Risk Taking in Hospitalized Patients with Acute and Severe Traumatic Brain Injury

Shirley Fecteau,Alvaro Pascual-Leone,José Maria Tormos,Teresa Roig,Alberto García-Molina,Monste Bernabeu,Jean Levasseur-Moreau,Raúl Pelayo Vergara,Hatiche Kumru,Anthony E Kline

doi:10.1371/journal.pone.0083598

Abstract

Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients’ characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury.

Highlights

Traumatic brain injury (TBI) is an important cause of disability among adults, resulting in tremendous human and financial cost [1,2]
We investigated whether performance at the Balloon Analogue Risk Task (BART) in individuals with TBI differed according to the Number of days post injury, the Severity of the head injury, and the Frontal lobe status
For the time course at the BART, there was an effect of group (repeated measures analysis of variance (ANOVA) with group and time as variables; F(1,36) = 13.804; p = 0.001), an effect of time (F(1.4,48.9) = 11.119; p = 0.001), and a significant interaction group by time (F(1.4,48.9) = 4.641; p = 0.026)

Summary

Introduction

Traumatic brain injury (TBI) is an important cause of disability among adults, resulting in tremendous human and financial cost [1,2]. Cognitive and behavioral deficits seem to be especially deleterious impacting overall functional outcomes and quality of life of patients and their families [8,9,10,11,12,13,14,15] The extent of these deficits following TBI is broad and includes information processing [16], attention [17], memory [18], executive function [19], computation, and discrimination of probabilities [20]. They can occur singly or in combination, can change in severity over time, and often remain greatly impaired despite rehabilitation [10,21,22,23]. We adopt here the definition of risk taking proposed by Leigh [25], that is ‘‘behaviors that involve some potential for danger or harm while providing an opportunity to obtain some form of reward’’

Methods

Results

Discussion

Conclusion