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Tables of Contents for Concussive Brain Trauma
Chapter/Section Title
Page #
Page Count
Concussive Brain Injury: Introduction
1
20
The Suffering Patient
1
3
The Myth of Minor Head Injury (MHI)
4
1
Some Guidelines for Assessment of TBI after Lesser Accidents
5
1
Taxonomy of Neurobehavioral Functions (TNB)
6
4
Neurological
6
1
Physiological
7
1
Cognitive Functions
8
1
Psychodynamic Reactions
8
1
Adaptive Functions
9
1
Special Problems of Children
9
1
Adaptation and Neurobehavioral Impairment
10
1
Traumatic Brain Injury as a Public Health Problem
10
2
Lack of Follow-Up
11
1
Problems of Research and Definition
11
1
Lack of Professional Concern
12
1
The Costs of TBI
12
1
General Statistics for Traumatic Brain Injury
12
4
Motor Vehicle Accidents
13
1
Sports Injuries
13
2
Incidence of Children's Traumatic Brain Injury
15
1
Predisposing Factors toward Brain Trauma and Enhanced Effects
16
5
Emotional and Social Factors
16
1
Risk-Taking Attributes
17
1
Medical Conditions
17
1
Alcohol Usage
17
1
Constitutional Factors
18
1
Consequences for Older Adults
19
2
An Introduction to the Postconcussive Syndrome
21
14
Introduction
21
1
Overview of Concussion: Beyond Tradition
22
1
Concussion in Children
23
1
The Traditional Postconcussion Syndrome (PCS)
23
2
Extended Symptom Range
25
1
Whiplash
25
1
Neurobehavioral Effects of Whiplash
25
1
Adaptive Disorders Post-Whiplash
26
1
Additional Postconcussive Symptoms
26
1
Toward a Definition of Concussion
27
2
Alterations of Consciousness
28
1
More Comprehensive List of PCS Symptoms
29
3
Classification and Assessment of Concussion
32
1
The Glasgow Coma Scale (GCS)
32
1
Parker's Wide-Range Grading of Traumatic Brain Injury
32
1
Initial Clinical Intervention
33
1
Conclusion
34
1
Controversial Issues of Concussion
35
20
Introduction
35
1
Contributions to Controversy
35
6
Lack of Formal Definition
35
1
Base Rates in the General Population
36
1
Premature Determination of the ``Resolution'' of Concussion
37
1
Emotional Factors Affecting Symptom Expression
37
1
Paradoxical Effect of Mild Blows (Prior TBI)
37
2
Complexity
39
1
Diagnostic Confusion
40
1
Exaggerating the Competence of the Examiner
40
1
Occult (Unrecognized) Traumatic Brain Injury
41
8
The Sensorimotor Exploration is Diagnostically Significant
41
1
Unattended Head Injuries
42
1
Insensitivity of Usual Neurological Procedures
42
1
Non-Recognition of Cerebral Personality Disorders
43
1
Issues Regarding Children with Traumatic Brain Injury
44
1
Children's Brain Trauma is Less Likely to be Associated with LOC than Adults'
45
1
Non-Recognition of Neuropsychological Dysfunctions
45
1
Co-Morbid or Preexisting Conditions
45
1
Non-Recognition of Traumatic Brain Injury in the Emergency Situation
46
1
Lack of Attribution to a Head Injury
47
1
Incomplete Sampling of Functions
48
1
Patient Contribution to Non-Recognition
48
1
The Problem of Objective Signs
49
1
The Question of Impaired Consciousness after Trauma
49
1
Fallacies Concerning Traumatic Brain Injury
50
2
Litigation
52
1
Stress
53
1
The Effect of Age on Outcome
53
2
The Elderly
53
2
Consciousness
55
16
Introduction
55
1
The Adaptive Function of Consciousness
56
2
In the Service of Action
56
1
Social Functioning
57
1
Reality
57
1
Information Processing
58
1
Components and Levels of Consciousness
58
5
Activation and Arousal
58
1
Awareness and its Levels
58
1
Orientation
59
1
Subjective Quality in Self-Awareness
60
1
Body Boundary and Consciousness
61
2
Focused Attention or Alertness
63
2
Selective Attention
63
2
The Organization of Consciousness
65
2
Consciousness is Differentiated and Fluctuating
65
1
Sense of Self as Unified
65
1
The Issue of Lateralization
66
1
The Consciousness Awareness System (CAS)
66
1
Contents and Products of Consciousness
67
1
Organization and Perception
67
1
Imagery
67
1
What is Consciousness?
68
1
Toward a Definition of Consciousness
69
1
Assumptions Concerning Consciousness and Action
69
1
Examination Considerations
69
1
Conclusions
70
1
Physical Principles and Neurotrauma
71
28
Introduction
71
1
Pathomechanics and Dynamics
71
8
Energy
72
1
Force
72
1
Velocity
73
1
Strain Deformations
73
5
Motion of the Skull and Brain
78
1
The Integration of Impact, Collision, and Contact
79
3
Reconstructing the Accident and Trauma
79
2
Vehicular Collisions
81
1
Application of Mechanical Principles to TBI
82
4
Impact Distortions of the Skull
82
1
Characteristics of Brain Materials
83
1
Skull-Brain Interface
83
1
The Direction of Energy and Brain Deformation
84
1
Examples of Mechanical Forces in Head Injuries
85
1
Determinants of Lesion Location and Extent
86
7
Association between Lesion Type and the Geometry of Movement
86
1
Association between Point of Impact and Site of Lesion
87
6
Skull Anatomy That Creates Neurotrauma
93
6
The Skull and Structures Creating Trauma
93
6
Primary Brain Damage and Concussion
99
18
Introduction
99
1
Concussive Brain Trauma is a Process
99
2
Second Impact Syndrome (SIS)
100
1
Brain Damage in Children
101
1
Diffuse Brain Lesions
102
2
Mild Trauma
103
1
Contusions
104
1
Hemorrhage
104
1
Cellular Damage
104
3
Membrane Damage and Ionic Flux
104
1
Genetic, Neurochemical, and Receptor Changes
105
1
Neurotraumatic Heat Effect
105
1
Neurotransmitter Systems
106
1
Oxygen Radical Effects
106
1
Transneuronal Degeneration
106
1
Diaschisis: Long-Distance Neuronal Impairment
107
1
Cellular Recovery and Regeneration
107
1
Regeneration
108
1
Compensatory Hypertrophy
108
1
Cortical Reorganization
108
1
Brain Damage is Not Simply Loss of Function
108
1
Injury to Blood-Brain Barrier (BBB)
109
1
Cerebral Blood Flow
110
1
Loss of Autoregulation of Blood Flow
110
1
Neurotraumatic Aspects of Concussion
111
1
Neural Components of Loss of Consciousness
111
1
Electrophysiological Aspects
111
1
Contributors to LOC
112
3
Brainstem Movement
112
1
Ascending Reticular Activating System (ARAS)
112
1
Cholinopontine Inhibitory Area (Cholinergic Pontine Sites)
113
1
Additional Anatomic Sites Affecting Consciousness
114
1
Summary
115
2
Non-Cerebral and Physiological Sources of Postconcussion Symptoms
117
18
Introduction
117
1
Cranial Nerve Injury
117
3
Cranial Nerve I (Olfactory)
117
1
Cranial Nerve II (Optic Nerve and Visual Dysfunction)
118
1
Cranial Nerves III, (Oculomotor), IV (Trochlear), and VI (Abducens)
118
1
Cranial Nerve V (Trigeminal)
119
1
Cranial Nerve VIII (Vestibuloauditory and Neck Receptors)
119
1
Cranial Nerve IX (Glossopharyngeal)
119
1
Cranial Nerve X (Vagus)
120
1
Cranial Nerve I (Accessory)
120
1
Cranial Nerve XI (Hypoglossal)
120
1
Cranial Nerve XII (As a Group, in Various Combinations, and Singly)
120
1
Peripheral Nerve Injury
120
1
Whiplash: Soft Tissue Injury of the Neck
121
1
Mechanics of Head and Neck Movement
121
1
Soft Tissue Injury
122
1
Neck Injury and Concussive Symptoms
122
1
Cervical Vasculature Dysfunctions
123
1
Mechanical Factors of Neck/Head Trauma
123
1
Control of Cerebral Circulation
124
1
Cerebral Autoregulation
124
1
Adrenomedullary SNS, CNS, Stress, and Anxiety
125
1
Cervical Sympathetic Ganglia
125
1
Trauma and Cerebral Circulation
125
2
Vascular Damage and Vasospasm
125
1
Concussion and Reduced Cerebral Circulation
126
1
Late Vascular Disorders
126
1
Joint Trauma
127
1
Endocrine Disorders
127
6
Homeostasis and Childrens' Development
128
1
Trauma
129
4
Circadian Rhythm Disturbance
133
2
Pain and Posttraumatic Headaches
135
12
Posttraumatic Pain
135
3
Soft Tissue Damage
136
1
Components of pain
136
2
Affective Aspects of Pain
138
1
Stress and Emotions and Pain
138
1
Depression and Pain
139
1
Pain Behavior
139
3
Prolonged Posttraumatic Headaches (PTH)
142
3
Traumatic Basis for Headaches
143
2
Classification of PTH: Headache Classification Committee, International Headache Society (1988)
145
1
Emotional and Psychiatric Components of PTH
145
2
Acute Alterations of Consciousness (Concussion)
147
12
Introduction
147
2
Representative Dysfunctions of Consciousness
147
1
Neurotrauma without LOC
148
1
Alterations in Level of Consciousness
149
1
Orientation
149
1
Brain Injury without Loss of Consciousness
149
1
Vignettes Reflecting Altered Consciousness
150
1
Posttraumatic Amnesia (PTA)
151
5
PTA as Altered Consciousness
151
1
Long-Lasting PTA and Coma
152
1
Anterograde Amnesia: Acute and Chronic
153
1
Retrograde Amnesia (RA)
154
1
Comorbidity of PTSD and PTA
154
1
Problems in Estimating Length of PTA
154
1
Prognostic Implications of PTA
155
1
Early Posttraumatic Seizures
156
1
Examination Considerations
157
2
Chronic Posttraumatic Disorders of Consciousness
159
30
Introduction
159
1
Disorders of Body Schema
160
1
Distortions of the Body Image (Schema)
160
1
Posttraumatic Epilepsy (PTE)
160
2
Subclinical Interictal Activity (Kindling)
162
1
PTE, Gender, and Age
162
3
PTE in Girls and Women
162
1
PTE in Children
162
1
PTE in Adults
162
3
Classification of Seizures
165
8
Neurobehavioral Disorders Associated with Epilepsy
171
1
Interictal Epileptogenic Activity
171
2
Treatment Issues with Posttraumatic Epilepsy
173
1
Medication effects
174
1
Seizure-Like Activity of Unknown Etiology (SLAUE)
174
5
Assumed Pseudo-Seizures
175
1
Emotional Considerations in Pseudo-Seizures
176
1
Diagnostic Considerations
176
3
Dissociative Disorders of Consciousness: Stress or TBI?
179
7
Dissociative Symptoms
181
1
Anxiety and Defensive Aspects of Dissociation
182
1
Symptoms Overlapping Between Concussion and Dissociation
182
1
Amnesia
183
1
Depersonalization
183
1
Derealization
184
1
Dissociative Identity Disorder
185
1
Sleep Disturbance
186
1
Clinical Assessment of Level of Consciousness
187
2
Information Processing and Mental Efficiency
189
22
Introduction: Information Processing and Control
189
2
Representative Dysfunctions
189
2
Cognition
191
1
Mental Control and Efficiency (MCE)
192
1
Executive Function
192
1
Employment Implications
193
1
Neurological Aspects of Information Processing
193
1
Neurological Structures Support Complex Information Processing
194
2
Particular Functions Are Performed by Multiple Structures
194
1
Behavior is Processed through a Sequence of Events
194
1
Neural Networks Functioning in Parallel
195
1
Two-Way Sensorimotor Functions Are One System
195
1
Cortical and Subcortical Structures Are Integrated
196
1
Information Processing
196
4
Concentration
197
3
Organizing Factors in Information Processing
200
5
Goal and Planning
200
1
Sequential Processing
201
1
Simultaneous Holistic Processing and Perception
201
2
Abstraction and Category Formation
203
1
Attribution of Meaning
203
2
Error Monitoring as Quality Control and Adaptive Adequacy
205
2
Foresight and Judgment
207
1
Flexibility
207
1
Perseveration
208
1
Alternating Attention
208
1
Personality Disorders Consequent to Impaired Information Processing
208
3
Poor Social Monitoring
209
1
Informational Processing Disorders
209
2
Cerebral Personality Disorders I: Mood Changes
211
18
Introduction
211
4
Excitability, Irritability, and Anger
215
1
Fear and Anxiety
216
1
Seemingly Inappropriate Affect
217
1
Reduced Expression of Affect Despite Dysphoria
217
1
Euphoria
217
1
Brain Trauma-Related Depression
217
4
Crying
219
1
Anatomical Loci and Depression
219
2
Endogenous Depression
221
1
Anhedonia: Reduced Intensity of Experience
221
2
Emotional Blunting
222
1
Indifference or Apathy Vignettes: Apathy
222
1
The Catastrophic Reaction
223
1
Graded but Disinhibitted Emotional Displays: Mood Changes
224
1
Dull/Flat Expression of Affect
224
3
Aprosodia: Discrepancy between Inner Experience and Overt Reactions
225
2
Amusia
227
1
The Clinician's Focus
227
2
Cerebral Personality Disorders II: Syndromes and Loss of Autoregulation
229
18
Introduction
229
1
Concurrent Intellectual Functioning
230
1
The Executive Function
230
3
Neurotraumatic Considerations
232
1
Maintaining Focus on a Goal
232
1
Personality Change or Frontal Lobe Syndrome
233
4
Exaggeration of Preexisting Personality Traits
236
1
Disinhibited (Orbitofrontal) Behavior
237
1
Pseudopsychopathic Behavior
237
1
Disorders of Information Processing and the Executive Function
237
1
Impaired Information Processing and Mental Efficiency
237
1
Deficiencies of Executive Control
238
1
Reduced Energy, Motivation, and Goal Achievement
239
2
Apathy: Loss of Volition and Decision Making
239
1
Akinetic Syndrome (Dorsolateral Frontal; Orbitomedial Frontal)
240
1
Loss of Goal-Directed Behavior
241
1
Reduced Social Interest
241
1
Enhanced Expression of Feelings: Disinhibition and Impulsivity
241
1
Gross Anger and Violence
242
3
Physiological Basis of Uncontrolled Violence
242
1
Classification of Violent Behavior
243
2
Examination Considerations with Possible CPD
245
2
Intelligence and Problem Solving
247
12
Introduction
247
1
Parameters of Intellectual Functioning
248
2
General Intelligence
250
2
Problem-Solving
252
2
Imagination and Creativity
252
1
Planning
253
1
Schema
253
1
Problem Solving and Depression
253
1
Comprehension, Reasoning, and Thinking
254
1
Intelligence Loss and Dementia
254
1
Is There Improvement After Trauma?
255
1
Clinical Example of Dementia
256
3
Communications, Aphasia, and Expressive Deficits
259
10
Introduction
259
1
Baseline Language Usage
259
1
Language Characteristics
259
1
Language Disorders
260
3
Effect of Age of Injury on Language Performance
261
2
Expressive Deficits: Inability to Describe Impairment
263
6
Requirements for Accurate Self-Reporting
264
5
Memory and Learning
269
10
Introduction
269
1
Neurological Complexity of Memory
270
3
Memory Deficits after TBI
271
2
Some Aspects of Memory
273
3
Short-term or Working Memory
273
1
Long-Term Memory
274
2
Learning
276
1
Procedural Learning
276
1
Motor Learning
277
1
Clinical Considerations in Memory or Learning Assessment
277
2
Problems of Assessing Memory
277
1
Practice Effects
278
1
Post-Accident Stress, Pain, Physiological Disorders and Disease
279
20
Introduction
279
2
Stress as a Multi-System Response
281
1
The Range of Stress Reactions
281
2
Brain Injury and Stress
283
1
Brain Injury and Stress in Children
283
1
Physiological and Endocrine Reactions Accompanying Stress
283
3
Hyperarousal
283
1
Endocrine
284
2
Posttraumatic Stress Disorder (PTSD)
286
9
Can PTSD and Altered Consciousness Be Co-Morbid?
286
1
Incidence of PTSD After Accidents
287
1
PTSD and Amnesia
288
1
Emotional Aspects of PTSD
289
4
Cognitive Disorders Consequent to Stress
293
1
Co-Morbid Conditions
294
1
Long-Term PTSD Persistence and Avoidance
295
1
Health Consequences of Persistent Stress Reactions
295
2
Clinical Vignettes
297
1
Recovery from PTSD
297
1
Treatment Implications
298
1
Conclusions
298
1
Psychodynamics: Identity, Insight, and Impairment
299
16
Introduction
299
1
The Sense of Self
299
1
Self, Identity, and Adaptation
300
1
Self-Awareness and Brain Injury
301
3
Body Schema
302
1
Components of Identity
303
1
Psychodynamic Depression
303
1
Guilt
304
1
Loss of Insight (Lack of Awareness of Deficit)
304
2
Lack of Insight: Body Schema
306
1
Neglect, Anosognosia, and Reduplication
306
1
Neglect
306
1
Reduced Self-Esteem
307
1
Contributors to Shame
308
1
Psychodynamic Reactions to the Impaired Condition
308
1
Meaning of the Event
308
1
Depression and Alcohol
309
1
Additional Reactions to Impairment
309
2
The Examination of Identity
311
1
Family Problems
311
4
Dreaming
313
2
The Outcome of Concussive Brain Trauma
315
38
Introduction
315
1
Definitions
316
1
Estimating the Baseline
316
2
What is Recovery?
318
2
The Rate of Recovery
319
1
Determinants of Outcome or Level of Recovery
320
8
Preexisting Factors
320
1
Previous Head Trauma
321
1
Ecological Demands
321
1
Developmental Level and Age
322
2
Community Support and Reaction
324
1
Emotional Factors Affecting Outcome
324
1
Social Interest
325
1
Litigation
325
1
Stress Resistance
326
1
Factors Reducing Employability
327
1
Persistent Symptoms: Distractors
327
1
Motivation
328
1
Outcome of Concussive Brain Injury
328
2
Safety and Vulnerability to Further Head Injury
329
1
PCS Symptoms Change with Time
329
1
Psychiatric Conditions
330
18
Obsessive-Compulsive
332
1
Schizophrenia
332
1
Mania
333
1
Secondary Mania
333
1
Sexual Problems
334
2
Children and Adolescents with TBI
336
1
Criminal Violence as TBI Outcome
336
2
Occupational Impairment
338
1
Return to Employment
339
1
Children
340
8
Treatment
348
2
Overview and Conclusions
350
1
Outcome Format for Concussive Traumatic Brain Injury
351
2
References
353
44
Index
397