摘要:

Objective:To test the hypothesis that changes in personality traits arc evident after traumatic brain injury (TM) using current models of normal adult personality variation.Design:Comparison of inception cohort and control group at two measurement occasions.Setting:A large urban academic medical center.Participants:Retrospective personality assessments were obtained from significant others of 21 TB1 patients within 30 days of injury and at 6-month follow-up and from a control group of significant others of 25 persons without neurological history twice over a 6-month interval.Main Outcome Measures:Five scales—Neuroticism, Extroversion, Openness to Experience, Agreeableness, and Conscientiousness— from the revised NEO Personality Inventory (NEO PI-R), Form R, and an observer rating scale for retrospective estimates of change (REC).Results:Significant score changes were found for only one of the five trait domains in the patient sample; controls showed minimal changes overall. Patients' Extraversion scores declined to average levels at 6-month follow-up, diminishing premorbid differences between patients and controls on this dimension. Subjective change estimates made by raters after follow-up reflected perceptions of increased neuroticism in patients that were inconsistent with the serial NEO PI-R data the raters provided.Conclusions:The absence of systematic changes in personality trait scores among the patients cautions against presuming that such changes account for the behavior of TDI patients.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:To evaluate the utility and neuropsychological correlates of serially performed recordings of event-related potentials (ERPs) in patients recovering from a severe closed head injury (CHI).Design:Prospective longitudinal study.Setting:Brain injury rehabilitation unit based in a national rehabilitation hospital.Subjects:Sixteen patients with severe CHI (significant degree of impaired consciousness greater than 24 hours) subclassified into two severity groups according to initial Glasgow Coma Scale (GCS)score:Those with initial GCS score<9, consistent with a more severe injury; and those with initial GCS score>8, indicating a less severe injury.Methods:ERPs were elicited using the standard auditory P300 “oddball” detection paradigm. ERP recordings were carried out three times: 2 months after injury, 1 month later, and 2.5 months or more after the initial study. Parameters analyzed included latencies and amplitudes of the P3, N2, P2, and Nl components of the ERPs. Correlations between changes in these ERP parameters and specific neuropsychological test results were evaluated.Results:Initial P3 latencies in the more severely injured group were significantly longer (P<.05) than those recorded in the less severely injured patients. In subsequent recordings, P3 latency was found to be significantly shorter compared with the initial P3 latency, and the difference in P3 latency between the two patient groups was no longer statistically significant by the time of the third recording. For the group as a whole, P3 latency decreased significantly on each repeated recording. N2 latency was found to be significantly shorter (P<.05) between the first and third recordings. Cognitive performance significantly improved between the first and third recordings. P3 latency shortening was correlated with improvement in neuropsychological test scores for short-term and long-term story recall and for word recall. N2 latency shortening was correlated with improvement in the neuropsychological test scores for word recall only.Conclusion:ERP recordings performed in the subacute stage after CHI may assist in evaluating injury severity. Moreover, serially performed recordings of P3 latency may be used as a physiologic index of brain activity that correlates with recover)' from CHI.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:To examine the prevalence and correlates of major depression in caregivers of individuals with moderate to severe traumatic brain injuries.Design:Repeated-measures design involving structured diagnostic interview and self-report of psychological distress administered on two occasions separated by 6 months.Setting:Three acute care rehabilitation hospitals.Subjects:Fifty-nine caregivers (39 mothers and 20 spouses) of individuals with moderate to severe brain injuries recruited from previous inpatient rosters. All caregivers were currently residing with the person with traumatic brain injury.Main Outcome Measure:The Diagnostic Interview Schedule-Revised [DIS-R] was utilized to assess depression. The Symptom Checklist 90-Revised (SCL 90-R) measured general psychological distress.Results:Fortyseven percent of caregivers initially met diagnostic criteria for depression, and 43% met criteria 6 months later. Nearly two thirds of those who were initially depressed continued to be depressed 6 months later, and 17% of those who were not depressed initially subsequently met criteria for depression. The best predictor of depression was a previous (pre-brain injury) depressive episode. Neither time since injury nor injury severity predicted diagnostic status, and spouses were no more likely to be depressed than were mothers. The SCL 90-R, including its depression scale, showed high specificity but low sensitivity in predicting diagnostic status.Conclusions:The prevalence of major depression is high in caregivers of individuals with brain injuries. Because depression may interfere with the capacity to provide care and contribute to the rehabilitation process, it is important for clinicians to carefully assess both the current and preaccident affective status of primary caregivers.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:To investigate the effectiveness of elaborative encoding in learning and remembering word definitions after traumatic brain injury (TBI).Design:Two case studies.Setting:University outpatient clinic.Participants:Two adolescents with severe memory impairments after TBI who needed specific vocabulary for school.Interventions:A series of individual speech-language therapy sessions incorporating clinician- and subject-generated strategies to facilitate elaborative encoding. Target words were based on school requirements and pretreatment test results and were assigned randomly to treatment or control groups.Main Outcome Measure:Accuracy of free-recalled definitions at the conclusion of therapy and after 1 month with no therapy.Results:Significant improvement in expressed word knowledge at the conclusion of therapy, with improvement on treated words maintained at 1 month for both subjects.Conclusions:Elaborative encoding was an effective tool for teaching specific information required for school. Patterns of response differed substantially from those of normally developing children. Generalization to classroom use was planned for and should be measured in future research

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:To investigate quantitative neuroSPECT findings, particularly from orbital frontal cortex, in patients rendered totally anosmic from head injury.Setting:Veterans Administration (VA) Medical Center.Subjects:Eighteen patients with head injury resulting in severe anosmia and five normal controls. All 18 patients had sustained their head injuries at least 5 years prior to involvement in the study.Measures:Quantitative neuroSPECT (count density) from sagittal regions of interest (ROIs) ranging circumferentially from orbital frontal cortex to occipital pole.Results:Quantitative evaluation of neuroSPECT findings for anosmic patients as a group showed substantial orbital frontal hypoperfusion compared with controls, with 67% of individual anosmic patients showing orbital frontal hypoperfusion at a level two or more standard deviations below that of the worst control subject. By contrast, there were no betweengroup differences for five other ROIs (inferior frontal pole, superior frontal pole, posterior superior frontal lobe, the parasagittal region, and occipital pole), and individual abnormalities were infrequent in these areas. In addition, orbital frontal count was significantly correlated with ratings of outcome, the only ROI to have such a relationship.Conclusions:Findings strongly suggest that posttraumatic anosmia and the neuropsychological deficits typically associated with posttraumatic anosmia are closely and specifically associated with hypoperfusion in orbital frontal cortex. The results also underscore the importance of posttraumatic anosmia as a clinical sign of orbital frontal damage, which is particularly important in patients with mild head injury who have normal computed tomography and magnetic resonance imaging scans

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:To assess the effects of methylphenidate on attention, memory, behavior, processing speed, and psychomotor skills of children with closed head injuries.Design:Double-blind, placebo-controlled, crossover design.Setting:An outpatient facility of a children's hospital medical center.Patients:Ten pediatric subjects identified through chart review. Subjects met baseline scores for hyperactivity (Conner's Hyperactivity Index 560) and intellectual functioning (Verbal Intelligence Quotient £70) and achieved minimal scores on two psychometric tests. All subjects evidenced head injury by focal lesions on computed tomography scan and/or sequelae reported at the time of injury. Severity of injury ranged from mild to severe. All subjects were medically stable at the time of testing. Mean time post injury was 2 years, 8 months.Intervention:Administration of methylphenidate and placebo. Main OutcomeMeasures:Percentage change in scores was calculated to assess differences between baseline and end of methylphenidate/ placebo trials.Results:No significant differences between methylphenidate and placebo on measures assessing behavior, attention, memory, and processing speed.Conclusions:The results of the study call into question the effectiveness of methylphenidate in the pediatric head injury population.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:Two related studies that evaluated the impact of a continuing education program about community- based rehabilitation on the performance of administrators, professionals, and paraprofessionals are presented. One study contained a second part that examined whether differences between precourse test performance and post-course test performance might be accounted for by practice effects.Design:Factorial mixed model designs.Setting:University classroom.Participants:Three hundred and eight professionals, administrators, and paraprofessionals from a variety of community-based rehabilitation programs.Intervention:The 4-day graduate-level course focused on three content areas: brain and behavior relationships, behavioral and cognitive intervention strategies, and a rehabilitation philosophy that emphasizes individual client rights.Main Outcome Measure:An examination completed before and immediately after taking the course.Results:Professionals and administrators perform better than paraprofessionals when tested at the beginning and end of the training. However, the absolute differences among these groups were not substantial. In addition, the rate of learning course content was the same for administrators, paraprofessionals, and professionals.Conclusions:The results support the usefulness of training for all levels of staff and suggest that all levels of staff benefit in an equal fashion.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Objective:To investigate the relevance of the Symptom Checklist 90-R Obsessive-Compulsive subscale to cognition in individuals with brain tumor.Design:A prospective study of patients assessed with a neuropsychological test battery.Setting:A university medical center. Patients: Nineteen adults with biopsyconfirmed diagnoses of malignant brain tumors were assessed prior to aggressive chemotherapy.Main Outcome Measures:Included in the assessment were the Mattis Dementia Rating Scale, California Verbal Learning Test, Trail Making Test B, Symptom Checklist 90-R, Mood Assessment Scale, Beck Anxiety Inventory, and Chronic Illness Problem Inventory.Results:The SCL 90-R Obsessive-Compulsive subscale was not related to objective measures of attention, verbal memory, or age. It was related significantly to symptoms of depression (r=.81, P<.005), anxiety (r=.66, P<.005), and subjective complaints of memory problems (r=.75, P<.005). Multivariate analyses indicated that reported symptoms of depression contributed 66% of the variance in predicting SCL 90-R Obsessive-Compulsive Scores, whereas symptoms of anxiety contributed an additional 6% (P<;0001).Conclusions:Our data suggest that the SCL 90- R is best viewed as an indicator of unidimensional emotional distress and somatic effects of structural brain injury.

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0885-9701    

出版商:OVID    

年代:1998

数据来源: OVID