Visual complications of traumatic brain injury. Web
Andrew Bateman's insight:
#neurovisual consequences of brain injury are of great interest to me. Opthalmologists and neuropsychologists can work together with orthoptists, physios, SALT and OT to ameliorate these difficulties, but to date there have been scant chances to develop the pathway in our region for this patient group. This is a really useful overview
This paper merits careful reading and discussion. It is day 3 of the #ABIweek2016 media push. Great work coming out of headway. But here's a paper that suggests the very word 'concussion' is unhelpful. I tend to agree. what do you think?
Objective:To estimate the number of adults in the United States from 2006 to 2012 who manifest selected health and social outcomes 5 years following a traumatic brain injury (TBI) that required acute inpatient rehabilitation. Design:Secondary data analysis. Setting:Acute inpatient rehabilitatio...
“... where he completed his MD and Fellowship, and the UK, where as clinical lead at Frank Cooksey Rehab Unit at King's College Hospital he is credited with helping embed rehabilitation medicine within the new major trauma networks.”
How to Tell if a Person Has a Concussion. A concussion can be a serious head injury, but sometimes the severity of the damage is not known immediately. If you fear that you or someone you're with may be suffering from a concussion, check...
I was pleased to be involved in some of the interviews that happened when the authors were planning this report... and then to be asked to write the Preface w…
Andrew Bateman's insight:
I find myself citing this report ever so often so I thought I'd retweet about it using this scoop.it page as I can never remember where I have filed it. It is also available on the Headway East London website
The ventromedial PFC (vmPFC) has been implicated as a critical neural substrate mediating the influence of emotion on moral reasoning. It has been shown that the vmPFC is especially important for making moral judgments about "high-conflict" moral dilemmas involving direct personal actions, that is, scenarios that pit compelling utilitarian considerations of aggregate welfare against the highly emotionally aversive act of directly causing harm to others [Koenigs, M., Young, L., Adolphs, R., Tranel, D., Cushman, F., Hauser, M., et al. Damage to the prefrontal cortex increases utilitarian moral judgments. Nature, 446, 908-911, 2007]. The current study was designed to elucidate further the role of the vmPFC in high-conflict moral judgments, including those that involve indirect personal actions, such as indirectly causing harm to one's kin to save a group of strangers. We found that patients with vmPFC lesions were more likely than brain-damaged and healthy comparison participants to endorse utilitarian outcomes on high-conflict dilemmas regardless of whether the dilemmas (1) entailed direct versus indirect personal harms and (2) were presented from the Self versus Other perspective. In addition, all groups were more likely to endorse utilitarian outcomes in the Other perspective as compared with the Self perspective. These results provide important extensions of previous work, and the findings align with the proposal that the vmPFC is critical for reasoning about moral dilemmas in which anticipating the social-emotional consequences of an action (e.g., guilt or remorse) is crucial for normal moral judgments [Greene, J. D. Why are VMPFC patients more utilitarian?: A dual-process theory of moral judgment explains. Trends in Cognitive Sciences, 11, 322-323, 2007; Koenigs, M., Young, L., Adolphs, R., Tranel, D., Cushman, F., Hauser, M., et al. Damage to the prefrontal cortex increases utilitarian moral judgments. Nature, 446, 908-911, 2007].
“... patients surviving major trauma · More patients surviving major trauma New system of care 'an NHS success story' OnMedica ... On the Library Blog. Northamptonshire Healthcare NHS Foundation Trust Libraries · Disruption ...”
Cecil Clayton, diagnosed as severely mentally impaired from a logging accident 40 years ago, to be put to death for killing a police officer in 1996
Andrew Bateman's insight:
Over the years I have noticed how brain injury is represented in the press and the language in this case of mental impairment is especially curious. However the other slant on this is the fact that a person was murdered by a survivor of traumatic brain injury.
In amongst all the speculation about how Derrick Bird arrived at the point of his catastrophic behaviour, consequences of brain injury that can result in ‘episodic dyscontrol’ – or simply loss of that ‘handbrake’ function of the frontal lobe– seems to have been, so far, an untold story.
I note that Derrick Bird is reported to have lost consciousness following an assault in 2007. According to quotes in the Sunday Times, he was punched, hit his head on the pavement, and was found disoriented by a colleague taxi driver, and that he was ‘never the same again’. It is obviously only wild speculation: we’ll probably never know if the assault caused brain injury. However, if there is a ‘brain injury’ part to this story, the case does raise an important issue about service provision.
There is much relevant research, not least to note that the alarmingly high prevalence of brain injury among people in custody. For example, Schofield et al. (2006) reported that 82 per cent recently received into custody in Australia had a traumatic brain injury in the past. UK data on the same subject is shortly to be published by Huw Williams, who has estimated that 65 per cent of prison population may have had a traumatic brain injury and that they are at elevated risk of reoffending, and that violent offences are the most common.
The Sunday Times reported: ‘An NHS Cumbria spokeswoman said there was no record of Bird attending the hospital or his GP in the last six months.’ That he was reported to be not known to NHS services is no surprise: there are few services that, three years after brain injury, offer psychological interventions and support that individuals need when experiencing classic chronic brain injury symptoms of increasing anger and frustration that we think emerge from an increasing sense of threat to identity. That mental health services did not see him would be consistent with a common narrative that the types of problems he had would not merit treatment by mental health services. This is despite the fact that there are treatment options available that can explore the way through this ‘threatened self’, including work toward a compassionate, shared understanding of ‘who I am now’. We have recently described an approach to providing a service with this kind of objective (Wilson et al., 2009).
I am certainly not suggesting our brain-injured patients are all at risk of becoming mass murderers. I also am certainly not trying to pretend that a clinic like ours might have helped in this case (although there are specialist units that might). The Oliver Zangwill Centre provides a service for people from around the UK, often years after their brain injury. However, in common with many teams in this field we continue to experience ongoing difficulties of securing NHS funding to enable us to admit patients to brain injury rehabilitation programmes geared to providing coping skills and psychological therapy in this period late after brain injury. This patient group with these types of needs – and the risks of not intervening – continue to be overlooked from a commissioning and public health point of view. Andrew Bateman Oliver Zangwill Centre for Neuropsychological Rehabilitation Ely Cambridgeshire
References Schofield, P.W., Butler, T.G., Hollis, S.J. et al. (2006). Neuropsychiatric correlates of traumatic brain injury (TBI) among Australian prison entrants. Brain Injury, 20(13–14) 1409–1418. Wilson, B.A., Gracey, F.G., Evans, J.J. & Bateman, A. (2009). Neuropsychological rehabilitation: Theory, models, therapy and outcome. Cambridge: Cambridge University Press.
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