Disconnection after traumatic brain injury: impairments of cognitive control and their impact on learning.

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Head injuries often lead to profound disability. Although patients may recover physically, many find it difficult to return to work or continue their social life. The reasons for this are often difficult to determine using conventional tests. A common and disabling problem is that patients have reduced awareness of their own physical and mental limitations. This lack of self-awareness makes attempts at rehabilitation difficult. How head injuries cause this problem is unknown. Awareness is thought to depend on long distance communication between distinct brain regions. This occurs through connections deep within the brain that are organized into bundles or ‘tracts‘, rather like electrical cabling in a switchboard. These connections are vulnerable in head injury, and new advances in brain imaging have provided tools to study damage in detail. I will investigate whether damage to the connections between brain regions involved in controlling actions produce impairments of self-awareness. As reduced self-awareness leads to difficulty in learning, I predict damage to this control network will be a critical factor in determining patient recovery. This work is important as it will identify a target within the brain for the development of new treatment strategies, which will form the next stage of my research.