Traumatic brain injury beyond the hospital : an exploration of neuro-psychosocial consequence across the continuum of severity

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The Nature of Permanent Post-concussion Symptoms after Mild Traumatic Brain Injury

Objective: Very few studies have examined permanent post-concussion symptoms (PCSs) after mild traumatic brain injury (MTBI). None have reported the nature of such symptoms. Our recent study was the first to report on a wide range of factors affecting PCSs in a representative sample of such patients. This paper presents the frequencies of the different PCSs experienced by this group and compares them with PCSs at earlier stages post injury.Method: One hundred consecutively referred patients to a Community Head Injury Service in Buckinghamshire, UK, for the treatment of long-term PCSs after MTBI were invited to participate in the original study. Those consenting to do so (n = 24, mean time post injury = 6.9 years) completed a Rivermead Post Concussion Symptoms Questionnaire. The frequency of the types of symptoms reported is presented. These are then contrasted with comparable PCS presentations at 7–10 days and 6 months post injury from two other studies.Results: Fatigue was reported by all long-term patients. Poor concentration, sleep disturbance, taking longer to think and irritability were the other most frequently endorsed permanent symptoms. The least reported were blurred/double vision, photophobia, nausea, headache and dizziness. A similar pattern was present in those at earlier stages post injury.Conclusions: The most common permanent PCSs may be those best conceptualised as the more cognitively and emotionally based symptoms, and the least common the more somatically based ones. There may be some consistency in the nature of PCSs reported over time.</jats:p

Keeping pain out of your mind: The role of attentional set in pain

BACKGROUND: The involuntary capture of attention by pain may, to some extent, be controlled by psychological variables. In this paper, we investigated the effect of attentional set (i.e., the collection of task-related features that a person is monitoring in order to successfully pursue a goal) on pain. METHODS: Two experiments are reported in which the task relevance of the modality and spatial location of a target stimulus was manipulated. In both experiments, somatosensory and auditory stimuli were presented on each trial. In experiment 1, 29 participants were cued on each trial to localize either a somatosensory or an auditory target. In experiment 2, 37 participants were cued on each trial to identify either a somatosensory or an auditory target at a particular location. RESULTS: In experiment 1, self-reported pain intensity and unpleasantness were reduced when participants had to localize the auditory target. The location of the painful stimulus relative to the location of the auditory target did not affect pain. In experiment 2, again, pain intensity and unpleasantness ratings were reduced when participants identified the auditory target. Now, the location of the painful stimulus relative to the location of the auditory target moderated the effect. Pain intensity was less when the painful stimulus was at a different location than the auditory target. CONCLUSIONS: Results are discussed in terms of the attentional set hypothesis, and we argue that the effectiveness of distraction tasks depends on the degree to which the task-relevant features of the distraction task are distinct from pain-related features