Diagnosis threat is a psychosocial factor that has been proposed to contribute to poor outcomes following mild traumatic brain injury (mTBI). This threat is thought to impair the cognitive test performance of individuals with mTBI because of negative injury stereotypes. University students (N = 45, 62.2% female) with a history of mTBI were randomly allocated to a diagnosis threat (DT; n = 15), reduced threat (DT-reduced; n = 15), or neutral (n = 15) group. The reduced threat condition invoked a positive stereotype (i.e., that people with mTBI can perform well on cognitive tests). All participants were given neutral instructions before they completed baseline tests of objective cognitive function across a number of domains, psychological symptoms, and PCS symptoms, including self-reported cognitive and emotional difficulties. Participants then received either neutral, DT, or DT-reduced instructions before repeating the tests. Results were analyzed using separate mixed model analysis of variances (ANOVAs); one for each dependent measure. The only significant result was for the 2 · 3 ANOVA on an objective test of attention/working memory, Digit Span ( p < 0.05), such that the DTreduced group performed better than the other groups, which were not different from each other. Although not consistent with predictions or earlier DT studies, the absence of group differences on most tests fits with several recent DT findings. The results of this study suggest that it is timely to reconsider the role of DT as a unique contributor to poor mTBI outcome.
This review evaluated the evidence for psychological interventions to improve sleep and reduce fatigue after mild traumatic brain injury (mTBI). Eight electronic databases were searched up until August 2016 for studies that: 1) included adults; 2) tested intervention effectiveness on sleep quality and fatigue post-acutely; and 3) applied a broadly-defined psychological intervention (e.g., cognitive behavioral therapy [CBT], counseling, or education). Only randomized controlled trials were eligible for inclusion. Of the 698 studies identified, four met the eligibility criteria and underwent data extraction. These studies were assessed for risk of bias by two independent reviewers using the Scottish Intercollegiate Guidelines Network Methodology Checklist 2 for randomized controlled trials. One study applied CBT and three studies used enhanced education to improve outcomes. Limited evidence and methodological bias prevents strong conclusions about the effectiveness of psychological interventions for sleep and fatigue after mTBI. All but one study targeted general post-concussion symptoms rather than sleep or fatigue specifically. This runs the risk that the potential benefits of a targeted approach are underestimated in this literature, and future sleep- and fatigue-focused interventions are recommended. It is tentatively concluded that compared with standard care or the provision of generic advice, small improvements in sleep and fatigue are observed through psychological intervention post-mTBI.
Objectivethe research involved a 25-year neuropsychological follow-up of an Australian Rules football (ARF) cohort studied originally by Maddocks and Saling (1996). The primary aim was to assess whether there is a long-term impact of concussional head injury on cognitive function.MethodIn addition to those tests originally administered (Digit Symbol Substitution Test; Paced Auditory Serial Addition Test; Four Choice Reaction Time), the California Verbal Learning Test, Trail Making Test, Controlled Oral Word Association Test, Victoria Stroop Test, and selected self-report functional health and well-being, and quality of life measures were used. Thirty former Australian Football League players, aged from 44-56 years (Mage
=48.8 years), completed both the neuropsychological testing and psychosocial questionnaires.Main resultsConcussional history did not have an influence on cognitive or psychosocial functioning in this sample of retired ARF players. There was no evidence of deterioration in cognitive function across time. Irrespective of concussional history, age appeared to be an important contributor to subjective memory complaints, with older participants reporting greater memory concerns.ConclusionsIn this sample of retired ARF players no evidence of objective cognitive change was found over the time period in which CTE is said to evolve. This research shows, for the first time that long-term cognitive and psychosocial outcome in ARF players may be unrelated to career-long concussional history.Competing interestsDavid Maddocks and Paul McCrory are members of the AFL Concussion Working Party.None.
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