related protein 2 (Arp2) after injury, whereas Nissl staining and DNA ladder assays were performed to detect neuron apoptosis.

RESULTS

Using water maze measurement, the authors found escape latency to be significantly higher in the TBI group compared with the control group, and at 7 days postinjury, the difference almost reached up to 30 seconds. Field excitatory postsynaptic potential measurement further found that the long-term potential decreased by nearly 20% in the TBI group compared with the control group, which meant the synaptic excitatory function was downregulated in the TBI group. Further, no significant neuron apoptosis could be detected in the TBI group by Nissl staining, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, and DNA ladder assays. At last, we found that after TBI treatment, the Arp2 mRNA and protein levels were decreased in a time-dependent manner and reached 29.3% and 45.7% of control at 7 days postinjury, separately, and the decrease of mRNA of Arp2 was correlated with delayed escape latency.

CONCLUSIONS

This study demonstrated that impairments of learning and memory function in the acute phase after mild TBI may be induced by a reduction in Arp2 expression.

Stress and coping among families of patients with traumatic brain injury: a review of the literature

AIMS AND OBJECTIVES

This literature review aims to structure the available information on the psychological reactions of family members confronted with traumatic brain injury. The stress-coping theory and the systems theory provide the theoretical framework for this review.

METHOD

Literature review.

RESULTS

The level of stress experienced by the family members of patients who have traumatic brain injury is such that professional intervention is appropriate, even after 10-15 years. Not the severity of the injury but the nature of the injuries determines the level of stress. Partners experience more stress than parents. Children have specific difficulties. Young families with little social support, financial, psychiatric and/or medical problems are the most vulnerable. Coping with traumatic brain injury can be described in phases. The better family members can cope with the situation, the better the patient's recovery. There are functional and non-functional coping mechanisms and coping is influenced by such factors as gender, social and professional support and the possibility to have reciprocal communication or an affective relation with the patient.

RELEVANCE TO CLINICAL PRACTICE

Support from professionals reduces the stress being experienced and encourages people to cope effectively. Conflicts with professional carers should be avoided. Every attempt should be made to develop models of long-term support and care that alleviate sources of burden on relatives. Further research is necessary to develop such models.

Coping and stress in Canadian family caregivers of persons with traumatic brain injuries

The purpose of this study was to document the stresses reported by Canadian caregivers of persons with brain injuries and to consider the factors which serve to mediate or moderate such stress. Highest stress scores on the Holroyd Questionnaire on Resources and Stress-Short Form (QRS) were associated with Lifespan Care and Personal Burden. Although overall burden as reported on the QRS by parents and spouses did not differ from other studies, it did differ somewhat for specific types of burden. Social Support and Spiritual Support, as measured by the F-COPES, fell within the medium use category, and scores for Reframing, Mobilizing and Passive Appraisal fell within the high use category. In multiple regression analyses, client competency as measured by the Patient Competency Rating Scale emerged as a major predictor of stress associated with Cognitive Impairment, Physical Limitations, Lifespan Care, Terminal Illness Stress, Limits on Family Opportunities, and Personal Burden. In contrast, other client characteristics (e.g. Time Since Injury) accounted for relatively little variance. The results also indicate that both Refraining and Seeking Spiritual Support as coping strategies can make an important contribution to stress reduction.

Head injury and sexual dysfunction

An extensive review of the head injury and human sexuality literature was completed, to augment an understanding of the impact of traumatic head injury on sexual functioning. Despite clinical evidence that sexual dysfunction after head injury is prevalent and of great import, sexual concerns have been neglected in much of the post-traumatic head injury and rehabilitation literature. Characteristics of head injury concerning cerebral physiology, post-traumatic sequelae, and the effects on sexual functioning are examined. Rehabilitation and family/spouse literature was also examined for information on sexuality. The majority of this article reviews research on sexual sequelae after head injury, such as impulsiveness/inappropriateness, changes in libido and sexual frequency, global sexual difficulties, and specific sexual dysfunctions. Treatment models for the sexual problems after head injury are also reviewed and found to be limited in number. Treatment issues and suggestions are addressed. This article provides information about the sexual problems of head-injured patients to facilitate the development of diagnostic and intervention programmes.

The post-concussional syndrome: physiogenesis, psychogenesis and malingering. An integrative model

Current models of post-concussional symptoms after mild head injury rest on the dichotomy between organic and psychogenic factors, which underpins Lishman's formulation; organic genesis and psychologically-driven persistence (Br J Psychiatry 1988; 153: 460-469). Recent prospective neuropsychological and bio-social studies of mild head injury, and perspectives from cognitive behavioural and health psychology, are reviewed. It is argued that the organic-psychogenic conceptualization inadequately explains chronic post-concussional symptoms. Psychosocial and cognitive-behavioural factors and the coping process may influence post-concussional symptoms over their entire time course, in particular the late phase. A multifactorial model of chronic post-concussional symptoms is proposed which integrates biological processes with these factors. It is through the recognition and identification of separate processes that questions about outcome, the limits of the impact of organic and psychosocial factors, the nature of exaggeration, and appropriate therapy, may be resolved.

Psychosocial outcome following spinal cord injury

Studies have indicated that loss of social contact remains the primary complaint of people with head injuries many years after discharge. In an attempt to disentangle specific and nonspecific effects of head injury a study was undertaken to compare a group of 15 men with severe closed head injuries and their wives, with a group of 15 men with complete, traumatic spinal cord injuries and their partners (n = 60). Time since discharge extended from 4 months to several years. This paper focuses primarily upon the results and implication of the responses from the group of men with spinal cord injuries and their partners. The Interview Schedule for Social Interaction was correlated with the Leeds Scale for the Self Assessment of Anxiety and Depression. All groups reported low availability and adequacy of social integration and exhibited high levels of depression. The group of men with spinal cord injuries had the lowest scores for the availability of social integration, indicating that the social isolation which has previously been identified amongst people with head injuries may not be attributable solely to brain damage.

Family functioning, social support and depression after traumatic brain injury

Functional outcome after traumatic brain injury (TBI) is thought to be dependent upon effective social support and avoidance of depressive episodes. Research indicates that post-injury changes often occur in the family's functioning, hence impacting the family's ability to provide the needed social support. Social support, in turn, has been hypothesized to work as a buffer between significant life event and levels of depressive symptoms. Thus poor social support after a TBI, due to changes in family functioning, could result in depressive episodes for the person with a TBI. This paper empirically examines this question by investigating whether social support is predictive of depression in persons who have sustained a TBI. Thirty-nine persons who had sustained TBI were interviewed to assess their family functioning, perceived social support, and current depressive symptomatology. The results showed that the effective use of problem-solving and behavioural coping strategies by the family in response to TBI was significantly related to lower levels of depression in the person who sustained the TBI. However, perceived social support was not predictive of depression.

Centripetal and centrifugal family life cycle factors in long-term outcome following traumatic brain injury

The family life cycle model categorizes stresses on family systems in terms of their source and their effects on family members. Centripetal forces bring members together while centrifugal forces lead to loosened intrafamilial ties. This study examined the association of normative, developmental and centripetal illness-related family forces with patient outcome. Hypothesized centripetal and centrifugal forces acting on 65 families of married male TBI patients were used as independent variables in stepwise multiple regressions with criterion measures of quality of life outcome used as dependent measures. Centripetal variables included measures of family coping, marital adjustment, and number of years married. Centrifugal variables included number of children, age of oldest child, and amount of perceived financial strain. Regression equations obtained had multiple R's ranging from 0.623 to 0.407 (p values < 0.017). Results suggest that families normatively dealing with the developmental stage of the family with young children may face unique challenges when a husband sustains a TBI, particularly when financial strain exists. Stages in family development involving conflict between centripetal and centrifugal forces may be most problematic for families to resolve, and potentially the most effective periods for intervention.