Bakgrund Högt intrakraniellt tryck hos traumatiskt hjärnskadade patienter kan behandlas med traditionell basbehandling, tiopentalsedering eller dekompressiv hemikraniektomi. Metoderna medför risk för komplikationer och svårigheter att utföra omvårdnad. Syfte Studiens syfte var att undersöka om det fanns någon skillnad i vändningsfrekvens, tid i ryggläge och förekomst av trycksår och lungkomplikationer mellan patienterna som fått basbehandling, behandlats med tiopental eller genomgått hemikraniektomi. Dessutom studerades förekomst av postoperativa komplikationer hos de patienter som hade genomgått hemikraniektomi. Metod Detta gjordes genom retrospektiv journalgranskning. 36 patienter från åren 2008–2016 inkluderades. Resultat Patienterna som fått basbehandling vändes oftare, 9,5 ggr/dygn, jämfört med patienterna som behandlats med tiopental, eller hemikraniektomi, vilka vändes 7,9 ggr/dygn. Tiden i ryggläge var kortare, 40,1%, jämfört med 52,3%, för de tiopentalbehandlade patienterna, respektive 54,8% för de hemikraniektomerade patienterna. Trycksår återfanns hos patienter behandlade med tiopental, 2(5%), eller hemikraniektomi, 2(5%). 50 % av patienterna som behandlades med tiopental och hemikraniektomi hade förtätningar på lungröntgen jämfört med 2% av patienterna som hade fått basbehandling. Längst ventilatortid hade patienterna som fått tiopental, 16,4 dygn, jämfört med hemikraniektomigruppens 14,1 dygn och de basbehandlade patienternas 13,8 dygn. Av patienterna som genomgick hemikraniektomi uppstod postoperativa komplikationer hos 2(17%) av 12. Slutsats Patienter behandlade med tiopental eller hemikraniektomi verkar vara mer utsatta för komplikationer och vänds i mindre utsträckning och spenderar mer tid i ryggläge är patienter som fått basbehandling. Omvårdnaden av de traumatiskt hjärnskadade patienterna behöver individualiseras, och vaksamhet krävs för att identifiera de mest utsatta patienterna och kunna förebygga riskerna för komplikationer, så att vårdlidandet kan minskas. / Background Intracranial hypertension following traumatic brain injury is treated with either basic medical treatment, barbiturate coma or decompressive craniectomy. The methods are associated with complications and difficulties performing nursing care. Aim To investigate whether there was a difference in frequency of repositioning, time spent in supine position and number of complications between the patient groups, and to out rule the number of postoperative complications following decompressive craniectomy. Method A retrospective medical record review was conducted including 36 patients from the years 2008-2016. Result The basic medical treatment group had a higher frequency of repositioning, 9,5 times a day, compared to 7,9 times a day in the other groups, and a shorter amount of time, 40,1%, in supine position, compared to 52,3% (barbiturate coma), or 54,8% (decompressive craniectomy). Pressure injuries occurred among patients treated with barbiturate coma 2(5%) or decompressive craniectomy, 2(5%). Increased density in chest x-ray was seen in 50% of the patients treated with barbiturate coma and decompressive craniectomy, compared to 2% (basic medical treatment). Barbiturate coma was associated with the longest time of mechanical ventilation, 16,4 days, compared to 14,1 days and 13,8 days for the decompressive craniectomy group and the basic medical treatment group. Postoperative complications occurred in 2(17%) patients. Conclusion Patients treated with barbiturate coma or decompressive craniectomy seem to be of higher risk of complications, as having a lower frequency of repositioning and more time spent in supine position. Nursing care needs to be individually adapted to prevent complications and minimise suffering in patients with traumatic brain injury.

Regardless of the tinnitus sound (itself), tinnitus can be especially challenging for clients when paired with traumatic brain injury and post-traumatic stress. Research offers insight into how clinicians can help clients manage this co-occurrence.

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The prevalence and sequelae of moderate-to-severe (M/S) traumatic brain injury (TBI) are significant and pervasive problems, and effective rehabilitation techniques are key. Errorless learning is regarded as a useful tool for memory impairments; however, the efficacy of errorless learning in a M/S TBI population is unclear. The primary goal (aim 1) of this study was to evaluate the efficacy of a single session of errorless vs. errorful learning in a group of M/S TBI survivors and matched controls. A secondary goal (aim 2) was to investigate the neural time course of errorless learning in participants with M/S TBI by analyzing the error-related negativity (ERN) component of the scalp-recorded event-related potential (ERP). The ERN is an electrophysiological measure of error processing that is disrupted in M/S TBI survivors. Measures of neuropsychological performance, self- and informant-report of executive functioning, and affect further informed both study aims. Data from 28 M/S TBI survivors (9 female) and 28 controls (9 female) were analyzed for aim 1, with data from 19 M/S TBI survivors (6 female) and 20 controls (8 female) analyzed for aim 2. There were significant differences between the TBI and control groups with regard to executive, mood, and neuropsychological functioning. Results from aim 1 indicated that TBI participants were slower across learning conditions, while both groups had significantly faster reaction times in the errorless condition. Regarding accuracy, there was not a statistically significant main effect of learning condition (p = .07), group (p = .06), or Group x Condition x Accuracy interaction (p = .33). Indices of memory and executive functioning, and group (TBI, Control) used in regressions predicted accuracy in both learning conditions (ps < .01). The memory composite was a significant independent predictor of errorless accuracy. Results from aim 2 indicated a reliable ERN was present across conditions, although there were no main effects of Condition, Group, or Group x Condition interactions on ERN amplitude or latency (ps > .22). ERN latency was not predictive of accuracy for either condition (ps > .08). Group was a significant independent predictor of accuracy in the errorless condition (p = .05), but not the errorful condition (p = .45). Findings indicate that memory functioning was a better predictor of accuracy than executive functioning or group membership. This suggests that the errorless learning benefit may be specific to memory functioning, rather than other cognitive variables. This conclusion aligns with research reporting that benefits of errorless learning depend upon the severity of memory impairments. Results from ERN analyses are only partially supported by previous research, and further work is needed to clarify the role of neural representations of errorless learning in M/S TBI.

The ability of the brain to change and form new neuropathways after brain injury is remarkable. The current study investigates the brains ability to form new pathways for language processing following traumatic brain injury (TBI), specifically a left temporal lobectomy. Two subjects participated in this study; one participant with TBI and one age-matched control. Sentence stimuli consisted of four types: semantically correct, semantically incorrect, syntactically correct, and syntactically incorrect. Participants underwent a fMRI scan while the auditory stimuli were presented in four blocks. Participants were asked to record if the sentence was correct or incorrect by pressing the corresponding button. It was found that reaction times for both the participant with TBI and the control were longer for the incorrect conditions. The participant with TBI generally had longer reaction times compared to the control participant and had more errors. During the fMRI scans, patient movement occurred. The block design was not set up to account for movement. Due to this factor, imaging results are questionable. While there were differences between the participant with TBI and the control participant, these differences are expected to be much larger in someone with this degree of brain injury. It is recommended for further studies to be conducted in this area with a revised block design to account for patient movement.

Thesis (M. A. (Psychology)) --University of Limpopo, 2017 / This study investigated the perceptions of African families of TBI. Caregivers and TBI victims were given the opportunity to talk about their TBI perceptions. The study revealed that people’s knowledge of TBI is not good. This is proven by the way in which the participants understood and explained the conditions the victims found themselves in, after the accidents and how their family members are. Findings reveal that culture does play a vital role in the perceptions of African people. The study illustrates that the perceptions are culturally-rooted. The study interviewed five individuals (n=5) with TBI and a total of nine caregivers (n=9) were interviewed. A total of fourteen (n=14) participants were interviewed. The study reveals that the causes of TBI were attributed a number of things. According to the participants TBI is caused by witchcraft, the will of God and ancestors. The study also helped highlight the beliefs and the cultural system of Africans. It also explained the reality of an African. The Afrocentric theory helped shape the study as it helped in explaining the importance of an Africans’ view. The Afrocentric theory postulates that Africans have a different reality from that of Westerns and it has been proven by the findings. Although the participants were told about TBI by the doctors, they still had their own explanations and attributions to the problem.

While multiple Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans suffer from mild Traumatic Brain Injury (mTBI), Post-traumatic Stress Disorder (PTSD), and co-morbid mTBI and PTSD, there remains difficulty disentangling the specific symptoms associated with each disorder using self-report and neurocognitive assessments. We propose that neurological soft signs (NSS), which are tasks associated with general neurologic compromise, may prove useful in this regard. Based on our review of the literature we hypothesized that individuals with PTSD would present with a greater number of NSS than controls or individuals with mTBI. Further, we hypothesized a synergistic effect, such that individuals with mTBI + PTSD would present with the greatest number of NSS. To test these hypotheses, we analyzed a subset of individuals (N=238) taken from a larger study of neurocognitive functioning in veterans. Participants completed a battery of neuropsychological measures, which included the Behavioral Dyscontrol Scale (BDS), the current study’s measure of NSS. A subset of other neuropsychological measures were also included to examine the utility of NSS over and above traditional neuropsychological measures. Individuals were removed from the study if they sustained a moderate/severe TBI or did not meet validity criteria on the Green’s Word Memory Test or the Negative Impression Management subscale of the Personality Assessment Inventory. Binomial logistic and multinomial logistic regression were used to examine the ability of NSS to discriminate between the study groups, first by themselves and then after the variance explained by the traditional neuropsychological measures was accounted for. Exploratory cluster analyses were performed on neuropsychological measures and NSS to identify profiles of cognitive performance in the data set. Results indicated that individuals in the mTBI and/or PTSD group had more NSS compared to controls. Of the individual NSS items only a go/no-go task of the BDS discriminated between groups, with worse performance among individuals in the mTBI, PTSD, and mTBI + PTSD group compared to controls. In contrast, the overall BDS score and individual NSS, in general, did not discriminate between the mTBI, PTSD, and mTBI + PTSD group. Overall, the current study suggests that, when eliminating participants who do not meet validity criteria, NSS do not aid in discriminating between individuals with mTBI, PTSD, and mTBI + PTSD.

Aquired brain injury is still a current topic and a serious problem nowadays. After a treatment, a lot of consequences appear which cause a long-term inability to work and invalidation of many people. One of the serious problems is a disorder of cognitive functions which disables people to get back to a normal life. One of the options how to affect the cognitive functions impairment is a system called CogniPlus. Theoretical part of this work presents aquired brain injury, its dividing, basic classification and the consequences. Furthermore, this work dedicates to rehabilitation of cognitive functions using both computers and conventional methods. It also shows the work of the occupational therapist and the possibility of cognitive function testing. The aim of the research is to find out if CogniPlus cognitive function training is more effective than the conventional pencil-paper method. 20 people were tested in this study. Unfortunately, one of them had to quit due to health problems. The experimental and the control group had a therapy once or twice a week. All the participants went through Addenbrooke cognitive test and through a questionnaire of cognitive mistakes at the beginning and at the end of the testing. The experimental group showed a significant improvement in the global score ACE and in the...

This study sought to determine how the severity of injury and cause of injury influences engagement in productive work. Using archival research, 1,322 records of adults diagnosed with Traumatic Brain Injury (TBI) were examined for the following variables: engagement in productive employment, job stability, severity of injury, cause of injury, satisfaction with life, and participation activities after TBI. Analysis of variance revealed significant differences in job stability and engagement in productive work between pre-injury and postinjury, which suggests that TBI has an impact on job stability. While no statistically significant differences were found in engagement in productive work among participants with mild, moderate, or severe TBI, there were significant differences in engagement in productive work based on cause of injury. Specifically, the study found that patients with vehicle-related TBI had significantly lower job engagement in productive work when compared with other causes of TBI. In addition, the multiple regression indicated that severity of injury, measured using Glasgow Coma Scale (GCS) score, is a significant predictor of employment outcome when severity of injury is treated as a continuous variable rather than a categorical variable that involves mild, moderate, and severe TBI. This finding suggests that patients with mild TBI may have different employment outcomes based on their GCS score; the case is the same for patients with moderate and severe TBI. Findings from this research have implications for employers, service providers, and policy makers. Employers must understand that TBI reduces employee productivity, which can be increased by focusing on participation activities and life satisfaction efforts. Rehabilitation centers have to focus on community integration efforts and efforts aimed at ensuring that TBI patients secure meaningful employment.