Cognitive Rehabilitation Therapy for Traumatic Brain Injury Evaluating the Evidence (2011) / Chapter Skim
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2 Traumatic Brain Injury
2 Traumatic Brain Injury
Pages 37-58
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From page 37... ...
The committee assumes civilian versus military populations respond similarly to TBI, unless otherwise noted. TBI causes both direct, immediate physical damage and delayed, secondary changes that contribute to subsequent tissue impairment and related neuropsychiatric dysfunction.
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From page 38... ...
for more in-depth discussion of TBI biology. The response to injury and subsequent treatment varies by multiple factors unique to the affected individual, such as age, gender, genetics, cognitive reserve, polytrauma, multiple concussions from the same impact, and history of prior brain injury (Colantonio et al.
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From page 39... ...
Severity can be classified in multiple ways, and each measure has different predictive utility, including determining morbidity, mortality, or long-term functional outcomes. Patients with more severe head injuries demonstrate lower cognitive functioning and have more gradual cognitive improvements following the initial injury (Novack et al.
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PTA can be directly assessed during the subacute stage of recovery using a brief examination that tests orientation and memory for circumstances of the injury and events prior to and following the injury. In addition, duration of PTA can be estimated retrospectively by asking the patient memory-related questions concerning TABLE 2-1 Classification of Mild, Moderate, and Severe Traumatic Brain Injury Severity of Injury/Measure Mild Moderate Severe Glasgow Coma Scale 13 to 15 9 to 12 3 to 8 Loss of Consciousness < 30 minutes > 30 minutes > 24 hours < 24 hours to 24 hours ≥ 7 days Posttraumatic Amnesia < 24 hours > 24 hours < 7 days ≤ 24 hours Altered Consciousness > 24 hours > 24 hours SOURCES: Helmick et al.
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However, the congressionally mandated Longitudinal Study on Traumatic Brain Injury Incurred by Members of the Armed Forces in Operation Iraqi Freedom and Operation Enduring Freedom (H.R.
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Some of the most important heterogeneous factors to consider are physical mechanisms, pathobiology, severity, presence of polytrauma, multiple impacts, and other factors including age, gender, cognitive reserve, and genetic variation. Physical Mechanisms of Injury The physical mechanism of TBI, which determines the forces involved in the injury, represents an alternate way of classifying head injury based on the causative forces of the injury.
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From page 43... ...
, which is often the result of a penetrating brain injury caused by severe whiplash or blast (Hynes and Dickey 2006) ; these features are commonly seen in military wounded with moderate-severe TBI.
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In the Vietnam War, approximately 40 percent of the 58,000 U.S. combat fatalities were due to head and neck wounds and 14 percent survived a head injury (Schwab et al.
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Research shows a dose–response relationship between acute brain injury severity and cognitive deficits; when acute injuries are severe as measured by the GCS or PTA duration, the residual cognitive deficits are severe, may involve more cognitive domains, and are more persistent (Dikmen et al. 1995; Rohling and Demakis 2010; Schretlen and Shapiro 2003)
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Reports of athletes sustaining repeated mild TBIs occurring over an extended period of time (i.e., months or years) have suggested that the effects are cumulative, as reflected by neurological and cognitive deficits (Guskiewicz et al.
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2007) , and females were associated with worse physical and cognitive symptoms and delayed recovery following mild TBI (Broshek et al.
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. Cognitive Reserve Cognitive reserve is a construct that has been invoked to explain interindividual variability in the response to brain injury.
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From page 49... ...
While many psychometric measures of outcome are used to evaluate and report on therapeutic interventions effects, more recent rehabilitation research has focused on functional outcome measures as more global indicators of patients coping or recovering from the disability. The most frequent cognitive sequelae of TBI are impairment of episodic memory, slowed cognitive processing speed, and impaired executive functions (i.e., the ability to switch between tasks, plan, and set and monitor goals)
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Other measures that may be more pertinent for personalized treatments involving cognitive rehabilitation therapy may include Goal Attainment Scaling (GAS) (Malec 1999, Malec et al.
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However, recently, Diffusion Tensor Imaging (DTI) , a method of assessing axonal integrity and white matter integrity, has shown promise as a predictor of some cognitive deficits (Kinnunen et al.
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2004. Prognosis for mild traumatic brain injury: Results of the WHO col laborating centre task force on mild traumatic brain injury.
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2002. APOE gen otype influences acquisition and recall following traumatic brain injury.
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2005. Outcome from mild traumatic brain injury.
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2007. White matter integrity and cognition in chronic traumatic brain injury: A diffusion tensor imaging study.
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2010. Diffusion tensor imaging of mild traumatic brain injury.
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2008. Early prediction of favour able recovery 6 months after mild traumatic brain injury.
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2009. Traumatic brain injury screening: Preliminary find ings in a U.S.
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