Early Stress Response: A Vulnerability Framework for Functional Impairment Following Mild Traumatic Brain Injury

By Bay, Esther H.; Liberzon, Israel | Research and Theory for Nursing Practice, April 1, 2009 | Go to article overview

Early Stress Response: A Vulnerability Framework for Functional Impairment Following Mild Traumatic Brain Injury


Bay, Esther H., Liberzon, Israel, Research and Theory for Nursing Practice


Nearly 64% of people with mild traumatic brain injury (MTBI) experience prolonged symptoms and functional impairments lasting months or years postinjury. Explanations for delayed recovery have varied and lacked a guiding framework, hindering intervention science. Using theory substruction and adapting McLean and associates' biopsychosocial model for chronic pain after trauma, we suggest that perceived psychological stress and associated neurobiological responses may predict risk for functional impairment. This model can be tested using a biopsychosocial approach to determine the interplay of psychological stress and neurobiological responses implicated in functional impairments after MTBI. Testing of this model will advance understanding of pathways to postconcussion syndrome.

Keywords: mild traumatic brain injury; stress; vulnerability; functional status

Stress-related disorders abound in the United States and developing countries. In fact, stress in its more chronic form has become a major focus in research concerned with chronic disorders, including Alzheimer's disease, cancer, heart disease, and depression (McEwen, 2002). Along with the increase of stress-related disorders is the rising worldwide incidence of mild traumatic brain injury (MTBI), also known as the signature wound of Operation Enduring Freedom (Hoge et al., 2008; Schneiderman, Braver, & Kang, 2008). While many people recovering from MTBI will experience full recovery by 12 weeks, sadly as many as 64% will experience prolonged symptoms (Meares et al., 2007), decline from preinjury function (Maio et al., 2006), psychiatric disorders, (Deb, Lyons, & Koutzoukis, 1998), and inability to return to their pre-injury employment (Ruffolo, Friedland, Dawson, Colantonio, & Lindsay, 1999). When such chronic difficulties persist after the expected 12-week recovery period, a diagnosis of postconcussion syndrome (PCS) can be made (American Psychiatric Association, 2000).

Understanding of and treatment for PCS is limited. Currently, scientists theorize that both biological and psychological factors contribute to this complex disorder (Rees, 2003; Wood, 2004). Research has suggested that physiological mechanisms associated with the injury event damage axonal and metabolic processes in the brain and may establish an environment of vulnerability for further damage (Biasca & Maxwell, 2007). Additionally, scientists have identified that pre- and postinjury stress are risk factors for poor outcome after MTBI (Bay & Bergman, 2006; Fenton, McClelland, Montgomery, MacFlynn, & Rutherford, 1993; Mooney, Speed, & Sheppard, 2005; Ponsford et al., 2000). These risk factors include preinjury psychiatric comorbidities, presence of stressful life events, and heightened perceived psychological stress after the injury event. We propose that the combination of the MTBI event (associated with the acceleration-deceleration injury and related damage of axonal structures and metabolic processes) and dysregulated early stress responses (psychological and neurobiological) may set the stage for the development of this disorder. The purpose of this article is to explicate our biobehavioral theory-early stress responses: a vulnerability framework for functional impairment following MTBI.

The community of rehabilitation science is multidisciplinary. This allows for varied approaches to clinical problems but perhaps has limited broad conceptualizations of problems that ultimately lead to standardized treatment approaches. An important first step in designing and testing interventions for complex clinical problem requires theoretically guided frameworks from which hypotheses can be tested and interventions designed. There has been a lack of a broad guiding theory that predicts those likely to have poor recovery, resulting in studies on variables of interest but not building toward a more comprehensive understanding.

We propose a broad conceptualization focused on the phenomenon of early stress responses after MTBI and its ability to predict those at risk for functional impairment. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Early Stress Response: A Vulnerability Framework for Functional Impairment Following Mild Traumatic Brain Injury
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.