Abnormal psychological traumatic brain injury
For those who survive and regain consciousness, recovery takes place in a typical fashion. The first stage is acute confusion and disorientation.
Closed traumatic brain injury occurs when the head is hit hard but there is no specific skull or brain injury. This type of trauma usually causes total brain concussion within the skull and diffuse damage. About half of the closed traumatic brain injuries are caused by traffic accidents. The second leading cause falls, especially for the elderly and young children. Fighting accounts for about 20% of cases, while sports injuries account for only about 3%. Alcohol abuse also increases the risk. People aged 15-20 are also a high-risk group. In the UK approximately 150/100,000 people are hospitalized with traumatic brain injury every year (Jennett, 1996).
A simple indicator of injury severity is “time required”, which is the amount of time after injury until the individual is able to meet simple requirements. simple. For mild traumatic brain injury, this period is less than 1 hour, for moderate trauma, it is from 1 hour to 13 days, and for severe, 14 days or more. About 30%-50% of deaths are due to severe traumatic brain injury. In about 10% of cases, the "vegetative" state persists for up to 3 months after the injury; 4% lasts up to 6 months and 2-3% lasts up to 1 year.
For those who survived and regained consciousness, recovery took place in a fairly typical fashion. The first stage is acute confusion and disorientation. During this stage, they are incapable of remembering: post-traumatic amnesia. The longer this phase of amnesia, the worse the ending. However, a prolonged period of amnesia following trauma does not necessarily mean a poor prognosis for recovery. For example, Jennett et al. (1981) reported that up to 7% of people with amnesia after trauma lasting 1 to 2 weeks had a good ending.
After a period of amnesia following moderate and severe traumatic brain injury, there are physical, cognitive, and behavioral problems. Most physical problems can be resolved, although some symptoms may persist, such as muscle tension, difficulty swallowing, and balance disturbances. About 5% of people with moderate to severe blunt traumatic brain injury have seizures: comparable to penetrating injuries, this rate ranges from 35 to 50%. After 5 years, the risk of having a seizure is still higher than normal.
Neurological and cognitive deficits are the most common sequelae of closed traumatic brain injury. Diffuse brain damage causes characteristic cognitive disturbances, including reduced cognitive speed, impaired attention plus memory disturbances, complex language functions, and “awakening functions” (Levin, 1993). A little later there are problems with current memory, problem-solving, showing control, and organization. Basic recovery occurs during the first 6 months after the injury, although recovery may continue beyond 1 year but is slow. Within the first month, most moderate to severe trauma victims have significant cognitive impairment. During the first 6 months after injury, about 8% of those with moderate injury and 16% of those with severe injury were hospitalized for cognitive disorders. The same rate after 1 year is 0% and 10%. Only a quarter of people with severe traumatic brain injury are able to return to their previous jobs (Sherer et al. 2000).
Neurobehavioral symptoms in individuals with severe traumatic brain injury include increased irritability, headache, anxiety, difficulty concentrating, fatigue, restlessness, and depression (Satz et al. 1998). ). These symptoms are more common than somatic symptoms or other cognitive deficits and can have a lasting impact on disease outcomes. One of the important features of late recovery from a traumatic brain injury is a decrease in self-consciousness. Perhaps that's why relatives of people who have sustained traumatic brain injury are often more likely to notice the psychological changes of the victim than the victim himself. Problems reported by victims' relatives include sluggishness, increased arousal, fatigue, depression, rapid emotional transitions, and anxiety (Brooks et al. 1986). The distal consequences of closed traumatic brain injury persist and increase the risk of divorce, unemployment, economic decline, and substance abuse. Perhaps unsurprisingly, rates of depression and suicide are higher in people with traumatic brain injury (Teasdale & Eng berg, 2001).
Cognitive rehabilitation after traumatic brain injury
For moderate to severe traumatic brain injuries, rehabilitation involves a number of therapeutic approaches offered by various specialized health professionals. Medical therapy includes pain control for headaches, pharmacotherapy for epilepsy, and surgery for hydrocephalus. Physical therapy aims to increase the strength and flexibility of the muscles, occupational therapy equips, develops the abilities necessary for self-care or the individual may return to certain occupations. Speech therapists can work with individuals to improve understanding as well as pronunciation. From a psychological perspective, the intervention mainly focuses on the behavioral and cognitive consequences of trauma. The remainder of the chapter will focus on some of the techniques used to improve cognitive function or help individuals deal with persistent cognitive deficits.
Coping with memory problems
There are a number of general techniques to improve memory such as memory training, combining pictures and words to improve representation etc. Specific techniques have also been developed for people with traumatic brain injury. These techniques often have very specialized learning exercises. For example, Wilson (1989) used the preview, question, read and test (PQRST) method to improve the coding and reproducibility of the word list. This method is implemented by having participants review the exercises, think about the requirements of the task then read through a few times the list of words, first reading aloud then silently, finally. just did the test. The additional cognitive processing in this method is thought to enhance learning more than the mere repetition of a list of words. Unfortunately, the memory that is reinforced through these training sessions often fails to promote the specific memory exercises. In addition, many traumatic brain injury patients often do not fully appreciate memory loss, so these programs are not always accepted. Dobkin (1996) concluded that the adjunctive "therapy" is memory therapy (for people with MS and AD). According to the author, tools that can be used to aid memory include tape recorders, notebooks, minicomputers, watches, walkie-talkies, or using a home radio system. Dobkin (1996) concluded that the adjunctive "therapy" is memory therapy (for people with MS and AD). According to the author, tools that can be used to aid memory include tape recorders, notebooks, minicomputers, watches, walkie-talkies, or using a home radio system. Dobkin (1996) concluded that the adjunctive "therapy" is memory therapy (for people with MS and AD). According to the author, tools that can be used to aid memory include tape recorders, notebooks, mini calculators, watches, walkie-talkies, or using a home radio system.
For those with significant damage, it may be necessary to practice using memory aids. For example, Sohlberg and Mateer (1989) used a 3-step training process to use mnemonic notebooks. The first step is to practice the content and purpose of the memo. This is reinforced in a question-and-answer format (“what are the 5 sections of your memo”). When put into the application, individuals practice according to the content of the handbook in the form of role-playing games. Finally, they use the notebook in “real life”. According to this approach, participants in the program take about 17 days of practice to develop the necessary skills using the manual.
Memory aids need to be helpful in reminding individuals to do things that they might forget. For example, Wilson et al. (2001) evaluated the use of a system of numbered pages to remind people with traumatic brain injury to do different things during the day.
Most of these sites are useful both at the time of doing so and for about 7 weeks afterward. Its advantage may be to establish relatively persistent patterns of behavior.
Improved “execution function”
The second problem that people with TBI face is a decline in problem-solving skills. Interventions to fill those gaps are designed to be problem-solving and step-by-step. One such model is IDEAL. This model uses simple initials that were developed by Bransford and Stein in 1984.
Identify the problem.
Defining the problem (its cause and effect).
Searching (exploring) solution options.
Action according to the option identified in step E L- Check the effectiveness of the selected plan.
People with traumatic brain injury can also be instructed not to try to solve complex problems at once, but to try specific problems and work on them one after another.
When individuals have impaired attention in problem-solving or other tasks, it is possible to train them to compensate for attention. The first step of this approach is for the individual to identify when attention has been reduced, and then to use strategies such as self-direction (Meichenbaum 1985: "come on in here") to aid focus. central attention. Outside help can also help (Wilson et al. 2001).
Several standard programs have been developed to correct attention problems. For example, the Attention Training Program (APT) of Park et al. (1999) used a number of different strategies. Some other exercises to reinforce attention include: paying attention to the tape, when you find the required words or sentences, ring the bell, listen to a passage and comprehension test, and mental arithmetic exercises. Practice moving your attention with an exercise that includes listening to a tape to detect the word you want to hear next to the word you have identified. Exercises are performed in turn from easy to difficult, repeated until the individual does exactly as required. If necessary, they will be trained at home or at home with the help of loved ones.
This approach also achieves certain results. Most studies also show improvement in psychological tests of memory or attention after implementing these programs… For the “real world” there seems to be less improvement although there is also evidence of improvement in some test results, for example driving skills, living independently, or returning to work (Sohlberg & Mateer 2001). Several other strategies aimed at increasing attention or preventing forgetfulness are covered in the section on reduced disorders.
For negative emotions
Depression and suicide are high in people with late-stage traumatic brain injury. It is generally thought that some psychological and pharmacological interventions are effective in improving mood in this group of people. For example, according to the National Institutes of Health, psychotherapy can be a very important aid in emotional recovery, reducing depression, and improving assessment related to cognitive disorders. . They also argue that such interventions should provide emotional support, explain trauma and its consequences, and help regulate self-assessment by striving to achieve achievable goals. gain, limit rejection and increase the ability of the individual to relate to family and society. Despite such optimism, it has also been noted that psychotherapy for people with traumatic brain injury has not been systematically studied and therefore its benefits have not been proven. It has also been noted that in addition to good results, antidepressants can also cause serious side effects in this group of people. Therefore, when giving the patient a drug, it is necessary to closely monitor and prescribe other therapies if deemed appropriate.
People who live with or care for someone with a traumatic brain injury may also experience significant stress or stress disorder (Harris et al. 2001). There is only limited evidence that family pressures are alleviated when patients achieve cognitive and well-being improvements. There are, however, strong foundations for programs to help families cope with the stress of caring for a traumatic brain injury. Even so, there hasn't been much research supporting emotional coping with trauma and its consequences and similarly, there hasn't been much research on the effectiveness of such programs. In addition, most of these studies were done spontaneously and without control. It is therefore difficult to assess the influence of family or assistance programs (Sinnakaruppan & Williams 2001).