NEUROPSYCHOLOGICAL REHABILITATION FOR POST-TRAUMATIC FRONTAL SYNDROME IN PATIENTS RECOVERING FROM PROLONGED COMA: A PRELIMINARY REPORT
Journal Title: Acta Neuropsychologica - Year 2003, Vol 1, Issue 2
Abstract
[b]Introduction.[/b] The set of neurobehavioral disturbances seen in patients who have suffered damage to the frontal lobes, known as frontal syndrome, is a serious detriment to the quality of life. However, there are no generally accepted programs of neuropsychological rehabilitation for patients with frontal lobe damage. This article describes the course of neuropsychological rehabilitation for two patients with frontal syndrome subsequent to traumatic brain injury (TBI) and prolonged coma, who participated in a program designed and implemented in the Department of Rehabilitation at the Academy of Medicine of Bydgoszcz, Poland. The program is based on microgenetic theory, and involves a combination of cognitive training and behavior modification.[b]Case reports.[/b] The study involved two male TBI patients with closed head injuries, confirmed by MRI or CT to be located predominately in the frontal lobes, accompanied by brainstem contusion and prolonged coma (> 16 weeks), treated under the program of neuropsychological rehabilitation described here. Patient PS presented with “Type 1” frontal syndrome, characterized by such symptoms as aggressiveness, jocularity, disinhibition, while patient CR showed “Type 2”, with deficit symptoms such as apathy and depression. Standard neuropsychological batteries were used to assess the patient’s symptoms, and the treatment results were evaluated using the Frontal Behavioral Inventory (FBInv). Therapy individually designed for the type of frontal syndrome, lasted for 12 weeks, 6 weeks in hospital and 6 weeks at home. The patients were evaluated upon admission to the program and again at the end of the 12 weeks.[b]Results.[/b] Both patients at baseline had FBInv profiles generally consistent with published norms for TBI. Though their average scores were quite similar, the profiles different considerably when particular items were compared: CR, with Type 2 frontal syndrome, had high baseline scores for apathy and aspontaneity, lower scores for excessive jocularity, inappropriateness and aggression, while PS’s scores, consistent with Type 1, were inverted. When the post-rehabilitation scores are compared to baseline, and again to the published averages for TBI patients, the positive differences are statistically highly significant (p < 0.0001 in all comparisons for both patients). This improvement was also observed clinically.[b]Conclusion.[/b] Both patients showed remarkable improvement in all tested parameters, with no measurable difference in outcome between Type 1 and Type 2 frontal syndrome, under a program of neuropsychological rehabilitation based on the assumption that frontal damage does not destroy either the capacity to reason or the capacity to act, but rather the system of metafunctions that enables action to be controlled at least in part by higher cognitive processes.
Authors and Affiliations
Maria Pąchalska
Keywords
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