Physiogenesis and Psychogenesis in the ‘Post-Concussional Syndrome’

Lishman, W. A.

doi:10.1192/bjp.153.4.460

Cited by 304 publications

(159 citation statements)

References 34 publications

Supporting

Mentioning

151

Contrasting

Unclassified

Order By: Relevance

“…This raises the additional possibility that the deficits found in the mild TBI group may partially or completely resolve over time. Indeed, this may explain why studies often report a higher frequency of problems in the early stages after a mild TBI than in the later stages (Kibby & Long, 1996;Lishman, 1988;Van der Naalt et al, 1999). It remains to be seen whether measures designed to target the effects of diffuse damage are better able to predict which mild TBI patients will experience long-term residual problems than traditional neuropsychological tests.…”

Section: Discussionmentioning

confidence: 95%

Neuropsychological and information processing deficits following mild traumatic brain injury

Mathias

Beall

Bigler

2004

J Int Neuropsychol Soc

119

View full text Add to dashboard Cite

Neuroradiological and neuropathological investigations have found evidence of diffuse brain damage in the frontal and temporal lobes, corpus callosum, and fornices in patients who have sustained a mild traumatic brain injury (TBI). However, neuropsychological assessments of these patients do not typically target many of the subtle information processing deficits that may arise from diffuse damage involving the frontotemporal regions of the brain as well as white matter pathology, including the corpus callosum. Consequently, we have a limited understanding of the deficits that may be attributable to temporary or permanent disruptions to these functional pathways. This study assessed a group of mild TBI patients (N 5 40) and a matched control group (N 5 40) on a number of standard neuropsychological tests of selective and sustained attention, verbal and non-verbal fluency, and verbal memory. In addition, reaction time (RT) tasks, requiring both the inter-and intra-hemispheric processing of visual and tactile information, were used to assess the functional integrity of the tracts that are likely to be affected by diffuse damage. In the 1st month after sustaining their injury, the mild TBI group demonstrated deficits in attention, non-verbal fluency, and verbal memory. They also demonstrated slower visual and tactile RTs, with the visual RTs of mild TBI patients being more affected by increased task difficulty and the need to transfer information across the corpus callosum, than did their matched controls. (JINS, 2004, 10, 286-297.)

show abstract

Section: Discussionmentioning

confidence: 95%

Neuropsychological and information processing deficits following mild traumatic brain injury

Mathias

Beall

Bigler

2004

J Int Neuropsychol Soc

119

View full text Add to dashboard Cite

show abstract

“…The strict rest group may have been better able to articulate their symptoms because they were slightly older. Lishman et al (1988) suggested that physiologic and psychological factors both contribute to the development of postconcussive syndrome, with psychological factors contributing more to symptoms over time. 42 The deleterious effects of strict rest may have more to do with emotional distress caused by school and activity restriction.…”

Section: Figurementioning

confidence: 99%

“…Lishman et al (1988) suggested that physiologic and psychological factors both contribute to the development of postconcussive syndrome, with psychological factors contributing more to symptoms over time. 42 The deleterious effects of strict rest may have more to do with emotional distress caused by school and activity restriction. Missing social interactions and falling behind academically may contribute to situational depression increasing physical and emotional symptoms.…”

Section: Figurementioning

confidence: 99%

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

et al. 2015

View full text Add to dashboard Cite

OBJECTIVES: To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED).METHODS: Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory.RESULTS: Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P , .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P , .03) and slower symptom resolution.CONCLUSIONS: Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest. WHAT'S KNOWN ON THIS SUBJECT:Expert consensus recommends rest after concussion with stepwise return to activity. Animal and retrospective human data suggest that early mental and physical activity may worsen outcome. There are no pediatric studies testing the efficacy of recommending strict rest after concussion. WHAT THIS STUDY ADDS:Recommending strict rest postinjury did not improve outcome and may have contributed to increased symptom reporting. Usual care (rest for 1-2 days with stepwise return to activity) is currently the best discharge strategy for pediatric mild traumatic brain injury/concussion. Dr Thomas developed the study concept and design, obtained funding, supervised the study, acquired data, analyzed and interpreted data, and drafted and revised the manuscript; Dr Apps assisted with study concept and design, supervised the study, provided technical support, analyzed and interpreted data, and critically revised the manuscript; Dr Hoffmann assisted with study design, analyzed data, provided statistical expertise, and critically revised the manuscript; Dr McCrea assisted with study design, analyzed and interpreted data, provided technical support, and critically revised the manuscript; Dr Hammeke assisted with study concept and ...

show abstract

“…A minority of individuals develop postconcussion syndrome (PCS), a persistent constellation of symptoms that may include headache, dizziness, fatigue, sleep disturbance, sensitivity to light and noise, anxiety, depression, and complaints of concentration and memory problems that may or may not be verified by cognitive testing [17,[66][67]. The causes of PCS are controversial and may involve an interplay between the neurological injury and psychological factors [68][69]. Weight has summarized the difficulties associated with assessing PCS [70].…”

Section: Postconcussion Syndromementioning

confidence: 99%

Review of sports-related concussion: Potential for application in military settings

Lew

Thomander²,

Chew³

et al. 2007

JRRD

View full text Add to dashboard Cite

Abstract-This article reviews current issues and practices in the assessment and clinical management of sports-related concussion. An estimated 300,000 sports-related concussions occur annually in the United States. Much of what has been learned about concussion in the sports arena can be applied to the diagnosis and management of concussion in military settings. Current military guidelines for assessing and managing concussion in war zones incorporate information and methods developed through sports-concussion research. We discuss the incidence, definition, and diagnosis of concussion; concussion grading scales; sideline evaluation tools; neuropsychological assessment; return-to-action criteria; and complications of concussion.

show abstract

Physiogenesis and Psychogenesis in the ‘Post-Concussional Syndrome’

Cited by 304 publications

References 34 publications

Neuropsychological and information processing deficits following mild traumatic brain injury

Neuropsychological and information processing deficits following mild traumatic brain injury

Benefits of Strict Rest After Acute Concussion: A Randomized Controlled Trial

Review of sports-related concussion: Potential for application in military settings

Contact Info

Product

Resources

About