Adverse effects of apathy and neurobehavioral deficits on the community integration of traumatic brain injury subjects.
OBJECTIVE
The aim of this study was to provide insight into the adverse effects of neurobehavioral features on the community integration of young adults who have had prior severe traumatic brain injury (TBI) with a positive long-term outcome in either functional or intellectual abilities. TBI subjects were compared with patients suffering from a health condition classified as mild intellectual disability (MID).


METHODS
Twenty-five subjects with prior severe TBI, but with substantially normalized perceptual-motor and intellectual functioning, were retrospectively selected according to demographic and clinical admission criteria. The TBI subject group was compared with a selected group of 34 MID subjects. The measures used were: the Wechsler Adult Intelligence Scale-Revised (WAIS-R), Instrumental Activity of Daily Living Scale (IADLS), Community Integration Questionnaire (CIQ), and Social Behaviour Check-list (SBC). The presence/absence of dysfunctional family environment and affective close relationships were also reported.


RESULTS
Significant differences between TBI and MID subjects (with greatest scores in TBI group) refer to: WAIS-R Full Scale IQ (FSIQ, indicating an average intellectual level), CIQ-Social integration (indicating a greater level than MID group), and SBC-Defective-type behaviour (indicating a greater level of apathy than MID group).


CONCLUSIONS
Defective-type behaviour--synthesized into the term apathy' has the following features: 1) can explain the unsatisfying community integration of TBI subjects with respect to the general population; and 2) best explains the similar CIQ-home integration and CIQ-productive activities compared to subjects presenting a higher intellectual disadvantage (MID patients). The multidisciplinary approach to the complex community integration process of TBI subjects might consider the high frequency of apathy as a primarily target of the community integration management.
Cattelani
R
R
Department of Neuroscience, University of Parma, Parma, Italy. cattel@unipr.it
Roberti
R
R
Lombardi
F
F