Risk Taking in Hospitalized Patients with Acute and Severe Traumatic Brain Injury

Abstract

Rehabilitation can improve cognitive deficits observed in patients with traumatic brain injury (TBI). However, despite rehabilitation, the ability of making a choice often remains impaired. Risk taking is a daily activity involving numerous cognitive processes subserved by a complex neural network. In this work we investigated risk taking using the Balloon Analogue Risk Task (BART) in patients with acute TBI and healthy controls. We hypothesized that individuals with TBI will take less risk at the BART as compared to healthy individuals. We also predicted that within the TBI group factors such as the number of days since the injury, severity of the injury, and sites of the lesion will play a role in risk taking as assessed with the BART. Main findings revealed that participants with TBI displayed abnormally cautious risk taking at the BART as compared to healthy subjects. Moreover, healthy individuals showed increased risk taking throughout the task which is in line with previous work. However, individuals with TBI did not show this increased risk taking during the task. We also investigated the influence of three patients’ characteristics on their performance at the BART: Number of days post injury, Severity of the head injury, and Status of the frontal lobe. Results indicate that performance at the BART was influenced by the number of days post injury and the status of the frontal lobe, but not by the severity of the head injury. Reported findings are encouraging for risk taking seems to naturally improve with time postinjury. They support the need of conducting longitudinal prospective studies to ultimately identify impaired and intact cognitive skills that should be trained postinjury.

Neural markers of vulnerability to anxiety outcomes following traumatic brain injury

“…This could also indicate a deficit in risk-assessment, or an increase in risk-taking behavior. Clinical studies have demonstrated increased impulsivity, compulsive behaviors, addiction, careless or violent behavior and suicide, in patients with moderate to severe injury (Greve et al, 2001, Grados et al, 2008, Noggle and Pierson, 2010, Fecteau et al, 2013, James et al, 2014, Juengst et al, 2014), consistent with deficits in risk-assessment. We conclude that post-injury increase in exploration of the exposed zones by vulnerable animals represents a maladaptive anxiety state.…”

The involvement of the striatum in decision making

“…64 Patients with traumatic brain injury also seem to display abnormally cautious risk taking as shown, for instance, in the Balloon Analog Risk Task. 65 Again, further investigations are needed to better describe impaired and intact decisionmaking skills and its associated neural substrates in these populations.…”

Hospital psychosocial interventions for patients with brain functional impairment: A retrospective cohort study

“…People with neurodevelopment disorders (NDD) such as autism, intellectual learning disability and attention deficit disorders; brain degenerative disorders (BDD) such as Alzheimer disease and other degenerative diseases of the nervous system; or traumatic brain injuries (TBI), have a high disease burden due in part to impaired brain functioning, experience challenges in their life situations, and require urgent clinical care at times (Fecteau et al . ; Garvin & Mangat ; Ghroubi et al . ; Gutierrez et al .…”

“…People with neurodevelopment disorders (NDD) such as autism, intellectual learning disability and attention deficit disorders; brain degenerative disorders (BDD) such as Alzheimer disease and other degenerative diseases of the nervous system; or traumatic brain injuries (TBI), have a high disease burden due in part to impaired brain functioning, experience challenges in their life situations, and require urgent clinical care at times (Fecteau et al 2013;Garvin & Mangat 2017;Ghroubi et al 2016;Gutierrez et al 2008;Howe 2008;Kopecky et al 2013). Most of these patients experience neuropsychiatric symptoms such as depression and anxiety (Garvin & Mangat 2017;Howe 2008;Kopecky et al 2013), as well as impaired self-efficacy (Ownsworth et al 2010;Ponsford et al 2016).…”

“…Most of these patients experience neuropsychiatric symptoms such as depression and anxiety (Garvin & Mangat 2017;Howe 2008;Kopecky et al 2013), as well as impaired self-efficacy (Ownsworth et al 2010;Ponsford et al 2016). Patients, who experience likely deterioration in their mental and social health, may also develop disruptive behaviours such as agitation, aggression, and resistance-to-care (Fecteau et al 2013;Ghroubi et al 2016). These secondary disorders and disruptive behaviours are associated with a decreased quality of care and an increased risk of unintentional physical harm for hospitalised patients (Ghroubi et al 2016;Gutierrez et al 2008).…”