Neurobehavioral and self-awareness changes after traumatic brain injury: Towards new multidimensional approaches

Abstract

Neurobehavioral and self-awareness changes are frequently observed following traumatic brain injury (TBI). These disturbances have been related to negative consequences on functional outcomes, caregiver distress and social reintegration, representing therefore a challenge for clinical research. Some studies have recently been conducted to specifically explore apathetic and impulsive manifestations, as well as self-awareness impairments in patients with TBI. These findings underlined the heterogeneity of clinical manifestations for each behavioral disturbance and the diversity of psychological processes involved. In this context, new multidimensional approaches taking into account the various processes at play have been proposed to better understand and apprehend the complexity and dynamic nature of these problematic behaviors. In addition, the involvement of social and environmental factors as well as premorbid personality traits have increasingly been addressed. These new multidimensional frameworks have the potential to ensure targeted and effective rehabilitation by allowing a better identification and therefore consideration of the various mechanisms involved in the onset of problematic behaviors. In this context, the main objective of this position paper was to demonstrate the interest of multidimensional approaches in the understanding and rehabilitation of problematic behaviors in patients with TBI.

The Spectrum of Long-Term Behavioral Disturbances and Provided Care After Traumatic Brain Injury

“…A large number of TBI survivors, especially those with moderate to severe TBI (mod/sevTBI), has permanent impairments regarding the physical, cognitive and behavioral domains and social functioning (4)(5)(6). Behavioral disturbances interfere with daily life and social interaction and vary from apathy, disinhibition, and agitation, to aggression and violent behavior, that frequently exist simultaneously (7,8). These behavioral disturbances are in general difficult to manage due to impaired self-awareness and may still be present several years after trauma (9)(10)(11).…”

Head injury serum markers for assessing response to trauma: Design of the HeadSMART study

“…Head computed tomography (CT) is the initial diagnostic test of choice; however, sub-optimal tissue characterization prevents accurate capturing of some TBI injuries such as white matter shearing and associated axonal injury. Behavioural presentations after TBI are heterogeneous and complex, requiring a level of observation and multidimensional assessment not routinely available in acute care settings [7]. There is an unmet clinical need for accurate, accessible biomarkers that can reliably detect TBI and predict TBI-associated outcomes.…”

A comparison of patients managed in specialist versus non-specialist inpatient rehabilitation units in Australia

“…[12] For instance, environmental factors including noise, overcrowding, restrictions and interactions can contribute to incidents of agitation [34] and aggression in patients with a brain injury. [35,36] Managing environmental stimuli through unit design, staff training and involvement of specialist clinicians (such as, neuro and clinical psychologists) to mitigate such behaviours is core business for specialist neuro-rehabilitation units. Resources, patient environment and infrastructure are important considerations when rehabilitating particular patient populations, such as brain injury and SCI.…”