Frontal Lobe Dysfunction following Closed Head Injury. A Review of the Literature

Mattson, Audrey J.; Levin, Harvey S.

doi:10.1097/00005053-199005000-00002

Cited by 159 publications

(74 citation statements)

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“…Several cognitive domains are predictably impaired, including frontal executive functions (problem solving, set shifting, impulse control, self-monitoring) (33,35), attention (36,37), short-term memory and learning (38)(39)(40)(41)(42)(43), speed of information processing (44,45), and speech and language functions (46)(47)(48)(49). Obviously, these are not completely independent domains, and there is typically a mixture of deficits of varying degrees across domains.…”

Section: Changes In Cognitionmentioning

confidence: 99%

Neurobehavioral sequelae of traumatic brain injury: evaluation and management

2008

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Traumatic brain injury (TBI) is a universal public health problem. A recent review of epidemiological studies in Europe suggests an incidence of 235 hospitalized cases (including fatalities) per 100,000 population (1). In the US, the incidence is estimated at 150 per 100,000 population (2). Less data is available from other regions of the world, but TBI is acknowledged as a significant problem worldwide. Of note is that the incidence rates are calculated from hospitalized cases only, and do not include injured individuals who do not seek or have access to care. Thus, the actual incidence of injury is probably 3 to 4 fold larger than the quoted numbers. Most studies suggest that the incidence rates for TBI are greatest in the second and third decades of life, with a secondary increase in the elderly stemming from falls (2,3). Males are more likely to suffer a TBI than females (2,3).In developed countries, there has been a reduction in the mortality rates associated with TBI over the last several decades, generally attributed to improved systems of trauma care and improved motor vehicle safety design. Many individuals with mild traumatic brain injury and virtually all individuals who survive moderate and severe TBI are left with significant long-term neurobehavioral sequelae (4-6). Thus, the reduction in TBI-associated mortality rates (7) has led to a significant increase in the number of individuals with long-term neurobehavioral disorders related to TBI (8,9).Brain trauma can be caused in a number of ways, including mechanisms which penetrate the substance of the brain (e.g., projectiles) and those that do not. This paper focuses on non-penetrating injuries. Despite different contexts and instruments, the physics and biomechanics underlying damage to the brain from non-penetrating injuries have some common features. This results in certain brain regions being at greater risk for damage than others and allows for some general statements to be made about typical profiles of brain injury associated with trauma. The assessment and treatment of the neurobehavioral sequelae of TBI follow logically from an understanding of this injury profile. RELATIONSHIP OF PROFILE OF INJURY TO NEUROBEHAVIORAL SEQUELAEThere are two broad categories of forces that result in brain injury: contact (or impact) and inertial (acceleration or deceleration). Contact injuries result from the brain coming into contact with an object (which might include the skull, or some external object). Contact mechanisms often result in damage to scalp, skull, and brain surface (e.g., contusions, lacerations, hematomas) (10). Frequent sites of such injury are the anterior temporal poles, lateral and inferior temporal cortices, frontal poles, and orbital frontal cortices.Inertial injury results from rapid acceleration or deceleration of the brain that produces shear, tensile, and compression forces. These forces have maximum impact on axons and blood vessels, resulting in axonal injury, tissue tears, and intracerebral hematomas. These mechanisms also produc...

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Section: Changes In Cognitionmentioning

confidence: 99%

Neurobehavioral sequelae of traumatic brain injury: evaluation and management

2008

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“…Patients with damage to orbito-frontal cortex and with ventromedial damage, that is, damage that includes both orbital and medial frontal cortex, typically have severe de cits in social functioning (Blumer & Benson, 1975;Damasio, Tranel, & Damasio, 1990;Eslinger & Damasio, 1985;Kaczmarek, 1984;Mattson & Levin, 1990;Saver & Damasio, 1991). These patients are able to correctly analyze social situations in the abstract, but when they respond to similar situations in real life, they choose inappropriate courses of action (Eslinger & Damasio, 1985;Saver & Damasio, 1991).…”

Section: Introductionmentioning

confidence: 99%

“…These patients can often say what the correct response is but have dif culty changing their behavior to respond appropriately to the social situation or to changing reinforcements in the environment (Rolls, 1996). Orbito-frontal patients often say inappropriate things and appear disinhibited (Mattson & Levin, 1990). Their conversation typically does not respond to signals of whether the other person is interested in what they are saying or whether they are on topic (Kaczmarek, 1984).…”

Section: Introductionmentioning

confidence: 99%

Frontal Lobe Contributions to Theory of Mind

Stone

Baron‐Cohen

Knight

1998

Journal of Cognitive Neuroscience

1,308

887

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Abstractn "Theory of mind," the ability to make inferences about others' mental states, seems to be a modular cognitive capacity that underlies humans' ability to engage in complex social interaction. It develops in several distinct stages, which can be measured with social reasoning tests of increasing dif culty. Individuals with Asperger's syndrome, a mild form of autism, perform well on simpler theory of mind tests but show de cits on more developmentally advanced theory of mind tests. We tested patients with bilateral damage to orbito-frontal cortex (n = 5) and unilateral damage in left dorsolateral prefrontal cortex (n = 5) on a series of theory of mind tasks varying in dif culty. Bilateral orbito-frontal lesion patients performed similarly to individuals with Asperger's syndrome, performing well on simpler tests and showing de cits on tasks requiring more subtle social reasoning, such as the ability to recognize a faux pas. In contrast, no speci c theory of mind de cits were evident in the unilateral dorsolateral frontal lesion patients. The dorsolateral lesion patients had dif culty only on versions of the tasks that placed demands on working memory. n

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“…Severity of brain injury correlated with measures of impaired awareness in some studies (Leathem et al, 1998;Prigatano & Altman, 1990), but not in others (Anson & Ponsford, 2006;Bach & David, 2006;O'Keeffe et al, 2007;Port et al, 2002). Also, the correlation between SA deficits and neuropsychological disturbances is not clear (Allen & Ruff, 1990;Boake et al, 1995) even if executive functions (EF), in particular, are frequently impaired in TBI patients (Mattson & Levin, 1990;Stablum et al, 1996) and are considered to influence degree of SA following brain damage (Hart et al, 2005;Noè et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Executive function and metacognitive self-awareness after Severe Traumatic Brain Injury

Bivona

Ciurli

Barba

et al. 2008

J Int Neuropsychol Soc

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The objective of this study is to identify the clinical, neuropsychological, neuropsychiatric, and functional variables that correlate with metacognitive self-awareness (SA) in severe traumatic brain injury (TBI) outpatients and to assess the influence of the same variables on the sensory-motor, cognitive, and behavioral-affective indicators of SA. This cross-sectional observational study evaluated 37 outpatients from May 2006 to June 2007 in a neurorehabilitation hospital on the basis of the following inclusion criteria: (1) age Ն 15 years; (2) diagnosis of severe TBI (Glasgow Coma Scale, GCS Յ 8); (3) posttraumatic amnesia (PTA) resolution; (4) capacity to undergo formal psychometric evaluation despite cognitive and sensory-motor deficits; (5) absence of aphasia; (6) availability of informed consent. A neuropsychological battery was used to evaluate attention, memory, and executive functions. SA was assessed by the awareness questionnaire (AQ), administered to both patients and relatives. Decreased metacognitive self-awareness is significantly correlated with increased problems in some components of executive system, even when the AQ subscales were considered separately. The significant correlation found between some components of executive system and metacognitive self-awareness confirmed the importance of addressing this issue to treat SA contextually in the rehabilitation of executive functions. (JINS, 2008, 14, 862-868.)

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Frontal Lobe Dysfunction following Closed Head Injury. A Review of the Literature

Cited by 159 publications

References 0 publications

Neurobehavioral sequelae of traumatic brain injury: evaluation and management

Neurobehavioral sequelae of traumatic brain injury: evaluation and management

Frontal Lobe Contributions to Theory of Mind

Executive function and metacognitive self-awareness after Severe Traumatic Brain Injury

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