Qualitative features of finger movement during the Halstead finger oscillation test following traumatic brain injury

Qualitative and quantitative performance on the Halstead Finger Tapping test may help differentiate brain dysfunctional patients from normal controls. Normal and abnormal finger tapping patterns during this task have been characterized and illustrated pictorially. Data from 65 patients with traumatic brain injury (TBI) and 15 normal controls support the dual proposition that (1) abnormal finger tapping patterns are more commonly observed in TBI patients than in controls and (2) the frequency of abnormal finger movements may relate to the severity of TBI during the acute stages after trauma. Future prospective studies are needed to replicate these findings

Non-pharmacological management of psychiatric disturbances after traumatic brain injury

Persons who suffer traumatic brain injury (TBI) often demonstrate a variety of psychiatric and neuropsychiatric disturbances. Some of those disturbances may be managed by non-pharmacological methods. The methods draw heavily on established principles of psychotherapy and behavioral modification. However, the unique problems imposed by neurocognitive deficits must be factored into any form of non-pharmacological intervention with this patient group. A simple model consolidates information about the important ingredients in the non-pharmacological management of psychiatric disturbances in TBI patients

Early cognitive and affective sequelae of traumatic brain injury: a study using the BNI Screen for Higher Cerebral Functions

OBJECTIVE: To demonstrate that the Barrow Neurological Institute (BNI) Screen for Higher Cerebral Functions (BNIS) can be used to briefly assess cognitive and affective disturbances during the acute stages after traumatic brain injury (TBI). DESIGN AND OUTCOME MEASURES: People with TBI were administered the BNIS during the first 60 days after injury and their performance compared to a convenience sample of control subjects used in the standardization of the BNIS. SETTING: Inpatient units of a neurological institute and medical center. SUBJECTS: Forty-two individuals with moderate-to-severe TBI and 21 control subjects. RESULTS: Compared to patients with TBI, control subjects performed significantly better on the BNIS total and all subtest scores. TBI patients were best classified by poor performance on measures of affect disturbance and impaired awareness. Stepwise discriminant analysis identified disturbances in memory, awareness, and affect as contributing most to the classification of an individual as having TBI. CONCLUSIONS: Both cognitive and affective disturbances can be directly assessed during the early stages after significant TBI. The BNIS can be used for this purpose and help document that TBI specifically affects memory, awareness, and affect during its early stages and should be addressed in rehabilitation

Awareness and distress after traumatic brain injury: A relative\u27s perspective

Objective: To examine the relationship between relatives\u27 distress level and their ratings of impaired awareness for persons with traumatic brain injury (TBI). Design and Outcome Measures: Participants were 25 patients with TBI, 16 with probably dementia, and 15 with memory complaints but no dementia. Participants completed the Barrow Neurological Institute Screen for Higher Cerebral Functions. Relatives of all patients completed the Patient Competency Rating Scale (Relative Form). Relatives also rated their distress level on a scale from 0 (no distress) to 10 (severe distress) and then rated the patient\u27s level of awareness of their difficulties, also on a scale from 0 (not aware) to 10 (completely aware). Setting: Clinical neuropsychology outpatient service of a neurological institute and medical center. Results: For relatives of patients with TBI, a significant correlation of -0.52 (P = .006) was found. Correlations for the dementia and memory complaint groups were -0.62 (P = .03) and -0.39 (P = .20), respectively. Conclusions: The presence of brain dysfunction associated with neuropsychological disturbances appears to influence the magnitude of the relationship between the distress level of family members and their ratings of impaired awareness in persons with TBI. © 2005 Lippincott Williams & Wilkins, Inc

Subjective reports of fatigue during early recovery from traumatic brain injury

Objective: To determine whether patients with traumatic brain injury (TBI) report higher levels of fatigue than do normal controls and to identify demographic and cognitive correlates of self-reported fatigue. Design: Prospective study. Setting: Inpatient neurorehabilitation unit in a medical center and neurological institute. Participants: Forty-seven neurorehabilitation inpatients with TBI. Main Outcome Measures: Barrow Neurological Institute (BNI) Fatigue Scale and BNI Screen for Higher Cerebral Functions. Results: Patients reported significantly greater levels of fatigue compared to the levels reported by normal controls, although fatigue was found to be unrelated to injury severity, number of days from injury to assessment, cognitive impairment, and gender. Inspection of individual items revealed no significant differences between severe versus moderate versus mild TBI groups. However, being able to last the day without taking a nap (ie, item 10) was found to be the most sensitive item associated with fatigue in the TBI group. Conclusions: Results of this study suggest the need to integrate activities and interventions to increase endurance in patients with TBI during early rehabilitation. Accommodating regular rest breaks and increasing restful sleep should be a focus of inpatient neurorehabilitation units. © 2005 lippincott Williams & Wilkins, Inc

Disturbances in affective communication following brain injury

Primary objective: Disturbances in affect expression and perception are often clinically observed in brain injured patients during the acute stages of recovery. This study examined whether such disturbances are related to the acute nature of the injury or specific type of injury in patients with stroke (CVA) versus traumatic brain injury (TBI). Research design: Retrospective cohort of patients seen for inpatient rehabilitation following brain injury. Procedures: Participants were 27 CVA and 27 TBI patients. Their performance was compared to 27 normal controls on the BNI Screen for Higher Cerebral Functions. Outcomes and results: While both patient groups performed significantly worse than the control group on affect expression, perception and spontaneity (p \u3c 0.01), the CVA group performed significantly worse than the TBI group (p \u3c 0.01) on affect perception. Results of this study document disturbances in affect in brain injured patients and highlight the importance of assessing affect during early recovery

The Patient Distress Scale questionnaire: Factor structure and internal consistency

Primary objective: This study examined the factor structure and internal consistency of the Patient Distress Scale (PDS). The PDS is an 11-item questionnaire that was developed to assess acute neurological patients\u27 awareness of emotional disturbances during early rehabilitation. Research design: A retrospective cohort of patients seen for inpatient rehabilitation following brain injury. Procedures: The PDS was administered to patients and family members upon admission to the neurorehabilitation unit as part of their neuropsychological evaluation. Outcomes and results: Subjects were heterogeneous sample of acute neurological inpatients (n = 84) and their relatives (n = 64). A principle components factor analysis with varimax rotation yielded a three factor solution, which together accounted for 62% of the variance. The factor solution provided partial support for the initial structure of the PDS. Analyses revealed relatively strong reliability coefficients for patients (r = 0.82) and relatives (r = 0.86) on the PDS total score. Acceptable reliability coefficients were also found for patients and relatives on each of the factor scores. Conclusions: Preliminary findings support the utility of the PDS as a measure of awareness in acute neurological patients

Learning and memory in adolescent psychiatric inpatients with major depression: A normative study of the California verbal learning test

Depressed adults have deficits in memory functions, especially on demanding tasks, but few studies of depressed adolescents have been published. In order to examine the extent of memory impairment and its diagnostic specificity, adolescent inpatients with DSM-III-R diagnoses of Major Depression ( n = 56), Conduct Disorder ( n = 42), or mixed Depression and Conduct Disorder ( n = 22) were tested on the California Verbal Learning Test (CVLT) and compared to each other, to CVLT norms, and to previously published CVLT norms for adults with Major Depression. Adolescents with Major Depression performed below normative standards on all aspects of the CVLT, but did not have a specific profile of memory impairments that was diferent from the two comparison samples. Relative to norms for adult patients with Major Depression, adolescent females under performed across all CVLT measures, but males did not differ from adults Depression in adolescence is not associated with specific memory impairments, but adolescent females with depression may have more severe deficits than depressed adults

Diagnosis of manic episodes in adolescent inpatients: structured diagnostic procedures compared to clinical chart diagnoses

This study examined the accuracy of clinical chart diagnoses of manic episodes in adolescent psychiatric patients, as well as treatment selection and patient outcome. A consecutive sample of 120 consenting adolescent patients was assessed at admission, discharge, and 30 and 120 days post-discharge. Clinical chart diagnoses were compared to research-quality diagnoses involving structured interview, chart review, and consensus. Agreement statistics were computed, and the symptom and treatment differences were compared between patients for whom there was and was not diagnostic agreement. Clinical diagnoses of manic episodes were more common than research diagnoses, and the rate of agreement between diagnoses was low (kappa=0.15). Patients diagnosed as experiencing a manic episode by the clinical chart, but not via the research procedure, had reduced severity scores on elation and activity, and higher scores on depression. These patients also had more severe scores on depressive symptoms at follow-up. Manic episodes were diagnosed more frequently by clinicians relative to research-quality procedures. Patients who were diagnosed as experiencing manic episodes by the clinician, but not the research procedure, appeared to have depression and hostility, but not elation. The depression in these patients may not be adequately treated, and there are potential clinical implications of over-diagnosis of manic episodes in adolescents