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Executive dysfunction following traumatic brain injury: Neural substrates and treatment strategies

Issue title: Evaluation and Management of Neurobehavioral Syndromes of Traumatic Brain Injury

Guest editors: Thomas W. McAllister

Article type: Research Article

Authors: McDonald, Brenna C.a; * | Flashman, Laura A.a; d | Saykin, Andrew J.a; b; c; d

Affiliations: [a] Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA | [b] Department of Radiology, Dartmouth Medical School, Hanover, NH, USA | [c] Department of Computer Science, Dartmouth Medical School, Hanover, NH, USA | [d] New Hampshire Hospital, Concord, NH, USA | Dartmouth Medical School, Department of Psychiatry, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. Tel.: +1 603 650 5824; Fax: +1 603 650 5842; E-mail: Thomas.W.McAllister@Dartmouth.edu

Correspondence: [*] Address for correspondence: Brenna C. McDonald, PsyD, Neuropsychology Program, Department of Psychiatry, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001, USA. Tel.: +1 603 650 5824; Fax: +1 603 650 5842; E-mail: Brenna.C.McDonald@dartmouth.edu

Keywords: executive functions, traumatic brain injury, TBI, assessment, treatment

DOI: 10.3233/NRE-2002-17407

Journal: NeuroRehabilitation, vol. 17, no. 4, pp. 333-344, 2002

Published: 17 December 2002
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Abstract

Executive dysfunction is among the most common and disabling aspects of cognitive impairment following traumatic brain injury (TBI), and may include deficits in reasoning, planning, concept formation, mental flexibility, aspects of attention and awareness, and purposeful behavior. These impairments are generally attributed to frontal systems dysfunction, due either to direct insult to the frontal lobes or to disruption of their connections to other brain regions. Evaluation of executive deficits typically includes neuropsychological assessment, though adjunctive interviews can be critical in detecting subtle dysexecutive symptoms that may not be apparent on standardized testing. Rehabilitation programs emphasizing cognitive-behavioral approaches to the retraining of planning and problem-solving skills can be effective in ameliorating identified executive deficits. In addition, pharmacological approaches may be useful in addressing aspects of executive dysfunction. This review summarizes the nature of executive deficits following TBI, their neuroanatomical substrates, selected assessment and treatment strategies, and recent research findings and trends.

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