Traumatic brain injuries: mechanisms, effects, and recovery

¶ … patients diagnosed with TBI cope better with counseling and outreach programs when dealing with new or abnormal behaviors?

Traumatic brain injury (TBI) may result in social and emotional defects (such as delayed word recall) that result in frustrating and embarrassing moments for the victim. Of all counseling and intervention programs, rehabilitation therapy (CRT) is the one that is commonly used and, therefore, this literature review will conduct a meta-analytic search (focusing on quantitative studies within the last five years) in order to assess the efficacy of CRT in helping TBI individuals with their social and emotional skills and perceptions.

The essay identified and reviewed seven randomized trials of language, emotional and social communication cognitive rehabilitation. Inclusion terms were that participants had to possess sufficient cognitive capacity to be included in a group and impairment in emotional and social skills was evidenced either by a questionnaire or by the clinician's reference. All of the studies were on chronic and moderately severe TBI.

Description of studies

Bornhofen and McDonald (2008a; 2008b) reported two trials that dealt with emotion deficits. Their program used group activities as well as home assignment and journal notation to teach skills for emotion perception. Sessions were 25 hours held over 8 weeks. The 12 participants were randomly recruited either to treatment or to a waitlist group. Researchers used facial expression (naming and matching), The Awareness of Social Inference Test (TASIT), and psycho-social reintegration as studies of outcome. TASIT showed significant results when individuals were tested immediately post treatment, with minimal results between intervention group and control on others. More significant results on all measures of intervention were however seen when follow up tests were taken a month later.

Bornhofen and McDonald (2008b) repeated their trial in order to identify the effective components of the program and see which of the counseling / treatment aspects were most responsible for improvement. They used three groups: self-instruction training, errorless strategy, and a waitlist. There were 25 hours across 10 weeks and a therapist worked with each group. The 18 participants were randomized across the three groups, and outcome measures included facial expression recognition, facial expression naming and matching, psycho-social reintegration, and depression and anxiety, as well as relative ratings of adjustment, social performance, and psycho-social reintegration. Few differences showed between the different elements used in the programs for treatment.

McDonald et al. (2008) conducted a randomized trial of social emotion perception training and social behavior compared to a control group. Each was 48 hours. Group sessions focused on social behavior (2 hours) and emotion training (1 hour) and a third intervention was CBT (1 hour). Social behavior was measured by the Partner Directed Behavior Scale and the Personal Conversational Style Scale as well as the TASIT for anxiety and Katz Adjustment Scale. Apparently, the social behavior treatment program (using skills other than CBT) was more effective than the CBT prong.

Schwandt et al. (2012) investigated the efficacy of aerobic exercise intervention in reducing depression of TBI individuals and helping them cope with their emotion. The design was a 12-week aerobic exercise program that was composed of a single group; participants were tested both before and after the program. Participants were randomly selected from a group of patients who were recruited form an outpatient clinic and had some physical impairment. The 12 participants were at least 11 months post injury. Measures used were the Hamilton Rating Scale for Depression; aerobic capacity (cycle ergometer, heart rate at reference resistance, perceived exertion); Rosenberg Self-Esteem Scale and program perception (survey). The participant's observation of effect of program was noted and summarized. Descriptive statistics also collated and described comparison between pre- and post -- results. Outcome showed significant increase in self-esteem, as well as enhanced skill in physical movements and reduction of depression. There were no adverse effects. Researchers concluded that an aerobic program is extremely helpful for TBI patients. Further research needs to be conducted on intensity, frequency, and duration of such a program.

Chard et al. (2011) used a far larger group -- 42 participants from a Veterans Administration residential program to test for the efficacy of psychoeducational activities and CBT on comorbid posttraumatic stress disorder (PTSD) and TBI. The participants were randomly selected between the two control groups. Each program also used standard cognitive processing therapy. Program lasted 13 weeks. Results discovered that CBT supplemented with cognitive processing therapy seemed to be the most effective in helping patients with both post-TBI and PTSD symptoms.

Previous studies show that social and emotional support can go a long way in helping victims of various diseases. Bell et al. (2011) therefore conducted a telephone support intervention in order to assess whether that may help victims f TBI better cope with social and emotional aggravation in their routine lives. They conducted a two group, randomized controlled trial on 433. Subjects who were recruited form inpatient rehabilitation. The subjects (mean age 16) were randomized between a Scheduled Telephone Intervention (STI) group and usual care (UC) and simply usual care (UC) which was the control. Aspects that were observed were function, health/emotional status, community/work activities, and well-being and these were monitored both now and two years after injury. The STI subjects received brief training in education, problem solving, and referral, and they received calls almost every month in order to check up on their welfare. The calls, lasting a year, were frequent at first and then gradually paced apart. Measures used included the Glasgow Coma Scale, race/ethnicity, age, FIM, sex, and Disability Rating Scale (DRS) as well as individual and composite measures (FIM, DRS, community participation indicators, Glasgow Outcome Scale [Extended], Short Form-12 Health Survey, Brief Symptom Inventory-18, EuroQOL, and modified Perceived Quality of Life). Despite thorough research and contrary to expectations, no significant findings were discovered between the groups leading researchers to conclude that whilst telephone-based counseling was shown effective in other cases, it has not proved greater efficacy to other models of treatment in the case of TBI.

A different treatment that was employed was an anger-management program with the idea that anger management may help patients of TBI deal with their depilating bitterness that caused many of the frustrating emotional and social shortfalls. Hart et al. (2012) randomly selected 10 people who had moderate to severe, chronic TBI with significant cognitive impairment and significant levels of anger and irritability and conducted a fully manualized, 8-session, psychoeducational treatment for irritability and anger which they called anger self-management training (ASMT). The group was a single intervention pilot study with pore- and post-assessment. Two subscales of the State-Trait Anger Expression Scale -- Revised and Brief Anger-Aggression Questionnaire were used as well as qualitative observation and solicitation of self-report. Researchers found significant improvement on all 3 measures of self-reported anger, with large effect sizes (>1.0), and advised further investigation of this program on individuals who had trouble managing their TBI symptoms in routine life.

Conclusion

Seven quantitative studies were selected in order to investigate therapeutic and other interventions that could help TBI patient's progress with their lives and deal with debilitative social and emotional post-injury symptoms. CBT was found effective in three of the treatments. Telephone counseling was found to have no significant effect in aiding patients. Anger management program was found o have potential as well as aerobics exercise. Chard et al. (2011) advocated regular therapy in addition to CBT. All consisted of random selecting. Most contained only a few participants, and these therefore require larger samples. All used reliable instruments and thorough conditions in order to assess outcomes in a reliable manner. Only two were single pore-post treatment groups. All suggested further investigation.