Addressing neuropsychiatric disturbances during rehabilitation after traumatic brain injury: current and future methods

Figures & data

Table I. Commonly used clinical case definitions of traumatic brain injury. Notes: Traumatically induced refers to injuries that result from the head being struck, the head striking an object, and/or the brain undergoing an acceleration/deceleration movement without direct external trauma to the head; tlntracranial lesion, usually identified with computed tomography or magnetic resonance imaging of the brain, includes: diffuse axonal injury; traumatic intracranial hematomas or hemorrhage (epidural, subdural, subarachnoid, or intracerebral); cerebral contusions or lacerations; or penetrating cerebral injuries (eg, gunshot wounds). External force includes any of the following events: the head being struck by an object; the head striking an object; the brain undergoing an acceleration/deceleration movement without direct externa! trauma to the head; a foreign body penetrating the brain; forces generated from events such as a blast or explosion; or other forces yet to be defined. VObjective neuropsychological abnormalities are determined from mental status and neuropsychological examinations, and include disorders of mental status (eg, disorientation, agitation, or confusion) and other changes in cognition, behavior, or personality; importantly, this clinical case definition was developed for use by injury surveillance systems that anchor case ascertainment to the medical record of the hospital stay at the time of injury - and, therefore, refers to neuropsychological abnormalities that are documented in that medical record (ie, not those identified at a later date and/or in another setting). AOther evidence of brain pathology may include visual, neuroradiologic, or laboratory confirmation of damage to the brain; such evidence may enable a diagnosis of TBI when clinical consequences are delayed or subtle; clinical diagnosis is confounded by a difficult context (eg, battlefield TBI); or there is a need to differential TBI-induced clinical signs from those with other causes (eg, chemical warfare). CDE, common data elements; TBI, traumatic brain injury; PH, psychological health

Table II. The differential diagnosis of event-related neuropsychiatric disturbances.

Table III. Classification of traumatic brain injury (TBI) severity used in the Department of Veterans Affairs and Department of Defense Clinical Practice Guideline: Management of Concussion/mild Traumatic Brain injury (April, 2009), modified to include complicated mild TBI. Use of this table to designate TBI severity requires consideration of as many variables as are available, and consideration of the differential diagnosis for eventrelated disturbances of consciousness and/or neuroimaging findings. LOC, loss of consciousness; PTA, post-traumatic amnesia (densely impaired new learning); AOC, alteration of consciousness (eg, confusion, disorientation, slowed thinking); GCS, Glasgow Coma Scale; CT, computed tomography of the brain; MRI, magnetic resonance imaging of the brain.

Table IV. Brain areas most vulnerable to traumatic brain injury, the neuropsychiatric functions in which they are involved, and the neuropsychiatric consequences of injury to these areas. GABA, γ-aminobutyric acid; DA, dopamine; NE, norepinephrine; 5HT, serotonin; ACh, acetylcholine; Ch, cholinergic

Table V. The stages of post-traumatic encephalopathy.

Table VI. Assessment scales relevant to the examination of patients at various stages of post-traumatic encephalopathy. Abbreviations: PTE, post-traumatic encephalopathy; PTA, post-traumatic amnesia