Personalised treatments for traumatic brain injury: cognitive, emotional and motivational targets.

03 Aug 2018

Traumatic brain injury (TBI) occurs when an external force to the head alters brain function. TBI is one of the leading causes of death and disability worldwide, with motor vehicle accidents and falls accounting for most hospital admissions. Each year, there are 50-60 million new cases of TBI, which disproportionately affect young men in low- to middle-income countries (Maas et al., 2017). TBI is a complex condition characterised by a wide range of physical, behavioural, cognitive, emotional and motivational disabilities. Post-injury effects are not limited to severe TBI and can also present in mild to moderate cases. TBI is one of the most established environmental risk factors for increased incidence of epilepsy, stroke and neurodegenerative disorders including Alzheimer’s disease. However, rehabilitation centred on physical therapy of movement and gait after injury often overlooks longer-term changes in mood and neuropsychiatric symptoms. Despite the rising burden of TBI to the individual, their families, healthcare services and society, recruiting patients to research studies remains challenging, with numerous practical and methodological difficulties leading to inadequate sample sizes and high dropout rates (e.g. more than 40%; Dikmen & Levin, 1993). The aim of this article is to identify common barriers between research participation and clinical translation, with a call for more personalised treatment approaches addressing cognitive, emotional and motivational targets to improve management and outcome in patients with TBI.