1/52. Conflict of intentions due to callosal disconnection.OBJECTIVES: Three patients with callosal syndrome manifested a peculiar symptom in that they were unable to perform intended whole body actions because another intention emerged in competition with the original one. Attempts were made to clarify the symptomatology of this manifestation and its possible mechanism is discussed. methods: The three patients are described and previous reports on patients with callosal damage were reviewed. Four additional patients with similar symptoms were found and the clinical features common to all seven patients were examined. RESULTS: This symptom could not be attributed to unilateral movement disorders such as unilateral apraxia, intermanual conflict, or compulsive manipulation of tools. The manifestations included marked hesitation in initiating actions, interruption of actions, repetitive actions, and performance of unintended actions with difficulty in correcting them. All patients, except one, had a lesion in the posterior half of the body of the corpus callosum, and there was no significant involvement of the cerebral cortex. The symptom became manifest later than 4 weeks after callosal damage. It occurred during spontaneous actions, but not during well automated actions nor when following instructions. CONCLUSION: This symptom, tentatively named "conflict of intentions", can be regarded as a fragment of diagonistic dyspraxia originally described by Akelaitis, although it can occur independently of intermanual conflict. Normally, the right and left cerebral hemispheres may be complementarily modifying automated whole body actions in order to adapt behaviour to changes of the environment as well as to the intention. Partial callosal disconnection without significant cortical involvement would exaggerate the disparity between the role of each hemisphere through the reorganisation of neural systems after callosal damage. Such double, often contrary, behavioural tendencies may sometimes simultaneously enter the patient's awareness.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/52. Reduction of chronic aggressive behaviour 10 years after brain injury.This study demonstrates the successful management of aggressive behaviour with a client 10 years post-injury in a small, residential neurorehabilitation unit. The case presented is unusual for two main reasons. First, it proved possible to significantly modify previously chronic challenging behaviour many years after brain injury had been sustained. Secondly, the rehabilitation environment in which treatment was conducted did not comprise a highly specialized neurobehavioural service, Instead, staff were specifically trained regarding the administration of the treatment programme, which was based on principles derived from behaviour modification and applied neuropsychology. Specific interventions used included those of differential reinforcement and graduated increase of expectations. Recordings made over the course of 85 weeks demonstrate a significant decrease in the frequency and severity of aggression. Successful inhibition of challenging behaviour attained a level which facilitated transfer of the client to a non-institutionalized community home. Reasons underlying the success of the intervention, and the limitations inherent in attempting to manage aggression within neurorehabilitation environments will be discussed.- - - - - - - - - - ranking = 4.5keywords = behaviour (Clic here for more details about this article) |
3/52. stereotypic movement disorder after acquired brain injury.stereotypic movement disorder (SMD) consists of repetitive, non-functional motor behaviour that interferes with daily living or causes injury to the person. It is most often described in patients with mental retardation. However, recent evidence indicates that this condition is common among otherwise normal individuals. This case study describes a patient with new-onset SMD occurring after subdural haematoma and brain injury. SMD has rarely been reported after acquired brain injury, and none have documented successful treatment. The current psychiatric literature regarding neurochemistry, neuroanatomy, and treatment of SMD are reviewed with particular application to one patient. Treatment options include serotonin re-uptake inhibitors, opioid antagonists and dopamine antagonists. SMD has been under-appreciated in intellectually normal individuals, and may also be unrecognized after brain injury. Further investigation is needed in this area, which may benefit other individuals with SMD as well.- - - - - - - - - - ranking = 0.5keywords = behaviour (Clic here for more details about this article) |
4/52. Behavioural disturbances following Japanese B encephalitis.Clinically, Japanese B encephalitis (JBE) is often overlooked as its occurrence in Western countries is rare. However, its neurological, cognitive and psychiatric sequelae constitute a major public health problem in the far east where JBE is endemic. European and American subjects may however experience the JBE when returning from a far east journey. In such cases, misdiagnosis is frequent because of the unawareness of psychiatrists and physicians. The present review, therefore, documents the behavioural and cognitive sequelae of JBE. This reactivates the debate concerning the vaccination against the virus all the more that the literature enlightens the importance of the vaccination for those who undertake frequent and extensive tourist excursions to the Orient but still discusses it for occasional travellers. Following is a case-report of a young western European post-graduate student who has contracted JBE by experiencing an acute febrile delirium during an unusual short stay in South East asia. Pyramidal syndrome, Parkinsonism and amnesia were the prominent acute deficits. Whereas these faded in great part during convalescence, emotional and behavioural instability associated with affective involvement, obsessive-compulsive symptoms and cognitive impairments appeared. A partial recovery was however obtained with neuroleptics, lithium and following electro-convulsive therapy. Organic personality syndrome was persistent and thereafter constituted the main sequelae syndrome. Hypersomnia and several enuretic episodes persisted.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/52. Sexually intrusive behaviour following brain injury: approaches to assessment and rehabilitation.Sexually intrusive behaviour, which may range from inappropriate commentary to rape, is often observed following a traumatic brain injury. It may represent novel behaviour patterns or an exacerbation of pre-injury personality traits, attitudes, and tendencies. Sexually intrusive behaviour poses a risk to staff and residents of residential facilities and to the community at large, and the development of a sound assessment and treatment plan for sexually intrusive behaviour is therefore very important. A comprehensive evaluation is best served by drawing on the fields of neuropsychology, forensic psychology, and cognitive rehabilitation. The paper discusses the types of brain damage that commonly lead to sexually intrusive behaviour, provides guidance for its assessment, and presents a three-stage treatment model. The importance of a multidisciplinary approach to both assessment and treatment is emphasized. Finally, a case example is provided to illustrate the problem and the possibilities for successful management.- - - - - - - - - - ranking = 4.5keywords = behaviour (Clic here for more details about this article) |
6/52. Extreme risk taker who wants to continue taking part in high risk sports after serious injury.The case is reported of a 40 year old male high risk sport athlete who had seriously injured himself several times and as a result was partially physically disabled and had trouble with mental tasks requiring concentration such as spelling, reading numbers, and writing. The athlete was referred to a sports psychologist. In consultations, it became clear that he was having difficulty reconciling the difference between his life as it used to be and as it would be in the future. Part of his difficulty was dealing with the frustration and anger "outbursts" which resulted from not being able to perform straightforward everyday motor skills. In spite of his injuries and disability, the patient badly wanted to continue participating in extreme sports. Reversal theory is used in the discussion to provide theoretical explanations of the motivation for his extreme risk taking behaviour.- - - - - - - - - - ranking = 0.5keywords = behaviour (Clic here for more details about this article) |
7/52. Psychotropic-absent behavioural improvement following severe traumatic brain injury.We present a case study in which severe agitation was reduced and independent functioning increased in a traumatically brain-injured individual. The subject's behaviour for the year prior to admission was characterized by increasing rates of maladaptive behaviours and corresponding increases in pharmacological attempts at behaviour management. Upon admission, the subject was totally dependent on others for all activities of daily living. A data-based systematic withdrawal of a number of psychotropic medications and the addition of an anticonvulsant medication was conducted in an AB experimental design. Reductions of medications in conjunction with behavioural interventions resulted in immediate reduction in rate of maladaptive behaviours. Further reductions in psychotropic medications and the addition of the anticonvulsant medication resulted in continued rapid deceleration of rate of occurrence of maladaptive behaviours with a concomitant increase in lucid statements and independent functioning. A follow-up conducted at 6 months showed the subject to be independent in performance of activities of daily living in a semi-independent living situation, with maladaptive behaviours continuing to be well managed.- - - - - - - - - - ranking = 5.5keywords = behaviour (Clic here for more details about this article) |
8/52. Behavioural and physiological evidence for covert face recognition in a prosopagnosic patient.In a previous report, Bauer (1984) described the patient LF, who was unable to recognise familiar faces. Despite the inability to verbally identify familiar faces, psychophysiological examination revealed preserved covert processing of facial identity. Subsequent studies have demonstrated covert face recognition using behavioural tasks. Investigations of the patient PH showed normal face familiarity effects on matching, interference, priming, and learning tasks, while overt recognition was completely absent (De Haan, Young and Newcombe, 1987b). The use of different methodologies has led to different theoretical conceptualisation of the "covert recognition" phenomenon. Until now, no individual patient has been exposed to both methodologies. In this study we evaluated LF, who shows psychophysiological evidence of covert recognition, using behavioural tasks previously used with PH. The results reveal clear behavioural evidence of preserved face recognition without awareness. These findings suggest that both methodologies tap similar phenomena, and have important implications for theoretical models of covert face recognition. A conceptual model designed to integrate psychophysiological and behavioural evidence of covert face recognition is proposed.- - - - - - - - - - ranking = 2keywords = behaviour (Clic here for more details about this article) |
9/52. Behaviour rehabilitation of the challenging client in less restrictive settings.Individuals who have sustained traumatic brain injury may provide friends, family, and rehabilitation professionals with challenges through an increased likelihood of their engaging in socially inappropriate behaviours. At extremes the inappropriate behaviours include vocal and physical assault, non-compliance, self-injurious behaviours, elopement, and property destruction. While these maladaptive behaviours are by themselves troublesome, for some individuals they provide severe barriers to rehabilitation. One option for the challenging rehabilitation client is a neurobehavioural programme, typically offering an access-limited or otherwise secure physical environment and which focuses on behaviour reduction. While outcomes from neurobehavioural programmes are typically positive, their expense and the negative connotations of this type of programme will at times dissuade family members from enrolling the client. We describe an alternative, less restrictive behavioural programme operated in the physical and social context of a larger, more typical community-based rehabilitation programme for traumatically brain-injured individuals. This programme has been in operation for nearly three years, successfully serving more than 200 clients, of which approximately 20% posed behaviour management problems. Identified variables accounting for these successes include: formal guidelines for programme development, staff training and monitoring, data collection, integration of an interdisciplinary team, discharge planning and post-discharge follow-up. We provide a general programme description followed by discussions of four brief case studies to illustrate basic principles of the programme. Programme strengths are discussed, as are constraints placed on the programme by the physical and social environments in which it operates.- - - - - - - - - - ranking = 4.5keywords = behaviour (Clic here for more details about this article) |
10/52. 'The ten pound note test': suggestions for eliciting improved responses in the severely brain-injured patient.The severely brain-injured patient may demonstrate a limited repertoire of responses. Anecdotal accounts suggest that stimuli of personal relevance, or of an unusual or innovatory nature, may sometimes elicit more meaningful responses. Two cases of severe acquired brain injury are described, in whom overall levels of responsiveness had been very low since coma ended. The use of stimuli with personal relevance provoked strong responses and presaged further behavioural change. The implications are discussed.- - - - - - - - - - ranking = 0.5keywords = behaviour (Clic here for more details about this article) |
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