Monitoring emergence from coma following a severe brain injury in an octogenarian using behavioral indicators, electrophysiological measure and metabolic studies: A demonstration of the potential for good recovery in older adults M. Crossley, A. Shiel, B. Wilson, M.R. Coleman, L. Gelling, T. Fryer, S. Boniface, and J. Pickard Brain Injury, 20 August 2005; 19(9):

KE 80 yr. old female “This case study demonstrates an attempt to integrate and link behavioral and metabolic/electrophysiological measures obtained during recovery following severe brain injury” (736)

KE was hit by a car while walking her dog. Admitted to the hospital, for the second time that day (earlier had been in a car accident). Upon admittance, 7 on Glasgow coma scale quickly devolved to a 3. She was intubated and remained in a coma for 4 weeks.

Brain and other injuries Extra-cranial fluid over her left temporal region, no skull fracture. Also, accompanying body injuries. Physical injuries included a closed fracture of her proximal left tib/fibula, a pelvic fracture, and right patella chipping

Memory impairments 6 weeks after accident, had trouble concentrating (especially for long periods of time), making decisions and judgments. Executive functions (eg. stroop test) at low- average range Also at 16 weeks after her injury, showed severe mood swings, sleep disturbance, and despondency

Neuropsychological test results

CMRGIc at 1 month after injury

CMRGIc at 1 year

WHM- Wessex head injury matrix

What can we learn? Temporal lobes are related to auditory processing and retaining knowledge about the identity of things in the world Damage to the area of the temporal lobe closest to the hippocampus is usually associated with autobiographical memory loss, ‘semantic amnesia’, and priming loss

Outlook, implications To what degree is restoration of neuro- functional integrity over the 12 months after injury possible? Shows correlates between behavior and neuropsychological aspects due to brain injury Implies a fairly positive outlook for recovery in older adults if they survive brain injury

What’s unclear? Exact nature of her injuries was not well documented in paper Nature of the two accidents, related? Although the researchers had a fairly clear picture of her previous functioning, not completely clear. It was mostly based on self-reports and family members accounts.

Unclear cont. Why did KE display no autobiographical memory problems, but showed other classic memory difficulties related to her injuries?