Marie-Christine Ouellet

Insomnia in patients with traumatic brain injury: frequency, characteristics, and risk factors.

ObjectivesTo document the frequency of insomnia (according to DSM-IV and ICSD criteria), to describe its sociodemographic and clinical characteristics, and to identify potential predictors of insomnia in persons with traumatic brain injury (TBI). Participants and procedureFour hundred fifty-two participants aged 16 years and older with minor to severe TBI answered a questionnaire pertaining to quality of sleep and fatigue. Main outcome measuresProportion of participants fulfilling criteria for insomnia symptoms or syndrome. Validated measures of insomnia severity, fatigue level, and psychologic distress. Results of a logistic regression analysis. ResultsOverall, 50.2% of the sample reported insomnia symptoms and 29.4% fulfilled the diagnostic criteria for an insomnia syndrome. For the latter participants, insomnia was a severe and chronic condition remaining untreated in almost 60% of cases. Risk factors associated with insomnia were milder TBIs, and higher levels of fatigue, depression, and pain. ConclusionInsomnia is a prevalent condition after TBI requiring more clinical and scientific attention as it may have important repercussions on rehabilitation.

Cognitive-Behavioral Therapy for Insomnia: Comparison of Individual Therapy, Group Therapy, and Telephone Consultations.

Forty-five adults with primary insomnia received cognitive-behavioral therapy (CBT) implemented in a group therapy format, in individual face-to-face therapy or through brief individual telephone consultations. The results indicate that CBT was effective in improving sleep parameters with all 3 methods of treatment implementation, and there was no significant difference across methods of implementation. All 3 treatment modalities produced improvements in sleep that were maintained for 6 months after treatment completion. These results suggest that group therapy and telephone consultations represent cost-effective alternatives to individual therapy for the management of insomnia.

Book Review: Insomnia following Traumatic Brain Injury: A Review

Sleep disturbances after a traumatic brain injury (TBI) have received very little scientific attention despite the fact that several studies indicate that they may occur in 30% to 70% of patients. For individuals with TBI, problems falling asleep or maintaining sleep can exacerbate other symptoms such as pain, cognitive deficits, fatigue, or irritability. Sleep disturbances can thus compromise the rehabilitation process and the ability to return to work. This article reviews the evidence on the epidemiology, etiology, and treatment of insomnia in the context of TBI and proposes areas for future research. Prevalence estimates of insomnia complaints in TBI patients are summarized. Potential etiological factors (i.e., lesions to the nervous system, anxiety) and possible consequences of insomnia (i.e., fatigue, cognitive problems) in the context of TBI are discussed. Finally, pharmacological and psychological treatments previously shown effective to treat insomnia in healthy individuals are discussed as valuable treatment options for TBI patients. Increased knowledge about the high prevalence, diagnosis, and potential etiological factors of insomnia following TBI may promote a better identification, evaluation, and treatment of sleeping difficulties in this population.

Sleep-wake disturbances after traumatic brain injury

Sleep-wake disturbances are extremely common after a traumatic brain injury (TBI). The most common disturbances are insomnia (difficulties falling or staying asleep), increased sleep need, and excessive daytime sleepiness that can be due to the TBI or other sleep disorders associated with TBI, such as sleep-related breathing disorder or post-traumatic hypersomnia. Sleep-wake disturbances can have a major effect on functional outcomes and on the recovery process after TBI. These negative effects can exacerbate other common sequelae of TBI-such as fatigue, pain, cognitive impairments, and psychological disorders (eg, depression and anxiety). Sleep-wake disturbances associated with TBI warrant treatment. Although evidence specific to patients with TBI is still scarce, cognitive-behavioural therapy and medication could prove helpful to alleviate sleep-wake disturbances in patients with a TBI.

Cumulative Incidence of Functional Decline After Minor Injuries in Previously Independent Older Canadian Individuals in the Emergency Department

To estimate the cumulative incidence of functional decline in independent older adults 3 and 6 months after a minor injury treated in the emergency department (ED) and to identify predictors of this functional decline.

Volunteer work and psychological health following traumatic brain injury.

ObjectivesTo compare the long-term psychological functioning of 3 groups of survivors of traumatic brain injury (TBI): (1) those who report being regularly active either by working or studying, (2) those who are not competitively employed but are active volunteers, and (3) those who report neither working, studying, nor volunteering. Participants and ProcedureTwo hundred eight participants aged 16 years and older with minor to severe TBI were classified as (1) Working/Studying (N = 78), (2) Volunteering (N = 54), or (3) Nonactive (N = 76). Main Outcome MeasuresMeasures of psychological distress (anxiety, depression, cognitive disturbance, irritability/anger), fatigue, sleep disturbance, and perception of pain. ResultsSurvivors of TBI who report being active through work, studies, or volunteering demonstrate a significantly higher level of psychological adjustment than persons who report no activity. Even among participants who are unable to return to work and are declared on long-term disability leave, those who report engaging in volunteer activities present significantly better psychological functioning than participants who are nonactive. ConclusionVolunteering is associated with enhanced psychological well-being and should be encouraged following TBI.

Roles of movement and temporal factors in spatial learning

Previous experiments suggested that rats can learn to discriminate between adjacent arms of an eight‐arm radial maze if they have an intact hippocampal system and are allowed to move around on the maze. These requirements are consistent with the hypothesis that this discrimination involves hippocampus‐based spatial learning. We examined the importance of self‐generated movement in this form of learning by moving rats manually (“passive movement”) between two adjacent maze arms within a single training trial. Rats moved passively between arms (only one of which contained food) within trials learned to discriminate between the arms, as measured by a conditioned preference for the food arm when both arms were empty. This form of learning was impaired by lesions of fimbria‐fornix, but was unaffected by lesions of the lateral nucleus of the amygdala. Normal rats that were picked up and replaced on the same arm within trials and experienced their food and no food arms on different daily trials failed to learn the same discrimination. These findings suggest that self‐generated movement is not required for spatial learning that may be mediated by a hippocampal system; rather, movement may simply serve to provide information from different locations about the cues in an environment. Hippocampus 1997;7:501–510.

A Preliminary Study to Identify Locomotor-Cognitive Dual Tasks That Reveal Persistent Executive Dysfunction After Mild Traumatic Brain Injury

OBJECTIVE To identify different combinations of physical (level, obstacle avoidance, stepping down) and cognitive (visual, mental) demands within a locomotor navigational context that best discriminates between persons with mild traumatic brain injury (MTBI) and control subjects for an eventual clinical tool to assess residual executive dysfunction. DESIGN Group comparison study. SETTING Rehabilitation facility. PARTICIPANTS Volunteer sample (N=14) of persons with MTBI (n=7) (6 women; age, 20±1.6 y) and a comparison group (n=7) of subjects without neurologic problems (6 women; age, 22.4±1.4 y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gait speed (m/s) and dual-task cost calculated as the relative change in gait speed from single (no cognitive task) to dual tasks for the same gait condition. RESULTS There were significant interactions between groups and cognitive tasks and between groups and cognitive and physical tasks for gait speed. Specifically, the MTBI group walked slower than control subjects in the dual-task conditions when stepping over an obstacle combined with each cognitive task. When gait speed was measured as dual-task costs, group differences were more evident, except for stepping down. CONCLUSIONS These preliminary results suggest that both absolute gait speed and calculated dual-task costs during the combination of stepping over an obstacle with a simultaneous cognitive task are sensitive to revealing executive dysfunction in persons with MTBI. Gait speed can be easily measured in the clinic to provide important information to make diagnoses and decide about return to play or function. Continued work building on these preliminary results is needed toward the development of a clinical tool.

Decline in activities of daily living after a visit to a Canadian emergency department for minor injuries in independent older adults: are frail older adults with cognitive impairment at greater risk?

To compare functional decline in activities of daily living (ADLs) of older adults visiting emergency departments (EDs) for minor injuries according to frailty and cognitive status.

The impact of poor sleep on cognition and activities of daily living after traumatic brain injury: A review

BACKGROUND/AIM Patients frequently report sleep disruptions or insomnia during their hospital stay, particularly after a traumatic brain injury (TBI). The consequences of these sleep disturbances on everyday activities are not well documented and are therefore not considered in the evaluation of independence in activities of daily living (ADLs). The goal of this narrative review is to explore the consequences of poor sleep quality on cognition and ADLs in the acute and subacute stages of a moderate and severe TBI, when patients are in acute care or inpatient rehabilitation. METHODS We will present an overview of normal sleep and its role in cognitive functioning, and then present the findings of studies that have investigated sleep characteristics in hospital settings and the consequences of sleep disturbances on ADLs. RESULTS During hospitalisation, TBI patients present severe sleep disturbances such as insomnia and sleep fragmentation, which are probably influenced by both the medical condition and the hospital or rehabilitation environment. Sleep disruption is associated with several cognitive deficits, including attention, memory and executive function impairments. Poor quality and/or insufficient quantity of sleep in acute TBI probably affect general functioning and ADLs calling for these cognitive functions. CONCLUSIONS AND SIGNIFICANCE The cognitive impairments present following TBI are probably exacerbated by poor sleep quality and sleep deprivation during hospitalisation, which in turn impact ADLs among this population. Health-care personnel should further consider sleep disturbances among people with TBI and a sleep protocol should be established.