Traumatic Brain Injury Disorders Research Articles

Attentional Orienting and Disfluency-Related Memory Boost Are Intact in Adults With Moderate-Severe Traumatic Brain Injury.

Traumatic brain injury (TBI) is associated with a range of cognitive-communicative deficits that interfere with everyday communication and social interaction. Considerable effort has been directed at characterizing the nature and scope of cognitive-communication disorders in TBI, yet the underlying mechanisms of impairment are largely unspecified. The present research examines sensitivity to a common communicative cue, disfluency, and its impact on memory for spoken language in TBI. Fifty-three participants with moderate-severe TBI and 53 noninjured comparison participants listened to a series of sentences, some of which contained disfluencies. A subsequent memory test probed memory for critical words in the sentences. Participants with TBI successfully remembered the spoken words (b = 1.57, p < .0001) at a similar level to noninjured comparison participants. Critically, participants with TBI also exhibited better recognition memory for words preceded by disfluency compared to words from fluent sentences (b = 0.57, p = .02). These findings advance mechanistic accounts of cognitive-communication disorder by revealing that, when isolated for experimental study, individuals with moderate-severe TBI are sensitive to attentional orienting cues in speech and exhibit enhanced recognition of individual words preceded by disfluency. These results suggest that some aspects of cognitive-communication disorders may not emerge from an inability to perceive and use individual communication cues, but rather from disruptions in managing (i.e., attending, weighting, integrating) multiple cognitive, communicative, and social cues in complex and dynamic interactions. This hypothesis warrants further investigation.

Neuroimaging Correlates of Post-Traumatic Stress Disorder in Traumatic Brain Injury: A Systematic Review of the Literature

IntroductionNeuroimaging has been a highly utilized technique for studying traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) independently of one another, however, neuroimaging has increasingly been identified as a useful tool in better understanding TBI-related psychiatric conditions, such as PTSD.ObjectivesTo complete a systematic review of the literature examining neuroimaging findings in TBI-related PTSD and to highlight the current literature’s limitations in order to strengthen future research.MethodsA PRISMA compliant literature search was conducted in PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases prior to May of 2019. The initial database query yielded 4388 unique articles, which were narrowed down based on specified inclusion criteria (e.g., clear TBI definition, clinician-diagnosed PTSD, statistically analyzed relationship between neuroimaging and PTSD, quantified time interval between TBI and neuroimaging).ResultsA final cohort of 10 articles met inclusion criteria, comprising the findings of 482 participants with TBI. Key neuroanatomical findings among the included articles suggest that PTSD is associated with significant changes in whole-brain networks of resting state connectivity and disruptions in bilateral frontal and temporal white matter tracts, fronto-limbic pathways, the internal capsule, and the uncinate fasciculus (Figure 1). Figure 1a:Neuroimaging Findings in TBI-related PTSD.Figure 1b.Replicated Neuroimaging Findings in TBI-related PTSD in the Right Uncinate Fasciculus.ConclusionsAdditional inquiry with attention to specified imaging timing post-injury, consistent TBI definitions, clinician-diagnosed TBI and PTSD, and control groups is crucial to extrapolating discrepancies between primary and TBI-related PTSD. Prospective studies could further differentiate predisposing factors from sequelae of TBI-related PTSD.DisclosureNo significant relationships.

Sleep Disorders in Traumatic Brain Injury.

Sleep disorders are common after traumatic brain injury (TBI). This study will review the spectrum and proposed mechanisms of TBI-associated sleep disorders and discuss the clinical approach to diagnosis and management of them. Disordered and fragmented sleep with insomnia and daytime sleepiness is very common after TBI. Sleep disruption contributes to morbidity and neurocognitive and neurobehavioral deficits and prolongs the recovery phase after injury. Early recognition and correction of these problems may limit the secondary effects of TBI and improve patient outcomes. Evaluating sleep disorders in TBI should be an important component of TBI assessment and management. Finally, newer research techniques for early diagnosis, prognosis, and improved outcomes after TBI will also be addressed.

Melatonin administration for sleep disorders in traumatic brain injury: A review of the literature

Melatonin administration for sleep disorders in traumatic brain injury: A review of the literature

Personally - emotional sphere in patients with mild traumatic brain injury

One of the earliest and most significant disorders in traumatic brain injury (TBI) is a violation of the emotional and personal sphere. To study the degree of anxiety and depression in patients with mild traumatic brain injury

Neuropsychological and behavioral disorders, functional outcomes and quality of life in traumatic brain injury victims.

Introductionthe assessment of neuropsychological and behavioral disorders outcomes, functional outcomes and quality of life in traumatic brain injury victims. It was also to evaluate initial means of care provided to these patients. Finally, to study correlations between neuropsychological and behavioral disorders with demographic characteristics, injury severity, functional status and quality of life.Methodsit was a cross-sectional study including 50 patients with traumatic brain injury conducted in the physical medicine and rehabilitation department of Sfax. Memory disorders were tested by the mini mental state and the Glaveston orientation and amnesia tests. Executive functions were evaluated by the dysexecutive function scale. The psychological profile was evaluated using the hospital anxiety and depression scale and behavioral disorders were tested by the agitated behavior scale. Glasgow outcome scale has allowed the assessment of traumatic brain injury severity in terms of disability. Otherwise, functional capacity was measured by functional independence measure scale. Finally, health-related quality of life was measured using a generic measure (short-form-36) and the QOLIBRI scales.Resultsabnormal executive functions were noted in 41 patients (82%) with a dysexcutive function average score of 33.20 ± 22.74. About psychological profile, depressive symptoms were found in 32 patients (64%). Moreover anxiety was noted in 20 patients (40%). Behavioral disorders such as aggressiveness and agitation were noted respectively in 32 (64%) and 8 patients (16%). The global social functional evolution was considered as unfavorable in 42% of the patients and favorable in 58%. Regarding to functional independence measure scale, 92% of the victims showed impairment. Memory impairment and abnormal executive functions were statistically correlated with traumatic brain injury severity. Elementary brain injury lesions shown on computed tomography were correlated with memory disorders especially for temporal, cortical brain contusion and diffuse axonal injury. Our study showed that patients with severe memory impairment, abnormal executive functions and depressive mood had significant functional.Conclusionthe executive function disorders, depressed mood and the memory disorders seemed to be the most frequent among neuropsychological disorders in traumatic brain injury. We noted that it is so important to evaluate neuropsychological disorders in traumatic brain injury because they were underestimated. We have already started this experience despite the lack of means in our department. The evaluation of the executive function in addition to the classic neuropsychological assessment is essential to propose efficient means of rehabilitation.

Study of Epidemiology of Traumatic Brain Injury and Prevalence of Psychiatric Disorders in Traumatic Brain Injury at 3 Months Follow-Up

Traumatic brain injury (TBI) is a major global health problem with an annual incidence of 10million cases globally. Despite the good recovery with modern treatment measures, the cognitive and behavioral deficits give rise to the major morbidity. These deficits amount in failure to return to work and maintain social activities. A prospective clinical study of 187 inpatients with Traumatic Brain Injury was done in Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh from August 2015 to August 2017. All patients aged between 15-60years, with normal premorbid personality admitted with traumatic brain injury, were included in the study. Appropriate socio-demographic and clinical data was collected while inpatient, and 3 months post trauma. All the patients were subjected to structured interview using MINI PLUS (English version 5.0.0) for assessment of cognitive and neurobehavioral disorders. The prevalence of cognitive and neurobehavioural disorders following traumatic brain injury in the present study was40.6%.Patients with traumatic brain injury often experience enduring emotional and cognitive consequences; major depressive disorder being the most common, followed by somatoform and anxiety disorders. Treatment of these patients should involve a multidisciplinary approach, with the psychiatrist working in close collaboration with the patient, family, neurologist/neurosurgeon, psychologist and social worker.

THE AMELIORATION OF BEHAVIORAL DISTURBANCES IN TBI PATIENTS WITH CHRONIC FRONTAL SYNDROME AFTER TREATMENT IN DIFFERENT REHABILITATION PROGRAMS

We evaluated the effectiveness of three different rehabilitation programs for chronic behavioral disorders in traumatic brain injury (TBI) patients with orbito-frontal damage (OFC), incurred from 13 to 15 years prior to enrollment. From among 547 adult patients with severe TBIs treated neurosurgically from 1999 to 2003, 60 were selected for the study, divided into three groups of 20, matched for age and sex. Each group received one of three different rehabilitation protocols. Group A received a comprehensive program with two components: (1) a 6-month early neuropsychological rehabilitation program targeting cognitive deficits, beginning immediately post-injury, and (2) the “Academy of Life” program, with weekly meetings aimed at reducing behavioral disorders in social transactions. Group B received only cognitive rehabilitation, while Group C received only the “Academy of Life” progam. The Frontal Behavioral Inventory (FBInv) was used to assess behavioral disorders at baseline and again after completion of the study. At baseline, all 60 patients still displayed all or most of the common behavioral symptoms characteristic of frontal syndrome. The improvement achieved by group A (the comprehensive program) was significantly better upon completion of the study than that shown by the patients in groups B (cognitive only) and C (social skills only). A comprehensive program of rehabilitation, which combines early neuropsychological rehabilitation of cognitive deficits with the “Academy of Life” program, aimed at improving social skills, proved to be more effective than either of these two components administered without the other

Quality Appraisal of Systematic Reviews for Behavioral Treatments of Attention Disorders in Traumatic Brain Injury.

This review appraised the quality of systematic reviews (SRs) and meta-analyses (MAs) to summarize research on behavioral interventions for attention disorders in persons with traumatic brain injury. A search of 7 databases revealed 15 MAs/SRs reporting outcomes for attention treatments in traumatic brain injury. Two examiners independently coded the quality of reviews with the Critical Appraisal of Systematic Review or Meta-Analysis and the Evidence in Augmentative and Alternative Communication Systematic Review Scale. The findings of both scales were highly correlated. Four reviews were conducted with high methodologic rigor indicated by a score of 60% or greater on both scales. No other study scored above 45%. Among the well-conducted SRs/MAs, evidence for direct attention training effects was limited to basic attention exercises, with little generalization to functional activities. Strategy training for activities and tasks requiring attentional abilities had a stronger evidence base in 1 rigorous MA. This appraisal provides valuable practice information. The conclusions of 4 rigorous reviews suggest that there is only limited positive scientific support for the effects of attention treatments for traumatic brain injury. Future SRs/MAs would benefit from adherence to review guidelines.

Disorders of Emotional Communication in Traumatic Brain Injury.

Traumatic brain injury (TBI) leads to a wide array of behavioral and cognitive deficits. Individuals with TBI often demonstrate difficulties with the recognition and expression of emotion communicated through multiple modalities including facial expression, vocal prosody, and linguistic content. Deficits in emotional communication contribute to a pattern of social pragmatic communication problems, leading to decreased psychosocial function. Growing evidence supports intervention targeting affective processing. This article summarizes the current evidence for evaluation and treatment of affective processing disorders in TBI.

Sleep disorders in traumatic brain injury.

Sleep disorders play a significant role in the care of those with Traumatic Brain Injury (TBI). To provide a literature review on the interaction of sleep and circadian processes on those with TBI. A literature review was conducted on PubMed using the following key words and their combination: "Sleep Apnea", "Traumatic Brain Injury", "Circadian", "Parasomnia", "Insomnia", "Hypersomnia", "Narcolepsy", and "Restless Legs". We review the spectrum of traumatic brain injury associated sleep disorders and discuss clinical approaches to diagnosis and treatment. Disordered sleep and wakefulness after TBI is common. Sleep disruption contributes to morbidity, such as the development of neurocognitive and neurobehavioral deficits, and prolongs the recovery phase after injury. Early recognition and correction of these problems may limit the secondary effects of traumatic brain injury and improve neuro recovery/patient outcomes. A more focused approach to sleep health is appropriate when caring for those with TBI.

Depression and anxiety among traumatic brain injury patients in Malaysia.

Depression and anxiety are common psychiatric sequelae of traumatic brain injury (TBI). However, there is lack of data on comorbid depression and anxiety, and depression and anxiety in TBI patients were often evaluated using non-validated diagnostic tools. This study aims to determine the rates, their comorbidity, and factors associated with depressive and anxiety disorders in TBI patients. In this cross-sectional study, 101 TBI patients were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders to assess the rates of depressive and anxiety disorders after TBI. The association of socio-demographic and clinical factors with depressive and anxiety disorders were determined using Pearson's Chi-Square test. A total of 25% of TBI patients (n = 25/101) were diagnosed with depressive disorders, of which 15% had major depressive disorder (n = 15/101) and 10% had minor depression (n = 10/101). Fourteen percent of TBI patients had anxiety disorders (n = 14/101), of which post-traumatic stress disorder (PTSD) was the commonest anxiety disorder (9%, n = 9/101). Seven percent of TBI patients (n = 7/101) had comorbid depressive and anxiety disorders. The only factor associated with depressive disorder was the duration of TBI (≥ 1 year) while the only factor associated with anxiety disorder was the mechanism of trauma (assault). Major depressive disorder, minor depression and PTSD are common psychiatric complications of TBI. Clinicians should screen for depressive and anxiety disorders in TBI patients, particularly those with ≥1 year of injury and had sustained TBI from assault.

The effects of untreated sleep disorders in traumatic brain injury and its impact on executive function

The effects of untreated sleep disorders in traumatic brain injury and its impact on executive function

Operationalisation of Assessment of Substance Use Disorders in Traumatic Brain Injury: A Rapid Review

Operationalisation of Assessment of Substance Use Disorders in Traumatic Brain Injury: A Rapid Review

La cognición social y su contribución a la rehabilitación de los trastornos de la conducta por traumatismo craneal

Social behaviour disorders in traumatic brain injury are caused by the dysfunction of cognitive processes involved in social and interpersonal interaction. The concept of social cognition was introduced by authors studying schizophrenia, autism or mental retardation. The boundaries and the content of the concept have not yet been definitively defined, but theory of mind, empathy and emotional processing are included in all the models proposed. The strategies proposed to improve social behaviour focus on the restoration of cognitive processes such as working memory, emotional recognition and processing, and empathy, as well as social skills. To date, there is very little evidence on the efficacy of the aforementioned social cognition strategies.

Communicative-pragmatic disorders in traumatic brain injury: The role of theory of mind and executive functions

Previous research has shown that communicative-pragmatic ability, as well as executive functions (EF) and Theory of Mind (ToM), may be impaired in individuals with traumatic brain injury (TBI). However, the role of such cognitive deficits in explaining communicative-pragmatic difficulty in TBI has still not been fully investigated. The study examined the relationship between EF (working memory, planning and flexibility) and ToM and communicative-pragmatic impairment in patients with TBI. 30 individuals with TBI and 30 healthy controls were assessed using the Assessment Battery of Communication (ABaCo), and a set of cognitive, EF and ToM, tasks. The results showed that TBI participants performed poorly in comprehension and production tasks in the ABaCo, using both linguistic and extralinguistic means of expression, and that they were impaired in EF and ToM abilities. Cognitive difficulties were able to predict the pragmatic performance of TBI individuals, with both executive functions and ToM contributing to explaining patients’ scores on the ABaCo.

Neuropsychological and behavioral disorders and their correlations with the severity of the traumatic brain injury

The goal of this study was to evaluate the different neuropsychological and behavioral disorders of patients with traumatic brain injury (TBI) and to study their correlations with the epidemiological and neurotraumatic characteristics. It was a cross-sectional study including 30 patients with TBI conducted in the physical medicine and rehabilitation department. The analysis of memory impairment was performed by the (MMS) and the (GOAT) tests. The psychological profile was evaluated by the HAD scale. Behavioral disorders were tested by the agitated behavior scale. Otherwise, the executive functions were evaluated by the DEX scale. The global social-functional evolution was measured by the GOS scale. The mean age was 32.19 ± 12.37 years with a sex-ratio of 3,5. The mean follow-up period was 3,9 ± 2.24 years. Fifteen patients (55.6%) had severe TBI. Memory disorders were observed in 9 patients (36%) when evaluated by the MMS scale and in 5 patients (18.5%) by the GOAT scale. Depressive symptoms were found in 17 patients (70.4%); Moreover, anxiety was noted in 15 patients (55.6%). Behavioral troubles, such as aggressiveness and agitation were noted respectively in 17 (63%) and 6 patients (22.2%). Severe agitation level was found in one patient (3.7%). Abnormal executive functions were noted in 17 patients (76.7%) with an average. Dex score of 23.68 ± 22.8. The most affected dimensions were intentionality and negative affect. Dex score of 23.68 ± 22.8. The most affected dimensions were intentionality and negative affect. We have found correlations between cognitive impairment and the education level ( P < 0.01), between aggression and male sex ( P < 0.01) and between abnormal executive functions and the initial GSC score ( P = 0.04, r = –0.43). The lack of overall improvement (GOS scale) was correlated to the degree of abnormal executive function ( P = 0.02). The executive function disorders, depressed mood and the memory disorders seemed to be the most frequent among neuropsychological disorders in TBI. We noted that it is so important to evaluate neuropsychological disorders in TBI because they were underestimated. We have started this experience despite the lack of means in our department. The evaluation of the executive function in addition to the classic neurospsychological assessment is essential to propose efficient means of rehabilitation.

Premorbid Antisocial Personality and Substance Use Disorder in Traumatic Brain Injury

We report on a 29 year-old male with a history of antisocial personality and polysusbtance use disorder, who sustained a traumatic brain injury five months before presenting to the psychiatric emergency room in an agitated state and with suicidal and homicidal ideations. We discussed medication management and psychotherapeutic interventions in this case, and we performed a literature review on brain traumatic injury.

Study of Generalized Anxiety Disorder in Traumatic Brain Injury

Authors’ contributions This work was carried out in collaboration between all authors. Author Anand Sharma participated in the design of the study and performed the statistical analysis. Author Achal Sharma participated in the design and conception of the study and its coordination, acquisition of data, carried out statistical analysis and drafted the manuscript. Author AJ participated in the conception of the study and participated in the design of the study, acquisition of data and manuscript revision. Authors RSM and IDG participated in reviewing of article. All authors read and approved the final manuscript.

Chronic Decrease in Wakefulness and Disruption of Sleep-Wake Behavior after Experimental Traumatic Brain Injury

Traumatic brain injury (TBI) can cause sleep-wake disturbances and excessive daytime sleepiness. The pathobiology of sleep disorders in TBI, however, is not well understood, and animal models have been underused in studying such changes and potential underlying mechanisms. We used the rat lateral fluid percussion (LFP) model to analyze sleep-wake patterns as a function of time after injury. Rapid-eye movement (REM) sleep, non-REM (NREM) sleep, and wake bouts during light and dark phases were measured with electroencephalography and electromyography at an early as well as chronic time points after LFP. Moderate TBI caused disturbances in the ability to maintain consolidated wake bouts during the active phase and chronic loss of wakefulness. Further, TBI resulted in cognitive impairments and depressive-like symptoms, and reduced the number of orexin-A-positive neurons in the lateral hypothalamus.