A Survey of Clinicians Working in Brain Injury Rehabilitation: Are Social Cognition Impairments on the Radar?

OBJECTIVES: To examine the social cognition assessment practices of clinicians working with children and adults with traumatic brain injury. MAIN MEASURES: Online survey addressing frequency of social cognition impairments, how these are assessed and obstacles to same, and treatment practices. PARTICIPANTS: A total of 443 clinicians worldwide working in inpatient and outpatient settings. RESULTS: While 84% of clinicians reported that more than half of their clients with severe traumatic brain injury had social cognition impairments, 78% of these reported that they infrequently or never assessed these domains using a formal assessment tool. Lack of reliable tests was most frequently (33% of respondents) cited as the greatest barrier to undertaking social cognition assessment. CONCLUSIONS AND IMPLICATIONS: Improvements are needed in the development and norming of instruments capable of detecting social cognition impairments in the traumatic brain injury population. Additional training and education is needed in the use of social cognition assessment tools.

Bilateral remote cerebellar haemorrhage after spinal surgery: a case study and review of the literature.

BACKGROUND: Remote cerebellar haemorrhage is a rare and unpredictable complication after intracranial and spinal surgery, although less frequently found in the latter. The physiopathology of this phenomenon has not been definitely explained. OBJECTIVES: To describe and discuss the potential implications and pathomechanism of a bilateral remote cerebellar haemorrhage case after spinal surgery and review the literature related to this rare phenomenon. CASE REPORT: A 75 year-old man developed bilateral remote cerebellar haemorrhage after a lumbar laminectomy. Brain CT and MRI examinations showed chronic bilateral remote cerebellar haemorrhage, right haemoventricle and bilateral supratentorial subarachnoid haemorrhage. Subsequently, the patient underwent rehabilitation therapy with improvement of symptoms. CONCLUSION: When large cerebrospinal fluid loss is observed during spinal surgery, brain imaging study should be carried out. The pathogenetic hypothesis of microcirculation vessels tearing, the role of previous spinal surgery and of cerebellar atrophy should be considered and validated with further investigation.

A metacognitive contextual intervention to enhance error awareness and functional outcome following traumatic brain injury: a single-case experimental design.

Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home; and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional outcome in real life settings.

The power of the human heart: a story of trauma and recovery and its implications for rehabilitation and healing.

Ms Trisha Meili revealed her identity as the Central Park Jogger in a presentation at Spaulding Rehabilitation Hospital in Boston in May 2003. Her co-presenter was Dr Jon Kabat-Zinn, whose teachings on mindfulness and meditation had been important in Ms Meili's rehabilitation process. This transcript of that conversation describes the various phases she underwent in her recovery, and documents the role of her self-discovered practice of mindfulness in restoring her emotional and physical functioning. Dr Kabat-Zinn reflects on the deeper meaning of the term "rehabilitation," and demonstrates its natural connections to the practice of meditation. A final question and answer section with audience members (clinicians, brain injury survivors and their families) documents the role of emotional support and inspiration in recovery from devastating injury.