51
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The persistent influence of concussion on attention, executive control and neuroelectric function in preadolescent children. Int J Psychophysiol 2016; 99:85-95. [DOI: 10.1016/j.ijpsycho.2015.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/02/2015] [Accepted: 11/18/2015] [Indexed: 11/23/2022]
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52
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Substance abuse and criminal activities following traumatic brain injury in childhood, adolescence, and early adulthood. J Head Trauma Rehabil 2015; 29:498-506. [PMID: 24263173 DOI: 10.1097/htr.0000000000000001] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Use a longitudinal birth cohort to evaluate the association of traumatic brain injury at ages 0 to 5, 6 to 15, and 16 to 21 years with drug and alcohol abuse and engagement in criminal activities. MAIN MEASURES Follow-up over 21 to 25 years using self-report of drug and alcohol use, arrests, and violent and property offenses. Outcomes were assessed for 2 levels of severity (inpatient, hospitalized; outpatient, seen by general practitioner or at emergency department). PARTICIPANTS Members of the Christchurch Health and Development Study, a longitudinal birth cohort. SETTING Christchurch, New Zealand. RESULTS Adjusted for child and family factors, compared with noninjured individuals, inpatients injured at 0 to 5 years or 16 to 21 years were more likely to have symptoms consistent with drug dependence. All inpatient groups had increased risk of arrest, with the age groups of 0 to 5 and 6 to 15 years more likely to be involved in violent offenses and the age group of 0 to 5 years more likely to engage in property offenses. Outpatient group had an increased risk of violent offenses for first injury 0 to 5 years, arrests and property offenses for injury 6 to 15 years, and increased risk of arrests and violent offenses for injury 16 to 21 years of age. However, when alcohol dependence and drug dependence were added as an additional covariate, traumatic brain injury was no longer associated with criminal behavior for the age group of 0 to 5 years. CONCLUSIONS Traumatic brain injury is associated with increased criminal behavior and may represent a risk factor for offending. However, early substance use is a mediating factor for those injured early in life.
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53
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Stamm JM, Koerte IK, Muehlmann M, Pasternak O, Bourlas AP, Baugh CM, Giwerc MY, Zhu A, Coleman MJ, Bouix S, Fritts NG, Martin BM, Chaisson C, McClean MD, Lin AP, Cantu RC, Tripodis Y, Stern RA, Shenton ME. Age at First Exposure to Football Is Associated with Altered Corpus Callosum White Matter Microstructure in Former Professional Football Players. J Neurotrauma 2015. [PMID: 26200068 DOI: 10.1089/neu.2014.3822] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Youth football players may incur hundreds of repetitive head impacts (RHI) in one season. Our recent research suggests that exposure to RHI during a critical neurodevelopmental period prior to age 12 may lead to greater later-life mood, behavioral, and cognitive impairments. Here, we examine the relationship between age of first exposure (AFE) to RHI through tackle football and later-life corpus callosum (CC) microstructure using magnetic resonance diffusion tensor imaging (DTI). Forty retired National Football League (NFL) players, ages 40-65, were matched by age and divided into two groups based on their AFE to tackle football: before age 12 or at age 12 or older. Participants underwent DTI on a 3 Tesla Siemens (TIM-Verio) magnet. The whole CC and five subregions were defined and seeded using deterministic tractography. Dependent measures were fractional anisotropy (FA), trace, axial diffusivity, and radial diffusivity. Results showed that former NFL players in the AFE <12 group had significantly lower FA in anterior three CC regions and higher radial diffusivity in the most anterior CC region than those in the AFE ≥12 group. This is the first study to find a relationship between AFE to RHI and later-life CC microstructure. These results suggest that incurring RHI during critical periods of CC development may disrupt neurodevelopmental processes, including myelination, resulting in altered CC microstructure.
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Affiliation(s)
- Julie M Stamm
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,2 Department of Anatomy and Neurobiology, Boston University School of Medicine , Boston, Massachusetts.,3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Inga K Koerte
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,4 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Marc Muehlmann
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,4 Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, Ludwig-Maximilian-University , Munich, Germany
| | - Ofer Pasternak
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,15 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Alexandra P Bourlas
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,5 Alzheimer's Disease Center, Boston University School of Medicine , Boston, Massachusetts
| | - Christine M Baugh
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,6 Interfaculty Initiative in Health Policy, Harvard University , Boston, Massachusetts
| | - Michelle Y Giwerc
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Anni Zhu
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Michael J Coleman
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Sylvain Bouix
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts
| | - Nathan G Fritts
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts
| | - Brett M Martin
- 7 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts
| | - Christine Chaisson
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,5 Alzheimer's Disease Center, Boston University School of Medicine , Boston, Massachusetts.,7 Data Coordinating Center, Boston University School of Public Health , Boston, Massachusetts.,8 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Michael D McClean
- 9 Department of Environmental Health, Boston University School of Public Health , Boston, Massachusetts
| | - Alexander P Lin
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,10 Center for Clinical Spectroscopy, Harvard Medical School , Boston, Massachusetts
| | - Robert C Cantu
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,11 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts.,12 Sports Legacy Institute , Waltham, Massachusetts.,13 Department of Neurosurgery, Emerson Hospital , Concord, Massachusetts
| | - Yorghos Tripodis
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,5 Alzheimer's Disease Center, Boston University School of Medicine , Boston, Massachusetts.,8 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Robert A Stern
- 1 CTE Center, Boston University School of Medicine , Boston, Massachusetts.,2 Department of Anatomy and Neurobiology, Boston University School of Medicine , Boston, Massachusetts.,5 Alzheimer's Disease Center, Boston University School of Medicine , Boston, Massachusetts.,11 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts.,14 Department of Neurology, Boston University School of Medicine , Boston, Massachusetts
| | - Martha E Shenton
- 3 Psychiatry Neuroimaging Laboratory, Harvard Medical School , Boston, Massachusetts.,15 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.,16 VA Boston Healthcare System , Brockton Division, Brockton, Massachusetts
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54
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Barker-Collo S, Jones K, Theadom A, Starkey N, Dowell A, McPherson K, Ameratunga S, Dudley M, Te Ao B, Feigin V. Neuropsychological outcome and its correlates in the first year after adult mild traumatic brain injury: A population-based New Zealand study. Brain Inj 2015; 29:1604-16. [DOI: 10.3109/02699052.2015.1075143] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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55
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Abstract
There is evidence to suggest that social skills, such as the ability to understand the perspective of others (theory of mind), may be affected by childhood traumatic brain injuries; however, studies to date have only considered moderate and severe traumatic brain injury (TBI). This study aimed to assess theory of mind after early, mild TBI (mTBI). Fifty-one children who sustained mTBI between 18 and 60 months were evaluated 6 months post-injury on emotion and desires reasoning and false-belief understanding tasks. Their results were compared to that of 50 typically developing children. The two groups did not differ on baseline characteristics, except for pre- and post-injury externalizing behavior. The mTBI group obtained poorer scores relative to controls on both the emotion and desires task and the false-belief understanding task, even after controlling for pre-injury externalizing behavior. No correlations were found between TBI injury characteristics and theory of mind. This is the first evidence that mTBI in preschool children is associated with theory of mind difficulties. Reduced perspective taking abilities could be linked with the social impairments that have been shown to arise following TBI.
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56
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Briggs R, Brookes N, Tate R, Lah S. Duration of post-traumatic amnesia as a predictor of functional outcome in school-age children: a systematic review. Dev Med Child Neurol 2015; 57:618-627. [PMID: 25599763 DOI: 10.1111/dmcn.12674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2014] [Indexed: 11/30/2022]
Abstract
AIM In adults, duration of post-traumatic amnesia (PTA) is a powerful early predictor of functional outcomes in traumatic brain injury. The aim of this work was to assess the predictive validity of PTA duration for outcomes in children (6-18y). METHOD PsycINFO, MEDLINE, Web of Science, and Embase were searched for papers published to January 2014. Ten studies met inclusion criteria: they used standardized instruments to assess PTA and functional outcomes, and examined relationships between the two. Outcomes were classified according to (1) the International Classification of Functioning, Disability and Health (ICF) core sets for neurological conditions for post-acute care and (2) global functioning and quality of life. Methodological quality was rated for each study. RESULTS The search identified 10 studies of moderate mean quality (M=11.8 out of 18). Longer PTA duration related to worse functional outcomes: global functioning and in the two ICF categories ('body function', 'activities and participation'). Relationships between PTA duration and quality of life and the ICF category of 'body structure' were not examined. PTA duration was, in 46 out of 60 (76.67%) instances, a stronger predictor of outcomes than other indices of injury severity. CONCLUSION Longer PTA duration is a valid predictor of worse outcomes in school-age children. Thus, PTA should be routinely assessed in children after traumatic brain injury.
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Affiliation(s)
- Rachel Briggs
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Naomi Brookes
- Brain Injury Rehabilitation Program, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robyn Tate
- Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
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57
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Alexander DG, Shuttleworth-Edwards AB, Kidd M, Malcolm CM. Mild traumatic brain injuries in early adolescent rugby players: Long-term neurocognitive and academic outcomes. Brain Inj 2015; 29:1113-25. [DOI: 10.3109/02699052.2015.1031699] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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58
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Moore RD, Pindus DM, Drolette ES, Scudder MR, Raine LB, Hillman CH. The persistent influence of pediatric concussion on attention and cognitive control during flanker performance. Biol Psychol 2015; 109:93-102. [PMID: 25951782 DOI: 10.1016/j.biopsycho.2015.04.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/04/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
Abstract
This study investigated the influence of concussion history on children's neurocognitive processing. Thirty-two children ages 8-10 years (16 with a concussion history, 16 controls) completed compatible and incompatible conditions of a flanker task while behavioral and neuroelectric data were collected. Relative to controls, children with a concussion history exhibited alterations in the sequential congruency effect, committed more omission errors, and exhibited decreased post-error accuracy. Children with a concussion history exhibited longer N2 latency across task conditions, increased N2 amplitude during the incompatible condition of the task, and decreased P3b amplitude across task conditions. Children with a history of concussion also exhibited decreased ERN and Pe amplitudes, with group difference increasing for the incompatible condition of the task. The current results indicate that pediatric concussion may lead to subtle, but pervasive deficits in attention and cognitive control. These results serve to inform a poorly understood but significant public health concern.
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Affiliation(s)
- Robert D Moore
- Department of Kinesiology, University of Illinois at Urbana-Champaign, Urbana IL, USA; Department of Kinesiology, University of Montreal, Montreal QC, Canada.
| | - Dominika M Pindus
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough Leicestershire, UK
| | - Eric S Drolette
- Department of Kinesiology, University of Illinois at Urbana-Champaign, Urbana IL, USA
| | - Mark R Scudder
- Department of Kinesiology, University of Illinois at Urbana-Champaign, Urbana IL, USA
| | - Lauren B Raine
- Department of Kinesiology, University of Illinois at Urbana-Champaign, Urbana IL, USA
| | - Charles H Hillman
- Department of Kinesiology, University of Illinois at Urbana-Champaign, Urbana IL, USA
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59
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Fakharian E, Omidi A, Shafiei E, Nademi A. Mental health status of patients with mild traumatic brain injury admitted to shahid beheshti hospital of kashan, iran. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e17629. [PMID: 25866741 PMCID: PMC4388991 DOI: 10.5812/atr.17629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 11/14/2014] [Accepted: 02/14/2015] [Indexed: 11/25/2022]
Abstract
Background: Planning for providing mental health services to the mentally patients due to brain injury need awareness of mental health status of the patient. Objectives: This study aimed to assess the mental health of patients with mild TBI. Patients and Methods: The descriptive cross-sectional study was performed on 286 patients with mild TBI who were admitted to department of neurosurgery of Shahid Beheshti Hospital, Kashan, Iran, during the first eight months of 2013. Enrolled patients were 15 to 70 years old who able to respond to questionnaires. The Brief Symptom Inventory (BSI) questionnaire is used to assess the mental health status of the patients. The data were presented using logistic regression and descriptive statistics. Results: A total of 286 patients, 79.7% males and 20.3% females with male to female ratio of 4:1, completed the study. Female had significantly higher Global Severity Index (GSI) compared to males. There was a significant association between, psychologic disorders’ symptoms and age (P = 0.00). The mean (SD) of GSI on the Symptom Checklist-90 (SCL-90) was 1.39 (0.58). Conclusions: This study showed that 36% of the patients with mild TBI symptoms had mental health problems. Given the high rates of psychologic disorders among patients with mild TBI, it is necessary to reduce the factors that caused the disorder.
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Affiliation(s)
- Esmaeil Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Abdollah Omidi
- Department of Clinical Psychology, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Elham Shafiei
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Elham Shafiei, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3655620634, Fax: +98-3655620634, E-mail:
| | - Arash Nademi
- Department of Statistics, Ilam Branch, Islamic Azad University, Ilam, IR Iran
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60
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Sinopoli KJ, Chen JK, Wells G, Fait P, Ptito A, Taha T, Keightley M. Imaging “Brain Strain” in Youth Athletes with Mild Traumatic Brain Injury during Dual-Task Performance. J Neurotrauma 2014; 31:1843-59. [DOI: 10.1089/neu.2014.3326] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katia J. Sinopoli
- Department of Psychology, Division of Neurology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jen-Kai Chen
- McGill University Health Centre and Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Greg Wells
- Department of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
- Department of Physiology and Experimental Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Philippe Fait
- Department of Physical Activity Science, University of Quebec at Trois-Rivières, Canada
- Research Group on Neuromusculoskeletal Dysfunctions, University of Quebec at Trois-Rivières, Canada
| | - Alain Ptito
- McGill University Health Centre and Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Tim Taha
- Department of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | - Michelle Keightley
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy and Graduate Department of Rehabilitation Science and Psychology, University of Toronto, Ontario, Canada
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61
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Predicting Adult Offending Behavior for Individuals Who Experienced a Traumatic Brain Injury During Childhood. J Head Trauma Rehabil 2014; 29:507-13. [DOI: 10.1097/htr.0000000000000000] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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62
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Bate S, Bennetts RJ. The rehabilitation of face recognition impairments: a critical review and future directions. Front Hum Neurosci 2014; 8:491. [PMID: 25100965 PMCID: PMC4107857 DOI: 10.3389/fnhum.2014.00491] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/17/2014] [Indexed: 12/31/2022] Open
Abstract
While much research has investigated the neural and cognitive characteristics of face recognition impairments (prosopagnosia), much less work has examined their rehabilitation. In this paper, we present a critical analysis of the studies that have attempted to improve face-processing skills in acquired and developmental prosopagnosia, and place them in the context of the wider neurorehabilitation literature. First, we examine whether neuroplasticity within the typical face-processing system varies across the lifespan, in order to examine whether timing of intervention may be crucial. Second, we examine reports of interventions in acquired prosopagnosia, where training in compensatory strategies has had some success. Third, we examine reports of interventions in developmental prosopagnosia, where compensatory training in children and remedial training in adults have both been successful. However, the gains are somewhat limited-compensatory strategies have resulted in labored recognition techniques and limited generalization to untrained faces, and remedial techniques require longer periods of training and result in limited maintenance of gains. Critically, intervention suitability and outcome in both forms of the condition likely depends on a complex interaction of factors, including prosopagnosia severity, the precise functional locus of the impairment, and individual differences such as age. Finally, we discuss future directions in the rehabilitation of prosopagnosia, and the possibility of boosting the effects of cognitive training programmes by simultaneous administration of oxytocin or non-invasive brain stimulation. We conclude that future work using more systematic methods and larger participant groups is clearly required, and in the case of developmental prosopagnosia, there is an urgent need to develop early detection and remediation tools for children, in order to optimize intervention outcome.
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Affiliation(s)
- Sarah Bate
- Department of Psychology, Faculty of Science and Technology, Bournemouth UniversityPoole, UK
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63
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Abstract
CONTEXT The long-term implications of concussive injuries for brain and cognitive health represent a growing concern in the public consciousness. As such, identifying measures sensitive to the subtle yet persistent effects of concussive injuries is warranted. OBJECTIVE To investigate how concussion sustained early in life influences visual processing in young adults. We predicted that young adults with a history of concussion would show decreased sensory processing, as noted by a reduction in P1 event-related potential component amplitude. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-six adults (18 with a history of concussion, 18 controls) between the ages of 20 and 28 years completed a pattern-reversal visual evoked potential task while event-related potentials were recorded. MAIN OUTCOME MEASURE(S) The groups did not differ in any demographic variables (all P values > .05), yet those with a concussive history exhibited reduced P1 amplitude compared with the control participants (P = .05). CONCLUSIONS These results suggest that concussion history has a negative effect on visual processing in young adults. Further, upper-level neurocognitive deficits associated with concussion may, in part, result from less efficient downstream sensory capture.
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Affiliation(s)
- Robert D. Moore
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign
| | | | - Charles H. Hillman
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign
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64
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Moore RD, Hillman CH, Broglio SP. The persistent influence of concussive injuries on cognitive control and neuroelectric function. J Athl Train 2013; 49:24-35. [PMID: 24377962 DOI: 10.4085/1062-6050-49.1.01] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Increasing attention is being paid to the deleterious effects of sport-related concussion on cognitive and brain health. OBJECTIVE To evaluate the influence of concussion incurred during early life on the cognitive control and neuroelectric function of young adults. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Forty young adults were separated into groups according to concussive history (0 or 1+). Participants incurred all injuries during sport and recreation before the age of 18 years and were an average of 7.1 ± 4.0 years from injury at the time of the study. INTERVENTION(S) All participants completed a 3-stimulus oddball task, a numeric switch task, and a modified flanker task during which event-related potentials and behavioral measures were collected. MAIN OUTCOME MEASURE(S) Reaction time, response accuracy, and electroencephalographic activity. RESULTS Compared with control participants, the concussion group exhibited decreased P3 amplitude during target detection within the oddball task and during the heterogeneous condition of the switch task. The concussion group also displayed increased N2 amplitude during the heterogeneous version of the switch task. Concussion history was associated with response accuracy during the flanker task. CONCLUSIONS People with a history of concussion may demonstrate persistent decrements in neurocognitive function, as evidenced by decreased response accuracy, deficits in the allocation of attentional resources, and increased stimulus-response conflict during tasks requiring variable amounts of cognitive control. Neuroelectric measures of cognitive control may be uniquely sensitive to the persistent and selective decrements of concussion.
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Affiliation(s)
- Robert D Moore
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign
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65
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Redell JB, Moore AN, Grill RJ, Johnson D, Zhao J, Liu Y, Dash PK. Analysis of functional pathways altered after mild traumatic brain injury. J Neurotrauma 2013; 30:752-64. [PMID: 22913729 DOI: 10.1089/neu.2012.2437] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Concussive injury (or mild traumatic brain injury; mTBI) can exhibit features of focal or diffuse injury patterns. We compared and contrasted the cellular and molecular responses after mild controlled cortical impact (mCCI; a focal injury) or fluid percussion injury (FPI; a diffuse injury) in rats. The rationale for this comparative analysis was to investigate the brain's response to mild diffuse versus mild focal injury to identify common molecular changes triggered by these injury modalities and to determine the functional pathways altered after injury that may provide novel targets for therapeutic intervention. Microarrays containing probes against 21,792 unique messenger RNAs (mRNAs) were used to investigate the changes in cortical mRNA expression levels at 3 and 24 h postinjury. Of the 354 mRNAs with significantly altered expression levels after mCCI, over 89% (316 mRNAs) were also contained within the mild FPI (mFPI) data set. However, mFPI initiated a more widespread molecular response, with over 2300 mRNAs differentially expressed. Bioinformatic analysis of annotated gene ontology molecular function and biological pathway terms showed a significant overrepresentation of genes belonging to inflammation, stress, and signaling categories in both data sets. We therefore examined changes in the protein levels of a panel of 23 cytokines and chemokines in cortical extracts using a Luminex-based bead immunoassay and detected significant increases in macrophage inflammatory protein (MIP)-1α (CCL3), GRO-KC (CXCL1), interleukin (IL)-1α, IL-1β, and IL-6. Immunohistochemical localization of MIP-1α and IL-1β showed marked increases at 3 h postinjury in the cortical vasculature and microglia, respectively, that were largely resolved by 24 h postinjury. Our findings demonstrate that both focal and diffuse mTBI trigger many shared pathobiological processes (e.g., inflammatory responses) that could be targeted for mechanism-based therapeutic interventions.
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Affiliation(s)
- John B Redell
- Department of Neurobiology and Anatomy, The University of Texas Health Science Center at Houston, Houston, Texas 77225, USA
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66
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Abstract
Pediatric mild traumatic brain injury (pmTBI) is the most prevalent neurological insult in children and is associated with both acute and chronic neurobehavioral sequelae. However, little is known about underlying pathophysiology and how injuries change as a function of recovery. Fractional anisotropy, axial diffusivity, and radial diffusivity were examined in 15 semi-acute pmTBI patients and 15 well-matched controls, with a subset of participants returning for a second visit. A novel analytic strategy was applied to capture spatially heterogeneous white matter injuries (lesions) in addition to standard analyses. Evidence of cognitive dysfunction after pmTBI was observed in the domains of attention (p = 0.02, d = -0.92) and processing speed (p = 0.05, d = -0.73) semi-acutely. Region of interest (ROI) and voxelwise analyses indicated increased anisotropic diffusion for pmTBI patients, with an elevated number of clusters with high anisotropy. Metrics of increased anisotropy were able to objectively classify pmTBI from healthy controls at 90% accuracy but were not associated with neuropsychological deficits. Little evidence of recovery in white matter abnormalities was observed over a 4-month interval in returning patients, indicating that physiological recovery may lag behind subjective reports of normality. Increased anisotropic diffusion has been previously linked with cytotoxic edema after TBI, and the magnitude and duration of these abnormalities appear to be greater in pediatric patients. Current findings suggest that developing white matter may be more susceptible to initial mechanical injury forces and that anisotropic diffusion provides an objective biomarker of pmTBI.
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67
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Yang Z, Yeo RA, Pena A, Ling JM, Klimaj S, Campbell R, Doezema D, Mayer AR. An FMRI study of auditory orienting and inhibition of return in pediatric mild traumatic brain injury. J Neurotrauma 2012; 29:2124-36. [PMID: 22533632 PMCID: PMC3419846 DOI: 10.1089/neu.2012.2395] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Studies in adult mild traumatic brain injury (mTBI) have shown that two key measures of attention, spatial reorienting and inhibition of return (IOR), are impaired during the first few weeks of injury. However, it is currently unknown whether similar deficits exist following pediatric mTBI. The current study used functional magnetic resonance imaging (fMRI) to investigate the effects of semi-acute mTBI (<3 weeks post-injury) on auditory orienting in 14 pediatric mTBI patients (age 13.50±1.83 years; education: 6.86±1.88 years), and 14 healthy controls (age 13.29±2.09 years; education: 7.21±2.08 years), matched for age and years of education. The results indicated that patients with mTBI showed subtle (i.e., moderate effect sizes) but non-significant deficits on formal neuropsychological testing and during IOR. In contrast, functional imaging results indicated that patients with mTBI demonstrated significantly decreased activation within the bilateral posterior cingulate gyrus, thalamus, basal ganglia, midbrain nuclei, and cerebellum. The spatial topography of hypoactivation was very similar to our previous study in adults, suggesting that subcortical structures may be particularly affected by the initial biomechanical forces in mTBI. Current results also suggest that fMRI may be a more sensitive tool for identifying semi-acute effects of mTBI than the procedures currently used in clinical practice, such as neuropsychological testing and structural scans. fMRI findings could potentially serve as a biomarker for measuring the subtle injury caused by mTBI, and documenting the course of recovery.
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Affiliation(s)
- Zhen Yang
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Ronald A. Yeo
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Amanda Pena
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Josef M. Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Stefan Klimaj
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
| | - Richard Campbell
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - David Doezema
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
- Neurology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico
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68
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Morissette SB, Woodward M, Kimbrel NA, Meyer EC, Kruse MI, Dolan S, Gulliver SB. Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans. Rehabil Psychol 2012; 56:340-50. [PMID: 22121940 DOI: 10.1037/a0025462] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A substantial proportion of the more than 2 million service members who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have experienced a traumatic brain injury (TBI). Understanding the long-term impact of TBI is complicated by the nonspecific nature of postconcussive symptoms (PCSs) and the high rates of co-occurrence among TBI, posttraumatic stress disorder (PTSD), and depression. The goal of the present research was to examine the relations among TBI, persistent PCSs, and symptoms of PTSD and depression among returning OEF/OIF veterans. METHOD 213 OEF/OIF veterans (87% male) completed a semistructured screening interview assessing deployment-related TBI and current, persistent PCSs. Participants also completed self-report measures of combat exposure and current symptoms of PTSD and depression. RESULTS Nearly half (46%) of sampled veterans screened positive for TBI, the majority of whom (85%) reported at least one persistent PCS after removing PCSs that overlapped with PTSD and depression. Veterans with deployment-related TBI reported higher levels of combat exposure and symptoms of PTSD and depression. Structural equation modeling was used to assess the fit of 3 models of the relationships among TBI, combat exposure, persistent PCSs, PTSD, and depression. Consistent with hypotheses, the best-fitting model was one in which the effects of TBI on both PTSD and depression were fully mediated by nonoverlapping persistent PCSs. CONCLUSIONS These findings highlight the importance of addressing persistent PCSs in order to facilitate the functional recovery of returning war veterans.
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Affiliation(s)
- Sandra B Morissette
- Department of Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA.
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69
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Rockhill CM, Jaffe K, Zhou C, Fan MY, Katon W, Fann JR. Health Care Costs Associated with Traumatic Brain Injury and Psychiatric Illness in Adults. J Neurotrauma 2012; 29:1038-46. [DOI: 10.1089/neu.2010.1562] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carol Mary Rockhill
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Kenneth Jaffe
- Department of Rehabilitation Medicine, Children's Hospital & Medical Center, Seattle, Washington
| | - Chuan Zhou
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Ming-Yu Fan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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70
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Lewis FM, Murdoch BE. Language function in a child following mild traumatic brain injury: Evidence from pre- and post-injury language testing. Dev Neurorehabil 2012; 14:348-54. [PMID: 22136119 DOI: 10.3109/17518423.2011.620576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pre- and post-injury language performance scores following mild traumatic brain injury (mTBI) were investigated through a replication and subsequent extension of a previous case study where a trend for declining language scores was described based on pre- and post-injury data. METHODS Test norms were used to descriptively analyze pre- and post-morbid language performance and performance score changes. Score changes were subsequently statistically analyzed using data obtained from a group of age-matched non-brain-injured control children. RESULTS Descriptive analysis identified a trend for declining skill on general and high-level language skills. Statistical analysis failed to differentiate the mTBI case from the control group on language score changes. CONCLUSIONS While supporting the earlier identified trends in language decline following mTBI, subsequent statistical analysis undertaken to extend the earlier findings failed to detect statistically significant changes in language outcomes following mild injury. The need for monitoring of yet-to-emerge higher-level adolescent language skills, however, is highlighted.
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Affiliation(s)
- Fiona M Lewis
- Centre for Neurogenic Communication Disorders Research, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
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71
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Anderson V, Godfrey C, Rosenfeld JV, Catroppa C. 10 years outcome from childhood traumatic brain injury. Int J Dev Neurosci 2011; 30:217-24. [PMID: 22100364 DOI: 10.1016/j.ijdevneu.2011.09.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 08/28/2011] [Accepted: 09/23/2011] [Indexed: 11/17/2022] Open
Abstract
Childhood traumatic brain injury (TBI) is a common, acquired disability, which has significant implications for subsequent development, and for later quality of life. To date few studies have documented outcomes in these children into adolescence, when academic, social and personal demands increase. The objective of this study was to document functional outcomes at 10 years post-injury, and to identify predictors of outcome including injury, socio-demographic and pre-injury characteristics. The study employed consecutive recruitment to a prospective, longitudinal study. Children with a diagnosis of TBI between 2 and 12 years were initially recruited and divided according to injury severity (mild, moderate, severe). The sample was reviewed at 10 years post-injury and intellectual, adaptive, executive and social domains were investigated. Results indicated that, at 10 years post child TBI, survivors' functional abilities fell overall within the low average to average range regardless of injury severity, suggesting no extreme impairments at a group level for any of the domains under investigation. Significant group differences were identified, though, for adaptive abilities and for speed of processing, with more severe injury associated with poorer performances in each instance. Further, a similar trend was identified for measures of intellectual ability and executive functions. Individual rates of impairment were considerably higher than population expectations across all severity groups for these domains. Although rates of social impairment were also elevated, they were less related to injury factors, suggesting that cognitive/adaptive outcomes and social consequences of TBI may have different bases.
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72
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Rivara FP, Koepsell TD, Wang J, Temkin N, Dorsch A, Vavilala MS, Durbin D, Jaffe KM. Disability 3, 12, and 24 months after traumatic brain injury among children and adolescents. Pediatrics 2011; 128:e1129-38. [PMID: 22025592 PMCID: PMC9923878 DOI: 10.1542/peds.2011-0840] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine disability in children and adolescents after traumatic brain injury (TBI) across the spectrum of injury severity. METHODS This was a prospective cohort study of children younger than 18 years treated for a TBI (n = 729) or an arm injury (n = 197) between March 1, 2007, and September 30, 2008. The main outcome measures were disability in health-related quality of life, adaptive skills, and participation in social and community activities 3, 12, and 24 months after injury compared with preinjury functioning. RESULTS The health-related quality of life for children with moderate or severe TBI was lower at all follow-up times compared with baseline, but there was some improvement during the first 2 years after injury. Three months after injury, there was a substantial decrease in the level of activities in which children with moderate and severe TBI were able to participate; these activities improved at 12 and 24 months but were still significantly impaired. Communication and self-care abilities in children with moderate and severe TBI were lower at 3 months than at baseline and did not improve by 24 months. Children who met the definition of mild TBI but had an intracranial hemorrhage had lower quality-of-life scores at 3 months. CONCLUSIONS Children with moderate or severe TBI and children with mild TBI who had intracranial hemorrhage had substantial long-term reduction in their quality of life, participation in activities with others, and ability to communicate and care for themselves.
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Affiliation(s)
- Frederick P. Rivara
- Departments of Pediatrics, ,Epidemiology, ,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and ,Address correspondence to Frederick P. Rivara, MD, MPH, Harborview Injury Prevention and Research Center, Box 359960, 325 Ninth Ave, Seattle, WA 98104. E-mail:
| | - Thomas D. Koepsell
- Epidemiology, ,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
| | - Jin Wang
- Departments of Pediatrics, ,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
| | | | | | - Monica S. Vavilala
- Departments of Pediatrics, ,Anesthesiology and ,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
| | - Dennis Durbin
- Department of Emergency Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth M. Jaffe
- Neurological Surgery, ,Rehabilitation Medicine, and ,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington; and
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73
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Larson MJ, Farrer TJ, Clayson PE. Cognitive control in mild traumatic brain injury: Conflict monitoring and conflict adaptation. Int J Psychophysiol 2011; 82:69-78. [DOI: 10.1016/j.ijpsycho.2011.02.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 02/24/2011] [Accepted: 02/28/2011] [Indexed: 11/26/2022]
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74
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Daneshvar DH, Riley DO, Nowinski CJ, McKee AC, Stern RA, Cantu RC. Long-term consequences: effects on normal development profile after concussion. Phys Med Rehabil Clin N Am 2011; 22:683-700, ix. [PMID: 22050943 DOI: 10.1016/j.pmr.2011.08.009] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Each year in the United States, approximately 1.7 million people are diagnosed with a traumatic brain injury (TBI), about 75% of which are classified as mild TBIs or concussions. Although symptoms typically resolve in a matter of weeks, both children and adults may suffer from postconcussion syndrome for months or longer. A progressive tauopathy, chronic traumatic encephalopathy, is believed to stem from repeated brain trauma. Alzheimer-like dementia, Parkinsonism, and motor neuron disease are also associated with repetitive brain trauma. Effective diagnoses, treatments, and education plans are required to reduce the future burden and incidence of long-term effects of head injuries.
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Affiliation(s)
- Daniel H Daneshvar
- Department of Neurology, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston 02118, MA, USA.
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75
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Abstract
PURPOSE OF REVIEW Severe childhood traumatic brain injury (TBI) is the leading cause of death and acquired disability in children, causing impairments in children's sensory-motor, cognitive and behavioural functioning, with devastating consequences on community integration. Community integration is the ultimate goal of rehabilitation; it is a complex outcome, with many variables contributing to it. RECENT FINDINGS Community integration and quality of life (QOL) are lower in children who sustained severe TBI at a younger age. Further, a wide range of injury-related, demographic and postinjury factors influence outcomes, and should serve as targets for specific interventions. An increasing number of interventions targeting cognitive, behavioural or family-related issues have been developed, with promising results. SUMMARY Children should benefit from early integrated patient and family-centred specific care, and receive long-term follow-up until early adulthood, with regular assessments, enabling detection and treatment of any emerging problem, and to ensure the acquisition of independent living skills and stable vocational outcome when this is possible. So far, few well conducted intervention studies are available, but their number is increasing with positive results on the trained skills. Well designed studies using large samples and looking at generalization of the skills in everyday life are needed.
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76
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Anderson V, Spencer-Smith M, Wood A. Do children really recover better? Neurobehavioural plasticity after early brain insult. Brain 2011; 134:2197-221. [PMID: 21784775 DOI: 10.1093/brain/awr103] [Citation(s) in RCA: 343] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Vicki Anderson
- Department of Psychology, Royal Children's Hospital, Parkville, Victoria 3052, Australia.
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77
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Thaler NS, Barney SJ, Reynolds CR, Mayfield J, Allen DN. Differential Sensitivity of TOMAL Subtests and Index Scores to Pediatric Traumatic Brain Injury. ACTA ACUST UNITED AC 2011; 18:168-78. [DOI: 10.1080/09084282.2011.595443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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78
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Ho J, Epps A, Parry L, Poole M, Lah S. Rehabilitation of everyday memory deficits in paediatric brain injury: Self-instruction and diary training. Neuropsychol Rehabil 2011; 21:183-207. [DOI: 10.1080/09602011.2010.547345] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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79
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Scherwath A, Sommerfeldt DW, Bindt C, Nolte A, Boiger A, Koch U, Petersen-Ewert C. Identifying children and adolescents with cognitive dysfunction following mild traumatic brain injury—Preliminary findings on abbreviated neuropsychological testing. Brain Inj 2011; 25:401-8. [DOI: 10.3109/02699052.2011.557351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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80
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Helmes E, Østbye T, Steenhuis RE. Incremental contribution of reported previous head injury to the prediction of diagnosis and cognitive functioning in older adults. Brain Inj 2011; 25:338-47. [PMID: 21314278 DOI: 10.3109/02699052.2011.556104] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Severe brain injuries may be a risk factor for the development of dementia in later life. Less severe incidents with relatively short or even no loss of consciousness may not carry the same prognosis. OBJECTIVES This study used data from the first two waves of the Canadian Study of Health and Ageing (CSHA-1 and CSHA-2) to investigate two questions. (1) Does a history of head injury improve the prediction of the diagnosis of dementia? This analysis was based on the 921 elderly individuals who underwent a clinical assessment in CSHA-2 and, 5 years earlier, had reported whether or not they had had a head injury. (2) Does adding information about a history of head injury improve the prediction of neuropsychological test scores? This second analysis included 585 elderly people who underwent neuropsychological assessment in both waves and who also reported whether or not they had had a history of mild or moderate-to-severe head injury. RESULTS RESULTS showed that the inclusion of head injury information did not improve the prediction of diagnostic outcome of dementia. Age and overall cognitive status were associated with most neuropsychological test scores, more so than the more limited influence of chronic health problems, which was associated with about half of the neuropsychological measures.
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Affiliation(s)
- Edward Helmes
- Department of Psychology, James Cook University, Townsville, Qld 4811, Australia.
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81
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Brown AW, Moessner AM, Mandrekar J, Diehl NN, Leibson CL, Malec JF. A survey of very-long-term outcomes after traumatic brain injury among members of a population-based incident cohort. J Neurotrauma 2011; 28:167-76. [PMID: 21121813 DOI: 10.1089/neu.2010.1400] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To assess quality of life and barriers to participation in vocational and community life for persons with traumatic brain injury (TBI) over the very-long term, a population-based cohort was identified in Olmsted County, Minnesota; 1623 individuals were identified as having experienced a confirmed TBI while a resident of Olmsted County, Minnesota, during the period from 1935-2000. A survey was sent to eligible individuals that included elements of standardized instruments addressing health status and disability, and questions that assessed issues important to successful social reintegration after TBI. Of 1623 eligible participants sent surveys, 605 responded (37% response rate). Thirty-nine percent of respondents were female and 79% had mild injuries. Mean age at injury was 30.8 years, and mean years since injury was 28.8. Overall, respondents reported living in the community; the majority were married and had achieved education beyond high school. Problems with memory, thinking, and physical and emotional health were most often reported. Respondents reported low levels of depression and anxiety, and high levels of satisfaction with life. Seventy-three percent of respondents reported no problems that they attributed to their TBI. Increasing injury severity was associated with a significant risk of reporting injury-related problems at survey completion. Respondents with a longer time since injury were less likely to report any TBI-related problems. These results indicate that self-reported outcomes and adaptation to impairment-related limitations improve as the time since injury increases. These findings highlight the importance of providing coordinated medical rehabilitation and community-based support services to promote positive outcomes over the life span after TBI.
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Affiliation(s)
- Allen W Brown
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota 55905, USA.
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82
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Rockhill CM, Fann JR, Fan MY, Hollingworth W, Katon WJ. Healthcare costs associated with mild traumatic brain injury and psychological distress in children and adolescents. Brain Inj 2010; 24:1051-60. [PMID: 20597633 DOI: 10.3109/02699052.2010.494586] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE Comparison of healthcare costs for youth with mild traumatic brain injuries (TBIs) to costs in a matched cohort of children without TBI in the 3 years following injury. RESEARCH DESIGN This study used a prospective cohort design with 3-year follow-up. Costs were examined using the well-established two-step model and controlling for potential confounding variables. METHODS AND PROCEDURES Four-hundred and ninety subjects from a large health maintenance organization, 14 years old or younger, who sustained a mild TBI in 1993, were identified using computerized records. For each youth with mild TBI, three control subjects were selected (n = 1470), matched on age, sex and enrolment at the time of injury. EXPERIMENTAL INTERVENTIONS Not applicable. MAIN OUTCOMES AND RESULTS TBI exposure was associated with an increase in the proportion of subjects who had non-zero medical costs in all categories examined and a 75% increase in mean total costs. Presence of psychological distress was also associated with increased proportion of subjects with costs in all categories examined and was associated with an approximate doubling of mean total costs. CONCLUSIONS Mild TBI and psychological distress were each associated with significant increases in healthcare costs in an HMO setting.
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Affiliation(s)
- Carol M Rockhill
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA.
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83
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Anderson V, Brown S, Newitt H. What contributes to quality of life in adult survivors of childhood traumatic brain injury? J Neurotrauma 2010; 27:863-70. [PMID: 20144003 DOI: 10.1089/neu.2009.1169] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adult outcome from childhood brain injury is largely unknown, and health professionals have minimal evidence available to inform families about their child's long-term prognosis. This study aimed to investigate long-term outcomes in this group, focusing on quality of life (QOL) and the injury, developmental, and environmental factors that influence this domain, using a retrospective and cross-sectional design. The sample was ascertained via medical record audit at the Royal Children's Hospital, Melbourne, Australia, and included 130 adult survivors of child traumatic brain injury (TBI) (84 men). Participants were 18-42 years at evaluation (mean = 23.2, SD = 3.3) and completed questionnaires regarding QOL and educational, employment, and psychological status. Analysis of variance, chi-square, and regression were employed to assess group differences and predictors of outcome. While most adult survivors of childhood TBI rated their QOL as intact, 17% of the sample reported poor QOL. Poor QOL was more likely with low levels of perceived independence, severe TBI, younger age at injury, failure to complete high school, and psychological problems. In conclusion, QOL in adult survivors of childhood TBI is better than expected and closely associated with both injury and noninjury factors, most consistently with the individual's perception of their level of independence.
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Affiliation(s)
- Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Australia.
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84
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Abstract
Explicit and implicit attitudes toward people who have sustained traumatic brain injury (TBI) were investigated to determine if negative attitudes exist and if the terminology used (brain vs. head injury) exacerbated predicted negativity. Participants (n = 103) rated Tony (brain/head injury) and Peter (limb-injury) on 10 characteristics using a 7-point scale. Familiarity with brain injury was also measured. Implicit Association Tests (IAT) assessed potential negative bias. Tony (M = 36.84) was judged more negatively than Peter (M = 31.69). The term "brain" versus "head" injury resulted in more negative evaluations (Ms = 38.72 vs. 34.78). Participants familiar with TBI were more positive toward Tony than those unfamiliar (Ms = 34.98 vs. 39.80). Only those unfamiliar with TBI demonstrated implicit negative bias. Negative attitudes toward TBI are expressed explicitly with individuals openly endorsing less desirable characteristics. When people have more knowledge about or experience with brain injury, they are less likely to endorse negative stereotypes.
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85
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Hartle KD, Jeffers MS, Ivanco TL. Changes in dendritic morphology and spine density in motor cortex of the adult rat after stroke during infancy. Synapse 2010; 64:602-10. [DOI: 10.1002/syn.20767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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86
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McKinlay A, Grace RC, Horwood LJ, Fergusson DM, MacFarlane MR. Long-term behavioural outcomes of pre-school mild traumatic brain injury. Child Care Health Dev 2010; 36:22-30. [PMID: 19250251 DOI: 10.1111/j.1365-2214.2009.00947.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract Background Mild traumatic brain injury (MTBI) is a leading cause of injury for children during their pre-school years. However, there is little information regarding the long-term outcomes of these injuries. Method We used fully prospective data from an epidemiological study of a birth cohort to examine behavioural effects associated with MTBI during the pre-school years. Cases of confirmed MTBI were divided into two groups, those that had received outpatient medical attention, and those that had been admitted to hospital for a brief period of observation (inpatient cases). The remainder of the cohort served as a reference control group. Results Mother/teacher ratings for behaviours associated with attention deficit/hyperactivity disorder and oppositional defiant/conduct disorder, obtained yearly from age 7 to 13, revealed evidence of deficits after inpatient MTBI (n = 21), relative to more minor outpatient injury MTBI (n = 55) and the reference control group (n = 852). For the inpatient group there was evidence of increasing deficits over years 7-13. Conclusions More severe pre-school MTBI may be associated with persistent negative effects in terms of psychosocial development. The vulnerability of pre-school children to MTBI signals a pressing need to identify high-risk cases that may benefit from monitoring and early intervention.
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Affiliation(s)
- A McKinlay
- Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
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87
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McKinlay A. Controversies and outcomes associated with mild traumatic brain injury in childhood and adolescences. Child Care Health Dev 2010; 36:3-21. [PMID: 19719771 DOI: 10.1111/j.1365-2214.2009.01006.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A McKinlay
- Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
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88
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Wilson BA. Brain injury: recovery and rehabilitation. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2009; 1:108-118. [DOI: 10.1002/wcs.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Barbara A. Wilson
- MRC Cognition and Brain Sciences Unit, 15 Chaucer Rd, Cambridge, CB2 7EF, England, United Kingdom
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89
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Anderson V, Jacobs R, Spencer-Smith M, Coleman L, Anderson P, Williams J, Greenham M, Leventer R. Does Early Age at Brain Insult Predict Worse Outcome? Neuropsychological Implications. J Pediatr Psychol 2009; 35:716-27. [DOI: 10.1093/jpepsy/jsp100] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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90
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Jacobsson LJ, Westerberg M, Söderberg S, Lexell J. Functioning and disability 6-15 years after traumatic brain injuries in northern Sweden. Acta Neurol Scand 2009; 120:389-95. [PMID: 19922583 DOI: 10.1111/j.1600-0404.2009.01238.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess long-term functioning and disability after traumatic brain injury (TBI). MATERIAL AND METHODS Individuals (n = 88) in Norrbotten, northern Sweden, who had been transferred for neurosurgical care were assessed with internationally established TBI outcome measures 6-15 years post-injury. RESULTS There was an improvement in overall outcome from discharge from inpatient rehabilitation to follow-up. Many individuals had a high degree of motor and cognitive functioning, which enabled them to live independently in their own home without assistance, but there remained a disability related to community reintegration and social participation. This affected their productivity and to some degree their marital stability. The remaining disability and reduced productivity were related to the age at injury and the injury severity. CONCLUSIONS Our data showed that individuals with a TBI can achieve and maintain a high degree of functioning many years after the injury. Increasing age and a greater injury severity contributed to their long-term disability.
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Affiliation(s)
- L J Jacobsson
- Medical Rehabilitation Section, Department of General Medicine, Kalix Hospital, Kalix, Sweden.
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91
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Anderson V, Catroppa C, Morse S, Haritou F, Rosenfeld JV. Intellectual outcome from preschool traumatic brain injury: a 5-year prospective, longitudinal study. Pediatrics 2009; 124:e1064-71. [PMID: 19948612 DOI: 10.1542/peds.2009-0365] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a common, acquired disability that may be used as a model to understand the impact of early brain injury on brain structure and function. To date, few studies have followed very young children over time after insult. OBJECTIVE To plot recovery and outcome of intellectual ability after early TBI over the 5 years after injury, and to identify predictors of outcome including injury, sociodemographic and preinjury characteristics, and acute functional recovery. DESIGN Children aged between 2 and 7 years who were diagnosed with TBI (N = 54) were consecutively recruited on admission to the Royal Children's Hospital, Victoria, Australia, to participate in a prospective, longitudinal study. Our study had a between-factor design that used injury severity as the independent variable. The participants were categorized into groups according to injury severity (mild, moderate, or severe), and were compared with healthy control participants (n = 16) at the acute time point, and at 12 months, 30 months, and 5 years after injury. Intellectual measures, including verbal and nonverbal skills, attention, and processing speed, were administered. RESULTS Children with severe injuries demonstrated slower recovery and poorer cognitive outcomes up to 5 years after injury than did those who were observed for less severe injuries. Recovery trajectories were associated with injury severity over the first 30 months after injury, with the greatest deterioration in function observed for more severe injuries. From 30 months to 5 years after injury, progress was stable. Only injury severity (as determined by the Glasgow Coma Scale score) and acute cognitive performance were strong predictors of 5-year outcomes. CONCLUSIONS This study has confirmed the high risk of persisting and global deficits associated with severe brain insult in early childhood. Contrary to previous speculation about "growing into deficits," children with severe brain insults have more protracted recovery periods but do not continue to lose ground compared with their peers. By 30 months after insult, recovery seems to stabilize and children begin to make appropriate developmental gains.
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Affiliation(s)
- Vicki Anderson
- Department of Psychology, Royal Children's Hospital, Parkville, Victoria 3052, Australia.
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92
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Beecham J, Perkins M, Snell T, Knapp M. Treatment paths and costs for young adults with acquired brain injury in the United Kingdom. Brain Inj 2009; 23:30-8. [PMID: 19096972 DOI: 10.1080/02699050802590338] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PRIMARY OBJECTIVES To identify the health and social care services used by young adults aged 18-25 years with acquired brain injury (ABI) and the costs of these supports. RESEARCH METHODS A review of existing literature and databases and contact with academics and stakeholders working with people with ABI. MAIN OUTCOMES AND RESULTS The likely care pathways of young adults with ABI were mapped over a notional 1-year period after presentation at hospital accident and emergency departments. Most young adults with ABI will use minimal health and social care support following injury but those with subsequent disabilities may cost the health and social care budget in excess of pound47.2 million per year. CONCLUSION Lack of available data mean the service use and cost estimates draw from a range of sources. However, the costs may under-estimate the true impact on budgets as incidence rates may be higher than identified and conservative values were selected for unit costs. The model estimates the cost of treatment and support as provided today, but high levels of unmet need remain.
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Affiliation(s)
- Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics, London, UK.
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93
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Hessen E, Nestvold K. Indicators of complicated mild TBI predict MMPI-2 scores after 23 years. Brain Inj 2009; 23:234-42. [PMID: 19205960 DOI: 10.1080/02699050902748349] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PRIMARY OBJECTIVE Research suggests that post-concussive syndrome may become persistent after mild traumatic brain injury (mTBI). The aim of this study was to investigate determinants of subjective complaints, characteristic for post-concussive syndrome, 23 years after mTBI. RESEARCH DESIGN The study was a follow-up after a prospective head injury study at a general hospital in Norway. METHODS AND PROCEDURES Ninety-seven patients were assessed with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) 23 years after sustaining primarily mTBI. MAIN OUTCOMES AND RESULTS A good overall outcome was found with scores close to the normative mean, average length of education and normal employment rate. However, the patients that sustained complicated mTBI showed somewhat more pathological scores, well-matched with mild post-concussive syndrome. The most important predictors of poor outcome were a combination of post-traumatic amnesia >30 minutes and EEG pathology within 24 hours after TBI. No influence of pre- and post-injury risk factors on current MMPI-2 profiles was found. CONCLUSIONS The results are in line with previous research findings and support the notion of potentially differential impact of uncomplicated vs. complicated mTBI. The findings suggest that complicated mTBI may cause subtle chronic symptoms typical of post-concussive syndrome.
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Affiliation(s)
- Erik Hessen
- Department of Neurology, Akershus University Hospital, Oslo, Norway.
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94
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Educational, Vocational, Psychosocial, and Quality-of-Life Outcomes for Adult Survivors of Childhood Traumatic Brain Injury. J Head Trauma Rehabil 2009; 24:303-12. [DOI: 10.1097/htr.0b013e3181ada830] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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95
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Pertab JL, James KM, Bigler ED. Limitations of mild traumatic brain injury meta-analyses. Brain Inj 2009; 23:498-508. [DOI: 10.1080/02699050902927984] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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96
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Cole WR, Paulos SK, Cole CA, Tankard C. A review of family intervention guidelines for pediatric acquired brain injuries. ACTA ACUST UNITED AC 2009; 15:159-66. [DOI: 10.1002/ddrr.58] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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