• What did and do we understand how the brain works in respect of
neuropsychological functioning following a head injury
• The longer term impact of brain injury: evidence from systematic
reviews
• The case of Mr P
• Conclusions
2
• The nature of the injury
• The location and extent
of the injury
• The usual clinical
parameters
[Conscious/unconsciou
s, GCS,PTA &
Neurological
investigations]
3
4
5
Left side : Speech and
Language Abilities
Right Side : Non-verbal, visuospatial abilities.
Frontal Lobe
Parietal Lobe
• Initiation
• Problem solving
• Judgment
• Inhibition of behavior
• Planning/anticipation
• Self-monitoring
• Motor planning
• Personality/emotions
• Awareness of
abilities/limitations
• Organization
• Attention/concentration
• Mental flexibility
• Speaking
(expressive language)
• Sense of touch
• Differentiation:
size, shape, color
• Spatial perception
• Visual perception
Frontal
Lobe
Parietal Lobe
Occipital Lobe
Occipital Lobe
Temporal Lobe
Cerebellum
Brain Stem
Temporal Lobe
• Memory
• Hearing
• Understanding language
(receptive language)
• Organization and sequencing
• Vision
Cerebellum
• Balance
• Coordination
• Skilled motor activity
Brain Stem
• Breathing
• Heart rate
• Arousal/consciousness
• Sleep/wake functions
• Attention/concentration
Presence of
Structural
Brain damage
Pre-morbid
status
Treatment
Age at
onset
Cognitive
status
Psychological /
Educational
History
Site
and size
of injury
Duration of
PTA
Previous head
injuries
QOL
Physical
Social
Level 1
Daily
functioning
Work
Social and family
relations
Cognitive
Emotional
Social
functioning
Cognitive
factors
Well being
Level 2
Physical
functioning
Impaired ADL
Employment
Pain
Social relationships
Impaired
Cognitive
function
Low Self esteem
Loss of Control
Anxiety
Depression
Energy
Psychological
Poor memory
Poor concentration
Slow thinking
Executive difficulties
Tiredness
Low tolerance
Poor insight
Unrealistic expectations
Impaired inter-personal skills
Poor memory
Poor concentration
Slow thinking
Executive difficulties
Tiredness
Low tolerance
Poor insight
Unrealistic expectations
Impaired inter-personal skills
•
•
•
•
•
•
•
Depression
Social skills problems
Mood swings
Problems with emotional control
Inappropriate behavior
Inability to inhibit remarks
Inability to recognize social cues
Systematic measurement of
cognitive functions
It investigates and
measures specific cognitive
impairments
It can help decide whether
the cause is organic or
functional aetiology
• What is going to be the
immediate effect of the head
injury
• What types of problems will
the individual experience?
• What are the longer term
outcomes
• Are there any treatments that
will aid recovery
• Can we predict who will do
well and who wont!
14
• Systematic reviews to determine
relationship between TBI and
neuropsychological impairment 6
months later
• Over 33 studies drawn from 430
articles
• Variable neuropsychological measures
employed
At Baseline
No LOC GCS14/15
LOC<10 min
At 48 hours
Distractibility
Distractibility
Impulsivity
Divided attention
Speed of information
processing
Working memory
At 1 month
Verbal learning
Distractibility
Impulsivity
Divided attention
Speed of information
processing
Working memory
At 3-6 months
Verbal learning
At 12 months
No deficits in key areas of
neuropsychological
functioning
No deficits in key areas of
neuropsychological
functioning
16
At Baseline
No LOC GCS14/15
LOC<10 min
At 48 hours
Distractibility
Distractibility
Impulsivity
Divided attention
Speed of information
processing
Working memory
At 1 month
Verbal learning
Distractibility
Impulsivity
Divided attention
Speed of information
processing
Working memory
At 3-6 months
Verbal learning
At 12 months
No deficits in key areas of
neuropsychological
functioning
No deficits in key areas of
neuropsychological
functioning
17
 90% good physical recovery 1 year
 50% long term disability
 Psychosocial problems significant obstacle to recovery
 Residual permanent neuropsychological impairment in key
areas
 Marital/ family break down common
 19-29% return to work by 5 years
 May need long term support
 May increase risk of Alzheimer's disease in later life
 90% good physical recovery 1 year
 50% long term disability
 Psychosocial problems significant obstacle to recovery
 Residual permanent neuropsychological impairment in key
areas
 Marital/ family break down common
 19-29% return to work by 5 years
 May need long term support
 May increase risk of Alzheimer's disease in later life
20
Mr P is driving
Mr P is married
Mr P is in employment
21
 In the majority of cases individuals with Mild TBI will make a very good
if not complete recovery after 12 months.
 Those individuals with severe TBI can expect to have residual and
permanent neuropsychological and psychological impairments
 Insufficient evidence to determine the impact of moderate TBI
 Little understanding of the natural history of TBI however the
importance of the PTA and radiological signs become relevant in the
prognosis of severe head injury.
Tribune Neuropsychology Services Ltd
Gus A Baker
7/31/2017
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