#NPsychTeamResearch – Impact of Covid-19 lockdown for people with brain injury in the UK. Carlacci De Mattia, Campbell, Parrett. The Neuropsychologist April 2023 via NPsych

The Neuropsychologist 15: 40-51

Impact of Covid-19 lockdown on the mood, behaviour, and social activities of people with brain injury in the UK: Results of a survey of brain injury professionals’ reports




The Covid-19 related lockdown of March–June 2020 in the United Kingdom (UK) may have negatively affected mood and behaviour of people with brain injuries. Conversely, there may have been beneficial effects due to reduced demand on cognition and emotional regulation. In this online survey study, care coordinators (n=19) assessed the consequences of lockdown on 130 individuals with ABI (range 3–29 clients per care co-ordinator; 10–65years+; and mostly living in residential care). The majority of reports were of no change to mood, behaviour, or social functioning (105 ratings). However, respondents reported that 88 (68 per cent) clients presented with changes: 63 clients (48 per cent) had lower mood, higher distress, and agitation, and were less engaged in usual activities; while 25 clients (19 per cent) were reported to have improved. Moreover, 13/19 (68 per cent) of respondents reported increased vulnerabilities in their clients, and 5/19 (26 per cent) reported online exploitation, controlling behaviour from partner and financial scams. These data present a mixed picture of how the first national lockdown affected people with ABI.

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Efficacy of Postacute Neuropsychological Rehabilitation for Patients with Acquired Brain Injuries is Maintained in the Long-Term. J Int Neuropsych Soc, Jan 2020

Postacute NR programs provide participants with various tools, skills, and psychological perspectives that they continue to gain from and generalize to real life after program completion, reflecting transformational processes with stable long-term benefits

Effects of animal-assisted therapy on social behaviour in patients with acquired brain injury: a randomised controlled trial. Scientific Reports, 2019.

Effects of animal-assisted therapy on social behaviour in patients with acquired brain injury: a randomised controlled trial.

Karin Hediger, Stefan Thommen, Cora Wagner, Jens Gaab & Margret Hund-Georgiadis. Nature: Scientific Reports, volume 9, Published: 09 April 2019.

Animal-assisted therapy (AAT) is increasingly used to address impaired social competence in patients with acquired brain injury. However, the efficacy of AAT has not been tested in these patients. We used a randomised, controlled within subject trial to determine the effects of AAT on social competence in patients undergoing stationary neurorehabilitation. Participants received both AAT sessions and paralleled conventional therapy sessions. The patients’ social behaviour was systematically coded on the basis of video recordings of therapy sessions. Moreover, mood, treatment motivation and satisfaction was measured during each therapy session. We analysed 222 AAT and 219 control sessions of 19 patients with linear mixed models. Patients showed a significantly higher amount of social behaviour during AAT. Furthermore, patients’ positive emotions, verbal and non-verbal communication, mood, treatment motivation and satisfaction were increased in the presence of an animal. Neutral emotions were reduced but no effect was found regarding negative emotions. Our results show that AAT increases aspects of social competence and leads to higher emotional involvement of patients with acquired brain injury, reflected in higher social engagement, motivation and satisfaction during a therapeutic session.

Traumatic Brain Injury and the Risk for Subsequent Crime Perpetration. Bonow, Wang, et al. J Head Trauma Rehabil 2019

Traumatic Brain Injury and the Risk for Subsequent Crime Perpetration

Bonow, Robert H; Wang, Jin, et al. The Journal of Head Trauma Rehabilitation: January/February 2019 – Volume 34 – Issue 1 – p E61–E69




To examine whether patients with traumatic brain injury (TBI) are at higher risk for subsequent crime perpetration compared with injured patients without TBI and those hospitalized for reasons other than injury.

Setting and Participants:

Patients hospitalized in Washington State from 2006-2007.


A retrospective cohort study using linked statewide datasets.

Main measures:

Primary outcomes were arrest for any violent or nonviolent crime within 5 years of discharge. Adjusted subhazard ratios were calculated using regression models incorporating death as a competing risk.


Compared with uninjured patients (n = 158 247), the adjusted rate of arrest for any crime was greater among injured patients with TBI (n = 6894; subdistribution hazard ratios [sHR], 1.57; 95% confidence interval [CI], 1.49-1.62) and without TBI (n = 40 035; sHR, 1.55; 95% CI, 1.49-1.62). When patients with TBI were directly compared with injured patients without TBI, no effect of TBI on subsequent arrests was found (sHR, 1.02; 95% CI, 0.94-1.11). TBI did not increase the likelihood of either violent or nonviolent crime when these outcomes were examined separately.


TBI survivors do not appear to be at increased risk for criminality compared with injured individuals without TBI. However, injured persons with or without TBI may be at elevated risk of crime perpetration compared with those who are uninjured.

The Association between Post-Concussion Symptoms and Health-Related Quality of Life in Patients with Mild Traumatic Brain Injury. Injury, 2018

The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury

Daphne C.Voormolena, Suzanne Polindera, Nicole von Steinbuechel, Pieter E.Vosc, Maryse C.Cnossena, Juanita A.Haagsmaad. Injury. Available online 7 December 2018


A subset of mild traumatic brain injury (mTBI) patients experience post-concussion symptoms. When a cluster of post-concussion symptoms persists for over three months, it is referred to as post-concussion syndrome (PCS). Little is known about the association between PCS and Health-Related Quality of Life (HRQoL) after mTBI. The aims of this study were to assess the implications of PCS on HRQoL six months after mTBI and the relationship between PCS and HRQoL domains. A prospective observational cohort study was conducted among a sample of mTBI patients. Follow-up postal questionnaires at six months after emergency department (ED) admission included socio-demographic information, the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), and HRQoL measured with the 36-item Short-Form Health Survey (SF-36) and the Perceived Quality of Life Scale (PQoL). In total, 731 mTBI patients were included, of whom 38.7% were classified as suffering from PCS. Patients with PCS had significantly lower scores on all SF-36 domains, lower physical and mental component summary scores and lower mean PQoL scores compared to patients without PCS. All items of the RPQ were negatively correlated to all SF-36 domains and PQoL subscale scores, indicating that reporting problems on any of the RPQ symptoms was associated with a decrease on different aspects of an individuals’ HRQoL. To conclude, PCS is common following mTBI and patients with PCS have a considerably lower HRQoL. A better understanding of the relationship between PCS and HRQoL and possible mediating factors in this relationship could improve intervention strategies, the recovery process for mTBI patients and benchmarking.

Traumatic Brain Injury in Early Childhood and Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Nationwide Longitudinal Study. J Clin Psychiatry, 2018

Traumatic Brain Injury in Early Childhood and Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Nationwide Longitudinal Study.

Chang HK, Hsu JW, Wu JC, Huang KL, Chang HC, Bai YM, Chen T, Chen M. J Clin Psychiatry. 2018 Oct 16;79(6).



Early childhood (< 3 years of age) is a critical period for neurodevelopment. This study investigated the correlation between early childhood traumatic brain injury (TBI) and subsequent risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental delay (DD) by analyzing a national-scale cohort.


Data from the National Health Insurance Research Database, which comprises health care information from > 99% of the Taiwanese population, were analyzed. Children with TBI in their early childhood were enrolled from 1998-2008, and the incidence of subsequent ADHD, ASD, or DD (according to ICD-9 criteria) was assessed and compared with controls without TBI. Patients’ age, number of TBI events, and TBI severity were investigated for the risk of ADHD, ASD, or DD.


A total of 7,801 and 31,204 children were enrolled in the TBI and control cohorts, respectively. The TBI cohort exhibited a higher incidence of subsequent ADHD, ASD, or DD than the controls (all P < .001). Diagnoses of ADHD, ASD, or DD in the TBI cohort were made at a younger age compared with the controls. Cox regression demonstrated the highest hazard ratios (HRs) of ADHD, ASD, or DD with repeated TBI events, severe TBI, and TBI events before 1 year of age, with the exception that the HR of ASD did not significantly increase after repeated TBI (P = .335). In addition, cumulative HRs (> 10 years) of ADHD, ASD, or DD were increased after TBI (all P < .001).


Data from this study suggest that the incidence of ADHD, ASD, and DD significantly increased after TBI events in early childhood (< 3 years of age). The risk factors include severe TBI, repeated TBI events, and TBI at a younger age. The long-term follow-up demonstrated an increased cumulative risk of ADHD, ASD, and DD after TBI.

The Brain Injury Rehabilitation Workbook

The Brain Injury Rehabilitation Workbook edited by Rachel Winson, Barbara A. Wilson, and Andrew Bateman.

Packed with practical tools and examples, this state-of-the-art workbook provides a holistic framework for supporting clients with acquired brain injury. Clinicians are guided to set and meet collaborative treatment goals based on a shared understanding of the strengths and needs of clients and their family members. Effective strategies are described for building skills and teaching compensatory strategies in such areas as attention, memory, executive functions, mood, and communication. Particular attention is given to facilitating the challenging process of identity change following a life-altering injury. In a large-size format for easy photocopying, the volume features 93 reproducible client handouts. Purchasers get access to a Web page where they can download and print the reproducible materials.

The Surprisingly Powerful Influence of Drawing on Memory

The Surprisingly Powerful Influence of Drawing on Memory by Myra A. Fernandes, Jeffrey D. Wammes, Melissa E. Meade. First Published August 30, 2018.

Abstract: The colloquialism “a picture is worth a thousand words” has reverberated through the decades, yet there is very little basic cognitive research assessing the merit of drawing as a mnemonic strategy. In our recent research, we explored whether drawing to-be-learned information enhanced memory and found it to be a reliable, replicable means of boosting performance. Specifically, we have shown this technique can be applied to enhance the learning of individual words and pictures as well as textbook definitions. In delineating the mechanism of action, we have shown that gains are greater from drawing than other known mnemonic techniques, such as semantic elaboration, visualization, writing, and even tracing to-be-remembered information. We propose that drawing improves memory by promoting the integration of elaborative, pictorial, and motor codes, facilitating the creation of a context-rich representation. Importantly, the simplicity of this strategy means it can be used by people with cognitive impairments to enhance memory, with preliminary findings suggesting measurable gains in performance in both normal aging individuals and patients with dementia.

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