scholarly journals Self-awareness, depression and neurocognitive functions in patients with moderate and severe traumatic brain injury

2020 ◽  
Vol 1 (1) ◽  
pp. 69-80
Author(s):  
Lisandro Heber Vales ◽  
Silveira Brussain ◽  
Fabian Roman
Keyword(s):  
Traumatic Brain Injury ◽  
Depressive Symptoms ◽  
Brain Injury ◽  
Episodic Memory ◽  
Executive Functions ◽  
Rating Scale ◽  
Verbal Learning ◽  
Self Awareness ◽  
Neurocognitive Functions ◽  
Severe Tbi

Introduction: Traumatic Brain Injury (TBI) is the most common cause of disability in youngpatients. In the  self-awareness deficits that can arise after TBI, patients experience difficulties in understanding the disabilities resulting from their injury. This is an important problem that affects the rehabilitation processes. Materials and methods: Self-awareness, neurocognitive functions and depressive symptoms were observed in 31 outpatients with a diagnosis of moderate or severe TBI, aged between 16 and 45 years. Instruments: Patient Competency Rating Scale (PCRS), Neurocognitive Assessment and Hamilton Depression Rating Scale (HDRS). Results: Correlations were found between self-awareness and its dimensions with visuospatial skills, executive functions (double task and cognitive inhibition), episodic memory (Rey Auditory-Verbal Learning Test and Montevideo short story) and depressive symptoms. Conclusions: Patients who have suffered a moderate or severe TBI may have impaired self-awareness. Self-awareness is the ability to objectively perceive (perceive our own self), while maintaining a sense of subjectivity, It is a complex function that needs to use executive functions and episodic memory. The relationship found between interpersonal self-awareness and depressive symptoms does not seem to be conclusive, since this association is probably more complex, and involves other variables not considered in this study.

Metacognitive unawareness correlates with executive function impairment after severe traumatic brain injury

2010 ◽  
Vol 16 (2) ◽  
pp. 360-368 ◽  
Author(s):  
PAOLA CIURLI ◽  
UMBERTO BIVONA ◽  
CARMEN BARBA ◽  
GRAZIANO ONDER ◽  
DANIELA SILVESTRO ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functions ◽  
Severe Traumatic Brain Injury ◽  
Rating Scale ◽  
Wisconsin Card Sorting Test ◽  
Self Awareness ◽  
Card Sorting ◽  
Neuropsychological Battery ◽  
Neuroimaging Data

AbstractThe aim of this study was to evaluate clinical, neuropsychological, and functional differences between severe traumatic brain injury (TBI) outpatients with good and/or heightened metacognitive self-awareness (SA) and those with impaired metacognitive SA, assessed by the Patient Competency Rating Scale (PCRS). Fifty-two outpatients were recruited from a neurorehabilitation hospital based on the following inclusion criteria: 1) age ≥ 15 years; 2) diagnosis of severe TBI; 3) availability of neuroimaging data; 4) post-traumatic amnesia resolution; 5) provision of informed consent. Measures: A neuropsychological battery was used to evaluate attention, memory and executive functions. SA was assessed by the PCRS, which was administered to patients and close family members. Patients were divided into two groups representing those with and without SA. Patients with poor SA had more problems than those with good SA in some components of the executive system, as indicated by the high percentage ofperseverativeerrors and responses they made on the Wisconsin Card Sorting Test. Moreover, a decrease in metacognitive SA correlated significantly with time to follow commands (TFC). This study suggests the importance of integrating an overall assessment of cognitive functions with a specific evaluation of SA to treat self-awareness and executive functions together during the rehabilitation process. (JINS, 2010,16, 360–368.)

scholarly journals Do People With Severe Traumatic Brain Injury Benefit From Making Errors? A Randomized Controlled Trial of Error-Based and Errorless Learning

2017 ◽  
Vol 31 (12) ◽  
pp. 1072-1082 ◽  
Author(s):  
Tamara Ownsworth ◽  
Jennifer Fleming ◽  
Robyn Tate ◽  
Elizabeth Beadle ◽  
Janelle Griffin ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Psychosocial Functioning ◽  
Rating Scale ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Self Awareness ◽  
Errorless Learning ◽  
Meal Preparation ◽  
Severe Tbi

Background. Errorless learning (ELL) and error-based learning (EBL) are commonly used approaches to rehabilitation for people with traumatic brain injury (TBI). However, it is unknown whether making errors is beneficial in the learning process to promote skills generalization after severe TBI. Objective. To compare the efficacy of ELL and EBL for improving skills generalization, self-awareness, behavioral competency, and psychosocial functioning after severe TBI. Method. A total of 54 adults (79% male; mean age = 38.0 years, SD = 13.4) with severe TBI were randomly allocated to ELL or EBL and received 8 × 1.5-hour therapy sessions that involved meal preparation and other goal-directed activities. The primary outcome was total errors on the Cooking Task (near-transfer). Secondary outcome measures included the Zoo Map Test (far-transfer), Awareness Questionnaire, Patient Competency Rating Scale, Sydney Psychosocial Reintegration Scale, and Care and Needs Scale. Results. Controlling for baseline performance and years of education, participants in the EBL group made significantly fewer errors at postintervention (mean = 36.25; 95% CI = 32.5-40.0) than ELL participants (mean = 42.57; 95% CI = 38.8-46.3). EBL participants also demonstrated greater self-awareness and behavioral competency at postintervention than ELL participants ( P < .05). There were no significant differences on other secondary outcomes ( P > .05), or at the 6-month follow-up assessment. Conclusion. EBL was found to be more effective than ELL for enhancing skills generalization on a task related to training and improving self-awareness and behavioral competency.

scholarly journals Distinct dopaminergic abnormalities in traumatic brain injury and Parkinson’s disease

2020 ◽  
Vol 91 (6) ◽  
pp. 631-637
Author(s):  
Peter Owen Jenkins ◽  
Andreas-Antonios Roussakis ◽  
Sara De Simoni ◽  
Niall Bourke ◽  
Jessica Fleminger ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Traumatic Brain Injury ◽  
Parkinson's Disease ◽  
Brain Injury ◽  
Rating Scale ◽  
Single Photon ◽  
Photon Emission ◽  
Striatal Dopamine ◽  
Cross Sectional ◽  
Severe Tbi

ObjectiveTraumatic brain injury (TBI) and rapid eye movement sleep behavioural disorder (RBD) are risk factors for Parkinson’s disease (PD). Dopaminergic abnormalities are often seen after TBI, but patients usually lack parkinsonian features. We test whether TBI, PD and RBD have distinct striatal dopamine abnormalities using dopamine transporter (DaT) imaging.Methods123I-ioflupane single-photon emission CT scans were used in a cross-sectional study to measure DaT levels in moderate/severe TBI, healthy controls, patients with early PD and RBD. Caudate and putamen DaT, putamen to caudate ratios and left-right symmetry of DaT were compared.Results108 participants (43 TBI, 26 PD, 8 RBD, 31 controls) were assessed. Patients with early PD scored significantly higher on the Unified Parkinson’s Disease Rating Scale motor subscale than other groups. Patients with TBI and PD had reduced DaT levels in the caudate (12.2% and 18.7%, respectively) and putamen (9.0% and 42.6%, respectively) compared with controls. Patients with RBD had reduced DaT levels in the putamen (12.8%) but not in the caudate compared with controls. Patients with PD and TBI showed distinct patterns of DaT reduction, with patients with PD showing a lower putamen to caudate ratio. DaT asymmetry was greater in the PD group than other groups.ConclusionsThe results show that patients with early PD and TBI have distinct patterns of striatal dopamine abnormalities. Patients with early PD and moderate/severe TBI showed similar reductions in caudate DaT binding, but patients with PD showed a greater reduction in putamen DaT and a lower putamen to caudate ratio. The results suggest that parkinsonian motor signs are absent in these patients with TBI because of relatively intact putaminal dopamine levels.

Further Directions in Cognitive Rehabilitation in Community- and Home-based Daily Trainings in Clients with Severe Traumatic Brain Injury

2010 ◽  
pp. 266-281
Author(s):  
Masako Fujii
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functions ◽  
Severe Traumatic Brain Injury ◽  
Cognitive Rehabilitation ◽  
Reading Abilities ◽  
Home Based ◽  
Severe Tbi ◽  
One Year ◽  
Paper Method

Community- and home-based daily intense cognitive rehabilitation (CR) of traumatic brain injury (TBI) clients was initiated on the basis on knowledge mentioned in Chapter 17. In the CR, statistically significant changes were demonstrated in attention and reading abilities in sixteen severe TBI clients by one-year daily CR. Improvement of memory and executive functions required more training periods as shown later. The temporary minimum scores of four neuropsychological tests required for social reentry, namely, 50 in TEA, 15 in RBMT, 80 in BADS and 40 in JART, were determined as a goal of our CR. In addition to the drill (pen and paper) method mainly using workbooks, a more advanced program for CR, particularly in clients who reached the required level, was developed together with the clients.

scholarly journals Genetic Variation in the TP53 Gene and Patient Outcomes Following Severe Traumatic Brain Injury

2020 ◽  
Vol 22 (3) ◽  
pp. 334-340 ◽  
Author(s):  
Kaleigh Mellett ◽  
Dianxu Ren ◽  
Sheila Alexander ◽  
Nicole Osier ◽  
Sue R. Beers ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Rating Scale ◽  
P53 Protein ◽  
Tp53 Gene ◽  
The United States ◽  
Preliminary Evidence ◽  
Disability Rating Scale ◽  
Severe Tbi ◽  
A Prospective Study

Traumatic brain injury (TBI) is a leading cause of death and disability, with more than 5 million people in the United States living with long-term complications related to TBI. This study examined the relationship between TP53, the gene that codes for the protein p53, and outcome variability following severe TBI. The p53 protein impacts neuronal apoptosis following TBI, thus investigation into TP53 genetic variability as a prognosticator for TBI outcomes (mortality, Glasgow Outcome Scale [GOS], Neurobehavioral Rating Scale [NRS], and Disability Rating Scale [DRS]) is warranted. Participants ( N = 429) with severe TBI (Glasgow Coma Scale score ≤8) were enrolled into a prospective study with outcomes assessed over 24 months following injury. The single-nucleotide polymorphism Arg72Pro (rs1042522), a functional missense polymorphism for which the CC homozygous genotype is most efficient at inducing apoptosis, was investigated. Individuals with the CC genotype (arginine homozygotes) were more likely to have poorer outcomes at 24 months following TBI compared to individuals with CG/GG genotypes (GOS: p = .048, DRS: p = .022). These findings add to preliminary evidence that p53 plays a role in recovery following TBI and, if further replicated, could support investigations into p53-based therapies for treating TBI.

scholarly journals Temporal lobe activation during episodic memory encoding following traumatic brain injury

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Abbie S. Taing ◽  
Matthew E. Mundy ◽  
Jennie L. Ponsford ◽  
Gershon Spitz
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Episodic Memory ◽  
Temporal Lobe ◽  
Middle Temporal Gyrus ◽  
Temporal Lobes ◽  
Complex Stimuli ◽  
Severe Tbi ◽  
Behavioural Performance ◽  
Episodic Memories

AbstractThe temporal lobes are critical for encoding and retrieving episodic memories. The temporal lobes are preferentially disrupted following a traumatic brain injury (TBI), likely contributing to the difficulties observed in episodic memory. However, the underlying neural changes that precipitate or maintain these difficulties in individuals with TBI remains poorly understood. Here, we use functional magnetic resonance imaging (fMRI) to interrogate the relationship between temporal lobe activation and encoding of episodic stimuli. Participants encoded face, scene, and animal stimuli during an fMRI run. In an out-of-scanner task, participants were required to correctly identify previously displayed stimuli over two presentation runs (each in-scanner stimuli presented twice). Forty-three patients with moderate-severe TBI were recruited and compared with 38 demographically similar healthy controls. The pattern of behavioural performance between groups depended on the stimuli presentation run. The TBI group demonstrated poorer episodic memory for faces and scenes during the first presentation, but not the second presentation. When episodic memory was analysed across all presentation runs, behavioural deficits were only apparent for faces. Interestingly, processing of faces emerged as the only between group-difference on fMRI, whereby TBI participants had an increased signal in the middle temporal gyrus extending to the superior temporal sulcus. These findings provide evidence to suggest that following TBI: (a) episodic memory is preferentially impaired for complex stimuli such as faces, and (b) robust behavioural inefficiencies are reflected in increased activation in specific temporal lobe structures during encoding.

scholarly journals Temporal Lobe Activation Predicts Episodic Memory Following Traumatic Brain Injury

2020 ◽  
Author(s):  
Abbie S. Taing ◽  
Matthew E. Mundy ◽  
Jennie L. Ponsford ◽  
Gershon Spitz
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Episodic Memory ◽  
Temporal Lobe ◽  
Post Injury ◽  
Complex Stimuli ◽  
Neuronal Processes ◽  
Significant Impairment ◽  
Severe Tbi ◽  
Episodic Memories

AbstractThe temporal lobes are critical for episodic memories and are preferentially affected following a traumatic brain injury (TBI). As such, episodic memory difficulties are common following TBI; however, the underlying neural changes that precipitate or maintain these difficulties in the early phase of recovery remains poorly understood. Here, we use functional magnetic resonance imaging (fMRI) to interrogate the relationship of temporal lobe activation in response to face, scene, and animal stimuli. Twenty-five patients with moderate to severe TBI were recruited an average of 2 months’ post-injury and compared with 21 demographically similar healthy controls. Findings indicate that memory for faces was preferentially impaired, compared to scene and animal stimuli. Decreased activity in temporal lobe structures was present for both face (right transverse temporal gyrus) and scene stimuli (right fusiform gyrus), but not for animals. Greater activation in these structures was associated with better long-term recognition. These findings provide evidence to suggest that TBI: a) preferentially affects memory for complex stimuli such as faces and scenes, and b) causes aberrant neuronal processes despite lack of evidence of significant impairment in behavioural performance. The mechanisms underpinning these findings are discussed in terms of differences in strategy use and reduced neural efficiency.

Recovery of Impairments After Severe Traumatic Brain Injury: Findings From a Prospective, Multicentre Study

2006 ◽  
Vol 7 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Robyn L. Tate ◽  
Ross D. Harris ◽  
Ian D. Cameron ◽  
Bridget M. Myles ◽  
Julie B. Winstanley ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Rating Scale ◽  
Hand Function ◽  
Rehabilitation Program ◽  
Acute Injury ◽  
Prospective Multicentre Study ◽  
Severe Tbi ◽  
Clinically Significant

AbstractThis study aimed to describe the recovery of impairments after severe traumatic brain injury (TBI) over a 3-year period. An inception cohort over 2 years was recruited from 11 brain injury rehabilitation units participating in a state-wide program. The 131 individuals with TBI were assessed at admission to the rehabilitation program, 18 months and 3 years post-trauma. This report described results from the Disability Rating Scale (DRS) and Mayo-Portland Adaptability Index (MPAI). Regression analyses, examining the influence of five acute injury variables on DRS and MPAI, revealed that posttraumatic amnesia (PTA) was a significant individual predictor. Data were thus analysed according to duration of PTA: 1 to 2 weeks (n= 19), 2 to 4 weeks (n= 44) and more than 4 weeks (n= 68). At program admission there was poorer overall level of functioning on the DRS in the longest PTA group, but no difference between the shorter PTA groups. Significant improvements occurred on the DRS for all PTA groups over the first 18 months posttrauma, with improvements continuing between 18 months and 3 years. At the 3-year follow-up, frequency data from the MPAI indicated that clinically significant impairments in mobility, hand function, communication and behaviour were uncommon in the shorter PTA groups, although 36% to 47% continued to experience cognitive impairments. Impairments were common in the longest PTA group in some areas, particularly cognition where two thirds or more continued to experience clinically significant impairments in attention, memory and novel problem-solving. These results confirm the predictive significance of PTA duration regarding longer-term level of recovery. They also highlight the limitation in classifying the ‘severe’ TBI category as an homogenous group: significant subgroup differences occurred on medical and functional variables at program admission, 18 months and 3 years posttrauma. These data further substantiate the persistence of neuropsychological impairments in the face of good physical recovery at all levels of severity within the severe TBI group.

scholarly journals The subcortical basis of outcome and cognitive impairment in TBI

Neurology ◽  
2020 ◽  
Vol 95 (17) ◽  
pp. e2398-e2408 ◽  
Author(s):  
Evan S. Lutkenhoff ◽  
Matthew J. Wright ◽  
Vikesh Shrestha ◽  
Courtney Real ◽  
David L. McArthur ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Episodic Memory ◽  
Executive Functions ◽  
Cognitive Functioning ◽  
Functional Outcome ◽  
Common Denominator ◽  
Neuropsychological Measures ◽  
Acute Event

ObjectiveTo understand how, biologically, the acute event of traumatic brain injury gives rise to a long-term disease, we address the relationship between evolving cortical and subcortical brain damage and measures of functional outcome and cognitive functioning at 6 months after injury.MethodsFor this longitudinal analysis, clinical and MRI data were collected in a tertiary neurointensive care setting in a continuous sample of 157 patients surviving moderate to severe traumatic brain injury between 2000 and 2018. For each patient, we collected T1- and T2-weighted MRI data acutely and at the 6-month follow-up, as well as acute measures of injury severity (Glasgow Coma Scale), follow-up measures of functional impairment (Glasgow Outcome Scale–extended), and, in a subset of patients, neuropsychological measures of attention, executive functions, and episodic memory.ResultsIn the final cohort of 113 subcortical and 92 cortical datasets that survived (blind) quality control, extensive atrophy was observed over the first 6 months after injury across the brain. However, only atrophy within subcortical regions, particularly in the left thalamus, was associated with functional outcome and neuropsychological measures of attention, executive functions, and episodic memory. Furthermore, when brought together in an analytical model, longitudinal brain measurements could distinguish good from bad outcome with 90% accuracy, whereas acute brain and clinical measurements alone could achieve only 20% accuracy.ConclusionDespite great injury heterogeneity, secondary thalamic pathology is a measurable minimum common denominator mechanism directly relating biology to clinical measures of outcome and cognitive functioning, potentially linking the acute event and the longer-term disease of traumatic brain injury.

scholarly journals Life after Adolescent and Adult Moderate and Severe Traumatic Brain Injury: Self-Reported Executive, Emotional, and Behavioural Function 2–5 Years after Injury

2015 ◽  
Vol 2015 ◽  
pp. 1-19 ◽  
Author(s):  
Torun Gangaune Finnanger ◽  
Alexander Olsen ◽  
Toril Skandsen ◽  
Stian Lydersen ◽  
Anne Vik ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Depressive Symptoms ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Executive Dysfunction ◽  
Behavioural Problems ◽  
Emotional And Behavioural Problems ◽  
Long Term Outcome ◽  
Severe Tbi

Survivors of moderate-severe Traumatic Brain Injury (TBI) are at risk for long-term cognitive, emotional, and behavioural problems. This prospective cohort study investigated self-reported executive, emotional, and behavioural problems in the late chronic phase of moderate and severe TBI, if demographic characteristics (i.e., age, years of education), injury characteristics (Glasgow Coma Scale score, MRI findings such as traumatic axonal injury (TAI), or duration of posttraumatic amnesia), symptoms of depression, or neuropsychological variables in the first year after injury predicted long-term self-reported function. Self-reported executive, emotional, and behavioural functioning were assessed among individuals with moderate and severe TBI (N=67, age range 15–65 years at time of injury) 2–5 years after TBI, compared to a healthy matched control group(N=72). Results revealed significantly more attentional, emotional regulation, and psychological difficulties in the TBI group than controls. Demographic and early clinical variables were associated with poorer cognitive and emotional outcome. Fewer years of education and depressive symptoms predicted greater executive dysfunction. Younger age at injury predicted more aggressive and rule-breaking behaviour. TAI and depressive symptoms predicted Internalizing problems and greater executive dysfunction. In conclusion, age, education, TAI, and depression appear to elevate risk for poor long-term outcome, emphasising the need for long-term follow-up of patients presenting with risk factors.

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