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Industry: Email Alert RSS FeedEmotional changes following brain injury: psychological and neurological components of depression, denial and anxiety
Journal of Rehabilitation, April-June, 1991 by Carol Armstrong
On the other hand, when persons injured in the right anterior hemisphere lose the ability to express the tonal, inflective, or nonverbal aspects of emotion, they sound flat and uninterested. Defending on the exact site of injury, there may also be inability to perceive emotional signals from others, as was the problem in the example given initially. These problems are very frustrating for caretakers as it renders the injured individual insensitive, in contrast to the left hemisphere injured person. In addition, the right anterior hemisphere injured patient may appear indifferent and unemotional, unable to express emotion in tone or gesture, although they are indeed experiencing emotion. In this case, the GSR response decreases (Valenstein & Heilman, 2979), and arousal mechanisms shared with the frontal lobe may be overly inhibited.
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These differences--emotional, perceptual and cognitive; receptive and expressive--between the hemispheres cannot be related to severity of deficits, and the differences exist regardless of the overall severity of the injury. However, we must also remember that the acquired injury to one hemisphere can create disruptions in the functionining of the other hemisphere due to diaschisis (dysfunction due to lack of normal afferent impulses), metabolic disturbance, or edema. In head injury, some disruption of both hemispheres is most common. These problems are usually found nearly in the more severely injured, and as very subtle changes in the more mildly injured. Positive psychological and cognitive interventions can help relink the disassociation of emotion and thought. (Grisgby, 1986).
Rehabilitation
For persons with head injuries and their families, what counts most in the long run are cognitive and personality changes, rather than physical disability (Bond, M., 1976). It was suggested by Weddell, Oddy and Jenkins (1980) that rehabilitation centers should relinquish their emphasis on physical recovery, develop more effective retraining for those with mental changes, and emphasize ways of helping patients and relatives adjust to what cannot be mended. Adjustment problems and emotional imbalance may increase when injured people get to rehabilitation units after long delay, for too short a time, or not at all. A study on early rehabilitation interventions done at Santa Clara Valley Medical Center in San Jose found better outcomes inpatients admitted earlier than in those admitted later to rehabilitation (Cope & Hall, 1982).
Few studies have been done to assess the outcome of rehabilitation (Cope & Hall, 1982, Miller, 1980, Miller, 1984, Rimmele & Hester, 1987, Tyerman & Humphrey, 1983). The cost associated with treating brain injured persons are increasingly problematic (Deutsch, 1987, Kalsbeek, McLaurin, Harris, & Miller, 1980), and studies of the effectiveness of rehabilitation are sorely needed. England has developed 25 years of experience in brain injury rehabilitation, and has recognized the importance of psychological rehabilitation. HEADWAY, a program for head injured patients in England, conducted a follow-up study of groups of ex-patients who had 12 and 24 weeks of inpatient treatment on average at two different rehabilitation centers. They (Tyerman & Humphrey, 1983) showed that while the longer course did not give more functional independence than the shorter, it did produce modest improvement in personality and behavior. However, at follow-up, 35 weeks after discharge during which time the ex-patients received no treatment, the emotional states of patients of both groups had worsened. Staff had expected 80% to become independent in self-care and capable of productive work. Most had failed this expectation. They concluded that the primary problem was failure to address the most basic underlying need, which was the continuation of structured yet flexible, individualized rehabilitation environments for these individuals.
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