An International Exploration of the Effect of Media Portrayals of Postconcussion Management on Concussion Identification in the General Public.

BACKGROUND: Concussion portrayal in media broadcasts of sporting events may contribute to lack of public understanding regarding concussion. METHODS: In total, 828 participants from Australia, New Zealand, and the United Kingdom completed a questionnaire assessing concussion knowledge. Participants were randomly assigned to either receive sports return-to-play (RTP) guideline information (RTP group) or not (no-RTP group). Participants viewed 12 short clips from televised rugby games and indicated whether they believed the player in each clip had sustained a concussion. Participants were then informed whether the player was removed, returned, or stayed in the game and again asked whether they thought a concussion had occurred. RESULTS: Probability of reporting a likely concussion over all videos was 65.6%. When told a player's possible concussion was managed by removal from the game, participants were more likely to change their response from "no" (no concussion) to "yes" (concussion) than from "yes" to "no." When told the player stayed or returned to the game, participants were more likely to change their response from "yes" (concussion) to "no" (no concussion) than from "no" to "yes." There was no significant main effect for RTP guideline manipulation or interaction effect with RTP information. CONCLUSION: Additional player's injury management information influenced participants' judgments of concussion occurrence. Results show that information provided via sports media broadcasts influenced viewers' perceptions of concussion and appropriate concussion management.

Traumatic brain injury and adverse life events: Group differences in young adults injured as children.

OBJECTIVES: To investigate whether individuals with a history of traumatic brain injury (TBI) experience a greater number of adverse life events (ALE) compared to controls, to identify significant predictors of experiencing ALE and whether the severity of childhood TBI negatively influences adult life outcomes. DESIGN: A total of 167 individuals, injured prior to age 18, 5 or more years post-injury and 18 or more years of age, were recruited in the Canterbury region of New Zealand, with 124 having sustained childhood TBI (62 mild, 62 moderate/severe) and 43 orthopaedic injury controls. Participants were asked about ALE they had experienced and other adult life outcomes. RESULTS: Individuals with a history of TBI experienced more ALE compared to controls. The number of ALE experienced by an individual was associated with more visits to the doctor, lower education level and lower satisfaction with material standard of living. CONCLUSIONS: Childhood TBI is associated with an increased number of ALE and adult negative life outcomes. Understanding factors that contribute to negative outcomes following childhood TBI will provide an avenue for rehabilitation and support to reduce any problems in adulthood.

A comparison of adult outcomes for males compared to females following pediatric traumatic brain injury.

OBJECTIVE: To identify the association between traumatic brain injury (TBI) and internalizing and externalizing problem behaviors and determine if these apply equally to males and females. METHOD: The association between adult psychosocial functioning and childhood TBI for males and females was examined using groups with a history of childhood TBI (mild or moderate/severe) or orthopedic injury (injury age, 1-17, assessed 18-31 at >5 years postinjury), including rates of depression and anxiety disorders, substance abuse/dependence and offending behavior. Repeated-measures logistic regression was used to determine if the rates of internalizing and externalizing problem behaviors varied by group and sex. RESULTS: Overall rates of problem behaviors were significantly greater for both moderate/severe TBI (OR = 4.00) and mild TBI (OR = 3.60) groups compared with orthopedic controls. Females were significantly more likely than males to report a history of internalizing problems (OR = 2.22), whereas males were more likely than females to report externalizing problems (OR = 2.10). The sex difference in internalizing/externalizing problems was found consistently across TBI groups and controls. CONCLUSIONS: Childhood TBI is associated with psychosocial problems in adulthood, regardless of injury severity. How deficits are expressed differs between the sexes, with important implications for interventions strategies.

Predicting adult offending behavior for individuals who experienced a traumatic brain injury during childhood.

OBJECTIVES: To examine whether individuals who experienced a childhood traumatic brain injury (TBI) are at increased risk for subsequent offending behavior, to identify the emotional characteristics of adults who experienced childhood TBI, and to examine whether these predict offending behavior. PARTICIPANTS: Individuals from the Canterbury region who had experienced a childhood (<18 years of age) injury event and were now 18 years or older and more than 5 years postinjury (between 18 and 30 years of age). Three groups were formed: (1) moderate/severe TBI (n = 62); (2) mild TBI (n = 58); and (3) fracture control group (n = 38). SETTING: University of Canterbury. MAIN MEASURES: A semistructured interview assessed lifetime involvement in offending behavior; the Emotional Behavior Scale measured internalizing and externalizing behaviors, including malevolent aggression, social anxiety, and social self-esteem. RESULTS: Compared with controls, there was an increased risk of offending behavior (mild TBI: odds ratio = 8.7; moderate/severe TBI odds ratio = 20.4). Binary logistic regression analysis revealed that the strongest predictors of offending behavior were TBI status, higher levels of malevolent aggression, and age at injury. CONCLUSIONS: Individuals who experienced childhood TBI are at increased risk of offending behavior. Emotional behavior measures were useful predictors of offending behavior, offering opportunity for intervention.

Self versus family ratings of the frontal systems behaviour scale and measured executive functions: adult outcomes following childhood traumatic brain injury.

Traumatic brain injury (TBI) frequently occurs during childhood and adolescence with long-term neuropsychological and behavioral effects. Greater personal awareness of injury is associated with better outcomes. However, personal awareness is often assessed using ratings obtained from family members or significant others. Surprisingly, the accuracy of family-ratings compared with self-ratings has not been well studied in the TBI population. Thus, the purpose of this study was to examine self versus family-ratings of frontal dysfunction and secondly, the association between self/family reported frontal dysfunction and measured executive function outcomes. A total of 60 participants, approximately 10 years post-TBI, comprised 3 groups including; moderate/severe TBI (N=26; mean age 22.9, SD=3.0), mild TBI (N=20; mean age, 21.7, SD=2.7), and control (N=14: mean age, 21.6, SD=3.7). Neuropsychological testing was used to obtain domain scores for executive function and working memory/attention for each participant, and nominated family members and participants with TBI were asked to complete the Frontal Systems Behaviour Scale (FrSBe), consisting of three sub-scales; apathy, disinhibition, and executive dysfunction. Using the FrSBe there was no significant difference between the groups in executive function score, but the moderate/severe and mild groups had significantly lower working memory/attention scores compared with the control group (p<0.05). Repeated measures analysis of variance showed higher self-ratings on all sub-scales compared with family in each group (p<0.05). Scores on executive function and working memory/attention domains correlated with self, but not family reported executive dysfunction. Self-rated executive dysfunction explained 36% of the variance in executive function (p<0.001). While agreement between self-rated and family-rated total FrSBe scores was significant in all groups (p<0.001), our results showed that self-ratings were of higher predictive utility for executive functioning compared with family ratings. Further, at 10 years post-TBI, patients show greater awareness of deficits compared with family who rate consistently closer to the normal functioning range.

The invisible brain injury: the importance of identifying deficits following brain injury in children with intellectual disability.

INTRODUCTION: Traumatic brain injury (TBI) is common during childhood. However, most of the extant literature about outcomes following childhood TBI is based on children who were functioning "normally" prior to the injury event. But, with the increasing community integration of children with Intellectual Disability (ID) there is an urgent need for specific information regarding problems following TBI for this group. METHOD: Using a case study, this paper presents an overview of problems faced by these children who subsequently experience a TBI event, and examines questions pertinent to this dual diagnosis. OUTCOMES: In the case study presented, despite supposedly having access to an internationally acclaimed comprehensive no fault accident compensation and rehabilitation system, a lack of assessment, intervention and support was evident for both the child and the family following a severe TBI because he had pre-existing ID. CONCLUSIONS: This case study highlights the need for clinicians to consider the impact of TBI for children with ID, to avoid incorrectly attributing TBI symptoms to pre-existing problems. Children with ID are at increased risk; appropriate treatment plans are vital to maximize quality of life for them and their caregivers.

Does the way concussion is portrayed affect public awareness of appropriate concussion management: the case of rugby league.

It is important to identify factors that might adversely affect appropriate medical consultation and management of concussion. One factor that might present a barrier to timely intervention is media portrayal of concussion in sporting events, such as professional rugby league. Accordingly, the current study employed a surveillance method of publicly available broadcast information to establish the incidence rate of probable concussion in the National Rugby League's Telstra Premiership 2010 season and examined how these injury events were shown to be managed with respect to return-to-play procedures. The incident rate for probable concussion was higher than previously reported: 11.10\1000 player hours (95% CI 5.78 to 16.40) and was likely underestimated. Importantly, most injured players were shown to continue playing or return to play despite being visibly concussed and described as such by the commentary team. Although 'return-to-play decisions' for professional players are guided by medical assessment, the authors discuss whether the way concussion is portrayed might affect public awareness of appropriate concussion management.

The recognition of facial expressions of emotion in Alzheimer's disease: a review of findings.

OBJECTIVE: To provide a selective review of the literature on the recognition of facial expressions of emotion in Alzheimer's disease (AD), to evaluate whether these patients show variation in their ability to recognise different emotions and whether any such impairments are instead because of a general decline in cognition. METHODS: A narrative review based on relevant articles identified from PubMed and PsycInfo searches from 1987 to 2007 using keywords 'Alzheimer's', 'facial expression recognition', 'dementia' and 'emotion processing'. CONCLUSION: Although the literature is as yet limited, with several methodological inconsistencies, AD patients show poorer recognition of facial expressions, with particular difficulty with sad expressions. It is unclear whether poorer performance reflects the general cognitive decline and/or verbal or spatial deficits associated with AD or whether the deficits reflect specific neuropathology. This under-represented field of study may help to extend our understanding of social functioning in AD. Future work requires more detailed analyses of ancillary cognitive measures, more ecologically valid facial displays of emotion and a reference situation that more closely approximates an actual social interaction.