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Review
. 2011;13(3):325-45.
doi: 10.31887/DCNS.2011.13.2/darciniegas.

Addressing neuropsychiatric disturbances during rehabilitation after traumatic brain injury: current and future methods

David B Arciniegas  1
Affiliations
Review

Addressing neuropsychiatric disturbances during rehabilitation after traumatic brain injury: current and future methods

David B Arciniegas. Dialogues Clin Neurosci. 2011.

Abstract
in English, Spanish, French

Cognitive, emotional, behavioral, and sensorimotor disturbances are the principal clinical manifestations of traumatic brain injury (TBI) throughout the early postinjury period. These post-traumatic neuropsychiatric disturbances present substantial challenges to patients, their families, and clinicians providing their rehabilitative care, the optimal approaches to which remain incompletely developed. In this article, a neuropsychiatrically informed, neurobiologically anchored approach to understanding and meeting challenges is described. The foundation for that approach is laid, with a review of clinical case definitions of TBI and clarification of their intended referents. The differential diagnosis of event-related neuropsychiatric disturbances is considered next, after which the clinical and neurobiological heterogeneity within the diagnostic category of TBI are discussed. The clinical manifestations of biomechanical force-induced brain dysfunction are described as a state of post-traumatic encephalopathy (PTE) comprising several phenomenologically distinct stages. PTE is then used as a framework for understanding and clinically evaluating the neuropsychiatric sequelae of TBI encountered commonly during the early post-injury rehabilitation period, and for considering the types and timings of neurorehabilitative interventions. Finally, directions for future research that may address productively the challenges to TBI rehabilitation presented by neuropsychiatric disturbances are considered.

Las alteraciones cognitivas, emocionales, conductuales y sensoriomotoras son las manifestaciones clinicas principales del daño cerebral traumático (DCT) durante el perfodo inicial post lesión. Estas alteraciones neuropsiquiátricas posiraumáticas presentan importantes desafíos para los pacientes, sus fa milias y los medicos a cargo del tratamiento durante la rehabilitación, y no se ha desarrollado en forma compléta un abordaje óptimo. En este artículo se describe un abordaje con information neuropsiquiátrica y soporte neurobiológico para comprender y enfrentar los desafíos. El fundamento para este abordaje se présenta con una revisión de las definiciones del caso clínico de DCT y una clarificatión de sus términos propuestos. A continuación se considéra el diagnóstico diferencial de las alteraciones neuropsiquiátricas relacionadas con el acontecimíento y luego se discute la heterogeneidad clínica y neurobiológica de las categorías diagnósticas del DCT. Las manifestacíones clínicas de la disfunción cerebral inducida por una fuerza biomecánica se describen como un estado de encefalopatía postraumátic (EPT) que incluye algunas etapas específicas fenomenológicamente. Porlo tanto la EPT se emplea como un marco para la comprensión y evaluacíon clinica de las secuelas neuropsiquiátricas del DCT que aparecen comúnmente durante el período inicial de la rehabilitación post lesion, y para tener en cuenta de los tiposy tiempos de las iniervenciones de neuro-rehabilitación, Por ultimo, se consideran las orientaciones para futuras investigaciones que puedan abordar de manera productiva los desafíos que presentan las alteraciones neuropsiquiátricas para la rehabilitación del DCT.

Les troubles cognitifs, émotionnels, comportementaux et sensorimoteurs sont les principales manifestations cliniques des lésions cérébrales traumatiques (LCT) au cours de la période posttraumatique précoce. Ces troubles neuropsychiatriques post-traumatiques représentent un véritable défi pour les patients, leur famille et les médecins qui prodiguent leurs soins de réadaptation, et dont les méthodes restent imparfaites. Nous décrivons dans cet article une approche neuropsychiatrique, sous-tendue par la neurobiologie, permettant la compréhension et la réalisation d'objectifs. Les fondements de cette approche reposent sur une revue des définitions des cas cliniques des LCT et sur une clarification de leur origine. Nous examinons ensuite le diagnostic différentiel des troubles neuropsychiatriques liés à ces événements, puis nous analysons l'hétérogénéité clinique et neurobiologique de la catégorie diagnostique des LCT, Les manifestations cliniques des troubles cérébraux induits par la force biomécanique sont décrites comme un état d'encéphalopathie post-iraumaiique (EPT) comprenant plusieurs stades distincts sur le plan phénoménologique, L'EPT est alors utilisée comme cadre de compréhension et d'évaluation clinique des séquelles neuropsychiatriques des LCT rencontrées habituellement pendant la période de réadaptation post-traumatique précoce, renseignant sur les types et la chronologie des interventions de réadaptation neurologiques à adapter. Les directions à prendre pour la recherche future sont envisagées, afin d'aborder de façon productive les défis de la réadaptation aux LCT liés aux troubles neuropsychiairiques.

Keywords: Traumatic brain injury; cognition; differential diagnosis; encephalopathy; neuropsychiatric assesment; rehabilitation.

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References

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