Online communities and social networking sites can be valuable to those with cognitive or social difficulties caused by traumatic brain injury. Virtual support systems can increase social participation and reduce isolation. Recent research shows that expressive online journaling appears to enhance quality of life and feelings of well-being for TBI patients.
So, do people with a TBI take advantage of virtual communities? A recent study found that 60% of individuals with TBI used Facebook. Age and gender were not significant factors in use of social networking tools. Several other studies show additional common online activities among people with a TBI including email, gaming, and research.
In addition, half of the TBI patients who were not Facebook users were interested in learning to use the site. Barriers for use were security concerns, cognitive defects including problems remembering passwords and navigating the site, and a preference for meeting with people in person. Costs associated with computers and internet services may also be a burden.
Identifying ways to increase social networking use may improve social outcomes in TBI patients.
Tsaousides, T, Matsuzawa, Y, and Lebowitz, M. Familiarity and prevalence of Facebook use for social networking among individuals with traumatic brain injury. Brain Injury. (November 2011).

Participation is defined as “involvement in a life situation.” Through this participation, children and adolescents acquire skills and competencies, and achieve physical and mental health. To increase understanding of how participation and recovery trajectories are linked in youth with acquired brain injury, researchers have recently examined available tools for measuring participation outcomes.
The study found that while some tools—like the Child and Adolescent Scale Participation and Children’s Assessment of Participation and Enjoyment (CAPE)—exist, they are underutilized in research. The study also suggests that a mixed quantitative/qualitative approach in research may provide the broadest picture of participation by ABI youth.
Consistent use of validated tools by researchers and blending qualitative and quantitative techniques will provide information on how and to what extent brain injury affects youth participation, and give providers strategies to maximize social engagement.
Van Tol, E, Gorter, JM, Dematteo, C, and Meester-Delver, A. Participation outcomes for children with acquired brain injury: A narrative review. Brain Injury. (2011).

In the highly supportive environment of early childhood, children with traumatic brain injury do not show evidence of significant friendship problems. However, as children age, relationships become more complex, and children with TBI become more vulnerable to social isolation and poor peer interactions.

Children with traumatic brain injury often show cognitive deficits related to emotional recognition and social problem solving. This can have negative impact on social functioning. A recent study on children ages 7-14 found that, while 75% of the control group reported 4 or more friends, only 39% with mild, 20% with moderate, and 14% of children with severe TBI had the same number. Researchers also found that children with severe TBI had difficulty managing conflict and less intimacy in their friendships.

Children with TBI have more severe problems with hyperactivity, attention deficit disorders, and emotional problems, which impact their ability to communicate and participate socially. Children with TBI may also be likely to experience loneliness and poor quality of life as a result of their injuries.

Ross, KA, McMillan, T, Kelly, T, Sumpter, R, and Dorris, L. Friendship, loneliness, and psychosocial functioning in children with traumatic brain injury. Brain Injury. (November 2011).

When a severe traumatic brain injury results in a disorder of consciousness, such as a vegetative or minimally conscious state, one question that families and clinicians want to know is—is there brain activity? Brain activity can predict coma outcome, and can be an important tool for rehabilitation planning.

Electroencephalography (EEG) is a widely accepted measure of brain activity. What is more variable is the type of environmental stimulation that can be used to measure EEG activity in coma patients. Robotic gait training is a type of stimulation that requires repetitive exercises. This type of exercise is known to result in brain reorganization, which can produce arousal and brain activity.

A recent study that used EEG to measure brain activity during robotic gait training found that, while healthy patients showed significantly increased activity, coma patients showed no change in activity. The researchers concluded that no increase in brain activity during robotic gait training may indicate a more severe injury and negative outcome.

Lapitskaya N, Nielsen JF, & Fuglsang-Frederiksen A. Robotic gait training in patients with impaired consciousness due to severe traumatic brain injury. Brain Injury. (October 2011)

Executive functioning is a mental skill that requires a higher level of thinking, such as planning and problem solving. Impaired executive functioning is common after a traumatic brain injury because it is associated with the prefrontal cortex, an area of the brain that is highly vulnerable to injury.

When a traumatic brain injury occurs in childhood, impaired executive functioning can be difficult to assess. Children often won’t develop comprehensive executive functioning until they are in high school. Even then, problems can be difficult to assess unless they have some relationship to real-life situations.

The Party Planning Task is an assessment tool for executive functioning. It requires the participant to organize a party while meeting several constraints. The task requires a high level of problem-solving and reasoning. A recent study found that the Party Planning Task accurately assessed impaired executive functioning in two adolescents who sustained a brain injury when they were younger. The Party Planning Task may therefore be a useful tool for clinicians who need an accurate, real-life simulation of executive functioning.

Shanahan L, McAllister L, & Curtin M. The Party Planning Task: A useful tool in the functional assessment of planning skills in adolescents with TBI. Brain Injury. (October 2011).

In many countries, spinal cord injury patients are placed in non-specific rehabilitation units rather than a unit that is specialized to care for spinal cord injury (the same applies to brain injury). This practice may indicate a lack of specialized units, but it also can be due to a bias towards a less expensive facility. Additionally, patients who are admitted to a specialized unit tend to be younger and have more significant injuries, but also show a more significant improvement in functioning before admission.

However, patients admitted to non-specific rehabilitation units are more likely to remain there for longer periods of time, are less likely to recover significantly, and may actually cost more than a specialist unit over the long term.

Much of the research that supports specialist rehabilitation comes from the UK, Canada, and Australia—who share similarities in their healthcare systems. But during this time of healthcare reform in the United States, there should be some consideration given to the long-term economic benefit of specialist rehabilitation units.

New PW, Simmonds F, & Stevermuer T. Comparison of patients managed in specialised spinal rehabilitation units with those managed in non-specialised rehabilitation units. Spinal Cord. (September 2011).

A brief, high dose treatment of methylprednisolone within the first 8 hours of a spinal cord injury has been associated with improved functional outcome, and has therefore become a routine treatment. However, methylprednisolone is also related to adverse effects on skeletal muscle and the immune system. The treatment is consequently a controversial one—do the adverse effects outweigh the potential benefits?

A recent animal study found that a brief, high dose treatment of methylprednisolone caused profound muscle atrophy. This atrophy occurred not only in the paralyzed muscles, but also functionally intact muscle, which can impact the ability to use a wheelchair in the future. In addition, the study indicated a potential atrophy in respiratory muscles, which can impact independent ventilation.

While an animal study may not be completely related to human functioning, this study shows significant evidence that the benefits of routine methylprednisolone treatment may not outweigh its adverse effects.

Wu Y, Hou J, Collier L, et al. The administration of high-dose methylprednisolone for 24h reduced muscle size and increased atrophy-related gene expression in spinal cord-injured rats. Spinal Cord. (September 2011).

Fatigue is one of the most common complaints after even the mildest of brain injuries. However, it can be difficult to assess and diagnose because it is often hidden by other common brain injury symptoms such as sleep problems, depression, or hypothyroidism.

A recent study of sport-related concussion found that complaints of fatigue not only correlated with increased errors on an attention test, it was also associated with changes in EEG activity. Increases in delta and theta rhythms on the EEG suggest decreased alertness and drowsiness. Athletes who complained of fatigue after a concussion also showed increased delta and theta rhythms on their EEG.

Fatigue is a very real and disabling problem for people a traumatic brain injury. It should be considered not only during the assessment of a concussed athlete’s return-to-sport, but also for anyone who suffers any severity of brain injury.

Barwick F, Arnett P, & Slobounov S. EEG correlates of fatigue during administration of a neuropsychological test battery. Clinical Neurophysiology. (September 2011).

People with a traumatic brain injury are at higher risk for developing certain neurological disorders. Post-traumatic seizures, hypopituitarism, and mood disorders have been well documented after traumatic brain injury. In addition, we know that a brain injury increases the risk of developing Alzheimer’s disease and Parkinson’s disease.

Less is known about the risk of a stroke after a traumatic brain injury. However, a recent study has shown that people with a traumatic brain injury are significantly more likely to suffer a stroke than people without injury. In addition, people with a traumatic brain injury are more likely to develop pre-stroke risk factors, such as hypertension, diabetes, and cardiovascular disease, within the first 6 months of injury.

The implication of this study is that clinicians and family members need to be extra alert to the early signs of stroke risk factors after brain injury. Those who receive early treatment will be less likely to have a stroke in the future.

Chen Y-H, Kang J-H, & Lin H-C. Patients with traumatic brain injury: Population-based study suggests increased risk of stroke. Stroke. (September 2011).

Attention is complex skill. It requires the ability to focus on an object or an idea, maintain that focus long enough for the information to be useful, filter out extraneous information, shift from one piece of information to another (or sometimes attend to more than one piece of information at a time), and stop from making automatic mistakes.

We know that attention is a critical skill during school years (thus the prevalence of ADHD drugs in school-aged children). But, we may not fully grasp impairments in attention after a child sustains a brain injury. Recent research has found that impairment of attention skills is common after traumatic brain injury, and especially so after severe traumatic brain injury.

Impairments in attention may last a long time after a brain injury. These results suggest that possibly long-term accommodations for these children may be necessary—both in the classroom and at home.

Anderson V, Eren S, Dob R, et al. Early attention impairment and recovery profiles after childhood traumatic brain injury. Journal of Head Trauma Rehabilitation. (August 2011).