Depression represents a major source of disability among individuals who have suffered a traumatic brain injury (TBI), with estimates of prevalence in this population ranging over 50%. In comparison with other sequelae of TBI, depression is often poorly conceptualized and treated among acute care and rehabilitation professionals. One reason for this is the lack of clear etiological models for the development of depression following TBI. This paper argues that post-TBI depression actually represents a heterogeneous category, with multiple etiologic pathways and clinical implications. The literature in this area is reviewed, with an emphasis on an appreciation of the diversity within this clinical population. Conclusions focus on suggestions for differential diagnosis and treatment options.

Athletes performed more poorly on computerized cognitive screening tools and reported greater symptoms after an acute concussion relative to their baseline performance. Female sex may be a modifier of an acute concussion outcome, given that female athletes in this study performed significantly worse than male athletes across all neurocognitive measures and reported greater symptoms relative to their baseline testing compared with male athletes, regardless of the sport played. Female athletes were also more likely than male athletes to demonstrate scores on neurocognitive testing that exceeded reliable change cutoffs and were predictive of a protracted recovery. The practical significance of these findings should be further verified by prospective longitudinal research given the medium- to large-sized effect demonstrated for the overall relationship between sex and concussions.

This study examined an operational conditioning paradigm designed to train procedural learning channels in a patient with anoxic encephalopathy. Prior to treatment the patient had been incontinent to bowel and bladder incontinent, minimally participant in daily activities and aggressive toward staff and residents for two years. Previous rehabilitation attempts had been unsuccessful in changing these behaviours. Based on the literature, it was hypothesized that through operant conditioning the patient could be trained on three behaviours: 1) bowel and bladder continence 2) activity level and 3) level of aggression. Results indicated that at a 4 month interval following the initial training, the patient had improved in all areas of functioning.

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Purpose This study examined relationships among concussion clinical profiles with patient demographic and clinical factors and the prognostic utility of the CP Screen tool at initial visit for prolonged recovery (>28 days). Methods 297 participants with concussion were selected through convenience sampling for this retrospective cohort study (9-68 years old, 59.3% males, 71.7% sport-related concussion). At initial visit in UPMC clinics, participants of the original study completed the CP Screen along with the ImPACT, PCSS, VOMS, as part of standard care. Clinical profiles (anxiety/mood, cognitive/fatigue, posttraumatic migraine, vestibular, ocular) were endorsed via CP Screen criteria. Participants’ demographic (age, sex, mechanism of injury) and clinical (psychiatric, migraine, ADHD/LD, concussion histories) factors were examined. Results Females endorsed more clinical profiles (M=1.20, SD=1.54) than males (M=.60, SD=1.13) (p<.001). Psychiatric history predicted endorsement of anxiety/mood profile (OR=3.29, 95% CI [1.41, 7.69], p<.01), controlling for migraine, ADHD/LD, and concussion histories. Vestibular profile, controlling for other clinical profiles, predicted prolonged recovery (OR=3.93, 95% CI [1.52, 10.22], p<.01). Exploratory analysis for cognitive/fatigue profile as predictor of prolonged recovery revealed statistical significance (OR=2.16, 95% CI [1.01, 4.62], p<.05). Conclusions At initial visit, clinicians may anticipate females to present more symptomatic with clinical profiles than males and expect anxiety/mood profile endorsement by those with pre-existing psychiatric problems. Clinicians may also need to closely monitor patients initially endorsing vestibular or cognitive/fatigue profiles as they are more likely to experience an extensive recovery.