Cognitive and behavioral disorders in neurorehabilitation.

Assessment and management of cognitive and behavioral issues in the neurorehabilitation of patients with brain injuries are extremely important. Because cognitive impairments can impede post-brain injury adaptive functioning, it is necessary to carefully assess the major neurocognitive functions to help determine potential obstacles to rehabilitation and to plan for effective interventions. Likewise, behavioral and emotional problems following brain injury, whether directly or secondarily caused by the injury, can hamper or undermine what may otherwise be an efficacious rehabilitative treatment plan. This article describes some of the most common cognitive, emotional, and behavioral deficits and provides practical suggestions about how to address them.

The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury.

OBJECTIVE: The authors sought to define the relationship between gender and postconcussion symptoms (PCSx) at 3 months after sport-related mild traumatic brain injury (mTBI) and, further, to examine whether age (minors vs. adults), source of PCSx reporting (self-reported vs. proxy), previous head injury or loss of consciousness, or the sport type in which the mTBI was incurred explain any observed gender differences in PCSx. DESIGN: Prospective nested cohort study. SETTING: Regional trauma center emergency department. PATIENTS: A total of 260 patients who presented with sport-related mTBI, as defined by American Congress of Rehabilitation Medicine criteria, began the study. The participants who lacked litigation concerning the mTBI and had participated in the follow-up assessment completed the study (n = 215). ASSESSMENT OF RISK FACTORS: Self, proxy, and interviewer report of age, gender, previous head injury or loss of consciousness, and sport in which injury was sustained. MAIN OUTCOME MEASUREMENTS: Rivermead Post Concussion Symptoms Questionnaire (RPQ). RESULTS: Adult females are at greater risk for elevated RPQ scores (odds ratio [OR] = 2.89, 95% confidence interval [95% CI] = 1.25-6.71; P = .013) but not female minors (OR = 0.87, 95% CI = 0.45-1.71]; P = .695), as compared with male subjects. Adjustment for empirically identified confounders in each age group revealed persisting elevated risk for adult females (OR = 2.57, 95% CI = 1.09-6.08; P = .031), but not minor females (OR = 1.07, 95% CI = 0.52-2.19, P = .852). The risk associated with female gender in adults could not be explained by characteristics of the sports, such as helmeted versus not, or contact versus no contact, in which women incurred mTBIs. No sport characteristics were associated with increased risk of PCSx after mTBI. CONCLUSIONS: Adult females, but not female minors, are at increased risk for PCSx after sport-related mTBI as compared with male patients. This increased risk cannot be explained by self-report, rather than proxy report, of symptoms, previous head injury or loss of consciousness, age, or sport characteristics. Further research is needed to elucidate the processes of age-differential recovery from mild brain injury in women and on how to most effectively incorporate appropriate follow-up after emergency department evaluation.

Ethical controversies in neuropsychological test selection, administration, and interpretation.

Due to the lack of uniform agreement on certain aspects of neuropsychological assessment practice, ethical issues can arise. Ethical controversies related to some of the most basic assessment practices of the clinical neuropsychologist are addressed. Current controversies related to neuropsychological test selection, test administration, and test interpretation are discussed and illustrated by case vignettes. Brief analyses of the ethical ramifications of the controversies are offered, followed by suggestions and recommendations for dealing with these conflicts. By resolving these conflicts as a discipline, more consistent standards of neuropsychological practice could be established, which would be of ultimate benefit to both professional and consumer alike.

Neuropsychological assessment of Asian Americans: demographic factors, cultural diversity, and practical guidelines.

Asian Americans belong to 1 of the most rapidly growing ethnic minority groups in the United States. Clinical neuropsychologists unfamiliar with Asian American peoples and cultures may not be able to perform an adequate evaluation with an individual of Asian descent because of lack of understanding of how cultural variables might affect the assessment. This article attempts to provide some basic knowledge and principles by which to guide neuropsychologists who might work with an Asian American patient by (a) familiarizing the reader with basic information and descriptions of some of the major specific Asian subgroups, (b) providing a context within which neuropsychological test selection and interpretation can be adjusted to account for cultural and linguistic factors, and (c) providing practical suggestions for working with Asian American clients in a neuropsychological setting.