NeuroRehabilitation

The past decade has seen numerous advancements in the assessment of malingered brain injury, though the current diagnostic system offers only guidelines in which malingering should be suspected. This article presents an overview of advances in the clinical and neuropsychological assessment of malingering, issues in diagnostic differential, neuropsychological test methods, and special issues presented by the medical-legal context, and other factors which may affect presentations. Cautions and recommendations for practice are presented.

One important challenge in neuropsychiatry is how to diagnose depression in patients with acute brain lesions, since there may be an overlap between symptoms of depression and signs associated with the neurologic disease. The best approach is to assess the presence of depressive symptoms using semi-structured or structured psychiatric interviews such as the Present State Exam, the Structured Clinical Interview for DSM-IV, or the Schedules for Clinical Assessment in Neuropsychiatry. The diagnosis of a depressive syndrome should be made using standardized diagnostic criteria for mood disorders due to neurological disease such as in the DSM-IV or the ICD-10. Depression rating scales, such as the Hamilton Depression Scale and the Center for Epidemiologic Scales for Depression may be used to rate the severity of depression and monitor the progression of antidepressant treatment. Most studies in acute and chronic neurologic disorders demonstrated the specificity of both autonomic and psychological symptoms for the syndrome of depression.

The present review article examines important considerations before a diagnosis of depression in neurologic disease, discusses a variety of psychiatric instruments that are used to examine the presence and severity of depression in neurologic disease, examines relevant phenomenological issues, and proposes different diagnostic strategies.

This paper questions the DSM IV TR criteria for Dementia Due to Head Trauma (DDHT). We studied 20 consecutive traumatic brain injury (TBI) patients and checked them for this criteria. We found the diagnosis criteria to be oversensitive and lacking in specificity, consequently raising the possibility for all subjects who have sustained severe TBI to be diagnosed with dementia. A careful analysis of data and literature showed that nearly half of these patients were able to return to work after undergoing an intensive and holistic rehabilitation program, indicating a reversal of the “dementia”. Severe head injury produces a set of multiple cognitive deficits that shouldn't be considered dementia. The term “Severe Neurocognitive Disorder” is suggested for use instead of DDHT for the cognitive deterioration of severe TBI patients.

This paper reviews the strengths and limitations of the DSM-IV in the diagnosis of children with Traumatic Brain Injury. The authors compare the DSM-IV diagnostic characteristics for effective classification and decision making in children with TBI. The DSM IV multiaxial approach can be useful in patients with brain injury because medical considerations can be incorporated with the diagnosis, along with standard mental health factors.

The definitions in the Diagnostic and Statistical Manual-4th Ed.-TR [5] relating to posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) after mechanical accidents do not reflect the range of dysfunctions, the significance of patient differences, and fluctuating intensity, direction, and symptoms with increasing time since an injury. The considerable overlapping of symptoms is not considered at all, nor is concussion given a diagnosis. Some anatomical and physiological considerations for these frequently comorbid conditions are specified to increase diagnostic precision, or call attention to unavoidable ambiguities. The current definitions lead to diagnostic error since there are many that are based upon symptoms that are not trauma related although they resemble those of TBI. A Taxonomy of Neurobehavioral Disorders draws attention to a wide range of physiological and behavioral functions, with implications for more accurate recognition of symptoms, diagnosis, and treatment. Persistent posttraumatic disorders, more complex than PTSD, exist, due to the effects of unhealed tissues, impairment, and the social consequences of impairment and rejection. There are recommendations for the improvement of the definitions of PTSD and traumatic brain injury when both may be co-morbid after a mechanical injury.

Conservation of the ipsilateral upper limb function is important in stroke subjects with contralateral hemiplegia, because often it must serve as a compensatory tool for activities of daily livings (ADLs). However, the amount of functional loss and/or the recovery pattern of the ipsilateral upper limb are not well known. We plan to investigate how to measure the progress of the ipsilateral upper limb function after the onset of stroke. Once a week we used the Manual Function Test (MFT) to evaluate the ipsilateral upper limb weakness of 72 stroke subjects with contralateral hemiplegia until maximum recovery. Proximal and distal arm weaknesses in the ipsilateral upper limb were maximally recovered within one month following the onset of hemispheric stroke, but their weakness was not to be completely recovered. Also the amounts of their recoveries were different from each other. These results indicate that the ipsilateral upper limb weakness in stroke is not a temporary event and that motor function of the proximal and distal arm might be mediated by different neuronal circuits.

Parkinson’s Disease (PD) is a progressive neurologic disorder, which includes an inability to activate appropriate muscle activity. Very little research has analyzed aerobic exercise for PD patients. The purpose of this study was to investigate the effect of a 16 week aerobic exercise intervention on aerobic capacity and movement initiation (MI) time for PD patients. With 8 PD subjects (Hoehn & Yahr stage 2), 4 completed the exercise intervention. Peak VO₂ scores significantly improved (26%) Choice MI improved from 532 ms to 415 ms, while simple MI improved from 285 ms to 261 ms. The improvement in aerobic capacity suggests that PD patients may benefit from exercise just as much as a normal population. The change in MI indicates that aerobic exercise may reduce the detrimental effects of neuromuscular slowing within PD patients, by improving the subjects’ ability to initiate and perform appropriate movement patterns.

This article provides a selective review of brain injury resources found on the Internet. It is geared toward the needs of survivors of brain injury and their families. Provided are listings of websites that focus on brain injury, those with sections pertaining to brain injury, and those with brain injury information found by searching the site. Sites that afford communication in the form of chatrooms, message boards, and mailing lists are described and listed. The value of this technology for consumers, as well as some of the challenges in searching for relevant materials on this topic, is discussed.