The lesion(s) in traumatic brain injury: implications for clinical neuropsychology

We applaud Dr. Bigler’s signaling the need for attention to the future prospects of neuropsychology in a competitive environment, and his enduring enthusiasm and leadership in encouraging neuropsychologists to involve themselves in neuroradiological imaging (Bigler, 2001). However, we have several concerns about possible misinterpretation of the data and views presented in the article entitled “The lesion(s) in traumatic brain injury: implications for clinical neuropsychology.” Our first concern is the blurring of the effects of mild traumatic brain injury (MTBI) with the effects of moderate and severe brain injury. Another concern is the pervasive tendency to suggest physiological origins of observed effects such as subjective complaints and test measures. Physiological origins are presumed far beyond the explanatory power of the available scientific literature. A third concern is a broad tendency to ignore and discount psychological explanations for the observed effects, specifically including a conspicuous failure to take into account recent literature on the profound effects of effort, response bias, and compensation-related contexts. The title, abstract, and introduction to Dr. Bigler’s article refer to traumatic brain injury (TBI) in general. There is no language in the title, abstract or introduction to indicate that his focus would be limited to moderate or severe TBI, and his conclusion makes an ambiguous reference to damage caused by “at least mild-moderate to severe TBI” (p. 123). The introduction states, “This review focuses on the neuropathological substrates of TBI in relation to