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Industry: Email Alert RSS FeedTraumatic brain injury occurring with spinal cord injury: significance for rehabilitation
Journal of Rehabilitation, April-June, 1993 by Mary Alice Povolny, Steven P. Kaplan
Alcohol or other drugs in the injured person's system can invalidate, or falsely retard performance on neuropsychological measures, another situation in which we might reach a false positive conclusion of TBI. A related issue concerns the debilitating effect of long term substance abuse on neuropsychological test performance and overall cognitive functioning. Overall deterioration of cognitive function might be attributed to the mechanical injury, rather than to long term substance abuse.
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Premorbid functioning. Before making conclusions about current functioning, it is important to assess the level of cognitive functioning prior to injury. We need that information to get reasonable indications of change due to head injury. Reviewing academic records, previous job performance or premorbid testing can provide some background data. Haas, Cope and Hall (1987) studied 80 head injured patients and found poor premorbid academic performance in 50% of the sample. In this study, poor academic performance was defined by diagnosis of a learning disability, multiple failed academic subjects, or school dropout during secondary education. Information was obtained from school records, reports of premorbid examinations by pediatricians and school psychologists, and interviews with the parents. We may find no demonstrable cognitive debilitation secondary to possible TBI when present functioning is compared to predisability levels. However, failure to make these comparisons can result in either a false positive or false negative diagnosis of TBI, depending if the injured individual was unusually high or low functioning prior to trauma.
Affect. Affective disorders, particularly depression, can adversely influence cognitive functioning. While depression is not an inevitable consequence of SCI, it can still be present, and may affect assessment results.
Goulet Fisher, Sweet and Pfaelzer-Smith (1986) looked at the relationship between depression and neuropsychological performance. They diagnosed depression in 15 individuals using the Beck Depression Inventory and DSM-III criteria. They then administered neuropsychological tests to these individuals, and to 15 individuals in a control group. The researchers found that the depressed group consistently performed at a more impaired level than the control group, suggesting that affective disturbance negatively influences the subject's test performance.
Current literature is somewhat inconsistent regarding the coexistence of depression with SCI, but does suggest that the occurrence of depression meeting DSM-III-R criteria during the first six months post injury, ranges from 10% to 30% (Judd & Burrows, 1986; Fullerton, Harvey, Klein & Howell, 1981). Howell, Fullerton, Harvey and Klein (1981) evaluated 22 patients with recent SCI using a standardized interview and diagnostic process. They found 22% of subjects had diagnosable depressions less than six months after injury. Frank, Elliott, Corcoran and Wonderlich (1987) evaluated 32 patients using a semistructured interview that permitted diagnosis by DSM-III criteria for affective disorders. Of the 32 patients, 14 (44%) had a DSM-III diagnosis of depressive disorder, 12 (38%) had major depression (five with melancholia) and two (6%) were dysthymic. If the person with SCI is experiencing depression at the time of testing, the results may be rendered inaccurate due to slower reaction time and/or reduced concentration efficiency.
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