Traumatic Brain Injury: Recovery, Prediction, and the Clinician

Abstract 

Robertson IH. Traumatic brain injury: recovery, prediction, and the clinician.

Traumatic Brain Injury produces long term disabling effects in a young population of normal life expectancy, yet very little is known about its medium to long-term outcome with the underlying pathologies often invisible to standard brain imaging methods. This collection of papers offers a major advance in defining the course of recovery following TBI, and demonstrating the utility of new brain imaging techniques such as diffusion-tensor imaging to predict outcome and detect hitherto concealed pathologies. These pathologies partly explain the profound behavioral deficits that have been widely demonstrated in TBI but often disputed in courts and elsewhere because of the lack of correlates in underlying brain structure. This edition also offers the first clear evidence of progressive postinsult long-term brain atrophy in some cases of TBI, as well as highlighting important neuropsychological and behavioral predictive variables for recovery, and including the possibility of effective behavioral treatments to mitigate some of these profoundly disabling deficits. This collection of papers is outstanding in a number of ways - in giving the clinician a sense of what can be said to the worried family and what cannot, and in offering researchers important insights from imaging and neuropsychology into the possible mechanisms for the postacute recovery process. But they are important in a third, even more important way - in yielding some real pointers as to how the course of recovery may be influenced.

Key Words: Atrophy, Brain injuries, Magnetic resonance imaging, Neuropsychology, Prognosis, Rehabilitation

List of Abbreviations: DTI, diffusion tensor imaging, MRI, magnetic resonance imaging, TBI, traumatic brain injury