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3 Factors Affecting Recovery
Pages 59-74

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From page 59...
... The following sections are not intended to be an exhaustive review of all possible associated conditions; rather this synthesis of the literature focuses on those factors that the committee determined were most relevant for this report -- those that may interfere with an individual's response to rehabilitation following TBI, including cognitive rehabilitation therapy (CRT)
From page 60...
... Sleep disturbances Access to acute care Access to general medical, mental or behavioral, Medical Care Quality of care and rehabilitation care Factors Quality of care Factors Affecting Factors Affecting Initial Response to TBI Recovery from TBI FIGURE 3-1 Factors affecting initial response to TBI and recovery from TBI. PREINJURY CONDITIONS Individuals who sustain TBI may have preexisting conditions, as well F igure 3-1 as diverse cognitive, medical, genetic, and environmental backgrounds that potentially moderate the effects of injury.
From page 61...
... Emotional disturbance and ongoing substance abuse can also affect a survivor's capacity to cognitively engage in and potentially benefit from even a well-designed cognitive rehabilitation program. Other preexisting factors may contribute to poor outcomes following TBI, including a lack of social support systems and environmental factors.
From page 62...
... In severe TBI in civilian populations, behavioral disturbances including irritability, disinhibition, aggression, and lack of insight or awareness pose a burden to caregivers and a challenge for rehabilitation clinicians. Meanwhile, the most commonly reported comorbidities among military populations include depression and anxiety disorders.
From page 63...
... Virtually all types of anxiety disorders have been documented individuals who have experienced mild TBI, including Generalized Anxiety Disorder at 3 to 28 percent, panic disorder at 4 to 17 percent, and obsessive-compulsive disorder at 2 to 15 percent (Moore et al.
From page 64...
... A cross-sectional study of substance abuse program participants reported that 10 to 20 percent of individuals with TBI, with no preinjury substance abuse issues, were substance abusers after their injuries (Corrigan et al.
From page 65...
... . Fatigue Fatigue is a common complicating condition following TBI and is prevalent even months following injury (Belmont et al.
From page 66...
... . Sleep Disturbance Diagnosed sleep disorders following TBI include excessive daytime sleepiness, hypersomnia, insomnia, and parasomnia and circadian rhythm alterations, such as delayed sleep phase syndrome and irregular sleep–wake pattern (Ayalon et al.
From page 67...
... Clinical Practice Guidelines for Management of Posttraumatic Stress (VA/DoD 2010) and by several other professional and scientific organizations.
From page 68...
... Psychological trauma can result in a broad array of adverse outcomes including, but not limited to, PTSD and depression. Moreover, physical trauma can be associated with adverse psychological consequences, and psychological trauma can have physical symptoms.
From page 69...
... Preinjury depression and anxiety disorders may be present and contribute to persistent symptoms for anyone with TBI. However, more severe preinjury psychiatric disorders or substance abuse may be more common in civilians due to screening procedures used by the military.
From page 70...
... 1999. Postconcussive symptoms and posttraumatic stress disorder after mild traumatic brain injury.
From page 71...
... 2000. The prevalence and neuro psychiatric correlates of posttraumatic stress symptoms following mild traumatic brain injury.
From page 72...
... 2007. Traumatic brain injury and delayed sequelae: A review -- traumatic brain injury and mild traumatic brain injury (concussion)
From page 73...
... 2009. Mild traumatic brain injury and post traumatic stress disorder in returning veterans: Perspectives from cognitive neuroscience.
From page 74...
... 2010. Multisite investigation of traumatic brain injuries, posttraumatic stress disorder, and self-reported health and cognitive impair ments.


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