Optimising Physical and Cognitive Health After Traumatic Brain Injury

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Original Editor - User:Ahmad Rifai Sarraj

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Introduction

Cognitive difficulties are very common in individuals with Traumatic Brain Injury (TBI) et can be a substantial sources of morbidity for them but also a major problem for their caregivers and their society (1). Domains of cognitive impairment can include attention, processing speed, episodic memory, and executive function (2). 

Attention disorders may affect concentration, necessary for planning, organization and synchronization of complex actions (3). Information processing speed is a slowness of the ability of the brain and the nervous system to process and conduct information. Although, Information processing speed usually tends to slow with age (4), it is frequently and remarkably impaired after TBI (5). 

Episodic Memory was defined by Tulving (1983, 2002) as a declarative memory that contains information specific to the time and place of acquisition, which is concerned with knowledge not tied to its context of acquisition (6). A recent meta-analysis conducted by Vakil et al. in 2019 concluded and confirmed the conclusions of Vakil (2005) ““The profile of the memory deficit in patients with TBI resembles that of patients with frontal injury rather than that of patients with amnesia.” (p. 1011)(7). The authors of this meta-analysis recommended that following TBI, it would be efficient to focus on remediation of executive functions, as well as directly on memory processes, to ameliorate memory functioning (8).

Finally, executive function can be considered as the most critical domain for goal-directed and complex behaviour (9). Planning, novel problem solving, monitoring, inhibition, initiation, updating, flexibility, set shifting, self-regulation and organization, can reflect the integrity or not of the executive function and abilities (10). 

Physiotherapists and rehabilitation team members must evaluate and optimize cognitive health and behaviour in individuals after TBI. Evidence about the effectiveness of rehabilitation in reducing the impact of brain injury related cognitive impairments, is still growing and consolidating. Results of studies are largely affected by the complexity and the heterogeneity of brain injuries.

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References

1. Arciniegas DB, Held K, Wagner P. Cognitive Impairment Following Traumatic Brain Injury. Curr Treat Options Neurol. 2002 Jan;4(1):43–57. 

2. Wortzel HS, Arciniegas DB. Treatment of post-traumatic cognitive impairments. Curr Treat Options Neurol. 2012 Oct;14(5):493–508. 

3. Royall DR, Lauterbach EC, Cummings JL, Reeve A, Rummans TA, Kaufer DI, et al. Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci. 2002;14(4):377–405. 

4. Ferreira D, Molina Y, Machado A, Westman E, Wahlund L-O, Nieto A, et al. Cognitive decline is mediated by gray matter changes during middle age. Neurobiol Aging. 2014 May;35(5):1086–94. 

5. Ríos M, Periáñez JA, Muñoz-Céspedes JM. Attentional control and slowness of information processing after severe traumatic brain injury. Brain Inj. 2004 Mar;18(3):257–72. 

6. Moscovitch M, Cabeza R, Winocur G, Nadel L. Episodic Memory and Beyond: The Hippocampus and Neocortex in Transformation. Annu Rev Psychol. 2016;67:105–34. 

7. Vakil E. The effect of moderate to severe traumatic brain injury (TBI) on different aspects of memory: a selective review. J Clin Exp Neuropsychol. 2005 Nov;27(8):977–1021. 

8. Vakil E, Greenstein Y, Weiss I, Shtein S. The Effects of Moderate-to-Severe Traumatic Brain Injury on Episodic Memory: a Meta-Analysis. Neuropsychol Rev. 2019 Aug 13; 

9. Gioia GA, Isquith PK, Guy SC. Assessment of executive functions in children with neurological impairment. In: Psychological and developmental assessment:  Children with disabilities and chronic conditions. New York, NY, US: Guilford Press; 2001. p. 317–56. 

10. Zimmermann N, Pereira N, Hermes-Pereira A, Holz M, Joanette Y, Fonseca RP. Executive functions profiles in traumatic brain injury adults: Implications for rehabilitation studies. Brain Inj. 2015;29(9):1071–81.